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Chase AM. Wilderness medicine for nursing students. Nursing 2024; 54:57-59. [PMID: 38913929 DOI: 10.1097/nsg.0000000000000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Affiliation(s)
- Ayla Marie Chase
- Ayla Marie Chase is a graduate of Johns Hopkins University School of Nursing
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Badger MS. The Intersection of Geriatrics, Climate Change, and Wilderness Medicine: Education is Critical. Wilderness Environ Med 2024:10806032241245399. [PMID: 38850046 DOI: 10.1177/10806032241245399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
According to the US Census, for the first time in history, older adults are projected to exceed the number of children by 2035. These seniors are headed to the outdoors in increasing numbers and face unique risks. They benefit from careful pre-event evaluation planning to maintain their health in wilderness environments. Climate change is affecting all of us, but seniors are considered an especially vulnerable group. This vulnerability needs to be addressed not only when older adults head into the wilderness but also when the wilderness "comes to them" in areas where wilderness medicine and disaster medicine overlap. Education of both providers and patients is vital. This article aims to discuss the special needs of older adults/seniors /elders (defined as those over 65 unless otherwise indicated) in the wilderness as well as the vulnerability of older adults to climate change, both during planned wilderness activities and when the wilderness "comes to them" because of climate change, and to identify opportunities for education and adaptation of patients and education of physicians and wilderness and disaster responders to care for these older patients. The PubMed and Google Scholar Database search engines were utilized to review relevant English language publications between 2000 and 2023 that addressed individuals over 65 and explored the overlap of geriatrics (aged over 65), wilderness and disaster medicine, and climate change and create a perspective summary. Because of increased numbers of older adults heading into the wilderness for outdoor activities or having wilderness thrust upon them due to climate change, cross training of all specialties including the fields of emergency, geriatrics, wilderness medicine, and disaster medicine is needed in collaboration with other organizations and search and rescue. Response agencies must recognize that training in wilderness medicine provides a background for practitioners working in dangerous and remote settings and ought to seek out individuals with such skills when placing responders in the field. Climate change is making these intersections and the need for this education more urgent with time.
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Russell BK, Burian BK, Hilmers DC, Beard BL, Martin K, Pletcher DL, Easter B, Lehnhardt K, Levin D. The value of a spaceflight clinical decision support system for earth-independent medical operations. NPJ Microgravity 2023; 9:46. [PMID: 37344482 DOI: 10.1038/s41526-023-00284-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 05/25/2023] [Indexed: 06/23/2023] Open
Abstract
As NASA prepares for crewed lunar missions over the next several years, plans are also underway to journey farther into deep space. Deep space exploration will require a paradigm shift in astronaut medical support toward progressively earth-independent medical operations (EIMO). The Exploration Medical Capability (ExMC) element of NASA's Human Research Program (HRP) is investigating the feasibility and value of advanced capabilities to promote and enhance EIMO. Currently, astronauts rely on real-time communication with ground-based medical providers. However, as the distance from Earth increases, so do communication delays and disruptions. Moreover, resupply and evacuation will become increasingly complex, if not impossible, on deep space missions. In contrast to today's missions in low earth orbit (LEO), where most medical expertise and decision-making are ground-based, an exploration crew will need to autonomously detect, diagnose, treat, and prevent medical events. Due to the sheer amount of pre-mission training required to execute a human spaceflight mission, there is often little time to devote exclusively to medical training. One potential solution is to augment the long duration exploration crew's knowledge, skills, and abilities with a clinical decision support system (CDSS). An analysis of preliminary data indicates the potential benefits of a CDSS to mission outcomes when augmenting cognitive and procedural performance of an autonomous crew performing medical operations, and we provide an illustrative scenario of how such a CDSS might function.
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Affiliation(s)
- Brian K Russell
- Auckland University of Technology, Auckland, New Zealand.
- NASA Ames Research Center, Moffett Field, Mountain View, CA, USA.
| | - Barbara K Burian
- NASA Ames Research Center, Moffett Field, Mountain View, CA, USA
| | - David C Hilmers
- NASA Johnson Space Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Bettina L Beard
- NASA Ames Research Center, Moffett Field, Mountain View, CA, USA
| | - Kara Martin
- NASA Ames Research Center, Moffett Field, Mountain View, CA, USA
| | - David L Pletcher
- NASA Ames Research Center, Moffett Field, Mountain View, CA, USA
| | - Ben Easter
- NASA Johnson Space Center, Houston, TX, USA
| | - Kris Lehnhardt
- NASA Johnson Space Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Dana Levin
- NASA Johnson Space Center, Houston, TX, USA
- Columbia University, New York, NY, USA
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Ma H, Zhang S, Zhu X, Huang J, Cheng Z, Luo Y. Continuing professional education experiences and expectations of nurses in Chinese military hospitals: A quantitative and qualitative study. NURSE EDUCATION TODAY 2023; 120:105645. [PMID: 36435155 DOI: 10.1016/j.nedt.2022.105645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/29/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Continuing professional education (CPE) is important for maintaining the competencies of nurses. The evaluation of training needs is necessary for well-organized CPE programs. OBJECTIVES To obtain a deeper understanding of the past experiences and future expectations of CPE among nurses in Chinese military hospitals in order to provide empirical support for planning effective CPE programs. DESIGN We implemented a two-phase procedure to investigate the experiences and expectations of CPE. SETTINGS Twenty one hospitals across China. PARTICIPANTS 382 nurses in quantitative study, and 20 nurses in qualitative study. METHODS Self-designed questionnaire was used to quantitatively measure past experiences, willingness to participate, and future expectations of CPE via a cross-sectional study. Semi-structured interviews were carried out to explore the characteristics of CPE activities among military nurses. RESULTS A total of 293 (76.7 %) participants had experience with CPE in the past, and 362 (94.8 %) were willing to take CPE in the future. The top five training items they wanted to learn about in the future were combat casualty care, emergency and critical care, military skills, trauma care in an austere environment, and specialist nursing. We identified the following 5 themes in the qualitative data: military missions, military training content, military medicine training content, training methods, and professional development paths. CONCLUSIONS Nursing administrators and educators should consider designing hierarchical, categorized CPE programs to meet the needs of self-development and professional growth among nurses.
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Affiliation(s)
- Huijuan Ma
- School of Nursing, Third Military Medical University/Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing 400038, PR China
| | - Suofei Zhang
- School of Nursing, Third Military Medical University/Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing 400038, PR China
| | - Xiaoli Zhu
- School of Nursing, Third Military Medical University/Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing 400038, PR China
| | - Jinyu Huang
- Institute of Military Preventive Medicine, Third Military Medical University/Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing 400038, PR China
| | - Zhen Cheng
- School of Nursing, Third Military Medical University/Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing 400038, PR China
| | - Yu Luo
- School of Nursing, Third Military Medical University/Army Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing 400038, PR China.
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Anderson M, Beach M. Nursing During a Disaster Starts With Education. AACN Adv Crit Care 2022; 33:360-367. [PMID: 36477846 DOI: 10.4037/aacnacc2022966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Future nurses, both entry level and advanced practice, are pivotal to the nation's disaster response. They are critical frontline, acute, primary, and public health workers in the United States and internationally. To respond well, they must be taught how to prepare and intervene appropriately. This preparation is multidimensional and includes not only concrete knowledge but mental, emotional, and ethical preparation for the realities of working and providing care while affected by chaos. Training should be experiential and reflective and expose students to the interprofessional nature of disaster planning and response. New nurses, as they enter practice, as the COVID-19 pandemic has demonstrated, may also take on the role of a frontline disaster responder. The ability to effectively respond and access available resources to care for patients is required. Schools of nursing and nursing faculty increasingly will be required to include disaster preparedness as an integral part of the nursing curriculum.
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Affiliation(s)
- Maighdlin Anderson
- Maighdlin Anderson is Assistant Professor and Director, Adult Gerontology Acute Care Nurse Practitioner Program, University of Pittsburgh, 3500 Victoria Street, PA 15261; and Nurse Practitioner PA-1 DMAT, US Department of Health and Human Services
| | - Michael Beach
- Michael Beach is retired Associate Professor and Commander PA-1 DMAT, US Department of Health and Human Services, Steubenville, Ohio
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Wilderness Medicine Curricula in United States EMS Fellowship, Emergency Medicine Residency, and Wilderness Medicine Programs. Prehosp Disaster Med 2022; 37:800-805. [PMID: 36210752 DOI: 10.1017/s1049023x22001388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Wilderness Medicine (WM) focuses on care delivered in austere or resource-scarce environments. The Accreditation Council for Graduate Medical Education (ACGME) requirements and core content for Emergency Medicine (EM) residency and Emergency Medical Services (EMS) fellowship in the United States (US) include some WM topics that are covered to varying degrees in these programs. Furthermore, there are no ACGME-approved WM fellowships or specific curricula. Different training programs may develop WM content and curricula that differ significantly, leading to variations in WM competencies and training. In 2009, the American College of Emergency Physicians (ACEP) Wilderness Medicine Section created a Fellowship Subcommittee and Taskforce to develop a standardized curriculum and core content for EM-based WM fellowships. However, to date, EMS fellowship and EM residency WM curricula in the US content have not been analyzed for consistency with the ACEP WM fellowship curriculum. METHODS In this study, the WM curricula components of EM residency and EMS fellowship were evaluated using the ACEP WM fellowship curriculum as a control. Potential curriculum gaps for each program type were identified. RESULTS Of the 19 WM competencies developed by the ACEP Wilderness Medicine Section Fellowship Subcommittee and Taskforce, EMS fellowship covers more WM topics (16 topics, or 84%) than EM residency (12 topics, or 63%), and combined, they cover 89% of these topics. CONCLUSIONS By expanding to cover two additional WM topics, all WM curricula topics recommended by the ACEP WM fellowship curriculum could potentially be covered in EM residency + EMS fellowship; however, the depth of education in each topic may vary. It may be beneficial for Graduate Medical Education (GME)-level learners for programs to implement hands-on educational experiences in WM topics.
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Dove AJ, Castaneda R, Spano SJ. Professional Outcomes and Satisfaction Among Graduate Medical Education Wilderness Medicine Fellowship Alumni in the United States. Wilderness Environ Med 2022; 33:154-161. [PMID: 35314106 DOI: 10.1016/j.wem.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 12/30/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Wilderness medicine (WM) graduate medical education (GME) fellowships were established in 2003. Outcomes and satisfaction of US WM GME fellowship alumni can inform prospective applicants and program directors of the strengths of fellowships and professional gaps in them. METHODS A 34-question Qualtrics survey was emailed to 111 alumni from 17 institutions listed in the Wilderness Medical Society's GME database in May 2019. Professional service, scholarship, and satisfaction were queried. Results are represented as percent response (n=answered affirmative) based on the number of respondents per question. RESULTS The survey response rate was 41% (n=46); 67% reported (n=31) Fellowship of the Academy of Wilderness Medicine recognition. Within the last 5 y, 71% (n=32) reported publications in WM. Free text entry questions had 78% (n=28) describe improved clinical skills, and 68% (n=26) were exposed to new career choices in fellowship. Those who rated exposure to a variety of WM knowledge and skills highly rated the overall fellowship experience higher (P<0.001), as did those reporting a higher number of WM publications (P=0.023). Nearly half, 48% (n=21), felt they could hold their current position without fellowship training. In hindsight, 76% (n=34) would follow the same professional path. CONCLUSIONS WM GME fellowship alumni reported high rates of professional engagement and scholarly productivity in the subspecialty. Responding alumni overwhelmingly rated the fellowship experience positively. Fellowships that ensure a wide exposure to experiences and foster scholarly productivity are more likely to yield professionally satisfied graduates.
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Davis CB, Lorentzen AK, Patel H, Cheung D, Wright A, Lemery J, Penninga L. The Intersection of Telemedicine and Wilderness Care: Past, Present, and Future. Wilderness Environ Med 2022; 33:224-231. [PMID: 35459612 DOI: 10.1016/j.wem.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/06/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
Wilderness medicine and telemedicine seemingly exist at opposite ends of the clinical continuum. However, these 2 specialties share a common history and the literature abounds with examples of successful deployment of telemedicine to resource limited settings. The recent widespread adoption of telemedicine has important ramifications for wilderness providers. Telemedicine is inherently reliant on some sort of technology. There is a wide spectrum of complexity involved, but in general these systems rely on a hardware component, a software component, and a network system to transmit information from place to place. Today, connectivity is nearly ubiquitous through access to cellular networks, Wi-Fi, or communication satellites. However, bandwidth, defined as the amount of data which can be transmitted through a given connection over time, remains a limiting factor for many austere settings. Telemedicine services are typically organized into 4 categories: 1) live/interactive; 2) store and forward; 3) remote patient monitoring; and 4) mHealth. Each of these categories has an applicable wilderness medicine use case which will be reviewed in this paper. Though the regulatory environment remains complex, there is enormous potential for telemedicine to enhance the practice of wilderness medicine. Drones are likely to transform wilderness medicine supply chains by facilitating delivery of food, shelter, and medicines and are able to enhance search and rescue efforts. Remote consultations can be paired with remote patient monitoring technology to deliver highly specialized care to austere environments. Early feasibility studies are promising, but further prospective data will be required to define future best practices for wilderness telemedicine.
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Affiliation(s)
- Christopher B Davis
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | | | - Hemali Patel
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Dickson Cheung
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Angela Wright
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jay Lemery
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Luit Penninga
- Department of Surgery and Transplantation C2122, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Palliative Care’s Role in Austere Medicine. Wilderness Environ Med 2022; 33:102-108. [DOI: 10.1016/j.wem.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/28/2021] [Accepted: 12/09/2021] [Indexed: 11/20/2022]
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Muthomi N, Wachira LJ, Ooko WS. Knowledge in pre-hospital emergency and risk management among outdoor adventure practitioners in East Africa afro-alpine mountains. Afr J Emerg Med 2021; 11:87-92. [PMID: 33680726 PMCID: PMC7910172 DOI: 10.1016/j.afjem.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The enjoyment of nature and other benefits of outdoor activities happen amid inherent hazards. This calls for knowledge and competency in emergency and risk management. Practitioners in outdoor activities, such as mountaineering, thus need to be knowledgeable on how to manage risks and attend to emergencies in their practice. The study sought to establish the preparedness of East African mountaineering practitioners in prehospital emergency and risk management. It sought to establish their knowledge on prehospital emergency and risk management, based on their age, gender, level of education and refresher training. METHODS The study purposively sampled one hundred and thirty six (N = 136) outdoor adventure practitioners from the Afro-alpine mountain areas in East Africa. It was hypothesized that there would be no significant relationship between the outdoor practitioners' knowledge in prehospital emergency risk management and their age, gender, level of education, refresher training. Somers' d was used to test the hypotheses. RESULTS It was established that the knowledge scores of prehospital emergency and risk management for the mountaineering practitioners was low. It was also established that the knowledge scores of outdoor practitioners were not dependent on their age, gender, and work experience. However, there was a significant relationship between the outdoor adventure practitioners' knowledge scores and their highest level of education as well as refresher training. CONCLUSIONS The study concluded that there were gaps in the knowledge of prehospital risk management of the East African Afro-alpine mountaineering practitioners. It recommends frequent and regular training and re-certification among outdoor adventure practitioners in order to raise the knowledge in prehospital emergency risk management.
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Affiliation(s)
- Nkatha Muthomi
- Department of Recreation and Sports Management, School of Hospitality, Tourism and Leisure Studies, Kenyatta University, Nairobi, Kenya
| | - Lucy-Joy Wachira
- Department of Physical Education, Exercise and Sport Science, School of Public Health and Applied Human Sciences, Kenyatta University, Nairobi, Kenya
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Ozkaya Senuren C, Yaylaci S, Kayayurt K, Aldinc H, Gun C, Şimşek P, Tatli O, Turkmen S. Developing Cricothyroidotomy Skills Using a Biomaterial-Covered Model. Wilderness Environ Med 2020; 31:291-297. [PMID: 32855020 DOI: 10.1016/j.wem.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Cricothyroidotomy is an advanced and life-saving technique, but it is also a rare and a difficult procedure. The purpose of the present study was to produce a low-cost simulation model with realistic anatomic features to investigate its effectiveness in developing cricothyroidotomy skills. METHODS This study was performed at a university simulation center with 57 second-year student paramedics and a cricothyroidotomy simulation model. Total scores were assessed using a checklist. This consisted of 13 steps and was scored as misapplication/omission=0, correct performance and timing with hesitation=1, and correct performance and timing without hesitation=2. One of these steps, local anesthesia of the area if time is available, was not performed owing to time limitations. The highest possible score was 24. Data are presented as mean±SD with range, as appropriate. Normal distribution was evaluated using the Kolmogorov-Smirnov test, Student t test, and Mann-Whitney U test, and correlation analysis was used for statistical analysis. RESULTS Students completed the cricothyroidotomy procedure steps in 116±46 (55-238) s. At performance assessment, the score achieved was 12±5 (2-24). The highest total score of 24 was achieved by 3 students (5%). Total scores exhibited negative and significant correlation with procedure time (r=-0.403, P=0.002). CONCLUSIONS The model developed in this study is an inexpensive and effective method that can be used in cricothyroidotomy training for student paramedics. We think that repeating the cricothyroidotomy procedure on the model will increase success levels.
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Affiliation(s)
- Cigdem Ozkaya Senuren
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
| | - Serpil Yaylaci
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Kamil Kayayurt
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Hasan Aldinc
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Cem Gun
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Perihan Şimşek
- Department of Nursing, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | - Ozgur Tatli
- Department of Emergency Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Suha Turkmen
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Hamad Medical Corporation, Emergency Department, Doha, Qatar
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Reid BO, Haugland H, Rehn M, Uleberg O, Krüger AJ. Search and Rescue and Remote Medical Evacuation in a Norwegian Setting: Comparison of Two Systems. Wilderness Environ Med 2019; 30:155-162. [DOI: 10.1016/j.wem.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/09/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
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Tritz D, Dormire K, Brachtenbach T, Gordon J, Sanders D, Gearheart D, Crawford J, Vassar M. Research Gaps in Wilderness Medicine. Wilderness Environ Med 2018; 29:291-303. [PMID: 29784570 DOI: 10.1016/j.wem.2018.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 02/08/2018] [Accepted: 02/16/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Wilderness medicine involves the treatment of individuals in remote, austere environments. Given the high potential for injuries as well as the unique treatment modalities required in wilderness medicine, evidence-based clinical practice guidelines are necessary to provide optimal care. In this study, we identify evidence gaps from low-quality recommendations in wilderness medicine clinical practice guidelines and identify new/ongoing research addressing them. METHODS We included relevant clinical practice guidelines from the Wilderness Medical Society and obtained all 1C or 2C level recommendations. Patient/Problem/Population, intervention, comparison, outcome (PICO) questions were created to address each recommendation. Using 24 search strings, we extracted titles, clinical trial registry number, and recruitment status for 8899 articles. We categorized the articles by trial design to infer the effect they may have on future recommendations. RESULTS Twelve clinical practice guidelines met inclusion criteria. From these we located 275 low-quality recommendations and used them to create 275 PICO questions. Thirty-three articles were relevant to the PICO questions. Heat-related illness had the highest number of relevant articles (n=9), but acute pain and altitude sickness had the most randomized clinical trials (n=6). CONCLUSION Overall, few studies were being conducted to address research gaps in wilderness medicine. Heat-related illness had the most new or ongoing research, whereas no studies were being conducted to address gaps in eye injuries, basic wound management, or spine immobilization. Animals, cadavers, and mannequin research are useful in cases in which human evidence is difficult to obtain. Establishing research priorities is recommended for addressing research gaps identified by guideline panels.
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Affiliation(s)
- Daniel Tritz
- Oklahoma State University Center for Health Sciences, Tulsa, OK (Mr Tritz, Dormire, Brachtenbach and Ms Crawford).
| | - Kody Dormire
- Oklahoma State University Center for Health Sciences, Tulsa, OK (Mr Tritz, Dormire, Brachtenbach and Ms Crawford)
| | - Travis Brachtenbach
- Oklahoma State University Center for Health Sciences, Tulsa, OK (Mr Tritz, Dormire, Brachtenbach and Ms Crawford)
| | - Joshua Gordon
- Anesthesiology Department, University of Oklahoma Medical Center, Oklahoma City, OK (Dr Gordon)
| | - Donald Sanders
- Emergency Department, Oklahoma State University Medical Center, Tulsa, OK (Drs Sanders and Gearheart)
| | - David Gearheart
- Emergency Department, Oklahoma State University Medical Center, Tulsa, OK (Drs Sanders and Gearheart)
| | - Julia Crawford
- Department of Psychiatry, Oklahoma State University Center for Health Sciences, Tulsa, OK (Dr Vassar)
| | - Matt Vassar
- Department of Psychiatry, Oklahoma State University Center for Health Sciences, Tulsa, OK (Dr Vassar)
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Chest Ultrasonography in Modern Day Extreme Settings: From Military Setting and Natural Disasters to Space Flights and Extreme Sports. Can Respir J 2018; 2018:8739704. [PMID: 29736195 PMCID: PMC5875054 DOI: 10.1155/2018/8739704] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/02/2018] [Accepted: 01/15/2018] [Indexed: 12/31/2022] Open
Abstract
Chest ultrasonography (CU) is a noninvasive imaging technique able to provide an immediate diagnosis of the underlying aetiology of acute respiratory failure and traumatic chest injuries. Given the great technologies, it is now possible to perform accurate CU in remote and adverse environments including the combat field, extreme sport settings, and environmental disasters, as well as during space missions. Today, the usage of CU in the extreme emergency setting is more likely to occur, as this technique proved to be a fast diagnostic tool to assist resuscitation manoeuvres and interventional procedures in many cases. A scientific literature review is presented here. This was based on a systematic search of published literature, on the following online databases: PubMed and Scopus. The following words were used: "chest sonography," " thoracic ultrasound," and "lung sonography," in different combinations with "extreme sport," "extreme environment," "wilderness," "catastrophe," and "extreme conditions." This manuscript reports the most relevant usages of CU in the extreme setting as well as technological improvements and current limitations. CU application in the extreme setting is further encouraged here.
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Bennett BL, Holcomb JB. Battlefield Trauma-Induced Hypothermia: Transitioning the Preferred Method of Casualty Rewarming. Wilderness Environ Med 2017; 28:S82-S89. [DOI: 10.1016/j.wem.2017.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 03/06/2017] [Accepted: 03/17/2017] [Indexed: 12/22/2022]
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Llewellyn CH. The Symbiotic Relationship Between Operational Military Medicine, Tactical Medicine, and Wilderness Medicine: A View Through a Personal Lens. Wilderness Environ Med 2017; 28:S6-S11. [DOI: 10.1016/j.wem.2016.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/20/2016] [Accepted: 12/30/2016] [Indexed: 10/19/2022]
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Butler FK, Bennett B, Wedmore CI. Tactical Combat Casualty Care and Wilderness Medicine: Advancing Trauma Care in Austere Environments. Emerg Med Clin North Am 2017; 35:391-407. [PMID: 28411934 DOI: 10.1016/j.emc.2016.12.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Tactical Combat Casualty Care (TCCC) is a set of evidence-based, best-practice prehospital trauma care guidelines customized for use on the battlefield. Military units that have trained all of their unit members in TCCC have now documented the lowest incidence of preventable deaths in the history of modern warfare and TCCC is now the standard for battlefield trauma care in the US Military. TCCC and wilderness medicine share the goal of optimizing care for patients with trauma in austere environments that impose significant challenges in both equipment and evacuation capability. This article reviews the current battlefield trauma care recommendations in TCCC and discusses their applicability to the wilderness setting.
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Affiliation(s)
- Frank K Butler
- Committee on Tactical Combat Casualty Care, Joint Trauma System, US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234-6315, USA.
| | - Brad Bennett
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA
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Prehospital Emergency Care Education for the Nepal Mountaineering Association. J Emerg Med 2015; 49:965-73. [PMID: 26412106 DOI: 10.1016/j.jemermed.2015.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 07/14/2015] [Accepted: 07/25/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Prehospital emergency care training programs are effective in reducing mortality and disability in low-income countries. Implementation of a specifically designed program in the mountainous regions of Nepal has the potential to benefit local populations, trekking and mountaineering guides, and adventure tourists. OBJECTIVE Our aims were to survey Nepal Mountaineering Association (NMA) members' past experiences with emergencies and medical training, characterize a geographic-specific prehospital emergency care training program, and evaluate the effectiveness and outcome of the program. METHODS Sixty-two trekking guides, police officers, and students attended the 2-day training program in Pokhara, Nepal in May 2014. Training curriculum was determined in coordination with the NMA. Instructors included Tulane University faculty, surgical residents, and graduate students. Surveys identified participants' experience with emergencies, confidence in providing emergency care, and interest in future trainings. Multiple modalities were utilized to assess trainees' comprehension. RESULTS Participants rated the program as valuable and expressed desire for additional trainings. Survey results indicated that participants had prior experience with a myriad of emergencies, were more confident in managing traumatic emergencies than medical or environmental, and showed that few had previously received training in cardiopulmonary resuscitation. Areas of instruction included general first responder and geographic-specific content. Participants achieved the course objectives and documented their abilities to successfully manage simulated clinical problems. CONCLUSIONS The training program, an international collaboration, was documented to be successful by instructors, NMA leadership, and participants. The training program's content matched the participants' specific needs and abilities. Areas for improvement include providing content related to burns, motorcycle injuries, cold-exposure injuries, fever management, and toxicology emergencies.
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