Volume 27, Number 2 - Wilderness Medical Society

SPRING 20 

10 

Volume 27, Number 2 

Dispatches from Haiti 

MSF Surgical Mission: Congo 

Why Wilderness Medicine? 

$12.50 US

WilDerneSS 

MeDiCAl 

SoCietY 

Mark your 2010 calendars 

for these upcoMing 

WMs conferences 

Photo by Peter Kummerfeldt 

WMS AnnuAl Meeting & 

CMe ConferenCe 

Snowmass, Colorado 

July 23-28, 2010 

Photo by Paul Auerbach 

WMS trAvel, Dive & MArine 

MeDiCine ConferenCe 

The Westin Ka’anapali Resort & Spa 

October 30 – November 3, 2010 

Lahaina, Maui, Hawaii 

These activities have been planned and implemented in 

accordance with the Essential Areas and Policies of the 

Accreditation Council for Continuing Medical Education through 

the Wilderness Medical Society. The Wilderness Medical Society 

is accredited by the ACCME to provide continuing medical 

education for physicians. 

REGISTER ONLINE 

WMS.org/conferences 

or call 801.990.2988 

for up-to-date info 

COMBINING YOUR PROFESSION 

WITH YOUR PASSION

EditorIAL STAFF 

SPRING 2010 INSIDE 

Wilderness Medicine 

A quarterly magazine published by the 

Wilderness Medical Society 

Christopher Van Tilburg MD, FAWM, Editor 

Jonna Barry Managing Editor 

Larry E. Johnson MD, PhD, Assistant Editor 

Seth C. Hawkins MD, FAWM, Senior Editor 

Debra Stoner MD, FAWM, Associate Editor 

George Rodway PhD, CRNP, Publications 

Committee Chair 

Contributing Editors 

Nancy Pietroski PharmD 

Sam Schimelpfenig MD 

Research Editors 

Tracy Cushing MD 

Matt Hamonko MD 

Marion McDevitt MD 

Editors Emeritus 

Edward Geehr MD, 1984-1986 

Howard Backer MD, 1986-1991 

Eric A. Weiss MD, 1991-1994 

Karl Neumann MD, 1994-2002 

WMS Editorial Office & Advertising Sales 

Jonna Barry 

1505 N Royer St 

Colorado Springs, CO 80907 

Tel: (719) 330-7523 

Fax: (801) 705-1483 

Email submissions to editor@wms.org 

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Wilderness Medicine (ISSN 1073-502X) is 

published quarterly in January, April, July, and 

October by the Wilderness Medical Society, 2150 

South 1300 East, Suite 500, Salt Lake City, Utah. 

Periodical postage paid at Salt Lake City, Utah and 

additional mailing offices. Annual subscription 

rate: $55. POSTMASTER: Send address changes 

to the Wilderness Medical Society, 2150 South 

1300 East, Suite 500, Salt Lake City, Utah. 

Submit request to reprint Wilderness Medicine in 

whole or in part to copyright.com. 

©2009 Wilderness Medical Society. All rights 

reserved. Printed on FSC-certified paper. 

Wilderness Matters........................................................................................... 4 

Colin Grissom MD, FAWM 

Dispatches from Haiti....................................................................................... 5 

Paul S. Auerbach MD, MS, FACEP, FAWM 

Off the Beaten Path: Surgical Mission with MSF in the Congo......... 12 

Michael Hauty, MD, FACS 

Why Wilderness Medicine?............................................................................ 16 

Rob Hart RN, FAWM 

Nosebleeds in the Backcountry................................................................. 18 

Sam Schimelpfenig, MD, FAAP 

Mount Hood SAR Operations....................................................................... 19 

Christopher Van Tilburg MD, FAWM 

Great Gear for Work and Play: Urbaneering with cyclocross....... 20 


What’s in Your Pack?....................................................................................... 21 

Greg Natsch MD 

Advanced Wilderness Life Support New Zealand-Style....................... 22 

Martin Watts MB ChB, FACEM 

Book Reviews..................................................................................................... 24 

Society Matters................................................................................................ 25 

News and Announcements 

Members in the News 

2010 Student Elective Update 

Tom Kessler MD and Scott Newton 

Cliff Notes......................................................................................................... 29 

Cathy Chamberlin 

2010 WMS Recognition Awards.................................................................... 29 

Conference Calendar.................................................................................... 31 

On the cover: Dr. Paul S. Auerbach carries a Haitian boy on his shoulders to a surgery clinic, 

where one of the boy’s fingers will be amputated. Photo courtesy of Chuck Liddy/The News & 

Observer ©2010. 

NOTE: Claims for copies lost in the mail must be received within 90 days (180 days foreign) of the 

issue date to ensure replacement at no charge. 

©2010 Wilderness Medical Society. All rights reserved. Printed on FSC-certified paper. 

The goals of Wilderness Medicine magazine are to: 

1. Provide timely information regarding WMS news and activities. 

2. Provide a forum for exchange of ideas and knowledge regarding wilderness, environmental, and 

travel medicine. 

3. Disseminate wilderness medicine information to the wilderness, outdoor, and travel community. 

The Wilderness Medical Society makes no representations 

regarding the legal or medical information provided by the 

individual authors in Wilderness Medicine magazine. 

WILDERNESS MEDICINE // Spring 2010 

3

WILDERNESS MATTERS Colin Grissom MD, FAWM, President WMS 

2010-2011 WMS board of directors 

One of the important responsibilities of the 

Wilderness Medical Society (WMS) is to 

establish standards of medical care in remote 

settings. One of the goals of my tenure as 

President is to increase the visibility of the 

WMS by making WMS Practice Guidelines 

for Wilderness Emergency Care (Guilford, 

CT: Globe Pequot; 2006) more widely 

available. Credit for establishment and 

revision of the published WMS Practice 

Guidelines for Wilderness Emergency Care goes 

to former WMS President Dr. Bill Forgey. 

WMS Practice Guidelines for Wilderness 

Emergency Care is the only existing consensus 

recommendations specifically for wilderness 

medicine practitioners. This is invaluable in 

a resource-limited environment where the 

Practice Guidelines adjust the standard of care 

to consider limited resources and lengthy 

delays before reaching definitive care. 

At the 2009 WMS winter meeting at The 

Canyons in Park City, Utah a consensus 

guideline was created on the treatment of 

frostbite. A committee of experts led by WMS 

Board member Dr. Scott McIntosh of the 

University of Utah reviewed the literature 

and created a manuscript with evidence-based 

grading on the treatment of frostbite. The 

intention is to submit this manuscript for 

publication in Wilderness & Environmental 

Medicine journal. This update to our 

Practice Guidelines follows two other similar 

manuscripts currently in preparation: one on 

epinephrine treatment of anaphylaxis led by 

Dr. Jay Lemery of Cornell University in New 

York City; and the other on prevention and 

treatment of high altitude illness led by Dr. 

Andrew Luks of the University of Washington. 

The process for creating Practice Guidelines for 

the WMS has evolved into the objective of 

publishing them in the peer reviewed medical 

literature, thus making them available on 

PubMed searches in the electronic medical 

literature. Previously the Practice Guidelines 

has been available only in book form. 

Having WMS Practice Guidelines available 

in the electronic medical literature and 

searchable in PubMed will increase the 

availability of WMS Practice Guidelines for 

use and reference. This will further the goal 

of having the WMS maintain its position as 

the primary resource for standards on medical 

care in wilderness settings. 

Consistent with the goal of making the WMS 

a member-driven organization, involvement 

of WMS members is encouraged as more 

WMS Practice Guidelines are revised using the 

consensus committee method. WMS members 

who submit proposals for lectures or workshops 

at meetings will be leading candidates for the 

consensus-committee-generated WMS Practice 

Guidelines in respective areas. Our goal over 

time is to establish and publish WMS Practice 

Guidelines in all wilderness medicine areas. 

This will maintain the position of the WMS 

as the premier organization in wilderness 

medicine. 

Executive Board 

Colin Grissom MD, FAWM, President 

Loren Greenway PhD, FAWM, 

Chief Executive Officer 

Tony Islas MD, FAWM, President-Elect 

Eric L. Johnson MD, FAWM, Past President 

Jay Lemery MD, FAWM, Secretary 

Members at Large 

Paul S. Auerbach MD, MS, FAWM, Emeritus 

D. Cristopher Benner PA-C, FAWM 

Brad Bennett PhD, WEMT, FAWM 

Catherine Chamberlin, Student Representative 

Lance Ferguson MD, FAWM 

Scott McIntosh MD, FAWM 

Chris McStay, MD 

George Rodway CRNP, PhD 

COMMITTEES 

Academy Oversight Committee Chair 

Loren Greenway PhD, FAWM 

Awards Committee Chair 

Ken Zafren MD 

Continuing Medical Education Chair 

Hill McBrayer MD 

Conference Committee Chair 

Loren Greenway PhD, FAWM 

Education Committee Chair 

Jay Lemery MD, FAWM 

Finance and Audit 

Tony Islas MD, FAWM 

Disaster Medicine Committee Chair 

Joy Crook MD 

Environmental Council Chair 

Lynn Yonge MD, FAWM 

International Medicine Committee Chair 

Tracy Cushing MD 

Membership Committee Chair 

D. Cristopher Benner PA-C, FAWM 

Nominations Committee Chair 

Eric L. Johnson MD, FAWM 

Publications Chair 

George Rodway PhD, CRNP 

Research Council Chair 

Tom DeLoughery MD, FAWM 

Student Services Chair 

Catherine Chamberlin MS4 

Web Development Chair 

Jim Ingwersen 

ADMINISTRATIVE OFFICE 

Loren Greenway PhD, FAWM, CEO 

Loren@wms.org 

Teri Howell, Administrative Director 

Teri@wms.org 


2150 South 1300 East, Suite 500 

Salt Lake City, UT 84106 

Email: wms@wms.org 

Tel: 801-990-2988 

Fax: 801-990-2987 

Jim Ingwersen, IT Director 

jim@wms.org 

1837 Austin Bluffs Pkwy Ste 200 


Tel: 719-492-2200 

4 WILDERNESS MEDICINE // Spring 2010

Dispatches froM Haiti 

Paul S. Auerbach, MD, MS, FACEP, FAWM 

On Tuesday, January 12, 2010 the worst earthquake in more 

than 200 years struck 16 miles from Port-au-Prince, Haiti. 

An estimated 3 million people were affected by the quake. In 

a country routinely referred to as the poorest in the western 

hemisphere, the devastation was dramatic and widespread. The 

relief effort has been and continues to be historic. An International 

Medical Corps team made up in part of Stanford doctors 

and nurses arrived on the scene soon after the earthquake. 

This is wilderness medicine at its most stark, leaving many 

who were first to arrive to describe the situation as “practicing 

Civil War medicine” in the 21st century. The following 

was adapted from Dr. Paul Auerbach’s blog at healthline.com/ 

blogs/outdoor_health. 


5

First Days in Haiti… 

I can now access the Internet, so am going to try to begin to post from 

Haiti. Under the auspices of International Medical Corps, we have been 

here working very hard now for four full days. Much more has happened 

than I could possibly relate, so I will try to hit the highlights. Each day 

is more difficult than the last. 

The decision to travel to Haiti to assist with medical relief following 

the earthquake was at the same time easy and difficult. It was easy, 

because how could anyone be aware of such misery and suffering and 

not volunteer to help, but difficult because it was intimidating. 

My good friend Bob Norris, MD from Stanford was asked to pull 

together a team for IMC. I joined a group with Bob, Ian Brown, MD, 

and Anil Menon, MD, all Stanford emergency physicians, and Stanford 

nurses Gaby McAdoo, Heather Tilson, Julie Racioppi, and Jon Gardner. 

I flew out on Thursday and was routed on Friday morning through the 

Dominican Republic. I was hoping to continue on to Haiti that day, but 

that was not possible because of air traffic control and the situation at 

the destination airport. We eventually chartered a bus and required an 

all night drive to get to Port-au-Prince. 

The scene on our arrival into Port-au-Prince was intense. Most of the 

buildings were crushed or damaged, and there were large crowds milling 

on the streets and surrounding relief trucks. We watched waves of people 

scramble over the rubble to obtain food and supplies. Just when we 

despaired about how we were going to find the hospital, a helpful police 

escort maneuvered us through wreckage-filled streets to the University 

Hospital, which had become the center of medical activity. Nearly the 

entire population of PAP was by now living on the streets in massive, 

enlarging tent cities. 

The hospital grounds were packed with patients, and the immediate and 

constant emotion was and remains a sense of urgency. There are hundreds 

of patients, with constant cries of distress, and a regular smell of death. 

However, there is also hope, and an enthusiastic growing collection of 

volunteers from many nations, including International Medical Corps, 

Doctors Without Borders, Partners in Health, Hope for Haiti, Canadian 

Red Cross, Norwegian Red Cross, Swiss governmental humanitarian aid 

surgeons, and many others. It is a team effort and will continue to evolve 

with the enormous need. 

We are caring for incredibly brave people, who are suffering under the 

most adverse of circumstances. Yet, they all have time to say how much 

they appreciate the help and to thank us. We are treating fractures, 

massively infected wounds, some infested with maggots, disfiguring 

injuries, and tetanus, while in the midst, babies are being born. We 

cannot do everything, and sometimes can do nothing, because there 

are individual situations that are beyond our control. We know that 

tomorrow morning we will wake up, go out, and do the best we can to 

relieve the suffering. 


Photo by Eric Holden. 

January 20… 

Today we were awakened by a 5.9 earthquake. We rushed to the hospital 

to discover that the patients who had been inside the hospital during the 

night had fled outdoors and many new patients had entered the grounds. 

Even though some of the buildings were inspected by engineers and felt 

to be safe, neither the patients nor the staff would agree to reenter them. 

Worse yet, by the middle of the day, the air temperature was in the low 

90s and the ground temperature closer to 100 degrees. There were too 

few tarpaulins and tents to cover the patients. Without sufficient shade 

or fluid replacement, the patients deteriorated rapidly, and we began to 

diagnose heatstroke, as well as cases of tetanus and gangrene. 

On the bright side, an entire battalion of soldiers came to the hospital to 

aid us. They provided security and added much-needed manpower and 

supplies. In addition, the USNS Comfort hospital ship arrived to accept 

patients, and we were able to transfer 53 of our sickest patients, which 

gave us more time with the remaining patients at the hospital. 

My heart is racing. 

I’m determined to get this 

information to you. 

January 21… 

We are receiving reinforcements from all directions, especially from 

International Medical Corps and from many other NGOs. The U.S. 

military continues to provide protection, supplies, transportation, 

medical assistance and most important, peace of mind. They never shirk 

a task when we need their help. 

We continue to triage, operate on and otherwise treat approximately 700 

patients, with injuries that will change their lives forever. We have seen 

countless amputations, disfigurements and open fractures. The medicine 

is intense, but we are up to the task most of the time. It is quite hot 

outside and there is little time to eat, drink or go to the bathroom, so 

by the end of the day we are quite tired and usually dehydrated. But we 

do not complain, because by comparison, the earthquake victims are 

so disadvantaged. 

WOW. We just suffered a serious aftershock. Right now as I am writing 

this post. The building just shook and everyone ran outside. I’m sitting 

here and continuing to write. Is this emotional progress? My heart is 

racing. I’m determined to get this information to you. 

Tomorrow I will be spending most of my day working to help structure 

interactions within the entire medical compound, to identify all the 

resources and to be certain that everyone working can find out how 

to get assistance. I’m splitting my time now between clinical care and 

administration. 

Let me share a typical story of a patient. She’s a small 3-yearold 

who had the side of her face crushed by falling rubble. 

Her ear and cheek were mangled and abraded. When I 

found her in the crowd a few days ago, I brought her to 

a team of Swiss surgeons that debrided the wound and 

administered antibiotics. Today the infection has progressed 

and it’s also apparent that she may have a broken femur and 

be developing a compartment syndrome in her leg. Her swollen face has 

distorted features, but she’s a brave little girl. We will do all we can for 

her. She lies in a tent with a young boy with a spinal cord injury, children 

with missing limbs and burn victims. This is not easy to watch and not 

easy to write, but it’s real. Thank goodness we have gotten to the point 

where we have enough staff to examine every patient at least once a day. 

The surgeries continue, and we have a dialysis setup for kidney failure 

patients and those with crush injuries, a central storehouse for medical 

supplies, and a small blood bank. The Norwegian Red Cross is putting 

up tents as fast as they can get them shipped here. We are hoping to soon 

have adequate staff to transition to a full 24-hour operation. 

Much is improvised – traction, splints, beds – but we are seeing the 

supply chain begin to catch up. Many new patients, like gunshot victims, 

are not directly earthquake-related, but we have not yet seen the “second 

wave.” We know it’s coming. 



7

January 22… 

There was incredible activity today at the University Hospital. We 

suffered through more aftershocks and had to permanently evacuate a 

large building, so once again patients were outside in the brutal heat. 

Under tarps and rapidly deployed tents, we treated them with fluids and 

attended to their now week-old wounds. 

The days are nonstop from dawn to dusk. I have assumed a role to help 

organize the operation, including the logistics of water, food, sanitation, 

operating room needs, and schedules. I’ve been coordinating volunteers, 

arranging for shelter, caring for orphans, and interfacing with the 

military. The enormity of suffering is beyond comprehension, but we are 

learning to deal with it and move forward. I’ve learned as much as I have 

contributed, so that I will be prepared for the next days and the future. 

The people with whom I’ve worked, from Haiti and all other nations, 

have been remarkable. We are becoming a family. 

Today’s story is about a 5-year-old survivor of a week beneath the rubble. 

He was pulled from the ground and came to our team emaciated, 

dehydrated, frightened and confused. Our doctors and nurses gently 

hydrated him and started him on the road to recovery. With so many 

people affected, there will be many such stories, but for each tale with a 

happy ending, there are thousands with a tragic outcome. 

January 23… 

We saw a lot of progress today. The surgeons are seeing a decrease in the 

number of patients that need emergency surgery for crush injuries and 

fractures, but that doesn’t mean that we are anywhere near a point where 

less-than-massive resources are needed. There are still countless broken 

bones, deformities, facial injuries, and burns. We are encountering the 

sequelae of the initial surgeries that were performed in non-optimal 

settings. These mostly include infections that require wash-outs of 

wounds and revisions of the prior surgeries. This is to be expected in 

our situation. 

The hospital campus is evolving into a decent structure. We now have a 

central pharmacy, three operating rooms for adults, one operating theatre 

(within a tent, as are most facilities) for children, and arrangements 

for childbirth, children, postoperative patients, and emergency triage 

assessments. These are crowded and extremely busy areas, staffed by 

dedicated volunteer physicians, nurses, and technicians. 

I spoke with a young woman today, a dancer in Haiti who lost part of 

one of her legs. She was brave and doing her best to cope. I told her 

that she will dance again, and that she will be a much better dancer 

on one leg than I could ever be on two. She smiled and squeezed my 

hand. These are such special people. I have not seen one seriously injured 

victim complain. 

I am now officially tasked to coordinate the medical activities of all the 

non-governmental agencies within the compound, so I am working on 

medicine, essential services like water, food, and sanitation, integration 

between services, creation of satellite pharmacies, placement of physicians 

and other volunteers, and many other activities. I have never worked so 

hard, but have also never been more focused. My job is to make the 

situation improve every day for these people and for this country. The 

IMC team and other international volunteers inspire me to go after this 

mission with great determination. 

The Stanford Emergency Medicine team that responded to Haiti under the 

auspices of International Medical Corps included: (seated, left to right) Ian 

Brown, MD; Jonathan Gardner, RN; Heather Tilson, RN; Paul Auerbach, 

MD; Gaby McAdoo, RN; Julie Racioppi, RN; (standing left to right) Robert 

Norris, MD; Anil Menon, MD. Photo courtesy of Paul Auerbach. 

Arm wound post debridement. Photo by Eric Holden. 


January 24… 

January 25… 

It was incredibly hot today on the grounds of the hospital. Fortunately, 

we have erected sufficient tents to accommodate all of the patients. We 

estimate that we have more than 600 patients on the grounds now, 

either in tents or living in a communal central area we call “the forest.” 

While there has been considerable progress, we have a way to go with 

communications (no phones yet), sanitation, information distribution, 

acquisition of key equipment, and development of social services like 

mental health. 

We continue to have new patients enter the compound, including 

nearly 100 emergency patients today. We are receiving patients referred 

from the countryside and other hospitals. The operating rooms are busy 

with orthopedic and wound care, skull fractures, hand surgery, facial 

reconstruction, and the like. Neurosurgery is still not ready to go at 

this facility. 

The Swiss have a pediatric surgery service next to our pediatric area. 

The tent ward is full of children with multiple amputations and severe 

injuries. There is no candy coating this – their lives will never be the 

same. A half a block away, when the wind shifts, it smells of death from 

bodies buried in the rubble of the nursing building. We have learned 

to adapt, to walk past this place and 

wrinkle our noses. We no longer need 

to wear facemasks. 

To facilitate progress, we have selected a 

chief of surgery and a nursing director, 

and have identified sufficient staff to 

cover the nights as well as the daytime. 

I have to sneak away now and again 

from my organizational duties to see patients and be a doctor. There 

are many doctors here to help, and we are grateful to have them. The 

emphasis now is to quickly transition this medical center back to its 

rightful owners. 

The city has been flattened, but the people are now picking up the 

pieces. We notice a decrease in the amount of garbage in the streets, and 

vendors are selling small amounts of fresh produce and cooked meat. 

The food drops appear to have been successful. 

I found someone willing to trade a hotel room shower for a medical 

consultation. Even though there was no hot water and almost no water 

pressure, it was the most wonderful shower I have ever taken. 

At the end of our 9th full day working at the University Hospital in 

Haiti, a functioning hospital has emerged. 

Our tent E.R. saw nearly 300 patients today, and we are preparing to 

see more than 500 tomorrow in what are essentially two rooms. To keep 

the place running, we are not only doctors, but also electricians, masons, 

and plumbers. 

I find myself beginning to lose my physical endurance. Everyone is 

getting tired…I can see it in the faces of the people with whom I have 

worked for many days. Each day brings new crises of capacity, supplies, 

sudden patient influx or something else. We have been with many of our 

same patients now for more than a week and have come to know them, 

so bad outcomes and deaths affect us a lot. 

The media frenzy is beginning to die down. Four days ago, you couldn’t 

avoid a camera or reporter being there to document your activity. If 

that brings resources to Haiti, I am all for it. I have been disappointed, 

however, in some of the innuendos. Let me tell you the truth – everyone 

is working incredibly hard, getting along, cooperating, and there are very 

few controversies. We have the operating rooms coordinated, a way to 

care for orphans, and simple 

paper medical records. Our big 

problem is space, but USAID 

[United States Agency for 

International Development] 

just brought us three big tents 

tonight, which is a huge relief. 

The city has 

been flattened, 

but the people are now picking up the pieces. 

I visited many of the patients I 

know this afternoon, just to touch their hands or wipe their foreheads, 

and encourage them. Many are missing a leg or arm, and have lost 

many relatives. Think about how life has changed for them and about 

what you might do to make it a bit better for them. Please pick a relief 

organization and make a donation. It truly makes a difference. 

Tent City... the beginning. 

Photo by Eric Holden.

January 26… 

On the 10th full day in Haiti, we find ourselves at the transition point 

where we must carry out our duties, but begin to transfer responsibility 

to the persons who will assume our roles when we depart. Some of our 

team has begun to “hit the wall.” These old muscles are aching for sure. 

However, each time I walk past a young Haitian child who has lost a 

limb, yet still smiles and tries to give me a wave, I am energized. It will 

be very difficult to leave, but I know that within a few days, we must get 

our batteries recharged. 

The hospital complex is really taking shape now. Tents are everywhere 

and all filled with patients. We have arranged for electricity and 

sanitation. We have oxygen bottles and new stretchers. Yet, we are still 

missing critical sterilization equipment for surgical instruments, modes 

of transportation, phones, and sufficient supplies to call this a complete 

medical operation. 

Some of my new friends from other NGOs have begun to rotate out, 

and I miss them already. We have become close “under fire,” in a way 

that is not possible in any other venue. We would trust each other with 

our lives. 

Three of us shared a common experience today, individually, as we 

walked down the road past the crushed nursing school and towards the 

Swiss surgery tent. We all noticed for the first time a beautiful flowering 

bougainvillea that had been completely overlooked when we marched, 

heads down, along what was only a week ago a thoroughfare of death. 

We smelled the cooking from the street, and walked past tents of injured 

persons singing, trying to be happy, and attempting to begin to get back 

to normal. 

Our group has befriended the young 5-year-old boy who was pulled 

from the rubble after a week. He comes to visit us, and clings to the nurse 

who was most attentive to him during his resuscitation. His parents were 

killed and he is an orphan. He is like thousands of children in Haiti now. 

The orphanages are full or filling and reconstruction cannot possibly 

occur fast enough to avoid enormous tent cities. 

January 27… 

We’ve been here working at the University Hospital in Port-au-Prince 

for nearly 2 full weeks, and it has shaped up. The care being delivered 

is remarkable given the circumstances since the earthquake. There are 

two operating rooms running 4 beds each, a tented medical unit for 

our sickest patients, a fully stocked pharmacy, an increasing laboratory 

testing capability, and more tents. Still, this is not a hospital as we 

have them in the U.S. It is a medical facility under tents, and the 

conditions are not sterile. While the situation is improving, and we 

have optimism that it will continue to improve, for the patients who 

have suffered bad injuries, they are certainly not completely out of 

the woods. 

I find myself going back to visit a few patients, like the young professional 

dancer who lost her leg. She was returned to the O.R. today for a revision 

of her stump, so was postoperative and asleep when I saw her. In the 

crowded tent, she was covered with flies, so I sat by her for a while and 

fanned them away with a small notebook. In another tent, I watched a 

mother bathe an emaciated infant. The baby will not make it through 

the next two days. One tent over, a woman shouted out in pain during 

childbirth. 

The garbage is being picked up, and we should have upright portable 

bathrooms tomorrow. That is a triumph towards which I have struggled 

for days. Once again, the U.S. military showed its compassion 

and coordination when nearly 50 patients were evacuated to more 

advanced care. 

Yesterday the generator went out for many hours, so we could not run 

the O.R., or so I thought. A team of resourceful surgeons wore their 

headlamps and made it through some of their cases. 

Tomorrow we will finalize coordination of sanitation, electrical lines, 

tent placement, number of physicians needed through the next 2 weeks, 

and how to accelerate the return of Haitian physicians and nurses. There 

is much work to be done. 

We got word today that we may be going home soon. I have mixed 

feelings about that. It will be difficult to leave, but all signs point to it 

approaching the right time. Emotionally, I am OK, but my legs are a bit 

wobbly. I wake up as tired as I was when I went to sleep. The patients 

here deserve fresh legs. 

January 28… 

We found out today that we ship out tomorrow. There is an incredible 

amount of work to be done here – we have only contributed to the first 

phase of what is necessary. I cannot remember the details of much of 

what we did the first 3 days, when we were functioning on hyper-drive 

in a battlefield setting. My recollections become detailed after the third 

day, when we were able to see only four or five patients at a time, and we 

stopped triaging amputees to the operating room. 

Teams of non-Haitian surgeons have left to go home, because the 

operations to be performed now are largely orthopedic and plastic 

surgery, as well as specialty cases. Sadly, there are scores of patients with 

spinal fractures who are paralyzed, and little can be done for them this 

far out from the initial injury. Children continue to reach out to us. I 


82nd Airborne preparing for a food drop. 


had a small child who is a triple amputee offer me his cracker with his 

remaining hand. One can only pray that the memories he carries of this 

tragedy are erased swiftly, that he is assisted in his rehabilitation, and that 

his life improves. All of these will, of course, be hard to achieve. 

I visited one of my favorite patients, the young woman who danced 

ballet professionally before she lost her leg below the knee. Today, she 

was bright and alert, and gave me a big smile when I walked to the side 

of her stretcher bed within a very hot tent. She motioned me to come 

closer, and we exchanged contact information. I will do what I can to 

stay in touch with her. 

Many of our interpreters are living outside in former parks in enormous 

congregations of people. I gave my tent to one of these persons and am 

distributing everything that might be useful to victims of the earthquake 

and to medical persons who have just arrived to take over from those 

leaving to rest or return home. There are plenty of medical supplies – the 

Haitian people need shelter, food, and water. Soon, they must begin to 

rebuild and take what was a feeble economy and turn it into something. 

This will be a gargantuan undertaking. 

It became time today for me to hand over the reins to Dr. Solomon 

Kuah, who will assume my role as the medical coordinator of the NGO 

activity. I said goodbye to many persons with whom I have become close 

under the most challenging circumstances. In a meeting of the leadership 

present, I told them that I have never been so proud to be among such 

an incredible collection of talent and dedication. Then I allowed myself 

to be infused with 9 liters of IV fluid so that I could get vertical and walk 

out under my own power. 


11

Off the Beaten Path 

Surgical Mis 

with MSF in the 


sion 

Congo 

Michael Hauty 

MD, FACS 

Photos courtesy of Michael Hauty 

The 

team was tightly squeezed into a white 

Toyota Land Cruiser making its way over 

a poorly maintained dirt road in eastern 

Democratic Republic of Congo (DRC). 

We were bound for the regional district 

hospital: Hopital General Referent-Rutshuru. 

The operations of the hospital have been 

a joint venture between the Congolese 

Ministry of Health and the French section 

of Medecins sans Frontieres (MSF), aka 

Doctors Without Borders, since 2005. The 

team, an international collection of health 

care providers, was leaving our residential 

compound for a busy day tending the needs 

of a traumatized local population. 

Dr. Michael Hauty with fellow 

"Rwandan warriors." 


13

Team members included internists from Great Britain, an OB/Gyn 

from Syria, surgeons from the DRC, India and the USA, a physical 

therapist from Switzerland, and a mid-wife from France. The ride was 

bumpy and dusty but the view of the spectacular Virunga National Park, 

quite possibly the most magnificent collection of designated parkland 

on the planet, made for a rewarding commute. The sprawling military 

compound of the region’s UN peacekeeping force, MONUC (Mission d' 

Organization des Nations Unis de Congo), and the teeming IDP (internally 

displaced people) camp along the route served as reminder of the current 

status in North Kivu province. The combination of unimaginable natural 

resources, a distant and ineffective national government and repeated 

iterations of the Hutu/Tutsi conflict had set the stage for a conflict with 

largest loss of life since WWII, some 5.4 million people. 

I was once again in the field with MSF, on my fifth surgical mission to 

French-speaking Africa. Attracted by the possibility of providing medical 

care independent of the mind-numbing machinations of the current 

medico-business environment in the U.S. and compelled by the plight 

of the Congolese population, especially the women and children, I soon 

realized the upcoming month would be far busier and more demanding 

than any in recent memory. 

In terms of combining my profession with my passion, few experiences 

measure up to a mission with MSF. Travel to locales not accessible to 

tourists, living conditions similar to a rustic summer camp, and a daily 

routine which tests medical resourcefulness and surgical ingenuity are all 

components of a typical mission. HGR-R’s daily census approached 300 

beds. The two-room operating theater saw 700-800 interventions each 

month. Patients slept two or three to a bed while receiving antibiotics 

for malaria, typhoid fever, and other tropical ailments. Nearly 300 live 

births, some 40% via C-section, occurred monthly. All of which is 

relatively standard for an African district hospital. 

What makes the Congo unique and the site of such an immense and 

sustained international humanitarian effort is the chronicity and extent 

of violence. The DRC, known 

as Zaire under the long rule 

In terms of combining my profession 

with my passion, few experiences 

measure up to a mission with MSF. 

of Mobutu Seso Seko and 

earlier as the Belgian Congo, 

under the brutal colonial yoke 

of Belgium and its mining 

companies, is the second 

largest (after Sudan) of the 

sub-Saharan African countries and home to some 65 million citizens. 

It serves as the global poster country for extreme sexual violence against 

women perpetuated by the genocidiares who fled Rwanda after the 

atrocities of 1994 and the breeding ground for bizarre militias such 

as the Mai-Mai. The bulk of the trouble resides in the eastern part of 

the immense country, far from the population and economic centers 

of Kinshasa and Kisangani. Here beneath the towering volcanic peaks 

of the Virunga and the densely forested habitat of the endangered 

mountain gorilla, tragedy strikes the mostly rural populace with tiresome 

regularity. 

An alphabet soup of armies – FARDC (Forces Armees de la Republique 

Democratique de Congo [National Army of the DRC], CNDP 

(Congres National pour la Defense du Peuple [Titso rebels]), and FDLR 

(Forces Democratiques de Liberation du Rwanda [Hutu rebels]) – rule the 

region and each has been blamed for atrocities. The young “soldiers” are 

armed with counterfeit Kalashnikov rifles and ancient grenade launchers, 

but undisciplined and rarely paid. Even during the prolonged lulls in 

combat, violence is inflicted on citizens as banditry and armed looting 

prevail. As the hundreds of hospital employees are known to be well paid, 

they are frequently targets of such crimes. Two weeks before my arrival, 

an operating room nurse was killed during a robbery. On my third 

call night, a maternity nurse was brought to the Salle d’Urgence with a 

gunshot wound to the abdomen. The hospital had constructed a separate 

building to deal with the 20 plus victims of rape and sexual violence who 

presented each week. This situation necessitated a mammoth workload 

for the surgical service above and beyond that imposed by the stream of 

fractures, burns, and abscesses seen daily. 

The intensity of the work and our cloistered existence fostered a strong 

camaraderie among the team members. Our activities were tightly 

proscribed by the tense security situation. Hiking the forests was 

not permitted due to the dangers posed by land mines and potential 

kidnappings by the militias. We were allowed to leave the compound 

only in pairs and during daylight hours. Even then our routes were 

limited to a 1.5 kilometer stretch of the town’s major road. For exercise 

we resorted to the occasional jog around the field of an adjacent school 

and weekend pickup matches of volleyball and soccer. Nonetheless, time 

passed rapidly. Before I knew it the logisticians were arranging car and 

driver for my 250 kilometer return to the relative calm and order of 

Kigali, Rwanda and several days as a regular tourist. Yet with the long 

call nights, mosquito netting, and abdominal cramps soon behind me, I 

knew I’d be eager to return to the field by next year. 

MSF is approaching its fortieth birthday and with its multi-billion 

dollar annual budget and thousands of employees and volunteers from 

all corners of the globe, it is a key player in the world of international 

humanitarian aid. We see 

ourselves as members of 

a movement rather than 

as cogs in an immense 

and bureaucratic 

organization. In 

addition to physicians, 

lab techs, physical 

therapists, nurses, and water and sanitation engineers, among many 

others, are regularly deployed. Postings vary in length according to 

position but range from six weeks to six months. Volunteers receive a 

salary, generous per-diem, travel expenses, and a full benefit package. Do 

yourself and the world a favor and check out their websites at: msf.org 

and doctorswithoutborders.org. An intense desire to help is spreading 

through American universities and medical schools. Global health 

programs abound. If time with MSF isn’t your cup of tea, a myriad of 

other organizations await your donation of talent and expertise. 

Dr. Hauty is a general surgeon in Hood River, Oregon. For a detailed account of his 

time in the Congo with MSF check out his blog at: http://hauty-congo.blogspot.com. 

To facilitate more time outdoors he has morphed into a part-time “acute care surgeon” 

(surgical hospitalist). 


Garden of "Villages des Mamas" set off 

from the rest of the hospital to house 

victims of sexual violence. 

Orthopedic ward with 

ancient traction devices. 

Children of Kiwanja. 

Mural for public-awareness campaign 

against sexual violence in Goma, DRC.

Why Wilderness 

Medicine? 

Rob Hart RN, CEN, FAWM • Photo by Rob Hart 

We are surrounded by wilderness medicine. It swims around us on 

vacation, it lurks in the dark corners of our garage, it’s tethered to a 

pole near the REI store, and it strides across the busy parking lot of 

the Starbucks. It seems to find us, wherever we are, and with as little 

equipment as we could possibly need. 

So, how do we cope with such a specter? What can we, as medical 

professionals, do to advance our skills in an environment filled with fire 

ants, rabid monkeys, swiftly moving snow, thin air, lightning, tropical 

genital rashes, torrential diarrhea, and a rainbow of poison-dart frogs? 

We start by acquiring a case of high-grade duct tape, flexible Steri-Strips, 

and Super Glue. We sign up for a few WMS conferences, preferably the 

ones associated with skiing or climbing or some other enjoyable sport 

we could use as a write-off. We become card-carrying members; commit 

to memory the content of the Journal – inspired by the writers, the 

research, and the colorful stories. We ingest the knowledge of those who 

have screwed up before us, so that during some backcountry epic, we can 

excrete the functional solution to any malady – traumatic or medical – 

that could be served to us. 

A surgeon I know used to say this: “See one. Do one. Do one right. 

Teach one.” I would expand on that and add, “Do one right a bunch 

of times, then teach one.” This, I believe, is where the speakers at the 

annual conferences are lecturing from. They are seasoned veterans of 

screwing up. Their knowledge of craft is built on the plight of many 

disasters. They have survived so that their wisdom can be passed on to 

others – others who will then go out into the world, be sought out by 

their own epic adventure, and be put to the test. It’s the great circle 

of learning: we make mistakes, we learn, we grow, we teach others to 

avoid mistakes. 


Nature, however, is a cruel prankster. 

Just when you think that you have mastered the art of wilderness 

medicine, a feral squirrel is flung into a roaring campfire by a visiting 

clan of German climbers who have spent the good part of a day devising 

a rodent-sized trebuchet. The squirrel, now engulfed in a healthy 

flame, leaps from the fire (which burns as bright as a small star from 

the magnesium Volkswagen cylinder head which was thrown in on a 

double-dog-dare) and rockets itself into the nearest open tent. Strangely 

enough, there is alcohol inside the tent, along with a pair of climbers 

about to toast their victorious ascent of More Monkey than Funky. Patron 

Silver, it turns out, is just as flammable as a Wal-Mart tent or unwashed 

dreadlocks. Instantly the tent burns away, temporarily eclipsing the 

campfire quasar, and leaving two stunned climbing bums spanking 

embers and charcoal from their heads, screaming and dancing as if they 

were on a talent show, and yielding a pair of top quality burn patients. 

The collective of equally intoxicated bystanders act quickly by beating 

out the insidious hair fire with a lawn chair – wrestling style – and drops 

one of them into the dirt, unconscious. 

Burn patient, closed head injury, suspect cervical injury, scalp wound, 

airway potential, intoxication, distracting injuries, remote location – 

now this wilderness medicine! 

And there you stand, beer in hand, with thoughts of CT orders, fluid 

resuscitation, transfer paperwork, and the life-saving tetanus status 

flowing through your brain like a mudslide. You process the spontaneous 

event quickly; there is duct tape in the glove box, a film can of outdated 

Vicodin in your pack, a wrinkled Sam Splint harvested from a fractured 

snowboarder under your seat, a few potentially clean shirts padding your 

camera, a partially smashed pill which looks like it might be Zofran, and 

26 potentially lethal assistants. It’s not quite enough to build a functional 

helicopter, but it might be just enough to get the writhing squirrel-attack 

victims to a local hospital. 

Love your craft. Learn as much as you can. Become a member of the 

WMS and plan some trips around the conferences. Seek out the lecturers 

who have gray hair or no hair at all, for they will be the ones with divine 

wisdom. The wisdom that can only be achieved through years of travel; 

of mistakes, both grand and slight; of learning and teaching the work 

that he or she has authored, and expanding the works of others; of doing 

a thing wrong, and a few right; impassioned practitioners exploiting the 

mileage God has given to few humans. 

Lastly, ingest the wisdom and art of improvisation, cultivate the ability 

to see beauty in the face of adversity - and most of all, appreciate the 

flashpoint of premium tequila. 

Rob Hart, RN, CEN, FAWM, works at a Level II trauma center in Boise, Idaho. When 

he is not at work in the trenches, he operates his fine art photography business (hartimages. 

com) and coordinates climbing and trekking adventures. 


17

ild Med 101: 

Nosebleeds in the Backcountry 

Sam Schimelpfenig, MD FAAP 

Photo by Rob Hart 

N 

Nosebleeds, also known as epistaxis, are very common, and most 

people will get one at one time or another. Although the bleeding can 

be impressive, it rarely causes any serious problems. The source of the 

bleeding is most often the anterior portion of the nasal septum, from 

a region rich in superficial blood vessels called the Kiesselbach Plexus. 

Most of the bleeding from this area is due to drying of the nasal mucosa 

which tends to occur in hot, dry climates, and during the winter months 

when home heating lowers the relative humidity indoors. However, in 

the wilderness setting, trauma (even mild) may contribute epistaxis. 

Morbidity from epistaxis is low, and typically results from underlying 

medical conditions that contribute to the nosebleed. Thus, in a wilderness 

setting, it is important to make sure the patient does not have any serious 

illnesses that could be of concern. Medications such as aspirin and other 

blood-thinning agents will inhibit the clotting process and make control 

of a nosebleed more difficult. 

The simplest way to treat a nosebleed is to gently squeeze the soft parts 

of the nose against the nasal septum; application of pressure to the hard 

nasal bones will not help control bleeding. Pressure is applied until the 

nosebleed stops, which can occasionally take as long as 10 to 15 minutes. 

Often a cold pack if available may help. The patient should lean slightly 

forward so that blood does not drip down the back of the throat. Tilting 

the head back may prevent blood from getting on the patient’s clothing, 

but the blood will then drain down the back of the throat into the 

stomach, where it typically causes nausea and vomiting. 

Occasionally, a nosebleed will need to be packed to control the bleeding. 

The myriad of methods for nasal packing available in an emergency 

department are not typically carried in a first aid kit; but packing can 

be improvised with Vaseline gauze or sterile gauze. Vaseline impregnated 

gauze is preferable as it easier to remove without causing additional 

trauma and bleeding. If only dry sterile gauze is available, try applying a 

topical antibiotic cream to the gauze so it easier to apply and remove. 

The packing should be gently applied from the anterior to the posterior 

portion of the nostril using forceps or a similar device. Packing can also 

be applied to the opposite nostril to provide additional compression of 

the nasal septum. The packing should be inserted as far as possible into 

the nostril, but not so far that it cannot be easily removed. A common 

mistake is to apply packing to the nasal opening only, where it simply 

serves as a plug and not a source of pressure against the bleeding vessel. 

The packing should be removed as soon as possible to avoid developing 

a serious infection, ideally in less than 48 hours, and the patient should 

be started on a prophylactic antibiotic. 

If available, constricting nasal sprays such as Afrin or Neo-Synephrine 

can be used as directed in conjunction with packing to help control a 

nosebleed. An expedition first aid kid may carry some of the commercial 

nasal packing devices typically used in a clinic or emergency department 

setting (e.g. Merocel nasal tampon, Rapid Rhino nasal tampon). 

If available, they should be placed in the nostril according to the 

accompanying directions. Again, the packing should be removed as soon 

as possible and the patient started on an oral antibiotic to help prevent 

infection. The patient should be counseled on not exerting, straining, or 

sneezing over the next 24 – 48 hours, as this may precipitate a rebleed. 

Epistaxis should rarely be a cause for concern in the backcountry; but 

if the bleeding cannot be controlled or there is a medical history that 

is of concern, the patient should be evacuated. Also, if the nosebleed 

was a result of trauma or the patient also has an altered mental status, 

control of the bleeding is an important part of making sure the airway 

is properly managed. Typically, epistaxis that requires packing to achieve 

hemostasis should be followed up by an otolaryngologist. 


Mount Hood 

SAR Operations 

On December 9th, 2009, three climbers 

ascending Mount Hood’s treacherous Leuthhold 

Couloir were reported missing. Dr. Van Tilburg’s 

mountain rescue team, Crag Rats, of Hood River, 

Oregon, was dispatched along with Portland 

Mountain Rescue, and American Medical 

Response’s Reach-and-Treat Team stationed in 

Government Camp. Late in the day, one body 

was recovered. In the days following, the search 

was limited due to extreme avalanche danger. At 

press time, two climbers remained missing. 

Photos by 


11:00 am Ascending Triangle Moraine, before 

turning back shy of the summit due to high 

avalanche danger, below freezing temps, 

double digit wind gusts, and 50-foot visibility. 

2:40 pm Scarfing turkey sandwiches, staying 

warm, packing gear. 

8:00 am Summit team at Timberline 

Lodge, jittery. 

1:30 pm Redeployed to Illumination 

saddle and built a deadman anchor. 

3:00 pm Traversing in a white-out above 

Mississippi Head cliffs, in the “Mount Hood 

Triangle,” good thing for GPS. 

4:30 pm Long ride down, the day’s ice 

starting to melt. 

2:00 pm Rope raising 

system inside the ping 

pong ball – sky and snow 

undistinguishable. 

9:00 am Snowcat ride to 8,470 feet, 

freezing rain. 

10:10 pm Search called off for tomorrow due 

to avalanche danger, turn off 4 am alarm. 

10:00 am Wind picks up, temperatures 

plummet: no country for a soft shell. 

2:15 pm Raising the SKED with the Portland 

Mountain Rescue “Hogsback Kit.”

for Work and Play Christopher Van Tilburg MD 

Urbaneering with cyclocross 

When I lived in the city, I sought out wild places in every nook 

and cranny of the urban megapolis. Trail running was my 

connection to the landscape. Kayaking, cycling, rock climbing, 

and buildering (climbing the university brick buildings) were all 

readily available from campus. Despite now living in a small 

mountain town, my urbaneering skills (as in, outdoor adventure 

sports in the city) just broadened to include the wild and crazy 

sport of cyclocross (a high-speed off-road criterion with some 

running and a scosh of mud). 

Photos by Christopher Van Tilburg 

Coaxed unexpectedly into a race by a friend, I pulled into the lineup 

with no prior experience, using my girlfriend’s shoes (one size too small) 

and by friend’s bike (once size too big). The mass start was disorientating 

as I careened across a horse pasture, slid into a gully, peddled frantically 

through a muddy canyon, and emerged in a field. Note to reader: a 

key part of cyclocross is barreling down a hairpin mud slope, jumping 

off your bike, hucking it on your shoulder, bounding over an obstacle, 

running up a mud bank still with bike, and sliding back on the saddle. 

All this joy comes in five, 2-mile laps around a fairground, equestrian 

center, park, or any other spot of urban green space. Make that urban 

brown space: did I mention the mud? At one race in the rain, a halfdozen 

6-inch-deep, 10-foot-long puddles the color of a double nonfat 

latte developed. We rode through them without pause, getting doused 

with frigid brown goodness. One slope was so muddy, I had to put my 

hand down in 6-inch-deep goo to climb the hill. 

This vintage sport—started in Europe in the early 1900s when cyclists 

added wide knobby tires to their road bikes to negotiate foul-weather— 

has gone high tech and urban. Races have the festiveness of a tailgate 

party, replete with cheering crowds, clanging cowbells, and tachycardia 

into the mid-triple digits. But don’t be fooled: anyone can ride cyclocross. 

Beginners and kids. Tandems, unicycles, and single speeds. 

The best part: the bikes are multifunctional. They are similar to road 

bikes, with burly mods. They zip through tight turns with a short 

wheelbase, bound over rocks with a high-clearance bottom bracket, 

run tubeless knobbies to minimize pinch flats, and sport old-school 

mud-shedding cantilever brakes. The workhorse cyclocross stallion 

will do double-duty as an overnight touring mount (add panniers), a 

randonneuring steed (aka long-distance cycling), a daily commuter (add 

fenders and flashing light), or wet-weather trainer (keep your carbon 

roadie in the garage). Except for true mountain bike trails, these bikes 

are built to tackle urban bike/ped paths, dirt or gravel backroads, or, yup, 

muddy low-tech singletracks. 

So, go get dirty. 


What’s in 

Your Pack? 

We invite you to send in five 

things you couldn’t do without 

in your pack. 

Dr. Natsch is currently the Chief, Bureau of Emergency 

Medical Services for the Missouri Department of Health and 

Senior Services. He has been involved with EMS for over 35 

years, 30 as a paramedic. 

Dr. Greg Natsch shares his 

can’t-do-without-gear: 

My Camelbak Hydration system (built into all my 

packs) goes without saying, but these are my 

“American Express” items… I don’t leave home 

without them. With me at all times. 

1. Cap 

2. Good prescription sunglasses. Good for 

all conditions. 

3. Swiss Army knife – all the tools you could want. 

4. Global Positioning System (GPS). 

5. Smartphone – loaded with medical references, 

maps, emergency beacon, camera, and music 

for sanity. 

VISIT WWW. MMMEDICINE. COM FOR MORE INFORMATION 

MATTERHORN 

MOUNTAIN MEDICINE 

Zermatt, Switzerland 

July 14-17, 2010 

Join the faculty of Mountain and Marine Medicine for 

our 4th annual High Altitude and Mountain Medicine 

conference! This interactive course is designed for 

physicians, nurses, EMT's, health providers, climbers 

and mountain sports enthusiasts. Join us for an incredible 

educational event at the base of the Matterhorn! 

Guided climbs and adventures offered by: 

Suntoucher 

M o u n t a i n G u i d e s 

THIS ACTIVITY HAS BEEN PLANNED AND IMPLEMENTED IN ACCORDANCE WITH THE ESSENTIAL AREAS AND POLICIES OF THE ACCREDITATION COUNCIL FOR CONTINUING MEDICAL 

EDUCATION THROUGH THE JOINT SPONSORSHIP OF THE WILDERNESS MEDICAL SOCIETY AND SUNTOUCHER MOUNTAIN GUIDES. THE WILDERNESS MEDICAL SOCIETY IS ACCREDITED BY 

THE ACCME TO PROVIDE CONTINUING MEDICAL EDUCATION FOR PHYSICIANS. THE WMS DESIGNATES THIS EDUCATIONAL ACTIVITY FOR A MAXIMUM OF 23 AMA PRA CATEGORY 1 CREDITS TM . 

EACH PHYSICIAN SHOULD ONLY CLAIM CREDIT COMMENSURATE WITH THE EXTENT OF THEIR PARTICIPATION IN THE ACTIVITY.

Advanced Wilderness Life Support 

New Zealand Style 

AWLS participants 

enjoy a short break for 

a hot drink, a photo 

opportunity, and to 

take in the magnificent 

alpine scenery. 

For those looking for some of the most beautiful and varied wilderness 

areas in the world to explore, New Zealand is worth more than a 

passing glance. This lovely South Pacific nation provides some of the 

most awesome and exciting wilderness experiences on earth. Tramping 

through unique native bush, temperate forest or high alpine areas is just 

the start. The country offers fantastic climbing and wonderful water 

sports including rafting and kayaking on white water, lake and sea. 

Winter time is also no time to rest, with skiing, snowboarding and ice 

climbing available for all. The country itself is a magnet for outdoor 

enthusiasts and adventure sports adrenaline seekers from around the 

globe. It is therefore quite appropriate that New Zealand recently hosted 

one of the first Advanced Wilderness Life Support (AWLS) courses run 

outside of America, and the first ever in Australasia. 

The courses were hosted by the Southland Wilderness Medicine Group 

and were based in the Adventure Sports capital of New Zealand, 

Queenstown in the impressive Central Otago Lakes District. Aside from 

breathtaking scenery Queenstown provides easy access to New Zealand’s 

lake and alpine adventure playgrounds. 

The Advanced Wilderness Life Support courses were overseen by lead 

instructor, Dr Rich Ingebretsen MD PhD, on his first visit to New Zealand, 

assisted by trainee instructors who had recently attended AWLS courses 

in the United States. The standard AWLS core curriculum was taught on 

the courses together with some local content relevant to the Australasian 

environment, specifically cold water immersion issues (common in New 

Zealand) and Australasian snake and spider bites. Didactic lectures were 

held at the Crowne Plaza convention centre against the backdrop of 

Lake Wakatipu and the Remarkables Mountains. The practical teaching 

component of the course was held up in the mountains overlooking the 


AWLS Instructor Cory Kreutzer 

demonstrates a single person roll 

on a casualty while protecting the 

cervical spine from further injury. 

AWLS Instructor Dr Martin Watts 

demonstrates spinal immobilization 

techniques on a trauma victim in the field 

using improvised materials (in this case SAM 

Splint, duct tape, and backpack). 

AWLS students evacuate a 

casualty on a makeshift litter. Lake 

Wakatipu and New Zealand’s 

Southern Alps form a wonderful 

backdrop. 

town and lake near the Coronet Peak ski field. Spring weather helped with a diet 

of sunshine and light breezes to make this one of the world’s premier classrooms! 

Practical scenarios on the final day were undertaken by the students on the shores 

of Lake Wakatipu before the inevitable AWLS exam. 

Such was the interest in the AWLS courses that further courses are now planned 

for New Zealand for 2010. The enthusiasm of the participants was such that 

several of those attending were further encouraged to continue their studies 

towards their Fellowship in the Academy of Wilderness Medicine. 

Wilderness 

Advanced 

Life Support 

(WALS) 36 CECBEMS CEUs 

Designed for medical professionals 

by medical professionals. 

Wilderness Medical Associates is the world leader in 

wilderness and remote medical training. We offer the 

courses needed to respond to emergency situations, 

whether in the backcountry or an urban area in crisis. 

MAY 25 - 28 

Mt. Destinations - Santa Fe, NM (for attendees of WMS conference) 

406-522-9038 www.mountaindestinations.com 

JUNE 26 - 30 

Northern Cairn - Grand Haven, MI 

866-221-8176 www.northerncairn.com 

AUGUST 31 - SEPTEMBER 3 

MedicalOfficer.net - Crested Butte, CO 

970-275-4999 www.medicalofficer.net 

SEPTEMBER 13 - 17 

Mayo Regional Hospital - Dover-Foxcroft, ME 

207-564-8401 x207 www.mayohospital.com 

The courses listed are accepted for credits by the 

WMS Academy’s Registry of Wilderness Medicine 

Practitioners and Fellowship Program. For more information 

and additional courses please visit our website. 

WMS member Martin Watts is an Emergency Medicine Specialist and Clinical Director of 

Emergency Medicine in Southland, NZ. He is part of the Southland Wilderness Medicine Group 

who was responsible for organizing New Zealand’s first AWLS courses in 2009. 

Photographer Dr. Justin Venable is an Advanced Trainee in Emergency Medicine and an 

expedition physician for Himalayan Rescue Association and the NZ Representative to International 

Mountaineering and Climbing Federation Medical commission 

1-888-WILDMED www.wildmed.com 


23

REVIEWS 

High Crimes: The Fate 

of Everest in an Age 

of Greed 

Michael Kodas 

New York, NY: Hyperion; 2008 

Softcover, 384 pages, US $15.99 

ISBN-10: 1401309844, 

High altitude mountaineering has long been noted to have the potential 

to bring out the most noble as well as the most sordid characteristics in its 

participants. Like any human activity that tends to place individuals in 

extreme circumstances, climbing on the earth’s greater ranges will place 

unusual demands on a person’s mental and physical capabilities – and 

not all rise to the challenge in the most gracious fashion. Michael Kodas’ 

High Crimes: The Fate of Everest in an Age of Greed details many of the less 

gracious recent deeds for which the world’s highest peak is unfortunately 

becoming well-known. The ugly side of human nature seems all too 

present in this work, and while the “tell-all” nature of the book will 

not appeal to some readers of mountain literature, I believe most will 

find it an engrossing read. It’s an attention-grabbing combination of 

sickening examples of poor mountaineering behavior intermixed with 

just enough worthy and highly respectable conduct to keep one’s interest 

on the page and wondering “yikes, what next?” In many respects Mt. 

Everest has become (and will probably continue to be) the quintessence 

of the “ultimate” challenges a cross-section of humankind will always 

seek. However, after reading High Crimes, the reader might just 

begin to wonder if such a mantle for Everest has somehow helped to 

create a high altitude Circus Maximus that seems an anathema to the 

old-school mountaineer. 

George W. Rodway, PhD 

Salt Lake City, Utah 

We would like to know 

what you’re reading! 

To contribute a book review to WM magazine, 

visit wms.org/publications/magazine for 

book reviewer guidelines. 

The Accidental Explorer: 

Wayfinding in Alaska 

Sherry Simpson 

Seattle, WA: Sasquatch Books; 2008 

Hardcover; 240 pages, US $23.95 

ISBN-10: 1570615373 

ISBN-13: 978-1570615375 

How do you find yourself in any wilderness intent on losing you? Read 

Sherry Simpson’s compilation of essays about her Alaskan adventures 

and you will start your next trip exploring your mind and soul as much 

as your surroundings. 

This refreshing collection of essays chronicles an inexperienced Alaskan 

adventurer as she sets out to discover her homeland and herself. The 

ten narrations describe her explorations of destinations such as famed 

Glacier Bay to an unidentified, secretive coastline trek. Certain to appeal 

to history aficionados she weaves narrations from historic explorers into 

her stories. Whether she travels with companions or alone, Simpson’s 

mind shuttles between self promulgation and adoration at her foibles and 

accomplishments. But the one engaging current that fuels and unifies 

you through the course of this book is the author’s charming humor. 

Simpson hosts a wit that guides her self-doubts into a courageous and 

enthusiastic path of becoming an adventurer. 

In these stories you won’t find the usual gear lists and how-to notes. 

What you will find is encouragement to use a navigation device that 

needs no batteries or power backup but still comes in a sturdy case. A 

devise that sits squarely on our shoulders but one we so often forget to 

use….our minds. This book meanders through the mind and soul of the 

author as much as the face of Alaska’s landscape and offers a refreshing 

outlook on outdoor adventures. 

How well does Simpson describe each setting and bring her reader on 

site as she struggles through the remote landscapes? Very well, because 

even when I read this book ensconced on a tropical beach the author’s 

poetic prose blew the icy wilds of Alaska across my skin. Step away from 

the “how to” books and into one that melts the physical, spiritual and 

mental truths of adventure into a true wilderness experience. 

Debra Stoner MD, FAWM 

Northumberland, PA 


SOCIETY MATTERS 

News & Announcements 

HUMANITARIAN RELIEF GRANT 

Humanitarian relief 

Grant 2010 

Dear WMS Member, 

The humanitarian catastrophe in Haiti this past January 

has resonated with us all. Many of us responded through 

donations of time or money, and others through relief 

efforts on the ground. There have been worse disasters 

in history, but few that have struck with such cruelty 

upon a fragile society with no reserves. 

For several years, the Wilderness Medical Society has 

embraced disaster response and global medical outreach 

as cross-over disciplines. They are environments that 

challenge caretakers to provide best-practice care in 

austere and unpredictable environments. So with the 

challenges of Haiti fresh on our minds, we would like 

to continue the growth of our Society by providing a 

meaningful contribution to the field of humanitarian 

relief. A new, annual research grant in this field 

sponsored by the WMS will provide for a sustainable, 

long-term focus on these issues, within the highest 

academic traditions of our Society. 

As a non-profit, member-supported Society, we now 

seek to endow such a grant, and we would like your 

help with the following: 

• Donation of items to be auctioned at the WMS 

Annual Meeting in Snowmass, Colorado this 

July. 100% of the proceeds from the auction will 

go to directly support the WMS Humanitarian 

Relief Grant. 

• Direct monetary tax-deductable donations to help 

fund the grant. We welcome donations of any size. 

• Help us with recruitment of corporate sponsors 

who could provide direct donations and/or 

matching funds. 

The Society’s leadership believes this is an important 

new initiative. Not only are we focusing our expertise 

in the direction of a growing and inadequately studied 

area of medicine, but we are also adding value to our 

membership. We can think of no better mission for a 

medical society than to stay focused on those in need, 

and we hope you'll help in this quest. 

With appreciation, 

Tony Islas & Jay Lemery 

Snowmass Conference Co-Chairs 

The Wilderness Medical Society 

Partners with Global Rescue 

The Wilderness Medical Society has partnered with Global Rescue in order to ensure the 

safety of Society members on expeditions and otherwise traveling to the world’s most 

remote locations. “The life-saving value of Global Rescue memberships can’t be overstated,” 

opines WMS CEO Loren Greenway. 

“There are many reasons to plan ahead for medical advice, evaluation, assistance, and 

evacuation,” the co-founder of WMS, Paul Auerbach, MD, wrote in an article about Global 

Rescue. “Furthermore, in this time of security risks up to and including armed conflict, 

kidnapping, and terrorism, one must be aware of how to get help quickly and reliably, 

because during or immediately after the event is not the time to begin planning.” 

Global Rescue is an emergency services company that provides best-in-class medical, 

aeromedical evacuation, and security services to travelers worldwide, and is the only such 

provider that performs field rescues. The company regularly airlifts climbers from the 

Himalayas, hunters from Africa, and skiers from the Alps and the Andes. Global Rescue 

also works with some of the world’s largest companies to protect their employees from 

health, safety, and security threats around the globe. 

Recent examples of Global Rescue’s work include evacuating an injured skier from 

Bariloche, Argentina, rescuing a safari client from Mozambique, and dispatching a special 

operations team to Africa to protect and prepare to evacuate Americans from a country 

experiencing civil unrest. For more information, visit www.globalrescue.com. 

Auction Info… 

We need to hear from you by 

JUNE 1st in order to include your 

item(s) in the auction. 

The WMS will host a silent auction 

after the Haiti presentation by Dr. 

Paul Auerbach at the WMS Annual 

Meeting in Snowmass, Colorado this 

July. All proceeds will go to directly 

support the WMS Humanitarian 

Relief Grant. 

Michelle Johnson and Pauli Ingwersen 

have graciously agreed to coordinate 

the auction. For your auction item(s), 

please email a description of your 

item or items and an estimate value 

to Pauli Ingwersen at pauli@wms.org. 

Artwork, unique jewelry, weekend 

get-aways at a cabin, float or raft 

trips, fly fishing lessons, wine, books, 

equipment of all kinds are just a few 

ideas to get you started. 

Donations: 

We'll take—and appreciate— 

donations of any size! 

Merchandise: 

The WMS will have limited 

edition, specially designed WMS 

Humanitarian Relief Grant 2010 

merchandise to encourage your 

support. This merchandise will be 

available during the Snowmass 

Conference and our website wms.org 

after the conference. 

Corporate or 

Matching Donations: 

Please contact Dr. Loren Greenway 

(loren@wms.org) if you know of a 

company or business that would help 

support us through direct matching or 

outright donations. 

Also… 

Although the WMS Humanitarian 

Relief Grant will be open for 

proposals involving any area of the 

world, for our inaugural grant, we 

will only be accepting proposals 

specifically addressing Haitian 

relief efforts. The size of our grant 

disbursement will depend on the 

success of our fundraising. 


25


Grant Winners 

The Wilderness Medical Society is keenly interested in fostering 

awareness and appreciation among healthcare professionals and scientists 

for the research of health-related concerns in outdoor and wilderness 

activities. The Charles S. Houston and Research-in-Training Awards are 

selected on a competitive basis to provide funding for a research project 

in the field of wilderness medicine. The Charles S. Houston Award is 

for medical students and the Research-in-Training Award is for residents 

and fellows of an accredited graduate medical education program or 

doctoral candidates working towards a PhD. The Herbert N. Hultgren 

Award is for members of the WMS. The 2010 Winners of the WMS 

Research Awards and their areas of research are: 

Charles S. Houston Award ($6000): Gabriel Willman MD, University 

Eye Hospital and Institute for Ophthalmic Research, Department for 

Ophthalmology, University of Tübingen, Germany. Research Project: 

Functional and structural analysis of ophthalmological changes caused 

by high altitude in relation to Acute Mountain Sickness. 

Herbert N. Hultgren Award ($5000): Matthew Sanborn MD, 

University of Pennsylvania Department of Neurosurgery. Research 

Project: Developing An Animal Model for High-Altitude Cerebral 

Edema for in vivo Testing of Cerebral NO Activity. 

Research-in-Training Award ($4000): Peter Byers MD, Eastern Virginia 

Medical School Department of Emergency Medicine. Research Project: 

A Novel Approach to Killing Ixodes scapularis and Dermacentor andersoni 

Ticks in Humans. 

2010 winter conference in 

park city, Utah 

The Winter Conference in Park City was packed full with workshops, 

plenary sessions, skiing, boarding, and fun fun fun! And as it turned 

out…it does have the Greatest Snow on Earth! 

Attendees commented on the expansive program, excellent 

speakers, and exciting workshops (especially those on the 

mountain). We were fortunate to have many of the celebrated 

experts in wilderness medicine disciplines on our faculty, as 

well as new stimulating speakers, topics, and workshops. 

Dr. David Shlim, our distinguished 

banquet speaker, gave a presentation 

entitled Limitless Compassion based in 

part on the book he co-authored with 

Chokyi Nyima Rinpoche Medicine 

Dr. Peter Hackett and Compassion: A Tibetan Lama’s 

Guidance for Caregivers (Summerville, 

MA: Wisdom Publications; 2004). Dr. Shlim 

concluded our winter conference by beautifully 

articulating how to encompass compassion into 

our encounters with our patients and in our 

everyday life. 

Plan now on attending the WMS Winter 

Conference in Park City FEBRUARY 2011! 

Dr. David Shlim 

Call for Abstracts: 2010 WMS Annual 

Summer Meeting 

The Wilderness Medical Society is pleased to announce the call for 

abstracts for the 27th Annual Meeting of the Wilderness Medical Society, 

July 23-28, 2010 in Snowmass, Colorado. 

The abstract session will focus on recent research covering the entire 

spectrum of Wilderness Medicine. Submissions should be limited 

to research presentations. Abstracts may be submitted for both oral 

and poster presentations using the specific format described below. 

Abstract submissions must be received by June 15, 2010. 

Posters should be no larger than 3-feet high by 6-feet long. Boards for 

presenting posters will be available at the meeting. Authors are encouraged 

to be by their poster for viewing during their day of presentation. Oral 

presentations will be 10 minutes with 5 minutes for questions. 

All accepted abstracts will be considered for publication in Wilderness & 

Environmental Medicine. 

The Abstract Application (cover sheet, abstract form and a sample 

abstract) are available at wms.org/research/abstract_applic.asp. 

Member Get-A-Member Award 

You still have time! The Awards Committee announced a new award 

to be given at the Annual Meeting in Snowmass. This award challenges 

members to bring new members into the WMS—and it has some great 

benefits. One regular member and one student member who recruit 

the most new members (regular members/associates/students) will 

receive free registration to the Annual Meeting and a copy of Dr. Paul S. 

Auerbach’s seminal textbook Wilderness Medicine. 

Call for Authors 

The WMS is in the process of developing a Community Education 

Lecture Series similar to the professional Educational Lecture Series 

already available at wms.org. This new series is designed for the wilderness 

medicine provider who wants to teach the general public. Many of your 

favorite content friendly topics are being developed in a format for the 

lay person with no wilderness medicine knowledge. 

If you are a WMS member with experience or interest in a wilderness 

medicine topic and interested in authoring a lecture for the Community 

Education Series, contact: Dr. Debra Stoner, deb.stoner@gmail.com. 

Educational Lectures 

If you are not familiar with the WMS Educational Lecture Series, 

you able to review some samples by logging into the Member area 

(wms.org/members/memberlogon.asp), then look for “free sample” 

under Announcements on your Member’s home page. These are readyto-use 

PowerPoint presentations with complete lecturer’s notes on 

these topics: Hazardous Marine Life, Wild Animal Attacks, Accidental 

Hypothermia, Wilderness Dermatology, Wilderness Ophthalmology, 

Submersion Injuries, Diarrhea from Foreign and Wilderness Travel, 

Surviving a Wilderness Emergency, Current Concepts in Dive 

Medicine, Field Water Disinfection, Frostbite and Cold Injuries, High 

Altitude Medicine, Venomous Snakebite Management, and Venomous 

Arthropods. Other topics such as Lightning Safety, Orthopedic Injuries, 

Heat Illness and Women’s Health are in development. 


Members in the News 

Kenneth W. Kizer, one of the original 

founders of the WMS, was recently 

elected to the National Academy of Public 

Administration. A long time member of 

the Institute of Medicine of the National 

Academy of Sciences, Dr. Kizer now joins 

a group of only about a dozen persons 

ever to have been elected to both of these 

national honorary bodies. Dr. Kizer has 

been repeatedly selected as of the “100 

Most Powerful People in Healthcare” by 

Modern Healthcare magazine. He is the 

former Under Secretary for Health in 

the U.S. Department of Veterans Affairs (1994-1999) and is currently 

President, CEO and Chairman of Medsphere Systems Corporation. 

Based in Aliso Viejo, CA, Medsphere is the leading commercial provider 

of open source information technology for the health care industry. 

Dr. Jolie Bookspan and 

husband Paul Plevakas shared 

the Master Instructor of the 

Year Award at the November 

2009 International Black Belt 

Hall of Fame. Dr. Bookspan 

taught a seminar on training 

ergonomics for higher 

performance and flexibility 

during the day events. Hundreds of top martial artists, teachers, and 

Grandmasters attended from all over the world. The event was held in 

Pittsburgh, Pennsylvania. 

Mr. Plevakas (Paul Sensei) runs their karate dojo in Philadelphia. Dr. 

Bookspan is 4th degree black belt and former undefeated full contact 

martial artist and Headmaster of the Academy of Functional Exercise 

Medicine (AFEM). 

You can meet Dr. Bookspan (and take one of her fitness classes!) at the 27th WMS Wilderness and 

Mountain Medicine Conference and Annual Meeting in Snowmass, Colorado, July 23-28, 2010. 

See their book Healthy Martial Arts on DrBookspan.com/books. 

Wilderness Medicine CME 

In the Backcountry of 

Yellowstone National Park 

Program Supports 

10 hours of AMA PRA Cat 1 CME & 

10 hours of WMS FAWM Credit 

September 3-6, 2010 

For more information contact 

gmatthews59718@gmail.com or visit 

www.yellowstonepacktrips.com/cme.html 

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical 

Education through the sponsorship of the Wilderness Medical Society and Yellowstone Pack Trips. The Wilderness Medical Societyis accredited by the 

ACCME to provide continuing medical education for physicians. The Wilderness Medical Society designates this educational activity for a maximum of 10 

AMA PRA Category 1 Credits TM. Each physician should only claim credit commensurate with the extent of their participation in the activity. 


27


Student Elective 2010 

Tom Kessler, MD 

Since 2003 the WMS has 

sponsored and staffed an 

elective in wilderness medicine 

geared toward medical 

students as a clinical rotation, 

but also open to other clinical 

students (physician assistants 

and nurse practitioners) 

and residents. With the 

cooperation of Camp Wesley 

Woods, Townsend, Tennessee, 

costs for room and board are kept as modest as possible in a setting ideal 

for the elective. In addition, the Smoky Mountain area and proximity 

to Maryville and Knoxville provide many opportunities to broaden the 

experience. 

But the volunteer faculty gives the experience its unique breadth and 

depth. With no more than modest travel support, these experienced 

experts find the reward of interacting with motivated adult learners 

sufficient to offer their knowledge, experience, and values. It would be 

impossible to have the strong program without such volunteers, and we 

are indebted to them. 

We would like to thank the following people for making this year’s 

Student Elective another great success. You all made this possible… 

• Camp Wesley Woods staff, 

including Director David Leech, 

Anna Kendra, Matt, Adam, and 

Joe David Bradley 

• Kirk Harris, Fred Baty, Lisa 

Burchfield, Bryan Rowell, 

Nathan Osborn – the 

prehospital faculty 

• Chuck Hestor, law 

enforcement ranger 

• Phil Bertram, MD 

• Great Smoky Mountain 

Heritage Center, Kathy 

Prince and Richard Way 

• Blount County Sheriff’s Office, 

Captain Jeff Burchfield and 

Officer Rodney Holloway with 

Bryan Rowell 

• Kurt Smith, MD 

• Jeff Wadley, Civil Air 

Patrol officer 

• David Keitz, MD 

• Jim Suozzi, MD 

• Jack Gotcher, MD 

• Laura Helfman, MD 

• Andrew Morgan, PA 

• Rob Worthing, MD 

• Chris Calvert, MD 

• Chris Pannucci, MD 

• Neal Pollock, PhD 

• Chris Moore, MD 

• Mel Otten, MD 

A Student’s Reflections 

on the 2010 Elective 

Scott Newton MS4 

This past February, eighteen medical students, two residents, and one PA 

student lived at Camp Wesley Woods near the Great Smoky Mountains 

National Park in Tennessee to study topics in Wilderness Medicine. A 

diverse faculty, including physicians, paramedics, National Park rangers, 

and local law enforcement officers, gave lectures, led discussions, and 

directed hands-on scenarios where students had the opportunity to 

employ the skills and knowledge they acquired in a simulated setting. 

The course concluded with a student-organized 4-day backpacking trip 

inside the Great Smoky Mountains National Park. 

Topics in the first week included pre-hospital care, food and water 

procurement in the wilderness, and common ailments faced by 

international and wilderness travelers. Students received hands-on 

training in initial management of patients in the field, with a particular 

emphasis on adapting standard first responder techniques to use in 

remote locations. Hands-on scenarios included evaluating and treating 

a patient who had suffered a fall and then safely transporting the patient 

away from the scene over rough terrain. Training officers from the 

Blount County Sheriff’s department gave a hands-on demonstration of 

a variety of firearms. 

“Folding this into my existing medical knowledge expands the scenarios 

where I could be of use,” said Nicole Ingram, medical student from Texas 

Tech. “I feel like we could be dropped into the middle of nowhere with 

nothing but a pocketknife and a match and make it back home.” 

“As long as we’re not wearing any cotton!” added Lindsay Merry, medical 

student from University of Manchester, UK. 

Topics for the remainder of the month included high altitude medicine, 

search and rescue skills, water and river sports, plant toxins, and 

management of soft tissue injuries and trauma. The hands-on scenarios 

continued and increased in difficulty, pushing students to the extent of 

their ability and knowledge. Students also gave short presentations on 

topics of their own choosing, ranging from identification of edible plants 

to treatment of hypothermia. 

Scott Newton is a 4th-year medical student at Albany Medical College in Albany, 

New York and graduated from the University of Washington in Seattle with a BA 

in Spanish. 

To contact the elective directors, please 

go to WMSelective.org, or email Dr. Chris 

Sloane: csloane@ucsd.edu 


CLIFF NOTES Catherine Chamberlin MS4 

Wilderness Medicine Electives 

It is that time of year – 2nd-year medical students are dreaming about 

being out of the classroom, 3rd years are trying to plan their 4th (and 

best) year of medical school, and 4th years are trying to squeeze in that 

last adventure before residency. 

In the past few weeks I have received several emails asking about 

Wilderness Medicine elective opportunities. To start, check out the 

Student Interest Groups (SIG) website where there is a long list of 

WM electives, including field-based and international opportunities 

(wms.org/studentgroups/sig_web_site/sigelective.htm) 

If you are looking for an elective in a remote area, check out Indian 

Health Service or AHEC (Area Health Education Centers). I would also 

recommend looking at the WMS directory (membership required for 

access) to find physicians located in your area of interest. 

Here’s a letter I received from a friend and fellow wilderness medicine 

4th-year medical student, Jeremy Brudevold, who did just that… 

As a student interested in wilderness medicine I find myself 

preoccupied with searching for my next big adventure. Even 

in the midst of interviewing for an Emergency Medicine Residency 

position, I cannot help but take time to explore what the 

wilderness has to offer. This past December my sister was married 

in Maui, Hawaii. When I found out the wedding location, 

I knew it would not only be a great opportunity to spend time 

celebrating with family, but also a time for me to search for a new 

exciting adventure. 

I began my search by sending emails to all of the WMS 

members in Hawaii to see what opportunities were available 

during my time in Maui. It did not take long for me to receive 

an email from Dr. Clayton Everline, who has not only started a 

wonderful non-profit organization (TheWavesofHealth.org), but 

is also an active WMS member on Maui. He informed me that 

the world’s best women surfers would be in Maui competing at 

the Billabong Pro Maui surfing event. Dr. Everline was very helpful 

and accommodating, and since I was an eager medical student 

seeking to lend a hand, he invited me to join him in providing 

medical care to the participants. 

When I arrived at Honolua Bay the view alone made the 

journey well worth it. The contestants’ athleticism and determination 

to capture each wave was amazing, and I could not help 

but think of how fortunate I was to be a part of it all. As the 

event was winding down, I spent some time with Dr. Everline, 

who taught me about many different aspects of surfing medicine. 

Having spent most of life in the Midwest, my exposure to surfing 

was somewhat limited to say the least. As I sat watching the 

waves crash against the reef, I was humbled and intrigued by the 

power of the ocean, and I knew one day I would be back. 

Letters such as these serve as a continuous reminder of the spectrum 

of opportunities that exist in Wilderness Medicine. If you know of any 

wilderness medicine electives to post on the SIG website, please email 

me at wmsstudentrep@gmail.com. 

2010 WMS Recognition Awards 

The WMS Awards Committee, chaired by Dr. Ken Zafren, invites you 

send your suggestions for nominees of members and non-members 

who you believe are worthy of the Society’s recognition. The winners 

will be honored at the 2010 Summer Conference and Annual Meeting 

in Snowmass, Colorado. The award categories are listed below: 

Dian Simpkins Service Award. Given in recognition of outstanding 

service to the function and operation of the Society. 

Education Award. Given in recognition of outstanding contributions in 

education to students, members, or the public in the field of Wilderness 

Medicine. 

Founders Award. Given in recognition of outstanding contribution to 

the principles and objectives of Wilderness Medicine as envisioned by 

the Society’s founders. 

Research Award. Given in recognition of outstanding research pertinent 

to the field of Wilderness Medicine. 

Warren D. Bowman Award. Given to an associate member or an allied 

health professional for outstanding contributions in education to students, 

members, or the public in the field of Wilderness Medicine. 

The Awards Committee believes that your participation will significantly 

expand the depth of reach for the awards program. Members in all of the 

membership categories are eligible to make a nomination. The Awards 

Committee will give full consideration to all those named. In support of 

your nomination please include: 

Nominator: Your name, member number, and contact information 

Nominee: 1) Award for which you are nominating him/her; 2) full 

name and contact information; 3) awards, recognition, degrees; 3) 

experience, accomplishments, and memberships; 4) your personal 

support statement 

Email your nomination(s) with supporting information to Dr. Ken 

Zafren: zafren@alaska.com. We look forward to your participation in 

helping the WMS to award our worthy colleagues with these honors. 

VISIT WMS.ORG TO: 

Register For The Summer 

Conference July 23-28, 2010 

Update Your Profile 

Renew Your Membership 

Check Out Our Store! 


29

Dagala Thousand Lakes Trek 

Himalayan Kingdom of Bhutan 

Continuing Medical Education 

October 7-22, 2010 

www.AndesMountainGuides.com/cme 

MOUNTAIN GUIDES 

WILDERNESS MEDICAL SOCIETY 

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the 

Wilderness Medical Society and Andes Mountain Guides. The Wilderness Medical Society is accredited by the ACCME to provide continuing medical education for physicians. The Wilderness Medical Society 

designates this educational activity for a maximum of 16 AMA PRA Category 1 Credits TM. Each physician should only claim credit commensurate with the extent of their participation in the activity.

2010 conference calendar & affiliated conferences* 

WHEN WHAT WHERE 

Apr 16 - 18, 2010 St. Luke's Hospital Wilderness Medical Conference (SLTC) Skytop, PA 

Apr 18 - 24, 2010 Desert Medicine Training Course (EM/UK) Namibia 

Apr 21-5, 2010 Wilderness Upgrade for the Medical Professional (WMI/NOLS) Sausalito, CA 

Apr 28-May 2, 2010 Wilderness First Responder (WTC) Southwest Rescue, Durango, CO 

May 1-9, 2010 Wilderness First Responder (WTC) University of Michigan, Ann Arbor, MI 

May 4-12, 2010 Wilderness First Responder (WTC) 

Southern Utah Univ, Bryce Canyon 

Nat. Park, UT 

May 5-7, 2010 Advanced Wilderness Life Support (AWLS) Moab, UT 

May 8-15, 2010 Sailing in British Columbia Expedition for Medical Professionals (WMI/NOLS) Conway, WA 

May 9-13, 2010 Wilderness Upgrade for the Medical Professional (WMI/NOLS) Kyle B. Brown, Ames, IA 

May 9-13, 2010 Wilderness First Responder/WEMT Module (WTC) 

Alaska Pacific University, Anchorage, 

AK 

May 15-16, 2010 Wilderness Medicine for the Professional Practitioner (WMI/NOLS) Sausalito, CA 

May 15-23, 2010 Wilderness First Responder (WTC) 

Oklahoma State University, Stillwater, 

OK 

May 24-June 1, 2010 Wilderness First Responder (WTC) University of San Diego, San Diego, CA 

May 25-28, 2010 Wilderness Advaned Life Support (WMA) Santa Fe, NM 

May 29-June 2, 2010 Wilderness First Responder, WEMT Module (WTC) WMTC Classroom, Winthrop, WA 

June 5-13, 2010 WFR/WEMT (WMO) Elizabeth, CO 

Jun 25-27, 2010 Advanced Wilderness Life Support (AWLS) Mt. Rainier, WA 

July 3-11, 2010 WFR/WEMT (WMO) Elizabeth, CO 

July 9-17, 2010 Rafting the Main Salmon Expedition for Medical Professionals (WMI/NOLS) Driggs, ID 

July 10-17, 2010 

Sea Kayaking in Prince William Sound Expedition for Medical Professionals 

(WMI/NOLS) 

Palmer, AK 

Jul 16-18, 2010 Advanced Wilderness Life Support (AWLS) Queenstown, New Zealand 

Jul 23-28, 2010 WMS Annual Meeting and CME Conference Snowmass, CO 

Aug 7-15, 2010 WFR/WEMT (WMO) Elizabeth, CO 

Aug 8-12, 2010 8th World Congress on High Altitude Medicine and Physiology (ISMM) Arequipa - Peru 

Aug 29 - Sep 5, 2010 

Backpacking in the Wind River Range Expedition for Medical Professionals 

(WMI/NOLS) 

Lander, WY 

Aug 31-Sep 3, 2010 Wilderness Advaned Life Support (WMA) Crested Butte, CO 

Sept 3-6, 2010 Yellowstone Pack Trips (WPT) Yellowstone National Park, WY 

Sep 17-19, 2010 Expedition Medicine National Conference (ExpedMed) Washington, DC 

Sep 18-19, 2010 Wilderness Medicine for the Professional Practictioner (WMI/NOLS) Cullowhee, NC 

Sep 19-27, 2010 Expedition for Medical Students and Residents (WMI/NOLS) Conway, WA 

Oct 6-9, 2010 Advanced Wilderness Life Support (AWLS) Moab, UT 

Oct 7-22, 2010 Dagala Thousand Lakes Tour with CME (AMG) Bhutan 

Oct 2010 Diving and Marine Medicine Training Course (EM/UK) Bandar Khairan, Oman 

Oct 16-23, 2010 Backpacking in the Galiuros Expedition for Medical Professionals (WMI/NOLS) Tucson, AZ 

Oct 30-Nov 3, 2010 WMS Dive, Marine and Travel Medicine Conference (WMS) Lahaina, Maui, HI 

For the most recent updates, registration, and links be sure to check the Wilderness Medical Society website www.wms.org. *Organizations 

that affiliate with the WMS are granted permission to advertise as offering course content that is accepted for credit by the WMS Academy’s 

Registry of Wilderness Medicine Practitioners and Fellowship Program (FAWM) and agree to allow their names to be listed on the WMS website as 

an affiliated organization. For more information regarding the FAWM program visit WMS.ORG. 

AMG = Andes Mountain Guides 

AWLS = Advanced Wilderness Life Support 

EM/UK = Expedition Medicine, UK 

ISMM = International Society of 

Mountain Medicine 

SLTC = Luke's Trauma Center 

WMA = Wilderness Medical Associates 

WMI/NOLS = Wilderness Medicine Institute/National 

Outdoor Leadership School 

WMO = Wilderness Medicine Outfitters 

WMS = Wilderness Medical Society 

WPT = Wilderness Pack Trips 

WTC = Wilderness Training Center 


31

Vol. 27, No. 2 

SPRING 2010 


2150 South 1300 East, Suite 500 

Salt Lake City, UT 84106 

wms.org 

27 TH WMS 

WILDERNESS MEDICINE 

CONFERENCE & 

ANNUAL MEETING 

WILDERNESS & 

MOUNTAIN MEDICINE 

SNOWMASS, COLORADO 

JULY 23-28, 2010 

REGISTER ONLINE 

WMS.ORG/conferences 

or call 801.990.2988 

for up-to-date info 

COMBINING YOUR PROFESSION 

WITH YOUR PASSION

Volume 27, Number 2 - Wilderness Medical Society

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