Hoping for the best, expecting the worst: A Backcountry Serenity Prayer

There’s a guy staggering around, looking dazed and mumbling something about his insurance coverage, blood seeping from his scalp. Two other patients—one of whom has a badly broken femur protruding from her pant leg—are tangled together on the damp ground. “Hey,” I say to the head wound guy, “I’m Emma. I have some wilderness medical training. Can I help you?”

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So there I am, walking down the trail, chatting amiably with my companions, when we hear shouting. There, around the corner, is a pretty gruesome scene.

There’s a guy staggering around, looking dazed and mumbling something about his insurance coverage, blood seeping from his scalp. Two other patients—one of whom has a badly broken femur protruding from her pant leg—are tangled together on the damp ground.

The mood shifts instantly: Is it safe to approach them? Who’s in the worst shape? We’re dropping packs, holding c-spine, checking for airway blockages.

“I forget, are we doing traction splints for broken femurs in the backcountry anymore?” someone asks.

“Hey,” I say to the head wound guy, “I’m Emma. I have some wilderness medical training. Can I help you?”

“Don’t forget,” calls the instructor, “We’re gonna need a verbal SOAP note in a few minutes!”

The blood, of course, is fake, as is the obviously deformed femur. It’s the third day of a Wilderness First Responder recertification, and thirty students with all sorts of wilderness backgrounds—mountain and river guides, backpacking instructors, wilderness therapists, weekend warriors—are knocking the rust off our medical training.

lightning
Pro Tip: Avoid lightning injuries by practicing lightning position early and often.

I took my first WFR course in 2013, a precursor to working as an avalanche safety instructor. Before that, I’d taken your standard Red Cross first aid/CPR course in hopes of raking in some serious babysitting cash in my early teens, re-upping every couple of years as needed until I realized infant CPR wasn’t going to do me much good if I encountered a broken arm twenty miles from the nearest trailhead.

WFR courses cover a wide range of potential backcountry afflictions: altitude sickness, sprained ankles, the sucking chest wound I’ve more than once threatened to give a snoring climbing partner with my ice axe. Some instructors use fake blood and props; others rely on their students’ ability to mimic telltale signs and symptoms. Nothing, of course, can quite prepare you for the real thing, which I often think about as I’m pretending to palpate someone’s spine.


Midway through my first season as a backpacking instructor, my coworkers and I used a rare day off to climb in the Mount Evans Wilderness, sixty miles southwest of Denver and some five-thousand-odd feet higher. The five of us, in the thick of our group bonding, had all spent the previous night crammed into a single tent, and, in an effort to impress our boss, I had really tied one on.

(Paradoxically, it worked: I am now married to him, though anyone who knows us both will tell you that I am the boss.)

The plan was to hike into the Chicago Lakes basin, where we’d spend the afternoon climbing and, in my case, nursing a moderate hangover and doing my best not to puke in front of my new friends. Saddled with giant crash pads—meant to cushion the inevitable falls we’d be taking as we climbed, unroped, on large boulders (an activity which, when described, sounds exactly as pointless as it actually is)—we left the trailhead and began the three-mile descent to the fire road running up the basin, where we knew there existed a concentration of the aforementioned boulders.

We climbed a few easy routes, some of us more nauseous than others, then packed up our supplies to head farther up the drainage, where I imagined my companions would attempt to climb harder things while I sat in the shade and tried not to move too much. Was it too early in our friendship, I wondered, to request that everyone please, for God’s sake, keep it down?

Half a mile up the trail from the fire road, we were intercepted by a panic-stricken man in his early sixties and a couple of badly behaved dogs.

“My sister-in-law—fell—can’t walk—” he gasped, not noticing that the smaller of the Very Bad Dogs had toddled over to hump my leg.

We quickly agreed to hike back to the fallen Boomer, and I tried not to hope this meant we were done climbing for the day. The dogs raced ahead, barking at squirrels and generally making a nuisance of themselves, while their owner teetered unsteadily behind us.

The sister-in-law, Anne*, was propped up against a tree, looking pale and unhappy. Her sister, the hopefully-not-our-cardiac-patient’s wife, was fussing with her pack, and didn’t didn’t bother to mask her surprise that her husband had returned with help so soon.

Bix introduced himself and listed his credentials. He was, in retrospect, giddy with excitement to have a real-life scenario on his hands—what can I say? The man’s good in a crisis—and immediately began taking stock of the patient’s injuries.

My spirits raised by the notion of someone feeling worse than me, I rummaged through my pack for a bottle of ibuprofen, quaffing a handful before I forked them over to Bix.

The rest of us shuffled uncomfortably, assuring the woman’s sister we’d stick around, as Bix checked her vitals and examined her chief complaint. The husband had been sent back to the fire road, where, it was hoped, he’d run into someone who could quickly go for help.

“Okay,” Bix whispered to us conspiratorially, “I think this lady’s got a sprained ankle. She’s not walking out. We’re gonna get her back to the road.”

This took the wind out of my sails a little. I’d already medaled in the Hungover Climbing Olympics; now Anne was standing between me and the bottle of Gatorade I so desperately needed. Still, eager to make a good impression (and, I guess, be a good samaritan), I stood dutifully opposite Bix at Anne’s right shoulder.

“Try putting, like, ten percent of your weight on it,” Bix instructed her.

No way. Anne crumpled into Bix’s arms; the sister shrieked and covered her mouth.

Having hiked back to the car on a broken ankle the previous year on bones forty-some years younger than hers, I could hardly blame her. Still, this meant thing were going to take longer than anticipated.

We huddled again, this time formulating a plan to use the crash pads as a sort of injured-person-throne and literally carry her to the trailhead.

Anne was a pretty good sport for all this, though internally I rolled my eyes a little every time she complained or insisted we shift positions. Over the next hour, we made painstakingly slow progress under darkening skies back to the fire road, where help, to our surprise, had already arrived. The EMTs had somehow gotten their rig up the rutted dirt road, and we said our goodbyes to Anne and her sister just as the first drops of rain began to fall.

A ranger, meanwhile, had driven his truck to the end of the fire road, and offered to give the rescuers, plus the now-forgotten brother-in-law and his mutts, a ride back to our cars. My friends started to protest that we might get some more climbing in if the weather held, but I was already piling into the bed of the truck.

By the time Ranger Rick delivered us to our cars—soaked to the gills, for the record—my hangover had mostly dissipated and I was ready to stuff an entire pizza into my gullet, perhaps washed down by a little hair of the dog.

A few weeks later, a thank-you card arrived at headquarters in Golden. In it, along with a generous gift certificate to the local pizza joint, was a handwritten note from Anne, in which she thanked us profusely for evacuating her with what turned out to be a broken tib-fib.

So much for my self-satisfaction: I may have hobbled around on a hairline ankle fracture, but this woman had been a total trooper after literally breaking both bones in her lower leg. (Yes, I am a douche.)

This is the part where I should say something like, “…and that’s why you should be up-to-date on your wilderness med training.”


As always, I finished this weekend feeling grateful not to have used my wilderness medicine skills since the last training, and with the fervent hope that I never encounter a tension pneumothorax.

Still, it’s important to dust off the cobwebs, because, as I’ve been reminded all too many times, you never know when the proverbial shit will hit the fan.

With that, let us close with a Backcountry Serenity Prayer:

Grant me the serenity to accept the ailments I cannot diagnose,
A satellite phone to evacuate the things I can, 
And enough Ace bandages to make do in the meantime.

wfr 2
Pro Tip #2: Only threaten sucking chest wounds when absolutely necessary.

*not her real name

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