“Hi there. Just wanted thank Wilderness Medical Associates (especially Phil, Robin, and Stephen) for their great instruction in last January’s Wilderness First Responder course at the University of Alabama.

This summer, I utilized my skills in the backcountry to treat many routine issues, and some minor emergencies. The training was very useful, but I didn’t really appreciate how valuable the course really was until Friday of last week, when I drove up to the scene of a grisly motorcycle wreck, only seconds after the crash. I first secured the scene, and made sure that 911 was dispatched for the motorcyclist who had presumably lost control of his bike, and crashed into a tree on a winding back road.

After identifying myself as a wilderness first responder, I began stabilizing the semi-conscious man’s cervical spine with in-line stabilization while I completed the initial assessment, which yielded findings of a rigid abdomen, presumably shattered pelvis, and fractures to both legs. In addition to complaining of intense pain, the patient also was devoid of sensation his legs, making tedious stabilization of the spine even more vital. I continued to hold stabilization and kept other bystander “rescuers” from moving the patient during the ten minute response times for local fire/rescue.

Once EMS arrived on scene, I presented my initial assessment to paramedics, and then assisted in log rolling the patient onto a backboard. Air Care Cincinnati was called to the scene and the man was flown by medical helicopter to the local trauma center for emergency surgery.

Last I have heard, he survived the surgery to repair damages to his internal organs and pelvis, and is beginning to regain feeling in his legs. Thanks to the realistic simulations, and thoughtful instruction I knew exactly what to do, and was able to make a positive impact. As a high school student, I surprised all of the adult bystanders on scene by taking control of the situation, and acting immediately to assist the injured man. Thank you!”

Click here for a list of upcoming Wilderness First Responder courses in your area.

The simple answer? Using the resources at hand, aggressively lower the person’s body temperature to 39°C (102.2°F) as quickly as possible.  Anything longer than 30 minutes has the potential to have more profound and long lasting pathophysiologic effects. The debate about treatment revolves around the efficacy and safety of cold water/ ice bath immersion versus the mist/ fanning method.  When feasible, I advocate cold water immersion. In fact, it is at least twice as fast as the best misting methods.  It appears to be as safe and maybe safer when one considers the relative rates of cooling.

How so? Cold water dissipates heat from the body 20 to 30 times faster than air does at the same temperature. Evaporation speeds cooling but not as much. People argue against cold immersion for fear that the cold will induce vasoconstriction and/or shivering and therefore inhibit cooling or even increase body temperature.  If these factors are important, one would expect to find clinically relevant support in the medical literature. I have never found any. (Jump into cold lake and see what your body temperature does!) In addition, some worry that cold immersion for heat stroke will precipitate a cardiac arrest.  Again, the literature does not appear to support this concern clinically, even in the elderly.  In the end, temperature height and duration are the key factors linked to morbidity and mortality in heat stroke.

The real question regarding treatment should revolve around what means are at hand to modify those factors that caused the heat stroke to begin with.  First, stop the heat stress by leaving the environment and resting. If there is insufficient cold water for immersion, apply water in small droplets, like mist from a spray bottle, and get the air moving.  The misted water will evaporate more quickly and probably cool better than pouring a bottle over your patient’s head.  A combination of techniques can work well, too.  On the other hand, ice bags in the groin and around the neck do not cut it.  Because the problem with heat stroke is related to increased heat production and/or decreased dissipation, not the thermostatic readjustment in the hypothalamus seen with a fever, don’t use antipyretics (e.g., ibuprofen, acetaminophen).  And don’t forget about appropriate volume replacement.

Greg Friese from CentreLearn sent me this link to a pretty good, non-scientific article about recovery from heat stroke.

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

2009 Wilderness Risk Management Conference

Bill Frederick, WMA lead instructor and Safety Director for School for Field Studies, will be conducting a presentation on navigating risk in international locales.  Bill will review the hazard landscape, research that is available, and best practices.

Specific topics will include:

- Info acquisition
- Transportation
- Medical Care
- Communications

Resources and Updates About the Wilderness Risk Management Conference:

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

Wilderness Medical Associates lead instructor Deb Ajango will be presenting a free workshop to Wilderness Risk Management Conference attendees. The workshop will inform audience members on how case studies can be utilized to improve risk management and safety.  Those attending will review a case study and then apply key concepts in risk management planning. The workshop will be held on October 14, 2009.

Click here to buy Lessons Learned II, written by Deb Ajango.

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

About the Workshop

The workshop is intended for experienced climbers and educators that wish to become providers of the PCIA Outdoor Climbing Instructor Courses.

Training will be held 2-3 hours away from Durham, NC and you will receive more information regarding logistics upon registering. Check out the Wilderness Risk Management Conference website for more information.

More About the 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

“I thought that I would share with you an event from this past weekend in which I was able to use my WFR training.  While Deanna and I were climbing a 5.7 route on Cathedral Peak in Tuolumne Meadows, a climber above us suddenly screamed out in pain.  He felt said pain while trying to make a mantle move onto a ledge.  He immediately asked me for help; knowing the scene was safe, I climbed up to him, got him to a safe place on the ledge and helped him sit down.  I told him that I’m a [Wilderness First Responder] and asked if he wanted me to take a look at what might be going on with his shoulder.  During my bilateral eval, I determined that his shoulder was likely dislocated.  Since it was an indirect injury of the joint, I told him that I could reduce it, and explained to him the process and pain relief benefit.  He asked me to do it, so I helped him to a lying down position (thankfully it was a big ledge) and started the reduction process. It only took two minutes or so to reduce the injury, and as expected, he felt immediate relief from the pain. I told him that I wanted to sling and swathe the arm, and then haul him the remainder of the way to the top.  (Thankfully I was only looking at 40 feet or so, which with a 5:1 mechanical advantage pulley system isn’t all that terrible.)  He didn’t want to be rescued any more than necessary, so he said he was going to try to climb the remainder by himself.  I told him that my offer stood if he changed his mind.  He was able to make it the remainder of the climb (a 5.6 crack).

I’ve thought a lot about this situation since then only to realize how things would have been very different had Deanna and I not taken the WFR course.  Not only did that course give us the specific tools to deal with such emergencies, but I have never felt more competent to provide medical care in wilderness context or otherwise. (And I didn’t even suffer any ASR, sympathetic or otherwise! {smile})  That said, I want to thank you once again for the great training.  I’m sure you’ve heard more than enough such stories, but I thought that you might like to hear another.  I hope this finds you well.”

This story was also featured in the August 2009 issue of Journal of Mountaineering on page 18.

Mountain Destinations will be hosting the 23^rd annual National Conference on Wilderness Medicine between July 29, 2009 and August 2, 2009 in Big Sky, MT. The objective of this conference is to teach both practical and theoretical skills to medical/outdoor professionals and enthusiasts. After completing this course, participants will have the knowledge to describe, assess, and  treat medical problems and emergencies that are frequently encountered in wilderness settings.

Wilderness Medical Associates’ Curriculum Director, Jeffrey Isaac PA-C, will be conducting a wilderness workshop at the conference on Technology in Wilderness Medicine and Rescue on July 31.

Wilderness Advanced Life Support (WALS)

There will be a Wilderness Advanced Life Support (WALS) course offered as an optional class between July 28, 2009 and July 31, 2009.  The Wilderness ALS course will be conducted by WMA instructors Jeff Isaac, Will Smith, and Fay Johnson.

Useful Resources on the National Conference on Wilderness Medicine:

• View the Big Sky Conference brochure
• Check out the Schedule-at-a-Glance
• Follow WMA on Twitter or check out our Facebook page
• Read more about the Wilderness Advanced Life Support (WALS) course.

Click Here Register Online for the National Conference on Wilderness Medicine.

Huyck Preserve is a non-profit organization on 2000 acres  just southwest of Albany, NY.  Along with miles of trails to hike and enjoy, there is an abundance of wildlife and natural treasures, making Huyck Preserve a wonderful place to take a wilderness medical course.

“Our mission is to protect the natural beauty of the Rensselaerville Falls, the watershed of Lake Myosotis and surrounding lands, to conduct long-term research on natural systems as part of a global effort to understand and preserve the Earth’s biodiversity, and to increase appreciation of this effort through innovative, field-based educational programs for students, teachers and the community.”

Huyck Preserve’s dedication to preservation, education, and research is beyond admirable. For information on how you can do your part in keeping the Preserve unspoiled, visit Huyck Preserve’s membership page.

Upcoming Wilderness Courses at Huyck Preserve

We are excited Huyck Preserve has chosen Wilderness Medical Associates for their first Wilderness First Responder (WFR) and their Recertification courses. Their first course, the full WFR, will be held between July 29, 2009 and August 5, 2009. Following the WFR class, Huyck Preserve will be offering an Open Recertification course between August 7, 2009 and August 2009. During the Open Recertification course, those holding a valid WMA certification may recertify a Wilderness Advanced First Aid (WAFA), Wilderness First Responder (WFR), or a Wilderness EMT (WEMT) certification. If you are a prospective student that was last certified through another organization, you may only recertify a WFR.