Wilderness Medicine Updates

This is part 1 of a multi-part series on the resuscitation of critically buried avalanche victims. In this episode we learn the physiology that we need to understand the resuscitation algorithm. To learn the necessary biology, we follow a rider as they are carried in an avalanche, subjected to traumatic injury, and are then buried and begin to asphyxiate and cool.  The background of this episode i...

Episode 11 brings you  my conversation with Michael Buchanan is a flight paramedic and senior firefighter / paramedic at the West Valley City Fire Department. He is the founder and operation of Mountain Medical Academy, a passion-driven backcountry medical care education company.  We discuss the medical care of avalanche victims which Michael has made accessible to recreational skiers and riders w...

In this episode, I discuss the article " Arterial Occlusion Effectiveness of Space Blanket-Improvised Tourniquets for the Remote Setting ". In this short blast I get into the meat of this article, and though the authors would tell you that space blankets aren't ready for primetime, I have some thoughts on the matter. In the podcast, I mistakenly say that you need to be a WMS member...

In this episode Dr BZ is back to talk about his experience deploying with the Federal Emergency Management Agency (FEMA) Urban Search and Rescue Task Force (USAR). Dr BZ just returned from a deployment with FEMA USAR to Lahaina, HI, where he served as a team physician supporting rescue and recovery efforts there. We touch on: -Training and gear -Deployments and schedule -Compensation -The care of...

In this two-part episode, I review an article from the Annals of Emergency Medicine "Occupational Accidents Among Search and Rescue Providers During Mountain Rescue Operations and Training Events" https://doi.org/10.1016/j.annemergmed.2022.12.015 In the second half, we review the treatment of diarrhea in the returning traveler. As always, thanks for listening to Wilderness Medicine Updat...

In this second Fast Push, you get a riff on a great article from JEMS entitled " Safety is Third, Not First, and We All Know It Should Be " by Christopher Davis MD et al. Apologies to all who got V1.0-- something weird happened in post that made me sound like a chipmunk. I might be a medical professional, but I'm no AV specialist.  Summary: 1. Get the Job Done 2. Have Fun 3. Safety...

In this episode I go deep on the health effects of wildfire smoke, answering some key questions that are relevant to recreational athletes, outdoors professionals, wildland firefighters, and industrial athletes alike: Why is wildfire smoke harmful? Is there a safe level of exposure? Can we trust the EPA's guideline levels? (Spoiler: no) Does the benefit of exercise outweigh the damage of smok...

In this inaugural interview episode I have the pleasure of grilling Dr. Brant-Zawadzki about operating an urban EMS system at a wilderness boundary. We talk about: - Improvising outside the protocol - Interfacing with SAR, rangers, and road workers - How response kit and expectations are changed beyond the pavement - What a fellowship in Wilderness Medicine can do for you career And more! Show Lin...

In this episode we review the available evidence, and the pros and cons, of using mechanical CPR devices like the LUCAS or Autopulse for ski patrol and mountain rescue applications. Episode links: CPR With a Lucas Device - An example video from EMS training Viglino et. al. - Outcomes of On-Hill Cardiac Arrests - More saves, probably because of younger patients, bystander CPR, shockable rhythms, an...

In this episode we discuss the HOPE score, a tool that improves our ability to select the severely hypothermic patients who can benefit from warming with extracorporeal life support (ECLS). We begin the with the case of Tayyab Jafar , a young man who was successfully resuscitated from severe hypothermia with both cardiopulmonary bypass and ECMO, but not without incident.  We then discuss the deriv...

For today, a new format, the Fast Push: Quick updates that you need to know sooner rather than later. This fast push tackles the growing issue of avalanche beacon interference. To see the source post and useful graphics, check out this link to the Utah Avalanche Center: https://utahavalanchecenter.org/blog/74828 TL:DR -Electronics, magnets, heated/foil line clothes near your beacon are bad.  -They...

Methoxyflurane: inhaled gas of the past and prehospital analgesic of the future? Only if we’re talking about ‘the future’ in North America. Used in Australian EMS for almost half a century, this safe and effective medication is only now starting to get the attention that it deserves outside of the down-under. Today’s paper: Trimmel, H., Egger, A., Doppler, R. et al. Usability and effectiveness of...

Today we look at IV acetaminophen vs IV NSAID vs topical lidocaine vs placebo for treatment of pain due to scorpion stings, with some bonus learning on tramadol. Turgut K, Yavuz E, Gülaçtı U, Aydın İ, Sönmez C, Aktaş N, Arslan E. Comparison of Intravenous Paracetamol, Dexketoprofen Trometamol, or Topical Lidocaine Use for Pain Relief in Scorpion Stings: A Placebo-Controlled, Randomized Study. Wild...

Welcome to Wilderness Medicine Updates!  This podcast, new for 2023, delivers brief reviews of research in wilderness medicine, SAR, disaster/austere medicine, and wilderness EMS to help you stay current and provide the best care to patients in challenging environments.  As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at wild...

Is intranasal fentanyl safe and effective for the treatment of acute severe pain on the ski hill? Lynch TV, Callas PW, Peterson TD, Schlein SM. Intranasal Fentanyl for On-the-Hill Analgesia by Ski Patrol. Wilderness Environ Med. 2022 Sep;33(3):296-303. doi: 10.1016/j.wem.2022.05.003. Epub 2022 Jul 16. PMID: 35851192. DOI: 10.1016/j.wem.2022.05.003 As always, thanks for listening to Wilderness Medi...