Over the last few years, there have been several reports describing the role of PTs in wilderness environments (Beattie P, 2021 & 2022; Young B, 2022; Young SW, 2023). These publications describe how PTs are increasing their involvement in the prehospital care of people who become injured or ill when hiking, skiing, mountain biking, fighting wildfires and many, many other activities that occur in beautiful but hard-to-reach places. The PT’s role includes, among other things, emergency first aid and innovative patient transport, as well as on-scene treatment for many conditions within PT scope of practice such as non-severe musculoskeletal problems, burns, vertigo, asthma, and concussions. Importantly, PTs also play big roles in promoting Leave-No-Trace principles and provide on-scene leadership during potentially scary wilderness circumstances through the establishment of therapeutic alliances with the personnel on scene e.g., “good trail-side manner.”
So, let’s say that you have met the legal requirements and have an opportunity to provide wilderness PT. For our example, we will say that you will be taking care of backcountry trail crews. These crews consist of 10-12 well-trained people who maintain backcountry trails that enhance safe passage for hikers and skiers while protecting the fragile habitats needed for plants and animals to flourish. To perform their jobs, the crews need to carry and use heavy hand tools and usually must stay at backcountry sites for several days. They often get banged-up and really benefit from onsite PT.
Your job for the next few weeks is to hike 5-15 km each day into various work sites, perform PT consultations and treatments and then hike back out for a well-deserved hot dinner and a great sleep. Sounds good, right? The exciting part is that you can do all your PT interventions out of a backpack. The trick is to bring the right stuff with you.
Scene safety is always the primary concern when going out in the backcountry, so the first issue is to travel safely, don’t get lost and don’t get hurt. A second big concern is to keep your load light – preferably less than 8 kg – while maximizing the versatility of everything you bring. Considering these requirements, here is a go-list that our PT group uses.
Let’s start with clothes and footwear. Clothes should be durable, comfortable, and dry quickly-avoid wearing blue jeans (they don’t dry) or yoga tights (they don’t offer much protection and rip easily). Spend some money and get well-fitting trail shoes or boots. Sandals and running shoes don’t protect your feet and are never a good idea. Always have a good quality rain jacket – in a pinch, it can make a great sling for upper limb problems.
Land navigation comes next. “Staying found” is critical- smart phones are great for trail apps and GPS locations but these are not always reliable so be sure to have a high-quality map that has topography lines, grids, and coordinates. Always have a compass and know how to use it. Make sure that someone knows of your route and projected return times. Depending upon the group you work with you might have a two-way radio. Carry a headlamp with spare batteries in case you are out after dark.
Adequate hydration and nutrition are a must. It is easy to get dehydrated in any type of weather so bring enough water (not sweetened or carbonated drinks). Portable water filters are a great back-up if you need to fill up from streams. A good lunch is a must. Don’t bring anything too odiferous if you are in bear country. You probably won’t have time to cook so a nice sandwich or burrito works great. Also have plenty of healthy snacks.
A small tarp or poncho and some light paracord can make an emergency windbreak, shelter or stretcher which could save the day and can also be used as ground cloth along with a foam pad for a “treatment table” in the backcountry. A tarp is also important as an outer shell in a hypothermia wrap, and the foam pad makes an excellent splint or cervical collar.
Paul Beattie (PhD, PT, FAPTA, OCS, WEMT)
Emeritus Clinical Professor, Wilderness Emergency Medical Technician
Paul Beattie is an Emeritus Clinical Professor at the University of South Carolina, USA. He is a Catherine Worthingham Fellow in the American Physical Therapy Association and is a Wilderness Emergency Medical Technician.
After many years as a PT clinician, educator, and funded researcher with over 150 peer-reviewed publications Paul is now primarily involved in developing the field of Wilderness Physical Therapy. A life-long trail runner, hiker and backpacker, Paul, and his wife Karen (also a PT) provide PT and EMS services as backcountry volunteers in remote areas of the U.S.
To learn more about the emerging field of wilderness physical therapy please see the references below. You can contact Paul at email@example.com
Your personal first aid kit can overlap with your PT gear. Key items include ace wraps (useful for tissue compression and most trauma), tape and some basic dressings such as rolled gauze for wounds and to pack splints. Vaseline dressings are great for non-adherence to open wounds and as a fire starter. Also bring some 4 X 4s, Tegaderm, Triangular bandages to make slings, a pocketknife and EMT shears. Medications should include baby aspirin (for acute chest pain), paracetamol, Loperamide, and Benadryl. A small lighter should be included.
Your personal protective equipment includes hand sanitiser, alcohol wipes, non-latex gloves, masks for you and your patient if needed, and a hazmat bag for trash.
Consider bringing some more specialized items including flexible splints, Coban and Kinesiotape, Theraband, and a TENS unit with extra electrodes. Finally, be sure to have a pad and pen to document your patient encounters.
When all of your gear is assembled it will easily fit into a medium-sized day pack and you will be ready to have a fun and productive day on the trail providing onsite care to those who protect our environment.
We need the tonic of the Wilderness. Henry David Thoreau
Want to learn more about PT in Wilderness Medicine? Join the upcoming CPTA Wilderness Medicine Symposium 👇
Beattie PF. The Emerging Role of Physical Therapists in Wilderness Medicine APTA Magazine April 2021;13.3:18-29. https://www.apta.org/apta-magazine/2021/04/01/the-emerging-role-of-physical-therapists-in-wilderness-medicine
Beattie PF, Jernigan D, McDavitt S, Hearn D. Point of View: Physical Therapists Can Be Value-Added Providers in Wilderness Medicine. Physical Therapy, 2022;102:1–4. https://doi.org/10.1093/ptj/pzac096
Young B., Beattie PF. A Physical Therapist’s Experience as a Point-of Contact Care Provider in a Wilderness Environment: A Case Series Report JOSPT Case Studies 2:3, 1-8 2022. https://doi.org/10.2519/josptcases.2022.10944
Beattie PF. Wilderness Medicine: Patient Evaluation and Management in a Challenging Environment. Chapter in Sports Injuries: Prevention, Diagnosis, Treatment and Rehabilitation. 3rd Edition, Springer 2023 (in-press).
Young SW, et al. Successful Physical Therapist Management of an Ankle Injury in the Austere Wilderness of Denali: A case report. JOSPT Cases 2023;3(1):74–80. https://doi.org/10.2519/josptcases.2022.11159