Archive for February, 2009

In the musculoskeletal system lecture WFR students learn about the signs and symptoms of compartment syndrome. Repetitive stress is a cause for compartment syndrome to the lower legs.

These two articles are accounts from Olympic ski racers that are suffering from compartment syndrome.

http://www.fasterskier.com/racing6146.html

http://www.cccski.com/main.asp?cmd=doc&ID=5429&lan=0

Submitted by:
Greg Friese, MS, NREMT-P, WEMT
President, Emergency Preparedness Systems LLC

During a Wilderness First Responder course at the University of WI at LaCrosse, Ann Dunphy, one of WMA’s instructor’s, asked students about WFR dreams, as she does with all of her courses. Interestingly enough, one student, D. Crye, was willing to share his story, and thankfully for us, he also shared it with the WMA office. We just had to post it!

“Did anyone leave a plastic bag in the refrigerator with a Leatherman Blast, smartwool socks and V8 Butternut Squash soup? Let me know!

Also, for those who want to hear a dream I had last night feel free to keep reading; I’ll make it short. I dreamt last night that I got to save a guy from drowning in a river after he drove into a frozen lake. It was crazy because we got him out of the water and carried him up a very steep bank. As we got him onto the street he starting throwing up gallon after gallon of water. It was a lot of water! The whole time we were trying to keep him stabilized because we were MOI spine of course. Well this guy didn’t want to stay still but we finally got him to stay laying down as we waited for the ambulance. But I was so excited that I was able to help rescue someone that I left my patient (not a good thing) to go tell Ann, who was down the road at some outdoor store purchasing a new first aid kit. I got there and started telling Ann how great it was and everything and then she was like “David, where is your patient now?” And I told her he was laying in the middle of the street by himself. So Ann said “Get back to your patient now!” So, I ran back. When I got back to my patient the ambulance had arrived and had him on a stretcher, but they also had two other people on stretchers too! I was freaking out because somehow there were 3 patients instead of just one! Furthermore, all of them were strapped down on there backs throwing up everywhere uncontrollably. I then sat down and started to realize all that I did wrong. First of all, I didn’t complete the first triangle to find out how many patients there were. Secondly, I didn’t complete a full SAMPLE history because I must have missed something because everyone was throwing up big time from something. And I shouldn’t have left my patient to go tell Ann what had happened. So, I learned some good lessons from my dream. These WFR dreams are getting crazy!

How do I become more involved & gain experience?

Q: I’m a first year medical student at the University of Minnesota-Duluth. I am looking to become more involved in Wilderness Medicine and gain more experience.

Thanks for your help

There are a variety of ways to get involved. What is it that you would like to do? You could teach, deliver care, consult, and conduct research, locally or in other parts of the world on your own, as part of a project or during an elective.

Joining the Wilderness Medical Society (www.wms.org) is a great first step. Attending their meetings will put you in contact with other like-minded people. They and other organizations conduct medical student electives around the US and in Canada. Maybe you ought to consider trying to organize one yourself.

There are also many wonderful role models like doctors Luanne Freer and Peter Hackett. In their own ways, both have been able to take their passions for medicine and the outdoors and turn them into lifetime work.
You may not think that your school’s faculty is “…involved/interested in Wilderness Medicine” but I bet there are physiologists who are interested in the impact of environmental extremes and infectious disease specialist focused on tropical diseases and the challenges of epidemiology, prevention and treatment. These folks are always looking for people with ideas and energy.

Duluth is located in a wonderfully rich environment with a great outdoor community. You might consider connecting with a local college or university outing group, an adventure tripping company, or even ski patrol. But be patient and learn what they do and how they do it. No one wants a doctor or any other expert who is not technically proficient in the environment. All would welcome and benefit from the kind of expertise that you are trying to develop.

Perhaps your definition of wilderness medicine is not broad enough. If you are thinking in terms of problems limited to travel in the mountains, on rivers and in the woods, have a look in our FAQ section and see what we think wilderness medicine encompasses. The truth is, wilderness medicine is what you want to make of it and there are many avenues open to you. For me, it is the lack of boundaries that make wilderness medicine so exciting.

Good luck, DJ

Q: I am a camp director who requires our staff to have medical training. If they do render care, what if anything should be documented?
A medical record or any similar form of documentation is more that just an effort by medical practitioners to protect themselves against a law suit. It provides a contemporary account of what happened and what has been done. When care and transport will be lengthy, the record can provide a chronological, objective look at what you thought and did and how things have evolved.

Download SOAP pdf

We advocate recording the information in the SOAP format because it forces clarity of thought. A good SOAP note is simple to generate and results in a logical and organized document.

In the acronym, the letter S is for subjective or the story of what happened and the person’s symptoms; O is for objective things observed, felt or measured during the exam; A is for assessment of the problems/working diagnosis, what the examiner thinks is going on and could evolve over time based on S and O – this should also include the potential logistical problems of transport; P is for plan or what are you going to do about each problem. Don’t forget the logistical dilemmas. This can have a big impact on what you do and how to utilize resources.

I personally believe that a note of some kind should be made any time medical care is rendered and most particularly for those problems that will require follow-up either on the trip or afterwards. This chronology should include:

1. What happened, including a description of an accident or events leading up to the problem and the symptoms that have evolved.
2. A list of medications, allergies, and important medical problems.
3. Pertinent finding on the examination.
4. A list of what one thinks is wrong, trying to be as accurate as one can. It is more important to be clear about the urgency of a problem than about the precise diagnosis. Is this really an emergency?
5. Formulate a list of anticipated problems – how things could get worse and what new problems may evolve.
6. A plan of action and what one has actually done. Don’t forget logistics of evacuation.
7. A periodic update describing any changes in condition and/or modification in the plan.

Why bother writing all of this down? As with any other observation, the precision of one’s recollection fades over time. Taking the time to record information and then analyze it will generally clarify what is going on and lead to a better plan. When it comes to understanding what is happening and what to do about it, objectivity always trumps one’s gut. This is particularly true for relatively inexperienced practitioners.

What should you do with this information? If care is to be transferred, ideally, copy the salient points for the receiving person and retain the original for yourself (or vice versa if it will be easier). Although these kinds of notes are not legally subject to HIPPA (rules and regulations mandating how medical professionals and institutions must safeguard patient information), it is important to protect a person’s privacy. Only share patient information with healthcare providers who really need to know.

Bottom line: Record relevant information including your impression, treatment and the person’s condition over time. It is important to outline concerns for evolving problems and solutions to evacuation challenges. Be sure to limit access to this information to people who really need to know.

I’m fact-checking a piece for a national outdoor magazine. I have several questions about snake bite treatment methods:

1. Is there any benefit to the “cut-and-suck” method or should we get rid of it altogether?
2. What is your professional opinion on the effectiveness of suction devices?
3. Should a responder apply a tourniquet to a snake bite victim?
4. Should a coldpack be applied to a snake bite victim?
5. Is marking the edge of the bite to track the swelling helpful to medical personnel?

Answers:

1. No, none. In fact, it could result in an infection, impair healing and the cut could cause an unintended injury.
2. Useless. A nice study done a few years ago demonstrated their lack of efficacy. Their reputation was based on hype and not science.
3. Never a tourniquet. For some with neurotoxins, especially the most potent ones found outside of NA, a compression wrap may be helpful.
4. It will not help and could cause more injury.
5. Yes, it could be.

Remember all snakes are not the same. There are different general kinds of toxins. The management of each is directed at the damage or harm that could result