For most physicians,
But with more than 11 million backpackers and campers venturing annually into the nation’s 104 million wilderness acres, the field is so popular that Stanford now offers a medical school course. UC San Diego recently sponsored a meeting at Snowmass, Colo., to review wilderness methods, and the American College of Emergency Physicians and a for-profit CME group held a similar conference at Big Sky, Mont.
High-tech rescue gear is also gaining ground. The meeting here included helicopter demonstrations, and among vendors’ wares was a portable hyperbaric chamber called the Gamow bag, a $2,500 zippered nylon shroud that when pumped up by foot can increase air pressure to simulate a descent to 7,000 feet, though it’s not adequate for diving accidents.
Mountaineers caught in an avalanche might extend breathing time from the average 10 to 14 minutes to up to an hour with a new snow-filtering vest-though Black Diamond Equipment notes its $200 AvaLung garment probably won’t help the 40% who die of trauma.
Several kits sold let physicians carry basic drugs and gear into the wild. Dr. Howard Donner of Telluride, Colo., jokes that the true ’90s survival kit includes a credit card, global position satellite receiver, and cell phone. A recent survey showed 17% of the accidents in Grand Teton National Park were reported by cell phones, says Jackson Hole P.A. Lanny Johnson. But Dr. Ed Otten of the University of Cincinnati says phones give a false sense of security, and University of Nevada’s Dr. Steven Zell warns they don’t work in valleys and can’t always speed up rescue time.
Such gizmos aside, most of the meeting here was taken up with reports on basic studies of the effects of altitude, new ways to treat acute mountain sickness, hyperthermia and hypothermia, methods of managing trauma, and rescue and survival in remote areas.
Contrary to popular belief, most wilderness injuries aren’t due to such exotic causes as animal attacks or falls, notes Dr. Ariel Marks of Stanford. He says fistfights and substance abuse lead to three times as many injuries as climbing.
Animal attacks are rare, but bears mauled 13 Wyoming visitors during three weeks last fall, Johnson reports. In the past 50 years, he says, there’ve been more than 600 significant accidents in the Tetons.
Musculoskeletal injuries are increasing simply because more people are venturing into wilderness areas, reports Stockton, Calif., orthopedic surgeon Joe Serra. He finds the most common injuries are fractured ankles and wrists, dislocated shoulders, and knee injuries.
Fractures can be splinted, he says, with pack frames, skis, ski poles, parkas, or tree branches as well as readily available lightweight commercial splints made of foam-backed aluminum.
For a kayaker with broken legs, Stanford’s Dr. Eric A. Weiss fashioned splints of the kayak’s air bags and a litter from the paddles and a life jacket. A shovel padded with clothing can stabilize the spine.
Open wounds can be irrigated without saline, Dr. Weiss says, by squeezing water sterilized with iodine tablets from a plastic bag.
If a wilderness patient’s blocked airway can’t be opened by a chin lift or jaw thrust, Dr. Weiss says, “a temporary airway can be established by pinning the anterior aspect of the victim’s tongue to his lower lip with two safety pins.”
Less painful improvisations are using plastic bags as barrier gloves, and tea bags for toothaches and nosebleeds.
Altitude causes frequent problems in wilderness areas. About 30 million western state visitors a year are at heights of 8,000 to 9,000 feet, and over 25% develop acute mountain sickness, Dr. Peter Hackett of Grand Junction, Colo., says.
Acute mountain sickness that may be manifested as hypoxia, disordered sleep, retinopathy, thromboembolism, high-altitude pulmonary edema, or more severe high-altitude cerebral edema is caused by leaks in the blood-brain barrier and not swelling of the cells as was previously thought, Dr. Hackett reports.
A graded ascent is the best way to prevent the illness, and acetazolamide (Diamox, Lederle) facilitates acclimatization, but some may still become ill, Dr. Hackett notes. Moderate or severe altitude sickness is effectively treated with dexamethasone and hyperbaric therapy, he says.
Patients who need to be evacuated from high or remote areas must be carefully “packaged” in a litter that must be carried by at least six bearers with others on hand for relief, says Dr. William Forgey of Crown Point, Ind. But the toughest part can be wrestling with the ethical questions inherent in risking the team to save the patient, says Dr. Ken Iserson of the University of Arizona. -Elsie Rosner
WHISTLER, B.C.-Pinning tongue to lower lip helps open an airway. Honey’s a make-do antibiotic salve. Plastic wrap can seal a sucking chest wound. Urine cools hyperthermia.
