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HMI Backcountry Medical Treatment and Evacuation Protocols (Feb 2016 Edition)
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Abdominal Illness and Injury1
Generalized abdominal complaints are common and lead to
challenging differential diagnoses. Outdoor leaders must be
diligent in the interview and examination of this Pt focusing
on identifying critical evacuation triggers. Many serious
abdominal problems ultimately result in surgery.
Tx: Abdominal Illness and Injury
If the Pt does not trigger the evacuation criteria:
1. Allow the Pt to rest.
2. Maintain hydration levels w/ clear fluids. Re-hydrate w/ an
electrolyte solution if the Pt is dehydrated.
3. Bland diet. The BRAT diet works well: Bananas, rice,
applesauce and toast (HMI rations such as rice, crackers,
soup)
4. Consider anti-diarrheals (e.g. Pepto-Bismol) as
necessary to maintain hydration levels.
5. If the Pt is constipated, aggressively hydrate, avoid high
fat foods and increase grains, vegetables and fruit,
attempt to stimulate bowel movements w/ caffeine or
alternating hot and cold liquids.
6. Monitor the Pt for worsening S&S. If the Pt does not show
improvement in 12-24 hrs consider evacuation.
7. If evacuation is possible w/in a few hrs, give nothing by
mouth.
Evacuate Rapidly:
Any Pt w/ abdominal pain who also has:
● S&S of shock.
● Blood in the vomit, feces or urine.
● Persistent and constant pain longer than 12 hrs.
● Localized pain especially w/ guarding, tenderness,
distension, rebound, movement or vibration, or rigidity.
● Persistent anorexia, vomiting or diarrhea greater than
24-72 hrs.
● Fever above 102 °F (39 °C).
Evacuate:
● Any Pt w/ abdominal pain that does not improve w/
treatment in 24 hrs.
● Any Pt w/ abdominal pain who is unable to stay
hydrated.
● S&S of pregnancy (history of sexual activity, amenorrhea,
excessive fatigue, breast tenderness, polyuria and
nausea).
Allergic Reactions and Anaphylaxis2
The incidence of true anaphylaxis is rare. Most allergic
reactions can be managed w/ over-the-counter antihistamines. Epinephrine has been given mistakenly to Pts
for mild allergic reactions, hyperventilation syndrome and
panic attacks.
Tx: Allergic Reactions and Anaphylaxis
1. Remove the allergen or the Pt from the offending
environment.
Evacuate Rapidly:
● Any Pt who continues to show respiratory compromise or
S&S of shock after treatment w/ epinephrine and
antihistamines.
Evacuate:
● Any Pt who has received epinephrine. Continue to
provide anti-histamines during evacuation.
Altitude Illnesses3
General Comments:
Severe altitude illness (HAPE or HACE) is rare in the United
States (except Alaska) when proper acclimatization
practices are followed. Mild or moderate altitude sickness
(Mild or Moderate AMS) is quite common however and
organizations should design programs to allow slow
acclimatization in an effort to prevent AMS.
Tx: Altitude Illness:
1. Do not continue ascending until symptoms have
resolved.
2. Maintain adequate hydration and nutrition. Light exercise.
3. Pain medication as needed for headache.
4. If symptoms do not improve over 24-48 hrs, descend until
symptoms abate. Generally 2000 feet (610m) is
adequate.
5. If Pt has HAPE or HACE, descent is critical. 2000-4000
feet (610m-1219m) can make a remarkable difference.
Evacuate Rapidly:
● Any Pt w/ severe altitude illness.
Evacuate:
● Any Pt unable to acclimatize.
Burns4
Large burns are uncommon in the backcountry, but even
small burns can be debilitating, painful and difficult to keep
clean. Small burns are relatively common backcountry
injuries, typically secondary to hot water spills.
Tx: Burns
1. Ensure the scene is safe.
2. Immediately soak or flush all burns in cold water.
Remove clothing and constricting objects (e.g. jewelry,
watches, belts).
3. Assess and manage Airway, Breathing and Circulation
problems.
4. Gauge the depth, extent and location of the burns.
5. Properly dress the burns w/ antibiotic ointment, burn gel,
Silvadene ® cream or 2nd Skin ® covered loosely w/
sterile dressings. In extended care situations debride
dead skin around blisters that have self-drained and
clean several times daily. Do not drain intact blisters.
6. Pain medication as needed (NSAIDs often
recommended).
7. Aggressive hydration.
Wilderness Medicine Institute of NOLS Wilderness Medicine Protocol Package © Modified with Permission by HMI. High Mountain Institute©2016.
HMI Backcountry Medical Treatment and Evacuation Protocols (Feb 2016 Edition)
8. If snow blindness is suspected, provide cool water
flushes of the eye and cool compresses. Rest and avoid
sun exposure until symptoms resolve.
Evacuate Rapidly:
● Any Pt w/ S&S of an airway burn.
● Any Pt w/ partial or full thickness burns covering more
than 15% TBSA (Total Body Surface Area).
● Any Pt w/ partial or full thickness circumferential burns.
Evacuate:
● Any Pt w/ a full thickness burn.
● Any Pt w/ burns to a special function area: face, neck,
hands, feet, armpits, or groin.
● Any Pt w/ a burn that can't be managed effectively in the
backcountry.
Cardiac Emergencies5
Differential diagnosis of non-traumatic chest pain is
challenging. Therefore any Pt exhibiting S&S of chest pain
that can't be attributed to a non-cardiac origin, should be
managed as if the origin is cardiac. Younger people may
complain of rapid uncontrolled heart rate w/out chest pain.
Tx: Cardiac Emergencies:
Reduce anxiety and activity. Place Pt in a position of
comfort. Avoid walking if possible.
Evacuate Rapidly:
● Any Pt w/ chest pain that does not relieve w/in 20 min.
Evacuate:
● Any Pt w/ non-traumatic chest pain that subsided w/ rest
or medication.
● Any Pt w/ sustained periods of rapid heart rate.
Chest Injuries6
General Comments
Lung injury is a primary concern secondary to a blow to the
chest wall. Specific diagnosis is difficult, but S&S of dyspnea
(difficulty breathing), especially at rest, should trigger
evacuation. Lung injury can occur spontaneously and
outdoor leaders should be attentive to sudden complaints of
difficulty breathing.
Tx: Chest Injuries
1. Place the Pt in a position of comfort or on the injured
side.
2. Stabilize any injuries. For a fractured rib sling and swathe
or tape the affected side. For a flail segment splint w/ a
bulky dressing.
3. For an open chest injury seal the wound w/ an occlusive
dressing secured on three sides.
4. Pain management. Avoid respiratory depressants (e.g.
narcotics).
5. Periodically encourage the Pt to breathe deeply.
6. Monitor for increasing Shortness of Breath (SOB) at rest
and diminishing breath sounds.
Evacuate Rapidly:
● Any Pt w/ S&S of serious chest trauma or respiratory
distress.
● Any Pt exhibiting increasing shortness of breath,
especially at rest.
● Any Pt w/ diminished or abnormal lung sounds.
Evacuate:
● Any Pt w/ a suspected rib or clavicle fracture.
Cardiopulmonary Resuscitation (CPR)7
CPR can be an effective life sustaining intervention in the
short-term; however there is no evidence that prolonged
CPR is valuable. The standards for performing CPR are well
established by the American Heart Association.
Contraindications to CPR in the Wilderness: There is no
reason to initiate CPR if there is:
1. Any sign of life in the Pt.
2. Danger to rescuers.
3. Dependent lividity (dependent bruising)
4. Rigor mortis.
5. Obvious lethal injury (e.g. decapitation, frozen solid).
6. A well-defined Do Not Resuscitate (DNR) status.
Discontinuation of CPR in the Wilderness: Once initiated
CPR should be continued until:
1. Resuscitation is successful.
2. The rescuers are exhausted.
3. The rescuers are placed in danger and/or other nonrescuers are in danger w/out the assistance, care,
oversight of the rescuers.
4. The Pt is turned over to more definitive care.
5. The Pt is pronounced dead by a qualified person.
6. The Pt does not respond to prolonged resuscitative
efforts, greater than 30 min.
Dental Emergencies8
Dental emergencies can be remarkably painful and
debilitating. There are some simple tools and treatment
guidelines that may allow a participant to finish a
backcountry expedition in relative comfort.
Tx: Dental Emergencies
1. Clean and rinse the mouth. Brush and floss the teeth if
the Pt can tolerate it.
2. If a crown or filling is lost or the tooth breaks, cover the
“hole” w/ Cavit ®. Cavit ® may also be used to “glue” the
crown or filling in place. If you do not have Cavit ® try
sugarless gum or wax.
3. If the tooth is knocked out of the socket, irrigate the tooth
w/ disinfected water and attempt to replace it in the
socket. If tooth can't be replaced, wrap in sterile gauze
and have Pt carry the tooth between their cheek and
gum.
4. Pain medication as needed.
5. If a periodontal abscess is suspected, clean and floss
teeth, gargle w/ warm salty water 3-4 times daily, and
administer antibiotics and pain medication.
Evacuate Rapidly:
● Any Pt w/ a tooth knocked out of the socket.
Evacuate:
● Any Pt w/ a broken tooth w/ exposed pulp.
● Any Pt w/ a periodontal abscess.
Diabetic Emergencies9
Well-controlled diabetics perform well in backcountry
settings. HMI strives to effectively screen for eligibility; this
will vary on program type and location. HMI strives to have a
plan for medication storage & administration. The diabetic
participant should bring adequate supplies (glucometer,
spare batteries, duplicate medications such as insulin,
glucagons hydrochloride, and glutose paste or tabs,
syringes and ketone strips) and an established sick day
plan.
Tx: Diabetic Emergencies
Wilderness Medicine Institute of NOLS Wilderness Medicine Protocol Package © Modified with Permission by HMI. High Mountain Institute©2016.
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HMI Backcountry Medical Treatment and Evacuation Protocols (Feb 2016 Edition)
1. Check blood sugar using the Pt’s glucometer.
2. If hypoglycemia is suspected, give the conscious Pt
sugar (glutose paste or tabs, sweet liquids, table sugar in
water) until they regain an adequate level of
consciousness. Place the unconscious Pt on their side
and rub sugar into their gums repeatedly until they regain
an adequate level of consciousness.
3. If hyperglycemia is suspected, check ketone levels w/
ketone urine strips. Assist the Pt to hydrate and adjust
insulin dose in accordance w/ his or her sick day plan. If
the hyperglycemic Pt is unconscious, do not administer
insulin.
4. Recheck blood sugar frequently. Have the Pt continue to
eat and/or medicate until an adequate level (80120mg/dl) is obtained.
5. If unknown whether a Pt is suffering from hypoglycemia
or hyperglycemia, give sugar to the Pt.
Evacuate Rapidly:
● Any Pt who is unconscious due to a diabetic emergency.
Evacuate:
● Any diabetic Pt who is unable to keep his or her sugar
levels under control in a backcountry setting.
● Any diabetic Pt who experiences: several days of illness,
has vomiting or diarrhea for more than 6 hrs, has
moderate to large amounts of ketones in their urine,
can't moderate their blood sugar readings w/ additional
insulin or feels a loss of control of blood sugar levels.
Dislocations10
Dislocations of the shoulder, digit and patella are most
common. Patients may have a history of chronic
dislocations. The mechanism of injury may be direct or
indirect, and the dislocation may be associated w/ other
injuries such as fractures. In general, the difficulty of
reduction and the amount of long-term complications both
increase w/ delay in reduction attempts.
Tx: Dislocations
1. Assess circulation, sensation and motion (CSM).
2. Consider attempting to reduce the dislocation if
evacuation time exceeds 1 hr or CSM has been
compromised by the dislocation.
3. Reduction is usually achieved by applying slow, steady
and gentle traction-in-line (TIL). Relaxation is key. Slow
down or discontinue your attempt if pain increases
significantly or you meet resistance.
4. In unable to reduce after multiple attempts, splint in the
position found.
5. After reduction, RICE therapy, pain medication and
immobilization as needed.
6. Monitor circulation, sensation and motion (CSM) before
and after reduction and/or immobilization.
7. Passive range of motion (ROM) 2-3 times per day, or to
Pt tolerance.
Evacuate Rapidly:
● Any Pt w/ an unreduced dislocation.
● Any Pt w/ altered CSM after reduction.
Evacuate:
● Any Pt w/ a first time dislocation, except distal joints of
the fingers or toes.
● Any Pt w/ altered CSM prior to reduction.
● Any Pt unable to use the reduced joint.
● Any Pt w/ persistent pain.
Eyes, Ears and Nose11
Tx: Eyes, Ears and Nose:
● Black eyes: cool compresses and pain medication.
● Objects in the eye should be flushed out w/ disinfected
water or dabbed out w/ a clean cloth. If the object is
embedded in the eye it should be stabilized and both
eyes bandaged.
● Objects in the ear may be drowned w/ oil, water or
alcohol, if needed, and then flushed out w/ an irrigation
syringe or grasped w/ tweezers if visible.
● Outer ear infection can be treated by keeping the ear dry
& daily flushing w/ dilute alcohol or vinegar solution.
● Bloody noses can be managed by pinching the nose just
below cartilage and leaning forward. If unable to control
bleeding, consider packing the nose w/ gauze.
Evacuate Rapidly:
● Any Pt w/ an uncontrollable nose bleed.
Evacuate:
● Any Pt w/ persistent vision changes, extraordinary and
persistent sensitivity to light, or discharge of fluid other
than tears, or an imbedded objects.
● Any Pt w/ an ear infection not responding to treatment.
Female Gender Medical Concerns12
Most female gender medical concerns are manageable in a
backcountry setting. It is important to create an environment
that encourages participants to discuss these concerns w/
trip leaders. The decision to allow pregnant group members
on the trip should be established ahead of time.
Tx: Female Gender Medical Concerns
1. Both dysmenorrhea and mittleschmerz can be managed
w/ analgesics, mild exercise and heat packs.
2. If vaginitis is suspected, wash the vaginal area
thoroughly and air dry. Consider over-the-counter antifungal (e.g. Monistat ®).
3. If a urinary tract infection is suspected, rest the Pt, and
provide aggressive hydration.
4. If an ectopic pregnancy is suspected, treat for shock.
Evacuate Rapidly:
● Any Pt w/ S&S of urinary tract infection who develops
tenderness over the kidneys.
● Any Pt w/ a suspected ectopic pregnancy (low
abdominal/pelvic pain, abnormal vaginal bleeding, S&S
of shock.)
Evacuate:
● Any Pt suspected of being pregnant or w/ pregnancy
complications.
● Any Pt w/ vaginitis that does not respond to treatment.
● Any Pt w/ a urinary tract infection.
Flu-Like Illness13
General Comments:
Viral “flu-like” illness are common on wilderness expeditions.
They may include gastrointestinal symptoms (nausea,
vomiting and diarrhea) or respiratory symptoms (cough,
congestion, runny nose, sore throat). Viral illnesses also
cause a viral headache, malaise, fatigue, low-grade fever,
muscle aches, body aches, etc. Flu is a medically distinct
illness from the “common cold”. It usually has a more abrupt
onset than a cold w/ a stronger overall impact on the Pt. The
illness can persist for several weeks. Management is
focused on symptomatic relief for the Pt.
Wilderness Medicine Institute of NOLS Wilderness Medicine Protocol Package © Modified with Permission by HMI. High Mountain Institute©2016.
HMI Backcountry Medical Treatment and Evacuation Protocols (Feb 2016 Edition)
Tx: Flu-like Illness:
1. General management for flu-like illness is symptomatic
treatment.
2. Rest and hydration.
3. Hand washing and hygiene.
4. Acetaminophen or NSAIDs for fever, sore throat
headache and muscle aches.
5. Decongestants (e.g. pseudophedrine) for congestion.
6. Bland diet for gastrointestinal distress.
Evacuate Rapidly:
Any Pt w/ S&S of flu-like illness who develops:
● Stiff neck, severe headache, difficult breathing or
wheezing.
● Gastroenteritis w/ persistent or worsening abdominal
pain over 24 hrs, spiking fever, bloody diarrhea or
dehydration.
● An inability to tolerate any oral fluids more than 48 hrs,
especially if accompanied by diarrhea volume losses,
fever or vomiting.
● A headache that does not respond to treatment, sudden
severe headaches, or a headache associated w/ altered
mental status.
Evacuate:
Any Pt w/ S&S of flu-like illness who develops:
● Fever persisting more than 48 hrs or is high
(>104°F/40°C).
● Signs or symptoms of pneumonia. This is usually
associated w/ increasing shortness of breath, decreasing
exercise tolerance, worsening malaise and weakness w/
a predominance of cough.
● An isolated sore throat w/ fever and a red throat w/ white
patches.
● A sore throat in conjunction w/ inability to swallow water
and maintain adequate hydration.
● Any Pt demonstrating increasing disorientation,
irritability, combativeness or otherwise altered level of
consciousness.
● Any Pt w/ persistent vomiting, lethargy, excessive
sleepiness, ataxia (extreme uncoordination), seizures,
worsening headache or vision disturbances.
● Any Pt w/ signs of a skull fracture.
Evacuate:
● Any Pt who has a change in level of consciousness after
a blow to the head (e.g. disoriented, seeing stars, brief
period of appearing to be asleep, unknown or
unwitnessed loss of consciousness).
● Any Pt whose S&S do not show improvement after 24
hrs.
Heat Illness15
Heat illnesses may present due to overexertion, underhydration, and over-hydration. An accurate Pt history is
critical to determine the correct origin and treatment.
Tx: Heat Illness
1. Change the environment, rest in cool, shady spot.
2. Fluid replacement w/ water, dilute solution of sugar drink
w/ a tsp. of salt or sports drink. If hyponatremia is
suspected, avoid fluid intake, provide gradual intake of
salty foods.
3. For heat stroke provide aggressive cooling, spray w/
water, fan and massage extremities.
Evacuate Rapidly:
● Any Pt w/ an altered level of consciousness.
Hypothermia16
Most mild-moderately hypothermic Pts are managed
effectively in the field and do not require evacuation.
Tx: Hypothermia
1. Change the environment and find shelter. Replace wet
Head Injuries14
clothing w/ dry clothing and add wind and waterproof
Accurate assessment of level of consciousness is critical in
layers. Treat gently.
determining the severity of a head injury. Patients may
2. Add insulation under and around the Pt. Consider a
initially appear well oriented and later demonstrate
hypothermia wrap for moderately and severely
increasing disorientation as swelling and pressure compress
hypothermic Pt. Add external heat sources and wellthe brain. The first 24 hrs are the most critical in observing
insulated heat packs at hands, feet, armpits, groin, and
the Pt for worsening S&S.
neck.
Tx: Mild Head Injuries
3. Encourage exercise if the Pt is able and allow shivering in
Conservative treatment w/ close observation for 24 hrs in
a dry, insulated environment.
the field can be done if the Pt did not lose consciousness or 4. Give warm, sweet, non-caffeinated, non-alcoholic liquids
was only momentarily dazed or stunned, but recovered
and encourage the Pt to eat a meal, if they are able.
appropriately and the Pt remains awake w/out negative
5. For a severely hypothermic Pt, assist ventilations for 5-15
change in mental status and has only transient nausea or
min prior to movement.
vomiting.
6. Avoid chest compressions if there are any signs of life or
1. Monitor the Pt for developing signs of serious head injury.
the Pt is rigid from the cold. Perform rescue breathing
2. Let the Pt rest, but wake them up every few hrs to
during evacuation.
monitor LOC.
Evacuate Rapidly:
3. Avoid pain medications for 24 hrs.
● Any Pt w/ severe hypothermia.
Tx: Serious Head Injuries
Lightning17
1. If the injury is open, use diffuse pressure w/ a bulky
dressing to control bleeding.
Lightning strikes can cause a multitude of injuries including
2. Manage Airway, Breathing and Circulation.
death. The best defense is a strong prevention plan specific
3. Immobilize the spine and elevate the head at
for your geographic area and group profile.
approximately a 30-degree angle. Consider placing the Pt Tx: Lightning Injuries
on his or her side to manage the airway.
1. Scene safety: Lightning will strike twice in the same spot.
4. Evacuate.
2. Aggressive Basic Life Support: Rescuers should be
Evacuate Rapidly:
prepared to provide prolonged rescue breathing.
Wilderness Medicine Institute of NOLS Wilderness Medicine Protocol Package © Modified with Permission by HMI. High Mountain Institute©2016.
Pag
HMI Backcountry Medical Treatment and Evacuation Protocols (Feb 2016 Edition)
3. Thorough Pt exam and treatment of any injuries found.
4. Monitor closely for cardiovascular, respiratory and
neurological collapse.
Evacuate Rapidly:
● Any Pt showing signs of cardiovascular, respiratory or
neurological compromise.
Evacuate:
● Any Pt struck by lightning even if they appear uninjured.
Compression: Elastic Wrap, distal to proximal.
Elevation: Above the Pt’s heart.
4. Pain medication as needed.
5. Allow the injury site to passively warm.
6. Assess again for usability.
7. Support the injury w/ tape or other adjuncts.
Tx: Obvious Fractures, Open Fractures and Unusable
Injuries
1. Assess circulation, sensation and motion (CSM).
Local Cold Injuries18
2. If fracture is open, thoroughly irrigate and clean wound
It is possible to see both freezing and non-freezing local cold
prior to manipulating injury.
injuries in the wilderness setting. Both can cause injuries
3. Use gentle traction-in-line (TIL) to establish normal
ranging from minor irritation to significant tissue loss and
anatomical position. Slow down or discontinue your
permanent disability.
attempt if pain increases significantly or you meet
Tx: Local Cold Injuries
resistance. If the bone ends do not reduce, protect them
1. If not frozen: Warm the injury w/ skin-to-skin contact, do
from freezing or drying.
not massage or use radiant heat.
4. Dress wounds.
2. If frozen: If possible, warm the injury in a circulating warm
5. Splint in a position of function w/ a well-padded and rigid
water bath at 104-108°F (40-42°C), otherwise use skinsplint.
to-skin contact. Do not massage or use radiant heat.
6. Traction splint mid-shaft femoral fractures.
Consider allowing a Pt to walk on frozen feet if it
7. RICE therapy. Pain medication as needed.
expedites the evacuation.
8. Monitor CSM before and after TIL and splinting.
3. Protect blisters and damaged tissue, avoid constriction.
9. Monitor wound site for infection (consider antibiotic
Protect from re-freezing. Elevate.
therapy for open fractures if evac > 8 hrs.)
4. Pain medication as needed (NSAIDs often
Evacuate Rapidly:
recommended).
● Any Pt w/ an open fracture.
Evacuate Rapidly:
● Any Pt w/ altered CSM.
● Any Pt w/ full thickness frostbite.
Evacuate:
Evacuate:
● Any Pt w/ an unusable musculoskeletal injury.
● Any Pt w/ more than a few, small, isolated clear fluid
filled blisters formed after warming a local cold injury.
Mental Health Emergencies
● Any Pt unable to use the injured area.
Mental health emergencies range from minor feelings of
● Any Pt unable to protect the area from continued
exposure to a cold wet environment or from re-freezing. anxiety to severe suicidal ideation. A good Pt history may
help you to assist your Pt.
● Any Pt whose pain can't be managed in the field.
Tx: Mental Health Emergencies
Male Gender Illness And Injury19
● Calm and comfort the Pt.
● Supervise the Pt in a manner appropriate that they will
It can be challenging to differentiate between traumatic and
not harm themselves or others.
infectious problems w/ the male genitalia. Since delay in
● If the Pt has experienced a similar mental health issues
care can result in the loss of a testicle, treatment should
in the past discuss and implement strategies that will
error on the conservative side.
help them to work through the episode.
Tx: Male Gender Illness and Injury
● If the Pt has experienced a similar mental health issues
1. Pain management, NSAIDs often recommended.
in the past (or you feel you need external assistance)
2. Cool compresses.
consider calling the EC so that they can seek advice
3. Elevation/support of the testicles.
from the patient’s doctor, the office of the HMI Physician
4. If epididymitis is suspected administer antibiotics.
Adviser or other mental health professional.
5. If inguinal hernia is suspected, attempt reduction.
Evacuate Rapidly:
Evacuate Rapidly:
● Any Pt that poses an immediate and severe threat to
● Any Pt w/ suspected testicular torsion.
themselves or others.
● Any Pt w/ testicular pain of unknown origin.
Evacuate:
Evacuate:
● Any Pt that is a threat to themselves or others.
● Any Pt w/ a suspected epididymitis.
● If the harm to the expedition greatly outweighs the
● Any Pt w/ an inguinal hernia that does not reduce or
benefit to the patient staying in the field.
reappears after reduction.
● If the mental health condition is beyond the instructors
Athletic Injuries And Fractures20
ability to manage in the field.
● If the patient continues to believe that they are
Treatment and evacuation decisions are based on the Pt’s
completely unsafe or unable to continue.
ability to use the injured area.
Tx: Strains, Sprains, Tendonitis and Minor Fractures
Neurological Emergencies21
1. Assess injury for stability and usability.
2. Assess circulation, sensation and motion (CSM).
Strokes are rare events in a backcountry setting, but when
3. RICE Therapy:
they do occur require immediate evacuation. Seizures are a
Rest: Get the pressure off of the injury site.
Ice: Cool the area for 20 min.
Wilderness Medicine Institute of NOLS Wilderness Medicine Protocol Package © Modified with Permission by HMI. High Mountain Institute©2016.
HMI Backcountry Medical Treatment and Evacuation Protocols (Feb 2016 Edition)
more common occurrence, fortunately they are rarely life
threatening.
Tx: Neurological Emergencies
● For a suspected stroke or transient ischemic attack
(TIA), provide emotional reassurance. Place the Pt in a
position of comfort unless unconscious, then place in
stable side position w/ the affected airway side down to
protect the airway. Administer high-flow/highconcentration oxygen, if available. Document precisely
the time of onset of S&S.
● For a Pt w/ a seizure, protect from harm, but do not
restrain. Do not place bite stick or any other object in
mouth. Place the Pt on side to maintain open airway
during post-ictal recovery phase. Perform a complete Pt
assessment to check for injuries. Protect the Pt’s dignity.
● For an unconscious Pt of unknown origin, stabilize the
spine, manage the airway, consider positioning of the Pt
on their side and search for clues to the Pt’s
unconscious state. Consider administering oral sugar.
Evacuate Rapidly:
● Any Pt w/ S&S of a stroke or TIA.
● Any Pt w/ multiple seizures in a short time period.
● Any Pt w/ an altered mental status of unknown origin.
Evacuate:
● Any Pt w/ a first time seizure.
● Any Pt w/ a breakthrough seizure-a seizure that occurred
in spite of medication.
● Any Pt w/ an isolated seizure of unknown origin.
Poisons22
When dealing w/ possible poisoning gather detailed
information about what was ingested, how much, when,
body size and age, what is in his or her stomach and was it
intentional. Carbon monoxide poisoning is common in
outdoor recreation according to the Centers for Disease
Control.
Tx: Poisons
1. Call the poison control center (1-800-222-1222), if
possible.
2. If poison is ingested and is non-corrosive, non-petroleum
based and the Pt is fully conscious: Induce vomiting
manually and absorb remaining poisoning w/ activated
charcoal. Dilute w/ water.
3. If poison is inhaled, remove Pt from exposure. Assist
ventilations if necessary.
4. If poison is absorbed, take universal precautions and
remove contaminated clothing. Brush dry poison off, flush
area w/ water and wash w/ soap.
Evacuate Rapidly:
Any poisoned Pt who has an altered level of consciousness
or shows signs of respiratory distress.
Evacuate:
Any Pt who has ingested quantities of a potentially harmful
substance. Contact the American Association of Poison
Control Centers at 1-800-222-1222 for advice.
Respiratory Emergencies23
General Comments:
Respiratory emergencies range from minor episodes of
hyperventilation and asthma to more serious infections,
embolisms and severe asthma. A good Pt history will help
you determine the likely cause and create the most
appropriate management plan. Cold, altitude, dehydration
and fatigue can all be complicating factors.
Tx: Respiratory Emergencies:
1. For suspected hyperventilation, calm the Pt, be direct but
reassuring. Assist the Pt to slow his or her breathing.
Oxygen is not indicated.
2. For suspected pulmonary embolism, place the Pt in a
position of comfort.
3. For a suspected Upper Respiratory Infection (URI) allow
the Pt to rest and hydrate. Consider over-the-counter
decongestants and analgesics.
4. For suspected pneumonia, encourage Pt to cough and
breathe deeply. Ensure the Pt stays hydrated. Give feverreducing medications. If evacuation is lengthy, administer
oral antibiotics.
5. For a suspected asthma attack help calm the Pt and
change the environment. Assist the Pt, if necessary, w/
his or her bronchodilators or Albuterol inhaler. Multiple
treatments may be required. Encourage pursed lip
breathing. Provide hydration and rest. If the attack is
severe (unable to speak a full sentence), administer
epinephrine .3ml/1:1000 SQ or IM and/or steroids.
Evacuate Rapidly:
● Any Pt w/ suspected pulmonary embolus.
● Any Pt w/ a severe or unbreakable asthma attack.
Evacuate:
● Any Pt w/ suspected pneumonia.
● Any Pt w/ increased frequency or duration of asthma
attacks or who does not show improvement w/
medication.
● Any Pt using a respiratory inhaler more than 3 times per
week (excepting prescribed inhaler used pre-exercise for
exercise induced asthma).
● Any Pt waking up at night and needing to use their
inhaler.
Shock24
General Comments:
In wilderness settings shock is most commonly brought on
by loss of fluid volume from bleeding, sweating, vomiting,
diarrhea and/or severe burns. Outdoor leaders should focus
on early recognition and intervention to control fluid loss and
maintain Pts in the field.
Tx: Shock:
1. Treat before serious signs develop.
2. Treat the cause. Keep the Pt calm.
3. Keep the Pt warm.
4. Keep the Pt flat w/ legs elevated no more than 12 inches
(30.5 cm)(Head or lower extremity injury may preclude
this.)
5. Consider administering oral fluids in an extended care
situation (If Pt can tolerate the fluids, mental status is
adequate to swallow and there is no abdominal injury.)
6. Monitor the Pt closely for deteriorating vital signs.
Evacuate Rapidly:
● Any Pt w/ S&S of cardiogenic or vasogenic shock.
● Any Pt w/ decreased mental status or worsening vital
signs.
● Any Pt w/ an absent radial pulse (not otherwise
explainable by an injury to that extremity).
Evacuate:
● Any Pt unable to stay hydrated in spite of concentrated
efforts.
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HMI Backcountry Medical Treatment and Evacuation Protocols (Feb 2016 Edition)
● Any Pt for whom you can't treat the underlying cause of
shock.
Skin Irritation25
Many skin irritations can be prevented though improved
hygiene practices and appropriate clothing. The active
ingredient in poison ivy, oak and sumac is urushiol. This oil
can be transferred to the skin regardless of whether or not
the plant has its traditional shiny three leaves in bloom.
Inhaled smoke from burning plants can also cause a
significant reaction. There are barrier creams for
hypersensitive individuals.
Tx: Skin Irritation:
1. Fungal infections of the skin can be treated by washing
the area thoroughly w/ soap and water, air drying and
applying a thin layer of 1% hydrocortisone cream or a
topical anti-fungal (e.g. Tinactin ®).
2. For a suspected contact w/ poison ivy, oak or sumac,
wash the area immediately after exposure w/ soap and
cool water. Wash all clothes and equipment that may
have been exposed. Once the rash appears, apply a thin
layer of 1% hydrocortisone cream or calamine lotion to
reduce itching. Oral antihistamines may help reduce
itching.
Evacuate Rapidly:
● Any Pt w/ respiratory distress after inhaling smoke from
burning poison ivy, oak or sumac.
Evacuate:
● Any Pt w/ a skin irritation that makes them too
uncomfortable to continue.
North Am. Spiders & Scorpions27
Many spider bites are initially painless making it difficult to
identity the specific spider. Fatalities are rare. Scorpion
stings are painful, but typically self-limiting. Systemic
reactions are possible from scorpions in the extreme
southwestern US.
Tx: Bites & Stings from N. Am. Spiders & Scorpions
1. Clean the bite/sting site. Continue to clean the site if
wound does not heal.
2. Ice the bite site for pain and consider painkillers for
abdominal cramps.
3. Monitor the bite site for necrosis.
4. Monitor the Pt for systemic S&S.
5. Administer pain medications.
Evacuate Rapidly:
● Any Pt exhibiting slurred speech, difficulty swallowing,
blurred vision, seizures, or respiratory or cardiovascular
involvement.
Evacuate:
● Any Pt w/ a suspected black widow spider bite.
● Any Pt w/ a wound that will not heal.
Spinal Injuries28
General Comments:
The utilization of the focused spine assessment to determine
presence or absence of spinal injury has been well
documented. Outdoor leaders should be attentive to
suspicious mechanisms of injury and take early spinal
precautions w/ Pts prior to the focused spine assessment.
Focused Spine Assessment:
North American Pit Vipers, Coral Snakes If the Pt has a mechanism for spinal injury but does not
exhibit S&S of spinal injury during the complete Pt
and Poisonous Lizards26
assessment, perform a focused spine assessment to
Fatalities due to envenomation by snakes or lizards are
determine whether further spinal immobilization is
extremely rare in North America, though tissue loss is a
warranted.
significant possibility. Not all bites will carry venom, and the
Focused Spine Assessment
injury should be monitored closely for signs of
1. Patient must be reliable: A+O x 3 or 4, sober, and have
envenomation. Anti-venom is available for most bites.
no distractions.
Tx: Bites from North American Pit Vipers, Coral Snakes 2. Patient must have normal Circulation (unless otherwise
and Poisonous Lizards
explainable by another injury or illness), Sensation (no
1. Ensure the scene is safe. Remain calm and put the Pt at
numbness, tingling or unusual hot or cold sensations)
rest. Avoid walking if possible.
and Motion (unless otherwise explainable by another
2. Remove constricting clothing and jewelry from the bite
injury or illness) in all four extremities.
site.
3. Patient must deny spinal pain and tenderness, w/ and
3. Wash and dress the wound.
w/out palpation, and, w/ and w/out active and passive
4. Measure and monitor swelling and signs of
movement.
envenomation. Do not apply cold.
4. If Pt meets all criteria, further spinal immobilization is not
5. A wide elastic bandage wrapped proximal to distal is
warranted.
recommended for coral snake bites.
Tx: Suspected Spinal Injury:
6. Splint the extremity and keep it at the same level as the
If the Pt exhibits S&S of spinal injury during either the Pt
heart.
assessment or the focused spine assessment:
7. Monitor for shock and cardiac and respiratory depression. 1. Stabilize the spine and control the head manually.
Evacuate Rapidly:
2. Check circulation, sensation and motion (CSM) in the
● Any Pt exhibiting shock, or cardiac or respiratory
extremities.
depression.
3. Establish neutral alignment of the spine.
Evacuate:
4. Apply a cervical collar.
● Any Pt bitten by a poisonous snake, ideally by carrying
5. BEAM or log-roll the Pt into a commercial litter or onto a
or slowly walking.
backboard.
6. Secure the entire body to the litter or backboard w/
padding and straps.
7. Secure the head to the litter or backboard.
8. Recheck CSM in the extremities.
Wilderness Medicine Institute of NOLS Wilderness Medicine Protocol Package © Modified with Permission by HMI. High Mountain Institute©2016.
HMI Backcountry Medical Treatment and Evacuation Protocols (Feb 2016 Edition)
9. Evacuate.
Evacuate Rapidly:
● Any Pt who demonstrates S&S of neurological injury.
Evacuate:
● Any Pt being treated for a spinal injury, ideally on a
commercial litter or on a backboard.
Submersion Incidents29
Rescuer safety is paramount when dealing w/ submersion
events. It is common to underestimate the effects of current
and temperature on both rescuers and Pts.
Tx: Submersion Injuries
1. Scene safety: Reach, Throw, Row, Tow, Go! Get the
person onto a safe, firm surface.
2. Aggressive Basic Life Support.
Evacuate Rapidly:
● Any Pt who develops: Wet lung sounds, productive
cough, rapid, shallow, respirations, cyanosis, substernal
burning, inability to take a deep breath, irregular and/or
depressed heart rate, or a decreased level of
consciousness.
Evacuate:
● Any Pt who was unconscious at any time during the
submersion.
Wounds and Infection30
Wounds and infection are exceedingly common in a
wilderness setting. Established infection is challenging to
manage so efforts should be directed at aggressive wound
cleaning and effective dressing.
Tx: Wounds and Infection
1. Control bleeding using direct pressure and elevation,
pressure dressings, pressure points and tourniquets.
2. Properly clean the wound: Wash your hands and put on
your gloves; Clean around the wound w/ soap and water,
an abrasion may be aggressively scrubbed, and rinse w/
disinfected water; Remove any foreign matter w/
disinfected tweezers or by gently brushing it out of the
wound; Pressure irrigate the wound w/ disinfected water.
3. Cover wound w/ a thin layer of antibiotic ointment and a
sterile dressing and bandage. If the cut gapes open less
than 1/2 inch (1 cm), approximate wound edges w/
wound closure strips. Monitor circulation, sensation and
motion (CSM). Keep the dressings clean and dry.
Change dressings at least every 24 hrs. If using
transparent film dressings, dressings may be left in place
until wound heals.
4. If the cut causes gaping of more than 1/2 inch (1 cm) or
wound is infected, pack the wound open wet-dry and
keep the wound moist during evacuation.
5. In case of an amputation, wrap the part in a moist sterile
dressing and seal in a plastic bag. Immerse the bag in
cool water and transport rapidly to the hospital w/ the Pt.
6. Consider removing an impaled object if it is through the
cheek. In remote environments consider removal if the
object is metal and the environment is cold or if the object
is in an extremity.
7. If the wound shows S&S of infection: Hot soaks for 20-30
min several times daily; Reclean the wound following the
hot soak; keep the Pt hydrated; Consider packing the
wound open (wet to dry) to allow drainage; Consider
antibiotic and fever reducing therapy.
Evacuate Rapidly:
● Any Pt w/ an amputation.
● Any Pt w/ an object still impaled.
● Any Pt w/ a wound that: Is heavily contaminated, opens
a joint space, involves underlying tendons or ligaments,
was caused by an animal bite, is on the face, or was
caused by a crushing mechanism.
● Any Pt w/ a wound that shows S&S of serious infection.
Evacuate:
● Any Pt w/ a wound that can't be closed in the field.
● Any Pt w/ an infection that does not improve w/in 12-24
hrs.
● Any Pt who starts a course of antibiotic therapy.
Zoonoses31
There are a wide-range of diseases transmitted from
animals to humans. The ones we worry about the most in
the United States are: Tick Fevers, West Nile Virus,
Hantavirus, Rabies and Plague. Field diagnosis can be
extremely difficult. Fever is a common symptom. The Pt may
trigger the flu-like illness evacuation criteria. Educational
efforts should focus on effective prevention.
Tx: Zoonoses
1. Symptomatic management, e.g. fever reducing
medication, pain medication, antihistamines and
antibiotic therapy.
2. Treat all mammal bites as a potential rabies exposure.
Clean wound thoroughly w/ soap and disinfected water.
Evacuate Rapidly:
● Any Pt w/ a mammal bite for initiation of the rabies
vaccine.
Evacuate:
● Any Pt w/ a history of an embedded tick who develops
fever, rash and flu-like symptoms.
Wilderness Medicine Institute of NOLS Wilderness Medicine Protocol Package © Modified with Permission by HMI. High Mountain Institute©2016.
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HMI Backcountry Medical Treatment and Evacuation Protocols (Feb 2016 Edition)
HMI Expedition Drug Kit
Before administering any medication read the protocols, confirm the dosage, review contraindications, read the label and
confirm the medication, ask the patient about previous history w/ this medication and any known allergies, ask the patient if
they are currently on any medication and if so, review the protocols for contraindications. All dosing is indicated for adults,
unless noted otherwise. Note: PO = Oral; SQ = Subcutaneous injection; IM = Intramuscular injection; 1kg (kilogram) = 2.2
pounds. 1g (gram) = 1000mg (milligrams), Rx = denotes prescription medication, OTC = denoted over-the-counter
medication
Tylenol
Advil, Motrin
Benadryl
Sudafed
Pseudoephedrine
hydrochloride
Diphenhydramine hydrochloride
Hydrocodone
bitartrate/
acetominophen
Vicodin
Ibuprofen
Acetaminophen
Classification
Non-narcotic
analgesic,
antipyretic
Dose
Contraindication
Side Effects
OTC
For symptomatic relief of
pain associated w/
Active peptic or
headache, colds, flu,
gastrointestinal ulcer,
frostbite, toothache,
Nausea,
gastrointestinal
arthritis, burns and
epigastric pain,
menstrual cramps. May be bleeding disorder,
dizziness and
history of
used to reduce fever. For
rash
hypersensitivity to
pain of inflammation and
aspirin or other
reduction of inflammation
NSAIDs.
associated w/ muscle, joint
and over-use injuries
OTC
For moderate to severe
pain. Narcotic. Good for
5-10mg/4 hrs musculoskeletal and dental
PO
pain. Good for people
allergic to codeine.
Suppresses cough reflex.
Hypersensitivity.
Patients w/ altered
mental status or
repertory distress.
Sedation,
decrease in Rx, for HMI
blood pressure, admin.
sweating and
typically
flushed face, triggers an
evac
drowsiness and
dizziness
For temporary relief of
respiratory allergy
symptoms and cold
Drowsiness,
symptoms. Helps relieve
Hypersensitivity,
dizziness,
the itching of allergic skin
25 mg/ 6 hrs
acute asthma attack,
weakness,
reactions. Useful in
PO, may give
glaucoma, peptic hypotension, dry
treatment of moderate
Antihistamine
2nd dose if
ulcer, hypertension
mouth,
allergic and anaphylactic
ineffective after
and COPD (Chronic
thickening
reactions. May be used as
60 min
Obstructive
bronchial
a mild sedative and for
Pulmonary Disease). secretions and
insomnia. May help
urinary retention.
alleviate seasickness. Can
be used to treat distonic
reactions.
Nasal
decongestant
Notes
Hypersensitivity,
For relief of pain due to
active alcoholism,
headache, cold and flu
liver disease,
15mg/kg body discomfort, minor muscle
hepatitis.
mass,
and joint discomfort and Acetaminophen is a
maximum
menstrual cramps. For common ingredient in Hypersensitivity
is rare
1000mg/4 hrs
reduction of fever.
over-the-counter pain,
PO, max dose Especially useful for those cold and flu medicine.
4g/24 hrs allergic to aspirin or aspirinBe careful of
containing products. Does accidental overdose
not control inflammation.
in combination w/
other products
10mg/kg body
Analgesic, Nonmass,
Steroidal Antimaximum of
Inflammatory
800 mg/8 hrs.
Drug (NSAID),
Maximum dose
antipyretic
4g/24 hrs
Narcotic
analgesic,
antitussive
Indication
60mg per 6-8
hrs PO
Decongestant useful in
treating upper airway
sinuses and nasal
passages. Use of more
than 5 days may cause
reverse effects.
Severe hypertension, Nervousness,
coronary artery
restlessness,
disease, lactating
insomnia,
women, MAO inhibitor trembling and
therapy.
headache.
OTC
OTC
Wilderness Medicine Institute of NOLS Wilderness Medicine Protocol Package © Modified with Permission by HMI. High Mountain Institute©2016.
HMI Backcountry Medical Treatment and Evacuation Protocols (Feb 2016 Edition)
Adrenalin, EpiPen
Polysporin
Azithromycin
Keflex
Tinactin
Monistat 3
Miconazole
Nitrate
Tolnaftate
Hydrocortisone
Cream 1%
Silver
Sulfadiazine
Cream
SSD
Cephalexin
Azithromycin
Polymyxin B
sulfate/bacitracin
Epinephrine
Albuterol
Two puffs of
metered dose Shortness of breath or
inhaler (MDI) respiratory difficulty thought
Bronchodilator w/ use of a to be secondary to reactive
spacer every 4
airway dysfunction
(asthma) or HAPE.
hrs and as
needed
Bronchodilator, 0.3ml 1:1000
antiallergenic,
SQ or IM.
cardiac
Repeat as
stimulant.
necessary.
Antibiotic
Topical
For severe allergic
reactions including
anaphylaxis and status
asthmaticus.
ingredients for prevention
of infection in minor
wounds. Works as a
lubricant, offers some relief
from itching.
Tachycardia
secondary to
underlying heart
condition.
Palpitations,
Rx (ref
tachycardia and only, not in
tremor.
HMI kits)
Increased heart
No true
rate,
Rx, for HMI
contraindications w/
nervousness,
admin.
anaphylaxis.
dizziness,
typically
Hypertension, cardiac
lightheadedness, triggers an
disease, glaucoma
evac
nausea and
and shock.
headache.
Hypersensitivity.
Hypersensitivity
reactionsburning, itching,
inflammation,
contact
dermatitis
OTC
Antibiotic
Abdominal
For sinus, pulmonary, ear,
discomfort and Rx, for HMI
500mg/24 hrs
Hypersensitivity, liver
eye, respiratory and soft
cramping,
admin.
(1 x per day)
disease, hepatitis.
tissue infections. Useful for
nausea,
typically
for 3 days PO.
Allergies to
patients who can't take
vomiting,
triggers an
Take w/ food.
macrolides.
penicillin or cephalosporin.
evac
diarrhea and
rash.
Antibiotic
250mg per 6
Oral and vaginal Rx, for HMI
Hypersensitivity.
hrs (4 x per
fungal infections, admin.
For skin, bone, pneumonia Sensitivity to penicillin
day) for at
diarrhea and
typically
and urinary tract infections.
and/or
least 5 days
abdominal
triggers an
cephalosporins.
PO.
cramping.
evac
Antibiotic
Topical, Apply
to affected
area in a thick
layer 2-3 x per
day
Antipruritic
Topical, apply
For the temporary relief of
to affected
itching associated w/ minor
area 2-3
skin irritations and rashes.
time/day
Steroid allergies
Allergic reaction
OTC
Antifungal
For treatment of superficial
skin fungi such as
Topical, 2
ringworm, jock itch and
applications/da
athlete’s foot. For external
y
use only (not for UTI's or
Vaginitis).
Hypersensitivity,
patients allergic to
tolnaftate.
Mild irritation.
OTC
Antifungal
200mg vaginal
suppositories
Hypersensitivity, first
nightly for
Vaginal candidiasis (yeast
Itching, burning
trimester of
infections).
and stinging.
three nights or
pregnancy.
topical cream
as needed.
Burns
Sulfa and sulfa drug
Allergic reaction
allergies
Rx
Rx
Wilderness Medicine Institute of NOLS Wilderness Medicine Protocol Package © Modified with Permission by HMI. High Mountain Institute©2016.
Page
2 tablets after
first loose
For use in the control of
stool.1 tablet
diarrhea, nausea and upset
after
stomach.
subsequent
loose stools
Loss of appetite,
cramps
Tums
Loratadine
Mild allergy
relief
Cavit
Relieves,
Chew 2-4
For use in relieving
heartburn, acid tablets, up to heartburn, acid indigestion,
indigestion 10 in 24 hours
upset stomach
Calcium
Carbonate
Loperamide
Antidiarrheal
Claratin
Imodium
HMI Backcountry Medical Treatment and Evacuation Protocols (Feb 2016 Edition)
Temporary
Filling Material
1 tablet daily,
no more than
one tablet in
24 hours
Temporarily relieves
sypmtops of upper
respiratory allergies
As per
directions
For use as a temporary
filling.
OTC
OTC
?
?
?
Pages following this page (the endnotes and references section) are
typically omitted for field use.
Wilderness Medicine Institute of NOLS Wilderness Medicine Protocol Package © Modified with Permission by HMI. High Mountain Institute©2016.
HMI Backcountry Medical Treatment and Evacuation Protocols (Feb 2016 Edition)
ENDNOTES/REFERENCES
Emergency Medical Technician-Basic: National Standard Curriculum Module 4 Medical/Behavioral Emergencies and Obstetrics/Gynecology. 22 June 199 National
Highway Traffic Safety Administration United States Department of Transportation. 2 Dec 200 <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>
“Gastrointestinal.” United States Special Operations Command. Special Operations Forces Medical Handbook. Jackson, Wyoming: Teton NewMedia, 200 4-70.
Schimelpfenig, Tod and Linda Lindsey. “Abdominal Injuries.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 8.
Specific Protocols for Wilderness EMS Abdominal Pain. Version 1.2 May 19, 199 The Wilderness Emergency Medical Services Institute. 2 Dec. 200
<http://www.wemsi.org/specific.html>
The Merck Manual 16th Edition. Rathaway, New Jersey: Merck & Co., Inc., 1992.
Tilton, Buck. “Abdominal Injuries.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 11.
Tilton, Buck. “Abdominal Illnesses.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 29.
Wilkerson, James A. “Acute Abdominal Pain.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 13.
Wilkerson, James A. “Abdominal Injuries.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 14.
2 Emergency Medical Technician-Basic: National Standard Curriculum Module 4 Medical/Behavioral Emergencies and Obstetrics/Gynecology. 22 June 199 National
Highway Traffic Safety Administration United States Department of Transportation. 2 Dec 200 <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>
“Position Statement 26:The Use of Epinephrine in the Treatment of Anaphylaxis.” American Academy of Allergy Asthma & Immunology. 28 Dec. 200
<http://www.aaaai.org/media/resources/position_statements/ps26.stm>
Schimelpfenig, Tod and Linda Lindsey. “Poisons, Stings, and Bites.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 11.
Specific Protocols for Wilderness EMS Allergic Reactions. Version 1.2 May 19, 199 The Wilderness Emergency Medical Services Institute. 2 Dec. 200
<http://www.wemsi.org/specific.html>
The Merck Manual 16th Edition. Rathaway, New Jersey: Merck & Co., Inc., 1992.
Tilton, Buck. “Allergic Reactions and Anaphylaxis.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 28.
Wilderness Field Protocols Protocol 1 Anaphylaxis. 200 Wilderness Medical Associates. 2 Dec. 2004 <
http://www.wildmed.com/field_protocols/anaphylaxis_protocol05.01.html top>
Wilkerson, James A. “Allergies.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 20.
3 Auerbach, Paul S. “High-Altitude Medicine.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter 1.
Forgey, William. “High-Altitude Illness.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The Globe
Pequot Press, 200 Chapter 10.
Hackett, Peter H. “The Cerebral Etiology of High-altitude Cerebral Edema and Acute Mountain Sickness.” Wilderness and Environmental Medicine 10 1999: 97-109.
Hackett, Peter H. and Robert C. Roach. “Medical Therapy of Altitude Illness.” Annals of Emergency Medicine 16, 9 September 1987: 89-95.
Schimelpfenig, Tod and Linda Lindsey. “Altitude Illness.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 14.
Schoene, Robert B. “High-Altitude Pulmonary Edema: Pathophysiology and Clinical Review.” Annals of Emergency Medicine 16, 9 September 1987: 99-104.
Stewart, Charles E. “Management of Altitude-Related Emergencies.” Environmental Emergencies. Baltimore, Maryland: Williams & Wilkins, 199 Chapter 6.
Tilton, Buck. “Altitude Illnesses.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 18.
Wilkerson, James A. “ Disorders Caused by Altitude.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 21.
Wilkerson, James A. “ Altitude and Common Medical Conditions.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter
22.
4 “Burns.” United States Special Operations Command. Special Operations Forces Medical Handbook. Jackson, Wyoming: Teton NewMedia, 200 3-17.
Emergency Medical Technician-Basic: National Standard Curriculum Module 5 Trauma. 22 June 199 National Highway Traffic Safety Administration United States
Department of Transportation. 2 Dec 200 <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>
Forgey, William. “Burn Management.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The Globe
Pequot Press, 200 Chapter 7.
Schimelpfenig, Tod and Linda Lindsey. “Burns and Lightning Injuries.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 4.
Specific Protocols for Wilderness EMS Wounds. Version 1.2 May 19, 199 The Wilderness Emergency Medical Services Institute. 2 Dec. 200
<http://www.wemsi.org/specific.html>
Stewart, Charles E. “Burns.” Environmental Emergencies. Baltimore, Maryland: Williams & Wilkins, 199 Chapter 2.
The Merck Manual 16th Edition. Rathaway, New Jersey: Merck & Co., Inc., 1992.
Tilton, Buck. “Wilderness Wound Mangament.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 15.
Wilkerson, James A. “Burns.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 8.
5 ACLS Provider Manual. Dallas, Texas: American Heart Association, 2002.
BLS for Healthcare Providers. Dallas, Texas: American Heart Association, 2002.
“Cardiac/Circulatory.” United States Special Operations Command. Special Operations Forces Medical Handbook. Jackson, Wyoming: Teton NewMedia, 200 4-1.
Emergency Medical Technician-Basic: National Standard Curriculum Module 4 Medical/Behavioral Emergencies and Obstetrics/Gynecology. 22 June 199 National
Highway Traffic Safety Administration United States Department of Transportation. 2 Dec 200 <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>
Schimelpfenig, Tod and Linda Lindsey. “Respiratory and Cardiac Emergencies, Seizures, Diabetes and Unconscious States.” Wilderness First Aid 3rd ed.
Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 18.
The Merck Manual 16th Edition. Rathaway, New Jersey: Merck & Co., Inc., 1992.
Tilton, Buck. “Cardiac Emergencies.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 23.
6 Emergency Medical Technician-Basic: National Standard Curriculum Module 5 Trauma. 22 June 199 National Highway Traffic Safety Administration United States
Department of Transportation. 2 Dec 200 <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>
“Thoracic Trauma.” PHTLS Basic and Advanced Prehospital Trauma Life Support. St. Louis, Missouri: Mosby, 200 Chapter 5.
Schimelpfenig, Tod and Linda Lindsey. “Chest Injuries.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 7.
Specific Protocols for Wilderness EMS Chest Injury. Version 1.2 May 19, 199 The Wilderness Emergency Medical Services Institute. 2 Dec. 200
<http://www.wemsi.org/specific.html>
Tilton, Buck. “Chest Injuries.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 10.
Wilkerson, James A. “ Chest Injuries.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 11.
7 ACLS Provider Manual. Dallas, Texas: American Heart Association, 2002.
BLS for Healthcare Providers. Dallas, Texas: American Heart Association, 2002.
Forgey, William. “Cardiopulmonary Resuscitation.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut:
The Globe Pequot Press, 200 Chapter 2.
Goth, Peter and George Garnett. “National Association of EMS Physicians Clinical Guidelines for Delayed/Prolonged Transport Cardiorespiratory Arrest.” Prehospital
and Disaster Medicine Vol. 6 No. 3 July-Sept. 1991: 335-339.
Specific Protocols for Wilderness EMS Cardio Pulmonary Resuscitation. Version 1.2 May 19, 199 The Wilderness Emergency Medical Services Institute. 2 Dec. 200
< http://www.wemsi.org/specific.html>
Tilton, Buck. “Cardiopulmonary Resuscitation.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 5.
Wilderness Field Protocols Protocol 3 Cardiopulmonary Resuscitation (CPR). 200 Wilderness Medical Associates. 2 Dec. 2004
<http://www.wildmed.com/field_protocols/cpr_protocol05.01.html top>
8 Auerbach, Paul S. “Dental and Facial Emergencies.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter23.
“Dentistry.” United States Special Operations Command. Special Operations Forces Medical Handbook. Jackson, Wyoming: Teton NewMedia, 200 5-9.
Schimelpfenig, Tod and Linda Lindsey. “Dental Emergencies.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 20.
Specific Protocols for Wilderness EMS Dental Injury. Version 1.2 May 19, 199 The Wilderness Emergency Medical Services Institute. 2 Dec. 200
<http://www.wemsi.org/specific.html>
The Merck Manual 16th Edition. Rathaway, New Jersey: Merck & Co., Inc., 1992.
Wilderness Medicine Institute of NOLS Wilderness Medicine Protocol Package © Modified with Permission by HMI. High Mountain Institute©2016.
1
Page
HMI Backcountry Medical Treatment and Evacuation Protocols (Feb 2016 Edition)
Tilton, Buck. “Common Simple Medical Problems.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 31.
9 Emergency Medical Technician-Basic: National Standard Curriculum Module 4 Medical/Behavioral Emergencies and Obstetrics/Gynecology. 22 June 199 National
Highway Traffic Safety Administration United States Department of Transportation. 2 Dec 200 <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>
“Endocrine.” United States Special Operations Command. Special Operations Forces Medical Handbook. Jackson, Wyoming: Teton NewMedia, 200 4-27.
Schimelpfenig, Tod and Linda Lindsey. “Respiratory and Cardiac Emergencies, Seizures, Diabetes and Unconscious States.” Wilderness First Aid 3rd ed.
Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 18.
Specific Protocols for Wilderness EMS Diabetes. Version 1.2 May 19, 199 The Wilderness Emergency Medical Services Institute. 2 Dec. 200
<http://www.wemsi.org/specific.html>
The Merck Manual 16th Edition. Rathaway, New Jersey: Merck & Co., Inc., 1992.
Tilton, Buck. “Diabetic Emergencies.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 26.
10 Auerbach, Paul S. “Orthopedics.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter 21.
Forgey, William. “Orthopedic Injuries.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The Globe
Pequot Press, 200 Chapter 8.
Goth, Peter and George Garnett. “National Association of EMS Physicians Clinical Guidelines for Delayed/Prolonged Transport Dislocations.” Prehospital and
Disaster Medicine Vol. 8 No. 1 Jan.-Mar. 1993: 77-80.
Schimelpfenig, Tod and Linda Lindsey. “Fractures and Dislocations.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 5.
Specific Protocols for Wilderness EMS Dislocations. Version 1.2 May 19, 199 The Wilderness Emergency Medical Services Institute. 2 Dec. 200 <
http://www.wemsi.org/specific.html>
Tilton, Buck. “Dislocations.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 13.
“Joint Dislocations.” United States Special Operations Command. Special Operations Forces Medical Handbook. Jackson, Wyoming: Teton NewMedia, 200 3-64.
Wilderness Field Protocols Protocol 5 Joint Dislocations. 200 Wilderness Medical Associates. 2 Dec. 2004
<http://www.wildmed.com/field_protocols/joint_dis_protocol05.01.html top>
11 Auerbach, Paul S. “The Eye in the Wilderness.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter22.
Auerbach, Paul S. “Dental and Facial Emergencies.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter23.
Forgey, William. “Wilderness Eye Injuries.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The Globe
Pequot Press, 200 Chapter 9.
“General Symptoms.” United States Special Operations Command. Special Operations Forces Medical Handbook. Jackson, Wyoming: Teton NewMedia, 200 3-1.
Schimelpfenig, Tod and Linda Lindsey. “Head, Spinal Cord and Eye Injuries.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200
Chapter 6.
The Merck Manual 16th Edition. Rathaway, New Jersey: Merck & Co., Inc., 1992.
Tilton, Buck. “Common Simple Medical Problems.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 31.
Wilkerson, James A. “Eye, Ear Nose, and Throat Disorders.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 17.
12 Emergency Medical Technician-Basic: National Standard Curriculum Module 4 Medical/Behavioral Emergencies and Obstetrics/Gynecology. 22 June 199 National
Highway Traffic Safety Administration United States Department of Transportation. 2 Dec 200 <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>
“Genitourinary.” United States Special Operations Command. Special Operations Forces Medical Handbook. Jackson, Wyoming: Teton NewMedia, 200 4-87.
“Gynecological Problems.” United States Special Operations Command. Special Operations Forces Medical Handbook. Jackson, Wyoming: Teton NewMedia, 200 337.
Schimelpfenig, Tod and Linda Lindsey. “Gender-Specific Medical Concerns.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200
Chapter 16.
Specific Protocols for Wilderness EMS Urinary Tract Infection. Version 1.2 May 19, 199 The Wilderness Emergency Medical Services Institute. 2 Dec. 200
<http://www.wemsi.org/specific.html>
The Merck Manual 16th Edition. Rathaway, New Jersey: Merck & Co., Inc., 1992.
Tilton, Buck. “Gender-Specific Emergencies.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 32.
Wilkerson, James A. “Genitourinary Disorders.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 18.
13 “General Symptoms.” United States Special Operations Command. Special Operations Forces Medical Handbook. Jackson, Wyoming: Teton NewMedia, 200 3-1.
“Respiratory.” United States Special Operations Command. Special Operations Forces Medical Handbook. Jackson, Wyoming: Teton NewMedia, 200 4-10.
The Merck Manual 16th Edition. Rathaway, New Jersey: Merck & Co., Inc., 1992.
Tilton, Buck. “Common Simple Medical Problems.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 31.
Wilkerson, James A. “Eye, Ear Nose, and Throat Disorders.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 17.
14 Emergency Medical Technician-Basic: National Standard Curriculum Module 5 Trauma. 22 June 199 National Highway Traffic Safety Administration United States
Department of Transportation. 2 Dec 200 <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>
Forgey, William. “Head Injury.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The Globe Pequot
Press, 200 Chapter 4.
McCrory, Paul R. and Karen M. Johnston. “Acute Clinical Symptoms of Concussion Assessing Prognostic Significance.” The Physician and Sportsmedicine Vol. 30
No. 8 August 2002.
“Head Trauma.” PHTLS Basic and Advanced Prehospital Trauma Life Support. St. Louis, Missouri: Mosby, 200 Chapter 8.
Schimelpfenig, Tod and Linda Lindsey. “Head, Spinal Cord and Eye Injuries.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200
Chapter 6.
Tilton, Buck. “Head Injuries.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter
Wilkerson, James A. “ Head and Neck Injuries.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 16.
15 Auerbach, Paul S. “Clinical Management of Heat-Related Illnesses.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter 11.
Backer, Howard D., Ellen Shopes and Sherrie L. Collins. “Hyponatremia in Recreational Hikers in Grand Canyon National Park.” Journal of Wilderness Medicine: Vol.
4, No. 4, 1993: 391–406.
Bouchama, Abderrezak and James P. K Nochel. “Heat Stroke.” The New England Journal of Medicine Vol. 346, No. 25 June 20, 2002: 1978-1988.
Casa, Douglas J., Lawrence E. Armstrong, Susan K. Hillman, Scott J. Montain, Ralph V. Reiff, Brent S.E. Rich, William O. Roberts, and Jennifer A. Stone. “National
Athletic Trainers’ Association Position Statement: Fluid Replacement for Athletes.” Journal of Athletic Training Vol. 35, No. 2 June 2000:212–224.
Forgey, William. “Heat-Related Illnesses.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The Globe
Pequot Press, 200 Chapter 13.
Schimelpfenig, Tod and Linda Lindsey. “Heat Illness.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 10.
Stewart, Charles E. “The Spectrum of Heat Illness.” Environmental Emergencies. Baltimore, Maryland: Williams & Wilkins, 199 Chapter 1.
Tilton, Buck. “Heat-Induced Emergencies.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 17.
Wilkerson, James A. “Heat and Solar Injuries.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 24.
16 Auerbach, Paul S. “Accidental Hypothermia.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter 6.
Forgey, William. “Hypothermia.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The Globe Pequot
Press, 200 Chapter 11.
Giesbrecht, Gordon G. “Prehospital Treatment of Hypothermia.” Wilderness and Environmental Medicine 12 2001: 24-31.
Schimelpfenig, Tod and Linda Lindsey. “Cold Injuries.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 9.
State of Alaska Cold Injuries and Cold Water Near Drowning Guidelines. Revision 01/9 Hypothermia Prevention, Recognition and Treatment.
Articles, Protocols and Research on Life-saving skills. 27 Dec. 200 <http://www.hypothermia.org/protocol.htm>
Stewart, Charles E. “Generalized Hypothermia.” Environmental Emergencies. Baltimore, Maryland: Williams & Wilkins, 199 Chapter 4.
Tilton, Buck. “Cold-Induced Emergencies.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 16.
Wilkerson, James A. “Cold Injuries.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 23.
Wilderness Medicine Institute of NOLS Wilderness Medicine Protocol Package © Modified with Permission by HMI. High Mountain Institute©2016.
HMI Backcountry Medical Treatment and Evacuation Protocols (Feb 2016 Edition)
Auerbach, Paul S. “Lightning Injuries.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter 3.
Forgey, William. “Lightning Injuries.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The Globe
Pequot Press, 200 Chapter 14.
Gookin, John. “NOLS Backcountry Lightning Safety Guidelines.” Lander, Wyoming: The National Outdoor Leadership School, 2000.
Schimelpfenig, Tod and Linda Lindsey. “Burns and Lightning Injuries.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 4.
Stewart, Charles E. “Electrical Injuries.” Environmental Emergencies. Baltimore, Maryland: Williams & Wilkins, 199 Chapter 9.
Tilton, Buck. “Lightning.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 20.
18 Auerbach, Paul S. “Nonfreezing Cold Injuries.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter 5.
Auerbach, Paul S. “Frostbite.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter 7.
Forgey, William. “Frostbite and Immersion Foot.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The
Globe Pequot Press, 200 Chapter 12.
Schimelpfenig, Tod and Linda Lindsey. “Cold Injuries.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 9.
State of Alaska Cold Injuries and Cold Water Near Drowning Guidelines. Revision 01/9 Hypothermia Prevention, Recognition and Treatment.
Articles, Protocols and Research on Life-saving skills. 27 Dec. 200 <http://www.hypothermia.org/protocol.htm>
Stewart, Charles E. “Frostbite and Cold Injuries.” Environmental Emergencies. Baltimore, Maryland: Williams & Wilkins, 199 Chapter 3.
Tilton, Buck. “Cold-Induced Emergencies.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 16.
Wilkerson, James A. “Cold Injuries.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 23.
Wilkerson, James A., Cameron C. Bangs and John S. Hayward. “Frostbite.” Hypothermia Frostbite and Other Cold Injuries. Seattle, Washington: The Mountaineers,
198 Chapter 7.
Wilkerson, James A., Cameron C. Bangs and John S. Hayward. “Other Localized Cold Injuries.” Hypothermia Frostbite and Other Cold Injuries. Seattle, Washington:
The Mountaineers, 198 Chapter 8.
19 Emergency Medical Technician-Basic: National Standard Curriculum Module 4 Medical/Behavioral Emergencies and Obstetrics/Gynecology. 22 June 199 National
Highway Traffic Safety Administration United States Department of Transportation. 2 Dec 200 <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>
“Genitourinary.” United States Special Operations Command. Special Operations Forces Medical Handbook. Jackson, Wyoming: Teton NewMedia, 200 4-87.
“Male Genital Problems.” United States Special Operations Command. Special Operations Forces Medical Handbook. Jackson, Wyoming: Teton NewMedia, 200 377.
Schimelpfenig, Tod and Linda Lindsey. “Gender-Specific Medical Concerns.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200
Chapter 16.
Specific Protocols for Wilderness EMS Testicular Pain. Version 1.2 May 19, 199 The Wilderness Emergency Medical Services Institute. 2 Dec. 200
<http://www.wemsi.org/specific.html>
The Merck Manual 16th Edition. Rathaway, New Jersey: Merck & Co., Inc., 1992.
Tilton, Buck. “Gender-Specific Emergencies.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 32.
Wilkerson, James A. “Genitourinary Disorders.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 18.
20 Auerbach, Paul S. “Orthopedics.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter 21.
Emergency Medical Technician-Basic: National Standard Curriculum Module 5 Trauma. 22 June 199 National Highway Traffic Safety Administration United States
Department of Transportation. 2 Dec 200 <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>
Forgey, William. “Orthopedic Injuries.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The Globe
Pequot Press, 200 Chapter 8.
“Musculoskeletal Trauma.” PHTLS Basic and Advanced Prehospital Trauma Life Support. St. Louis, Missouri: Mosby, 200 Chapter 10.
Schimelpfenig, Tod and Linda Lindsey. “Athletic Injuries.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 15.
Schimelpfenig, Tod and Linda Lindsey. “Fractures and Dislocations.” Wilderness First Aid. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 5.
Tilton, Buck. “Athletic Injuries.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 14.
Tilton, Buck. “Fractures.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 12.
21 ACLS Provider Manual. Dallas, Texas: American Heart Association, 2002.
BLS for Healthcare Providers. Dallas, Texas: American Heart Association, 2002.
Emergency Medical Technician-Basic: National Standard Curriculum Module 4 Medical/Behavioral Emergencies and Obstetrics/Gynecology. 22 June 199 National
Highway Traffic Safety Administration United States Department of Transportation. 2 Dec 200 <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>
Schimelpfenig, Tod and Linda Lindsey. “Respiratory and Cardiac Emergencies, Seizures, Diabetes and Unconscious States.” Wilderness First Aid 3rd ed.
Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 18.
The Merck Manual 16th Edition. Rathaway, New Jersey: Merck & Co., Inc., 1992.
Tilton, Buck. “Neurological Emergencies.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 25.
22 Auerbach, Paul S. “Toxic Plant Ingestions.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter 48.
Emergency Medical Technician-Basic: National Standard Curriculum Module 4 Medical/Behavioral Emergencies and Obstetrics/Gynecology. 22 June 199 National
Highway Traffic Safety Administration United States Department of Transportation. 2 Dec 200 <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>
Forgey, William. “Botanical Encounters.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The Globe
Pequot Press, 200 Chapter 17.
Keyes, Linda E., Robert S. Hamilton, and John S. Rose. “Carbon Monoxide Exposure from Cooking in Snow Caves at High Altitude.” Wilderness and Environmental
Medicine, 12, 2001: 208-212.
Schimelpfenig, Tod and Linda Lindsey. “Poisons, Stings, and Bites.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 11.
Stewart, Charles E. “Plants That Poison.” Environmental Emergencies. Baltimore, Maryland: Williams & Wilkins, 199 Chapter 8.
The Merck Manual 16th Edition. Rathaway, New Jersey: Merck & Co., Inc., 1992.
Tilton, Buck. “Poisoning Emergencies.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 27.
23 Busse, William W. and Robert F. Lemanske. Jr. “Asthma.” New England Journal of Medicine Vol. 344, No. 5 February 1, 2001: 350-362.
Emergency Medical Technician-Basic: National Standard Curriculum Module 4 Medical/Behavioral Emergencies and Obstetrics/Gynecology. 22 June 199 National
Highway Traffic Safety Administration United States Department of Transportation. 2 Dec 200 <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>
“Respiratory.” United States Special Operations Command. Special Operations Forces Medical Handbook. Jackson, Wyoming: Teton NewMedia, 200 4-10.
Schimelpfenig, Tod and Linda Lindsey. “Respiratory and Cardiac Emergencies, Seizures, Diabetes and Unconscious States.” Wilderness First Aid 3rd ed.
Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 18.
Specific Protocols for Wilderness EMS Asthma. Version 1.2 May 19, 199 The Wilderness Emergency Medical Services Institute. 2 Dec. 200
<http://www.wemsi.org/specific.html>
The Merck Manual 16th Edition. Rathaway, New Jersey: Merck & Co., Inc., 1992.
Tilton, Buck. “Respiratory Emergencies.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 24.
Wilderness Field Protocols Protocol 6 Severe Asthma. 200 Wilderness Medical Associates. 2 Dec. 2004
<http://www.wildmed.com/field_protocols/joint_dis_protocol05.01.html top>
Wilkerson, James A. “Respiratory Disorders.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 10.
24 Emergency Medical Technician-Basic: National Standard Curriculum Module 5 Trauma. 22 June 199 National Highway Traffic Safety Administration United States
Department of Transportation. 2 Dec 200 <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>
“Shock and Fluid Resuscitation.” PHTLS Basic and Advanced Prehospital Trauma Life Support. St. Louis, Missouri: Mosby, 200 Chapter 6.
Schimelpfenig, Tod and Linda Lindsey. “Shock.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 2.
Tilton, Buck. “Shock.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 7.
25 Auerbach, Paul S. “Plant-Induced Dermatitis.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter 47.
“Skin.” United States Special Operations Command. Special Operations Forces Medical Handbook. Jackson, Wyoming: Teton NewMedia, 200 4-38.
17
Wilderness Medicine Institute of NOLS Wilderness Medicine Protocol Package © Modified with Permission by HMI. High Mountain Institute©2016.
Page
HMI Backcountry Medical Treatment and Evacuation Protocols (Feb 2016 Edition)
Stewart, Charles E. “Plants That Poison.” Environmental Emergencies. Baltimore, Maryland: Williams & Wilkins, 199 Chapter 8.
The Merck Manual 16th Edition. Rathaway, New Jersey: Merck & Co., Inc., 1992.
Tilton, Buck. “Common Simple Medical Problems.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 31.
Wilkerson, James A. “Allergies.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 20.
26 Auerbach, Paul S. “North American Venomous Reptile Bites.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter 38.
Forgey, William. “Reptile Envenomations.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The Globe
Pequot Press, 200 Chapter 20.
Gold, Barry S., Richard C. Dart and Robert A. Barish. “Bites of Venomous Snakes.” New England Journal of Medicine Vol. 347, No. 5, August 1, 2002: 347-356.
Russell, Findlay E. Snake Venom Poisoning. Great Neck, New York: Scholium International Inc., 1983.
Schimelpfenig, Tod and Linda Lindsey. “Poisons, Stings, and Bites.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 11.
Stewart, Charles E. “Bites and Stings.” Environmental Emergencies. Baltimore, Maryland: Williams & Wilkins, 199 Chapter 7.
Tilton, Buck. “North American Bites and Stings.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 21.
Wilkerson, James A. “Animal Bites and Stings.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 25.
27 Auerbach, Paul S. “Spider Bites.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter 34.
Auerbach, Paul S. “Scorpion Envenomation.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter 35.
Forgey, William. “Arthropod Envenomations.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The
Globe Pequot Press, 200 Chapter 21.
MMWR Weekly 45 (21) May 31, 1996: 433-43 “Necrotic Arachnidism -- Pacific Northwest, 1988-1996.” Centers for Disease Control and Prevention. 27 Dec. 200
<http://www.cdc.gov/mmwr/preview/mmwrhtml/00042059.htm>
Schimelpfenig, Tod and Linda Lindsey. “Poisons, Stings, and Bites.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 11.
Stewart, Charles E. “Bites and Stings.” Environmental Emergencies. Baltimore, Maryland: Williams & Wilkins, 199 Chapter 7.
Tilton, Buck. “North American Bites and Stings.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 21.
Wilkerson, James A. “Animal Bites and Stings.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 25.
28 Emergency Medical Technician-Basic: National Standard Curriculum Module 5 Trauma. 22 June 199 National Highway Traffic Safety Administration United States
Department of Transportation. 2 Dec 200 <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>
Domeier R. M. “Position Paper, National Association of EMS Physicians: Indications for prehospital spinal immobilization.” Prehospital Emergency Care 3(3) 1999:
251–253.
Forgey, William. “Spinal Injury.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The Globe Pequot
Press, 200 Chapter 5.
Hoffman J. R. and W. R. Mower. “Out-of-hospital cervical spine immobilization: Making policy in the absence of definitive information.” Annals of Emergency Medicine
37 June 2001: 632–634.
“Spinal Trauma.” PHTLS Basic and Advanced Prehospital Trauma Life Support. St. Louis, Missouri: Mosby, 200 Chapter 9.
Schimelpfenig, Tod and Linda Lindsey. “Head, Spinal Cord and Eye Injuries.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200
Chapter 6.
Tilton, Buck. “Spine Injuries.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 8.
Wilderness Field Protocols Protocol 4 Spine Injuries. 200 Wilderness Medical Associates. 2 Dec. 200
<http://www.wildmed.com/field_protocols/spine_man_protocol05.01.html top>
Wilkerson, James A. “ Head and Neck Injuries.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200
Chapter 16.
ACLS Provider Manual. Dallas, Texas: American Heart Association, 2002.
Auerbach, Paul S. “Submersion Incidents.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter 56.
Forgey, William. “Submersion Injuries.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The Globe
Pequot Press, 200 Chapter 3.
Harries, Mark. “ABC of resuscitation Near drowning.” BMJ Vol. 327 6 Dec. 2003: 1336-1338.
Schimelpfenig, Tod and Linda Lindsey. “Cold Water Immersion and Drowning.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200
Chapter 13.
State of Alaska Cold Injuries and Cold Water Near Drowning Guidelines. Revision 01/9 Hypothermia Prevention, Recognition and Treatment.
Articles, Protocols and Research on Life-saving skills. 27 Dec. 200 <http://www.hypothermia.org/protocol.htm>
Stewart, Charles E. “Near-Drowning.” Environmental Emergencies. Baltimore, Maryland: Williams & Wilkins, 199 Chapter 11.
Tilton, Buck. “Immersion and Submersion Incidents.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 19.
30 Emergency Medical Technician-Basic: National Standard Curriculum Module 5 Trauma. 22 June 199 National Highway Traffic Safety Administration United States
Department of Transportation. 2 Dec 200 <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>
Goth, Peter and George Garnett. “National Association of EMS Physicians Clinical Guidelines for Delayed or Prolonged Transport Wounds.” Prehospital and Disaster
Medicine Vol. 8 No. 3 July-Sep. 1993: 253-255.
Forgey, William. “Wilderness Wound Managment.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut:
The Globe Pequot Press, 200 Chapter 6.
Schimelpfenig, Tod and Linda Lindsey. “Soft Tissue Injuries.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 3.
Specific Protocols for Wilderness EMS Wounds. Version 1.2 May 19, 199 The Wilderness Emergency Medical Services Institute. 2 Dec. 200 <
http://www.wemsi.org/specific.html>
The Merck Manual 16th Edition. Rathaway, New Jersey: Merck & Co., Inc., 1992.
Tilton, Buck. “Wilderness Wound Mangament.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 15.
Wilderness Field Protocols Protocol 2 Wound Managament. 200 Wilderness Medical Associates. 2 Dec. 200
<http://www.wildmed.com/field_protocols/spine_man_protocol05.01.html top>
Wilkerson, James A. “Soft-Tissue Injuries.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 6.
31 Auerbach, Paul S. “Tick-Borne Diseases.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter 33.
Auerbach, Paul S. “Wilderness-Acquired Zoonoses.” Wilderness Medicine 4th ed. St. Louis, Missouri: Mosby, 200 Chapter 44.
Forgey, William. “Tick-Transmitted Diseases.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The
Globe Pequot Press, 200 Chapter 22.
“Infectious Diseases.” United States Special Operations Command. Special Operations Forces Medical Handbook. Jackson, Wyoming: Teton New Media, 200
Chapter 13, 5-33.
Schimelpfenig, Tod and Linda Lindsey. “Poisons, Stings, and Bites.” Wilderness First Aid 3rd ed. Mechanicsburg, Pennsylvania: Stackpole Books, 200 Chapter 11.
Specific Protocols for Wilderness EMS Rabies. Version 1.2 May 19, 199 The Wilderness Emergency Medical Services Institute. 2 Dec. 200
<http://www.wemsi.org/specific.html>
Stewart, Charles E. “Bites and Stings.” Environmental Emergencies. Baltimore, Maryland: Williams & Wilkins, 199 Chapter 7.
The Merck Manual 16th Edition. Rathaway, New Jersey: Merck & Co., Inc., 1992.
Tilton, Buck. “North American Bites and Stings.” Wilderness First Responder 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 200 Chapter 21.
Wilkerson, James A. “Animal Bites and Stings.” Medicine for Mountaineering 5th ed. Seattle, Washington: The Mountaineers Books, 200 Chapter 25.
Wilkerson, James A. “Rabies Update.” Wilderness And Environmental Medicine: Vol. 11, No. 1, 2000: 31–39.
Medication Kit
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Wilderness Medicine Institute of NOLS Wilderness Medicine Protocol Package © Modified with Permission by HMI. High Mountain Institute©2016.