Q: The new medical advisor of our guiding company has advised us not to distribute over-the-counter medication to our clients. What is your opinion? Technically, one could argue that giving medication under these circumstances (paid guide giving to a client, non-family member) could be considered practicing medicine without a license. Many school nurses are prohibited from dispensing… Read more »
Posts By: David Johnson, MD
Tourniquets have a checkered history past and current combat in the SW Asian theaters has drawn new attention to them.
A medical advisor can and should be an integral part of your risk management team, not just the person who writes prescriptions for epinephrine. Functions could include review and advice on policies that have to do with safety, medical management and treatment protocols. If you do any screening, an adviser can also give some guidance… Read more »
Femur fractures are serious injuries that usually occur as the result of significant forces. A full assessment, focusing on critical system problems and their stabilization is the crucial first step.
Effective stabilization of femur injuries will help alleviate pain and decrease the possibility of complications. I believe that either a vacuum splint or good padding in a stable carrying device does a good job of providing both.
Although there is no literature supporting their efficacy in the prehospital setting, a commercial traction splint can be a useful tool when applied by a skilled practitioner who receives periodic training on a particular device and/or uses it during rescues or EMS calls. They should not be left on for a prolonged period of time (e.g., greater than 2 hours) unless limb neurovascular integrity and splint tension can be monitored properly and regularly.
Regardless, these are painful injuries. All require the administration of analgesics.
Creating protocols for administering epinephrine in vials and things to consider.
Dr. Johnson’s thoughts on using pulse oximeters to diagnose High Altitude Pulmonary Edema (HAPE).
If you heard about the man who survived a cardiac arrest by receiving 96 minutes of cardiopulmonary resuscitation (CPR), you might be wondering how I feel now about our position on when to discontinue CPR.
In the wilderness or remote setting, stop resuscitation if there is no pulse after performing 30 minutes of continuous CPR.
Q: Can a group of field researchers, certified in basic first aid, be allowed to have an epipen in a first aid kit at the location. There are no individuals with known allergies or prescription for epipen, but they will be in a remote location (2-6 hrs from emergency medical services.
Could/should Wilderness First Responders be certified to use the King Airway? Could be, yes; should be, no. The limited time available in a WFR course are better spent on more relevant and practical topics and skills.