Risk and Consequence

Help! Guys, he’s over here. It looks bad! The dull roar of spring runoff rushing down the rapids filled my ears as we rushed over to the yellow whitewater kayak. Our friend Tim sat in the kayak’s cockpit at a funny angle, fully alert, but complaining of back pain and numb feet. “What happened?” someone asked. “The force of the water threw the boat up on shore,” Tim replied with a grimace. Suddenly, everyone was talking at once. “How can we get him out and keep his spine stable?” What if we move the kayak like this?” “Who’s going to grab his weight centers?” “I’ve got his head,” assured Dan, as he took the lead position and began directing the rescue.”

Four people positioned themselves at Tim’s shoulders and hips, others stood nearby, ready to help free his legs and boots from the molded foam foot and thigh braces. I grabbed the bow of the kayak, ready to steady it and then pull it out of the way. “Anyone not ready?” asked Dan. Alert silence. One, two, three, go. With a fairly smooth movement, the rescuers removed Tim from the boat, I pulled it out of the way and went to support his feet. Carefully, we levitated him a few feet up the shore to flat patch of grass.

“Lowering on three,” warned Dan from the head position. “Anyone not ready?” With a slow movement, bending at our knees not our backs, we gently placed our patient on the ground.

“Hey, that was pretty good. Nice job team!” commended Tim while he sat up and brushed off his pants.

Conversation irrupted among the group of Wilderness First Responder (WFR) students as we discussed the details of what worked and what didn’t during our simulation. By now, halfway through the course, we were getting pretty comfortable with the patient assessment system, and responding to (simulated) traumatic injuries, even in awkward places.

All week, this group of 21 students has been learning about risk assessment, emergency care, and wilderness medicine. We’re here for a variety of reasons: some students will be working for Voyageur Outward Bound or other outfitters leading expeditions to the Boundary Waters; others are leading trips for a college outdoor rec program; one woman from Chicago will be leading high school students on service learning trips to Central America. I will be leading kids down the Namekagon River, and adults to the Boundary Waters on public programs for the Cable Natural History Museum.

One thing we all have in common is a passion for adventurous travel, and a need to keep ourselves and others safe while doing it. Could someone really have had a kayak accident like the fake one we just responded to? Absolutely. Would just the possibility of that unfortunate event keep any of us in the class out of the water? It depends.

 “Risk is a function of both probability and consequence,” declares our textbook’s introductory chapter. Therefore, the best way for us to stay safe is to avoid the combination of high probability and high consequence risks. Any sort of outdoor activity requires good risk assessment and risk management skills. By understanding what could go wrong, and how serious different outcomes could be, we are becoming better at both reducing the probability of risk, and reducing the consequences through good patient care.

After this drill, I might scout that rapid one more time before running it. If the water was too high, or I was by myself, or I was in a remote location, I might not run it. That situation has a high probability of huge consequences. After doing simulated CPR on a classmate acting convincingly like she’s just been hit by lightning, I might not watch a thunderstorm roll in on a rocky point. But if someone else takes those risks and gets into trouble, as least I can respond with the basic life support that gives them the best chance for survival.

Wilderness medicine isn’t all about broken bones and serious accidents, though. Much of our class has been about determining if an ailment is serious or not serious, and making sure the minor things stay that way. The best way to cure a blister? Don’t get one in the first place. The best way to deal with infection? Clean even minor wounds well right from the beginning. The best way to prevent injuries from a hasty and risky evacuation? Be able to tell that your patient’s intestinal distress is just a little gas from dinner instead of appendicitis.

In the end, accidents like the ones we simulate in class are pretty rare. I took my first WFR course in 2001, and in the subsequent 13 years, the most I’ve used my knowledge for is blister care and risk management. I’m at more risk for injury while I’m getting to the wilderness in my car than while I’m actually traveling by canoe in the back country.

What if I didn’t go? What if I got scared about the “what ifs” of wilderness travel and stayed home? I think that would create a high probability, high consequence situation, too. The probability is 100% that I would be missing out on life-affirming adventures in beautiful places that bring me deep personal satisfaction. That’s not a risk I’m willing to take.

Once again, Mary Oliver says it well: “Tell me, what else should I have done? Doesn't everything die at last, and too soon? Tell me, what is it you plan to do with your one wild and precious life?”

For over 45 years, the Cable Natural History Museum has served to connect you to the Northwoods. Come visit us in Cable, WI! The current exhibit, “Nature’s Superheroes—Adventures with Adaptations,” opens in May 2014 and will remain open until March 2015.

Find us on the web at www.cablemuseum.org to learn more about our exhibits and programs. Discover us on Facebook, or at our blogspot, http://cablemuseumnaturalconnections.blogspot.com