• David Andrew Townes.
• Division of Emergency Medicine, University of Washington School of Medicine, University of Washington Medical Center, PO Box 356123, Seattle, WA 98195-6123, USA. expedition_med@hotmail.com
• Prim. Care. 2002 Dec 1; 29 (4): 1027-48.

AbstractWilderness medicine is not a single entity. It encompasses clinical practice, instruction, and research as they pertain to wilderness settings. Clinical practice often takes place in removed settings far from traditional medical resources and facilities. Many of the conditions treated are unique to wilderness medicine. Decisions commonly are based on limited information. Practitioners of wilderness medicine must combine specialized training, resourcefulness, and improvisation. Instruction and research in wilderness medicine often are directed at clinical practice, with the focus on maximizing patient outcome. Preparation and planning are the best methods of reducing illness and injury; these involve conditioning and choosing clothing and equipment, including the medical kit. Conditioning should mimic the type of trip or activity, because choice will depend on the type, complexity, and duration of the trip, the anticipated environmental conditions, and specific needs of the group. Equipment should be designed for the type of activity, in good working condition, and familiar to the members of the group. The medical kit should include basic medical supplies, with additional supplies and equipment depending on the specific trip, the anticipated needs of the group, and their level of medical training and expertise. Once in the wilderness, the focus shifts from preparation and planning to prevention of illness and injury. This includes the use of safety equipment, appropriate shelter, water treatment, and location knowledge. The most common methods of water treatment are mechanical filters, chemicals, and heat. When an injury or illness does occur in the wilderness, proper assessment of the patient is essential to determine both the appropriate treatment and the need for evacuation to definitive care. This is best accomplished with an organized, systematic approach. The decision of what treatment should be initiated and if the patient requires evacuation to definitive care often is difficult. There are four phases of an SAR event: location, access, stabilization, and evacuation. Evacuation may require the assistance of organized search and rescue services.

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