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General Principles in Wilderness Medicine
Questions and Answers
1
What is wilderness medicine?
Wilderness medicine is, in general, as defined by Hawkins in Wilderness EMS , “medical care and problem-solving in circumstances where the surrounding environment, has more power over our well-being than does the infrastructure of our civilization.” Many texts have defined wilderness medicine with various verbiage over the years, but as the field has matured, the definition has evolved. Historically, definitions have centered on time from “definitive care,” often referring to a hospital or emergency department. Many organizations still use the definition of 1 or 2 hours from definitive care to activate “wilderness” protocols. This is based off of the increasingly questioned, historical concept of the “golden hour” for trauma, presuming that patients should arrive at a hospital within an hour of a traumatic injury. Auerbach’s Wilderness Medicine defines wilderness medicine as “medical care delivered in those areas where fixed or transient geographic challenges reduce availability of, or alter requirements for, medical or patient movement resources.” Practically speaking, this refers to any medical care provided in austere conditions, which may be anywhere from a remote Alaskan mountain, to a battlefield, in space or at sea, in an urban area on the side of a steep cliff, or during a natural disaster.
2
What is the relationship between wilderness medicine and wilderness EMS?
Wilderness EMS (WEMS) is increasingly being recognized as its own distinct subspecialty. WEMS is truly a specific subtype of wilderness medicine. Traditionally, there has been a divide in wilderness medicine between “professional rescuers” and recreationalists. This has evolved over time, but the two primary contexts remain: recreationalists who are providing ad hoc care without a duty to act and organized teams of credentialed providers who do have duty to act. Wilderness medicine traditionally has had the connotation that it is ad hoc medical care provided in an unplanned manner. It is largely improvisational, and presupposes rescue. WEMS, on the other hand, as defined by Hawkins is “The systematic and preplanned delivery of wilderness medicine by formal healthcare providers.” This includes special operations teams in both civilian EMS and the military, ski patrols, search and rescue (SAR) teams, or conventional EMS who have been unexpectedly placed in a “wilderness context.” In the context of the definition discussed earlier, this could be a vehicle rescue over a cliff, an injury on a trail in a suburban park, or routine EMS care during a natural disaster. Although the resources available to a WEMS team are different than in conventional EMS, the public expectation for high-quality care does not change. While, traditionally, wilderness medicine has been referred to as “austere” or “resource-limited” medicine, within a WEMS system, there may be highly advanced resources such as helicopters, blood products, or antivenin that is not available in an urban context. This is the premise upon which the concept for preplanning and development of a WEMS system is built. Systems should be developed locally and designed to meet the anticipated needs based on the patient population and geographic areas served.
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