spring 04 / 17:1 - Grand Canyon River Guides

Medical Control Quandries
The following is a copy of a letter sent to Superintendent
Joe Alston from the gcrg Board of Directors
on January 31, 2004 regarding medical control.
The Grand Canyon River Guides board received, and
has discussed at length, your December 5, 2003 response
to our letter dated January 27, 2003. There were several
questions regarding first aid certification requirements
that remain unanswered, although we have been
discussing this with Grand Canyon National Park
(gcnp) for four years. As the National Park Service
(nps) moves toward requiring that guides be certified as
Wilderness First Responders (wfr), these concerns must
be answered, and quickly.
The commercial season is approaching and guides
who have been forced to learn advanced wilderness
medical protocols still have not been told why this
training is deemed necessary, nor which protocols are
appropriate for them to follow. We ask you to please
respond to these questions promptly and thoroughly, in
writing, before the beginning of the 2004 river season.
We also request that a gcnp representative attend the
Guides Training Seminar, and be prepared to respond to
these questions:
1) Which of the protocols (list attached) are approved
by the nps
When a minimum of Advanced First Aid was the nps
requirement, although many guides had higher levels of
training, the expectation of standard of care was unambiguous.
Guides were expected to provide advanced first
aid. Changing the minimum requirement in the
Commercial Operating Requirements to wfr raises the
implied standard of care beyond that which we can
legally provide. The advanced protocols taught in wfr
courses require medical control, which most outfitters
have been unwilling or unable to acquire. Our question
has been, and remains, without medical control, which
of these protocols are appropriate for guides to use
In your letter, you stated that “If you do not have
medical control you may not perform invasive procedures,
such as administering of medications and reducing
fractures.”
You must understand that this vague statement only
complicates the matter. Pulling traction on an open
femur fracture, for example, drastically reduces pain,
bleeding, and tissue damage. Advil is a medication used
to reduce pain and swelling. Electrolytes are used for
heat and dehydration emergencies. Your letter ruled out
these protocols, as well as many others.
First aid courses do not distinguish procedures on the
basis of “invasive” vs. “non-invasive.” Cleaning a wound
would doubtless be considered invasive and, according
to wfr protocols requires medical control. Are you
saying we should not clean wounds
Protocols vary widely depending on the company
teaching the course, and by the individual instructor,
because there is no standard for wfr. Attached is a list
of wilderness protocols that could be considered “invasive.”
Because the nps is requiring this level of training,
you should review this list, correct it as necessary, and
clearly state which protocols are appropriate for guides
to use in gcnp, and which are not.
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
If the nps is unwilling to approve or disapprove of protocols,
or believes that none of them are appropriate, then
why should guides be compelled to be trained in them
According to one instructor, “these protocols are what
make wfr a wfr. Without them, they would be first
responders.”
3) At the meeting between board members and nps
personnel last January, Sherrie Collins, Deputy Chief
Ranger, told us that “wfr is the national standard.”
How, specifically, did she reach that conclusion
To which “industry” was Ranger Collins referring The
job of a guide, after all, is not providing Emergency
Medical Service (ems); it is preventing illness and injury.
A guide who is honing his first aid skills in Grand
Canyon isn’t doing his job very well. But regarding river
guiding, the industry standard clearly is not wfr. In
California, Oregon, Idaho, Utah, North Carolina, South
Carolina, Tennessee, and Montana, land management
agencies require basic or advanced first aid.
Each wfr course is different; protocols vary, and
course lengths range from 60 to 100 hours over six to
eleven days, because there is no standard, nor is there an
overseeing organization that defines what a wfr certification
means. Because of this, providers of the training
often won’t recognize each other’s courses when it’s time
to recertify.
Is wfr recognized by the state of Arizona We are
investigating this now, because it is not recognized by
the state of Utah, nor by the state of New Mexico. In
both these states, someone certified in wfr who follows
wfr protocols, is considered to be practicing medicine
without a license. Is the same true in Arizona
page 12
grand canyon river guides