Introduction
Nature is a beautiful thing that should be explored and persevered for the future generation, it does come with its challenges such as patients getting injured and exposure to elements in the environment that can produce many types of emergencies. Emergency practitioners must be ready to recognize and manage these conditions. They can do this by becoming knowledgeable about the causative factors and by learning the pathophysiology of these specific disorders that can occur in the wilderness.
Literature Review
We can also look at published data on specific wilderness medicine problems. The possibility of anaphylaxis generates much angst among wilderness trip leaders, yet the incidence of anaphylaxis from any cause, let alone bees, is elusive. Bears kill less than one person a year in the US, and alligators, cougars, and bison share this statistic. Lightning is the cause of an average of 88 fatalities a year (23 in 2013). Snakes bite an average of 5000 people a year in the US. Very few of these snakebites are in the wilderness and very few of the victims die. Hypothermia and heat stroke kill several hundred people a year, primarily in urban areas. The most prominent killer is drowning, a common cause of death in the outdoors. The studies on altitude illness show us that Acute Mountain Sickness is common, High Altitude Pulmonary Oedema, and High Altitude Cerebral Oedema are rare. Acute mountain Sickness at ski areas in Colorado reportedly affects 22% of visitors, and among Nepal trekkers, 45% suffer signs and symptoms of Acute Mountain Sickness.
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A set of studies of emergency medical services in western national parks are perspectives of medical services in parks and echo themes from the adventure program data. In one study 70% of injuries were musculoskeletal or soft tissue, 35% involved the lower limbs (ankle and knee) and 27% the upper limbs (hand and wrist). The illness was spread through multiple categories ranging from cardiac, diabetes, and seizures to anaphylaxis
Discussion
In the wilderness, the climate or weather can range from intense extreme heat and freezing temperatures during a single day. The general rule in wilderness search and rescue is to prepare for the worst-case scenario possible. There are four things a human need to survive namely food, shelter, water, and warmth.
Bag of choice
The external frame rucksack is the bag of choice as it has multi compartments nylon bag, has an aluminum H-frame attached to it, which has two padded shoulder straps and a hip belt, and the frame has one or more tensioned nylon bands that rest against the shoulder blades creating space between your back. The hip belt at the bottom of the frame improves the distribution of weight to the hip, it also has many points of attachment for various items such as tents, sleeping bags, and pots, with all thing there are disadvantages due to the bag having an aluminum frame it can restrict movement and is not always well balanced.
Drug list
The medication that might be needed for this patient would include intravenous lines with a drop set and cannula due to the information not much is mentioned so it could everything but what we do know is that the patient is able to walk is it due bleeding or broken leg or back there is no telling really if that the case the patient might be in hypovolaemic shock, depending on the patient status and responses to cooling methods, these drugs may include diazepam or lorazepam for sedation and seizures control.
The patient might have been poisoned or allergic reaction to adrenaline, or promethazine for antihistamine release. Weather condition plays an important part in the type of drug to be taken for extremely cold temperature. The body generates heat in a form of shivering, so shivering continues until the core body temperature reaches about 30 degrees Celsius, glucose or glycogen is depleted, or insulin is no longer available for glucose transfer, 50% dextrose may be needed.
Pain management is needed for this patient morphine and ketamine for analgesia, for high-altitude illness it is attributed directly to exposure to reduce atmospheric pressure, so Oxygen and nitrates might be needed. If possible take the whole drug bag.
Consumables
When it comes to consumables ready to eat food is advised, water for hydration and enough for the patient as well, as we don’t know if they are hydrated enough, foods such as peanuts for protein and sweets for energy, dried fruits, biltong, and energy bars and at least lunch box that can last 48 hours.
Equipment
Communicative equipment is most crucial to maintain communication with the operation center to keep track of your location for example radio (with spare batteries), compass, and cell phone. Insulation and shelter such as extra clothes, a rain jacket, a space blanket for warmth, flashlights such as headlamps for a night search, fire flares as well an extra torch with spare batteries, pressure dressing(bandage), multi-purpose knife and small first aid kit. Two cow’s tails and a topographic map in case GPS does not work or spare batteries die. A whistle could be helpful and most importantly toilet paper, a sleeping bag accompanied with a tent for shelter.
Conclusion
In conclusion, when it comes to environmental injuries or illness there is no telling what scenario the rescuer will be faced with, planning for the worse is the golden rule and there won’t be enough equipment, what matter is the safe retrieval of the patient and taken to a definitive facility and this help rescuer prepare for other scenarios.
References
- McIntosh S, Brillhart A, Dow J, Grissom C. Search and Rescue Activity on Denali, 1990 to 2008 Wilderness & Environmental Medicine, 21, 103–108 (2010) 33
- Johnson R, MD, Huettl B, Kocsis V, Chan S, Kordick M. Injuries Sustained at Yellowstone National Park. Wilderness and Environmental Medicine, 18, 186 189 (2007) 34
- Forrester J, Holstege C. Injury and Illness Encountered in Shenandoah National Park Wilderness and Environmental Medicine, 20, 318–326 (2009) 35
- Popplow JR. A review of Canadian Forces searches and rescue Technician medical training and operations 1990-1993. Aviat Space Environ Med. 1996; 67:486-490. 36
- Kaufmann M, Moser B, Lederer W. Changes in injury patterns and severity in a helicopter air-rescue system over a 6-year period. Wilderness Environ Med. 2006; 17:8-14 37
- Schmidt TA, Federiuk CS, Zechnich A, Forsythe M, Christie M, Andrews C. Advanced life support in the wilderness: 5-year experience of the Reach and Treat team. Wilderness Environ Med. 1996; 7:208–215 38
- Burdick TE, Brozen R. Wilderness event medicine. Wilderness Environ Med. 2003; 14:236–239 39
- Mclaughlin K, Townes D, Wedmore I, Billingsley R, Lidstrom C, Iverson L. Patterns of injury and illness during the expedition-length adventure races. Wilderness Environ. Med. 2006; 17:158-161
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