Wilderness medicine is a medical specialty concerned with medical care in remote, wilderness and expedition environments. The specialty includes prior planning, public health issues, a number of sub-specialties as well as responding to emergencies. One modern definition of wilderness medicine is "medical care delivered in those areas where fixed or transient geographic challenges reduce the availability of, or alter requirements for, medical or patient movement resources". This rapidly evolving field is of increasing importance as more people engage in outdoor activities, with more participants coming from the extremes of age, and with more people engaging in high risk activities. The exact aegis of wilderness medicine as a specialty is in constant flux to match the requirements of patients underlying wilderness or remote activities. While wilderness medicine is the preferred terminology for this medical speciality in the

United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...

, terminology such as extreme medicine, remote medicine or expedition medicine, are used internationally. Wilderness medicine overlaps with a number of other medical specialties in terms of knowledge base and scope of practice, these most notable include;

Pre-hospital emergency medicine Pre-hospital emergency medicine (abbreviated PHEM), also referred to as pre-hospital care, immediate care, or emergency medical services medicine (abbreviated EMS medicine), is a medical subspecialty which focuses on caring for seriously ill or ...

, Military medicine,

Humanitarian aid Humanitarian aid is material and Humanitarian Logistics, logistic assistance, usually in the short-term, to people in need. Among the people in need are the homelessness, homeless, refugees, and victims of natural disasters, wars, and famines. Th ...

Disaster medicine Disaster medicine is the area of medical specialization serving the dual areas of providing health care to disaster survivors and providing medically related disaster preparation, disaster planning, disaster response and disaster recovery le ...

and

Public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the de ...

. The future of extreme, expedition, and wilderness medicine will be defined by both recipients and practitioners, and empirical observations will be transformed by evidence-based practice. Unlike

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 ...

which is focused on the provision of immediate care to the sick and injured in a wilderness setting, wilderness medicine has a far broader approach. These include but are not limited to: * Prolonged Field Care / Prolonged Casualty Care / Austere Emergency Care * Secondary care follow up in remote settings, such as expeditions or in humanitarian settings * The prevention of wilderness medical emergencies, illnesses and injuries * Public health interventions * Providing

Critical care medicine Intensive care medicine, usually called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes ...

in austere environments

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):

Epidemiology

The epidemiology of wilderness medicine is as broad as the patient groups, geography and activities in question. Common risks to many of these are gastointestinal upset, and minor injuries (ankle sprains, fractures, scrapes and lacerations) as well as the rarer and more serious disorders such as major trauma, heat related illnesses and cardiovascular disease (e.g. cardiac arrest). There are also a number of specific wilderness medical emergencies.

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 including the military. More recently, advances in the development of Prolonged Field Care (PFC) guidelines has led to the development of military and civilian PFC courses, such as the international Austere Emergency Care course. Nepal ambo

Notable Individuals

* Prof Paul Auerbach (January 4, 1951 – June 23, 2021)(Wilderness Medicine) * Dr Jon Dallimore (Expedition Medicine) * Dr Luanne Freer (Founder Everest ER) * Dr Peter Hackett (Altitude Medicine) * Hon Prof. Mark Hannaford (Extreme Medicine) * Dr Seth C. Hawkins (Wilderness Medicine) * Dr Olivia Kiwanuka (Founde
Adventure Medicine
* Dr Sean Hudson MBE (Expedition Medicine) * Prof Chris Imray (Altitude Physiology) * Dr Kenneth Iserson (Improvised Medicine) * Col Sean Keenan (Prolonged Field Care, Special Operations Medicine) * Dr Burjor Langdana (Expedition Dentistry) * D
Hannah Lock
(Expedition & Mountain Medicine) * Mr Aebhric O’Kelly (Special Operations Medicine, Prolonged Field Care)

Education

Few countries provide formal medical accreditation for specialists in wilderness medicine. The credentialing that exists is mostly drawn from professional organisations run for and by wilderness medicine clinicians. As a result, there is a huge variety in the education available for wilderness medicine, with only a few educational institutions specialising in this field. The Wilderness Medical Society is perhaps the oldest and most well established organisation in this area and has established international reach. The Wilderness Medical Society produce the Wilderness & Environmental Medicine journal and administer the Fellowship of the Academy of Wilderness Medicine (FAWM) award. The FAWM was first awarded in 2007 in 28 clinicians (20 men and 8 women). The FAWM continues today and recognised educational activity form a number of providers which provide credit towards the Fellowship. The College of Remote and Offshore Medicine (CoROM) in Malta offers FAWM credit as well as; undergraduate, postgraduate and short courses in wilderness medicine-related topics. and mountain medicine. An ''extreme medicine'' master's degree has run in partnership between World Extreme Medicine and the University of Exeter since 2016. There are a number of higher education and specialist qualifications available internationally:

Applications to Covid-19

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

nitric oxide Nitric oxide (nitrogen oxide, nitrogen monooxide, 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 den ...

in the treatment of

COVID-19 Coronavirus disease 2019 (COVID-19) is a contagious disease caused by the coronavirus SARS-CoV-2. In January 2020, the disease spread worldwide, resulting in the COVID-19 pandemic. The symptoms of COVID‑19 can vary but often include fever ...

. 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 virus SARS-CoV-1, the first identified strain of the SARS-related coronavirus. The first known cases occurred in November 2002, and the ...

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

Massachusetts General Hospital Massachusetts General Hospital (Mass General or MGH) is a teaching hospital located in the West End neighborhood of Boston, Massachusetts. It is the original and largest clinical education and research facility of Harvard Medical School/Harvar ...

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 medical school of Harvard University and is located in the Longwood Medical and Academic Area, Longwood Medical Area in Boston, Massachusetts. Founded in 1782, HMS is the third oldest medical school in the Un ...

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

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

on mountain climbers, such as those who climb

Mount Everest Mount Everest (), known locally as Sagarmatha in Nepal and Qomolangma in Tibet, is Earth's highest mountain above sea level. It lies in the Mahalangur Himal sub-range of the Himalayas and marks part of the China–Nepal border at it ...

. 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.

References

External links

*
''Wilderness Medics''
produced by

Oregon Public Broadcasting Oregon Public Broadcasting (OPB) is the primary public broadcasting, public media organization for the U.S. state of Oregon as well as southern Washington (state), Washington. It provides news, information, and programming via television stati ...

. {{Emergency medical services Medical emergencies Wilderness medical emergencies