Wilderness Medicine Health Article

Definition

Wilderness medicine encompasses the prevention, diagnosis, and treatment of injuries and medical conditions that may occur during activities in remote territories.

Purpose

Activities that may require wilderness medicine include backpacking, cross-country skiing, mountaineering, white water rafting, scuba diving, and exploration in undeveloped regions such as deserts or jungles. Wilderness medicine has evolved to deal with situations in which definitive medical care is hours or days away, and in which patients may require quick or extended attention. Wilderness medicine utilizes first aid techniques, but requires additional skills that take into account demanding environments, uncommon threats to health, hazardous or lengthy travel to medical facilities, and difficulties in obtaining food, water, and shelter.

Wilderness medicine uses techniques to assess and treat a variety of conditions and injuries, including:

• wounds and burns
• external and internal bleeding
• cardiac arrest
• head injuries
• spinal cord injuries
• fractures and dislocations
• altitude sickness
• problems from cold and heat
• allergic and anaphylactic reactions
• lightning strikes
• near drowning
• insect, reptile and animal bites
• poisoning
• emergency child birth

Precautions

In wilderness situations caregivers should follow the maxim of first, do no harm. Uninjured members of groups should not attempt rescues that place themselves in danger. People administering first aid or wilderness medicine should remain calm and organized at all times. Only those with experience should administer medications and medical procedures. Injured people should not be moved until they are fully evaluated, or unless environmental conditions are threatening and require immediate shelter.

People with certain medical conditions should avoid travel in the wilderness, which can make existing conditions worse. These conditions include metastatic cancer, peptic ulcers, coronary artery disease, chronic obstructive pulmonary disease, clotting or bleeding disorders, high-altitude sickness, chronic rheumatoid arthritis, chronic severe back pain, and chronic knee and hip joint disease.

Description

The first stage of wilderness medicine begins with an assessment of the injury or condition. Primary assessment is used to quickly determine if a patient is in a life-threatening situation and to provide immediate emergency care. Secondary assessment is the thorough evaluation of a patient after life-threatening circumstances are relieved.

Primary assessment

A rule of thumb for the first steps of primary assessment, recommended by the Wilderness Medicine Institute, is the ABCDE procedure. It stands for Airway, Breathing, Circulation, Disability, and Exposure assessment. First, a patient's airway should be checked by close observation of whether or not air can move in and out and any obstructions to breathing should be alleviated. In unconscious people the tongue can often fall to the back of the throat and block breathing and the head should be tilted back and the lower jaw raised to alleviate the obstruction. If neck or spinal cord injuries are suspected, the head must be handled with extreme care to avoid further injury to the delicate spinal cord. In these cases, the lower jaw can be pulled forward to open the airway. If the neck is severely out of alignment due to an injury or fall, it may be gently realigned to free the airway.

After the airway is cleared and breathing is ensured, a patient's circulation is checked by noting the pulse of the carotid artery, on the neck, the pulse of the femoral artery in the front groin, and by listening to the heartbeat. If pulse is lacking, cardiopulmonary resuscitation (CPR) may be required, which requires chest compression and mouth-to-mouth breathing. Circulation checks include surveying a patient for bleeding. If severe bleeding is present, it should be stopped by direct pressure to the injured area, and by elevating the wound level to the heart if possible.

Disability assessment means checking for damage to the spinal cord, particularly in the cervical region of the neck. Assessment of exposure determines if environmental conditions, such as heat or cold, are immediate threats to a patient's life, which may require actions such as seeking shelter or covering the patient with protective clothing.