Willie<br>I think that there is a significant issues in question. First, what is a reasonable level of training to undergo to feel comfortable to provide emergency care. What equipment is it reasonable for a prepared layman to carry with him on an outing, and what are likely injuries to expect in a remote setting.<br><br>You mentioned the wilderness EMT program. The wilderness EMT program is an advanced medical program that advocates reduction of dislocations, advanced wound care, and use of medications that fall outside of the realm of the "usual" paramedic. There are many states that would not allow these treatments to be applied by a non-licensed practitioner.<br><br>I think for the average weekend "explorer" a basic red cross course in first aid is adequate. I would think that the majority of injuries can be handled with basic first aid and possibly external assistance in evacuation.<br><br>For a scout leader or someone with comperable responsibility for others, an EMT course might be appropriate. However, EMT courses focus on motor vehicle trauma with an emphasis on spinal immobilization and cardiac emergencies which are the "bread and butter" of an EMS system. Much of the equipment used in EMT programs is not available down in the boondocks.<br><br>As you and I have discussed previously, if I were approached by a layman planning a trip to the Boundary Waters Canoe Area, I would consider the inclusion of antibiotics; stuff for nausea, vomitting, and diarrhea; something for little pain and big pain; injectable corticosteroids; something for eye injuries and infections; and so on. I do the same for cruising sailors now in my practice.<br><br>How much of this stuff do you (1) want to carry and (2) are you REALLY gonna need on a weekend trip? What is the risk to the patient if they don't receive "advanced" treatment? <br><br>Responding to the question that you raised regarding wound care, there is no emergency in the treatment of a major soft-tissue wound. When a doctor is confronted with a laceration that occurred longer than eight hours ago or is heavily contaminated, appropriate treatment is to pack the wound with sterile gauze (dry or soaked with sterile saline or a dilute solution of betadine or clorox). The packing is changed daily for three days. If there is no infection after three days, the wound can be sutured with no increase in scarring and a far lower risk of infection. In the situation that you describe, there is no rush for definitive treatment.

Thnaks for the reality check! I guess I was guilty of "over analyzing." <br><br>With regards to the weekend warrior on scout trips. I am not authorized to administer any medication other than non-asperin for pain releif. And that's with the express written authorization from the parent on each trip's permission slip. So any additional meds I carry would be for myself only.<br><br>Most outings are near enough to civilization that we're usually only hiurs away from help. That would usually be over-night at worse. However, there are times when that could be prolonged if we were to get lost and/or use poor judgement and travel away from where we're expected.<br><br>Some of our outings would put us several days away from care, such as te Boundary Waters trip. This would be the type of trip where I'd be most concerned if something went terribly wrong. I have heard stories of paddlers who misuses a hatchet and hacked their legs instead of fire wood. Or one adult leader who went into shock after using an undluted DEET insect replelent. So even the layman may be faced with a prolonged emegency situation where propping up the feet and keep warm until help arrives is not sufficient. This type of scenario is not covered in Red Cros Training, at least it asn't many years ago when I took it. (That statement alone should send up a flag that I need to retake the course )

Actually, there are some BSA requirements - wisely so, I think - for persons with advanced training to accompany activities that take Crews/Scouts farther away from emergency responders, just as there are requirements for some advanced capabilities for activities with "higher risks" - for example, climbing. No need to go into details here - Willie, if you would like to contact me via email sometime, I can pass on what I know regarding those kinds of requirements and then - if you like - we can discuss those particulars here.<br><br>If you're taking a Boundary waters trip through the Charles Sommers Canoe Base, you're going to be covered by the staff and the resources the base has, even in remote areas. If your Troop is doing it on thier own or via some other outfitter, you may or may not be required to add some trained capability to your adult leadership on the trip - particulars of the trip will dictate that. A peak-bagging trip into a remote wilderness area may or may not require similar capabilities, again depending on how "far" away (time-wise) are the emergency responders. The requirements seem to be based on good sense.<br><br>Hope this helps.<br><br>Scouter Tom

Chris -<br><br>Sounds like you did a great job - hope the mare heals up OK. Is it just me, or was that a pretty ambitious cougar? I've laid eyeballs on them a few times and see the scat frequently (NOT here in Illinois, Willie!) - except for 3 deer kills I found at various times, seemed like they mostly were eating bunnies and birds (and the occasional dog if I understood the scat correctly). I only lived in cougar country a couple of years, so most of my sightings have been incidental to other "business" - I'm curious what you make of the attempt to take down a horse.<br><br>One quick story: Once upon a time... We came across a freshly cougar-killed mule deer - night before. Set up a dry camp in a natural "blind" in a prevailing downwind direction about 100 meters away, hoping to catch a glimpse. Should have stayed up all night; gave up about 1/2 hour after moonset. Heard nothing, but next morning - deer was gone. A few drag marks, then just splay-footed pug marks. Tracked it about 1/2 mile up to higher ground - quite an outpost - where we found the carcass - now minus the meat on a ham - stashed up in a scruffy conifer - I mean, UP a tree. Must have tossed the carcass "over its shoulder" and walked off - and we never saw anyplace where it touched ground, other than an occasional scrape (dangling hoof, we assumed). Strong bugger!

Tom, The couger was a younger juvenile and underweight. We found the poor creature with her head kicked in by the mare. She was desperate! California passed legislation giving them total protection. Now we have gone from unsportsmanlike hunting to overpopulation. The Sespe is also the dumping ground for problem park bears. So; problem bears, starving lions, marijuana farms with booby traps, lost cattle and hikers and neophyte nimrods shooting at anything in sight make for a great field test of gear!

Must have been terribly hungry to take on a horse. Plus I imagine the dehydrated horse was in a weakened state and being a domesticated animal, must have seemed to be a viable target for the cougar.<br><br>re: Illinois. They were once indigenous to Illinois where they were also called Pumas [color:green](Puma concolor, Linnaeus, 1771 - a.k.a. Mountain Lion & Catamount)</font color=green>. But they are extirpated from Illinois now, which is a fancy word meaning they don't live in this area anymore. There still is a species of large cat in our state, the Bobcat, more correctly called the Lynx [color:green](Lynx rufus, Schreber, 1777 - a.k.a. Bobcat)</font color=green>. But it's on our state-threatened list.<br>

Beachdoc:<br>I appreciate your "to the point" medical perspective. I've learned to "underdo it" if at all possible. In October I was with my buddies high and far away.. on a horseback trip in Montana. Two of the guys are physicians, and I'm a gear/gadget freak. So our medical kit(s) would have put a MASH hospital to shame. <br> BUT... when one of the guys had a disagreement with his horse ending in being launched face first into a tree and causing a 5" lac. across his r.eyebrow and lid, I thought we'd be able to able to use all the neat stuff we were carrying. Didn't happen: the OBGYN looked at the wound and stated "not my end". The Opthalmologist opined that he couldn't do much without his Laser.... but used a bottle of visine one of us had to wash the big chunks of tree out of the guy's eye. Then he cut some butterflies out of duct tape, closed the lac., and we went on. <br>Today... not a scar. I'm dumping all of my firstaid supplies out in favor of a bottle of visine and a roll of duct tape.

Your minimalist approach strikes me as a pinch extreme!<br>

You're right Doc... but it's the most I can get precertified<br>by the Managed Care case manager... in the field.

With all due respect to Beachdoc, not all Wilderness First Aid courses are designed to train you to the level of professional paramedic or EMT. I teach a course which is one weekend long; it requires Standard First Aid as a prerequisite, so the total course is about 2 weekends (there is a combined 3-day course which combines Standard and Wilderness First Aid). I talked to a Saint John Ambulance volunteer last night who had taken a WFA through Red Cross many years ago, but unfortunately didn't have much time to compare notes and see how it differed from mine. <br><br>The course I teach is basically to go over the differences in treatment when medical help is more than 10 hours away. Up to 10 hours, Standard First Aid *should* be sufficient.<br><br>I also teach early recognition of potentially life-threatening conditions such as systemic infection (blood poisoning) and stress to the students that if one of your travelling companions develops such a condition, the vacation is OVER - I don't care how much you paid to get here, or how much you were looking forward to it, if your buddy has a cut that's gotten infected and red streaks are emanating from it, he needs emergency medevac immediately.<br><br>A good WFA course should also deal with when to call for emergency evacuation (and when you don't need to) as well as the basics of how to prepare a makeshift helipad and how to approach a helicopter or aircraft. <br><br>There are important differences between First Aid for an office environment and First Aid for 15 miles out on a X-country ski trail, but you don't have to be a licensed paramedic to be of use.<br><br>Just my $.02 worth. :-)