 | The examples and perspective in this article may not represent a worldwide view of the subject.(January 2020) |
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]
Few programs teach psychological first aid, although mental distress is commonly encountered by wilderness guides and outdoor athletes. [2]
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.
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]
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]
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.
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]
In the Republic of Ireland and the United Kingdom various Wilderness First Aid courses and certifications are facilitated by WEMSI International who have bench marked their standards from the US based WEMS [11]
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. [12]
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. [13]
Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. They may also be known as a first aid squad, FAST squad, emergency squad, ambulance squad, ambulance corps, life squad or by other initialisms such as EMAS or EMARS.
An emergency medical technician is a medical professional that provides emergency medical services. EMTs are most commonly found serving on ambulances and in fire departments in the US and Canada, as full-time and some part-time departments require their firefighters to at least be EMT certified.
A portable hyperbaric bag, of which one brand is the Gamowbag, is an inflatable pressure bag large enough to accommodate a person. The patient can be placed inside the bag, which is then sealed and inflated with a foot pump. Within minutes, the effective altitude can be decreased by 1000 m to as much as 3000 m depending on the elevation. The bag is pressurised to 14.0–29.3 kPa (105–220 mmHg); the pressure gradient is regulated by pop-off valves set to the target pressure.
Battlefield medicine, also called field surgery and later combat casualty care, is the treatment of wounded combatants and non-combatants in or near an area of combat. Civilian medicine has been greatly advanced by procedures that were first developed to treat the wounds inflicted during combat. With the advent of advanced procedures and medical technology, even polytrauma can be survivable in modern wars. Battlefield medicine is a category of military medicine.
A certified first responder is a person who has completed a course and received certification in providing pre-hospital care for medical emergencies. Certified individuals should have received much more instruction than someone who is trained in basic first aid and cardiopulmonary resuscitation (CPR) but they are not necessarily a substitute for more advanced emergency medical care rendered by emergency medical technicians and paramedics. First responders typically provide advanced first aid level care, CPR, and automated external defibrillator (AED) usage. The term "certified first responder" is not to be confused with "first responder", which is a generic term referring to the first medically trained responder to arrive on scene and medically trained telecommunication operators who provide pre-arrival medical instructions as trained Emergency Medical Dispatchers (EMD). Many police officers and firefighters are required to receive training as certified first responders. Advanced medical care is typically provided by EMS, although some police officers and firefighters also train to become emergency medical technicians or paramedics.
Ski patrols are organizations that provide medical, rescue, and hazard prevention services to the injured in ski area boundaries, or sometimes beyond into backcountry settings. Many have technical-medical certifications, such as Outdoor Emergency Care (OEC) provided by the National Ski Patrol (USA), that are specific to the winter-season environment and providing emergency medical services in remote locations. Many patrollers also hold EMS issued credentials, such as emergency medical technician or any other pre-hospital care certification. Due to the remote location and terrain, transportation is often limited to Rescue toboggan, snowmobile, or, for life-compromising injuries or extremely remote terrain, helicopter rescue. Depending on the ski area terrain, ski patrollers can be versed in a large variety of specialized rescues, such as avalanche search and rescue, outdoor emergency transportation, chairlift evacuation, and, in some cases, helicopter rescue techniques are taught. Patrols work to promote ski safety, enforce area policies, and help the injured within their jurisdiction. Ski patrollers also work to set up the mountain before it opens by conducting trail checks, providing avalanche control work, and setting up necessary equipment in preparation for the day. At the end of the day, they also conduct a sweep clearing the mountain for off-hours.
The nonprofit National Ski Patrol (NSP) is the largest winter education organization in the world. The NSP provides education, outreach, and credentialing related to outdoor recreation and safety. It is currently composed of more than 31,000 members who serve in over 650 patrols. NSP members, both volunteer and paid, ensure the safety of outdoor recreation enthusiasts in ski areas throughout the United States of America and certain military areas of Europe. For its dedication to the promotion of public safety in skiing and other winter sports, the group was granted a congressional charter under Title 36 of the United States Code in 1980.
Outdoor emergency care (OEC) was first developed by the National Ski Patrol in the 1980s for certification in first aid, and other pre-hospital care and treatment for possible injuries in non-urban settings. Outdoor emergency care technicians provide care at ski resorts, wilderness settings, white-water excursions, mountain bike events, and in many other outdoor environments.
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 education, search and rescue, mountain rescue, remote area operations including research, exploration, and offshore oil platforms, as well as tactical environments. In mainland Europe, where mountain rescue is done by paid professionals, there are courses for physicians that help qualify them to be mountain rescue or expedition doctors. Many of these courses lead to an International Diploma in Mountain Medicine, which is recognized by the Union Internationale des Associations Alpinistes.
An wilderness emergency medical technician is an emergency medical technician that is better equipped than other licensed healthcare providers, who typically function almost exclusively in wilderness environments, to better stabilize, assess, treat, and protect patients in remote and austere environments until definitive medical care is reached. Despite the term, wilderness emergency medical technician training is available and geared not just to the emergency medical technician, but also the paramedic, prehospital registered nurse, registered nurse, physician assistant, and medical doctor. After all, without an understanding of the applicable gear, skills, and knowledge needed to best function in wilderness environments, including a fundamental understanding of the related medical issues more commonly faced, even an advanced provider may often become little more than a first responder when called upon in such an emergency. WEMT training and certification is similar in scope to wilderness advanced life support (WALS) or other courses for advanced providers such as AWLS, WUMP, WMPP, and RMAP. Unlike more conventional emergency medicine training, wilderness emergency medicine places a greater emphasis on long-term patient care in the backcountry where conventional hospital care can be many hours, even days, away to reach.
Wilderness first responders are individuals who are trained to respond to emergency situations in remote locations. They are part of a wide variety of wilderness medical providers who deal with medical emergencies that occur in wilderness settings. While wilderness first responder can generically refer to anyone providing first response, this term typically refers to individuals trained and certified with specific Wilderness First Responder (WFR) certification.
Explorer Search and Rescue (ESAR) are teams of Explorers in the Learning for Life program of the Boy Scouts of America who are trained and deployed for search and rescue missions. Well-developed ESAR programs emerged in the state of Washington in the mid-1950s and were followed by others in California and elsewhere. The rugged, mountainous terrain of these areas often require massive amounts of manpower for proper searches for missing people, not to mention their rescue and evacuation from remote areas. The ESAR mission has also expanded over the years to include urban search and rescue and other disaster-related disciplines. Many ESAR groups also provide wilderness safety training to the public.
Stonehearth Open Learning Opportunities (SOLO) is the oldest continuously operating school of wilderness medicine in the world. SOLO is one of the originators of today's Wilderness First Responder (WFR) and Wilderness Emergency Medical Technician (WEMT) programs. In 2004 it provided first aid training to the cast and crew of PBS' Colonial House program, and a number of colleges and universities across the United States recognize its courses for credit. SOLO also trains advanced providers in disaster recovery medicine and extended remote care through its GEOMEDIC course.
Emergency medical personnel in the United Kingdom are people engaged in the provision of emergency medical services. This includes paramedics, emergency medical technicians and emergency care assistants. 'Paramedic' is a protected title, strictly regulated by the Health and Care Professions Council, although there is tendency for the public to use this term when referring to any member of ambulance staff.
Emergency Medical Responders (EMRs) are people who are specially trained to provide out-of-hospital care in medical emergencies, typically before the arrival of an ambulance. Specifically used, an emergency medical responder is an EMS certification level used to describe a level of EMS provider below that of an emergency medical technician and paramedic. However, the EMR is not intended to replace the roles of such providers and their wide range of specialties.
The following outline is provided as an overview of and topical guide to emergency medicine:
Wilderness medicine is a medical specialty concerned with medical care in remote, wilderness and expedition environments. The specialty includes prior planning, public health issues, a number of sub-specialties as well as responding to emergencies. One modern definition of wilderness medicine is "medical care delivered in those areas where fixed or transient geographic challenges reduce the availability of, or alter requirements for, medical or patient movement resources".
Wilderness first aid as an established medical discipline is a relatively new phenomenon compared to the more established field of prehospital emergency medicine. While instructional guidelines for curriculum for prehospital emergency medical care have been standardized by the U.S. federal government, there are no current federal regulations defining scopes of practice for varying levels of wilderness medicine.
Seth Christopher Collings Hawkins is an American emergency physician, writer, anthropologist, and organizational innovator. He has made notable contributions to the fields of wilderness medicine, Emergency Medical Services (EMS), and medical humanities. His work has particularly specialized in EMS and wilderness medicine in the southeastern United States, where he is the founder of the Appalachian Center for Wilderness Medicine, the Appalachian Mountain Rescue Team, and the Carolina Wilderness EMS Externship.
William 'Will' R. Smith, is an emergency physician and wilderness medicine consultant who lectures about integrating combat medicine into wilderness rescues around the world. He started Wilderness & Emergency Medicine Consulting, a company that helps people with pre-trip planning, online medical support, travel medicine in remote areas and provides expert witness testimony in court cases related to wilderness medicine. As medical director for the National Park Service, he oversaw the largest rescue event ever to occur in Grand Teton National Park. He lives in Jackson, Wyoming, where he is an emergency medicine physician at St. John’s Medical Center.
Media related to Wilderness medical emergencies at Wikimedia Commons