Submitted by Dr. David Johnson, WMA President & Medical Director.

DJ in the Belen market of Iquitos, Peru.

This venue winds forever along the river’s edge.  It serves the population 7 days a week, offering all manner of food, herbs, spices, wood products, alcohol and jungle remedies produced or grown in the many distant jungle communities up and down river.  Iquitos, a city with more than 500,00 inhabitants, is bounded by the Amazon, Nanay and Itaya rivers.  It is purported to be the largest city in the world unreachable by a road.

DJ has been in Cusco and Lima studying tropical medicine for the past 9 weeks.

Submit Your Entries

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?: Carrefour, Haiti

“I just got back from  a medical relief trip to Carrefour Haiti (suburb of Port-Au-Prince). The shot is looking over the compound I was based at. There were approximately 1500 people living in very close proximity to each other under tarps and tents.  We also treated many patients in mountain clinics cut off from aid.

Surely, my WALS () training benefited me and other team members immensely. For instance, I had a female patient that had severe abdominal distension that I needed to relieve. Unfortunately, I had no catheter. However, what I did have was IV tubing. I cut off an appropriate length, rounded off one end with a match, and sterilized it the best I could with alcohol and betadine. I was able to drain over 900 mL of urine. The procedure was a success.”

-Brian W., RN, WALS

Submit Your Entries

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

The Man in Arunachal Pradesh, NorthEast India to the Myanmar border

Here’s the man (or actually me wearing the famous t-shirt) in Arunachal Pradesh in the North East of India close to the Myanmar border on a 3 week hiking trip.

Submit Your Entries

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 .

Last year we began the ‘Where’s the Man?’ contest and received some great entries! This year, we will be continuing to collect submissions, which will all be posted on our blog and on our Facebook page. At the end of the year, our team will review all of the pictures and captions to select three winners. Those three winners will receive a $50 gift certificate to our online Gear Store.

If you are attending wilderness medicine course through WMA that is three days or longer, you will receive a course t-shirt. Simply take a snapshot of yourself sporting your da Vinci-inspired tee and submit to with a caption.

Looking to upgrade your Wilderness EMT?  How about taking the WEMT-I?

Starting in May of 2010, Wilderness Medical Associates, the industry leader in wilderness medicine will begin offering the .  This course is designed to expand the knowledge base and scope of currently certified Wilderness EMTs or EMTs.

Wilderness EMT Course Content

This course meets all requirements of the Department of Transportation (DOT) Emergency Medical Technician-Intermediate/85 (EMT-I/85) curriculum and the Wilderness Medical Associates WEMT-I curriculum. Topics include patient assessment, body systems, equipment improvisation, trauma, oxygen administration, automatic defibrillation, ECG interpretation, IV therapy, pharmacology, overview of primary care medicine, advanced assessment, endotracheal intubation, environmental medicine, toxins, backcountry medicine, wilderness protocols, and wilderness rescue.

Wilderness specific subject topics include:

Logistics and Introduction, General Concepts in Wilderness Medicine, Roles and Responsibilities, Patient Assessment, Critical System Problem Recognition Drill, Critical System Summary, Spine Musculoskeletal, Limb Splinting, Dislocation Reduction Demo and Practice, Skin, Soft Tissues and Burns, SAR/Organization, Small Group BLS Simulations Thermoregulation, Cold Injuries, Altitude, ALS Treatments and Meds, Appropriate Technology, ALS Tools and Medications, Night Simulation, Expedition Practitioner/Backcountry medicine, Toxins, Bites and Stings, Lightning, Submersion injuries, Diving, Improvised carries, low angle litter evacuation, hypothermia wraps, antibiotic usage, pain management, common problems associated with the EENT.

Wilderness EMT Class Format

This course is 75 hours classroom and 36 hours clinical time over 16 days. On most days class will run from 8:00 a.m. to 6:00 p.m. Mornings will begin with quizzes and case presentations from students who had hospital rotations on the previous day. The rest of the morning will be devoted to lectures.

Afternoons are devoted to practical hands-on sessions and video taped simulations. Expect 2-3 emergency rescue simulations with made-up victims and stage blood that will be videotaped for enhanced learning. Evenings are reserved for case studies, clinical rotations, and assignments.

Need more information or want to enroll?

Contact us at:

for the list of upcoming Wilderness EMT-I courses.

Click here for more information about the Wilderness EMT-I course.

2010 Medical Wilderness Adventure Race (MedWAR)

The race series for the 2010 MedWAR events have been announced! MedWAR is a unique opportunity for you to learn about and test your wilderness survival and medical skills through a combination of wilderness medicine and adventure racing. These races usually sell out 3-4 weeks in advance.

Check out the following resources on MedWAR:

A student sent us in this story about how he used his to assist a woman that suffered a femur fracture.

A woman slipped and fell on the ice three feet in front of me. While she was lying on the ground in great pain she reported that she was recovering from a hip replacement. I had my hip replaced a couple of months ago and thus knew she was at risk for a femur fracture. She said it felt like her femur broke. I immediately rushed into action using my WFR skills by having someone dial 911 (we were in front of a drug store, one building over from the Cleveland Clinic where I had just had an MRI on my hip). I also immediately used my WFR skills by protecting the woman from would-be rescuers. The ambulance arrived in under 3 minutes, and she was transported the one block to the ER at the Cleveland Clinic. Turns out she did have a femoral neck fracture. So, thanks for the wonderful training, and know that if we had been more than 2 hours from a hospital I would have done more than call 911. Phil and Robyn’s lesson that many times the best thing you can do is “protect the patient from other rescuers” was very pertinent in this case b/c two would be rescuers first reaction was to try to have her stand up and “walk it off”. Not a good idea with a femur fracture…. Also, their constant reminders of the difference between street reaction (e.g., call 911) and field reaction immediately came to mind.

Q:  I sustained a “mild” concussion about a month ago and seem to be doing well.  I am planning to begin work at 3100 m (10,200 feet) starting at the end of the month.  Should I be concerned?  I have worked at this altitude before without any problems.

I do not believe that you should have a particular concern regarding work at altitude because of the recent concussion per se.

Also frequently referred to as a traumatic brain injury (TBI), a concussion is commonly diagnosed clinically when a person experiences any loss of consciousness, confusion, or amnesia following a blow to the head.  Increased intracranial pressure (increased ICP) or brain swelling is the anticipated problem or what we worry about afterward.  The swelling results from bleeding or the accumulation of edema (fluid) in brain tissue.  The early symptoms of increased ICP include persistent vomiting, worsening headache and deterioration of one’s mental state.  It does not sound like you had these symptoms or have this problem now.

Do you have any other symptoms now?  Frequently, following a blow to the head, even without ever experiencing a concussion, people can develop a post concussive syndrome (PCS).  The symptoms of PCS include headache, insomnia, feeling more tired than usual, blurry vision, light sensitivity, difficulty concentrating, feeling off balance, and emotional liability.  These are not signs of increased ICP; they can last for weeks.  If you have any of these, they could get worse at altitude and thereby potentially make you more accident prone.

People who go to altitude, especially over 3000 m (9800 ft), are at risk to develop altitude-related increased ICP called high altitude cerebral edema (HACE).  This is related to the lower oxygen levels and in part, to the resulting reflex increase in brain perfusion or blood flow.  Theoretically, I suppose, if you were continuing to have a slow blood leak from your injury, it could increase in size more quickly as a result of going to 3100 m.  But without ICP symptoms now, this seems very unlikely…unless you sustain another TBI.

I do not know whether a TBI with or without PCS makes one more susceptible to HACE. I doubt it but I could find no substantive references one way or the other.

Bottom Line

If you are feeling fine, go for it and have a great time.  Remember, the best way to minimize altitude symptoms is to ascent gradually, especially over 2500 m (8200 ft).  In addition, increase your physically activity as you acclimate to the new environment.   Some good rules include:

1.  If you can, before sleeping above 3000 m, spend a night above 1500 m (5000 ft).

2.  Above 3000 m, don’t sleep higher than 300 – 500 m (1000 to 1650 ft) above your previous night’s sleeping altitude.

3.  With each 1000 m (3300 ft) in altitude gain, add a rest day and/or sleep at the same altitude for 2 consecutive nights.

If you want more information on altitude, check out .  They have a nice summary.

Q: I understand the steroids (e.g., prednisone) can sometimes be helpful in managing allergic reactions and asthma and that their use is part of your protocols for those conditions.  If there was nothing else available, would ingestion of a steroid cream be a suitable and effective alternative for prednisone?

After spending some time and given the resources I have at hand, I cannot give you a satisfactorily accurate answer.

Hydrocortisone is available in a pill form and is used particularly by people whose adrenal glands are absent or not functioning properly.  In this form it is rapidly absorbed in the gut.  4 mg of hydrocortisone equals 1 mg of prednisone.

Hydrocortisone is sold for topical use (on the skin) either as 0.5 or 1% creams or ointments.  1 gm of 1% topical hydrocortisone is equal to 10 mg of hydrocortisone.  That would give you nearly 300 mg in a 1 ounce/30 gm tube or, theoretically, the equivalent of 75 mg of prednisone.  What I don’t know and what I was unable to find out easily is what happens to hydrocortisone topicals on ingestion.   The cream is water soluble so, at least theoretically, it is more easily absorbed in the gut than the ointment. In addition, I could not find any pharmacokinetic (movement of a drug through the body) data about rates of absorption from the gut or subsequent blood levels and I have no idea what happens with either when exposed to digestive enzymes.  Aside from nausea and vomiting or diarrhea, the poison control literature suggests that a mouthful is not likely to be toxic.

So yes, theoretically, it could help but any potential effect would be unpredictable.  By the way, a tube cost about 5$US; thirty 20 mg tablets of prednisone tablets are less than 10$US.  I think you know what I would choose.

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As you may have seen, has been traveling around the globe- climbing trees, swimming rivers, hiking trails, helping those medically needy, and even spreading some holiday cheer!

It took us, in the WMA office, a long time of pawing through these amazing photographs to finally decide one which ones to select for the three $100 cash prizes, but we have come to our decision. Thank you to the many contestants who submitted photos and shared your stories!

Winners of the $100 Cash Prizes

Click on the photos above to see their full entry.

Honorable Mention

Thank you to Josh Martin and Paul Cunningham at Northern Cairn who submitted and came with the idea of holding this great contest. What a wonderful way for instructors, students, and others to interact and compete for some cash!

Stay tuned to see what contest we will be holding this year!