Wilderness medicine is a rapidly evolving field and is of increasing importance as more people engage in hiking, climbing, kayaking, and other potentially hazardous activities in the backcountry. The modern definition of wilderness medicine is "medical care delivered in those areas where fixed or transient geographic challenges reduce availability of, or alter requirements for, medical or patient movement resources". A primary focus of the field is the evaluation, prioritization (triage), preliminary treatment of acute injuries or illnesses which occur in those environments and the emergency evacuation of victims. However, back country rescue and wilderness first aid is not the sole activity of wilderness medical professionals, who are also concerned with many additional topics. These include but are not limited to:
- Secondary care follow up to first aid in remote settings, such as expeditions
- Evaluation of experience and issuance of updated protocols for first response and secondary care
- The prevention of wilderness medical emergencies
- Epidemiological studies
- Public policy advisement to wilderness planning agencies, and issuance of guidelines to disaster planning agencies, professional guides and amateur back country enthusiast organizations
Wilderness medicine is a varied sub-specialty, encompassing skills and knowledge from many other specialties. The specific curricula will vary but an example can be seen in the curriculum for Fellowship in the Academy of Wilderness Medicine (FAWM).
Diving and hyperbaric medicine
- Physics and physiology of depth
- Dive medicine
- Dysbarisms and barotrauma
Tropical and travel medicine
- Immunizations for travel
- Tick-borne illness, malaria and tropical diseases
- Parasites and protozoal infections in the traveler
- Traveler's diarrhea
- Women's issues in traveling
- Safety and security while traveling
- Travel medicine
- Travel and tropical dermatology
- Fever in the returned traveler
- Viral Haemorrhagic Fevers
- STDs in the traveler
High-altitude and mountaineering medicine
- Physics and physiology of altitude
- AMS, HAPE and HACE
- The effect of high altitude on underlying medical conditions
- Basic (emergency) field dentistry
- Expedition planning, pre- and post-expedition responsibilities
- Camp safety and layout
Survival, field craft and equipment
- Survival techniques and equipment
- Water procurement
- Food procurement
- Hiking and trekking
- Foot gear and care of the feet
- Clothing selection for wilderness survival
- Land navigation
Safety, rescue and evacuation
- Search and rescue theory and practice
- Evacuation of injured persons
Sports medicine and physiology
Preventive medicine, field sanitation and hygiene
- Field sanitation and hygiene measures
- Vector control and barriers
- Water purification methods
General environmental medicine
- Lightning injuries
- Submersion and drowning
- Envenomation and toxicology
- Animal attacks
- Heat Illness and dehydration
- Cold injuries and hypothermia
- Nutrition in extreme environments
- Aerospace medicine
- Improvised field wound management
- Improvisational medical techniques in the wilderness
Disaster and humanitarian assistance
- Field hospital provision
- Malnutrition therapy
Wilderness emergencies and trauma management
- Pre-hospital patient assessment
- Pain management in the wilderness setting
- Emergency airway management
- Psychological response to injury and stress
- Management of trauma and injuries
The Center for Disease Control in the U.S., and its corresponding agencies in other nations, also monitor leading health threats, pathogen vectors in conjunction with local departments of health, such as Lyme disease, plague and typhus which may be carried by small mammals in a back country or wilderness context.
Austere environments interdisciplinary interface
Insights from the field of Military Combat Tactical Care (TCCC) interact with wilderness medical practice and protocol development. Moreover, new products and technologies tested in combat are adopted by wilderness medical personnel and vice versa.
Applications to Covid-19
As of April 2020, studies and trials are underway that examine the possible benefits of nitric oxide in the treatment of Covid-19. This research is related to the role of nasal breathing in the creation of nitric oxide, which increases oxygen absorption in the lungs. Nitric oxide was also investigated as an experimental therapy for SARS.
Brian Strickland, MD, a fellow in Wilderness Medicine at Massachusetts General Hospital who studies “acute respiratory distress” in high altitudes, is applying this research towards Covid-19. He is currently involved in clinical trials which apply the use of inhaled nitric oxide as a treatment for Covid-19. This approach was inspired by the work of Associate Professor of Emergency Medicine at the Harvard Medical School N. Stuart Harris, who has been studying the effects of altitude sickness on mountain climbers, such as those who climb Mount Everest. Harris noticed that the consequences of high level altitude sickness on the human body mirrored Covid-19’s dysfunctional impact on the lungs. His focus on nitric oxide comes from its role in being able to breathe in high altitudes.
Internationally there is huge variety in the medical training for wilderness medicine.
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