Ep. 4 - HOPE Score for Severe Hypothermia

This is part 1 of a multi-part series on the resuscitation of critically buried avalanche victims. In this episode we learn the physiology that we need to understand the resuscitation algorithm. To learn the necessary biology, we follow a rider as they are carried in an avalanche, subjected to traumatic injury, and are then buried and begin to asphyxiate and cool. 

The background of this episode is useful to understand why:
-Cardiac arrest from trauma is usually unsalvageable;
-Arrest due to hypoxia can happen within minutes or be delayed more than an hour;
-Why we care if someone is really, really cold;
-Why potassium measurement is useful in the hospital treatment of severe hypothermia;
-And why we can largely forget about that other gas, CO2.

Look out for the next episode, where I''ll dive into the ICAR Avalanche Victim Resuscitation Algorithm.

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD.

Connect with us by email at wildernessmedicineupdates@gmail.com.

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Episode 11 brings you  my conversation with Michael Buchanan is a flight paramedic and senior firefighter / paramedic at the West Valley City Fire Department. He is the founder and operation of Mountain Medical Academy, a passion-driven backcountry medical care education company.  We discuss the medical care of avalanche victims which Michael has made accessible to recreational skiers and riders who don't have a medical background.

Other topics that we discuss include:
-Finger sweeps to clear the airway
-How the presence of an air pocket changes your medical care
-How long to perform CPR after an avalanche
-What equipment may be useful to a lay rescuer
-The importance of psychological care after a critical event
And more.

Below are links to things discussed in this podcast:

Mountain Medical Academy - mountain medical education

After the Avalanche - Open source resources for responding medically and psychologically after an avalanche

Email Michael to Join a Class or Partner Up

Israeli Battle Dressing (affiliate link) - elastic compressive dressing for bleeding control

SWAT-T Elastic Tourniquet (affiliate link) - elastic tourniquet also useful in splinting

CPR Mask / Oral / Nasal Airways (affiliate link) - tools for rescue breathing / CPR

ICAR Avalanche Resuscitation Recommendations for advanced life support personnel

Responder Alliance - individual and organizational resilience for rescuers in the face of traumatic stress.

Not Alone complete film - Sarah Hueniken - a personal story of recovery from stress injury and trauma by a world class ice climber. 

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD.

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode, I discuss the article "Arterial Occlusion Effectiveness of Space Blanket-Improvised Tourniquets for the Remote Setting". In this short blast I get into the meat of this article, and though the authors would tell you that space blankets aren't ready for primetime, I have some thoughts on the matter.

In the podcast, I mistakenly say that you need to be a WMS member to access this article, but you don't! It's available open access here:

https://www.wemjournal.org/article/S1080-6032(23)00043-1/fulltext

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD.

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode Dr BZ is back to talk about his experience deploying with the Federal Emergency Management Agency (FEMA) Urban Search and Rescue Task Force (USAR). Dr BZ just returned from a deployment with FEMA USAR to Lahaina, HI, where he served as a team physician supporting rescue and recovery efforts there.

We touch on:
-Training and gear
-Deployments and schedule
-Compensation
-The care of canines
-How you can get involved, and more!

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD.

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

In this two-part episode, I review an article from the Annals of Emergency Medicine "Occupational Accidents Among Search and Rescue Providers During Mountain Rescue Operations and Training Events"

https://doi.org/10.1016/j.annemergmed.2022.12.015

In the second half, we review the treatment of diarrhea in the returning traveler.

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD.

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

In this second Fast Push, you get a riff on a great article from JEMS entitled "Safety is Third, Not First, and We All Know It Should Be" by Christopher Davis MD et al.

Apologies to all who got V1.0-- something weird happened in post that made me sound like a chipmunk. I might be a medical professional, but I'm no AV specialist. 

Summary:

1. Get the Job Done
2. Have Fun
3. Safety Third

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD.

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode I go deep on the health effects of wildfire smoke, answering some key questions that are relevant to recreational athletes, outdoors professionals, wildland firefighters, and industrial athletes alike:

Why is wildfire smoke harmful?
Is there a safe level of exposure?
Can we trust the EPA's guideline levels? (Spoiler: no)
Does the benefit of exercise outweigh the damage of smoke exposure?
If you have to be outside, how can you limit harms?

And more. Get ready for a trip down nerd lane.

Links from the show:
Bad reporting from the NY Times
EPA Air Quality Index Infopage
Study: Effects of Air Pollution and Habitual Exercise
Respro Ultralight Particulate Mask
CDC Building Ventilation Info
PurpleAir Indoor Air Quality Monitor
AwAir Indoor Air Quality Monitor

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD.

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

In this inaugural interview episode I have the pleasure of grilling Dr. Brant-Zawadzki about operating an urban EMS system at a wilderness boundary.

We talk about:
- Improvising outside the protocol
- Interfacing with SAR, rangers, and road workers
- How response kit and expectations are changed beyond the pavement
- What a fellowship in Wilderness Medicine can do for you career
And more!

Show Links:
EMS Fellowship, U of U
Wilderness Fellowship, U of U
Unified Fire Authority
Become world class by combining multiple domains of knowledge (lesswrong)
Wilderness Medical Society (twitter)

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD.

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode we review the available evidence, and the pros and cons, of using mechanical CPR devices like the LUCAS or Autopulse for ski patrol and mountain rescue applications.

Episode links:

CPR With a Lucas Device - An example video from EMS training

Viglino et. al. - Outcomes of On-Hill Cardiac Arrests - More saves, probably because of younger patients, bystander CPR, shockable rhythms, and shorter time to defib.

WMS Guidelines on the Care of Avalanche Victims - Recommends LUCAS use for prolonged transports and extrications.

Putzer et. al. - LUCAS in Simulated Helicopter Rescue
"Physical strain during a realistic alpine rescue mission scenario at high altitude led to a significant reduction in quality of resuscitation. Resuscitation guidelines developed at sea level are not directly applicable in the mountain terrain."

Wang et. al. - CPR Quality at Altitude, Unacclimatized Rescuers

Egger et. al. - CPR Quality at High Altitude, Acclimatized Rescuers

Cascade Rescue 'Trauma One' Toboggan

YouTube: Alyeska Resort Patrol High Performance CPR in Toboggan

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD.

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode we discuss the HOPE score, a tool that improves our ability to select the severely hypothermic patients who can benefit from warming with extracorporeal life support (ECLS).

We begin the with the case of Tayyab Jafar, a young man who was successfully resuscitated from severe hypothermia with both cardiopulmonary bypass and ECMO, but not without incident. 

We then discuss the derivation and validation studies for the HOPE score.

You can calculate and use the HOPE score at HypothermiaScore.org.

HOPE score derivation PDF

HOPE score validation: not freely available

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD.

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.