A wilderness medical emergency is a

medical emergency A medical emergency is an acute injury or illness that poses an immediate risk to a person's life or long-term health, sometimes referred to as a situation risking "life or limb". These emergencies may require assistance from another, qualified ...

that takes place in a

wilderness Wilderness or wildlands (usually in the plural), are natural environments on Earth that have not been significantly modified by human activity or any nonurbanized land not under extensive agricultural cultivation. The term has traditionally re ...

or remote setting affinitive care (

hospital A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emergen ...

, clinic, etc.). Such an emergency can require specialized skills, treatment techniques, and knowledge in order to manage the patient for an extended period of time before and during evacuation.

Types

Injury and illnesses

* Arthropod bites and stings *

Appendicitis Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a r ...

(leading to

peritonitis Peritonitis is inflammation of the localized or generalized peritoneum, the lining of the inner wall of the abdomen and cover of the abdominal organs. Symptoms may include severe pain, swelling of the abdomen, fever, or weight loss. One part o ...

folkloric "what if" for long-distance sailing) *

Ballistic trauma A gunshot wound (GSW) is a penetrating injury caused by a projectile (e.g. a bullet) from a gun (typically firearm or air gun). Damages may include bleeding, bone fractures, organ damage, wound infection, loss of the ability to move part of ...

(gunshot wound when hunting) * Eye injuries (such as from branches) *

Flail chest Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall. Two of the symptoms of flail chest are chest pain and shortness of breath. ...

associated with ice climbing and snowclimbing falls *

Hyperthermia Hyperthermia, also known simply as overheating, is a condition in which an individual's body temperature is elevated beyond normal due to failed thermoregulation. The person's body produces or absorbs more heat than it dissipates. When extrem ...

(

heat stroke Heat stroke or heatstroke, also known as sun stroke, is a severe heat illness that results in a body temperature greater than , along with red skin, headache, dizziness, and confusion. Sweating is generally present in exertional heatstroke, ...

sunstroke Heat stroke or heatstroke, also known as sun stroke, is a severe heat illness that results in a body temperature greater than , along with red skin, headache, dizziness, and confusion. Sweating is generally present in exertional heatstroke, b ...

) **

Malignant hyperthermia Malignant hyperthermia (MH) is a type of severe reaction that occurs in response to particular medications used during general anesthesia, among those who are susceptible. Symptoms include muscle rigidity, fever, and a fast heart rate. Complica ...

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 ...

Frostbite Frostbite is a skin injury that occurs when exposed to extreme low temperatures, causing the freezing of the skin or other tissues, commonly affecting the fingers, toes, nose, ears, cheeks and chin areas. Most often, frostbite occurs in t ...

Poison Poison is a chemical substance that has a detrimental effect to life. The term is used in a wide range of scientific fields and industries, where it is often specifically defined. It may also be applied colloquially or figuratively, with a broa ...

ing **

Food poisoning Foodborne illness (also foodborne disease and food poisoning) is any illness resulting from the spoilage of contaminated food by pathogenic bacteria, viruses, or parasites that contaminate food, as well as prions (the agents of mad cow disea ...

associated with warm weather expeditions **

Venomous Venom or zootoxin is a type of toxin produced by an animal that is actively delivered through a wound by means of a bite, sting, or similar action. The toxin is delivered through a specially evolved ''venom apparatus'', such as fangs or a sti ...

animal Animals are multicellular, eukaryotic organisms in the biological kingdom Animalia. With few exceptions, animals consume organic material, breathe oxygen, are able to move, can reproduce sexually, and go through an ontogenetic stage ...

bite **

Botanical Botany, also called , plant biology or phytology, is the science of plant life and a branch of biology. A botanist, plant scientist or phytologist is a scientist who specialises in this field. The term "botany" comes from the Ancient Greek w ...

from mushrooms or "wild greens"" * Severe

burn A burn is an injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or ultraviolet radiation (like sunburn). Most burns are due to heat from hot liquids (called scalding), solids, or fire. Burns occur ma ...

(forest fire) * Spreading wound

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...

* Suspected spinal injury from falls, falling rock, ice *

Traumatic brain injury A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity (ranging from mild traumatic brain injury TBI/concussionto severe traumatic br ...

from falls, falling rock, ice

Infections

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 ...

infection *

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. ...

infection associated with expeditions *

Necrotizing Fasciitis Necrotizing fasciitis (NF), also known as flesh-eating disease, is a bacterial infection that results in the death of parts of the body's soft tissue. It is a severe disease of sudden onset that spreads rapidly. Symptoms usually include red or p ...

Rabies Rabies is a viral disease that causes encephalitis in humans and other mammals. Early symptoms can include fever and tingling at the site of exposure. These symptoms are followed by one or more of the following symptoms: nausea, vomiting, ...

infection *

Salmonella ''Salmonella'' is a genus of rod-shaped (bacillus) Gram-negative bacteria of the family Enterobacteriaceae. The two species of ''Salmonella'' are '' Salmonella enterica'' and '' Salmonella bongori''. ''S. enterica'' is the type species and is ...

poisoning associated with expeditions

Neurologic

Subdural hematoma A subdural hematoma (SDH) is a type of bleeding in which a collection of blood—usually but not always associated with a traumatic brain injury—gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surround ...

, associated with

rockfall A rockfall or rock-fallWhittow, John (1984). ''Dictionary of Physical Geography''. London: Penguin, 1984. . is a quantity/sheets of rock that has fallen freely from a cliff face. The term is also used for collapse of rock from roof or walls of mi ...

icefall An icefall is a portion of certain glaciers characterized by relatively rapid flow and chaotic crevassed surface, caused in part by gravity. The term ''icefall'' is formed by analogy with the word ''waterfall'', which is a similar phenomenon of ...

, falls while climbing, glissade crashes with rocks,

mountain bike A mountain bike (MTB) or mountain bicycle is a bicycle designed for off-road cycling. Mountain bikes share some similarities with other bicycles, but incorporate features designed to enhance durability and performance in rough terrain, which m ...

crashes

Respiratory

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 ...

Asphyxia Asphyxia or asphyxiation is a condition of deficient supply of oxygen to the body which arises from abnormal breathing. Asphyxia causes generalized hypoxia, which affects primarily the tissues and organs. There are many circumstances that can ...

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 as ...

Smoke inhalation Smoke inhalation is the breathing in of harmful fumes (produced as by-products of combusting substances) through the respiratory tract. This can cause smoke inhalation injury (subtype of acute inhalation injury) which is damage to the respirator ...

(related to

Forest fire A wildfire, forest fire, bushfire, wildland fire or rural fire is an unplanned, uncontrolled and unpredictable fire in an area of combustible vegetation. Depending on the type of vegetation present, a wildfire may be more specifically identi ...

) *

Pneumothorax A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve i ...

Pulmonary edema Pulmonary edema, also known as pulmonary congestion, is excessive liquid accumulation in the tissue and air spaces (usually alveoli) of the lungs. It leads to impaired gas exchange and may cause hypoxemia and respiratory failure. It is due ...

associated with high altitude (

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. ...

) *

Respiratory Arrest Respiratory arrest is a sickness caused by apnea (cessation of breathing) or respiratory dysfunction severe enough it will not sustain the body (such as agonal breathing). Prolonged apnea refers to a patient who has stopped breathing for a long pe ...

associated with neurotoxic bites

Shock

Anaphylaxis Anaphylaxis is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of use of emergency medication on site. It typically causes more than one of the follo ...

associated with stings *

Hypovolemic shock Hypovolemic shock is a form of shock caused by severe hypovolemia (insufficient blood volume or extracellular fluid in the body). It could be the result of severe dehydration through a variety of mechanisms or blood loss. Hypovolemic shock is a ...

(due to

hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, v ...

) associated with climbing falls, kayak crashes, etc. *

Electric shock Electrical injury is a physiological reaction caused by electric current passing through the body. The injury depends on the density of the current, tissue resistance and duration of contact. Very small currents may be imperceptible or produce a ...

Mental health

Few programs teach

psychological first aid Psychological first aid (PFA) is a technique designed to reduce the occurrence of post-traumatic stress disorder. It was developed by the National Center for Post Traumatic Stress Disorder (NC-PTSD), a section of the United States Department of Ve ...

, although mental distress is commonly encountered by wilderness guides and outdoor athletes.

Mass-casualty incidents

A mass casualty incident (MCI) is a situation in which the number or severity of casualties overwhelms the available medical resources and service providers. Wilderness MCIs may include blizzards,

earthquake An earthquake (also known as a quake, tremor or temblor) is the shaking of the surface of the Earth resulting from a sudden release of energy in the Earth's lithosphere that creates seismic waves. Earthquakes can range in intensity, fr ...

avalanche An avalanche is a rapid flow of snow down a slope, such as a hill or mountain. Avalanches can be set off spontaneously, by such factors as increased precipitation or snowpack weakening, or by external means such as humans, animals, and ea ...

landslide Landslides, also known as landslips, are several forms of mass wasting that may include a wide range of ground movements, such as rockfalls, deep-seated slope failures, mudflows, and debris flows. Landslides occur in a variety of environmen ...

floods A flood is an overflow of water ( or rarely other fluids) that submerges land that is usually dry. In the sense of "flowing water", the word may also be applied to the inflow of the tide. Floods are an area of study of the discipline hydrolog ...

and

forest fire A wildfire, forest fire, bushfire, wildland fire or rural fire is an unplanned, uncontrolled and unpredictable fire in an area of combustible vegetation. Depending on the type of vegetation present, a wildfire may be more specifically identi ...

, but they need not be natural disasters. Mass casualties have also been caused by

human error Human error refers to something having been done that was " not intended by the actor; not desired by a set of rules or an external observer; or that led the task or system outside its acceptable limits".Senders, J.W. and Moray, N.P. (1991) Human ...

in parties of climbers or explorers, with or without complications from inclement weather. In mass casualty incidents, emergency service providers must prioritize their patients using a process called

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 ...

in order to make the most of their limited resources.

Response

Extrication and evacuation

Transporting an injured person out of the wilderness on a stretcher can be a difficult exercise requiring considerable manpower. It is advised that at least one person stay with an injured party and that no one attempt to seek help by travelling alone over inhospitable terrain.

Golden hour

emergency medicine Emergency medicine is the Medical specialty, medical speciality concerned with the care of illnesses or Injury, injuries requiring immediate medical attention. Emergency physicians (often called “ER doctors” in the United States) continuous ...

, some advocates assert that there is a golden hour which refers to a time period lasting from a few minutes to several hours following

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 inju ...

tic injury being sustained by a casualty, during which there is the highest likelihood that prompt medical treatment will prevent death. While most medical professionals agree that delays in definitive care are undesirable, recent peer reviewed literature casts doubt on the validity of the 'golden hour' as it appears to lack a scientific basis. Dr. Bryan Bledsoe, an outspoken critic of the ''golden hour'' and other EMS "myths" like critical incident stress management, has indicated that the peer reviewed medical literature does not demonstrate any "magical time" for saving critical patients.

Responder certifications

First aid

Wilderness first aid (WFA) is the specific discipline of

first aid First aid is the first and immediate assistance given to any person with either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery. It includes initial i ...

which relates to care in remote areas, where

emergency medical services Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...

will be difficult to obtain or will take a long time to arrive. Locating the victim precedes assessment and intervention and in the case of wilderness response is often a difficult matter. Specialists in white water rescue,

mountain rescue Mountain rescue refers to search and rescue activities that occur in a mountainous environment, although the term is sometimes also used to apply to search and rescue in other wilderness environments. This tends to include mountains with tech ...

, mine disaster response and other fields are often employed. In some cases, emergency extrication procedures at incidents such as automobile accidents are required before assessment is possible. Only once the location of the victim has been determined, a trained responder has been dispatched and successfully reached the victim, can the ordinary

process begin. Assessment is then enabled and it follows carefully specified protocols which have been refined through a long process of evaluation.

Certification

Wilderness First Aid is a relatively new field compared to regular or 'urban' first aid. For this reason, there are a number of boards and societies which have been formed in recent years to attempt to establish normalized standards for wilderness first aid certification and

wilderness medicine 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 "m ...

in general. Currently, there are no national standards for wilderness medicine, however one of the most popularly followed curricula is the "National Practice Guidelines for Wilderness Emergency Care" published by the Wilderness Medical Society in 2010. The American Red Cross Wilderness & Remote First Aid (r.2010) certification is valid for 2 years. In Canada the first WFA courses were taught in the mid-1980s and the first organization to adopt standards was the Wilderness First Aid and Safety Association of BC (defunct since 1998).

First responders

A Wilderness First Responder (72- to 80-hour course) certification is both a higher certification than a Wilderness First Aid or (16- to 20-hour course) certification, and may also be used to upgrade an

Emergency Medical Technician An emergency medical technician (EMT), also known as an ambulance technician, is a health professional that provides emergency medical services. EMTs are most commonly found working in ambulances. In English-speaking countries, paramedics are ...

to a Wilderness Emergency Medical Technician. Outdoor Emergency Care is a National Ski Patrol certification, but it doesn't fully meet the requirements for a WFR certification.

Training and certification organizations

A number of fellowships are available for emergency medicine graduates including prehospital medicine (

), hospice and palliative care, research, undersea and hyperbaric medicine, sports medicine, ultrasound, pediatric emergency medicine, disaster medicine, wilderness medicine, toxicology, and Critical Care Medicine.

References

External links

* {{First aid Medical emergencies