Dr. Decipher: Alaska and Wilderness Medicine

By Dr. John Janousek, M.D. Monday, August 16, 2010

I am in Alaska right now; what a beautiful and wild place. My bucket list included a trip here, and our family is doing an adventurous tour of the frontier state. Yesterday at the Matanuska Glacier we donned helmets, harnesses, crampons, and using ice picks climbed a vertical ice wall.

My wife fell while coming down, and dangled at the end of the belay rope, repeatedly hitting against the wall of ice like a pendulum. She bruised her back and nose, and brought to mind more serious injuries that can and do occur in the wilderness, and the field of Wilderness Medicine in general.

In our area all we have to do is call 911 for emergency medical care, but it is not a long drive until you get to rural areas and the mountains. When a traumatic or a medical emergency occurs in more remote areas it is up to bystanders or first responders to provide care until transportation can be obtained to definitive care. The first 60 minutes of a traumatic emergency has been called the “golden hour” because of its importance, and time is a matter of life and death.

Air transports, mainly helicopters, can be lifesavers, and I have thanked God for them many times when I have been “knee deep in alligators.” But the team has to be activated, a proper landing zone must be available, and the weather must not be too bad. Of course bad weather is one of the reasons traumatic accidents occur in the first place.

While working a winter in a 24-hour clinic in the Outer Banks years ago, a middle-aged man burst in at 3 a.m., clutching his throat. His daughter told me in a worried voice that he had pulled out a piece of chicken bone several hours earlier and he had experienced increasing difficulty breathing. He was now in acute respiratory distress. Outside, freezing rain was falling, the roads were impassable, and flying was impossible.

Airway is the top priority, and this was a difficult case in the best hospitals, let alone in a beach clinic. I sedated the patient and took a quick look into his throat with a laryngoscope; all I saw was swollen tissue - no wonder he could not breathe. After saying a prayer and preparing for a cricothyrotomy (cutting a hole in the neck) I was able to insert an endotracheal tube into the area where the trachea should have been, and it worked, I was in!

I began bagging the patient to ventilate him, and because of the lack of transport we had to continue for an hour until the road was cleared. While OBX is not exactly wilderness, because of the weather and lack of medical facilities (at that time) this is a dramatic example of “when help is delayed.”

The Red Cross offers wilderness medical training but one should start out by taking CPR and the basic first aid course. NOLS also does a combined CPR/wilderness first aid course lasting a couple of days at various locations around the country.

Most of the wilderness medical treatment I have administered on my treks to Philmon, New Mexico and other campouts with the Boy Scouts consists of handing out Motrin and Imodium, but I am prepared for a more serious emergency if it arises.

With all the adventure travel going on, more lay persons should get training and be ready to help if the need arises. Also, remember that each group should have at least two trained providers, as one of them may become a victim himself.

We are going halibut fishing out of Seward tomorrow; hopefully no mishaps will occur. If you have any wilderness medical experiences or information about training courses to share, please let us know and be safe!