Wilderness medicine is a relatively new form of medicine that emerged with the recent increase in 
wilderness travel (and subsequent injuries). It is defined as the skills necessary to assess and treat injuries 
or illness in a prolonged pre-hospital setting. Since assessment and treatment often occur in severe environments with minimal facilities 
available, practitioners require a broader range of knowledge and skills 
than standard urban medical courses offer. The United States legal system is complex. The following 
paragraphs outline some of the legal concepts you should be aware of as a guide, outdoor instructor, Search 
and Rescue (SAR) team member, or as part of the general public. 

Substantive versus Procedural Law 

Conceptually our legal system is divided into substantive and procedural law. Substantive law dictates 
the rules people should follow within a given society, essentially how they should act. Procedural law 
dictates how a person is treated after they break a law, essentially the procedure that is followed. 

Criminal versus Civil Law 

The legal system is also divided into criminal and civil law. Criminal law prohibits specific acts (theft, 
murder, assault, etc.) and sets a range of punishments for violations. The intent is for the severity of the 
punishment (imprisonment, fine, etc.) to match the severity of the crime. A violation of criminal law 
requires that the government bring charges against the defendant and prove them beyond a reasonable 
doubt; law enforcement is a branch of criminal procedural law. Instead of prohibiting specific acts, civil 
law dictates what a “reasonable” person’s conduct should be in a given situation. Violations of civil law are 
not punished but the violators may be required to provide compensation for damages. Any given act may 
violate criminal law, civil law, or both, depending on the act and circumstances. Contract law and tort law 
are two subdivisions of civil law that relate to wilderness medicine practitioners. 

Contract Law 

Contract law is the area of civil law that deals with agreements between people and/or organizations. 
Contracts may be expressed or implied, written or oral. A person may bring a civil suit against a person or 
organization if they think a contract has been broken or breached. 

Tort Law 

Social responsibility dictates that people within a given society have a duty to act reasonably towards 
one another. Tort law is the area of civil law that deals with injury or damage to people and property as a 
result of a person’s “unreasonable” actions. Injured persons are entitled to compensation for the damages 
caused by the defendant’s unreasonable conduct. The standard for reasonable is usually set by the defendant’s 
profession and called the “standard of practice”. 

Standards of Practice 

There are two standards of practice commonly applied to cases involving wilderness medicine. One 
pertains to sponsoring organizations (outfitters, schools, etc.) and the other to individual care givers. An 
organization or individual who fails to meet their standards of practice may be in violation of criminal law, 
civil law or both. 

Organizations are held to the industry standards of their profession. Industry standards are defined by 
committees within a given industry and/or by the state where the organization operates. Industry standards usually dictate the minimum 
level of training, certification, and/or licensure required for the 


organization’s staff. They may also include requirements or recommendations for expedition equipment. 
In general, an organization sponsoring a trip into a remote area is responsible for providing adequate 
medical care until the patient has entered the local health care system. 

The Wilderness Medical Society (WMS), a nonprofit physician and professional organization, publishes a list of approved practice 
guidelines for wilderness medicine in book form. The WMS also publishes a list of recommended minimum topics and hours for a 
Wilderness First Responder course and 
certification. While the WMS does not offer certifications in wilderness medicine, they do hold annual 
conferences in wilderness medicine that are approved for credit (CME) for physicians, nurses, and EMTs. 
Similar conferences are also held by other national organizations. The National Association of Emergency Room Physicians (NAEMSP) 
has published a series of position papers that address ruling out spine 
injuries, reducing dislocations, CPR, and wound cleaning in a wilderness environment. Care rendered by 
wilderness medicine providers is likely to be held to the practice guidelines established by the WMS and 
the position papers published by the NAEMSP. Training, certification, and standing orders/protocols should 
be in alignment with both industry and medical standards of practice. 

Duty to Act 

Duty to act (provide reasonable medical care) is defined by law. How you should act is defined by your 
profession’s standard of practice (as described above), your training, certification, the protocols set by your 
medical advisor, and state laws. It seems prudent to note that in most cases wilderness medicine providers 
have been sued for a failure to act rather than their actions. You have a duty to act if: 

1) You have a prior relationship with the person. 

2) The person is under your direct care. 

3) The person is a participant in an activity you have been hired to instruct or supervise. 

4) You have entered into a contractual agreement to provide medical services. 

Good Samaritan Laws 

To encourage trained people to act in emergencies when they do not have a duty to act, most states 
have enacted “Good Samaritan” laws that protect physicians and health care providers against simple 
negligence. They do not protect against gross or willful negligence. In order to be protected by Good 
Samaritan laws the aid must be unscheduled and unplanned and it must be provided at or near the scene 
where the illness or injury occurred. The provider must act without compensation and outside of their 
normal scope of employment. They must also have consent from and not abandon their patient(s). In 
emergencies, consent is usually implied. Implied consent may be indicated by a patient’s lack of resistance 
prior to and during treatment. It may also be indicated by the situation. Patients with a normal mental 
status have the right to refuse treatment. Once aid has begun, medical providers are under a legal obligation to see that it continues until 
the patient is no longer in danger. Based on their training, a medical 
provider is also expected to anticipate and plan for common problems that may arise en route to definitive 
care. Abandonment occurs when a patient’s care is terminated prematurely and they suffer subsequent 
harm as a result of the lack of treatment. 

Increasing Your Legal Umbrella 

The law requires only what a reasonable patient would require in similar circumstances and protects 
medical providers who act according to their training and in the best interests of their patient. For a 
defendant’s action(s) to be labeled unreasonable and the plaintiff to prevail in a civil suit, the plaintiff 
must prove four things: 

1) That the defendant had a duty to act; 

2) That the defendant did not adhere to the standard of practice of their profession (negligence); 

3) That the plaintiff suffered a loss or injury; and 

4) That the plaintiff’s loss or injury was caused by the defendant’s negligence. 


If a court finds against a defendant, the defendant may be required to pay damages consistent with the 
plaintiff’s injury or loss as determined by the judge and/or jury. 

Given the above information, there are a number of things organizations and individuals can do to 
increase the size of their legal umbrella (amount of legal protection) before an illness or injury occurs: 

1) Have all participants sign a release form giving advance permission for the sponsoring organization’s 
staff to render appropriate aid in the event of injury or illness. The form should also acknowledge that the 
participant is aware of, accepts, and releases the sponsoring organization and its staff from the risks associated with the activity. The 
release form is a contractual agreement and should be drawn up by an attorney 
licensed in the state where the business is registered or licensed. 

2) The sponsoring organization should be aware of and meet or exceed the industry standards for their 
profession. 

3) Staff should be trained and certified by an organization that teaches according to the WMS practice 
guidelines and the NAEMSP position papers. Wilderness First Responder courses should meet or exceed 
the WMS minimum standards for certification. 

4) The sponsoring organization should employ a physician advisor that is aware of the WMS and 
NAEMSP standards and acts in an active advisory capacity. In the absence of direct on-line control via 
radio or cell phone, the medical advisor should issue written “standing orders” or “protocols” appropriate 
to the staff’s certification and the activity(s) and environmental conditions likely to be encountered 
during the sponsoring organization’s trip(s). 

5) Staff should document their patient care in a standardized SOAP format that includes: time, dates, 
a description of the mechanism of injury, environmental conditions, a detailed patient history, the staff’s 
assessment, treatment and evacuation plans, and changes in the patient’s condition while still under their 
care. If it isn’t written down, it is difficult, and often impossible, to prove. Judges and juries generally place 
greater weight on field notes written during the incident than on notes recorded after the patient has 
passed from their care. It is also important for staff to document a patient’s refusal of treatment. Many 
SAR organizations, ambulance squads, ski patrols, etc. require a patient to sign a contractual document 
releasing them of all liability from damages resulting from a refusal of treatment. Such a document is 
usually signed in the presence of a witness who in turn signs as well. 

Related web sites: 

National Association of EMS Physicians: www.wms.org 
Wilderness Medical Society: www.naemsp.org 
Wilderness Medicine Training Center: www.wildmedcenter.com/home.html