Defining Wilderness Medicine

Wilderness medicine is a topic with a wide variety of definitions, often causing confusion amongst those who practice wilderness medicine. Some say wilderness medicine is any medical care provided more than 24 hours from definitive care. That is way off in my opinion. Others say wilderness medicine can only be practiced 12 hours away from definitive care. The third common definition, and the one I most agree with is any care provided outside of the “Golden Hour” of urban EMS. The “Golden Hour” is in reference to the hour that EMS providers have between first patient contact to delivery to definitive care. The hour is shown to provide the best chances for survival in the world of urban EMS.  Wilderness medicine does not necessarily require a wilderness setting. Any situation where care is provided outside the “Golden Hour” is wilderness medicine. The biggest two elements of wilderness medicine are extended patient care and improvisation. Extended patient care presents problems that are not commonly seen in urban EMS. Transport problems are common and most often effected by the terrain as well as the weather. In addition if you are with your patient for a few hours, days, or in extreme cases weeks, normal human functions still need to take place, this means feeding, hydration, and assistance with urination and defecation. In urban EMS these aren’t really issues and if they are can be easily done in the back of an ambulance. In a wilderness setting you don’t have all the supplies of an urban EMS team, you have to improvise, and not everything you use is going to be a medical device. You can improvise almost anything you need, this keeps wilderness medicine kits small but also requires a lot of thought to be put into each intervention. Quality patient care is still king, but that quality often has to be achieved in unique and unconventional ways. One thing that can’t be improvised is medications. Urban EMS teams, provided they are an ALS unit, have a very large, well-stocked drug box. These boxes contain a lovely cocktail of medications that help with pain and reactions and a whole host of other things. The most a wilderness medicine provider will have is typically Tylenol and aspirin. On rare occasions they will have epinephrine. Pain management isn’t really a thing in wilderness medicine. The only thing you can really give a patient for pain is a 10mg dose of suck it up. Practicing wilderness medicine is a unique field. It requires skill and ingenuity. It’s a whole new world in the wilderness.

 

-Adam Froehlich, VP Wilderness Medicine