What is Wilderness & Disaster First Aid?
This is a simple, and difficult, question all at the same time. Simply, Wilderness First Aid (WFA), is a course taught to people who plan to be away from immediate help because of their location. i.e. wilderness or foreign travel. In recent years more people have also been looking at WFA to prepare for disasters, both natural or manmade.
In order to better understand where WFA fits into the whole scheme of things, we need to look at the whole field of pre-hospital patient care. We are going to look at this from the Ontario perspective only because each province does things a little differently.
At the bottom is Emergency First Aid (EFA), this is an 8-hour course; its content is set by the Government through its Ministries and boards. It is designed for you to provide immediate life-threatening care for a short period of time. If it is to be used in a workplace the course must be approved by the Workplace Safety Insurance Board (WSIB). The next level up is Standard First Aid (SFA), this 16-hour course is designed for more in-depth training on various medical problems and injuries. It also, teaches you what to do if help is delayed. This course also has standards set by the WSIB.
Next in line is Emergency First Response (EFR). Generally, a 60 –to 80-hour course, it is designed for those who respond to emergencies because of the nature of their jobs. For example, Firefighters or first aid attendants in remote work areas. The course deals with equipment that most people do not have. The Emergency Medical Responder (EMR)is a more advanced level of the EFR course and is usually, around 120 – 140 hours. Many full-time fire services train their firefighters to this level.
Primary Care Paramedic (PCP) is the entry level position for anyone who wants to work on an ambulance. This is a 2-year, soon to become a 3-year, college course, with written provincial certification exams at the end.
Advanced Care Paramedic (ACP) is another year in college and written provincial exams.
Critical Care Paramedic (CCP) is about another year of training, mostly they work on critical inter-facility transfers. Ex Ornge.
So, where does WFA fit in this list? It doesn’t. In the above list, no matter where the patient enters the system, there is a progression upward, ending at the Physician and while there may be delays, these delays are manageable. In a wilderness or disaster situation that progression may be delayed by hours, days, or never.
Your WFA course should be about critical thinking, the ability to look at a problem from multiple angles. A good WFA course should also build on the fundamentals of standard first aid and expand your knowledge and skills. It should be teaching select pieces from the EMR courses as part of a Basic or Standard WFA. It should also be teaching select pieces from medicine as part of the Advanced course.
That may be a little confusing so, I will try to simplify it through a scenario.
You and 2 friends are on a 5-day hiking excursion, it is day 3 and the weather fine warm and dry. One of your friends trips and falls down a hill. On examination you find that they have a deformed right femur and are in a lot of pain. We are at least 2 days from help.
- How are we going to treat this leg?
- How are we going to get help?
Standard First Aid would tell you to keep it still, tie the 2 legs together and wait for help.
Seeing as it going to be at least 2 days no matter what we do, leaving the leg like this is not an option.
Your friend needs a traction splint. EFR and upward teaches to use a traction splint with a commercial traction splint. WFA should teach you not only how to use a traction splint but how to improvise one out in the wilderness.
The Paramedic training is the first place where pain control is taught and authorized to use, and this is a delegated act controlled by a Physician’s licence.
So, what about our friend? Do we leave him in pain, or do we see what we have and give him something? Depending on what you have there are choices and questions. Drug allergies? How much to give? This should be part of an Advanced WFA.
Next decision is on how to get help. Improvise a stretcher and try to carry him out or set up camp while one of us walks the 2 days out? Lots of tough questions.
Now that, I hope, we have made that clearer, let’s muddy the water again. In most of Canada, WFA is a non-regulated course. That means that there are no government bodies setting standards for content.
In Ontario, EFA and SFA are regulated by the WSIB.
PCP, ACP, and CCP are regulated by the Ministry of Health.
Anything else is not regulated. This is why it is so important to know who is teaching and what they are teaching. A quick internet check shows all manner of courses from basic Wilderness First Aid to Wilderness Emergency Responder. Decide what you need and compare it against the courses offered. Just don’t be taken in by a name.