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 plurale tantum, plural) are Earth, Earth's natural environments that have not been significantly modified by human impact on the environment, human activity, or any urbanization, nonurbanized land not u ...

or remote setting affinitive care (

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

, 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 (anatomy), appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, fever and anorexia (symptom), decreased appetite. However, approximately 40% of people do not have these t ...

(leading to

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

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

Ballistic trauma A gunshot wound (GSW) is a penetrating trauma, penetrating injury caused by a projectile (e.g. a bullet) Shooting, shot from a gun (typically a firearm). Damage may include bleeding, bone fractures, organ (anatomy), organ damage, wound infectio ...

(gunshot wound when hunting) * Eye injuries (such as from branches) * Flail chest associated with ice climbing and snowclimbing falls *

Hyperthermia Hyperthermia, also known 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 extreme te ...

(

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 heatstro ...

or sunstroke) **

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 someone is exposed to extremely 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 occ ...

Poison A poison is any chemical substance that is harmful or lethal to living organisms. 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 figurati ...

ing **

Food poisoning Foodborne illness (also known as foodborne disease and food poisoning) is any illness resulting from the contamination of food by pathogenic bacteria, viruses, or parasites, as well as prions (the agents of mad cow disease), and toxins such ...

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 Biology, biological Kingdom (biology), kingdom Animalia (). With few exceptions, animals heterotroph, consume organic material, Cellular respiration#Aerobic respiration, breathe oxygen, ...

bite **

Botanical Botany, also called plant science, is the branch of natural science and biology studying plants, especially Plant anatomy, their anatomy, Plant taxonomy, taxonomy, and Plant ecology, ecology. A botanist or plant scientist is a scientist who s ...

from mushrooms or "wild greens"" * Severe

burn A burn is an injury to skin, or other tissues, caused by heat, electricity, chemicals, friction, or ionizing radiation (such as sunburn, caused by ultraviolet radiation). Most burns are due to heat from hot fluids (called scalding), soli ...

(forest fire) * Spreading wound

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

* 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 (mTBI/concussion) to severe traumati ...

from falls, falling rock, ice

Infections

Lyme disease Lyme disease, also known as Lyme borreliosis, is a tick-borne disease caused by species of ''Borrelia'' bacteria, Disease vector, transmitted by blood-feeding ticks in the genus ''Ixodes''. It is the most common disease spread by ticks in th ...

infection *

Malaria Malaria is a Mosquito-borne disease, mosquito-borne infectious disease that affects vertebrates and ''Anopheles'' mosquitoes. Human malaria causes Signs and symptoms, symptoms that typically include fever, Fatigue (medical), fatigue, vomitin ...

infection associated with expeditions *

Necrotizing Fasciitis Necrotizing fasciitis (NF), also known as flesh-eating disease, is an infection that kills the body's soft tissue. It is a serious disease that begins and spreads quickly. Symptoms include red or purple or black skin, swelling, severe pain, fever ...

Rabies Rabies is a viral disease that causes encephalitis in humans and other mammals. It was historically referred to as hydrophobia ("fear of water") because its victims panic when offered liquids to drink. Early symptoms can include fever and abn ...

infection *

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

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 surrou ...

, associated with rockfall,

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 biking''). Mountain bikes share some similarities with other bicycles, but incorporate features designed to enhance durability and performance in r ...

crashes

Respiratory

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 ...

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 all the tissues and organs, some more rapidly than others. There are m ...

Drowning Drowning is a type of Asphyxia, suffocation induced by the submersion of the mouth and nose in a liquid. Submersion injury refers to both drowning and near-miss incidents. Most instances of fatal drowning occur alone or in situations where othe ...

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 (a kind of acute inhalation injury) which is damage to the respirator ...

(related to

Forest fire A wildfire, forest fire, or a bushfire is an unplanned and uncontrolled fire in an area of combustible vegetation. Depending on the type of vegetation present, a wildfire may be more specifically identified as a bushfire ( in Australia), dese ...

) *

Pneumothorax A pneumothorax is 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 dyspnea, shortness of breath. In a minority of cases, a one-way valve is ...

Pulmonary edema Pulmonary edema (British English: oedema), also known as pulmonary congestion, is excessive fluid accumulation in the tissue or air spaces (usually alveoli) of the lungs. This leads to impaired gas exchange, most often leading to shortness ...

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 . HAPE is a severe presentation of altitude sickness. Cases have also been r ...

) *

Respiratory Arrest Respiratory arrest is a serious medical condition caused by apnea or respiratory dysfunction severe enough that it will not sustain the body (such as agonal breathing). Prolonged apnea refers to a patient who has stopped breathing for a long period ...

associated with neurotoxic bites

Shock

Anaphylaxis Anaphylaxis (Greek: 'up' + 'guarding') is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of the use of emergency medication on site. It typicall ...

associated with stings *

Hypovolemic shock Hypovolemic shock is a form of Shock (circulatory), shock caused by severe hypovolemia (insufficient blood volume or extracellular fluid in the body). It can be caused by severe dehydration or blood loss. Hypovolemic shock is a medical emergency ...

(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, ...

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

Electric shock An electrical injury (electric injury) or electrical shock (electric shock) is damage sustained to the skin or internal organs on direct contact with an electric current. The injury depends on the Current density, density of the current, tissu ...

Mental health

Few programs teach psychological first aid, although mental distress is commonly encountered by wilderness guides and outdoor athletes.

Mass-casualty incidents

mass casualty incident A mass casualty incident (often shortened to MCI) describes an incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of Casualty (person), casualties. For example, an ...

(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 A blizzard is a severe Winter storm, snowstorm characterized by strong sustained winds and low visibility, lasting for a prolonged period of time—typically at least three or four hours. A ground blizzard is a weather condition where snow th ...

earthquake An earthquakealso called a quake, tremor, or tembloris the shaking of the Earth's surface resulting from a sudden release of energy in the lithosphere that creates seismic waves. Earthquakes can range in intensity, from those so weak they ...

avalanche An avalanche is a rapid flow of snow down a Grade (slope), slope, such as a hill or mountain. Avalanches can be triggered spontaneously, by factors such as increased precipitation or snowpack weakening, or by external means such as humans, othe ...

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

floods A flood is an overflow of water (list of non-water floods, 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 of significant con ...

and

forest fire A wildfire, forest fire, or a bushfire is an unplanned and uncontrolled fire in an area of combustible vegetation. Depending on the type of vegetation present, a wildfire may be more specifically identified as a bushfire ( in Australia), dese ...

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

human error Human error is an action that has been done but 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 Er ...

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 process by which care providers such as Health professional, medical professionals and those with first aid knowledge determine the order of priority for providing treatment to injured individuals and/or inform th ...

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 concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians (or "ER doctors") specialize in providing care for unscheduled and undifferentiated pa ...

, some advocates assert that there is a golden hour which refers to a time period lasting from a few minutes to several hours following traumatic 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 Critical incident stress management (CISM) is a system of support for individuals and groups who have been exposed to trauma. It is a form of psychological first aid. It includes pre-incident preparedness and acute crisis management through po ...

, 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 a medical emergency, with care provided to preserve life, prevent the condition from worsening, or to promote recovery until medical services arrive. First aid is gener ...

which relates to care in remote areas, where

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

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, 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 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). In the Republic of Ireland and the United Kingdom various Wilderness First Aid courses and certifications are facilitated b
WEMSI International
who have bench marked their standards from the US based WEMS

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 (often, more simply, EMT) is a medical professional that provides emergency medical services. EMTs are most commonly found serving on ambulances and in fire departments in the US and Canada, as full-time and som ...

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