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Wilderness Medicine Expedition Resources

Wilderness Medicine Expedition for Medical Professionals Resource Center
 
This webpage is intended to help you prepare for your upcoming Wilderness Medicine Expedition for Medical Professionals. Reading at least one * article or case study from each section will allow us to focus on field practices while we travel in the wilderness.  The case studies are written for lay providers and are based on actual field incidents. 

Introduction

A thoughtful read by David Shlim MD on Wilderness Medicine

Foreword by D Shlim to Wilderness Medicine 6th Ed 2012 Foreword by D Shlim to Wilderness Medicine 6th Ed 2012 (75.75 KB)
 
Leadership and Teamwork

Search and Rescue for Outdoor Leaders (Shimanski MRA)
SAR for Outdoor Leaders  SAR for Outdoor Leaders (104.05 KB)

* Decision Making and Judgment (Chapter from Risk Management for Outdoor Leaders by Tod Schimelpfenig and Drew Leemon. NOLS Publication 2005)
Decision Making and Judgment Decision Making and Judgment (205.56 KB)
 
Wilderness Medicine Research
Much of the framing of our curriculum is based on the NOLS Risk Management database, now in its 25th year with 3.2 million person days of experience and over 12,000 incidents.    
* This paper reviews this data, which gives us a picture of injury and illness on wilderness expeditions. 
Medical Incidents and Evacuations on Wilderness Expeditions.pdf Medical Incidents and Evacuations on Wilderness Expeditions.pdf (112.05 KB). McIntosh SE, Leemon D, Schimelpfenig T. Visitacion J, ; Fosnocht, D: Medical Incidents and Evacuations on Wilderness Expeditions. Wilderness and Environmental Medicine, 18, 298 304 (2007)
 
Other publications based on this database include:

Wilderness Injuries and Illness Annals Emerg Med July92 Wilderness Injuries and Illness Annals Emerg Med July92 (341.09 KB) Gentile DA, Morris JA, Schimelpfenig Auerbach PS: Wilderness Injuries and Illness Annals Emerg Med July92. Ann Emerg Med July 1992;21:853-861

NOLS Incident Data Paper WEMJ03 NOLS Incident Data Paper WEMJ03 (76.38 KB)  Leemon D, Schimelpfenig T:  Wilderness Injury, Illness and Evacuation: NOLS Incident Profiles 1999-2002  Wilderness and Environmental Medicine, 14, 174 182 (2003)
 
Wilderness Medicine  Wilderness Medicine "What Happens Out There" (232.07 KB) This layperson paper takes a broader look at the evidence on medical incidents on wilderness trips. 

Injury and Illness Sailing WEMJ2010 Injury and Illness Sailing WEMJ2010 (99.61 KB)  A recent paper on injury and illness patterns when sailing keelboats and dinghies.


Injury in the Wilderness

* Patient Assessment

Letter to the Editor re The Physicial Exam WEMJ2010 Letter to the Editor re The Physical Exam WEMJ2010 (87.17 KB) 
 
Wounds, Burns and Infections
The data shows these are common and thankfully, mostly minor. We’ll focus on wound cleaning and preventing infection, review field management of burns and wound infections and look at modern techniques for blister management.
Blisters Treatment Blister Treatment (259.26 KB)
 
Fractures and Dislocations
Quinn RH., Macias DJ. The Management of Open Fractures. Wilderness and Environmental Medicine: Vol. 17, No. 1, pp. 41–48. (2006)
 
NOLS/WMI Case Studies

* Open Fracture Case Study

Open Fracture in the India Himalaya Open Fracture in the India Himalaya (1.18 MB)

AlaskaCrevasseFall AlaskaCrevasseFall (1.84 MB)
Case Study 1   ankle injury            Case Study 3    head/spine injury
Case Study 7   hot water burn        Case Study 8    soft tissue infection
 

Environmental Topics

Lightning
 NOLS Backcountry Lightning Safety Guidelines.pdf NOLS Backcountry Lightning Safety Guidelines (234.79 KB)
 
Water Disinfection
Water Disinfection:  CDC Guide

Water  Disinfection: Research on Wilderness Water Quality

Hypothermia and Local Cold Injury
We’ll review hypothermia with a focus on prevention and will demonstrate practical field treatment for mild and severe hypothermia. We’ll also look at assessment, treatment and prevention of frostbite. injuries.
 
* Gordon Giesbrecht’s article is a sound review of current thought on prehospital treatment of hypothermia
Giesbrecht GG. Prehospital treatment of hypothermia. Wilderness and Environmental Medicine: Vol. 12, No. 1, pp. 24–31. 2001.
 
A look at recognition and prevention of the less well known  written for NOLS Field staff. Non-Freezing Cold Injury Non-Freezing Cold Injury (58.67 KB)
 
NOLS/WMI Case Study
Case Study 2  Hypothermia

This is the Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite.

WMS Consensus Position Paper on Frostbite June 2011 copy.pdf WMS Consensus Position Paper on Frostbite June 2011 (290.86 KB)
 
Heat Illness
As with all our curriculum, our focus will be on field assessment and treatment, prevention and the decision on evacuation need and urgency.

Rogers IR.Water Intoxication: A Possible Complication During Endurance Exercise Wilderness and Environmental Medicine: Vol. 15, No. 4, pp. 219-220 (2005).

Bouchama A. Knochel JP. Heat Stroke. N Engl J Med 346:1978, June 20, 2002
 
NOLS/WMI Case Studies
Case Study 5  Heat Illness        Case Study 11  Heat Cramps
 
Altitude Illness
These articles review current understanding of pathophysiology of acute mountain sickness, high altitude cerebral and pulmonary edema.

This is the Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Altitude Illness 2010

WMS Consensus Guidelines Altitude 2010 WMS Consensus Guidelines Altitude 2010 (90.77 KB)


* Altitude Illness
Altitude Illness Current Concepts Altitude Illness Current Concepts (191.26 KB) Hackett PH

Stream JO, Grissom CK. Update on High-Altitude Pulmonary Edema: Pathogenesis, Prevention, and Treatment. Wilderness and Environmental Medicine: Vol. 19, No. 4, pp. 293–303 (2008).

Hackett PH. The cerebral etiology of high-altitude cerebral edema and acute mountain sickness. Wilderness and Environmental Medicine: Vol. 10, No. 2, pp. 97–109 (1999).

West JB. Who Should Not Go High HAMB Mar09 Who Should Not Go High (47.21 KB) High Altitude Medicine & Biology. Spring 2009, 10(1): 1-2.
 
Snakebite
It’s not a wilderness medicine course if we don’t address field treatment of the bites of venomous snakes.

Bites Of Venomous Snakes. NEJM, Vol 347, No5 August 1, 2002.

Coral Snake Envenomation.  Robert Norris MD  eMedicine Dec 17, 2008
 
NOLS/WMI Case Study
Case Study 6 Rattlesnake Bite
 
Plant Dermatitis
Poison Ivy, Oak and Sumac WEMJ 06
 
Medicine In the Wilderness
We all carry our medical history with us into the wilderness.  These case studies are common presentations on wilderness trips.  We talk about field management and evacuation guidelines.

NOLS/WMI Case Studies 
 Case Study 4    Abdominal Pain       Case Study 9   Hyperventilation
 Case Study 10  Seizure                     Case Study 12  Flu-Like illness
 
Medical Legal
Physicians are often asked to serve as medical advisors for outdoor programs.  We’ll discuss several medical legal issues pertinent to practicing medicine in the wilderness; wilderness specific practices/scope of practice, the role of the medical advisor, legal implications of prescription medications.

* These are our thoughts on the topic.
Wilderness Medicine, Practicing without a License? Dec 2011 Wilderness Medicine, Practicing without a License? Dec 2011 (100.21 KB)

Legal Implications of Prescription Drugs for WMI.pdf Legal Implications of Prescription Drugs (28.33 KB) Attorney Frances Turner Mock, who serves as NOLS’ legal advisor, presents the legal perspective on administering emergency prescription drugs by non-licensed providers.

 

Check out more photos like this one in The NOLS Photo Group at www.flickr.com

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