Understanding Stress Injuries in First Line Responders with Laura McGladrey

This 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.

Links

Responder Alliance Home Page
Access all that the organization has to offer.

Responder Alliance: Resource Hub
Easy access to critical tools and offerings.

The Stress Continuum
See the visual continuum that we discuss on the show.

Scholarships: Responder Alliance Foundation
Apply 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.

Chapters
00:00 Introduction and Guest Welcome
02:11 Laura's Background and Work
06:00 Understanding Stress Injuries
10:02 Responder Alliance Mission and Challenges
20:55 Critical Incident Stress Management
30:49 Empowering First Responders
32:13 Daily Investments in Resilience
37:26 Recognizing and Managing Stress
38:14 Organizational Support for Stress Management
39:45 Building Resilient Teams
46:12 Learning from Resilient Leaders
52:42 Resources for Stress Mitigation
57:54 Conclusion and Final Thoughts

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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 Overview
01:29 Importance of Thermoregulation
03:12 Human Thermoregulation Mechanisms
04:20 Measuring Core Temperature
07:55 Heat Exchange Methods
14:52 Behavioral and Physiological Responses
24:48 Sex and Age Differences in Thermoregulation
27:14 Conclusion and Next Steps

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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.

Links

Eisendle 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.2025.16837

Articles I've written about Safeback:

Suffocation or Survival: A Crucial Factor in Avalanche Burials

Avalanche Safety: Assessing the Safeback SBX System

First Look: Safeback SBX Avalanche Safety System

Chapters
00:31 Overview of SafeBack SBX Technology
02:55 Importance of SafeBack in Avalanche Safety
05:40 Details of the SafeBack Study
07:53 Study Results and Analysis
11:07 Implications and Future Directions
15:50 Conclusion and Final Thoughts

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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. 

Offer

Are 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.

Links

Training 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 Fitness

Chapters

00:00 Introduction to Wilderness Medicine
00:46 Guest Introduction: Rob Shaw from Mountain Tactical Institute
04:38 The Evolution of Mountain Tactical Institute
06:58 Training for Mountain and Tactical Athletes
11:43 Fitness Demands for Ski Patrol
19:13 In-Season Training and Professionalism
24:47 Fitness for Search and Rescue Volunteers
25:10 Integrating Training with Da

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

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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:10.1177/10806032251337476

Van 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.2023.05.014

Fink 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:10.1177/10806032241248422

EP. 21 - Snow Immersion Suffocation 

Chapters:

00:00 Introduction and Episode Overview

00:43 Upcoming Events in Wilderness Medicine

Part 1

02:07 Tree Well Burials vs. Avalanche Burials

05:36 Study Findings and Analysis

08:23 Limitations and Implications of the Study

Part 2

11:21 Q&A: Careers in Wilderness Medicine

12:48 Zach's Journey and Career Questions

20:35 Balancing Wilderness Medicine with Other Careers

26:05 Pathways to Wilderness Medicine

30:32 Debating the Value of Wilderness Medicine Fellowships

32:21 Personal Experience with Wilderness Medicine Fellowship

34:29 Research in Wilderness Medicine

37:05 Essential EMS Gear for Wildland Firefighters

39:19 Prioritizing Care in Wilderness Settings

47:31 Psychological First Aid in Wilderness Medicine

50:49 Preparing for Wilderness Medicine Challenges

53:55 Future of Wilderness Medicine

57:33 Signoff

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

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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.

Links

WEM Article

Photo: Ledge from the fallen climber

Photo: Himalayan clinic resuscitation

Connect with Dr Weinberg: [email protected]

Timeline

00:00 Introduction and Overview

00:26 Meet Dr. Nicholas Weinberg

01:48 Dr. Weinberg's Background and Career

03:55 Case Introduction: The Climbing Accident

05:38 On-Scene Response and Initial Assessment

08:11 Airway Management and Rescue Coordination

11:05 Patient's Condition and Medical Interventions

18:34 Patient's Recovery and Conclusion

21:01 Reflecting on a Remarkable Case

21:30 Discussing the Second Case

22:59 Experiences in Wilderness Medicine

25:24 Challenges and Strategies in Remote Medical Care

30:31 Managing Airway in Austere Environments

37:42 Advice for Aspiring Wilderness Physicians

42:24 Concluding Thoughts and Listener Shoutouts

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

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Exploring Xenon Gas for Altitude Acclimatization and Sport Performance
In 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 - Wildmedupdates
Bluesky - wildmedupdates.bsky.social
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YouTube - WildernessMedicineUpdates

Chapters
00:00 Introduction to Wilderness Medicine Updates
00:19 Xenon Gas in Sports and Altitude Acclimatization
02:26 The Science Behind Xenon Gas
06:13 Human Studies on Xenon Gas
12:19 Risks and Side Effects of Xenon Gas
15:50 Conclusion and Final Thoughts
18:04 Social Media Announcement

Sources
Dias, 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

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

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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:
Website
Blue Sky
Instagram
Substack
Book: Searching
Book: When Accidents Happen

Did you enjoy this episode? Contribute to YOSAR!

Links from the show:
The Stress Continuum
Responder Alliance
Quell Foundation
Dr. Nicola Lester: trauma informed practice

More Reading:
Ranger Confidential
Nature Noir
The Cold Vanish
The Last Season

CHAPTERS
00:00 Introduction and Guest Welcome
00:19 Moose Motlow's Background and Career
01:58 Challenges in Search and Rescue
02:58 The Importance of National Parks
05:23 Moose's Nickname and Early Career
07:07 Transition to the US and Outdoor Adventures
10:54 Search and Rescue Experiences
15:20 Swift Water Rescue Operations
19:38 Training and Mentorship in SAR
30:18 Role of Family Liaison Officer
45:24 Managing Emotio

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

Connect with us by email at [email protected].

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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 Rescue

Citations

Baugher, 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/2076

Cadman, 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.2010.04.004

Van 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.2016.10.001

Chapters
00:00 Introduction: The Hidden Dangers of Snow Immersion
00:37 Understanding Snow Immersion Suffocation
02:58 Historical Context and Research
03:09 Where and How Snow Immersion Happens
04:54 Mechanics of Snow Immersion Traps
06:23 Risk Factors and Victim Profiles
09:27 Prevention and Safety Measures
11:48 Rescue Techniques and Immediate Response
13:34 Professional Rescuer Guidelines
16:12 Advanced Medical Care and Resuscitation
20:11 Conclusion and Final Thoughts

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

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King Tube vs IGEL for Airway Management

In 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 LMA

King Tube

Smida 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.2023.109812

Smida, 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/s12873-021-00444-0

Chapters

00:00 Introduction and Listener Question

00:55 Understanding Airway Adjuncts

02:12 Basic Airway Management Techniques

06:34 Advanced Airway Devices: King Tube and LMA

11:35 Comparative Studies on Airway Devices

17:35 Prospective Data and Final Thoughts

25:24 Conclusion and Listener Engagement

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

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