Survival Medicine

   This week RMI was asked to give a talk on the medical aspects of survival. It is a subject that can range from the gun toting, fear-based, bunker living survivalist found in Montana and it can mean the permaculture, polytunnel living, hippy types.
   Survival Medicine is found somewhere between these two very different approaches to surviving the coming emergency.

Foot Care for Adventure Racing

   There are the adventurous few who enjoy giving their feet a pounding while filling their head with endorphines. For these hardy folks it is important to keep your feet well cared for.

Prolonged Field Care

   For the wilderness and remote medic, casualty evacuation is often a long process. Sometime you may have your patient for a few hours or you may have them for several days while waiting for the weather to clear.

RMI begins to offer ExMed courses

   Over the past couple of weeks, RMI and the UK based ExMed have been negotiating terms for RMI to begin offering some of the ExMed flagship courses.

Clinical Procedures Course

In July 2012, Dr. Hagmann ran a procedures course for Deployment Medicine International. An RMI instructor was there to help Doc with the course.

RMI Paramedic Course

   This coming August, 2012, RMI will launch our first AREMT Paramedic programme. At the moment we have nine students enrolled and ready to start their adventure.

Wilderness First Aid Level 3

   Last weekend RMI offered our first WFA3 course here in Killarney National Park. We had students come in to gain their certification requirements for either mountain leader or level three kayaking instructor.

Wilderness First Aid Course

RMI offered a WFA course this past weekend in the Killarney National Park's Education Centre. During this course nine students enjoyed fantastic Kerry weather and earned their certificate in Wilderness First Aid.

Traction Splints

For Remote Medics, dealing with a mid shaft femur fracture can be extremely challenging. Luckily there are some options for dealing with this injury.

Most common ailments and treatments in Remote Medicine

   In the practise of Remote and Austere Medicine you will find yourself without a lot of kit, in suboptimal locations, without a great light source, and with rain pelting down from all angles. In this unfortunate situation you will still be required to provide the best medical care that you can. 


   This is some good information given by a doctor practising in Central America. He is one of the coauthors of Remote and Austere Medicine: An Introduction. 


   Below are the results of his experience in the provision of health care in various remote and austere locations. He treated nearly two thousand people over a 15-month period. The record keeping was a bit unreliable at times, but the following summary is reasonably accurate.


The Top 20 injuries:

1. Minor musculoskeletal injuries (ankle sprains most common)
   
2. Upper respiratory tract infections
   
3. Allergic reactions/Hay fever/Anaphylactic reactions/Rashes
   
4. Minor open wounds
   
5. Gastroenteritis/Vomiting/Diarrhoea
   
6. Sexual health/Contraceptive problems
   
7. Skin infections/Cellulitis
   
8. Mental health problems
   
9. Dental problems
   
10. Abdominal pain (2 confirmed acute appendix + 1 gangrenous gall
    bladder; no cause found. Renal or biliary colic were most common)
    
11. Flu/Viral illness
    
12. Chest infections
    
13. Major musculoskeletal injuries (fractures/dislocations)
    
14. Asthma
    
15. Ear infections
    
16. Urinary tract infections
    
17. Chest pain
    
18. Syncope/Collapse/Faints
    
19. Early pregnancy problems
    
20. Burns
    

Top 12 prescribed drugs:

1. Paracetamol (Acetaminophen)
   
2. Loratadine (and other assorted antihistamines)
   
3. Diclofenac (and other assorted antiinflammatories)
   
4. Combined oral contraceptive
   
5. Flucloxacillin
   
6. Throat lozenges
   
7. Augmentin
   
8. Loperamide
   
9. Nystatin (and other antifungals)
   
10. Hydrocortisone cream
    
11. Ventolin inhalers
    
12. Morphine 
    
    
    
                       excerpt from Survival and Austere Medicine: An Introduction.
                                                      Download it here

Blister care

   For the adventurous types foot care and treatment for blisters are a large part of our medical practise. Blisters can be debilitating and bring to an end an expedition.

Survival Blanket Review

   For those who spend a lot of time out in the rugged areas of the world, hypothermia is one of the constant threats that we face. As a Remote Medic it is important to have the best kit available to treat hypothermic casualties.

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. 

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.  

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.

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.

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.