Wilderness and Rescue Medicine 8th Edition

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Wilderness and Rescue Medicine

Introduction Wilderness and Rescue Medicine (WARM) is com- posed for use as the primary text for Wilderness Medical Associates International (WMA International) courses. As such, it was conceived to be a clear, concise, and user-friendly guide to medical care in remote and low-resources settings. In this, our 8th Edition, we have remained focused on knowledge and techniques that are practi- cal and useful in field medicine while updating from the current medical literature and our own evolving base of experience. The content will be appreciated by practitioners at all levels of train- ing, but it is aimed at learners in our Wilderness First Responder and Wilderness EMS courses. WARM is more practical than encyclopedic and is written to be read from front to back. We have tried to structure it in a way that is logical, with one section building on to the next. The general principles described in the beginning will enhance your appreciation of the systems and problems discussed later. Your initial understanding of the body systems will guide the process of develop- ing accurate and useful assessments leading to appropriate and realistic treatment plans for evermore complex problems. One of our goals is to offer assessment criteria that are logical and practical for field application. To apply compe- tently, one only needs to integrate the information acquired from listening and observing with the principles that we have outlined in WARM and the classroom. Although this text can be understood as a stand- alone resource, it is best accompanied by the Field Guide of Wilderness and Rescue Medicine as well as case studies provided by Wilderness Medical Associates International. The Field Guide is designed for your first aid kit as a quick-reference alternative packaged in a weather resistant format. The case studies offer an opportunity to review important principles in realistic settings. Within these publications you will find certain procedures identified as Wilderness Protocols. The procedures described expand the scope of practice for traditional first aid and many EMS practitioners. They are meant to address specific

problems often encountered in a wilderness and rescue environment. WMA International gradu- ates have been trained in these techniques, but the authorization to use them comes from the patient’s informed consent and, where relevant, practitioner’s licensing agency. The Wilderness Protocols are freely offered for modification and use for the wilderness and res- cue setting. Each carries the acknowledgment that the practitioner is appropriately trained and that the protocol is employed only in situations where transport to definitive care would result in unac- ceptable risk to the patient or rescuers or where field treatment offers a clear benefit in improved outcome and diminished pain. The Wilderness Protocols require a clear diagnosis and a specific action. Not all situations, however, can be so clearly addressed. As you train for medical care in remote and low-resource settings, you must be prepared to do some unconventional thinking. Mainstream medical practice may have little relevance to you as the skipper of a small boat hundreds of miles from shore or as the leader of a rescue team on a high mountain ledge. There are many cases where applying conventional EMS protocols and equip- ment will substantially increase the risk to the patient and entire rescue effort. For some of you, especially those with years of emergency medical services training, this perspective may be difficult to adopt. Others among you may find that it vali- dates opinions formed by experience. Within the text and presentations, these issues take the form of wilderness perspective notes and risk versus benefit discussions. While you may have been taught that the ideal plan for traumatic brain injury is evaluation in a hospital, what if the route to get there is extremely dangerous for you and your patient? How do you balance the risk versus the potential benefit? These types of deci- sions are not easy, but they are necessary. This text and the courses it serves are designed to provide you with some background with which to make tough choices and to provide the most effective medical care possible in unique and