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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Improvisation According to Iserson

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. The presentation was entitled “MacGyver Medicine: Improvising Patient Care Solutions When Other Options Don’t Exist.” It was delivered by Kenneth V. Iserson, MD, who is Professor Emeritus of Emergency Medicine at the University of Arizona in Tucson. Ken is an amazing person who is expert in emergency medicine, wilderness medicine (and other medical) ethics, medical improvisation, and currently, polar medicine. He is currently assigned to duty at McMurdo Station at the South Pole.

Ken’s presentation was on a favorite topic for wilderness medicine doctors, namely, how to improvise. The essence of medicine in the outdoors is making do with what you have, in situations that would normally call for lots of equipment and support. Dr. Iserson showed us all some old and new tricks, and we can’t wait to try out some of them.

When do we need such improvisation? We need it in multiple venues, such as after disasters, in third world countries, rural settings, in the wilderness, on the battlefield, or any other time we are away from our usual support systems. The truth is, things go wrong all the time, and you must be prepared.

For instance, if you need to measure things, there are parts of your body that reasonably approximate what you can accomplish with a ruler. The middle phalanx on an adult little finger is approximately one inch; the distance between the tip of your thumb and first finger when spread to maximal distance is about one inch.

If you need to keep an unconscious person’s airway open by keeping their tongue from falling back into the throat, you can try pushing a finger under the chin, grasping the tongue with a pliers and pulling it forward, or even using a safety pin or needle and threat to attach the tongue to the lower lip. Of course, you need to have some idea of what you are doing before you attempt any of these!

Why struggle in the dark inside a building, if you can care for a victim outside in the light? Simple thinking, but effective! If you are a doctor and the earpiece on your stethoscope goes missing, you can improvise with the rubber nipple from a baby’s bottle. Ingenious! Wound care is facilitated by being able to visualize the wound. Skin hooks, retractors, and sutures can all be improvised, by bending wires, using silverware, and opening your sewing kit. And, of course, your razor blade becomes a scalpel.

Dr. Iserson's presentation was intended for health care professionals, but much of what he discussed has application for laypersons involved in field health care as well. Examples include improvised protective (from body fluids, infectious fluids, etc.) equipment (like a scarf to cover the head and face), sterilization of instruments in hot water, and many useful tips. For instance, the fastest way to identify an infant's pulse is simply to put one's ear to the child's chest.

As hard as I try, I must admit that I cannot cross my eyes like Dr. Iserson in order to transform side by side x-rays into a stereoscopic image. But I can certainly take pictures of x-rays with my cell phone and send them to him! I have experience using the Pericardium 6, or Neiguan, meridian acupressure point in the wrist to treat motion sickness, and was delighted to see him highlight this in his lecture. Universal prescription instructions using symbols rather than foreign languages make great sense.

There was much more for the doctors, such as discussions of improvisational methods to address post-partum hemorrhage, anoscopy/proctoscopy (ouch...), laboratory materials and equipment, blood transfusions, rehydrating patients without intravenous lines, diagnosing broken bones by auscultation (using a tuning fork and stethoscope) or ultrasound, hypnosis for painful procedures, traction, and more. Of all of the advanced medical information, one interesting fact stood out - namely, that papier mache does NOT work for casts. Way too fragile and subject to water penetration, it will not hold up under rugged outdoor conditions.

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About the Author

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