Wilderness medicine

Overview
Wilderness medicine (also known as expedition medicine) is the practice of medicine where definitive care is more than one hour away, and often days to weeks away. The practice of wilderness medicine is defined by difficult patient access, limited equipment, and environmental extremes. The development of wilderness medicine has paralleled the evolution of pre-hospital care in the urban setting, beginning with the Napoleonic Wars.

History
Today, wilderness or expedition medicine is practiced by Wilderness First Responders, Wilderness EMTs, Remote/Offshore Paramedics and Physicians on expeditions, in outdoor education, search and rescue, mountain rescue, remote area operations including research, exploration, and offshore oil platforms, as well as tactical environments. In mainland Europe, where mountain rescue is done by paid professionals, there are courses for physicians that help qualify them to be mountain rescue or expedition doctors. Many of these courses lead to an International Diploma in Mountain Medicine, which is recognized by the Union Internationale des Associations Alpinistes.

In the United States, where mountain and other wilderness rescue on land is usually done by volunteers, there is no equivalent diploma. However, there are many wilderness medicine conferences at which medical professionals can earn continuing education credits, and some medical schools (for example, at the University of New Mexico) have begun offering electives in wilderness medicine.

The US-based Wilderness Medical Society is an organization dedicated to wilderness medicine education and research, and they conduct multiple conferences annually in this area. Anyone who is interested in wilderness medicine can join the organization as an associate member, and receive their magazine, Wilderness Medicine. Their peer-reviewed journal, Wilderness and Environmental Medicine, is archived on their web site ([www.wms.org]), and back issues are accessible to the public at no cost.

Training in wilderness medicine is specialized, involving advanced practices and protocols due to the distance from hospitals and physicians. Common US certifications include Wilderness First Aid, Wilderness First Responder, and Wilderness EMT. While there is no legislation on standards of care for wilderness emergency care, there is a consensus of wilderness medical experts published by the Wilderness Medical Society (www.wms.org): Practice Guidelines for Wilderness Emergency Care, edited by Wm. W. Forgey, M.D.

Many organizations offer training in wilderness emergency care to lay people, which may include techniques that go beyond urban first aid or EMT training, such as reducing dislocations. The National Ski Patrol (www.nsp.org), a volunteer organization with a congressional charter, has an 80-hour course to train patrollers, Outdoor Emergency Care, which meets the standards for an EMT (Emergency Medical Technician) course. The Wilderness Medicine Institute of NOLS, Wilderness Medical Associates, Aerie Backcountry Medicine, SOLO, and Remote Medical International offer courses up to the Wilderness EMT level. The American Safety & Health Institute (www.ashinstitute.org) has a Wilderness Emergency Care program that offers a full range of courses including Wilderness First Aid, Wilderness First Responder, and Wilderness EMT Upgrade. Most outdoor organizations that take people into wilderness settings now require their trip leaders, guides or camp councilors to be certified in such a course.