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Dave and Anke
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Saturday, December 31, 2011

Is there a DOCTOR on board???

'Tis nobler in the mind to suffer
The slings and arrows of outrageous fortune???
Take arms against a sea of troubles
And by opposing, end them!
Apologies to William Shakespeare

Okay. So I yanked this out of context, elide words and repunctuate; barbarously twist once melancholy words into a battle cry? Sue me.

"Slings and arrows of outrageous fortune." Medicinal jargon calls them insults... injury and damage to the body. "Take arms against a sea of troubles..."? You bet.

Emergency Medical Services define wilderness context as "two hours or more from definitive care", a.k.a. an Emergency Room. Two hours... time, not distance. How much of our life on the water is spent, by this definition, in the wilderness? Most of it.

Fortunately, you can go a long way to prepare yourself for trouble.

Wilderness First Responder (WFR, pronounced 'Woofer') is First Aid Merit Badge on steroids. They're spendy and eat up a week of long days, but you can't ask for better, on-board insurance. Consider training for every long-term crew-member; you never know who's going to need assistance, and trained teams are better than individuals.

Within the ambulance context (the two hour radius from definitive care), different rules apply. Goals are stabilize, package, transport. You might count jump kits, ambulances and oxygen among your resources, and an emergency room or trauma center only minutes ahead of you.

In wilderness context, a WFR must stabilize, diagnose, treat, provide long-term care, package, evacuate, transport. In short, you are trained and empowered to be the doctor on-site. Intensive training includes everything from blisters to high-risk wound management, from hyper- to hypothermia, from broken nails to broken bones. Improvisation is emphasized, adapting materials at hand to the needs of the moment.

Sound scary? It is, but let me tell you. There is very little in this world worse than standing by, wringing hands in helpless ignorance, while someone you care about slips away. Yes, it's scary. Take a deep breath. Take several. Remember your training protocols; like a mantra, they will calm and focus your mind. Take effective action.

On our own, we've only had to use full-on WFR skills once. A friend had a fall, and was able to hail us by radio. He'd snapped his ulna (bone in forearm), and was in great pain. No possibility of transport till the next day. We were able to apply traction and splint. Pain diminished from storm to near-gale (remember, the Beaufort scale is logarithmic!). Without the training, he - and we - would have been in a lot worse shape.

One way to gain experience is to volunteer for your local EMS, Fire Hall and/or SAR (Search and Rescue). WFR certification includes and surpasses ambulance context certificates. Your help is needed and appreciated, and you benefit from others' years in the field. Many times, the organization will pay for your training. Make sure you get the wilderness context covered, though. If you're even sub-urban, they may never have heard of it.

It's not just for others' sake that you train, either. Not a few WFRs have talked untrained friends through life-saving procedures on their own behalf. The life you save might be your own! Recall, too, an ounce of prevention is worth a pound of cure in ambulance context; in the wilderness its priceless!

One last word. Even with training, there is only so much you can do. The wilderness context is... wild. Inherently dangerous. As sailors, we face the chance that we won't pull through...

But let's hedge our bets, shall we?

PS. I'd recommend the books Where There Is No Doctor and Where There Is No Dentist, published by Hesperian Health Guides. These are village oriented guides for preventative, general and emergency health care. WFR courses will include excellent reference books for your medical library.


  1. State of Alaska is trendsetting in the USSA with a dental medic program aimed at providing non-dentist care for remote villages. Trainees will be able to extract teeth, do simple fillings, and relieve basic pain situations. Awesome foresight on this program and, sadly, the ADentalA is coming down on the state for it.

  2. Thanks for pointing that out! Somehow I'd missed it. From what I'm finding on-line, they can't do fillings (possible I just haven't found the right source), everything else. Here's a summary:

    Unfortunately, it appears to be a two year training course.

    I once read that more people have died from dental complications than in all wars put together. That's one grim factoid!