Core content for wilderness medicine fellowship training of emergency medicine graduates.

Wilderness medicine is the practice of resource-limited medicine under austere conditions. In 2003, the first wilderness medicine fellowship was established, and as of March 2013, a total of 12 wilderness medicine fellowships exist. In 2009 the American College of Emergency Physicians Wilderness Medicine Section created a Fellowship Subcommittee and Taskforce to bring together fellowship directors, associate directors, and other interested stakeholders to research and develop a standardized curriculum and core content for emergency medicine (EM)-based wilderness medicine fellowships. This paper describes the process and results of what became a 4-year project to articulate a standardized curriculum for wilderness medicine fellowships. The final product specifies the minimum core content that should be covered during a 1-year wilderness medicine fellowship. It also describes the structure, length, site, and program requirements for a wilderness medicine fellowship.

Austere, remote, and disaster medicine missions: an operational mnemonic can help organize a deployment.

Medical care in resource-limited environments (austere settings) can occur in the context of a disaster, wilderness, or a tactical field operation. Regardless of the type of environment, there are common organizational themes in most successful humanitarian missions that occur in harsh natural or manmade environmental conditions. These principles prioritize the initiation and execution of any given deployment in austere or remote settings, diverging from priorities that would occur in a situation in which change to the existing medical structure is intact and operating well. Attention to these priorities not only helps providers to deliver medical care to people in need during a period of resource limitations but it also can keep providers, teams, the public, and patients safe during and after a deployment.

Portable handheld ultrasound in austere environments: use in the Haiti disaster.

INTRODUCTION: A 7.0 magnitude earthquake struck Haiti on January 12, 2010, resulting in 222,000 deaths and 300,000 injuries. Three weeks after the initial quake, the New Mexico Disaster Medical Assistance Team (NM DMAT-1) was deployed to Haiti for ongoing medical relief. During this deployment, a portable handheld ultrasound machine was tested for usefulness in aiding with patient care decisions. OBJECTIVE: The utility of portable ultrasound to help with triage and patient management decisions in a major disaster setting was evaluated. METHODS: Retrospective observational non-blinded images were obtained on 51 patients voluntarily presenting to the Gheskio Field clinic at Port-au-Prince. Ultrasound was used for evaluation of undifferentiated hypotension, torso trauma, pregnancy, non-traumatic abdominal pain, deep venous thrombosis and pulmonary embolism, and dyspnea-chest pain, as well as for assisting with procedures. Scans were obtained using a Signos personal handheld ultrasound machine with images stored on a microSD card. Qualitative data were reviewed to identify whether ultrasound influenced management decisions, and results were categorized in terms of percent of scans that influenced management. RESULTS: Fifty-one ultrasound scans on 50 patients were performed, with 35% interpreted as positive, 41% as negative, and 24% as equivocal. The highest yields of information were for abdominal ultrasound and ultrasound related to pregnancy. Ultrasound influenced decisions on patient care in 70% of scans. Most of these decisions were reflected in the clinician's confidence in discharging a patient with or without non-emergent follow-up. CONCLUSION: The use of a handheld portable ultrasound machine was effective for patient management decisions in resource-poor settings, and decreased the need to triage selected patients to higher levels of care. Ultrasound was very useful for evaluation of non-traumatic abdominal pain. Dynamic capability is necessary for ultrasound evaluation of undifferentiated hypotension and cardiac and lung examinations. Ultrasound also was useful for guidance during procedural applications, and for aiding in the diagnosis of parasitic diseases.

The management of open fractures.

This is a review of Medline and PubMed articles on open fractures published in the English literature between 1945 and April 2005. The emphasis of most published articles has been placed on definitive treatment of these injuries at sophisticated referral hospitals. The prehospital emphasis has been on rapid evacuation and referral to ensure that definitive treatment can be initiated as quickly as possible. Little has been discussed about the management of these injuries in remote settings where evacuation may consume considerably more time. Contemporary recommendations for management of these injuries are reviewed.

Regional highlights in global emergency medicine development.

There are a number of notable trends in the development of EM that have been highlighted at the regional level globally. From the establishment of formal EM training as the standard of care to practice in an ED to the influence of transnational regulatory bodies and financing mechanisms on specialty development and the broad-based issues of health security that affect EM, the specialty continues to grow around the world. As practitioners in each of these regions struggle to respond effectively to the development issues and challenges presented here, they continue to advance EM as one of the more dynamic young specialties in medicine. The regions presented here are as distinctive as the people who practice our specialty; however, in many respects the highlights and challenges are universal. This recognition is perhaps what motivates the appeal for collaboration in international EM development.