Wilderness Medical Society
Medical Conference and Annual Meeting
Snowmass, Colorado - July 23-28, 2010

MAIN SESSIONS

Case Studies from the Khumbu, Eric Johnson
Mon-11:00am
The lecture will present and discuss some of the more interesting cases over the past few years.

Dive Safety, Loren Greenway
Tue-9:45am
The program will review the safety issues relating to the first Wilderness Medical Society dive fatality during a meeting.  We will discuss overall dive accident causes, treatments and pre-dive planning.  Further, we will discuss post event issues and the importance of event insurance and post event planning.  The Wilderness Medical Society adapted its administrative response as a result of this unfortunate event.  We will explain that response during this program.

Environment and Human Health, Jeremy Hess
Wed-1:30pm
This lecture will focus on grand challenges in environmental health, and to discuss different ways to think, communicate, and act on three important issues: climate change, energy scarcity, and ecosystem degradation.  Specifically it will discuss our perception of risks related to these issues, ways to talk about these concerns that acknowledge the complexity of the topics but also the need to act and strategies for physicians and other health care providers to be proactive around these concerns.

Expedition Medicine, Luanne Freer
Sun-7:30am
"Hey! How would you like an all expense paid trip to Africa?" It sounds pretty inviting; in exchange for your expertise as a health care provider, you get a free trip.  But before you accept this tempting offer, you need to know the right questions to ask, whether you're properly prepared, and just how much work and risk you will be taking on.  The speaker will review the preparations and challenges associated with being the practicing medic on expedition through real-life examples.

Frostbite, Luanne Freer
Sun-10:45am
Frostbite care in 2010 includes a new gold standard for evaluation and direction of treatment, and new treatment modalities that increase the margin of spared tissue.  Make sure you're prepared to treat your next frostbite patient and to counsel for prevention.

High Altitude Genetics, Ron Crystal
Sun-8:15am
Normal physiologic function and risk for disease is a combination of our inherited genetic variability interacting with the stress of the environment.  In the context of the defined stress of high altitude hypoxia, there is increasing evidence that variability in the inherited genome dictates, in part, whether you can comfortably reside at and/or climb to high altitude.  Humans adapt to high altitude by using a variety of physiologic compensatory mechanisms, but these adaptations are governed in part by inherited genetic variability.  Environment x genome interactions dictate the ability to live at high altitude, and the risk for chronic mountain sickness and intrauterine growth retardation.  Environment x genome interplay is also true for climbing to high altitude, when the ability to perform, as well as the risk for high altitude pulmonary edema or cerebral edema, is dependent on  genome variability responding to the stress of hypoxia.

Hypothermia, Eric Johnson
Mon-9:15am
Will define and review current epidemiology; discuss assessment and treatment strategies; review the current state of therapeutic hypothermia.

Lightning & Electricity, Chris McStay
Wed-4:00pm
Describe avoidance, physics, injury patterns and treatment decisions of patients who suffer electrical injuries.

Medical Kits: Beyond First Aid, Chris Van Tilburg
Sun-11:30am
An oversight of light, compact medical kits geared for doctors, nurses, paramedics including advance life support equipment and medicines, gear for international travel to austere locations, and use of medications in the field.  Geared toward weekend backcountry trips and week long excursions.  Discussed size, containers, international travel with medications, and medical-legal issues with dispensing medical care in the backcountry.

“Mishap in the Wilderness: Risk and Who’s Fault Is It?”, Brownie Schoene
Sun-9:45am
Risk of illness, injury, and death is increased in the wilderness environment. Individuals with cavalier, naive, and ignorant attitudes run a higher risk. This talk will discuss the concept of risk and attitudes which will minimize the risk and increase the benefit. The discussion will center on the individual's acceptance of risk, the concept of self-sufficiency, and the non-reliance of rescue. Several examples of adventure travel litigation will be discussed and the talk will evolve into an interactive experience.

Mountain Rescue Doctor, Chris Van Tilburg
Sun-9:00am
When Dr. Van Tilburg received a page on 12/9/06, little did he know that he’d be involved in one of the largest search and rescue missions in the US.  His team, Hood River Crag Rats, the oldest mountain rescue unit in the US, spearheaded the 10-day search, battling five feet of new snow, gargantuan crevasses, 100 mph wind, single digit temperatures and extreme avalanche danger.  Dr. Van Tilburg describes the search first hand and shows exclusive images of the search operations based out of 120 year old Cloud Cap Inn.  He describes two very prominent controversies: What is the risk of climbing mountains and adventure sports? Who should pay for search and rescue?

Rescue on Everest, Luanne Freer
Sat-6:30pm
Every year brings a larger crowd to climb on Everest and every year calamities claim lives.  The 8th season for Everest ER sees its volunteers growing the mission of the clinic to extend to rescue on the mountain; listen as the clinic's founder describes the genesis of Everest’s' first rescue team.

Tactical Medicine for Civilians, Joy Crook
Tue-10:30am
Updates on the latest research and best practice guidelines in the field will be discussed.

Top 10 Articles, Scott McIntosh
Mon-8:30am
This lecture will describe the current status of research in Wilderness Medicine.  We will discuss the history of submissions, the type of research that is being preformed, and outline the directions that wilderness medicine can/should go.  The lecture will highlight the top ten articles that have been published in the past year and what they contribute to the field of Wilderness Medicine.

Tropical Medicine, Phil Levy
Wed-2:15pm
Using a case-based format, this presentation will cover multiple aspects of Tropical Medicine including often overlooked issues of individual preparedness and “what to expect” when planning healthcare-oriented travel.  Attendees will gain critical knowledge regarding risk-factors for contraction of tropic-related diseases, associated clinical presentations, and the most current, recommended treatments.

Update on Disaster and Avian Flu, Michael Callahan
Mon-10:15am
The latest research and best practice guidelines in the field will be discussed.

Wet & Wild: Submersion Injuries, Seth Hawkins
Tue-8:45am
Discussion of submersion injuries, including definitions, prevention, treatment and epidemiology, with a focus on wilderness medical care.  Submersion injuries include drowning, near-drowning, and other injuries resulting from immersion or submersion in liquid media, but excludes injuries whose primary mechanism is pressure (diving injuries) or bites/stings (marine animal injuries).

Wilderness Standards of Care: Who Cares?, Angela F. Gardner
Wed-3:15pm
With the emergence of wilderness postgraduate fellowships and the development of crisis standards of care at the federal level, there is a growing movement to establish standards of care in wilderness medicine.  This presentation discusses the role and responsibilities of wilderness providers in shaping and responding to those standards.  The participants will be able to identify and understand the crisis standards of care recommended by the institutes of Medicine; detail the impact of standards of care on both recreational an commercial exploration of the wilderness; articulate the role of the wilderness provider in establishing standards of care.  The participant will have an increased awareness of the impact of practice standards in the field of wilderness medicine and compliance with those standards.

Wounds in the Wilderness, Eric Johnson
Tues-8:00am
This lecture will be a primer for consideration of wound management in many wilderness type settings.

SMALL GROUP SESSIONS

9/11 to Haiti - What disasters teach about leading and serving, James Geiling
Mon-12:30pm; Tues-1:30pm
Participants will discuss the planning, preparedness and training involved in disaster medicine. They will learn how to coordinate with local, state and federal agencies and what assistance is available from each. Important communication issues and disaster phases will be identified and discussed.

Awareness, Sign Cutting and Tracking Course, Rob Speiden ($75)
Sun-1:00-5:00pm; Mon-1:00-5:00pm
The ability to find, interpret and follow tracks or signs left by human passage is an essential skill for persons interested in being attentive and responsive to occurrences in their surroundings. Rob Speiden teaches human tracking (aka man-tracking) and sign cutting skills to search and rescue, law enforcement and other government organizations. Rob has trained with many tracking experts around the country and participated in over 100 missing person search missions. As the Virginia Department of Emergency Management Field Team Sign Cutter (FTS) course coordinator, and through his Natural Awareness Tracking School, he currently instructs SAR volunteers and law enforcement officers in tracking and awareness skills that enhance search efforts for missing persons. Rob has written a textbook for the FTS course.

Backcountry Trauma Ultrasound, Jay Gupta
Sun-4:00pm; Mon-3:30pm
This lecture will describe the utilization of small, transportable, hand-held ultrasound machines in the detection, management, and disposition of trauma cases that may occur in the backcountry environment. The lecture will cover ultrasound basics, transducer positioning, and interpretation of normal and pathologic anatomy. The cases to be covered include: thoracic trauma, abdominal trauma, long-bone fracture, and ocular trauma.

Basics of Canine Resuscitation, Chris Ralphs
Mon-3:30pm
“No, not the Hind lick maneuver!” This lecture will address resuscitation techniques and medications that can be used when veterinary care is not available. Basics of canine anatomy, CPR, fluid therapy, a drug treatment will be covered. Some advanced topics such as IV catheter placement, thoracocentesis, and blood pressure monitoring will be discussed also. Participants will have the opportunity to practice their skills on our special guest “Resusci-Rover”! (This is not a joke and he can run circles around Rususci-Annie).

Diving and Hyperbaric Physiology – Advancing Your Knowledge, Jolie Bookspan ($25)
Tues-12:00pm
Fast paced, clinically relevant, rarely available topics for those with knowledge of diving and hyperbaric physiology. Presented by researcher who did the work in the field.

Finding Your Niche, Jay Lemery
Sun-1:00pm; Wed-7:30am
This lecture will offer strategies for WMS members to develop their interests for professional distinction and personal growth. Dr. Lemery will emphasize the resources that the WMS offers, as well as ideas to stimulate a creative approach to career development. He will cite evidence-based literature to support this lecture.

Finger Injuries in Rock Climbing, Volker Schoeffl
Sun-1:00pm
The lecture will give  anatomic and biomechanical details on climbing-specific finger injuries, including cadaver studies to the pulley function. Additionally, differential diagnosis of finger injuries in climbers will be discussed, and the diagnostic and therapeutical patterns shown.

Functional Core Re-Training for the Outback, Jolie Bookspan ($25)
Wed-10:00am
Learn several state-of-the-art techniques to stop hyperlordotic lower back pain from hiking, swimming/scuba, and backpacks and understand and maintain neutral spine. Practice teaching methods under supervision with feedback, with optional certification.

Hemostatic Agents & Tourniquets, Brad Bennett ($25)
Wed-7:30am; Wed-10:00am
This 2-hour workshop will provide the ability to see the tourniquets and hemostatic agents currently recommended for use by the Committee on Tactical Combat Casualty Care (CoTCCC), Defense Health Board. We will discuss the correct application, how they work, the pros and cons, and lessons learned for managing severe bleeding.

Improvised Splinting, Tod Schimelpfenig ($25)
Sun-1:00-3:00pm
Learn this fundamental wilderness medicine skill of improvising splints under the guidance of Wilderness Medicine Institute instructors.

In-Flight Medical Emergencies, Joan Garrett
Mon-12:30pm; Tue-12:00pm
The path between your home and your adventure destination can present a remote medical emergency of a different nature: in-flight. Next time you’re traveling into the wilderness via commercial flight, think about what you will do when a flight attendant pages a doctor, nurse or paramedic to volunteer in this remote setting to care for a sick passenger. Just as it does in the wilderness, your instincts are sure to kick in. But what are the treatment nuances, and what can you expect when it comes to treating illness and injury in an aircraft environment? Some questions that occur include: What kinds of supplies, equipment and resources are available; how do the rules change for domestic vs international travel; and, depending on the severity of the emergency, why can’t we simply land ASAP? WMS member Joan Sullivan Garrett is a former flight nurse in fixed wing and helicopter transport, and founder and chairperson of the board of MedAire. MedAire is a telemedicine provider to the aviation and maritime sectors, where time, distance, isolation and maintaining the integrity of the crew play a critical role in the way medical advice and assistance are given. In her presentation In-Flight Medical Emergencies: Wilderness Adventures in Their Own Right, Joan will reveal proprietary statistics and discuss a live case from the company’s 24/7 MedLink Global Response Center located in a Level I trauma center in Phoenix, Ariz. Today MedLink manages more than 15,000 in-flight medical cases annually, both life-threatening and less-serious conditions. MedLink also handles crewmember illness worldwide, comprising about 8,500 cases per year. MedAire’s parent company, International SOS, is a global assistance and security company; together, the companies managed the medical evacuation and repatriation of more than 18,000 individuals worldwide in 2008.

International Air MedEvac, Richard Jones
Sun-2:30pm; Mon-2:00pm
Transporting sick, injured, or deceased patients from an overseas location is a complicated, time consuming, logistically challenging, and often frustrating event. Medical personnel should be familiar with the process so that they have realistic expectations. They should also properly prepare patients to be sent and received. Finally, wilderness medicine practitioners should be able to provide accurate anticipatory guidance to patients, family members, and other healthcare personnel.

 

Jungle Travel & Survival, John Walden
Tues-12:00pm; Wed-7:30am
Drawing on over 40 years of living and trekking with isolated tribal populations throughout the Amazon Basin, Dr. Walden presents the basics for successful participation in trips into the tropical rainforest as well as a brief overview of strategies for emergency jungle survival and survival in hostage situations.

Litters: Commercial and Improvised, Tod Schimelpfenig ($25)
Sun-3:20-5:20pm
Learn this fundamental wilderness medicine skill of commercial and improvised litter building, packaging and carrying under the guidance of Wilderness Medicine Institute Instructors.

“Lookin’ for Eight…” The Mechanisms of Rodeo, Equestrian and Other Large Herbivore Caused Injures, Gordon Worley
Tues-3:00pm; Wed-9:00am
Rodeo, equestrian sports and other human/large animal interactions, whether voluntary or involuntary, have the potential for significant injury. Many health care practitioners have little or no exposure to the injuries caused by rodeo, equestrian and other large animal encounters. Using case reviews, descriptions of current practice and a review of the current trauma, sports medicine and wilderness medicine literature, this presentation will examine the mechanisms of injury, injury patterns, remote location/prehospital treatment and evacuation/transport considerations for patients injured as a result of rodeo events, equestrian activities, cattle ranching and motor vehicle collisions with large animals. Injury prevention strategies and resources for rodeo and equestrian activities will also be discussed.

Medical Advisors in Outdoor Education, Shana Tarter
Sun 4:00pm; Mon-2:00pm
Outdoor programs can struggle to find physicians to partner with as medical advisors. Physicians are often unsure how to get involved with organizations running educational trips and expeditions. This workshop will look at typical program needs and common physician questions with the goal of fostering increased connections.

Moulage for Medical Training, Gates Richards ($25)
Mon-1:00pm; Mon 3:10pm
Enhance the realism of your training simulations with simple mock injuries. Wilderness Medicine Institute’s experienced educators will share tricks of the trade in using moulage effectively in your education setting.

Musculoskeletal Workshop for the Wilderness Practitioner, Tony Islas
Tues-1:30pm; Wed-7:30am
This lecture will review the current literature for the types of musculoskeletal injuries seen in the wilderness traveler. It will discuss the use of tape and braces for wilderness travel and athletics. It will utilize the group for demonstration and group practice of the evaluation of hands, wrists, shoulders, knees and ankles. Participants will discuss and demonstrate improvisational techniques using duct tape and Sam splints regarding common musculoskeletal injuries.

Non-freezing Cold Injuries, Andrea Gravatt
Sun-1:00pm; Sun-2:30pm
This session will address common and important non-freezing injuries that can occur both in the backcountry and in the backyard. These important "injuries/diseases" may simply be a nuisance, such as cold induced rhinnorhea, or may result in a fatality, as in the case of cold urticaria. Recognition of these entities may prevent unnecessary medical work-up and prevent morbidity and mortality.

Not the Same Old Stretches: Why well-known stretches aren’t stopping injury and what to do instead, Jolie Bookspan ($25)
Wed-7:30am
Learn therapeutic, diagnostic, and innovative stretches and take home effective, state of the art techniques that work quickly in both office and outback. Practice teaching methods under supervision with feedback, with optional certification.

Peds Emergencies in Austere Environments, Ron Kaplan
Sun-4:00pm; Mon-2:00pm
Many pediatric medical emergencies can be initially managed in the field without access to a medical facility or sophisticated equipment. Examples include dehydration secondary to acute gastrointestinal illness, status asthmaticus and status epilepticus. The management of these conditions will be addressed, including a review of the relevant literature regarding treatment modalities available in the field.

Prevent and Fix Common Expedition Injuries, Jolie Bookspan ($25)
Tues 2:20pm
Fast moving, jam packed, hands-on workshop of breakthrough, evidence-based innovations in sports medicine in wilderness environments. Practice teaching methods under supervision with feedback, with optional certification.

River Health Travel, Rebecca Love
Tues-12:00pm; Wed-9:00am
A summary of the common injuries and ailments of travelers on wild rivers with special attention to the Colorado through the Colorado Plateau and Grand Canyon. Special attention to the issues of first aid kits, prevention, self care, and institution of definitive treatment and indications for evacuation.

Rock climbing: Consequences for children and long-time climbers, Volker Schoeffl
Tue-12:00pm
Two main topics will be analyzed: Consequences of intense climbing in children and teenagers and consequences of long-time climbing on possible osteoarthritis in the hands and fingers.

SCUBA with Disability, JenFu Cheng
Sun-1:00pm; Mon-12:30pm
Self-contained underwater breathing apparatus (SCUBA) diving has become an increasingly popular recreational activity, enjoyed by millions of individuals. There has also been a growing interest in SCUBA diving in the disabled population for rehabilitation and recreation. It is important for physicians and healthcare professionals to understand the medical issues relevant to individuals with disabilities who wish to participate in SCUBA diving. In addition, they need to be familiar with specialized equipment, adaptations in techniques, and additional precautions. SCUBA diving can be an enriching experience, potentially helping to improve self-image and quality of life. Knowledgeable healthcare professionals can help to guide their patients who are interested in SCUBA diving. A solid understanding of these medical issues can help to prevent the inappropriate restriction of individuals with disabilities in diving activities.

Simple Rope Rescue, Todd Miner ($75)
Tues-12:00-4:00pm
Whether it is to rescue a patient needing care, or simply to take care of one’s self or one’s own party, simple rope rescue techniques are important skills for those practicing wilderness medicine. In this hands-on workshop learn simple self-rescue rope techniques for escaping a crevasse, recovering a pinned boat, or even just freeing a car from a deep ditch. Learn how to safely and efficiently set up a slingshot (2:1), Z-pulley (3:1), and double slingshot (4:1) rescue techniques, using basic climbing gear readily available in the field.

Search & Rescue Theory, Aaron Billin
Tues-1:30pm; Wed-7:30am
An introduction to search and rescue theory including (1) the construction of a complete subject profile and its use in the prediction of the behavior of lost or missing persons, and (2) application of a mathematical model to determine how to best go about a search for a lost or missing person.

Shark Attacks, Jacob Miss
Tues-3:00pm; Wed-9:00am
Perhaps the most feared predator in the sea, great white sharks attack more humans in the "Red Triangle," extending north and south of San Francisco Bay, than any other geographic location on the planet. This presentation will discuss the lessons learned from the shark attacks in the Red Triangle of Northern California, describing factors and variables related to the attacks in the area such as time of day, activity, location, time of year, etc. In addition, the recent data describing migration patterns of great white sharks in the Northern Pacific Ocean will be discussed and correlated with the historical shark attacks. How to survive great white attacks will be discussed and common injury patterns initial treatment will then be presented. Finally, prevention of great white shark attacks will be described with an emphasis on both simple solutions and some of the technological advances that have been proposed to ward off attacks.

Smart Phones and Crisis Mapping: Update from Haiti, Satchit Balsari
Sun-1:00pm; Mon-3:30pm
This working group will explore the use of smart phone applications and the internet in austere settings in coordinating response, aid and communication. The group will leave with a basic understanding of the evolving components of crisis mapping through a case study of the humanitarian response to Haiti, where several key members of the Wilderness Medical Society provided early, time-sensitive, and life-saving critical medical care.

 

Sport and Ice Climbing: Injuries and epidemiology, Volker Schoeffl
Sun-2:30pm
This session will analyze injury patterns and epidemiology in sport, rock and ice climbing. The sport specific pathologies will be discussed as well as their prevention. All climbing specific injuries will be further shown. Injuries to the lower extremity specific for climbing will be also analyzed.

Teaching Ideas for Wilderness Training, Tommy Walker
Tues-1:30pm; Wed-9:00am
This lecture will focus on sharing teaching ideas and method with the main focus being on Wilderness Medicine. We will cover teaching ideas, learning styles, lecture and practical skills preparations, etc.


The Only Thing to Fear, Andrew Watters
Tues-1:30pm; Wed-7:30am
This talk reviews the common causes and effects of survival situations: planning errors, execution errors, and the neuropsychological reaction to stress situations. Review of current and developing theories in neurobiology will be covered, as they apply to wilderness medicine and survival. The implications and application of this material is also particularly relevant to group leaders, medical directors, search and rescue teams, and EMS providers.

Tired of Terrestrial Living, Aspiring Marine Mammals Enter Rebreather Diving, Jonathan Conard
Sun-2:30pm; Mon-3:30pm
This lecture will give a history of rebreather diving. Comparing and contrasting SCUBA and rebreather diving. Different rebreather technologies will be discussed. Rebreather mechanics as related to dive physiology will be discussed. This will include current issues with hypoxia, hyperoxia, and hypercapnia. Diving with a rebreather in different situations, i.e., wreck diving, altitude diving, cave diving, cold water, etc., will be discussed. Failure issues and emergency recovery procedures will be discussed.

Travel and Pregnancy at Altitude, Linda Keyes
Sun-4:00pm; Mon-12:30pm
Interactive lecture covering what is known and not known about the risks of travel and exercise at high altitude during pregnancy. The lecture will be evidence based and cover the most current research and the UIAA Consensus Guidelines published in 2008.

Tyrolean Traverses, Todd Miner ($75)
Mon-1:00-5:00pm
Transporting a mobility-impaired patient across a stream, gorge, crevasse, or other wilderness impediment can present major challenges. In this hands-on workshop learn how to set up and build a simple rope system to safely and efficiently transport a patient (or care givers) over and across an otherwise impassible obstacle. Also relevant for health care providers involved in disaster or expedition medicine.

Ultrasound Under Extreme Conditions: Can he get an Ultrasound?, Doug Sward
Mon-3:30pm; Tues-3:00pm
Review and describe uses and potential uses of portable ultrasound machines in wilderness settings. Review both trauma and medical uses of ultrasound to aid in diagnosis and management in the wilderness.

Venomous Snakebite Treatment, Jonathan Allen
Tues-3:00pm; Wed-9:00am
Identification of venomous snakes; prehospital and hospital management of venomous snakebites – both Crotaidae and Elapidae; understanding the physiologic effects of snake venoms.

Veterinary WM, Chris Ralphs
Mon-2:00pm; Tues-12:00pm
“What’s that Timmy? Lassie’s trapped in a well?” This lecture will be dedicated to preparing you to prevent and treat veterinary medical emergencies that you may encounter in a wilderness setting with an emphasis on dogs. Topics to be covered will include basics of canine physiology, drug dosages, and fluid therapy. Specific scenarios will also be discussed including heat stroke, water immersion, porcupine quills, poisoning, lacerations, leg trap wounds, and many others. Handout will include drug dosages for human drugs that can be used to treat canine patients.

Wilderness Medicine Rotation, Vicki Mazzorana
Sun-4:00pm; Mon-12:30pm
This small group discussion will include the planning and organizing of a Wilderness Medicine rotation for students at their respective facilities. Specifically, to put together these rotations at respective sites. There are others within WMS who are currently involved and interested. The target audience would include educational coordinators of student rotations at educational institutions as well as educational coordinators at National Parks.

EVENING PROGRAM

WMS Members Respond to Haiti - Paul Auerbach, Anil Menon, James Geiling
Many WMS members responded to the Haiti earthquake. Stanford University Hospital sent a team that included Doctors Paul Auerbach, Anil Menon and Robert Norris. Dartmouth-Hitchcock Medical Center sent a team that included Doctor James Geiling. Auerbach, Menon and Geiling share their experiences and demonstrate the value of wilderness medicine knowledge and skills in the setting of a catastrophic natural disaster.