I think that in every Wilderness First Responder and Wilderness EMT I've taught, I get one question repeatedly, " Do we have to do the entire patient assessment every time?" and my answer has always been yes, and a recent experience reiterated how important this is. While it seems like a lot to go through, in a remote setting you have the time, and should welcome the opportunity to practice your critically important assessment skills. Working as a paramedic in the urban setting, I am constantly reminded that patients present in a variety of ways and what seems like one thing can often times be something entirely different that only an inquiring provider would find. In providing remote site ALS support, I am much more conservative and thorough, knowing that evacuation is weeks away if not impossible. It is an entirely different game where your mistakes have much higher consequences.

The remote or wilderness setting is different in many ways, besides never having the right equipment, working in austere and extreme conditions without other providers to assist or correct you, and as a Wilderness First Responder, you don't get the opportunity to see a lot of patients or skills practice. For that reason alone, the WFR should gather as much information as possible to make informed decisions about treatment.

In teaching, I have always referenced a story about a patient who was dehydrated in de-compensatory shock. At first glance, a WFR looked at the patient and saw a weak, pale patient who had vomited several times in the preceding hours. It is important to point out that it was a reasonable assumption for most people. Without getting vital signs or a solid SAMPLE history, which would have clearly shown the patient had a serious medical condition, the WFR gave some Tylenol Cold & Flu, and sent them to bed. This persisted for over two days - while the patient continued to worsen, and eventually was unable to sit up with a dangerously low blood pressure. When I saw the patient he needed IV fluid resuscitation, and in short was very sick, though once the volume issue was corrected he was as good as new. Evacuation at that time with 7 - 10 days away, and given the circumstances, the patient could have been severely injured, or worse.

On a further note, I think one of the most important aspect of skills upkeep as a WFR is practicing your assessment skills in an organized and deliberate fashion, doing it the exact same way every time: the scene size-up, primary survey, physical exam, vitals, and history. Any chance you get to practice will develop your muscle memory to complete a solid assessment, even under the stress of adrenalin. Remember, without finding all the clues it will be nearly impossible to confidently decide how to best treat your patient.