⛰️ Stuff Every Backcountry Traveler Should Know: Training Guide

Protect Yourself and Size Up the Scene

Before you help, look for hazards that could injure you. Check terrain, weather, animals, traffic, fire, and body fluids. If you become hurt, you add a second patient.

A scene size-up surveys hazards, the number of patients, and what happened. Repeat the size-up when conditions change.

Introduce yourself and ask permission before care. If a patient is unresponsive or confused, you may treat under implied consent.

ABCDE: Find Immediate Life Threats

ABCDE is the initial assessment part of the patient assessment system. It looks for immediate threats to life, and you address a threat as soon as you find it.

The A step checks whether the airway is open. A person who is making sounds is moving some air past the vocal cords.

Breathing is assessed by looking, listening, and feeling. Notice whether breathing is easy, labored, deep, or shallow.

Circulation includes checking for signs of circulation and searching for severe bleeding. Control life-threatening bleeding during this step.

D stands for disability. In the wilderness initial assessment, you decide whether continued spine protection is needed.

Expose and examine for major injuries by opening or moving bulky clothing carefully. Do not move the patient unnecessarily.

The Patient Assessment Sequence

Use this order: scene size-up, initial assessment, secondary assessment, and plan. A consistent sequence helps you avoid skipping urgent threats.

Scene safety is not a one-time check. Conditions such as weather, fire, or animal behavior can change, so repeat the size-up when needed.

An unresponsive patient may be treated under implied consent, but if a patient is alert, ask first and explain what you will do.

SAMPLE History

SAMPLE organizes the patient story: symptoms, allergies, medicines, history, intake, and events.

Symptoms are what the patient feels and reports. Begin with the chief complaint and use the patient's own words when possible.

Ask the patient when possible. If they cannot answer, use companions for the history.

Vital Signs and Skin Signs

SCTM organizes three observable skin findings: color, temperature, and moisture. Record the actual findings instead of writing only normal.

In extended wilderness care, monitor and interpret vital signs over time. Repeating observations shows whether findings change.

Do a head-to-toe exam during the secondary assessment, after immediate threats are addressed.

SOAP Documentation

SOAP stands for subjective, objective, assessment, and plan. It keeps patient information organized for remote consultation and handoff.

The subjective part reports the story from the patient or witnesses. It includes symptoms, history, and the event story.

The objective part records what you directly observe or measure, such as exam findings and timed vital signs. Use numbers and specific descriptions.

The plan section records treatments, the response to treatment, monitoring, and the evacuation or communication plan.

Carry a notepad and pencil with SOAP forms in your first-aid kit. They help you preserve findings for care and handoff.

Evacuation Decisions

Base a wilderness evacuation decision on the patient's condition and the resources you have, including people, equipment, communication, and transport.

Evacuate rapidly when life threats or urgent definitive care are present. Activate rescue immediately when possible and choose the fastest safe method.

Rapid evacuation does not mean reckless evacuation. Rescuer safety still comes first.

What Rescuers Need to Know

Report what happened, the patient's condition, first aid already given, location, people, equipment, and identifying details.

Also report the colors of the patient's tent, pack, and clothing to help searchers identify the group.

Leave a trip plan with a reliable person who is not going on the trip. That plan gives searchers a starting point if you are overdue.

Signaling Tools

Three blasts on a whistle is a recognized distress call. Pause after the blasts to listen for a response.

A signal mirror flashes sunlight toward aircraft or searchers. It does not need batteries.

A large contrasting ground shape, such as a shelter or arranged rocks, can help aircraft see you from above. Use open terrain only when safe.

While waiting for rescue, find or build shelter that protects the group from sun, rain, snow, and other elements.

Emergency Beacons and Satellite Devices

A personal locator beacon, or PLB, sends a distress signal on the 406 MHz frequency. Satellites relay that signal to search and rescue.

Register your 406 MHz beacon. Registration tells rescuers who and what they are looking for and helps them check false alarms.

Before relying on a satellite communication device, verify whether that exact device supports two-way messages. Remote technology can fail in cold, wet, harsh environments.

Bleeding and Wounds

A tourniquet is for life-threatening arm or leg bleeding that direct pressure cannot stop. Write down the time it went on and evacuate.

Clean a dirty trail wound by flushing it with clean water under pressure. A syringe or a bottle with a pinhole works better than soaking.

Spreading redness, warmth, swelling, and pus suggest a wound infection. Bites and deep punctures are the riskiest and need medical care.

A scalp cut can bleed heavily because the scalp has rich blood flow. Firm pressure often controls it, but watch for confusion, vomiting, or drowsiness.

Deep puncture wounds from a stick or nail can seal over and trap germs deep inside. Clean well, check tetanus status, and watch for infection.

Burns, Blisters, and Chemical Eye Injuries

For a small friction blister, keep it intact and stop the rubbing. The skin over the blister helps block infection.

For a small campfire burn, cool it with cool running water for about 10 minutes, then cover it loosely with a clean, dry dressing. Do not put ice directly on the burn.

Deep or large burns, burns on the face, hands, feet, or joints, and burns that circle a limb need medical care. A burn that circles a limb can swell and cut off circulation.

If a chemical splashes into an eye, flush it with clean water for at least 15 minutes. Hold the eyelid open and flush from the inner corner outward.

Prevent friction blisters by wearing well-fitting shoes and socks. Acrylic or nylon socks can help keep moisture away from feet.

Sprains, Fractures, Splints, and Slings

A sling supports the arm and limits movement. A bandanna or jacket can make a sling, and tying it higher or lower changes the amount of support.

Early care for a sprain includes rest, ice, and compression. A sprain is a stretched or torn ligament, which connects bones at a joint.

Sprains and fractures can share symptoms such as pain, swelling, and bruising. A provider may use an X-ray or other imaging test to confirm a fracture.

A good improvised splint is a rigid support padded against the skin. Trekking poles, sleeping pads, and sticks can work.

After splinting, check the fingers or toes for color, warmth, feeling, and movement. If they turn pale, cold, or numb, loosen and retie the splint.

Head and Spine Injuries

After a hard fall, suspect a spinal injury if there is neck or back pain, numbness, tingling, or weakness. Keep the person still and call for help.

If a person with a suspected spine injury must be moved away from danger, move the head, neck, and body together as one unit. Use several helpers and move only as far as safety requires.

Repeated vomiting, worsening headache, seizure, confusion, or inability to wake after a head blow are urgent. Activate rescue or evacuate urgently.

After a concussion, return to normal activity slowly and only after a health care provider says it is okay. Activity too early may make symptoms return.

Cold Illness and Frostbite

Shivering is an early sign of hypothermia. Later signs can include confusion, slurred speech, clumsiness, and drowsiness.

While arranging rescue for suspected hypothermia, move the person into shelter, handle them gently, remove wet clothing, and use warm, dry layers. Warm drinks are only for someone who is awake and can swallow.

Frostbite can cause numb, hard, waxy-looking skin. Skin color can vary, so texture and sensation matter too.

In the field, thaw frozen frostbitten tissue only when there is no risk it will refreeze. Refreezing thawed tissue can cause more severe damage.

Prevent frostbite by keeping hands, feet, and face warm and dry. Wear mittens, avoid tight clothing, and change out of wet gloves, hats, and socks.

Heat Illness and Dehydration

Heat exhaustion commonly causes heavy sweating, weakness, headache, nausea, thirst, or dizziness. Move to a cool place, cool the body, and arrange medical evaluation.

For heat exhaustion in the backcountry, rest in shade, remove excess clothing, fan the person, and have them sip cool fluids. Monitor so it does not become heat stroke.

If someone shows signs of heat stroke, get emergency help right away. Move the person out of the sun, take off extra layers, and cool them quickly with cold water or any cooling method you have.

In an adult, dark-colored urine can indicate dehydration. Thirst, tiredness, dizziness, and confusion can also occur; severe dehydration needs medical treatment right away.

Altitude Illness

HAPE and HACE are life-threatening altitude illnesses. Begin descent and activate rescue. Give oxygen if available, and keep exertion minimal.

HACE can cause confusion, drowsiness, and loss of coordination. A person with these signs at altitude needs immediate descent and rescue.

Supplemental oxygen can relieve altitude symptoms, but it only buys time. Descent to lower elevation is the reliable cure.

Water, Weather, and Snow Hazards

To treat backcountry water, boiling is best. If boiling is impossible, filter first and then use another treatment method such as chemical disinfection or UV light.

Wear UV blocking sunglasses or goggles to prevent snow blindness. Snow and ice reflect UV rays intensely, and symptoms can appear hours later as gritty, painful eyes.

A lightning victim is safe to touch and needs urgent first aid. Call 911, begin CPR or use an AED if needed, and move to safety if necessary.

In avalanche terrain, each person should wear a transceiver in transmit mode. If caught, swim toward the surface and create an air pocket; companions then use transceivers, probes, and shovels.

When a flash flood threatens a canyon, leave low ground immediately and move to higher ground. Do not enter floodwater, and follow official warnings.

If you must float in cold water, use the Heat Escape Lessening Posture, or HELP, by crossing your arms over your chest and drawing your knees up. This conserves body heat.

Animal Bites and Stings

For an animal bite in the backcountry, wash it well with soap and water right away, then get advice about rabies shots, tetanus, and antibiotics.

Cat bites often get medical attention because their narrow punctures infect easily. Sharp teeth push bacteria deep and the small hole seals over.

If a bee sting leaves its stinger in the skin and there are no allergy signs, scrape or flick the stinger out and wash the area. Do not squeeze, because that can push more venom in.

Throat swelling or trouble breathing after a sting suggests anaphylaxis. Call 911 and use an available epinephrine auto-injector right away.

For suspected anaphylaxis far from help, give epinephrine into the outer thigh. Antihistamines do not treat breathing trouble.

Snakebites and Ticks

After a possible venomous snakebite, seek emergency care and keep calm. Do not cut, suck, ice, or tourniquet the bite, and remove rings and watches before swelling begins.

Keeping a snakebite victim still matters because movement helps venom spread through the body. Calm reassurance also keeps the heart rate down.

Remove an attached tick by gripping near the skin with fine-tipped tweezers and pulling upward with steady, even pressure. Do not twist or jerk.

After a tick bite, see a doctor if a spreading rash or fever develops days later. Early treatment for Lyme disease and other tickborne illnesses works best.

Poisonous Plants and Bear Safety

After touching poison ivy, oak, or sumac, wash skin and clothing right away. The plants' oily sap can cause a blistering rash.

A poison ivy rash usually appears about 12 to 72 hours after contact. Cool compresses and anti-itch creams ease the discomfort.

Never burn poison ivy, oak, or sumac. The smoke can carry the oil and injure the lungs.

If a defensive brown or grizzly bear attack makes contact, leave your pack on and play dead. Lie face down, protect your neck, spread your legs, and fight back if the attack persists.

First-Aid Kit and Training

Size a wilderness first-aid kit to trip length, group size, destination, hazards, remoteness, and training. Inspect and restock it before departure.

Pack only first-aid items you know how to use. Keep medication instructions with labeled containers, and make sure everyone in the group knows where the kit is.

A typical NOLS Wilderness First Aid course provides 16 hours of hands-on wilderness medicine, including patient assessment and evacuation plans.

NOLS Wilderness First Responder is an 80-hour course with deeper remote-care practice, extended patient management, and evacuation decisions.

Cards can strengthen recall, but physical skills need coached practice and feedback. Choose WFA or WFR based on remoteness and responsibility.