For over 30 years Wilderness Medical Associates International has been teaching practical medicine to people who work in remote and difficult environments. The core curriculum is designed to provide the skills and insight needed to improvise, adapt, and exercise reasonable judgment at any level of medical training. Although the company’s roots are in the mountains, deserts, and oceans as the name implies, the training philosophy has proven effective in any setting where access to definitive care is delayed or impossible. The term wilderness context applies just as well to a city whose infrastructure has been destroyed as to a fishing boat off the coast of Alaska. Throughout its history, Wilderness Medical Associates International has promoted the idea that pre-hospital practitioners can be trained to make a diagnosis and develop a plan appropriate to whatever challenges they face. In the early 1980s, the company’s founder added spine assessment criteria, the treatment of anaphylaxis, advanced wound care, and other medical protocols to the first aid training of Outward Bound instructors and wilderness guides. The company also insisted that his students understand the medical principles behind the procedures. Back then, this met with considerable resistance from the mainstream medical community but the training was so much more effective than anything previously offered that the idea flourished anyway.Today, wilderness medical training is ubiquitous worldwide, and many of the protocols and training procedures are being adopted by mainstream emergency medical services. They are learning, as we have, that there is no place in field medicine for unreasonable restrictions on the practical application of medical judgment. This is nowhere more apparent than in a difficult backcountry rescue or the chaos of a mass disaster. Training is designed to give pre-hospital practitioners the ability to think on their feet and function independently when the medical system is disrupted or unavailable.
Inevitably, the curriculum has eliminated some sacred cows and challenged some long-standing assumptions. Double blinded trials, the gold standard for hospital medicine, are few and far between for medicine in the field. Some studies purporting to comprehensively speak for wilderness medicine are too narrowly focused to have much application to the broad range of environments this training seeks to address. In addition, some of the better-known sources focus on wilderness-related problems but do not pay sufficient attention to the realities of solving them in the field. This is a difficult environment in which to seek scientific validation.
Wilderness Medical Associates International does not deviate from the mainstream arbitrarily, but is not afraid to do so when necessary. Opinions and positions are based on careful analysis of the available science and considerable clinical experience measured against the reality of providing medical care in difficult and dangerous places. This is not an attempt to change mainstream medicine, but to provide some guidance to those working well outside of it.