Tuesday, May 25, 2021

Wilderness Emergency Medical Care; The Case for WFR, Part 1


RAW Medicine Podcast with Todd Pschimelpfenig and Dr. David Johnson, two of the pioneers in Wilderness Medical Training: 


A wilderness first responder is trained to deal with many situations that may be encountered in the wilderness. The training is principally geared towards lay providers, with little to no actual medical experience, though they are often already professionals in other aspects of the outdoors industry, like park rangers, climbing instructors, and guides. A standard Department of Transportation defined emergency medical responder (EMR) course, which focuses on urban medical emergencies, requires approximately 60 hours of training, while its backcountry counterpart, wilderness first responder course, typically involves 80 hours of training, covering much of what is taught in an EMR course, but with the additional hours spent putting it in a wilderness context. Wilderness first responder training courses focus on teaching the students to assess a situation, improvise solutions using available resources to stabilize the patient, and identify the best way to get the patient to definitive medical treatment. In many courses, students are encouraged to develop the habit of systematically thinking through and documenting their assessment decisions/plans using a SOAP note. Topics covered usually include, but are not limited to, the following principles:

Monday, April 19, 2021

BEWARE! The Menace With Eight Legs is Back!

 Reposted from: https://www.dnr.state.mn.us/insects/deerticks/index.html

Deer ticks

children walking through tall grass

Protect yourself. Avoid tick-borne illness.

deer tick

Deer ticks, also known as blacklegged ticks, are just one of thirteen known tick species in Minnesota. They are most common in the east and central areas of the state and are found in hardwood forests and wooded and brushy areas. Deer ticks are potential carriers of Lyme disease, human anaplasmosis and babesiosis.


Risk timeframe

Primarily risks are from mid-May through mid-July when the smaller nymph stage of the deer tick is feeding. Risk is present, but lower, in early spring and again in the fall (late September-October) when the adult stage of the deer tick is active.

Deer tick bites


Check and re-check for ticks when you are in tick-infested areas.

  1. When in deer tick habitat, walk in the center of the trail to avoid picking up ticks from grass and brush.
  2. Wear light colored clothing so ticks will be more visible.
  3. Create a barrier to ticks by tucking pants into socks or boots and tuck long sleeved shirt into pants.
  4. Use a repellent containing DEET or permethrin, and carefully follow the directions on the container.
  5. After being outdoors in tick habitat, get out of your clothes immediately, do a complete body check, shower and vigorously towel dry. Wash your clothes immediately as to not spread any ticks around your living area.
  6. Pets should also be checked for ticks.

Tick removal

The risk of getting a tick-borne disease is small if the tick is removed soon after it becomes attached. Deer ticks must remain attached one to two days to transmit Lyme disease, and about one day for the other diseases.

  1. Take precautions when in tick habitat, but don't panic if you find a deer tick on you. Not all ticks are infected, and prompt tick removal can prevent illness
  2. Use tweezers to grasp the tick close to its mouth.
  3. Gently and S-L-O-W-L-Y pull the tick straight outward.
  4. To avoid contact with the bacteria, if present, do not squeeze the ticks' body.
  5. Wash the area and apply an antiseptic to the bite.
  6. Watch for early signs and symptoms of Lyme disease.

Lyme disease signs, symptoms and treatment

Please visit the Minnesota Department of Health's Web site (link is external) for more information on this topic.

Wednesday, December 30, 2020

Keeping Your Cool in the Cold

'Tis the season for fat-bikes, snowshoes, and skis, but before you slide into the Winter Wilderness, remember, "There is no such thing as bad weather, just poor clothing choices."


It only takes a few minutes for exposed skin to become frostbitten if the temperature is below 20 F and the wind is blowing at 20 mph or more.

What is Frostbite?

When outside in the cold, your body is focused on maintaining its core temperature. To do that, it shifts blood away from the extremities and toward the central organs of the heart and lungs. This increases the risk of local cold injury such as frostbite to your extremities, particularly the feet and hands, and if uncovered, the nose, cheeks and ears on the head. We have even treated a case of frostbite of the corneas of the eyes at one x-c ski race.

Body tissues actually freeze when they are frostbitten. Ice crystals form in the cell, causing physical damage and permanent changes in cell chemistry. When the ice thaws, additional changes occur and may result in cell death.

If just the skin surface is affected, it's known as superficial frostbite; deep frostbite affects underlying tissues.

Preventing Frostbite

Anyone who is not dressed properly, is outside for too long, or gets wet in cold weather can get frostbite. It is easier to prevent frostbite than to treat it.

*  Dress for the weather, not against it. Wear light, layered clothing that provides ventilation as well as insulation. Wear a water-repellent, breathable shell on top.

*  Protect your head, hands and feet. COVER ALL EXPOSED SKIN! A number of new face masks specifically designed for winter athletes have come on the market in recent years. If you prefer to have your mouth and nostrils uncovered, consider putting moleskin or Vaseline on susceptible areas. Much of your body's heat loss occurs through your head and extremities. Helmets specifically designed for winter sports can protect your ears as well as your noggin, and also help retain body warmth. Goggles protect the eyes, and are less prone to fog up than sunglasses. Mittens are warmer than gloves. Wear wool or micro fleece socks and boots to keep your feet warm. Don't drink or smoke before going out into the cold. If you plan on being out in the cold for a prolonged period, don't drink alcohol or smoke. Alcohol and nicotine cause constriction of blood vessels and leave the skin more prone to thermal injury.

*  If you get wet, go inside. Keep your skin dry. Remove wet clothing as quickly as possible. Check yourself every half-hour or so for signs of frostbite. If your toes, fingers, ears or other body parts feel numb, get inside.

*  Hydrate! Drink plenty of fluids since hydration increases the blood's volume, which helps prevent frostbite. Adequate hydration helps sustain circulation


*  Numbness

*  Skin feels frozen

*  Skin appears waxy, white, or grayish.

Frostbite is very serious. If you suspect you have frostbite, seek medical care immediately.



Hypothermia occurs when the body looses it’s ability to keep itself warm. There are varying severities of hypothermia, the cooler the core body temperature the more severe the hypothermia. Prolonged exposure to cool, wet, windy environmental conditions increases the likelihood of hypothermia.

Surprisingly, hypothermia can occur even in moderately cool weather (up to 60ยบ F) . When spending time outdoors in colder weather, the body generates heat to maintain core body temperature in two ways: through exercise and by shivering, which is the primary mechanism the body uses to generate heat. Shivering intensity is determined by the severity and duration of cold exposure and generally occurs in the large muscles of the trunk first.

How do you recognize the onset of hypothermia? Look for signs of the "umbles":

  • Grumbling (personality change);
  • Mumbling (having a hard time articulating words);
  • Stumbling (reduced coordination in the arms and legs); and
  • Fumbling (decreased dexterity).

To prevent hypothermia, you should:

  • Wear a hat (Winter helmet). The most significant loss of body heat is from the head and the body has no way to minimize heat loss in this region of the body.
  • Layer clothing.  Wear warm but breathable layers of clothing to stay warm
  • Pay attention to shivering.  Shivering is a good thing because it produces body heat, but if it reaches severe levels, stop exercising and head indoors.
  • Keep up the pace.  Keep your exercise intensity in the cold at moderate to high intensity to help maintain core body temperature. In order to maintain this intensity, take numerous breaks if needed
  • Bring extra clothing.  If you are exercising in a relatively remote area (such as on a long cross-country skiing excursion) bring an extra set of dry clothes with you.

Pay attention to the other riders! If you notice any of these warning signs of frostbite or hypothermia in another racer or even yourself, let one of the bike patrollers know as quickly as possible, either by flagging down a course medic or at the nearest aid station.

Sunday, November 15, 2020

More Emphasis on Trails, Less on Events in 2021

As I have recounted here on previous occasions, the Backcountry Trail Patrol Association was formed in 1999 as a program of the old North-Central Mountain Bike Patrol (NCMBP) and was incorporated as a separate organization in 2003. The reason that the patrol program was established was due to NCMBP’s increasing emphasis on special event medical coverage, and search and rescue, with a decreased emphasis on its or original purpose of patrolling trails. When Backcountry became a separate organization, it's stated purpose was to develop, maintain, and patrol mountain bike trails on the three National Forests in Minnesota and Wisconsin. Over the ensuing decade and a half our primary emphasis has tried to remain trail patrol on the Chequamegon Area Mountain Bike Association trails in Northwest Wisconsin, and the surrounding Chequamegon-Nicolet National Forest.

In recent years, the other National Mountain Bike Patrols in the region have gone inactive, while the Backcountry Trail Patrol (and the Wisconsin Mountain Bike Patrol in the Milwaukee area) has stayed active, and the emphasis once again shifted to providing medical support at events. In and of itself, event support is a good thing and that’s why we advocated for the establishment of what is now the Twin Cities Mountain Bike Patrol, but it is not the reason that the Backcountry Patrol was formed. Our name says it all, "Backcountry Trail Patrol." Where events intersect with the trails we serve, such as the Chequamegon Mountain Bike Festival, the Borah Epic, the Fat Bike Birkie and the Tour de Chequamegon, we’re here and of course, we will help. (Of course, after the COVID-19 pandemic has eased and we are allowed to have events again.)

However, in September of 2020, something happened on the CAMBA trails that should cause us to refocus our emphasis on trail patrol. There was a crash on Flow Mama Trail, and the rider sustained fatal injuries. I’m not saying that the presence of a patrol would have changed those circumstances, but it does draw attention to the need for what we were organized to do.

Trail patrol is simple. Once you are trained, wear your red jersey, carry your patrol pack, and get out and ride. Record and report your hours. You can ride anywhere on the CAMBA system and Isanti County Parks. Educate, Assist, Inform, Observe, and Report. In 2003 we made a commitment as an organization to, “protect trail users and forest resources through service and backcountry education.” It’s what we do, what we are needed to do, and what we are supposed to do.

As the region heals from the pandemic, a record number of people have been seeking outdoor recreation as an escape from the frustrations of lockdowns and quarantines. Mountain biking is a great way to experience the outdoors, but as in any endeavor, some of the participants are not prepared or properly equipped. That’s where the education component of what we do comes in.

We’re going to make a concerted effort to increase our patrol presence on the CAMBA trails in 2021. We hope to recruit and train new members, expand educational programs, including possibly sponsoring a MTB first aid class by Backcountry Lifeline, and provide information to help riders enjoy the trails in a safe manner and assist CAMBA in developing an effective Emergency Medical Services contact and evacuation system, similar to that found on the Cuyuna Country State Recreation Area Mountain bike trails in Minnesota. We hope you’ll come along for the ride.

If you are not a member and are interested in the Backcountry Trail Patrol, please email “backcountry@trailpatrol.org”