What drives me nuts in wilderness medicine education?
1. Classroom medicine
This is advice that makes sense in the classroom but fails in the reality of the field. Years ago, we taught—I taught—not to apply warmth to a severely hypothermic patient. These people were in a "stable metabolic icebox." Then, I knelt next to my first profoundly hypothermic patient in the wilderness and this advice melted. I had no illusions I would warm this patient in the field, but not applying heat to stabilize his temperature made no sense.
I once read advice to keep frozen toes frozen by sleeping with the foot outside of the sleeping bag. This fell to the axe of reality when I stared at my own frozen toes in a tent on a cold winter's night. We used to think tourniquets implied amputation and that open chest wounds needed to be sealed with three-sided dressings to allow air to escape. This classroom advice did not survive the test of the battlefield.
2. Inaccurate statements of frequency
Hearing something once and acting upon it, no matter how thin the supporting evidence is.
With all the cheese NOLS courses consume, it's good that the data supports strains and sprains, rather than cheese slicing, as the most common cause of injury.
If I acted upon all the dramatic tales I’ve heard from someone who heard from someone who knew a guy, I would not leave home without an auto-injector of epinephrine in a hip holster, locked and loaded. When I read the NOLS incident data history, solid enough to generate multiple medical papers, I can argue that anaphylaxis is rare in the wilderness. But I won't make that argument (and I’m from NOLS). A snapshot is not the entire picture. Data is often a matter of context, and the bottom line is that we don't know the incidence of anaphylaxis in the outdoors. I have epinephrine in my first aid kit. I don’t imagine I will ever use it.
In the same vein, I recently read about the high risk of a lawsuit from reducing a shoulder dislocation in the field. Based on documented cases or data? I think not. I've also heard outdoor experts say that the most common injury on NOLS courses is a laceration from slicing cheese. The real answer, sprains and strains, is easily accessible in the published literature.
When you see or hear numbers, ask for the source, and ask for the conflicting evidence. If the educator is worth his salt, he will be able to tell you the breadth of science on this question. Consider any unreferenced number to be junk.
3. And then there are those who claim expertise in wilderness medicine, but whose wilderness experience is limited to conference rooms and catered trips.
How can you talk the walk when you don’t walk the talk?
Am I innocent? Probably not, but I have the good fortune of working in a community of colleagues who will call me to task if I slip into the traps of classroom medicine, deceptive statistics, un-factual facts, or when I spend too little time out of doors.
Read more posts from Tod Schimelpfenig, our Curriculum Director, on the blog's Wilderness Medicine page.
