Wilderness Medicine Updates

This discussion dives into the intriguing potential of inhaled xenon gas for improving athletic performance and helping climbers acclimatize to high altitudes. A UK climbing team claims it aided their rapid ascent of Mount Everest, but scientific evidence in humans remains sparse. While studies indicate xenon might stimulate crucial physiological responses, the reality is that it may not deliver significant benefits beyond a placebo effect. The conversation also raises important safety concerns regarding unsupervised use of this gas.

In this episode of Wilderness Medicine Updates, host Patrick Fink interviews Moose Mutlow, an experienced outdoor educator and search and rescue professional with nearly four decades of experience globally. Moose discusses his extensive career from being an Outward Bound instructor to working with Yosemite Search and Rescue, and his role as a Family Liaison Officer for the National Park Service. The conversation touches on the challenges faced by search and rescue teams, the importance of robust communication skills, and how to build resilience against trauma in high-stress professions. Moose also shares his personal experiences, reflecting on the value of mentorship, the significance of team dynamics, and the essential need for compassionate support during crises. The episode includes practical advice for those in the field of wilderness medicine and search and rescue, highlighting the necessity of emotional balance and continuous learning.Connect with Moose:WebsiteBlue SkyInstagramSubstackBook: SearchingBook: When Accidents HappenDid you enjoy this episode? Contribute to YOSAR!Links from the show:The Stress ContinuumResponder AllianceQuell FoundationDr. Nicola Lester: trauma informed practiceMore Reading:Ranger ConfidentialNature NoirThe Cold VanishThe Last SeasonCHAPTERS00:00 Introduction and Guest Welcome00:19 Moose Motlow's Background and Career01:58 Challenges in Search and Rescue02:58 The Importance of National Parks05:23 Moose's Nickname and Early Career07:07 Transition to the US and Outdoor Adventures10:54 Search and Rescue Experiences15:20 Swift Water Rescue Operations19:38 Training and Mentorship in SAR30:18 Role of Family Liaison Officer45:24 Managing Emotional Burden as a Liaison Officer47:12 Recognizing and Addressing Trauma48:36 The Importance of Peer Support49:44 Cultural Norms and Vulnerability51:05 The Cost of Ignoring Trauma53:37 Building Resilience and Longevity in CAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at wildernessmedicineupdates@gmail.com.You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode, we dive into one of the most overlooked but deadly hazards in deep powder skiing: snow immersion suffocation (NARSID). Unlike avalanches, snow immersion deaths happen silently—often within feet of a groomed run—when skiers and snowboarders fall into deep snow or tree wells and become trapped. We explore the research behind these incidents, where and how they occur, who is most at risk, and the tragic mechanics of asphyxiation in deep snow. Using studies from Van Tilburg, Baugher, and Cadman, we break down ra eal survival story, discuss prevention strategies, and how both bystanders and professional rescuers should respond. Whether you’re a backcountry adventurer, resort skier, or ski patroller, this episode will change the way you think about deep snow safety. Stay aware, ski with a partner, and stay out of tree wells.Must Watch: GoPro Awards: Tree Well RescueCitationsBaugher, P. (2006). Risk trends at U.S. and British Columbia ski areas: An evaluation of the risk of snow immersion versus avalanche burials. In Proceedings of the 2006 International Snow Science Workshop (pp. 584–591). International Snow Science Workshop. URL: https://arc.lib.montana.edu/snow-science/item/2076Cadman, R. (1999). Eight nonavalanche snow-immersion deaths: A 6-year series from British Columbia ski areas. The Physician and Sportsmedicine, 27(13), 31–43. URL: (No publicly available link found—may be available through institutional access)Van Tilburg, C. (2010). Non–avalanche-related snow immersion deaths: Tree well and deep snow immersion asphyxiation. Wilderness & Environmental Medicine, 21(3), 257–261. URL: https://doi.org/10.1016/j.wem.2010.04.004Van Tilburg, C. S., Grissom, C. K., Zafren, K., McIntosh, S. E., Radwin, M. I., Paal, P., et al. (2017). Wilderness Medical Society practice guidelines for the prevention and management of avalanche and non-avalanche snow burial accidents. Wilderness & Environmental Medicine, 28(1), 23–42. URL: https://doi.org/10.1016/j.wem.2016.10.001Chapters00:00 Introduction: The Hidden Dangers of Snow Immersion00:37 Understanding Snow Immersion Suffocation02:58 Historical Context and Research03:09 Where and How Snow Immersion Happens04:54 Mechanics of Snow Immersion Traps06:23 Risk Factors and Victim Profiles09:27 Prevention and Safety Measures11:48 Rescue Techniques and Immediate Response13:34 Professional Rescuer Guidelines16:12 Advanced Medical Care and Resuscitation20:11 Conclusion and Final ThoughtsAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at wildernessmedicineupdates@gmail.com.You can pay us a compliment and share the show with a new listener on any popular platform here.

King Tube vs IGEL for Airway ManagementIn this episode of Wilderness Medicine Updates, Dr. Patrick Fink addresses a listener's question on whether to use a King Tube or an IGEL as an out-of-hospital airway adjunct. The episode begins with an overview of airway management techniques from mouth-to-mouth resuscitation to supraglottic airway devices. Dr. Fink explains the benefits and drawbacks of various airway adjuncts, including oral and nasal pharyngeal airways. The discussion then shifts to a detailed comparative analysis of King Tubes and IGELs based on retrospective and prospective studies. Dr. Fink evaluates the evidence indicating that IGEL may be more effective and easier to use than King Tubes, particularly in pre-hospital cardiac arrest situations. The episode concludes with recommendations for pre-hospital providers and an encouragement for listeners to share their questions and feedback.Links:iGel LMAKing TubeSmida T, Menegazzi J, Scheidler J, et al. A retrospective comparison of the King Laryngeal Tube and iGel supraglottic airway devices: A study for the CARES surveillance group. Resuscitation. 2023;188:109812. doi:10.1016/j.resuscitation.2023.109812Smida, Tanner & Menegazzi, James & Crowe, Remle & Scheidler, James & Salcido, David & Bardes, James. (2023). A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehospital emergency care. 28. 1-13. 10.1080/10903127.2023.2169422. Lønvik, M.P., Elden, O.E., Lunde, M.J. et al. A prospective observational study comparing two supraglottic airway devices in out-of-hospital cardiac arrest. BMC Emerg Med 21, 51 (2021). https://doi.org/10.1186/s12873-021-00444-0Chapters00:00 Introduction and Listener Question00:55 Understanding Airway Adjuncts02:12 Basic Airway Management Techniques06:34 Advanced Airway Devices: King Tube and LMA11:35 Comparative Studies on Airway Devices17:35 Prospective Data and Final Thoughts25:24 Conclusion and Listener EngagementAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at wildernessmedicineupdates@gmail.com.You can pay us a compliment and share the show with a new listener on any popular platform here.

In this discussion, Dr. Ross Hofmeyr, an anesthesiologist and wilderness medicine expert from South Africa, sheds light on methoxyflurane, a game-changer for pain management in remote settings. He shares the history and practical applications of this anesthetic gas, which boasts efficacy and ease of use, particularly as a 'green whistle' device. Dr. Hofmeyr emphasizes its importance in acute traumatic pain scenarios and discusses the challenges of using it in extreme conditions, making a compelling case for its role in wilderness medicine.

Dr. Christopher Van Tilburg, an expert in emergency and wilderness medicine, discusses the innovative use of ketamine for pain management in challenging outdoor settings. He shares insights on administering ketamine during mountain rescues, comparing it to traditional medications like fentanyl. The conversation dives into dosing strategies, environmental considerations, and the importance of patient monitoring. Dr. Van Tilburg also teases his upcoming book, 'Crisis on Mount Hood,' celebrating a century of mountain rescue stories.

Dive into the life-saving techniques behind the ICAR resuscitation algorithm for avalanche victims. Discover the critical factors that determine survival, from burial duration to airway management. Detailed explanations of Basic and Advanced Life Support algorithms make complex protocols accessible. Real-life case studies illustrate practical rescue scenarios, emphasizing the urgency of quick action and the impact of hypothermia. Essential listening for anyone involved in avalanche emergencies!

Dive into a thrilling tale of survival during a backcountry hut trip in Colorado where a surprise medical crisis unfolds. Discover the harrowing diagnosis of high-altitude pulmonary edema and the emergency response that follows. The discussion highlights essential medications and tools required for remote expeditions. Learn about the crucial lessons on preparedness and how to navigate medical emergencies in the wild. This is a must-listen for anyone venturing into the great outdoors!

Explore how airway patency heavily influences survival rates for avalanche victims. The discussion delves into a meta-analysis revealing that many victims manage to keep their airways clear, despite being buried. Current safety technologies receive scrutiny for their effectiveness, highlighting the need for advancements. The importance of better incident reporting and ongoing research is emphasized, shedding light on critical factors that could enhance rescue efforts and survival outcomes.

Explore groundbreaking updates on spinal injury management in wilderness settings. The discussion emphasizes a goal-oriented approach for protecting spinal cords while maintaining neutral alignment. Discover the innovative lift and slide technique and learn about the vacuum mattress—an effective alternative to traditional backboards. Plus, dive into the open-access Wilderness Medical Society guidelines that are revolutionizing how we think about spinal immobilization!