Wilderness Medicine New

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Volume 29, Number 4 Preventative Search & Rescue Dispatches from Flight Surgeon School Off the Beaten Path: Zulu-Lander

INSIDE

Preventative Search & Rescue

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Dispatches from Flight Surgeon School

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Off the Beaten Path: Zulu-Lander

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WHAT'S INSIDE Wilderness Matters Jay Lemery, MD, FAWM..................................................................................................................................................... 4

Preventative Search & Rescue: Public Health in the Wilderness

Wilderness Medicine

Matthew T. Hamonko MD, MPH, FACEP, FAWM, FAAEM............................................................................................. 6

Flight Surgeon School Dispatches Michael V. Arnett, MAJ MC, FAWM.................................................................................................................................. 8

Off the Beaten Path: Zulu-Lander Rob Conway, MBBS, BSc (Hons), DiMM......................................................................................................................... 12

Wilderness SVT Rob Hart, RN, CEN, FAWM............................................................................................................................................. 14

Wilderness Medicine E-News and More Nancy Pietroski, PharmD.................................................................................................................................................. 18

Great Gear for Work and Play: Fall Preview for Weight Weenies Christopher Van Tilburg, MD, FAWM............................................................................................................................. 20

Wilderness Skills: Tourniquets—from the battlefield to the woods Chris Cousar PA-C, NREMT-P, FAWM............................................................................................................................. 21

Trail Mix: Nutrition for Adventurers—Steak in the Wild Wayne Askew, PhD........................................................................................................................................................... 22

First Aid Training for Kitesurfers Michiel van Veelen, MD . ................................................................................................................................................. 24

Society Matters.......................................................................................................................................... 25 Student Elective 2013 Research Grants

A quarterly magazine published by the Wilderness Medical Society The Wilderness Medical Society makes no representations regarding the legal or medical information provided by the individual authors in Wilderness Medicine magazine. The goals of Wilderness Medicine magazine are to: 1. Provide timely information regarding Wilderness Medical Society news and activities. 2. Provide a forum for exchange of ideas and knowledge regarding wilderness, environmental and travel medicine. 3. Disseminate wilderness medicine information to the wilderness, outdoor and travel community. Wilderness Medicine (ISSN 1073-502X) is published online quarterly in January, April, July and October by the Wilderness Medical Society, 2150 South 1300 East, Suite 500, Salt Lake City, Utah, 84106. Submit request to reprint Wilderness Medicine in whole or in part to copyright.com. ©2012 Wilderness Medical Society. All rights reserved. WMS Editorial Office & Advertising Sales Jonna Barry 1505 N Royer St Colorado Springs, CO 80907 Tel: (719) 330-7523 Fax: (801) 705-1483 Email submissions to [email protected]

Call for Abstracts 6th World Congress—A Success! Educational Presentation Series Community Education Lecture Series Practice Guidelines

Cliff Notes Ali Arastu............................................................................................................................................................................ 28

Design & layout: CoPilot Creative 301 E Pikes Peak Ave Colorado Springs, CO 80903 copilotcreative.com

WILDERNESS MEDICINE // Fall 2012

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WILDERNESS MATTERS Jay Lemery MD, FAWM, President WMS

“ The future is looking very bright.

”

Dear fellow WMS members, It’s a privilege to take over the stewardship of the WMS from my good friend Tony Islas. I can say that no President has ever assumed the helm in a better position than I do now—thanks guys! Over the past 30 years, we have never been as fiscally sound, diverse in opportunities and strategically placed as we are now. The future is looking very bright. This summer we’re coming off an outstanding World Congress at Whistler, BC, Canada. It was one of the most beautiful ecosystems I’ve ever seen (the lack of the infamous Pacific Northwest rain was a welcome bonus!). The conference was steeped with worldclass learning and camaraderie. For those who couldn’t make it to Whistler, we have another blockbuster year coming up. February 15-20, 2013, we return to Canyons Resort in Park City for our annual meeting on mountain medicine. As a kid who grew up skiing on the ice and granite of the Northeast, this is my favorite WMS Conference— although Wasatch powder is often a dangerous

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EDITORIAL STAFF Christopher Van Tilburg, MD, FAWM Editor-in-Chief

Jonna Barry Managing Editor

2013 CONFERENCES more at WMS.ORG/CONFERENCES

for FEB MedSail: FEB Medicine JUL FEB OCT FEB

30 to Mariners 2-9 15-20 15-20 11-17 NOV 3 Virgin Islands 2013 British 2013 2013 2013 2013 2013

2-9

FEB 2-9

2013

Wilderness & OCT FEB Winter JUL Mountain Medicine 30 to 15-20 11-17 NOV 3 Conference FEB 2013 FEB JUL 2013 2013 Canyons Resort, Park City, 2-9 15-20 11-17 Utah

2013

OCT 30-

MAR 24-

NOV 3

APRIL 13

2013

2013

2013

Conference MAR 24OCT Summer 30OCT 30OCT JUL 30th

Seth C. Hawkins, MD, FAWM Senior Editor

MAR 24-

to 3 APRIL 13Medicine NOV NOV 3andAPRIL 13 on30 Wilderness NOV 3 2013Meeting 2013 2013 2013 2013 Annual 2013

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Beaver Run Resort, Breckenridge, Colorado

OCT 30-

MAR 24-

NOV 3

APRIL 13

MAR & 24OCTChange 302013 Environmental 2013 OCT APRIL 13 Human Health 30 to NOV 3 NOV 3 Dauphin Island Sea Lab, Dauphin 2013 2013 2013

Island, Alabama

Debra Stoner, MD, FAWM Deputy Editor

Larry E. Johnson, MD, PhD Assistant Editor

Contributing Editors Nancy Pietroski, PharmD

WMS Everest Experience 2013

2013 Khumbu Valley, Nepal Sam Schimelpfenig, MD

distraction from the lectures and workshops. Next summer (July 11-17, 2013) we return to Colorado for the Annual Meeting and it’s a big one! The WMS turns 30 years old, and we plan to turn Breckenridge into a big party to celebrate our rich history. We’ll be pulling in world class speakers as well as dusting off some of the old guard too, so please plan on being there. Headed into the fall of 2013 (October 30-November 3), we are dedicating an entire conference to a topic that is of concern to any wilderness medicine aficionado—Our Patients-Our Planet: Environmental Change and Human Health. We will be based out of the Dauphin Island Sea Lab on the Gulf Coast of Alabama, and I personally think this will expose a whole new audience of medical practitioners to the world of wilderness medicine.

We also have big plans to augment our on-line learning, expand our Diploma of Mountain Medicine course, and begin to offer our members tailor-made adventure travel courses specifically designed to foster the best attributes of the WMS. Please remember to check out wms.org for the most up-to-date information about the Society, as well as our Facebook page which is a great forum for member-to-member communication. I’d love to hear from you too—please email anytime: [email protected]. See you out there! JAY Editor’s Note: Dr. Lemery was installed as the President of the Wilderness Medical Society during the July 2012 6th World Congress and Annual WMS conference in Whistler, BC. Dr. Lemery will serve as President July 2012 to July 2014.

Lynn Yonge, MD, FAWM

Editors Emeritus Edward Geehr, MD 1984-1986 Howard Backer, MD 1986-1991 Eric A. Weiss, MD 1991-1994 Karl Neumann, MD 1994-2002

PRE VENTA TIVE

SEARCH AND RESCUE: PUBLIC HEALTH IN THE WILDERNESS Matthew T. Hamonko MD, MPH, FACEP, FAWM, FAAEM Photos courtesy of Matthew Hamonko.

Search and rescue (SAR) teams are called upon to perform many duties. These include rescuing individuals in distress in the wilderness, searching for lost individuals and recovering the bodies of individuals who have died. In addition to responding to emergencies that occur in the wilderness, there has been an increased focus in recent years on preventative search and rescue (PSAR). PSAR programs focus on the prevention of emergency situations in the wilderness before they occur so that activation of a SAR team is not necessary.

Using SAR training students, Dr Hamonko (top) demonstrates proper patient packaging in the event that an evacuation is necessary.

From 2003 to 2006, there were 12,337 SAR operations at U.S. national parks. The total cost of these missions was $16,552,053.00. Fatalities were reported in 522 of the operations. Day hiking was the most common activity associated with SAR operations, and studies specifically evaluating the cause of fatalities in US national parks have reported that 10 to 22.8% of fatalities are associated with hiking. In Utah, from 2001 to 2005, there were 1190 SAR operations recorded. Insufficient equipment, clothing or experience was associated with 185 cases, and 81 cases were associated with adverse weather conditions. A study reviewing cases of illness and injury in Shenandoah National Park from 2003 to 2007 concluded that most cases were associated with trauma rather than medical illness. Hiking was the most common activity associated with injury, and most injuries were described as injuries to the lower extremities. In addition to finding that musculoskeletal injuries were a common cause for SAR activation, a study conducted at Yosemite National Park found that, from 1990 to 1999, 8.3% of the situations requiring SAR services were related to dehydration, hypovolemia or hunger; these factors combined were the most common non-traumatic reason the SAR team was activated. The authors of this study suggested that, based on their data, preventative strategies should focus on the education of day hikers regarding how to prevent lower extremity injuries, dehydration, hypovolemia and hunger. During the summer of 2009, I worked with the SAR team in Yosemite National Park and was introduced to the concept of PSAR. Activities included setting up stations at trail heads where we counseled guests regarding appropriate clothing and gear, adequate hydration and nutrition, and ways to prevent the need for SAR team assistance. We also assisted park guests with injuries and counseled guests regarding proper behavior in the wilderness. During the evenings, lectures were given by the PSAR staff. These lectures included reviews of SAR incidents that had occurred in the park and instruction regarding the appropriate clothing, equipment, nutrition and fluids that guests should bring with them while participating in activities in the park. I was inspired by my experience with the PSAR program in Yosemite National Park to establish similar programs at other

parks. In April of 2010, I traveled to Zion National Park to execute a pilot program. The program contained three components: trail head stations where guests were counseled and preparedness and demographic data were collected; an evening lecture series; and volunteering as a member of the SAR team. This program design may be used as a basic framework for future programs and research studies. The available published literature on SAR in the United States and abroad suggests that many missions may be avoided with proper education and training. Preventative measures in this area have the potential to significantly reduce morbidity and mortality rates, as well as monetary losses. In the future, I would encourage healthcare professionals, especially those with public health and wilderness medicine training, to become involved in PSAR programs where they are already being implemented and to speak with state and national park representatives that do not have established programs to encourage them to implement them. As physicians with wilderness medicine experience, we have a unique opportunity to make a difference in this area of public health. Dr. Hamonko is the attending physician at the Maine Medical Center’s Emergency Department in Portland, and Medical Director for the South Portland Fire Department.

DISPATCHES FROM

FLIGHT SURGEON

SCHOOL Michael V. Arnett, MAJ MC Photos courtesy of Department of Defense.

The U.S. Army School of Aviation Medicine (USASAM) at Fort Rucker, Alabama is the U.S. Army’s premiere center for training aeromedical personnel to include MEDEVAC pilots, flight medics, flight nurses and flight surgeons/aeromedical physician assistants. The flight surgeon course is a six-week program that covers the medical aspects unique to the aviation community and includes the basic mechanics of rotary flight, flight physiology, MEDEVAC doctrine and operations, mishap prevention and investigation, survival equipment and skills and providing routine medical care to aviators. Below are some highlights of this course from my personal notes.

THE PHYSICIAN STOOD BEHIND THE APPLICANT AND FIRED A PISTOL BLANK ROUND.

DAY 1: History of Aviation Aeromedical Evaluations On September 17, 1908, the first casualty of powered flight was Army Lieutenant Thomas Selfridge, who was killed on a demonstration flight with Orville Wright. When the United States entered World War I, the aeromedical screening examination was so exclusive that none of the pilot applicants were found fit for duty, even American pilots who had combat experience. The “needle test” required a blindfolded applicant to hold a long needle between his thumb and index finger. The physician stood behind the applicant and fired a pistol blank round. If the startled candidate squeezed his fingers and caused bleeding, he was deemed “nervously unfit.” More interesting is the “mallet test” in which the examiner stands behind the candidate, and strikes the candidate on the head with a mallet. If the candidate remained unconscious for more than 20 seconds he was disqualified. DAY 4: Aerodynamics of Rotary Flight Because of Newton’s Third Law regarding equal and opposite reactions, the counterclockwise rotation of the main rotors of a helicopter creates a clockwise rotation of the fuselage. This “antitorque” is cancelled out by the tail rotor.

DAY 17: Simulator Training From the outside, it looks like a 20-foot metal box suspended 10 feet above the ground on three hydraulic lifts. Inside, I am sitting in the cockpit of a UH-60 Blackhawk and looking at the flight line. There are hundreds of important-looking buttons and switches that surround me. The instructor pilot talks me through our flight plan and assists with the take-off. The helicopter begins drifting right and I apply left pressure to the cyclic to steady the helicopter. At least, that is what I intended to do. Instead, I apply excessive pressure to the cyclic and send the aircraft into the pavement which turns my windshield into the red screen of death. Rookie mistake. The next take-off goes much smoother, but I crash again on the landing. DAY 22: Familiarization flight on CH-47 Chinook The Chinook CH-47 crew chief briefs us on emergency procedures. In the Chinook, the course director hands me an IV kit and points to my fellow student. Just before I attempt the IV stick, the helicopter banks hard to the left. I wait for a moment of level flight, advance my needle, and see the flash of red. The flight medics do this in total darkness wearing night vision goggles. DAY 34:

DAY 8: Altitude Chamber Eight of us sit in the hypobaric chamber, with a balloon hanging from the ceiling to demonstrate Boyle’s Law: as we lose pressure when simulating gain in altitude, the balloon gets bigger. Upon reaching a pressure of 15,000 feet, we remove our masks and turn off our supplemental oxygen. We take an easy quiz: simple addition, draw a clock face and list the signs and symptoms of hypoxia. I circle “sleepy,” “headache” and “apathy.” “Do you feel safe to operate an airplane?” I answer “NO” I have the insight to put my oxygen back on. DAY 12: Spatial Disorientation The vestibular and somatogyral systems are designed for the “terrestrial environment.” The importance of visual reference rules all of the senses. This is ideal for most humans, but can create dangerous situations for aviators. A pilot coming in for a landing who turns his head quickly to look at an instrument on the other side of the cockpit may instantly induce debilitating vertigo. There is little room for error in keeping a helicopter in controlled flight.

Water Survivability Training In the pool, I wear my flight suit, equipment vest, boots and helmet. The real awkwardness is in performing a semi-coordinated swim. Treading water is particularly difficult. I survive. GRADUATION DAY The dean of the U.S. Army School of Aviation Medicine gives us at graduation shiny, silver wings that support a caduceus. Several classmates leave soon for Afghanistan. They receive the most applause. MAJ (Dr) Michael Arnett is a graduate of the military’s medical school, Uniformed Services University, completed residency training in Internal Medicine at Tripler Army Medical Center, and is a Fellow of the Academy of Wilderness Medicine. He is stationed at Fort Campbell, Kentucky.


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OFF THE BEATEN PAT ZULU-LANDE Rob Conway, MBBS, BSc (Hons), DiMM Photos courtesy of Rob Conway.

It struck me as I watched my wife hold a beating heart in one hand and stitch it up with the other that open heart surgery for penetrating trauma was one thing every newlywed couple should do. I am a doctor from the UK part of the way through my anaesthesia training. My wife, a general surgeon, and I took time to work in rural Africa to gain some experience of real medicine. We set off for Northern Kwa-Zulu Natal, South Africa, in a busy district general hospital called Ngwelezane. with 500 acute and 8 ICU beds. The catchment area covers 22 referring hospitals and a population of 4 million. This work is incredibly demanding, with an emphasis on trauma, emergencies, paediatrics and obstetrics. African Health Placements (AHP.org.za), a group facilitating doctors’ placements in rural South Africa, assisted with our planning. The work was varied and interesting. The nurses sing the day in with a mixture of traditional Zulu and Christian church songs, their voices drift across the hospital. The patient population seemed to be younger and fitter than at home, although the majority had underlying HIV and tuberculosis. Hours were long and operating lists are generally overbooked.

TH: ER

The operating room was the main battlefield and, unlike the UK, I was not involved in managing acute trauma in the emergency department or in critical care medicine. Except in extreme circumstances: once, I was called when two packed buses collided, injuring 40 people, many of them children. I cared for a four-year-old girl, whose mother had died in the crash. The girl had a severe head injury and lower limb trauma. It was the weekend, we had no way of contacting a guardian, and there was no senior physician to ask for advice. I was under pressure from my peers to rush her to theatre, however, I was aware of the serious head injury and the damage that my

anaesthetic may do with the limited medications I had available. I decided to delay and review the outcome of her head injury prior to rushing her to the operating room. With no one to ask for advice, I acted in what I felt was her best interest. Following 24 hours of observation and improving consciousness, only then did we operate to mend bilateral tibula-fibula fractures. Over Christmas the workload and hours were relentless. Each period of on-call involved multiple penetrating trauma laparotomies and a number of stabbed hearts. The Zulus are tough, stoic and appreciative of treatment. Once, a young Zulu man had been attacked with multiple stab wounds, including one to his left ventricle. Until this point I had never contemplated the anaesthetic considerations for a patient with a stabbed heart. After induction, the surgeon cracked the sternum, grabbed the beating heart, and said “He’s not going to like this.” He was right. The capnography trace disappeared and the patient went into PEA [pulseless electrical activity]. As the surgeon repaired the hole, a normal rhythm appeared. Remarkably the patient went home four days later. I have seen many weird and wonderful things too numerous to include here; the 30 cm worm crawling out of an abdomen intraoperatively, a hippo attack, snake bites, rare tropical diseases and the use of agents we no longer commonly use in anaesthesia such as halothane and ketamine. Every day I treated cases outside of my normal comfort zone and much of the time I was unsure if I was doing the right thing. At times, it has helped to debrief in an online forum and ask advice from others who may know better. There were also many non-clinical roles needing to be filled such as scheduling and teaching. If there was one thing I will remember vividly it is that KwaZulu Natal is a gem. We had a beautiful home overlooking the Zulu hills minutes from the beach. Within two hours we visited world class game reserves, two of the world’s top ten dive sites, and surfed. A little further away are the Drakensburg Mountains, Mozambique, and it is only a short flight to Cape Town. The experiences, especially exposure to trauma and paediatrics, were amazing. This environment highlighted the value of training. Would I recommend Ngwelezane? If you want a hands-on, raw, frightening, yet exhilarating African experience, then I don’t think you could do better. Dr. Rob Conway is an anaesthetics trainee from the UK who took time out of training to undertake a year working in a busy rural South African hospital. His placement was assisted by African Health Placements.


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Wilderness

SVT Rob Hart, RN, CEN, FAWM Photos © Rob Hart, hartimages.com.

I was lying on my back on a narrow stone ledge. A bandana was draped over my face, my legs in a Trendelenburg position, and my wife poured ice water onto my face. It was at about this point that I was contemplating the next logical step in breaking a run of supraventricular tachycardia (SVT). I had tried the valsalva maneuver over and over, nearly to the point of popping out an eye like an excited Chihuahua. I also struggled with the carotid massage, locating the carotid bulb and rubbing my neck to conjure a genie. I even attempted to do both at the same time, bearing down with the image of birthing twins and burying two fingers into my neck like I was looking for change between the cushions of my sofa. No good.

My personal history of palpitations and tachycardia started years ago, in 1991, during a dehydrated mountain bike ride up the face of a local Boise legendary hill, where my heart rate hit 204. At the bottom of the downhill my heart rate monitor was still showing a rate of 160. A few simple deep coughs broke the cycle and I was on my way – and my SVT has followed me intermittently for the rest of my years. In the mid 1990s, near the top of the Grand Teton, I again felt the pressure of a runaway heart. “Not good,” I thought, climbing at a slower pace. I tried the usual valsalva moves, anything that would increase my intrathoracic pressure and trigger my vagus nerve. However, all that accomplished was to redirect my concentration from climbing to my tachycardia. I needed to pay attention to climbing. To my benefit, my climbing partner that day was Mark, a cardiologist. I slowed, then stopped, and waited for him to climb up to me. I am sure he was wondering why it appeared as if I was trying to force a spirited bowel movement, but within seconds he realized my plight, palpated my indiscernible pulse, and said, “Do you know where we are?” Like a well-rehearsed magic trick, a few seconds of Mark’s experienced kneading to my lateral neck instantly broke the reentry cycle, and I was symptom-free. In fact, I felt so good that we climbed on to the summit. I was grateful, and also quite pleased that my vessels didn’t yet have enough plaque in them to replace the SVT with a cerebral vascular accident. Incidents involving your heart seem to be quite clear in your memory, like they were inscribed with a soldering iron. So, after mining the history of my rare episodes of SVT, the perpetrator of my rapid rate seemed to be a cruel combination of caffeine and dehydration.

for luck. Nothing. My pace was slowing. “I wonder if I could just hike in short bursts until we got to the Pheriche clinic? Surely they have some adenosine there,” I thought. Once I was stopped and supine (I would like to add here that to continue any stressful activity involving a strained electrical system will undermine any conversion tactics) my trekking friend, and ER physician, proposed the solution-ice water immersion. I had never tried the diving reflex myself, but at this point it was the only option. I hoped the embarrassing display of my impromptu waterboarding wouldn’t raise the attention of every medical person on the trail, creating a Gore-Tex funded rugby scrum, but thankfully no one seemed to mind the spectacle. Within seconds of the ice water plunge, my pulse was radially palpable at a rate of 65 bpm, and my symptoms of fatigue and lightheadedness instantly resolved. So immediate was my relief that I was able to sit up, stand, and hit the trail within thirty seconds of conversion. I swore off caffeine for the remainder of the trek and began drinking water nearly to

all of which were vanquished without any more than a protracted valsalva – until Nepal.

Since that day I have monitored my hydration status closely during any outdoor adventure, as well as my coffee intake. I contemplated a visit with an electrophysiologist for a possible ablation, but decided instead to avoid the “burn” and the rate-limiting medications that were suggested by various wellintentioned associates. Instead I decided to live normally, although more thoughtfully, and have only had a few repeat instances of SVT, all of which were vanquished without any more than a protracted valsalva – until Nepal. We had just passed the village of Pangboche when palpitations and a rapid heart rate beat me into submission. Even though I was drinking three liters of water a day, I had discovered Starbucks Singles, which I had shamefully abused. I attempted the usual – cough, valsalva, cough and valsalva again. But tachycardic I remained. I hiked further and then threw in the carotid massage

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the point of obsession – to ensure a reoccurrence was less likely. I found out later, the Pheriche clinic does not carry adenosine, has no defibrillator, and relies entirely on metoprolol for tachycardias. The only answer might have been a rescue helicopter back to Kathmandu. My solution for future adventures will have to be more than just traveling with a cardiologist. It will involve the potentially lethal combination of dehydration and caffeine. Until then, my heart remains a jack-in-the-box, and I continue to turn the tiny handle, waiting for the thrilling moment when I am faced with another manifestation of the SVT jester. Rob Hart, RN CEN FAWM, works at the Level II trauma center in Boise, Idaho. When he is not at work in the trenches, he operates his sideline photogrpahy business (hartimages.com) which has taken him from climbing in Nepal and trekking in Patagonia to diving the coral reefs of the Similan Islands of Thailand.

The Khumba trail, beyond Namche.

Rob giving himself a carotid massage

WILDERNESS MEDICINE

Hot (As a Lightning Bolt) Off the Press The WMS published

WMS Piques Interest at Whistler Whether or not you

experienced the excitement of attending WMS’ 6th World Congress of Wilderness Medicine in Whistler BC in July, check out “Medics Gone Wild,” the somewhat irreverent but important coverage of the meeting’s events, that also contained sound bites from WMS notables in Whistler’s newsmagazine Pique.

CLICK HERE Free-Ride, Take It Easy Might

be a cautionary mantra for the multitudes of mountain bike riders who do lift-accessed riding on big hills. Ashwell et al. conducted a retrospective study on injuries in MTB cyclists who presented to the Whistler Health Clinic (Whistler, BC) over a 5-month period in 2009 (Wilderness & Environmental Medicine June 2012; 23:140-145). A concerning 12.3% of riders had injuries threatening to life, limb or function. The authors offered suggestions for prevention of injuries and areas for further research.

CLICK HERE

Practice Guidelines for the Prevention and Treatment of Lightning Injuries online in early August, right in the middle of a very active season of serious thunderstorms. Be among the first to access critical guidelines published in Wilderness & Environmental Medicine journal.

CLICK HERE Don’t Get Caught With Drugs on the Midnight Express: Traveling with Medications

Dr. Larry Goodyer, the immediate past president of the International Society of Travel Medicine’s Pharmacist Professional Group reviewed traveling with personal medicines across international borders, offering advice on which drugs are the most troublesome, useful websites, and other very helpful recommendations such as how to pack and store meds and what type of documentation to get from the prescribing physician.

CLICK HERE Hypothermia Heals Heatstroke

Hong et al. reported the first case of therapeutic hypothermia using a noninvasive cooling system (Medivance Arctic Sun system) to successfully treat a patient with near-fatal exertional heatstroke including multiorgan dysfunction; the patient recovered completely. This was reported in the Annals of Emergency Medicine 2012;59:491-493.

CLICK HERE

Calling All RNs: Get Your Wilderness Medicine Education

R. Bryan Simon makes a compelling and comprehensive case in Nursing 2012 for nurses to get wilderness medicine education-whether they are outdoor enthusiasts or to become a trained resource if a natural or other disaster strikes.

CLICK HERE

E-NEWS AND MORE Compiled by Nancy Pietroski, PharmD

Calling All EM Residents: Matthew Ryan Curley Wilderness Medicine Scholarship Fund

Announced in June by St. Luke’sRoosevelt Emergency/Columbia University and WMS, the MRCWMF Scholarship will be awarded yearly to one Emergency Medicine (EM) resident and will provide $1000 toward travel expenses, free registration, and the option to give a lecture at a WMS national Conference.

Is There a Doctor in the Woods?

Dr. David Johnson of the Wilderness Medical Institute International (and WMS member) offers advice on getting a medical advisor for your outdoor program. Check out this very useful blog if you run one of these programs!

CLICK HERE Venerable Venables to Speak At Expedition Medicine Course In

CLICK HERE Emergency Medicine Residents Invited to Join Budding Wilderness Medicine Committee

The Emergency Medicine Residents’ Association (EMRA) is forming a Wilderness Medicine Committee for those interested in practicing in austere environments or just learning more about this exciting subspecialty. They will be holding their first meeting at the ACEP’s Scientific Assembly meeting in Denver this October. Visit their site for more information.

September Stephen Venables, the first British mountaineer to summit Mt. Everest without supplementary oxygen (also the first to bivouac solo above 28,000 feet) is an accomplished expeditioner, extremely prolific writer, and captivating speaker. Visit the expeditionmedicine. co.uk site to get more information (this group runs WMS approved courses).

CLICK HERE

CLICK HERE WFA for BSA The Emergency Care & Safety Institute has put

out a call for open enrollment in Wilderness First Aid classes needed by Boy Scout instructors. They will advertise your course on their Facebook page! Email their membership office if you are interested in doing your best and getting your course name out there. [email protected] WILDERNESS MEDICINE // Fall 2012

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GREAT GEAR: FOR WORK AND PLAY

W SK

Christopher Van Tilburg, MD

FALL PREVIEW FOR WEIGHT WEENIES

Here’s my pick of Fall gear for sliding, shushing and spinning.

Lighter than a hat? You have no more excuse not to wear a skimo (ski mountaineering) helmet. The CAMP Speed clocks in at an OMG! 210 grams ($130, camp-usa-com). Big wheels roll. And carbon is superstiff and light, and when it comes to 29-inch hoops the Santa Cruz Tallboy still weighs in sub30 pounds (from $5399 with Shimano XT group, santacruzebicycles.com). Airbag retires my Avalung. Thanks to Backcountry Access Chamonix, I took the Float 38 avalanche airbag backpack on a 7-day ski tour on the Haute Route; it was just big enough for a week hut touring. And, compared to the competition, the price is right ($685, backcountryaccess.com). Three decades proven. The burly Dynifit binders are basically unchanged because they work. My 2013 Dynafit kit includes Mansalu 169 cm skis, Radical binders, ski crampons, pre-cut Speed Skins, and TLT Mountain 5 boots that weighs in like an Olympic gymnast at 1225 grams (dynafit.com).

Surf SUP’ing. When I paddled my Slingshot Crossbreed 11’ x 30” standup paddleboard into Oregon Coast waves, I caught so many waves, I felt like I was cheating compared to traditional surfers. Unfortunately, I took the 14’ Slingshot Nitro race prototype out on a glassy day on Oregon’s Columbia River: it’s super fast, super sleek and hollow. Now I want one of the $2K rockets for flatwater workouts (slingshotsports. com). Mudslinging for fun and recreation. Anyone else drooling over the Redline Conquest Carbon Pro cyclocross bike with internal routing cables? Mate it with a pair of Shimano Ultegra hoops with tubeless Hutchinson Bulldog rubber. Sure, wheelset isn’t as great in deep doo as Dughast Rhino tubulars glued to Easton EA70 rims. But for low maintenance, I inflate once at the beginning of the season: nothing more ($2599 complete, redlinebikes.com). Designed in Chamonix, built in Italy. I’m taking Alps-tested Friction mountain shoe on the Mont Blanc Circuit CME trip this fall. Light and stiff Vibram sole mated with waterproof leather. They are so burly, I may even climb Kilimanjaro in them ($120, www.millet.fr).

WILDERNESS KILLS: Tourniquets - from the battlefield to the backcountry Chris Cousar PA-C, NREMT-P, FAWM

Tactical Combat Casualty Care (TCCC) is the military version of Prehospital Trauma Life Support and was developed in the mid-90s by the Naval Special Warfare Command. The lessons taught have been saving lives on the battlefield and in many civilian tactical situations. Many of the principles utilized by TCCC have a direct application in the wilderness setting. One of the most effective principles in TCCC is tourniquet application. Tourniquet usage is the first-line treatment for lifethreatening extremity hemorrhage on the battlefield. While tourniquets have been shunned in the civilian setting, the military has shown that they are effective with minimal complications. There have been no reported amputations arising from military tourniquet application, but a small number of transient nerve palsies were noted. As extremity hemorrhage is one of the most preventable causes of death. The prompt application of a tourniquet has saved approximately 1,000 – 2,000 military personnel since the advent of TCCC. Definitive surgical care is delayed in a firefight, and the same holds true for many wilderness expeditions. While the mechanism of injury is often different than the typical military casualty, the prompt application of a suitable tourniquet could save lives in the backcountry.

it should not be applied for wounds where simple direct pressure can easily stop a bleed. There is no need to immediately remove clothing as a tourniquet is designed to apply over these items and you save precious time in stopping the bleed. Excess clothing can be removed at a later time during your secondary survey and the tourniquet repositioned, on the skin surface, 2-3 inches proximal to the wound. Do not apply over cargo pockets or other areas containing bulky items as this will limit the effectiveness of the tourniquet. Tourniquets should be left in place no longer than 2 hours before attempting to reassess hemorrhage although, when used in a surgical environment, tourniquets have been left in place up to 6 hours with no untoward effects. A common mistake is waiting to apply the tourniquet in the setting of a life-threatening hemorrhage. Upon recognizing this situation, a tourniquet should be applied promptly. Another mistake is applying the tourniquet too loosely. A properly applied tourniquet should abolish the distal pulse on the involved extremity resulting in tamponade of blood flow. It is not uncommon, in the setting of profuse hemorrhage, to apply two tourniquets in order to achieve this goal. The tourniquet should never be applied over a joint surface, as this will prevent proper vessel compression against the bone and result in the tourniquet loosening when the joint is moved.

There are guidelines for tourniquet usage and not all tourniquets are created equal. The old cravat and stick routine has gone the way of a Tyrannosaurus rex. There are TCCC recommended tourniquets that have undergone extensive testing under harsh environments. The Combat Application Tourniquet (CAT) and the SOF-Tactical Tourniquet are, perhaps, the most commonly used, and can be purchased by non-military through a reputable online company. These tourniquets are designed for single-hand self-application and can be applied in seconds should you not have a buddy around. Commonly utilized practice tests are to be done blindfolded, then effectively apply the tourniquet in less than 2 minutes. These commercial tourniquets are small and lightweight. They utilize a self-adhering band with hook and loop closures. A windlass system is incorporated for single-hand use and ensures a tight fit.

An important caveat to remember is that a properly applied tourniquet will hurt! If you are equipped to do so, pain management will likely be needed. If the tourniquet is applied to a lower extremity, prolonged ambulation will be next to impossible. This is the time when those improvised litter skills come in handy!

Whichever tourniquet is chosen, one must be adept at its use and familiar with the indications for application. The indication for usage is life-threatening extremity hemorrhage. In other words,

Kragh Jr, JF, Walters TJ, Baer, DG, et al. Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma. 2008; 64(2 Suppl): S38–S50.

The addition of a TCCC commercial tourniquet to your rucksack is an invaluable investment. While tourniquets are simple to use, learn proper instruction in the application of these devices. Chris is an Emergency Medicine Physician Assistant at Children’s Hospital Colorado. He is a former Navy Hospital Corpsman and Special Response Team Paramedic. Recommended Reading: PHTLS: Prehospital Trauma Life Support, Military Edition, 7th edition.


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TRAIL MIX: NUTRITION FOR ADVENTURERS Wayne Askew, PhD

STEAK I N

T H E

WILD Anticipating the usual campfire fare of trail mix, beans and weenies or ramen noodles without enthusiasm? If your first day of backpacking revs up your appetite and has you craving something more substantial than typical trail food, don’t feel alone. It is not a sign of weakness to pamper one’s self on that first night out on the trail by breaking out some special food as a reward for a hard day’s work. One way to do that is what Popular Mechanics columnist Michael Frank calls “Steak in the Wild” (Popular Mechanics August, 2012).

“ an important part of the backcountry experience is

grilling a hunk of red meat ”

T

o some of us, an important part of the backcountry experience is grilling a hunk of red meat over the smoke and coals of a wood campfire. If this strikes a sympathetic cord in you, read on. If you are experiencing a bit of revulsion at the thought, don’t retreat because vegan suggestions follow. Here’s the catch: this only works the first day on the trail. The trick to treating yourself to a steak in the wild is freezing the steak prior to departure and transporting it in your pack in a plastic zip bag wrapped in insulating material such as a towel or sweat shirt. Most frozen steaks will remain cold throughout your first day on the trail. The best choice would be a one to two inch thick 6 to 8 ounce T-bone or rib eye. The bone can actually serve as bit of a heat sink for even cooking, which is often a challenge over campfire coals using a tiny grate precariously perched on rocks. Bring a utensil to turn the steak that has a bit more reach than your trusty pocket knife. In a pinch, two sharpened green sticks can do the trick. Bring along your favorite rub. Herbs and spices give an added bonus because they are rich in antioxidant nutrients. If you don’t want to bring a lightweight grate, use your cooking pan with canola oil, but your beef will lack that smoky grilled flavor (think breakfast steak from a restaurant). Once you have a bed of glowing coals, preferably from some dead hardwood gathered from the wilderness if permitted, sear the steak on each side for a few minutes. Then move the steak and grate to a cooler side of the coals and slow cook to medium rare. Don’t be too picky about how close you are to the “true north” of medium rare; be happy with something in between rare and well done. Whatever you do, don’t overcook or char this nice cut of steak!

If you are not a red meat backpacker, substitute a hefty portabella mushroom. But you’ll need several portabellas since they are not very calorie dense. Or try the other white meat, a thick center cut pork chop. Bison is now readily available in most supermarkets and makes a great choice for less fat and more protein and iron than beef. I don’t particularly like to recommend chicken since the uncontrolled temperatures in your pack can, under the right conditions, favor the proliferation of some of the undesirable poultry-borne microbes. Don’t forget, humans cannot experience optimum glycogen repletion on an all meat diet; plan to supplement this meal with a good carbohydrate source such as rice, potatoes, beans or quinoa. Top it off with a dessert of your choosing to further boost carbohydrate intake. Bon appétit! Here is some nutritional information* for some typical 6 oz meat servings and faux meat (portabella) choices**: Grill item choice

Fat (g) Protein (g)

Calories (kcal)

Beef T-bone steak

16

46

343

Beef rib eye steak

23

46

390

Bison rib eye steak

9

50

301

Pork chop center cut 12

46

306

Portabella Mushroom**

5.6

49

1.0

*Values are cooked grilled or broiled from USDA National Nutrient Database for Standard Reference Release 24. These values can vary depending upon the cut and trimming of the meat. **Portabella mushrooms also have 4-5 g of CHO; the CHO content of meat is negligible compared to its fat and protein content.


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FIRST AID TRAINING for Kitesurfers

In my day-to-day job I work as a resident in the Emergency Department in The Hague, a coastal city in the south of the Netherlands. For the last ten years the outdoor sport of kitesurfing has seen a huge increase in popularity, including myself as an enthusiastic participant. This has its downsides; more and more inexperienced people find themselves in trouble either on the water or on the beach every weekend.

Michiel van Veelen, MD

Circumstances on the North Sea can be harsh, wind can change direction or force rapidly and currents are always a danger. Onthe-beach incidents can happen if the wind is gusty; people are handling kites up to around 15m2 and can be pulled into fixed objects such as trees, rocks and buildings. The last few years many major and minor accidents have involved kitesurfers. Rescuing kitesurfers is a time-consuming effort for the Dutch Coastguard. In fact, it is not yet obligatory in The Netherlands for instructors or schools to obtain a certificate from the International Kiteboarding Organization. All said, the local and national press has not always been friendly towards the sport. In an effort to turn this around I contacted the Dutch Kitesurfing Association to organize a kitesurfing-specific first aid course to supplement an existing safety course. The first aid course was given in collaboration with certified first aid instructors from the Dutch Red Cross. We adapted the program to focus on kitesurfing-specific scenarios and mechanism of injury: drowning, hypothermia, and head and cervical spine injury. To maximize the course effectiveness, we targeted key people who would be likely first responders. This includes members of a local kitesurfing club on lookout shift, a local manager of a beach bar, local kitesurfers and kite school instructors. We performed a pilot session with great success. By organizing this course, we hope to raise awareness of health risks and a quicker response to incidents in kitesurfing. And, it would help to improve on the poor reputation of kitesurfing in the general public. Michiel van Veelen is co-founder of the Dutch Outdoor Medicine group and a Fellow candidate for the Academy for Wilderness Medicine. Medical school internships took him to Nepal, Malawi and Pakistan.

SOCIETY MATTERS

2013 STUDENT ELECTIVE

Course directors Elisabeth Edelstein, MD and Tom Kessler, MD have announced the 2013 student elective dates and registration. The monthlong course will be held February 4 - March 1, 2013 in the Great Smoky Mountain National Park of Tennessee. The comprehensive objectives and outcomes-based curriculum is designed to prepare future physicians for the complexities of providing medical care in remote and austere environments. It emphasizes basic clinical science with an exciting mix of practical, small group, case-based and didactic training.

Students engage in: • Small group discussions of wilderness medical scenarios • Formal lectures on wilderness medicine principles and specific topics by leaders in the field • Field and hands-on instruction in survival and prehospital patient assessment and evacuation • Supervised 5-day field practicum incorporating medical assessment, treatment, evacuation, survival and improvisational techniques • A 48-hour formal Wilderness First Responder course Selection criteria include demonstrated interest in the field, intent to disseminate/further acquired knowledge in future career pursuits, outdoor and wilderness experience, and ability to work well in group settings. Space available for 28 students. All applications recieved by October 1 will be considered. If slots remain open in October applications will continue to be accepted “first come, first taken,” until the registration is at capacity with a waiting list. Interested students are encouraged to apply online.

2013 RESEARCH GRANT APPLICATION

Research Council Chair, Jay Gupta, MD, has announced that applications for the 2013 Research Grants are available online now and the due date for grant submission is January 7, 2013. The WMS grants foster awareness and appreciation for the research of health-related concerns in outdoors and wilderness activities. The Charles S. Houston and Research-in-Training grants are selected on a competitive basis to provide funding for a research project in the field of wilderness medicine. The Charles S. Houston Grant is for medical students. The Research-in-Training Grant is for residents and fellows of an accredited graduate medical education program or doctoral candidates working towards a PhD. The Herbert N. Hultgren Grant is for members of the WMS.

2013 CALL FOR RESEARCH ABSTRACTS

Abstract applications are available online for the 2013 Winter and Summer Conferences. The abstracts will focus on recent research covering the entire spectrum of wilderness medicine. Incoming Research Council Chair, Dr. Jay Gupta, has announced a new format for the abstracts—oral presentations only with PowerPoint graphics. Check the website for complete details. Wilderness & Mountain Medicine Winter Conference abstracts may be submitted for 5-minute “lightning” oral presentation only, using the specific format described on our website. Abstract submissions for the Winter Conference in Park City must be received by December 3, 2012. Wilderness Medicine Conference & Annual Summer Meeting abstracts may be submitted for consideration for a 5-minute “lightning” oral presentation or 10-minute full oral presentation, using the specific format described on our website. Abstracts must be received by May 1, 2013.


25

SOCIETY MATTERS

THE 6TH WORLD CONGRESS OF WILDERNESS MEDICINE—A SUCCESS!

George Rodway, PhD, APRN, 2012 Annual Conference Chair

sessions/workshops, and presented stimulating evening talks which featured more wilderness adventure than medicine. The weather during the week of the meeting was most agreeable for outdoor conference sessions and workshops, as well as for any and all mountain recreation in the spectacular Coast Range of British Columbia which surrounds the Whistler area. We can look forward to an equally successful 7th World Congress of Wilderness Medicine in 2016!

EDUCATIONAL PRESENTATION SERIES

(Left) Dr. Budda Basnyat and Dr. David Shlim. (Right) Dr. Charlie Clarke and Dr. Bruno Durrer

The WMS 6th World Congress of Wilderness Medicine 13-17 July, 2012 in Whistler, British Columbia presented a “full plate” for attendees. The Disaster-Humanitarian, Dive and Diploma in Mountain Medicine (DiMM) pre-conferences July 13-14 were all well-attended and the organizers of these respective sessions did a wonderful managerial job – making my work as conference chair (with the help of co-chair Chris McStay) a much more smooth affair than it might have been otherwise. While Disaster-Humanitarian and Diving-specific pre-conferences have historical precedents at WMS meetings, the DiMM is new for 2012. Fortunately, this Union Internationale des Associations d’Alpinisme (UIAA)/ International Commission for Alpine Rescue (IKAR) / International Society for Mountain Medicine (ISMM)-approved international mountain medicine specialty course sponsored in the USA by the WMS (which focuses on medical care provided in technical alpine environments) is off to a very strong start. For the very first time, at my invitation, the WMS hosted the annual meeting of the UIAA Medical Commission in Whistler on July 18, the day after the main conference ended. Most of the UIAA representatives (all non-US citizens aside from me) had never attended a WMS meeting, and I can honestly report they were very pleased with what they witnessed. We were privileged to be able to attract many US-based expert speakers in wilderness medicine as well as an impressive number of international speakers from Canada, Australia, Nepal, Switzerland, and the United Kingdom. These experts gave preconference talks, main session plenary lectures, ran small group

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We’ve released two new topics in this premier presentation series: Tickborne Illnesses by Gillian Beauchamp MD and Edward J. (Mel) Otten MD; and Group Travel— Planning and Execution by Robert M. Worthing, MD. Both of these presentations can be located by members and nonmembers in the WMS Trading Post Store. Click on Educational Products; the two new topics are located in Volume II. For those of you who are unfamiliar with the WMS Presentation Series, our experts have developed 22 wilderness medicine educational presentations for healthcare professionals to use as a teaching aid. These lectures are ready to go: each presentation contains PowerPoint slides (60-140 images depending on the topics) and a separate slide-by-slide guide with Presenter’s Notes to assist you with the presentation. The presentations are sold individually or bundled as Volume I and II. Check them all out and see what you’ve been missing!

COMMUNITY EDUCATION LECTURE SERIES

The Community Education Lecture Series are PowerPoint lectures designed for presentation in your communities to non-medical outdoor enthusiasts. The topics are scaled down to appeal to the general public. There are thirteen topics available for purchase ranging from Wild Animal Attacks to High Altitude Medicine. Each presentation is sold individually and available as a downloadable file which contains 30 - 50 PowerPoint slides with presenter notes. Watch for the latest earth shattering CELS by Ben Abo and Seth Hawkins called the “Shocking Reality of Lightening.”

WMS PRACTICE GUIDELINES

Publication of WMS Practice Guidelines provides expert consensus and evidence-based recommendations for prevention and treatment of wilderness medicine related injuries or illnesses. The topics are selected by the WMS Practice Guidelines Committee chaired by Colin Grissom, MD, and Tracy Cushing, MD. Publication after peer review in the Society’s journal Wilderness & Environmental Medicine (WEM) makes the guidelines available to interested persons using online searches of the indexed medical literature. A supplement to the journal is planned for 2014 that will contain all of the topics under one cover. Look for more updates in 2013 and beyond in Wilderness & Environmental Medicine. Thus far, the published practice guidelines are among the most read and cited publications in WEM and are available online at wemjournal.org, or follow the link to a pdf for each topic below. Epinephrine in Outdoor Education and Wilderness Settings Flavio Gaudio, MD; David Johnson, MD; Jay Lemery, MD; Frances Mock, JD; Tod Schimelpfenig, EMT, Joanne Vitanza, MD, Carl Weil, EMT The WMS convened this roundtable to explore areas of consensus and uncertainty in the field treatment of anaphylaxis. There is a paucity of data that address the treatment of anaphylaxis in the wilderness. Anaphylaxis is a rare disease, with a sudden onset and drastic course that does not lend itself to study in randomized, controlled trials. Therefore, the panel endorsed their position based on the limited available evidence, as well as expert consensus. The position represents the consensus of the panelists and is endorsed by the WMS. wemjournal.org/article/S1080-6032(10)00202-4/fulltext Prevention and Treatment of Acute Altitude Illness Andrew M. Luks, MD; Scott E. McIntosh, MD, MPH; Colin K. Grissom, MD; Paul S. Auerbach, MD, MS; George W. Rodway, PhD, APRN; Robert B. Schoene, MD; Ken Zafren, MD; Peter H. Hackett, MD To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the prevention and treatment of acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema

(HAPE). These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations for their roles in disease management. Recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to the prevention and management of each disorder that incorporate these recommendations. wemjournal.org/article/S1080-6032(10)00114-6/fulltext Prevention and Treatment of Frostbite Scott E. McIntosh, MD, MPH; Matthew Hamonko, MD, MPH; Luanne Freer, MD; Colin K. Grissom, MD; Paul S. Auerbach, MD, MS; George W. Rodway, PhD, APRN; Amalia Cochran, MD; Gordon Giesbrecht, MD; Marion McDevitt, DO; Christopher H. Imray, MD; Eric Johnson, MD; Jennifer Dow, MD; Peter H. Hackett, MD The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens for each modality according to methodology stipulated by the American College of Chest Physicians. wemjournal.org/article/S1080-6032(11)00077-9/fulltext Prevention and Treatment of Lightning Injuries Chris Davis, MD; Anna Engeln, MD; Eric Johnson, MD; Scott McIntosh, MD, MPH; Ken Zafren, MD; Arthur A. Islas, MD, MPH; Christopher McStay, MD; William “Will” R. Smith, MD; Tracy Cushing, MD, MPH To provide guidance to clinicians about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the treatment and prevention of lightning injuries. These guidelines include a review of the epidemiology of lightning strikes and recommendations for the prevention of lightning strikes, along with treatment recommendations organized by organ system. Recommendations are graded based on the quality of supporting evidence according to criteria put forth by the American College of Chest Physicians. A supplement to the journal is planned for 2014 that will contain all of the topics under one cover. Look for more updates in 2013 and beyond in Wilderness & Environmental Medicine. wemjournal.org/article/S1080-6032(12)00180-9/fulltext


27

CLIFF NOTES

Ali Arastu, MSIII, Student Representative Keck School of Medicine, University of Southern California Students! It was so great to see such a strong student showing at the summer Whistler conference. We had a great meeting for all the students and several of the board members to discuss both what students are interested in and how the Society can better meet the needs of the students. First and foremost, we are actively revamping the student website (www.wms.org/students) to include an easy to navigate source of all your wilderness medicine needs, from registering your student interest group to finding the perfect fourth-year elective. The website will also have spaces for the existing committees to share their work with you. For example, the student interest group committee is in the process of creating a “Student Interest Group President’s Packet,” with ideas and strategies for your group at school. Also, don’t forget to “like” us on Facebook (Wilderness Medical Society—Student Sector). Also discussed at the conference was the plethora of opportunities for students to get involved with any one of our many student committees, from the educational committee to the environmental to the newsletter! If you would like to be involved with any of these committees, have any questions at all, or simply want to talk wilderness medicine, do not hesitate to contact me at [email protected]!

COMING

SOON

28

Base Camp Rx by Nancy Pietroski, PharmD Starting in the next issue of Wilderness Medicine Magazine...your prescription for essential information about drugs used in wilderness, expedition and travel medicine, and disaster response. We’ll present a scenario, then focus on a particular drug or class of drugs and cover history, latest literature, and brewing controversies. We’ll also discuss what drugs to pack in a medical kit, stability and storage, and whether it’s safe to travel across country borders (or even within a country) with a stash of medications. And (groan) a little bit of Pharmacology 101. Stay tuned!


Certify in Wilderness Medicine Learn treatments for the most common wilderness injuries and illnesses Manage live scenarios while earning CME and FAWM credits Available to all medical professionals (PA’s, MD’s, DO’s, RN’s, PN’s, EMT’s and Paramedics) 2012/2013 AWLS Certification Courses Zion Park, UT / Big Sur, CA / Park City, UT / Houston, TX / Netherlands / Moab, UT Ft. Worth, TX / Mt. Rainier, WA / Jackson. WY / New River Gorge. VA / Boulder, CO / Grand Canyon, AZ

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www.awls.org / 1-866-830-3394

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U N I V E R S I T Y O F U TA H S C H O O L OF M E D I C I N E

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17 Hours of AMA/PRA Category 1 Credits & 17 Hours of FAWM Credits

January 16, to February 4, 2013

The BEST Continuing Education Trip: Accredited by the BEST Wilderness Medical Society www.

Taught by the BEST Dr. Rachel Anderson

Guided by the BEST Andes Mountain Guides

AndesMountainGuides.com/cme

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Wilderness Medical Society and Andes Mountain Guides. The Wilderness Medical Society is accredited by the ACCME to provide continuing medical education for physicians. The Wilderness Medical Society designates this educational activity for a maximum of 17 AMA PRA Category 1 Credits TM. Each physician should only claim credit commensurate with the extent of their participation in the activity.


29

BOARD OF DIRECTORS 2012 WMS BOARD OF DIRECTORS EXECUTIVE BOARD

Jay Lemery, MD, FAWM, President Arthur (Tony) Islas, MD, FAWM, Past-President Brad Bennett, PhD, WEMT, FAWM, Treasurer, Conference Chair Aaron R. Billin, MD, FAWM, Secretary, Director of the Academy of Wilderness Medicine Loren Greenway, PhD, MFAWM, CEO and Associate Director of the Academy of Wilderness Medicine

MEMBERS AT-LARGE

Ali Arastu, Student Representative Tracy Cushing, MD, FAWM Lance Ferguson, MD, FAWM Marion McDevitt, DO, FAWM Scott E. McIntosh, MD, FAWM Chris McStay, MD, FAWM George W. Rodway, APRN, PhD, FAWM Sara Squyers, PA-C, MPAS, FAWM Robert H. Quinn, MD, FAWM Greg Stiller, MD, FAWM Lynn Yonge, MD, FAWM

COMMITTEES

Academy of Wilderness Medicine Director Aaron R. Billin, MD, FAWM Awards Committee Chair Ken Zafren, MD, FAWM Continuing Medical Education Chair Hill McBrayer, MD, FAWM Conference Committee Chair Brad Bennett, PhD, WEMT, FAWM Education Committee Chair Michael Caudell, MD, FAWM Finance and Audit Brad Bennett, PhD, WEMT, FAWM Environmental Council Chair Carlton Heine, MD, FAWM International Medicine Committee Chair Chris Tedeschi, MD, FAWM Membership Committee Chair Aaron Billin, MD, FAWM Nominations Committee Chair Colin Grissom, MD, FAWM Publications Chair Edward (Mel) Otten, MD, FAWM Research Council Chair Jay Gupta, MD, FAWM Student Services Chair Ali Arastu, MS3 Web Development Chair Jim Ingwersen

EXPAND YOUR MEDICAL HORIZONS

NOLS WILDERNESS MEDICINE EXPEDITIONS FOR HEALTHCARE PROFESSIONALS CONTINUING EDUCATION AVAILABLE SKIING IN THE TETONS, IDAHO NOLS Teton Valley, Driggs, Idaho March 4–11, 2013 Difficulty: Challenging

SAILING IN BRITISH COLUMBIA, CANADA NOLS Pacific Northwest, Conway, Washington June 14–21, 2013 Difficulty: Easy

BACKPACKING IN THE WIND RIVERS, WYOMING NOLS Rocky Mountain, Lander, Wyoming August 11–19, 2013 Difficulty: Moderate

BACKPACKING IN THE GALIURO WILDERNESS, ARIZONA NOLS Southwest, Tucson, Arizona October 6–13, 2013 Difficulty: Moderate FIND MORE INFORMATION AND A COMPLETE COURSE SCHEDULE AT WWW.NOLS.EDU/WME, [email protected], OR (866) 831-9001.

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ADMINISTRATIVE OFFICES

Loren Greenway, PhD, FAWM, CEO [email protected] Teri Howell, Administrative Director [email protected] Jim Ingwersen, IT Director [email protected] Wilderness Medical Society 2150 South 1300 East, Suite 500 Salt Lake City, UT 84106 Tel: 801-990-2988 Fax: 801-990-4640 Jonna Barry, Editorial & Marketing Services 1505 N Royer St. Colorado Springs, CO 80907 Tel: 719-330-7523 Fax: 801-705-1483 [email protected]

Extraordinary Polar Medical Opportunities ...and that’s just the tip of the iceberg UTMB Health Center for Polar Medical Operations The University of Texas Medical Branch (UTMB Health) is currently seeking Physicians and Mid-level candidates with Emergency Medicine backgrounds as we provide support for the National Science Foundation U.S. Antarctic Program (USAP). UTMB Health is providing the medical component and will be working collaboratively with Lockheed Martin in support of the USAP. The USAP operates and maintains the United States’ facilities in Antarctica that supports scientific research activities. UTMB Health has medical opportunities available at the South Pole, McMurdo and Palmer Stations in Antarctica. These positions are seasonal and we maintain a running list of interested candidates for future seasonal opportunities. This is an extraordinary opportunity in a location few get to experience and will provide adventures for you to remember for a lifetime. If you have questions or would like to be notified of future opportunities please contact us at [email protected].

University of Texas Medical Branch As the first academic health center in Texas and among the oldest in the nation, the University of Texas Medical Branch (UTMB Health) has helped define health care for generations. Today, UTMB Health remains a home of continued clinical, educational and research excellence, committed to ensuring better health—and a better life—for the people of Texas and beyond. www.utmb.edu

To apply or find out more information about UTMB Health Positions in Antarctica

www.UTMB-PolarMedical.com For more information about United States Antarctic Program

www.usap.gov

Antarctic photos courtesy National Science Foundation: Bill Meurer, Bob DeValentino, Ken Keenan, and Calee Allen.

COMBINING YOUR PROFESSION WITH YOUR PASSION™ THE WILDERNESS MEDICAL SOCIETY’S 2013 CME CONFERENCES EXCITING DESTINATIONS FOR LEARNING, EARNING CME, AND OUTDOOR ADVENTURE

MEDSAIL: MEDICINE FOR MARINERS & SAFETY AT SEA February 2-9, 2013 The Moorings, British Virgin Islands

WINTER WILDERNESS & MOUNTAIN MEDICINE CONFERENCE February 15-20, 2013 Canyons, Park City, Utah

WMS EVEREST EXPERIENCE 2013

WMS 30TH ANNIVERSARY & WILDERNESS MEDICINE CONFERENCE

July 11-17, 2013 Beaver Run Resort, Breckenridge, Colorado

ENVIRONMENTAL CHANGE & HUMAN HEALTH

October 30-November 3, 2013 Dauphin Island Sea Lab, Dauphin Island, Alabama

March 24 - April 13, 2013 Khumbu Valley, Nepal

WMS.ORG/conferences or call 801.990.2988 for up-to-date info

To view all activities for WMS Partners, see Partner/Affiliate Events at wms.org/conferences/calendar.aspx. Note: all items are listed as a community service and are not necessarily CME/ FAWM approved. To determine if an activity is eligible for FAWM credits, please see eligible activities at wms.org/fawm

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