Safety in the Wilderness

Based on an Intervew with Dr. Gil Hallows of Aspen Achievement Academy in Utah

Wilderness programs can often effect profound changes in troubled youth. Participants learn through direct experience the consequences of their own behavior. However, a balance must be achieved that allows the wilderness to provide an environment that cannot be manipulated while not compromising the safety of the participants. In the Aspen Education Group wilderness programs, safety always takes precedence over natural consequences. Because nature is itself sufficient teacher; there is no need to allow any situation to progress to a degree that might put participants at risk of injury or illness. By keeping risk at a minimum, we create a physical environment where dramatic changes can take place while keeping the participant is as safe, if not safer, than they would be in their home and school environment.

At the heart of our philosophy is the belief that managing risk takes precedence over every other consideration, including budgetary considerations. To maintain the exemplary record of our programs, many now in their second decade of existence, a great deal of redundancy has been built into the system. Emphasis is on training, support structure, and back up mechanisms. To illustrate the way we make sure our children are as safe, if not safer, than they are in their home-town environments, we specifically address below the safety measures taken at our program in Loa, Utah-Aspen Achievement Academy.

The Basic Elements for Managing Risk

The Support Center is "base camp" for risk management. A trained member of the staff is always on duty every day whose primary responsibility is to support the groups out in the field. At least two people monitor the radio 24 hours a day, 7 days a week, enabling an immediate emergency response should one be necessary. While the field groups can make contact at any time should there be a concern or emergency, Aspen's Support Center personnel make contact with Field staff automatically twice a day to get an update on the status of the group and to find out if there are any medical concerns.

The Emergency Response Team (ERT) is composed of all the leadership at Aspen Achievement Academy as well as support center and other personnel. They can mobilize and respond to any emergency, whether it is a coming snowstorm or a child whose behavior is out of control. The Academy also maintains a secondary and tertiary list of names so that sufficient people are always available to respond immediately to any crisis. The ERT meets regularly to debrief any incidents they may have responded to the preceding month.

The Medical Staff are an essential part of risk management. The Medical Director, Keith Hooker, M.D., is one of the original founders of the Academy. Dr. Hooker was the chair of Emergency Services at Utah Valley Hospital in Provo and is currently the Paramedic Director for the Lone Peak and Provo city districts. Dr. Hooker looks at every applicant that has a medical question before that child is admitted. Under his supervision, a Field Medic routinely goes into the field. The Field Medic and her assistant are on call at all times in case they need to respond to any medical emergency. The Field Medic also conducts a weekly medical inspection of each child. She checks blood pressure, ears, throat, and feet. If ever there is sickness or accident, the field medic or her assistant go to the field and evaluate the condition of the child.

Wilderness First Responders (WFR), the wilderness equivalent of an EMT, are personnel trained in wilderness medicine and first aid. All senior staff at Aspen Achievement Academy must be either a qualified WFR or EMT. We have at least one WFR or EMT with every group of students in the field. If something is beyond their expertise they call in the Field Medic, who can then call in the Medical Director if necessary. The Academy has conducted an 80-hour EMT class on site for field staff. Staff members are also subsidized to take the off-site 40-hour WFR certification program. Every person on staff who works with the children in any capacity must be annually certified in first aid and CPR. This includes the drivers who bring the kids in from Salt Lake City, therapists, and field instructors.

To keep all personnel up to date on safety and medical issues, we have an in-service every week before they go into the field. Issues related to weather, activity, medication, and safety are reviewed to insure current competency of staff members.

Extreme Conditions and Risk

Aspen Achievement Academy has an excellent record when it comes to handling risk in extreme conditions. Studies have shown that many of these children are safer out in our wilderness than they are in the streets of their hometowns or the halls of their high schools. In one major study conducted by the Outdoor Behavioral Healthcare Industry Council (OBHIC), it was found that children were more at risk playing high school football or driving in motor vehicles (Table I) than being in a wilderness program.

Cold Weather

Because temperatures in the high desert can be very low, part of managing risk involves protection against the cold. Students are equipped with appropriate gear such as sleeping bags rated at 20 degrees below zero; additionally we provide a fleece liner for added warmth. Temperature can vary greatly from high noon to midnight in the desert, so layered clothing allows participants to remove outer layers during warmer times of the day. We supply thermal underwear during both the summer and winter; an inner polyester lining takes moisture away from body so participants keep dry while hiking. Each child is also given a couple of layers of fleece and an outer coat/windbreak layer. The very outside layer is a water-resistant poncho. Students are also issued both wool gloves and leather gloves for cooking and working around the fire and wool pants.

Footwear is extremely important in these conditions. Students get a total of nine pairs of polyester liners that wick the moisture away from their feet while they hike. Each week a new pair of both liners and wool socks are sent out so kids can keep feet clean and dry. Because of potential problems when hiking every day in cold and wet weather, field personnel take a look at students' feet twice a day and record their observations on a chart. They do not simply ask a participant how his or her feet are doing; they take off shoes and socks twice a day to do this visual inspection. The goal is to keep feet healthy, free of blisters, and as clean as possible. Should there be snow on the ground, a winter overshoe over the top of hiking boot keeps snow out of their hiking boots.

Hot Weather

Hot weather issues must also be addressed in the desert. Students are carefully monitored at all times, with particular emphasis on their nutritional needs during the challenging hikes. During the hotter seasons, hikes are done early in the morning to avoid the noon heat. Other important steps taken to ensure the health and safety of all participants are:

- Sunscreen is carried by all groups and used liberally. Hats with sun visors and long-sleeved shirts are issued to all students.
- Insect repellent is carried by all groups. Students are issued head nets to protect against mosquitoes.
- All senior field instructors carry epinephrine kits in case of allergic reactions to bee stings, or anything else.
- During thunderstorm season, staff follow a lightening drill protocol whenever a storm approaches.
- Students are required to drink ample water. This is accomplished by having everyone drink a quart in the morning before hiking begins, and during the day, periodically designating a time for everyone to drink water. All students must have two full quart bottles of water for "last call" in the evening.

Managing Defiance in the Wilderness

On rare occasions a student will try to defy their counselors by refusing to take the precautions necessary to keep warm and dry in the cold, wet weather. However, as it starts to get dark and cold, students come into control of their emotions and realize they need to start preparing for the evening. The wilderness seems to have an effect on them immediately, and they rarely put themselves into enough harm that they have to be removed from the field. A student may try every trick they can to get out the field, but field personnel are trained to deal with such situations. Group peer pressure often moves a defiant participant to take the necessary steps to ensure his or her safety. If the child's behavior ever creates a safety threat, field staff step in and intervene, moderating the natural consequences. Safety always takes precedence over natural consequences. For example, we would not allow a child to walk in the snow without overshoes so that they can learn that the consequence will be frostbite. Once again, it is our belief that participants can still experience and learn from natural consequences without compromising their safety.

The Ultimate Teacher

Students who participate in the Aspen Achievement Academy's wilderness program often undergo profound transformations. Nature serves as the ultimate teacher that cannot be manipulated by defiant teenagers. By providing a safe yet dramatic environment within which to effect positive behavioral changes, the Academy's wilderness experience accelerates the therapeutic process and gives students a powerful foundation on which to build a more positive, productive life.

Table I: Activity Injuries per 1000 Participant Days
Wilderness treatment program for adolescents (OBHIC study), 1.2 (1)
Adventure program: downhill skiing, 3.28 (2)
Adventure program: rock climbing, 1.86 (3)
Adventure program: canoeing, 1.54 (4)
High school football practice, 19.74 (5)

Footnotes: (1)Aspen Achievement Academy incident rate date for 1999: For 11,803 participant field days there were 8 injuries and 16 illnesses. Total evacuations for these 11,803 field days were 24 (7 for injuries, 14 for illness, 3 for preventive intervention). (2) Liddle & Stork, 1995. (3) Leemon, 1998. (4) Leeman, 1998. (5) Zemper, 1998.