In this episode Dr BZ is back to talk about his experience deploying with the Federal Emergency Management Agency (FEMA) Urban Search and Rescue Task Force (USAR). Dr BZ just returned from a deployment with FEMA USAR to Lahaina, HI, where he served as a team physician supporting rescue and recovery efforts there.

We touch on:
-Training and gear
-Deployments and schedule
-Compensation
-The care of canines
-How you can get involved, and more!

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

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In this two-part episode, I review an article from the Annals of Emergency Medicine "Occupational Accidents Among Search and Rescue Providers During Mountain Rescue Operations and Training Events"

https://doi.org/10.1016/j.annemergmed.2022.12.015

In the second half, we review the treatment of diarrhea in the returning traveler.

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

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In this second Fast Push, you get a riff on a great article from JEMS entitled "Safety is Third, Not First, and We All Know It Should Be" by Christopher Davis MD et al.

Apologies to all who got V1.0-- something weird happened in post that made me sound like a chipmunk. I might be a medical professional, but I'm no AV specialist. 

Summary:

1. Get the Job Done
2. Have Fun
3. Safety Third

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

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In this episode I go deep on the health effects of wildfire smoke, answering some key questions that are relevant to recreational athletes, outdoors professionals, wildland firefighters, and industrial athletes alike:

Why is wildfire smoke harmful?
Is there a safe level of exposure?
Can we trust the EPA's guideline levels? (Spoiler: no)
Does the benefit of exercise outweigh the damage of smoke exposure?
If you have to be outside, how can you limit harms?

And more. Get ready for a trip down nerd lane.

Links from the show:
Bad reporting from the NY Times
EPA Air Quality Index Infopage
Study: Effects of Air Pollution and Habitual Exercise
Respro Ultralight Particulate Mask
CDC Building Ventilation Info
PurpleAir Indoor Air Quality Monitor
AwAir Indoor Air Quality Monitor

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

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In this inaugural interview episode I have the pleasure of grilling Dr. Brant-Zawadzki about operating an urban EMS system at a wilderness boundary.

We talk about:
- Improvising outside the protocol
- Interfacing with SAR, rangers, and road workers
- How response kit and expectations are changed beyond the pavement
- What a fellowship in Wilderness Medicine can do for you career
And more!

Show Links:
EMS Fellowship, U of U
Wilderness Fellowship, U of U
Unified Fire Authority
Become world class by combining multiple domains of knowledge (lesswrong)
Wilderness Medical Society (twitter)

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

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In this episode we review the available evidence, and the pros and cons, of using mechanical CPR devices like the LUCAS or Autopulse for ski patrol and mountain rescue applications.

Episode links:

CPR With a Lucas Device - An example video from EMS training

Viglino et. al. - Outcomes of On-Hill Cardiac Arrests - More saves, probably because of younger patients, bystander CPR, shockable rhythms, and shorter time to defib.

WMS Guidelines on the Care of Avalanche Victims - Recommends LUCAS use for prolonged transports and extrications.

Putzer et. al. - LUCAS in Simulated Helicopter Rescue
"Physical strain during a realistic alpine rescue mission scenario at high altitude led to a significant reduction in quality of resuscitation. Resuscitation guidelines developed at sea level are not directly applicable in the mountain terrain."

Wang et. al. - CPR Quality at Altitude, Unacclimatized Rescuers

Egger et. al. - CPR Quality at High Altitude, Acclimatized Rescuers

Cascade Rescue 'Trauma One' Toboggan

YouTube: Alyeska Resort Patrol High Performance CPR in Toboggan

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

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In this episode we discuss the HOPE score, a tool that improves our ability to select the severely hypothermic patients who can benefit from warming with extracorporeal life support (ECLS).

We begin the with the case of Tayyab Jafar, a young man who was successfully resuscitated from severe hypothermia with both cardiopulmonary bypass and ECMO, but not without incident. 

We then discuss the derivation and validation studies for the HOPE score.

You can calculate and use the HOPE score at HypothermiaScore.org.

HOPE score derivation PDF

HOPE score validation: not freely available

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

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For today, a new format, the Fast Push: Quick updates that you need to know sooner rather than later.

This fast push tackles the growing issue of avalanche beacon interference. To see the source post and useful graphics, check out this link to the Utah Avalanche Center:

https://utahavalanchecenter.org/blog/74828

TL:DR
-Electronics, magnets, heated/foil line clothes near your beacon are bad. 
-They need to be at least 20cm away from your transmitting beacon, and 50 cm away when you're performing a search. 
-When using radios or cell phones to call for help, stay at least 50 cm away from anyone who is searching. 
-Professional digital VHF radios need to be at least 1 m away.
-Don't search while on or within 3 m of a snowmobile. 

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

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Methoxyflurane: inhaled gas of the past and prehospital analgesic of the future? Only if we’re talking about ‘the future’ in North America. Used in Australian EMS for almost half a century, this safe and effective medication is only now starting to get the attention that it deserves outside of the down-under.

Today’s paper:

Trimmel, H., Egger, A., Doppler, R. et al. Usability and effectiveness of inhaled methoxyflurane for prehospital analgesia - a prospective, observational study. BMC Emerg Med 22, 8 (2022). https://doi.org/10.1186/s12873-021-00565-6

Open access PDF:

https://bmcemergmed.biomedcentral.com/counter/pdf/10.1186/s12873-021-00565-6.pdf

Penthrox inhaler “selfie” image:

https://bmcemergmed.biomedcentral.com/counter/pdf/10.1186/s12873-021-00565-6.pdf

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

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Today we look at IV acetaminophen vs IV NSAID vs topical lidocaine vs placebo for treatment of pain due to scorpion stings, with some bonus learning on tramadol.

Turgut K, Yavuz E, Gülaçtı U, Aydın İ, Sönmez C, Aktaş N, Arslan E. Comparison of Intravenous Paracetamol, Dexketoprofen Trometamol, or Topical Lidocaine Use for Pain Relief in Scorpion Stings: A Placebo-Controlled, Randomized Study. Wilderness Environ Med. 2022 Dec;33(4):379-385. doi: 10.1016/j.wem.2022.08.002. Epub 2022 Oct 11. PMID: 36229383.
https://doi.org/10.1016/j.wem.2022.08.002

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

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