Medical Training Requirements

The ISKGA guide will be working in many different environments around the globe, with different skill sets and knowledge required for each, as well as many different risks involved in the areas involved. No single set of guidelines can match such diverse environments and defined skills are specifically required for each. Therefore the onus is on the ISKGA guide to ensure that within his or her group, they have the medical skills knowledge and experience to match the particular environments they work in and the clients within their group. Although it is not a requirement to be a medical professional to be an ISKGA guide, it is a requirement that each guide should have extensive skills and knowledge appropriate to a lay person working in austere environments.

Competency Based Model

ISKGA will define medical competences required by its guides rather than qualifications from specific organisations. Internationally three levels of outdoor appropriate emergency care training are recognised and defined by both contact hours and core subjects.

The levels are:

1. Remote / wilderness first, aid 24 hours contact time.
2. Advanced First aid / wilderness first responder. 60 hours contact time. These 60 hours are often taken as entry training with no previous experience with the consent of the training organisation.
3. Wilderness EMT / Physician led wilderness training. 70 hours contact time. This is not an entry level for non-medical personnel. Medical professionals who hold registered professional licenses can enter at this level but would benefit from some previous wilderness emergency care training.

Characteristics of training courses.

The training guides take should be orientated towards the remote environment. All emergency care training is relevant but urban based training has significant omissions that would leave guides poorly equipped to deal with medical emergencies in remote environments. Those holders of professional medical qualifications such as paramedics nurses and doctors should hold a specific qualification in wilderness emergency care or alternatively prove to have significant experience and knowledge of wilderness care by other means. Most wilderness physicians have taken formal training in wilderness care and often hold the wilderness command physician qualification. Non-physicians should where possible develop a relationship with a wilderness command physician to have a direct mentor to aid in their continual professional medical development.

Continual Professional Development Log.

ISKGA see training courses as the beginning of a guides training in emergency medical skills. To maintain core competences guides should regularly revise core material and practice core skills. These activities should be recorded in a CPD log as proof of continued advancement.

Appropriate training and competences for different environments

ISKGA has identified 3 general environments within which guides will operate. Each of these environments calls for different minimum standards of training and competency in emergency care. These levels are defined below with the minimum standard of emergency care provision defined. These are minimum standards and guides are encouraged to develop their emergency care abilities to the highest standard regardless of environment.

Sheltered Bay / help within one hour maximum. 24 hour basic outdoor orientated first aid course. Should include the core competences of :

Assessment of Scene / Mechanism of Injury / Safety / Need for further help

Vital signs assessment / Primary and Secondary Surveys

Airway / Breathing / Circulation Assessment and Management.

Resuscitation , CPR , Choking

Bleeding / Shock / Wound Management

Fracture / Dislocation / Sprain / Strain Management

Head, chest, abdominal and spinal trauma

Environmental Emergencies: Hypo / Hyperthermia, Drowning, Basic Marine Envenomation’s / Injuries

Medical Emergencies: Asthma , Epilepsy , Diabetes , Chest Pain, Anaphylaxis , Drowning

Miscellaneous: Burns , Pain Management , Eye Injuries , Dental problems

Introduction to basic personal medication use, eg: inhalers (salbutamol) and emergency medication use eg: Intramuscular adrenaline

2. Exposed Costal Environments 1 to 24 hours from help. Advanced First Aid / Wilderness First Responder 60 hours contact time.

These levels include all the core subjects of a basic course but examined in more detail and the students are expected to have a deeper understanding of the pathophysiology  of injuries and illness included in the program. Apart from the additional subjects named below the principle benefit of this level of training is the opportunity to include more extensive and complex scenario simulations. In these scenarios students have the opportunity to begin to develop greater skills of vital signs assessment, differential diagnosis (basic), scene management , team leading , communications and treating patients.

Advanced Vital Signs including blood pressure , breath sounds , oxygen saturation assessment without a probe.

Advanced fracture management with the use of flexible, rigid and traction splints, including improvised splints.

Fitting of commercial and improvised cervical collars.

Emergency medication use including salbutamol and administration of intramuscular injections.

Familiarisation with advanced expedition medical kits and wilderness medical pocket guides.

Communication with supporting doctors / ambulance personnel.

Scenario based discussions on preventing and dealing with common medical problems whilst on expedition: Hydration and dehydration, diarrhoea and constipation, and genitourinary tract disorders.

Practical sessions on environmental hazards including sea survival and cold water immersion response, hypo and hyperthermia, and dealing with lightning injury.

3. Wilderness coastal environments up to a week from rescue. 70 additional hours of physician level training. An example of this training is the Wilderness Emergency Medical Services Institute, wilderness emergency medical technicians course / wilderness command physician programme. The key characteristics of this level of training are:

Direct physician oversight, at least one doctor should be present to give clinical direction as complex medical training requires this level of clinical oversight. Various sessions will be delivered by clinicians at different levels but ultimate responsibility for protocol rests with the clinical director.

Most training at this level is underpinned by the practice guidelines of the Wilderness Medical Society. This is a large international society formed largely of doctors who base their recommendations on research. They meet regularly to discuss the latest developments and research in the area of wilderness medicine. Any training at this level should be based on international best practice and current high quality research.

The core subjects and competencies at this level are those defined in the Wilderness Medical Society’s practice guidelines.