Submitted by WMA instructor, :

This is “Buddy” enjoying the view from one of the overlooks along the AT as it wends its way between NY and NJ….  Buddy was found by a colleague of mine abandoned and tied to a post near one of our worksites in the Bronx at the end of July. I ended up with him–all 45 ringworm infested pounds of him… Since then, he’s (obviously) much healthier, and is so much fun to have around that I couldn’t send him away.

When he is a year old (in Feb.) he will be testing for Canine good Citizen and Therapy dog certifications. From there, he’ll try his paw at some SAR and/or agility work. In the meantime, he’s doing a bit of advertising for WMA!

Don’t forget! At the end of the year, we will select the 3 best submissions. The winners will receive $100 cash prize.  Send in a picture of yourself wearing your WMA course t-shirt to [email protected] in order to be eligible for the prizes.

Q: What are your thoughts regarding Quickclot? One of the kids in my program recently had a fairly severe laceration to the knee and the bleeding was hard to control/messy. If the stuff works, it seems it may reduce possible contact with blood borne pathogens to staff.

“…the stuff works..”  or “…they make a difference…”, those are the suppositions that get to the heart of the matter.  I have written previously about clot enhancers and have expressed my unabashed skepticism.

In the last few years, the original QuikClot that was supposed to stop all bleeding without any harmful effects has been reformulated to be cooler because of concerns about burns.  Reengineered again, it is available, impregnated in gauze.  But do any of these really work?  There are anecdotal reports and animal studies.  The claims made by Z-Medica that their products have saved hundreds of lives seem hyperbolic and unsubstantiated by anything more than individual or pooled testimonials.  Each new animal trial shows the new product to be better than the prior one, the one that was supposed to stop all bleeding.( )  This is not science, this is marketing.  I am not aware of any clinical trials that look at important human outcome in any meaningful way.  The fact that someone, like the army, is using something does not make it efficacious or safe.  And in addition to burns, there have been other problems reported with the older formulations.  I don’t believe that the science with the other leading products (chitosan-based: e.g., is any better.

I completely understand why the military wants a product that will stop bleeding easily.  Think about it.  As with all combat, bleeding is the major pathway to death.  Field treatment has improved significantly but who wouldn’t want to do better for otherwise healthy young women and men?  What could be better than being able to pour something into an exsanguinating wound and have the bleeding stop, especially where a tourniquet cannot be applied?  It does not work that way with any product on the market.  It does seem that the gauze formulations of each have some promise.  They can be wrapped around a wound or tightly stuffed into deeper ones and then secured by a tight pressure wrap.  Assuming that the product added is safe and effective, it could enhance what already works.

What should you do?  We know that bandaging that is visually directed toward the bleeding site (well-aimed), stuffed in for deeper wounds, and then secured by a pressure wrap have a good track record.  This is certainly true for the vast majority of wounds we are likely to see in non-combat, civilian events.  There are no confounding substances and anyone can buy these materials easily and inexpensively.  On the other hand, the least expensive of either of the major clot enhancing products retail for about 10$ US and many are 25$ US and more.  But wouldn’t it be worth it to decrease exposure to potential m thinking FG and OHbloodborne pathogens?  If there is bleeding, there is blood around.  Whether you use the sachet containing QuikClot or either gauze impregnated product, you still have to apply it manually and hold it in place like plain gauze until secured.  Gloves, eye protection, and clothing are still your best protection.  And what are you going to use if you haven’t got a clot enhancer with you?

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“I am pretty sure this is the first posting for the “Man” in a tree. I was in a 150 foot tall, 100+ year old Douglas-fir near Fort Lewis, WA.”

-Zebediah, WFR and Arborist from Washington.

Don’t forget! At the end of the year, we will select the 3 best submissions. The winners will receive $100 cash prize.  Send in a picture of yourself wearing your WMA course t-shirt to [email protected] in order to be eligible for the prizes.

Q: If water supply is very limited during a survival situation, in a hot/dry environment, is it better to delay food intake?  I’ve heard both opinions: either digestion would increase water demand (could be lethal), or it would supply water (considering there’s a significant amount in that food).

Interesting question.  I am not sure that I can give you a definitive answer.

Water is essential for all body functions.  It aids in digestion in both direct and indirect ways.  Water is part of the circulation that perfuses the gut so that it works properly.  Digestive enzymes, juices if you like, are secreted as water-based liquids.  Digestion is also easier and more efficient if the food is pulverized through chewing and is moisturized within the mouth and gut (yes, it is a good idea to drink with meals).  Inadequate fluids could therefore impair nutrient absorption.   In addition, when a person is fluid deprived, the colon reabsorbs water to help maintain fluid balance thus producing more solid feces and slowing transit time.  How much water do we need?  The old adage that we all need 8, 8oz (or about 240 mL) glasses of water generally fails to complete the thought, namely that there is an awful lot of water in food.  A large part of our fluid needs are met by the water contained within foods that we eat.

So, should you avoid food if water is in short supply?  Is the utility of water during digestion really a “demand” or just a reallocation of resources?  I would think that it would depend to a large degree on the food you have.   In fact, if you are selective in your choices, you might be able to nearly avoid drinking any water.  Dry or dehydrated foods, if not poorly absorbed, would at least be unpalatable.  I doubt that you could eat enough of them to cause a problem like worsening dehydration.  High salt content could be another problem, but that is a different discussion.

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Click on the images for a larger view.

“During a orthopedic surgery medical mission in Nicaragua, this child from one of the villages was found to have a foot injury, later to be diagnosed with a 2nd – 4th metatarsal fracture.

The boy was being carried back to his house at time of injury – later to be casted.”

Pictures submitted by WMA instructor, .

Don’t forget! At the end of the year, we will select the 3 best submissions. The winners will receive $100 cash prize. Send in a picture of yourself wearing your WMA course t-shirt to in order to be eligible for the prizes.

There is a curious post on’s web page today.  It relates a story about a record setting effort by a group of 8th graders in Texas.

No it was not a pie eating contest or sporting event.  Apparently they were certified by the Guinness folks for holding the world’s largest CPR class – 4626 students.

“As expected with thousands of junior high students, there was plenty of goofing around during the lesson. Giggling was common when they first gave their inflatable mannequins mouth-to-mouth resuscitation, and more than a few decided to head butt or slap their Mini Anne CPR dummies. But most appeared to take the lesson seriously.

Cluck (the mayor who helped organize the CPaRlington program)walked several laps around the field during the lesson, and he said most participants understood the techniques and could resuscitate someone if needed. Each student is now required to take the dummies home and teach four other people.”

Although not specifically mentioned, 30 minutes and inflatable CPR dummies sound a lot like the American Heart Association’s (AHA) CPR Anytime. Regardless of whose curriculum, I am assuming that this was not a certifying course.

The CPR Anytimeis a real departure from where the AHA was even 5 years ago.  There was a time when everyone taking one of their courses was hovered over by a hypervigilant instructor making sure that each student’s compressions and ventilations were within an upper and lower limit.  Skill testing success or failure was determined by lines on a piece of graph paper spit out from the side of the testing dummy.  Everyone knew that you had to modify your technique for the testing mannequin used, in order to pass.

Most instructors led their students to believe that if their technique varied in anyway from the norm, those efforts would hasten a patient’s demise.  Everyone assumed that the AHA knew what it was doing and as a result no one else (other than the American Red Cross and a few others) could be trusted to teach CPR.  Now these courses are more user friendly and accessible, engineered to train the masses.  These self-directed offerings are a convenient way for people to learn a skill that could enhance survivability following a cardiac arrest without having to take a course.  No one knows whether or not this new approach will make a difference.  Others of us have been allowed to use our own curricula and ideas to teach this once sacred procedure.  It seems that AHA mantra has become, do something.  Over the years, anecdotal stories suggest that an untrained person doing something is potentially beneficial and not harmful.  Science shows us that early intervention does make a difference.  I agree

Still, this rock concert-like event makes me cringe.  Why not do it right?  Is the time spent in school classrooms so valuable that they don’t have time for this or practical First Aid?   The AHA hopes people taking self-directed courses will in turn teach someone else.  Would these kids do a better job teaching their parents after a course like the one noted above or after a proper course, esepically one that utilized a variety of teaching methodolgies (e.g., fun) and was integrated in with what they are leaning in school?

This is not a criticism of these kids.  This is what they know.  Kudos to them not for the record but for the initiative and sense of civic concern.  But with a little guidance and effort, think about how much more could be done.

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girl with the fluIt is difficult to know how to respond to H1N1.  Last spring schools were closing with the first whiff of a possible infection.  Now, kids who are sick are segregated until they can be sent home.  Schools are unlikely to be closed unless the numbers of absentees are large enough to prevent normal function or vulnerable populations are put at risk.

Based on research, plain surgical masks were felt to afford insufficient protection compared to the more expensive, fitted, N95 mask.  This week, the result of an important N95 vs plain mask study is being questioned because of the methodology used.  Still, this is a big deal, especially for at risk populations like young kids, pregnant women and people over 65.  Underlying conditions like asthma and other chronic illnesses can increase a person’s risk for a more severe illness.

Influenza virus can be broadcast about 3 feet from droplets generated by coughing and sneezing.    The virus laden droplets gain access and infect through eye and nose mucous membranes.  This initial contact is either direct or indirect.  The later occurs when the droplets land on a surface and then are spread to the mucous membranes by hand contact.  It is often difficult to get more 3 feet away from someone in a tent, on-board ship or in a classroom.  Keeping surfaces clean under these kinds of circumstances can be a challenge.

Here is what I think:

  1. Most people with influenza are sick.  Cough, sore throat, headache or muscle aches with a fever should get your attention.
  2. Hand washing regularly both before but particularly after contact is very important.
  3. Coughing into a disposable tissue that is immediately thrown out or, lacking one, into one’s elbow crease will minimize spread potential.
  4. If you are running a program, isolating people with some symptoms will help.  In the middle of the ocean you cannot send the person home but you can use a mask and good hygiene.  If conditions permit, on deck, some distance from others would be better than being trapped below deck.   Think of this principle for other settings.
  5. Some kind of a mask is better than none and one mask for someone ill is cheaper and easier than one mask for everyone else.  It is hard to believe, if lacking a mask, that even a bandana wouldn’t offer at least some protection.
  6. Canceling or postponing a trip for the person with symptoms makes sense.
  7. When you think about hygiene don’t forget about things that you touch – e.g., flash lights, binoculars, GPS.  An outbreak of conjunctivitis at a college, reported in the NEJM in 2003, was felt to be related to ubiquitous public computer terminals.  Placing hand cleaner near them accompanied by instructions to use before and after was credited in part for getting things under control.
  8. Most of these steps make some sense to help minimize or contain many infectious illnesses.

The vast majority of people who contract H1N1 will survive just fine.  But, when you are not at home, little problems have a way of getting worse (magnifier effect), ultimately affecting everyone’s health and safety.  Expeditions or other remote missions are always easier and more fun when people are well.

Is there a standard in wilderness medicine training?

Authors of an editorial and article that appeared in the earlier this year (Vol 20, 106 and 113-117) argued that there is no standard in wilderness medicine training for outdoor educators. In addition, they suggested that organizations offering this training have curricula that are not evidenced-based and are quite possibly irrelevant to the true needs of their intended audiences. They characterized these training organizations as fractious and secretive (my selection of words). These suggestions and characterizations are misleading and inaccurate. I personally have an open and collegial relationship with the principles of a number of these organizations. We attend and present at some of the same conferences and regularly meet to discuss what we are doing and why. Anyone can see what we teach by buying our texts, reading our blog, listening to our conference presentations, and freely downloading articles and protocols from our web site. Over the years, these interactions have resulted in changes and upgrades for all of us. The competitive atmosphere of excellence has forced each of us to look carefully at what we teach and how we teach it. Being wrong and inept would result in marginalization as well as loss of business. Over the last several years these conversations have become more focused. The participants are highly experienced outdoor and educational professionals, some with long careers as outdoors medical practitioners. They work or manage training organizations who have taught over 150,000 WFA students since 2000. Through a collaborative effort with these peers, we hope to write Scope of Practice (SOP) documents to define the intended audience and what a person at different levels of training should be able to do and should not do in the field. Ultimately the signatories will publish them for public information and scrutiny. The first of these is a SOP for Wilderness First Aid (WFA). It will be discussed at this year’s in Minneapolis and presented to the .

These photos are from the beach and fruit stand near my current place of residence in Maputo, Mozambique.  A few weeks ago I got to put my first aid skills to use on this very beach — tending to a deep cut on my own foot!  Fortunately, I had everything I needed to clean the wound… including, somehow, the patience to pick out every last grain of sand.

-Rachel Mason
( Monteverde 2009)

Click on the pictures for a larger image.

Don’t forget! At the end of the year, we will select the 3 best submissions. The winners will receive $100 cash prize.  Send in a picture of yourself wearing your WMA course t-shirt to in order to be eligible for the prizes.

Click here to view the Avalanche POV video clip.

I viewed the link below this PM and am still shaking my head. The introduction to this clip notes:

“This is simply a very sobering and unbelievable video. However, you should take away from this video all the positive things that you can learn from it. Yes there are risks to the backcountry – but with proper gear, training, and guide(s) with avalanche and EMT training – you can greatly lower your chances of getting caught in an avalanche in the first place … and coming back alive if you ever were to get caught in a slide.”

I always thought that we were supposed to AVOID getting swept up in avalanches by steering clear of high risk areas.

David Johnson

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