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.

Call of the wild: creating a formal wilderness medicine elective for Canadian pre-clerkship medical students.

Wilderness medicine education is interesting to medical students, yet not widely implemented in Canadian medical curricula. We describe a curriculum for a pre-clerkship wilderness medicine elective at a Canadian medical school. Our study reports increased student awareness of career opportunities in wilderness medicine after elective completion, and interest in hands-on learning for wilderness medicine topics. Medical schools may benefit from incorporating feedback from our elective towards a successful wilderness medicine curriculum in their own programs.

La médecine en milieu sauvage est un domaine que les étudiants trouvent intéressant, mais dont l'enseignement est peu répandu dans les programmes d'études médicales au Canada. Nous décrivons le contenu d'un stage au choix de médecine en milieu sauvage offert au pré-externat dans une faculté de médecine canadienne. Notre étude montre qu'à la suite du stage, les étudiants sont mieux informés des possibilités de carrière en médecine en milieu sauvage et qu'ils manifestent un intérêt pour l'apprentissage pratique dans ce domaine médical. Les commentaires recueillis sur notre stage peuvent être utiles à d'autres facultés souhaitant introduire une formation en médecine en milieu sauvage dans leur programme.

Prevention and Treatment of Nonfreezing Cold Injuries and Warm Water Immersion Tissue Injuries: Supplement to Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite.

We convened an expert panel to develop evidence-based guidelines for the evaluation, treatment, and prevention of nonfreezing cold injuries (NFCIs; trench foot and immersion foot) and warm water immersion injuries (warm water immersion foot and tropical immersion foot) in prehospital and hospital settings. 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. Treatment is more difficult with NFCIs than with warm water immersion injuries. In contrast to warm water immersion injuries that usually resolve without sequelae, NFCIs may cause prolonged debilitating symptoms, including neuropathic pain and cold sensitivity.

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.

Implementation of a Specialty Society‒Sponsored Wilderness Medicine Fellowship Match.

INTRODUCTION: Previously, wilderness medicine (WM) fellowships offered spots to applicants using an offer date. Due in part to increases in the number of WM fellowships and applicants, in 2021, the WM program directors (PDs) agreed to conduct the first WM fellowship match through the Wilderness Medical Society graduate medical education committee. This article outlines the process used and demonstrates its feasibility. METHODS: To create an independent matching process, a simulation was performed using imaginary programs and participants. Using the same algorithm utilized by the National Resident Matching Program, this process was completed manually and by computer to ensure accuracy. The PDs shared an email with the applicants they interviewed and submitted their names. Applicants registered for the match and generated a match list. The PDs then submitted a rank list of applicants they interviewed through a similar Google form. These lists were used to run the matching algorithm both manually and by computer. Any programs that did not "fill" or applicants who did not "match" were contacted to participate in a secondary match. Following the match, a survey was sent to PDs and participants for process improvement. RESULTS: The match filled 11 of 14 participating programs and 15 of 19 applicants. The results obtained via a computer algorithm were consistent with multiple human validations. The survey results were mostly positive, with 2 neutral responses and no negative responses. CONCLUSIONS: The inaugural WM fellowship match was successful in matching the majority of programs and participants and was well-received by both directors and applicants.

Wilderness Medicine Curricula in United States EMS Fellowship, Emergency Medicine Residency, and Wilderness Medicine Programs.

OBJECTIVE: Wilderness Medicine (WM) focuses on care delivered in austere or resource-scarce environments. The Accreditation Council for Graduate Medical Education (ACGME) requirements and core content for Emergency Medicine (EM) residency and Emergency Medical Services (EMS) fellowship in the United States (US) include some WM topics that are covered to varying degrees in these programs. Furthermore, there are no ACGME-approved WM fellowships or specific curricula. Different training programs may develop WM content and curricula that differ significantly, leading to variations in WM competencies and training. In 2009, the American College of Emergency Physicians (ACEP) Wilderness Medicine Section created a Fellowship Subcommittee and Taskforce to develop a standardized curriculum and core content for EM-based WM fellowships. However, to date, EMS fellowship and EM residency WM curricula in the US content have not been analyzed for consistency with the ACEP WM fellowship curriculum. METHODS: In this study, the WM curricula components of EM residency and EMS fellowship were evaluated using the ACEP WM fellowship curriculum as a control. Potential curriculum gaps for each program type were identified. RESULTS: Of the 19 WM competencies developed by the ACEP Wilderness Medicine Section Fellowship Subcommittee and Taskforce, EMS fellowship covers more WM topics (16 topics, or 84%) than EM residency (12 topics, or 63%), and combined, they cover 89% of these topics. CONCLUSIONS: By expanding to cover two additional WM topics, all WM curricula topics recommended by the ACEP WM fellowship curriculum could potentially be covered in EM residency + EMS fellowship; however, the depth of education in each topic may vary. It may be beneficial for Graduate Medical Education (GME)-level learners for programs to implement hands-on educational experiences in WM topics.