How to save a life – Wilderness First Response Training

(9-19 January 2011)

Day 0 (Interim day 6)

My 2011 Calvin College interim team ended up leaving our Single Pitch rock-climbing instructor training in Joshua Tree, California a little later than expected. At 1:00 in the morning we finally arrived in Flagstaff, Arizona. We were all exhausted from waking up at 6:00 the previous morning in order to accomplish our final day of instruction before leaving for Arizona. Yet, regardless of our fatigue and the fact that we had to get up to start our next day in six and a half hours, none could pass up the long awaited opportunity to take a shower. At this point, nobody has showered in over a week because the desert we camped in did not have running water.

The shower in the hostel where we stayed was quite something. The tiles were stained, and there were spiders and other insects to keep us company while we washed up. Nobody thought twice about the grimy shower, it was the first shower in a week and that was all that mattered. My watch read 2:30 AM by the time we were all in bed. That meant only four hours until we would be woken up for breakfast – at least I was not assigned to be a cook that morning.

Day 1 (Interim day 7)

After a very long day and a very short night, we woke up early for our initial Wilderness First Response class. Class took us from 8:00 AM to 5:00 PM every day, with some additional evening sessions, since we were squeezing a standard 3-credit college course into a nine day period. It’s no wonder one of our instructors, Pete, had eight cups of coffee during class every day.

Once the first class was over, a majority of us went to the local climbing gym where our AMGA instructor from the Joshua Tree portion of our trip was employed. The gym was ridiculously large and had a wonderful variety of climbs and boulder routes.

I helped cook dinner when we returned from the climbing gym. We made a lot of spaghetti. Both groups from my college were together for this class and that made about 25 hungry mouths to feed. Everyone ate together in the recreation room of the hostel, and had a blast playing pool, lounging on the couches and listening to an old-style music player similar to a jukebox – my favorite item in the room. In the evenings though, most of the group would study together in this room and practice scenarios in between their turns to play on the pool table. Occasionally other tenants at the hostel would come in and play with us as well. We did our best to be a very inviting group, conscious of other tenants in the hostel, and respectful about cleaning up after ourselves.

Day 3 (Interim day 9)

This is where the Wilderness First Response (WFR) training went from fun to outstandingly enjoyable. By this point in the course we had learned enough of the basics that it was time to go out and practice. The large group was split into sub-groups, half became patients while the other half did assessments.

The WFR instructors had Hollywood quality fake blood, bruise make-up, burned skin, and splintered bones. As patients it was our job to act well enough to deserve this quality of equipment – so that’s just what we did. Every actor was slightly different from the others, making every situation unique, and all were in competition to see who could be the most obnoxious but still believable patient.

Several of us, during the asthma attack scenario hyperventilated well enough that we came very near blacking out. The story that took the cake was from a group two years prior where a student wet his own pants as part of the scenario. None of us would attempt to top (or even match) that, but we still did a very good job and had fun screaming, moaning, and insulting the people helping us whenever they made a mistake. Each got their turn in various positions and it soon became apparent that “what goes around comes around” as people who were tough patients would get tough patients in return. This only made the experience more enjoyable.

The temperature during the morning practice sessions often hovered between zero and ten degrees Fahrenheit, which is very cold as a patient. In the cold morning sessions, if the rescuers had not brought an insulated pad or if they needed to check feet or under layers of clothing, their patient would became cold very quickly. This was not a fun aspect of the training, but if was very beneficial. We were often reminded that WFR’s trained in the winter have a distinct advantage because we know and have practiced how to deal with cold weather conditions.

Day 4 (Interim day 10)

This day focused on splints for injured patients. We learned a variety of splinting techniques and the best ways to improvise them, since we would rarely pack splints into the back country. We built some very interesting splints, my favorite of which was held together by a cord tied in a carpet-stitch pattern, wrapping around the whole splint from knee to ankle (In the picture shown).

Another cool splint we learned to make was the ‘traction splint,’ which is used if someone breaks his or her femur. Now while this may be a remarkable split, it is one you never want to have to make. We were told that breaking a femur is like snapping a 2X4 board along its 4-inch width. In the unlikely event that this happens (which it occasionally does), a splint must be built that will sling the ankle and pull the lower leg until the two ends of the femur separate. Next, the splint must be tied off in this position so the broken ends of the femur can’t slide back together and potentially pinch or sever the femoral artery (a very life-threatening situation). Sound fun yet? Well, the next part ought to make it even better. After this whole contraption is built, the patient must be evacuated to a hospital before the splint can be removed, and in some situations this could take several days.

Day 5 (Interim day 11) “Where’s my helivac?”

A plane crashed in the field behind our building. We, the WFR’s in-training were the only ones around to respond. This was the two-hour scenario on the fifth day of class. We quickly organized into six teams of three to four people, each with the fourth member of our team preparing to form an additional group under my supervision should it become necessary. In addition to these teams, we also had two site supervisors who organized teams and processed requests, along with a gear distributor who would bring backboards, litters, and other necessary equipment to the highest priority teams as needed.

The first patient I began working on had a double-femur fracture and a severed femoral artery that was squirting blood with each beat of his heart (explain to me how was he not already dead?). The med-kit we were given did not have trauma sheers so I quickly jury-rigged my knife to take their place (this later earned quite a few MacGyver comments) and cut open the pant legs to reveal the injuries. I rolled a ball of athletic tape over the tip of the blade and taped off all but two inches. This made it safe to use near the patient without accidentally causing more injuries.

While the rest of the team stabilized the patient, I ran to get a backboard. On my way I noticed the scene commander’s assistant tending to a seventh patient who had quietly wandered into the scene. I turned around and let my former team know I wouldn’t be back as I now needed to assemble my own team for this extra patient.

The seventh patient was holding his amputated right hand in his left hand (he was actually holding a second left hand from a dummy because that is all the instructors had to work with, but we rolled with it). Nick, the scene commander’s assistant stabilized the spine of this seventh patient while I put a tourniquet on the right hand. I delegated the task of monitoring vitals to another member of my team, while I proceeded to clean and bag the amputated limb.

The field where we practiced the plane crash scenario

Our patient was going into shock and was complaining of feeling very cold. We put a call in to the commander for a sleeping bag. He responded quickly by indicating that response team 5 was not using theirs and we could go fetch it from them. Off I ran.

Upon my return, the patient was carefully put into the sleeping bag and we were able to calm him down a little. With the combination of the patient being too distracted to do a Focused Spine Assessment and his form of injury, we decided to keep his head immobilized in case there was a spinal injury.

We radioed the S.O.A.P. (Subjective, Objective Assessment, Plan) notes to the commander and requested a backboard and helivac. While we waited for the helivac, other calls came in that were higher priority. The helivac was directed to another group without us being informed of our priority bump. This was stressful to say the least. We radioed in numerous times requesting to know the ETA of our helicopter or at least our number on the priority list so we could tend to the patient accordingly but there was no response.

After about twenty minutes the patient stabilized and the snow kept the amputated hand cool. The scenario ended before our helicopter ever arrived but I believe we did a very good job in the treatment of our patients’, considering we were only half way through the course. This was the conclusion of class for the day and we had to wait until the next morning to conduct a debriefing session.

Days 6-8 (Interim day 12-14)

The debrief went well. We discussed what could have gone better and what we did well (like having an extra team ready to form). The two biggest hurdles we had were not having enough equipment (backboards, litters, helicopters) and not having good enough communication. Both of these are real-world problems that can make a mission successful or a complete failure. Professionals have to practice often in order to keep their communication skills honed, and they must be able to accept that their patients’ injuries may not be as severe as another’s, trusting that the Incident Commander will make the best call for everyone.

As the class drew to an end, I spent extra time and energy studying and practicing scenarios to make sure I would pass the course. The exam was 100 multiple-choice questions and a hands-on scenario during which we would be closely scrutinized. The written section covered all of the protocols, possible injuries, and intuition based on signs and symptoms being displayed in various scenarios. This was material that had been taught for 80 hours + study time in the past eight days and filled a large book about a quarter-inch thick with information (Quite a lot to memorize in just over a week!). The hands-on portion of the exam was going to be a surprise because it tested us on our ability to follow our order of operations and think on our feet. This was the sort of thing we would have to do in the real world, so we had better be able to get it exactly right now. With the pressure of the upcoming test looming, others in the group studied in the evening as well. This made for an environment that was very conducive to studying.

Night 8

            The last opportunity we had to practice was our night scenario the evening before the exam. We split into groups in the dark woods and were told which direction to head to find our patients. The snow was knee deep and very hard to walk through, we used the light of the mood and our headlamps to find our way. Just before we made it into the patch of woods where we were supposed to find our patient we heard a snap and a scream as one of our group members fell to the ground wincing in pain. We rushed over (confident in our ability to act) and began to take care of her.

When she ignored our questions of whether this was real or not, we determined the scary situation we found ourselves in was actually the scenario and the snap had been a stick she stepped on. Upon exposing the wound, we saw that the tibia had splintered and was protruding through the front of her shin. We cleaned the area and dressed it before building a splint to immobilize the leg. A proper splint should immobilize the joints immediately above and below an injury, so our splint went from the thigh to the foot of our friends right leg.

Since it was already late and we were lost (as the scenario stated), we decided to build camp for the night. Having to tent, sleeping bags, or any other overnight items and not wanting to move our injured friend, I began to build a shelter around the group. I built a snow fort in the shape of a pentagon from the five trees surrounding us. I used sticks to begin a roof then packed snow over them. The fort made the area much warmer as it cut the wind and helped hold in some heat.

After about thirty minutes, a group member went off to use the bathroom. He did not return and did not respond to our calls. We found him unconscious at the foot of a tree. He may have struck his head so we did not want to move him unless we had to (in case of spinal injury). We attempted to illicit a response but he was not even responsive to pain (a fun test to do when you know the person is only faking unconscious). We put warm clothes over our friend and packed him in with snow to insulate.

The count was two injured, three healthy. One member of my group monitored the unconscious body while the other stayed in the fort with our first injured friend. I continued to work on the fort to improve its warmth and keep my body warm (I had lent out nearly all of my layers).

We continued to monitor our friends and prepared ourselves for spending the night. After another hour or two we saw lights moving towards us and were informed the scenario was over. Miraculously our unconscious friend woke up. He had done a great job staying in character as a patient. We had rubbed sugar packets in his mouth (In case he was unconscious from a diabetic coma), bruised his trapezius muscle in trying to get him to respond to pain (we knew he wasn’t actually unconscious and we wanted him to break), and he had dealt with being cold because we simply were not given sufficient materials to keep him warm. Had this been a real life scenario, we would have made fire, and even laid next to him to keep him warm – this was not a life or deal scenario so there was no way we were going to lay with him to keep him warm.

Day 9-10 (Interim days 15-16)

           I successfully passed my Wilderness First Response exam with high scores, along with all of the other students in the course. We celebrated and thanked our instructors, Pete and Ari, before going back to the hostel. Pizza was our dinner and boy did it taste good! I had not eaten pizza in two weeks (probably the longest I have ever gone without it). I washed my clothes and spent some time alone time while others went out rock climbing.

The next day would consist of some R&R, saying goodbye to the half of our group that would now be going to Joshua Tree for their AMGA training, wandering through downtown Flagstaff, and eating at a restaurant as a group before preparing for the Grand Canyon, the last stage of this interim trip. With the other patrol gone, the hostel was quiet. I mopped the floor as a thank you to the hostel owners for letting our whole group use their facilities (and somewhat overwhelm the common space) for the week, and other members did similar jobs as thank-you’s. We packed our clothes and got ready to leave in the morning for the Grand Canyon.

See Related:

[Interim 2011 Part I] Joshua Tree

coming soon:

Interim 2011 Part III] Grand Canyon Backpacking