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2. Wilderness Paramedic—A Practice Analysis.

Author

Thurman, Jeffrey T., Hawkins, Seth C., Fifer, David, Clark, John R., and Abo, Benjamin

Subjects
MEDICALLY underserved areas, OCCUPATIONAL roles, TASK performance, EMERGENCY medical technicians, MEDICAL care, EMERGENCY medical services, PROFESSIONAL licensure examinations, SURVEYS, EXPERIMENTAL design, RESEARCH methodology, EMERGENCY medical services education, PARAMEDICINE, CONCEPTS, PROFESSIONAL competence
Abstract

Emergency medical services (EMS) has existed in its modern form for over 50 years. EMS has become a critical public safety net and access point to the larger health care system. Mature EMS systems are in place in most urban areas. However, EMS systems are not as developed in wilderness areas. A barrier to further development of these systems is the lack of an agreed-upon standard of minimum competence and validation of specialized practice. A practice analysis was completed to create such standards. The practice analysis was completed using a multi-step process. A group of subject matter experts constructed a survey of tasks and knowledge needed for wilderness EMS (WEMS) specialty practice. The tasks and knowledge were validated through an industry survey. A total of 947 surveys were submitted for analysis. Of these, 196 were at least 55% complete and used for analysis. North America was heavily represented as a primary practice location with 177 (90.3%) responses out of the 196 total. Of these 177 responses, 164 (92.7%) were from the United States and 12 (6.8%) were from Canada. One hundred seven of the 116 tasks identified by the subject matter expert group were passed by the survey group, and 164 of the 175 knowledge statements were passed by the survey group. An index of agreement (IOA) was calculated and found to be greater than 0.9 for each task and knowledge statement across all subgroups. A content coverage rating was also calculated and the results indicate survey participants felt the content was "adequate" to "well" covered. The survey results were used to construct a pilot examination. Beta testing of the pilot examination was performed. The beta test results were analyzed and a cut score was determined using the Angoff method with a Beuk compromise. The final product of this process is a defensible exam that will certify candidates' cognitive knowledge of the specialty of WEMS. Completion of this practice analysis solidifies WEMS as distinct subspecialty of out-of-hospital medicine. Additionally, it establishes a consensus definition of wilderness paramedicine and standards that may be used by WEMS systems and regulatory entities. [ABSTRACT FROM AUTHOR]

Published
2024
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20. Wilderness Medicine Education: How to Choose the Right Resources for Archaeology Field Programs.

Author

Hawkins, Seth C., Winstead, Corey, Klehm, Carla, Eifling, Kurt P., and Peixotto, Becca

Subjects
*WILDERNESS medicine, *HISTORY of medicine, *ARCHAEOLOGY, *FIRST responders, *CONTINUING education
Abstract

Wilderness medicine classes are widely available to archaeologists and field scientists, but because wilderness medicine is an unregulated field, knowing what the various courses and products mean can be difficult. Based on the education chapter in the recently published textbook Wilderness EMS, this article—written by same two authors as the book—explores a number of topics relevant for the field scientist, program director, or administrator seeking to obtain wilderness medicine training for archaeologists. The article first explores the history of wilderness medicine products and certificates available to interested parties. It then differentiates between the various products available today along with their benefits and limitations for the end user. Products and trainings described include certifications (including Wilderness First Aid [WFA], Wilderness Advanced First Aid [WAFA], Advanced Wilderness First Aid [AWFA], and Wilderness First Responder [WFR]), as well as single use or continuing education trainings (including Stop the Bleed, CPR, conference courses, and field schools). Particular attention is paid to the specific and actionable needs of a field scientist in remote areas. [ABSTRACT FROM AUTHOR]

Published
2021
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21. Ten Myths about Medical Emergencies and Medical Kits.

Author

Hawkins, Seth C., Simon, R. Bryan, Klehm, Carla, Eifling, Kurt P., and Peixotto, Becca

Subjects
*SURVIVAL & emergency equipment, *MEDICAL emergencies, *MEDICAL misconceptions, *WILDERNESS medicine, *EMERGENCY medical services, *SNAKEBITES
Abstract

Wilderness medicine is plagued by myths and dogmatic teachings not supported by evidence. This article focuses particularly on those teachings and tools that would be most likely used in archaeological fieldwork. It lays out 10 of the most common and concerning myths taught in wilderness medicine and wilderness emergency medical services, both in terms of first aid and preparation of medical kits. The myths described are provide a structure for the main purpose of the article: to explain interventions and medical kit contents that are more evidence based and supported by modern understandings of wilderness medicine and fieldwork risk management. The list of top 10 myths includes (1) the use of medications other than epinephrine for anaphylaxis and (2) the availability and proper use of epinephrine auto-injectors, (3) the use of suction devices and tourniquets for snakebites, (4) the use of spinal immobilization for neck injuries, (5) the identification and treatment of heat illnesses, (6) the use of CPR in remote areas, (7) the appropriateness of dislocation reduction in remote areas, (8) the use and choice of tourniquets for arterial bleeding, (9) the initial definition and management of drowning patients, and (10) wound management myths. [ABSTRACT FROM AUTHOR]

Published
2021
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25. Use of Ultrasound for Joint Dislocation Reduction in an Austere Wilderness Setting: A Case Report.

Author

Kranc, David A., Jones, A. Wooten, Nackenson, Joshua, Davis, Christopher A., Abo, Benjamin N., and Hawkins, Seth C.

Subjects
JOINT dislocations, EMERGENCY medical services, EMERGENCY medicine, FENTANYL, HIKING injuries, NATURE, POINT-of-care testing, GLENOHUMERAL joint
Abstract

Point-of-care ultrasound has been shown to have a demonstrable impact in the austere/out-of-hospital environment. As ultrasounds become more affordable and portable, a myriad of uses in austere environments are becoming recognized. We present a case of a stranded hiker with an ultrasound-confirmed glenohumeral joint dislocation who underwent ultrasound-guided intra-articular lidocaine injection and ultrasound-confirmed reduction. This procedure allowed the patient to hike out under his own power, avoiding the potential dangers of extrication to both patient and rescuers. We believe this case demonstrates the feasibility and utility of ultrasound in the out-of-hospital environment both procedurally and diagnostically. [ABSTRACT FROM AUTHOR]

Published
2019
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27. MEDICAL OVERSIGHT, EDUCATIONAL CORE CONTENT, AND PROPOSED SCOPES OF PRACTICE OF WILDERNESS EMS PROVIDERS: A JOINT PROJECT DEVELOPED BY WILDERNESS EMS EDUCATORS, MEDICAL DIRECTORS, AND REGULATORS USING A DELPHI APPROACH.

Author

Millin, Michael G., Johnson, David E., Schimelpfenig, Tod, Conover, Keith, Sholl, Matthew, Busko, Jonnathan, Alter, Rachael, Smith, Will, Symonds, Jennifer, Taillac, Peter, and Hawkins, Seth C.

Subjects
CLINICAL competence, DELPHI method, EMERGENCY medical services, EMERGENCY medicine, EXPERTISE, MEDICAL personnel, MEDICAL practice, NATURE
Abstract

Introduction: Adisparity exists between the skills needed to manage patients in wilderness EMS environments and the scopes of practice that are traditionally approved by state EMS regulators. In response, the National Association of EMS Physicians Wilderness EMS Committee led a project to define the educational core content supporting scopes of practice of wilderness EMS providers and the conditions when wilderness EMS providers should be required to have medical oversight. Methods: Using a Delphi process, a group of experts in wilderness EMS, representing educators, medical directors, and regulators, developed model educational core content. This core content is a foundation for wilderness EMS provider scopes of practice and builds on both the National EMS Education Standards and the National EMS Scope of Practice Model. These experts also identified the conditions when oversight is needed for wilderness EMS providers. Results: By consensus, this group of experts identified the educational core content for four unique levels of wilderness EMS providers:Wilderness Emergency Medical Responder (WEMR), Wilderness Emergency Medical Technician (WEMT), Wilderness Advanced Emergency Medical Technician (WAEMT), and Wilderness Paramedic (WParamedic). These levels include specialized skills and techniques pertinent to the operational environment. The skills and techniques increase in complexity with more advanced certification levels, and address the unique circumstances of providing care to patients in the wilderness environment. Furthermore, this group identified that providers having a defined duty to act should be functioning with medical oversight. Conclusion: This group of experts defined the educational core content supporting the specific scopes of practice that each certification level of wilderness EMS provider should have when providing patient care in the wilderness setting. Wilderness EMS providers are, indeed, providing health care and should thus function within defined scopes of practice and with physician medical director oversight. [ABSTRACT FROM AUTHOR]

Published
2017
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30. Contributors

Author

Adachi, Javier A., Navarrete Aldana, Norberto, Alexander, Martin E., Anderson, Susan, Andrews, Christopher J., Askew, E. Wayne, Atkins, Dale, Auerbach, Brian S.S., Auerbach, Paul S., Backer, Howard D., Baggish, Aaron L., Basnyat, Buddha, Bettinger, Pete, Biddinger, Paul D., Binford, Greta J., Blue, Rebecca S., Blumenthal, Ryan, Bookspan, Jolie, Bovard, Ralph S., Bowman, Warren D., Jr, Boyer, Leslie V., Brady, Michael B., Brandenburg, Mark A., Briese, Beau A., Briese, Millicent M., Brown, Calvin A., III, Bucks, Colin M., Burgess, George H., Bush, Sean P., Butler, Frank K., Jr, Butterwick, Dale J., Byron, Christopher R., Cardwell, Michael D., Carleton, Steven C., Carpenter, Christopher R., Carroll, Scott P., Castellani, John W., Caudell, Michael J., Chalfin, Steven, Charkoudian, Nisha, Cheuvront, Samuel N., Clark, Richard F., Cohen, Kenneth S., Cole, Richard W., Constance, Benjamin B., Conway, Daniel G., Cooper, Donald C., Cooper, Mary Ann, Coppock, Kevin, Crawshaw, Larry I., Cummins, Gregory A., Cushing, Tracy A., Dallimore, Jon, D'Andrea, Shawn, Danzl, Daniel F., Davis, Kathleen M., Davison, Kevin, Dawson, Chad P., Deeb, George R., Degan, Janice A., DeLoughery, Thomas G., Dent, Arlene E., DiTullio, Alexandra E., Dobbs, Katherine R., Douglas, Eric L., Dow, Jennifer, DuPont, Herbert L., Eglin, Thomas, Erickson, Timothy B., Evans, Thomas, Eyre, Andrew J., Feldman, Joanne, Fernando, D. Nelun, Firth, Paul G., Fradin, Mark S., Frank, Bryan L., Freeman, Esther E., Freer, Luanne, Garrison, Tom, Gianotti, Alan, Gibbons, Robert V., Giesbrecht, Gordon G., Goldenberg, Alina, Goolsby, Craig, Graeme, Kimberlie A., Grebner, Donald L., Grissom, Colin K., Hackett, Peter H., Handford, Charles, Harris, N. Stuart, Hawkins, Seth C., Hawley, Charles G., Heimbach, David M., Heine, Carlton E., Heiskell, Lawrence E., Hendee, John C., Herring, Andrew A., Holle, Ronald L., Hovey, John R., Huecker, Martin R., Imray, Christopher H.E., Irons, Hillary R., Iserson, Kenneth V., Jacobs, Michael E., Jamshidi, Ramin, Jauregui, Joshua M., Jeffers, James M., Johnson, Amber M.H., Johnson, Kirsten N., Kanzaria, Hemal K., Kassel, Misha R., Kayden, Stephanie, Kemen, Katherine M., Kenefick, Robert W., Kent, Michael L., Kim, Minjee, Kimball, Alexa B., Kimberly, W. Taylor, Kivlehan, Sean M., Klein, Judith R., Koller, Karyn, Krabak, Brian J., Krakowski, Andrew C., Krzyzaniak, Michael J., Kummerfeldt, Peter, Lafave, Mark R., Laird, Ashley R., Lampard, Bruce, Lang, Michael A., Langer, Carolyn S., Lanteri, Charlotte A., Larsen, Gordon L., Lawley, Justin S., Ledrick, David J., Lemery, Jay, Leon, Lisa R., Levine, Benjamin D., Lewin, Matthew R., Liffrig, James R., Lindsay, Robin W., Lipman, Grant S., Lipnick, Michael S., Liu, Joanne, Luks, Andrew M., Ly, Binh T., Macias, Darryl J., MacInnis, Martin J., Maeder, Monika Brodmann, Maeyens, Edgar, Jr, Markenson, David S., Márquez, Armando, Jr, Marshburn, Thomas H., Martinez, Denise M., Mason, Nicholas P., Matteucci, Michael J., Mazzorana, Vicki, McCurley, Loui H., McGinnis, Henderson D., McHarg, Marilyn, McIntosh, Scott E., Meyer, Carolyn Sierra, Miller, Richard S., Millin, Michael G., Minns, Alicia B., Mioduszewski, John, Mitchell, James K., Moore, James, Mortimer, Roger B., Mosier, Michael J., Murray, Alice F., Mutch, Robert W., Nguyen, Ken, Noble, Vicki E., Norris, Robert L., Nunez, Timothy C., O'Brien, Karen K., O'Connor, Francis G., O'Connor, Terry, Oddy, Lisa K., Olesnicky, Bohdan T., Otten, Edward J., Parmar, Parveen K., Patel, Sheral S., Paterson, Ryan D., Paul, Suchismita, Phillips, Lara L., Pitman, Justin T., Quinn, Robert H., Radwin, Martin I., Ralphs, S. Christopher, Ranney, Wayne D., Read, Mark A., Reed, Sheila B., Rhodes, Martin, Richards, Gates, Roach, Robert C., Rodway, George W., Rodway, Nancy V., Ruoff, Brent E., Salas, Renee N., Salkowe, Richard S., Schimelpfenig, Tod, Schmidt, Andrew C., Schneider, Sandra M., Schoene, Robert B., Semple, John, Sempsrott, Justin, Shandro, Jamie R., Shaye, David, Sheehy, Susan B., Sheridan, Robert L., Shimanski, Charles S., Shofner, Joshua D., Simonson, Tatum S., Singletary, Eunice M., Smith, William “Will” R., Sørenson, Hans Christian, Spano, Susanne J., Spitzer, Matthew C., Stafford, Brian, Steinman, Alan M., Strapazzon, Giacomo, Suchard, Jeffrey R., Switzer, Julie A., Taleghani, Noushafarin, Tanner, John, Tarter, Shana L., Thomas, Owen D., Thomas, Stephen H., Thomsen, Todd W., Tilling, Robert I., Townes, David A., Traub, Stephen J., Vail, Sydney J., Van Hoesen, Karen B., VanRooyen, Michael, Venugopal, Raghu, Villar, Julian, Waite, Brandee L., Walden, John B., Warrell, David A., Weisman, Ashley Kochanek, Wiegand, Timothy J., Wing-Gaia, Stacie L., Wolfe, Sarah A., Young, Megann, and Zafren, Ken

Published
2017
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37. Emergency Management of Chronic Pain and Drug-Seeking Behavior: An Alternate Perspective

Author

Hawkins, Seth C., Smeeks, Frank, and Hamel, John

Subjects
*PAIN management, *EVALUATION of medical care, *EMERGENCY management, *CHRONIC pain
Abstract

Abstract: Pain is one of the most prevalent conditions treated by Emergency Physicians, although it remains contested how to interpret, measure, and treat this condition. In particular, there is controversy over how to identify and treat patients with chronic under-treated pain and those who are potentially malingering (drug-seeking). This article discusses currently accepted paradigms for treating potentially malingering patients, difficulties some communities may have when these paradigms are applied, and the results of implementing pain treatment guidelines that limit opioid use. Systematically limiting opioids via these guidelines was not associated with a decrease in overall patient satisfaction, patient satisfaction with pain management, overall volume, or volume of patients with potential drug-seeking diagnoses. Emergency Physicians’ perception of quality of care delivered, as well as job satisfaction, increased after implementation of the guidelines. [Copyright &y& Elsevier]

Published
2008
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38. Contributors

Author

Adachi, Javier A., Alexander, Martin E., Allen, Robert C., Anderson, Susan, Andrews, Christopher J., Askew, E. Wayne, Atkins, Dale, Auerbach, Paul S., Bacal, Kira, Backer, Howard D., Baggish, Aaron L., Baine, Jennifer G., Basnyat, Buddha, Bayley, Ryan P., Binford, Greta J., Bird, Nicholas H., Blumenthal, Ryan, Bookspan, Jolie, Bovard, Ralph S., Bowman, Warren D., Boyer, Leslie V., Bradford, John E., Brandenburg, Mark A., Briese, Beau, Bucks, Colin M., Burgess, George H., Bush, Sean P., Butler, Frank K., Jr., Butterwick, Dale J., Carleton, Steven C., Carlisle, Betty, Carroll, Scott P., Castellani, John W., Cheuvront, Samuel N., Clark, Richard F., Clarke, Charles, Cohen, Kenneth S., Coleman, Stephen D., Collier, Bryan R., Compton, Shon, Constance, Benjamin B., Cooper, Donald C., Cooper, Jimmy L., Cooper, Mary Ann, Coppock, Kevin, Crawshaw, Larry I., Crook, Joy E., Cummins, Gregory A., Cushing, Tracy A., Dallimore, Jon, Danzl, Daniel F., Davis, Ian, Davis, Kathleen Mary, Davison, Kevin, Dawson, Chad P., Degan, Janice A., DeLoughery, Thomas G., Dent, Arlene E., Ditzler, Thomas F., Donnelly, Mark, Donner, Howard J., Douglas, Eric, Dow, Jennifer, DuPont, Herbert L., Dillard, Blair, Erickson, Timothy B., Ericsson, Charles D., Fagenholz, Peter J., Feldman, Joanne N., Fernando, D. Nelun, Fowler, Murray E., Fradin, Mark S., Franco, Michael E., Freer, Luanne, French, Steven P., Friedline, Nathan K., Gaeta, Raymond R., Garrison, Tom, Garza, Daniel, Gianotti, Alan, Giesbrecht, Gordon G., Graeme, Kimberlie A., Grissom, Colin K., Gross, Kirby R., Hackett, Peter H., Harris, N. Stuart, Hastings, Patricia R., Hawkins, Seth C., Hawley, Charles G., Heimbach, David M., Heine, Carlton E., Heiskell, Lawrence E., Hendee, John C., Herrmann, Henry J., Holle, Ronald L., Hsia, Renee Y., Hubbell, Franklin R., Hudson, Stephen E., Idzik-Starr, Cynthia L., Imray, Christopher H.E., Iserson, Kenneth V., Jacobs, Michael, Jamshidi, Ramin, Jeffers, James M., Jenkins, Jamie G., Johnson, Kirsten, Kanzaria, Hemal K., Kaplan, Lee A., Kassel, Misha R., Kayden, Stephanie, Kazura, James W., Kenefick, Robert W., Kimball, Alexa B., Klein, Judith R., Krabak, Brian J., Krakowski, Andrew C., Kummerfeldt, Peter, Laird, Ashley R., Langer, Carolyn S., LaValla, Patrick H., Lemery, Jay, Leon, Lisa R., Levine, Benjamin D., Lewin, Matthew R., Liffrig, James R., Lipman, Grant S., Liu, Joanne, Luks, Andrew M., Ly, Binh T., Maeyens, Edgar, Jr., Mahadevan, Swaminatha V., Marinelli, Rick, Markenson, David S., Marmer, Millicent, Márquez, Armando, Jr., Martinez, Denise, Mason, Nicholas P., Matteucci, Michael J., Mazzorana, Vicki, McCurley, Loui H., McDevitt, Marion C., McHarg, Marilyn, McIntosh, Scott E., McStay, Christopher M., Mier, Timothy P., Minns, Alicia B., Mioduszewski, John, Mitchell, James K., Moore, James, Moore, Larry A., Morenz, Barry, Morris, John A., Jr., Mortimer, Roger B., Mosier, Michael J., Mutch, Robert W., Nagashima, Kei, Nakamura, Mayumi, Noji, Eric K., Norris, Robert L., Jr., O’Brien, Karen K., Ogden, Lesley J., Olesnicky, Bohdan T., Olson, Sheryl, Otten, Edward J., Parmar, Parveen K., Patel, Naresh J., Patel, Sheral S., Radwin, Martin I., Reed, Sheila B., Riordan, William P., Jr., Roach, Robert C., Robinson, David A., Rodriguez, Eloy, Rodway, Nancy V., Salkowe, Richard S., Schneider, Sandra M., Schoene, Robert B., Sempsrott, Justin, Shandro, Jamie R., Shimanski, Charley, Shimizu, Uta S., Shlim, David R., Shofner, Joshua D., Singletary, Eunice, Smart, Kieran, Smith, Jennifer Cohen, Smith, Will, Spitzer, Matthew C., Steinman, Alan M., Stoffel, Robert C., Suchard, Jeffrey, Switzer, Julie A., Tilling, Robert I., Tokizawa, Ken, Tonna, Joseph E., Townes, David A., Traub, Stephen J., Uchida, Yuki, Vail, Sydney J., Van Hoesen, Karen B., VanRooyen, Michael, Venugopal, Raghu, Waite, Brandee L., Walden, John, Warrell, David A., Weiss, Eric A., West, Jan, Wilkerson, James A., III, Yoda, Tamae, Yonge, Lynn E., and Zafren, Ken

Published
2012
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39. Deep-Water Soloing 101.

Author

SIMON, R. BRYAN and HAWKINS, SETH C.

Subjects
DIVERS, DROWNING, MOUNTAINEERING techniques, DIVING techniques, REPERFUSION injury
Published
2018

40. Table Rock Rescue.

Author

Hawkins, Seth C.

Subjects
FIRST person narrative, MOUNTAINEERING accidents
Abstract

A personal narrative is presented which explores the author's experience of responding to a wilderness emergency call from a woman mountaineer who was trapped in Table Rock, South Carolina.

Published
2009

46. Wilderness EMS Medical Director Course.

Author

Hawkins, Seth C.

Subjects
EMERGENCY medical services, WILDERNESS medicine, PHYSICIAN training
Abstract

The article focuses on the development of the Wilderness Emergency Medical Services (EMS) Medical Director Course for healthcare providers that operate EMS system in the wilderness. It says that EMS is already recognized by the American Board of Medical Specialties which is specifically made to benefit the degree of preparation of physicians. It discusses the creation of the said course, which was designed by Michael Millin of National Ski Patrol.

Published
2012

47. Dispatches from the field.

Author

Hawkins, Seth C.

Subjects
RESCUE work, EMERGENCY medical personnel, MEDICAL emergencies, TRACTOR trailer combinations, ACCIDENTS
Abstract

The article offers the author's insights regarding the author's rescue of a patient trapped in a tractor trailer loaded with I-beams in a remote highway in the Pisgah National Forest in North Carolina. The author states that he along with his Wilderness Emergency Medical Service (EMS) Extern Ben Abo worked for more than four hours to remove the patient in the tractor trailer. The author also mentions that everyone involved in the rescue work were honored with the Green Cross Award.

Published
2012

50. THE BEST: WILDERNESS MEDICINE BOOKS: A READING LIST (VOLUME I).

Author

Hawkins, Seth C.

Subjects
NONFICTION
Abstract

The article reviews several books including "Wilderness Medicine" edited by P.S. Auerbach, "Wilderness Search and Rescue" by T.J. Setnicka and "Into the Unknown: The Remarkable Life of Hans Kraus" by S.E.B. Schwartz.

Published
2012

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