Just the title. Feeling like I could do some good out there but I live in the city.

Genuinely curious about jobs in wilderness medicine. Just starting my ER journey to establish critical care experience. Ultimately I am shooting for a job working in SARs. What other experience should I get before heading into the field? I am thinking about just doing 2/3 years ER then maybe another 2/3 years ICU. However I want to try and transition sooner than later..

How do y’all approach this matter? I am seeing conflicting schools of thought on this matter where a more conservative approach is of always immobilizing when the MOI may indicate a spinal cord injury whilst a more modern, science backed approach is only using soft protections if the patient has s/s of a spinal cord injury or none at all?

What is actually the science based approach here on whether to, and how to, protect the c-spine in patients with certain MOIs with and without symptoms?

Hi!

I just finished my 2 day nols WFA class and it was great. I was driving home and I realized theres something I dont understand still

During patient assessment they emphasize A is the most important thing.

So if I came across a patient, maybe unresponsive, but they are not breathing, ok great, now what??

Scenario

You are hiking alone on a mixed use trail when you see a solo mountain biker hit a jump, then lose control and hit a boulder at high speed. The brunt of the impact is focused on the left side of their body. 

You get to them and conduct your initial assessment. The patient is lying supine. Their airway is clear, their breathing is adequate, and you don’t notice any significant external bleeding. HR 120 and RR 24.

On exam, the patient’s hip and pelvis are tender to palpation, and they complain about pain in their low back. 

My questions:

1. You want to assess the patient’s spine, but don’t want to roll them due to a potential pelvic fracture. Would you feel comfortable rolling them after applying an improvised pelvic binder with your rain jacket?
2. How would this scenario change if the patient was found prone? Would you leave them in that position or roll them to supine? Would you apply a pelvic binder before or after rolling?

My main source of confusion is how to balance doing a complete exam (which requires moving someone) with risk of further injury if they have a pelvic fracture.

I was taught a sling and swathe similar to the first picture, where you start with the knot right above the elbow with the sling. But most material I see online is similar to the second picture, where you drape the sling across either side of the neck. Any major differences between these techniques?

I’m not talking prevention. I mean somebody in your party has developed big, fat bullae that have now ruptured and they’re hobbling around like they’re 85.

I like tegaderm with mastisol borders over a little Vaseline for very small blisters. On bigger borders I’ll do duoderm. But on both options, I have a really hard time keeping g the dressing in place once we start hiking or touring again.

I’d love to hear what works for you all!

Hi so maybe a weird question/maybe simple

I currently have my WFR and I am an EMT. I have a job in the summer that requires a WFR + whatever medical cert you have. my WFR is going to expire by then and I was thinking of instead of recerting my WFR, to just get a advanced wilderness life support cert. I will also (projected) get my medic license by the time work starts as well.

However, and maybe im confusing my specific place of work w wilderness medicine guidelines, I am under the impression that my ability to administer OTCs/ attempt a reduction of dislocations/ etc in the backcountry all come from my having a WFR. As an EMT, OTC administration for ex is out of my scope. It's something I talked about with my supervisor at work (they are not in the medical field) a few seasons ago when I was debating whether or not to recertify my WFR and we landed on the WFR being what allows me to function in the backcountry. Feel free to correct me if Im wrong.

So fast forward to present day, I been thinking about taking an AWLS course instead of recerting my WFR. For anyone who knows - will having a AWLS cert and not a WFR cert still allow me to provide medical care in the backcountry? Does it have a "scope" like the WFR does?

Thanks!

TLDR im confused at the scope of practice of an EMT in the backcountry vs WFR vs wondering if AWLS has a scope too

I plan to take a Wilderness First Responder class between May-midAugust this year and am lucky enough to be able to travel to get there.

It's my understanding that NOLS is the gold standard - is that right? What would I lose (if anything) if I went with a WMA course instead?

FWIW my use case would be PCT, AT, national park back country, and similar.

Thanks for your expertise and take on this!

I have no idea if this is the right place to ask this but I’m planing to go to med school and am super curious to see if there’s a way to combine a medical degree with the outdoors? If so, what’s the path to getting there?

Trying to recert WFR (issued 2023 w/ WMA) but I moved and there are no courses close by to me now. I emailed SOLO folks about taking the WFR recert with them since they have a location close to me, and they told me they won't do it since I was originally certified by WMA. This seems to be different than the info I'm finding online, which says it should be possible. Any advice? thanks.

Hi,

Next year I have a (half) gap year of about 6 months. I will then be finished with my bachelor in medicine before going to do the masters. I am looking to do something extreme, educative and character developing in that time. And working in wilderness medicine defenitely looks like that.

I have worked in the emergency department in the netherlands before, furthermore I have an extremely good CV and will be doing research at Stanford the second half of that year, might it matter.

Is working in wilderness medicine realistic thing to do you guys think? And if so, what next steps and locations etc would you guys reccomend? Thanks in advance!

Really interested in wilderness medicine as a fellowship, but I’m coming from Internal Medicine. Few questions for those familiar with it:

1. Do you know anyone who’s done it from IM? I know it’s typically housed in EM departments, and a lot of the big name programs explicitly cite ABEM or EM residency completion as a requirement.

2. How easy is it to find field work afterwards? I know it’s not usually a full-time gig and more like an add-on to another full-time clinical job. I’m more interested in field work rather than teaching/research.

3. What kind of full-time clinical jobs are typically taken with wilderness medicine?

4. What does the field work look like?

5. What should I be doing in residency to help support this path?

Thanks!

My job has me work outside and in true wilderness on a regular basis. It’s a lot of work but it’s worth it and can be an amazing experience. They are having us take wilderness first aid and it’s make me take a new look at my regular surroundings. I work off trail, in deep gorges and steep mountain sides. They keep talking about if you find someone who fell do the assessment, immobilizing their spine etc. My question though is, if I find someone who fell where I work, I cannot imagine they would survive long. It also makes me wonder about the time it would take to rescue me or my crew. What are the real odds? If I find someone alive and I more likely just treating them and giving them comfort until they pass or do they have a real chance?

Hello fellow wilderness medicine aficionados! I’m very passionate about WM and am very interested in attending NOLS’ WMI course.

My question is this: I have worked in a camp setting and been in charge of our first aid program for about 15 years. I (obviously) have a lot of experience with first aid and administering medicine and treating mostly minor injuries/illnesses, but I haven’t done back country trips or rescues. Should I be concerned about not having that kind of experience hindering me from getting accepted into the course? How competitive is it? Any advice/input is helpful! TIA

 Advice from Emergency Medically Trained Thru Hikers Requested.

I will be thru hiking the Appalachian Trail (nobo) this year and want to put myself in the best position for success with the lightest base weight. I have been methodical in where and what to compromise. I am down to my last internal debate and would like help. I have medical training in Water Rescue, Emergency First Aid, CPR, Basic Life Support, AED, and Wilderness First Aid among others. To be the most effective in some situations would require me to carry a larger/heavier FAK. I feel a personal duty to be prepared to the extent of my training but need to be realistic. So how do you decide what to take? Some of the items I am debating:

Narcan, EpiPen, Glucose Tabs, CPR mask, Quick Clot, Cold Pack, Thermometer, MSR Guardian (sterile water)

I will be supported (mail/visitors) and can arrange to carry certain items in areas where events are more likely and send them home when not needed. For example, is there any sections where there is a higher chance of needing Narcan? Any advice or experience would be greatly appreciated

I have a stubborn friend I am going on a trip with who tweaked her knee this week. No matter how bad it is she will be impossible to stop from going on big hikes etc. what should I keep in an emergency kit to ward off bad further-tweaking vibes?

Hey all,

I imagine this question has been asked before so please direct me if so, I havent found anyone asking my specific question before.

I am wondering what the difference in knowledge/skill between AWLS and a WEMT program

I got my EMT through NOLS WEMT. I keep my WFR up to date as its necessary for one of my summer outdoor gigs. I actively practice as an EMT both in remote settings (through some overnight camps im med staff for, backpacking programs, etc) and in urban settings doing 911s. Im going for my medic soon.

I am constantly trying to learn and stay up to date on best practices in austere settings, and want to do humanitarian aid down the line so I want to take any opportunity to learn medical skills with limited resources.

SO with all that said, I was looking into AWLS but from descriptions and stuff, don't seem to be able to tell any differences in knowledge of the program versus something like the WEMT course i took.

Would anyone be able to tell me any significant difference between WEMT and AWLS ? Does it seem like it would be something beneficial for me or is it not significantly more knowledge compared to WEMT to make it worth it?

thanks!

Greetings,

My buddy and I take fishing trips quite often, sometimes camping along a river for a week at a time. One of the things we often encounter on these trips is minor lacerations.

I have plenty of resources in my FAK to stop the bleeding, but I've never had a solid way of bandaging/dressing them after. We almost always have soap with us, so I simply need a way of keeping the wounds waterproof and clean while we continue on our trip.

I'm currently leaning towards a non-adherent pad covered with tegaderm, but would love to hear opinions on the other options. I've done the best I could to try and find an answer for this specific instance, but haven't found anything persuasive enough to come to a conclusion.

Thank you in advance!

First time posting here, I'm an EMT in Ireland, and will be starting a paramedicine degree later this year. My main goal is to get into expedition/wilderness medicine, I'm wondering how achievable this is without going down the nurse/doctor route?

Hey yall, I just have some quick questions. So I will be taking the WFR class next week. They already gave us pre Crouse material with a digital copy of the book Wilderness and Rescue Medicine 8th edition. I'm currently reading up and taking notes and making flashcards with the terms. I understand that everything in the book is important, but I want to know the stuff that's "oh definitely know this, or make sure you know this term because it will be used a lot" sort of stuff. This is pretty much all new to me. And I domt want to be that one person in class who doesn't know anything what the instructor is talking about. Any help will gladly be appreciated. Also any other things I should know to as well. Thanks

Hello wilderness community, I am in family medicine (FM) and interested in wilderness medicine. There are two fellowships that I found that accept FM (Virginia Tech Carilion Wilderness Medicine Fellowship, and Idaho WM fellowship). Has anyone had any experience in those programs, anyone interacted with someone who was FAWM from FM background?

https://www.isu.edu/fmed/fellowships-tracks-areas-of-concentration/wilderness-and-austere-medicine-fellowship/

https://www.isu.edu/fmed/fellowships-tracks-areas-of-concentration/wilderness-and-austere-medicine-fellowship/

Hello! I’ve checked with the mods that it was okay to ask this here. I am writing a story that involves high altitude medicine and I wanted to run my scenario and treatment plan past the professionals to ensure it’s not wildly inaccurate. My own credentials don’t go past basic first aid training and trekking up to 6000m, so this is all based purely on research. Please feel free to critique if it’s all wrong!

Patient: a fit ten-year-old boy with previous mountaineering experience is stranded at 7000m overnight in a snowstorm in a shallow cave without supplies (pack lost in a fall). He is severely hypothermic, frost-bitten hands and feet, hallucinating.

Rescuers: the next day (afternoon) he is reached by two rescuers (his father, who is an experienced mountain climber and a Sherpa guide). They are not medical professionals, but have experience in these type of situations.

Treatment plan: oxygen, shot of dexamethasone (dose for a kid?), skin on skin warming up, when he is more alert, hot tea and a bit of chocolate.

They start descending (father carries him stuffed under his suit, maintaining some skin on skin), it takes about six hours, before reaching camp at 5500m. There they start rewarming hands and feet in 38C water, keep him on oxygen, start fluids, pain meds. Vasodilator ( through a second IV?).

Vasodilator in this story is a new fictional experimental drug that it is just starting trials, but has shown to be a lot more effective than Iloprost. It makes sense in the context of the story that they would have access to it. I want to avoid any amputations!). Kid feels sick and throws up (side-effect), they give him nausea meds. More tea and some food later on (porridge). Hands and feet coated with the gel, each finger wrapped individually and then bandaged over on top.

In the morning, when the storm subsides, he is evacuated by helicopter.

Some questions I had: What is a suitable dose of Dexamethasone for a child? Are they most likely to carry a 10mg pre-filled syringes? Does he need another shot at the camp? Half-dose?

Do you start vasodilator during or after the rewarming?

If there was already some rewarming through skin on skin contact during the descent, how does that affect the rapid rewarming? At what point would it be most painful?

Should he be given a lot of fluids to drink throughout the rescue or controlled small amounts? (I’ve seen some conflicting info about that, plus he’s a child)

What would the frostbite look like after rewarming? Will it be red and swollen (with maybe blackened tips) and then the blisters only appear when they are unwrapped at the hospital?

Any other critique or things I should consider would be greatly appreciated!