Wilderness Medical Associates instructor Jon Tierney, left, observes as students work through a medical scenario in a wilderness first-aid course. Carey Kish photo

You’re on a four-day backpacking trip in Maine’s Debsconeag Backcountry and settled into a nice campsite next to a pretty pond. It’s evening and you’re relaxing around the picnic table with your companions, chatting about the day, and cooking supper.

Suddenly, things go awry.

A friend knocks over the cook stove, sending a pot of scalding water into his lap. Another friend rushes over to help, but trips, stumbles, and twists an ankle. A third friend, returning now from the privy, has just kicked up a yellow jacket’s nest and been stung several times.

The basics of wilderness first aid are all contained in this handy pocket brochure that you can tuck into your pack for quick reference. Carey Kish photo

In the blink of an eye, your peaceful campsite has devolved into a chaotic scene.

Burns, sprains, and insect bites are among the most common hiker injuries. There are also blisters, cuts, scrapes, bruises, dehydration, nausea, vomiting, diarrhea, hypothermia, sunburn, abdominal pain, hiker rash and itch, dislocated and broken bones and more.

Would you know how to address these medical issues? With the benefit of an intensive two-day wilderness first-aid course under you belt, you’d certainly have the knowledge and skills to handle these basic types of backcountry emergency situations.


Last summer, this hiker participated in a wilderness first-aid refresher course taught by Jon Tierney, mountain guide, outdoor educator and paramedic, and longtime instructor with Wilderness Medical Associates. WMA has been teaching practical medicine to all levels of outdoor users, non-professional and professional alike, since 1984.

WMA was founded by Maine’s own Dr. Peter Goth, who “developed a wilderness medicine training system that utilized a body-systems approach to teaching combined with simulations and other hands-on learning.” This set the standard for the curriculum and methods which have been adopted by most other wilderness medicine training organizations that followed.

“WFA is designed as an introduction to care in an extended setting. The intention is to teach you basic patient assessment skills and begin to develop the ability to decide serious vs. not serious,” said Tierney. “Attention is paid to the simple things, like completing a good assessment, thermoregulation, and lifting and moving an injured person. Students learn to clean and dress wounds to prevent infection and to administer life-saving epinephrine, among other skills.”

Basic wilderness first-aid training is a helpful asset to have when traveling in the backcountry. Carey Kish photo

The core of the WFA training is the Patient Assessment System (PAS), which begins with scene size-up. Here you consider safety factors, people and resources, and the mechanism of injury. Then it’s on to the primary assessment, which is a quick look at the patient’s three critical systems – the circulatory (pulse, bleeding), respiratory (airway, breathing) and nervous (mental state, spine). Any life-threatening problems are addressed immediately.

“It’s red flags and green flags,” said Tierney. “Find the red flags and fix them!” Only then do you proceed to the secondary assessment, a thorough head-to-toe patient examination, a SAMPLE (symptoms, allergies, medications, past history, last fluids in/out, events) history, and then vital signs (pulse, respiration, blood pressure among them).

For two intense eight-hour days, Tierney gave brief lectures and then we went to work on a wide range of possible medical scenarios that hikers and backpackers can and do encounter out in the backcountry, starting each with the same standard approach – scene safety, primary survey, and secondary survey.


Jon Tierney, Wilderness Medicine instructor, lectures students during a wilderness first aid course. Carey Kish photo

As I worked alongside my classmates, I kept a few nuggets of Tierney wisdom in mind. “Be as right as you can be without being wrong.” “Ideal to real: somewhere along this continuum is the thing to do.” “Think ‘big picture,’ then ask, ‘what is really going on here?’”

Remain calm, breathe, look, think, then do; that was the measured approach I tried to follow. It’s hard sometimes, though, when there’s screaming and blood and rushing Adrenalin, but with lots of practice it can be done. Repetition works wonders.

“Most backcountry accidents can be de-escalated once a thorough assessment has been done and you think about what’s going on,” said Tierney. “You’ll learn generic treatment plans but sometimes can implement a specific plan.”

In addition to WMA, there are a host of other WFA course providers. Find one that works for you and take it. It’s a wise investment in your health and safety and that of others around you on the trail and a real confidence booster.

“A WFA course also helps you gain an appreciation of next steps, what more you could learn about wilderness medicine, and fosters a preventive mindset,” Tierney said.

Carey Kish of Mt. Desert Island is the author of AMC’s Best Day Hikes Along the Maine Coast and editor of the AMC Maine Mountain Guide. Follow Carey’s adventures on Facebook @CareyKish.

Only subscribers are eligible to post comments. Please subscribe or login first for digital access. Here’s why.

Use the form below to reset your password. When you've submitted your account email, we will send an email with a reset code.