WMO News & Views

Gary Sinise American Hero caring for Americas Heros

2012-04-20T12:41:00.002-07:00

Gary Sinise once again steps up to the plate caring for one of Americas rare, now 4th, Quadriplegic War survivors US Army Sgt Travis Mills. I had guessed playing the roll of Lt Dan had an impact on him but I found out he has been a doer for others far before that roll. Garys humanitarian and philanthropic work is vast. He is only the third actor in history to have received the Presidential Citizens Medal. His foundation The Gary Sinise Foundation is a great one to donate through. garysinisefoundation.org

EPI Autoinjector Deadly Warning

2012-04-02T13:35:00.001-07:00

EPI Autoinjector Deadly Warning

To The Editor:

We suspect most of your readers are familiar with the EPIPEN. Its black needle tip and grey safety cap has been a standard for almost 40 years. In the fall of 2010, the EPIPEN colors were changed: the black needle end became orange and the grey safety cap became blue. Other changes were made to the EPIPEN autoinjector that might not be readily apparent to all providers or users, especially in the excitement of a life-threatening anaphylactic reaction. Photo for clarity may be seen at Wildernessmedicine.com on our blog. One of them is not epinephrine, but might find its way into your hands or your patients, and would allow a patient in anaphylaxis to die. There is no warning that it is not epinephrine despite its nearly identical appearance to traditional epinephrine autoinjectors. The drug name administered by the non-epinephrine autoinjector is Alsuma, an anti-migraine medication. The new EPIPEN is oval, same length and colors. Studies have shown 9 year old EPIPENs still have 63% efficacy (FR Estelle Simons J Allergy Clin Immunol. 2000 May;105(5):1025-30.) and many consumers and physicians are aware of this, so it is likely we will have this problem for several more years. We urge all Alsuma autoinjectors be labeled NOT EPI in red and black letters on the white container. There are other EPI autoinjectors in a white container. This warning and request for relabeling is being sent to the FDA who we hope will require Alsuma to apply strong adhesive labels to device and case saying NOT EPI until both can be redesigned to more clearly differentiate this product from epinephrine autoinjectors.

Carl Weil, NREMT-I/C, FAWM

Director, Wilderness Medicine Outfitters

Education Director, Anaphylaxiseducators.com

Elizabeth, Colorado

carl@wildernessmedicine.com

David Fitzpatrick, MD, FAWM FAAFP

Anaphylactic specialist and patient

Goosecreek, South Carolina

Seth C. Hawkins, MD, FACEP, FAAEM, FAWM

Morganton, NC

Photo 1- 5 different auto injectors

Photo 2- 3 different” Epipen” autoinjectors

Photo 3- 2 identical safety end caps -EPIPEN and ALSUMA

Photo 4- Labeled Alsuma case

Freedom- thanks

2009-11-11T13:54:00.000-08:00

We are only free thanks to our veterans who paid for our freedom with their blood--
Interesting that Veterans day and the Marine Corp Birthday are one day apart-
10% VETERANS DAY MED KIT DISCOUNT IF ORDERED BY NOV 21 by a veteran.
Unfortunately some who make it home have difficulty fitting back in here at home
- More than 1 in 3 homeless persons are veterans. Tonight, approximately 131,000 veterans will sleep in cardboard boxes, alleys, under bridges, on bus shelter benches. Please help those you can.

ACAI

2009-11-08T09:15:00.000-08:00

Carl --Have you ever heard of the ACAI Berry? It suppose to be great for weight loss. Let me know.DG
Answer I have been taking 3 to 4 oz for 16 months--over all it is healthy-one of the strong antioxidants but not a noticeable weight loss substance. There are several multi level markets but I found a lower cost yet high percentage is found in NOW brand at vitamin cottage

New Boy Scout WFA required program

2009-11-04T20:02:00.000-08:00

A New Boy Scout of America Wilderness First Aid program was unveiled Aug 1 2009
This completely changes what courses Scout Leaders must take effective March 2010.
For detailed information and how you might be involved visit our new web site
www.WFA-BSA.com. You can get a free on line WFA lesson by logging in with your email contact for coming up dates.

Should all WFR students pass?

2009-11-02T10:55:00.000-08:00

WMO's answer is they will Only pass if the are all practically competent! That means they must be able in written testing, practical excessive and scenario testing to give very good care. That is the care WMOs pool of instructors would want to personally receive if in need of help. So what about the student who did not study hard enough to pass a written or just makes bad decisions on a scenario final? School is practice and as such we feel it is a learning experience and mistakes can be remedied in school. The student is given topics to review from their class work and write essays on that are discussed with an instructor and polished until well done. This year we had 8 out of hundreds who were not proficient at class end. often this is because the student does not really study which includes written work. The written work of all 8 was substandard and when reviewed clearly did not follow the guidelines given. Two of the eight were current college students who chose not to do the work as instructed and did not pass.Two were college graduates, one of whom just never turned the work in even though he was so close to passing. The other, a first primary year teacher, felt they knew it and should not have to prove and promised to bad mouth WMO if we did not pass her- we did not pass her. Of the four of eight that started their work two were the least school educated and worked most on it. One of them, barely a high school grad worked and worked until he actually not only learned data but showed in his essays [16 pages]practical use of it. He earned the certificate and was awarded it with my congratulations.
WMO wants all to pass and our instructors work hard to make that happen but the student must do the work and walk the walk on their own as they will be in the emergency on their own.

NEW Wilderness First Aid 16 hr industry standards.

2009-11-02T09:46:00.000-08:00

Today, Nov 02 marks a cooperative work smoothly done in the Wilderness Medicine community. This was done from start to finish over 90 days. It appears to be a easily modified living document compared to the Boy Scouts 16 hr WFA which states no change till 2014. Tod Schimelpfenig did the hard work of collecting ideas and coordinating this new standard of "Minimum Guidelines and Scope of Practice" for Wilderness First Aid (WFA). This consensus document involving seven leading wilderness teaching schools shows our willing to promote industry standards. WMO is pleased to be not just one of the seven but to have contributed actual lines of content to this project. This is the third of this type of industry project for me wnd WMO. The first two were: the 1999 Wilderness Medicine Society [WMS] minimum WFR 68 hour standards and the WMS Wilderness first Aid teaching program turned over to National Safety Council now run by Emergency Care and Safety Institute. You may read this new minimum standard on WMO s web site under classes/ 16 hr WFA SOP.(PDF file, requires Adobe Acrobat Reader). The link is http://media.wildernessmedicine.com/WFA-SOP-Nov02.pdf.

Passing of a great gentleman- Doctor Charlie Houston

2009-10-07T08:05:00.000-07:00

Today I was saddened to learn of the passing of a great man. I was privileged to have contact with Doctor Charlie. He was a gentleman of the old school and one of the finest kind considerate humans I have known. Ironically I have a book waiting for his signature, something he often did for me with great courtesy. One year he sent a journal from his Banff conference unasked for on my part. When his 5th edition going higher book camp out I once again called him and he graciously spent a lot of time on the phone talking about teaching high altitude with me. I told him that I thought he had written the most amazing book and he proceeded in real modesty to tell me, no it was me teaching the altitude knowledge to students that was more important. This past July at the WMS meeting I talked about him to another Wilderness Medicine Gentleman Doctor, Blair Erb [about Doctor Charlie] and I asked Him why he thought He was such a gentleman of great kindness, Blair said he thought it was a because he had lived through so many hard times in the world that he saw the correct way to live. Blair in my opinion is in the same fine vain as Doctor Charlie. Both of them reminds me of both Sir Edmond Hillary and Warren Bowman [the great ski instructor Doc- what a writer] who I was also fortunate to have been with on several occasions. These Men are precious but passing national, nay world treasures. Doc Charlie was one of the finest-30-

last 90 days

2009-09-08T12:53:00.000-07:00

Just back from teaching a hunting guide course in the Rahaw Wilderness west of Ft Collins, Colorado -- saw moose and deer even though it is archery season. The colors in the Laramie river valley were just starting to turn. Stayed at a great guest ranch and enjoyed the weather. Took the long way with 80C back to Ft Collins- gorgeous!

We have been over busy here at WMO as I have taught 12 classes my self with other of WMO staff over the last 90 days.
Up coming WFR classes are Golden Colo OCT tue and thur evenings and Eastern Penn 9 days in two sessions Jan 2010

Just got a email of a life saved with emergency EPI delivery using the "Carl-WMO McGyvered" system the short version follows-Kudos to the sharp Navy Captain:

My patient was a 29 y/o adventure racer with bee sting allergies nearly ¾ through the event. He was in a two man team and within a mile of base but in thick terrain. He sustained multiple bee stings. His running mate arrived at base describing his buddy as having difficulty breathing, appearing pale/blue, diaphortic, and with urticaria. The patient didn't have his epipen with him. (A lesson he learned well after my debrief with him-always have your epipen)

First dose of epipen and prior treatment dramatically improved his situation with pulse ox 94, RR down from mid 20's to 14, and improved color. He continued to improve while we prepped for scoop and swoop to get back to our First aid station Enroute by stretcher, he started to experience recrudescence of SOB with expanding urticaria. I McGyvered the second dose as you had instructed. On arrival to base he had resolved his urticaria except for presence of mild erythema at the wheal sites. RR was 12, 98% sat on room air, no audible wheezing, and overall a happy ending. I attribute this excellent outcome to the information acquired during the "Anaphylaxis in the Back Country" lecture [by Carl Weil] and would recommend this course highly to anyone.

CAPT R. J. MC USN

Carl Comment after speaking with good friend JR
We teach for the above life saving opportunity and we forget that these occur when we have a student who complains about the test score they did not like.

GI wound kit

2009-07-21T11:50:00.000-07:00

This is the GI heavy Trauma Wound kit we copied from the Marine Corps kit and send to requesting GIs

What might you want in a comphrensive dental kit?

2009-07-09T14:28:00.000-07:00

I just put together a comprehensive foreign travel kit for 30 + folks going to the Ukraine. What would you guess is the least thought of in prolonged transport care? You would be on the same page as me if you said Dental. Having traveled to 5 of the continents and many 2 and 3 world countries, the thought of dental emergencies is disturbing. Because of that we offer a short dental emergency course in our Wildness Advanced Life Support course. Still one needs the tools to give care. Here is a kit list you can copy and working with a good dentist learn to use. Feel free to ask about the contents.
WMO Comprehensive Dental Kit
33 pieces
Mirror, Explorer
Dental Floss, Dental Picks
Irrigation Tips, 2 styles,Syringe
Chlorine Dioxide Tablets,Cotton Roll Packs
Gauze,Cavit/Filling Replacement
Crown/Cap cement,Mixing Tool
Oil of clove/Eugenol-tooth pain reliever
Rincinol-gum pain reliever
root cancel file and brochettes
scapel blade

Saving lives and being prepared

2009-07-07T07:18:00.000-07:00

just finished teaching 2 classes our Elizabeth location 9 day WFR/WEMT module and a 3 day class for Scout leaders in Minnesota. Both had great folk and in spite of a sprained knee [ medial collateral ligament]. As usual folks in the Elizabeth class came from all over - furthest distance was Hawaii! All are now better prepared to handle what comes. You can see their comments at http://wildernessmedicine.com/StudentFAQbrLinks/Testimonials/tabid/1890/Default.aspx

Have just shipped off or am shipping First Aid kits ranging from Blister care to heavy foreign group travel care to the Ukraine, MO, Colorado, Arizona and other points.

Just heard from a true American Hero a young soldier of the lives in Iraq he saved with our Soldier Heavy Trauma Wound kits. THREE lives in that explosion and ONE life previously. These are the same trauma contents of the Marine Corp kits. We sent at no cost 40 kits to his company and 10% saved lives!!!!
If you know a GI who will carry this kit to save lives send us their APO and any donations you can make . Kits materials wholesale cost us 28$ plus shipping. Donations appreciated.

Our Next class is August 8-16 in Elizabeth-- 9 days--
We also have a 2 day special discounted price class [public service once a year limited space] in Golden Colorado Aug 22-23. You can also catch us at the wilderness medicine conference july 24-26 snow mass and the Order of the Arrow BSA NOAC at Univ of Indiana Aug 1-4

Great site for those planing a trip out of the USA

2009-05-26T13:29:00.000-07:00

One of our distance learning students just found and sent me this UK Medical Travel
site.
It is very impressive and appears very up to date.http://www.traveldoctor.co.uk/diseases.htm
Carls WMO Simple Travel Health guide lines
-Be wise, immunize
-Always drink purified bottled water or treat with
boiling, bleach or better yet chlorine dioxide
-If you must eat fruit wash it in bleach and peel it your own with washed hands
-Never eat fruit others have peeled for you
-Always wash your hands before eating and after bathroom
-Carry benzalkonium chloride towelettes or small bottles[made by Katadyne]to wash with
-Carry a well stocked but modest size medical kit 8"x10"x5" [approximate]photo on http://wildernessmedicine.com/Portals/348/ProductImages/11.jpg as well as sample list
http://wildernessmedicine.com/Supplies/MedicalKits/tabid/1759/ctl/Edit/mid/3096/Default.aspx

Cost of Freedom

2009-05-23T09:07:00.000-07:00

While we care givers [wilderness "medics" of all levels]think of patients and sharpening our skills, hopefully on this special weekend we will remember and thank those who served and gave their all, being ever mindful and supportive of those still serving and in harms way. WMO gives scholarships to all veterans in need who wish to learn care giving wilderness skills as a way of being mindful and great full. We also still give Heavy Trauma Kits [like the Marine Corps IFAC]to any requesting GI in combat zone, at no cost if needed, to those who wish to be better prepared. Please pass this on to any vets you know. We give them our thanks wishes to come home soon and safe and our prayers.

WMO director
Carl Weil
[lcp USMC]

whats been happening and a WMO teaching tip

2009-05-17T18:07:00.000-07:00

We are working on a new WMO course more on that latter and have just finished the majority of work.
We had a 35' Pine tree [75yrs?]with beetle killed that Patrick C and Bob W helped me cut down today -- It was tooo close to the shop building for comfort so It was a relief when it came down and missed the building..,inches :)

A side note this is WMO's 25 year off the power grid [mostly active as well as passive solar]
We are a conservation land trust [project started 10 years ago]yes all 130 acres.
We recycle metal, glass, cardboard, and the hard one plastic which ha sto be hauled 25 miles.

As to a teaching tip and a recycle tip. When teaching suturing [as well do in our WFR,WEMT, WALS classes] we use soft plastic trays to work on. I have learned black meat trays are not good as they make the black thread too hard to see. The best are the blue seafood trays from the fish dept in the grocery store a store give good visual contrast. White ones also fish or, heaven forbid, bakery [unhealthy good tasting sugar fat food]are a second choice

Swine?

2009-04-29T10:43:00.000-07:00

Yes it is real!
How did they handle it in Honk Kong? They shut down schools , meetings and travel. What is the US doing- whining. Write your representatives NOW to close our southern boarder NOW.
What else can you do with this admittedly over hyped problem? following article is the best I have found.It starts with wash hands! stay safe--stay out of Mexico. Carl

Staying Safe from Swine Flu

On Monday, the World Health Organization raised the influenza pandemic alert to phase 4 on its "pandemic alert" scale, meaning that they have evidence that there is human-to-human transmission of the virus that is capable of leading to a sustained community outbreak. Whether or not swine flu will become a major pandemic remains unclear -- but there’s absolutely no question that everyone would benefit from measures to strengthen their immune systems to minimize the likelihood of infection.

I have written numerous times about flu prevention with regard to both the "standard" flu viruses as well as avian flu, so have pulled together the most significant and helpful information to help you protect yourself. These are good strategies at all times but especially important and relevant right now.

It’s vital to follow all the same common-sense advice we’ve ever heard about staying healthy during the annual flu season: Wash your hands often... avoid exposure to infected people... try not to touch your face, as this is a common way germs are transmitted... cover your mouth and nose with a tissue (not your hands) when you cough or sneeze... and get plenty of fresh air.

IMMUNE-BUILDING STRATEGIES

According to Daily Health News contributing editor Andrew L. Rubman, ND, there are a number of particular strategies that are helpful in boosting your immune system in order to be strong enough to fight off the assault of germs. He is quick to point out that the real danger has less to do with exposure than with the state of your health at the moment -- being exposed to a virus doesn’t mean you absolutely will get it. Organisms are able to cause disease only when they can get past the body’s defenses. A strong immune system will help limit the duration and intensity of symptoms.

Dr. Rubman’s favorite immune boosters to fight viral infections:

Selenium: A Powerful Antioxidant

This essential trace mineral is a valuable antioxidant that prevents cell damage from free radicals. Selenium helps the immune system recognize viruses and block them from entering cells, explains Dr. Rubman. He recommends a dose of 400 micrograms (mcg) to 500 mcg a day divided into three parts -- that is about four times the usual.

Lomatium

Another potent and powerful weapon against flu is a plant called Lomatium dissectum, a member of the parsley family that grows in the northwestern US. This herb was traditionally used by Native Americans to treat upper respiratory infections and is thought to possess antimicrobial properties as well.

Specialized formulations of Lomatium are available to physicians, but consumers can purchase Lomatium - Osha throat spray (Eclectic Institute). Lomatium is most effective if used as soon as possible after a known exposure (such as a person with whom you work or attend school).

Vitamins

Supplemental vitamin C and D are both very helpful -- C in improving mucous membrane resistance, which is how the virus is most commonly transmitted, and D in reducing risk of infection (and if you do get sick, severity).

Red-Hot Chili Peppers: A Spicy, Immune-Boosting Tea

Another of Dr. Rubman’s flu-fighting favorites is a spicy tea concocted from echinacea, goldenseal, slippery elm bark and just a touch of the red-hot pepper capsicum. Echinacea, goldenseal and capsicum team up to fight off germs, while slippery elm allows the tea to coat the back of the throat, where viruses are most likely to take hold.

Here’s how to make it: At your local health-food store, purchase one-half ounce of powdered goldenseal root... one-half ounce of powdered echinacea root (not the whole plant)... two ounces of slippery elm bark powder... and one teaspoon of capsicum.

At home, put ingredients in a brown paper bag or plastic baggie, close tightly and shake. Transfer the contents to a screw-top jar. Give this jar a shake each time you use it in order to remix the ingredients.

To make the tea, pour one cup of very hot water into a mug over one-half teaspoon of the powder.

Cover and steep for five minutes. Sip up to several cups daily throughout flu season.

LAST BUT NOT LEAST...

It is important enough to repeat -- wash your hands. It’s age-old advice that remains critical. Wash hands before eating... before leaving the bathroom... and indeed, anytime they are dirty.

Read on to learn what to do if you do happen to be stricken with swine flu...

Source(s):

Andrew L. Rubman, ND, medical director, Southbury Clinic for Traditional Medicines, Southbury, Connecticut

PLB / SPOT for wilderness use

2009-04-03T16:16:00.000-07:00

A reader asked about PLBs.
The SPOT device seems to me to be the best with all wilderness issues
considered. I have worked with several SPOTS since they came out. The real deal is that one has to preplanned what is to be done IF the emergency button is pushed-- Who will be notified? What are they suppose to do? Have you up dated this info? The cost is low $150 and the annual is low. A cheap device for the back country with long delayed wilderness medical help.

Spelling

2009-04-03T10:40:00.000-07:00

have been out teaching our annual, highly successful, Wilderness Advanced Life support class. More on this soon. This week was a lot of catch up work requiring a lot of typing
LOL --I had a lot of misspelled words that seemed correct and now i find I have been unknowingly using a French dictionary- whee just got English back !!

a smile

2009-03-18T11:55:00.000-07:00

a friend sent this photo which made me smile
I have no idea who took it but kudos

more on lightning

2009-03-17T16:10:00.000-07:00

yes Schrund in you comment on my march 10 post---Colorado and Florida are usually the high point on the chart re this phenomena. To the best of my knowledge no one really knows how many strikes of a none fatal nature occur. I once attended a lecture on lightning and was able to ask the crowd of around 80 how many of them had been struck. Turns out over half including my self were survivors who had been struck with no apparent ill effects which of course do happen on occasion to survivors. Our Wilderness Advanced Life Support class starts next Wednesday and we are all working to be ready for that. There are still a few spaces if any wish to join. more soon. Carl

a breather and lightning info

2009-03-10T13:09:00.000-07:00

Have been teaching at a fast pace
had a wilderness medicine class student from an other instructor, email me to tell them about the field of WM- I am happy to help folks learn but it is a lot easier to give a phone interview than write a " paper " for them
Here is one I did write on lightning

Wilderness Medicine Outfitters Tips on Lightning Strikes

Lightning can be a significant risk for travelers in the backcountry. As with any risk in the outdoors, prevention is the most important factor. If you are traveling in lightning prone areas, keep in mind these tips

*

Be off the mountain by 1pm. (thunderstorms are more common after moisture has built up during the day)
*

Keep a close eye on the weather, if you see clouds building up, get down, lightning can strike from 15 km away when you are in clear skies, so be conservative.

If you do find yourself in the wrong place when a storm strikes think about the following ways to lessen your chance of being struck.

*

Stay away from single high landmarks e.g. a tree or tower
*

Tall objects provide a cone of protection of 45 degrees, the best place to be in on the outskirts of this cone. A stand of trees of a similar height may offer good protection
*

Get rid of all metal things, e.g. ice axes, tent poles snow picket etc
*

Crouch down with you hands off the ground, you are trying to prevent the lightning from going to your heart and to present a smaller target.
*

Stay at least 20m from your travel companions. That way if one gets hit the others will still be ok and can help you

If someone does get struck by lightning they will be likely to have burns and cardiac/breathing troubles

*

The good news is that CPR can be successful with people whose heart has stopped because of lightning strike.
*

Treat lightning burns like any other burns, cold running water for 20 mins and then cover and keep clean
*

These people need to get to a hospital, even if they seem ok. Start thinking of an evacuation plan.

A wilderness medicine course is an invaluable investment for anyone who ventures out into the backcountry. It may well help you save a life. And it’s an awful lot of fun.

good folks and trauma kits

2009-02-25T17:44:00.000-08:00

Just had Sheriff Deputy assigned to very large high school stop by.
I watched him and his brothers grow up and taught their parents many classes including WALS over the last decades [our next WALS is March 25-29 / more later]. This time he brought two of his youngers over- so polite and well mannered a pleasure, He and his department in a large population, slow response area, are considering traumatic wound emergency kits. I have built kits like the USMC kit for the past 3 years giving them to peace officers and over 600 GIs in Iraq.
My current content for non combat zones is 1- original Quick Clot[QC], 1- Cinch Tight, 2 vacuum compressed gauze rolls and a Boline chest seal. In combat zones we include a TK4 - more on this later.

Some one always asks is it QC dangerous? Answer [proven] NO
the army did a retrospective study of 118 uses in the military and guess what ?? ALL lived!! YHAAA [ realize my numbers could be a little off as I have these reports verbal only many from pentagon sources]
2 had to have skin grafts-- Why? well having sold and trained the use of QC for 4 years I realize some of those who use it have little idea that they must dry water off before applying. Sort of like hot coffee-- most of us know NOT to pour in our lap. Some professional [docs and medics] are so busy they did not train until recently if at all with QC. For those who are concerned, QC now has several very good versions without the heat aspect -- What about the other hemostatic agents you ask? Good question -- the navy has slaughtered almost 900 hogs by partially cutting their femoral artery and testing what would save them--What is number one?? original QC!! Who do I want to fly my plane ? the best not 5 best etc. What do I carry original QC or recent versions of QC- [yes outdoorsrx.com sell these as do a few others]
number two and three are cooler QC products.

What is a Bolin? A new better version of the Wyoming created asherman chest seal now owned by Rush. What is better the seal, stronger and more glue and 3 valves which have no hx of clogging. You can take the Bolin off and reapply if in wrong spot or reapplying on opposite end of respiration cycle seems needed.

So what will they stock for trauma disasters? I hope 1- original Quick Clot[QC], 1- Cinch Tight, 2 vacuum compressed gauze rolls and a Boline chest seal. Will let you know – after I know -- Carl

feb 25 09 welcome

2009-02-25T15:17:00.000-08:00

Just started a blog on wilderness medicine / remote- delayed care
I type slow but more to come
Carl