You are hiking with a friend through the San Juan Mountains of Colorado, heading toward a nearby campsite - and at 9600’ feet elevation. Dark clouds have developed in the east, hinting at a possible thunderstorm. You decide to ignore them: your day’s plan requires you make it to the campsite by late afternoon.
As you and your partner hike quickly up the steep incline, gusty winds begin to blow, a misty rain begins to fall, and low rumbles of thunder develop. Quickening your pace, you peer over the trail’s edge and note your forested campsite a mile past an alpine meadow.
A storm is now upon you both, as hail pounds down and a bright flash illuminates the sky. Your partner suggests you both should stop and assume a lightning position, but you disagree, deciding it’s better to make a dash for the shelter of trees beyond the meadow.
You begin to sprint erratically down the trail, your partner right behind you. Suddenly, a bright flash strikes nearby! Your partner is momentarily disoriented and slips in the mud, his knee bending awkwardly as it strikes a rock when he hits the ground. You hurry to him, feeling incredibly vulnerable in the wide open space.
Asking if you can touch his knee, you gently assess for any abnormalities. It feels ok. You ask if he can stand, and he nods yes, but his right knee hurts, and it may be difficult to walk. You assist him to his feet, not interested in a detailed patient assessment. Letting his body lean against yours, you both hustle toward the nearby tree line.
Seeking uniform cover by a small patch of trees, another nearby lightning strike illuminates the sky. The campsite must be somewhere nearby. Your partner is hurt and looks to you for help. Do you assess his injuries here or make a dash for the campsite?
Introduction to Wilderness Nursing
The ability to reason when challenged with missing information, or to apply sound judgement when faced with uncertainty or lack of resources, is the recipe for a skilled nurse leader. But how many of us apply these same skills in the wilderness setting?
What if I told you there is a whole world out there (literally) that combines sports medicine, emergency medicine, travel medicine, military medicine, occupational medicine, expedition medicine, orthopedics, (keep going!), and the outdoors?
Medical care in austere environments; yes, it’s a thing. It’s called wilderness medicine, or sometimes referred to as adventure or expedition medicine, and it incorporates a vast list of unique topics, specialties, and perspectives.
What Does Wilderness Nursing Entail?
Dr. Paul Auerbach, co-founder of The Wilderness Medical Society, and a premiere authority on the subject, defines it as:
“medical care delivered in those areas where fixed or transient geographic challenges reduce availability of, or alter requirements for, medical or patient movement resources.”
Seth Hawkins, emergency physician and founder of Carolina Wilderness Medicine, has his own definition:
“medical care and problem-solving in circumstances where the surrounding environment has more power over our well-being than does the infrastructure of our civilization.”
Think rural medical facilities, search and rescue teams, Everest ER, humanitarian aid in disaster zones, and expedition leaders or expedition medical planners. If you have ever provided medical care to an individual with bad blisters in the backcountry, kept a septic patient alive in a rural mountain clinic without an ICU, or helped the trapped and injured after a gas main blew in downtown, you have functioned within the definition of wilderness medicine.
While there are no clear-cut pathways to wilderness medicine—such as applying for a course or degree and then searching Monster.com for a job—there are a myriad of resources to help you network, gain real-life experience, or join a team that provides wilderness medical services.
For example, joining the Wilderness Medicine Society (WMS) and World Extreme Medicine (WEM) are great places to start! Acquiring industry-recognized certifications such as The Fellowship of the Academy of Wilderness Medicine or Advanced Wilderness Life Support are great ways to jump in, network, and gain highly sought after skills and experience.
So are applying to your region’s Search & Rescue team, volunteering as a nurse with a global charity that runs adventure races such as Wilderness Traverse, or joining Raleigh International as a medic or RN to assist a remote Costa Rican village. Doctors Without Borders (Mèdecins sans Frontières) accepts RN’s, though experience and another language skill will make you a more attractive candidate. And research grants are a fantastic way to fund and support your own project to advance the field of wilderness medicine.
Through time, you will gain vast knowledge, meet incredibly talented and unique people (think hiking boots and shorts, not suits and dress shoes), and have had the glorious outdoors as your common classroom.
Luanne Freer, MD, WMS Fellow, and founder of Everest ER, advises those starting out in wilderness/adventure medicine, to stick with it:
“[Be] open to improvisation, and [be] ready to not do things the way you would do them at your home practice—and not being frightened by that.”
If you are salivating for more, or your interests are mildly tickled, then check out our informational webinar hosted by nurses experienced in wilderness medicine! You will learn how to combine your love of nursing with the great outdoors during our hour-long chat with three wilderness nursing experts. You can watch the full event here!
But what about our hikers in the lightning storm?
Well, if you guessed a brief physical assessment was performed, and then a hauling of butt to cover, you guessed correctly. And don’t forget the moral of our story: risk mitigation. The biggest risk factor in this scenario is not the lightning itself, but the hiker’s unwillingness to change plans in the face of inopportune weather. As nurses, we should apply this same moral to our own medical practice.
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