WILDCARE

February 23, 2015

WILDCARE — Working In Less than Desirable Conditions And Remote Environments

SOLO’s newest textbook is done, 7 years in production, and worth every minute.

A very unusual book designed to teach how to practice and provide emergency and extended care in remote and austere environments.

It is a teaching text, in that there are very few paragraphs, instead information is bundled into lists, bullets, and illustrations.

Check it out at TMCBooks.com

Advertisements

SOLO SAFETY BULLETIN – SURVIVING AN AVALANCHE

February 23, 2015

SOLO SAFETY BULLETIN – SURVIVING an AVALANCHE

We have had a lot of snow this winter and the avalanche dangers are extremely high. We felt this was a good time to review how to survive and avalanche.

Avalanche-related Deaths:

In the USA, there is an average of 30 deaths per year.

In Europe, there is an average or 120 deaths per year.

Causes of Death in an Avalanche:

Asphyxia accounts for about 90% of deaths.

Trauma accounts for about 10% of deaths.

Head trauma and cervical spine trauma are the most common cause of

traumatic death in an avalanche.

Risk of Death = The Risk is Hypoxia, Hypothermia, and Asphyxia.

Increases with the depth of burial – how many feet under the snow pack.

Increases with the time or duration of burial under the snow pack.

Decreases with available air pockets within the snow pack.

Principle #1: The primary principle to increase the chance of surviving an avalanche is to STAY ON TOP!

Move sideways

Jump upslope

Carry an avalanche beacon – avalanche transceiver

Grab something and hang on

Swim to stay on top

Get rid of anything heavy – anchors

Create an air pocket

Trail a rope – avalanche cord

Urinate

Locate up from down and push and arm up

Be prepared – Take a course

MOVE SIDEWAYS

As the avalanche flows downhill, there is more depth of snow in the center of the avalanche than along the sides. The avalanche also moves faster towards the center. Moving towards the side will bring you into areas of less depth of snow that is moving slower than in the center.

JUMP UPSLOPE

The fracture line of the avalanche may be directly under your feet. You may have caused the fracture line and simply stepping up hill may put you on solid footing, instead of on the river of flowing snow.

CARRY AN AVALANCHE BEACON/TRANSCEIVER

Wear the avalanche beacon under clothing so that it cannot be stripped off you in the avalanche. It is the quickest and most reliable way to locate a buried person in the snow pack. Time is life. A beacon is a big factor in surviving an avalanche due to the risk of asphyxia.

GRAB ONTO SOMETHING AND HANG ONTO IT

By grabbing onto a rock or tree, assuming the tree is not uprooted by the avalanche, it will allow the avalanche to flow past you, minimizing the depth of burial.

SWIM TO STAY ON TOP

An avalanche is a river of flowing snow and it acts just like water. The difference is that as soon as it stops flowing, it rapidly hardens into “snowcrete.” Snowcrete is just like concrete, only it consists of snow.

Swimming will help to keep you on top of the moving snow mass. Again, minimizing the depth of burial increases survival. Some experts say swim uphill and some downhill. The reality is you will probably not know up from down, so simply swim to try to stay light and on top of the snow.

GET RID OF ANYTHING HEAVY, ANCHORS!

Back packs, skis, ski poles, snow shoes can weigh you down and act like anchors dragging you deeper into the snow. Shedding these “anchors” will help to keep you closer to the top of the flow.

CREATE AIR POCKETS

As the flow begins to slow, place your hands in front of your face and push away creating an air pocket. Also, take a deep breath to expand your chest and try to move around to make space. Once the snow stops moving it will harden and turn into “snowcrete” in approximately one minute. Remember, up to 90% of deaths from avalanches are from asphyxia, i. e. you simply cannot breathe.

TRAIL A ROPE

This is an old technique. The idea behind this is if you are caught in an avalanche and you were trailing a piece of rope, when the rescuers find the rope they can follow it along to find you.

URINATE

If you are in an area where they use rescue dogs to search for avalanche victims, the dogs locate primarily by scent. They smell you out. Urine stinks and peeing in the snow will give the rescue dogs a bigger scent, odor, aroma by which to find you.

LOCATE UP FROM DOWN AND PUSH AN ARM UP

Trapped inside of snow, it can be very difficult to tell up from down. The pressure on the body is consistent all around, and the light is the same all around as well. It has been said that drooling or spitting will give you the direction of gravity. This is probably a myth, as you will most likely be encased in snow. However, do try to figure up from down, and if you can, shove an arm or leg upward in hopes of being able to stick a hand out of the snow pack, or at least be closer to the top with hopes of being found sooner.

DON’T SHOUT OR SCREAM – DON’T WASTE YOUR BREATH

Snow is very sound-absorbing. Don’t exhaust yourself trying to call or scream for help; the snow absorbs the sound, and, therefore, the sound only carries a few feet.

BE PREPARED – TAKE A COURSE

Last but not least, if you are going into avalanche country, wear your beacon, consider wearing an avalanche airbag or float, carry hiking poles that can be converted to avalanche poles for probing the snowcrete, and pack a light weight shovel to dig out the victims of the avalanche. Get smart and take a course.

A few specific avalanche devices to consider which could save our life.

Avalanche airbags and floats:

These are safety devices that are fit to a backpack, designed to be deployed in the event of an avalanche. They are simply big bags of air that help to keep you afloat or buoyant, thus keeping you closer to the top of the snow pack.

There is an excellent review of avalanche airbags at www/outdoorgearlab.com/avalanche-airbag-review

Avalung

The Avalung is a device that can be added to an existing back pack. It has a mouth piece for breathing attached to a shoulder strap. As you inhale via the mouth piece, the air is drawn in from your front and the exhaled air is exhausted out the back of the pack. This reduces the rate at which snow melts around your head and face and slows the rate at which ice forms. This buys you time to be able to extract oxygen from the snow pack, preventing hypoxia and asphyxiation.

New! From The Wilderness Medicine Newsletter

February 10, 2012

For decades the Wilderness Medicine Newsletter has provided up-to-date information to pre-hospital and definitive care providers. Since becoming an on-line journal, the readership of the WMN has become international. Now the WMN has it’s own web site: www.wildernessmedicinenewsletter.com

Subscribers pay the same $15 a year subscription rate but have access to more than 165 articles from back issues as well as current issues. You can search the site either by category, or by key words making the Wilderness Medicine Newsletter site a much more useful reference for everything from reviewing splinting to the prevention and treatment of tropical diseases.

Check it out!

New Soap Note app!

December 8, 2011

Everyone practicing pre-hospital medicine in either a street environment or wilderness environment should know about this new app.

The new SOAP note app allows you to create highly accurate SOAP notes in ways that were not possible before. As patient care transfers from one level of care to the next, patient care data can now travel with the patient. SoapNoteApp enables you seamlessly transfer your SOAP notes from person to person. It tracks and secures all your notes. It includes a digitally signed change record so you can be confident your notes are safe. You can access your notes from anywhere at any time.

As well as clear simple screens that allow you enter data quickly and accurately, the new app has additional features such as streaming text, which allows you to keep a log with a time stamp, easy fill in boxes for vital signs with time stamp, an injury location screen that allows you to touch locations on a schematic of the body of the patient to more accurately highlight injury sites as you find them. The app also allows you to place a priority on specific injuries and treatments and then change those priorities as treatments are applied. The app records all of this data easily and allows you to go back and look more accurately and easily at events as they unfolded on scene. If you carry an iPad, iPhone, or Android this app can make your SOAP notes cleaner, more accurate, and easy to access digitally—check it out.

SOAPNoteApp

2010 in review

January 3, 2011

The stats helper monkeys at WordPress.com mulled over how this blog did in 2010, and here’s a high level summary of its overall blog health:

Healthy blog!

The Blog-Health-o-Meter™ reads This blog is on fire!.

Crunchy numbers

Featured image

About 3 million people visit the Taj Mahal every year. This blog was viewed about 37,000 times in 2010. If it were the Taj Mahal, it would take about 5 days for that many people to see it.

 

In 2010, there was 1 new post, growing the total archive of this blog to 91 posts.

The busiest day of the year was December 7th with 321 views. The most popular post that day was Heat Loss Through the Head and Hypothermia.

Where did they come from?

The top referring sites in 2010 were en.wikipedia.org, wintercampers.com, en.wordpress.com, facebook.com, and tmcbooks.com.

Some visitors came searching, mostly for manchineel tree, body heat loss, ample history, heat loss through head, and patella.

Attractions in 2010

These are the posts and pages that got the most views in 2010.

1

Heat Loss Through the Head and Hypothermia February 2007

2

Toxins #1 – The Manchineel Tree December 2006

3

About this blog October 2006
2 comments

4

Reducing a dislocated patella November 2006

5

Introduction to Frozen Mythbusters and Myth #1 October 2006

Haiti

February 5, 2010

the  Major disasters in the last 10 years, 2000 – 2010:

2001 – Gujarat Earthquake, India                                20,000 Deaths

2003 – Bam Earthquake, Iran                                      30,000 Deaths

2004 – Indian Ocean Earthquake and Tsunami    230,000 Deaths

2005 – Kashmir Earthquake, Pakistan                       85,000 Deaths

2005 – Hurricane Katrina, USA                                       1,300 Deaths

2008 – Sichuan China Earthquake, Chine                 70,000 Deaths

2008 – Cyclone Nargis, Burma (Myanmar)              150,000 Deaths

2010 – Haitian Earthquake, Haiti                               170,000+ Deaths

These natural disasters have cost hundreds of thousands of lives, displaced and made homeless millions of people, mostly the poorest of the poor, cost billions upon billions of dollars, and their global impact has lasted for years.

There is no reason for us to expect that these moanings and groanings of our living planet will ever stop. Therefore, it is essential that we are prepared for the worst. First, we have to be prepared in our own home, then in our community, our state, our country, and finally the world.

The point of this brief article is to provide you with a list of the principles of being prepared to go, to help, and to unselfishly SERVE others in their time of need.

The Principles that will help you to prepare to go and to SERVE:
SAFETY
SHELTER
SUSTENANCE
SANITATION
STAYING WELL
STRESS

SAFETY

Safety is first and foremost is having a well-thought-out plan and sticking to it.
There is safety in numbers; always travel in a group, and try to work together as a group. Keep the team together.
When moving around, remember that traveling during the day is much safer than traveling at night.
Know where you are going, how you are going to get there, and who is going to meet you.
Find out well in advance if there are any local concerns for safety or if there are dangerous areas that you should avoid.
Ask questions. Don’t guess. Most people are more than glad to answer questions and be helpful.
Have an evacuation plan. You need to know what to do if someone in your group does become sick or injured. The plan should include how to evacuate them to home.
It is a very good idea to have some form of evacuation insurance from a group such as Global Rescue, the American Alpine Club, or Divers Alert Network to name a few.
If you do have evacuation insurance, make sure that you carry the details of the policy on your person with appropriate contact information and phone numbers. You do not want to leave it at home or back at base camp. It needs to be with you at the time of the crisis, so the plan can be easily and accurately activated.

SHELTER

When you go into areas of destruction, you cannot count on there being any housing.
You have to carry your own shelter, i.e. a tent, and in the tropical climates you have to be able to sleep under mosquito netting at night to avoid bug bites.
Warmth. Check the weather conditions and carry appropriate sleeping bag or bed roll for the anticipated climate conditions. Remember, in the tropics 60F is considered cold.
Know how to and be prepared to bivouac, to be able to make an emergency shelter from a sheet of plastic or tarp.

SUSTENANCE

Food and water:
Like shelter, you cannot assume that there will be potable water or adequate foods supplies. You do not want to use up the resources of the people whom you’ve come to help.
Food:
You have to carry enough food for your team. Preferably, food that does not take a lot of cooking time or preparation time.
Carry food that can be eaten without cooking, such as protein bars or food that cooks quickly in boiling water, such as macaroni and cheese, instant potato, rice, or premade meals.

Water:
You have to be prepared to purify all you water.
Techniques of water purification: BOIL, CHEMICAL, FILTER, UVC LIGHT
All these techniques are very effective.
Boil: Bring to a rolling boil to sterilize. You have to have a source of heat.
Chemical: Chlorine or iodine.
Use chlorine for large supplies of water for a group.
Use iodine for individual water supply, one water bottle at a time. Although iodine is inexpensive, and safe to use, it does give the water an unpleasant taste.
Filtration: You can use for a group, but usually used by individuals.
Use a filter that also contains iodine to kill the viruses that are too small too filter.
UVC or ultraviolet C light.
Steripen is used by individuals for their own water bottles.

SANITATION
Sanitation is more than just good hand washing. It involves:
Wear gloves when examining and treating patients. It is essential that you bring lots of gloves.
Having a plan to properly dispose of human waist, urine and feces.
Choices: digging a pit and making an outhouse for the group to use or you can use commercially available potties or toilet bags with proper disposal. You want to avoid fecal contamination of the local water supply.
Staying clean. Keep the perineal area clean to avoid rashes and a painful butt. Applying a thin layer of Vasoline to the area around the rectum will help to stay clean and avoid chafing.
Bring lots of toilet paper and personal wipes.
Women need to bring sanitary napkins or pads.
You have to know how to bathe in a bucket of water, and do so daily.
Rinse out clothing every day with soap and water, i.e. the skill of hand washing.
Check your skin several days for ticks, bug bites, and rashes.

STAYING WELL

Immunizations/vaccinations:
Go to the CDC.gov website, travel advice, for information on travel vaccines and common diseases in the area you are going to.
Usual childhood vaccinations plus; Hepatitis A and B, IPV poliovaccine, Typhoid, make sure tetanus and diptheria are up-to-date, consider yellow fever and meningiococcal.
Antimalarials:
If you are going into an area where there is malaria, take an antimalarial daily such as doxycycline or Malarone. Remember that malaria is treatable, but not necessarily curable; therefore, malaria porphylaxis is common sense.
Know the modes of transmission of disease and practice good body substance isolation.
Insect repellants and insecticides. Do every thing that you can to avoid being bitten by insects – mosquitoes, black flies, ticks, sand flies, etc. Use insect repellants, wear appropriate clothing, and sleep under mosquito netting.

STRESS

Post Traumatic Stress Disorder:
One of the most difficult tasks is trying to determine who is emotionally prepared to face all the destruction and human suffering that you may be confronted with.
During the deployment, try to get your group together several times daily to share in their ongoing experiences, expectations, concerns, and to pray together if appropriate.
Have a follow-up plan for after everyone has returned home. PTSD can be prevented and is treated by talking about the tough work, the difficult things that you saw and did, and the sense of disappointment or even failure that can haunt you once you are back home, safe and secure.

We have to consider the whole human being; the body, the mind, and spirit. One cannot exist well without the others and they have powerful influences over one another. Being mature, having a wide variety of human experiences, a desire to serve as well as being well grounded in faith can be very helpful and important.

This post is an excerpt from the current special edition of the Wilderness Medicine Newsletter and is reprinted here with the permission of the editors.

Cholera and Diarrhea

January 1, 2009

CHOLERA and DIARRHEA

At this very moment there is an outbreak of cholera in Zimbabwe– not a worldwide pandemic, but a localized epidemic. This is not a trivial point of interest, but a major news event that will not only have a dramatic impact on the population of Zimbabwe but also on the entire world as the aftermath of this epidemic will require international aid. Cholera will most likely kill thousands of people in Zimbabwe, impact tens of thousands of lives, and will continue to be a constant threat around the world and a very real concern for the adventurous and international travelers.

What is cholera?
Cholera, an acute infectious diarrheal illness that can cause death in less than 24 hours due to the profuse diarrhea, is caused by the bacteria, Vibrio cholera.  Spread by oral-fecal contamination of food or water supplies, it is highly contagious, as has been demonstrated by at least seven worldwide pandemics over the past several hundred years.

How does cholera cause illness?
When consumed, the cholera bacteria passes through the stomach, where, fortunately, most of the bacteria are killed by the gastric juices and acid. Once the surviving bacteria have made it into the small intestine, they invade the lining of the small intestine and begin to multiply. In the process the bacteria produce an enterotoxin, and it is this enterotoxin that is responsible for causing the profuse, watery diarrhea that results in large quantities of fluid and electrolyte loss.

How does cholera cause death?
Death is a result of hypovolemic shock brought on by the profound dehydration from the enterotoxin-induced diarrhea.  The very watery, grayish diarrhea is referred to as a rice water diarrhea. The victim of cholera can easily have massive diarrhea at a rate of 3 – 4 liters per hour or even more, literally dehydrating and shriveling up right before your eyes. Cholera is a very dehumanizing, debilitating disease.

What are the signs and symptoms of cholera?
Diarrhea – copious amounts of watery, rice water diarrhea.
Dehydration leading to hypovolemic shock – rapid, weak pulse; hypotension; rapid, shallow breathing; pale, cool, clammy skin; anxiety; and a sense of impending doom
Headache
Exhaustion and prostration
Malaise
Possible nausea and vomiting

How is cholera treated?
Hydration, Hydration,Hydration
The initial goal, and that means IMMEDIATELY is to replace the lost fluids and electrolytes. Then continue to replace the fluids that are being lost as quickly as they are being lost. As long as these patients can drink, oral therapy works very well. However, you have to replace the electrolytes as well as the water that is being lost. Water alone will not improve their survivability.

Electrolytes are charged ions: sodium (Na+), chloride (Cl-), potassium (K+), and bicarbonate (HCO3-).  Glucose is also required to supply the energy that is needed to live. These electrolytes with the addition of glucose maintain the basic and vital functions on a cellular level to sustain life as we know it.

How do you make an Oral Rehydration Solutions (ORS)?
1. ORS can by made by mixing a commercially available ORS powder with water.
2. Home remedy can by made by simple adding sugar and salt to water.
1 liter of water + 1 teaspoon of salt + 8 teaspoons of sugar
3. Rice water is also a very effective ORS. It is made by cooking rice as usual.
1 liter of water + ½ cup of the cooked rice + 4 teaspoons of sugar + 1 teaspoon of salt. Stir to create a drinkable liquid.
The calories from sugar are very important. If sugar is not available you substitute molasses, brown sugar, fruit juice (contains glucose and fructose), or green coconut water. In fact molasses and brown sugar are better as they contain additional compounds that are also helpful.

Antibiotic Therapy:
Cholera is also caused by the bacteria, Vibrio cholera, and fortunately it is susceptible to several different antibiotic therapies.

Antibiotics that can be used to treat cholera:

Oral rehydration is the cornerstone of therapy. Antibiotics will shorten the course of the diarrhea and speed recovery. Following is a list of several antibiotics and their dosages that will help to eliminate the Vibrio cholera in the small intestine. There are several options, all are equally efficacious.

Single dose antibiotics:
Doxycycline: single dose – 7mg/kg up to 300mg.
Tetracycline: single dose – 25mg/kg up to 1000mg.
Ciprofloxacin: single dose – 30mg/kg up to 1000mg.

Multiple dose antibiotics:
Trimethoprim/sulfamethoxazole:  5-10mg/day, divided bid x 3 days, up to 320mg of the
trimethoprim/day and 1600mg of the sulfamethoxazole/day.
Ampicillin: 50mg/kg/day, divided qid x 3 days up to 2000mg/day.
Erythromycin: 40mg/kg/day, divided tid x 3 days, up to 1000mg/day.

How can the spread of cholera be prevented?

Cholera is spread by oral-fecal contamination of the food and water supplies that are then consumed by others causing further spread of the illness.
Therefore, drink only water that has been properly treated with iodine, chlorine, filtration, boiling, or UVC light.
Avoid ice as freezing does not sterilize water.
Eat only properly prepared foods:
Vegetables that can be peeled or cooked.
Well cooked meats and fish.
Avoid raw or undercooked meats.
Beware of sanitation practices, hand washing, and dirty dishes.
In addition, health care providers must take Body Substance Isolation (BSI) precautions and practice extremely safe hygiene when working with cholera patients.
Quick summary of Cholera and its influence on recent history:
1816-1826: Cholera Pandemic:
The outbreak began in Bengal and then spread across India. Approximately 10,000 British troops and countless Indians died during this pandemic.
1829-1851: Cholera Pandemic:
This outbreak lasted 22 years and extended initially from Russia into Europe. In London, the disease claimed close to 7,000 victims, and in Paris alone another 20,000 perished with approximately 100,000 deaths in all of France.
The epidemic reached Quebec, Ontario, and New York in 1832 and the Pacific coast of North America by 1834. The number of deaths appears to not have been recorded.  In 1848, a two-year outbreak occurred in England and Wales which claimed about 52,000 lives.
1849:  A second major outbreak spread in Paris and London. In London it claimed 14,137 lives, twice as many as the 1832 outbreak.
1849:  Cholera was responsible for 5,308 deaths in Liverpool, England, and 1,834 in Hull, England.
1849: Cholera spread into the Mississippi river system killing over 4,500 in St. Louis and over 3,000 in New Orleans, and thousands more in New York. Cholera also spread along the California and Oregon trails; hundreds died during the California Gold Rush.
1852-1860:  Cholera Pandemic:
The pandemic mainly affected Russia, with over a million deaths.
In 1853-1854, another London’s epidemic claimed 10,738 lives.
1854: An outbreak of cholera in Chicago killed about 3,500 people.
1863-1875:  Cholera Pandemic:
Occurring primarily in Europe and Africa, at least 30,000 of the 90,000 Mecca pilgrims died from cholera during their pilgrimage. Cholera also claimed 90,000 lives in Russia in 1866.
1866: A cholera outbreak took place in North America while at the same time in London where cholera killed 5,596. Also more than 21,000 people died in Amsterdam, The Netherlands.
1881-1896: Cholera Pandemic:
The 1883-1887 epidemic took 250,000 lives in Europe and at least 50,000 in America. Cholera claimed 267,890 lives in Russia, 120,000 in Spain, 90,000 lives in Japan, 60,000 in Persia, 58,000 in Egypt, and 8,600 in Germany.
1899-1923: Cholera Pandemic:
This pandemic killed more than 800,000 in India.
1961-1970s:  Cholera pandemic:
Beginning in Indonesia, this pandemic reached Bangladesh in 1963, India in 1964, and the USSR in 1966. From North Africa it spread into Italy by 1973. In the late 1970s, there were small outbreaks in Japan and in the South Pacific.
January 1991 to September 1994:
An outbreak in South America, beginning in Peru where there were 1.04 million identified cases and almost 10,000 deaths.
November 2008 – Doctors Without Borders, (Medicines Sans Frontiers) reported an outbreak in a refugee camp in the Congo.
November – December 2008
Is has been estimated that more than 11,000 people in the African nation of Zimbabwe are infected, and there have been more than 600 deaths.
Please note that these statistics come from a variety of resources. If you are interested, one of the most complete sources of the history of cholera pandemics can be found on Wikipedia by looking up cholera.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

Improvised Pelvic Splint

July 30, 2008

In keeping with the other video demonstrations that we have posted on this site, below you will find a video of an improvised splint for a possible fractured pelvis….

Improvised Traction Video

June 11, 2008

Back in December of 2007 we wrote a series of posts on lower Extremity injuries. Here is a video demonstration of an improvised traction splint to go along with that post.

IX. Patient Assessment System – Checklist

April 29, 2008

Part 9 of 9: PATIENT ASSESSMENT CHECK LIST:

SCENE SURVEY:
Is the SCENE SAFE?
Is the PATIENT SAFE?

PRIMARY SURVEY: 
Are they CONSCIOUS?
Do they have an OPEN AIRWAY?
How is their BREATHING?
Do they have a PULSE? 
Are they BLEEDING?
Are there any serious injuries on the CHUNK CHECK?
Is their neck and spine STABLE?
Do they need to be MOVED?
Do we need to protect them from the ENVIRONMENT?
How is everyone else DOING?

SECONDARY SURVEY – VITAL SIGNS:
What is their RESPIRATORY RATE & EFFORT?
What is their HEART RATE & EFFORT?
What is their LEVEL OF CONSCIOUSNESS?
What is their SKIN COLOR, TEMPERATURE, & COLOR?

SECONDARY SURVEY – PATIENT EXAM:
HEAD  – scalp, face, eyes, nose, mouth.
NECK  – spine, trachea.
CHEST – clavicles, shoulders, ribs.
ABDOMEN – compress the abdomen.
PELVIS – compress the pelvis anterior/posterior and lateral.
LEGS  – circulation, sensation, and motion.
ARMS  – circulation, sensation, and motion.
BACK  – log roll and palpate the length of the spine.

SECONDARY SURVEY – AMPLE HISTORY:
ALLERGY – allergy to drugs, foods, insects, etc. 
MEDS  – prescription and non-prescription drugs.
PREVIOUS – significant past medical history, surgeries, etc.
LAST   – last intake & last output.
” EVENT – events leading up to this crisis.

SOAPnote:
Putting it all together and creating a treatment plan.

RESCUE PLAN:
” Looking at all factors and creating a rescue or evacuation plan.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.