Good question.

If the symptoms are isolated to the lower airways as manifested by wheezes, an inhaled Beta agonist like albuterol will probably help with the symptoms.  But remember that unlike asthma, anaphylaxis is a systemic, not a local, problem.  In anaphylaxis chemical mediators are released in the circulation and then migrate to sites around the body.  Albuterol works locally and will have no effect on the generation of these mediators.  If the manifestations are shock or upper airway obstruction (the two most lethal manifestations of anaphylaxis), the albuterol will not be useful.

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.

“…the stuff works..”  or “…they make a difference…”, those are the suppositions that get to the heart of the matter.  I have written previously about clot enhancers and have expressed my unabashed skepticism.

In the last few years, the original QuikClot that was supposed to stop all bleeding without any harmful effects has been reformulated to be cooler because of concerns about burns.  Reengineered again, it is available, impregnated in gauze.  But do any of these really work?  There are anecdotal reports and animal studies.  The claims made by Z-Medica that their products have saved hundreds of lives seem hyperbolic and unsubstantiated by anything more than individual or pooled testimonials.  Each new animal trial shows the new product to be better than the prior one, the one that was supposed to stop all bleeding.( http://www.z-medica.com)  This is not science, this is marketing.  I am not aware of any clinical trials that look at important human outcome in any meaningful way.  The fact that someone, like the army, is using something does not make it efficacious or safe.  And in addition to burns, there have been other problems reported with the older formulations.  I don’t believe that the science with the other leading products (chitosan-based: e.g., http://www.celoxmedical.com) is any better.

I completely understand why the military wants a product that will stop bleeding easily.  Think about it.  As with all combat, bleeding is the major pathway to death.  Field treatment has improved significantly but who wouldn’t want to do better for otherwise healthy young women and men?  What could be better than being able to pour something into an exsanguinating wound and have the bleeding stop, especially where a tourniquet cannot be applied?  It does not work that way with any product on the market.  It does seem that the gauze formulations of each have some promise.  They can be wrapped around a wound or tightly stuffed into deeper ones and then secured by a tight pressure wrap.  Assuming that the product added is safe and effective, it could enhance what already works.

What should you do?  We know that bandaging that is visually directed toward the bleeding site (well-aimed), stuffed in for deeper wounds, and then secured by a pressure wrap have a good track record.  This is certainly true for the vast majority of wounds we are likely to see in non-combat, civilian events.  There are no confounding substances and anyone can buy these materials easily and inexpensively.  On the other hand, the least expensive of either of the major clot enhancing products retail for about 10$ US and many are 25$ US and more.  But wouldn’t it be worth it to decrease exposure to potential m thinking FG and OHbloodborne pathogens?  If there is bleeding, there is blood around.  Whether you use the sachet containing QuikClot or either gauze impregnated product, you still have to apply it manually and hold it in place like plain gauze until secured.  Gloves, eye protection, and clothing are still your best protection.  And what are you going to use if you haven’t got a clot enhancer with you?

Authors of an editorial and article that appeared in the Wilderness and Environmental Medicine Journal earlier this year (Vol 20, 106 and 113-117) argued that there is no standard in wilderness medicine training for outdoor educators. In addition, they suggested that organizations offering this training have curricula that are not evidenced-based and are quite possibly irrelevant to the true needs of their intended audiences. They characterized these training organizations as fractious and secretive (my selection of words). These suggestions and characterizations are misleading and inaccurate. I personally have an open and collegial relationship with the principles of a number of these organizations. We attend and present at some of the same conferences and regularly meet to discuss what we are doing and why. Anyone can see what we teach by buying our texts, reading our blog, listening to our conference presentations, and freely downloading articles and protocols from our web site. Over the years, these interactions have resulted in changes and upgrades for all of us. The competitive atmosphere of excellence has forced each of us to look carefully at what we teach and how we teach it. Being wrong and inept would result in marginalization as well as loss of business. Over the last several years these conversations have become more focused. The participants are highly experienced outdoor and educational professionals, some with long careers as outdoors medical practitioners. They work or manage training organizations who have taught over 150,000 WFA students since 2000. Through a collaborative effort with these peers, we hope to write Scope of Practice (SOP) documents to define the intended audience and what a person at different levels of training should be able to do and should not do in the field. Ultimately the signatories will publish them for public information and scrutiny. The first of these is a SOP for Wilderness First Aid (WFA). It will be discussed at this year’s American Outdoor Recreation and Education (AORE) conference in Minneapolis and presented to the Wilderness Medical Society.

Click here for the Wilderness First Aid (WFA) Scope of Practice.

In addition to four Wilderness Medical Associates’ instructors presenting at the conference, the company will staff a booth in the vendor hall.

Please stop by to say hello and find out what’s new at WMA.  Anne Rugg, the WMA General Manager,  is looking forward to talking with current or potentially new sponsors and WMA grads!

WMA Instructors Teaching at the Wilderness Risk Management Conference

Jon Tierney
PCIA Outdoor Climbing Instructor Course Provider Training

Deb Ajango
Using Case Studies as a Risk Management Teaching Methodology

Bill Frederick
Navigating Risk in International Locales

David Johnson
Medical Topics – New, Controversial and Old

More about the 2009 Wilderness Risk Management Conference

• View a list of the WRMC workshops
• WRMC Website
• Follow WRMC on Twitter
• Follow Wilderness Medical Associates on Twitter
• Subscribe to WMA blog via email
• View the invitation letter from Chair