Retention of Wilderness Medicine

Knowledge & SkillsBy: Kent Clement, Ph.D. Nadia Kimmel, M.S.

Consider This Scenario

SCENARIOYou and your friends are hiking on a mountain trail in mid-August. You are enjoying a beautiful sunny afternoon with a temperature of 72 F. You come across a person sitting on the trail holding his/her right arm. This person is alone and there are no bystanders. You are 5 miles from the nearest trailhead where your vehicle is parked. It is ten miles from the trailhead to the nearest town. There is no cell reception until you reach the town limits.

Based on your WFR knowledge and skills what are some of the things that

you should do?

SCENE SIZE – UP & INITIAL ASSESSMENT

After determining that the scene is safe, you find out the person’s name but he/she does no know what happened. The person is confused and exhibits a slurred speech. They complain of pain while guarding their right arm. No sign of life threatening trauma is apparent.

WHAT NEXT?

SCENARIOAfter asking SAMPLE and taking vitals you find out the following:

S: Pain in the right arm, pale, confused, slurred speech.A: NoneM: NoneP: Diabetes (Type II)L: Not sureE: Does not recall

HR: 132RR: 30BP: Strong radial pulseLOC: A & 0 X 1 (Alert & oriented to person only)SCTM: Pale, warm & dryCSM: Weak in all four extremities, can feel, does not

respond to commands well but has good pulses PERRL: Normal

WHAT NEXT?

SCENARIO TREATMENTS

Glucose administration while protecting the airway.

Splint the arm and check CSM before and after. Head-to-toe exam (reveals nothing) Clear the spine while meeting all criteria Formulate an evacuation plan

Average Score44%

INCOMPLETE SAMPLE

INCOMPLETE VITALS

NO GLUCOSE ADMINISTRATION

POOR AIRWAY MANGMENT

10/23

Participants’ Demographics

34 total F-9, M-25 Age Range

Highest WEM Certification – WFR-33, WEMT-1

Age 18-24

25-30

31-35

36-40

41-50

51-55

56-60

60 up

Num. 12 8 3 4 3 1 1 2

Study Limitations

Not generalizable as it stands due to a small sample size

Not randomized design – opportunity sampling Preliminary study – You can get involved with

this research – details to follow…

More Demographics

First Obtained WEM Certification in years ago:

Number of Recertification Courses:

Years

Ago

2 3 4 5 6 7 10 11 15

Num. 12 4 1 3 5 1 5 1 1

Re-Cert

0 1 2 3 4

Num. 16 8 4 3 2

Still More Demographics The Type of Work They Currently Pursue:

Guides – 19 Therapy – 1 Outward Bound – 9 Outdoor Education – 2 Volunteer Organization – 1 Conservation – 1 Field Biologist – 1

Why did you get an WEM Cert. in the 1st place? Required by job – 29, SAR – 1, Required in School - 3

Results Before the scenario, participants were asked to

estimate the percentage of knowledge required to be fully-qualified as a WEM provider they have retained. Answer average: 65%, Range: 17.5 to 90.

Before the scenario, participants were asked to estimate the percentage of skill required to be fully-qualified as a WEM provider they have retained. Answer average: 68%, Range: 20 to 90.

Remember, accuracy was 44%

More Results After the scenario, participants were asked if

they retained as much knowledge required to be fully-qualified as a WEM provider as they thought they would. Answer: Yes – 7, No – 27

After the scenario, participants were asked if they retained as much skill required to be fully-qualified as a WEM provider as they thought they would. Answer: Yes – 18, No - 16

Injuries With Which Participants Dealt:

ligament sprain 12 Laceration 22 muscle sprain 13 Sunburn 29 Frostbite 5 tooth related 5 Fracture 9 Burn 14 Dislocation 5

blister(s) 25 immersion foot 6 bruise, contusion 18 Tendonitis 6 head injury without loss of

consciousness 10 head injury with loss of

consciousness 1 eye injury 5 skin abrasions25

Injuries With Which Participants Dealt:

near drowning 3

shoulder dislocation 7 life threatening bleed0 back injury 5 “Other” includes: fish hook,

fractured pelvis, sickle cell disease, ruptured spleen, compound fracture, snake bite.

Illnesses With Which Participants Dealt:

allergic reaction 17 Anaphylaxis 2 Diarrhea 20 AMS 12 food related illness 9 HAPE 0 HACE 0 non-spec. fever illness 4

urinary tract infection 4 skin infection 10 heat cramps 2 heat exhaustion 15 heat stroke 1 chest pain or cardiac cond. 2 eye infection 2 upper respiratory illness 2

Illnesses With Which Participants Dealt:

abdominal or other gastrointestinal problem without diarrhea 12

hypothermia illness 6 heat illness 7 cardiac emergencies 0 diabetic emergencies3 Seizures 3 Asthma 6 behavioral emerg. 8

Hyponatremia3 dehydration 21 snake bites 1 spider bites 6 scorpions stings 3 bee stings 13 red/fire ant stings 5 animal bites 1 gender spec. issues 4

Illnesses With Which Participants Dealt:

toleo (foot rot specific to the Grand Canyon) 3

ear infection 0 Cpr 2 rescue breathing 1 Other 0

Are we failing?

Ideas for Improving Retention Limit rescuer distraction

Simplify wilderness medicine curricula Emphasize SAMPLE and information gathering skills in

wilderness medicine classes Offer continuing education classes on-line as part of the

recertification process Look at other medical industry standards for recertification

requirements and lengths•CPR•NREMT•ACLS•OEC

More Ideas for Improving Retention

Recalibrate rescuer overconfidence Design curriculum giving precedence to the

activities with which rescuers are most likely to face in an emergency situation.

Shorten the re-certification period. (I know, I know)

Getting involved with the study:The End