Wilderness medical emergency

Wilderness medicine is defined as a medical emergency which takes place in a wilderness or remote setting which is at least 60 minutes away from definitive care (hospital, clinic, etc.) and present unique challenges that may require specialized skills, treatment techniques, and knowledge in order to manage the patient for an extended period of time before being evacuated.

Mass casualty incidents

These are incidents which produce an elevated number of injuries, such as blizzards, earthquake, avalanche, landslide, floods and forest fire. Triage is a concern as well as location of victims who may be in dense foliage, rocky and remote locations or covered in mud, snow and debris. Helicopters are used to access remote locations during natural disasters. In other instances, mass casualties have resulted when parties of climbers or explorers suffer the adverse consequences of human error, with or without complications from inclement weather.

Response

Extrication and evacuation

Main article: Wilderness emergency response

Transporting an injured person out of the wilderness on a stretcher can be a difficult exercise requiring considerable manpower. It is advised that at least one person stay with an injured party and that no one attempt to seek help by travelling alone over inhospitable terrain.

First aid

Wilderness First Aid (WFA) is the specific discipline of First aid which relates to care in remote areas, where emergency medical services will be difficult to obtain or will take a long time to arrive.

Locating the victim precedes assessment and intervention and in the case of wilderness response is often a difficult matter. Specialists in white water rescue, mountain rescue, mine disaster response and other specialties are often employed. In some cases, emergency extrication procedures at incidents such as automobile accidents are required before assessment is possible. Once the location of the victim has been determined, a trained responder has been dispatched and successfully reached the victim can the ordinary first aid process begin. Assessment is then enabled and it follows carefully specified protocols which have been refined through a long process of evaluation.

Specific conditions

• Exposure, sometimes called hypothermia, is a normal hazard of temperate wilderness. It occurs when a person's core body temperature falls below 33.7C (92.6F). If a person is wet, in a mild wind, it can occur in less than an hour at temperatures as high as 15 °C (59 °F).
• Heat syncope: heat exhaustion or sunstroke Both maladies tend to occur during heavy exercise in high humidity, or with inadequate water. Some chronically ill persons enter this state normally.
• Burns There are many types of burns including; scalds, flame burns, flash burns, chemical and electrical burns. Each type of burn can be very variable, effecting different layers of the dermis and can cover varying degrees of the total body surface area (TBSA). For that reason, it can be very hard to treat, especially in remote or harsh environments.
• Cramps There are two basic causes of cramping. One is inadequate oxygenation of muscle, and the other is lack of water or salt. Cramps from poor oxygenation can be improved by rapid deep breathing, and stretching the muscle. Cramps from lack of salt and water can be treated by stretching the muscle, drinking water and eating salt. Cramps occur when lactic acid builds up because of normal anaerobic muscle metabolism. When the muscle burns sugar without enough oxygen, it makes lactic acid. The lactic acid finally becomes concentrated enough to trigger the contraction of the muscle. When the muscle lacks salt, the nerves firing the muscle are unable to recharge properly, causing a similar effect.
• Insect and animal bites
  Main articles: bite (medicine) and bites
• Anaphylactic shock. Insect bites as well as exposure to allergens can trigger anaphylaxis in some people. Anaphylaxis is a life-threatening medical emergency because of rapid constriction of the airway, often within minutes of onset.
• Altitude sickness can begin in susceptible people as low as 8,000 ft. The early symptoms are drowsiness, feeling unwell, and weakness, especially during exercise. Acute mountain sickness can progress to high altitude pulmonary edema (HAPE) or high altitude cerebral edema (HACE).
• Wounds The care of significant wounds in the wilderness presents a great challenge. Lack of access to sterile supplies and hospital care renders useless many aspects of routine wound care. The care of wounds can be broken down into acute care (immediate) and chronic (long term – day to day care).

Certification

Wilderness First Aid is a relatively new field compared to regular or 'urban' first aid. For this reason, there are a number of boards and societies which have been formed in recent years to attempt to establish normalized standards for wilderness first aid certification and wilderness medicine in general. Currently, there are no "National Standards" for wilderness medicine, however one of the most popularly followed curricula is the "National Practice Guidelines for Wilderness Emergency Care" published by the Wilderness Medical Society in 2010.

The American Red Cross Wilderness & Remote First Aid (r.2010) certification is valid for 2 years.

In Canada the first WFA course were taught in the mid 1980s and the first organization (now defunct 1986 to 1998) to adopt standards was the Wilderness First Aid and Safety Association of BC.

The Boy Scouts of America now requires at least two (2) individuals per crew be currently certified in Wilderness First Aid and Adult CPR/AED for all High-Adventure treks, and at least one person be certified for all Scout-related backpacking & camping activities where a BSA Tour Plan is filed.

In US Scouting

As of 2014, all official BSA high adventure programs (such as Philmont) will require that at least two people (either an adviser or a youth participant) in each crew be currently certified in Wilderness First Aid or the equivalent and Adult CPR/AED from the American Red Cross, American Heart Association, Emergency Care and Safety Institute (ECSI), or American Safety & Health Institute (ASHI). At least one person must be certified in both WFA and CPR for all backpacking and camping activities where a Tour Plan must be filed. The preferred course is the American Red Cross Wilderness and Remote First Aid, which is a sixteen-hour course designed to help in situations where help is not readily available. Several hours may be required for high adventure staff to reach a remote backcountry location after a message is delivered to the nearest staffed camp. First aid and CPR training will result in proper and prompt attention being given to injuries and/or illnesses. Participants must present current certification cards upon check in to verify this requirement.

First responders

A Wilderness First Responder (72- to 80-hour course) certification is both a higher certification than a Wilderness First Aid (16- to 20-hour course) certification, and may also be used to upgrade an Emergency Medical Technician to a Wilderness Emergency Medical Technician. Outdoor Emergency Care is a National Ski Patrol certification, but it doesn't fully meet the requirements for a WFR certification.

Golden hour

In emergency medicine, some advocates assert that there is a golden hour which refers to a time period lasting from a few minutes to several hours following traumatic injury being sustained by a casualty, during which there is the highest likelihood that prompt medical treatment will prevent death. While most medical professionals agree that delays in definitive care are undesirable, recent peer reviewed literature casts doubt on the validity of the 'golden hour' as it appears to lack a scientific basis. Dr. Bryan Bledsoe, an outspoken critic of the golden hour and other EMS "myths" like critical incident stress management, has indicated that the peer reviewed medical literature does not demonstrate any "magical time" for saving critical patients.

Training and certification organizations

Main article: Wilderness medicine

A number of fellowships are available for emergency medicine graduates including prehospital medicine (emergency medical services), hospice and palliative care, research, undersea and hyperbaric medicine, sports medicine, ultrasound, pediatric emergency medicine, disaster medicine, wilderness medicine, toxicology, and Critical Care Medicine.

• Wilderness Medicine Institute (WMI) of NOLS
• Wilderness Medicine Outfitters (WMO)
• Stonehearth Open Learning Opportunities (SOLO)
• True North Wilderness Survival Schhol - http://www.ExploreTrueNorth.com
• The Center for Wilderness Safety (CWS)
• American Red Cross - http://www.redcross.org/
• Longleaf Wilderness Medicine - http://www.longleafmedical.com/ (LWM)

Characterization of specific wilderness medical emergencies

Main articles: List of wilderness medical emergencies and Diagnosis

• Eye injuries may result from branches, bullets, rock fall or animal attacks.

See also

• List of medical emergencies
• List of wilderness medical emergencies
• First aid
• Ski patrol
• National Ski Patrol
• Oxygen first aid
• Medical emergency
• Emergency medical services
• Triage
• Paramedic
• Medic
• Certified first responder

Further reading

• Where There is No Doctor covers the whole range of medicine, and is targeted to developing countries.
• Wilderness & Environmental Medicine (WEM) journal is published by Elsevier Publishing. Manuscripts should be uploaded to our Elsevier web address http://ees.elsevier.com/wemj.
• Cymerman, A; Rock, PB. Medical Problems in High Mountain Environments. A Handbook for Medical Officers. USARIEM-TN94-2. US Army Research Inst. of Environmental Medicine Thermal and Mountain Medicine Division Technical Report. Retrieved 2009-03-05.
• Muza, SR; Fulco, CS; Cymerman, A (2004). "Altitude Acclimatization Guide.". US Army Research Inst. of Environmental Medicine Thermal and Mountain Medicine Division Technical Report (USARIEM-TN-04-05). Retrieved 2009-03-05.

External links

• Medline. Search on wilderness.
• wilderness medicine wikispace