Workplace Wilderness First Aid: Directive, Protocol or Guideline?

When developing your workplace wilderness first aid safety program, it won’t be long before you come across the terms directive, protocol, and guideline.  These three terms refer to the documents adopted by workplaces to structure the provision and delivery of practitioner care.  While they are often used interchangeably, don’t be fooled – these three documents are each very different.

In this article, we’ll take a look at each document type.  We’ll clarify its meaning, determine its applicability to wilderness medicine, and answer the question your health and safety plan needs to ask: which of these documents works best for wilderness medical care?

Directive

A directive is a specific order from a physician to another health professional delegating her authority to perform a medical act.  In a healthcare facility, a directive is a particularly useful tool to empower nurses, paramedics, and even physician assistants to deliver quality care to patients.  

In a wilderness context, directives are not useful or appropriate.  Wilderness care providers are not health care professionals working under the direct supervision of a physician. Whether you’re providing care to a co-worker at a remote drill site, or a client on a guided raft trip, you are not treating a specific condition in a controlled environment. Bottom line: directives will not work for the delivery of wilderness medicine in your workplace.

Protocol

A protocol is defined as a detailed written set of instructions to guide the care of a patient or to assist the practitioner in the performance of a procedure.  Protocols tend to be rigid, and define a specific series of actions.  They leave little room for adjustment and judgement by the practitioner. 

Protocols do have some applicability in a wilderness context, and are particularly useful for managing a specific problem.  If you’re responding to a cardiac arrest in a remote forestry block, a CPR protocol would be useful.  Similarly, a spine assessment protocol would be useful when responding to an injured kayaker that just took a drop over a falls.

Unfortunately, protocols are too rigid to accommodate the dynamics of a wilderness context, and the wide variety of medical problems and patients that come with that context.  Protocols leave little room for judgement, flexibility, and adaptability.  Workplace wilderness first aid needs something more, something to guide and support practitioner decisions and treatment in diverse situations in a way that will enable them to bridge the gap from ideal to real…

Guideline

Guidelines are general statements that contain recommendations for best care.  They are developed from a research review and evaluation of the risk and benefits of care options. 

Guidelines require interpretation and judgment on the part of the practitioner.  In the medical world, these documents are generally called Clinical Practice Guidelines.  In the world of remote medicine, the document becomes Emergency Treatment Guidelines.  You’ll see this evolution carried out in Raven Medical training.  Raven Medical students learn that Emergency Treatment Guidelines are decision-making aids for the delivery of medical care in an emergency by nonmedical professionals.

Raven Medical’s Emergency Treatment Guidelines reflect the best treatment option in wilderness environments, and in any environment that has limited access to supplies and advanced medical care.  Emergency Treatment Guidelines evolved from industry standard documents like Wilderness Medical Society’s Clinical Practice Guidelines and accepted international practices.  

The goal of guidelines is to support life saving care in remote settings by combining reasonable and (relative) low-risk treatments with a high level of benefit to the patients.  Emergency Treatment Guidelines represent the standard in wilderness medicine and will support your workplace in providing the best possible care.

Choosing What’s Right For Your Workplace

Learn more about taking Wilderness Medical training into your remote workplace – from urban disaster response and operations in militarized zones, to remote industrial field work and outdoor adventure education.