After the "customizing' thread on FAKs got off on a tangent about tourniquets, Russ suggested that it should be another thread. This thread is a result of that suggestion, so it's entirely Russ's fault - I, as usual, am blameless....

Let's not talk about tourniquets, or even primarily about FA gadgets, but about the knowledge, skill, background, etc. that one might bring to a first aid situation. These intangibles are at least as important as all the dressings, pads, tape, etc. that you might carry.

For one thing, the first task is to define the problem: you must check the victim and find all the injuries. Sometimes there is only one boo-boo, but my experience is that there usually is more than one and the most serious is not always obvious.

Allied with this is the often related problem of environmental stress; I have seen this quite commonly in wilderness settings. Your victim may be too hot or too cold or perhaps dehydrated, as well as injured.

The scene may be unsafe. If you are treating someone hit by a falling rock, are you are sure that that hazard is no longer present.

How long will the victim be in your care? The longer you are responsible, the greater the challenge and responsibility.

These are just some of the factors that indicate that training, as well as practice, are just as important as the goodies in your kit. I maintain that a trained person, improvising, can arrive at a better outcome than an untrained person with the very best kit available. The ideal, naturally, is a trained, well equipped person in ideal weather and rapid transport to definitive care.

This mirrors many aspects of survival - where training and skills are just as important as gear.

So, how does one get this training/ experience and in what proportion should resources be committed? What are other important considerations?

Yes - The more advanced courses teach this well.

FWIW —I recommend the National Outdoor Leadership School’s NOLS Wilderness Medicine curriculum with courses for certification in Wilderness First Aid (WFA), Wilderness First Responder (WFR) and Wilderness EMT (WEMT) — not short, not cheap, but very comprehensive. (There is another course for Wilderness Advanced First Aid (WAFA) which has two dates, both in Patagonia, Chile, and one in Texas.).

For most of us, the WFA cert is all that’s required, and that course is 2 full days - Saturday & Sunday. WFR is 9-10 days, Saturday through the following Sunday. WEMT is 4 weeks.

Select a curriculum and use the filters to find a course that works for you.

I second the NOLS courses, and there are others available as well for wilderness first aid, wilderness first responder and EMT. The Red Cross offers good basic classes on CPR and first aid. Many local community colleges offer EMT courses.

As Hikermor says, assessing the situation and the casualty are critical. Learn how to look. How you look is very important in approaching any emergency situation. With experience it gets easier, more natural and more effective.

Scan the scene and glove up. Once you go hands on you need to be protecting yourself from bodily fluids and other contaminants. That and it changes your mindset.

In my opinion, training is far more important than the contents of your first aid kit. Having a well stocked first aid kit is no substitute for knowing what to do. The more training, and the more realistic and stressful that training is, the better.

I'm currently certified as an EMT, and also as a Wilderness First Responder (WFR). While the basic skills are much the same, WFR puts more emphasis on decision making. In town, if there is any doubt about the severity of a patients injuries or illness, the EMT will immediately transport to a hospital. In a remote setting, evacuating the patient might be more dangerous than staying put. Thus WFR tends to have "Red Flags" to help one make a decision. Can this patient wait until daylight, or better weather? Or do we need to attempt a high risk evacuation ASAP? And of course EMT training generally assumes one has access to lots of equipment, while WFR stresses improvisation.

People generally don't perform as well under stress in a real situation than they do in training. Hence WFR courses tend to include a lot of scenario based training exercises, which are deliberately designed to be stressful. It is fascinating to me how a well run scenario can get ones adrenaline pumping. When you get to the point where you can perform well in a stressful scenario, you might do OK in a real deal situation.

As noted upthread, NOLS courses are good. My WFR is through WMA (Wilderness Medical Associates), who also put on a great class (usual disclaimers, satified customer etc). While there are minor differences, in general NOLS and WMA follow a fairly similar curriculum in their courses.

Many moons ago, during my senior year in college, I was brusquely made aware of the need for mountain rescue and I volunteered with a newly formed mountain rescue group (Southern Arizona Rescue Association). One requirement was First Aid certification, so I signed up for a university level course taught by the PE department. At some point, I asked the instructor, "What do we do if that is not available?" He looked at me like I had just fallen out of my tree and replied, "That will never happen..".

He was thinking "athletic field" and I was thinking "back country..."

Some years later or so (1970)when EMT became available, I was able to take an NPS sponsored course which was deliberately slanted toward wilderness settings, definitely more appropriate for the situations I was encountering as a SAR volunteer (and also pertinent to the field work I was doing). That course was challenging and the lessons I learned were not learned later the hard way on the victims I have encountered since.

Context is everything.

As a firearms instructor, I try to take a self aid / buddy aid course roughly once a year, based on CoTCCC principles. The goal of such a course should be to keep the victim of trauma alive long enough to get them to definitive care. I’ve been through the CERT first aid training a few times, as well as some other first aid classes, with one course on suturing in austere environments.

I’ve been wanting to take WFR classes for some years. When I had the time I couldn’t afford it. Now it’s a bit more affordable but I don’t have the time.