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Where’s the Man?: Pacific Crest Trail, WA

WMA-certified ,  LT, sent us this photo of him cruising along with the man alongside the caption below. Thank you for making the trails a better place!

“The man soaring over White Pass, Washington.  He joined my crew and I as we performed 6 months of restoration work along the PCT from Washington to Southern California for the Pacific Crest Trail Association.”

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Send an email to with a picture of you wearing your ‘Where’s the Man?’ t-shirt alongside a caption to be eligible to win. At the end of the year, we will select three entries to receive $50 gift certificates to our online gear store.

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Where’s the Man?: Anchorage, AK

Jerimiah was putting “The Man” hard at work while rebuilding Rome for his vacation bible school. Jerimiah is a medical missionary and is certified as a .

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Send an email to with a picture of you wearing your ‘Where’s the Man?’ t-shirt alongside a caption to be eligible to win. At the end of the year, we will select three entries to receive $50 gift certificates to our online gear store.

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Where’s the Man?: Golan Heights of Northern Israel

Kevin Z., a WMA certified , was hiking the Golan Trail and decided to take this photo of him next to a minefield (yes, a minefield). I don’t know if this would go beyond the first triangle in the Patient Assessment system.

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Send an email to with a picture of you wearing your alongside a caption to be eligible to win. At the end of the year, we will select three entries to receive $50 gift certificates to our

Where’s the Man?: Isla Bella, Panama

WMA Instructor, Stephen Leavins, sent in this photo of him while he was on a sea kayaking trip. The locals dug him out some canoes and great paddles.

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What is the best way to cool off a heat stroke victim?

The simple answer? Using the resources at hand, aggressively lower the person’s body temperature to 39°C (102.2°F) as quickly as possible.  Anything longer than 30 minutes has the potential to have more profound and long lasting pathophysiologic effects. The debate about treatment revolves around the efficacy and safety of cold water/ ice bath immersion versus the mist/ fanning method.  When feasible, I advocate cold water immersion. In fact, it is at least twice as fast as the best misting methods.  It appears to be as safe and maybe safer when one considers the relative rates of cooling.

How so? Cold water dissipates heat from the body 20 to 30 times faster than air does at the same temperature. Evaporation speeds cooling but not as much. People argue against cold immersion for fear that the cold will induce vasoconstriction and/or shivering and therefore inhibit cooling or even increase body temperature.  If these factors are important, one would expect to find clinically relevant support in the medical literature. I have never found any. (Jump into cold lake and see what your body temperature does!) In addition, some worry that cold immersion for heat stroke will precipitate a cardiac arrest.  Again, the literature does not appear to support this concern clinically, even in the elderly.  In the end, temperature height and duration are the key factors linked to morbidity and mortality in heat stroke.

The real question regarding treatment should revolve around what means are at hand to modify those factors that caused the heat stroke to begin with.  First, stop the heat stress by leaving the environment and resting. If there is insufficient cold water for immersion, apply water in small droplets, like mist from a spray bottle, and get the air moving.  The misted water will evaporate more quickly and probably cool better than pouring a bottle over your patient’s head.  A combination of techniques can work well, too.  On the other hand, ice bags in the groin and around the neck do not cut it.  Because the problem with heat stroke is related to increased heat production and/or decreased dissipation, not the thermostatic readjustment in the hypothalamus seen with a fever, don’t use antipyretics (e.g., ibuprofen, acetaminophen).  And don’t forget about appropriate volume replacement.

Greg Friese from CentreLearn sent me

Where’s the Man?: Cape Peninsula, South Africa

Allie sent in this photo of herself showing off the man in Cape Peninsula, located near Cape Town, South Africa.

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Where’s the Man?: Boston, MA – Run of the Charles

Henry Chance was on hand in Boston, MA for the annual . The only major medical incident that day was a collection of bruised egos.

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In order to establish guidelines for comprehensive, thorough, and more consistent wilderness medical training, AORE and other organizations that hold a respectively large place in the field of wilderness medicine have signed off on the Wilderness First Responder SOP (Draft), a document that complements the .

Please consider helping AORE make a difference by reviewing this document if you have ever sponsored a WFR course, attended at WFR course, or instructed a WFR course. Does this document include the topics that you want your staff to know? As a participants of a Wilderness First Responder course, is this training enough to prepare you for backcountry medical emergencies? Are the elective topics sufficient? Please be clear, professional, and thorough.

Please send your comments to Tim Mertz (). Comments received will be consolidated and then presented to the wilderness medical providers for consideration in the final document.

Q: What do you think of burn gels, specifically those containing tea tree oil? A practitioner from a burn center recently made a comment during a web presentation that we in the field should stop using cool, wet towels in favor of a burn gel for partial thickness burns. I have not found FDA approval for their use.

A: There is a lot of art in the practice of burn care.  As I have traveled the country and the world, I have heard competent people insist that they have found the best way to treat burns.  Not surprisingly, they do not all use the same products.  I suspect that this is often a matter of preference and habit rather than proven superiority.

Cool compresses are utilized to stop the burning process.  This is usually complete within 1/2 hour, and probably less.  Although continued use makes things feel better, there is really no extra therapeutic benefit.  And, prolonged cooling of a large surface area burn can cause hypothermia

Tea tree oil?  I don’t know.  I have heard aloe vera and honey endorsed, too.  What matters?  After making sure that critical system issues are addressed and the burning process is neutralized, all burns should be cleaned, protected and monitored.

When it is comes to wound and burn care, more often than not, good nursing care trumps any particular product.

Where’s the Man?: Butter Island, ME

Here’s the man in Maine on Butter Island. This submission is from Jeff Isaac, PA-C, WMA’s very own curriculum director and instructor.

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