Care in the wilderness

Hawkins, Seth C.; Millin, Michael G.; Smith, William R.

doi:10.1002/9781118990810.ch116

Cited by 5 publications

(4 citation statements)

References 38 publications

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“…While this definition focuses on physical distance from definitive care, it does not account for prolonged extrication time and specialised skills required for evacuation that may exceed local EMS resources. Hawkins et al note that wilderness EMS (WEMS) concepts may apply in situations involving a person injured at a ski resort or an urban nature preserve near a roadside when there is a need for specialised skills to extricate, manage or get supplies to the individual without the availability of an ambulance: ‘It is important to understand that WEMS is substantially more complex than the application of traditional medical training in a wilderness environment, and the indiscriminate application of traditional care and standards often proves to be dangerous to patients and/or providers in a wilderness setting.’10 In the context of this paper, we use the term WEM to represent any sporting event in a challenging environment that exceeds the capacity of local EMS systems either in transport time to definitive care or skills and equipment required for expedient extrication.…”

Section: Defining Wilderness Event Medicinementioning

confidence: 99%

Extreme event medicine: considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions

et al. 2017

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Obstacle, adventure and endurance competitions in challenging or remote settings are increasing in popularity. A literature search indicates a dearth of evidence-based research on the organisation of medical care for wilderness competitions. The organisation of medical care for each event is best tailored to specific race components, participant characteristics, geography, risk assessments, legal requirements, and the availability of both local and outside resources. Considering the health risks and logistical complexities inherent in these events, there is a compelling need for guiding principles that bridge the fields of wilderness medicine and sports medicine in providing a framework for the organisation of medical care delivery during wilderness and remote obstacle, adventure and endurance competitions. This narrative review, authored by experts in wilderness and operational medicine, provides such a framework. The primary goal is to assist organisers and medical providers in planning for sporting events in which participants are in situations or locations that exceed the capacity of local emergency medical services resources.

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Section: Defining Wilderness Event Medicinementioning

confidence: 99%

Extreme event medicine: considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions

et al. 2017

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“…This complex setting, as with other ongoing NPS EMS programs, require continued close medical oversight with experience in these specialty areas. 9 The National Association of EMS Physicians (NAEMSP) and National Association of State EMS Officials (NASEMSO) have also made this clear recognition of the importance of strong medical oversight in their position statement. 10 This continued recognition and the growing awareness of the benefit of the military tactical combat casualty care (TCCC) 11,12 and other TEMS programs with improved survival of those injured in tactical settings, led the NPS to begin developing a formal tactical EMS program.…”

Section: Introductionmentioning

confidence: 99%

Integration of Tactical EMS in the National Park Service

Smith

2017

Wilderness & Environmental Medicine

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The National Park Service (NPS) has domestic responsibility for emergency medical services (EMS) in remote and sometimes tactical situations in 417 units covering over 34 million hectares (84 million acres). The crossover between conflicting patient care priorities and complex medical decision making in the tactical, technical, and wilderness/remote environments often has many similarities. Patient care in these diverse locations, when compared with military settings, has slightly different variables but often similar corresponding risks to the patients and providers. The NPS developed a Tactical EMS (TEMS) program that closely integrated many principles from: 1) Tactical Combat Casualty Care (TCCC); 2) Tactical Emergency Casualty Care (TECC); 3) and other established federal and civilian TEMS programs. Combining these best practices into the NPS TEMS Program allowed for standardized training and implementation across not only the NPS, but also paralleled other military/federal/civilian TEMS programs. This synchronization is critical when an injury occurs in a joint tactical operation, either planned (drug interdiction) or unplanned (active shooter response), so that patient care can be uniform and efficient. The components identified for a sustainable TEMS program began with strong medical oversight, protocol development with defined phases of care, identifying specialized equipment, and organized implementation with trained TEMS instructors. Ongoing TEMS program management is continuously improving situationally appropriate training and integrating current best practices as new research, equipment, and tactics are developed. The NPS TEMS Program continues to provide ongoing training to ensure optimal patient care in tactical and other NPS settings.

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“…This mirrors other recent publications that argue that “wilderness” in its application to health care must be contextual (Hawkins 2018). The unified definition of wilderness across many leading wilderness medicine texts is “areas where fixed or transient geographic challenges reduce availability of, or alter requirements for, medical or patient movement resources” (Hawkins 2018; Hawkins, Millin, and Smith 2017; Hawkins et al 2015). The relevance of this for many archaeological sites that would not be typically considered “wilderness” is immediately apparent.…”

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confidence: 99%

Ten Myths about Medical Emergencies and Medical Kits

Hawkins

Simon²

2021

Adv. archaeol. pract.

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Wilderness medicine is plagued by myths and dogmatic teachings not supported by evidence. This article focuses particularly on those teachings and tools that would be most likely used in archaeological fieldwork. It lays out 10 of the most common and concerning myths taught in wilderness medicine and wilderness emergency medical services, both in terms of first aid and preparation of medical kits. The myths described are provide a structure for the main purpose of the article: to explain interventions and medical kit contents that are more evidence based and supported by modern understandings of wilderness medicine and fieldwork risk management. The list of top 10 myths includes (1) the use of medications other than epinephrine for anaphylaxis and (2) the availability and proper use of epinephrine auto-injectors, (3) the use of suction devices and tourniquets for snakebites, (4) the use of spinal immobilization for neck injuries, (5) the identification and treatment of heat illnesses, (6) the use of CPR in remote areas, (7) the appropriateness of dislocation reduction in remote areas, (8) the use and choice of tourniquets for arterial bleeding, (9) the initial definition and management of drowning patients, and (10) wound management myths.

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Care in the wilderness

Cited by 5 publications

References 38 publications

Extreme event medicine: considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions

Extreme event medicine: considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions

Integration of Tactical EMS in the National Park Service

Ten Myths about Medical Emergencies and Medical Kits

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