For several years, I have had the privilege to contribute to the “Tech” column in Wilderness Medicine Magazine. I have searched for “game changers” that impact wilderness patient care and expand our capabilities in resource-deprived wilderness environments. Focused on identifying technological novelties and cutting edge opportunities, my aim has been to pursue the same standards of care we hold to in the practice of front-country medicine.
Looking back at my own journey of training, education, and practice, I recall an AWLS course I took nearly 20 years ago. We were completing a discussion on the tools to include in your backcountry kit. I was admonished to consider that the most important ingredient to our backcountry medical kit was not a fancy new gadget in the top of our pack, but that the most amazing piece of “tech” laid between our ears.
With that said, I look at the recent context of the pandemic, the retreat of an entire population into the outdoors, an increase of backcountry recreationalists, and the highest avalanche mortality year on record. The historic significance of what we have collectively endured will never be forgotten. As our minds ponder the impact of what has been lost, I can’t help but think of that “greatest piece of tech” that has helped us move through this period of time—the human brain.
The human brain is able to process calculations at speeds of up to 60 bits per second and even though computers and artificial intelligence (AI) are sometimes eclipsing our processing speeds, they lack the ability to use reason and logic, to learn, to overcome and to problem-solve. Expertly crafted, the brain utilizes chemical neurotransmitters and hormone regulation to enact amazing potential from the rest of the body. The sympathetic and parasympathetic components of the nervous system work in a dichotomous marriage of harmony to maintain homeostasis. Connected to the cranial nerves and the peripheral nervous system, the power of the brain is augmented to engage with all the elements of medical knowledge and technology covered in previous iterations of this column. In many ways, it is the gatekeeper, the rule maker, and the chief instrument in the practice of wilderness medicine. Yet, like an ophthalmoscope with dead batteries, or an ultrasound without a screen, the brain is not without limitations. It is not impervious to injury or stress.
Indeed, the influences of physiological and environmental stressors can render an impairment that cannot only inhibit the practice of medicine but also threaten personal care and safety. As we consider this amazing piece of technology, some time will be dedicated in reviewing two elements of concern that not only pose a threat to our patients but also to us as the wilderness medical provider. These elements include: environment and trauma.
It doesn’t require a long meditation on the acronym AEIOUTIPS to ascertain the many components of the environment that can affect our brain. Exposure to allergens, infection, or overdose from environmental toxins are all a consideration. Add to this group the effects of altitude, heat, cold, the presence or absence of adequate hydration and you have a group of several environmentally mediated threats to our central piece of technology—the brain.
When considering the associated effects of trauma, multiple confounding elements are revealed. Typically, our thoughts on trauma lean in on our understanding of physical trauma—those issues related to a singular event, like falling from an inadequately protected pitch of climbing or being caught in an avalanche/whitewater event. These, and other physically traumatizing events, are easy to conceptualize as a threat to our brain. What often escapes our consideration, however, is the trauma of survival—the process of stress injury formation which also renders our cognitive processes impaired.
The requirements of adequate cognition are not to be understated. Without adequate function, our ability to care for ourselves and others would not be possible. In closing out this brief reflection on the amazing design of our brain and the threats to its survival, I will lay out a couple of practical considerations to mitigate injury and prolong cognitive function even when threats of impairment are present.
1) Helmets: I wear them for everything. I have a healthy quiver of them for each outdoor event I would consider. As a medical director and provider in the field, I’m typically the first to put it on and last to take it off, hopefully serving as a role model for others. Unfortunately, I’ve slipped on ice—even in the parking lot. On my bike, I’ve been hit by a car only a block from home.