Browse the corpus

Wilderness medicine is an amalgamation of many different medical disciplines. The base medical knowledge needed for competent practice aligns closely with emergency medicine and primary care specialties. However, familiarity with many other subspecialties, such as emergency medical services (EMS), expedition medicine, tactical medicine, travel medicine, and others, may be necessary depending on individual practice circumstances. With such a broad knowledge base, an agreed-upon definition of wilderness medicine has proven difficult. Most reasonable definitions center on delayed time to definitive care and limitations of available resources. Modern wilderness medicine is a relatively new and evolving area of clinical practice. The Wilderness Medical Society (WMS) is a leading organization that promotes research and education in wilderness medicine, but it has only existed since 1983. Several other national organizations providing wilderness medical care and education, such as the National Outdoor Leadership School (NOLS) and the National Ski Patrol (NSP), can trace their roots back several decades earlier. Since the early 2000s, there has been more interest from the mainstream medical community in wilderness medicine education and practice. This appears to coincide with increased participation in outdoor recreation by the general public during the same timeframe. With this increased focus, the practice of wilderness medicine has been changing. Many providers are familiar with wilderness medicine teachings emphasizing impromptu care. Serious wilderness medicine practitioners understand that this method is inadequate when providing an organized medical response to patients in a wilderness setting. In recent years, the idea of incorporating wilderness medicine into the existing EMS structure has gained traction.[1] However, many questions remain unanswered regarding the best way to integrate adequate wilderness response.

Modern wilderness medicine is a relatively new and evolving area of clinical practice. The Wilderness Medical Society (WMS) is a leading organization that promotes research and education in wilderness medicine, but it has only existed since 1983. Several other national organizations providing wilderness medical care and education, such as the National Outdoor Leadership School (NOLS) and the National Ski Patrol (NSP), can trace their roots back several decades earlier. Since the early 2000s, there has been more interest from the mainstream medical community in wilderness medicine education and practice. This appears to coincide with increased participation in outdoor recreation by the general public during the same timeframe. With this increased focus, the practice of wilderness medicine has been changing. Many providers are familiar with wilderness medicine teachings emphasizing impromptu care. Serious wilderness medicine practitioners understand that this method is inadequate when providing an organized medical response to patients in a wilderness setting. In recent years, the idea of incorporating wilderness medicine into the existing EMS structure has gained traction.[1] However, many questions remain unanswered regarding the best way to integrate adequate wilderness response. Several studies have attempted to establish the incidence of medical issues in remote settings. Most of these studies have focused on the medical response in the national parks.[2][3][4][5][6][7] A few studies have explored this incidence in other outdoor settings, such as wilderness expeditions and Everest base camps.[8][9][10][11][12] One study explored outdoor recreational injuries presented to emergency departments.[13] While all these studies suffer from flaws inherent to retrospective reviews, they establish certain trends that prove useful in further developing wilderness emergency medical services (WEMS). The national park data shows a relatively even split between medical and traumatic calls for service.[2][6] Trauma, however, produces more fatalities.[2][5][6] The majority of nonfatal trauma is due to athletic-type injuries and extremity fractures.[7][8][10][11][13] Counterintuitively, most expedition injuries occur in camp or while hiking, not during more "high-risk activities" (climbing, mountaineering, skiing, kayaking, etc).[4][7][8][11] During expeditions, many medical issues were due to gastrointestinal and respiratory illnesses.[8][9][10][11][12] Mirroring data from urban EMS response, most care rendered is at the basic life support level.[2][4] Reviewing this data can help physicians and EMS organizations prepare to provide rational WEMS responses.