AMC Wilderness First Aid?

[JohnMcK]

I'm thinking of taking this course at the Mohican Outdoor Center, at the Delaware Water Gap next month. Does anyone have any thoughts or info on this course?

 

[Jonatha]

Have taken WFA and WFR with SOLO - are they teaching it for AMC? If you are going to be out on the trails, it's good info to have, you need to add your own common sense.

 

[sleeping bear]

I'm taking that course to renew my Wilderness First Responder certification. I registered last week, so there may very well still be space.

It's January 6 through the 8 at the Mohican Outdoor Center, $200.

It's a SOLO course being offered through the AMC, as far as I can tell it's the only one happening anywhere close before Spring.

I took this course in college, it's excellent, pretty much the standard. I think it is Wilderness First Aid, as opposed to Responder, although it is a re-cert for Responder. Unless Responder is required for a job, I don't think there's much difference.

 

[David Metsky]

SOLO is teaching a course there 1/6-1/8, I assume that's your course. The instructors from SOLO are wonderful, this will be a very rewarding course for you.

-dave-

 

[Chip]

this is the one I did through the ADK out of Heart Lake by Wilderness Medical Associates. I was hoping for more hands-on first aid training. We did ALOT of patient assessment, which is important, but the focus was on producing the assessments for the arriving EMT/ambulance, not as much on first aid and evacuation. I understand the SOLO courses are highly regarded.

"Wilderness First-Aid Course w/ Wilderness Medical Associates
April 22-23, 2006 @Heart Lake Program Center
This intense two-day workshop will teach students how to deal with medical emergencies when they are miles from help and dialing 911 is not an option. Through hands-on scenarios and lecture structure, students will learn to assess patients, become certified in wilderness first aid, CPR, and anaphylaxis training. Class time will be spent both inside and out, rain, shine, or snow, (just like in real life!), so please be prepared for unpredictable Adirondack weather.
Cost: $198 includes instruction and materials
Package: $272 includes instruction, materials, meals, and lodging for 2"

 

[sleeping bear]

We did ALOT of patient assessment, which is important, but the focus was on producing the assessments for the arriving EMT/ambulance, not as much on first aid and evacuation. I understand the SOLO courses are highly regarded.
"

Wilderness Medical Associates are the other big one. I could be wrong, but I think NOLS does stuff with them.

That must be the major difference between Wilderness First Aid, and Wilderness First Responder- Responder did much more with actually treating the victim in the field. My favorite part was learning how to make a traction splint out of a big stick, some rope and a coffee cup! I think the Responder certification is accepted for search and rescue groups, although, again I could be wrong. Responder does a ton of hands on, for our final "test" we had a mock rescue at night, in the snow. It wasn't over until all of the victims were correctly assessed, attended to, comfortable, and safely gotten back to the trail head a mile and a half away. It was tough, and nerve wracking, cold, and our instructor wasn't afraid to tell you if you were doing a crappy job.

That course was spread out over the semester, and I felt like I lost some stuff because it took too long and I was more focussed on "harder" classes. I'm looking forward to everything cram packed into two days. Should be intense.

My husband took a WFR course in Alaska, in their mock rescue they had to deal with gun shot wounds and a drunk guy trying to attack the rescuers with his ice axe!

 

[Chip]

With Wilderness Medical Associates the Wilderness First-Responder Course is an 8 day gig, vs the 2 1/2 days of the Wilderness First Aid course. The First-Responder is what I'd like to do, but it's just not happening any time soon.

 

[SAR-EMT40]

Wilderness First Responder- Responder did much more with actually treating the victim in the field. I think the Responder certification is accepted for search and rescue groups

In order to be called a first responder and be certified as such you must complete the DOT training course (in most states). Unlike rendering first aid, being a first responder or EMT has legal obligations and expectations at the point you put hands on a patient. That certification usually consists of 40 hours of class in addition to passing a written and hands on test. In Connecticut First responders are also refered to as Medical Response Technicians.

Be aware the qualifier "Wilderness" in First responder's or EMT's titles doesn't give any special dispensation in performance, expectations, or treatment. You have a legal obligation to perform to "standard care". Some states allow people trained in wilderness/extended care to perform what they have been trained to do. When they may perform in a wilderness capacity and what legal protection you have is highly subjective. Being a member of a search organized by the FS or State police or as a SAR group brought in by the FS or State police also gives you legal protection under state law in VT and NH. First aiders are covered by Good Samaritan laws in most states as long as what you are doing is considered first aid.

Just a FYI,
Keith

 

[sleeping bear]

Be aware the qualifier "Wilderness" in First responder's or EMT's titles doesn't give any special dispensation in performance, expectations, or treatment. You have a legal obligation to perform to "standard care".

I thought "wilderness" meant that your medical training was for specific use when outside medical attention was more than two hours away. So a "wilderness" FR wouldn't have the same legal responsibilities in say, Boston, as they might in the middle of the Pemi wilderness because the training is different.

But even then it's only if you have a duty to act. As a recreational weekend hiker by myself, I have no legal obligation to provide first aid to someone in need. Obviously I would help them, that's where the standard of care comes in. If In an official leadership role, a WFR would have a legal obligation, and would then be negligent for not providing necessary care within their scope of training.

I'm positive that the above was the case in Michigan, but maybe it's different here in New England. Do the laws on this stuff vary that much from state to state?

I guess I'm fuzzy on the categorizing of the certifications. WFR was a required course for me in college, so I just took it.

I think I'm due for this refresher next month.

 

[MAJZHike]

I just took the WFA course with the Berkshire AMC also run by solo and it was great. Although the course was only two days long you get an amazing amount of usefull information. If you are looking at continuing your training towards the First Responder Solo credits your hours in the WFA class if you complete your training within 6 months or a year? I forget exactly. Highly recomended!!
Mark

 

[smitty77]

Do the laws on this stuff vary that much from state to state?

State to state, and sometimes between certification levels.
The "Duty to Act" can be a very fine line. Some jurisdictions may count a WFR as a staright FR, and you may have a duty to act outside of the "wilderness" setting.

Keep in mind your certification does not necessarily transfer from one state to another. It may not be valid or considered adequate for the level of care being rendered. When I was an EMT (since lapsed 2 years ago), MA was not a member of the National Registry, and viewed out of state EMTs as First Responders. This fact can have big implications as you can be found liable for treating a patient using skills beyond what your "certification" allows. This may have changed in recent years, but my point is to know what is required of you in the states where you may have to render aid.

Good luck with the course. The knowledge will be with you forever. Now if they would stop changing CPR guidelines every two years....

Smitty

 

[SAR-EMT40]

I'll take a crack at this. Hopefully this isn't too disjointed. I'll try to clarify if needed. Sorry for the length.

I thought "wilderness" meant that your medical training was for specific use when outside medical attention was more than two hours away. So a "wilderness" FR wouldn't have the same legal responsibilities in say, Boston, as they might in the middle of the Pemi wilderness because the training is different.

Bottom line this is probably not correct. Your legal responsibility remains the same. Your treatment may be different.

Because you received your “wilderness” certification along with your FR certification I understand how you might get confused. If you look at SOLO’s web page and most other Wilderness “first responder” courses you will see the that the WFR course complies with the DOT First responder course and then gives some extra training to get you the wilderness certification. Most classes that have “first responder” in the title start with the DOT class as a baseline. That means that you are trained as a first responder. There are very clear cut protocols that a FR is supposed to follow. Normally, these protocols assume that you will be near a place that an ambulance will be able to get to you within 10 minutes or less, generally speaking. The wilderness setting is defined, again generally, as one hour or one mile from the trailhead.

As far as legal responsibilities, let me say up front, I am not a lawyer but, we do have some legal training to protect us, our service and the town. I would welcome anyone with other opinions to chime in. If you have started treatment then you have a legal responsibility to act within your scope of practice. That is defined not by your training but actually by state protocol and your medical control doctor. Most of the procedures taught in the first aid SOLO course are not too far outside the standard protocols of most states. Setting splints, controlling bleeding, etc are pretty run of the mill stuff. Other things, such as clearing C-spine, while accepted protocols for paramedics could get a WFR in trouble without a medical control doctor saying to do it if it is not the standard of care for that state. There is no doubt that if the C-spine can be cleared it should be and is even part of some states protocols such as Maine and Alaska and others. Anyone that has been back boarded and collared for 10 minutes I am sure realizes that being boarded and collared for hours could lead to problems that the patient didn’t have to start with. I have been told that there are studies to confirm that. There are also dangers in a carry out to both the patient and the crew doing the carrying that could be avoided if the c-spine can be cleared. Maine has had a (wilderness) protocol to do this for a long time and has never had a bad outcome. New Hampshire has a wilderness protocol in the works but it is not an accepted protocol. I have seen it. It looks excellent but it is only in the discussion stage right now. Of course it should look excellent. Dr Hubbell was involved in creating it. I’ll send it to anyone who is interested. But like I said, it isn’t standard protocol yet to my knowledge.

A little example. You are merrily attending to this patient you found lying on the ground. You did what you were taught in the manner in which you were taught. Get this patient out and alive to the hospital. Good job. Now, his lawyer says you did xyz and it caused abc. These are the questions that are going to be asked. Did you follow state protocol? Who was your medical control doctor? Were you trained to do the procedure that you did? Are you authorized to do the procedure you did? Did you do the procedure correctly? Was the person conscious when you did what you did? Did you get the patients informed consent to do what you did? By the way, did you document everything you did and what you found before and after you did whatever you did?

These are going to be very important questions in the lawsuit. Here is another question, who is representing you? Since you are not affiliated with a hospital or service, you are going to have to pay for your own legal representation. Even if you win, it is going to cost you a fortune and you may not win which is going to cost you even more.

There are basically three levels of legal standards for medical people. This is obviously a simplification but it is reasonably correct to my understanding.

Lowest: Someone trained in first aid only or not trained at all and who renders aid would be covered under the Good Samaritan act. Basically under the GSA in most states in order to prove negligence it must be gross negligence. A reasonable person would have had to know that doing what s/he was doing would result in serious injury or death to the patient. I.e. you yanked out your Leatherman tool and started whacking away doing open heart surgery. Other than that, if you did reasonable things to try to help that person, even if they died because of your actions, you are probably not liable and a lawsuit would be dismissed before it even got started.

Middle: FR’s, EMT’s, Paramedic’s. We are held to a higher level for standard of care. The lawyer must prove that not only did we make a mistake, but that mistake caused the patient harm. We must abide by our state protocols unless directed otherwise by our medical control doctors either by standing orders or online consult.

Highest: Doctors, (I don’t know if nurses fall into the second or third tier, probably second). All a doctor has to do is make a mistake. The person doesn’t have to be injured from it to win a law suit. I suspect that many of these types of lawsuits wouldn’t be brought primarily because the payoff probably isn’t very good if the person wasn’t injured. Don’t forget the medical board that he would also have to talk too as well.

Example: You come across an unconscious person who fell and is bleeding heavily from a laceration on his head. You have always heard that you should stop all bleeding. You heard that the best way to do this is to apply direct pressure. You do this; unfortunately the patient eventually gets to the hospital and dies. Winds up that he had a skull fracture and you pressed bone fragments into his brain and killed him. If you are an untrained person, or trained in first aid only you would probably be covered under the Good Samaritan act and not legally liable. You didn’t do anything grossly negligent so you aren’t responsible. If you are a WFR, you are probably liable. You made a mistake and it probably contributed to his death. As a FR you probably should have known that while scalp injuries can bleed like hell that is not the primary consideration in this case. His possible head and neck injuries are and should have been given due consideration. You might get sued.

There are several things for those trained as a FR to remember. One is that if you are acting to help someone in the city (whether you realize it or not) you are actually a FR (in the legal sense) and have all of the obligations and duties to uphold as any FR (i.e working to the standard of care the state requires) if you put hands on a patient. Second, that doing things not covered in the state protocols out in the wilderness could also open you up to possible legal action if they are determined that they caused injury or exceeded what the state considers your scope of practice. There is another way you could possibly get yourself into trouble. If you have the knowledge to help someone that you don’t use. Yeah, I know. They have it both ways. I have followed many legal wilderness medicine forums and the gist from the lawyers seems to be to do the best that you can for your patient. That is “the easiest” thing for a lawyer to defend. Again, I am referring to the wilderness setting and with states that don’t have wilderness/extended care protocols that you have been trained to do. This doesn’t mean that all the other things were baloney. It is not. There is definite possible legal problems you could run into but if a lawyer has to defend you from a lawsuit from a wilderness injury. You are best served by doing the best you can for your patient as long as you really know what you are doing.

In the wilderness setting and elsewhere. If you are a FR, which again, WFR's are, and you are treating someone you are obliged to turn your patient over to someone of equal or higher training. If you start care on someone and then his brother or some bystander comes along and you decide that you will leave him with that person until the ambulance comes. I am sure that you were taught, that is called abandonment.

Keith

 

[JohnMcK]

Thanks, folks. I just got off the phone with them. I'm all registered. I just have to run the cash up to them.

 

[sleeping bear]

John, it'll be cool to meet you.

I know I've now got plenty of liability/state law questions for when they ask "are there any questions?"

 

[SAR-EMT40]

You can of course ask. But, here is most of page 2 of the NH wilderness protocol that is marked "for discussion only". Does it look like they are covering all legal bases?

Keith

 

[cushetunk]

If you have started treatment then you have a legal responsibility to act within your scope of practice. That is defined not by your training but actually by state protocol and your medical control doctor.

FWIW, and I learned much of what I think I know from reading this: www.wildmed.com/legal_samaritan.html, I think all this legal worry is somewhat overblown. As a private citizen, my ability to give safe first aid is defined entirely by my training (in my case, a WFR from Wilderness Medical Associates). Again, as a private citizen, I think I am best covered by making a good faith effort to follow my training and work only in the patient's best interests. I do not recall that I have ever been at a WFR/WFA course where I was instructed anything other than this. Nor for that matter do I remember anyone telling me the state I chance to be in had some sort of de facto organizational authority over me -- i.e. transforming me into anything other than a private individual rendering assistance -- simply because I have a WFR.

 

[SAR-EMT40]

had some sort of de facto organizational authority over me -- i.e. transforming me into anything other than a private individual rendering assistance -- simply because I have a WFR.

I find it interesting that you say that when the document that you cite has this as part of its content. It clearly says that as a First responder you are not just a private citizen and you are liable to a higher standard of care. At least that is how I interpret it. Bold type mine.



3. The standard of care for a person providing emergency services
There is one more legal principle that comes into play before considering Good Samaritan laws. When emergency assistance is volunteered, in the absence of the Good Samaritan law, or in circumstances where the Good Samaritan law does not apply, the person rendering assistance must exercise the skill and knowledge normally possessed by members of that profession or trade. (Restatement, 2d, Sec. 299-A.)
A doctor who volunteers assistance will be held to the standard of care reasonably expected of a physician. An EMT will be held to the standard of care of EMTs. A person who has been certified as WFR, will be held to that level. The volunteer will be exposed to liability suits if the care exercised is less than the standard applicable and further injury results.


I may not have explained it as well but that is pretty much was what I was trying to say.

My other point was that you are held to that standard whether you are out in the woods or in the city and if you are out in the woods and you do things not listed in the state protocol you are legally liable. That doesn't mean that you will be sued. It means you could be sued and the suit has a good chance of being won by the patient.

Hope this is clearer.
Keith

 

[cushetunk]

I think we both agree that if you are a WFR, you are expected to perform at that level. Where ever you are.

In my mind, my "WFR level" is what I was trained to do. No more, no less. To attempt to provide care that I have not been trained in would be foolish. To fail to provide care that I have been trained in and am using appropriately, because of quibbles over how a F.R. is defined, seems counter to the Good Samaritan law's intent.

But it seems clear you still are a volunteer, not obligated to assist. Only once you assist are you held to your standards. And even within that level, then (at least in Maine) it seems the bar is high: all but "willfully, wantonly or recklessly or by gross negligence on the part of the volunteer" is protected.

I think you'd also agree with what I said before and still maintain: an individual is best covered by making a good faith effort to follow their training and work only in the patient's best interests.

Fascinating topic; though perhaps the thread drift is getting out-of-bounds.

 

[DougPaul]

Fascinating topic; though perhaps the thread drift is getting out-of-bounds.

Off topic? Perhaps, but of interest to at least this thread lurker...

Doug

 

[cushetunk]

I think you'd also agree with what I said before and still maintain: an individual is best covered by making a good faith effort to follow their training and work only in the patient's best interests.

I just realized that SAR-EMT40 did say this, before I even jumped in the discussion.

Over and out.