Looking to upgrade your Wilderness EMT?  How about taking the WEMT-I?

Starting in May of 2010, Wilderness Medical Associates, the industry leader in wilderness medicine will begin offering the WEMT-Intermediate course.  This course is designed to expand the knowledge base and scope of currently certified Wilderness EMTs or EMTs.

Wilderness EMT Course Content

This course meets all requirements of the Department of Transportation (DOT) Emergency Medical Technician-Intermediate/85 (EMT-I/85) curriculum and the Wilderness Medical Associates WEMT-I curriculum. Topics include patient assessment, body systems, equipment improvisation, trauma, oxygen administration, automatic defibrillation, ECG interpretation, IV therapy, pharmacology, overview of primary care medicine, advanced assessment, endotracheal intubation, environmental medicine, toxins, backcountry medicine, wilderness protocols, and wilderness rescue.

Wilderness specific subject topics include:

Logistics and Introduction, General Concepts in Wilderness Medicine, Roles and Responsibilities, Patient Assessment, Critical System Problem Recognition Drill, Critical System Summary, Spine Musculoskeletal, Limb Splinting, Dislocation Reduction Demo and Practice, Skin, Soft Tissues and Burns, SAR/Organization, Small Group BLS Simulations Thermoregulation, Cold Injuries, Altitude, ALS Treatments and Meds, Appropriate Technology, ALS Tools and Medications, Night Simulation, Expedition Practitioner/Backcountry medicine, Toxins, Bites and Stings, Lightning, Submersion injuries, Diving, Improvised carries, low angle litter evacuation, hypothermia wraps, antibiotic usage, pain management, common problems associated with the EENT.

Wilderness EMT Class Format

This course is 75 hours classroom and 36 hours clinical time over 16 days. On most days class will run from 8:00 a.m. to 6:00 p.m. Mornings will begin with quizzes and case presentations from students who had hospital rotations on the previous day. The rest of the morning will be devoted to lectures.

Afternoons are devoted to practical hands-on sessions and video taped simulations. Expect 2-3 emergency rescue simulations with made-up victims and stage blood that will be videotaped for enhanced learning. Evenings are reserved for case studies, clinical rotations, and assignments.

Need more information or want to enroll?

Contact us at:

office@wildmed.com

1-888-WILDMED

Click here for the list of upcoming Wilderness EMT-I courses.

Click here for more information about the Wilderness EMT-I course.

A student sent us in this story about how he used his Wilderness First Responder training to assist a woman that suffered a femur fracture.

A woman slipped and fell on the ice three feet in front of me. While she was lying on the ground in great pain she reported that she was recovering from a hip replacement. I had my hip replaced a couple of months ago and thus knew she was at risk for a femur fracture. She said it felt like her femur broke. I immediately rushed into action using my WFR skills by having someone dial 911 (we were in front of a drug store, one building over from the Cleveland Clinic where I had just had an MRI on my hip). I also immediately used my WFR skills by protecting the woman from would-be rescuers. The ambulance arrived in under 3 minutes, and she was transported the one block to the ER at the Cleveland Clinic. Turns out she did have a femoral neck fracture. So, thanks for the wonderful training, and know that if we had been more than 2 hours from a hospital I would have done more than call 911. Phil and Robyn’s lesson that many times the best thing you can do is “protect the patient from other rescuers” was very pertinent in this case b/c two would be rescuers first reaction was to try to have her stand up and “walk it off”. Not a good idea with a femur fracture…. Also, their constant reminders of the difference between street reaction (e.g., call 911) and field reaction immediately came to mind.

Q: I understand the steroids (e.g., prednisone) can sometimes be helpful in managing allergic reactions and asthma and that their use is part of your protocols for those conditions.  If there was nothing else available, would ingestion of a steroid cream be a suitable and effective alternative for prednisone?

After spending some time and given the resources I have at hand, I cannot give you a satisfactorily accurate answer.

Hydrocortisone is available in a pill form and is used particularly by people whose adrenal glands are absent or not functioning properly.  In this form it is rapidly absorbed in the gut.  4 mg of hydrocortisone equals 1 mg of prednisone.

Hydrocortisone is sold for topical use (on the skin) either as 0.5 or 1% creams or ointments.  1 gm of 1% topical hydrocortisone is equal to 10 mg of hydrocortisone.  That would give you nearly 300 mg in a 1 ounce/30 gm tube or, theoretically, the equivalent of 75 mg of prednisone.  What I don’t know and what I was unable to find out easily is what happens to hydrocortisone topicals on ingestion.   The cream is water soluble so, at least theoretically, it is more easily absorbed in the gut than the ointment. In addition, I could not find any pharmacokinetic (movement of a drug through the body) data about rates of absorption from the gut or subsequent blood levels and I have no idea what happens with either when exposed to digestive enzymes.  Aside from nausea and vomiting or diarrhea, the poison control literature suggests that a mouthful is not likely to be toxic.

So yes, theoretically, it could help but any potential effect would be unpredictable.  By the way, a tube cost about 5$US; thirty 20 mg tablets of prednisone tablets are less than 10$US.  I think you know what I would choose.

Several times each year someone asks in class about the relative danger of an envenomation from a small versus a large crotaline (aka pit viper).  Some people are insistent that smaller snakes are more dangerous.  This idea has always felt counterintuitive to me.  The explanations seem fanciful at best.  Usually, people argue that larger (and therefore older) snakes possess some sort of volume control.  They argue that larger snakes hold back venom against humans because we are not food for them.  These larger snakes want to warn us with a strike but preserve venom for when it matters, like a meal.   I have been unable to find any science and none of the experts that I have spoken with can give a definitive answer one way or the other.  With the publication of a recent study, perhaps this theory will disappear.

This past December the Annals of Emergency Medicine published an article by Herbert and Hayes (2009; Volume 54 #6: p 831) in which they argue that a protective layer of denim over the skin may help to decrease the severity of an envenomation from a defensive strike by a southern Pacific rattlesnake. (I leave you to view the details and decide for yourselves.)   In their study, after provoking a test snake, they presented it a latex glove filled with warm water, one time bare and another time covered with a denim glove.  After a bite, they measured the venom in the water within the latex glove and, when used, on the denim glove.  The order of the trials were randomized and occurred 2 weeks apart.  They found that the amounts of venom measured were consistently and significantly greater from the larger (greater than 66 cm in length) versus the smaller (less than 55cm) snakes.

In the discussion section, they point out the volume differences as well as information from other sources that argue against the smaller is more dangerous theory.  Included are the facts that larger snakes are more likely to strike and that their strikes are more accurate.  Large snakes have longer fangs with larger hollow spaces allowing for deeper penetration and more venom flow.   They cite references (that I did not check) that claim that larger snakes cause more serious envenomations.  Herbert and Hayes state:

Thus, the more effective antipredator deterrent of bites from larger snakes may explain why they resort to biting more readily than smaller snakes.

And maybe Homo sapiens don’t learn to stand back.

Bottom Line

Although the results from this study do not definitively answer the question about size it does lend some scientific basis for debunking an unfounded belief.  Practically, of course, it does not really matter.  The anticipated problem of a venomous snake bite is an envenomation.  There is no good way to predict beforehand who will be envenomated, and if so, how bad it will be.  We treat what we see.  By the way, some skin covering, like denim, seems better than none.

Robin Nesbeda, WMA lead instructor, sent in these submissions of ‘The Man’ surfing through the holidays on a family vacation.  Click on the pictures to enlarge.

Today is the last day to submit your photos for consideration. 3 $100 cash prizes are at stake. If you would like to submit your last minute entry, please email webmaster@wildmed.com with your picture and a caption.