WFR Behavioral and Psychological Emergencies 4

Question 1

A patient with a known history of schizophrenia has run out of medication and now believes the group is poisoning their food. They are agitated and pacing, but they have made no threats and have no weapon. Which approach is MOST appropriate?

Accepted Answer

Stay calm and keep a safe distance, speak in short simple sentences, acknowledge their fear without confirming or arguing against the belief, and let them prepare their own food

Answer

The recommended approach is to acknowledge the patient's feelings and avoid arguing with the delusion or agreeing with it. Keep the environment calm and non-threatening, and give the patient some control, such as preparing their own food. Restraint is a last resort and is reserved for imminent danger to self or others. Arguing escalates fear, and colluding reinforces the delusion and may undermine trust.

Question 2

The team leader is deciding whether to use physical restraint on a combative patient who is a danger to others. Which statement reflects correct wilderness practice?

Accepted Answer

Use restraint only as a last resort after verbal de-escalation fails, use enough people to do it safely, never place the patient prone or compress the chest or neck, and monitor airway and circulation continuously while restrained

Answer

Restraint carries a real risk of positional asphyxia, rhabdomyolysis, hyperthermia, and nerve injury. It should be used only for imminent danger after de-escalation has failed, with enough rescuers (typically at least four) to limit injury. The patient should not be prone, and nothing should compress the chest or neck. The airway, breathing, circulation, and limb perfusion should be monitored continuously, and the restraint should be removed as soon as it is safe to do so.

Question 3

A previously healthy 24-year-old woman in the group becomes withdrawn after a fall in which a companion was seriously injured. Four days later, she reports intrusive images of the event, avoids the accident site, has trouble sleeping, and jumps at any loud noise. She denies any thoughts of self-harm. Which statement BEST describes the appropriate field approach?

Accepted Answer

Provide reassurance that these reactions are common after a traumatic event, keep her connected to the group with routine tasks and rest, watch for worsening symptoms or self-harm risk, and recommend professional follow-up after the trip

Answer

Acute stress reactions after a traumatic event are common and often resolve with support, rest, normal routines, and social connection. Field care should be supportive and should watch for worsening symptoms or suicide risk. Mandatory group debriefings and forced recounting of the event have not shown benefit and may cause harm. PTSD cannot be diagnosed in the first days, because it requires symptoms to persist for more than a month. Isolation removes the social support that aids recovery.

Question 4

A 17-year-old on a wilderness expedition is found with a self-inflicted superficial laceration on the forearm. The student states they 'only did it to cope with stress' and say they did not want to die. Which response by the WFR is MOST appropriate?

Accepted Answer

Treat the wound, ask directly and calmly about suicidal thoughts without judgment, remove access to sharp objects, arrange supervision, notify the leader and appropriate guardians per program policy, and plan for a mental health evaluation

Answer

Non-suicidal self-injury is a sign of significant distress and is associated with a higher risk of later suicide attempts, so it should never be dismissed. The WFR should treat the injury, ask directly about suicidal thoughts (asking does not plant the idea), restrict access to means, arrange supervision, and notify the responsible parties for a mental health evaluation. The patient's own denial of intent does not remove the risk, and punishment would increase shame and make disclosure less likely.

Question 5

A WFR team is evacuating a patient who threatened suicide earlier in the trip. The patient is now calm, apologizes, and says they 'feel much better and just want to put it behind us.' They ask the team not to tell the rescue crew or their family. What is the MOST appropriate action?

Accepted Answer

Share the history with the receiving rescue and medical personnel, continue direct observation, and keep means of self-harm out of reach, because sudden calm after a threat does not show the risk is gone

Answer

A sudden calm after a suicidal statement can reflect resolution of ambivalence or a decision to act, so it is not reassuring. Wilderness protocols call for continuous observation, removal of means, and a handoff of the history to the next level of care. Patient confidentiality does not outweigh the duty to pass on safety-critical information. A no-harm contract has no proven protective value and does not replace observation.

WFR - Wilderness First Responder Practice Test

WFR - Wilderness First Responder Practice Test

WFR Behavioral and Psychological Emergencies 4