Position Statements
Statements supporting the institutes position on key matters
IAES Postion Statements
Position statements issued by the Institute for Austere & Emergency Sciences (IAES) provide formal guidance on key educational, clinical, and operational issues relevant to austere and expeditionary medical practice. These statements are developed to clarify IAES standards, uphold professional integrity, and support consistency across certified training programmes and affiliated organisations. Each position reflects current best practice, expert consensus, and the unique realities of providing care in remote, resource-limited, or delayed-access environments. While they are not legally binding, IAES position statements inform accreditation decisions, instructional expectations, and the scope of recognised qualifications.
The Institute for Austere & Emergency Sciences (IAES) recognises the importance of both wilderness medicine and austere medicine as critical sub-disciplines within remote healthcare. While closely related, the two are not interchangeable. IAES supports clarity in terminology to ensure that training, practice, and professional development are appropriately contextualised.
Wilderness Medicine:
Wilderness medicine is the provision of healthcare in remote or outdoor environments where traditional medical infrastructure is not immediately accessible. It focuses on field improvisation, environmental exposures (e.g., hypothermia, altitude, bites/stings), and delayed evacuation scenarios. Wilderness medicine often occurs in natural settings such as mountains, forests, oceans, and deserts—typically in recreational, exploratory, or expedition contexts.
Austere Medicine:
Austere medicine refers more broadly to the provision of healthcare in environments characterised by scarcity—of resources, personnel, infrastructure, or logistical support. These settings may be remote, chaotic, or under-resourced due to geography, disaster, conflict, or economic limitations.
IAES adopts the definition and framework informed by the Oxford Handbook of Wilderness & Expedition Medicine, which identifies seven types of austere medical environments:
- Wilderness – Remote natural areas without immediate access to care or communication.
- Disaster – Regions affected by natural or man-made disasters where infrastructure is compromised.
- Conflict – Active war zones or post-conflict areas with instability and limited healthcare access.
- Humanitarian – Low-resource settings, often with complex emergencies and vulnerable populations.
- Remote – Geographically isolated communities without consistent medical support.
- Expedition – Self-contained teams operating independently in field or scientific expeditions.
- Space/Extreme Environments – Environments such as polar regions or space missions, where conventional systems cannot function.
At IAES, we assert that wilderness medicine is a vital subset of austere medicine, but not its entirety. Austere medicine encompasses a wider operational, ethical, and logistical scope—including disaster response, humanitarian aid, expeditionary operations, and remote-area healthcare delivery.
By recognising this distinction, IAES ensures that its training frameworks, certifications, and professional designations reflect the full range of challenges practitioners face in austere, expeditionary, and extreme environments.
The Austere First Aid (AFA), Austere Advanced First Aid (AAFA), Austere First Responder (AFR), and Austere Medic (AM) programmes are designed to meet the needs of individuals operating in environments where conventional emergency services may be delayed, unavailable, or overwhelmed. These programmes are part of the IAES framework for equipping responders with the clinical skills, judgment, and leadership capacity required in austere and expeditionary settings.
Levels of Practice
Austere First Aid (AFA) is intended for the individual enthusiast—such as hikers, travellers, or outdoor hobbyists—who may become an accidental rescuer in remote or disrupted settings. This course equips participants with essential skills for initial response in situations where help is expected to arrive within several hours but may be delayed.
Austere Advanced First Aid (AAFA) is suited for those wishing to expand their capabilities beyond basic care. It is designed for enthusiasts, team members, and support staff who may serve as occasional or assistant responders. This includes expedition participants, outdoor instructors, or team members supporting fieldwork in low-resource environments.
Austere First Responder (AFR) is designed for the intentional rescuer—those assigned a primary response role. This includes expedition medics, field team leaders, humanitarian aid workers, remote researchers, rural health volunteers, security personnel, and community responders operating in prolonged care or delayed evacuation scenarios.
Austere Medic (AM) certification is designed for the designated lead caregiver in remote, resource-limited, or prolonged care environments. This includes wilderness EMTs, NGO medical staff, remote clinic providers, and tactical or rural medics tasked with delivering frontline medical care where higher-level support may be unavailable for days or weeks. Austere Medics are trained to initiate complex treatment protocols, manage critical illness and injury, and coordinate extended care and evacuation logistics.
Scope, Clinical Oversight, and Practice Authorisation
While IAES programmes are built on what is medically indicated in austere contexts, the legal use of these skills is ultimately determined by local regulation, organisational policy, and the practitioner’s qualifications.
IAES strongly encourages the use of formal standing orders and documented advanced practice protocols for any responder expected to operate beyond conventional first aid scope—particularly for those trained at the AFR and Austere Medic levels.
Such protocols should be:
Developed in collaboration with a qualified medical advisor or medical director, depending on the operating context (e.g. expedition consultant, NGO clinical lead, staff physician).
Reviewed and approved within the responder’s organisation or mission structure, with clear indications, limitations, and documentation requirements.
Aligned with the IAES scope of practice standards, which define expected competencies for each certification level.
Tailored to the specific risks, capabilities, and evacuation contingencies of the deployment environment.
These standing orders may cover interventions such as:
Field pharmacology (e.g. analgesia, epinephrine, antibiotics)
Protocol-directed procedures (e.g. wound packing, joint reduction, field diagnostics)
Escalation protocols for telemedicine consultation or delayed evacuation scenarios
By formalising authorisation and scope through clear documentation, IAES-accredited providers and their affiliated responders are better positioned to deliver safe, ethical, and effective care, while reducing legal ambiguity and risk.
Conclusion
The IAES training pathway prepares individuals for a spectrum of responsibility, from first aid through to advanced, prolonged care delivery. While training focuses on what is medically necessary, implementation must always reflect what is legally and operationally permitted. Through the responsible use of medical oversight, documented standing orders, and a commitment to role clarity, IAES-certified practitioners and their organisations can safely extend the reach of medical care into the most remote and austere environments.
The Institute for Austere & Emergency Sciences (IAES) supports the responsible use of online education for professional development and theoretical learning. However, we draw a clear and necessary distinction between online CPD and certification-level training programmes that are intended to prepare practitioners for independent practice in austere, remote, and resource-limited environments.
Online CPD – Supported with Caveats
IAES recognises the value of online continuing professional development (CPD) for refreshing knowledge, engaging with emerging research, and maintaining familiarity with evolving best practices. CPD modules delivered online may include:
- Case reviews
- Journal-based learning
- Protocol updates
- Environmental or biome-specific briefings
- Remote seminars or webinars
While these contribute meaningfully to lifelong learning, they are not a substitute for hands-on training, and cannot be used to revalidate a lapsed or expiring certification where in-person competencies are required.
Online-Only Certification – Not Recognised
IAES does not recognise or endorse online-only certification courses for any programme that includes mandatory face-to-face components, such as:
- Austere First Aid (AFA)
- Austere Advanced First Aid (AAFA)
- Austere First Responder (AFR)
- Austere Medic and above
These programmes are designed to ensure graduates can function independently in high-consequence, high-complexity environments. Skills such as:
- Patient assessment and clinical decision-making
- Scenario-based triage and field leadership
- Safe application of interventions (e.g., haemorrhage control, airway management, medication administration)
- Communication and evacuation planning under pressure
require supervised, face-to-face instruction and assessment. These cannot be reliably taught or evaluated through asynchronous or remote-only formats.
Certification Integrity and Risk
Granting certification without in-person skill verification undermines the credibility of the qualification, endangers patients, and exposes both the provider and certifying body to legal and ethical risk. In austere environments, there is no margin for untested skill.
Policy Summary
| Training Type | Online-Only Permitted? | In-Person Mandatory? |
|---|---|---|
| Certification (AFA, AAFA, AFR, Austere Medic) | ❌ Not accepted | ✅ Required |
| CPD / Refreshers / Knowledge Updates | ✅ Permitted with guidance | Optional unless specified |
Conclusion
IAES encourages innovation in blended and digital learning. However, where lives depend on competence, online-only certification is insufficient. Certification must be earned through in-person, scenario-driven, supervised assessment, ensuring that responders are not only knowledgeable—but capable.
The Institute for Austere & Emergency Sciences (IAES) develops and accredits educational programmes based on what is clinically and operationally indicated in austere, remote, or prolonged field care contexts. Our curricula are structured around the knowledge, skills, and decision-making frameworks necessary to provide safe, effective care when conventional systems are delayed, unavailable, or overwhelmed.
IAES-certified programmes prioritise medical need, not jurisdictional restriction.
This means that some procedures, medications, or interventions taught within IAES-accredited courses may not fall within the legal or licensure scope of all learners in all countries, roles, or employment contexts.
Local Responsibility for Legal Use of Skills
IAES affirms that it is the responsibility of each training provider to ensure that their course delivery and assessment practices comply with applicable laws and professional regulations in their jurisdiction. Similarly, it is the individual learner’s responsibility to understand and respect the legal limits of their own practice, whether determined by:
National or regional health regulations
Organisational standing orders or protocols
Licensure or certification frameworks
Role-specific authorisations in humanitarian, government, or expedition contexts
IAES Emphasis on Scope Awareness and Professional Ethics
IAES curricula include instruction on scope of practice awareness, legal frameworks, and ethical decision-making. This ensures that graduates are not only equipped with practical skills, but also understand the importance of:
Practising only within their authorised limits
Seeking appropriate supervision or oversight where required
Clearly documenting decisions and recognising when to escalate care
Summary
IAES provides training based on what is medically indicated in the field—not what is universally permitted in every legal jurisdiction. Training is designed to prepare responders to act competently and ethically when lives are at stake, and to do so with full awareness of the legal, professional, and operational frameworks in which they function.