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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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Medical Technology in the Wilderness

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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 “Medical Technology in the Wilderness.” It was delivered by Major David Hile from the U.S. Army.

The thesis of the presentation was that certain medical technologies, largely designed for urban settings, can be utilized in wilderness settings, either “as is” or in a modified/adapted fashion. The focus was upon portable medical technolgies. It was noted that underlying the development of medical technologies is the need for these to serve our increasing elder population, the desire to apply technology in the outpatient environment, a propensity for travel, and increased access to remote areas. Contributors to increased portability include semiconductor technology, rechargeable lithium ion batteries, miniaturization (pumps, solenoid valves, etc.), and improved wireless communication.

It is not always safe to assume that something that works in the hospital will work in the backcountry, or that it will play the same role in the absence of the usual support system. The general categories of devices for which we are currently seeing innovation are wound care, monitoring, portable oxygen (canisters and concentrators; pressure administrators), fluid and blood administration, thermal (e.g., cold) protection, diagnostics (e.g., ultrasound), survival (e.g., avalanche) and communication integration. To this list may be added, airway, burn care, nutrition, water disinfection, sensory augmentation and personal protection.

In wound care, the advances that seem to be translated most rapidly into clinical practice are hemostatic agents and tourniquets to control bleeding, and wound treatments and coverings. Portable monitoring is most familiar to clinicians in the form of pulse oximetry, which represents the concept of non-invasive (e.g., without needing to enter the bloodstream) determination of critical values and parameters. For instance, one of the holy grails would be non-invasive glucose monitoring.

An exciting new concept is “smart clothing” that might contain integrated sensors to monitor heart rate, respiratory rate, body positioning and location, skin temperature, heart function, and so forth. Another is intravenous fluid warmers.

The use of ultrasound in the emergency department is increasing rapidly, so it is logical that investigators are attempting to find ways to make the units smaller, more sensitive, and applicable to various field settings. This may have importance for diagnosis of many conditions, such as dehydration, internal bleeding and fluid in the lungs, heretofore only estimated in the field.

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About the Author

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

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