Dr. Will Smith was suspended beneath a helicopter in Wyoming’s backcountry when his wilderness rescue team noticed something concerning. The man they were rushing to save was on the ground, and above him was another person vigorously performing CPR. Dr. Smith instantly knew his search and rescue team may not get there in time, so the man’s chances of survival were bleak.
“Not too many people in cardiac arrest survive, even in places where an ambulance can get right to them or when a public AED (automated external defibrillator) is available,” Dr. Smith said. “Everything has to line up in that chain of survival to save a life.”
A few factors were in the rescue team’s favor. The weather was beautiful that March day, making it possible to fly a rescue helicopter. The location made it easier for the man’s wife to use her cellphone for the emergency call and to track their location. Two of the couple’s friends were on the ground helping with CPR. And Dr. Smith was available for volunteer duty with the SAR team.
It’s fairly uncommon for physicians to be in the field responding to emergency calls. Dr. Smith has a rare combination of traits that make him a wilderness rescue leader. He’s a colonel in the United States Army Reserve, an emergency department physician at St. Johns’ Health in Jackson, Wyoming, and a world traveler who’s handled a wide variety of emergencies – shootings, avalanches, bear maulings, lightning strikes, swift water rescues and more.
He also is the Medical Director for Rustic Pathways and has traveled the world to ensure student safety on the international travel programs. He has been on Rustic Pathway trips to Kilimanjaro, Fiji, Dominican Republic, and Panama.
His background led him to volunteer for the Teton County Search and Rescue Team that provides services for Teton County, Wyoming and often Grand Teton National Park. He’s been part of the 41-person team since 2004 and currently is its Co-Medical Director.
The group spent more than 5,300 hours providing rescue services in 2023. This included helping lost and injured hikers, mountain bikers, and horseback riders.
Learn more about how SAR teams manage emergencies in diverse environments in our article on SAR operations.
During calls like the chest pain one that led to cardiac arrest, a key decision Dr. Smith and his team have to make involves the right equipment and training. For a helicopter rescue, Dr. Smith says he needs a “24-hour pack” that he carries on his back. It would include backcountry skis, a fire starter and avalanche gear.
“If the helicopter can’t come back and get us, we have to be able to get ourselves out and survive in the backcountry,” Dr. Smith said. “So we’ve got all our own personal gear, and then we have to decide what medical gear we take on top of that. A lot of times it’s limited to pain control medications and splinting supplies. But with chest pain, we decided it needed to be an AED.”
Dr. Smith says without the helicopter they probably wouldn’t have brought the AED because it would take three hours to get there responding on the ground. Even with the helicopter and AED, the chance of a good outcome was low. But Dr. Smith remained focused on the patient who was in front of him.
“I can take care of 99 patients with cardiac arrest who will die, but then have that one out of 100 who lives,” Dr. Smith said. “With those odds, it’s usually not going to be good. But you make the best impact that you can when you can… That’s what really drives me.”
That determination began young and would carry him through that day. Dr. Smith is internationally known as the go-to doctor for many challenges.
He has assisted several government agencies at two presidential inaugurations. He’s traveled to remote areas like South Sudan to work with local medics.
Over the years, Dr. Smith has played a key role in how emergency care is handled in the field. These initiatives have improved survival rates and led to the push for devices like AEDs in public settings. But this progress took many years. Dr. Smith first had to undergo extensive training that allowed him to perfect his skills.
“Whether there’s bullets flying at you or a bear chasing you or you’re on an avalanche path, a lot of the care principles are the same.”
Laying the Foundation for a Search and Rescue Career
Dr. Smith grew up on a 22,000 cattle ranch in a remote area of southeast Wyoming near the town of Wheatland. He also spent time on a larger 44,000 acre ranch that was nearby.
On these ranches, young Will learned how to ride horses and pay attention to his surroundings. From early childhood, he could explore without getting lost and operate large farm equipment.
“I learned personal responsibility and how to take care of yourself in a remote environment,” Dr. Smith recalled.
In high school, he found his passion when he took an EMT class. Dr. Smith says he caught the “medicine bug,” and that kept him motivated and guided his wilderness medicine career.
To use his EMT skills, he had to learn to take care of patients directly. Ambulance crews under 21 were not allowed to drive an ambulance, so to go on calls, teenager Will had to become an EMT-Intermediate with even more advanced medical skills to help patients, before he could even drive the ambulance. He also worked on the ski patrol outside Laramie, Wyoming to learn more about austere environments.
“I enjoyed being outdoors, so marrying up medical skills with wilderness skills made sense,” Dr. Smith said.
After high school, he majored in molecular biology and pre-medicine at the University of Wyoming. Following graduation, he hit a bump in the road.
Dr. Smith didn’t get into medical school the first year he applied, so instead he trained to be a paramedic with the Colorado Association of Paramedic Education in Denver, Colorado. He says his backup plan was to be a flight paramedic. While a slight detour, this additional pre-hospital education had contributed immensely to his knowledge as a physician medical director for many organizations.
The next year, a program called WWAMI came to the rescue. It allowed Dr. Smith to get a medical degree from the University of Washington. This program’s WWAMI acronym comes from the five states that participate – Washington, Wyoming, Alaska, Montana and Idaho. He also went on to become board certified in pre-hospital EMS – Emergency Medical Systems.
“Some medical directors never respond directly to scenes, but EMS is now a board certification where you are able to practice out there in the field,” Dr. Smith explained. “You’re not just supervising others but actually using your basic emergency care skills and sometimes higher level skills.”
The WWAMI program allowed Dr. Smith to practice medicine in several states. The students do clinical rotations throughout the WWAMI region, so that included stints in Anchorage and elsewhere.
“I even snuck down to Australia for seven weeks to do an international medicine rotation,” Dr. Smith said. “It gave me a good opportunity to go practice medicine in all these different locations.”
After medical school, Dr. Smith perfected many of his medical skills during his military service. In his first year of residency, he joined the Army Reserve in its medical corps. During deployments he began to develop specialized skills that he would later use in the civilian world.
“The Army Reserve has definitely taken me to a lot of unique and extraordinary places,” Dr Smith said. “Whether there’s bullets flying at you or a bear chasing you or you’re on an avalanche path, a lot of the care principles are the same.”
In the military, these principles are learned during training in Tactical Combat Casualty Care. One important life-saving technique on the battlefield is controlling bleeding. In the civilian world, this was once not as much of an initial priority.
“When I was an EMT in high school, a tourniquet was considered a last resort, so we virtually never put one on a patient,” Dr. Smith noted. “Then we found out through military conflict that tourniquets save lives with very little side effects. So now it’s common to use a tourniquet first in wilderness medicine.”
The change in procedures led to “Stop the Bleed” campaigns, and now there are often “stop the bleed” kits (including tourniquets) with public AEDs. And that is not the only lesson learned from military medicine.
On the battlefield, sometimes the first priority is to extricate a patient from the scene. That also is a key decision in other austere places where it may be dangerous to stay put, like during an avalanche.
“You need to decide what’s the best medical procedure to do at the time. Sometimes it’s more important to get a patient to a safe location,” Dr. Smith said.
Another crossover is the need for outdoor skills, such as climbing, swimming, and rappelling. Dr. Smith is also SCUBA certified as a rescue diver and hyperbaric medical officer. He also enjoys mountaineering, trekking and climbing, and has scaled Mt. Kilimanjaro in Tanzania and Mt. Orizaba in Mexico. And now he can ensure his own safety in a variety of challenging settings.
“If you can’t take care of yourself in the wilderness, whatever or wherever that may be, then you can’t really take care of your patient very well. So that again comes back to my roots of growing up on the ranch and learning how to take care of myself – knowing how to rock climb, how to scuba dive, how to avoid an avalanche, and how to go above and beyond the basics,” Dr. Smith said.
Slowly but surely he was learning what it takes to save lives in every imaginable scenario.
“When you have a massive casualty event above 13,000 feet, you have to change it up a little bit.”
Facing Lightning Strikes, Hot Air Balloon Crashes And Other Unexpected Crises
As the years progressed, Dr. Smith’s medical expertise would be tested in a number of unusual emergencies. One of the earlier events happened in 2010, when 17 mountain climbers were struck by lightning when a sudden storm popped up in Wyoming. And all of them were near the summit of the Grand Teton.
“This is a unique mass casualty event with having so many patients when you usually only have one or two at a time,” Dr. Smith said. “When you have a massive casualty event above 13,000 feet, you have to change it up a little bit.”
The first 911 call came from a group of five climbers, but it was lost before the dispatcher could get much information. A second call from a group of eight reported that one person fell over a ledge, two were unconscious and one couldn’t move his legs. A third party had four people with one unconscious and two paralyzed.
Dr. Smith took over the role of medical group supervisor and a massive rescue mission developed. Helicopters used a short haul system to move people off the mountain. They were carried by ropes underneath the helicopters, much like what Dr. Smith did in his cardiac arrest call.
Eventually they got the patients evacuated to the hospital. One died before the rescuers’ arrival from the fall. The others recovered from their various burns and orthopedic injuries. The paralysis was temporary, so the climbers affected by that recovered. Overall, it was a massive success in an extreme situation.
Such unusual challenges would prepare the team for future events. A decade later, Dr. Smith and his team faced another unexpected emergency when three air balloons crashed at the same time.
A sudden weather change created a microburst with strong winds that pushed the balloons to the ground. Immediately the 911 center received a flurry of emergency calls.
“I think the dispatchers are the forgotten link sometimes in that pre-hospital realm. But they are really where the care starts. We’ve got some amazing dispatchers,” Dr. Smith said.
The dispatchers gathered information on locations and the number of patients. First, the rescue team thought there was only one balloon, but the ground crew for the balloon company told them there were three balloons. They also shared client lists, so they knew there were a total of 41 possible patients.
Dr. Smith raced to the scene in his response vehicle that has enough equipment for ICU level care for one patient. Complications that day included possible danger from the balloon’s propane tanks, along with how spread out the balloons were. The ground crew turned off the tanks to avoid explosions, and the rescue team used a drone to help map out the locations.
After triage, seven patients needed to go to the hospital. And this is one event where Dr. Smith followed them.
“I went to the scene initially, helped take care of patients and organize the field medical response, flew the drone to get situational awareness on the scene, and then went to the ER and helped care the patients once they all got to the hospital,” Dr. Smith said.
That ability to do it all during a very long day has served Dr. Smith well, as he’s used these various skills to travel to various remote regions around the world.
“You have to decide what’s your acceptable risk level. If you want zero risk, you may stay on your couch but then have a heart attack there.”
Finding Medical Solutions in Remote Regions of the World
Dr. Smith says the most remote region he has visited is Easter Island. The volcanic island is a Chilean territory, but it’s a six-hour plane ride from the mainland. About 2,100 miles separate Chile from Easter Island and its surrounding islets. Easter Island is considered one of the world’s most isolated inhabited islands.
Dr. Smith was asked to go to the island as a medical doctor for a solar eclipse trip. About 100 people, mostly over the age of 50, were attending.
“The medical resources on the island were quite limited – just a very small clinic with limited capability,” Dr. Smith said.
That meant Dr. Smith had to bring what he could in a Pelican case. He packed a number of medicines but was unable to carry equipment like an AED due to several limitations.
“If someone has a cardiac arrest in such a remote location, there’s only a limited amount of care I’m going to be able to provide,” Dr. Smith said.
Still, Dr. Smith adds that the benefits of traveling greatly outweigh the risks. So he doesn’t think most worries should stop people from seeing the world.
“You have to decide what’s your acceptable risk level. If you want zero risk, you may stay on your couch but then have a heart attack there,” Dr. Smith said.
Luckily there were no major incidents on Easter Island. That has not been the case in other countries where he’s traveled, particularly for the military. During his deployments in Iraq, he saw his share of catastrophic injuries. But he found his residency in Milwaukee prepared him for many of the challenging cases he has seen.
“When I was working in the Baghdad ER, it was pretty much like working in an inner city emergency department,” Dr. Smith said. “Some of the bigger blast injuries were a little different, but the shootings are similar to what we see in the U.S.”
Elsewhere, his volunteer work in Wyoming has helped him provide assistance in other austere locations. For Rustic Pathways, he helped a student who experienced altitude sickness while climbing Mount Kilimanjaro. He also was able to give guidance in a case where a student had a seizure in Fiji.
“I’ve been to the Fiji lodgings, so I understood what the house looked like. I understood there was a swimming pool there, so obviously we didn’t want her to do any swimming. Having an understanding of the program locations has been helpful over the years,” Dr. Smith said.
Learning how to judge scene safety is among the skills Dr. Smith teaches students and newer medical personnel in the field. He has a passion for sharing his expertise that saves lives in difficult pre-hospital settings.
Teaching Younger Generations
Dr. Smith is the Medical Director and conducts many classes for an organization called Wilderness Medical Associates International. Since 1982, this organization has been advocating for better medical care in remote environments. Dr. Smith’s educational work takes him to many countries, along with places across the United States.
He recently taught medical students in Mount Hood, Oregon.
“I gave them a talk on how I built my career in wilderness medicine because a lot of them are interested in doing similar things with their future,” Dr. Smith explained. “They wanted to know, ‘How can they get to do all the things that I’ve been able to?’”
Overall, Dr. Smith’s educational and medical work has taken him to six continents. On his bucket list is the one continent where he hasn’t set foot.
“I haven’t been to Antarctica, and I haven’t taken care of a patient in Antarctica. So it’s last on the list of the continents to go to and provide patient care,” Dr. Smith said.
If he makes it there, Dr. Smith is hopeful his different “silos of expertise” will help him in one of the world’s most rugged environments. His work with the emergency department, the army, park service and travel programs has given him his unique perspective on care.
“I found my real niche is being able to cross pollinate best medical practices between all those different things. So it seems like I’ve got a lot of hats, which I do, but so many of them blend together,” Dr. Smith said.
One of his common tidbits of advice is for people who are not medical professionals. If you like traveling to remote places, it’s a good thing to keep his mantra in mind.
“I always use my number one rule – ‘Don’t freak out,’” Dr. Smith said. “If you’ve ever thought about what you’re going to do in a situation, you’re going to be much more prepared. But again, that first thing is just kind of controlling yourself and not freaking out.”
Once you get that down pat, you can embrace the many reasons Dr. Smith loves the outdoors, traveling and helping others. For one, he gets to save lives.
“I always use my number one rule – ‘Don’t freak out.’”
Celebrating a Successful Rescue in Grand Teton National Park
After he arrived for that chest pain call in Wyoming, Dr. Smith used the AED he carried to the scene. By this point, the patient had no pulse. The man would later say, “I really had no pain when I died” – except that he didn’t die.
The shock brought back the patient’s pulse, and the team quickly extracted him by short haul to the waiting ambulance. Still, he wasn’t out of the woods. After he arrived at the cardiac catheterization lab, he went into cardiac arrest again, and they discovered he had a complete blockage of his left anterior descending artery.
The staff shocked the patient again, and again regained a pulse and the cardiologist was able to put a stent in. His treatment was such a success that later the patient and his wife made plans for a biking trip. Dr. Smith and his team received an award from the National Park Service for the rescue. Better yet, they got to meet the patient in person, which doesn’t happen too often.
“There is this podcast called The Fine Line that invites patients we’ve saved and sometimes their family members. So you get to see the case from the opposite side – from the patient and family perspective,” Dr. Smith said.
The patient says he is grateful the rescue team treated him and his wife as family. Not surprisingly, Dr. Smith doesn’t describe such a dramatic rescue experience in a dramatic way. Events that would be a once-in-a-lifetime occurrence for us would just be a day at the office for him.
Still, Dr. Smith says being able to save a life is what keeps him going. It’s what makes his job rewarding. Plus, he can appreciate the beauty of the nature that surrounds him, as he spends another day amid the planet’s most renowned landscapes.
“It brings that sense of adventure and lets you see what’s out there in the world,” Dr. Smith said. “It’s great to be able to explore that and to share it with others.”