Arriving in Seattle

When you arrive at the Seattle-Tacoma (SeaTac) airport, you may find a spectacular view of Rainier to the south. The anticipation of a new, and different medical conference rises in your mind, and the anticipation of summiting this beautiful, Fuji like peak creates excitement. You might not even know much about high altitude, but you know you will after the conference. You have been running and training a bit at the gym in order to prepare you for a more adventurous type of CME. But you forgot a few supplies. No worries, because beautiful Seattle has it all! You can go to REI at 222 Yale North in Seattle (phone 206-223-1944, see http://www.rei.com/seattle for store locations) to load up or rent equipment for our excursions. Besides, a little detour is worth it. Nearby boasts the Space Needle, built for the World Expo in 1962, with a surrounding park, zoo, and museums (http://www.spaceneedle.com/restaurant). You might even plan to stay by the seaside community of Queen Anne and eat seafood overlooking the spectacular waterfront.

The Puget Sound, and the surrounding islands are rich with open air markets, kayaking possibilities in the San Juan Islands, fishing, and excursions to Victoria Island. Before or after the conference, Seattle is not to be missed! TripAdvisor.com can keep you apprised of good places to stay. Your family will enjoy these options, as well. Don't hesitate to contact us at worlddoc@comcast.net for more information.

Telluride Mountainfilm 2008

The 30th Mountainfilm in Telluride, Colorado will be held on May 23 - 26. This is a four-day experience that draws athletes, artists, and activists from around the world. The wide range of short and feature length films aims to inspire and challenge the audience. Mountainfilm in Telluride seeks to explore critical and compelling issues the world is facing while showcasing the art of documentary and filmmaking.

A few highlights from the upcoming lineup of non-film events include:
“Moving Mountains Symposium on Water”
“Tribute to the Late Sir Edmund Hillary” hosted by David Breashears
“Foreign Policy Roundtable, Hot Spots Around the World” with Christiane Amanpour, Richard Holbrooke, Roger Cohen and Samantha Power
“The Village Green,” a discussion Ashton Hayes, England, and its efforts to be carbon neutral

Big names in the world of travel, art, adventure, and environmental awareness will grace the event. Early bird tickets are on sale until May 1. For more information please visit mountainfilm.org.

International Activities-A Refocus

Our phenomenal month with our wilderness medicine class has catapulted us to many activities in the wilderness and international medicine scene. Our Mount Rainier 2008 conference on July 31 to August 3 is gonna be amazing, and many of you know about it. But in the works is an amazing international emergency medicine conference in Buenos Aires, Argentina. On June 11-13, we will join in with the American College of Emergency Physicians (ACEP) and the Argentine Society of Emergency Medicine (SAE-Sociedad Argentina de Emergencias) to bring participants an exceptional educational event, whether you speak Spanish or English. Not only will talks on emergency and wiliderness medicine be given, but a unique opportunity to meet with the "movers and shakers" in emergency medicine throughout the Americas will be there. And don't forget the Patagonia backcountry skiing and jungle tours to take place after the conference! More information can be found at http://internationalemergencymedicine.blogspot.com.
Also in the makings are a four day mountain medicine survival course in October, and an opportunity to participate in many other activities in the future. Feel free to mail us at mail@mountainandmarinemedicine.com for more info!

Congratulations to Wilderness Medicine Class Participants

Our March Wilderness Medicine Class at the University of New Mexico was our best yet! Congratulations to our student and physician participants. We wish you well in all your future endeavors.

Our next course will be our Mt. Rainier High Altitude Medicine Course this July 31 - August 3, 2008.

Sneak Peak of upcoming courses: events for the upcoming fall and winter will include a some courses a little closer to home here in New Mexico. We are busy planning a weekend survival course in a spectacular little-known wilderness area and a wilderness medicine course for non-medical providers!

Check back for more details!

Joe Alcock MD

Wilderness Medicine Tip of the Week

Woman killed by Eagle Ray! Mortality from stingrays is increasingly reported. Read on...

The LA times today reports that a woman encountered a stingray that leaped into the boat she was traveling in. She may have died from a wound inflicted by the calcium carbonate barb of a full size eagle ray (example pictured above).

The UNM wilderness medicine class visited the stingray exhibit 2 days ago for a scenario-based learning experience; marine stings were discussed in great detail at the Albuquerque Biopark aquarium. As we discussed, approximately 4 instances of stingray barbs penetrating the heart have been reported in Australia. Most readers no doubt are aware of Steve Irwin's well-publicized untimely death by this mechanism. Exsanguination and arterial lacerations have also caused human deaths.

Short of cardiac penetrating trauma, first aid consists of immersion of the affected extremity in non-scalding hot water. The venom that surrounds the calcium carbonate barb is heat labile. Prompt hot water treatment results in impressive pain relief. Xrays may be necessary to rule out retained foreign bodies. Tetanus vaccination is indicated - as in all lacerations. Be aware that marine injuries may be complicated by unusual pathogens - such as Vibrio species and Mycobacterium marinum.

The best approach is to avoid being stung altogether. Most bathers can avoid injury by shuffling their feet when entering the water. Otherwise - avoid cornering a large sting ray in shallow water - as Steve Irwin reportedly did. The recent death of the boater encountering a leaping ray, while seemingly bizarre, has been reported more than once in Australia. If a ray leaps into your boat, you may just be out of luck! Be aware that the stinging barb is located about 1/3 of the distance down the tail from the body of the fish.

Finally, note that hot water is the treatment of choice for most penetrating marine stings, including stonefish, scorpionfish, even invertebrate stings such as urchins. Hot water is increasingly recognized as effective treatment for box jellyfish stings and portuguese man of war stings. More on that later!

Médecine de la montagne/Medicina de la montaña

For Francophones and Castillano wilderness enthusiasts:

Médecine de la montagne et de l’environnement.
Ici vous avez un site pour l’information sur la pratique de médecine dans les terrains extrêmes, et la médecine “d’improvisation.” Il y aura des podcasts sous cette rubrique en français dans l’avenir. Notre conférences sur la médecine de la montagne à Quito Equateur et Chamonix faisaient un, no, deux tabacs! Nous avons un mois de médecine de l’environnement chaque mars à Nouveau Mexique, et nous aurions notre prochaine course de médecine de la montagne à Mont Rainier, dans l’état de Washington. Nous sommes en train de collaborer avec l’Ifremmont (www.ifremmont.org) pour developer la formation de médecine de l’environement en français et anglais. Voilà une photo de notre course de survie et navigation dans le désert de Nouveau-Mexique. Vous pourriez nous contacter a www.mountainandamrinemedicine.com/contact/ pour plus d’infos.

Medicina en ambientes extremos
Aquí hay un sitio dedicada a la medicina en terrenos remotos, incluyendo medicina en el yermo y medicina improvisaciónal. Para los hispanohablantes, hemos proporcionado “minicursos” sobre estos tópicos. Infórmense aquí en este sitio lo que estamos haciendo en cuanto de la capacitación de un tópico muy interesante. Recientemente, hemos hecho un congreso de mal de montañas y altura a Quito Ecuador y Chamonix Francia, un curso de buceo en Bonaire (al mar caribe) y tendremos un congreso a Monte Rainier, en el estado de Washington. Hemos hablado en el congreso internacional de la Sociedad Mexicana de Medicina de Emergencias (a México, DF.) sobre la tema de “Hipotermia,” y vamos participar al congreso de la Sociedad Argentinas de Emergencias, a Buenos Aires el 11-13 junio 2008. La foto es una foto de navegación y supervivencia en el desierto de Nuevo México. Escriben al sitio de www.mountainandamrinemedicine.com/contact/ para mas información. También hay información sobre el sitio de www.reeme.org.

Bizarre death in Chamonix

According to reports, a man fell from a cable car (gondola) in Chamonix, France to his death. The gondola was one that travels to get to Planpraz, the mid-station to Le Brevent. This is of interest, because I took that gondola as did many of the Chamonix High Altitude Medicine participants during our marvelous excursion and course there last summer.
Read more
http://snowheads.com/ski-forum/viewtopic.php?t=37292

This is what the area looks like in winter.

Link to description of our course in July, 2007.

Hypothermia Lab

Wow, what a day up at the top of Sandia Peak today as a group of us tested some of the techniques of backcountry rewarming in cases of hypothermia. All were mildly hypothermic as measured clinically and by vital signs. There were slight afterdrops in all except the pair rewarming inside a sleeping bag. Definitely comfortable for the one being warmed, but not for the one warming! The shivering really burned energy, as all the participants were fatigued after the experience. A truly unforgettable learning experience!

Mac Guyver Medicine-does it work?

On Wednesday, February 27 2008, the UNM Wilderness Medicine course participants tested out the commonly accepted, tried and true ideas that are taught in many wilderness medicine courses. Problem is, most classes are in auditoriums of over 400 people, with a keynote speaker in the front. We found many of the ideas to work, but not as well as you would think. We devised ideas that are not normally taught in wilderness settings. Paul Romo is demonstrating yet another use for a foley...as a stethoscope! A good friend, Ken Iserson, gave me this idea with the baby nipple, and we thought of the foley. By the way, Ken will have a great book about MacGuyver medicine coming out this year-a tome that will pique the interest of the wilderness medicine or international medicine traveler alike. At any rate, the usual improvised airway control ideas were taught in our lab today, but the a question comes up...how do you improvise on the BVM?
Dario

UNM Wilderness Course is Underway!

This afternoon, students and medical residents from around the country met at the base of the Sandia Mountains in Albuquerque, NM to initiate the 9th consecutive UNM Wilderness Medicine elective.

The first part of the course teaches wilderness life support, the general approach to wilderness scenarios, and environmental emergencies. The UNM School of Medicine has provided the BATCAVE (basic advanced trauma computer-assisted virtual experience), a computerized human patient simulator, to teach wilderness ACLS and BLS principles. Skills and breakout areas are dedicated to basic and advanced airway techniques using mannequins. Students learn how to use bag valve masks, oral and nasal airways, multilumen airways, laryngeal mask airways, as well as endotracheal intubation and surgical cricothyrotomies. Other sessions are devoted to intravenous and alternative access for fluid resuscitation. Wilderness resuscitation scenarios with computerized mannequins allow students to practice their response to emergencies and understand when to terminate efforts.

Improvisational techniques are emphasized during this first week to provide a framework for subsequent scenario-based training. An entire day is spent at a local ski lodge, where 4 instructors teach students outdoor medical skills. In addition, we cover airway and breathing management, hemodynamic stabilization, splinting, and patient transport scenarios. A hypothermia laboratory session is performed in which 3 volunteers are cooled outside and are promptly rewarmed.

The first weekend of the course is devoted to wilderness survival and land navigation, which evolved from a 4-hour classroom gathering to a 2-day field trip in the New Mexican high desert. Shelter, matchless fires (flint and steel, bow and drill, and several other methods), water procurement, filtration, food, and weather prediction are covered during the first day's session. Three instructors teach 3 groups of 6 to 7 students in 3 stations covering the above topics. The second day consists of training on the use of a map and compass. Students learn a primitive means of route finding, and ways in which to measure distance and time. The course continues with a nighttime land navigation course, using a compass or the stars as a directional indicator. This field trip is consistently rated as one of the most valuable in the course; students feel more confident in dealing with a survival situation, both physically and psychologically.

Half- and full-day field trips near Albuquerque are educational as well as recreational. These trips are introductions to various types of activities, which also allow instructors to evaluate group strengths and weaknesses. A half-day mountain biking trip incorporates approximately 10 mini-lectures with patient scenarios during rest stops. A day of rock climbing instruction is usually performed nearby, where the basics of climbing, rappelling, anchors, knots, technique, and safety are practiced. Although New Mexico lacks an ocean, the excellent Albuquerque Biopark Aquarium is available as a classroom. Diving emergencies, marine envenomations, and marine biology are very popular subjects taught there. Professional divers (who staff the aquarium) demonstrate scuba diving equipment, mock dysbarisms, and marine envenomations. Land envenomations are taught by staff of the New Mexico Poison Control Center. A backcountry yurt near the Taos Ski Valley is our venue for a ski clinic and avalanche awareness course. Snow camping in Taos gives students opportunities to build snow shelters and experience high-altitude at nearly 12,000 feet.

The last module of the course is a 5 day trip to the Cedar Mesa primitive area of southeastern Utah. This remote canyon country provides a spectacular backdrop for lectures on dehydration, lightning injury, flash flood danger, medicinal plants, and land navigation. An hour each day is devoted to wilderness medicine scenarios in rugged sandstone terrain. These lessons demonstrate the difficulty of initiating a rescue effort and transporting patients in the backcountry.

The survival and land navigation training (as well as the medical and leadership aspects of wilderness medicine taught during the month) culminates during the day-long timed exercise called the Eco-Resus Challenge. Students are randomized into groups with an equivalent distribution of ability, gender, and physical conditioning. Each participant is given a general orientation to this grueling event, which takes place in a rugged area outside Albuquerque. All backpacks are examined for items that are deemed contraband (eg. GPS units, radios). Students are staggered into groups that are evenly matched in terms of physical and navigational abilities. These teams must navigate their way to a patient care station and stop to treat and/or transport that patient. Students are given a topographic map for navigation and are expected to use skills obtained during the course to find patients. Groups must navigate their way through the desert into a mountainous woodland. Tasks must be completed at patient care stations that must be completed before continuing to the next objective. Each group must fill out log sheets describing patient encounters in standard format. Simulated patients are to be treated in an appropriate manner for the existing conditions. "Victims" often will require evacuation to the next station. During the course, participants are expected to use a signal device to communicate to an incident commander. Each group is accompanied by an instructor familiar with the course who does not offer assistance, unless necessary for safety.

Students and faculty will finish this course on March 22, 2008 after the Eco-Resus challenge. The most effective rescue teams will be celebrated during a debriefing of the event. Students are encouraged to keep a journal of their experiences during the 4 week elective. Previous participants have contributed original artwork, song, poetry, videos, photo-journals, and even, yes, blogs to the UNM Wilderness Medicine historical record.

Exerpts from the best creative journals will be posted at this site, along with new videos, podcasts, and photography.

The UNM Wilderness Medicine Website is here:
UNM Wilderness

For further reading:
Wilderness and Environmental Medicine

Joe Alcock MD