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Medication Administration by WFR and WFA Graduates (December 2011)

A common misunderstanding in wilderness medicine at the Wilderness First Responder (WFR) and Wilderness First Aid (WFA) level revolves around the question of medication administration.  A reputable wilderness medicine program, following the WFR and WFA Scope of Practice Documents, would not be instructing a WFA or WFR course graduate to stock their personal first aid kits with prescription medication with the intention of using this on a patient.  Nor would the reputable wilderness medicine program be advising WFA and WFR course graduates to be making decisions on the need for prescription (Rx) medication use by a patient.  This would be beyond the intended Scope of Practice of the WFA or WFR.

The text in the WFA Scope of Practice is:

"A WFA graduate may care for a patient who is taking personal medications (e.g. nitro, aspirin or prescribed inhaler) under the direction of their physician. WFA graduates should not be making decisions on whether a patient should or should not take their personal prescription medications (unless it’s an obvious situation of abuse or harm) ."

The text in the WFR Scope of Practice is:

"A WFR should not be making decisions on whether a patient should or should not take their personal prescription medications (unless it’s an obvious situation of abuse or harm). A WFR may assist trip participants in the administration of prescription medications and may offer OTC medications for adults to make their own decision according to the package label."

"The possession and administration of epinephrine by laypeople is a complex issue. Support for laypeople using epinephrine for anaphylaxis amongst jurisdictions, including from country to country, varies considerably. It is important to encourage students to become familiar with any specific regulations in this regard and to know the implications. Organizations should be strongly encouraged to seek advice from a lawyer and/or guidance from a person acting as a medical advisor before deciding to initiate a policy that includes the emergency use of injectable epinephrine."

In the early years of wilderness medicine education many programs were looser with their language about medication administration. In the past decade we've been working to tighten this language and change this perception. The layperson with a WFA or WFR credential does not have the competence to make these decisions (besides the reality of the legal questions.)

Tod Schimelpfenig

Curriculum Director

Wilderness Medicine Institute of NOLS

December 2011

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