Course Subscriber is a service dedicated to notifying students when courses are added to wildmed.com. You choose the criteria: Type of course, the distance you are willing to travel, and dates that work with your schedule. This is a useful tool if you want to know when viable recertification options become available. Course Subscriber may also be used if you are a WAFA (or AWFA) student looking for Bridge courses to further your training.

How to Access Course Subscriber

Follow this link and complete a quick registration form. It’s that simple! You will receive notification as courses are added that meet your parameters.

We encourage you to continue educational pursuits in wilderness medical training. We are always receptive to your feedback, as it’s integral to our progress. If you have suggestions on how we can improve our services to you, please contact us.

Click on the image to enlarge.

Where’s the Man?: Pacific Crest Trail, WA

WMA-certified Wilderness First Responder (WFR),  LT, sent us this photo of him cruising along with the man alongside the caption below. Thank you for making the trails a better place!

“The man soaring over White Pass, Washington.  He joined my crew and I as we performed 6 months of restoration work along the PCT from Washington to Southern California for the Pacific Crest Trail Association.”

Send in Your Photos!

Send an email to webmaster@wildmed.com with a picture of you wearing your ‘Where’s the Man?’ t-shirt alongside a caption to be eligible to win. At the end of the year, we will select three entries to receive $50 gift certificates to our online gear store.

Please consider helping AORE make a difference by reviewing this document if you have ever sponsored a WFR course, attended at WFR course, or instructed a WFR course. Does this document include the topics that you want your staff to know? As a participants of a Wilderness First Responder course, is this training enough to prepare you for backcountry medical emergencies? Are the elective topics sufficient? Please be clear, professional, and thorough.

Click here for the Wilderness First Responder Scope of Practice.

Please send your comments to Tim Mertz (mertzt@uwstout.edu). Comments received will be consolidated and then presented to the wilderness medical providers for consideration in the final document.

Submitted by Dr. David Johnson, WMA President & Medical Director.

DJ in the Belen market of Iquitos, Peru.

This venue winds forever along the river’s edge.  It serves the population 7 days a week, offering all manner of food, herbs, spices, wood products, alcohol and jungle remedies produced or grown in the many distant jungle communities up and down river.  Iquitos, a city with more than 500,00 inhabitants, is bounded by the Amazon, Nanay and Itaya rivers.  It is purported to be the largest city in the world unreachable by a road.

DJ has been in Cusco and Lima studying tropical medicine for the past 9 weeks.

Submit Your Entries

Send an email to webmaster@wildmed.com with a picture of you wearing your ‘Where’s the Man?’ t-shirt alongside a caption to be eligible to win. At the end of the year, we will select three entries to receive $50 gift certificates to our online gear store.

If you are attending wilderness medicine course through WMA that is three days or longer, you will receive a course t-shirt. Simply take a snapshot of yourself sporting your da Vinci-inspired tee and submit to webmaster@wildmed.com with a caption.

2010 Medical Wilderness Adventure Race (MedWAR)

The race series for the 2010 MedWAR events have been announced! MedWAR is a unique opportunity for you to learn about and test your wilderness survival and medical skills through a combination of wilderness medicine and adventure racing. These races usually sell out 3-4 weeks in advance.

Check out the following resources on MedWAR:

• Upcoming schedule of their races
• Mission and objectives of MedWAR
• MedWAR slideshow

I do not believe that you should have a particular concern regarding work at altitude because of the recent concussion per se.

Also frequently referred to as a traumatic brain injury (TBI), a concussion is commonly diagnosed clinically when a person experiences any loss of consciousness, confusion, or amnesia following a blow to the head.  Increased intracranial pressure (increased ICP) or brain swelling is the anticipated problem or what we worry about afterward.  The swelling results from bleeding or the accumulation of edema (fluid) in brain tissue.  The early symptoms of increased ICP include persistent vomiting, worsening headache and deterioration of one’s mental state.  It does not sound like you had these symptoms or have this problem now.

Do you have any other symptoms now?  Frequently, following a blow to the head, even without ever experiencing a concussion, people can develop a post concussive syndrome (PCS).  The symptoms of PCS include headache, insomnia, feeling more tired than usual, blurry vision, light sensitivity, difficulty concentrating, feeling off balance, and emotional liability.  These are not signs of increased ICP; they can last for weeks.  If you have any of these, they could get worse at altitude and thereby potentially make you more accident prone.

People who go to altitude, especially over 3000 m (9800 ft), are at risk to develop altitude-related increased ICP called high altitude cerebral edema (HACE).  This is related to the lower oxygen levels and in part, to the resulting reflex increase in brain perfusion or blood flow.  Theoretically, I suppose, if you were continuing to have a slow blood leak from your injury, it could increase in size more quickly as a result of going to 3100 m.  But without ICP symptoms now, this seems very unlikely…unless you sustain another TBI.

I do not know whether a TBI with or without PCS makes one more susceptible to HACE. I doubt it but I could find no substantive references one way or the other.

Bottom Line

If you are feeling fine, go for it and have a great time.  Remember, the best way to minimize altitude symptoms is to ascent gradually, especially over 2500 m (8200 ft).  In addition, increase your physically activity as you acclimate to the new environment.   Some good rules include:

1.  If you can, before sleeping above 3000 m, spend a night above 1500 m (5000 ft).

2.  Above 3000 m, don’t sleep higher than 300 – 500 m (1000 to 1650 ft) above your previous night’s sleeping altitude.

3.  With each 1000 m (3300 ft) in altitude gain, add a rest day and/or sleep at the same altitude for 2 consecutive nights.

If you want more information on altitude, check out The International Society of Mountain Medicine.  They have a nice summary.

As you may have seen, ‘The Man’ has been traveling around the globe- climbing trees, swimming rivers, hiking trails, helping those medically needy, and even spreading some holiday cheer!

It took us, in the WMA office, a long time of pawing through these amazing photographs to finally decide one which ones to select for the three $100 cash prizes, but we have come to our decision. Thank you to the many contestants who submitted photos and shared your stories!

Winners of the $100 Cash Prizes

Click on the photos above to see their full entry.

Honorable Mention

Thank you to Josh Martin and Paul Cunningham at Northern Cairn who submitted the very first entry and came with the idea of holding this great contest. What a wonderful way for instructors, students, and others to interact and compete for some cash!

Stay tuned to see what contest we will be holding this year!

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.

http://www.ems1.com/ems-products/cpr/articles/605748-Texas-youths-set-record-for-worlds-largest-CPR-training-class/

No it was not a pie eating contest or sporting event.  Apparently they were certified by the Guinness folks for holding the world’s largest CPR class – 4626 students.

“As expected with thousands of junior high students, there was plenty of goofing around during the lesson. Giggling was common when they first gave their inflatable mannequins mouth-to-mouth resuscitation, and more than a few decided to head butt or slap their Mini Anne CPR dummies. But most appeared to take the lesson seriously.

Cluck (the mayor who helped organize the CPaRlington program)walked several laps around the field during the lesson, and he said most participants understood the techniques and could resuscitate someone if needed. Each student is now required to take the dummies home and teach four other people.”

Although not specifically mentioned, 30 minutes and inflatable CPR dummies sound a lot like the American Heart Association’s (AHA) CPR Anytime. Regardless of whose curriculum, I am assuming that this was not a certifying course.

The CPR Anytimeis a real departure from where the AHA was even 5 years ago.  There was a time when everyone taking one of their courses was hovered over by a hypervigilant instructor making sure that each student’s compressions and ventilations were within an upper and lower limit.  Skill testing success or failure was determined by lines on a piece of graph paper spit out from the side of the testing dummy.  Everyone knew that you had to modify your technique for the testing mannequin used, in order to pass.

Most instructors led their students to believe that if their technique varied in anyway from the norm, those efforts would hasten a patient’s demise.  Everyone assumed that the AHA knew what it was doing and as a result no one else (other than the American Red Cross and a few others) could be trusted to teach CPR.  Now these courses are more user friendly and accessible, engineered to train the masses.  These self-directed offerings are a convenient way for people to learn a skill that could enhance survivability following a cardiac arrest without having to take a course.  No one knows whether or not this new approach will make a difference.  Others of us have been allowed to use our own curricula and ideas to teach this once sacred procedure.  It seems that AHA mantra has become, do something.  Over the years, anecdotal stories suggest that an untrained person doing something is potentially beneficial and not harmful.  Science shows us that early intervention does make a difference.  I agree

Still, this rock concert-like event makes me cringe.  Why not do it right?  Is the time spent in school classrooms so valuable that they don’t have time for this or practical First Aid?   The AHA hopes people taking self-directed courses will in turn teach someone else.  Would these kids do a better job teaching their parents after a course like the one noted above or after a proper course, esepically one that utilized a variety of teaching methodolgies (e.g., fun) and was integrated in with what they are leaning in school?

This is not a criticism of these kids.  This is what they know.  Kudos to them not for the record but for the initiative and sense of civic concern.  But with a little guidance and effort, think about how much more could be done.