Core Content for Wilderness Medicine Training: Development of a Wilderness Medicine Track Within an Emergency Medicine Residency.

Wilderness medicine training has become increasingly popular among medical professionals with numerous educational opportunities nationwide. Curricula for fellowship programs and for medical student education have previously been developed and published, but a specific curriculum for wilderness medicine education during emergency medicine (EM) residency has not. The objective of this study is to create a longitudinal wilderness medicine curriculum that can be incorporated into an EM residency program. Interest-specific tracks are becoming increasingly common in EM training. We chose this model to develop our curriculum specific to wilderness medicine. Outlined in the article is a 3-year longitudinal course of study that includes a core didactic curriculum and a plan for graduated level of responsibility. The core content is specifically related to the required EM core content for residency training with additions specific to wilderness medicine for the residents who pursue the track. The wilderness medicine curriculum would give residencies a framework that can be used to foster learning for residents interested in wilderness medicine. It would enhance the coverage of wilderness and environmental core content education for all EM residents in the program. It would provide wilderness-specific education and experience for interested residents, allowing them to align their residency program requirements through a focused area of study and enhancing their curriculum vitae at graduation. Finally, given the popularity of wilderness medicine, the presence of a wilderness medicine track may improve recruitment for the residency program.

EMS Intubation Improves with King Vision Video Laryngoscopy.

INTRODUCTION: Intubation success by paramedics has historically been variable. The lack of first-pass success (FPS) has been associated with increased adverse events. Various video laryngoscope (VL) devices have been investigated to improve success among paramedics. Conflicting research exists on VL vs. direct laryngoscopy (DL) by paramedics and on the effects of the specific King Vision device on FPS and overall success (OS) in an emergency medical services (EMS) system with low intubation frequency and historically low success rates. OBJECTIVES: To evaluate the effect of an ongoing training program using the King Vision VL on FPS, OS, and success per attempt when compared with DL in one suburban EMS system with low historical intubation success rates. METHODS: We performed a retrospective analysis of electronic patient care reports in a suburban EMS system. We analyzed three metrics of intubation success before DL and after implementation of ongoing training with VL in both cardiac arrest and in all other indications: success per attempt, overall success, and first-pass success. We also performed an intention to treat analysis of these rates to account for protocol violations. RESULTS: During the study period, intubation was attempted on 514 patients. There was no difference between the DL and VL groups in age, weight, gender, or percentage receiving paralytic medications. There was improvement over DL with VL in each of the outcome measures: overall success (64.9 vs. 91.5%, p < 0.01), first-pass success (43.8% vs. 74.2%, p < 0.01), and success per attempt (44.4 vs. 71.2%, p < 0.01). A subgroup analysis by indication for intubation also showed improvement in all metrics for all indications. There were several protocol violations: 11 of 376 attempts that should have used VL (2.9%) but were done with DL. An intention to treat analysis was therefore done. Again, we saw an improvement in all metrics for all indications. CONCLUSION: In this suburban EMS system with historically low intubation success rates and low frequency of intubation, paramedics were able to improve all measures of intubation success using the King Vision video laryngoscope and an ongoing training program when compared with direct laryngoscopy.