The WMS Practice Guidelines for Wilderness Emergency Care were originally published in 1987 and updated five times by 2006 in a chapter-based book format to provide WMS members with an “official statement” of the best methods of handling wilderness related trauma, environmental illnesses, and managing medical problems in the wilderness. While a valuable source of practical information to WMS members, as the book was coming up for revision in 2007, the WMS decided to move towards a more evidence-based, expert panel driven consensus of practice guidelines that could be referenced in the medical literature as well as accessed by those outside of the society.
With the publication of “Recommendations on the Use of Epinephrine in Outdoor Education and Wilderness Settings” the new format of WMS Practice Guidelines was born. The guidelines are published in Wilderness and Environmental Medicine, the official journal of the Wilderness Medical Society, and as such are available on PubMed and to members outside of the WMS.
Currently in progress are practice guidelines on Drowning and Envenomations from North American Venomous Snakes.
The process of developing useful, unbiased practice guidelines is a challenge, as noted by the Institute of Medicine (IOM) in their recent report “Clinical Practice Guidelines We Can Trust,” as well as recent editorials in JAMA and Archives of Internal Medicine that raise questions as to the ability of guidelines to be developed free from bias, with external review, and with a transparent process for both author and literature inclusion. The WMS Practice Guidelines committee reviews proposals for potential topics and panels, and seeks to ensure broad representation from amongst our membership in our expert panels. The literature is reviewed and graded based on the American College of Chest Physicians (ACCP) (Chest 2006;129;174-181; DOI 10.1378/chest.129.1.174). While this grading system satisfies all recommendations of the IOM for how to grade evidence, there remains a dearth of high quality, randomized or prospective trials in much of the wilderness medicine literature, and thus we rely also on the expertise of our authors to make recommendations based on their collective experience.
In fall of 2014, the WMS published a supplement to Wilderness and Environmental Medicine containing updated Practice Guidelines. The following guidelines were updated and published in the supplement. Original versions of the guidelines are accessible from with the updated versions:
Luks A, McIntosh S, Grissom C, Auerbach P, Rodway G, Schoene R, Zafren K, Hackett P. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Acute Alititude Illness: 2014 Update. Wilderness Environ Med. 2014; S4-S14.
Gaudio F, Lemery J, Johnson D. Wilderness Medical Society Practice Guidelines for the Use of Epinephrine in Outdoor Education and Wilderness Settings: 2014 Update. Wilderness Environ Med. 2014; S15-S18.
Paterson R, Drake B, Tabin G, Butler F, Cushing T. Wilderness Medical Society Practice Guidelines for Treatment of Eye Injuries and Illnesses in the Wilderness: 2014 Update. Wilderness Environ Med. 2014; S19-S29.
Bennett B, Hew-Butler T, Hoffman M, Rogers I, Rosner M. Wilderness Medical Society Practice Guidelines for Treatment of Exercise-Associated Hyponatremia: 2014 Update. Wilderness Environ Med. 2014; S30-S42.
McIntosh S, Opacic M, Freer L, Grissom C, Auerbach P, Rodway G, Cochran A, Giesbrecht G, McDevitt M, Imray C, Johnson E, Dow J, Hackett P. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite: 2014 Update. Wilderness Environ Med. 2014; S43-S54.
Lipman G, Eifling K, Ellis M, Gaudio F, Otten E, Grisson C. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Heat-Related Illness: 2014 Update. Wilderness Environ Med. 2014; S55-S65.
Zafren K, Giesbrecht G, Danzl D, Brugger H, Sagalyn E, Walpoth B, Weiss E, Auerbach P, McIntosh S, Nemethy M, McDevitt M, Dow J, Schoene R, Rodway G, Hackett P, Bennett B, Grissom C. Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2014 Update. Wilderness Environ Med. 2014; S66-S85.
Davis C, Engeln A, Johnson E, McIntosh S, Zafren K, Islas A, McStay C, Smith W, Cushing T. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Lightning Injuries: 2014 Update. Wilderness Environ Med. 2014; S86-S95.
Russell K, Scaife C, Weber D, Windsor J, Wheeler A, Smith W, Wedmore I, McIntosh S, Lieberman J. Wilderness Medical Society Practice Guidelines for the Treatment of Acute Pain in Remote Environments: 2014 Update. Wilderness Environ Med. 2014; S96-S104.
Quinn R, Williams J, Bennett B, Stiller G, Islas A, McCord S. Wilderness Medical Society Practice Guidelines for Spine Immobilization in the Austere Environment: 2014 Update. Wilderness Environ Med. 2014; S105-S117.
Quinn R, Wedmore I, Johnson E, Islas A, Anglim A, Zafren K, Bitter C, Mazzorana V. Wilderness Medical Society Practice Guidelines for Basic Wound Management in the Austere Environment: 2014 Update. Wilderness Environ Med. 2014; S118-S133.
The WMS Practice Guidelines will continue to be published in a peer-reviewed, index-searchable journal. We hope these will serve as both a practical resource and as a guide for where future research in the wilderness medicine literature is needed. The Practice Guidelines committee welcomes ideas and suggestions for future articles – please contact our managing editor Alicia Byrne at [email protected].
Gaudio F, et al. Wilderness Environ Med. 2010; 21;185-187.
National Academy of Sciences (nap.edu/catalog.php?record_id=13058)
Ransohoff D et al. How to Decide Whether a Clinical Practice Guideline Is Trustworthy. JAMA. 2013; 309.
Shaneyfelt, T. In Guidelines We Cannot Trust. Arch Intern Med. 2012; 172.