Buchanan James T., Thurman Jeff
Norton Health, University of Louisville
University of Louisville/Norton Healthcare
Wilderness medicine is an amalgamation of many different medical disciplines. The base medical knowledge needed for competent practice aligns closely with emergency medicine and primary care specialties. However, familiarity with many other subspecialties, such as emergency medical services (EMS), expedition medicine, tactical medicine, travel medicine, and others, may be necessary depending on individual practice circumstances. With such a broad knowledge base, an agreed-upon definition of wilderness medicine has proven difficult. Most reasonable definitions center on delayed time to definitive care and limitations of available resources. Modern wilderness medicine is a relatively new and evolving area of clinical practice. The Wilderness Medical Society (WMS) is a leading organization that promotes research and education in wilderness medicine, but it has only existed since 1983. Several other national organizations providing wilderness medical care and education, such as the National Outdoor Leadership School (NOLS) and the National Ski Patrol (NSP), can trace their roots back several decades earlier. Since the early 2000s, there has been more interest from the mainstream medical community in wilderness medicine education and practice. This appears to coincide with increased participation in outdoor recreation by the general public during the same timeframe. With this increased focus, the practice of wilderness medicine has been changing. Many providers are familiar with wilderness medicine teachings emphasizing impromptu care. Serious wilderness medicine practitioners understand that this method is inadequate when providing an organized medical response to patients in a wilderness setting. In recent years, the idea of incorporating wilderness medicine into the existing EMS structure has gained traction. However, many questions remain unanswered regarding the best way to integrate adequate wilderness response. Several studies have attempted to establish the incidence of medical issues in remote settings. Most of these studies have focused on the medical response in the national parks. A few studies have explored this incidence in other outdoor settings, such as wilderness expeditions and Everest base camps. One study explored outdoor recreational injuries presented to emergency departments. While all these studies suffer from flaws inherent to retrospective reviews, they establish certain trends that prove useful in further developing wilderness emergency medical services (WEMS). The national park data shows a relatively even split between medical and traumatic calls for service. Trauma, however, produces more fatalities. The majority of nonfatal trauma is due to athletic-type injuries and extremity fractures. Counterintuitively, most expedition injuries occur in camp or while hiking, not during more "high-risk activities" (climbing, mountaineering, skiing, kayaking, etc). During expeditions, many medical issues were due to gastrointestinal and respiratory illnesses. Mirroring data from urban EMS response, most care rendered is at the basic life support level. Reviewing this data can help physicians and EMS organizations prepare to provide rational WEMS responses.
野外医学是许多不同医学学科的融合。胜任野外医学实践所需的基础医学知识与急诊医学和初级保健专科密切相关。然而，根据个人的实践情况，可能还需要熟悉许多其他亚专业，如紧急医疗服务（EMS）、远征医学、战术医学、旅行医学等。由于知识基础如此广泛，已证明很难对野外医学给出一个商定的定义。大多数合理的定义都围绕着获得确定性治疗的时间延迟和可用资源的限制。现代野外医学是临床实践中一个相对较新且不断发展的领域。野外医学协会（WMS）是促进野外医学研究和教育的领先组织，但它自1983年才成立。其他几个提供野外医疗护理和教育的全国性组织，如国家户外领导学校（NOLS）和国家滑雪巡逻队（NSP），其根源可以追溯到几十年前。自21世纪初以来，主流医学界对野外医学教育和实践的兴趣有所增加。这似乎与同一时期公众对户外休闲活动的参与度增加相吻合。随着关注度的提高，野外医学的实践也在发生变化。许多从业者熟悉强调即兴护理的野外医学教学内容。严肃的野外医学从业者明白，在野外环境中为患者提供有组织的医疗响应时，这种方法是不够的。近年来，将野外医学纳入现有EMS结构的想法已获得认可。然而，关于整合充分的野外响应的最佳方式，仍有许多问题没有答案。几项研究试图确定偏远地区医疗问题的发生率。这些研究大多集中在国家公园的医疗响应上。一些研究在其他户外环境中探索了这种发生率，如野外探险和珠峰大本营。一项研究探讨了急诊科收治的户外休闲损伤情况。虽然所有这些研究都存在回顾性研究固有的缺陷，但它们确立了某些趋势，这些趋势在进一步发展野外紧急医疗服务（WEMS）方面证明是有用的。国家公园的数据显示，医疗求助和创伤求助的比例相对均衡。然而，创伤导致的死亡更多。大多数非致命创伤是由于运动型损伤和四肢骨折。与直觉相反的是，大多数探险损伤发生在营地或徒步过程中，而不是在更多“高风险活动”（攀岩、登山、滑雪、皮划艇等）期间。在探险过程中，许多医疗问题是由胃肠道和呼吸道疾病引起的。与城市EMS响应数据相似，提供的大多数护理是基本生命支持水平。审查这些数据有助于医生和EMS组织做好准备，提供合理的WEMS响应。
