Epi Pens in High Demand

Below is an CNBC news blog link to an article on the increase in epi pen demand and use, given the proliferation of peanut and other allergen based responses. DJ and Dr. Peter et.al. were saying this years back, confirming they were forward leaning ‘ahead of their time’, despite being viewed as heretics when they proposed that doing things like reducing dislocations, discontinuing CPR, and treating severe allergic reactions were reasonable and prudent things to be doing.

My rhetorical question would be, with this increase in prescriptions being written for epi pens (thus profits), why hasn’t some other medical company resurrected the patent on the old user – friendly, cost – efficient “Anaguard” syringe system? Pharmaceutical collusion, perhaps?


Submitted by:
Dennis Kerrigan, NREMT-P, WEMT
WMA Lead Instructor

Funny Questions Students Ask

Q: Greg, what is the strangest question you have ever been asked by a student.

A: During the emergency childbirth lecture at WFR class in Illinois a very serious student asked at the end of the lecture, “After the placenta delivers can you feed the placenta to your dog?”

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

Injury on Course

“Where’s Greg? Does anyone know where Greg is,” a pale and anxious teacher hollered as she ran down the hall way.

I was teaching a WFR course at a junior and senior high school in northern Minnesota.

“Greg is right here,” I calmly replied.

“Come quick a little boy had a fire extinguisher fall on his finger. It is bleeding and his fingernail is hanging off.”

That bit of information gave me a lot of Scene Size-up details:
MOI: trauma from heavy object to an upper extremity
Numbers: 1 actual patient. Likely to have multiple ASR patients
Safety: expecting blood I donned gloves and confirmed that the fire extinguisher was safely reattached to the wall.

As I walked to bathroom to where the child was with his mother I could hear the young boy screaming.

Initial Assessment details:
Airway: open
Breathing: yes
Spine stabilization: not indicated
AVPU: awake
Pulse: present
Severe bleeding: need to see wound, but not likely.

When I entered the bathroom mom was rinsing the child’s finger in a forceful stream of cold water. She was very anxious and talked really fast to tell me what had happened.

1015 problem list:
Patient 1: Mom
A: Sympathetic ASR
A’: More ASR
Rx: calm and reassure mom, give her specific directions to stop rinsing, stop rinsing child’s finger, apply well aimed direct pressure with a paper towel, and prepare to safely transport child to urgent care

Patient 2: 17 month old male
A: Sympathetic ASR, proximal finger nail partially torn on right pointer finger
A’: pain, infection, more ASR
Rx: well aimed direct pressure to control bleeding, urgent care evaluation of finger. Be held by a calm and reassured mom.

Focused history and physical exam:
Physical exam: partially torn proximal finger nail on right pointer finger with bleeding. No other injuries
Vital signs: within normal limits
SAMPLE: up-to-date on vaccinations. Fire extinguisher tipped over and fell on his finger while playing with his older brother. No other pertinent findings

1021 problem list:
A: all patients resolving ASR
A’ return of ASR
Rx: continue to calm and reassure

A: evacuation to urgent care in privately owned vehicle
A’ return of child’s ASR during transport
Rx: another teacher found to drive car so mom could ride in the backseat to provide reassurance to properly restrained child

Outcome: x-rays showed no fracture to finger bones. Wound cleaned and dressed. Finger nail left in place. Mom directed to monitor for improvement and signs of infection.

Notes: wilderness medicine providers rarely assess and treat injury and illness in the back country because they work so hard to prevent problems and to intervene early. You are much more likely to use the patient assessment system for a situation like I encountered, when you are first on scene at a car accident, a stranger collapses in the grocery store, or a relative complains of feeling ill during a holiday get together. Use the PAS to establish a problem list and to determine if the patient is having an emergency. Based on your findings call for help, evacuate to definitive care, or treat on scene.

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

A WFR Comes in Handy… Even on a Buddhist retreat.

Using My WFR on a Buddhist Retreat…

I recently attended a Buddhist retreat in the mountains of eastern Spain and wasn’t expecting to use my WMA Wilderness First Responder training. The retreat center was high in the mountains and quite remote- 5 miles on a single track to the nearest village. Great views, so quiet, away from civilization. Lovely, until….

One afternoon I went for a hike with two other women. We didn’t have a map or a clear understanding of where we were going other than, “follow the path, then look for a side trail that leads to the top of the limestone cliff”. We couldn’t find the side trail started bushwhacking up a rather steep slope.

I HATE bushwhacking, but went along. However, when we started up the steepest rock face I’d ever climbed without a rope, I stopped and encouraged the others to do so also. Prevention, prevention, prevention! I couldn’t imagine the nightmare a rescue would be from such a steep slope.

One in our party stopped, but the other one would not. She is a 60+ year old woman with little hiking experience. I felt so powerless to stop her. It was interesting to watch my emotions escalate while waiting. She was putting herself, the two of us, and the entire retreat of 17 women at considerable risk. Luckily she descended and we all returned without a scratch.

The second “incident” occurred when we awoke to a foot of snow! We were now in a real wilderness situation: remote, without proper medical equipment and in a hostile environment. I couldn’t believe my eyes when I saw two women (yes, one was my friend from the previous day!) start walking to the shrine room for morning meditation. The five minute walk was an easy path, except for the middle part which I named, “the Hillary Steps”. Beneath this tricky part was a precipitous ravine. I called them to come back, which thank heavens they did.

I immediately talked to the leader of the retreat and explained that I was a certified WFR and we were now in wilderness conditions and needed to make some rules and decisions regarding safety. Again, I thought of the complexity of a rescue from that setting…prevention, prevention, prevention! I was able to convince the leadership team that the risks were not worth the benefit and we banned walking on ANY trails, no solo walks on the track, and a group evacuation the following day.

This experience is an interesting case study of what can happen when people mean well, but are unaware of potential risks, and don’t know the serious implications of a remote rescue. Safety and prevention are key!


Snakebites & Antivenom

20,000 people per year are killed by snakebites each year in developing countries. Wow.

Read this article to learn about the difficulties of making and distributing antivenom.

We are fortunate in North America to have very few poisonous snakes and just a handful of deaths each year.

As I routinely remind students if you are close enough to a pit viper to see if it has vertical pupils or if a coral snake’s color bands are red on yellow you are probably too close. Or you should let go of the snake immediately.

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

Falling Through the Ice; What to do.

What to do if you fall through the ice. Would you know what to do? When I teach a WFR in the far north in the winter I am always able to find a student volunteer to “fall through” the ice. After a safe extrication is conducted WFR students act quickly to remove the patient’s wet clothing, package the patient in a hypothermia wrap, and evacuate the patient to a nearby building. From time of extrication to time inside a building I have had students do this in 8 minutes.

This video by Dr. Gordon Giesbrecht, an expert on hypothermia physiology, explains how to self-extricate from the water after falling through the ice. He also explains how hypothermia develops. Several years ago Dr. Giesbrecht delivered a hypothermia training program to WMA instructors.

This video is often shown during WFR classes and is a great thing to refresh as the cold weather season arrives.

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

October 2008 Wilderness Risk Manager’s Conference

A forum on managing technology in wilderness was convened at the October 2008 Wilderness Risk Managers Conference. Browse to http://www.nols.edu/nolspro/pdf/wrmc_managing_technology_on_adventure_programs.pdf to read a recap of the forum discussion by two members of the Wilderness Risk Manager’s Committee.

Benefits from Hydrogen Sulfide Emissions

Wilderness medicine is generally understood to encompass prolonged patient transport, limited or improvised equipment, and/or severe environments. One of the most severe environments encountered by wilderness providers is the tent after a group meal of beans and rice. Any meal that includes dried onions is guaranteed to elicit gasps for relief from my tentmates and groans from any others in tents downwind.

In news that can only be described as reassuring for the emitter researchers have determined that the hydrogen sulfide produced in the intestinal tract and released in flatulence lowers blood pressure in a test of group of mice. Due to similarities in all mammals researchers believe their research findings will lead to new blood pressure therapies. Read more at http://www.msnbc.msn.com/id/27343876/.

Meanwhile, protect yourself using diligent meal planning, careful tent mate selection, and excellent ventilation to protect yourself from inhalation of your tent mate’s hydrogen sulfide. Your safety is #1. Finally, remember the nose experience quick odor fatigue so seek out a replacement smell from nearby polypropylene for immediate relief.

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

Spider Strap Removal

Hey folks!

Wilderness Medical Associates instructors Greg Friese and Kevin Collopy just created this great video on the removal of spider straps, which is important so that you can maintain your equipment and keep it clean for the next time they’re used.

Check it out!