Wilderness medicine is a rapidly evolving field and is of increasing importance as more people engage in hiking, climbing, kayaking, and other potentially hazardous activities in the backcountry. The modern definition of wilderness medicine is "medical care delivered in those areas where fixed or transient geographic challenges reduce availability of, or alter requirements for, medical or patient movement resources". A primary focus of the field is the evaluation, prioritization (

triage In medicine, triage () is a practice invoked when acute care cannot be provided for lack of resources. The process rations care towards those who are most in need of immediate care, and who benefit most from it. More generally it refers to prio ...

), preliminary treatment of acute injuries or illnesses which occur in those environments and the emergency evacuation of victims. However, back country rescue and

wilderness first aid A wilderness medical emergency is a medical emergency that takes place in a wilderness or remote setting affinitive care (hospital, clinic, etc.). Such an emergency can require specialized skills, treatment techniques, and knowledge in order to m ...

is not the sole activity of wilderness medical professionals, who are also concerned with many additional topics. These include but are not limited to: * Secondary care follow up to first aid in remote settings, such as expeditions * Evaluation of experience and issuance of updated protocols for first response and secondary care * The prevention of wilderness medical emergencies * Epidemiological studies * Public policy advisement to wilderness planning agencies, and issuance of guidelines to disaster planning agencies,"Preparation through education is less costly than learning through tragedy" - Max Mayfield, Director National Hurricane Center professional guides and amateur back country enthusiast organizations

Scope

Wilderness medicine is a varied sub-specialty, encompassing skills and knowledge from many other specialties. The specific curricula will vary but an example can be seen in the curriculum for Fellowship in the Academy of Wilderness Medicine (FAWM)

Diving and hyperbaric medicine

*Physics and physiology of depth *Dive medicine *Dysbarisms and

barotrauma Barotrauma is physical damage to body tissues caused by a difference in pressure between a gas space inside, or contact with, the body and the surrounding gas or liquid. The initial damage is usually due to over-stretching the tissues in tensio ...

Tropical and travel medicine

*Immunizations for travel *

Tick-borne illness Tick-borne diseases, which afflict humans and other animals, are caused by infectious agents Vector (epidemiology), transmitted by tick bites. They are caused by infection with a variety of pathogens, including rickettsia and other types of bacter ...

malaria Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. S ...

and

tropical diseases Tropical diseases are diseases that are prevalent in or unique to tropical and subtropical regions. The diseases are less prevalent in temperate climates, due in part to the occurrence of a cold season, which controls the insect population by forci ...

Parasite Parasitism is a close relationship between species, where one organism, the parasite, lives on or inside another organism, the host, causing it some harm, and is adapted structurally to this way of life. The entomologist E. O. Wilson has ...

s and protozoal infections in the traveler *

Traveler's diarrhea Travelers' diarrhea (TD) is a stomach and intestinal infection. TD is defined as the passage of unformed stool (one or more by some definitions, three or more by others) while traveling. It may be accompanied by abdominal cramps, nausea, fever, ...

*Women's issues in traveling *Safety and security while traveling *

Travel medicine Travel medicine or emporiatrics is the branch of medicine that deals with the prevention and management of health problems of international travelers. Globalization and travel Globalization facilitates the spread of disease and increases the num ...

*Travel and tropical

dermatology Dermatology is the branch of medicine dealing with the skin.''Random House Webster's Unabridged Dictionary.'' Random House, Inc. 2001. Page 537. . It is a speciality with both medical and surgical aspects. A dermatologist is a specialist medical ...

*Fever in the returned traveler *

Viral Haemorrhagic Fevers Viral hemorrhagic fevers (VHFs) are a diverse group of animal and human illnesses in which fever and hemorrhage are caused by a viral infection. VHFs may be caused by five distinct families of RNA viruses: the families '' Filoviridae'', ''Flav ...

* STDs in the traveler

High-altitude and mountaineering medicine

*Physics and physiology of altitude *

AMS AMS or Ams may refer to: Organizations Companies * Alenia Marconi Systems * American Management Systems * AMS (Advanced Music Systems) * ams AG, semiconductor manufacturer * AMS Pictures * Auxiliary Medical Services Educational institutions * A ...

HAPE High-altitude pulmonary edema (HAPE) is a life-threatening form of non-cardiogenic pulmonary edema that occurs in otherwise healthy people at altitudes typically above . However, cases have also been reported between in more vulnerable subjects. ...

and

HACE High-altitude cerebral edema (HACE) is a medical condition in which the brain swells with fluid because of the physiological effects of traveling to a high altitude. It generally appears in patients who have acute mountain sickness and involves di ...

*The effect of

high altitude Altitude or height (also sometimes known as depth) is a distance measurement, usually in the vertical or "up" direction, between a reference datum and a point or object. The exact definition and reference datum varies according to the context ...

on underlying medical conditions

Expedition medicine

*Basic (emergency) field

dentistry Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the teeth, gums, and mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, disorders, and conditions o ...

*Expedition planning, pre- and post-expedition responsibilities *Camp safety and layout

Survival, field craft and equipment

*Survival techniques and equipment *Water procurement *Food procurement *Hiking and trekking *Foot gear and care of the feet *Clothing selection for wilderness survival *Land navigation

Safety, rescue and evacuation

Search and rescue Search and rescue (SAR) is the search for and provision of aid to people who are in distress or imminent danger. The general field of search and rescue includes many specialty sub-fields, typically determined by the type of terrain the search ...

theory and practice *Evacuation of injured persons

Sports medicine and physiology

* rock climbing * ultramarathons * endurance sports * kayaking / sailing etc

Preventive medicine, field sanitation and hygiene

*Field sanitation and hygiene measures *Vector control and barriers *Water purification methods

General environmental medicine

Lightning Lightning is a naturally occurring electrostatic discharge during which two electric charge, electrically charged regions, both in the atmosphere or with one on the land, ground, temporarily neutralize themselves, causing the instantaneous ...

injuries *Submersion and

drowning Drowning is a type of suffocation induced by the submersion of the mouth and nose in a liquid. Most instances of fatal drowning occur alone or in situations where others present are either unaware of the victim's situation or unable to offer a ...

Envenomation Envenomation is the process by which venom is injected by the bite or sting of a venomous animal. Many kinds of animals, including mammals (e.g., the northern short-tailed shrew, ''Blarina brevicauda''), reptiles (e.g., the king cobra), spider ...

and

toxicology Toxicology is a scientific discipline, overlapping with biology, chemistry, pharmacology, and medicine, that involves the study of the adverse effects of chemical substances on living organisms and the practice of diagnosing and treating expo ...

*Animal attacks *

Heat Illness Heat illness is a spectrum of disorders due to increased body temperature. It can be caused by either environmental conditions or by exertion. It includes minor conditions such as heat cramps, heat syncope, and heat exhaustion as well as the mo ...

and

dehydration In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mil ...

*Cold injuries and

hypothermia Hypothermia is defined as a body core temperature below in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe h ...

*Nutrition in extreme environments *

Aerospace medicine Aviation medicine, also called flight medicine or aerospace medicine, is a preventive or occupational medicine in which the patients/subjects are pilots, aircrews, or astronauts. The specialty strives to treat or prevent conditions to which aircr ...

Improvised medicine

*Improvised field wound management *Improvisational medical techniques in the wilderness

Disaster and humanitarian assistance

Triage In medicine, triage () is a practice invoked when acute care cannot be provided for lack of resources. The process rations care towards those who are most in need of immediate care, and who benefit most from it. More generally it refers to prio ...

*Field hospital provision *Malnutrition therapy

Wilderness emergencies and trauma management

*Pre-hospital patient assessment *Pain management in the wilderness setting *Emergency

airway management Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either cl ...

*Psychological response to injury and stress *Management of

trauma Trauma most often refers to: * Major trauma, in physical medicine, severe physical injury caused by an external source * Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic i ...

and injuries

Epidemiology

The Center for Disease Control in the U.S., and its corresponding agencies in other nations, also monitor leading health threats, pathogen vectors in conjunction with local departments of health, such as

Lyme disease Lyme disease, also known as Lyme borreliosis, is a vector-borne disease caused by the ''Borrelia'' bacterium, which is spread by ticks in the genus ''Ixodes''. The most common sign of infection is an expanding red rash, known as erythema migran ...

plague Plague or The Plague may refer to: Agriculture, fauna, and medicine *Plague (disease), a disease caused by ''Yersinia pestis'' * An epidemic of infectious disease (medical or agricultural) * A pandemic caused by such a disease * A swarm of pes ...

and

typhus Typhus, also known as typhus fever, is a group of infectious diseases that include epidemic typhus, scrub typhus, and murine typhus. Common symptoms include fever, headache, and a rash. Typically these begin one to two weeks after exposure. ...

which may be carried by small mammals in a back country or wilderness context.

Austere environments interdisciplinary interface

Insights from the field of Military Combat Tactical Care (TCCC) interact with wilderness medical practice and protocol development. Moreover, new products and technologies tested in combat are adopted by wilderness medical personnel and vice versa. Experts in wilderness medicine come from various professional groups and specialist backgrounds.

Notable Individuals

* Prof

Paul Auerbach Paul Stuart Auerbach (January 4, 1951 – June 23, 2021) was an American physician and author in the academic discipline of wilderness medicine. He was the founder and past president of the Wilderness Medical Society. Auerbach was the editor ...

(Wilderness Medicine) * Dr Seth C. Hawkins (wilderness Medicine) * Dr Peter Hackett (Altitude Medicine) * Prof Chris Imray (Altitude Physiology) * Dr Burjor Langdana (Expedition Dentistry) * Dr. Luanne Freer (Founder Everest ER) * Dr Jon Dallimore (Expedition Medicine) * Dr Kenneth Iserson (Improvised Medicine) * Mr Aebhric O’Kelly (Special Operations Medicine)

Applications to Covid-19

, studies and trials are underway that examine the possible benefits of

nitric oxide Nitric oxide (nitrogen oxide or nitrogen monoxide) is a colorless gas with the formula . It is one of the principal oxides of nitrogen. Nitric oxide is a free radical: it has an unpaired electron, which is sometimes denoted by a dot in its che ...

in the treatment of

COVID-19 Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was COVID-19 pandemic in Hubei, identified in Wuhan, China, in December ...

. This research is related to the role of nasal breathing in the creation of nitric oxide, which increases oxygen absorption in the lungs. Nitric oxide was also investigated as an experimental therapy for

SARS Severe acute respiratory syndrome (SARS) is a viral respiratory disease of zoonotic origin caused by the severe acute respiratory syndrome coronavirus (SARS-CoV or SARS-CoV-1), the first identified strain of the SARS coronavirus species, ''sever ...

. Brian Strickland, MD, a fellow in Wilderness Medicine at

Massachusetts General Hospital Massachusetts General Hospital (Mass General or MGH) is the original and largest teaching hospital of Harvard Medical School located in the West End neighborhood of Boston, Massachusetts. It is the third oldest general hospital in the United Stat ...

who studies "acute respiratory distress" in high altitudes, is applying this research towards COVID-19. He is currently involved in clinical trials which apply the use of inhaled nitric oxide as a treatment for COVID-19. This approach was inspired by the work of associate professor of Emergency Medicine at the

Harvard Medical School Harvard Medical School (HMS) is the graduate medical school of Harvard University and is located in the Longwood Medical Area of Boston, Massachusetts. Founded in 1782, HMS is one of the oldest medical schools in the United States and is consi ...

N. Stuart Harris, who has been studying the effects of

altitude sickness Altitude sickness, the mildest form being acute mountain sickness (AMS), is the harmful effect of high altitude, caused by rapid exposure to low amounts of oxygen at high elevation. People can respond to high altitude in different ways. Sympt ...

on mountain climbers, such as those who climb

Mount Everest Mount Everest (; Tibetan: ''Chomolungma'' ; ) is Earth's highest mountain above sea level, located in the Mahalangur Himal sub-range of the Himalayas. The China–Nepal border runs across its summit point. Its elevation (snow heig ...

. Harris noticed that the consequences of high level altitude sickness on the human body mirrored COVID-19's dysfunctional impact on the lungs. His focus on nitric oxide comes from its role in being able to breathe in high altitudes.

Specialist Qualifications

Internationally there is huge variety in the medical training for wilderness medicine with few educational institutions specialising in this field. The

College of Remote and Offshore Medicine A college (Latin: ''collegium'') is an educational institution or a constituent part of one. A college may be a degree-awarding tertiary educational institution, a part of a collegiate or federal university, an institution offering ...

in Malta offers undergraduate, postgraduate and short courses in various wilderness medicine related topics. The

Wilderness Medical Society The Wilderness Medical Society was created on 15 February 1983 by three physicians from California, United States — Dr. Paul Auerbach, Dr. Ed Geehr, and Dr. Ken Kizer. It is the largest international non-profit membership organization devoted ...

runs the internationally renowned Fellowship programme as well as diplomas in marine and mountain medicine. The specialty of Tropical medicine is generally considered a separate (but aligned) field, in which there are many specialist qualifications.

Diplomas

* DiMM / DipMtnMed ( Mountain Medicine) * DipExpWildMed ( RCPSG) * DiDMM (Dive and Marine Medicine) * DipROM ( RCSEd)

Bachelors

*Remote Paramedic Practice ( CoROM)

Masters Degrees

* MSc Extreme Medicine * MSc Austere Critical Care

Fellowships

* FAWM - Fellow of the

wilderness medical society The Wilderness Medical Society was created on 15 February 1983 by three physicians from California, United States — Dr. Paul Auerbach, Dr. Ed Geehr, and Dr. Ken Kizer. It is the largest international non-profit membership organization devoted ...

™ (3-5 year educational programme) * FEWM - Fellow of Extreme and Wilderness Medicine (membership to a club) *

FRGS The Royal Geographical Society (with the Institute of British Geographers), often shortened to RGS, is a learned society and professional body for geography based in the United Kingdom. Founded in 1830 for the advancement of geographical scien ...

- Fellow of the Royal Geographical Society (may be awarded for achievement in wilderness or expedition medicine)

References

External links

*
''Wilderness Medics''
produced by

Oregon Public Broadcasting Oregon Public Broadcasting (OPB) is the primary television and radio public broadcasting network for most of the U.S. state of Oregon as well as southern Washington. OPB consists of five full-power television stations, dozens of VHF or UHF tra ...

. {{Emergency medical services Medical emergencies Wilderness medical emergencies