I recently came back from a 5 day Wilderness First Responder certification course held in Mammoth Lakes, CA from 10/4 - 10/9. The program that we took was from Wilderness Medical Associates International in conjunction with Beyond Limits Education, led by Brigitte Denton and Dan Flynn. I was supposed to attend their class in May, but I broke my ankle earlier in the year and had to reschedule and ended up taking the class in October.
The WFR certification course is usually 8 days but my roommate and I opted for the 5 day course as it was not only cheaper, but also required less days off of work which was really enticing. The tradeoff was that we had to do 25+ hours of pre-course work and studying.
The pre-course work consisted of quizzes on each textbook unit, worksheets to fill out based on the material, and a study guide with questions to answer. It also had links to useful videos to watch and online flashcards for quick drilling. I put in close to 30 hours of studying in the course, which consisted of doing some exercises with my roommate who was already WFA certified and knew some of the basics like a physical exam and getting a patient's history, as well as creating my own study guide not unlike the ones I created in college.
I ended up getting an 84% in the pre-course work, mostly because I accidentally didn't turn in a part of an assignment. Overall, you had to have an 80% in the pre-course work to be able to "pass" and move on to the in person course. I had only just barely made the cut and my anxiety on if I would pass or not was peaking.
To be honest, there was a lot of self doubt leading up to and during the course. I had studied off an on for a total of 5 weeks and I wasn't sure about my comfort with touching others to do a physical exam and being able to think fast enough to do a patient assessment and troubleshooting.
Wilderness First Responder Course
Classmate Playing With Tourniquets
Looking back, each day was packed and it was hardly believable that we did so many things in a single day.
There were 18 students in the class and many of them were from all over California and some were from out of state. We met in a fire station in Mammoth Lakes each day starting at 8am and finished at 6-6:30pm, leaving exhausted and mentally drained. My roommate and I would regularly go back to our AirBnB, decompress, process the day together, and then drill each other on protocols or techniques in prep for the next day.
The first day consisted of a quick overview of the basic procedures and concepts and then we were immediately thrown into a scenario where half of us were playing patients and the other half were rescuers. It was incredibly overwhelming; not a single one of us felt comfortable and smooth in the scenario. Little did we know that the feeling would be a recurring theme for the entire course. We ran more scenarios and each time, we felt more comfortable being thrown into an unexpected situation. Yet the goalpost and complexity of each scenario kept ramping up, requiring us to apply more skills and make more mistakes from which we built on top of and improved on, determined to not make the same mistakes again.
In the following days, we learned the importance of following up on answers for patient history and not being afraid to ask the awkward, probing questions that needed to be asked. We learned how to care for a patient with multiple critical system failures, what to consider with someone in brain failure who was unconscious, how to do a spine assessment, how to reduce a dislocated joint in certain circumstances, when and how to administer epinephrine for severely asthmatic and anaphylactic patients,. how to provide CPR to infants, kids, and adults, and so much more.
Each day I still felt the anxiety and pressure of needing to pass the class. I felt I needed the cert to take a step closer to my goal of becoming an outdoor guide or an educator/advocate. Although I could measure how confident I was in the course material and concepts every day, I always felt like I wasn't quite good enough. It took me a minute to realize a patient needed epinephrine from anaphylactic shock; it took me 20 minutes to realize why a patient was presenting with a gastrointestinal infection, and when hearing about other patients and how other rescuers were dealing with them, I was not confident that I would have been able to provide better care than the rescuers that was attending to them.
We were also often reminded that sometimes, we can't save everyone. In one scenario we had a patient presenting with late stage increased intracranial pressure who faced certain death especially in a backcountry setting. During the scenario debrief, Dan, one of our instructors, remarked "not everyone is going to make it. It is an incredibly powerful thing to witness someone's last breath." I teared up in that moment, recalling a death I witnessed and acknowledging indeed how powerful that was. We had a few other sobering moments throughout the course which drove home the idea that learning these skills can help but isn't a guarantee and we may in fact, face situations where we can't do anything but provide the patient respect and dignity in their last moments.
There were some high moments amidst the stressful, adrenaline-inducing scenarios though. My roommate played a patient with an open femur fracture and enjoyed pumping blood out of his wound. His rescuer began unbuttoning his pants without asking first but quickly realized she probably should have asked for consent and was super embarrassed. I played a patient with an altered mental status who was a jerk and at one point told my rescuer that I didn't like his voice. For the next few minutes, he spoke to me in a hilarious English accent and I couldn't help but break character and laugh. My roommate also played someone who had terrible gas and used his phone with a fart noise app. He played the noises for each rescuer that came around but all of them thought he was legitimately farting. Brigitte walked around during the final day of drills with a severed hand, making it difficult for rescuers to take her questioning seriously as she flung the hand around.
The instructors were also evaluating our skills and progress made during the practical scenarios they threw at us every day; were we understanding the medicine? Were we reacting to each situation appropriately and going through the proper steps before treating the patient? They questioned our judgements and made sure we were confident in why we were taking the actions we settled on.
And so, despite our collective insecurities, all 18 students passed the course after taking the written exam on the last day. I felt incredibly relieved and thankful but still doubtful. Did I really deserve this? Did I really prove that I am able to act in situations that may require these skills? Honestly I still don't know but I do know I am better prepared for if/when I run into high stress situations.
A core tenant of the class was that making mistakes was the best way of learning. We make the mistakes and we never forget why we failed and what the correct course of action should have been. It was hard learning but it was efficient and provided real doses of reality that rarely is anything perfect and these skills need to be honed and reused lest they be forgotten.
Me with my cert!
Okay. So. I have this certification. What am I going to do with it?
My overall goal is to go into guiding for climbing/backpacking. I also plan to get my Single Pitch Instructor's certification in 2021. This will require a lot of time in the backcountry and if I work for an organization, they most likely require a WFR cert.
In the mean time, I plan to volunteer for medic tents at races and music festivals. I also am exploring joining the local Bay Area search and rescue teams where possible. Some of these require passing some FEMA classes which are available online so I'll be taking those in my spare time. Hopefully all of this makes me a competitive prospective employee, but we'll see.
General takeaways that I thought were really important and that anyone can and should do:
- Know your adventure partners' medical history. Not to say everything under the sun, but potentially life-threatening conditions that on the off chance they need assistance with, that you can help with. Do they have allergies that can result in anaphylactic shock? Where do they store their medication in their bag? Do they have a heart condition that may be aggravated during periods of intense exercise? Do they have diabetes and are they able to eat regularly and enough during the trip?
- Plan your contingencies ahead of time. On the off chance you or someone you find on your adventure needs urgent medical assistance, be prepared to know what resources to contact, how to contact them, or where the nearest trailhead is in case you need to evacuate that person.
- Take care of your body and teach your adventure partners to do the same. Pay attention to and take care of each hot spot, crack or nick in the skin, or any general abnormalities/developing symptoms, even if it's just as simple as "I feel crummy." It could get worse and tracking the development of symptoms to understand if it's slow acting or fast is incredibly important.
I would recommend anyone who is in the backcountry often to get a WFR certification. It is really challenging and a commitment to get but if you put the time and effort in and you stay engaged, you'll have a high likelihood of passing and it is incredibly worth it.