Summary

• Wilderness First Responder (WFR) over 9-10 days is the standard level of first aid training for outdoor guides, instructors, and search-and-rescue team members. Wilderness First Responder Recertification (WFR-R) over 2-3 days is its refresher course, taken every 2 years.
• For most recreationists, a Wilderness First Aid (WFA) course over 2 days is the better fit.
• Everyone should take a CPR course, as professional help will often not arrive in time when someone enters cardiac and/or respiratory arrest.
• Divers should consider supplementing WFA and CPR with an Emergency Oxygen Provider course, which covers dive-specific injuries.
• WFR-R focuses on reviewing and practicing key skill-sets like the Patient Assessment System, lifts and rolls, recognizing and handling life-threatening issues, managing spinal injuries, excellent wound care, improvising splints, and CPR. It is centered around hands-on scenarios in all weather conditions.

What is WFR(-R)?

What would you do if you or your friends got injured outdoors? This isn't a theoretical concern. COVID-19 boosted the popularity of time outside to unprecedented levels.

The majority of those outings are day-hikes, and they also constitute the majority of incidents that trigger search-and-rescue operations [base-rates]. Day-hikers are the least likely to be prepared for the issues that can hit anyone, regardless of fitness levels: tripping and falling, hypothermia, hyperthermia, dehydration, car accidents to/from destinations [car-tourniquets], and getting lost and stuck with an unplanned overnight stay. If you, like me, are a climber, diver, or skier, then there are even more risks to manage in the pursuit of Type II fun.

Thinking about this is what drove me to learn more skills. I started with Wilderness First Aid (WFA), a 2-day course targeted to folks doing mainly day-trips. That inspired me to take Wilderness First Responder (WFR), a 9 to 10-day course that is the standard level of training for outdoor guides/instructors and search-and-rescue team members. The wilderness focus of these courses means learning to recognize wilderness-specific hazards in addition to urban ones, safely improvise in austere conditions, communicate well with rescue authorities, and plan well to prevent mishaps.

Who are these courses for?

For this post, I wanted to cover the Wilderness First Responder Recertification (WFR-R) course. It's required every 2 years to keep a WFR certification current. When I did my pre-course research, WFR-R courses were not well-described on the web and I can now help fill that gap.

First, here's a comparison table of the different wilderness first aid courses available out there. Here's my take on who should take which course:

• Wilderness First Aid (WFA): most outdoor enthusiasts (2 days)
• Wilderness Advanced First Aid (WAFA): anyone who needs more skills than WFA, but doesn't have time for WFR (5 days)
• Wilderness First Responder (WFR): outdoor professionals, search-and-rescue volunteers, and serious recreationists with extended time in remote settings, like backcountry backpackers, alpine climbers, etc. (9-10 days)
• Wilderness Emergency Medical Technician (WEMT): outdoor professionals and members of especially high-demand search-and-rescue teams, e.g., YOSAR (30 days)
• Wilderness Upgrade for Medical Professionals (WUMP): current healthcare professionals (EMT, DDS, PharmD, RN, NP, PA, MD, etc.) who are outdoor recreationists, interested in joining a search-and-rescue team, or who dread answering the call for medical help in everyday settings (5 days)

One notable gap across all of these courses is coverage of dive medicine. None of the NOLS courses cover diving injuries in detail, and a diving-specific course (Emergency O2 Provider) + a CPR course is worth it for anyone who's a regular diver.

For course providers, I love NOLS, the National Outdoor Leadership School. I've also had instructors in other areas vouch for Wilderness Medical Associates (WMA) as another excellent training provider. I have not taken any WMA courses myself, but plan to try them down the line based on the quality of their textbook and field guide.

What to Expect

I took the Hybrid WFR-R course, meaning it had an online component via Canvas to work through in advance. I spent 10-20 hours reviewing key topics through videos and readings, followed by an online final exam (which was way easier than e.g., an AP exam). These materials unlock 3 weeks before the 2 days of in-person practice, so budget time to work through them properly.

I was initially skeptical of hybrid courses in general, but after this experience, I actually think they're generally superior for learning. There's time to review and think through new concepts, rather than being left behind if you were sleep-deprived. You can them come in ready-to-go for hands-on practice. The exception would be for someone whose life schedule is more amenable to hitting a full pause on the rest of life and then focusing full-time on a course.

Folks who had done WFR-R through the traditional course said the Hybrid option allowed far more practice scenarios. The scenarios are about as difficult as middle to late-stage scenarios at the original WFR course. They generally had 1-2 problems with any mix of trauma (e.g., bleeds + fractures), environmental (e.g., {hypo,hyper}-thermia), or medical (e.g., anaphylaxis) issues. Patients would often be in non-ideal starting positions, and be potentially unreliable (e.g., head injuries).

Given that everyone in the course had completed at least a full WFR course beforehand, the few lectures/demonstrations that we did have focused on perishable psychomotor skill-sets. This began with a thorough review of the Patient Assessment System, followed by rolls + lifts, handling bleeding, proper wound care, CPR + AED usage, and so on.

Skills were demonstrated and reviewed indoors in a classroom and then practiced outdoors regardless of weather. This allows skills to be (re)learned under calm conditions and then reinforced under more stressful conditions [run-under-fire]. The more automatic your skills are, the more you'll be able to do despite the initial loss of cognitive capacity that stressful situations introduce. Simulated stress in training helps inoculate against panic and is what produces the automaticity of responses. It really built my confidence to know that I could handle a bona fide emergency despite the rain, snow, and wind. It also leads to practical improvements like waterproof notebooks and weighting down gear to keep it from being blown away. Train like you fight!

Who to Expect

What kind of folks attend a WFR-R course?

Similar to my original WFR course, my classmates were mostly outdoor guides, instructors, search-and-rescue team members, and scientists who work in remote settings. Except WFR-R has even more of a selection bias, as it's composed of folks who need to maintain their certification for their jobs or who just really want it.

I was again the exception as a standing desk-jockey. While I'm someone who only recently (<5 years) learned to love the outdoors, my classmates were kind, welcoming, and helpful.

Retrospective

Highlights

• We received specific guidance for working with deaf/hard-of-hearing patients.
• The CPR training was superb and left me feeling far more confident for handling a patient in cardiac arrest.
• We learned a protocol for rescue breathing.
• I met wonderful classmates with whom I'd go outdoors any time.
• Our instructors were fantastic! They really cared about student safety with e.g., keeping us out of tick territory, checking for prior injuries during dislocation reduction demonstrations, etc.

Lowlights

• The shorter course duration meant less bonding time with classmates compared to the original WFR course, where I made multiple new friends.
• I forgot to take more group photos!

Lessons Learned

• Mass casualty incident management is a challenge even when everyone present has prior training. Establish a clear command structure upfront and delegate with a short, simple plan.
• Refresh CPR + AED skills at least annually; I'd forgotten more than I realized.
• Invest in skills and knowledge! They compound over time and unlock new adventures.
• Enjoy the learning process and challenge as a reward unto itself.

Final Thoughts

I highly recommend WFR-R for anyone who's a current Wilderness First Responder (WFR)—keep those skills fresh! For everyone else, spend a weekend on Wilderness First Aid (WFA) and be better prepared to take on all that the outdoors can throw at you.

For the future, a Basic Life Support (BLS) course and the NOLS Wilderness Emergency Medical Technician (WEMT) course are next on my bucket list.

Footnotes

[base-rates]: One thing that would be interesting to compare is the base rate of incidents among day-hikers vs climbers, divers, etc. There's a interesting balance between additional preparation and training and the greater intrinsic
risks with some outdoor activities.

[car-tourniquets]: Vehicle accidents are why I always carry a tourniquet in both urban and outdoor contexts. A high-velocity impact that shears major blood vessels instantly introduces life-threatening hemorrhage.

[run-under-fire]: Don't make the mistake of thinking that training should jump ahead to simulating stressful conditions. New skills need to be mastered in a calm environment before you can start practicing under them stress. Crawl, walk, run, and then run under fire. This is my top pedagogical complaint with most wilderness survival courses, and another example of the Curse of Knowledge.