Wilderness medicine

Wilderness medicine is a rapidly evolving field and is of increasing importance as more people engage in hiking, climbing, kayaking, and other potentially hazardous activities in the backcountry.[1] The modern definition of wilderness medicine is "medical care delivered in those areas where fixed or transient geographic challenges reduce availability of, or alter requirements for, medical or patient movement resources".[2][3][4] A primary focus of the field is the evaluation, prioritization (triage), preliminary treatment of acute injuries or illnesses which occur in those environments and the emergency evacuation of victims. However, back country rescue and wilderness first aid is not the sole activity of wilderness medical professionals, who are also concerned with many additional topics. These include but are not limited to:

  • Secondary care follow up to first aid in remote settings, such as expeditions
  • Evaluation of experience and issuance of updated protocols for first response and secondary care
  • The prevention of wilderness medical emergencies
  • Epidemiological studies
  • Public policy advisement to wilderness planning agencies, and issuance of guidelines to disaster planning agencies,[5] professional guides and amateur back country enthusiast organizations
Wilderness medicine
SubdivisionsExpedition medicine

Diving medicine

Aviation medicine
Significant diseasesAltitude sickness

dysbarism

envenomation
Significant testsPoint of care Ultrasound

Scope

Wilderness medicine is a varied sub-specialty, encompassing skills and knowledge from many other specialties. The specific curricula will vary but an example can be seen in the curriculum for Fellowship in the Academy of Wilderness Medicine (FAWM)[6].

Diving and hyperbaric medicine
  • Physics and physiology of depth
  • Dive medicine
  • Dysbarisms and barotrauma

Tropical and travel medicine

High-altitude and mountaineering medicine
  • Physics and physiology of altitude
  • AMS, HAPE and HACE
  • The effect of high altitude on underlying medical conditions

Expedition medicine
  • Basic (emergency) field dentistry
  • Expedition planning, pre- and post-expedition responsibilities
  • Camp safety and layout

Survival, field craft and equipment
Casualty extrication by road
  • Survival techniques and equipment
  • Water procurement
  • Food procurement
  • Hiking and trekking
  • Foot gear and care of the feet
  • Clothing selection for wilderness survival
  • Land navigation

Safety, rescue and evacuation

Preventive medicine, field sanitation and hygiene
  • Field sanitation and hygiene measures
  • Vector control and barriers
  • Water purification methods

General environmental medicine

Improvised medicine
  • Improvised field wound management
  • Improvisational medical techniques in the wilderness

Disaster and humanitarian assistance
  • Triage
  • Field hospital provision
  • Malnutrition therapy

Wilderness emergencies and trauma management
  • Pre-hospital patient assessment
  • Pain management in the wilderness setting
  • Emergency airway management
  • Psychological response to injury and stress
  • Management of trauma and injuries

Epidemiology

The Center for Disease Control in the U.S., and its corresponding agencies in other nations,[7] also monitor leading health threats,[8] pathogen vectors in conjunction with local departments of health, such as Lyme disease, plague and typhus which may be carried by small mammals in a back country or wilderness context.[9]

Austere environments interdisciplinary interface

Insights from the field of Military Combat Tactical Care (TCCC) interact with wilderness medical practice and protocol development. Moreover, new products and technologies tested in combat are adopted by wilderness medical personnel and vice versa.[10]

Applications to Covid-19

As of April 2020, studies and trials are underway that examine the possible benefits of nitric oxide in the treatment of COVID-19.[11][12][13] This research is related to the role of nasal breathing in the creation of nitric oxide, which increases oxygen absorption in the lungs.[14] Nitric oxide was also investigated as an experimental therapy for SARS.[15]

Brian Strickland, MD, a fellow in Wilderness Medicine at Massachusetts General Hospital who studies "acute respiratory distress" in high altitudes, is applying this research towards COVID-19.[16][17] He is currently involved in clinical trials which apply the use of inhaled nitric oxide as a treatment for COVID-19.[18] This approach was inspired by the work of associate professor of Emergency Medicine at the Harvard Medical School N. Stuart Harris, who has been studying the effects of altitude sickness on mountain climbers, such as those who climb Mount Everest. Harris noticed that the consequences of high level altitude sickness on the human body mirrored COVID-19's dysfunctional impact on the lungs. His focus on nitric oxide comes from its role in being able to breathe in high altitudes.[16][19]

Specialist Qualifications

Internationally there is huge variety in the medical training for wilderness medicine.

See also

References
  1. "Wilderness Medicine Fellowship". Stanford University. Retrieved 2020-06-28.
  2. Hawkins, SC (2018). Wilderness EMS. Wolters Kluwer. p. 21. ISBN 9781496349453.
  3. Auerbach, PS (2017). Auerbach's Wilderness Medicine, 7e. Elsevier. p. 1200. ISBN 978-0323359429.
  4. Cone, David (2021). "Wilderness EMS". Emergency Medical Services: Clinical Practice and Systems Oversight, 3e. John Wiley & Sons, Ltd. ISBN 9781118865309.
  5. "Preparation through education is less costly than learning through tragedy" - Max Mayfield, Director National Hurricane Center
  6. Mallinson, Tom (2010-10-22). "Wilderness medicine: a fellowship programme". Journal of Paramedic Practice. 2 (10): 488–491. doi:10.12968/jpar.2010.2.10.79206. ISSN 1759-1376.
  7. "Disease Surveillance Fact Sheet" (PDF).
  8. "Disease Surveillance and Monitoring | About | CDC". www.cdc.gov. 2018-07-19. Retrieved 2018-11-04.
  9. http://www2c.cdc.gov/podcasts/media/pdf/EID_7-09_Sylvatic_Typhus.pdf
  10. Will Smith M.D. "Taking Combat Medicine to the EMS and Wilderness Settings". Retrieved February 11, 2010.
  11. Katsnelson, Alla (2020-05-20). "Multiple clinical trials test whether NO gas can treat and prevent COVID-19". Chemical & Engineering News. Retrieved 2020-07-14.
  12. Gander, Kashmira (2020-04-07). "What Is Nitric Oxide? How the Gas That Gave Us Viagra Could Help Treat Coronavirus Patients". Newsweek. Retrieved 2020-06-25.
  13. "Nitric Oxide Investigated as COVID-19 Treatment". WebMD. Retrieved 10 April 2020.
  14. Glazier, M.D., Eve (2019-11-04). "'Nose breathing has more benefits than mouth breathing". The Times and Democrat. Retrieved 2020-07-09.
  15. Åkerström, Sara; Mousavi-Jazi, Mehrdad; Klingström, Jonas; Leijon, Mikael; Lundkvist, Åke; Mirazimi, Ali (1 February 2005). "Nitric Oxide Inhibits the Replication Cycle of Severe Acute Respiratory Syndrome Coronavirus". Journal of Virology. 79 (3): 1966–1969. doi:10.1128/JVI.79.3.1966-1969.2005. PMC 544093. PMID 15650225.
  16. Powell, Alvin (2020-05-06). "Applying wisdom from the Himalayas to the ER's COVID battle". The Harvard Gazette. Retrieved 2020-06-25.
  17. "Lessons from the Backcountry in Finding a Potential COVID-19 Treatment". Massachusetts General Hospital. 2020-06-24. Retrieved 2020-06-25.
  18. "Inhaled Nitric Oxide Therapy for Emergency Room COVID-19 Patients". Massachusetts General Hospital. 2020-06-24. Retrieved 2020-06-25.
  19. Meredith, Sam (2020-05-01). "How the gas that gave the world Viagra could help treat coronavirus patients". CNBC. Retrieved 2020-07-05.
  20. "Wilderness Medical Society". wms.org. Retrieved 2018-09-05.
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