Wilderness Medicine

9/19/2017  By HealthNews

September 19, 2017

Surgeon Dr. Tom Penoyar and other KVH providers will give a community presentation on Wilderness First Aid on October 24 in Cle Elum.

What exactly is Wilderness Medicine?

Technically, the term refers to a medical subspecialty that examines the effects of wilderness environments on human physiology - effects like temperature, low oxygen levels, or high pressure; environments on a spectrum as diverse as hiking in the Himalayas or deep sea diving in the Caribbean.

While studying at the University of Washington School of Medicine, Dr. Tom Penoyar and his classmate Carl Schillhammer developed a wilderness medicine elective that was the first of its kind at UW. With ongoing support from Harborview pulmonologist Dr. Andrew Luks, the 16-hour didactic course is still being taught today.

For those who aren’t planning a career in medicine, there are basic skills anyone can learn for medical safety in the outdoors. "In Kittitas County, we're primarily looking at rugged terrain," says Penoyar. "Sprains and fractures are typical in this kind of environment. Splinting is a good skill to have."

Enter Wilderness First Aid. It's like Basic First Aid, but honed for a 'remote environment.'

"The first person to provide aid isn't usually the certified Wilderness First Responder who's called to the scene of an accident, but a friend or family member - someone in the victim's party who applies pressure to a wound within moments," says Penoyar. Which emphasizes the importance of never truly going it alone in the wilderness - at least not without a communication plan (more on that later).

Penoyar recalls an incident when he was hiking Mt. Olympus with his wife Lauren. At the base of the summit block, they encountered an injured climber. He'd dislocated his shoulder near the summit, and was making his way down the glacier, slowly, painfully, but managing. The Penoyars made the decision to finish the climb and check on him again on their own descent.

Meanwhile, further down the glacier, another group of hikers had a different idea.

"They saw he was in pain, and gave him Percocet," says Penoyar. "By the time we met up with him again, he was in less pain but incapacitated from the narcotics, swinging his climbing axe around and generally a danger to himself."  The result? A helicopter was called to take the incapacitated man off the mountain. Though out of pain, he was now in no shape to make the rest of the trip down on his own.

Penoyar offers a short list of "must-dos" to prepare for wilderness recreation:

1. Have a communication plan. From beacons to walkies to satellite phones, there are lots of options for staying in contact. Know the capacity for your communication tool. How long does your cell phone charge last? Is there coverage in the area? Making arrangements to check in periodically - at scheduled times - with someone who knows where you're going is another good option.

2. Understand the risks. If you're headed to a new place, learn as much as you can about the type of terrain and what to expect before you go. Take appropriate safety equipment. Remember that you are in a remote area and can't expect to access care and treatment the way you would at home.

3. Learn basic splinting techniques. When someone in your party takes a spill, a splint can keep a possible broken bone stabilized until they can get back to civilization for medical treatment. In the case of an upper extremity injury, a splint/sling can make the difference between being to walk out or being in too much pain to move. 

4. Apply direct pressure to bleeding. In many cases, direct firm pressure is enough to stop or significantly slow bleeding. Of course, there's more to it than that; Basic First Aid training can help fill in your knowledge gaps. Which leads us to...

5. Increase your knowledge. Even if you're not headed to medical school, there's nothing to stop you from reading up on the subject. For example, Wilderness Medicine: Beyond First Aid, written by a physician, is just the first search result in a long list of related books for sale on Amazon.

6. Take responsibility. You are responsible for your own safety. You are aware of your knowledge and skill level. It's ultimately up to you to do wilderness recreation in a safe and responsible manner. If you're taking children with you, or others with dependent needs or a lack of experience in the outdoors, take responsibility for them, too. Be prepared, be aware, and be conscientious.

With KVH General Surgery since 2015, Dr. Tom Penoyar is a native Washingtonian.

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.