EPISODE · May 26, 2026 · 43 MIN
Sick vs Not Sick: Decisions That Saves Lives in the Wilderness
from Spiked Out · host The Journeyman
Two hours from the nearest hospital, “standard ER thinking” breaks fast. We’re joined by Dr. Miguel Pineda, an emergency physician and wilderness medicine fellowship trained doc, to talk about what actually matters when you’re doing EMS in austere environments like wildland fires, remote rescues, and rural transport corridors.We get into the decision skill that drives everything else: telling sick vs not sick early. From there we talk field priorities that hold up when you might lose an airway, run out of supplies, or wait on a helicopter. Dr. Pineda explains what he hopes to see from EMS crews in the woods, why a clean and confident call-ahead report helps the ER move faster, and how limited-resource work (including solo coverage in a border community) changes the way you lead, communicate, and improvise.Then we go practical on common fire line hazards: rattlesnake bites, scorpion stings, and venomous spider myths. You’ll hear what helps in the field (rings off, mark swelling with a time stamp, protect the limb) and what can seriously hurt patients (tourniquets, cutting, sucking venom, and other Hollywood fixes). We also talk anaphylaxis and why we’d rather you treat early with IM epinephrine than wait for a “perfect” picture, plus poison oak or poison ivy smoke exposure and how allergy meds and steroids can fit into a solid prehospital plan.If you work wildland fire EMS, wilderness medicine, or prehospital care, this one is built for you. Subscribe, share this with a teammate, and leave a review with your biggest take-home from the conversation.Find The Journeyman here:https://livetjm.com/Find The Journeyman on Google Play Store:https://play.google.com/store/apps/details?id=com.livetjm.thejourneyman&pcampaignid=web_shareFind The Journeyman on the Apple App Store:https://apps.apple.com/us/app/tjm-the-journeyman/id65039028630:00 The Reality Of Fireline Medicine4:21 Small Town ER And Border Work7:42 Sick Or Not Sick In The Woods13:51 Improvised Ultrasound Gel In Heat16:49 Snakebites Without The Hollywood Myths25:55 Scorpions And Venomous Spider Truths36:07 Anaphylaxis And Early Epinephrine39:56 Poison Oak Smoke And Steroids
What this episode covers
Two hours from the nearest hospital, “standard ER thinking” breaks fast. We’re joined by Dr. Miguel Pineda, an emergency physician and wilderness medicine fellowship trained doc, to talk about what actually matters when you’re doing EMS in austere environments like wildland fires, remote rescues, and rural transport corridors. We get into the decision skill that drives everything else: telling sick vs not sick early. From there we talk field priorities that hold up when you might lose an air...
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Sick vs Not Sick: Decisions That Saves Lives in the Wilderness
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