Wilderness Medicine Updates

In this episode, Dr. Patrick Fink reviews accidental hypothermia for wilderness providers, building on Ep. 27 Thermoregulation, explaining physiologic changes as core temperature falls  and why accurate core temperatures are difficult to obtain in the field. We learn the modified Swiss staging system (0–4) based on signs and symptoms and outlines field management: - 0 cold stress (shelter, dry/insulate, warm calories; avoid alcohol), - 1 mild hypothermia (ataxia/fine motor impairment; passive plus active external rewarming with a hypothermia wrap and heat near axilla/groin; frequent reassessment), - 2 moderate hypothermia (confusion/lethargy; active external rewarming, evaluate hypoglycemia, gentle handling and no exertion to avoid afterdrop, cardiac monitoring, expedite evacuation), - 3 severe hypothermia (unresponsive with vital signs; airway/ventilation support, extremely gentle transport)- 4 hypothermic cardiac arrest (60-second pulse check, CPR, limited shocks under 30°C, withhold epinephrine/amiodarone under 30°C, consider intermittent CPR per protocol, and note potassium’s role in termination decisions). We also briefly contrasts slow non-extracorporeal warming with ECMO/cardiopulmonary bypass, previewing a future episode on advanced care and the HOPE scoreLinksEpisode 27: ThermoregulationWMS 2019 Accidental Hypothermia GuidelineAHA Hypothermia GuidelinesEuropean Resuscitation Council Hypothermia AlgorithmChapters:00:00 Welcome and Overview00:48 Hypothermia Basics01:12 Cooling Physiology04:06 Severe Effects and Arrhythmias06:38 Field Temp Challenges07:41 Swiss Staging Intro08:35 Stage 0 Cold Stress11:40 Stage 1 Mild Hypothermia16:04 Stage 2 Moderate Hypothermia20:44 Afterdrop and Handling22:54 Stage 3 Severe Hypothermia27:00 Stage 4 Cardiac Arrest27:57 CPR Shocks and Drugs37:01 Advanced Rewarming ECMO43:26 Key Takeaways Summary46:57 Wrap Up and SupportAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

Reevaluating Spinal Motion Restriction: Evidence UpdateIn this episode of Wilderness Medicine Updates, host Dr. Patrick Fink delves into the evolving guidelines and practices concerning spinal motion restriction. Drawing from historical dogma and modern research, Patrick explores the inefficacies and potential harms of traditional spinal immobilization tools like rigid spine boards and cervical collars. Instead, he advocates for more flexible, evidence-based approaches such as using well-padded surfaces and coaching patients to minimize their own motion. Key points from a comprehensive literature review by the National Association of EMS Physicians and other authoritative bodies are discussed, highlighting the shift from immobilization to motion restriction and its practical implications. Listeners are urged to stay updated with current evidence and consult medical directors before altering their practices.LinksEp. 14 - Spinal Immobilization Guidelines Update2018 ACEP/NAEMSP Sminal Motion Restriction Position StatementPrehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries - A NAEMSP Comprehensive Review and Analysis of the LiteratureChapters00:00 Introduction to Wilderness Medicine Updates00:42 Historical Perspective on Spinal Immobilization01:44 Transition to Spinal Motion Restriction03:30 Review of Recent Literature05:40 Key Findings on Spinal Motion and Neurological Outcomes09:30 Effectiveness of Backboards and Cervical Collars12:10 Potential Harms of Immobilization Tools16:38 Practical Recommendations and Future Directions21:48 Conclusion and Final ThoughtsAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

Wilderness Orthopedics: Managing Trauma in Remote Environments with Dr. Chris HealyIn this episode of Wilderness Medicine Updates, host Dr. Patrick Fink tackles orthopedic injuries in the wilderness with Dr. Chris Healy, an orthopedic surgeon and outdoor enthusiast. They explore the management of long bone fractures, traction for femur, pelvic binders, and the nuances of treating injuries in limited-resource environments. The episode covers strategies for handling common injuries like shoulder dislocations, tibia fractures, knee injuries, and how to prioritize care. They also emphasize the importance of timely evacuation and when and how to safely attempt reductions in the field.Links:Donate to the Tina Biddle Memorial ScholarshipSulcus sign / Squaring of the shoulderChapters:00:00 Introduction and Episode Overview01:36 Tribute to Tina Biddle04:09 Meet Dr. Chris Healy05:11 Ski Patrol Background and Pre-Hospital Care08:12 Approaching Orthopedic Injuries in the Field17:50 Managing Tibia and Fibula Fractures21:40 Understanding Compartment Syndrome27:50 Femur Fractures and Traction Splinting36:57 Pelvic Fractures: Identification and Management38:41 Understanding Pelvic Fractures and Binders39:53 The Role of Pelvic Binders in Pre-Hospital Care41:11 Challenges with Pelvic Binders in the Field43:15 Proper Placement of Pelvic Binders46:36 Field Management of Shoulder Dislocations50:43 Techniques for Reducing Shoulder Dislocations54:17 Managing Upper Extremity Injuries57:51 Handling Knee Injuries in the Field01:00:37 Patella vs. Knee Dislocations01:08:06 Evacuation Priorities for Knee Dislocations01:10:53 Common Issues in Pre-Hospital Orthopedic Care01:15:36 Final Thoughts and Listener EngagementAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

Understanding Stress Injuries in First Line Responders with Laura McGladreyThis episode of Wilderness Medicine Updates, hosted by Patrick Fink, features a conversation with Laura McGladrey, founder of the Responder Alliance. They discuss the critical issue of stress injuries among first line responders, including professional ski patrollers, healthcare workers, and rescue team members. Through personal stories and expert insights, Laura explains the concept of stress injuries, how they develop, and the importance of early detection and mitigation. The episode highlights the need for both individual and organizational strategies to support resilience and manage stress. Listeners are introduced to practical tools, cultural shifts, and personal anecdotes to help maintain a long, healthy, and fulfilling career in high-stress environments.LinksResponder Alliance Home PageAccess all that the organization has to offer.Responder Alliance: Resource HubEasy access to critical tools and offerings.The Stress ContinuumSee the visual continuum that we discuss on the show.Scholarships: Responder Alliance FoundationApply for aid for an individual or team training.Make a Donation to Responder Alliance Foundation!Join me in making a tax-deductible donation to support the valuable work of the Responder Alliance and bring this work to those who need it, regardless of cost.Chapters00:00 Introduction and Guest Welcome02:11 Laura's Background and Work06:00 Understanding Stress Injuries10:02 Responder Alliance Mission and Challenges20:55 Critical Incident Stress Management30:49 Empowering First Responders32:13 Daily Investments in Resilience37:26 Recognizing and Managing Stress38:14 Organizational Support for Stress Management39:45 Building Resilient Teams46:12 Learning from Resilient Leaders52:42 Resources for Stress Mitigation57:54 Conclusion and Final ThoughtsAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode of Wilderness Medicine Updates, host Patrick Fink delves into the topic of thermoregulation, explaining how our bodies regulate temperature in response to environmental changes. Listeners will learn about methods of heat exchange (conduction, convection, radiation, and evaporation), how to measure core temperature, and the body's physiological responses—such as shivering, sweating, and blood flow control. The episode also touches on the effects of age, metabolic stressors, and pregnancy on thermoregulation, as well as the importance of understanding these principles in the context of treating conditions like hypothermia and heat-related illnesses.00:00 Introduction and Episode Overview01:29 Importance of Thermoregulation03:12 Human Thermoregulation Mechanisms04:20 Measuring Core Temperature07:55 Heat Exchange Methods14:52 Behavioral and Physiological Responses24:48 Sex and Age Differences in Thermoregulation27:14 Conclusion and Next StepsAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode of Wilderness Medicine Updates, host Patrick Fink delves into groundbreaking technology designed to improve safety during avalanche events. The focus is on SafeBack SBX, a Norwegian-developed device that supplies air to users buried in avalanches, potentially extending survival time. Patrick reviews new research published in the Journal of the American Medical Association, which demonstrates significant efficacy in delaying hypoxia during simulated avalanche burials. The episode provides an in-depth analysis of SafeBack SBX, its mechanisms, study results, and its comparative and complementary role alongside existing safety technologies like airbags. Concluding with potential applications and limitations, Patrick aids listeners in deciding whether SafeBack SBX is a worthy addition to their avalanche safety gear.LinksEisendle F, Roveri G, Rauch S, et al. Respiratory Gas Shifts to Delay Asphyxiation in Critical Avalanche Burial: A Randomized Clinical Trial. JAMA. Published online October 08, 2025. doi:10.1001/jama.2025.16837Articles I've written about Safeback:Suffocation or Survival: A Crucial Factor in Avalanche BurialsAvalanche Safety: Assessing the Safeback SBX SystemFirst Look: Safeback SBX Avalanche Safety SystemChapters00:31 Overview of SafeBack SBX Technology02:55 Importance of SafeBack in Avalanche Safety05:40 Details of the SafeBack Study07:53 Study Results and Analysis11:07 Implications and Future Directions15:50 Conclusion and Final ThoughtsAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

On this episode of Wilderness Medicine Updates, host Patrick Fink shifts focus from the science and literature of wilderness medicine to practical fitness tips for search and rescue personnel, ski patrollers, and outdoor rescuers. Patrick interviews Rob Shaw, founder and head coach of the Mountain Tactical Institute, about his specialized training programs for various types of mountain athletes, including those in industrial and tactical roles. They discuss the nuances of preparing for seasonal work, the distinct fitness demands of ski patrollers versus search and rescue members, and the importance of chassis integrity and mental fitness. Rob highlights minimal equipment training plans that can be effective for mountain professionals and recreational athletes alike, and offers a special discount for the show's listeners. Additional topics covered include Rob's nutritional recommendations and the concept of the 'quiet professional,' someone deeply committed to the craft of their work. OfferAre you involved in mountain or wilderness rescue? Rob is offering the first 50 listeners who reach out to him a 20% discount on a training plan. Send your rescue or professional credentials to [email protected] to secure your discount.LinksTraining Plans Patrick Likes:Mountain Base Fitness Greek Heroine Series Busy Dad Training Packet Backcountry Ski Preseason Training Plan Exercises Discussed:Leg Blasters Scotty Bobs Touch Jump Touch Rob's Resources:Ideal bodyweights for mountain athletes Nutritional guidelines Mountain/Wilderness SAR Fitness Assessment Training Plan Resilience vs. Discipline vs. Perseverance: Why the Distinctions Matter in Mental Fitness The 8 Core Attributes of Mental FitnessChapters00:00 Introduction to Wilderness Medicine00:46 Guest Introduction: Rob Shaw from Mountain Tactical Institute04:38 The Evolution of Mountain Tactical Institute06:58 Training for Mountain and Tactical Athletes11:43 Fitness Demands for Ski Patrol19:13 In-Season Training and Professionalism24:47 Fitness for Search and Rescue Volunteers25:10 Integrating Training with Daily Life25:15 Physical and Mental Demands of SAR25:38 Uphill Endurance and Chassis Integrity26:25 Step Ups and Efficient Training Methods28:23 Chassis Integrity Explained31:53 Mental Fitness and ResilienceAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode of Wilderness Medicine Updates, host Patrick Fink breaks down a recent research paper on the differences between simulated avalanche burial and tree well burial, analyzing the findings and their implications for skiers and outdoor rescue personnel. We then transition to a special Q&A session with pre-med student Zack Majd, tackling questions about forming a career in wilderness medicine. Patrick discusses the necessary educational paths, the benefits and limitations of fellowships, and the essentials of wilderness medical training. Additionally, the episode highlights upcoming educational events and provides practical advice on wilderness medical gear, psychological support techniques, and the integration of wilderness medicine with other medical disciplines. A must-listen for anyone interested in advancing their career in the field of wilderness medicine.Links:Kanaan NC, Abdul Cader J, Krakker J, Beasley H, Grissom CK, McIntosh SE. Simulated Avalanche vs Tree-Well Burial Effects on Human Physiology. Wilderness & Environmental Medicine. 2025;36(3):361-367. doi:10.1177/10806032251337476Van Tilburg C, Paal P, Strapazzon G, et al. Wilderness Medical Society Clinical Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents: 2024 Update. Wilderness & Environmental Medicine. 2023;35(1_suppl):20S-44S. doi:10.1016/j.wem.2023.05.014Fink PB, Wheeler AR, Smith WR, et al. Wilderness Medical Society Clinical Practice Guidelines for the Treatment of Acute Pain in Austere Environments: 2024 Update. Wilderness & Environmental Medicine. 2024;35(2):198-218. doi:10.1177/10806032241248422EP. 21 - Snow Immersion Suffocation Chapters:00:00 Introduction and Episode Overview00:43 Upcoming Events in Wilderness MedicinePart 102:07 Tree Well Burials vs. Avalanche Burials05:36 Study Findings and Analysis08:23 Limitations and Implications of the StudyPart 211:21 Q&A: Careers in Wilderness Medicine12:48 Zach's Journey and Career Questions20:35 Balancing Wilderness Medicine with Other Careers26:05 Pathways to Wilderness Medicine30:32 Debating the Value of Wilderness Medicine Fellowships32:21 Personal Experience with Wilderness Medicine Fellowship34:29 Research in Wilderness Medicine37:05 Essential EMS Gear for Wildland Firefighters39:19 Prioritizing Care in Wilderness Settings47:31 Psychological First Aid in Wilderness Medicine50:49 Preparing for Wilderness Medicine Challenges53:55 Future of Wilderness Medicine57:33 SignoffAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode of Wilderness Medicine Updates, Dr. Patrick Fink discusses airway management in austere situations with Dr. Nicholas Weinberg. They explore two cases published in the Wilderness Medicine Journal, detailing the decision-making processes in managing critically injured patients. Dr. Weinberg shares his background in emergency and wilderness medicine, and highlights the importance of flexibility and the application of basic life support techniques in the wilderness. The episode emphasizes the significance of understanding the limitations and capabilities of the available tools in wilderness settings.LinksWEM ArticlePhoto: Ledge from the fallen climberPhoto: Himalayan clinic resuscitationConnect with Dr Weinberg: [email protected]:00 Introduction and Overview00:26 Meet Dr. Nicholas Weinberg01:48 Dr. Weinberg's Background and Career03:55 Case Introduction: The Climbing Accident05:38 On-Scene Response and Initial Assessment08:11 Airway Management and Rescue Coordination11:05 Patient's Condition and Medical Interventions18:34 Patient's Recovery and Conclusion21:01 Reflecting on a Remarkable Case21:30 Discussing the Second Case22:59 Experiences in Wilderness Medicine25:24 Challenges and Strategies in Remote Medical Care30:31 Managing Airway in Austere Environments37:42 Advice for Aspiring Wilderness Physicians42:24 Concluding Thoughts and Listener ShoutoutsAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

Exploring Xenon Gas for Altitude Acclimatization and Sport PerformanceIn this episode of Wilderness Medicine Updates, host Patrick Fink delves into the use of inhaled xenon gas for sports performance enhancement and altitude acclimatization. The discussion is prompted by a recent claim from a UK climbing team that xenon helped them achieve a rapid ascent of Mount Everest. Xenon, a noble gas traditionally used as an anesthetic, has been shown to trigger hypoxia response pathways and boost EPO levels in animal studies. However, human trials have yet to demonstrate significant performance benefits or lasting changes in blood composition. The episode also examines the safety concerns and potential risks associated with unsupervised xenon use. While xenon shows some promise, current evidence suggests it may be more of a placebo effect rather than a reliable tool for enhancing athletic performance or altitude adaptation.Join us on social!Instagram - WildmedupdatesBluesky - wildmedupdates.bsky.socialX - WildmedupdatesYouTube - WildernessMedicineUpdatesChapters00:00 Introduction to Wilderness Medicine Updates00:19 Xenon Gas in Sports and Altitude Acclimatization02:26 The Science Behind Xenon Gas06:13 Human Studies on Xenon Gas12:19 Risks and Side Effects of Xenon Gas15:50 Conclusion and Final Thoughts18:04 Social Media AnnouncementSourcesDias, K.A. et al. (2019). Effect of acute and chronic xenon inhalation on erythropoietin, hematological parameters, and athletic performance. Journal of Applied Physiology, 127(6), 1503-1510 Lawley, J.S. et al. (2019). Safety, hemodynamic effects, and detection of acute xenon inhalation: rationale for banning xenon from sport. Journal of Applied Physiology, 127(6), 1511-1518 Ma, D. et al. (2009). Xenon preconditioning protects against renal ischemic-reperfusion injury via HIF-1α activation. Journal of the American Society of Nephrology, 20(4), 713-720 Pappas, S. (2023). “Did Inhaling Xenon Gas Really Help Mount Everest Climbers Reach the Summit in Record Time?” Scientific American Hackett, P. (2025). “Xenon Gas and High-Altitude Performance: What We Know and What We Don’t.” Uphill Athlete As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode of Wilderness Medicine Updates, host Patrick Fink interviews Moose Mutlow, an experienced outdoor educator and search and rescue professional with nearly four decades of experience globally. Moose discusses his extensive career from being an Outward Bound instructor to working with Yosemite Search and Rescue, and his role as a Family Liaison Officer for the National Park Service. The conversation touches on the challenges faced by search and rescue teams, the importance of robust communication skills, and how to build resilience against trauma in high-stress professions. Moose also shares his personal experiences, reflecting on the value of mentorship, the significance of team dynamics, and the essential need for compassionate support during crises. The episode includes practical advice for those in the field of wilderness medicine and search and rescue, highlighting the necessity of emotional balance and continuous learning.Connect with Moose:WebsiteBlue SkyInstagramSubstackBook: SearchingBook: When Accidents HappenDid you enjoy this episode? Contribute to YOSAR!Links from the show:The Stress ContinuumResponder AllianceQuell FoundationDr. Nicola Lester: trauma informed practiceMore Reading:Ranger ConfidentialNature NoirThe Cold VanishThe Last SeasonCHAPTERS00:00 Introduction and Guest Welcome00:19 Moose Motlow's Background and Career01:58 Challenges in Search and Rescue02:58 The Importance of National Parks05:23 Moose's Nickname and Early Career07:07 Transition to the US and Outdoor Adventures10:54 Search and Rescue Experiences15:20 Swift Water Rescue Operations19:38 Training and Mentorship in SAR30:18 Role of Family Liaison Officer45:24 Managing Emotional Burden as a Liaison Officer47:12 Recognizing and Addressing Trauma48:36 The Importance of Peer Support49:44 Cultural Norms and Vulnerability51:05 The Cost of Ignoring Trauma53:37 Building Resilience and As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode, we dive into one of the most overlooked but deadly hazards in deep powder skiing: snow immersion suffocation (NARSID). Unlike avalanches, snow immersion deaths happen silently—often within feet of a groomed run—when skiers and snowboarders fall into deep snow or tree wells and become trapped. We explore the research behind these incidents, where and how they occur, who is most at risk, and the tragic mechanics of asphyxiation in deep snow. Using studies from Van Tilburg, Baugher, and Cadman, we break down ra eal survival story, discuss prevention strategies, and how both bystanders and professional rescuers should respond. Whether you’re a backcountry adventurer, resort skier, or ski patroller, this episode will change the way you think about deep snow safety. Stay aware, ski with a partner, and stay out of tree wells.Must Watch: GoPro Awards: Tree Well RescueCitationsBaugher, P. (2006). Risk trends at U.S. and British Columbia ski areas: An evaluation of the risk of snow immersion versus avalanche burials. In Proceedings of the 2006 International Snow Science Workshop (pp. 584–591). International Snow Science Workshop. URL: https://arc.lib.montana.edu/snow-science/item/2076Cadman, R. (1999). Eight nonavalanche snow-immersion deaths: A 6-year series from British Columbia ski areas. The Physician and Sportsmedicine, 27(13), 31–43. URL: (No publicly available link found—may be available through institutional access)Van Tilburg, C. (2010). Non–avalanche-related snow immersion deaths: Tree well and deep snow immersion asphyxiation. Wilderness & Environmental Medicine, 21(3), 257–261. URL: https://doi.org/10.1016/j.wem.2010.04.004Van Tilburg, C. S., Grissom, C. K., Zafren, K., McIntosh, S. E., Radwin, M. I., Paal, P., et al. (2017). Wilderness Medical Society practice guidelines for the prevention and management of avalanche and non-avalanche snow burial accidents. Wilderness & Environmental Medicine, 28(1), 23–42. URL: https://doi.org/10.1016/j.wem.2016.10.001Chapters00:00 Introduction: The Hidden Dangers of Snow Immersion00:37 Understanding Snow Immersion Suffocation02:58 Historical Context and Research03:09 Where and How Snow Immersion Happens04:54 Mechanics of Snow Immersion Traps06:23 Risk Factors and Victim Profiles09:27 Prevention and Safety Measures11:48 Rescue Techniques and Immediate Response13:34 Professional Rescuer Guidelines16:12 Advanced Medical Care and Resuscitation20:11 Conclusion and Final ThoughtsAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

King Tube vs IGEL for Airway ManagementIn this episode of Wilderness Medicine Updates, Dr. Patrick Fink addresses a listener's question on whether to use a King Tube or an IGEL as an out-of-hospital airway adjunct. The episode begins with an overview of airway management techniques from mouth-to-mouth resuscitation to supraglottic airway devices. Dr. Fink explains the benefits and drawbacks of various airway adjuncts, including oral and nasal pharyngeal airways. The discussion then shifts to a detailed comparative analysis of King Tubes and IGELs based on retrospective and prospective studies. Dr. Fink evaluates the evidence indicating that IGEL may be more effective and easier to use than King Tubes, particularly in pre-hospital cardiac arrest situations. The episode concludes with recommendations for pre-hospital providers and an encouragement for listeners to share their questions and feedback.Links:iGel LMAKing TubeSmida T, Menegazzi J, Scheidler J, et al. A retrospective comparison of the King Laryngeal Tube and iGel supraglottic airway devices: A study for the CARES surveillance group. Resuscitation. 2023;188:109812. doi:10.1016/j.resuscitation.2023.109812Smida, Tanner & Menegazzi, James & Crowe, Remle & Scheidler, James & Salcido, David & Bardes, James. (2023). A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehospital emergency care. 28. 1-13. 10.1080/10903127.2023.2169422. Lønvik, M.P., Elden, O.E., Lunde, M.J. et al. A prospective observational study comparing two supraglottic airway devices in out-of-hospital cardiac arrest. BMC Emerg Med 21, 51 (2021). https://doi.org/10.1186/s12873-021-00444-0Chapters00:00 Introduction and Listener Question00:55 Understanding Airway Adjuncts02:12 Basic Airway Management Techniques06:34 Advanced Airway Devices: King Tube and LMA11:35 Comparative Studies on Airway Devices17:35 Prospective Data and Final Thoughts25:24 Conclusion and Listener EngagementAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

Exploring Methoxyfluorane for Wilderness Pain Management with Dr. Ross HofmeyrIn this episode of Wilderness Medicine Updates, host Dr. Patrick Fink discusses the use of methoxyfluorane, an anesthetic gas for pain management in wilderness settings. Joined by guest Dr. Ross Hofmeyr, an anesthesiologist and wilderness medicine expert from South Africa, the episode delves into the history, usage, benefits, and limitations of methoxyfluorane. Highlighting its efficacy, ease of use, and safety, especially for pre-hospital scenarios, Dr. Hofmeyr shares insights into its ideal applications, contraindications, and personal experiences. The episode underscores the significance of methoxyfluorane as a potent analgesic suitable for acute traumatic pain and procedural analgesia in austere environments.LinksWild MedixRoss Hofmyer on InstagramThe Inhaler DeviceMethoxyflurane at Altitude - Case ReportMethoxyflurane in the Outback - Survivor ClipWMS Pain Management GuidelinesChapters:00:00 Welcome to Wilderness Medicine Updates00:55 Meet Dr. Ross Hofmeyr03:14 Dr. Hoffmeier's Background in Wilderness Medicine04:45 Methoxyfluorine: An Overview12:20 The Mechanics of Methoxyfluorine Inhaler20:15 Practical Applications in Pre-Hospital Pain Control20:53 Analgesic Intervention: Quick and Effective21:09 Using Methoxyfluorane in Wilderness Settings22:42 Training Non-Medical Personnel23:49 Procedural Analgo-Sedation24:30 Regulatory Considerations and Prescriptions26:33 Combining Methoxyfluorane with Other Medications28:10 Monitoring and Safety29:09 Ambulating Patients with Methoxyfluorane31:31 Environmental Considerations: Temperature and Altitude40:10 Cost and Practical Downsides41:45 Conclusion and Final ThoughtsAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

Ketamine Use in Wilderness Pain Management: An Interview with Dr. Chris Van TilburgIn this episode of Wilderness Medicine Updates, host Patrick Fink discusses wilderness pain control with guest Dr. Chris Van Tilburg, focusing on the effective use of ketamine. The episode delves into how ketamine serves as a versatile medication for pain management, sedation, and intubation in emergency and wilderness environments. Dr. Van Tilburg, an expert in wilderness medicine with extensive field experience, shares insights on administering ketamine in challenging rescue scenarios, the limitations and benefits of various medications, and practical considerations for field use. The conversation touches on dose ranges, administration techniques, and patient management during rescues. Additionally, Dr. Van Tilburg talks about his soon-to-be-released book, 'Crisis on Mount Hood: Stories from 100 Years of Mountain Rescue,' celebrating the centennial of the Crag Rats, America's oldest mountain rescue team.LinksWMS Guideline: Avalanche and Nonavalanche Snow Burial WMS Guideline: Pain Management in Austere Environments  Chris’s Linktree Contact Chris through LinkedIn Preorder Chris’s book “Crisis on Mt Hood”Chris on WikipediaCrag Rats Mountain RescueChapters:00:00 Welcome and New Year Greetings00:29 Introducing Today's Guest: Dr. Chris Van Tilburg03:07 Podcast Shoutouts and Listener Appreciation03:37 In Conversation with Dr. Chris Van Tilburg05:58 Challenges of Wilderness Pain Management09:37 Pain Management Strategies14:23 Ketamine vs. Other Pain Medications18:01 Ketamine Dosage and Administration22:16 Nitty Gritty Tactics: Needle Sizes and Administration23:02 Intramuscular Injection Sites and Techniques24:22 Timing and Dosage of Ketamine Administration25:16 Challenges in Mountain Rescue Situations27:17 Case Study: Seizure Patient and Ketamine Use29:18 Considerations for Head Injuries and Ketamine33:03 Medications in Wilderness Medical Kits34:02 The Art of Wilderness Medicine37:54 Protecting Medications in the Field38:55 Wrapping Up: Upcoming Book and Final ThoughtsAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

In episode 17 of Wilderness Medicine Updates, host Patrick Fink delves into the ICAR resuscitation algorithm for buried avalanche victims. The episode reviews the physiology of avalanche burial and discusses critical determinants of survival, such as duration of burial, airway patency, signs of life, and lethal injuries. The Basic Life Support (BLS) and Advanced Life Support (ALS) algorithms are explained in detail, with a focus on the practical application for both amateur and professional rescuers. The episode also includes two detailed case studies that illustrate the application of the resuscitation algorithm, providing listeners with practical scenarios to better understand the protocols. Key insights on the importance of quick action, hypothermia, and ongoing CPR are highlighted, making this episode essential listening for anyone involved in avalanche rescue operations.Ep. 12 - Resuscitation of the Buried Avalanche Victim, Part 1: PhysiologyICAR Rescue AlgorithmICAR Paper in ResuscitationChapters:00:00 Ep. 17 - Resuscitation of the Buried Avalanche Victim, Part 201:26 Review08:52 BLS Algorithm14:30 ALS Algorithm25:30 Interlude25:30 Case 1: Partner Rescue31:01 Case 2: Professional Rescue39:54 Conclusion/OutroAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode, I share an intense story of dealing with a suprise medical condition during a backcountry hut trip in Colorado. I walk through the diagnostic process, treatment options, and the importance of preparation for stays in remote places. Essential medications and tools needed for handling such emergencies in remote settings are discussed, along with advice on how to prepare for future expeditions.My articles on The-High-Route.comThe Hut Medication CardChapters: 00:00 Introduction and Personal Update01:31 The Backcountry Hut Trip Begins03:19 Will's Health Deteriorates04:38 Diagnosing the Problem07:04 The Emergency Descent09:16 Lessons Learned and Preparedness10:37 Essential Medications for Wilderness Trips16:19 Final Thoughts and ConclusionAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

This episode, I look at a study from the Eurac research group on rates of airway occlusion in critically buried avalanche victims. Eurac looked at this critical feature of avalanche resuscitation triage as it both affects the way we treat buried avalanche victims, and it helps us to better understand whether technologies like the black diamond Avalung (retired) and the Safeback SBX can help us survive longer under the snow if buried. Full study text HEREThe High Route article on the Safeback system HEREEpisode 12: Avalanche victim physiology. Listen on web, Apple Podcasts, or Spotify. Episode 14: Spinal immobilization updates. Listen on web, Apple Podcasts, or Spotify.As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

Today, we discuss updates in the WMS guidelines regarding the protection of patients with suspected spinal injuries.The Wilderness Medicine Society Clinical Practice Guidelines are all open-access, and you can find links to all of these guidelines on the right sidebar of this page.The education in this episode is based on the:Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection: 2024 UpdateIf you've never seen a vacuum mattress before, this video (2:10) gives a good introduction. If the brief mention of the Diploma in Mountain Medicine alpine skills course got you interested, you can learn more about the DiMM here.As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

This episode is a repost of an interview that was first posted on The High Route Podcast. Hosted by the editor of The-High-Route.com, Jason Albert, we discuss my background in wilderness medicine, and then move on to discuss the research that support my argument and assertion that the avalanche airbag backpack should be standard equipment for backcountry skiers, snowboarders, snowmobilers, and anyone who regularly works or recreates in avalanche terrain. Check out The-High-Route.com for awesome backcountry ski and ski-mountaineering content that is unbiased by financial relationships with gear companies and advertisers. Show Note Links:-ISSW Research Manuscript from my avalanche airbag study-My personal website, Mountain Lessons-The Backcountry Shit Kit, original postAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

This is part 1 of a multi-part series on the resuscitation of critically buried avalanche victims. In this episode we learn the physiology that we need to understand the resuscitation algorithm. To learn the necessary biology, we follow a rider as they are carried in an avalanche, subjected to traumatic injury, and are then buried and begin to asphyxiate and cool. The background of this episode is useful to understand why:-Cardiac arrest from trauma is usually unsalvageable;-Arrest due to hypoxia can happen within minutes or be delayed more than an hour;-Why we care if someone is really, really cold;-Why potassium measurement is useful in the hospital treatment of severe hypothermia;-And why we can largely forget about that other gas, CO2.Look out for the next episode, where I''ll dive into the ICAR Avalanche Victim Resuscitation Algorithm.As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

Episode 11 brings you  my conversation with Michael Buchanan is a flight paramedic and senior firefighter / paramedic at the West Valley City Fire Department. He is the founder and operation of Mountain Medical Academy, a passion-driven backcountry medical care education company.  We discuss the medical care of avalanche victims which Michael has made accessible to recreational skiers and riders who don't have a medical background. Other topics that we discuss include:-Finger sweeps to clear the airway-How the presence of an air pocket changes your medical care-How long to perform CPR after an avalanche-What equipment may be useful to a lay rescuer-The importance of psychological care after a critical eventAnd more.Below are links to things discussed in this podcast:Mountain Medical Academy - mountain medical educationAfter the Avalanche - Open source resources for responding medically and psychologically after an avalancheEmail Michael to Join a Class or Partner UpIsraeli Battle Dressing (affiliate link) - elastic compressive dressing for bleeding controlSWAT-T Elastic Tourniquet (affiliate link) - elastic tourniquet also useful in splintingCPR Mask / Oral / Nasal Airways (affiliate link) - tools for rescue breathing / CPRICAR Avalanche Resuscitation Recommendations for advanced life support personnelResponder Alliance - individual and organizational resilience for rescuers in the face of traumatic stress.Not Alone complete film - Sarah Hueniken - a personal story of recovery from stress injury and trauma by a world class ice climber. As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode, I discuss the article "Arterial Occlusion Effectiveness of Space Blanket-Improvised Tourniquets for the Remote Setting". In this short blast I get into the meat of this article, and though the authors would tell you that space blankets aren't ready for primetime, I have some thoughts on the matter. In the podcast, I mistakenly say that you need to be a WMS member to access this article, but you don't! It's available open access here:https://www.wemjournal.org/article/S1080-6032(23)00043-1/fulltextAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode Dr BZ is back to talk about his experience deploying with the Federal Emergency Management Agency (FEMA) Urban Search and Rescue Task Force (USAR). Dr BZ just returned from a deployment with FEMA USAR to Lahaina, HI, where he served as a team physician supporting rescue and recovery efforts there.We touch on:-Training and gear-Deployments and schedule-Compensation-The care of canines-How you can get involved, and more!As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

In this two-part episode, I review an article from the Annals of Emergency Medicine "Occupational Accidents Among Search and Rescue Providers During Mountain Rescue Operations and Training Events" https://doi.org/10.1016/j.annemergmed.2022.12.015In the second half, we review the treatment of diarrhea in the returning traveler.As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

In this second Fast Push, you get a riff on a great article from JEMS entitled "Safety is Third, Not First, and We All Know It Should Be" by Christopher Davis MD et al.Apologies to all who got V1.0-- something weird happened in post that made me sound like a chipmunk. I might be a medical professional, but I'm no AV specialist. Summary:1. Get the Job Done2. Have Fun3. Safety ThirdAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode I go deep on the health effects of wildfire smoke, answering some key questions that are relevant to recreational athletes, outdoors professionals, wildland firefighters, and industrial athletes alike:Why is wildfire smoke harmful?Is there a safe level of exposure?Can we trust the EPA's guideline levels? (Spoiler: no)Does the benefit of exercise outweigh the damage of smoke exposure?If you have to be outside, how can you limit harms?And more. Get ready for a trip down nerd lane.Links from the show:Bad reporting from the NY TimesEPA Air Quality Index InfopageStudy: Effects of Air Pollution and Habitual ExerciseRespro Ultralight Particulate MaskCDC Building Ventilation InfoPurpleAir Indoor Air Quality MonitorAwAir Indoor Air Quality MonitorAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

In this inaugural interview episode I have the pleasure of grilling Dr. Brant-Zawadzki about operating an urban EMS system at a wilderness boundary.We talk about:- Improvising outside the protocol- Interfacing with SAR, rangers, and road workers- How response kit and expectations are changed beyond the pavement- What a fellowship in Wilderness Medicine can do for you careerAnd more!Show Links:EMS Fellowship, U of UWilderness Fellowship, U of UUnified Fire AuthorityBecome world class by combining multiple domains of knowledge (lesswrong)Wilderness Medical Society (twitter)As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode we review the available evidence, and the pros and cons, of using mechanical CPR devices like the LUCAS or Autopulse for ski patrol and mountain rescue applications. Episode links:CPR With a Lucas Device - An example video from EMS trainingViglino et. al. - Outcomes of On-Hill Cardiac Arrests - More saves, probably because of younger patients, bystander CPR, shockable rhythms, and shorter time to defib.WMS Guidelines on the Care of Avalanche Victims - Recommends LUCAS use for prolonged transports and extrications.Putzer et. al. - LUCAS in Simulated Helicopter Rescue"Physical strain during a realistic alpine rescue mission scenario at high altitude led to a significant reduction in quality of resuscitation. Resuscitation guidelines developed at sea level are not directly applicable in the mountain terrain."Wang et. al. - CPR Quality at Altitude, Unacclimatized RescuersEgger et. al. - CPR Quality at High Altitude, Acclimatized RescuersCascade Rescue 'Trauma One' TobogganYouTube: Alyeska Resort Patrol High Performance CPR in TobogganAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode we discuss the HOPE score, a tool that improves our ability to select the severely hypothermic patients who can benefit from warming with extracorporeal life support (ECLS). We begin the with the case of Tayyab Jafar, a young man who was successfully resuscitated from severe hypothermia with both cardiopulmonary bypass and ECMO, but not without incident.  We then discuss the derivation and validation studies for the HOPE score. You can calculate and use the HOPE score at HypothermiaScore.org.HOPE score derivation PDFHOPE score validation: not freely availableAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

For today, a new format, the Fast Push: Quick updates that you need to know sooner rather than later.This fast push tackles the growing issue of avalanche beacon interference. To see the source post and useful graphics, check out this link to the Utah Avalanche Center:https://utahavalanchecenter.org/blog/74828TL:DR-Electronics, magnets, heated/foil line clothes near your beacon are bad. -They need to be at least 20cm away from your transmitting beacon, and 50 cm away when you're performing a search. -When using radios or cell phones to call for help, stay at least 50 cm away from anyone who is searching. -Professional digital VHF radios need to be at least 1 m away.-Don't search while on or within 3 m of a snowmobile. As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

Methoxyflurane: inhaled gas of the past and prehospital analgesic of the future? Only if we’re talking about ‘the future’ in North America. Used in Australian EMS for almost half a century, this safe and effective medication is only now starting to get the attention that it deserves outside of the down-under.Today’s paper:Trimmel, H., Egger, A., Doppler, R. et al. Usability and effectiveness of inhaled methoxyflurane for prehospital analgesia - a prospective, observational study. BMC Emerg Med 22, 8 (2022). https://doi.org/10.1186/s12873-021-00565-6Open access PDF:https://bmcemergmed.biomedcentral.com/counter/pdf/10.1186/s12873-021-00565-6.pdfPenthrox inhaler “selfie” image:https://bmcemergmed.biomedcentral.com/counter/pdf/10.1186/s12873-021-00565-6.pdfAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

Today we look at IV acetaminophen vs IV NSAID vs topical lidocaine vs placebo for treatment of pain due to scorpion stings, with some bonus learning on tramadol.Turgut K, Yavuz E, Gülaçtı U, Aydın İ, Sönmez C, Aktaş N, Arslan E. Comparison of Intravenous Paracetamol, Dexketoprofen Trometamol, or Topical Lidocaine Use for Pain Relief in Scorpion Stings: A Placebo-Controlled, Randomized Study. Wilderness Environ Med. 2022 Dec;33(4):379-385. doi: 10.1016/j.wem.2022.08.002. Epub 2022 Oct 11. PMID: 36229383.https://doi.org/10.1016/j.wem.2022.08.002As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

Is intranasal fentanyl safe and effective for the treatment of acute severe pain on the ski hill?Lynch TV, Callas PW, Peterson TD, Schlein SM. Intranasal Fentanyl for On-the-Hill Analgesia by Ski Patrol. Wilderness Environ Med. 2022 Sep;33(3):296-303. doi: 10.1016/j.wem.2022.05.003. Epub 2022 Jul 16. PMID: 35851192.DOI: 10.1016/j.wem.2022.05.003As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.

Welcome to Wilderness Medicine Updates! This podcast, new for 2023, delivers brief reviews of research in wilderness medicine, SAR, disaster/austere medicine, and wilderness EMS to help you stay current and provide the best care to patients in challenging environments. As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected]. You can pay us a compliment and share the show with a new listener on any popular platform here.