NOLS WMI Wilderness First Aid Part 3 (End Game)

In the last part I covered the patient assessment system (PAS) through the first three levels:

  1. Scene Size Up
  2. Life Threats (ABCDEs)
  3. Head to Toe/Vital Signs/SAMPLE

The first part of a first aid situation will be a mess. I was seriously messed up ever time we did a scenario and it was just class in REI’s back yard. Try to get through the previous steps, write everything down or you’ll forget it, and do the best you can.

During all that chaos, with your other hand, you should also be trying to put the patient at ease and dealing with environmental issues. I learned damn fast that laying on the ground will make you cold right damn now. If your patient is laying on the ground get something underneath them when you roll them over to check their spine. I have a couple NATO, fold up, sleeping pads I picked up 100 years ago and my plan is to bring them along “outdoors.”

If hypothermia is possible get them into some shelter. You may need to put the shelter up around them if you’re holding their head for a possible c-spine.

Use their stuff if you possibly can. If they’re EVACed away with your shell and it starts raining you’ll be the next hypothermia patient. And out your shell because you’re not getting that back.

But now we’re to the introspective part. Deep breath.

Problem List and Plan

This is the fourth level on the PAS pyramid.

The patient is as stable as possible, you’re squared away, and you have all kinds of information scribbled down incoherently all over the place. If you’re on day 4 of a 10 day hike and they’ve broken their leg, you can take some time to figure out how screwed you are.

“Stay and play” or “gotta go?”

Since this is first aid class we’ll assume gotta go. How’s that going to work? We practiced carrying a person and it sucked big damn rocks. Seriously. Sucked. If it is at all possible for them to self evac that is 110% the way to go. If they can’t, build a litter. Or call for help. Or ranger up because this is gonna suck.

NOLS has a protocol for calling for help. The idea is to get the most important info out first. If the connection is spotty search and rescue (SAR) will have something to go on.

An aside. You let somebody know where you were going, right? Somebody knows when it’s been too long and something’s wrong, right? I need to get in the habit of leaving a note…

Anyway, you’re calling somebody for help.

“This is Aric Czarnowski (C as in Cat, Z as in Zebra …) and I’m 5 days into the BWCA from Saw[schreech]”

At least now they can hit the permit list to find yours out of Sawbill and have a radius to start looking.

The pocket card NOLS sells on their site covers the radio report so I won’t rewrite it in detail. Here’s what you’re trying to cover in order:

  1. Subjective/Summary/Story (Who, What and Where): a. Your name and your request for evac help b. Your location c. Name/age of the patient with chief complaint d. Brief method of injury (MOI) e. Current patient status
  2. Objective/Observation/Findings (Head to Toe, Vitals, Patient History): a. Major injury list b. Vital signs (skin, orientation, heat/resp rates, heart/resp quality) c. Relevant SAMPLE notes
  3. Assessment a. “We suspect the following problems….”
  4. Plan a. Treatment plan b. EVAC plan c. List of needed help/assistance

Try to keep this to the point. Reorganize your notes and you probably want to also write down what you’re planning to say on the call. The SAR guys don’t want to listen to you rambling for 15 minutes. And if you get the info out in a concise way you’ll be in a better position to hand off when they get there. They won’t think they’re dealing with an idiot.

With your plan in place make it happen. That might mean making yourselves comfortable for a really long wait.


This is the final, base layer, of the PAS pyramid. After all the rush of the previous PAS steps maybe your best option is to sit down and wait for the cavalry. Or you need to take a day to see what happens next. You’re now in a monitoring phase.

Retake vitals, check wounds for changes, make sure they’re doing OK, keep’em warm and fed, etc. Hurry up and wait. Catch them getting worse before it becomes a crisis.

Good notes matter here because you’ll eventually hand them off. Keep good records with time, LOR, HR, RR, SCTM, intake, output, etc. What else you got to do?

There’s not much else to it at this point. Either they’re staying and playing, they’re self EVACing, you’re working our ass off to carry them out, or you’re waiting for the cavalry.