Luanne Freer is president-elect of the Wilderness Medical Society, medical director of Yellowstone National Park, and director of Everest Base Camp Medical Clinic (Himalayan Rescue Association). She can be contacted at 220 Deer Path, Bozeman, MT 59718, USA “Wilderness settles peace on the soul because it needs no help; it is beyond human contrivance. Wilderness is a metaphor for unlimited opportunity.” — E O Wilson People ask me all the time—“what is it that you do? Exactly, what is wilderness medicine?” It is easy to imagine a doctor in a jungle caring for a patient with malaria, or on top of a mountain caring for a snowblind climber, and that, for sure, is wilderness medicine. But I have also practised medicine in the urban street, and I could not rely on much of what I learnt in medical school. At the scene of a motor vehicle accident, when all resources were overwhelmed, with no skilled help and very little equipment, a couple of jackets, a seatbelt, and a scrap of plywood became an immobilisation device. This is wilderness medicine as much as a clinic in the depths of the woods; it is the practice of medicine using a knowledge base—much of which is anecdotal and unscientifically derived—in inopportune and often hazardous surroundings, requiring the art of improvisation… and I haven't yet begun to really describe the discipline. More than a decade ago, I graduated from emergency-medicine residency training in Washington, DC, and left for my very first job in a small seasonal hospital in Yellowstone National Park. I thought I knew everything I needed to know to practise medicine in a remote setting: I was half right. I had the proper didactic instruction on injuries and illnesses that arise in the wilderness. I had yet to learn how to create a femoral traction splint out of a couple of tree branches, or how to take care of patients when all resources or equipment are either not present or no longer available, when there are no consultants to lean on, when a grizzly bear attacks and the rescuer is worried if he or she is next, when communications are not working properly, or when lightning is striking near the rescue scene. In short, I had yet to learn how to function when all my familiar hospital surroundings were gone and I was in the middle of nowhere—with no book to read to tell me what to do next. I am still in the process of being educated; it is a lifelong endeavour. But here is what I've learnt so far. A good wilderness medicine doctor can come from almost any training background, but must possess skills and knowledge in various disciplines—emergency management of illnesses and injuries, paediatrics, anaesthesia, orthopaedics, obstetrics and gynaecology, infectious disease, sports medicine, disaster, and military medicine, to name a few. Much of this learning is done in the doctor's so-called free time, and dedication to continuing learning outside the realm of routine practice is typical. He or she must be educated about health risks of specific environments, such as mountain, desert, jungle, marine, aerospace, and subterranean, among others. The effects of the environment on global-health issues are within the domain of wilderness medicine curriculae, as are environmental health disorders—heat illness, hypothermia, frostbite, altitude illness, barotrauma, and submersion injury. A properly prepared doctor of wilderness medicine should have a working knowledge of health risks from flora (eg, toxic and injurious plant species) and fauna (eg, animal-bite wounds and zoonoses) and how to prevent illness and injury from contact with both. Recognition of indigenous infectious diseases that could affect travellers to a region is an important piece of a wilderness medicine practice. Expedition and travel medicine are popular subdisciplines in this area; understanding how to assess, protect, and provide care for a patient travelling to medically underserved areas is an ever-expanding course within the domain of wilderness medicine. A trained wilderness medicine doctor can be called on to supervise an emergency response service or search and rescue team in a remote setting. He or she can direct or provide medical care for unusual types of injuries sustained in the wilderness—eg, climbing, diving, avalanche, lightning, and animal attack injuries, to name a few. What we are told about wilderness medicine is often anecdotal and perhaps unscientific. To that end, members of the medical community interested in research have abundant opportunities to make a real contribution to the knowledge base of the specialty. Wilderness and Environmental Medicine—a peer-reviewed and indexed journal in its 12th year of publication—promotes the growth of scientific research on topics relevant to wilderness medicine. Wilderness medicine doctors are called on to share their expertise to educate not only their patients but also other doctors, ancillary health-care providers, and the public on safe and healthy travel in the wilderness. Much of what causes a person to fall ill or become injured in austere environments is preventable with well-timed and well-informed education. In April, 2003, I embarked on an adventurous mission to set up a medical clinic at Mount Everest base camp (5350 m) in Nepal (http://www.BaseCampMD.com), intent on practising all that I had learnt. I carefully itemised the medical supplies, and took the proper drugs to treat everything from altitude illness to the infectious diseases we would probably encounter. Splints, a portable hyperbaric chamber, and even a battery-powered oxygen concentrator were among the yak-loads of clinical supplies delivered to our tent in the clouds. I felt prepared for just about anything. Then, in quick succession, the generator malfunctioned and could no longer charge our batteries for oxygen or radios, the foot pedal that inflated the hyperbaric chamber broke, the intravenous fluids froze in the tubing en route to the ill patient, and the injectable drugs froze solid. And then the glacier melted, and we found the floor of the clinic tent was under water. It would be dishonest of me to say that my feathers weren't a little ruffled. But adaptability and improvisation are key to making it in the wilderness. Soon, with some help and a little duct tape (a staple item in the pack of any experienced wilderness doctor), I was able to master the wiring of electrical equipment to be powered by solar panels, throw a hot water bottle into an insulated cooler to keep drugs from freezing, and turn a bystander into an intravenous fluid warmer by placing the bag inside his down jacket. My Sherpa assistant engineered a diversion run-off stream to drain the growing pond under our clinic. I survived (as did my patients!) in the shadow of Mount Everest for 2 months in the most austere environment in which I have ever had the opportunity to work. So, what is wilderness medicine? For me, time will tell. I have been practising in the wilderness for more than a decade and I still find myself searching for a concise answer. But there is nothing concise about it. The real joy is that I plan to continue to look for that answer for the rest of my life. Herein lies the opportunity for anyone who seeks to understand and practise wilderness medicine—to combine your profession with a passion for the unknown and the wild.