Welcome to the book I’ve long wanted to write. Over the past 25 years, I’ve worked as a guide, educator, researcher, and clinician. My path has taken me across all four hemispheres—through mountains, deserts, jungles, rivers, and oceans. I’ve rowed a raft through the Himalaya, slept in the sands of the Sahara, and built Island Fly to guide serious anglers in some of the best fisheries on the planet. These experiences have shaped how I think, teach, lead—and how I move through the world.

This book is for guides, wilderness responders, expedition leaders, and anyone working in remote settings. It won’t focus much on complex techniques or equipment—there are already excellent resources that already do, and in true wilderness settings far from care, advanced procedures rarely change outcomes.

While I have deep respect for herbalists, naturopaths, survivalists, and indigenous healers, this isn’t a survivalist manual or a guide to traditional remedies. Where treatments are discussed, I’ve focused on what’s commonly taught in wilderness responder courses or found in base camps, fishing lodges, or the kitchen box on a multi-day river trip. The book focuses on the principles and science that shape decision-making in the field—the “why” behind adventure medicine: why certain calls are made; why some risks aren’t  worth taking; and why real improvisation relies on a deep understanding of how the body responds to stress, illness, and injury.

This book assumes a baseline familiarity with core medical concepts on the part of the reader and is meant to supplement that knowledge, not replace it. The structure is based on questions I’ve asked over the years; and the ones that have come from students, colleagues, guests, and fellow guides. It covers topics often left out of standard training, including the guiding philosophy, women’s health, psychiatric emergencies, and the medical realities of remote care. Scattered throughout are real cases from my own experiences—situations that pushed past protocol and forced improvisation in places far from help.

Wilderness medicine isn’t just a guiding skillset—it’s a foundation built on knowledge, experience, and judgment that gives guides the confidence to lead with clarity—even in the face of uncertainty.

What follows is my gift to you—lessons learned through experience; some mistakes; and the wisdom of mentors, colleagues, and clients. I hope it gives you the tools and perspective to lead not only with competence—but with intention, clarity, and respect for the places and people you meet along the way.

Enjoy.

sjm