Applying Wilderness First Responder Principles to Covid-19

by Endria Richardson

Last Spring, I became certified as a Wilderness First Responder through the National Outdoor Leadership School (NOLS). The premise of WFR training is that it teaches lay-people systems for responding to a medical crisis when, *emphasis*, there is no other access to medical care. In the context of WFR training, that’s generally when you are in the backcountry (that is, far enough into the woods, or mountains, or other nature that cell service, roads, or hospitals aren't readily accessible).

But WFR training can be relevant in any crisis where professional medical help is not available. This might occur during large-scale natural disasters like earthquakes or hurricanes. And it is occurring to some extent right now, due to the rapid spread of the novel coronavirus, or Covid-19.

I am not a doctor, nurse, paramedic, or EMT. I am only a certified Wilderness First Responder. That means I’ve taken a 10 day course in wilderness medicine and have a laminated piece of paper that says I’m a WFR. And a sticker!

That said, I’ve been refreshing myself on pertinent WFR training, mostly as a way to calm myself. Because Covid-19 has spread in some places more quickly than doctors and hospitals can respond, people who get sick, and their caretakers, may be placed into a backcountry-like experience: needing to manage potentially severe symptoms with no or limited access to doctors, hospitals, or medical equipment. Already, lay people around the world have been responsible for taking care of sick friends and relatives, or taking care of themselves, with decreased access to emergency care. Mostly, that has meant learning what to do to alleviate symptoms—and, importantly, manage stress.

The most helpful part of WFR training was learning systems (mnemonics for assessment, or checklists for treatment) to make caring for someone in the wilderness a manageable, non-panic-inducing, step-by-step process.

The end goal is not to cure the “patient,” it’s to stabilize them enough to either get them to a hospital, or until their symptoms resolve on their own. This is similar to a situation many of us may find ourselves in over the coming weeks.

Thinking through the steps I would take as a non-medical professional without a ventilator, or antibiotics, or oxygen to care for someone with a fever, trouble breathing, cough, and pain through the WFR lens has been calming and helpful.

Again, the goal is not to think about being equipped to cure someone, but to manage their symptoms and your stress response with as calmly and effectively as possible.
 
 
So, I thought I’d share some of the specific treatment checklists from the NOLS WFR training. This isn’t a replacement for WFR training (or any medical training), but if you are like me, you might take comfort in having *some kind* of guidance at all. 

The following are adapted from the NOLS Wilderness Medicine Handbook, 17th Edition.

Treatment Principles for Managing a Flu-Like Illness

1. Hydrate.
2. Rest and be patient.
3. Massage for muscle tension headaches.
4. Administer medicines to reduce pain and fever (i.e. Tylenol, or acetaminophen. For suspected Covid-19, doctors are recommending Tylenol/acetaminophen over ibuprofen.)
5. Decongestants like Mucinex can help coughs and congestion.
6. Antihistamines like Benadryl may help running roses.
7. Bland foods are best for gastrointestinal distress.

Treatment Principles for Managing Asthma

1. Calm the patient. A patient with a mild asthma attack may be coached into normal breathing.
2. Begin treatment promptly.
3. If the patient has an asthma treatment plan, support them to follow this plan. This usually involves administration of an inhaler, 2 puffs every 4 hours and as needed.
4. Acute episodes may need more aggressive treatment of 4-8 puffs every 20 minutes for up to 4 hours.
5. Hydration and rest.
6. The patient may have oral steroids prescribed by a physician. These may be administered, often for a severe asthma episode unresponsive to the patient’s inhaler, according to the prescription.
7. A patient with severe asthma not responding to their normal medications may need treatment with epinephrine. Ideally contact your medical advisor prior to administering epinephrine for life threatening asthma.
8. For suspected Covid-19 infections, the use of nebulizers is not recommended, as it can make the virus airborne for a period of time.

Treatment Principles for Managing Pneumonia

1. Encourage patient to cough and breathe deeply.
2. Administer fever-reducing medication. (i.e. Tylenol. For suspected Covid-19, doctors are recommending Tylenol/acetaminophen over ibuprofen.)
3. Administer oxygen, if available.

Tips for Managing Anxiety Responses

• Create a sense of safety by reducing chaos (tidying up a cluttered space, washing dishes) and reflecting evidence of safety (immediate safety, citing recovery rates--bot avoid promising recovery)
• Create calm by calming yourself first and emphasizing the present, the practical, and the possible.
• Create self and collective efficacy by involving the patient in problem-solving and self-care to the extent possible (have them hold their inhaler or water glass); recognize and remind people of existing strengths
• Create connection through reading, touch as appropriate, or talking; help people contact friends, family, and loved ones (including pets)
• Create hope by reflecting specific, accurate, positive facts and predictable, realistic steps
• Personally maintain and communicate hope.

Tips for Good Decisions

• Seek honest and accurate feedback
• Be self-aware (are you hungry? angry? lonely? or tired?)
• Communicate effectively (use specific, accurate details and facts)
• Call on your teammates (housemates, family members, friends) for support

Acetaminophen: How much can you take safely?

Acetaminophen: How much can you take safely?
	325 mg	500 mg	650 mg extended release
Take how many pills at a time?	1 or 2	1 or 2	1 or 2
Take how often?	Every 4 to 6 hours	Every 4 to 6 hours	Every 8 hours
Safest maximum daily dose for most adults	8 pills	6 pills	4 pills
Never take more than this in a 24-hour period	12 pills (3900 mg)	8 pills (4000 mg)	6 pills (3900 mg

Source: https://www.health.harvard.edu/pain/acetaminophen-safety-be-cautious-but-not-afraid

For more information, visit https://www.nols.edu/en/wilderness-medicine/resources/.
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Endria Richardson (she/her) is a Black and Malay queer writer, climber, and lawyer. Her work has appeared in Syntax & Salt Magazine and The Harvard Advocate, and is forthcoming in Anathema Magazine. When not writing, Endria works to end the prison industrial complex, the ultimate fantastical horror of our time. You can follow her on twitter @endriaraa.