2011, November/December Adirondac Adirondoc
I am frequently asked for recommendations on first aid books for the backcountry user. This is a difficult question, not because there are none but because there are so many. In an era of vanity publishing and e-books, almost anyone can get his or her book published. So, I will stick to the tried and true “mainstream” books.
Before I get into specific recommendations, there is a simple fact one needs to know about wilderness firs aid: Illnesses and injuries in the backcountry tend to be pretty minor affairs. Ankle sprains, lacerations, and stomach discomfort make up the vast bulk of afflictions requiring evacuation in most databases. Wilderness emergencies are largely more a function of the complexities of the remote environment than of the ailments themselves. Thus, I am not a fan of books (or courses) that place a big emphasis on tools or techniques of little value (e.g. making traction splints for thigh fractures out of trekking poles). Rather, the books I recommend stress simple, evidence-based approaches to problems which are likely to be encountered.
Here are my favorites:
The best first aid is that which is not needed. Thus, my first recommendation is a book that can keep you out of trouble in the first place. Indeed, if there is a single best all-around reference for someone headed into the backcountry, it is Mountaineering: The Freedom of the Hills (Seattle: The Mountaineers, 2003). Although the casual hiker might be intimidated by the illustrations of hanging belays and portaledges, don’t be fooled into thinking that this book is only for the technical climber. There is no better single place to learn about matters ranging from clothing selection and backpack-fitting to lightning avoidance and stove safety. Although the chapters on safety and first aid take up only 22 pages, they have more practical advice than some entire books ten times the length.
The venerable American Red Cross has been late to the wilderness first aid party, but in the past year crashed it big-time. In conjunction with a number of partners, the ARC has developed a wilderness first aid course that has already been endorsed by organizations representing tens of thousands of outdoor users. The text for the course, Wilderness and Remote First Aid (Yardley, Pa.: StayWell, 20I0) includes a helpful pocket reference. The organization and writing are simple (sometimes to the point of appearing “dumbed down”) and the illustrations are clear. This is a bare-bones first aid book. but one which covers nicely virtually everything the casual camper is likely to encounter.
For someone interested in more detail, Carline, Lentz, and Macdonald’s Mountaineering First Aid (Seattle: The Mountaineers, 2004) is a good choice. More compact than the ARC book. this one packs a lot of detail into its 160+ pages. Here, you will find quite a bit beyond pure first aid (trek preparation, fitness, communication, etc.) and lots of practical wilderness wisdom. Its small size makes it quite “packable”
Two major wilderness medicine physicians have each produced first aid texts for the layperson : Bill Forgey’s Wilderness Medicine: Beyond First Aid (Guilford, Conn.: Globe Pequot, 2000) and Paul Auerbach’s Medicine for the Outdoors (Philadelphia: Mosby, 2009). Although I admire the authors (and am friends with one), I think that they are less useful for most backcountry users than the first three. By trying to include too much, both texts devote a lot of attention to topics the casual reader would find too esoteric. and the professional would consider superficial. A great example is Auerbach’s description of a vaginal breech delivery. This would rarely be undertaken by an advanced obstetric resident; the idea of a layperson doing it at Panther Gorge after reading a book is a bit much. Better advice would be to avoid the wilderness in the later stages of pregnancy! One valuable component of the Forgey book is an excellent description of first aid kit contents, including where to acquire them and useful substitutions.
My final selection, Wilkerson’s Medicine for Mountaineering and Other Wilderness Activities (Seattle: The Mountaineers, 2010) is really more suitable for health professionals. This text, now in its sixth edition, provides much detail about the basic pathology and physiology of a lot of wilderness injuries-of great interest to the professional; but of marginal value to the layperson. A multi-author work from over twenty physicians, the text provides some of the best technical writing on subjects like altitude illness that one can find anywhere. Much of the treatment recommendations in the book. including the use of prescription medications, goes beyond the legal definition of “first aid”- and actually constitutes the practice of medicine. This is the book I recommend to medical students and practicing physicians for their first real wilderness medicine textbook.
~Tom Welch, MD, is professor and chair of pediatrics at Upstate Medical University in Syracuse and an active member of the Wilderness Medical Society. He is a licensed professional guide, a certifying instructor for the Wilderness Education Association, and has guided groups in the Adirondacks, Montana, and Alaska. More information is available at his website and blog: www.adirondoc.com.General First Aid