Wilderness medicine (practice)

Wilderness medicine, providing "vital emergency care in remote settings",[1] 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.[2] A primary focus of the field is the evaluation, prioritization (triage), 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 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,[3] professional guides and amateur back country enthusiast organizations[1]

Scope

Wilderness medicine is a varied sub-specialty, encompassing skills and knowledge from many other specialties.

Diving and hyperbaric medicine

  • Physics and physiology of depth
  • Dive medicine
  • Dysbarisms and barotrauma

Tropical and travel medicine

  • Immunizations for travel
  • Tick-borne illness, malaria and tropical diseases
  • Parasites and protozoal infections in the traveler
  • Traveler's diarrhea
  • Women's issues in traveling
  • Safety and security while traveling
  • Travel medicine
  • Travel dermatology
  • Fever in the returned traveler and VHFs
  • STDs in the adventure traveler

High-altitude and mountaineering medicine

  • Physics and physiology of altitude
  • AMS, HAPE and HACE
  • The effect of high altitude on underlying medical conditions

Expedition medicine

  • Basic field dentistry
  • Expedition planning, pre- and post-expedition responsibilities

Survival, field craft and equipment

Casualty extrication by road
  • 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

Sports medicine and physiology

Preventive medicine, field sanitation and hygiene

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

General environmental medicine

Using the sky as a lightbox

Improvised medicine

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

Disaster and humanitarian assistance

  • Triage
  • Field hospital provision
  • Malnutrition therapy

Wilderness emergencies and trauma management

  • Pre-hospital patient assessment
  • Pain management in the wilderness setting
  • Emergency airway management
  • Psychological response to injury and stress
  • Management of trauma and injuries

Epidemiology

The Center for Disease Control in the U.S., and its corresponding agencies in other nations[4], also monitor leading health threats[5], pathogen vectors in conjunction with local departments of health, such as Lyme disease, plague and typhus which may be carried by small mammals in a back country or wilderness context.[6]

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.[7]

Applications to Covid-19

Studies and trials are currently underway that examine the possible benefits of nitric oxide in the treatment of Covid-19.[8][9] This research is based on the fact that nitric oxide was investigated as an experimental therapy for SARS.[10] Just as Nitric Oxide (NO) is developed and increased in the human body through nasal breathing, it is likewise decimated by mouth breathing. A May 2020 study notes that in the same way that “mouth breathing has been associated with many health issues, including abnormal facial and dental development, cardiovascular disease, fatigue, halitosis, headaches, hypertension, inflammation, sleep apnea, snoring, stress, and tooth decay,” mouth breathers also were found to have “lower levels of NO within the respiratory tract compared to nasal breathers.”[9] The researchers thus conclude that replacing mouth breathing with nasal breathing is a “lifestyle change” that “may also help to reduce SARS-CoV-2 viral load and symptoms of COVID-19 pneumonia by promoting more efficient antiviral defense mechanisms in the respiratory tract.”[9]

Brian Strickland MD is a Fellow in the Division of Wilderness Medicine at Massachusetts General Hospital.[11][12] He studies “acute respiratory distress” in high altitudes and is applying related research towards Covid-19[13][12] and is currently involved in clinical trials which apply the use of inhaled nitric oxide as a treatment for Covid-19.[14] This approach was inspired by the work of Associate Professor of Emergency Medicine at the Harvard Medical School N. Stuart Harris, who has been studying the effects of altitude sickness on mountain climbers, such as those who climb Mount Everest. 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 enabling breathing ability in high altitudes.[13]

See also

References

  1. "Wilderness & Travel Medicine". Mountaineers Books. 1992. Retrieved 2020-06-28.
  2. "Wilderness Medicine Fellowship". Stanford University. Retrieved 2020-06-28.
  3. "Preparation through education is less costly than learning through tragedy" - Max Mayfield, Director National Hurricane Center
  4. "Disease Surveillance Fact Sheet" (PDF).
  5. "Disease Surveillance and Monitoring | About | CDC". www.cdc.gov. 2018-07-19. Retrieved 2018-11-04.
  6. http://www2c.cdc.gov/podcasts/media/pdf/EID_7-09_Sylvatic_Typhus.pdf
  7. Will Smith M.D. "Taking Combat Medicine to the EMS and Wilderness Settings". Retrieved February 11, 2010.
  8. "Nitric Oxide Investigated as COVID-19 Treatment". WebMD. Retrieved 10 April 2020.
  9. Martel, Jan; Ko, Yun-Fei; Young, John D.; Ojcius, David (2020-05-06). "Could nasal nitric oxide help to mitigate the severity of COVID-19?". Microbes and Infection. doi:10.1016/j.micinf.2020.05.002. Retrieved 2020-05-06.
  10. Åkerström, Sara; Mousavi-Jazi, Mehrdad; Klingström, Jonas; Leijon, Mikael; Lundkvist, Åke; Mirazimi, Ali (1 February 2005). "Nitric Oxide Inhibits the Replication Cycle of Severe Acute Respiratory Syndrome Coronavirus". Journal of Virology. 79 (3): 1966–1969. doi:10.1128/JVI.79.3.1966-1969.2005. PMC 544093. PMID 15650225.
  11. "Division of Wilderness Medicine". Massachusetts General Hospital. Retrieved 2020-06-28.
  12. "Lessons from the Backcountry in Finding a Potential COVID-19 Treatment". Massachusetts General Hospital. 2020-06-24. Retrieved 2020-06-25.
  13. Powell, Alvin (2020-05-06). "Applying wisdom from the Himalayas to the ER's COVID battle". The Harvard Gazette. Retrieved 2020-06-25.
  14. "Inhaled Nitric Oxide Therapy for Emergency Room COVID-19 Patients". Massachusetts General Hospital. 2020-06-24. Retrieved 2020-06-25.
  15. "Wilderness Medical Society". wms.org. Retrieved 2018-09-05.
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