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INTRODUCTION

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Although many definitions of wilderness medicine have been suggested, one of the most used definitions derives from transport time, and is usually described as longer than one or two hours away from definitive care. This definition suggests an inclusive nature of wilderness medicine which can be superimposed upon other subsets of prehospital care such as austere, expedition, rural EMS, and disaster medicine. In defining it as such, wilderness medicine encompasses quite an area of significance that extends into the very core of emergency medical services.

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Much like tactical EMS, wilderness medicine has seen a surge in academic progress recently, and shares the same sense of pride and accomplishment that comes from practicing in a rich, maturing subspecialty. Indeed, advances in the science of wilderness medicine can be applicable to everyday EMS care—from a remote rescue dispatch to an urban medical call.

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OBJECTIVES

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  • Define wilderness medicine and describe various types and facets.

  • Discuss wilderness search and rescue and discuss essential personnel, specialized techniques/equipment, and proper interface with IC and EMS.

  • Discuss basic principles of operational EMS in austere environments.

  • Contrast philosophies concerning readiness versus improvisation with equipment and supplies examples.

  • Describe types of wilderness medicine practitioners.

  • Discuss wilderness medicine training, certifications, societies, and fellowship status.

  • Define expedition medicine and describe applications of this type of operational medicine.

  • Discuss planning process for medical support of expeditions.

  • Discuss operational concerns that may arise during the expedition and how to respond to these challenges.

  • Briefly discuss contractual arrangements and terms that are important to successful medical support of expeditions.

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DEFINITION OF AND FACETS UNIQUE TO WILDERNESS MEDICINE

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Although a commonly used definition of wilderness medicine is described above, in practice, the subspecialty tends to be defined using an additional, circumstantial descriptor which helps exclude some of the overlapping scope of other EMS subsets. These descriptors can be based on a type of location such as “in the woods” or “on a mountain,” a type of activity such as hiking or skiing, or a specifically prolonged transport time usually defined as one to two hours.

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Further characterization can be made based on the interaction of several of these factors. Commonly, patients are recreating in the wilderness at the time of the illness or injury. For example, snow blindness (UV keratitis) might occur in a mountaineer who has spent significant time on a glacier without eye protection. Although it would be rare, UV Keratitis could conceivably occur in a nonwilderness setting and may not be considered wilderness medicine. Thus this situation is defined as wilderness medicine by the type of injury, the location, and the activity during which it occurred. Many other “typical” wilderness medicine problems can be considered where the illness or injury most commonly occurs in a nonurban area.

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Wilderness medicine may also be defined by the need to improvise or use a ...

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