Wilderness medical emergency
Encyclopedia
Medical emergencies in areas of wilderness
present particular challenges that can requires specialised responses.
, 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
.
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.
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.
The American Red Cross Wilderness & Remote First Aid (r.2010) certification is valid for 2 years.
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.
The Boy Scouts of America is now also requiring a Wilderness First Aid certification for anybody who goes on a High-Adventure trek.
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.”
, a Wilderness Emergency Medical Technician
, a general Emergency Medical Technician
or other person. A less technical credential is offered via the "National Practice Guidelines for Wilderness Emergency Care" published by the Wilderness Medical Society. These parties, in accordance with their different level of training, administer Wilderness first aid. 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 trauma
tic 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.
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 wikispace
Wilderness
Wilderness or wildland is a natural environment on Earth that has not been significantly modified by human activity. It may also be defined as: "The most intact, undisturbed wild natural areas left on our planet—those last truly wild places that humans do not control and have not developed with...
present particular challenges that can requires specialised responses.
Mass casualty incidents
These are incidents which produce an elevated number of injuries, such as blizzards, earthquakeEarthquake
An earthquake is the result of a sudden release of energy in the Earth's crust that creates seismic waves. The seismicity, seismism or seismic activity of an area refers to the frequency, type and size of earthquakes experienced over a period of time...
, avalanche
Avalanche
An avalanche is a sudden rapid flow of snow down a slope, occurring when either natural triggers or human activity causes a critical escalating transition from the slow equilibrium evolution of the snow pack. Typically occurring in mountainous terrain, an avalanche can mix air and water with the...
, landslide
Landslide
A landslide or landslip is a geological phenomenon which includes a wide range of ground movement, such as rockfalls, deep failure of slopes and shallow debris flows, which can occur in offshore, coastal and onshore environments...
, floods and forest fire. Triage
Triage
Triage or ) is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate,...
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
Weather
Weather is the state of the atmosphere, to the degree that it is hot or cold, wet or dry, calm or stormy, clear or cloudy. Most weather phenomena occur in the troposphere, just below the stratosphere. Weather refers, generally, to day-to-day temperature and precipitation activity, whereas climate...
.
Extrication and evacuation
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 is the specific discipline of First aidFirst aid
First aid is the provision of initial care for an illness or injury. It is usually performed by non-expert, but trained personnel to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care...
which relates to care in remote areas, where emergency medical services
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
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
Mountain rescue
Mountain rescue refers to search and rescue activities that occur in a mountainous environment, although the term is sometimes also used to apply to search and rescue in other wilderness environments. The difficult and remote nature of the terrain in which mountain rescue often occurs has resulted...
, 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
First aid
First aid is the provision of initial care for an illness or injury. It is usually performed by non-expert, but trained personnel to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care...
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 hypothermiaHypothermiaHypothermia is a condition in which core temperature drops below the required temperature for normal metabolism and body functions which is defined as . Body temperature is usually maintained near a constant level of through biologic homeostasis or thermoregulation...
, 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
- Anaphylactic shock. Insect bites as well as exposure to allergenAllergenAn allergen is any substance that can cause an allergy. In technical terms, an allergen is a non-parasitic antigen capable of stimulating a type-I hypersensitivity reaction in atopic individuals....
s can trigger anaphylaxisAnaphylaxisAnaphylaxis is defined as "a serious allergic reaction that is rapid in onset and may cause death". It typically results in a number of symptoms including throat swelling, an itchy rash, and low blood pressure...
in some people. Anaphylaxis is a life-threatening medical emergency because of rapid constriction of the airway, often within minutes of onset.
- Altitude sicknessAltitude sicknessAltitude sickness—also known as acute mountain sickness , altitude illness, hypobaropathy, or soroche—is a pathological effect of high altitude on humans, caused by acute exposure to low partial pressure of oxygen at high altitude...
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 edemaHigh Altitude Pulmonary EdemaHigh altitude pulmonary edema is a life-threatening form of non-cardiogenic pulmonary edema that occurs in otherwise healthy mountaineers at altitudes typically above ....
(HAPE) or high altitude cerebral edemaHigh altitude cerebral edemaHigh altitude cerebral edema is a severe form of altitude sickness. HACE is the result of swelling of brain tissue from fluid leakage and almost always begins as acute mountain sickness...
(HACE).
- WoundsThe care of significant woundWoundA wound is a type of injury in which skin is torn, cut or punctured , or where blunt force trauma causes a contusion . In pathology, it specifically refers to a sharp injury which damages the dermis of the skin.-Open:...
s 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 medicineWilderness medicine
Wilderness medicine is defined by difficult patient access, limited equipment, and environmental extremes. Today, wilderness or expedition medicine is practiced by Wilderness First Responders, Wilderness EMTs, Remote/Offshore/Wilderness Paramedics and Physicians on expeditions, in outdoor...
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.
The American Red Cross Wilderness & Remote First Aid (r.2010) certification is valid for 2 years.
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.
The Boy Scouts of America is now also requiring a Wilderness First Aid certification for anybody who goes on a High-Adventure trek.
In Scouting
"PhilmontPhilmont Scout Ranch
Philmont Scout Ranch is a large, rugged, mountainous ranch located near the town of Cimarron, New Mexico, covering approximately of wilderness in the Sangre de Cristo Mountains of the Rocky Mountains of northern New Mexico...
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 ResponderWilderness First Responder
Wilderness First Responders are individuals who are trained to respond to emergency situations in remote settings. They are part of a wide variety of wilderness medical professionals who deal with medical emergencies that occur in wilderness settings....
, a Wilderness Emergency Medical Technician
Wilderness emergency medical technician
Wilderness Emergency Medical Technician, or WEMT, is the second highest level of wilderness emergency medical training available in the USA , or other courses for advanced providers such as AWLS, and RMAP...
, a general Emergency Medical Technician
Emergency medical technician
Emergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services...
or other person. A less technical credential is offered via the "National Practice Guidelines for Wilderness Emergency Care" published by the Wilderness Medical Society. These parties, in accordance with their different level of training, administer Wilderness first aid. In emergency medicine
Emergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...
, some advocates assert that there is a golden hour which refers to a time period lasting from a few minutes to several hours following trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
tic 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
Critical Incident Stress Management
Critical incident stress management is an adaptive short term helping process that focuses solely on an immediate and identifiable problem. It spans pre-incident preparedness to acute crisis to post-crisis follow up. Its stated purpose is to enable people to return to their daily routine more...
, has indicated that the peer reviewed medical literature does not demonstrate any "magical time" for saving critical patients.
Training and certification organizations
- The American Academy of Emergency MedicineAmerican Academy of Emergency MedicineThe American Academy of Emergency Medicine is a professional medical association of emergency medicine physicians concerned with the "corporate practice of medicine" and the negative consequences related to patient care. It was formed in 1993...
(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 PhysiciansAmerican College of Emergency PhysiciansThe American College of Emergency Physicians is the first and largest professional organization of emergency medicine physicians in the United States. It was founded in 1968 and is now headquartered in Irving, Texas. As of 2009 ACEP has over 28,000 physician members.The college exists to support...
(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. - The Association of Emergency PhysiciansAssociation of Emergency PhysiciansThe Association of Emergency Physicians is a professional organization of emergency medicine physicians. It was founded in 1991 and offers membership to any practicing emergency physician regardless of training. Therefore, it is more inclusive than its counterparts ACEP and ACOEP...
(AEP) offers membership to any practicing emergency physician regardless of training.
A number of fellowships are available for emergency medicine graduates including prehospital medicine (emergency medical services
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
), 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 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.
See also
- List of medical emergencies
- List of wilderness medical emergencies
- First aidFirst aidFirst aid is the provision of initial care for an illness or injury. It is usually performed by non-expert, but trained personnel to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care...
- Ski patrolSki patrolA Ski Patrol is an organization that provides Emergency Medical and rescue services to skiers and participants of other snow sports, either at a ski area or in a back country setting. Patrollers are trained in Basic or Advanced Life Support to stabilize and transport patients to definitive care,...
- National Ski PatrolNational ski patrolThe National Ski Patrol is the largest winter rescue organization in the world. It was founded in 1938 by Charles Minot Dole, at the urging of Roger Langley...
- Oxygen first aid
- Medical emergencyMedical emergencyA medical emergency is an injury or illness that is acute and poses an immediate risk to a person's life or long term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies can be dealt with by the...
- Emergency medical servicesEmergency medical servicesEmergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
- TriageTriageTriage or ) is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate,...
- ParamedicParamedicA paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...
- MedicMedicMedic is a general term for a person involved in medicine, especially emergency or first-response medicine, such as an emergency medical technician, paramedic, or a military member trained in battlefield medicine. Also the term is used toward a Nurse in pre-hospital care and/or emergency...
- Certified first responderCertified first responderA certified first responder is a person who has completed a course and received certification in providing pre-hospital care for medical emergencies. They have more skill than someone who is trained in basic first aid but they are not a substitute for advanced medical care rendered by emergency...
External links
- Medline. Search on wilderness.
wilderness medicine wikispace