Avalanche Awareness & Video Link!

This video is a graphic description of both the allure of backcountry skiing and the risk to those who tempt steep powder slopes!

http://revver.com/video/310519/a-dozen-more-turns/

We are going to post this as a permanent link at our sister site:

http://unmwildernessmed.blogspot.com/

Great video, Thanks Diane for the link!

Joe Alcock MD

What to bring to Rainier

As I am winding my way up to Seattle via Colorado and Wyoming, the Rockies have been warm. August will be nice at Rainier, too. But don't relax...bring mountain clothes!


For those NOT climbing, I recommend:
Jacket and waterproof or water resistant shell; rainjacket
Layers of clothing for upper body and pants (possible water resistant pant shell as well)-from material that wicks the sweat away from the body
Warm hat and a cap
Sunglasses, sunblock or the like
Gloves
Sturdy pants for outings, hiking boots or sturdy trail shoes
Daypack, water container
Warm socks
Thermal underwear
CAMERA
Writing implements
Personal medical kit: blister kit, ibuprofen/Tylenol, tape, personal meds; acetazolamide (if tolerated) if going up high and you have a history of acute mountain sickness)
Hint: for activewear, I avoid cotton, opting for Coolmax or similar clothing. Nothing worse than wearing your sweat when a blast of cold air blows in from Alaska!

Since we are hoping to take a hike to a snowfield (time permitting), in addition to the above, you may ALSO want to bring these as options (but don't knock yourself out in buying these if you don't have):
Crampons, snow climbing boots on which the crampons fit
Long ice axe
Trekking poles
Gaiters
Climbing harness, locking carabiner (large)
Climbing helmet
Duct tape
A Release waiver (see website)-this outing is not required as part of the course!

For climbers, consult the IMG website (http://www.mountainguides.com/rainier-gear.shtml). I am leaving the cannister of oxygen at home, but bringing, in addition to all the above:
Down jacket
Insulated winter gloves (waterproof) and and EXTRA PAIR!
Plastic bags (for trash, and for vapor barrier liners)
Glacier glasses
Rope (for 2)
Prusiks or jumars
extra cord/cordelettes and extra carabiners
Sleeping bag, bivy sac, insulated foam pad/Thermarest equivalent
Tent (four season), groundcloth/tarp
Implements and small stove for cooking, food
Survival kit (map, compass or GPS, knife, fire starter, chocolate bars or glucose gels, cell phone, signal mirror (on my compass), HEADLAMP with extra batteries
Shovel, avy beacon, probe

Happy packing

Darryl

High Altitude Medicine Course at Mt. Rainier National Park

Mountain & Marine Medicine is pleased to report that our upcoming course at Mt Rainier National Park is nearly Sold Out!

If you are on the fence about coming, now is the time to send in your payment or pay online.

We have great group of participants with a diverse background. There will be plenty of opportunities for great conversations, starting on July 31

at the Nisqually Lodge.

Bob Quinn MD at rquinn@salud.unm.edu ,as always, is available to give details about the optional climb of Mt. Rainier immediately following the course. Don't miss this special event.

PS. The photo is from our climb last summer of Mont Blanc in France, not Rainier!

Joe

The Value of Pre-Acclimatization

We encourage everybody to who is planning on the climb of Rainier to make an effort to visit high altitude prior to the course. This is easier for some than others. Look back to this blog for more details!

Physical Preparation for Rainier

Now it’s time to think about our climb to Rainier. Physically preplanning your summit day will enhance your chances of getting to the top, and enjoying it. If you have not been exercising, do so now. Cardiovascular fitness will be key. Engaging in activities specific to the goal will be important. Running and/or walking around with a heavy backpack (at least a third of your weight) for 30 minutes for 3 times a day will help. Get your heart rate up to 80 percent of maximal (220 minus age is your “maximal”-an easy formula). Cross train at least once a week doing a favorite activity, preferably climbing and or swimming for overall conditioning. If you are not fit, start your exercise slowly. If you are in good shape, you can double these workouts.
Increase complex carbohydrate intake (pasta for example) once you are doing this regimen, unless you need to shed a few pounds. In the latter case, decrease carbohydrate content, but keep protein intake the same. Substitute red meat intake for chicken or fish, or beans with corn or rice. Stop smoking, and if you have any health problems or are over 50, get a medical exam if you haven’t done so before.
If you are around high altitude, begin acclimatizing. This will be crucial. Initiate by going up to 8,000-foot elevations once or twice a week to walk in the first week for at least 2 hours. If possible, spend three days over 8,000 feet the second week, with a sojourn to 10,000 feet, walking. Spend the third week doing three of your routine workouts over 8,000 feet, going to at least 80 percent of maximal heart rate for 20-30 minutes. If adventurous, do one of your workouts at 10,000 feet. Rest at least a day between workouts.
Continue this the fourth week, especially if you were unable to do this routine during week 3. For the fifth and sixth week, if possible, add a hike (with a backpack) to 12,000-14,000 feet, or whatever is highest for you. Keep well hydrated at all times, and consider drinking “Endurox” or “Accelerade” to your hydration regimen. For “extra credit,” sleep above 10,000 feet once a week on weeks 3-5.
This regimen should reduce your chances for high altitude illness. Before you undertake this suggested program, MAKE SURE YOU CLEAR IT WITH YOUR PERSONAL PHYSICIAN FIRST, AND DO NOT UNDERTAKE THIS PARTICULAR REGIMEN IF YOU HAVE CARDIOPULMONARY DISEASE OR OTHER ILLNESSES THAT MIGHT FLARE UP AS A RESULT OF THIS REGIMEN. AND EXERCISE CAUTIOUSLY AT ALTITUDE IF YOU HAVE HAD PROBLEMS AT ALTITUDE BEFORE. You may contact us for further information.
dario

One of our Rainier participants writes:

" I am looking forward to the conference in just a couple of months. I was wondering if you knew through your blogging or people signing up.....if there are any folks sharing rides from SEA TAC down to Ashford for the conference? I was hoping to rideshare with some one, pay for gas, etc..."

Now is the time to but tickets to Seattle and make travel arrangements. I can help coordinate rideshares if there is interest. Send an email to info@mmmedicine.com

Cheers,

Joe Alcock

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

Airline Emergencies

A recent story in the LA Times highlights the death of an airlines passenger, allegedly because of faulty medical equipment. Click on the picture to right to see the medical kit/equipment that large commercial airliners should have available.

The article in the New England Journal of Medicine "Responding to Medical Events during Commercial Airline Flights" is available here:
http://content.nejm.org/cgi/content/extract/346/14/1067

We will be discussing this and other articles during a fireside UNM Wilderness Medicine journal club later this month in Utah!

Update on the death in the skies:
Woman dies on American Airlines flight

JA

The Basic Medical Kit

The components of a basic medical kit can include:

Cpr mask
Ace wrap
Safety pins
Epipen
Duct tape
Superglue
Soap
Sunscreen
Sam Splint
Tweezers
Gloves
Iodine water tabs
Aspirin & Ibuprofen
Antibiotics, (Narcotic Analgesics)
Moleskin, bandages
Hand Sanitizer
Syringe
Survival Gear
Clothing
Whistle
Cellphone

Note that a stethoscope and blood pressure cuff are unnecessary for this basic kit. Prescription medications and controlled substances are optional and will be the subject of another post.

Survival kit and comprehensive medical kit information can be found here:
Medical Kits

Wilderness Medicine Tip of the Week

While great media attention is devoted to victims of avalanches, the Everest death zone, and shark attacks, it is easy to lose sight of more broadly useful wilderness medicine information.

This winter, several parties of skiers got lost near our regional ski areas. At the time of this writing, two snowboarders have not been found and are presumed to have perished on the mountain. Another group included a wilderness medicine trained physician. They ultimately survived after building a snow cave and calling for help.

Training and appropriate gear are paramount when trying to survive the unexpected night out in the snow. To that end, we will be posting several entries on the wilderness medical kit.

Our medical kit changes depending on whether we are traversing glaciers in the Alps, diving in the Caribbean, or hiking in the Rockies. However, the medical kit should always contain personal protective gear such as sunglasses, sunscreen, and gloves. Medications should include OTCs like ibuprofen, antihistamines, as well as prescription analgesics and antibiotics. Wound care and dressing supplies are important. Finally, survival gear is essential. We are not talking about shark-repellants and grizzly stun-guns here.

Wilderness Medicine Tip of the Week:

Bring a signaling device in the backcountry.

Survival gear includes a communication device. This could be as simple as bringing a cell phone or radio to call for help. (One should bear in mind that cell phone reception is spotty at best in much of the backcountry - but the "pings" between cell towers and the phone can aid in finding victims even when the signal is too weak to make a call). Some authors recommend bringing extra cell phone batteries on a backcountry trip. Don't forget about signal mirrors. Signal mirrors are effective when the sun is shining. Commercial products are available at your sporting goods store. Alternatively signal mirrors may be improvised from a compact disk, the inside of a soda can, or anything shiny. You should also bring a whistle. Some backpacks have an integrated whistle in the chest strap. Even if your backpack doesn't have that feature, whistles are lightweight and are very helpful in a rescue scenario. Other options include visible signals, such as bright clothing, a smoky fire (assuming you are not going to cause the biggest forest fire in the history of Arizona!) and nighttime strobe lights. Divers can carry whistles that attach to their supplemental air supply. Aviators sometimes carry dyes that stain the water if they have to parachute into the ocean. While diving, I carry an inflatable "safety sausage" balloon-like device that is visible from a distance. So while circumstances matter, the concept of a communication device is of utmost importance!

Refer back for more. Soon we will post examples of lightweight and comprehensive medical kits at our websites.

Thanks go to Stephen Guine for providing the classic in wilderness medicine literature: "How it Feels to Be Attacked by a Shark"

Joe Alcock MD

Good Conditions for the Wilderness Class

We went to the Sandia Crest today to check on conditions for the upcoming Wilderness Medicine Elective. The verdict? Great snow for the beginning part of the course. The wilderness medicine course has several modules, including the hypothermia lab in the Sandias, desert survival at Cabezon, backcountry snow camping and avalanche awareness at Taos, and canyon country backpacking in Utah. March is a great month to experience the variety of environments and weather conditions in the high desert of the Southwest. In some years past, we have had very little precipitation, however, for our snow-dependent activities. This year promises to be a good year for our Sandia Mountain and Taos excursions! This photo was taken today by my wife, Satkirin Khalsa. The well-dressed attractive individual in this photo is our dog Nanda.

Avalanche Awareness & Video Link!

This video is a graphic description of both the allure of backcountry skiing and the risk to those who tempt steep powder slopes!

http://revver.com/video/310519/a-dozen-more-turns/

We are going to post this as a permanent link at our sister site:

http://unmwildernessmed.blogspot.com/

Great video, Thanks Diane for the link!

Joe Alcock MD

UNM Wilderness Medicine Course Blog

The UNM Wilderness Medicine Elective starts in 4 days! We are very excited about this year's course, which promises to be a very educational and action-packed four weeks. We have some great additions to our faculty, with Jason Williams of Albuquerque Mountain Search and Rescue playing a prominent role in the planning of this year's course. We will be introducing other faculty and personalities of the elective in upcoming posts.

Jason's photo is posted at our a new blog that is dedicated to the UNM Wilderness course.
you can find the blog here:

http://unmwildernessmed.blogspot.com/

The site you are currently reading - Mountain and Marine Medicine Blog - will continue to bring news of the UNM wilderness medicine events but not on a daily basis.

UNM Wilderness Medicine News will contain directions to events, brief descriptions of the people involved in the course, lecture handouts and useful information for students!

We hope you enjoy the new blog!

Joe Alcock MD

More on the Sandia Ski Area Lab

The upcoming Wilderness Medicine Course is visiting the Sandia Ski area. (Most people do not know that Albuquerque is one of the few major metro areas with its own ski area. In fact, you can access the slopes from the Sandia Tramway which leaves from the Albuquerque foothills.) We will be meeting at the ski lodge area next week. Directions to the Sandia Ski area from Albuquerque are: I40 East to Tijeras. Take route 14 north to Sandia Park. Follow the signs to the Sandia Ski area and park at the lodge for lectures on hypothermia and survival in the snow!

Joe Alcock MD

Travel Medicine Can't Miss Diagnoses

Can't miss diagnoses in travel medicine.

The majority of returned travelers with health complaints have garden variety illness such as gastroenteritis and upper respiratory infections. However, health care providers need to be aware that life threatening travel-related illness also occurs. Some of the "can't miss" diagnoses in returned travelers include:

1) Falciparum malaria

2) Malaria, especially falciparum, in pregnant females

3) Viral hemorrhagic diseases, including ebola virus, marburg virus, lassa fever, and rift valley fever. Dengue shock syndrome and yellow fever can also he complicated by hemorrhagic manifestations. While the viral hemorrhagic fevers are relatively rare, the high mortality rate makes them "can't miss" diagnoses.

Further reading here:
Viral Hemorrhagic Fever

Joe Alcock MD

Sandia Ski Area Hypothermia Lab

Next week the faculty of Mountain and Marine Medicine will accompany students of the Wilderness International and Improvisational Medicine Course to the Sandia Ski area. There, we lecture on hypothermia and frostbite, among other topics. At right is photo of a volunteer who was (temporarily) underdressed for the elements. Faculty and students have "chilled" outside for a few minutes. Students then practice rapidly rewarming these "victims" in a hypothermia wrap and plentiful hot chocolate.

Students who will be joining us should look at this gear list:

Outdoor snow gear - ski wear - sunglasses/screen -swimsuit for some!
Daypack
Ski area: Alpine/Telemark or Snowboards
Backcountry: X-country skis or Snowshoes
Bring or buy lunch/drinks
You may rent cross-country skis/snowshoes at REI - (505) 247-1191
Other gear at Sportz Outdoor (505) 837-9400
Ski Systems (505) 296-9111
UNM outdoor shop 277-8182

Joe Alcock MD
www.mmmedicine.com

Travel Medicine Case (?)

This is the case of a 44 year old male who presented to an Albuquerque hospital after passing a pale 1 meter long parasite. Pictured at right is the worm, which has the appearance of fresh linguine.

The specimen was taken to the lab where it was placed in fixative and then sent to the hospital media department for photographs.

History revealed that the man had not in fact traveled, but was an aficionado of fresh seafood. Additional questioning revealed that he had enjoyed salmon sushi, made at home, prepared from fresh fish. It is unknown whether he used wasabi or a fine sake with his meal!

As for the parasite ID:
Click here to see what happened to our patient:
Answer

When the UNM Wilderness Medicine Course begins next week - we will start by explaining the general approach to wilderness medicine patients: The Scene size-up. The scene size-up has three components: First - Check the scene safety - Is it safe for rescuers to approach and attend to victims. Second - Assess the mechanism of injury - Consider what injury patterns might arise from such a mechanism. Third - Find how many victims are involved - the number of injured persons has large consequences for the rescue effort.

Go to the UNM website for additional information about our March Wilderness Medicine course!

UNM Wilderness Medicine

Hope to see you soon!

Joe Alcock MD
www.mmmedicine.com

Brand New Website

You can find our listing of wilderness medicine CME courses at our brand spanking new website:
http://www.mmmedicine.com/index.cfm
Be sure to bookmark the page!

Joe Alcock MD

UNM Wilderness Medicine Course News

In a little more than 1 week, Darryl Macias MD and I will welcome 20 students for the University of New Mexico's Wilderness International & Improvisational Medicine Course! The first week of the course will take students to the Sandia Mountains for high desert hiking and backcountry and alpine skiing adventures. Each excursion has a heavy didactic component and features scenario-based learning. We will end the week with a visit to the BATCAVE, a computer-driven human mannequin that allows students to practice life-saving techniques in wilderness cardiac and respiratory arrest scenarios. Later, we will visit a backcountry yurt in Taos, the remote desert of north central New Mexico (pictured above), and the canyon country of Utah! Visit this blog for upcoming updates as we track our progress through the month!

Joe Alcock MD
www.mmmedicine.com

New Logo

Mountain & Marine Medicine has a new Logo! Among the many new developments at Mountain & Marine Medicine (M3) is this new image that will soon be emblazoned on new T shirts and other M3 merchandise. Email us for details!
www.mmmedicine.com/contact/

Many props go to our new web designer, Joe Black, for this well-produced emblem that conveys what Mountain and Marine Medicine is all about. Thanks, Joe!

Visit this site frequently for lots of new and exciting changes at M3!!!

Joe Alcock MD

Wilderness Medicine Course pictures can be found at our new Mountain & Marine Medicine Multimedia Page:
http://www.mmmedicine.com/multimedia/
Pictured here is a workshop from our High Altitude and Mountain Medicine Course on Mont Blanc!

Joe Alcock MD

Wilderness Medicine Tip of the Week

This is a New Feature of the Mountain & Marine Medicine Blog:
Each week we will publish a wilderness medicine "pearl", explaining priorities of caring for patients in the out of doors.

Wilderness Medicine Tip of the Week!

Foot fractures are common injuries among climbers, as in this example of a 29 year old male who fell while bouldering.

Calcaneus fractures can be obvious as in the radiograph above, or they can be subtle. The inability to bear weight is an important clue. However, don't forget to finish your exam. Rapid deceleration from a fall from height delivers energy sufficient to break bones elsewhere in the body. This week's tip: 10% of patients with a calcaneus fracture will have a lumbar spine compression fracture. Always protect the victim's neck and back & examine the spine for tenderness!

Check back next week for more! And don't forget to visit
www.MMMedicine.com for great wilderness medicine adventures!

Joe Alcock MD

UNM Wilderness, Improvisational and International Medicine 2008

Hello from Albuquerque to all taking the March class!
We are excited to have you come out at the end of February. Things are on track for another OUTSTANDING course-so get ready to learn, live, and laugh! Although I am honing my survival skills a bit (practicing with a bow and drill for firestarting), I have been "checking" out the snow for you as well. The backcountry skiing and snowshoeing is really good this year, and the weather is mild after several weeks of pretty cold weather. Dress properly...we are all meeting at the Copper open space for orientation at 1pm on Feb 25. You should have received a map. Registration will be done first (we will also do a little "accounting" work). Then, on a nice hike. Give us a jingle at 505-272-5062, or email me at dmacias@salud.unm.edu for questions. If you have anything that you would like to learn other than what is on the WIIM website, let us know. And tell your friends and family not to get too jealous while you embark on this fun educational event...
Cheers, aloha, namaste, and hasta...Darryl (Dario)

High Altitude Medicine

High Altitude Medicine - Rainier July 31, 2008 - August 2 2008

Mountain & Marine Medicine LLC 's Rainier High Altitude Course has been endorsed by the American Academy of Emergency Medicine.

And...the course has been approved for AAFP CME credit for 21.75 prescribed credits. See our site for the full statement:
www.mmmedicine.com

Join us for this exciting event in July 2008!