July 2007 - Posts

• It’s Hot in the Mountains!

  I’ve just returned from leading a NOLS wilderness course in the Absaroka Mountains on the southern border of Yellowstone National Park.  I saw a grizzly bear sow with two cubs close enough to be uncomfortable, heard wolves howl just outside our camp, and enjoyed the diverse wildflowers in a beautiful wilderness.  I also experienced the hottest temperatures I can remember in 30 years of traveling in the Wyoming mountains.  Gosh it was hot.  I could stand in the Buffalo Fork for 30 minutes fly fishing in water up to my thighs without having my legs become numb.  This is astounding.  The daytime temperatures must have been in the high 80’s F and the nighttime lows in the 50’s.  I never wore more than a light nylon wind shirt over a cotton shirt. It was clear by the second day that we had to behave in these mountains as if we were living in a hot desert.  The students were not acclimated to either the altitude or the heat, so we needed to watch their stress and give their physiology time to adjust, especially the women.  Luanne Freer MD, past president of the Wilderness Medical Society (WMS), noted in a talk at the WMS Annual Conference last week (www.wms.org) that women take longer than men to acclimatize to hot environments. We also needed to use good habits for living and traveling in hot environments; drinking enough water to stay hydrated, and eating to prevent hyponatremia.  We talked about urinating clear light yellow urine, and wearing hats to keep the sun off our heads and necks.  We rested in shade – at times hard to find as we hiked through some of the burned areas from the fires of ’88 -  and sought water to lie in once a day to dump the heat stress.   I had to carry water and pay attention to where the next water source may be, something I’d never had to think about in these mountains. As a wise leader once told me, "when the going gets tough, the tough go camping."  I pulled off the trail early one day because some of my students looked very tired and sweaty, and a few had headaches and felt dizzy.   These are early signs of possible heat illness.  We rested in shade, lay in a river, drank water and got a good nights sleep.   The following day we woke at dawn to hike in the relative morning cool.  Heat wave or global warming?  It doesn’t matter when you're in the middle of it.  One of the attributes of wilderness I appreciate is the immediacy of the world.  If it’s wet and cold we don’t hide inside, we  use our clothing, skills and good habits to stay dry and warm.  If it’s hot, we don’t turn the air conditioner on, we use our brains and find ways to live in rhythm with the weather.  Take care Tod   Posted Jul 27 2007, 11:02 AM by Tod Schimelpfenig with 1 comment(s)

• What is Wilderness Medicine?

  How does one start a blog - prime the pump so to speak.  How about with thoughts on a definition? Back in the day, only 30 or so years ago, many of us, and the practice of wilderness medicine, were in our youth.  As I sat through a boring and not very practical Advanced First Aid class I never thought we would have a specialty medical practice of wilderness medicine, nor could I imagine I’d be writing a blog! The roots of wilderness medicine are in providing medical care for wilderness travelers.  The first programs focused on mountain medicine.  The class on improvised litters was real.  There was no other way to get the patient out of the backcountry.  Today, the scope of wilderness medicine is expanded to include disaster responses, rural clinics, military medicine – really any remote care. Today,  not all medicine in the wilderness is wilderness medicine.  Technology has managed to extend the reach of modern medicine into many wilderness areas.  Multi-day evacuations with improvised litters are less common, largely replaced by helicopters.  Communication technology now offers the chance of quick transport from remote areas to medical care, and many wilderness visitors have come to expect such service A common definition for wilderness medicine has been "an hour to definitive care", but this is arbitrary.  It isn’t in the latest edition of the Wilderness Medical Society Practice Guidelines or Auerbach’s 5th edition of Wilderness Medicine.  I serve on an ambulance service where we can easily be a hour from definitive care and still be on pavement.  Granted my environment is controlled, I have modern gear and good communications, but I will see the patient change over time, and I may need to use interventions, such as making a decision on whether to immobilize the spine, that are usually reserved for “wilderness”, but it's not wilderness. The definition is not the medicine we practice.  Most of this is basic first aid and health education, albeit with an emphasis on relevant environmental topics such as heat, cold and altitude.  The nuances, which are significant and should be in the definition, are the context in which we practice our medicine; the remote environments, the need to improvise, to care for patients for more than the minutes it takes an ambulance to arrive, and to do so in adverse weather and challenging terrain.  The subtle distinctions are also in our need to make decisions on how soon a patient needs to see a physician, and how we might make that happen.  Wilderness medicine teaches us to function without the support of modern technology, which as natural disasters have shown, can be quickly stripped away even in urban environments.  We learn to care for our companions, to thrive with less, to be patient, tolerant of adversity and self-reliant.  One of wilderness medicine’s assets, which perhaps should be in it’s definition, is learning to act like we are in the wilderness, with all it’s good habits and values, every day of our lives. Tod   Posted Jul 12 2007, 11:05 AM by Tod Schimelpfenig with no comments