Park 1st Aid Letter

On February 10, 2004, the Grand Canyon River Guides Board of Directors sent a letter to Superintendent Joe Alston questioning medical control issues. This letter was printed in the last issue of the bqr, volume 17:1. Following is a response from the National Park Service to that letter.
March 26, 2004
Thank you for your letter of February 10, 2004. We have discussed the questions you raise on numerous occasions over the years, and our position remains the same. We’ll address each of your questions below:
Questions #1: Which of the protocols (list attached) are approved by the nps?
None, because the nps does not approve protocols. Only a physician can approve protocols for your organization. However, in reviewing the attached protocols it appears several are within the normal scope of practice for all emergency medical service (ems) providers from First Aid to Paramedic (cpr, shallow wound care, impaled objects). Whereas protocols expand the scope of practice for First Responders (i.e. reducing dislocations, high risk wounds and clearing spine injuries), a physician sponsor must approve those protocols.
Questions #2: Why require this level of training for every guide when the bulk of the course teaches protocols that, without medical control, we should not use?
The purpose of Wilderness Training (wafa and wfr) is to prepare guides to deal with medical emergencies in a wilderness situation. This is why it is required for river guides in Grand Canyon National Park. Standard First Aid (non-Wilderness) courses prepare trainees for dealing with emergencies in an urban setting where an ambulance is readily available, and simply do not prepare trainees to deal with emergencies in locations like the river corridor of the Grand Canyon. Wilderness training by reputable vendors provides comprehensive training in wilderness care for working in extreme environments with improvised equipment and a unique set of emergencies that may be encountered in the field. Since guides have been taking wilderness First Aid training, injured clients have received much better care by river guides. Wilderness First Aid training is much more than a few protocols in reducing dislocations and clearing spinal injuries. It is the best training available for dealing with emergencies in a wilderness situation.
Question #3: At the meeting between board members and nps personnel last January, Sherrie Collins, Deputy Chief Ranger, told us that “Wfr is the national standards.” How, specifically, did she reach that conclusion?

Sherrie Collins is a highly credible spokesperson for the nps who is well versed in ems matters at the national level. Her communication with the ems community indicates that wfr is the training most sought after by guides and outfitters across the country. In reviewing the guide license statistics, we see that the vast majority of guides with current licenses meet the new First Aid Standards: wafa for guides and wfr for trip leaders. It appears that the guides themselves have embraced these standards. We’ve had no complaints about these standards from the outfitters. In fact, the park has been told by a number of outfitters that they feel wfr is the appropriate training for the guides. It should also be noted that four outfitters will be conducting guides training trips this Spring. Wfr will be taught on each of these training trips.
In answer to your questions about licensure and certification issues, those must be addressed with the outfitters. In many states, First Responders are not licensed ems providers, which means there is no state requirement for oversight. It does not mean that you cannot be trained. The key issue is medical direction and physician sponsorship. Those are internal questions and issues that the Guides Association and outfitters should address and resolve.
The Guide and Trip Leader Standards that will be required by the end of 2004 are appropriate and working. Most guides now have wfr certification, outfitters are sponsoring wfr courses every year, and injured clients are receiving much better care that they received before guides obtained Wilderness Medical Training. Effective January 1, 2005, guides must be certified in wafa and trip leaders must be certified in wfr.
Finally, we want you to know that the nps values the relationship that has developed with Grand Canyon River Guides and that we look forward to working with your organization in the future. If you should have any further questions or require additional information, please contact Mike McGinnis, River Sub-District Ranger, at (928) 638-7832.
Sincerely,
Joeseph F. Alston
Superintendent