The intersection of wilderness/austere medicine and conventional urban and suburban pre-hospital care have been approaching an unavoidable intersection for years. The existence of ski patrol providing medical care on more and more isolated mountain resorts, search and rescue teams reaching further into the wilderness setting to access their patients than ever before, and the acceptance of a much larger population recreating in more remote environments has prompted a medical movement in the last two decades that is only gaining momentum as the existence of serious medical issues become inevitable in less than ideal environments. The future of how we aim to deal with that inevitability exists in adapting to the need for organized and sufficient care in the backcountry setting, and empowering providers to do so.