A wilderness medical emergency is a medical emergency that takes place in a wilderness or remote setting affinitive care (hospital, clinic, etc.). Such an emergency can require specialized skills, treatment techniques, and knowledge in order to manage the patient for an extended period of time before and during evacuation.[1]
YouTube Encyclopedic
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Wilderness Medicine | Patient Assessment
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Wilderness Medicine | Usable Ankle Injury
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Whats in a Wilderness Medical Kit
Transcription
Hi, I'm Todd Schimelpfenig. I'm the curriculum director for the wilderness medicine institute at NOLS. We are going to shoot an educational video here today to demonstrate our patient assessment system and then our focused spine assessment, our tool for gathering information and making a decision about whether we need to continue spine immobilization in a patient who's got a spine mechanism of injury. We've got a beautiful day here at zero degrees fahrenheit outside, so we are going to be able to demonstrate how we do this, manage the cold, keep the patient in a sleeping bag, zip and unzip layers, deal with our hands and body substance isolation, and gloves in a real winter environment. We hope you enjoy the video. You can totally climb this. No, I can't do this. Do it. I bet you can. You climb harder than this all the time. This is just like a 5.Tree. Oh yeah, you totally got it. Oh yeah, go big, go big! I did it! Oh Jeeze! Charlie! Are you okay? Uh. I think so. Okay, that was quite a fall. I'm going to go get help. Lay still and don't move. >>Okay. This is my buddy. He fell out of the tree up there and landed on his back. From all the way up there? Like 10 or 15 feet? Okay. The scene looks safe to me. I just see him. Is there anybody else who is hurt? No. Nobody else. I have gloves in my pocket. Do you have gloves as well? >> I've got gloves in my pocket. Hi Charlie. I'm Shana. I'm wilderness EMT and a friend of Travis'. Can we help you? Yes. Great. And you remember Travis? Yup. What's your last name Charlie? Manganiello. And what happened to you? >> I was up in the tree and I just fell down. Can you open your mouth and stick out your tongue? Did you bite your tongue? Do you feel like you have any broken teeth? >> No. Any food or gum in your mouth? >> No. Okay. Take a big deep breath for me. Is that painful or difficult? No. Im going to go ahead and just see if I can find a pulse here at your wrist. You are nice and warm and you have a good strong pulse. Do you feel like you are bleeding anywhere? No not at all. Okay, do you mind if I get underneath this waterproof layer and I double check? Go ahead. Okay. I'm just going to reach my hands in underneath these clothes. Okay. No blood. I'm just going to reach my hands down the side of your pants. Okay? Okay. I'm not finding any obvious blood. Charlie, I'm just going to peel back your hat for a second. So no obvious bleeding. You took a pretty big fall, Charlie, so what we are going to do is keep you stabilized until we can do more assessment, okay? >> Okay. Is there anything that is hurting you right now? No. Okay Travis. Let's consider E, expose and the environment. He's not complaining of any injury, so there is nothing for us to expose, and though it is cold outside, the environment does not pose an immediate threat to life so we'll attend to getting him off the snow after we've completed a head to toe exam. I'm just going to peak inside your ear. Nothing coming out. No bruising back there. Go ahead and bite down. Does it hurt your jaw at all? Not at all. Okay great. I'm going to move your glasses for just a minute. Close your eyes. Open up your eyes. Pupils look round, equal, and reactive to light. I'm going to unzip you one more time and take a look at your neck. I don't see any obvious injury. You don't wear any medical alert necklaces, bracelets, anklets, do you? No. I'm going to check your shoulders. How does that feel? Fine. >> Here? Good. I'm going to put my hands right up in your armpits. Take a big deep breath. Any pain? No. Second one. Any pain? Nope. Final one. No pain? Okay great. Do me a favor and point to your belly button. Alright I'm going to press on your belly. Anything uncomfortable? Nope. Check your pelvis. Is there any reason I need to check your genitals? Did you injure them on the fall? I don't think so. Legs feel good? Yup. Go ahead and push down on the gas. Pull up for me. Im gonna go ahead and unlace and loosen up your boots so I can reach my fingers in there. Okay? Okay. Okay Charlie. Both of your feet feel warm to me. Do they feel warm to you? Yes. Can you tell me what side of your foot I am touching? The inner side or right side. On which foot? The left foot. How about here? Can you tell me what I am pinching? The right big toe. Okay great. So we have good circulation, sensation and motion in his feet. I'm going to leave your shoes undone because eventually we are going take those boots off and get you into a warm sleeping bag. Okay? Okay. Let me finish up with your arms. Give my fingers a squeeze. Good. Wiggle your fingers. Your hands feel nice and warm to me. Do they feel warm to you? Yes. Nice strong pulse. So good circulation, sensation, and motion in the hands as well. So I think what I would like to do Travis is let's roll him up on his side and check his back and we'll get him back on a pad and a sleeping bag when we do that. So Travis, what I want to do is roll him up on his side. Let's make sure we roll him a little more than vertical so we can get all of this packaging underneath him. I'm going to zip your jacket, Charlie, so that I can feel along your spine. I'm going to take your shoes off so that when we get you back down we can get your feet tucked into that sleeping bag. Does that work for you? Yes. So I'm going to unzip this one all the way. And this one as well because I think I can feel through this fairly thin layer. Your job, Charlie, is to give yourself a big hug. Okay excellent. And can you cross this right foot over your left leg? Okay, we are going to go on your count. We will go on my three. One, two, three. So Charlie, I'm just going to walk my fingers down your spine. You tell me if I cause you any discomfort or if i'm not on your spine. Am I still on your spine? Yes. No pain? No pain. I'll check the rest of your back. Good? >> Good. Okay, on your count, Travis. One, two, three. Can you bend this knee for me, Charlie? Actually bend both of them. Great. I'll take this boot off. Go ahead and bend your knees a little bit more. Let's get your feet tucked in here. Go ahead and rest your legs on this bag to get them off the snow. Is that comfortable for you? Yup. Alright, so Travis, on the head to toe exam I didn't find any pain, any obvious wounds, or deformities. How about vital signs? His vitals look great at 1/12. He was awake and oriented to who he is, where he is, what time of day it is, and what the events were leading up to his fall. His heart rate was 76 strong and regular. His respiratory rate was 16 regular and unlabored. His skin was a little pale, but warm and dry. Okay. And his pupils were equal and reactive to light. His pupils were equal, round and reactive to light? Okay, great. So Charlie, we have a couple more questions to ask you. Do you have a chief complaint right now? Is there anything that's hurting you? No. So you took a fall of about 15 feet. That's what we understand. Is that what you understand? Yes, yes. So you have no complaints. No symptoms that you are feeling? You are not tired, hungry, nauseous, headache? Anything like that? None. Okay. Are you allergic to anything like medications? I'm allergic to sulfur drugs. Okay. Have you had any today? No. Okay what happens when you take sulfur drugs? Hives and rash. Are you allergic to any animals? No. Foods? Nope. Do you take any prescription medications? No. How about over the counter medications? Just Advil when I have a sore ankle or leg or if I hurt myself. Okay, have you had any Advil today? No. Do you take any herbal medications or supplements? No. Okay. How about any alcohol or drugs today? No. Okay great. So symptoms, allergies, medications ... past medical history. Do you have any problems with your heart? No. How about your breathing? No. How about belly stuff? Like ulcers? Nope. Ever had a seizure? No. Are you diabetic? Nope. Have you ever hurt your spine or your head before from a fall? Never. Okay great. No pertinent medical history. What's the last thing you had to eat, Charlie? I had a sandwich at lunch. At lunch. So right now it's about one o'clock so do you eat lunch at noon or 11? Right around noon. How about fluid intake today? What have you had? Just coffee in the morning and a glass of water with lunch. Okay, how much exercise have you been doing today? Not much at all. So is that a pretty typical amount of fluid for you? Yes. Okay great. Then urination today? About mid-morning. Okay, normal for you? Yes. Okay. Defecation? Same question. No. Not yet. Okay. Normal though? Yes. Great. So last ins and outs and events. We got the fact that you fell out of the tree. Did anything cause you to fall out of the tree? Did you get dizzy or did you slip? I just slipped on the snow. Slipped on the snow. Okay. Anything unusual in the last 24 hours we need to be aware off? No. Great sample history. Is there anything else you wanted to ask? No. That sounded good to me. Okay. I do you have one last question. How old are you Charlie? I am 25 years old. Thanks. So at this point we have a full physical exam. We have a full set of vital signs and a good medical history and I have no evidence right now that he has any signs or symptoms of an injury to his spine. If we were in town we would maintain spinal stabilization and wait for medical help to arrive. However, since we were in the wilderness, it is appropriate for us to utilize the focused spine assessment to make a decision about immobilization.
Types
Injury and illnesses
- Arthropod bites and stings
- Appendicitis (leading to peritonitis folkloric "what if" for long-distance sailing)
- Ballistic trauma (gunshot wound when hunting)
- Eye injuries (such as from branches)
- Flail chest associated with ice climbing and snowclimbing falls
- Hyperthermia (heat stroke or sunstroke)
- Hypothermia
- Frostbite
- Poisoning
- Food poisoning associated with warm weather expeditions
- Venomous animal bite
- Botanical from mushrooms or "wild greens""
- Severe burn (forest fire)
- Spreading wound infection
- Suspected spinal injury from falls, falling rock, ice
- Traumatic brain injury from falls, falling rock, ice
Infections
- Lyme disease infection
- Malaria infection associated with expeditions
- Necrotizing Fasciitis
- Rabies infection
- Salmonella poisoning associated with expeditions
Neurologic
- Subdural hematoma, associated with rockfall, icefall, falls while climbing, glissade crashes with rocks, mountain bike crashes
Respiratory
- Altitude sickness
- Asphyxia
- Drowning
- Smoke inhalation (related to Forest fire)
- Pneumothorax
- Pulmonary edema associated with high altitude (HAPE)
- Respiratory Arrest associated with neurotoxic bites
Shock
- Anaphylaxis associated with stings
- Hypovolemic shock (due to hemorrhage) associated with climbing falls, kayak crashes, etc.
- Electric shock
Mental health
Few programs teach psychological first aid, although mental distress is commonly encountered by wilderness guides and outdoor athletes.[2]
Mass-casualty incidents
A mass casualty incident (MCI) is a situation in which the number or severity of casualties overwhelms the available medical resources and service providers. Wilderness MCIs may include blizzards, earthquakes, avalanches, landslides, floods and forest fire, but they need not be natural disasters. Mass casualties have also been caused by human error in parties of climbers or explorers, with or without complications from inclement weather.[3] In mass casualty incidents, emergency service providers must prioritize their patients using a process called triage in order to make the most of their limited resources.
Response
Extrication and evacuation
Transporting an injured person out of the wilderness on a stretcher can be a difficult exercise requiring considerable manpower.[4][5] 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.[4]
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.[6] 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.[7]
Responder certifications
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.[citation needed] Specialists in white water rescue, mountain rescue, mine disaster response and other fields are often employed. In some cases, emergency extrication procedures at incidents such as automobile accidents are required before assessment is possible. Only 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.
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.[8]
The American Red Cross Wilderness & Remote First Aid (r.2010) certification is valid for 2 years.[9]
In Canada the first WFA courses were taught in the mid-1980s and the first organization to adopt standards was the Wilderness First Aid and Safety Association of BC (defunct since 1998).[10]
First responders
A Wilderness First Responder (72- to 80-hour course) certification is both a higher certification than a Wilderness First Aid or (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.[11]
Training and certification organizations
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.[12]
See also
References
- ^ "Wilderness Medicine". Farlex. Retrieved 1 February 2017.
- ^ Sohn, Emily (9 November 2020). "When a Psychological Emergency Strikes in the Outdoors". Outside Online. Retrieved 18 November 2020.
- ^ "First Aid and Wilderness Medicine - Training Guide for Natural Disasters". www.thecityedition.com.
- ^ a b Wilkerson, James (2001). "Evacuation". Medicine for mountaineering & other wilderness activities. pp. 25–7. ISBN 978-0-89886-799-2.
- ^ Keller, William (2001). "Transporting the Injured". Keller's Outdoor Survival Guide: How to Prevail When Lost, Stranded, or Injured in the Wilderness. p. 88. ISBN 978-1-57223-266-2.
- ^ American College of Surgeons (2008). Atls, Advanced Trauma Life Support Program for Doctors. Amer College of Surgeons. ISBN 978-1-880696-31-6.[page needed]
- ^ Bledsoe, BE (2002). "The Golden Hour: fact or fiction?". Emergency Medical Services. 31 (6): 105. PMID 12078402.
- ^ McIntosh, SE; Opacic, M; Freer, L; et al. (2014). "Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite: 2014 update". Wilderness Environ Med. 25 (4). Elsevier Inc.: 43–54. doi:10.1016/j.wem.2014.09.001. PMID 25498262.
- ^ "Wilderness and Sports". Red Cross. Retrieved 31 January 2017.
- ^ [1] St. John Ambulance provides a Wilderness First Aid course[failed verification] Archived 20 July 2011 at the Wayback Machine
- ^ Hawkins, Seth C. (2012). "The Relationship Between Ski Patrols and Emergency Medical Services Systems". Wilderness & Environmental Medicine. 23 (2): 106–11. doi:10.1016/j.wem.2012.03.008. PMID 22656654.
- ^ "Subspecialty Certification". ABEM. Archived from the original on 6 September 2011. Retrieved 29 June 2011.
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 Editorial Manager®.
- 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
Media related to Wilderness medical emergencies at Wikimedia Commons
This page was last edited on 25 November 2023, at 19:36