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Ryan Clancey
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Jul 13, 2020
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Nashua, NH
· Joined Apr 2019
· Points: 15
Hi all. I got into this sport almost by accident with a group of people who teach Top Roping for mostly youth in the BSA. In these 5 years, I've passionately followed my interests in skill development and personal growth. Ice climbing for 2 years, and starting Trad this year have really shot my interests through the roof. Mostly for fun, I'm pursuing the AMGA Multi-Pitch Guide pathway.
ANYWAY, one of the hurdles I face is the need(and desire) for advanced outdoor medical skills. I've taken WFA a couple times and look forward to my next Re-Cert, but it's not enough for me. I've taken and taught all sorts of First Aid classes, but I feel like I need more dynamic experience or else I'm really not learning anymore. People in the Boy Scouts just don't get hurt often, and I don't get myself hurt every other day like I did when I was a kid. Not to sound sadistic, but I really want to get my hands on open bleeds and broken bones.
Does anyone have any advice for how to build real, quality, lasting skills in this discipline? My best idea at this point is to someday find a volunteer ambulance position and start exposing myself to extreme trauma, and see where that goes. AMGA Requires "WFR or Equivalent", does anyone have any preference for an outdoor medicine organization? I've heard about WEMSI, and it sounds pretty cool; intensive.
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Philip Magistro
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Jul 13, 2020
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Estes Park, CO
· Joined Dec 2013
· Points: 0
Ryan Clancey
wrote:
I've taken and taught all sorts of First Aid classes, but I feel like I need more dynamic experience or else I'm really not learning anymore. People in the Boy Scouts just don't get hurt often, and I don't get myself hurt every other day like I did when I was a kid. Not to sound sadistic, but I really want to get my hands on open bleeds and broken bones.
Does anyone have any advice for how to build real, quality, lasting skills in this discipline? My best idea at this point is to someday find a volunteer ambulance position and start exposing myself to extreme trauma, and see where that goes. AMGA Requires "WFR or Equivalent", does anyone have any preference for an outdoor medicine organization? I've heard about WEMSI, and it sounds pretty cool; intensive. I would recommend taking either a WFR course or WEMT. Working as an urban EMT (or trying to volunteer in that capacity) will get you patient care experience, but frankly isn't pertinent to most backcountry situations. In the backcountry, patient care is really extrication. You can fix a few small things, but for anything major it boils down to: get them out. Almost any care provided beyond literally stopping the bleeding is mostly to facilitate a litterout by managing pain, etc. While some skills are durable (patient assessment is second nature for me at this point, for example), most are perishable. You dont generally get "real, quality, long lasting skills", you learn and practice and refresh continuously. So my advice is: take a WFR. Volunteer for your local SAR team. Practice skills whenever possible.
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Jack Yip
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Jul 15, 2020
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San Jose, CA
· Joined Sep 2012
· Points: 155
So speaking as an eagle scout and someone who lead scouting backpacking and climbing trips (in New Hampshire) and has volunteered in SAR and has been current WFR for about 5 years and has considered getting my guiding certs for years...
It sounds like you need a lot more experience on rock before taking any rock guiding courses, like I personally think it's one of those, the more you learn, you realize how much more there is to learn sorts of things. AMGA has guidelines for this, how many routes of what difficulty you should climb before considering a cert. Some testpieces like this are routes on Cannon Mountain, Moby Grape, Whitney Gilman, Moonshadow, etc. with a lot of laps on each of them (i.e. know your guiding area like the back of your hand). I've been climbing trad/ice/backcountry skiing for over 10 years and still don't feel that I'm up to starting those courses, namely because I think that the main point of those courses is to hone the skills you already have rather than help you get the foundational skills required to solve difficult situations in the mountains. I personally think that it might be worth it to you to hire a guide on some grade III or IV route (try IMCS in North Conway) so you can observe how they work with clients and how dialed their systems and such are. Maybe consider getting your AMGA singe pitch instructor first, this is where many guides start rather than multipitch rock.
So with that, the medical training part: The big thing about choosing your certifications has a lot to do with what organization you're hoping to use it with. What I mean by that is what organizational policies are in place for providing skills within the scope of your practice to clients. This is fully based on the amount of liability the organization is willing to take on for the possibility of malpractice, negligence, etc. If you are planning on starting your own guide service, then you have to think about that amount of liability on your own. So with that, if you are stepping from being a recreational climber to a professional guide, I personally think that WFR is a good 'hold over,' with the thought that you should probably have a WEMT course on your close horizon because it broadens the scope of your practice. Any WFR or WEMT course you take should address what I discussed above in regards to liability and scope of practice.
So that addresses the which you should take, for the who you should take it with:
Like I said above, the two main points of these courses is to 1. give recreationalists and guides the skills to provide care to victims of trauma or medical emergencies in a 'wilderness' environment and 2. to limit the liability that an organization takes on when a client or bystander falls victim to trauma or medical emergency in a 'wilderness' environment. Wilderness is broadly defined as an emergency occurring a certain amount of time from definitive care (i.e. a hospital that has advanced life support services). What ever organization you go to should address those two points by giving you the skills as spelled out by the wilderness medical society, wilderness medical institute (NOLS), or other association that follows their guidelines (NOLS provides a list of courses and orgs).
Last, in terms of building long lasting skills, I totally agree with Phillip, volunteering for your local SAR organization is both a great way to help the local community and find mentorship with those more experienced. Other considerations are the National Ski Patrol (who operate volunteer ski and bike patrols), working to go lead outings with local clubs (e.g. Sierra Club, Appalachian Mountain Club, American Alpine Club local chapters), or spending a lot of time climbing the routes where you'd consider wanting to be a guide, you hire a Yosemite guide because they know Yosemite like the back of their hand, you hire an ice guide in North Conway because they've climbed every route in every condition.
Hope that helps.
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Ryan Clancey
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Jul 23, 2020
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Nashua, NH
· Joined Apr 2019
· Points: 15
Philip Magistro
wrote:
I would recommend taking either a WFR course or WEMT. Working as an urban EMT (or trying to volunteer in that capacity) will get you patient care experience, but frankly isn't pertinent to most backcountry situations. In the backcountry, patient care is really extrication. You can fix a few small things, but for anything major it boils down to: get them out. Almost any care provided beyond literally stopping the bleeding is mostly to facilitate a litterout by managing pain, etc.
While some skills are durable (patient assessment is second nature for me at this point, for example), most are perishable. You dont generally get "real, quality, long lasting skills", you learn and practice and refresh continuously.
So my advice is: take a WFR. Volunteer for your local SAR team. Practice skills whenever possible. Thanks for your input! That is a great point. I'm looking forward to taking WFR when appropriate, but I don't think my skills are there yet and more importantly I don't yet have a good way to stay current and practice constantly. Volunteering for SAR is such a great idea, that's exactly what I should do. My Tech Rescue skills are intermediate AT BEST, but I'm very passionate and learn fast. Complex rigging and intense mental discipline are huge parts of why I love climbing.
I'm hopefully doing a "Stop The Bleed" Course next month, which should be super cool.
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FrankPS
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Jul 23, 2020
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Atascadero, CA
· Joined Nov 2009
· Points: 276
Ryan Clancey
wrote:
Thanks for your input! That is a great point. I'm looking forward to taking WFR when appropriate, but I don't think my skills are there yet and more importantly I don't yet have a good way to stay current and practice constantly. Volunteering for SAR is such a great idea, that's exactly what I should do. My Tech Rescue skills are intermediate AT BEST, but I'm very passionate and learn fast. Complex rigging and intense mental discipline are huge parts of why I love climbing.
I'm hopefully doing a "Stop The Bleed" Course next month, which should be super cool. I've taken the WFA a couple of times, but the WFR is the minimum for most guide services. You don't need "skills" to take the WFR. I would guess that most people with a WFR don't practice, except during their recertification. Regardless of your ultimate goals (even if you don't guide), WFR is the next step, if you want to increase your ability to deal with a wilderness medical problem.
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FosterK
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Jul 23, 2020
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Edmonton, AB
· Joined Nov 2012
· Points: 67
Not really sure why you'd pursue AMGA guide courses if you aren't planning on working professionally - you could pay an AMGA guide much less to get similar content.
If you want to get more patient experience, as others have mentioned, volunteering with a SAR team, Ski Patrol, or athletic events are the way to go - assuming the volume of calls or contact is there. If you have a suitably active SAR team (>25 calls annually, with significant portions including rescues and medical extrications not just missing persons searches), a nearby ski patrol at a suitably large hill, or many, large scale athletic events (ultra/marathons, adventure races, Spartan races, etc.) , they will all give you patient contact on a range of problems (though primarily athletic injuries and concussions if you are doing ski patrol or athletic events) with a large level of support from other volunteers and often quick connection to a public EMS system.
I also would not hold off on a WFR waiting for more experience - it's not relevant to the qualification because a WFR is still an entry-level ticket.
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Ryan Clancey
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Jul 23, 2020
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Nashua, NH
· Joined Apr 2019
· Points: 15
Jack Yip
wrote:
So speaking as an eagle scout and someone who lead scouting backpacking and climbing trips (in New Hampshire) and has volunteered in SAR and has been current WFR for about 5 years and has considered getting my guiding certs for years...
It sounds like you need a lot more experience on rock before taking any rock guiding courses, like I personally think it's one of those, the more you learn, you realize how much more there is to learn sorts of things. AMGA has guidelines for this, how many routes of what difficulty you should climb before considering a cert. Some testpieces like this are routes on Cannon Mountain, Moby Grape, Whitney Gilman, Moonshadow, etc. with a lot of laps on each of them (i.e. know your guiding area like the back of your hand). I've been climbing trad/ice/backcountry skiing for over 10 years and still don't feel that I'm up to starting those courses, namely because I think that the main point of those courses is to hone the skills you already have rather than help you get the foundational skills required to solve difficult situations in the mountains. I personally think that it might be worth it to you to hire a guide on some grade III or IV route (try IMCS in North Conway) so you can observe how they work with clients and how dialed their systems and such are. Maybe consider getting your AMGA singe pitch instructor first, this is where many guides start rather than multipitch rock.
So with that, the medical training part: The big thing about choosing your certifications has a lot to do with what organization you're hoping to use it with. What I mean by that is what organizational policies are in place for providing skills within the scope of your practice to clients. This is fully based on the amount of liability the organization is willing to take on for the possibility of malpractice, negligence, etc. If you are planning on starting your own guide service, then you have to think about that amount of liability on your own. So with that, if you are stepping from being a recreational climber to a professional guide, I personally think that WFR is a good 'hold over,' with the thought that you should probably have a WEMT course on your close horizon because it broadens the scope of your practice. Any WFR or WEMT course you take should address what I discussed above in regards to liability and scope of practice.
So that addresses the which you should take, for the who you should take it with:
Like I said above, the two main points of these courses is to 1. give recreationalists and guides the skills to provide care to victims of trauma or medical emergencies in a 'wilderness' environment and 2. to limit the liability that an organization takes on when a client or bystander falls victim to trauma or medical emergency in a 'wilderness' environment. Wilderness is broadly defined as an emergency occurring a certain amount of time from definitive care (i.e. a hospital that has advanced life support services). What ever organization you go to should address those two points by giving you the skills as spelled out by the wilderness medical society, wilderness medical institute (NOLS), or other association that follows their guidelines (NOLS provides a list of courses and orgs).
Last, in terms of building long lasting skills, I totally agree with Phillip, volunteering for your local SAR organization is both a great way to help the local community and find mentorship with those more experienced. Other considerations are the National Ski Patrol (who operate volunteer ski and bike patrols), working to go lead outings with local clubs (e.g. Sierra Club, Appalachian Mountain Club, American Alpine Club local chapters), or spending a lot of time climbing the routes where you'd consider wanting to be a guide, you hire a Yosemite guide because they know Yosemite like the back of their hand, you hire an ice guide in North Conway because they've climbed every route in every condition.
Hope that helps. Thanks for your input.
To be clear, I'm super aware that I have a long way to go, and a lot of years to put in before I reach my goal. As of now, I'm not worried about "getting there", rather I want to start working on it and bettering myself in that direction, nothing more ambitious than that. I've been satisfied with my skills for too long, and I crave growth and a long, hard goal.
I've never heard of Moby Grape, Whitney Gilman or Moonshadow. I'll definitely look into them. I know I have a long way to go before climbing Cannon, but if I keep up the rate I've been climbing this year, I may be ready to climb it with a good partner by next year. It's a magnificent cliff. I feel the same about Lake Willoughby's ice up in Vermontreal. I deeply aspire to be a good enough climber to justify a day or week up there, but I have no illusions that I'll definitely be there by Winter. It may be years for all I know. It's my deep, intense love for climbing ice that made me start taking rock so seriously this year, why I wanted to start mastering lead climbing this year so I can go set my own pitches on ice instead of having to look for a hike and some trees on top like an infant.
I'm somewhat familiar with the concepts of liability and programatic legal coverage. 90%+ of my experience as a climber has been working as a top-rope instructor in the BSA. It's only this year and a couple winters that I've done a significant amount of off-work recreational climbing. I'm not a scout myself, I found the BSA as an adult around 5 years ago and I've been working closely with my council since. We have council "Suits" who take care of all that stuff, but as an instructor it's my responsibility to thoroughly understand what they do for us and how significant it is to stay within our standards: NCAP and ACCT. That differentiates $5million liability protection, from being totally unprotected. Even if I was AMGA, it's unlikely the BSA would let me use it at all because there's nothing in the NCAP that empowers it in any way. I'd still just be a COPE lv2 and Climbing Lv2 (and Directors of both, but my Lv2 means a lot more to me than a week at Camp School) We have an incredible group of volunteer instructors who have decades experience in different parts of the sport who come together to provide very simple top-roping for thousands of youth a year. It's a swimming pool of experience just waiting to be absorbed by "students" like me (Everyone is a student, IMO), and we go way beyond the scope of typical BSA program to keep ourselves entertained. It's great program.
Volunteering for SAR sounds like the perfect idea. I'd love that, and I'm already looking into options. Thanks to you both for suggesting it. Philip also makes a good point about the applicability of volunteering for EMS. I'm still interested, but it may not cover much in the scope of where I'm trying to get.
Ski Patrol is something I've considered. I do love to ski, but getting the slope experience I need is time and money that I'd rather be ice climbing. I've only Skied 20-30 times and I'm not about to be able to ski well enough to learn wilderness medical with those guys.
Thanks again for your input
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Mark Pilate
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Jul 23, 2020
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MN
· Joined Jun 2013
· Points: 25
Ski patrol near a major metro area with a terrain park definitely keeps your trauma, packaging, and patient (not to mention patience) skills up to snuff. Dang near every shift you can count on something happening. Get and Read the Auerbach manuals for real knowledge for yourself or close associates (not applicable on the “street”). Took the WEMT through WMA and it was a blast. Normal EMS volunteer Time is dang near worthless.
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jonathan hamilton
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Jul 25, 2020
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Unknown Hometown
· Joined Mar 2012
· Points: 0
I have been climbing on and off for 30 years (started in Boy Scouts) and it was climbing that prompted me to seek out wilderness medical training to build confidence if things happened while on a climb. I took a WFR course and before I knew it I was taking an EMT course and working in EMS then going to nursing school and eventually became an NP. I have also since taken WEMT- this would be a good option if you plan on pursuing a career in EMS. WMI/NOLS does a month long EMT course w/ WEMT tagged on at the end. You don’t need any prerequisite skill to take a WFR and it is what I would recommend as others have mentioned it is pretty much the bench mark for guiding/ leading etc.
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Eric Bjugstad
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Jul 26, 2020
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Jackson Wyoming
· Joined Apr 2019
· Points: 0
I second Mark. Join the ski patrol!
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Mark NH
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Jul 26, 2020
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03053
· Joined Feb 2013
· Points: 0
Some guide services look at medical certs based on the terrain you're working and proximity to regular medical care. I have a WFA and most of my guiding areas fall into “close to regular medical care.” I’ll be guiding more remote areas soon and have to have a WFR.
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Mark Pilate
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Jul 26, 2020
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MN
· Joined Jun 2013
· Points: 25
This thread made me “re-up” by re-reading the Auerbach Wilderness medicine two volume “bible”. Highly recommended for useful info in remote areas. WEMT gets you about 30% there (WFR about 25%) More focused study on head and spinal injuries is required for climbing than you get in either.
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Tyler Newcomb
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Jul 26, 2020
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New York, New York | Boston
· Joined Dec 2012
· Points: 81
Mark Pilate
wrote:
Normal EMS volunteer Time is dang near worthless. I wouldn't say it's totally worthless (though maybe volunteer EMS is much lower volume). Working in a large city really allows you to get really good at scene management, patient assessments, and handling a stressful situation. I do agree that wilderness specific experience is better overall, but if all you have access to is a part time job as a 911 EMT, it's worth doing for a while at least.
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Brad Larson
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Jul 26, 2020
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portland
· Joined Apr 2019
· Points: 0
Auerbach Wilderness medicine two volume “bible”
Damn, that looks awesome! Edit: Looks like something a lay person could read? I took WFA a decade ago. Almost prefer springing for such a solid looking text to taking another weekend of instruction.
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Mark Pilate
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Jul 28, 2020
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MN
· Joined Jun 2013
· Points: 25
Brad, I felt a scientifically oriented lay person, especially with some basic EMS background would understand and benefit from them. basically don’t need to be an MD to read, but ya gotta be somewhat medically savvy to get full benefit.
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Andrew Hildner
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Aug 7, 2020
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Unknown Hometown
· Joined Jan 2006
· Points: 20
Good info here, Ryan. If you're specifically wanting to beef-up your rescue skills for climbing (self or others), one thing I'd add that others haven't is to learn rope rescue skills; self, companion, organized rescue. As others have pointed out, the best treatment for outdoors-related trauma or medical conditions is evacuation (after addressing basic ABC's and environmental isolation). for climbing, being able to improvise a technical rescue for yourself and partner from rocky technical terrain--even if it's just getting down to the ground--can save hours of time off an evac to get the the TH or hospital. Knowledge of components and familiarity with equipment and improvisational techniques can really make life-saving time difference. Multi-pitch aid climbing with a heavy haul bag is a good way to really get you dialed on your knowledge and systems and provide a serious reality check about what it's like to manipulate a static weight (haul bag substituting for unconscious/unhelpful partner) on rope systems in the vertical realm. Outdoors recreational medicine is all about improvisation (and NOT in the 'emergency cricothyrotomy with a BIC pen' kinda way). Auerbach's texts are THE gospel for wilderness medicine, which it is important to note is different from rescue medicine. To be clear, it is still very good info to learn, but it's important to recognize that wilderness medicine is based on an idea of very remote situations where evac and transport are poor options even if the ultimate goal is getting them to a hospital ('stay and play'), whereas the reality of most incidents in the lower 48 states are more rescue in nature where SAR is available ('load and go'), even though formal SAR is a response over hours and parts of days (there are no helicopters just waiting to swoop in as soon as you cry out for help). For example, a first aid kit for wilderness medicine will be huge, and have antibiotics and suture kit and yada yada yada; after 100's of experiences, my rescue kit is duct tape, some safety pins, a very small wire splint, a few oxycodone, an extra layer, a SOL emergency bivvy (like a space blanket, but doesn't shred as soon as you take it out of the package), and an inReach mini. That allows self-evac for isolated lower extremity injuries (the most common injury), and environmental isolation and means of notification to trigger formal SAR and keep the patient alive until they arrive for more serious injuries/illness. In the winter I add a very small inflatable sleeping pad and a tiny stove for warm fluids. Learning to recognize 'sick' vs 'not sick', provide basic interventions with limited gear (ABCDE's) and then self-rescue or helping speed-along formal rescue is the best tx and things to focus on. Good on you for taking time to improve your knowledge, skills and ability to manage accidents and emergencies that inevitable the more time you spend outdoors. Hope this thread is helpful.
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