Point-of-Care Ultrasound Transmission for Remote Interpretation in Austere Environments.

INTRODUCTION: Point-of-care ultrasound (POCUS) is used in wilderness medicine and could potentially be the only imaging modality available. Cellular and data coverage is often lacking in remote areas, limiting image transmission. This study evaluates the viability of transmitting POCUS images from austere environments using slow-scan television (SSTV) image transmission methods over very-high-frequency (VHF) hand-held radio units for remote interpretation. METHODS: Fifteen deidentified POCUS images were selected and encoded into an SSTV audio stream by a smartphone and transmitted over a VHF radio. A second radio and smartphone 1 to 5 mi away received and decoded the signals back into images. The original images and transmitted images were randomized into a survey graded by emergency medicine physicians using a standardized ultrasound quality assurance scoring scale (1-5 points). RESULTS: The difference in mean scores between the original image and transmitted image showed a 3.9% decrease in transmitted image scores, with P <0.05 on a paired t test; however, this is not likely a clinically significant decrease. Comparing transmitted images using different SSTV encodings and distances ranging up to 5 mi, 100% of survey respondents determined the images to be clinically usable. This dropped to 75% when significant artifacts were introduced. CONCLUSIONS: Slow-scan television image transmission is a viable option for transmitting ultrasound images in remote areas where more modern forms of communication are unavailable or not practical. Slow-scan television may have potential as another data transmission option in the wilderness, such as electrocardiogram tracings.

Resident Wilderness Medicine Curriculum Consensus Guidelines: Summarization and Recommendations for Resident Rotations in Wilderness Medicine.

INTRODUCTION: Wilderness medicine education is one of the fastest growing facets of both graduate and undergraduate medical education. Currently, there are curriculum guidelines for both student electives and fellowships in wilderness medicine. However, there are no guidelines for resident elective curricula. The student/resident education committee of the Wilderness Medical Society (WMS) convened a task force to develop curriculum guidelines for these electives. METHODS: A survey of previously described core wilderness medicine topics was sent to a cohort of educators involved in wilderness medicine resident electives. They were asked to rank topics on the basis of their importance of being included on a Likert scale. Multivariate analysis of medians was used to distinguish among topics to determine which topics were voted most and least necessary for a curriculum. RESULTS: Of the database members contacted, 35 responded to the survey. The described current state of residency electives was that 16 institutions offered their own elective (46%). For subject preferences, multivariate analysis of scoring distribution medians demonstrated a significantly higher pattern of responses (P<0.01) for subjects with a median of 3 (must include) than for the lowest-scoring subjects that had a median of 1 (can include). Every topic was rated "must" by at least 1 respondent. Topics were further subdivided into an educational framework reflecting a common approach to education of wilderness medicine fellows focusing on education, leadership, knowledge, and skills. CONCLUSIONS: There was a wide variety in the ranking of topics; however, there were multiple topics on which a consensus for inclusion was reached. These topics are organized and presented here as a suggested curriculum by the student/resident education committee of the WMS.

Novel Technique for Epinephrine Removal in New Generation Autoinjectors.

Anaphylaxis is a severe, life-threatening, multisystem hypersensitivity reaction that can rapidly progress to hypotension and airway compromise. Successful management of anaphylaxis has been documented with the use of prescription intramuscular epinephrine pens that require only minimal training for safe use. The prior generations of these commercially available autoinjectors were produced for single use; however, safe removal of multiple doses has been demonstrated for use in dire situations. We aim to show a novel technique for removal and administration of additional doses of epinephrine from the new generation autoinjector, the Auvi-Q. There was a voluntary manufacturer recall of this product as of October 30, 2015, because of concerns about inaccurate dosing. However, an uncertain number of devices remain in public hands.

Medical student electives in wilderness medicine: curriculum guidelines.

Wilderness medicine has been a part of medical student education for many years and is becoming more popular. To help standardize and improve the student experience, we surveyed current elective directors to gain an understanding of what experts in the field thought were priority elements in a wilderness medicine elective. Although there is a diversity of opinion among leaders in the field, there are multiple topics on which there is concordance on inclusion or exclusion.

Injuries in mountain bike racing: frequency of injuries in endurance versus cross country mountain bike races.

OBJECTIVE: To determine the frequency of injuries requiring medical attention among mountain bike racers at endurance races (6 hours or greater in duration) versus traditional cross country races (less than 6 hours duration) and to determine the medical support available at races. METHODS: A survey was developed to determine participants' experience level, previous injuries, and demographic information. An additional survey was completed by injured riders to determine injuries and treatment received. The number of medical providers, their level of training, and the supplies available was determined. RESULTS: The endurance riders had more years of mountain biking experience, averaged more hours of riding per week, and had fewer injuries requiring medical attention in the past year than the riders in the races. Of the cross-country riders, 7.2% were injured during the race, and 4.7% of endurance racers were injured. There was no increased risk of being injured in a race over an endurance race (odds ratio 1.6, 95% CI [0.50, 2.92]). Lacerations and abrasions were the most common injuries in both events. Head injuries, eye injuries, and blisters were only reported in the endurance events. Endurance events were more likely to have medical assistance available. CONCLUSION: There was a greater percentage of riders reporting injuries in the cross-country races. It is possible that many of the endurance racers did not report injuries, continuing to ride or taking care of their own injuries quickly. Both events tended to have similar types of injuries and, therefore, both events most likely need similar medical support.

Advanced wilderness life support education using high-technology patient simulation.

OBJECTIVE: (1) To determine if, after using the simulation mannequin SimMan in a wilderness "megacode" exercise, participants believe high-tech simulators are an effective tool for learning wilderness medicine skills. (2) To determine if participants believe high-tech simulation mannequins should be used with more or less frequency in future wilderness medicine exercises. METHODS: After completing a basic training session outlining the capabilities of SimMan and completing a wilderness megacode (defined as a series of progressive conditions that accumulate over time) using SimMan, participants were surveyed to ascertain whether they perceived SimMan to be an effective teaching tool for wilderness medical skills and to determine if they would like SimMan to be used with greater frequency at future wilderness medicine courses. The data were compiled and analyzed using Microsoft Excel. RESULTS: Participants found the wilderness SimMan experience to be an effective tool with an average score of 3.15 on a scale where 4 is most effective and 1 is least effective. Participants also desired to see high-tech simulation more frequently in wilderness courses with a score of 3, on a scale where 4 is more frequently and 1 is less frequently. There was little difference in responses based on previous experience with simulation. CONCLUSIONS: High-tech simulation is an underused tool for wilderness medicine education. Currently, several barriers exist to its implementation in wilderness medicine. Participants in wilderness courses feel it is an effective tool and would like to see it used more frequently.