Tick-Borne Illnesses in Emergency and Wilderness Medicine.

This review highlights the causative organisms, clinical features, diagnosis, and treatment of the most common tick-borne illnesses in the United States, including Lyme disease, Rocky Mountain spotted fever, anaplasmosis, ehrlichiosis, tularemia, Powassan virus, and alpha-gal syndrome. Tick bite prevention strategies and some basic tick removal recommendations are also provided.

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite: 2024 Update.

The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the guidelines published in 2019.

Wilderness Medical Society Clinical Practice Guidelines for the Treatment of Acute Pain in Austere Environments: 2024 Update.

The Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded based on the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. This is an update of the 2014 version of the "WMS Practice Guidelines for the Treatment of Acute Pain in Remote Environments" published in Wilderness & Environmental Medicine 2014; 25:41-49.

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update.

The Wilderness Medical Society (WMS) convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. The current panel retained 5 original members and welcomed 2 new members, all of whom collaborated remotely to provide an updated review of the classifications, pathophysiology, evidence-based guidelines for planning and preventive measures, and recommendations for field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality. This is an updated version of the WMS clinical practice guidelines for the prevention and treatment of heat illness published in Wilderness & Environmental Medicine. 2019;30(4):S33-S46.

Wilderness Medical Society Clinical Practice Guidelines for Treatment of Eye Injuries and Illnesses in the Wilderness: 2024 Update.

A panel convened to develop an evidence-based set of guidelines for the recognition and treatment of eye injuries and illnesses that may occur in the wilderness. These guidelines are meant to serve as a tool to help wilderness providers accurately identify and subsequently treat or evacuate for a variety of ophthalmologic complaints. Recommendations are graded based on the quality of their supporting evidence and the balance between risks and benefits according to criteria developed by the American College of Chest Physicians.

Wilderness Medical Society Clinical Practice Guidelines on Water Treatment for Wilderness, International Travel, and Austere Situations: 2024 Update.

To provide guidance to medical providers, wilderness users, and travelers, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for treating water in situations where the potability of available water is not assured, including wilderness and international travel, areas impacted by disaster, and other areas without adequate sanitation. The guidelines present the available methods for reducing or eliminating microbiological contamination of water for individuals, groups, or households; evaluation of their effectiveness; and practical considerations. The evidence base includes both laboratory and clinical publications. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians.

Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2024 Update.

The Wilderness Medical Society convened a panel to review available evidence supporting practices for acute management of drowning in out-of-hospital and emergency care settings. Literature about definitions and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded available evidence supporting practices according to the American College of Chest Physicians criteria and then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking. This is the second update to the original practice guidelines published in 2016 and updated in 2019.

Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection: 2024 Update.

The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2023, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to American College of Chest Physicians methodology. Key recommendations include the concept that interventions should be goal-oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique-oriented (immobilization). An evidence-based, goal-oriented approach excludes the immobilization of suspected spinal injuries via rigid collars or backboards.

Regional Anesthesia in the Austere Environment: Lessons Learned from Current Out-of-Hospital Practice.

INTRODUCTION: Pain management for trauma in the extreme environment is vital for both casualty comfort and aiding safe extrication. However, adequate pain management in a resource-limited environment can be challenging and is often limited. We conducted a scoping review of the use of regional anesthesia in the prehospital environment, evaluating which regional anesthetic procedure was performed for various indications, their efficacy, and the type of healthcare provider delivering the anesthetic. METHODS: A PRISMA-guided systematic literature review was conducted of Medline, Embase, and Cochrane databases for studies reporting the use of regional anesthesia in the prehospital environment published before June 30, 2022. RESULTS: Thirty studies met the criteria and were included in the review. The most common types of regional anesthesia were fascia-iliaca compartment block (n = 317, from 12 studies) and femoral nerve block (n = 210, from 8 studies), along with various other blocks for a range of indications. These blocks had good efficacy and a low-risk profile and could be delivered by a wide range of healthcare providers. CONCLUSIONS: Regional anesthesia is an effective and non-resource-heavy pain management tool in prehospital environments, which may be applicable to austere settings. It can cover a wide range of injuries and can avoid systemic complications for casualties that may already be challenging to manage in out-of-hospital settings. Additionally, regional anesthesia can be effectively delivered by a wide range of providers. This review provides a holistic summary of pain management using regional anesthesia in the prehospital environment, with a discussion on its potential use in more extreme settings.

Moção de apoio nº 010, de 16 de dezembro de 2016: manifestar apoio e o mais profundo agradecimento aos mais de 11 (onze) mil médicos e médicas cubanas, que até o momento prestaram atendimento à saúde da população brasileira, nos mais longínquos lugares deste Brasil ainda tão desigual / Supporting motion No. 010, of December 16, 2016: to express support and the deepest thanks to the more than 11 (eleven) thousand Cuban doctors, who have so far provided health care to the Brazilian population, in the most distant places of this Brazil still so uneven

Manifestar apoio e o mais profundo agradecimento aos mais de 11 (onze) mil médicos e médicas cubanas, que até o momento prestaram atendimento à saúde da população brasileira, nos mais longínquos lugares deste Brasil ainda tão desigual.

Médicos para atenção primária em regiões rurais e remotas no Brasil: situação atual e perspectivas / Physicians for primary health care in rural and remote regions in Brazil: current situation and perspectives / Médicos para la atención primaria en regiones rurales y remotas en Brasil: situación actual y perspectivas

Ao longo do último ano, com o Projeto Mais Médicos para o Brasil (PMMB), ganhou força a discussão sobre o provimento de médicos para a atenção primária brasileira. O debate vem sendo acirrado, permeado por discussões ideológicas, e frequentemente se desviando de uma análise cientificamente embasada dos temas em questão. Um dos poucos pontos consensuais é que a distribuição de médicos nas diferentes regiões do Brasil é muito desigual,1,2 contribuindo para o que vem sendo denominado defasagem rural-urbana. Mesmo enfrentando forte oposição, especialmente das entidades médicas,3 o PMMB foi em frente, contando atualmente com mais de 14 mil profissionais, de diferentes nacionalidades, dos quais cerca de 11 mil são cubanos. Esses médicos estão distribuídos em 3,8 mil municípios e 33 distritos de saúde indígena,4 todos teoricamente trabalhando na Estratégia Saúde da Família, ou seja, atuando na porta de entrada do sistema de saúde. Esse projeto constitui hoje a principal política pública de provimento de recursos humanos para parcela significativa da população brasileira e é a primeira etapa, atualmente a mais visível, de um programa mais amplo de reformulação da força de trabalho médica no país, denominado Programa Mais Médicos,5 a maior parte do qual está em construção. Embora o alcance dessa iniciativa seja inegável, deve-se destacar a preocupação quanto à sua sustentabilidade a longo prazo, que dependerá do sucesso dos demais componentes do programa e da superação das deficiências do PMMB. Uma das principais deficiências é que esse projeto prevê a contratação do médico por um período de três anos,5 sem estarem definidas estratégias claras para sua fixação ou substituição por outro profissional que irá permanecer na mesma comunidade por um tempo maior. Pelo contrário, a partir do momento em que o gestor municipal fica desobrigado ao pagamento dos salários, devendo apenas oferecer uma contrapartida de moradia e alimentação, constrói-se uma grande dependência dos municípios sobre o programa, o que pode ser extremamente destrutivo para o processo de estruturação de sistemas de saúde locais. De fato, tem havido relatos de demissão de médicos para dar lugar a esses médicos novos temporários,6 mesmo isso estando contra as regras do programa.5. Por esse motivo, o consenso internacional é de que, paralelamente a estratégias de curto prazo para provimento de profissionais médicos, deveriam ser implementadas medidas de médio e longo prazo, multifacetadas e focadas na retenção dos profissionais.7 Deveria-se também investir na construção de um sistema de saúde forte, regionalizado e alicerçado nos atributos da atenção primária: primeiro contato, longitudinalidade, integralidade e coordenação do cuidado.8 Os interesses imediatistas de provimento não podem conflitar com a necessidade a longo prazo de fixação de profissionais e de integração destes em um sistema de saúde bem estruturado. Os incentivos para a estruturação a longo prazo do sistema de saúde local deveriam parecer aos gestores municipais mais atraentes do que o pagamento pelo governo federal de bolsas para os profissionais temporários do PMMB. Um componente fundamental de uma política de estruturação de sistemas de saúde para áreas rurais e remotas é a formação de recursos humanos capacitados para atuarem nessas regiões. Isso envolve a reorganização dos currículos médicos e a descentralização da formação em saúde, juntamente com medidas para facilitar o acesso de estudantes do interior aos cursos de medicina.7 O padrão-ouro para a formação pós-graduada de médicos para a atenção primária de áreas rurais e remotas é o treinamento em programas de residência em Medicina de Família e Comunidade, que os capacita para serem resolutivos no manejo dos problemas mais frequentes vistos nos territórios em que atuam, inclusive nas regiões rurais, bem como para prestarem cuidado continuado às populações que habitam nesses territórios. Para debater esses e outros importantes assuntos ligados à saúde das populações rurais, foi realizada este ano, em Gramado, a 12ª Conferência Mundial de Saúde Rural, que reuniu mais de 700 participantes de mais de 20 países, incluindo autoridades mundiais nesse tema. Durante a conferência, foi elaborada a Declaração de Gramado, que está sendo publicada neste número da Revista Brasileira de Medicina de Família e Comunidade9, e que propõe recomendações sobre como melhorar a saúde rural por meio da organização de sistemas de saúde e sobre como estruturar políticas de recursos humanos para atuarem nesses sistemas. Essas recomendações, se incorporadas no desenho das políticas para provimento e fixação de médicos no Brasil, têm grande potencial de contribuir para superar a defasagem rural-urbana e propiciar cuidados de saúde de qualidade para a população que mora em áreas rurais e remotas.

Estrategia curricular de Medicina Tradicional y Natural en la carrera de Psicología de la Salud / Curricular strategy of Traditional and Natural Medicine in the studies of Psychology of Health

Introducción: la Medicina Tradicional y Natural (MTN) en la carrera de Psicología de la Salud como estrategia curricular contribuye a la formación de habilidades en los estudiantes en estas técnicas terapéuticas. Métodos: se realizó una investigación con enfoque cualitativo en la Universidad de Ciencias Médicas de Villa Clara durante el curso académico 2012-2013, con el propósito de diseñar una estrategia curricular para implementar la MTN en la carrera de Psicología de la Salud. Se utilizaron métodos teóricos: el histórico-lógico, análisis_síntesis y empíricos: análisis documental, cuestionario a docentes y estudiantes, guías de observación de visitas a clases, observación no participante de las consultas en la educación en el trabajo, se realizó una entrevista semiestructurada a 10 especialistas,y análisis porcentual de los resultados. Resultados: se constató que la MTN no se aborda como estrategia curricular en las actividades docentes de la carrera de Psicología de la Salud por lo que se diseñó una estrategia curricular de MTN a partir de las deficiencias detectadas y la documentación consultada. Conclusiones: el diagnóstico efectuado permitió conocer la no existencia de una estrategia para la implementación de estos contenidos en dicha carrera, por lo que se elabora una estrategia curricular, la cual fue sometida a criterios de especialistas, y se obtuvo una valoración positiva en relación con su calidad y pertinencia teniendo en cuenta los aspectos siguientes; coherencia, actualidad, trascendencia y su valor científico pedagógico.

Background: Natural and Traditional Medicine (NTM), in the studies of Psychology of Health as a curricular strategy, contributes to the training of skills in the students in these therapeutic techniques. Methods: a research project with a qualitative approach was done at the Villa Clara University of Medical Sciences during the 2012-2013 academic year, with the purpose of designing a curricular strategy in order to implement the NTM in the studies of Psychology of Health. Theoretical methods were used: historic-logic, analysis-synthesis; and empirical: documentary analysis, questionnaire to teachers and students, class observation guides, non-participant observation of consultations in education at work, a semistructured interview to ten specialists, and percentage analysis of the results. Results: it was verified that NTM is not approached as a curricular strategy in the teaching activities of the studies of Psychology of Health. Because of this, a curricular strategy of NTM was designed, based on the deficiencies detected, and the documents that were consulted. Conclusions: the diagnosis done allowed to know the lack of a strategy for the implementation of this content in the studies of Psychology of Health. Because of this, a curricular strategy was designed, and it was submitted to the criteria of specialists, and a positive assessment was obtained in relation with its quality and pertinence, taking into account the following features: coherence, updating, transcendence and pedagogical and scientific value.