Curriculum Updates

Compartment Syndrome

February 14, 2021

Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment and can lead to muscle and nerve damage and problems with blood flow. It can be caused by fractures, crush injury, burns or other trauma or repetitive activities, such as running. Compartment syndrome is most common in the lower leg and forearm, although it can also occur in the hand, foot, thigh, and upper arm.

 

Signs and Symptoms

    • Pain out of proportion to the injury or stimulated by stretching or movement
    • Pallor: Pale or cyanotic skin
    • Pulseless: Diminished or absent distal pulse
    • Pressure: The muscle may feel tight or full

 

 

Treatment Principles

    • Assess all extremity injuries for compartment syndrome.
    • Acute compartment syndrome is a surgical emergency.
    • There is no effective nonsurgical treatment.
    • Evacuate to definitive care.

 

 

These curricula recommendations have been adopted from NOLS Wilderness Medicine and have been edited to conform to the standards
set by Center for Wilderness Safety and the Wilderness Medical Society in accordance with the WMS National Practice Guidelines.

Curriculum Updates

Frostbite Treatment

February 14, 2021

The Wilderness Medical Society released a position paper on frostbite (Wilderness & Environmental Medicine, 22, 156–166. 2011). One of the points they made refers to the decision of “to thaw or not to thaw.” Partial or full ­thickness injuries are ideally thawed in a warm water bath at 99-­102°F (37-­39°C). However, in the backcountry, skin-­to‐skin contact might be most practical. If this is not possible, spontaneous or slow thawing may be unavoidable and should be allowed. Don’t purposely keep tissue frozen for extended periods of time.

 

 

These curricula recommendations have been adopted from NOLS Wilderness Medicine and have been edited to conform to the standards
set by Center for Wilderness Safety and the Wilderness Medical Society in accordance with the WMS National Practice Guidelines.

Curriculum Updates

Suspected Spinal Injury MOI

February 14, 2021

How far must one fall to have a mechanism for spine injury? We don’t know. It depends on the height of the fall, how you land, the surface on which you land, your age and other factors. As a guideline, the WFA and WFR Scope of Practice documents incorporate mechanisms based on the Canadian Spine Rule (JAMA. 2001; 286 (15): 1841‐1848.) They are primarily expert opinion, not validated by science.

 

They are:

      • Falls associated with loss of responsiveness/altered mental status.
      • High velocity impacts: (e.g., car/ATV crash, climbing falls, high speed skier/biker crashes).
      • Falls from greater than 3 ft (1 meter) landing on the head, back/side or buttocks.

 

If you are unsure of the mechanism and/or the patient assessment does not find signs or symptoms of spine injury you can use the Focused Spine Assessment to gather information to aid your decision whether to continue to immobilize the spine.

 

Spinal MOI Canadian C-Spine Rule Diagram

 

 

These curricula recommendations have been adopted from NOLS Wilderness Medicine and have been edited to conform to the standards
set by Center for Wilderness Safety and the Wilderness Medical Society in accordance with the WMS National Practice Guidelines.

Curriculum Updates

Don’t Bandage Both Eyes

February 14, 2021

In the case of imbedded objects or penetrating eye injury, the common advice has always been to bandage both the injured AND the uninjured eye. The rationale was conjugate gaze; if one eye moves, so does the other (we can’t move each eye independently like chameleons).

 

However, we now know that while our eyes do track together they also react to sound and other stimuli. There is actually more eye movement when vision is occluded, especially in children. There is no need to routinely bandage both eyes, unless both eyes are injured. Maintaining vision allows the patient to function and limits overall eye movement. Also, the eye moves more when closed than when opened, thus potentially doing more internal damage than of the uninjured eye were allowed to stay un-occluded.

 

 

These curricula recommendations have been adopted from NOLS Wilderness Medicine and have been edited to conform to the standards
set by Center for Wilderness Safety and the Wilderness Medical Society in accordance with the WMS National Practice Guidelines.

Curriculum Updates

Pressure Points + Bleeding Control

February 14, 2021

Squashing an artery to control severe bleeding (a.k.a. “pressure points”) is a difficult skill to perform and there is little evidence it helps; plus, what little evidence may be more lore than substance. Our bleeding control curriculum well-aimed direct pressure, elevation, and as a last resort, tourniquet.

 

Pressure points are also no longer part of the Red Cross, Pre-­Hospital Trauma Life Support, Tactical Combat Casualty curriculum, or the National Registry of EMT Skills Sheets.

 

 

These curricula recommendations have been adopted from NOLS Wilderness Medicine and have been edited to conform to the standards
set by Center for Wilderness Safety and the Wilderness Medical Society in accordance with the WMS National Practice Guidelines.

Curriculum Updates

Chest + Back Seals Taped on 4 Sides

February 14, 2021

The Pre-Hospital Trauma Life Support and Tactical Combat Casualty Curriculum is now recommending taping chest wound seals on all 4 sides. The goal is to seal the hole completely and quickly. The concept of a one-­way valve from a dressing taped on 3 sides doesn’t seem to work in the real world. If a tension pneumothorax develops, release the dressing to release the pressure.

 

 

These curricula recommendations have been adopted from NOLS Wilderness Medicine and have been edited to conform to the standards
set by Center for Wilderness Safety and the Wilderness Medical Society in accordance with the WMS National Practice Guidelines.

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