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SUMMER 2012
RESEARCH, EDUCATION & MEDICINE //
F I E L D M E D I C I N E
E
xotic, far-flung destinations hold pristine sights
full of natural beauty. But the more remote the
location, the more difficult it may be to manage
an emergency should one occur. Understanding
the specific challenges presented by remote environments
gives adventurers a leg up. These challenges include time,
environment, resources and independent decision-making.
Time
In cities, towns and many resort areas, people are rarely
required to spend more than a few minutes with individuals
who are seriously injured. Emergency medical technicians
(EMTs), paramedics, nurses or doctors are available to take
over care within minutes. In the time it takes to call 911
and have an ambulance dispatched and arrive on scene, a
patient can be in the hands of expert medical-care providers.
In remote environments, however, traveling companions of
those who become ill or injured may find themselves forced
to give care to the best of their ability for hours or even days.
This means wounds must be cleaned thoroughly to
prevent infection, and splints, wraps or slings may need to
be constructed to limit further injury to bones and muscles.
Medication may have to be administered, and careful notes
should be taken to give to professional caregivers when an
evacuation can be conducted.
When providing care over an extended period, there is
more to it than just addressing patients’ medical needs.
Caregivers must also figure out how to help them stay
nourished, hydrated, warm and able to relieve themselves.
It isn’t just training, planning and sound judgment that are
helpful in extended-care situations; good bedside manner
and a willingness to provide comfort and encouragement are
important as well.
environmenT
Hospitals, clinics and even ambulances offer climate control,
shelter, light and other amenities that are not guaranteed in
wilderness settings. Be prepared to care for injured traveling
companions in darkness, rain and high winds when you visit
remote areas. Be ready to face the sun’s relentless rays, lethargy-
inducing heat or finger-numbing cold as you administer aid.
Since bad conditions can increase the potential for injury, it
is quite possible you’ll be called on to provide care in heavy
weather, at night or in extreme temperatures. Evacuation to a
higher level of medical care will not be necessary for every little
annoyance, but be prepared for trips to the doctor for simple
infections and other seemingly mundane problems to become
daylong ordeals.
resources
When an ambulance arrives at the scene of an accident, it
comes loaded with equipment designed to provide assistance
and relief to the sick or hurt. When no ambulance is available,
you’re stuck with the gear aboard your boat or in your pack.
This means time spent deciding what equipment to bring on
a trip is time well spent. It’s worth brainstorming a variety of
scenarios to improve your chances of being prepared for the
most likely and most serious situations you may face. It also
means you may need to improvise important gear you don’t
have with you. Effective improvisation of equipment is an
essential skill in wilderness medicine.
Even where medical care is available in rural or remote
areas, the imaging equipment necessary to determine injury
severity may not be. Basic casting materials, medications and
expertise in reducing fractures, for example, may likewise
be unavailable. It might be necessary for a group to splint
an injury using whatever padding and rigid materials are
available. When doing so, immobilize the injury without
restricting circulation, and always use lots of padding.
Group members may even need to build a makeshift
stretcher that can be dragged along the ground or carried
to transport a patient to a clinic, hospital or airstrip. This
is appropriate except when a patient may have suffered a
spine injury. When a spine injury cannot be ruled out, avoid
moving the injured person unless there is an immediate
threat to life or group members have the training to secure
the patient to an available backboard — a device designed
specifically for moving people who may have spine injuries.
Some equipment should not be improvised.
independenT decision-making
When a satellite phone isn’t available and you cannot get a
cell signal, you may find yourself having to make decisions
without the guidance of a doctor, DAN® medic or other
expert. Good judgment and decision-making ability comes
from training and experience. If you don’t yet have these,
travel with those who do. Ask your guides or tour operators
about their training and emergency protocols before you
book your trip. Some small resort islands have clinics in
which physicians or nurses rotate through, but even in these
B y S c o t t S M i t h , E M t - P , D M t , a n D B R i a n h a R P E R , W - E M t , D M t
Defining Remote