Wilderness Drum > Wilderness Books > Medicine > First Response

In America lately, we have been carrying on two parallel conversations: one about respecting human diversity, the other about preserving natural diversity. Unless we merge those two conversations, both will be futile. Our effort to honor human differences cannot succeed apart from our effort to honor the buzzing, blooming, bewildering variety of life on earth. All life arises from the same source, and so does all fellow feeling, whether the fellows move on two legs or four, on scaly bellies or feathered wings. If we care only for human needs, we betray the land; if we care only for the earth and its wild offspring, we betray our own kind. The profusion of creatures and cultures is the most remarkable fact about our planet, and the study and stewardship of that profusion seems to me our fundamental task.

— Scott Russell Sanders

There are dozens and dozens of wilderness first aid books out there, of widely varying quality. What makes a good wilderness first aid book? In many ways, I think it is similar to what makes a good dictionary. All the common conditions need to be in there, of course; but the book must also give enough information so you can handle the rare and unusual – and the book must be small enough to fit in your backpack. The list below does not pretend to be comprehensive. The books reviewed are either widely used or, in my opinion, particularly helpful – sometimes both at once, but not always. Also, the books include both those specifically directed to wilderness medicine and those used, primarily in urban settings, by emergency medical technicians, for reasons explained below. What are my own recommendations? I suggest that a core wilderness first response library should contain three books:

Paul Auerbach, Wilderness Medicine: Management of Wilderness and Environmental Emergencies (St. Louis MO: 4th edition, Mosby, 2001), ISBN 0-323-009506, to keep at home as an encyclopedic reference;

Howard Backer, et al., Wilderness First Aid: Emergency Care for Remote Locations (Sudbury MA: Jones and Bartlett Publishers, 1998), ISBN 0-7637-0407-5, to study for practical procedures in the wilderness; and

James Morrissey, Wilderness Medical Associates’ Field Guide (Bryant Pond ME: Wilderness Medical Associates, 2000), ISBN 0-97046-460-6, to put in your backpack and take with you.

Additions, comments, and disputes are all welcome.

American Heart Association, Basic Life Support for Healthcare Providers (Dallas TX: American Heart Association, 1997), ISBN 0-87493-615-2.  Many books are available dealing with what used to be called CPR, or cardiopulmonary resuscitation, but is now called BLS, or basic life support. BLS differs from ACLS, or advanced cardiac life support, in that the latter involves the administration of drugs and the use of a manual defibrillator, which are not likely to be available in the wilderness in any event. In the urban setting, BLS is used primarily to try to keep a patient’s brain oxygenated long enough for the defibrillator to show up on the ambulance. In the wilderness, heart attacks are less likely to happen, because people hiking in remote areas are unlikely to be obese sedentary smokers; but people in the wilderness still get struck by lightning or nearly drown, and in such cases BLS will save their lives. This book – the official text of the American Heart Association – is short, clear, and straightforward.

Paul Auerbach, et al., Field Guide to Wilderness Medicine (St. Louis MO: Mosby-Year Book, 1998), ISBN 0-815109-26-1. Written primarily for physicians, this field guide – even at almost 500 pages still small enough to fit in your backpack – summarizes many of the most important chapters from the author’s own encyclopedic Wilderness Medicine, discussed below. Thus the text is in many ways a small-scale medical encyclopedia, written, like its elder cousin, primarily for physicians, with 43 chapters covering everything from high altitude medicine to firearm and arrow injuries, envenomations to diabetic emergencies, fishhook injury to animal attacks. It is hard to discern why the chapters are in the order they are; fortunately, there is a thorough index. It contains a full-color insert with 36 illustrations of skin rashes, frostbite injuries, poisonous mushrooms, insects, and snakes.

Paul Auerbach, Medicine for the Outdoors: A Guide to Emergency Medical Procedures and First Aid (Boston MA: Little, Brown and Company, 1991), ISBN 0-316-05931-5. First published in 1986, this book was one of the first of the now many texts on wilderness emergency medicine, thorough and comprehensive, written by one of the leaders in the field. But it suffers from a lack of focus: it is too detailed to be a useful basic text, and not quite detailed enough to be a reference. Another early text, William W. Forgey’s Wilderness Medicine, discussed below, suffers from the same problem, as if, when these texts first started to appear, the various audiences for wilderness medicine texts had not yet been clearly defined.

Paul Auerbach, Wilderness Medicine: Management of Wilderness and Environmental Emergencies (St. Louis MO: 4th edition, Mosby, 2001), ISBN 0-323-009506. This is it – the book that made wilderness medicine respectable. It is almost 2000 large pages of tiny print, costing just about $150, and worth every damn penny. This encyclopedic reference contains chapters on every conceivable subject relating to wilderness medicine, each written by an expert in the field. It includes diagnostic and treatment protocols, definitions, clinical presentations, how-to explanations,  practical approaches to emergencies, and information on children and women in the wilderness, legal aspects, and ethics. But it weighs around ten pounds and will not fit in your backpack.

Howard Backer, et al., Wilderness First Aid: Emergency Care for Remote Locations (Sudbury MA: Jones and Bartlett Publishers, 1998), ISBN 0-7637-0407-5. In my opinion, this book, a collaboration between the National Safety Counsel and the Wilderness Medical Society, is now the single best general text on wilderness first aid, replacing such books as the NOLS and Outward Bound handbooks, discussed below. It is clear, comprehensive, and the best illustrated of any of its competition. Each section clearly lists what to look for, what to do, and what to avoid doing, and is illustrated by clear color drawings and photographs. Very highly recommended.

Gordon A. Benner, et al., Emergency Medical Procedures for the Outdoors (Birmingham AL: Menasha Ridge Press, 2nd edition, 1996), ISBN 0-89732-051-4.  This skinny book is unique in having virtually no narrative text, but rather a series of flow-chart-like medical decision trees for the treatment of the most common wilderness medical emergencies. It is not a primary learning text; it is, instead, an easy-to-carry handy quick reference for procedures you have learned and practiced elsewhere. There are virtually no illustrations; there is a combination – and somewhat confusing – index and table of contents at both the front and rear of the book.

Warren D. Bowman, Outdoor Emergency Care: Comprehensive First Aid for Nonurban Settings (National Ski Patrol System, Inc., 1999), ISBN 0-929752-01-5.  This is a large – more than 500 pages – and comprehensive wilderness medicine text used as the basis of the National Ski Patrol’s program for certifying Outdoor Emergency Care Technicians, and emphasizing, as you might expect, winter- and skiing-related injuries and medical conditions. Written in collaboration with the American Academy of Orthopaedic Surgeons, it has excellent coverage and a large number of helpful illustrations. A new edition is anticipated to be published in early 2003.

Michael K. Copass, et al., EMT Manual (Philadelphia PA: W.B. Saunders Company, 1998), ISBN 0-7216-6965-4. This is a  well organized 450-page wire-bound pocket-size manual which thoroughly covers all the major topics in a clear straightforward style. Written for an Emergency Medical Technician rather than a wilderness medic, it provides useful information on the sorts of trauma and emergency medical conditions that can occur in the wilderness as well. It does not have many pictures, but the line drawings it has are clear and informative. There is an extensive index. If you want a portable but comprehensive text, this book is about one quarter the size of most EMT course textbooks, but covers the same material, sometimes in more detail. Recommended.

William W. Forgey, Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care (Guilford CT: The Globe Pequot Press, 2000), ISBN 01-76270-671-6.  This book is not really a wilderness medicine text at all. It is, instead, the second edition – much expanded and improved – of a set of practice guidelines promulgated by the Wilderness Medical Society for handling wilderness-related trauma, illness, and environmental injury. The Wilderness Medical Society is an organization of doctors, allied health specialists, and other people with a special interest in wilderness medicine; the practice guidelines were compiled by thirty-one contributors and then peer-reviewed by two panels consisting of an additional fourteen physicians. With all that said, this is actually a very good summary of generally accepted wilderness medical procedures, and it fits neatly into a backpack. Highly recommended.

William W. Forgey, Wilderness Medicine: Beyond First Aid (Guilford CT: The Globe Pequot Press, 5th edition, 1999), ISBN 0-76270-490-X. William Forgey is one of the pioneers of wilderness medicine, and, in its earlier editions, this was one of the classic texts of wilderness medicine. The problem is that the author did not seem to have a clear idea of who his audience was, and thus mixes beginning and advanced material indiscriminately. While there is much in the text that remains useful and definitely worth reading, I believe that as a basic text this book has now been superseded by others.

Jeff Isaac, et al., The Outward Bound Wilderness First-Aid Handbook (New York NY: Lyons & Burford, 1998), ISBN 1-55821-682-0. This book, along with Tod Schimelpfenig’s NOLS Wilderness First Aid, is one of the standard wilderness first aid texts. They both cover pretty much the same ground in a basically similar fashion. This book is a clear, straightforward exposition of basic wilderness first aid. The books are, as lawyers put it, fungible – that is, largely interchangeable; you won’t go far wrong with either of them.

Norman E. McSwain, Jr., et al., The Basic EMT 2003: Comprehensive Prehospital Patient Care (St. Louis MO: Mosby-Year Book, 3rd edition, 2002), ISBN 0-3230-2256-1. There are a number of books – put out primarily by Mosby and Brady, the two major publishers in the field – that cover the EMT-Basic curriculum that is prescribed by the Department of Transportation and used in community college and similar EMT courses. Although it varies from state to state in the United States, there are generally three grades of emergency medical technician, called, again with some variation, EMT-Basic, EMT-Intermediate, and EMT-Paramedic. Often the EMT-B is simply called an EMT, and an EMT-P is simply called a paramedic. Depending on the state, an EMT-I can do things an EMT-B cannot, such as start IV lines, administer some medications, or use an automatic external defibrillator. A paramedic is additionally trained in ACLS or advanced cardiac life support. Thus, in many ways, the skills of an EMT-B are closest to the skills used by a wilderness or survival caregiver, who seldom has access to intravenous saline, oxygen masks, or defibrillators anyway. Thus, looking at books devoted to the EMT-B curriculum can be very helpful in filling in gaps left by the wilderness first aid and medicine texts. In addition to the book listed here, you can take a look at Michael F. O’Keefe, Brady Emergency Care (Englewood Cliffs NJ: Brady, 2000), ISBN 0-13015-7945-5, and Walt A. Stoy, Mosby’s EMT-Basic Textbook (St. Louis MO: Mosby Lifeline, 1996), ISBN 0-8151-7958-8. They are all well illustrated and cover pretty much the same ground. Which one you like is largely a matter of taste. New editions come out frequently.

Wayne Merry, The Wilderness First-Aid Guide (Toronto ON: McClelland & Stewart, 1997), ISBN 0-771082-50-9. This book quite competently covers all the important topics, in more detail than other basic wilderness first aid texts. Each section discusses both what the author calls How to Tell and What to Do. The book also, commendably, covers some of the more obscure topics, including infected wisdom teeth, trench mouth, and beaver fever. It contains a useful discussion, more detailed than most, on methods of evacuation. My appreciation for this book has grown with time and repeated reading.

James Morrissey, Wilderness Medical Associates’ Field Guide (Bryant Pond ME: Wilderness Medical Associates, 2000), ISBN 0-97046-460-6. This is a small, thin, wire-bound, waterproof and tear-proof manual that fits neatly into your backpack or medical kit. It is a comprehensive summary of most of the material covered in the Wilderness Medical Associates’ Wilderness First Responder course, with numerous color illustrations. It is not itself a wilderness medicine or first aid guide; it is more a comprehensive reminder of what you should know already, and as such it is invaluable. Highly recommended. This is the one in my backpack.

Peter T. Pons, et al., Prehospital Emergency Care Secrets (Philadelphia PA: Hanley & Belfus, 1998), ISBN 1-56053-250-5.  This text covers the basic organization of prehospital emergency medical systems and the various categories of emergency care – for example, burns, fever, seizures, hypothermia – in a lively question-and-answer format. While many urban-oriented prehospital care texts focus on urban sorts of cases, this book covers a surprising range of topics, including water emergencies, high-angle rescue, tactical medicine, lightning, and envenomations.

Tod Schimelpfenig, et al., NOLS Wilderness First Aid (Lander WY: NOLS Publications, 1991), ISBN 0-81173-084-0.  This book, along with Jeff Isaac’s Outward Bound Wilderness First-Aid Handbook, is one of the standard wilderness first aid texts. It is a clear, straightforward exposition of basic wilderness first aid – lacerations, fractures, sprains, lightning strikes, near drownings. Like the Outward Bound book, it is limited in scope, focusing on the basics.

Buck Tilton, et al., Medicine For The Backcountry (Guilford CT: Globe Pequot Press, 1999), ISBN 0-762704-527-2.  This slim volume, now in its second edition, used to be the text for the SOLO Wilderness First Responder course. Despite its size, it covers virtually all the relevant topics, providing a lot of useful information in a small size and rather conversational style. However, a lot of detail has been sacrificed for brevity. The book makes an excellent review – it is, essentially, the WFR curriculum – but is probably not the best primary text.

Buck Tilton, The Wilderness First Responder (Old Saybrook CT: The Globe Pequot Press, 1998), ISBN 0-7627-0392-X. This is an updated and greatly expanded version of Tilton’s Medicine For The Backcountry, but it has not replaced the earlier book as the text for the highly regarded SOLO Wilderness First Responder course; as I understand it, the SOLO people are now working on developing their own text. If you are looking for clear and thorough coverage of the generally accepted WFR curriculum, this text will give you just what you need.

James A. Wilkerson, Medicine For Mountaineering & Other Wilderness Activities (Seattle WA: The Mountaineers, 1992), ISBN 0-89886-331-7.  This book is one of the classic wilderness medicine texts, with very thorough coverage of all of the relevant topics, perhaps the most comprehensive of the standard first aid texts, recognizing, more than the others, that you may really have to face life-threatening injuries with no help at hand. The book provides detailed coverage of general principles, trauma, medical conditions, and environmental injuries. There is an index and glossary, as well as appendices on medications and therapeutic procedures, including intramuscular injection, intravenous medications, nasogastric intubation, urethral catheterization, and tube thoracostomy – information the other standard first response texts do not give.

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