As an ambulance EMT I make an assessment, provide necessary treatment, and in most cases transport the patient. I rarely make a decision whether or not the patient needs to see the doctor.
Yet in the wilderness this may be my decision to make. My judgment can affect the patient’s health, the safety of my expedition members, and the quality and success of our planned journey or climb. This is an understated difference between urban and wilderness medicine, especially for those of us whose experience and expertise lies in outdoor practices, not practicing medicine. We may be well trained as WFR’s or WEMT’s, but our actual patient care experience is often limited. The decisions we may have to make can range from the critical (whether to evacuate someone with a belly ache), to the commonplace (whether to bandage a blister).
Pre-hospital medical courses rarely have a component addressing how decisions are made, or the elusive, yet critical asset of good “clinical judgment”. I find it a fascinating area of study and have gathered some thoughts in an article on medical decision making that you can access at www.nols.edu/wmi/curriculum_updates/.
If you’re interested in this topic, you will find “How Doctors Think” by Jerome Groopman M.D. (Houghton Mifflin, 2007) a very readable presentation of how medical decisions are made. In contrast to the seductive power of intuition made popular by Malcolm Gladwell’s “Blink”, Groopman presents a contrasting view with old fashioned virtues of careful, deliberate and systematic thinking – a decision-making process that can serve us well when we use our judgment in the wilderness.