Wilderness medical emergency

Medical emergencies in areas of wilderness present particular challenges that can requires specialised responses.

Contents 1 Mass casualty incidents 2 Response 2.1 Extrication and evacuation 2.2 First aid 2.2.1 Specific conditions 2.2.2 Certification 2.2.3 In US Scouting 3 First responders 4 Training and certification organizations 5 Characterization of specific wilderness medical emergencies 6 Bibliography 7 See also 8 References 9 External links

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 have suffered adverse consequences of human error, with or without complications from inclement weather.^[1]

Response

Extrication and evacuation

Transporting an injured person out of the wilderness on a stretcher can be a difficult exercise requiring considerable manpower.^[2][3] 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.^[2]

First aid

Wilderness first aid 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.

• 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.^[4] Acute mountain sickness can progress to high altitude pulmonary edema (HAPE) or high altitude cerebral edema (HACE).^[4]

• WoundsThe 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 is 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.^[5]

The American Red Cross Wilderness & Remote First Aid (r.2010) certification is valid for 2 years.^[6]

In Canada the first wilderness first aid course were first taught in the mid 1980's and the first organization (now defunct 1986 to 1998) to adopt standards was the Wilderness First Aid and Safety Association of BC.^[7]

The Boy Scouts of America is now also requiring a Wilderness First Aid certification for anybody who goes on a High-Adventure trek.^[8]

In US Scouting

"Philmont requires that a least one person, preferably two, (either an advisor or a youth participant) in each crew be currently certified in Wilderness First Aid or the equivalent* and CPR from the American Heart Association, the American Red Cross, Emergency Care and Safety Institute (ECSI), or American Safety & Health Institute (ASHI). The preferred course is the American Red Cross, Wilderness First Aid, which is a sixteen-hour course designed to help in situations when 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. You must present current certification cards upon check in to verify this requirement.”

First responders

A first responder may be a certified Wilderness First Responder, a Wilderness Emergency Medical Technician, a general Emergency Medical Technician or other person.^[9] A less technical credential is offered via the "National Practice Guidelines for Wilderness Emergency Care" published by the Wilderness Medical Society.^[10] These parties, in accordance with their different level of training, administer Wilderness first aid.^[11] 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.^[12] 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.^[13]

Training and certification organizations

• The American Academy of Emergency Medicine (AAEM) restricts its membership to board certified specialists in emergency medicine, and as of 2009 has over 6000 members. It promotes the independence of emergency physicians and seeks to limit the interference of corporations and other outside groups in the doctor-patient relationship.
• The American College of Emergency Physicians (ACEP) is the oldest and largest professional organization. Originally founded in 1968, it now has over 25,000 members, although some became members before board certification in Emergency Medicine was required.^[14][15]
• The Association of Emergency Physicians (AEP) offers membership to any practicing emergency physician regardless of training.^[16]

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.^[17]

• Wilderness Medical Society (WMI)

• Wilderness Medical Institute of NOLS (WMI)

• Wilderness Medical Associates (WMA)

• Center for Wilderness Safety (CWS)

• Canadian Wilderness Medical Training (CWMT)

• Wilderness Medicine Training Center (WMO)

• Stonehearth Open Learning Opportunities Wilderness Medicine (SOLO)

• Slipstream First Aid

Characterization of specific wilderness medical emergencies

• Eye injuries may result from branches, bullets, rock fall or animal attacks.^[18]

Bibliography

• 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.

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

References

External links

• Medline. Search on wilderness.

wilderness medicine wikispace