WFR Behavioral and Psychological Emergencies — Questions and Answers
Question 1: A hiker who was uninjured in a rockfall is pale, sweating, has a fast pulse, and briefly faints after seeing an injured partner. Their vital signs return to normal within minutes while lying down. What is the most likely cause?
- Hypovolemic shock
- Acute stress reaction (psychogenic/vasovagal response) (Correct answer)
- Hypoglycemia
- Traumatic brain injury
Correct answer: Acute stress reaction (psychogenic/vasovagal response)
An acute stress reaction, also called a sympathetic or vasovagal response, can cause pallor, sweating, a racing pulse, and fainting. Unlike true shock, it resolves quickly once the patient lies down and is reassured. Because this patient was not injured, this is the most likely explanation.
Question 2: During a wilderness trip, a participant says they have been thinking about ending their life. What should the WFR do first?
- Change the subject to keep the conversation positive
- Ask directly whether they have a plan and the means, and keep them under constant supervision (Correct answer)
- Promise to keep the conversation confidential
- Let them hike ahead alone so they have time to think
Correct answer: Ask directly whether they have a plan and the means, and keep them under constant supervision
Asking directly about a plan and the means to carry it out is how you assess suicide risk, and asking does not increase that risk. The patient should never be left alone, any means should be removed, and evacuation and professional help should be arranged. You cannot promise confidentiality when someone's life is at risk.
Question 3: A patient becomes suddenly combative and confused on a trip. Before treating this as a purely psychiatric problem, what should the WFR do?
- Restrain the patient right away
- Rule out medical causes such as hypoxia, hypoglycemia, head injury, and hypothermia or hyperthermia (Correct answer)
- Give an antihistamine to sedate them
- Ignore the behavior until it passes
Correct answer: Rule out medical causes such as hypoxia, hypoglycemia, head injury, and hypothermia or hyperthermia
A sudden change in mental status is often caused by a medical problem: low oxygen, low blood sugar, brain injury, temperature extremes, or toxins. Assume a medical cause until you have ruled those out.
Question 4: Which of the following is a core principle of psychological first aid after a traumatic event in the backcountry?
- Make survivors describe the event in detail right away
- Provide safety, calm, connection, and practical help (Correct answer)
- Keep survivors apart from each other
- Tell survivors they should feel lucky
Correct answer: Provide safety, calm, connection, and practical help
Psychological first aid focuses on safety, calming, connection, practical help, and helping people feel capable again. Forcing a detailed debriefing is no longer recommended.
Question 5: A patient is breathing rapidly and reports tingling in their hands and around their mouth during an anxiety episode. There is no injury, and their SpO2 is normal. What is the best management?
- Have them breathe into a paper bag
- Coach slow, controlled breathing, reassure them, and rule out other causes (Correct answer)
- Give rescue breaths
- Start an immediate evacuation
Correct answer: Coach slow, controlled breathing, reassure them, and rule out other causes
Coached slow breathing and reassurance are the standard treatment for anxiety-related hyperventilation, once medical causes have been considered. Paper-bag rebreathing is discouraged because it can cause hypoxia and can hide serious conditions.
Question 6: A violent patient on an expedition poses a danger to the group. What is the WFR's top priority?
- Physically restrain them alone
- Keep yourself and the group safe, then de-escalate and get help (Correct answer)
- Argue with the patient until they calm down
- Give them an unprescribed sedative
Correct answer: Keep yourself and the group safe, then de-escalate and get help
Scene safety comes first. Rescuers and bystanders must not become patients. Use verbal de-escalation, keep your distance, and use restraint only as a last resort with enough people and attention to the patient's airway.
