What's in Your Medical Kit? - Wilderness Medical Society

Volume 24, #2 

S p r i n g 2 0 0 7 

What’s in Your Medical Kit? 

Expedition Cruise Ship Doc 

Training with the Marines 

Location Devices

Cover: 

Dr. Guibor hiking 

in the valley of 

the Geysers, 

Kamchatka, Russia 

© Yvonne Lanelli 

Volume 24, Number 2 Spring 2007 

Backcountry Medicine: 

What’s in Your Kit? 

Timothy Platts-Mills, MD 

Page 5 

Off the Beaten Path: 

Expedition Cruise Ship Doc 

Yvonne Lanelli and Pierre 

Guibor, MD 

Page 8 

2nd Battalion of the 1st 

Marine Regiment 

Training Operations 

Fred Trayers, LT MC USN 

Page 12 

Ask the Experts Roundtable: 

Location Devices 

Mike McDonald, 

Dale Atkins, Ken Zafren MD, 

Rocky Henderson, Howard Paul 

Page 19

+ WHAT’S NEW + EDITORIAL 

Wilderness Matters 

Eric L. Johnson, MD ..................................4 

Student Elective Update 

Christopher Sloane, MD .............................7 

Member Profiles 

Sam Schimelpfenig, MD ...........................15 

Book Reviews 

Seth C. Hawkins, MD, editor ...................16 

Search and Rescue 

on Mt. Hood Photo Essay 

Christopher Van Tilburg, MD ...................18 

ICAR - IKAR - CISA Statement: 

Avalanche Rescue Devices 

and Systems .....................................22 

CALL FOR: 

Board Member Nominations ...22 

Fit to be Wild: 

A New Look at Old Wilderness 

Medicine for Traveler’s Diarrhea 

Jolie Bookspan, PhD ................................23 

Dispatches: 

Mountain Medicine 

Conference, Argentina 

Ken Zafren, MD ......................................26 

From the PA’s Desk 

Cristopher Benner, PA-C, MMSc ...............28 

Cliff Notes 

Andrew “Woody” Bursaw, MSA .................29 

CALL FOR: 

WMS Award Nominations .........29 

Conference Calendar ...................30 

CALL FOR: 

Abstracts 2007 ................................30 

+ BOARD Of DIRECTORS 

The 2007 WMS Board of Directors 

Eric L. Johnson, MD, WMS President 

Luanne Freer, MD, Past-President 

Colin Grissom, MD, Treasurer 

Chris Moore, MD, Secretary 

Andrew “Woody” Bursaw, MS4 

Nat’l Student Representative 

Tom DeLoughery, MD 

Tony Islas, MD 

Kimberly Johnson, MD, PhD 

Shean Phelps, MD, MPH 

James A. Wilkerson III, MD 

Standing Committees 

Finance and Audit 

Colin Grissom, MD, Chair 

Nominating Committee 

Luanne Freer, MD, Chair 

Ongoing Recommended Committees 

Awards Blair Erb, MD, Chair 

CME James A. Wilkerson III, MD and 

Kimberly Johnson, Co-Chairs 

Environmental Council Kimberly Johnson, 

MD, Chair 

Executive Board Eric L. Johnson, MD, Chair 

FAWM Shean Phelps, MD, MPH, Chair 

Membership Tony Islas, MD, Chair 

Publications George Rodway, 

PhD, CRNP, Chair 

Research Colin Grissom, MD, Chair 

Student Services Andrew “Woody” Bursaw, MS4 

Wilderness Medicine 

A quarterly magazine published by the 

Wilderness Medical Society 

Christopher Van Tilburg, MD............Editor 

Jonna Barry........................Managing Editor 

Larry E. Johnson, MD, PhD................................Assistant Editor 

Seth C. Hawkins, MD................................Associate Editor 

George Rodway, PhD, CRMP..............................Associate Editor 

Karl Neumann, MD.............Editor Emeritus 

Contributing Editors: 

Jolie Bookspan, PhD 

Yvonne Lanelli 

Debra Stoner, MD 

Contributors: 

Cristopher Benner, PA-C 

Andrew (Woody) Bursaw, MS4 

Christian Sloane, MD 

Email submissions and comments to: 

Christopher Van Tilburg: vantilburg@gorge.net 

& Jonna Barry: jonna@wms.org 

Wilderness Medicine (ISSN 1073-502X) is published quarterly in January, 

April, July, and October by the Wilderness Medical Society, 810 E 10th 

Street., PO Box 1897, Lawrence, KS 66044 

Tel: 800-627-0629. Periodicals postage paid at 

Lawrence, KS and additional mailing offices. 

Annual subscription rate: $55. 

POSTMASTER: 

Send address changes to the Wilderness Medical Society, 

810 E 10th Street., PO Box 1897, Lawrence, KS 66044. 

Requests to reprint Wilderness Medicine in whole or in part must be 

submitted to www.copyright.com. 

© 2007 Wilderness Medical Society. All rights reserved. 

Printed on recycled paper in the USA. 

The goals for Wilderness Medicine magazine are to: 

1. Provide timely information regarding WMS 

news and activities; 

2. Provide a forum for the exchange of ideas and knowledge 

regarding wilderness medicine, and regarding WMS, and 

3. Promote active membership involvement 

through solicitation and publication of 

members’ articles and photographs. 

Joyce Lancaster, Executive Director 

Jason Gilbert, Association Manager 


810 E 10th Street, PO Box 1897 

Lawrence, KS 66044 

Tel: 800-627-0629 

Int’l: 785-843-1235 

Email: wms@wms.org 

Send address changes and 

requests for back issues 

to the address above. 

Send advertising inquiries to: 

Rhett Dubiel: 

rdubiel@acgpublishing.com.

+ WILDERNESS MATTERS Eric L. Johnson, MD, President, WMS 

Springtime is always a time for me to clean up post-winter season and 

look for the annual renewal that comes with this seasonal cycle. It’s time 

to put away the telemark skis and ice-climbing gear, and break out the 

road bike, rock gear, and tennis racket. For those who reside in other 

parts of the country or world, this may seem very foreign, however in 

Idaho we are very much tied to the seasons. For your society, it is much 

the same with the administration putting away 2006 year-end financials 

and the winter meeting, and looking forward to the upcoming events 

and activities. 

The WMS completed a successful society meeting in Park City, Utah in 

March, and my many thanks to Dr. Colin Grissom for acting as Program 

Chair. Besides great didactics, this meeting offered Level 1 avalanche 

certification and the Advanced Wilderness Life Support course. If you 

missed this opportunity in 2007, stay tuned as plans are in the works to 

offer another Winter Meeting in Park City in 2008. 

During the month of February, the annual ritual of reading the emails 

from the Wilderness Medicine Student Rotation held in Tennessee offers 

an amazing tale of the trials and tribulations of medical student wilderness 

education. Tom Kessler does a wonderful job in coordinating this effort, 

and I am envious of the opportunity these young physicians have. It 

is to be applauded and supported. I am also humbled by these young 

upcoming wilderness docs, as their bios are filled with broad experiences 

and interests that took me years to develop and discover…if they are any 

indication of future WMS members, the Society is in good hands. 

As we turned the calendars to 2007, WMS rolled out revised guidelines 

for the achievement of Fellow through the Academy of Wilderness 

Medicine. These revised guidelines have taken months to evolve and 

include not only wilderness didactic credits as before, but awards credit 

for wilderness experiences, volunteer work, WMS committee work, 

research and the like. I encourage all members to check out the new 

guidelines at www.wms.org. My thanks to Dr. Shean Phelps, Jason 

Gilbert, and Dr. Tony Islas for all their efforts in developing this 

program. Of note, at the upcoming Annual Meeting in July, we are 

excited to be acknowledging our first group of Wilderness Medicine 

Fellows at the Awards Ceremony! 

WILDERNESS MEDICINE // Spring 2007 

We’re all looking forward to the Society’s Annual Meeting 

being held in Snowmass CO July 21st-25th, 2007. Check 

out the WMS website for program details and online 

registration. Dr. Luanne Freer, Program Chair, has put 

together a must-attend wilderness meeting. Besides great 

didactics, hands-on workshops, and fun activities, it is your 

society’s “work” meeting that includes Committee meetings 

and your Board of Directors meeting. For me, it is always a 

time to see old friends and meet many new ones. The WMS 

Banquet night features the Awards Ceremony (Master of 

Ceremonies our own Dr. Blair Erb) and evening speaker, 

Dr. Mark Plotkin. I encourage all members to attend. 

For those wishing for a fall season overseas learning 

experience, the World Congress of Wilderness and 

Mountain Medicine held in Aviemore Scotland October 

3rd-7th will be what you need to attend. Co-sponsored 

by the WMS and the International Society of Mountain 

Medicine (ISMM), the pre-conference day as well as 

conference didactics offers world-class speakers and activities. 

Please see www.wms.org for all details. I registered on-line and it took all 

of 5 minutes. I have not been to Scotland in the fall, but am assured by 

my colleagues across the pond that I will not be disappointed. 

The WMS continues to seek out ways to better serve our membership, 

and I have noted a few already. Streamlining the Fellow process, offering 

great educational opportunities, ensuring an efficient administration 

structure, seeking out active Board and Committee members, 

encouraging student involvement, liaison with like-minded corporate 

and national/international organizations and many others is what your 

Board is focused on. If you have any additional thoughts or ideas, your 

society wishes to hear them! 

As always, I encourage all to follow our theme to “combine your 

profession with your passion.” Let us know how best we can improve 

your society and remember wilderness matters. 

You may contact Dr. Johnson at President@wms.org. 

WMS Summer Conference 

in the HEART of the Rockies! 

Make plans to attend the WMS Summer 

Conference and Annual Meeting in Snowmass 

at Aspen, Colorado, July 21 – 25, 2007. 

Visit www.wms.org for conference 

details and registration.

+ BACKCOuNTRY MEDICINE Timothy Platts-Mills, MD 

The ideal expedition medical kit would weigh nothing yet contain 

everything found in a well-stocked Emergency Department. But 

Emergency Departments are heavy, and finding a balance between the 

Ray Jardine (the “light is right” backpacking guru) approach and the 

Carolinas MED-1 truck is not simple. Although no “best” medical kit 

exists, once trip length and participants reach a critical mass, some key 

items need to come along. This article describes 40 of the most useful 

medicines and supplies to bring into the backcountry and presents 

principles that apply to both small and large expedition medical care. A 

recommended reading list is provided for those wanting to learn more. 

Preparation, Organization, 

and Communication 

Although not part of the kit, these represent the surest and lightest 

way to stay healthy. Study the area you’re traveling to, learn about 

the problems others have encountered, and anticipate the injuries 

and illnesses you will have to treat. If trekking in the tropics, review 

the CDC recommendations for vaccinations and malaria prophylaxis. 

Identify team members’ medical problems and substance dependencies 

and be prepared to address them. Encourage team members to ready 

themselves physically. Wilderness medical problems often stem from 

failures in leadership and communication; a fancy medical kit is not a 

substitute for either. Teams should have clearly defined objectives and 

agreed upon alternative plans if hazardous weather or illness occurs. 

Although you may travel sans cell phone, they’re now a standard safety 

device for U.S. backcountry travel. Outside the U.S., satellite phones 

may be appropriate. Waterproof paper and pencil weigh little and can 

be critical when trying to find a lost team member or recruit help for a 

search and rescue party. 

Foot Care and Skin Care 

Unless you are sea kayaking or orbiting Mars, you will be on your feet, 

and eventually they will hurt. Ask team members to tell you immediately 

if they have any foot discomfort. I drain blisters with a small incision, 

cover them with cyanoacrylate tissue adhesive (Dermabond), cover the 

dried adhesive with mole skin, cover the mole skin with duct tape, and 

put Vaseline over the duct tape to decrease friction between the foot 

and the footwear. There are lots of other ways to do this, but you need a 

plan. A petroleum-based antibiotic ointment serves as a lubricant and 

is useful for the treatment of superficial skin infections. 

Essential in most environments – sunscreen, lip protection, and 

sunglasses. At altitude, at sea, and on snow an extra pair of sunglasses 

for every two team members is recommended. 

Respiratory Problems 

Epinephrine is an essential medication because of its role in anaphylaxis 

treatment. The recommended dose for adults is 0.3 mg (0.3 ml of 

1:1000) intramuscularly. The EpiPen can deliver this dose, but it’s bulky, 

painful when injected, and only provides a single dose. An alternative— 

bring a 1 mL vial of 1:1000 epinephrine (3 doses). Pack albuterol 

inhalers to treat asthma and bronchospasm associated with cold, 

altitude, or respiratory illness. Intramuscular epinephrine may be used 

for the treatment of severe asthma. Asthmatics should continue their 

routine medications and carry a burst dose of oral prednisone, typically 

60 mg for 5 days. A 7-day course of levofloxacin (Levaquin) 500 mg is 

appropriate treatment for those with fever and respiratory complaints 

consistent with pneumonia. Oxymetazoline nasal spray (Afrin) and a 

non-sedating antihistamine with pseudoephedrine such as Claritin-D 

treat congestion. Oxymetazoline applied to a small piece of cotton wool 

or tissue paper also serves as anterior packing for nose bleeds. Throat 

lozenges quiet coughs and are particularly appreciated at high-altitude 

and in cold environments. 

Altitude Illnesses 

Altitude illness treatment depends on three drugs. Acetazolamide 

(Diamox) 250 mg orally twice a day both prevents and treats acute 

mountain sickness. Dexamethasone (Decadron) 8 mg intramuscularly 

followed by 4 mg injections every 6 hours treats high altitude cerebral 

edema. Oral prednisone is an acceptable dexamethasone substitute, 

but an injectable steroid is preferable due to altered mental status and 

vomiting in many with cerebral edema. Nifedipine (Procardia) 10-20 

mg orally every 6 hours is the drug of choice for high altitude pulmonary 

edema. Supplemental oxygen should also be given if available. 

Wounds 

The key to wound care in the backcountry is cleansing and hemostasis. 

Use clear flowing water to wash wounds initially; the bacterial 

concentrations are likely to be lower than on the skin. Thereafter, a 

plastic water bottle with a hole or a 20 ml syringe with an 18-gauge 

needle can be used for high-pressure irrigation. Wound closure 

prevents further contamination and controls bleeding, but is usually 

not essential and is inappropriate for puncture or dirty wounds. An Ace 

wrap works well as a compression bandage and keeps the wound clean. 

WILDERNESS MEDICINE // Spring 2007

Tissue adhesive closes small cuts. A skin stapler or suture kit may be 

appropriate. Reasonable choices for suture are 3-0 and 4-0 vicryl and 4-0 

and 5-0 nylon. Several 0-silk sutures are useful for the repair of backpack 

straps and tents. A sharp-tipped knife aids in splinter removal. Treat 

infected wounds or those with crushed tissue, gross contamination, or 

exposed tendon or bone with cephalexin (Keflex) 500 mg every 6 hours. 

Fashion splints out of insulation pads and duct tape. 

Abdominal Complaints 

There are a few bad belly problems common enough to consider that 

cannot be definitively addressed in the backcountry. Abdominal pain 

and fever, not obviously due to gastroenteritis, requires antibiotics 

and evacuation. Levofloxacin 500 mg once a day and metronidazole 

(Flagyl) 500 mg four times a day are appropriate. Pregnant trekkers 

with abdominal pain also require evacuation; bring a urine pregnancy 

test. Both urinary infections and traveler’s diarrhea can be treated with 

levofloxacin. For symptomatic treatment of gastrointestinal complaints 

bring prochlorperazine (Compazine) 25 mg suppositories, antacid 

pills, docusate sodium (Colace), bismuth subsalicylate (Pepto-Bismol), 

loperamide (Imodium), and hydrocortisone hemorrhoid cream 

(Anusol HC). 

Analgesia and Central 

Nervous System Treatments 

Traveling solo, you might forgo pain medications, but if you’re responsible 

for an expedition you need to have options. Ibuprofen (Motrin) 600 

mg tabs and oxycodone and acetaminophen (Percocet) 5/325 mg 

tabs will cover most situations. Use intramuscular morphine for those 

with major injuries. Remember, large narcotic doses cause respiratory 

depression. 

Injectable lorazepam (Ativan) treats seizures, agitation, and alcohol 

withdrawal, and works synergistically with oxycodone and morphine to 

control pain. Caffeine 200 mg tabs are useful for caffeine withdrawal 

headaches and during long drives or prolonged rescues, but are 

unnecessary if you have coffee. 

Communication: 

1. Cell or satellite phone 

2. Waterproof paper and pencil 

Foot and Skin Care: 

3. Petroleum-based antibiotic cream 

4. Duct tape 

5. Mole skin 

6. Cyanoacrylate tissue adhesive 

7. Sunscreen 

8. Lip protection 

9. Sunglasses 

Respiratory: 

10. Epinephrine 1 mg (1:1000) in vials 

11. Albuterol inhaler 

12. Oxymetazoline nasal spray 0.05 percent 

13. Loratadine/pseudoephedrine 10 mg tabs 

14. Throat lozenges 

Altitude Illness: 

15. Acetazolamide 250 mg tabs 

16. Dexamethasone injectable solution 

17. Nifedipine 10 mg tabs 


Miscellaneous 

Fluconazole (Diflucan) 150 mg orally treats vaginal candidiasis 

and athlete’s foot. Insect repellant containing DEET repels flies 

and mosquitoes. A mixture such as Cavit is useful for filling cavities. 

Ciprofloxacin ophthalmic drops (Ciloxan) treats bacterial infections 

of the eye and corneal ulcers associated with contact lens use. When 

traveling with older individuals, carry aspirin 325 mg tabs to treat chest 

pain. Nitroglycerine and furosemide (Lasix) tabs should be brought for 

patients with congestive heart failure and are important in the treatment 

of severe high-altitude pulmonary edema. Intravenous start kits, 

intravenous fluids, tube thoracostomy equipment, and advanced airway 

equipment may be appropriate for large groups with a base camp. 

Tim Platts-Mills is a senior resident in Emergency Medicine in Fresno, California. He thanks 

Dr. Michael Burg for assistance in preparing this article and Dr. Matt Lewin for insights into 

providing medical care in remote settings. 

Recommended Reading 

1. Wilkerson JA. Medicine for Mountaineering and Other Wilderness Activities, 

5th ed. Seattle WA: The Mountaineers Books; 2001. 

2. Zell SC, Goodman PH. Wilderness preparation, equipment, and medical 

supplies. In: Auerbach PS, ed. Wilderness Medicine, 4th ed. Philadelphia, PA: 

Elsevier Inc; 2001:1662-1685. 

3. Lentz M et al. Mountaineering First Aid, 4th ed. Seattle WA: The 

Mountaineers Books; 1996. 

4. Vonhof J. Fixing Your Feet, 2nd ed. Manteca, CA: Footwork 

Publications; 2001. 

5. Forgey WW. Wilderness Medical Society Practice Guidelines for Wilderness 

Emergency Care. Old Saybrook, CT: The Globe Pequot Press; 1995. 

TOP 40 ITEMS FOR A BACKCOUNTRY MEDICAL KIT 

Wounds: 

18. High-pressure irrigation device 

19. Ace wrap 

20. Suture kit 

21. Knife 

22. Cephalexin 500 mg tabs 

Abdominal Complaints: 

23. Urine pregnancy test 

24. Levofloxacin 500 mg tabs 

25. Metronidazole 500 mg tabs 

26. Calcium carbonate antacid 

750 mg tabs 

27. Bismuth subsalicylate 

250 mg tabs 

28. Docusate sodium 

100 mg tabs 

29. Prochlorperazine 

25 mg suppositories 

30. Loperamide 2 mg tabs 

31. Hydrocortisone hemorrhoidal 

2.5 percent cream 

Analgesia and Central 

Nervous System Treatments: 

32. Ibuprofen 600 mg tabs 

33. Oxycodone/acetaminophen 5/325 mg tabs 

34. Morphine sulfate injectable 

35. Lorazepam injectable 

36. Caffeine 200 mg tabs 

Other: 

37. Fluconazole 

150 mg tabs 

38. Insect repellant 

containing 

DEET 

39. Cavit 7 gm tube 

40. Syringes and 

needles for 

intramuscular 

injections 

Photo courtesy of Tender Corporation and 

Adventure Medical Kits. www.tendercorp.com

February 19, 2006: The 2007 elective is well underway. As I write 

this I am here to spend a week with Dr. Tom Kessler and his international 

crew of 24 students at Camp Wesley Woods in the Great Smoky 

Mountains. They are all having a great time. This truly is a great opportunity 

for the students. For daily updates and a chronicle of the entire 

experience, from start to finish, go online and check our new “Blog.” 

The link is http://blog.wms.org. 

The best way to learn is by doing, 

and that maxim is certainly followed 

for our wilderness medicine training. 

The students have submitted a brief update: 

“The best way to learn is by doing, and that maxim is certainly followed 

for our wilderness medicine training. For our first scenario, we were hiking 

after lunch when two of us decided to race down a steep incline. 

After tripping over a root, I was face down on my belly at the bottom of 

the hill, precariously resting on some branches inches over the creek. My 

back was hyper-extended and everything hurt. We had spent the morning 

practicing spinal immobilization, so the task of my teammates was 

to assess the scene of the accident and to get me to safer ground with my 

possible spinal cord injury. My awkward position didn’t make it easy for 

them, and luckily one of the rescuers noticed a sharp stick right next to 

my ribs, which would have made rolling me much more painful. Even 

though this was our first day of intense scenario training, we took it seriously 

and did a great job. 

In our short time here, we have had quite a few unique lectures about 

bear encounters, mushroom toxicity, planning a medical trip to Mars, 

creative rehydration methods, and the history of the Great Smoky 

Mountains, among many others. However, I am sure we would all agree 

that our favorite part of the course is getting outside and getting dirty. 

On our second day here, we did just that. We learned about search and 

rescue by tracking Lt. Col. Jeff Wadley through the woods here at our 

home base – Camp Wesley Woods. We took turns tracking a path left 

by a theoretical missing person, sometimes even on our hands and knees 

through the brush. Of course, we stored the information for what is sure 

to be a rescue scenario later in the course. 

We have spent our first week discussing topics that many of us are familiar 

with, but the emphasis now is on what we may encounter in a 

wilderness setting and what we can do with the problem outside the 

comfortable confines of the well-stocked emergency department or intensive 

care unit. Whether it is the country road loop 5 minutes from 

home that some of us run every day or mile 1,345 of the Appalachian 

Trail, we are thinking about and practicing what we can do to prevent 

the need for any wilderness medicine and how we can get people safely 

through an unforeseen tragedy. 

Most of us have not been in a classroom for over a year now but we have 

been in the emergency room, operating room, wards, and clinics learning 

while doing. This rotation is a truly unique opportunity for us both to 

get back into the classroom and to get our hands dirty at the same time. 

We are looking forward to learning a lot more and testing our knowledge 

in a wide range of scenarios, topped off by our own planned 4-day backpacking 

journey in the Great Smoky Mountain National Park.” 

Thanks to the many WMS members and volunteers who have made this 

elective possible. Without your assistance, this elective simply would not 

be the excellent experience that it is. A special thanks to Jason Gilbert 

and the staff at the WMS offices who have worked tirelessly to make 

sure the elective went off without a hitch. 

About the elective 

The elective is held in February in the Great Smoky Mountains at 

Camp Wesley Woods, just outside of Knoxville, TN. The course is a 

well balanced mix of didactics, small group sessions, and hands-on, 

scenario-based learning in an outdoor setting. There is an extended 

hike practicum. Leadership training is integrated through the course. 

The Wilderness First Responder Curriculum is integrated through the 

month and successful completion of the course allows students to take 

the WFR certification test (for an extra fee). A comprehensive syllabus, 

written by recognized leaders in the field of wilderness medicine is given 

to each participant. Academic credit is provided by the Uniformed Services 

University of the Health Sciences (USUHS) through an ongoing 

memorandum of understanding. 

Many of you have emailed, asking about plans for next year. We 

hope to have dates finalized soon for the 2008 elective. Check 

the website in April for updated dates and application materials: 

www wms.org/academy/elective.asp. 


Yvonne Lanelli and Pierre Guibor, MD 

Photos by Yvonne Lanelli 


CRuISE SHIP DOCTOR — WILDERNESS MEDICINE AT SEA

I was snorkeling with twelve expedition cruise ship 

passengers on Belize’s White Reef. Suddenly the 

divemaster yelled, waved his arms and pointed down. 

A 42-year-old female passenger lay flat on the sandy 

bottom. I took a deep breath and free-dove 30 feet. . . . 

If the phrase “cruise ship doctor” conjures images of partying Love Boatstyle 

mega-liners, a stint on an expedition cruise vessel will blow that 

cliché higher than a whale’s spout. 

“It’s wilderness medicine at sea,” says WMS member Pierre Guibor 

MD. In his eighth year as expedition cruise ship physician, he has 

sailed both small and large cruise lines from the Arctic Circle to 

South America. Currently, he serves as Cruise Medicine and 

Surgery Consultant for Clipper Cruise Lines. 

Expedition cruise vessels typically carry 120 passengers and 

80 crew. The ship’s doctor functions alone—without nurse, 

labs, X-ray or specialty consults—in remote locales such as 

Russia’s Kamchatka Peninsula, Galápagos, the South Pacific, 

or Belizean reefs. 

“WHERE AM I?” 

She was seizing. I grasped her under her chin, pushed off the 

bottom and kicked hard to the surface, emerging next to the panga 

[small skiff]. The captain and mate pulled her 90-pound limp, 

cyanotic body aboard. I jerked off my fins and mask and leaped 

up the panga’s ladder. She was not breathing, had no pulse and her 

stomach was distended. I performed one abdominal thrust. Water 

gushed over the bottom of the panga. Laying her on her back, I cleared 

her airway with my fingers. She was still unconscious, not breathing 

and pulseless. I gave her two mouth-to-mouth breaths and started cardiac 

PERFORMING UNDER PRESSURE—CAN YOU DO IT? 

Without labs, x-rays, EKG, nurse, or specialty consults, 

the expedition ship doctor reverts to the basics, “much 

like what we learned in medical school.” Most crucial: 

taking a thorough exam and history. “Document date and 

time of accident or onset of illness, signs and symptoms, 

allergies, medications, previous illnesses, and surgeries. 

Take blood pressure, pulse, respirations, and temperature 

on every patient, no matter the symptoms, diagnosis, 

or treatment.” 

Fortunately, cases such as the seizing snorkeler are rare. 

“I see mostly GI episodes and sore throats with coughing. 

I clean minor wounds, give IM tetanus toxoid boosters, 

suture lacerations, and treat minor muscle aches and 

strains of passengers who didn’t work out prior to their 

expedition. And I stress the merits of hand washing!” 

Severe trauma aboard ship is uncommon. However, “be 

ready to handle a tension pneumothorax or hemothorax 

with an emergency chest tube. Review cardio-pulmonary 

resuscitation (CPR) techniques. Take ACLS (Advanced 

Cardiac Life Support) or ATLS (Advanced Trauma Life 

Support) courses.” 

Obtaining medications in exotic foreign locations presents 

challenges as well. Before leaving the U.S., Dr. Guibor 

emails the doctor currently onboard and determines 

which meds he should bring with him, in concurrence with 

the medical director of the cruise line. “But,” he cautions, 

“when doctors from different countries bring their favorite 

meds, unfamiliar brands cause confusion.” Passengers 

themselves cause confusion as well. “They stockpile all 

their meds in one bottle instead of in individually labeled 

ones. When asked, many can’t remember the name of the 

meds, dosage, frequency—even the MD who prescribed 

them!” Possible solution—a pre-cruise form listing meds, 

dosages, frequency, and prescribing doctor. “And it would 

be extremely helpful to have a copy of a recent EKG.” 


MORE THAN SICK CALL 

The ship doctor also forms part of the ship’s documents 

department. “The mandated Center for Disease Control 

(CDC) Gastrointestinal Upset Log is an important statement 

of wellbeing aboard the ships, whether in U.S. or International 

waters.” The ship doctor takes regular water samples and 

maintains the water sampling log testifying to the absence 

of E. coli. When a health issue affects a crew member or 

passenger, the doctor and hotel manager coordinate specific 

hygiene awareness or ship cleaning procedures. If an illness— 

usually diarrhea episodes—requires cabin isolation, the doctor 

coordinates with the hotel manager, captain, and first officer. 

compressions. After 30 seconds—which seemed like 30 minutes—she 

coughed and started breathing on her own. Her pulse returned. Her color 

went from dark blue to pink in one minute. She opened her eyes and said, 

“Where am I?” 

Dr. Guibor’s efforts had just begun. Onboard the cruise ship, he plunged 

into emergency evacuation efforts that he had initiated by radio from 

the panga, mobilizing the ship captain, first officer, hotel manager, 

cruise director, Belize agent, the ship’s U.S. office, and the patient’s 

insurance company. In the patient’s cabin, Dr. Guibor re-warmed her, 

performed a complete physical exam—during which she denied a prior 

history of seizures—and started two large bore IVs in each arm with 

Ringers Lactate. 

Thirty minutes later, evacuation began. Dr. Guibor, the patient, and her 

mother bounced across the waves in the little open outboard panga to 

the small city of Dendriga, Belize. “I kept her warm with blankets and 

jackets.” Night fell. When the panga stuck on a sandbar, the crew and 

captain jumped out and pushed it over. Onshore, they transferred to the 

ship agent’s Suburban. It was 10 PM. “We drove from Dendriga over an 

unpaved road to Belize City.” During the entire trip, “I kept my index 

and middle finger on her radial pulse, the IVs open and ran O2 with a 

nasal cannula—until the O2 ran out. I attached AED pads for cardiac 

monitoring—and in case a shockable cardiac event occurred. We were 

fortunate; she didn’t seize during transport. ” 

At 6 AM, they arrived at the Belize City Medical Clinic. “Before 

boarding the ship I had already checked out this facility, anticipating an 

emergency.” The patient remained there on IV Dilantin for two more 

days before flying back to the U.S. by commercial carrier. 

10 WILDERNESS MEDICINE // Spring 2007 

Dr. Guibor, who returned to 

the ship once she had been 

admitted, followed-up after 

her return to the U.S. “She’s 

had no recurrence of seizures. 

It’s been over four years and 

I’m still in contact with her, 

Christmas cards and emails.” 

THAT’S WHY THEY (DON’T) 

PAY ME THE BIG BUCKS 

Small expedition cruise 

ship doctors are usually not 

salaried. So why trade 3 to 6 

weeks of your valued office 

time for a stint of wilderness 

medicine at sea? 

I stood on top of the highest 

temple in the Mayan ruins of 

Tikal. The steamy Guatemalan jungle spread below me. Howler monkeys 

boomed. Something red—a scarlet macaw maybe?—flashed in the 

distance. I had just climbed five stories of steep stone stairs and listened to 

expert naturalists and historians. A few hours earlier I’d been bouncing over 

the jungle canopy in a little plane. Spanning over 400 years in less than a 

day—priceless. 

Cruise lines usually provide complimentary air transportation, cruise 

experience, and shore excursions to the ship doctor. The doctor’s 

companion or spouse may also receive the cruise but is responsible for 

his/her air transportation to and from the ship plus shore excursions. 

Since most small expedition ship’s cruises range from $6,500 to $15,000 

per person, this translates into a sizable compensation package. 

In addition, the ship doctor—on his/her own—can research and arrange 

pre- or post-cruise travel. Dr. Guibor, a NAUI Dive Instructor and 

Divers Alert Network Referral Physician, often schedules scuba diving 

before and after his assignment. Being a professional diver jokingly 

earned him the ship doctor title when his vessel struck an uncharted rock 

and he “doctored the ship.” “On scuba, I evaluated and photographed 

puncture damage to the hull. Then I helped repair it!” 

Intangibles also keep Dr. Guibor at sea. “There are rewards for making 

accurate decisions rapidly, much like combat,” says the former U.S. 

Marine. “Some of us with military service vicariously enjoy the sea 

experience that we had in the past.” As in the military, he enjoys working 

with ship officers who are consummate professionals, forming friendships 

that continue after the voyage ends. 

But it isn’t all happy outcomes and Christmas cards. 

“Downsides are isolation and uncertainty of your diagnosis and treatment 

plan for serious patients. If the condition worsens and you made an 

incorrect patient management decision, you are solely responsible. Ships 

stock limited medical supplies, including oxygen. If you run out, you 

can’t call Walgreen’s.” 

AN ADVENTURE FOR THE INTREPID 

Packing his duffle for the next assignment, he reflected, “Small 

expedition ship duty is much different from large cruise ship duty. You 

practice medicine under unusual circumstances, challenge yourself both 

physically and mentally, participate as a professional mariner providing

the best care possible to passengers and crew for whom you’re their only 

resource—and experience some of the most remote parts of the world. 

The rewards are not so much financial but rather providing the service. 

Consider the currency, ‘Job well done, Doctor!’” 

He closed the duffle. “Being a ‘team player’ on a small ship delivers great 

rewards. Would you like to find out?” 

CHAIN OF COMMAND AND PEOPLE SKILLS 

Unlike a hospital setting, the ship’s doctor frequently finds him/herself 

low in authority except when medical issues are in question. Balancing 

medical concerns with ocean-going operations requires tact—plus 

common sense and basic seamanship. 

“Most Captains consider medical issues, unless life threatening, to be 

secondary. Learn the chain of command, such as the first officer who 

then communicates with the Captain if needed.” 

The ship is an isolated, self-contained community at sea. Teamwork 

is essential. “A team consensus builder uses skills that enable the team 

members to arrive at the same conclusions for problem solving and 

corrective measures. Rather than forcing an issue in an authoritative 

manner, the effective ship doctor is low key, avoiding heavy-handed 

directives.” Dr. Guibor summons all his tact when advising passengers 

that treatment will involve “isolation in their cabin for several days of 

their expensive voyage”! 

Cruise sHiP PHYsiCiANs 

Pierre Guibor, MD, PA 

Cruise Medicine & Surgery Consultant 

Email: Pguibor@aol.com 

Office: 201-392-3438 

www.intrav.com 

Clipper Cruise Line specializes in small cruise ship 

expedition-type experiences in remote areas of Alaska, 

Russia, Japan, Asia and South Pacific, aboard the Clipper 

Odyssey. The ship doctor must be able to handle a multitude 

of general medical problems and consider a number of 

solutions, with limited alternatives/supplies available. 

Flexibility, availability and affability, with a teamwork 

attitude, are important factors for this position. 

Daily sick-call hours and emergency availability to 

paxs and crew members. 

Dr. Guibor examines a polar bear skin (Ursus maritimus) 

drying in the Arctic summer sun on the rocky beach at Little 

Diomede, Alaska. Villagers explained that a hunting party had 

found the polar bear trapped on the island when the northern 

ice pack moved out early, perhaps due to global warming. 

DO YOu HAVE WHAT IT TAKES? 

Qualifications for expedition cruise ship 

doctors vary for each ship. 

Generally, requirements include: 

• Active state medical license 

• Current passport 

• ACLS, ATLS, or equivalent 

• Good general health and flexible attitude 

• Availability for a 3 to 6-week tour of duty. 

Experience in Emergency Medicine, Family Practice, 

General Surgery, or Internal Medicine is a plus. 

“You’ll be suturing small wounds.” 

Additional preparation for a ship doctor 

position might include: 

• Membership and attending conferences of 

organizations such as the Wilderness Medical 

Society (WMS) or International Society of Travel 

Medicine (ISTM) 

• Keeping physically and mentally fit with regular 

activities, i.e. hiking, swimming, etc. 

• Networking with other cruise ship physicians with 

experience aboard the same ship 

• Planning pre- or post-excursions to derive the utmost 

from your remote travel 

• Staying optimistic! 

Ship doctor applicants should have the following: 

1) Current US State Licensure & CV; 2) Copy photo page 

passport; 3) ACLS or equiv.; 4) Good general health/positive 

attitude; 5) Available for 3-6 weeks tour of duty. Preference 

given to past ship physician experience and/or military service. 

Computer skills essential. 

EM, FM, IM or Surg preferred. No labs, xray or nurse 

available. Contracts provide Med. Liab. Insur., air/land 

travel to and from ship, and cruise itinerary for doctor 

and comp cruise for companion. 


11

With the Marines 

Awesome…absolutely awesome. There’s no other way to describe the 

raw power of the 120mm smoothbore cannon of an M1A1 Abrams 

Main Battle Tank. I stood 10 feet behind this steel monstrosity when its 

main gun roared again. Despite wearing a flak jacket with armor plates, 

Kevlar helmet and ear protection, the shock wave almost knocked me off 

my feet with its massive overpressure, and I was engulfed in a cloud of 

dust and smoke. This was hardly what I expected to be doing 6 months 

after completing my internship! 

Serving with the United States Marine Corps as a physician is a unique 

experience. The Marine Corps falls under the Department of the Navy, 

which provides the Marines with their medical support. This includes 

all levels of healthcare providers from physicians to Hospital Corpsmen, 

who are equivalent to U.S. Army Medics. The career path of a Navy 

physician is different than that of a civilian counterpart. After graduation 

from medical school, Navy physicians complete an internship in the 

usual fashion. However, following internship, most Navy physicians will 

be assigned as “General Medical Officers” for 2 to 3 years, providing 

medical support directly to the fleet. This “GMO tour” as it is called, 

may be as a Flight Surgeon, Undersea Medical Officer, ship’s doctor, or 

it could be with the Marines. 

The medical issues for a Marine infantry battalion are interesting, to say 

the least. The patient population consists mostly of young men who are 

in generally excellent health. There are two general categories of medical 

problems: The majority consists of preventive medicine issues, minor 

injuries, and acute illnesses: the types of things that would be seen at a 

local acute care clinic. The second category consists of wounds or other 


2nd Battalion of the 1st 

Marine Regiment 

TRAININg OPERATIONS 

Fred Trayers, LT MC USN 

2nd Battalion, 1st Marines 

Assistant Battalion Surgeon 

An M1A1 Abrams tank fires its main gun. 

Photos by Fred Trayers 

injuries received in combat or training. Medical care is complicated by 

the fact that military operations are frequently conducted in austere 

environments. There are almost always limits in personnel, equipment, 

and transportation, which sometimes make managing routine patients 

far more challenging. If there were ever a “classic” example of wilderness 

medicine, it can be seen in the care of a Marine Corps small unit 

operating in the field. 

The 2nd Battalion / 1st Marines Battalion Aid Station 

(BASP at 29 Palms, California).

For four weeks last spring, the 2nd Battalion of the 1st Marine Regiment 

conducted training operations in Victorville, California, and the 

Marine Corps Air-Ground Training Center in 29 Palms, California. 

The training operations were crucial in preparing the battalion for its 

upcoming deployment to the Western Pacific, and medical training was 

an important element to the overall training package. 

Victorville is home to the former George Air Force Base. Instead of 

completely abandoning the facility, however, it has been transformed 

for use in Military Operations in Urban Terrain (MOUT) training. 

The hundreds of buildings that used to be base housing are perfect to 

train Marines to operate in the type of environments that are common 

in modern warfare. The battalion conducted task-specific training 

before proceeding to integrated platoon-, company-, and battalionsized 

operations. Medical training was specifically addressed. In order 

to provide the highest level of intensity and realism, a Hollywood 

production company was hired to support the training. Special effects 

technicians, makeup artists, and actors are used to create a highly realistic 

training simulation for the Marines and Corpsmen. 

Marines apply 

tourniquets 

and give 

first-aid to a 

simulated 

casualty. 

1. Return fire / 

take cover 

After a simuluated IED blast, an actress/double amputee 

is found ejected from a Humvee. 

BASIC MANAgEMENT PLAN FOR CARE UNDER FIRE: 

2. Direct/expect 

casualty to remain 

engaged as combatant, 

if appropriate 

3. Direct casualty to 

move to cover/apply 

self-aid if able 

4. Try to keep casualty 

from sustaining 

additional wounds 

5. Massive Hemorrhage: 

Stop life-threatening external 

hemorrhage if tactically feasible 

6. Airway Management: Position changes, 

airway adjunct or cricothyroidotomy 

7. Respirations: Consider tension 

pneumothorax and decompress if required 

8. Circulation: Assess for unrecognized 

hemorrhage and control 

9. Hypothermia: Minimize casualty’s 

exposure to elements / maintain 

protective gear if feasible 

In our scenario, the Marines were gathered in a parking lot in the center 

of the MOUT town. They are receiving an otherwise unremarkable 

lecture on basic first aid when a passing Humvee detonates an improvised 

explosive device (IED). A huge but harmless explosion startles everyone 

to action. The Humvee swerves off the road and hits a secondary IED as 

it comes to rest alongside one of the buildings. When the dust settles, the 

screams of our actors can be heard as they call out for help. 

The Marines immediately deploy and move towards the casualties. They 

set security and establish a defensive perimeter. The buildings are cleared 

to ensure no hostile forces lie in wait to inflict further casualties on our 

forces. Simultaneously, under the direction of the Navy Corpsmen, the 

Marines tend to the grievous wounds of the victims. The Hollywood 

makeup effects are gory, with eviscerated bowels, mangled bones, and 

shredded tissue bathed in large quantities of bright red “blood.” To 

achieve the highest level of realism and shock, many of the actors are 

amputees. Imagine the look of surprise and horror when a Marine opens 

the Humvee door to find the victim splattered in blood and sees two 

bloody stumps where the legs should be! 

The basic level of medical 

training for the Marines 

is called “Combat 

Lifesavers” which follows 

the Prehospital Trauma 

Life Support (PHTLS) 

guidelines. A military 

specific version of these 

guidelines have been 

An actor/amputee 

awaits the arrival 

of Combat Lifesaver 

trained Marines 

after a simulated 

IED blast. 

(Photo by Daniel DeAndrade) 

Marines and 

Corpsmen tend 

to the chest 

wound and arm 

amputation of the 

simulated casualty. 


13

developed, which differs slightly from traditional civilian 

protocols. The most notable difference is that medical 

care is only provided if it is tactically feasible to do so. 

In a combat environment, accomplishing the mission 

and avoiding additional casualties are of the utmost 

importance. Another interesting difference is that the 

traditional ABCDs of trauma care are modified slightly 

through use of the acronym MARCH, which stands for 

Massive hemorrhage, Airway, Respirations, Circulation, 

and Hypothermia. This sequence of trauma life support 

is tailored to suit the more commonly seen mechanisms 

of injury and environmental circumstances of combat. 

The most dangerous and challenging aspects of 

providing medical care to the Marines falls on the 

shoulders of the U.S. Navy Corpsmen. Corpsmen are 

enlisted sailors who work in all areas of Navy medicine, 

in many different roles. Among the Marines, however, 

Corpsmen have a special role in that they are assigned 

directly to combat units. This means that in addition to their medical 

responsibilities, Corpsmen will face the same tremendous challenges as 

their Marines during training and combat. Initial Corpsman training is 

roughly equivalent to that of an EMT-Basic curriculum. Corpsmen are 

frequently called upon to do far more, and will address the daily routine 

medical problems of their Marines, as well as be the primary medical 

provider during combat operations. On an almost daily basis, I am 

humbled by the ability and courage of these Corpsmen, many of whom 

wear Purple Hearts and other awards for valor, which they have earned 

by caring for their Marines under the most horrifying circumstances. 

Military medicine is unique but extremely rewarding. The sacrifices 

made by the young men and women who serve in the armed forces are 

inspiring, and it has been a privilege to take care the medical needs of 

these individuals and their families. 


Corpsmen: (L to R) HM3 Sean Phinney, HM3 Juan 

Galarza, HN Daniel Lee, and HM3 Joshua Salyer. 

Recommended Reading 

1. National Association of Emergency Medical Technicians. 

PHTLS Prehospital Trauma Life Support: Military Version (6th Ed.). 

Philadelphia, P:Mosby; 2007. 

2.Yevich S, et al. Special Operations Forces Medical Handbook. Jackson, 

WY:Teton NewMedia; 2001. 

3. Peters JM, Fansler JR. Not On My Watch: The 21st Century Combat 

Medic. Bloomington, IN:Authorhouse; 2007 

4. Bradley J. Flags of Our Fathers. New York, NY: 

Random House; 2006. 

LT Trayers is a Battalion Medical Officer with 2nd Battalion, 1st Marines. After this tour 

of duty, he plans to apply for continued residency training in Emergency Medicine at Naval 

Medical Center, San Diego.

+ MEMBER PROfILES Sam Schimelpfenig, MD 

Sheryl Olson, RN, currently works as a flight nurse in Colorado. 

She grew up in Wyoming, which fostered her interest in the great 

outdoors. Later, she began teaching skills in winter emergency care 

while working with the Ski Patrol in Breckenridge, Colorado and 

has continued to teach since then. She has been actively involved 

in teaching EMT courses, CPR and ACLS courses, and also at 

annual WMS conferences covering helicopter rescue and evacuation, 

wilderness improvisation skills, and children’s courses on survival, 

navigation, and first aid. Her current project involves organizing a 

Wilderness Medicine Adventure Course in Tibet and China in the 

summer of 2007. 

A member of the Wilderness Medical Society since 

2002, Dr. Vidal Haddad Jr., has been actively 

involved in research on aquatic animals and 

toxicology for several years. He completed medical 

school in Brazil in 1983 and afterwards specialized 

in dermatology. He also obtained a PhD from the 

Federal University of Sao Paulo in Brazil. He is a 

member of the Brazilian Society of Dermatology 

where he serves as a peer reviewer for the official 

journal of the society, as well as a member of the 

Brazilian Society of Toxicology. He has served 

as the chairman of several aquatic dermatology 

symposiums and has received numerous awards for 

his research in the field of aquatic dermatology. He 

is the author of several books on Brazilian aquatic 

and poisonous animals and maintains a website 

dedicated to the treatment of venomous Brazilian 

aquatic animals. 

Dr. William Karesh is a veterinarian who 

directs the Field Veterinary Program of the Wildlife 

Conservation Society. This program serves to fill the 

need for health-related services and technical advice 

for field biologists, conservation organizations, 

and government agencies around the world. Dr. 

Karesh has also served as the Director of Wildlife 

Conservation at the Woodland Park Zoo in Seattle, 

and as veterinarian at the San Diego Zoo and the 

Wild Animal Park in California. His main interest is 

on the practical problems raised by the interactions 

of people and wildlife. Dr. Karesh is the author of 

the critically acclaimed book Appointments at the End 

of World: Memoirs of a Wildlife Veterinarian (Warner 

Books, 1999, 2006). Wilderness Medicine magazine 

featured his article on gorillas in the Congo (Vol 

21:3; 20-22, located on the web at http://www.wms. 

org/pubs/newsletter.html). 

Graeme Walker is at the end 

of his post-graduate training for 

general practice/family medicine 

in Scotland. He developed an 

interest in wilderness medicine 

while at medical school, and his 

attendance at the 1999 WMS World 

Congress in Whistler had a major 

influence on his subsequent career 

development. Since medical school, 

he has been fortunate to have been 

able to combine his medical career 

with regular freelance work as an 

expedition leader in a variety of 

countries around the world, and this 

year he stepped foot on his seventh 

continent while working as ship’s 

doctor on a cruise to Antarctica. 

He continues his active interest in 

wilderness medicine while at home 

in the highlands of Scotland, as a 

volunteer member of Dundonnell 

Mountain Rescue Team. 


1

To the Ends of the Earth: 

Adventures of an 

Expedition Photographer 

Gordon Wiltsie 

W.W. Norton, New York , 2006 

Clothbound, 224 pages, $35 US 

ISBN-13:978-0-393-06028-7 

Gordon Wiltsie is considered one of 

the world’s preeminent “expedition 

photographers,” a term he prefers 

to “adventure photographer.” In To the Ends of the Earth, the reader 

is treated to Gordon’s talents in every conceivable way – both artistic 

with his photography, and literary with the prose that accompanies 

the images. 

The photographs tell stories, so they are not always spectacular poster 

images suitable for reproduction and hanging on a wall of art. Rather, 

they represent the action, support the stories, and guide one through 

the tales of adventure. I am largely in favor of this method, because 

rather than being enticed to quickly flip through the book and become 

1,000 PLACES TO SEE BEfORE 

YOu DIE: A Traveler’s Life List 

Patricia Schultz 

Workman Publishing, New York, 2003 

Softcover, 974 pages, 

$18.95 US, $28.95 CAN 

ISBN-10-:0-7611-0484-4 

Moonlight caressing the Taj Mahal. 

Trekking Machu Pichu. Exploring Anasazi 

ruins at Canyon de Chelly. Welcoming the 

New Year in Times Square or the summer solstice in Stonehenge. 

Sharpen your pencil and start marking off 1,000 Places to See Before 

You Die. Patricia Shultz’s New York Times bestselling Life List challenges 

travelers, real and armchair. There is something for literally everyone. 

The historian—medieval castles, Thanksgiving at Plymouth Plantation. 

The literary—Stratford-upon-Avon. The art lover—Louvre, Moscow’s 

subway system. Not to mention the religious pilgrim—Christmas in 

Bethlehem, Omayyad Mosque. Also the shopper—Dubai’s Gold Souk. 

The golfer—St. Andrews—and skier—New Zealand’s Alps, Utah’s 

Wasatch. Oh, yes, and the war buff—Normandy’s D-Day beaches. 


breathless in wonder of monumental portraiture, the reader must move 

back and forth from words to photos, to understand how the threads 

have been woven into tales. This is a book to be read over a period of 

weeks, or even months, because you will find yourself expending a bit of 

emotional energy in the process. 

It is skewed towards cold environments, like the Arctic Ocean, beginning 

and ending that way, but in his accounting of an expedition to Peru, 

Wiltsie hints that there can be gratification in staying warm. I am fearful 

that the sub-zero places he might take me would be too hard on this 

aging adventurer. However, with someone as talented and extraordinary 

as Gordon Wiltsie allowing me to stay in an armchair and soak in the 

experience, I feel much better about the future. 

If you appreciate the wilderness and wish to inspire yourself to become 

more adventurous, or just understand the motivations and trials of 

those who have already committed themselves to expeditions into the 

wild, this is a book that you should read, and have your children read 

as well. Gordon Wiltsie has created a wonderful book, and I highly 

recommend it. 

Reviewed by Paul S. Auerbach, MD, Los Altos, California 

The gourmet—Vienna’s Heurigers, Singapore’s street food—and the 

drinker—whisky distilleries and wineries. Even the party-goer—Rio’s 

Carneval, New Orleans’s Mardi Gras. And, not to be left out, the 

fisherman—Li River, Nuku’alofa—and the wildlife observer—polar 

bear safari, Masai Mara migration. The scuba diver—Roatan, Yap. 

And the outré—Count Dracula’s castle, Amsterdam’s Red Light District. 

And, yes, wilderness adventurer—bicycling, climbing, caving, bungee 

jumping, elephant riding! And 962 more. 

Covering every continent, 1,000 Places . . . includes the obvious (the 

Parthenon, Panama Canal) and not-so-obvious (Costa Rica’s Manuel 

Antonio National Park). Special indexes will guide you to ten areas of 

particular interest including “Glories of Nature” (Sun Yat-Sen Classical 

Chinese Garden, Great Barrier Reef) or ultra-pricey “Great Hotels and 

Resorts” (Raffles, Sweden’s Ice Hotel). And 955 more. 

Its 974 pages add over 2 pounds to your backpack, so unless you’re doing 

all 1,000 in one marathon adventure, copy selected logistic details to a 

coupla pages and leave the tome at home. 

Ballooning over Albuquerque, cruising the Nile. . . . 

Reviewed by Yvonne Lanelli, Alto, New Mexico

Wilderness Survival: Living off the Land with the 

Clothes on Your Back and the Knife on Your Belt 

Mark Elbroch and Mike Pewtherer 

Ragged Mountain Press, Camden, ME, 2006 

Softcover, 288 pages, $15.95 US 

ISBN: 0-07-145331-8 

For 46 days, Mike Pewtherer and Mark Elbroch lived off the 

land—facing the day-to-day struggle of meeting their body’s 

need for warmth, water, and food. To do this, they improvised 

a myriad of tools and containers, slept in leaf insulated shelters, 

drank untreated water, and killed a variety of animals with sticks 

and stones. Their book, Wilderness Survival, captures the reality 

of their journey as they challenge learned wilderness living skills in a long-term setting. 

Wilderness Survival is actually two books in one: Mike Pewtherer’s essays on basic survival 

skills interlaced with Mark Elbroch’s diary of their 46-day adventure. I was able to read 

Mark’s story without technical jargon bogging things down and yet when needed, I could 

refer to Mike’s essays for clarity on skills Mark mentioned. I found this to be a breath of 

fresh air! 

Although writings on wilderness living skills are always of interest, the candor found in 

Mark’s diary is what captured my attention. His words relay a harsh reality that contrasts 

with a modern adventurer’s fantasy. The text is filled with stories of unrelenting mosquitoes, 

rain, hypothermia, diarrhea, yearning for familiar meals and sweets, and a rollercoaster of 

emotions including a heartrending cry after killing a young deer. I encourage you to pick 

up a copy and share the adventure. 

Reviewed by Paul Greg Davenport, Stevenson, Washington 

Voyagers of the Chilcotin 

Carolyn Foltz 

Booksurge Publishing, Charleston, SC, 2007 

Softcover, 214 page, $14.95 US 

ISBN 0-9650963-0-0 

In 1965, a young couple from California became “landed 

immigrants” and traveled to Bella Coola, British Columbia, to 

live in a small community surrounded by the vast wilderness 

of the Chilcotin Plateau. This book is the account of living in a 

community similar to a hundred years ago, with kerosene lights, wood heat, and homemade 

entertainment. Although they lived in a small town and had the advantages of a store, 

a vehicle, and nearby relatives, the influence of the wilderness around them was intense. 

They stayed for about two years, had two children, then decided that they could not raise a 

family there and returned to California. 

The stories are charming and also vividly describe bear encounters in yards and along 

streams as well as the injuries common among loggers and workers in fish canneries. There 

is a special account of women’s experiences of “cabin fever,” feeling isolated and apart from 

support of family and friends in the winter, with limited understanding from the men in 

their lives. Interestingly, it was not unusual for women to check into the local hospital for a 

couple of weeks to get a break from household responsibilities when this happened. 

This book is not like the heavy accounts of Canadian wilderness travel in A Death in the 

Barrens or Going Inside, both of which describe long canoe voyages. It is, however, a fun 

read, especially for those who imagine living more simply in a wilder place. 

Reviewed by Susan Snider, MD, Spruce Pine, North Carolina 


1

Search and Rescue on Mt. Hood 

Photos by Christopher VanTilburg 


December 7, 2006 three climbers left Tilly 

Jane Trailhead to ascent the rugged, remote 

North Face Gully on Oregon’s Mt. Hood. 

The next day, one of the largest and most intense storms of the 

decade, one that would later leave 1.5 million people without 

power, hit Oregon’s highest peak. The Hood River Crag Rats 

are the mountain rescue team that initially responded to the 

distress call on December 10 and coordinated one of the 

largest searches in many years, one that would gain headline 

news as far away as Australia. 

These images are from 

WM’s Editor Dr. Van 

Tilburg’s collection 

of the search. For a 

detailed account of 

the 10-day mission, 

read Mountain Rescue 

Doctor, forthcoming 

from St. Martins Press 

in November 2007.

The nation, and many parts of the rest of the world, watched the Mt. 

Hood search in December 2006 unfold. We all were disheartened with 

the end of the story. At Wilderness Medicine we felt we should clarify 

a common question that appeared in the lay media: why didn’t these 

climbers have a rescue beacon? We asked experts to clarify the differences 

among the commonly used location devices: personal locator beacons, 

avalanche transceivers, the RECCO system, and the Oregon-specific 

Mt. Hood Locator. While technically not a locator search, two highprofile 

searches in Oregon, the Kim search in the Oregon Coast Range in 

November and the Mt. Hood search in December, both used computer 

technology to determine which cell phone towers their cell phones were 

communicating with, thus narrowing the search. We asked search and 

rescue experts to explain the different devices. 

Keep in mind, no device is foolproof: batteries die, electronics fail if they 

get dropped or wet, and sometimes we just forget how to operate them, 

the user manuals can be a thick as a novel. Also, these devices require 

proper training, routine practice, and plenty of experience. Nothing, of 

course, substitutes for common sense and good judgment. Ed. 

Personal Locator Beacons 

Mike McDonald of Douglas County (Colorado) Search and Rescue Team 

Personal Locator Beacons (PLB) are distress beacons intended for people 

involved in land-based outdoor activities. There are similar beacons for 

aviators and mariners. All three types of beacons transmit radio signals 

that are detected by 12 earth-orbiting satellites. 

The satellites relay the signals to ground stations that process the signals 

to determine beacon location and ownership, and alert search and rescue 

(SAR). This is an international program with 63 ground stations located 

in 27 countries. Another 13 countries without ground stations are 

participants in the program. 

Beacon location is determined by the frequency shift in the received 

signal as the satellite passes the beacon (Doppler shift). It takes several 

satellite passes over some time, possibly hours, to get a relatively accurate 

location. To eliminate this problem, some beacons transmit coordinates 

from an external or internal GPS (Global Positioning System) receiver. 

The coordinates are transmitted to the ground stations through the 

satellites, so an accurate location is known in the time it takes the system 

to process the signals; there are geostationary satellites that “see” an entire 

hemisphere at once, so this can be a matter of minutes. PLBs sold in the 

U.S., but not necessarily elsewhere, also transmit a low-power homing 

signal so that SAR forces can locate the beacon once they reach the 

satellite provided location. 

Each beacon transmits a unique identifier. If the beacon is registered with 

the proper authority (National Oceanic and Atmospheric Administration, 

NOAA, in the U.S.) the ground station computers match the identifier 

with the registration database. A report is generated with the beacon 

owner’s contact information, emergency contact information, and, 

of course, location. SAR then begins attempting contact. If a beacon 

detected in one country has an identifier belonging to another, the 

second country is automatically contacted so the registration database 

can be queried. If the beacon is unregistered, the report contains only the 

country code, location, and beacon information. 

The registration system in the U.S. is accessed via the internet, so a 

beacon owner can update contact information as often as necessary. 

The form has space for comments and some users input trip itineraries. 

Although U.S. law requires PLBs to be registered, many are not. For a 

PLB to provide the maximum benefit it needs to be registered. 

As with any tool, there are caveats for PLB usage. Unlike beacons 

for aviation and maritime use that can be automatically activated in 

a crash or sinking, PLBs require three separate manual operations to 


1

e activated. This means the user, or someone in the party, must have 

sufficient mental and physical capabilities to activate the beacon. The 

PLB needs to be located where it has a reasonably clear view of the sky. 

For GPS equipped beacons this is even more important because the PLB 

must be able to receive GPS signals. PLB users also need to understand 

that although the beacon may be detected within minutes of activation, 

it may take search and rescue many hours to reach the area. Despite 

these issues, when properly used, PLBs and their aviation and maritime 

counterparts can be truly life-saving devices. 

Avalanche Transceivers 

Dale Atkins, Colorado Avalanche Center 

Avalanche rescue transceivers are the best tool for companions to 

locate a buried friend. Costing typically between $300 and $400+, 

the transceivers are strongly recommended for all who play and work 

in avalanche terrain. Strapped to the torso and usually worn under the 

outer-most layer of clothing the transceiver is a small electromagnetic 

induction device (about the size of one’s hand) that transmits a constant 

signal when turned on. The device should be turned on at the start of a 

day’s adventure and then turned off at the end of the day. When a member 

of the group is buried in an avalanche, all remaining companions switch 

their devices to “receive” and begin to search for the signal. Once the 

signal is detected the searcher can hone in on the signal by following the 

flux lines of the sending unit’s magnetic field. The last few meters are 

searched in a grid-style pattern with the final pinpointing done with a 

collapsible probe pole (like a tent pole) or ski pole. 

The first transceiver, the Skadi, became available in 1968 and was thought 

to be a tool for professionals, such as ski patrollers, snow rangers, and 

plow drivers, but not for the general public. These first devices like all of 

today’s avalanche rescue transceivers work on the principle of a simple 

transformer. The sending unit creates a magnetic field that is produced 

by an electrical current pulsed in a coil around a small ferrite rod. In 

the presence of a receiving unit (magnetic coupling) a current is created 

(induced) in the receiving unit creating a detectable signal. In the early 

1980s European manufacturers settled upon a standard frequency: 

457 kHz. The U.S. adopted this higher frequency—the international 

standard—in 1996. 

For over 30 years searchers could only listen to changes in volume as 

the signal indicator. In the late 1990s the introduction of “digital” 

transceivers with multiple receiving antennas greatly improved the easeof-use. 

Digital units capture the pulsed signal, transform it to digital data, 


Photos by Christopher VanTilburg 

interpret the signal information with a microprocessor, and then present 

the data visually. Most of today’s transceivers use distance displays and 

directional arrows to guide a companion to his buried friend. 

Avalanche transceivers in the hands of practiced users, along with a probe 

and shovel, are the best tools to locate a buried companion. However, 

despite their acknowledged superiority as a companion rescue tool, the 

transceivers’ success is mediocre. Since the first use of a transceiver to 

find a buried victim in the U.S. in 1974 (through 2006), many more 

victims have been found dead (98) than alive (65). The reason is simple: 

most users are not well practiced to be fast enough to save a life. Looking 

deeper into the data offers a glimmer of optimism. Since 2000 when 

digital transceivers began to dominate the market, the mortality rate of 

subjects found by transceiver plunged from 70 percent to 50 percent. 

Experts attribute this statistically significant drop to the improved easeof-use 

with digital transceivers. Even with this dramatic improvement in 

survival, the statistic is also a sobering reminder that using transceivers 

does not guarantee survival for the buried avalanche victim. 

RECCO 

Ken Zafren, Alaska Mountain Rescue Group and WMS 

Photo courtesy of RECCO Avalanche Rescue System 

The RECCO Avalanche Rescue System (Lidingö, Sweden) is a tool that 

is widely used by organized rescue groups worldwide for rapid location of 

buried avalanche victims. RECCO uses a harmonic radar detector to find 

reflectors that are permanently attached (usually by the manufacturer) to 

clothing and gear used by skiers, snowboarders, and participants in other 

winter sports. Their use requires no training or other action on the part 

of the person venturing into avalanche terrain other than using clothing 

or equipment with reflectors. The reflectors are inexpensive, don’t use 

batteries, and weigh less than 4 grams (about 0.15 ounces). The use of 

the RECCO system does not interfere with other methods of locating 

buried victims, including avalanche transceivers or search dogs. Because 

of the high frequency it uses, RECCO allows direct and very accurate 

location of the reflectors, minimizing time spent probing to find the 

exact location of the victim. 

Photo courtesy of RECCO Avalanche Rescue System

RECCO does not replace avalanche transceivers, which are the most 

effective method of finding buried avalanche victims while they are still 

alive and can be used by the victim’s own party for rapid location and 

rescue. However, RECCO provides a complementary method for finding 

the victims in a timely manner once organized rescue arrives on the scene. 

With the increasing use of cell phones to notify rescue organizations and 

the increasing availability of snow machines and helicopters, RECCO 

has increasing potential to find live avalanche victims. A large portion 

of backcountry activity takes place close to developed ski areas, where 

the RECCO detectors are available and from where they can be rapidly 

brought to an avalanche site. The current generation RECCO detector 

weighs 1.6 kg (3.5 lbs) and is very portable. The detector can be used 

easily from a helicopter or by a rescuer on foot. The system’s range is over 

200 meters through air and 20 meters through snow. In North America, 

the RECCO system is used by over 100 ski resorts, helicopter skiing 

operations, and mountain rescue groups. The RECCO Avalanche Rescue 

System website (recco.com) has more information about the RECCO 

System as well as a very useful introduction to avalanche safety. 

Mountain Locator Unit 

Rocky Henderson, Portland (OR) Mountain Rescue 

The Mountain Locator Unit is a solution to a particular problem. In 

1986, the Oregon Episcopal School tragedy on Mt. Hood inspired 

a tremendous amount of energy toward preventing such an accident 

again. Nine people lost their lives partly because rescue teams could not 

find their snow cave in time. The solution that was selected was an 

Photo by Christopher VanTilburg 

adaptation of wildlife tracking technology. In order to implement 

the system, a special law exempting the manufacturer from tort liability 

had to be passed in the Oregon legislature. Due to FCC and other 

regulatory challenges the MLU is only available and legal to be used 

on Mt. Hood. 

The system consists of transmitters that are rented to climbers and 

sensitive directional receivers used by search teams. You cannot buy an 

MLU. Local climbing shops and a motel at Government Camp rent 

them for $5 per weekend. The climber is instructed on how to activate 

them in case of an emergency. The important thing to remember about 

MLU’s is that when they are activated no one is listening. They send a 

pulsing radio signal on the VHF band. Upon notification that you are 

missing and that you have an MLU, searchers are able to pinpoint your 

location in extreme mountain weather and environment. The transmitter 

has a sealed-in battery that will keep transmitting for literally months 

after activation. The range the searchers can hear the signal depends on 

all the factors that affect radio waves such as terrain, body shielding, and 

antennae position. It has been tested and detected up to 20 miles away 

from aircraft receivers. 

It has proven to be an effective solution to a real problem but is not the 

solution to all SAR situations. 

Cell Phones and Personal Radios 

Howard Paul, Mountain Rescue Association 

A cellular phone can save enormous time in reporting an emergency. 

However, do not depend upon a cell phone by itself—batteries die, 

coverage frequently is intermittent or nonexistent, and you are still 

without help. You must be prepared to recognize, prevent and deal with 

backcountry emergencies without a cellular phone or a radio. Know firstaid, 

how to use a map and compass; understand weather and its danger; 

carry the “10 Essentials” of backcountry travel. 

10 ESSENTIALS OF BACKCOUNTRY TRAVEL 

1. Extra food & water 

2. Extra clothing 

3. Map 

4. Compass 

5. Flashlight + extra 

batteries & bulb 

6. Sunglasses & sunscreen 

7. Matches in a waterproof container 

8. Fire starter or candle 

9. Pocket knife or utility tool 

10. First-aid kit 


21

+ CALL fOR NOMINATIONS TO SERVE ON THE WMS BOARD Of DIRECTORS! 

The WMS nominations committee is looking for members interested in stepping up their commitment to the WMS by serving on its Board of Directors. 

If you are interested in being considered, please send by email a list of your special qualifications and a written statement itemizing what you feel you can 

bring to the board and why you should be considered. Deadline for nominations is May 1, 2007, send to wms@wms.org. 

WMS Board MeMBer joB deScription 

H Define and pursue the mission of the WMS and safeguard the values of the organization. 

H Select, monitor, support, evaluate and compensate the Executive Director. 

H Establish long-term direction through oversight of and participation in strategic planning. 

H Promote financial viability through budget and financial oversight, fund development 

and investment management. 

H Maintain and continuously improve the services of the WMS. 

H Monitor the effectiveness of significant organizational programs and take action where appropriate 

to improve, modify, or eliminate such programs as necessary to maintain excellence. 

H Oversee and promote positive relationships with liaison organizations. 

H Promote and maintain positive external relationships with the community and other wilderness, 

healthcare, and environmental organizations. 


ICAR - IKAR - CISA Statement 

(Avalanche Rescue, Terrestrial Rescue 

and Medical Commissions) 

Avalanche Rescue Devices and Systems 

Kranjska Gora, Slovenia 

October 14, 2006 

Internationale Kommission für Alpines Rettungswesen IKAR Commission Internationale 

de Sauvetage Alpin CISA International Commission for Alpine Rescue ICAR 

Considering the ongoing development of avalanche safety devices in recent years the above commissions of ICAR–IKAR-CISA 

update their statement of 1999 concerning these devices and systems by highlighting the following points: 

A. Most people trigger their own avalanche and this can result in death. 

The best way not to be caught is to not trigger an avalanche. 

If caught, preventing burial is the best way to stay alive. 

B. The best way to avoid avalanche accidents is prevention, including information (avalanche bulletins), 

knowledge, experience, awareness, and caution. 

C. If caught, some safety systems/devices may increase one’s chances of survival. Survival depends upon quick rescue. 

The efficiency of the transceiver in combination with probe and shovel, and of airbag systems has been proven. 

At this time support for other systems is based upon personal opinion and case reports. 

However, no device or system guarantees against either injuries to or death of avalanche victims. 

D. All rescue systems require training and practice. 

E. For organized rescue early notification is essential, e.g., by mobile phone, satellite phone, or radio — wherever possible. 

f. To be equipped with a transceiver or at least a transponder, e.g., the RECCO system, renders organized rescue more efficient. 

H Oversee effective governance, including Board recruitment, selection and orientation, 

board education, and self-evaluation and effective function and structure. 

H Act with the highest integrity to advance the best interests of the WMS and achieve its mission. 

H Oversee fundraising and participate in fund development through personal contributions. 

H Set policies for the WMS. 

H Serve as advisor for the Executive Director 

H Bring at least one corporate sponsor to the WMS. 

H During his/her term or before taking a seat on the Board, each Board member should 

become a life member of the WMS. 

H Each Board member is expected to attend (in person or by phone conference) a minimum of 

50% of annual scheduled Board meetings, and may not be absent from 2 consecutive meetings of the Board.

FiT to be WiLD: 

A New Look at Old Wilderness Medicine for Traveler’s Diarrhea 

Jolie Bookspan, PhD 

Traveler’s diarrhea is common in visitors to tropical areas and during 

expeditions to wilderness locations. It is inconvenient and sometimes 

uncomfortable, with abdominal pain, dizziness, and nausea. While 

antibiotics are often used to treat some kinds of traveler’s diarrhea, there 

are other time-honored options. In deciding the best treatment, several 

issues need to be considered. 

Some of the gastrointestinal illnesses (GI), like E. coli, can be made 

worse with antibiotics. Killing the bacteria can sometimes cause release 

of large amounts of the Shiga toxin. Antibiotics also wipe out the GI 

tract’s “good bugs” along with the bad. Without the beneficial flora that 

normally live in the GI tract, normal nutritional and immunogenic 

products in your body are not made, and the organisms responsible 

for several illnesses can proliferate. An example is antibiotic-associated 

Clostridium difficile (C. difficile) colitis, an infection of the colon that 

occurs primarily among patients exposed to antibiotics. More than three 

million C. difficile infections occur in hospitals in the U.S. each year. It 

is estimated that 20,000 C. difficile infections now occur each year in the 

U.S. outside the hospital. 

Antidiarrheal medicines, such as loperamide, sometimes help, but in 

some situations are not recommended for particular infectious sources 

of diarrhea, because they may keep infectious bacteria in contact with 

the gastrointestinal tract for longer periods of time. For example, some 

authorities recommend loperamide for non-invasive bacterial infections 

(generally marked by no fever and no blood), but withholding loperamide 

for invasive bacterial infections (generally marked by fever and blood 

in stool). 

Antacids and proton pump inhibitors (PPIs), drugs to reduce acid 

production in the GI tract and to treat ulcers and reflux, can also allow 

ingested infectious organisms to grow in your stomach. Stomach acid is 

necessary to kill unhealthy germs and food-borne infection. A known risk 

factor for gastroenteritis is using PPIs like Nexium, Prilosec, Prevacid, 

Zoton, Inhibitol, and others. 1-3 

Long-term PPI-induced acid suppression in conjunction with 

Helicobacter pylori (H. pylori) colonization may promote development 

of atrophic gastritis, a well-accepted step in the progression to 

gastric cancer. 4 

Use of PPIs add to the confusion in making the differential diagnosis, 

as side effects of PPIs may include diarrhea, abdominal pain, and 

nausea. Diarrhea is also a side effect of antibiotics, which may have 

been prescribed prophylactically to prevent traveler’s diarrhea. It is easy 

to confuse these symptoms for a infectious mechanism, and then add 

medicines that further the cycle of problems. What are some possible 

alternative treatments? 

Photo by Jonna Barry 

The use of probiotics, 

which are beneficial bacteria 

and yeasts, dates 

back thousands of years. 


23

Time-Honored Medicine 

One effective remedy for traveler’s diarrhea, historically used in many 

societies, is eating fermented food. The use of “probiotics,” which are 

beneficial bacteria and yeasts, dates back thousands of years. People in 

ancient civilizations, from Mongolian nomads to Babylonian royalty, 

drank soured milk, and Asiatics ate fermented beans and vegetables 

to stop gastrointestinal illness. Russian and Mongolian military troops 

campaigning across vast distances ate sauerkraut, which is fermented 

cabbage, for scurvy prevention and against diarrhea. Sauerkraut is a 

version of kimchi, Korean fermented cabbage that was brought to the 

Teutonics with the Mongols and other wandering tribesmen who had 

contact with the Orient. 

Modern Confrmation 

The Lancet recently published a study by researchers from Johns Hopkins 

University who concluded that probiotics effectively treat acute diarrhea 

and antibiotic-associated diarrhea in adults and children. Several probiotic 

strains were evaluated, including Saccharomyces boulardii, Lactobacillus 

rhamnosus GG, Lactobacillus acidophilus, Lactobacillus bulgaricus, and 

others. The researchers urged eating probiotic-containing food when 

traveling, especially internationally. 5 Other major studies support that 

probiotics prevent and reduce duration of acute diarrhea in adults and 

children. 6,7 

Germ inhibiting Foods 

Cabbage may be an accepted antibacterial for stomach ulcers, now 

known associated with the gastrointestinal bacteria H. pylori. Clinical 

trials indicate that some types of probiotics also help control several 

diseases, such as ulcerative colitis, reflux, and irritable bowel. 8 

2 


Photo by Rhonda Martin 

Fermented vegetables like kimchi are nutritious in themselves, plus 

produce nutrients that beneficial lactobacteria need to thrive and produce 

antibacterial action. Two top foods for promoting beneficial bacteria and 

inhibiting unhealthy bacteria are cabbage and onions. Broccoli sprouts 

have been found to specifically reduce H. pylori. Seasoning food with 

raw crushed garlic and fresh ginger root may inhibit strains of H. pylori, 

E. coli, Staphylococcus, and Streptococcus, without harming beneficial 

digestive bacteria. 

Several spices have bacteria-inhibiting properties: garlic, allspice, and 

oregano have been found to have action against “bad” bacteria, followed 

by thyme, cinnamon, tarragon, and cumin. Capsicum, such as chilies 

and other hot peppers, have moderate antimicrobial action. White and 

black pepper, ginger, anise seed, celery seed, and lemon and lime juice 

follow. Researchers at the University of Kansas found that garlic, cloves, 

cinnamon, oregano, and sage kill E. coli. 9-12 Research in Mexico has 

found the spice oregano to be more effective than prescription drugs 

against Giardia. 13,14 

Many foods have been long used 

against fungal + worm infestations. 

In addition to antibacterial properties, many foods have been long used 

against fungal and worm infestations. The World Health Organization 

recommends crushed garlic, curry, and cloves for their specific antiworm 

properties, confirmed in studies 15, and the anti-worm properties 

of coconut. 16,17

In Russia, a lacto-fermented beverage called kvass has long been made 

from old rye bread. It tastes like beer but is not alcoholic and can be 

purchased in modern supermarkets packaged just like soda. Kvass was 

used by peasants, military, and even the Czars. Another kvass made from 

beets was made during war times and taken during travel to protect 

against infections. Ancient Iraqis and Egyptians made similar drinks from 

bread. Fungus-fermented teas have long been used throughout Russia, 

China, Japan, Poland, Bulgaria, Germany, and Southeast Asia (called 

chainyi grib in Russia, kombucha in Asia, and elsewhere as teeschwamm 

or teewass, wunderpilz, cajnij, fungus japonicus, and hongo, which 

means “mushroom”). Australian aborigines lacto-fermented grains and 

legumes to make a bubbly, sour drink that modern Australians call 

“wholegrain.” South American Native Indians fermented several drinks 

they say prevent digestive problems including diarrhea. In Africa, lactofermented 

munkoyo was made from millet or sorghum (sorghum beer) 

and given to babies to stop infection and diarrhea. Missionaries (and 

others) suppressed munkoyo in favor of commercial soft drinks. 

What To Do – Simple and inexpensive Food 

For serious cases, seek medical attention to determine the pathogen 

and proper course of treatment. Most of the time, traveler’s stomach is 

not a medical emergency. Several things may lessen, prevent, and 

alleviate outbreaks. 

Instead of soda, try kvass. Instead of antacids and antibiotics for traveler’s 

stomach pain, it is healthier and often as effective or more effective 

to use cabbage, cabbage juice, and fresh sauerkraut. Try apple cider 

vinegar diluted in a little water. Squeeze lemons and limes on fruit and 

vegetables, and add to drinks and blender shakes. Add balsamic vinegar 

to salads. Soothe an uncomfortable stomach with fresh ginger. For the 

gas of traveler’s stomach, season food with cardamom, coriander, fennel, 

or cumin. For traveler’s diarrhea, try kimchi, tempeh, and sauerkraut. 

Eat fermented vegetables like fresh pickle (fermented, not vinegar 

cucumbers), sauerkraut (fermented cabbage), fermented chutney, 

tempeh, oncham, and kimchi. Season with spices like garlic and 

curry. Look for fermented food with live cultures. Many products kill 

the cultures through heating, processing, and packaging. Use freshmade 

sauerkraut, not pasteurized or canned. The packaging process 

deliberately removes helpful nutrients and living cultures created 

through fermentation so that the lids don’t blow off. There are “quick” 

sauerkrauts made with vinegar; the vinegar is fermented, but the cabbage 

isn’t. To get real fermented cabbage, check the label for sauerkraut made 

from cabbage, water, and salt, with no vinegar. Although “probiotics” are 

often expensively packaged in supplements, you can have the benefits 

from inexpensive simple foods. 

Photo by David Barry 

What To Do – Simple and inexpensive Containers 

Dishwashing techniques in hiking camps and expedition kitchens 

have been found to be a cause of many cases of wilderness and highaltitude 

gastroenteritis. 

One time-honored method is not to use dishes. Find or bring large leaves 

like banana, spinach, grape leaves, chards, and other greens to wrap 

foods for cooking, and use for sturdy plates and napkins. The leaves 

pack lighter and flatter than dishes. Make pronged vegetable roasters 

from long, narrow stems and branches. Cut lengths into simple spoons, 

spatulas, and chopsticks. Return them to the earth when finished. Don’t 

destroy living trees, and keep your impact low. It’s healthier for you and 

the wilderness. 

Old Ways Are New 

People go to the wilderness to get back to nature, then often eat no 

greens or healthy foods, add to litter with disposable containers, lug piles 

of dishware, and add bleach into the environment from disinfecting 

dishwashing technique. Fermented food is health food for you, for the 

environment, and portable convenience food. Use healthy foods for a 

simpler life and better health. 

Dr. Bookspan and her husband live half of each year in Southeast Asia and have previously lived 

in Mexico, eating and drinking local food and water, successfully using these techniques. More on 

fermented food and healthy nutrition for home and travel can be found in Dr. Bookspan’s new 

book Healthy Martial Arts ( www.DrBookspan.com/books). 

References: 

1. Cunningham R, Dale B, Undy B, Gaunt 

N. Proton pump inhibitors as a risk factor for 

Clostridium difficile diarrhoea. J Hosp Infect. 

2003 Jul;54(3):243-5. 

2. Dial S, Delaney JA, Barkun AN, Suissa 

S. Use of gastric acid-suppressive agents and 

the risk of community-acquired Clostridium 

difficile-associated disease. JAMA. 2005 Dec 

21;294(23):2989-95. 

3. Canani RB, Cirillo P, Roggero P, Romano C, 

Malamisura B, Terrin G, Passariello A, 

Manguso F, Morelli L, Guarino A. Therapy 

with gastric acidity inhibitors increases 

the risk of acute gastroenteritis and 

community-acquired pneumonia in children. 

Pediatrics. 2006 May;117(5):e817-20.) 

4. Peek RM. Helicobacter pylori and 

Gastroesophageal Reflux Disease. Curr Treat 

Options Gastroenterol. 2004 Feb;7(1):59-70. 

5. S. Sazawal, G. Hiremath, U. Dhingra, P. 

Malik, S. Deb, R. Black. Efficacy of probiotics in 

prevention of acute diarrhoea: a meta-analysis of 

masked, randomised and placebo-controlled trials. 

Lancet Infect Diseases. 2006;6:374-382. 

6. Sur D, Bhattacharya SK. Acute diarrhoeal 

diseases—an approach to management. J Indian 

Med Assoc. 2006 May;104(5):220-3. 

7. Yan F, Polk DB. Probiotics as functional food 

in the treatment of diarrhea. Curr Opin Clin 

Nutr Metab Care. 2006 Nov;9(6):717-21. 

8. Chande N, McDonald JW, MacDonald JK. 

Interventions for treating collagenous colitis. 

Cochrane Database Syst Rev. 2006 Oct 18;(4): 

CD003575. 

9. Takikawa A, Abe K, Yamamoto M, 

Ishimaru S, Yasui M, Okubo Y, Yokoigawa 

K. Antimicrobial activity of nutmeg against 

Escherichia coli O157. J Biosci Bioeng. 

2002;94(4):315-20. 

10. Burt SA, Reinders RD. Antibacterial 

activity of selected plant essential oils against 

Escherichia coli O157:H7. Lett Appl Microbiol. 

2003;36(3):162-7. 

11. Elgayyar M, Draughon FA, Golden DA, 

Mount JR. Antimicrobial activity of essential 

oils from plants against selected pathogenic and 

saprophytic microorganisms. J Food Prot. 2001 

Jul;64(7):1019-24. 

12. De M, Krishna De A, Banerjee AB. 

Antimicrobial screening of some Indian spices. 

Phytother Res. 1999 Nov;13(7):616-8. 

13. Ponce-Macotela M, Rufino-Gonzalez 

Y, Gonzalez-Maciel A, Reynoso-Robles R, 

Martinez-Gordillo MN. Oregano (Lippia 

spp.) kills Giardia intestinalis trophozoites in 

vitro: antigiardiasic activity and ultrastructural 

damage. Parasitol Res. 2006 May;98(6):557-60. 

Epub 2006 Jan 20. 

14. Ponce-Macotela M, Navarro-Alegria I, 

Martinez-Gordillo MN, Alvarez-Chacon R. In 

vitro effect against Giardia of 14 plant extracts. 

Rev Invest Clin. 1994 Sep-Oct;46(5):343-7. 

15. Soffar SA, Mokhtar GM. Evaluation of the 

antiparasitic effect of aqueous garlic (Allium 

sativum) extract in hymenolepiasis nana 

and giardiasis. J Egypt Soc Parasitol. 1991 

Aug;21(2):497-502. 

16. Giove Nakazawa RA. Traditional medicine 

in the treatment of enteroparasitosis. 

Rev Gastroenterol Peru. 1996 Sep- 

Dec;16(3):197-202. 

17. Chowhan GS, Joshi KR, Bhatnagar HN, 

Khangarot D. Treatment of tapeworm infestation 

by coconut (Co-cos-nucifera) preparations. 

J Assoc Physicians India. 1985 Mar;33(3):207-9. 


2

+ DISPATCHES Part I – The 3rd Congress of the Argentina Society of Mountain Medicine – San Juan, Argentina 

The views 

from an airplane approaching Santiago and continuing on to Mendoza, 

Chile, are spectacular. Flying into Santiago from the north provides a 

look at the high Andes from the west. Aconcagua, the highest mountain 

in the Western Hemisphere is the pinnacle, but there are many other 

peaks above 6000 meters (about 20,00 feet). 

The Argentina Society of Mountain Medicine (SAMM) invited me 

back to Argentina, in December 2006, to speak at their 3rd Congress of 

Mountain Medicine and to help teach the first Basic Mountain Medicine 

Diploma Course for Doctors to be given in the Americas. This course is 

part of the curriculum that leads to the Diploma in Mountain Medicine 

approved by the Medical Commissions of the UIAA (International 

Federation of Mountaineering Associations) and ICAR (International 

Commission for Mountain Rescue). As a member of the ICAR Medical 

Commission, I helped design this course. 

After landing in Mendoza, the two-hour drive to San Juan took us 

through an arid landscape with little vegetation and ever-more distant 

views of the high mountains until we reached the oasis town of San Juan 

with its vineyards. Northern Argentina is known for its wine. My friends 

from San Juan insist that the wine from San Juan is better than that 

from Mendoza, but my friends from Mendoza hold exactly the opposite 

opinion. Although I am no expert, both seemed excellent. 

The first session concerned chronic intermittent altitude exposure (EICA 

from its Spanish name – Exposición Intermittente Crónica a la Altitud). 

This theme is very topical in Argentina and in neighboring Chile, 

because thousands of people work at high altitude mines but live at or 

near sea level. After a welcome by Dr. Carlos Pesce, the chairman of the 

Congress, Dr. Daniel Jimenez from Santiago, discussed the advantages 

and disadvantages of different schedules and the effects of EICA on 

hypertension, diabetes, and obesity. Dr. Jean-Paul Richalet, from Paris, 

who has studied EICA extensively in Chile, discussed the physiological 

changes associated with intermittent altitude exposure. Dr. Conxita 

Leal from Barcelona discussed contraindications to altitude exposure. 

The first half of the morning concluded with Dr. Nora Vainstein from 

Buenos Aires discussing the approach to cardiac risk factors in workers 

undergoing EICA. The general conclusion of these talks was that EICA 

can be quite stressful, especially to the cardiovascular system. Many 

workers are eliminated during the initial trial period, but the longterm 

effects on workers who undergo EICA over a period of years is 

not known. 

The second part of the morning focused on neurological changes at 

altitude. Dr. Damian Bailey from Wales discussed molecular effects of 


Mountain Medicine in Argentina 

– December 2006 

Ken Zafren, MD Photos by Ken Zafren 

altitude on the nervous system, emphasizing his research on oxidative 

stress and oxygen free radicals. Dr. Marco Maggiorini from Zurich 

talked about the effect of hypoxia on the central nervous system from a 

clinical point of view. 

Since almost nobody in Argentina would dream of eating dinner before 

9 PM, our schedule seemed quite relaxed. The only problem was that of 

sleep. In a previous era, everyone took a siesta, but now they still eat late 

and get up at what we would consider a normal hour. The first two hours 

of the afternoon session were devoted to work in hostile environmental 

conditions—altitude and cold—and the effects of solar radiation. This 

session included a talk on medical screening for high altitude workers 

and a presentation on the effects of EICA and altitude-related illness on 

work performance. To a large extent, EICA workers are a self-selected 

group. This makes it difficult to do research concerning their fitness; 

EICA workers who cannot tolerate this exposure do not continue to 

work. At the same time, there is great concern about the long-term 

health effects of EICA. 

The final session concerned psychosocial health of high altitude workers. 

Topics included living standards and quality of life at high altitude 

mining camps, recreation for workers at remote sites, effects of EICA 

on family life of the workers, and the benefits of physical activities for 

EICA workers. The final talk concerned the effects of work rotations on 

the quality of life of the workers. The speaker was Dr. Acacia Aguirre, a 

Spanish doctor who lives in Boston. 

The next day of the Congress began with a session devoted to altitude. 

Dr. Bailey spoke first about the pathophysiology of Acute Mountain 

Sickness (AMS) and High Altitude Cerebral Edema (HACE). Dr. 

Bailey discussed the deleterious effects of oxygen free radicals in hypoxia. 

Attempts to use sacrificial antioxidants such as Vitamin C have been 

unsuccessful, since these turn out to be quenched by free radicals. Dr. 

Bailey suggested a new approach using antioxidant catalysts. 

Dr. Maggiorini emphasized the possible 

role of brain hypoxia in producing HAPE 

and discussed the mechanism by which 

PDE-5 inhibitors may act in preventing 

and treating HAPE.

Next, Dr. Maggiorini spoke on the subject of High Altitude Pulmonary 

Edema (HAPE). Dr. Maggiorini is a member of the group carrying out 

research on HAPE using subjects who are known to be susceptible to 

HAPE (HAPE-Susceptibles or just HAPE-S). These subjects nevertheless 

repeatedly ascend to the Margherita Hut at 4559 meters (about 15,000 

feet) on Monte Rosa, in order to be studied. He emphasized the possible 

role of brain hypoxia in producing HAPE and discussed the mechanism 

by which PDE-5 inhibitors, such as sildenafil and tadalafil, may act in 

preventing and treating HAPE. Following these two excellent speakers, I 

gave a presentation on conditions at altitude not related to AMS, HACE, 

or HAPE, in which I emphasized a host of neurological conditions. Any 

neurological condition that occurs at sea level can, of course, also occur at 

altitude. Some conditions may be exacerbated or unmasked by hypoxia. 

The following session dealt with physical and intellectual performance at 

altitude. Dr. Maggiorini discussed acclimatization, Dr. Richalet covered 

oxygen enrichment for EICA workers, and Dr. Leal discussed women 

at altitude. Although oxygen enrichment may be a great advantage 

for EICA workers there are some theoretical disadvantages, including 

slowing of acclimatization. The main reason that it is not used, however, 

is the perception by the mining companies as too expensive. 

The afternoon theme was sleep and fatigue at altitude. Dr. Jorge Lasso 

from Santiago, demonstrated the utility of oxygen enrichment during 

sleep in EICA workers. This is quite effective in abolishing periodic 

breathing, but costs more than acetazolamide, which has similar effects. 

There were two talks concerning somnolence and fatigue in drivers and 

another talk about the quality of sleep at altitude. 

The day’s final session covered nutrition, oxidative stress, and 

antioxidants at altitude. Three of the talks concerned nutrition and 

digestive disturbances at altitude. Dr. Bailey gave a fascinating talk about 

oxidative stress at altitude. Although we know that too little oxygen is 

not a good thing, Dr. Bailey’s research showed that too much oxygen 

in cells can lead to increased generation of oxygen free radicals. This 

effect seems quite paradoxical. Dr. Claus Behn from Santiago also gave 

a talk on the same subject with a different point of view. He showed 

some positive results from antioxidant supplemenation. Dr. Behn is a 

great exponent of mountain medicine in Chile. He was the organizer 

of the World Congress of Mountain Medicine in 2000 at Arica, Chile. 

Most of the Chilean doctors in the mountain medicine course studied 

under Dr. Behn and credited him with fostering their interest in 

mountain medicine 

The following morning was devoted to organization of medical services 

in remote areas. As the first speaker of the day, I covered care of critical 

patients in remote areas and air medical evacuation. The following talks 

were about trauma care and rescue. I was spirited away by the five other 

non-South American invited speakers who had arranged a tour of the 

area by minivan. This featured a tour of a local winery, with a museum 

and a film showing its history followed, of course, by wine tasting. The 

next stop was a champagne manufacturing operation located in a cave, 

with tasting of the unfinished product, but not the bottled final product. 

After this, we went to two lakes formed by dams and then to lunch at – I 

am not making this up – a Howard Johnson Resort, by the shore of the 

second lake. Fortunately the food was Argentine style. 

The last stop of the day, the Sarmiento house, was by far the most 

interesting. Domingo Sarmiento (1811-1888) was a provincial governor 

and later the President of Argentina, from 1868-1874, and an educator. 

He had a great interest in elementary education, which he championed 

in Argentina. There were placards with pithy quotes here and there on 

the old furniture which Sarmiento himself had used. He was clearly far 

ahead of his time. To paraphrase one of the quotes, he believed that: 

the degree of progress of a civilized culture could be judged by the role 

of women. 

After returning to the hotel, my friend from San Juan, Julio Claudeville, 

invited me to dinner at his house. Dr. Claudeville was the medical 

director of the Veladero mine, near San Juan when I met him in Arica, 

at the 2000 World Congress of Mountain Medicine. Dr. Claudeville 

remains very interested in mountain medicine and mountain rescue. 

The Veladero mine is located at 3800 meters (12,500 feet) not far from 

San Juan. The miners, who live at and around San Juan at 500 meters 

(1640 feet) reach the mine by a 6-hour drive on a dirt road through 

uninhabited country. Dr. Claudeville has had to learn about EICA and 

rescue from necessity. He organized the system of medical care for the 

mine and also for the road, where each transport bus carrying miners has 

at least one trained first responder and carries medical equipment. There 

have been some crashes near San Juan where these buses have been first 

on the scene and have rendered aid. 

On the drive to his house, Julio told me about a crash involving his two 

children, an 11-year-old boy and a 16-year-old girl, which occurred last 

winter. The car in which they were riding with another family member 

overturned on a mountain road in Chile. The first witness to the accident 

was a mining engineer from a nearby mine. He called the mine for aid 

and a truck with medical equipment and personnel responded. An 

ambulance came and took the three victims to the local hospital. The 

first Julio knew about this was when the man called him to say that his 

children were injured and in the hospital. He told him that he would 

do everything for them that a father would do until Julio could come to 

the town in Chile. Until Julio arrived, this man had no idea that Julio 

also worked for a mine and that he was a doctor. The children have since 

made a full recovery and the son still calls the man from time to time, 

remembering his kindness. For me, at least as important as the medicine 

in mountain medicine was the chance to make friends from around 

the world. 

Part II to be continued in the next issue of Wilderness Medicine. 

Dr. Zafren is an emergency physician, having practiced emergency medicine in Anchorage, 

Alaska since 1994. He is Past-President of the Alaska Chapter of the American College of 

Emergency Physicians and served several terms on the WMS Board of Directors. He also hold a 

faculty appointment in the Department of Surgery, Division of Emergency Medicine at Stanford 

University Medical Center, Stanford, California. 


2

+ fROM THE PA’S DESK Cristopher Benner, PA-C, MMSc 


Following is a 

interview of Kristin 

Peterson, a family 

practice PA in 

Colorado who 

works seasonally as 

a medical provider 

in Antarctica. She 

and her husband 

also run Katabatic 

Consulting, a 

company providing 

special environment 

medical consulting. 

Q: What is life like in Antarctica? 

A: McMurdo Station is on an island just off the coast of Antarctica 

and we share the island with an active volcano, Mt. Erebus. It 

looks like a mining town, with heavy equipment and huge fuel 

containers and cargo all over the place. But if you look beyond 

the town across the sea ice to the continent you can see mountains 

and glaciers. At McMurdo we live in dorms and everyone has at 

least one roommate. Everyone eats in a huge dining hall. When we 

are not working, there is actually much to do. There is a gym for 

sports, a weight room, a bouldering cave, a bowling alley and, 

of course, three bars. There is a recreation department whose 

job is to get folks out to experience Antarctica. It defeats 

the purpose of being there if you do not get out cross 

- country skiing or hiking. In addition, we all have 

multiple non-medical duties. We may do things 

like shovel snow, assist with landing cargo flights, 

and help keep equipment running. 

Q: What medical facilities and equipment 

do you have available? 

A: At McMurdo Station they have everything they need to treat a 

patient there or to stabilize a patient for medevac to Christchurch, 

New Zealand, about 2,000 miles to the north. There are two PAs, 

two civilian MDs, a military flight surgeon (MD), a physical 

therapist, physical therapist assistant, x-ray tech, lab tech, dentist, 

flight nurse, and administrative nurse. There is x-ray, ultrasound, a 

lab and tele-medicine with the University of Texas Medical Branch. 

At field camps, however, the situation can be quite different. At 

field camps I am the only medical provider and responsible for 

everyone’s medical needs. I often had oxygen, basic trauma gear, 

and plenty of medications, including narcotics and antibiotics. I 

may or may not have a cardiac monitor. My “medical station” is 

often a small table in a corner. The most important thing I have 

is my brain. 

Q: What is it like to practice medicine 

in such a remote location? 

A: The responsibility is enormous when you are the only medical 

provider there. I go through possible scenarios in my head, all the 

time. I made sure I knew everyone’s medical history. I was on call 

24 hours a day and needed to be prepared to respond quickly. My 

biggest worries were usually the science groups that came to camp 

with someone who had a medical waiver. That meant they did not 

have to pass the physical but were allowed to come to a very remote 

location anyway. Often it was someone with a cardiac history, so we 

would meet to discuss physical restrictions and the need to check in 

often with me. I always informed them that a medevac flight to our 

field camp was minimum of five hours, so the chance of survival due 

to a cardiac event decreased significantly. 

Q: What was your most challenging medical 

experience in Antarctica? 

A: My first season at McMurdo Station we had an across-thecontinent 

medevac. A crew member on a research ship off the 

coast on the other side of the continent suffered a stroke. He was 

helicoptered off the ship to a field camp where he was stabilized. 

From there he was flown to South Pole Station where bad weather 

grounded him overnight. The South Pole Station is not a good 

environment for a stroke patient because it is at an altitude of 9,300 

feet. He was then flown in an LC 130 plane to McMurdo Station 

where again bad weather grounded him for another night. I cared 

for him that night and he was able to speak and kept asking for 

cigarettes! In the morning, he suddenly lost consciousness. We 

intubated him and placed him on a ventilator and medevaced him 

to New Zealand, where he was pronounced brain dead. The whole 

experience brought home to me how life is harsher “on the ice.” 

Definitive care is days, not hours, away. Something you may survive 

in the U.S. you may not survive in Antarctica. I always give a 

safety lecture at the field camps. I go through a whole scenario 

and time line from time of injury to treatment at the field 

camp, to the arrival of a medevac flight, to its arrival 

at McMurdo. From there the patient may need to 

go on to New Zealand. This may take as much as 

24 hours, weather depending. I let people mull that 

over and hopefully everyone stays safe. Bottom line: you 

are more likely to die from trauma or medical problems in 

Antarctica than you would in the U.S. 

Q: Would you go back? 

A: Yes, I plan to return in a few years. My husband, a paramedic, and 

I have our own company, Katabatic Consulting, where we provide 

special environment 

medical consulting. 

So for us going to 

Antarctica was not a 

one-time experience. 

It is part of our lives. 

We love it. 

Cris is a WMS member 

and the Director of the 

Coalition of Outdoor 

Medicine Physician 

Assistants (COMPAS). 

He can be contacted at 

cdbenner1@yahoo.com. 

To learn more about 

COMPAS visit www. 

wildernessmedicinepa.org/.

+ CLIff NOTES Andrew (Woody) Bursaw, WMS Nat’l Student Rep. 

This is my fourth and 

final Cliff Notes article 

as the WMS Student 

Representative. It has been 

a good year and I leave the 

position in a time of growth, 

both for the Society as a 

whole and for the student 

groups. I continue to get 

weekly emails from students 

interested in starting new 

WMS Student Interest 

Groups on their campuses 

and from new student 

leaders of established SIGs. 

This is very encouraging 

as it tells me that the 

interest in wilderness medicine is increasing and becoming much 

more mainstream than it was a few years ago when I first learned of it. 

Keep those emails coming! 

+ WMS AWARDS CALL fOR NOMINATIONS 

Awards for outstanding contributions to wilderness medicine will be 

presented to respective recipients at the Awards Banquet during the 

Wilderness Medicine Conference and Annual Meeting, at Snowmass 

Colorado, July 21-25, 2007. 

This is a call for nominations for the awards that include: Simpkins 

Service Award, Research Award, Education Award, Bowman Associate 

Member Award, Founders Award, and the Auerbach Award. The 

World Congress (Erb) Award, will be presented at the World Congress 

Meeting in Aviemore, Scotland, this October 3-7, 2007. 

Specifically, these awards define: 

At this time I would like to introduce the incoming WMS Student Rep: 

Jamie Karambay (wmsstudentrep@gmail.com). Jamie is currently a 3rdyear 

medical student at Albany Medical College and has been very active 

in the WMS during his medical education. He even helped start up a 

new MedWar race near his school. I’m sure he will do a great job as your 

next rep and couldn’t leave the position in more capable hands. 

Lastly, I want to make a few announcements. 

1) Dr. Paul Auerbach’s newest edition of the textbook, Wilderness 

Medicine, 5th edition (Mosby) is scheduled to be released 

March 23, 2007. 

2) Several WMS conferences are still available this year: Snowmass, 

CO, Summer Conference (July 21–25, 2007), and the International 

Conference in Aviemore, Scotland (October 3–7, 2007). If you are 

interested in sharing lodging or travel arrangements, post a message 

on the WMS student message boards at http://wms.academy.sk/ 

Have a great spring and stay active! Woody 

1. Dian Simpkins Service 

Award: Given in recognition 

of outstanding service to the 

function and operation of 

the WMS. 

2. Research Award: Given 

in recognition of outstanding 

research pertinent to the field of 

wilderness medicine. 

3. Education Award: Given 


contributions in education to 

students, members, or the public 

in the field of 

wilderness medicine. 

4. Warren D. Bowman Associate 

Member Award: Given to an 

associate member or allied health 

professional for outstanding 

contributions in support services 

for wilderness medicine. 

5. Founders Award: Given 


contributions to the principles 

and objectives of wilderness 

medicine as envisioned by 

the founders. 

6. Paul S. Auerbach Award: The 

Auerbach Award is given to a 

physician or PhD recommended 

by Dr. Auerbach, the Awards 

Committee and/or by past 

or present members of the 

Board of Directors. It is given 

in recognition of sustained 

significant clinical or service 

contributions to wilderness 

medicine, preferably with service 

to the Society. The Board of 

Directors confirms the selection. 

It takes into account integrity, 

ingenuity, effort, humility, 

selflessness, and serves as a source 

of inspiration for others. 

7. Blair Erb World Congress 

International Award: 

Since wilderness knows 

no boundaries, the Society 

maintains relationships with 

individuals and organizations 

representing countries, groups, 

academic societies, operational 

societies, and centers involved in 

wilderness medicine. Outstanding 

contributions by such individuals 

or organizations are eligible for 

recognition through this award. 

WMS Award nominations should be sent to: Joyce Lancaster, Director, Wilderness Medical Society 

810 East 10th • Lawrence, Kansas 66044 • jlancaster@allenpress.com 


2

CONFERENCE 

CALENDAR 

WMS & Affiliated* Conferences 2007-2008 


Wilderness Medicine Conference & Annual Meeting 

July 21 - 25, 2007 Snowmass, Colorado 

www.wms.org 

When What Where info 

Mar. 16–21, 2007 WMS Winter Specialty Meeting on Mountain Medicine CME/FAWM Park City, UT www.wms.org 

Mar. 16-21, 2007 Advanced Wilderness Life Support (by AdventureMed & Univ. of Utah SOM) Park City, UT awls.org/index.htm 

Mar. 21-25, 2007 Wilderness Advanced Life Support/ Expeditionary Medicine (by Wilderness Medicine Outfitters) Denver, CO wildernessmedicine.org 

Mar. 21-25, 2007 Wilderness Advanced Life Support (Wilderness Medical Associates) Thunder Bay, Ontario, Canada www.wildmed.ca/ 

Mar. 27-31, 2007 Wilderness Upgrade for Medical Professionals (by WMI-NOLS) Tucson, AZ www.nols.edu/wmi/courses/ 

Apr. 18-24, 2007 Wilderness Advanced Life Support (by ICE-SAR Rescue & Wilderness Medical Assc.) Gufuskalar, Iceland http://wildmed.com/Schedule/ 

Apr. 19 (6 wks), 2007 Wilderness First Responder (by Wilderness Medical Outfitters) Dodge City, KS wildernessmedicine.org 

May 5-9, 2007 Wilderness Advanced Life Support (by Montana Family Practice & Wilderness Medical Assc.) Red Lodge, MT http://wildmed.com/Schedule/ 

May 9-12, 2007 Advanced Wilderness Life Support (by AdventureMed and U of Utah SOM) Moab, UT awls.org/index.htm 

Jun. 2-10, 2007 Wilderness First Responder (by Wilderness Medicine Outfitters) Elizabeth, CO wildernessmedicine.org 

Jun. 7-15, 2007 Wilderness First Responder (by Wilderness Medicine Outfitters) Elizabeth, CO wildernessmedicine.org 

July 21-25, 2007 Wilderness Medicine Conference & Annual Meeting Snowmass, CO www.wms.org 

Aug. 2-14, 2007 Wilderness First Responder (by Wilderness Medicine Outfitters) Elizabeth, CO wildernessmedicine.org 

Aug. 8-12, 2007 Wilderness Advanced Life Support (by Emergency Preparedness Systems & Wilderness Medical Assc.) Greenbay, WI http://wildmed.com/Schedule/ 

Aug. 27-Sept. 8, 2007 Dolma Valley Trek and Central Tibet Tour (WildernessWise) Tibet wildernesswise.com 

Sept. 23-28, 2007 Fly-Fishing CME Adventure (Mountain Medicine Seminars) Northern California wilderness-medicine.com 

Sept. 26-28, 2007 Northeast Medicine CME Conference (NY-Presbytarian Dept. of Emergency Medicine/Cornell University) Ithaca, NY nypemergency.org/wilderness/ 

Oct. 3-7, 2007 World Congress 2007: Mountain and Wilderness Medicine Aviemore, Scotland www.wms.org 

Nov. 1-15, 2007 African Wildlife Safari CME Adventure (Mountain Medicine Seminars) CME/FAWM Mt Kilimanjaro, Africa wilderness-medicine.com 

Jan. 20-27, 2008 Cousteau So. Pacific CME Adventure (Mountain Medicine Seminars) CME/FAWM Fiji Islands Resort wildernessmedicine.com 

Jan. 27-Feb 8, 2008 Explore Patagonia CME Adventure (Mountain Medicine Seminars) CME/FAWM Argentina/Chile wilderness-medicine.com 

April 7-25, 2008 Mt. Everest Base Camp CME Trek Kathmandu (Mountain Medicine Senimars) CME/FAWM Kathmandu/Khumbu Region/Nepal wildernessmedicine.com 

For the most recent updates, always 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 and agree to 

allow their names to be listed on the WMS website as an affiliated organization. 

CALL 

FOR 

ASTRACTS 

For more information regarding the Fellow and Registry Program for the Academy of Wilderness Medicine 

visit wms.org. Want to see your program or conference in our calendar? Affiliate with WMS! Visit the Academy 

website wms.org/academy For the most recent updates, be sure to check the Wilderness Medical Society 

website www.wms.org. 

Abstracts are being accepted for the Annual Meeting and Summer 

Wilderness Medical Conference (July 21-25, 2007). Abstract presentations 

will feature original research covering the spectrum of wilderness 

medicine. The opportunity to learn about new approaches, advances 

in medical technology, and epidemiologic studies is unique. Abstracts 

for oral and poster presentations are invited and are peer-reviewed. 

Abstract application forms are available online at www.wms.org under 

“Research” and then “Abstract Submission.” The deadline for the receipt 

of abstracts for the Summer Wilderness Medical Conference and Annual 

Meeting is May 15, 2007. All accepted abstracts will be considered for 

publication in the Society’s journal, Wilderness & Environmental Medicine.

+ SAVE THESE DATES! 

www.wms.org 

WMS & ISMM 

MOUNTAIN AND 

WILDERNESS 

MEDICINE 

WORLD CONGRESS 

2007 

Aviemore, Scotland 

October 3-7, 2007 

worldcongress2007.org.uk 

WMS 

WILDERNESS 

MEDICINE 

CONFERENCE & 

ANNUAL MEETING 

Snowmass, Colorado 

July 21-25, 2007 

wms.org 


31

EducATIoN, INSpIrATIoN, 

rEcrEATIoN, rELAxATIoN, 

rENEwAL…& commuNITy. 

You will find all of this and more at the 23rd Annual Meeting 

and Summer Conference of the Wilderness Medical Society, 

July 21 – 25, 2007, in spectacular Snowmass, Colorado. 

We invite you 

to attend our special 2007 program that surpasses others in education, recreation, and value for your time and money. 

With the growing popularity of wilderness activities there’s a tremendous need for quality wilderness medicine 

educational programs. This year’s conference meets the challenge of providing new knowledge and basic information 

and skills needed for safe wilderness adventures and travels. 

Volume 24, No. 2 

Summer 2007 


10 E 10th, PO Box 1 

Lawrence, KS 0 

www.wms.org 

A potential of 51 educational credits for FAWM! 

A potential of 39 AMA PRA Category 1 CMEs! 

PLUS an additional 17.5 AMA PRA Category 1 

CMEs for AWLS certification course!

What's in Your Medical Kit? - Wilderness Medical Society

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