Clinical update on emergency medical care in the wilderness.

Abstract

Wilderness emergency medical care differs from ur­ ban prehospital care in many ways. Definitive medical care may be up to days away, physician control by radio may be unavailable, limited medical equipment can be carried by rescuers, and the environment may present physical hazards. In addition, illnesses seldom seen in the urban setting, such as acute mountain sickness and frostbite, may be encountered [1]. Despite these obsta­ cles, wilderness emergency medical care is a vital ne­ cessity, owing to the large number of people who par­ ticipate in outdoor activities in the backcountry. The delivery of optimal emergency medical care in remote areas requires knowledge of all aspects of wil­ derness medicine. First, the epidemiology of wilderness injuries and illnesses must be understood. Defining the types of injuries sustained and the populations at risk is crucial for estimating medical need. Second, the neces­ sary scope of medical response must be determined. The need for medical skills, especially advanced life support (ALS) techniques, must be balanced against the con­ straints of training and skill maintenance. Finally, this information must be synthesized to design an emergency medical care system that is able to provide effective wil­ derness care. This clinical update reviews the current medical literature regarding the occurrence of injury and the provision of emergency medical care in the wilder­ ness. The evidence regarding ALS training for wilder­ ness medical providers is also presented.