Dermoclysis - Subcutaneous Hydration for the Remote Medic

   Dermoclysis is the infusion of sterile saline fluids into the subcutaneous space in the belly of the casualty. For the Remote Medic, it is important to have the medical skills to deal with a hypovolemic casualty who needs rehydration fluids but who does not have an easily obtainable intravenous access. 

SAM Splint versus Commercial Cervical Collar

In an issue of Wilderness and Environmental Medicine (Volume 20, Number 2, 2009), Todd McGrath and Crystal Murphy have written an article entitled “Comparison of a SAM Splint-Molded Cervical Collar with a Philadelphia Collar.” 

New toys for CFR-Advanced

   PHECC have brought out the new guidelines for the Cardiac First Responder - Advanced curriculum. This week has been the first time that RMI instructors have had a look at the new toys. The Supraglottic Airway, Suction, OPA and BVM are all part of the course.

OTC Pain Management for Remote Areas

   Casualties found in wilderness and remote locations have two main complaints: Thirst and Pain.
How would you as a Remote Medic deal with both of these issues? How can you provide pain management if you are not a doctor and only have access to Over The Counter medications?

Anaphylaxis and Asthmatic management in Remote Areas

   Anaphylaxis is rare enough even in civilian and city based environments but in remote areas there will not be a doctor around to administer helpful drugs. As a Remote Medic it is important to have the skills, training and kit on hand to deal with anaphylaxis and asthmatic illnesses.  

Tactical Emergency Medicine for Operations

This past weekend saw the first TEMO course run for the Irish Defence Forces. The course ran over three days and offered Tactical Combat Casualty Care curriculum for the troops. The TCCC was designed by Dr. John Hagmann and the US military in the mid ninety's. 

Diploma of Remote Medical Practice

   RMI has been negotiating with Middlesex University to grant a Diploma for the wilderness and remote courses. Currently, we are still discussing terms, conditions and pricing but it looks like things will fall into place.
   The structure of the diploma will follow the WEFR/REMT courses and hopefully allow for clinical placements in Dublin, London or Croatia. Those details will emerge later in 2012. The basis of the diploma is outlined below.

The importance of the Pain Scale

   Using your medical assessment skills in remote areas can be challenging. You are limited to what kit you have available and often find yourself with not much more than just your wits and training to deal with traumatic injuries.

Pelvic Fractures in Remote Areas

   For those who enjoy extreme sports such as rock climbing, mountain biking, abseiling, parachuting, paragliding and mountaineering the rewards far outweigh the risks. Still the risks for major injuries are ever present.
   This week we are going to focus on injuries to the pelvis.

How to use Steri Strips

   In a remote setting minor cuts and lacerations can be a huge nuisance or worse transform into a major illness. Having the skills and toys available to clean and close minor cuts can be a benefit for expedition medics.
   Steri Strips, Benzoin Tincture and a Tegaderm dressing can be your best friend.

   *WARNING*
   This blog is not a substitute for treatment from a doctor. If you have a cut DO NOT try this unless you are trained to at least the Wilderness Emergency First Responder level AND unless you are in a Remote & Austere environment!

   Let me introduce you to the Wound Pack.

NPA used for suction

   During our WEFR course we introduce the skill of suctioning a compromised airway of a casualty. For the Wilderness First Aid level of training the best was to clear an airway is to roll the casualty over and let gravity do the dirty work.
   That is still the best option for the medical professional. The difference is that it is important to have a few more skills in your tool box to deal with situations where rolling a casualty might not be the best option.

Wilderness First Responder Course August 2011

We have just finished up with the latest WEFR course. We had eight students and three instructors come from around Ireland come to Killarney for six days of intense medical education.

Improvised head mirror

   Before the use of electronic lights, physicians used a head mirror to look into the patients, eyes, ears, nose and throat. They would have this mirror strapped to their head all day. In fact, most of us older types can remember going to the GP and having them use this device to exam you.
   In the wilderness improvisation is the key. How can one use this obsolete technology in the practise of Austere Medicine?

Fellow of the Academy of Wilderness Medicine

   One of the RMI instructors has decided to enrol into the Fellow of the Academy of Wilderness Medicine offered by the Wilderness Medical Society. This award is offered for medical professionals who wish to validate their training and experience in Wilderness Medicine.
   The award is primarily designed for doctors but is open for the motivated medic or nurse. Since it is research based and requires academic achievement is more difficult for non physicians to achieve.

RTE filming improvised stretchers

   Over the past couple of weeks, Aebhric has been filming for the RTE kids programme Elev8. One of the 3.5 minute episodes was on how to make a stretcher in the wilderness. We had six kids ages around 10-12 who were broken down into two teams of three.
   My challenge for them was to build an improvised litter or stretcher out of wood harvested from the wilderness.

Be Here Now

  There are many approaches to survival and wilderness psychology. It is important to have the skills and dirt time to deal with emergencies in remote settings.

   The ability to accept and internalize the realities that you are lost or in danger is the first step to survival. Acknowledging the fact that you are lost, unable to return to safety, or simply in a rough situation is rarely done quickly. People tend to refuse the realities of a harsh situation.

56 Uses for a triangular bandage

-Simple bandage of small wounds
-Wound packing
-Tie a splint to an extremity
-Secure a pressure dressing
-Sling and swath for orthopaedic injuries
-Secure and dress an abdominal evisceration
-Secure an IV bag to the casualty

Common Wilderness Diseases

Infectious disease is a rapidly evolving field; new viral agents are continually being identified, and the geographic ranges of known viruses continue to evolve (Berger et al, 2003.) As recent experiences with West Nile virus, severe acute respiratory syndrome (SARS), and Avian flu dramatically illustrate, people in any setting may be called on to consider infectious entities from any part of the globe due to shifts in geographic disease distribution, travel-related imported infections, or even potentially intentional releases of exotic viruses. The recent crisis of avian flu shows the importance of knowledge of infectious diseases for anyone  working in a wilderness setting.

Few diseases frequent a wilderness excursion. However, these ailments have common occurrences in the  wilderness. They are Cryptosporidium, E. Coli, Rocky Mountain Spotted Fever, Giardia, Lyme’s Disease, and finally Tularemia. This list is by no means comprehensive. The outdoor enthusiast should research what diseases and vectors are prevalent in the area where they are hiking.

Medical Kits

   Whether you are in the woods or in town it is important to have medical training 
and a good medical kit available.

   During our Basic Bushcraft course we discuss how important it is to always have a small survival tin with you at all times. You can make them small enough that you forget about it somewhere in one of your pockets. You should have one of these kits in every jacket, jumper, and coat that you own.
   The same preparation is important with a medical kit. You don't need a large kit containing massive trauma supplies. Put a few plasters, tablets, steristrips and an alcohol wipes into your bushcraft kit or a separate medical kit.

Collar bone separations and fractures

Mountain bikers tend to have cornered the market on clavicle injuries. They are going downhill at a fast rate of speed and often find themselves going over the handlebars when they munch it. Landing on your outstretched hand while at speed creates a shockwave that travels up your arm and damages your shoulder or clavicle.

   Clavicle injuries are most often quite stable and easy to manage. Pain is a major consideration and pain management should be high on your list of treatment protocols.
   Once you have completed a full patient assessment you can begin treatment. Whether the injury is a separation or a full fracture the treatment is the same. Grab a triangular dressing or cut up his spare tee shirt into long strips.
   This is called a clavicle splint and a quick google search will show loads of variations. Basically run two strips over the shoulders and make an X at the small of their back. Tie it tight enough to make their shoulders rotate back. It makes them look like they are standing at attention.
   This treatment will provide some pain relief but more importantly will stabilise your casualty and make evacuation easier.

RDS Adventure Weekend

   We just returned from a three day event at the RDS where 60 small businesses gathered to show people where and how to enjoy Ireland's great outdoors. We had a small booth where we talked with hundreds of people who hadn't heard about Remote Medicine Ireland.
   Aebhric also had a discussion at the Outsider Think Tank where he discusses Wilderness Psychology and why is it that some people live and some people just sit down and die in survival conditions.
   We enjoyed the weekend but are happy to be back here in South Kerry with our mountains, trees and ocean.