Professional Documents
Culture Documents
Spring 2007
Student Elective Update Luanne Freer, MD, Past-President Christopher Van Tilburg, MD............Editor
Christopher Sloane, MD..............................7 Jonna Barry........................Managing Editor
Colin Grissom, MD, Treasurer Larry E. Johnson, MD, PhD................................Assistant Editor
Seth C. Hawkins, MD................................Associate Editor
Member Profiles Chris Moore, MD, Secretary George Rodway, PhD, CRMP..............................Associate Editor
Sam Schimelpfenig, MD............................15 Karl Neumann, MD.............Editor Emeritus
Andrew Woody Bursaw, MS4
Natl Student Representative Contributing Editors:
Book Reviews Jolie Bookspan, PhD
Seth C. Hawkins, MD, editor....................16 Tom DeLoughery, MD Yvonne Lanelli
Debra Stoner, MD
Tony Islas, MD
Search and Rescue Contributors:
on Mt. Hood Photo Essay Kimberly Johnson, MD, PhD Cristopher Benner, PA-C
Christopher Van Tilburg, MD....................18 Andrew (Woody) Bursaw, MS4
Shean Phelps, MD, MPH Christian Sloane, MD
ICAR - IKAR - CISA Statement: James A. Wilkerson III, MD Email submissions and comments to:
Avalanche Rescue Devices Christopher Van Tilburg: vantilburg@gorge.net
& Jonna Barry: jonna@wms.org
and Systems. ....................................22 Standing Committees
Wilderness Medicine (ISSN 1073-502X) is published quarterly in January,
CALL FOR: Finance and Audit April, July, and October by the Wilderness Medical Society, 810 E 10th
Colin Grissom, MD, Chair Street., PO Box 1897, Lawrence, KS 66044
Board Member Nominations....22 Tel: 800-627-0629. Periodicals postage paid at
Nominating Committee Lawrence, KS and additional mailing offices.
Fit to be Wild: Luanne Freer, MD, Chair Annual subscription rate: $55.
A New Look at Old Wilderness POSTMASTER:
Send address changes to the Wilderness Medical Society,
Medicine for Travelers Diarrhea Ongoing Recommended Committees 810 E 10th Street., PO Box 1897, Lawrence, KS 66044.
Jolie Bookspan, PhD .................................23 Requests to reprint Wilderness Medicine in whole or in part must be
Awards Blair Erb, MD, Chair submitted to www.copyright.com.
Dispatches: CME James A. Wilkerson III, MD and 2007 Wilderness Medical Society. All rights reserved.
Mountain Medicine Kimberly Johnson, Co-Chairs Printed on recycled paper in the USA.
Conference, Argentina
Environmental Council Kimberly Johnson, The goals for Wilderness Medicine magazine are to:
Ken Zafren, MD.......................................26 MD, Chair 1. Provide timely information regarding WMS
news and activities;
From the PAs Desk Executive Board Eric L. Johnson, MD, Chair 2. Provide a forum for the exchange of ideas and knowledge
Cristopher Benner, PA-C, MMSc................28 regarding wilderness medicine, and regarding WMS, and
FAWM Shean Phelps, MD, MPH, Chair 3. Promote active membership involvement
through solicitation and publication of
Cliff Notes Membership Tony Islas, MD, Chair members articles and photographs.
Andrew Woody Bursaw, MSA..................29
Publications George Rodway,
PhD, CRNP, Chair
CALL FOR:
WMS Award Nominations..........29 Research Colin Grissom, MD, Chair
Student Services Andrew Woody Bursaw, MS4 Joyce Lancaster, Executive Director
Conference Calendar....................30 Jason Gilbert, Association Manager
Wilderness Medical Society
810 E 10th Street, PO Box 1897
CALL FOR: Lawrence, KS 66044
Abstracts 2007................................30 Tel: 800-627-0629
Intl: 785-843-1235
Email: wms@wms.org
During the month of February, the annual ritual of reading the emails You may contact Dr. Johnson at President@wms.org.
from the Wilderness Medicine Student Rotation held in Tennessee offers
an amazing tale of the trials and tribulations of medical student wilderness
education. Tom Kessler does a wonderful job in coordinating this effort,
and I am envious of the opportunity these young physicians have. It
is to be applauded and supported. I am also humbled by these young
upcoming wilderness docs, as their bios are filled with broad experiences
and interests that took me years to develop and discoverif they are any
indication of future WMS members, the Society is in good hands.
The ideal expedition medical kit would weigh nothing yet contain
everything found in a well-stocked Emergency Department. But
Emergency Departments are heavy, and finding a balance between the
Ray Jardine (the light is right backpacking guru) approach and the
Carolinas MED-1 truck is not simple. Although no best medical kit
exists, once trip length and participants reach a critical mass, some key
items need to come along. This article describes 40 of the most useful
medicines and supplies to bring into the backcountry and presents
principles that apply to both small and large expedition medical care. A
recommended reading list is provided for those wanting to learn more.
Preparation, Organization,
and Communication
Although not part of the kit, these represent the surest and lightest
way to stay healthy. Study the area youre traveling to, learn about
the problems others have encountered, and anticipate the injuries
and illnesses you will have to treat. If trekking in the tropics, review
the CDC recommendations for vaccinations and malaria prophylaxis.
Identify team members medical problems and substance dependencies
and be prepared to address them. Encourage team members to ready
themselves physically. Wilderness medical problems often stem from
failures in leadership and communication; a fancy medical kit is not a
substitute for either. Teams should have clearly defined objectives and for the treatment of severe asthma. Asthmatics should continue their
agreed upon alternative plans if hazardous weather or illness occurs. routine medications and carry a burst dose of oral prednisone, typically
Although you may travel sans cell phone, theyre now a standard safety 60 mg for 5 days. A 7-day course of levofloxacin (Levaquin) 500 mg is
device for U.S. backcountry travel. Outside the U.S., satellite phones appropriate treatment for those with fever and respiratory complaints
may be appropriate. Waterproof paper and pencil weigh little and can consistent with pneumonia. Oxymetazoline nasal spray (Afrin) and a
be critical when trying to find a lost team member or recruit help for a non-sedating antihistamine with pseudoephedrine such as Claritin-D
search and rescue party. treat congestion. Oxymetazoline applied to a small piece of cotton wool
or tissue paper also serves as anterior packing for nose bleeds. Throat
Foot Care and Skin Care lozenges quiet coughs and are particularly appreciated at high-altitude
Unless you are sea kayaking or orbiting Mars, you will be on your feet, and in cold environments.
and eventually they will hurt. Ask team members to tell you immediately
if they have any foot discomfort. I drain blisters with a small incision, Altitude Illnesses
cover them with cyanoacrylate tissue adhesive (Dermabond), cover the Altitude illness treatment depends on three drugs. Acetazolamide
dried adhesive with mole skin, cover the mole skin with duct tape, and (Diamox) 250 mg orally twice a day both prevents and treats acute
put Vaseline over the duct tape to decrease friction between the foot mountain sickness. Dexamethasone (Decadron) 8 mg intramuscularly
and the footwear. There are lots of other ways to do this, but you need a followed by 4 mg injections every 6 hours treats high altitude cerebral
plan. A petroleum-based antibiotic ointment serves as a lubricant and edema. Oral prednisone is an acceptable dexamethasone substitute,
is useful for the treatment of superficial skin infections. but an injectable steroid is preferable due to altered mental status and
vomiting in many with cerebral edema. Nifedipine (Procardia) 10-20
Essential in most environments sunscreen, lip protection, and mg orally every 6 hours is the drug of choice for high altitude pulmonary
sunglasses. At altitude, at sea, and on snow an extra pair of sunglasses edema. Supplemental oxygen should also be given if available.
for every two team members is recommended.
Wounds
Respiratory Problems The key to wound care in the backcountry is cleansing and hemostasis.
Epinephrine is an essential medication because of its role in anaphylaxis Use clear flowing water to wash wounds initially; the bacterial
treatment. The recommended dose for adults is 0.3 mg (0.3 ml of concentrations are likely to be lower than on the skin. Thereafter, a
1:1000) intramuscularly. The EpiPen can deliver this dose, but its bulky, plastic water bottle with a hole or a 20 ml syringe with an 18-gauge
painful when injected, and only provides a single dose. An alternative needle can be used for high-pressure irrigation. Wound closure
bring a 1 mL vial of 1:1000 epinephrine (3 doses). Pack albuterol prevents further contamination and controls bleeding, but is usually
inhalers to treat asthma and bronchospasm associated with cold, not essential and is inappropriate for puncture or dirty wounds. An Ace
altitude, or respiratory illness. Intramuscular epinephrine may be used wrap works well as a compression bandage and keeps the wound clean.
Injectable lorazepam (Ativan) treats seizures, agitation, and alcohol 4. Vonhof J. Fixing Your Feet, 2nd ed. Manteca, CA: Footwork
withdrawal, and works synergistically with oxycodone and morphine to Publications; 2001.
control pain. Caffeine 200 mg tabs are useful for caffeine withdrawal
headaches and during long drives or prolonged rescues, but are 5. Forgey WW. Wilderness Medical Society Practice Guidelines for Wilderness
unnecessary if you have coffee. Emergency Care. Old Saybrook, CT: The Globe Pequot Press; 1995.
He closed the duffle. Being a team player on a small ship delivers great
rewards. Would you like to find out?
Clipper Cruise Line specializes in small cruise ship Ship doctor applicants should have the following:
expedition-type experiences in remote areas of Alaska, 1) Current US State Licensure & CV; 2) Copy photo page
Russia, Japan, Asia and South Pacific, aboard the Clipper passport; 3) ACLS or equiv.; 4) Good general health/positive
Odyssey. The ship doctor must be able to handle a multitude attitude; 5) Available for 3-6 weeks tour of duty. Preference
of general medical problems and consider a number of given to past ship physician experience and/or military service.
solutions, with limited alternatives/supplies available. Computer skills essential.
Flexibility, availability and affability, with a teamwork EM, FM, IM or Surg preferred. No labs, xray or nurse
attitude, are important factors for this position. available. Contracts provide Med. Liab. Insur., air/land
Daily sick-call hours and emergency availability to travel to and from ship, and cruise itinerary for doctor
paxs and crew members. and comp cruise for companion.
The medical issues for a Marine infantry battalion are interesting, to say
the least. The patient population consists mostly of young men who are
in generally excellent health. There are two general categories of medical
problems: The majority consists of preventive medicine issues, minor
injuries, and acute illnesses: the types of things that would be seen at a
local acute care clinic. The second category consists of wounds or other The 2nd Battalion / 1st Marines Battalion Aid Station
(BASP at 29 Palms, California).
The Marines immediately deploy and move towards the casualties. They
set security and establish a defensive perimeter. The buildings are cleared
to ensure no hostile forces lie in wait to inflict further casualties on our
forces. Simultaneously, under the direction of the Navy Corpsmen, the
Marines tend to the grievous wounds of the victims. The Hollywood
makeup effects are gory, with eviscerated bowels, mangled bones, and
shredded tissue bathed in large quantities of bright red blood. To
achieve the highest level of realism and shock, many of the actors are
amputees. Imagine the look of surprise and horror when a Marine opens
the Humvee door to find the victim splattered in blood and sees two
After a simuluated IED blast, an actress/double amputee
is found ejected from a Humvee. bloody stumps where the legs should be!
The basic level of medical
Marines apply training for the Marines
tourniquets is called Combat
and give
first-aid to a Lifesavers which follows
simulated the Prehospital Trauma
casualty. Life Support (PHTLS)
guidelines. A military
specific version of these
guidelines have been
An actor/amputee
awaits the arrival
of Combat Lifesaver
trained Marines
after a simulated
Basic Management Plan for Care under Fire: IED blast.
(Photo by Daniel DeAndrade)
1. Return fire / 5. Massive Hemorrhage:
take cover Stop life-threatening external
hemorrhage if tactically feasible
2. Direct/expect
casualty to remain 6. Airway Management: Position changes,
engaged as combatant, airway adjunct or cricothyroidotomy Marines and
if appropriate Corpsmen tend
7. Respirations: Consider tension to the chest
pneumothorax and decompress if required wound and arm
3. Direct casualty to amputation of the
move to cover/apply 8. Circulation: Assess for unrecognized simulated casualty.
self-aid if able hemorrhage and control
4. Try to keep casualty 9. Hypothermia: Minimize casualtys
from sustaining exposure to elements / maintain
additional wounds protective gear if feasible
directly to combat units. This means that in addition to their medical Recommended Reading
responsibilities, Corpsmen will face the same tremendous challenges as 1. National Association of Emergency Medical Technicians.
their Marines during training and combat. Initial Corpsman training is PHTLS Prehospital Trauma Life Support: Military Version (6th Ed.).
roughly equivalent to that of an EMT-Basic curriculum. Corpsmen are Philadelphia, P:Mosby; 2007.
frequently called upon to do far more, and will address the daily routine
medical problems of their Marines, as well as be the primary medical 2.Yevich S, et al. Special Operations Forces Medical Handbook. Jackson,
provider during combat operations. On an almost daily basis, I am WY:Teton NewMedia; 2001.
humbled by the ability and courage of these Corpsmen, many of whom 3. Peters JM, Fansler JR. Not On My Watch: The 21st Century Combat
wear Purple Hearts and other awards for valor, which they have earned Medic. Bloomington, IN:Authorhouse; 2007
by caring for their Marines under the most horrifying circumstances.
4. Bradley J. Flags of Our Fathers. New York, NY:
Random House; 2006.
Military medicine is unique but extremely rewarding. The sacrifices
made by the young men and women who serve in the armed forces are
LT Trayers is a Battalion Medical Officer with 2nd Battalion, 1st Marines. After this tour
inspiring, and it has been a privilege to take care the medical needs of of duty, he plans to apply for continued residency training in Emergency Medicine at Naval
these individuals and their families. Medical Center, San Diego.
Moonlight caressing the Taj Mahal. Covering every continent, 1,000 Places . . . includes the obvious (the
Trekking Machu Pichu. Exploring Anasazi Parthenon, Panama Canal) and not-so-obvious (Costa Ricas Manuel
ruins at Canyon de Chelly. Welcoming the Antonio National Park). Special indexes will guide you to ten areas of
New Year in Times Square or the summer solstice in Stonehenge. particular interest including Glories of Nature (Sun Yat-Sen Classical
Chinese Garden, Great Barrier Reef) or ultra-pricey Great Hotels and
Sharpen your pencil and start marking off 1,000 Places to See Before Resorts (Raffles, Swedens Ice Hotel). And 955 more.
You Die. Patricia Shultzs New York Times bestselling Life List challenges
travelers, real and armchair. There is something for literally everyone. Its 974 pages add over 2 pounds to your backpack, so unless youre doing
The historianmedieval castles, Thanksgiving at Plymouth Plantation. all 1,000 in one marathon adventure, copy selected logistic details to a
The literaryStratford-upon-Avon. The art loverLouvre, Moscows coupla pages and leave the tome at home.
subway system. Not to mention the religious pilgrimChristmas in
Bethlehem, Omayyad Mosque. Also the shopperDubais Gold Souk. Ballooning over Albuquerque, cruising the Nile. . . .
The golferSt. Andrewsand skierNew Zealands Alps, Utahs
Wasatch. Oh, yes, and the war buffNormandys D-Day beaches. Reviewed by Yvonne Lanelli, Alto, New Mexico
Wilderness Survival is actually two books in one: Mike Pewtherers essays on basic survival
skills interlaced with Mark Elbrochs diary of their 46-day adventure. I was able to read
Marks story without technical jargon bogging things down and yet when needed, I could
refer to Mikes essays for clarity on skills Mark mentioned. I found this to be a breath of
fresh air!
Although writings on wilderness living skills are always of interest, the candor found in
Marks diary is what captured my attention. His words relay a harsh reality that contrasts
with a modern adventurers fantasy. The text is filled with stories of unrelenting mosquitoes,
rain, hypothermia, diarrhea, yearning for familiar meals and sweets, and a rollercoaster of
emotions including a heartrending cry after killing a young deer. I encourage you to pick
up a copy and share the adventure.
The stories are charming and also vividly describe bear encounters in yards and along
streams as well as the injuries common among loggers and workers in fish canneries. There
is a special account of womens experiences of cabin fever, feeling isolated and apart from
support of family and friends in the winter, with limited understanding from the men in
their lives. Interestingly, it was not unusual for women to check into the local hospital for a
couple of weeks to get a break from household responsibilities when this happened.
This book is not like the heavy accounts of Canadian wilderness travel in A Death in the
Barrens or Going Inside, both of which describe long canoe voyages. It is, however, a fun
read, especially for those who imagine living more simply in a wilder place.
Avalanche rescue transceivers are the best tool for companions to The RECCO Avalanche Rescue System (Liding, Sweden) is a tool that
locate a buried friend. Costing typically between $300 and $400+, is widely used by organized rescue groups worldwide for rapid location of
the transceivers are strongly recommended for all who play and work buried avalanche victims. RECCO uses a harmonic radar detector to find
in avalanche terrain. Strapped to the torso and usually worn under the reflectors that are permanently attached (usually by the manufacturer) to
outer-most layer of clothing the transceiver is a small electromagnetic clothing and gear used by skiers, snowboarders, and participants in other
induction device (about the size of ones hand) that transmits a constant winter sports. Their use requires no training or other action on the part
signal when turned on. The device should be turned on at the start of a of the person venturing into avalanche terrain other than using clothing
days adventure and then turned off at the end of the day. When a member or equipment with reflectors. The reflectors are inexpensive, dont use
of the group is buried in an avalanche, all remaining companions switch batteries, and weigh less than 4 grams (about 0.15 ounces). The use of
their devices to receive and begin to search for the signal. Once the the RECCO system does not interfere with other methods of locating
signal is detected the searcher can hone in on the signal by following the buried victims, including avalanche transceivers or search dogs. Because
flux lines of the sending units magnetic field. The last few meters are of the high frequency it uses, RECCO allows direct and very accurate
searched in a grid-style pattern with the final pinpointing done with a location of the reflectors, minimizing time spent probing to find the
collapsible probe pole (like a tent pole) or ski pole. exact location of the victim.
Photo courtesy of RECCO Avalanche Rescue System
The first transceiver, the Skadi, became available in 1968 and was thought
to be a tool for professionals, such as ski patrollers, snow rangers, and
plow drivers, but not for the general public. These first devices like all of
todays avalanche rescue transceivers work on the principle of a simple
transformer. The sending unit creates a magnetic field that is produced
by an electrical current pulsed in a coil around a small ferrite rod. In
the presence of a receiving unit (magnetic coupling) a current is created
(induced) in the receiving unit creating a detectable signal. In the early
1980s European manufacturers settled upon a standard frequency:
457 kHz. The U.S. adopted this higher frequencythe international
standardin 1996.
For over 30 years searchers could only listen to changes in volume as
the signal indicator. In the late 1990s the introduction of digital
transceivers with multiple receiving antennas greatly improved the ease-
of-use. Digital units capture the pulsed signal, transform it to digital data,
Considering the ongoing development of avalanche safety devices in recent years the above commissions of ICARIKAR-CISA
update their statement of 1999 concerning these devices and systems by highlighting the following points:
A. Most people trigger their own avalanche and this can result in death.
The best way not to be caught is to not trigger an avalanche.
If caught, preventing burial is the best way to stay alive.
B. The best way to avoid avalanche accidents is prevention, including information (avalanche bulletins),
knowledge, experience, awareness, and caution.
C. If caught, some safety systems/devices may increase ones chances of survival. Survival depends upon quick rescue.
The efficiency of the transceiver in combination with probe and shovel, and of airbag systems has been proven.
At this time support for other systems is based upon personal opinion and case reports.
However, no device or system guarantees against either injuries to or death of avalanche victims.
E. For organized rescue early notification is essential, e.g., by mobile phone, satellite phone, or radio wherever possible.
F. To be equipped with a transceiver or at least a transponder, e.g., the RECCO system, renders organized rescue more efficient.
The WMS nominations committee is looking for members interested in stepping up their commitment to the WMS by serving on its Board of Directors.
If you are interested in being considered, please send by email a list of your special qualifications and a written statement itemizing what you feel you can
bring to the board and why you should be considered. Deadline for nominations is May 1, 2007, send to wms@wms.org.
WMS Board member job description
H Define and pursue the mission of the WMS and safeguard the values of the organization. H Oversee effective governance, including Board recruitment, selection and orientation,
H Select, monitor, support, evaluate and compensate the Executive Director. board education, and self-evaluation and effective function and structure.
H Establish long-term direction through oversight of and participation in strategic planning. H Act with the highest integrity to advance the best interests of the WMS and achieve its mission.
H Promote financial viability through budget and financial oversight, fund development H Oversee fundraising and participate in fund development through personal contributions.
and investment management. H Set policies for the WMS.
H Maintain and continuously improve the services of the WMS. H Serve as advisor for the Executive Director
H Monitor the effectiveness of significant organizational programs and take action where appropriate H Bring at least one corporate sponsor to the WMS.
to improve, modify, or eliminate such programs as necessary to maintain excellence. H During his/her term or before taking a seat on the Board, each Board member should
H Oversee and promote positive relationships with liaison organizations. become a life member of the WMS.
H Promote and maintain positive external relationships with the community and other wilderness, H Each Board member is expected to attend (in person or by phone conference) a minimum of
healthcare, and environmental organizations. 50% of annual scheduled Board meetings, and may not be absent from 2 consecutive meetings of the Board.
Some of the gastrointestinal illnesses (GI), like E. coli, can be made Long-term PPI-induced acid suppression in conjunction with
worse with antibiotics. Killing the bacteria can sometimes cause release Helicobacter pylori (H. pylori) colonization may promote development
of large amounts of the Shiga toxin. Antibiotics also wipe out the GI of atrophic gastritis, a well-accepted step in the progression to
tracts good bugs along with the bad. Without the beneficial flora that gastric cancer. 4
normally live in the GI tract, normal nutritional and immunogenic
products in your body are not made, and the organisms responsible Use of PPIs add to the confusion in making the differential diagnosis,
for several illnesses can proliferate. An example is antibiotic-associated as side effects of PPIs may include diarrhea, abdominal pain, and
Clostridium difficile (C. difficile) colitis, an infection of the colon that nausea. Diarrhea is also a side effect of antibiotics, which may have
occurs primarily among patients exposed to antibiotics. More than three been prescribed prophylactically to prevent travelers diarrhea. It is easy
million C. difficile infections occur in hospitals in the U.S. each year. It to confuse these symptoms for a infectious mechanism, and then add
is estimated that 20,000 C. difficile infections now occur each year in the medicines that further the cycle of problems. What are some possible
U.S. outside the hospital. alternative treatments?
The views
from an airplane approaching Santiago and continuing on to Mendoza, altitude on the nervous system, emphasizing his research on oxidative
Chile, are spectacular. Flying into Santiago from the north provides a stress and oxygen free radicals. Dr. Marco Maggiorini from Zurich
look at the high Andes from the west. Aconcagua, the highest mountain talked about the effect of hypoxia on the central nervous system from a
in the Western Hemisphere is the pinnacle, but there are many other clinical point of view.
peaks above 6000 meters (about 20,00 feet).
Since almost nobody in Argentina would dream of eating dinner before
The Argentina Society of Mountain Medicine (SAMM) invited me 9 PM, our schedule seemed quite relaxed. The only problem was that of
back to Argentina, in December 2006, to speak at their 3rd Congress of sleep. In a previous era, everyone took a siesta, but now they still eat late
Mountain Medicine and to help teach the first Basic Mountain Medicine and get up at what we would consider a normal hour. The first two hours
Diploma Course for Doctors to be given in the Americas. This course is of the afternoon session were devoted to work in hostile environmental
part of the curriculum that leads to the Diploma in Mountain Medicine conditionsaltitude and coldand the effects of solar radiation. This
approved by the Medical Commissions of the UIAA (International session included a talk on medical screening for high altitude workers
Federation of Mountaineering Associations) and ICAR (International and a presentation on the effects of EICA and altitude-related illness on
Commission for Mountain Rescue). As a member of the ICAR Medical work performance. To a large extent, EICA workers are a self-selected
Commission, I helped design this course. group. This makes it difficult to do research concerning their fitness;
EICA workers who cannot tolerate this exposure do not continue to
After landing in Mendoza, the two-hour drive to San Juan took us work. At the same time, there is great concern about the long-term
through an arid landscape with little vegetation and ever-more distant health effects of EICA.
views of the high mountains until we reached the oasis town of San Juan
with its vineyards. Northern Argentina is known for its wine. My friends The final session concerned psychosocial health of high altitude workers.
from San Juan insist that the wine from San Juan is better than that Topics included living standards and quality of life at high altitude
from Mendoza, but my friends from Mendoza hold exactly the opposite mining camps, recreation for workers at remote sites, effects of EICA
opinion. Although I am no expert, both seemed excellent. on family life of the workers, and the benefits of physical activities for
EICA workers. The final talk concerned the effects of work rotations on
The first session concerned chronic intermittent altitude exposure (EICA the quality of life of the workers. The speaker was Dr. Acacia Aguirre, a
from its Spanish name Exposicin Intermittente Crnica a la Altitud). Spanish doctor who lives in Boston.
This theme is very topical in Argentina and in neighboring Chile,
because thousands of people work at high altitude mines but live at or The next day of the Congress began with a session devoted to altitude.
near sea level. After a welcome by Dr. Carlos Pesce, the chairman of the Dr. Bailey spoke first about the pathophysiology of Acute Mountain
Congress, Dr. Daniel Jimenez from Santiago, discussed the advantages Sickness (AMS) and High Altitude Cerebral Edema (HACE). Dr.
and disadvantages of different schedules and the effects of EICA on Bailey discussed the deleterious effects of oxygen free radicals in hypoxia.
hypertension, diabetes, and obesity. Dr. Jean-Paul Richalet, from Paris, Attempts to use sacrificial antioxidants such as Vitamin C have been
who has studied EICA extensively in Chile, discussed the physiological unsuccessful, since these turn out to be quenched by free radicals. Dr.
changes associated with intermittent altitude exposure. Dr. Conxita Bailey suggested a new approach using antioxidant catalysts.
Leal from Barcelona discussed contraindications to altitude exposure.
The first half of the morning concluded with Dr. Nora Vainstein from
Buenos Aires discussing the approach to cardiac risk factors in workers
undergoing EICA. The general conclusion of these talks was that EICA
Dr. Maggiorini emphasized the possible
can be quite stressful, especially to the cardiovascular system. Many role of brain hypoxia in producing HAPE
workers are eliminated during the initial trial period, but the long-
term effects on workers who undergo EICA over a period of years is and discussed the mechanism by which
not known.
PDE-5 inhibitors may act in preventing
The second part of the morning focused on neurological changes at and treating HAPE.
altitude. Dr. Damian Bailey from Wales discussed molecular effects of
Following is a have to pass the physical but were allowed to come to a very remote
interview of Kristin location anyway. Often it was someone with a cardiac history, so we
Peterson, a family would meet to discuss physical restrictions and the need to check in
practice PA in often with me. I always informed them that a medevac flight to our
Colorado who field camp was minimum of five hours, so the chance of survival due
works seasonally as to a cardiac event decreased significantly.
a medical provider
in Antarctica. She Q: What was your most challenging medical
and her husband experience in Antarctica?
also run Katabatic A: My first season at McMurdo Station we had an across-the-
Consulting, a continent medevac. A crew member on a research ship off the
company providing coast on the other side of the continent suffered a stroke. He was
special environment helicoptered off the ship to a field camp where he was stabilized.
medical consulting. From there he was flown to South Pole Station where bad weather
Q: What is life like in Antarctica? grounded him overnight. The South Pole Station is not a good
A: McMurdo Station is on an island just off the coast of Antarctica environment for a stroke patient because it is at an altitude of 9,300
and we share the island with an active volcano, Mt. Erebus. It feet. He was then flown in an LC 130 plane to McMurdo Station
looks like a mining town, with heavy equipment and huge fuel where again bad weather grounded him for another night. I cared
containers and cargo all over the place. But if you look beyond for him that night and he was able to speak and kept asking for
the town across the sea ice to the continent you can see mountains cigarettes! In the morning, he suddenly lost consciousness. We
and glaciers. At McMurdo we live in dorms and everyone has at intubated him and placed him on a ventilator and medevaced him
least one roommate. Everyone eats in a huge dining hall. When we to New Zealand, where he was pronounced brain dead. The whole
are not working, there is actually much to do. There is a gym for experience brought home to me how life is harsher on the ice.
sports, a weight room, a bouldering cave, a bowling alley and, Definitive care is days, not hours, away. Something you may survive
of course, three bars. There is a recreation department whose in the U.S. you may not survive in Antarctica. I always give a
job is to get folks out to experience Antarctica. It defeats safety lecture at the field camps. I go through a whole scenario
the purpose of being there if you do not get out cross and time line from time of injury to treatment at the field
- country skiing or hiking. In addition, we all have camp, to the arrival of a medevac flight, to its arrival
multiple non-medical duties. We may do things at McMurdo. From there the patient may need to
like shovel snow, assist with landing cargo flights, go on to New Zealand. This may take as much as
and help keep equipment running. 24 hours, weather depending. I let people mull that
over and hopefully everyone stays safe. Bottom line: you
Q: What medical facilities and equipment are more likely to die from trauma or medical problems in
do you have available? Antarctica than you would in the U.S.
A: At McMurdo Station they have everything they need to treat a
patient there or to stabilize a patient for medevac to Christchurch, Q: Would you go back?
New Zealand, about 2,000 miles to the north. There are two PAs, A: Yes, I plan to return in a few years. My husband, a paramedic, and
two civilian MDs, a military flight surgeon (MD), a physical I have our own company, Katabatic Consulting, where we provide
therapist, physical therapist assistant, x-ray tech, lab tech, dentist, special environment
flight nurse, and administrative nurse. There is x-ray, ultrasound, a medical consulting.
lab and tele-medicine with the University of Texas Medical Branch. So for us going to
At field camps, however, the situation can be quite different. At Antarctica was not a
field camps I am the only medical provider and responsible for one-time experience.
everyones medical needs. I often had oxygen, basic trauma gear, It is part of our lives.
and plenty of medications, including narcotics and antibiotics. I We love it.
may or may not have a cardiac monitor. My medical station is
often a small table in a corner. The most important thing I have
is my brain.
Cris is a WMS member
Q: What is it like to practice medicine and the Director of the
in such a remote location? Coalition of Outdoor
A: The responsibility is enormous when you are the only medical Medicine Physician
Assistants (COMPAS).
provider there. I go through possible scenarios in my head, all the
He can be contacted at
time. I made sure I knew everyones medical history. I was on call cdbenner1@yahoo.com.
24 hours a day and needed to be prepared to respond quickly. My To learn more about
biggest worries were usually the science groups that came to camp COMPAS visit www.
with someone who had a medical waiver. That meant they did not wildernessmedicinepa.org/.
WMS Award nominations should be sent to: Joyce Lancaster, Director, Wilderness Medical Society
810 East 10th Lawrence, Kansas 66044 jlancaster@allenpress.com
Mar. 16-21, 2007 Advanced Wilderness Life Support (by AdventureMed & Univ. of Utah SOM) Park City, UT awls.org/index.htm
Mar. 21-25, 2007 Wilderness Advanced Life Support/ Expeditionary Medicine (byWilderness Medicine Outfitters) Denver, CO wildernessmedicine.org
Mar. 21-25, 2007 Wilderness Advanced Life Support (Wilderness Medical Associates) Thunder Bay, Ontario, Canada www.wildmed.ca/
Mar. 27-31, 2007 Wilderness Upgrade for Medical Professionals (by WMI-NOLS) Tucson, AZ www.nols.edu/wmi/courses/
Apr. 18-24, 2007 Wilderness Advanced Life Support (by ICE-SAR Rescue & Wilderness Medical Assc.) Gufuskalar, Iceland http://wildmed.com/Schedule/
Apr. 19 (6 wks), 2007 Wilderness First Responder (by Wilderness Medical Outfitters) Dodge City, KS wildernessmedicine.org
May 5-9, 2007 Wilderness Advanced Life Support (by Montana Family Practice & Wilderness Medical Assc.) Red Lodge, MT http://wildmed.com/Schedule/
May 9-12, 2007 Advanced Wilderness Life Support (by AdventureMed and U of Utah SOM) Moab, UT awls.org/index.htm
Jun. 2-10, 2007 Wilderness First Responder (by Wilderness Medicine Outfitters) Elizabeth, CO wildernessmedicine.org
Jun. 7-15, 2007 Wilderness First Responder (by Wilderness Medicine Outfitters) Elizabeth, CO wildernessmedicine.org
July 21-25, 2007 Wilderness Medicine Conference & Annual Meeting Snowmass, CO www.wms.org
Aug. 2-14, 2007 Wilderness First Responder (by Wilderness Medicine Outfitters) Elizabeth, CO wildernessmedicine.org
Aug. 8-12, 2007 Wilderness Advanced Life Support (by Emergency Preparedness Systems & Wilderness Medical Assc.) Greenbay, WI http://wildmed.com/Schedule/
Aug. 27-Sept. 8, 2007 Dolma Valley Trek and Central Tibet Tour (WildernessWise) Tibet wildernesswise.com
Sept. 23-28, 2007 Fly-Fishing CME Adventure (Mountain Medicine Seminars) Northern California wilderness-medicine.com
Sept. 26-28, 2007 Northeast Medicine CME Conference (NY-Presbytarian Dept. of Emergency Medicine/Cornell University) Ithaca, NY nypemergency.org/wilderness/
Oct. 3-7, 2007 World Congress 2007: Mountain and Wilderness Medicine Aviemore, Scotland www.wms.org
Nov. 1-15, 2007 African Wildlife Safari CME Adventure (Mountain Medicine Seminars) CME/FAWM Mt Kilimanjaro, Africa wilderness-medicine.com
Jan. 20-27, 2008 Cousteau So. Pacific CME Adventure (Mountain Medicine Seminars) CME/FAWM Fiji Islands Resort wildernessmedicine.com
Jan. 27-Feb 8, 2008 Explore Patagonia CME Adventure (Mountain Medicine Seminars) CME/FAWM Argentina/Chile wilderness-medicine.com
April 7-25, 2008 Mt. Everest Base Camp CME Trek Kathmandu (Mountain Medicine Senimars) CME/FAWM Kathmandu/Khumbu Region/Nepal wildernessmedicine.com
For the most recent updates, always be sure to check the Wilderness Medical Society website, www.wms.org For more information regarding the Fellow and Registry Program for the Academy of Wilderness Medicine
*Organizations that affiliate with the WMS are granted permission to advertise as offering course content that is accepted visit wms.org. Want to see your program or conference in our calendar? Affiliate with WMS! Visit the Academy
for credit by the WMS Academys Registry of Wilderness Medicine Practitioners and Fellowship Program and agree to website wms.org/academy For the most recent updates, be sure to check the Wilderness Medical Society
allow their names to be listed on the WMS website as an affiliated organization. website www.wms.org.
CALL Abstracts are being accepted for the Annual Meeting and Summer
Wilderness Medical Conference (July 21-25, 2007). Abstract presentations
FOR
will feature original research covering the spectrum of wilderness
medicine. The opportunity to learn about new approaches, advances
in medical technology, and epidemiologic studies is unique. Abstracts
ASTRACTS for oral and poster presentations are invited and are peer-reviewed.
Abstract application forms are available online at www.wms.org under
Research and then Abstract Submission. The deadline for the receipt
of abstracts for the Summer Wilderness Medical Conference and Annual
Meeting is May 15, 2007. All accepted abstracts will be considered for
publication in the Societys journal, Wilderness & Environmental Medicine.
WMS
WILDERNESS
MEDICINE
CONFERENCE &
ANNUAL MEETING
Snowmass, Colorado
July 21-25, 2007
wms.org
Aviemore, Scotland
October 3-7, 2007
worldcongress2007.org.uk
You will find all of this and more at the 23rd Annual Meeting A potential of 39 AMA PRA Category 1 CMEs!
and Summer Conference of the Wilderness Medical Society, PLUS an additional 17.5 AMA PRA Category 1
CMEs for AWLS certification course!
July 21 25, 2007, in spectacular Snowmass, Colorado.
We invite you
to attend our special 2007 program that surpasses others in education, recreation, and value for your time and money.
With the growing popularity of wilderness activities theres a tremendous need for quality wilderness medicine
educational programs. This years conference meets the challenge of providing new knowledge and basic information
and skills needed for safe wilderness adventures and travels.