Wild Rescues

1. Embracing Wilderness EMS: A Transformative Career Shift

I’d assumed things would get easier after attending paramedic school—the hardest physical and mental thing I’d ever done—but as soon as I stepped off the graduation podium, I’d taken my place at the back of a long, serpentine hiring line composed of thousands of men and women who, like me, sought firefighter paramedic jobs in Los Angeles.

Seeking purpose. Kevin Grange, a paramedic disillusioned with the competitive, low-paying, and often dangerous urban EMS environment in Los Angeles, sought a profound change. His career felt stagnant, marked by routine transports and a lack of advanced skill utilization, compounded by personal setbacks. A chance encounter with a National Park Service (NPS) ambulance in Yosemite sparked a new dream: to combine his medical skills with his love for the outdoors.

A new calling. The idea of working as a park ranger and paramedic in remote, wild parts of the United States offered a compelling alternative to city life. He envisioned a role where he could experience pure nature, fulfill a long-held dream of working for the NPS, and immerse himself in wilderness medicine. This shift represented not just a job change, but a quest for a more direct and meaningful way to help people, aligning his professional aspirations with his personal values.

Initial hurdles. Despite his enthusiasm, the application process for NPS positions proved as challenging as his previous job hunt, with strict formatting requirements and intense competition. After a year of persistence, an offer from Yellowstone National Park's Old Faithful district finally arrived. The district ranger, Rachel Johnson, noted his Los Angeles background, joking that he could handle the "craziness" of bison gorings and bear maulings, a stark contrast to urban emergencies.

2. The Unpredictable Nature of National Park Emergencies

You probably won’t see gang shootings, but we do have bison gorings and bear maulings.

Wild encounters. Working in national parks like Yellowstone, Yosemite, and Grand Teton meant responding to emergencies in some of America's most isolated and rugged terrains, where the environment itself posed unique threats. The author quickly learned that calls could range from routine medical complaints to dramatic wildlife incidents, often requiring improvisation and a heightened sense of scene safety.

Diverse dangers. The parks presented a myriad of ways for visitors to get into trouble, from natural hazards to human error.

• Wildlife interactions: Bison gorings (often from selfie attempts), bear maulings, and even elk getting stuck in trees.
• Environmental challenges: Rockfalls, drownings in swift rivers, lightning strikes, and the dangers of geothermal features.
• Recreational accidents: Rock climbing falls, backcountry skiing injuries, and vehicle accidents on winding, icy roads.

Beyond the expected. The author's first call in Yellowstone involved a woman with a racing heart during a snowstorm, highlighting the immediate immersion into unpredictable conditions. Later, he encountered a grizzly bear running through a crowded geyser basin, only to find it had climbed a tree, becoming prey to a mob of picture-taking tourists. This underscored a recurring theme: often, the greatest danger came from human behavior rather than the wild itself.

3. Mastering Remote Medicine: Expanded Scope and Improvisation

On most calls, the paramedic work is really finished within the first twenty minutes. After that, it’s all about connecting with your patient. Talking is often the best treatment.

Frontier medicine. Working in remote national parks necessitated an expanded scope of practice, far beyond what was typically allowed in urban settings with nearby hospitals. Paramedics were trained for prolonged field care and long transport times, requiring advanced skills and a wide array of medications. This included procedures like needle cricothyrotomy for airway obstruction, intraosseous access for difficult IVs, and medications like ketamine for pain or sedation.

Adaptability is key. The absence of immediate hospital access meant that paramedics had to become highly self-reliant and adaptable. Lessons learned from experienced colleagues like Sam included:

• Order big, order early: Requesting more resources than initially needed, with the option to cancel.
• Triage treatment: Prioritizing immediate life-saving interventions and delegating tasks to bystanders.
• Compartmentalize, adapt, overcome: Mentally preparing for inevitable obstacles and changing plans.
• Backup plans: Always considering alternatives if initial strategies fail.

Beyond interventions. While technical skills were crucial, the human element of care became paramount during long transports. Sam's advice to focus on "connecting with your patient" and using "talking as the best treatment" highlighted the importance of compassionate care in alleviating fear and discomfort over extended periods, transforming a traumatic experience into a more manageable one.

4. The Indispensable Role of Teamwork and Community

It really took a village to save a life in a remote setting.

A collective effort. In the vast, challenging landscapes of national parks, saving a life was rarely a solo endeavor. It required the coordinated efforts of a diverse "campfire community" of park rangers, volunteers, and specialized teams. This collaborative spirit was evident in every emergency, from medical calls to complex search-and-rescue missions.

Diverse roles, shared mission. The author's experiences highlighted the varied expertise contributing to patient care:

• Law Enforcement Rangers: Often first on scene, providing initial assessment and life support.
• Volunteers-In-Parks (VIPs): Like Will, who offered to drive the ambulance day or night.
• Clinic Staff: Nurses and Physician's Assistants who worked closely with paramedics for patient transfers and higher-level care.
• Specialized Teams: YOSAR (Yosemite Search and Rescue) and Jenny Lake Climbing Rangers, renowned for their expertise in technical rescues.

Camaraderie and support. Beyond formal roles, a strong sense of community and mutual support defined life in the parks. From potlucks and shared meals to informal debriefings after tough calls, this camaraderie was essential for both operational success and emotional well-being. The author's initial feeling of being an outsider in Yosemite eventually gave way to acceptance, realizing that a shared commitment to service forged deep bonds.

5. Navigating the Human Element: From "Bucket Listers" to "Frequent Flyers"

There was a life-affirming defiance of death in their decision to visit Yellowstone, and I came to love them for it.

Unique patient populations. National parks attract a diverse array of visitors, each presenting unique challenges and perspectives on emergency care. The author encountered two distinct groups that profoundly shaped his understanding of patient autonomy and purpose.

The "Bucket Listers":

• Defying odds: Elderly or infirm individuals who, despite medical advice, traveled to the parks to fulfill lifelong dreams.
• Risk vs. reward: Often stopped taking medications (e.g., water pills) to avoid inconvenience, leading to medical emergencies like congestive heart failure or heart attacks.
• Philosophy of living: Inspired by Dr. Atul Gawande's "Being Mortal," the author learned to respect their choice to prioritize a "good life to the very end" over simply prolonging existence, even if it meant refusing aggressive treatment.

The "Frequent Flyers":

• Recurring patients: Individuals like Leroy, a concession employee with seizures, who frequently called 9-1-1.
• Beyond medical needs: While their medical issues were real, their repeated calls often highlighted a deeper need for connection, purpose, or a desire to remain in their "happy place" within the park, even if it meant refusing hospital transport.
• The "Leizure": A humorous term coined for Leroy's frequent seizures, reflecting the team's familiarity and concern for his well-being within the park community.

These experiences taught the author to look beyond immediate symptoms, understanding the broader context of a patient's life and their reasons for being in the park.

6. Becoming an All-Hazards Responder: Beyond Medical Skills

My job as a paramedic—and as a person—was to never stop expanding the ways in which I could serve, protect, and save lives.

Expanding capabilities. Driven by a desire to be a comprehensive "all-hazards responder," the author actively pursued training beyond traditional paramedic duties. This commitment reflected the diverse demands of working in national parks, where emergencies often required a blend of medical, fire, and rescue skills.

Specialized training included:

• Structural Firefighting Academy: Learning to fight blazes, perform vehicle extrication, forcible entry, and hazardous material response. This was crucial for protecting park infrastructure and visitors.
• Search and Rescue (SAR): Gaining proficiency in patient packaging, rope rescue, backcountry navigation, and extrication techniques for lost or injured hikers and climbers.
• Counter Narcotics and Terrorism Operational Medical Support (CONTOMS): Training to provide medical support for SWAT and law enforcement teams in high-risk tactical situations, such as active shooter incidents, bringing emergency care closer to the point of injury.

The "Kill House" experience. The CONTOMS course, culminating in an intense "kill house" scenario, pushed the author to operate under extreme stress, making life-or-death decisions in blackout conditions amidst simulated gunfire and casualties. This training, though harrowing, prepared him for the grim reality that mass violence could occur anywhere, even in national parks, emphasizing the need for medics to operate in "bad places."

7. Confronting the Dark Side: Trauma, Suicide, and First Responder Well-being

Each first responder inhabited his or her own haunted house, and these were just a few of my ghosts.

The invisible wounds. The demanding nature of first responder work, particularly in the raw environment of national parks, took a significant emotional toll. The author grappled with the cumulative impact of traumatic incidents, realizing that the psychological scars could be more insidious than physical injuries.

Specific traumatic incidents included:

• Samantha Kennedy's suicide: A young woman who took her life overlooking the Grand Teton, leaving the author with profound grief and intrusive flashbacks.
• Lucy's missing leg: A horrific motorcycle crash where a woman's leg was severed, and her husband later died, leaving two orphaned children.
• Phil's snowmobile crash: Transporting a deceased snowmobiler for an hour in the back of an ambulance, surrounded by the beauty of Grand Teton, while confronting the grim reality of his injuries.
• Scott's suicide: The tragic death of a beloved fire academy instructor, highlighting the alarming rates of suicide among first responders.

Acknowledging the pain. The author's journey through his "darkest hour" involved confronting his own suffering, recognizing that he wasn't alone, and seeking healthy coping mechanisms. This included journaling to process fragmented memories, learning about PTSD, and finding solace in practices like hot yoga, which helped him "turn pain into gold" and "breathe through whatever arises."

8. The Profound Impact of Nature and Purpose

I didn’t want to simply visit nature. I wanted to make it my permanent residence.

Finding true north. The author's initial move to Yellowstone was a quest for a break from city life and a deeper connection to nature. This journey evolved into a profound realization that his true calling lay not in returning to Los Angeles, but in making the mountains his permanent home. He found a sense of belonging and purpose within the NPS community and the wild landscapes.

Nature as healer. Living and working in national parks transformed his outlook:

• Present moment immersion: The natural environment forced a focus on the present, reducing reliance on technology and constant "busyness."
• Renewed perspective: Witnessing geyser eruptions, sunsets over El Capitan, and wildlife migrations instilled a sense of awe and interconnectedness.
• Community values: He discovered a "tribe" that prioritized conservation, shared stories, and valued experiences over material possessions.

A life-affirming choice. Despite the lack of permanent job security in seasonal NPS roles, the author chose to decline a firefighter paramedic position in Los Angeles. This decision, though not "rational" by conventional standards, was a heartfelt commitment to a life that felt more authentic and fulfilling, aligning with Hannah's advice to "follow your heart." He sought permanent roles in mountain towns, ultimately finding a full-time position with Jackson Hole Fire/EMS, allowing him to remain in the wildland-urban interface he had come to love.

9. The "Swiss Cheese Model" of Accidents and Silver Linings

While the holes sometimes lined up, and a tragedy occurred, there were also many times when, against all odds, a human life was saved.

Understanding causation. The author frequently encountered the "Swiss cheese model" of accident causation, where multiple small failures or "holes" in different layers of defense align to create a catastrophic outcome. This model helped explain tragedies like Roger Graham's stroke, caused by an undetected hole in his heart (PFO) combined with other physiological factors.

The paradox of intervention. The model also highlighted the delicate balance in emergency response. For instance, the "afterdrop phenomenon" in hypothermia meant that rewarming a patient could paradoxically cause their vital signs to crash, as cold, toxic blood returned to the heart. This underscored the complexity of interventions and the need for constant vigilance.

Silver linings and resilience. Despite the inherent risks and the alignment of "holes" that sometimes led to tragic outcomes, the author also witnessed miraculous saves.

• Veronica's recovery: A seemingly minor ice-skating fall led to an epidural brain bleed, but quick action and gut instinct saved her life, leading to a full recovery and a heartfelt reunion.
• Alex Hulet's survival: After a 50-foot fall and two days lost in the wilderness, Alex survived thanks to a massive community SAR effort, despite the afterdrop phenomenon.

These experiences reinforced the belief that while tragedy was a part of the job, the dedication and skill of first responders often created "silver linings," saving lives against all odds and reaffirming the tenuous beauty of life.

10. The Call to Serve: A Life Dedicated to Saving Lives

As I recalled that terrifying night and the prayer I’d made in the looming, 24,035-foot moon shadow of Mount Chomolhari, I felt proud to have kept the promise I’d made with God to dedicate my life to helping people.

Fulfilling a promise. The author's journey began with a desperate prayer on the Snowman Trek in Bhutan, promising to dedicate his life to saving others if a client suffering from altitude sickness survived. This promise became the guiding principle of his career, driving him to continuously expand his skills and commitment as a first responder.

A culmination of experience. Working in Grand Teton National Park, alongside his full-time role with Jackson Hole Fire/EMS, represented the culmination of his "rewilding" journey. He integrated all the lessons learned from Yellowstone and Yosemite, becoming a highly competent all-hazards responder capable of operating in diverse and challenging environments.

The essence of service. Whether it was a pediatric overdose, a complex wilderness extrication, or a suicide attempt, each call reinforced his dedication. He learned that true service extended beyond medical interventions to include compassion, active listening, and a deep understanding of the human spirit. His interaction with Beatrice, a young woman attempting suicide, exemplified this, as he offered hope and validation, echoing the support he himself had sought during his darkest hours.

An ongoing commitment. The author's story is a testament to the enduring call to serve, to run towards danger, and to find profound meaning in helping others. It highlights the sacrifices, the emotional toll, and the ultimate fulfillment found in a life dedicated to protecting both people and the "America's Best Idea"—its national parks.

Last updated: December 10, 2025