Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Disaster Medicine and Wilderness Medicine

This is the next post based upon a presentation given at the Wilderness Medical Society Annual Meeting held in Snowmass, Colorado from July 24-29, 2009. Joy Crook, MD of Johns Hopkins School of Medicine, with whom I had the great pleasure of trekking to Everest Base Camp a few years ago, organized a symposium within the meeting dealing with disaster medicine and its intersection with wilderness medicine. Her introduction to the sessions was instructive and set the stage for the other presenters. She astutely understands that in this day and age, the skill sets needed by health care professionals in the time of a disaster are identical to those that are practiced regularly by wilderness medicine experts.

What is a disaster? With a great sense of humor, Dr. Crook pointed out that the definition of a disaster is sometimes in the eye of the beholder. For instance, in the Emergency Department, it might be the 1st of July, when the new interns arrive. In the context of the intersection between wilderness medicine and disaster medicine, it is a situation or event that overwhelms local capacity, necessitating a request to national or international external assistance (Centre for Research on the Epidemiology of Disasters) or a vast ecological breakdown in the relation between humans and their environment…on such a scale that the stricken community needs extraordinary efforts to cope with it, often with outside help or international aid (Eric Noji, The Public Health Consequences of Disasters). We are all familiar with earthquakes, floods, tsunamis and other natural disasters, so that is the context in which we should consider disasters. These are overwhelming (for existing resources) events. To these, we must add epidemics of famine, drought, desertification, infectious diseases, genocide, and warfare.

Disasters may be classified as natural or technological (man-made), or rapid or slow in onset. The “disaster management cycle” begins with preparedness (for an imminent or eventual disaster), after which follows the disaster, response, immediate recovery, prevention (of situations that might lead to a disaster), mitigation (long-term recovery, and back to preparedness. Traditionally, disaster experts and agencies have focused a great deal on response. We all realize now that prevention and mitigation are very integral to disrupting the inevitability of a catastrophic outcome(s) from a disaster. This involves shifting thinking, from a focus on the health of the individual to a focus upon the health of the public (e.g., water and sanitation, nutrition, living conditions, safety, vulnerable populations, and systems preservation [health, government]). Other considerations include how to manage in a scarce-resource environment, whether or not to deploy altered standards of care, and how to reconcile various choices of command structures and jurisdictions. Central to all of these concerns is adequate communication and extraordinary collaboration, because acts of heroism alone will not sustain a large population in need of assistance during and following a disaster.

For wilderness medicine and the Wilderness Medical Society, disaster medicine is increasingly important, because disasters are occurring more frequently and affect more people than ever before, austere environments don’t just exist in the wilderness, wilderness medicine practitioners are already the same people who volunteer for global relief and humanitarian efforts, and significant public health dollars and much political attention is focused on disaster management. If you are a person who can handle him- or herself in the outdoors, then you are likely a person who could be of great assistance during the time of a disaster, but there is much that you need to learn to be effective in a coordinated response.
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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.