There’s a moment I think about every time I teach a wilderness first responder scenario. A student team had been crouched over their mock patient for close to twenty minutes. They were thorough — I’ll give them that. Checking, rechecking, debating every detail of their primary survey while their “patient” lay there in the dirt, perfectly stable and going absolutely nowhere.
Finally I said it: “Are you going to get him down to the base clinic before he dies of old age?”
The whole group cracked up. But every single one of them remembered it.
That moment captures something I’ve spent years trying to teach — something that doesn’t show up cleanly on a skills checklist. In wilderness medicine, the most important decision you’ll often make isn’t what to do. It’s when to stop doing it and move.
How I Teach It: The Three Triangles
Over the years I’ve landed on a framework I call the three-triangle approach. It keeps people organized without turning them into robots, and more importantly, it helps them recognize when they’ve done enough and it’s time to go.
First Triangle: Scene Survey
Before you touch anyone, you have to understand where you are and what you’re walking into. A responder who gets hurt trying to help just adds another patient to the problem.
I teach scene safety through what I call the Four P’s — and the order matters: Personal safety first, then Partner safety, then Public (bystanders), and finally Patient safety. Absolutely and necessarily in that order.
From there, you’re asking: what do I have to work with? Your human and material resources. Who else is here? What’s in the kit? What can we use for shelter or evacuation? And then — critically — what actually happened? Understanding the mechanism of injury or nature of illness tells you an enormous amount before you’ve laid a hand on the patient.
All three of these surveys can take place in a matter of seconds while donning PPE (e.g. gloves), or may take slightly longer depending on the scene. Once you have that “wide-angle” view of what happened and you know your scene is safe enough to proceed, it’s time to narrow down to the person needing medical attention.
Second Triangle: Primary Survey
This is where you stop the dying. Whatever mnemonic system you use to remember your steps — MARCH, XABCDE — the job is the same: find the life threats and fix them immediately.
Depending on what’s in front of you, that might mean bleeding control first. Arterial bleed that you can see? That gets priority before airway, or even during airway. If the subject is trying to hold pressure on arterial bleeding while screaming for help, we already know they have an airway, and we can even keep an eye on respiration in our peripheral vision while working on stopping the bleeding. Otherwise you’re generally working in order through airway, breathing, circulation, and then environment and disability — hypothermia, heat illness, head injury, in order to determine if there are any life threats. The primary survey (aka primary assessment) may only last seconds. There may not even be a necessity for a primary survey (e.g. a sprained ankle), but it is still critical to understand how to function competently to overcome life threats first and foremost.
And here’s where the real wilderness decision starts. Once you’ve addressed the immediate life threats, you have to ask yourself: do I keep working here, or do I move?
If you’re four hours from the trailhead, more stabilization and best possible “packaging” of injuries to make sure the movement won’t exacerbate any injuries might genuinely change the outcome. If you’re forty minutes out and the patient is stable, spending another thirty minutes perfecting your assessment might just be burning valuable time.
Third Triangle: Secondary Survey
Once life threats are handled and you’ve made the call about movement, you go deeper. Vital signs — pulse, respirations, skin signs, level of consciousness — give you a baseline and tell you whether things are trending in the right direction or not.
From there, a focused physical exam and a SAMPLE history (Symptoms, Allergies, Medications, Past history, Last intake, Events) fill in the last two legs of the third triangle. This is where you’re building the story of your patient — the information that will matter when you hand them off to higher care. These are taskls that can generally be done from the relative comfort and warmth of a tent or car or even a field clinic, while waiting for transporation.
The Real Skill: Knowing When Enough Is Enough
I’ve watched a lot of student teams over the years, and the instinct to over-treat is almost universal in beginners. It comes from a good place — they want to do everything right. But wilderness medicine is fundamentally about time management under uncertainty.
Perfect care in the field is almost never possible. What matters is appropriate care, delivered at the right moment.
Some things are non-negotiable. Uncontrolled bleeding. Airway compromise. A patient sliding into hypothermia in an exposed location. You don’t move until those are addressed. But a slightly imperfect splint? A secondary survey you’ll complete en route? Those aren’t reasons to sit on a mountainside for another hour.
The environment itself is part of the equation too. Sometimes the most dangerous thing you can do is stay put — and getting the patient to shelter or lower elevation takes priority over a more detailed assessment.
Where Herbal Field Medicine Comes In
Our on-site Wilderness First Aid course is a little different from most. We integrate up to eight hours of herbal field medicine training into the full 24-hour curriculum — not as an alternative to conventional first aid, but as a practical extension of it.
In remote environments, that distinction matters. When evacuations stretch into days, when supplies run low, when you’re managing a minor wound or a gastrointestinal illness far from a pharmacy — knowing what’s growing around you, and when it’s appropriate to use it, genuinely expands what you can do for a patient.
We teach basic botanical applications alongside western pathophysiology, so students understand the why behind both approaches. Inflammation, infection, tissue healing, thermoregulation — these principles apply whether you’re reaching for an herbal compress or a pharmaceutical dressing.
A Few Examples of Herbs and Formulas I Often Use In The Field
| Situation | Herbs/Formulas | Field Use |
|---|---|---|
| Wounds, possible infections | Broad Spectrum Defender Echinacea mix, Algerita mix, Black Walnut mix, Myrrh, Andrographis, Uva Ursi, Chaff Flower, Angelica D., Baikal Skullcap, Chaparral, Black Pepper | Diluted 50/50 with clean, potable water as a wound wash, tincture poultice, internally for bacterial infection (respiratory or urinary) |
| Gastrointestinal upset | Activated Charcoal Gut Health Formula Algerita mix, Wafer Ash, Gentian, Chamomile, Ginger, Angelica | Use activated charcoal first, 1-2 tbs per 4-8 oz of filtered or distilled water. Then 2 hours later, work with the herbs. Alternate every 2-3 hours as needed |
| Urinary Tract Infection (enteric bacteria) | Urinary Tract Health Bilberry Leaf/Root, Corn Silk, Echinacea A + P, Khella, Cranberry, Uva Ursi, Kava, Baikal Skullcap Biofilm Buster Baikal Skullcap, Dandelion (leaf), Dahurian Angelica, Algerita (root and leaf), Chaff Flower, Birch Bark, Uva-Ursi, Yerba Mansa, Andrographis | Hydrate well, alternate smaller doses of formulas (1/2 – 1 tsp) every few hours throughout the day. |
| Topical Pain Relief | Trail Runner Salve Elder Leaf/Bark, Yarrow, Arnica, Camphorweed, Mugwort, Ox-Knee, Cayenne, Devil’s Claw, Gotu Kola, Black Cohosh, Comfrey, Self-Heal, Juniper Berry, Red Sage The Athlete’s Relief Liniment Safflower, Red Sage, Ox Knee, Elder Leaf, Gotu Kola, St. John’s Wort, Ginger, Prickly Ash, Mexican Arnica, Cayenne | Massage into affected area. Alternate between oil-based salve and isopropyl-alcohol based liniment to prevent drying out of skin. Rest affected tissue. |
| Upper Respiratory Tract Infection (e.g. cold, flu) | RC2 Formula Thyme, Elecampane, Neem, Japanese Knotweed, Gumweed, Wild Cherry, Perilla Seed, Alpinia k., Chinese Lovage RADS Formula Yerba Santa, Yerba Mansa, Ligusticum Chuan Xiong, Angelica d., Thyme, Gumweed, Echinacea mix, Pleurisy Root, Plantago, Horehound, Marshmallow Rt./Lf., Mullein Lf | Take RC2 at the initial onset of URI, or when feeling “exposed” to a cold or flu virus. Continue with RADS during and after for support of upper respiratory tissue, phlegm, etc. |
Move With Purpose
Every wilderness incident eventually comes down to the same question: Is it time to move, or do we need more time here?
The answer lives at the intersection of how serious the life threats are, how far you are from care, what the environment is doing, and what you have to work with. There’s no formula that spits out the right answer — it takes judgment, and judgment takes practice.
What I try to give students isn’t just a set of skills. It’s a way of thinking through messy, unpredictable situations where the checklist runs out and you’re left making calls with incomplete information. The three-triangle framework is a tool for that. The herbal training is a tool for that. Scenario practice is a tool for that.
And sometimes, a well-timed question about dying of old age is a tool for that too.
Want to Train With Us?
If you want hands-on wilderness first aid training that also integrates practical herbal field medicine, we have a spring certification coming up. It’s built around real decision-making in the backcountry — not just skills, but the judgment to use them well.
Wilderness Herbal First Aid Certification – Spring 2026 Register here →