Wilderness & environmental medicine
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Wilderness Environ Med · Jun 2015
Wilderness Emergency Medical Services Medical Director Course: core content developed with Delphi technique.
The National Association of Emergency Medical Services Physicians' (NAEMSP) position on the role of medical oversight within an operational Emergency Medical Service (EMS) program highlights the importance of integrating specially trained medical directors within the structure of these programs. In response, the NAEMSP Wilderness EMS (WEMS) Committee recognized the need for the development of an educational curriculum to provide physicians with the unique skills needed to be a medical director for a WEMS agency. This paper describes the Delphi process used to create the subject matter core content, as well as the actual core content developed. This core content was the foundation for the development of a specific WEMS medical director curriculum, the Wilderness EMS Medical Director Course.
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Wilderness Environ Med · Jun 2015
Case ReportsHow not to train your dragon: a case of a Komodo dragon bite.
Komodo dragons (Varanus komodoensis) are the world's largest lizards, known for killing prey that exceed their body mass. Reports of bites to humans in the popular press suggest high degrees of morbidity and mortality. ⋯ We describe the case of a zookeeper who was bitten by a Komodo dragon, with a resultant mallet finger. We further discuss the various potential mechanisms of Komodo dragon lethality, including sepsis and venom deposition theories that are useful in guiding management.
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Wilderness Environ Med · Jun 2015
ReviewApplication of current hemorrhage control techniques for backcountry care: part one, tourniquets and hemorrhage control adjuncts.
Decade-long advancements in battlefield medicine have revolutionized the treatment of traumatic hemorrhage and have led to a significant reduction in mortality. Older methods such as limb elevation and pressure points are no longer recommended. Tourniquets have had a profound effect on lives saved without the commonly feared safety issues that have made them controversial. ⋯ This article, the first of two parts, reviews the literature for advancements in prehospital hemorrhage control for any provider in the austere setting. It emphasizes the significant evidence-based advances in tourniquet use on the extremities that have occurred in battlefield trauma medicine since 2001 and reviews the newer junctional tourniquet devices. Recommendations are made for equipment and techniques for controlling hemorrhage in the wilderness setting.
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Wilderness Environ Med · Jun 2015
ReviewApplication of current hemorrhage control techniques for backcountry care: part two, hemostatic dressings and other adjuncts.
Decade-long advances in battlefield medicine have revolutionized the treatment of traumatic hemorrhage and have led to a significant reduction in mortality. Part one of this review covered the use of tourniquets on the extremities and the newer devices for use in junctional areas. Part two focuses on the use of hemostatic agents or dressings, pelvic binders, and tranexamic acid. ⋯ Most of these agents are inexpensive and lightweight, making them ideal products for use in wilderness medicine. The use of pelvic binders to stabilize suspected pelvic fractures has gained new interest as these products are developed and refined, and the prehospital use of tranexamic acid, a potent antifibrinolytic, has been found to be life saving in patients at risk of death from severe hemorrhage. Recommendations are made for equipment and techniques for controlling hemorrhage in the wilderness setting.