Almost by definition, doctors should know how to administer an injection or take a blood pressure reading. But not all doctors know that, in a pinch, you can tie strands of someone’s hair together to close a scalp wound, use duct tape and a ski pole to fashion a splint, or mix a drop of dish soap in with someone’s drinking water to relieve constipation — unless, that is, they’re among the growing number of medical professionals specializing in wilderness medicine.
Today’s travelers are increasingly drawn to adventure vacations, like caving, deep sea diving or climbing Mount Everest. As the popularity of adventure travel continues to rise, so does the need for medical professionals who can address the hazards specific to these endeavors. Clinics are popping up in remote destinations and adventure travel companies are hiring trained medical professionals to accompany groups of travelers on excursions.
Wilderness medicine, according to the Wilderness Medical Society, is “the practice of medicine where definitive care is more than one hour away, and often days to weeks away. It is defined by difficult patient access, limited equipment, environmental extremes, decision making, creative thinking and improvising.” While wilderness medicine is a distinct field of study, it encompasses skills used in sports medicine, emergency medicine, military medicine and travel medicine. As natural disasters increase, experts believe proficiency in these skills will become ever more relevant.
Improvised medical care in the wilderness has always been a thing (think Boy Scouts), and it’s only expanding as medicine becomes more sophisticated and people venture into increasingly remote areas for intrepid challenges.
Stanford University offered the first formal fellowship in wilderness medicine, as a subspecialty, in 2003. Now 15 medical schools across the country, including Harvard, Yale, the University of Colorado and the University of Utah, offer one-year post-residency fellowships. Shorter, more basic courses, for which you don’t need an MD, are also widely available around the country. Nurses, EMTs, forest rangers and other first responders can all be trained in various levels of the practice, as can lay people without any medical expertise.
Some practitioners do wilderness medicine full time; others hold down full-time jobs in related specialties, such as traditional emergency medicine, and practice wilderness medicine on the side, often on a volunteer basis. There are a number of sub-specialties within wilderness medicine, such as dive medicine and avalanche medicine. Depending on their training and personal interests, wilderness medical experts usually collaborate with local rescue organizations, like the Rocky Mountain Rescue Group or the Divers Alert Network.
Along with dedication to safety and medicine, those who pursue wilderness medicine typically share a love of the outdoors. For Eli Schned, currently a fellow in the Yale program, his interest piqued while working as a firefighter for the forest service. “That first season, a packer — a person who uses pack animals to get equipment into wilderness areas — got kicked in the head by a mule and I somehow wound up leading his evacuation,” recalls Schned. “I really had no idea what I was doing, and luckily his injuries were not lethal, but I knew I wanted to learn more after that.”
Stewart Decker, a family physician in Klamath Falls, Oregon, decided to take a “Wilderness First Responder” class as an undergraduate at the University of Puget Sound, so he could lead students on backpacking trips. The bulk of the course focused on treating wounds, dehydration, sprained ankles and the like. Later, he took a more advanced course in which the students simulated disasters, complete with screaming victims and fake blood. Decker and his classmates staged a cruise ship crash, played out in the freezing waters of Puget Sound.
“Some of them really hammed it up with the drama, which was amusing, but actually valuable, because we got the perspective of the people in these situations who need help and got to register how scared they are,” he says. Another important aspect of these pretend disasters is getting to practice how to control your own fears in these situations, so you can act calmly and rationally during a real emergency.
Once you’re certified, a typical day at the office might entail manning a makeshift clinic at the base of a towering mountain peak, operating a hyperbaric chamber near a dive site to treat divers with the bends, or accompanying a group on a whitewater rafting trip. A perk of the Yale fellowship is the opportunity to travel around the world on a three-week National Geographic expedition, which might include snowshoeing in Iceland or kayaking in Costa Rica.
The art of wilderness medicine comes down to two essential skills: improvising with bare-bones supplies in an austere environment and making on-the-spot decisions. “First, you have to know how to safely and rapidly get someone stabilized, and then you have to figure out how to get them somewhere else,” says Decker. “That means determining when to call for an evacuation, when and how to get them out yourself or how to help them walk themselves out.”
Some of the most common ailments include frostbite, animal bites and stings, altitude sickness, broken bones and gastrointestinal troubles. Travelers who attempt heroic feats, however, sometimes end up in dire straits. Luanne Freer is the medical director at Yellowstone National Park and founder of Everest ER, a rudimentary clinic at the base of Mount Everest that treats an average of 575 of climbers per year. “Humans, even the fittest, most genetically adapted of us,” Freer told me, “cannot live for long at extreme altitudes — above around 5,500 meters (approximately 18,045 feet).”
A few years ago, Freer was on duty at the clinic when a climber was brought in with high-altitude pulmonary edema (HAPE), the most common cause of death at high altitudes.
“This was the worst case of HAPE I’d ever seen,” Freer said in an interview on ABC’s 20/20. “The man was gravely ill and could barely breathe. Blood was pooling in his lungs, putting him at risk for drowning in his own blood.” High-flow oxygen is the most common treatment for HAPE, but in the mountains, you don’t have access to unlimited oxygen, as you would in a hospital.
Patients with pulmonary edema are usually severely dehydrated, so rehydrating them with IV fluids is also key, but keeping the fluid from freezing in the tube at 30 below presents another challenge. Freer and her team ran the tube through the arm of someone’s down jacket, relying on their body heat to keep the fluid warm.
When nothing worked to ease the patient’s distress, “we gave him every medicine I could think of to decrease the blood pressure in his lungs,” Freer told 20/20. “We ended up using Viagra, which was in fact originally developed to decrease blood pressure.” Once the man was stabilized, a team of Sherpas carried him 5,000 feet down the mountain, where he was rescued by a helicopter and successfully treated at the closest hospital.
If you’re inclined to head into the wild, whether informally or on an organized tour, spend some time educating yourself about where you’re going, what precautions to take and what to pack in a basic first aid kit. It’s also important to understand exactly what your health insurance policy covers if you need to be rescued or receive medical care. Most major tour operators require that you purchase additional coverage, either through them or an independent travel insurance provider.
At the same time, adventure travel means taking risks, which is part of the allure. “You can’t, and shouldn’t, try to eliminate all risk, says Schned. “Even with the increasing prevalence of trained wilderness doctors, you shouldn’t assume you’ll be rescued if something happens.”