Wilderness Medicine Updates

Dr. Patrick Fink interviews Dr. Nick Daniel and Dr. Gavin Clark about an in-hospital case of exertional heat stroke in a mid-20s runner who collapsed just before the finish of an October New England half marathon in 45°F weather. EMS treated presumed SVT with adenosine, but in the ED the patient was hypotensive, profoundly diaphoretic, and altered; an oral temperature was normal while a rectal core temperature was 105.5°F, highlighting that peripheral temps can’t rule out heat stroke. We discuss rapid “cool first” management using ice packs, misting, and fans to reach 102°F within ~30 minutes, compare cooling methods (cold-water immersion, tarp-assisted oscillation, Quantico method, frozen sheets), review labs showing lactate 9 and AKI, explain sepsis-like physiology via gut hypoperfusion, and note possible risk contribution from recent COVID and acute Lyme IgM positivity. Links : Ep. 33 - Heat Illness Fundamentals Ep. 27 - Thermoregulation: The Physics and Physiology of Body Temperature Regulation Clark G, Kocen S, Daniel N. Icy Hot: A Case of Unexpected Heat Illness. Wilderness Environ Med. 2026 Jun 16:10806032261458332. doi: 10.1177/10806032261458332. Epub ahead of print. PMID: 42300334. Eifling KP, Gaudio FG, Dumke C, et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update. Wilderness & Environmental Medicine . 2024;35(1_suppl):112S-127S. doi: 10.1177/10806032241227924 Chapters: 00:00 Show Intro and Guests 02:43 Meet the Doctors 03:48 Race Day Collapse Setup 04:47 Finish Line Differential 06:48 EMS Report and History 08:55 Core Temp Surprise 11:25 Field Temp Takeaways 13:38 Rapid Cooling in ED 15:36 Cooling Rates and Goals 16:28 Immersion and Alternatives 18:17 Tarp and Body Bag Hacks 19:32 Quantico and Frozen Sheets 21:10 Field Cooling Methods 21:48 Lab Workup Red Flags 23:23 Lactate Nine Explained 24:21 Heatstroke Sepsis Pathway 26:40 Hidden Factors COVID Ticks 29:09 Fever Versus Hyperthermia 31:27 Prehospital Takeaways 35:00 Race Day Kit Checklist 36:35 Cool First Transport Later 37:29 Outcome And Wrap Up 39:46 Podcast Closing Notes As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 .

Forty to seventy-five percent of tourniquets placed in the field are never actually needed. In Ukraine, tourniquets left on too long during delayed evacuations have cost people limbs that the original wound never would have. This fast push covers the new May 2026 TCCC Guidelines update and two CoTCCC training briefs on tourniquets, built around lessons from prolonged evacuations in the Russo-Ukrainian war. Topics: telling truly life-threatening bleeding from bleeding that just looks bad, the case of an 11.5-hour tourniquet that cost an arm, reassessment moving from a medic-only skill to something every responder needs, the six options at reassessment (remove, convert, reposition, tighten, add a second, leave alone), how to convert a tourniquet, and what changes once one's been on past six hours. Takeaway: applying a tourniquet is the easy part. Knowing what to do with it for the next several hours is what actually saves the limb. References: Committee on Tactical Combat Casualty Care. TCCC Guidelines, 01 May 2026. https://deployedmedicine.com/tccc Full guidelines PDF: https://learning-media.allogy.com/api/v1/pdf/18ccfdfc-a076-47e9-8a34-376efdd81b43/contents Butler F, Holcomb J, Dorlac W. TCCC Quick-Look: What Kind of Bleeding Requires a Tourniquet? 19 May 2026. https://www.aast.org/static/dadfd895-d295-4a5d-9f45f8d92940991c/TCCC-260521-TCCC-Quick-Look-Who-Needs-a-Tourniquet.pdf Koch EJ, Andersen M, Barbee GA, et al. Standardizing Tourniquet Reassessment and Conversion Across TCCC Tiers: TCCC Guidelines Proposed Change 25-2. J Spec Oper Med. 2026;26(1):M4V1-O3Y7. This is the peer-reviewed paper behind the Tourniquet Reassessment Quick-Look. https://jsomonline.org/product/standardizing-tourniquet-reassessment-and-conversion-across-tccc-tiers-tccc-guidelines-proposed-change-25-2/ PubMed: https://pubmed.ncbi.nlm.nih.gov/41818038/ As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 .

Dr. Patrick Fink reviews the spectrum of heat illness using 2024 Wilderness Medical Society guidelines, covering recognition, physiology, field treatment, and key mimics. He distinguishes heat edema, heat cramps (salt-depletion vs exercise-associated), heat syncope and exercise-associated collapse, and defines heat exhaustion by preserved mental status versus heat stroke by altered mental status in a heat context, warning not to wait for a temperature threshold. He explains heat stroke pathophysiology as direct thermal injury plus a sepsis-like inflammatory cascade from gut hypoperfusion and barrier failure, emphasizing “heat × time” and a 30-minute cooling window. Core management is “cool first, transport second,” with cold water immersion as gold standard and improvised “tarp taco” alternatives; stop cooling around 38.3–38.8°C, avoid antipyretics and dantrolene, and use fluids only as support. He highlights exercise-associated hyponatremia as a dangerous mimic requiring hypertonic saline, and discusses disposition, including possible field release after full recovery within two hours for healthy exertional cases. Links Episode 27: Thermoregulation: The Physics and Physiology of Body Temperature Regulation Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update Chapters 00:00 Heatstroke Trail Scenario 01:02 Episode Roadmap 03:34 Thermoregulation Basics 06:43 Mild Heat Illness 11:21 Heat Exhaustion Line 13:32 Heat Stroke Recognition 17:18 Why Heatstroke Kills 22:37 Cool First Transport Second 24:51 Cold Water Immersion 27:31 Improvised Field Cooling 28:28 Myths Meds and Fluids 33:56 Hyponatremia Mimic 36:57 Disposition and Transport 39:38 Gear and Preparation 41:05 Key Takeaways Wrap Up As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 .

That EpiPen in your kit expired eighteen months ago. Anaphylaxis is happening. Do you use it? This episode digs into a 2025 systematic review from the American Red Cross Scientific Advisory Council that asked a question most of us have quietly wondered about: do expired resuscitation medications still work? We walk through the evidence on the four drugs that matter most in the field — albuterol, aspirin, epinephrine, and naloxone — and what the science actually says when in-date meds aren't an option. In this episode: Why the expiration date is a manufacturer's guarantee, not a tombstone — and what it actually measures The honest limitation behind all 17 studies: this is bench chemistry, not human outcomes Albuterol holding 98% potency 20–30 years out, and why the inhaler's valve is the real weak link The aspirin asterisk: solid for years, but down to under 12% active drug at 28–40 years Epinephrine that's gone a little brown — discolored doesn't mean toxic, it means weaker The nornaloxone question, and why decades-old naloxone still isn't dangerous Sterility, storage, and the dashboard-baked-pen problem the studies couldn't answer Where the ethics land: doing something with a probably-weakened drug vs. doing nothing The takeaway: Carry in-date meds. Rotate your stock. Store them cool and dark. But throw out the binary — in a real emergency with no alternative, that expired pen very likely still has most of its fight left. The mountain doesn't check expiration dates. Neither does anaphylaxis. Reference: Charlton N, Berry DC, Kannan V, Yee R, Carlson JN, Orkin AM. "The use of expired resuscitation medications for life-threatening first aid conditions: a systematic search and narrative review." Resuscitation Plus . 2025;26:101110. Open access (CC BY). As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 .

Prehospital Airway Fundamentals for BLS: Positioning, Pocket Mask, NPA/OPA, BVM, and LMA Dr. Patrick Fink presents a BLS-focused airway fundamentals episode for prehospital and wilderness/SAR responders, emphasizing an ingrained, stepwise approach to stave off respiratory badness. Links: Airway Fundamentals Video Intersurgical iGel LMA Chapters: 00:00 Airway Basics Overview 01:52 Questions And Upcoming Episodes 04:04 Scenario Mountain Biker 05:33 Airway Positioning Jaw Thrust 09:42 Pocket Mask Ventilations 13:24 Nasal Airway NPA 17:53 Oral Airway OPA 22:22 Putting It All Together 24:26 Oxygen And Bag Valve Mask 29:03 PEEP Valve Tips 30:29 Laryngeal Mask Airway 35:52 Full Airway Algorithm Walkthrough 38:39 What I Carry In My Kit 39:39 Practice And Mental Rehearsal 42:17 Wrap Up And Support The Show As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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. Patrick Fink reviews accidental hypothermia for wilderness providers, building on Ep. 27 Thermoregulation, explaining physiologic changes as core temperature falls and why accurate core temperatures are difficult to obtain in the field. We learn the modified Swiss staging system (0–4) based on signs and symptoms and outlines field management: - 0 cold stress (shelter, dry/insulate, warm calories; avoid alcohol), - 1 mild hypothermia (ataxia/fine motor impairment; passive plus active external rewarming with a hypothermia wrap and heat near axilla/groin; frequent reassessment), - 2 moderate hypothermia (confusion/lethargy; active external rewarming, evaluate hypoglycemia, gentle handling and no exertion to avoid afterdrop, cardiac monitoring, expedite evacuation), - 3 severe hypothermia (unresponsive with vital signs; airway/ventilation support, extremely gentle transport) - 4 hypothermic cardiac arrest (60-second pulse check, CPR, limited shocks under 30°C, withhold epinephrine/amiodarone under 30°C, consider intermittent CPR per protocol, and note potassium’s role in termination decisions). We also briefly contrasts slow non-extracorporeal warming with ECMO/cardiopulmonary bypass, previewing a future episode on advanced care and the HOPE score Links Episode 27: Thermoregulation WMS 2019 Accidental Hypothermia Guideline AHA Hypothermia Guidelines European Resuscitation Council Hypothermia Algorithm Chapters: 00:00 Welcome and Overview 00:48 Hypothermia Basics 01:12 Cooling Physiology 04:06 Severe Effects and Arrhythmias 06:38 Field Temp Challenges 07:41 Swiss Staging Intro 08:35 Stage 0 Cold Stress 11:40 Stage 1 Mild Hypothermia 16:04 Stage 2 Moderate Hypothermia 20:44 Afterdrop and Handling 22:54 Stage 3 Severe Hypothermia 27:00 Stage 4 Cardiac Arrest 27:57 CPR Shocks and Drugs 37:01 Advanced Rewarming ECMO 43:26 Key Takeaways Summary 46:57 Wrap Up and Support As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 .

Reevaluating Spinal Motion Restriction: Evidence Update In this episode of Wilderness Medicine Updates, host Dr. Patrick Fink delves into the evolving guidelines and practices concerning spinal motion restriction. Drawing from historical dogma and modern research, Patrick explores the inefficacies and potential harms of traditional spinal immobilization tools like rigid spine boards and cervical collars. Instead, he advocates for more flexible, evidence-based approaches such as using well-padded surfaces and coaching patients to minimize their own motion. Key points from a comprehensive literature review by the National Association of EMS Physicians and other authoritative bodies are discussed, highlighting the shift from immobilization to motion restriction and its practical implications. Listeners are urged to stay updated with current evidence and consult medical directors before altering their practices. Links Ep. 14 - Spinal Immobilization Guidelines Update 2018 ACEP/NAEMSP Sminal Motion Restriction Position Statement Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries - A NAEMSP Comprehensive Review and Analysis of the Literature Chapters 00:00 Introduction to Wilderness Medicine Updates 00:42 Historical Perspective on Spinal Immobilization 01:44 Transition to Spinal Motion Restriction 03:30 Review of Recent Literature 05:40 Key Findings on Spinal Motion and Neurological Outcomes 09:30 Effectiveness of Backboards and Cervical Collars 12:10 Potential Harms of Immobilization Tools 16:38 Practical Recommendations and Future Directions 21:48 Conclusion and Final Thoughts As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 .

Wilderness Orthopedics: Managing Trauma in Remote Environments with Dr. Chris Healy In this episode of Wilderness Medicine Updates, host Dr. Patrick Fink tackles orthopedic injuries in the wilderness with Dr. Chris Healy, an orthopedic surgeon and outdoor enthusiast. They explore the management of long bone fractures, traction for femur, pelvic binders, and the nuances of treating injuries in limited-resource environments. The episode covers strategies for handling common injuries like shoulder dislocations, tibia fractures, knee injuries, and how to prioritize care. They also emphasize the importance of timely evacuation and when and how to safely attempt reductions in the field. Links: Donate to the Tina Biddle Memorial Scholarship Sulcus sign / Squaring of the shoulder Chapters: 00:00 Introduction and Episode Overview 01:36 Tribute to Tina Biddle 04:09 Meet Dr. Chris Healy 05:11 Ski Patrol Background and Pre-Hospital Care 08:12 Approaching Orthopedic Injuries in the Field 17:50 Managing Tibia and Fibula Fractures 21:40 Understanding Compartment Syndrome 27:50 Femur Fractures and Traction Splinting 36:57 Pelvic Fractures: Identification and Management 38:41 Understanding Pelvic Fractures and Binders 39:53 The Role of Pelvic Binders in Pre-Hospital Care 41:11 Challenges with Pelvic Binders in the Field 43:15 Proper Placement of Pelvic Binders 46:36 Field Management of Shoulder Dislocations 50:43 Techniques for Reducing Shoulder Dislocations 54:17 Managing Upper Extremity Injuries 57:51 Handling Knee Injuries in the Field 01:00:37 Patella vs. Knee Dislocations 01:08:06 Evacuation Priorities for Knee Dislocations 01:10:53 Common Issues in Pre-Hospital Orthopedic Care 01:15:36 Final Thoughts and Listener Engagement As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 .

Understanding Stress Injuries in First Line Responders with Laura McGladrey This episode of Wilderness Medicine Updates, hosted by Patrick Fink, features a conversation with Laura McGladrey, founder of the Responder Alliance. They discuss the critical issue of stress injuries among first line responders, including professional ski patrollers, healthcare workers, and rescue team members. Through personal stories and expert insights, Laura explains the concept of stress injuries, how they develop, and the importance of early detection and mitigation. The episode highlights the need for both individual and organizational strategies to support resilience and manage stress. Listeners are introduced to practical tools, cultural shifts, and personal anecdotes to help maintain a long, healthy, and fulfilling career in high-stress environments. Links Responder Alliance Home Page Access all that the organization has to offer. Responder Alliance: Resource Hub Easy access to critical tools and offerings. The Stress Continuum See the visual continuum that we discuss on the show. Scholarships: Responder Alliance Foundation Apply for aid for an individual or team training. Make a Donation to Responder Alliance Foundation! Join me in making a tax-deductible donation to support the valuable work of the Responder Alliance and bring this work to those who need it, regardless of cost. Chapters 00:00 Introduction and Guest Welcome 02:11 Laura's Background and Work 06:00 Understanding Stress Injuries 10:02 Responder Alliance Mission and Challenges 20:55 Critical Incident Stress Management 30:49 Empowering First Responders 32:13 Daily Investments in Resilience 37:26 Recognizing and Managing Stress 38:14 Organizational Support for Stress Management 39:45 Building Resilient Teams 46:12 Learning from Resilient Leaders 52:42 Resources for Stress Mitigation 57:54 Conclusion and Final Thoughts As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 of Wilderness Medicine Updates, host Patrick Fink delves into the topic of thermoregulation, explaining how our bodies regulate temperature in response to environmental changes. Listeners will learn about methods of heat exchange (conduction, convection, radiation, and evaporation), how to measure core temperature, and the body's physiological responses—such as shivering, sweating, and blood flow control. The episode also touches on the effects of age, metabolic stressors, and pregnancy on thermoregulation, as well as the importance of understanding these principles in the context of treating conditions like hypothermia and heat-related illnesses. 00:00 Introduction and Episode Overview 01:29 Importance of Thermoregulation 03:12 Human Thermoregulation Mechanisms 04:20 Measuring Core Temperature 07:55 Heat Exchange Methods 14:52 Behavioral and Physiological Responses 24:48 Sex and Age Differences in Thermoregulation 27:14 Conclusion and Next Steps As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 of Wilderness Medicine Updates, host Patrick Fink delves into groundbreaking technology designed to improve safety during avalanche events. The focus is on SafeBack SBX, a Norwegian-developed device that supplies air to users buried in avalanches, potentially extending survival time. Patrick reviews new research published in the Journal of the American Medical Association, which demonstrates significant efficacy in delaying hypoxia during simulated avalanche burials. The episode provides an in-depth analysis of SafeBack SBX, its mechanisms, study results, and its comparative and complementary role alongside existing safety technologies like airbags. Concluding with potential applications and limitations, Patrick aids listeners in deciding whether SafeBack SBX is a worthy addition to their avalanche safety gear. Links Eisendle F, Roveri G, Rauch S, et al. Respiratory Gas Shifts to Delay Asphyxiation in Critical Avalanche Burial: A Randomized Clinical Trial. JAMA. Published online October 08, 2025. doi:10.1001/jama.2025.16837 Articles I've written about Safeback: Suffocation or Survival: A Crucial Factor in Avalanche Burials Avalanche Safety: Assessing the Safeback SBX System First Look: Safeback SBX Avalanche Safety System Chapters 00:31 Overview of SafeBack SBX Technology 02:55 Importance of SafeBack in Avalanche Safety 05:40 Details of the SafeBack Study 07:53 Study Results and Analysis 11:07 Implications and Future Directions 15:50 Conclusion and Final Thoughts As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 .

On this episode of Wilderness Medicine Updates, host Patrick Fink shifts focus from the science and literature of wilderness medicine to practical fitness tips for search and rescue personnel, ski patrollers, and outdoor rescuers. Patrick interviews Rob Shaw, founder and head coach of the Mountain Tactical Institute, about his specialized training programs for various types of mountain athletes, including those in industrial and tactical roles. They discuss the nuances of preparing for seasonal work, the distinct fitness demands of ski patrollers versus search and rescue members, and the importance of chassis integrity and mental fitness. Rob highlights minimal equipment training plans that can be effective for mountain professionals and recreational athletes alike, and offers a special discount for the show's listeners. Additional topics covered include Rob's nutritional recommendations and the concept of the 'quiet professional,' someone deeply committed to the craft of their work. Offer Are you involved in mountain or wilderness rescue? Rob is offering the first 50 listeners who reach out to him a 20% discount on a training plan. Send your rescue or professional credentials to rob@mtntactical.com to secure your discount. Links Training Plans Patrick Likes: Mountain Base Fitness Greek Heroine Series Busy Dad Training Packet Backcountry Ski Preseason Training Plan Exercises Discussed: Leg Blasters Scotty Bobs Touch Jump Touch Rob's Resources: Ideal bodyweights for mountain athletes Nutritional guidelines Mountain/Wilderness SAR Fitness Assessment Training Plan Resilience vs. Discipline vs. Perseverance: Why the Distinctions Matter in Mental Fitness The 8 Core Attributes of Mental Fitness Chapters 00:00 Introduction to Wilderness Medicine 00:46 Guest Introduction: Rob Shaw from Mountain Tactical Institute 04:38 The Evolution of Mountain Tactical Institute 06:58 Training for Mountain and Tactical Athletes 11:43 Fitness Demands for Ski Patrol 19:13 In-Season Training and Professionalism 24:47 Fitness for Search and Rescue Volunteers 25:10 Integrating Training with Daily Life 25:15 Physical and Mental Demands of SAR 25:38 Uphill Endurance and Chassis Integrity 26:25 Step Ups and Efficient Training Methods 28:23 Chassis Integrity Explained 31:53 Mental Fitness and Resilience 35:45 Nutritional Recommendations for Athletes 37:49 The Quiet Professional 42:30 Conclusion and Resources As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 of Wilderness Medicine Updates, host Patrick Fink breaks down a recent research paper on the differences between simulated avalanche burial and tree well burial, analyzing the findings and their implications for skiers and outdoor rescue personnel. We then transition to a special Q&A session with pre-med student Zack Majd, tackling questions about forming a career in wilderness medicine. Patrick discusses the necessary educational paths, the benefits and limitations of fellowships, and the essentials of wilderness medical training. Additionally, the episode highlights upcoming educational events and provides practical advice on wilderness medical gear, psychological support techniques, and the integration of wilderness medicine with other medical disciplines. A must-listen for anyone interested in advancing their career in the field of wilderness medicine. Links: Kanaan NC, Abdul Cader J, Krakker J, Beasley H, Grissom CK, McIntosh SE. Simulated Avalanche vs Tree-Well Burial Effects on Human Physiology. Wilderness & Environmental Medicine . 2025;36(3):361-367. doi: 10.1177/10806032251337476 Van Tilburg C, Paal P, Strapazzon G, et al. Wilderness Medical Society Clinical Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents: 2024 Update. Wilderness & Environmental Medicine . 2023;35(1_suppl):20S-44S. doi: 10.1016/j.wem.2023.05.014 Fink PB, Wheeler AR, Smith WR, et al. Wilderness Medical Society Clinical Practice Guidelines for the Treatment of Acute Pain in Austere Environments: 2024 Update. Wilderness & Environmental Medicine . 2024;35(2):198-218. doi: 10.1177/10806032241248422 EP. 21 - Snow Immersion Suffocation Chapters: 00:00 Introduction and Episode Overview 00:43 Upcoming Events in Wilderness Medicine Part 1 02:07 Tree Well Burials vs. Avalanche Burials 05:36 Study Findings and Analysis 08:23 Limitations and Implications of the Study Part 2 11:21 Q&A: Careers in Wilderness Medicine 12:48 Zach's Journey and Career Questions 20:35 Balancing Wilderness Medicine with Other Careers 26:05 Pathways to Wilderness Medicine 30:32 Debating the Value of Wilderness Medicine Fellowships 32:21 Personal Experience with Wilderness Medicine Fellowship 34:29 Research in Wilderness Medicine 37:05 Essential EMS Gear for Wildland Firefighters 39:19 Prioritizing Care in Wilderness Settings 47:31 Psychological First Aid in Wilderness Medicine 50:49 Preparing for Wilderness Medicine Challenges 53:55 Future of Wilderness Medicine 57:33 Signoff As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 of Wilderness Medicine Updates, Dr. Patrick Fink discusses airway management in austere situations with Dr. Nicholas Weinberg. They explore two cases published in the Wilderness Medicine Journal, detailing the decision-making processes in managing critically injured patients. Dr. Weinberg shares his background in emergency and wilderness medicine, and highlights the importance of flexibility and the application of basic life support techniques in the wilderness. The episode emphasizes the significance of understanding the limitations and capabilities of the available tools in wilderness settings. Links WEM Article Photo: Ledge from the fallen climber Photo: Himalayan clinic resuscitation Connect with Dr Weinberg: Nicholas.E.Weinberg@hitchcock.org Timeline 00:00 Introduction and Overview 00:26 Meet Dr. Nicholas Weinberg 01:48 Dr. Weinberg's Background and Career 03:55 Case Introduction: The Climbing Accident 05:38 On-Scene Response and Initial Assessment 08:11 Airway Management and Rescue Coordination 11:05 Patient's Condition and Medical Interventions 18:34 Patient's Recovery and Conclusion 21:01 Reflecting on a Remarkable Case 21:30 Discussing the Second Case 22:59 Experiences in Wilderness Medicine 25:24 Challenges and Strategies in Remote Medical Care 30:31 Managing Airway in Austere Environments 37:42 Advice for Aspiring Wilderness Physicians 42:24 Concluding Thoughts and Listener Shoutouts As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 .

Exploring Xenon Gas for Altitude Acclimatization and Sport Performance In this episode of Wilderness Medicine Updates, host Patrick Fink delves into the use of inhaled xenon gas for sports performance enhancement and altitude acclimatization. The discussion is prompted by a recent claim from a UK climbing team that xenon helped them achieve a rapid ascent of Mount Everest. Xenon, a noble gas traditionally used as an anesthetic, has been shown to trigger hypoxia response pathways and boost EPO levels in animal studies. However, human trials have yet to demonstrate significant performance benefits or lasting changes in blood composition. The episode also examines the safety concerns and potential risks associated with unsupervised xenon use. While xenon shows some promise, current evidence suggests it may be more of a placebo effect rather than a reliable tool for enhancing athletic performance or altitude adaptation. Join us on social! Instagram - Wildmedupdates Bluesky - wildmedupdates.bsky.social X - Wildmedupdates YouTube - WildernessMedicineUpdates Chapters 00:00 Introduction to Wilderness Medicine Updates 00:19 Xenon Gas in Sports and Altitude Acclimatization 02:26 The Science Behind Xenon Gas 06:13 Human Studies on Xenon Gas 12:19 Risks and Side Effects of Xenon Gas 15:50 Conclusion and Final Thoughts 18:04 Social Media Announcement Sources Dias, K.A. et al. (2019). Effect of acute and chronic xenon inhalation on erythropoietin, hematological parameters, and athletic performance. Journal of Applied Physiology, 127(6), 1503-1510 Lawley, J.S. et al. (2019). Safety, hemodynamic effects, and detection of acute xenon inhalation: rationale for banning xenon from sport. Journal of Applied Physiology, 127(6), 1511-1518 Ma, D. et al. (2009). Xenon preconditioning protects against renal ischemic-reperfusion injury via HIF-1α activation. Journal of the American Society of Nephrology, 20(4), 713-720 Pappas, S. (2023). “Did Inhaling Xenon Gas Really Help Mount Everest Climbers Reach the Summit in Record Time?” Scientific American Hackett, P. (2025). “Xenon Gas and High-Altitude Performance: What We Know and What We Don’t.” Uphill Athlete As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 of Wilderness Medicine Updates, host Patrick Fink interviews Moose Mutlow, an experienced outdoor educator and search and rescue professional with nearly four decades of experience globally. Moose discusses his extensive career from being an Outward Bound instructor to working with Yosemite Search and Rescue, and his role as a Family Liaison Officer for the National Park Service. The conversation touches on the challenges faced by search and rescue teams, the importance of robust communication skills, and how to build resilience against trauma in high-stress professions. Moose also shares his personal experiences, reflecting on the value of mentorship, the significance of team dynamics, and the essential need for compassionate support during crises. The episode includes practical advice for those in the field of wilderness medicine and search and rescue, highlighting the necessity of emotional balance and continuous learning. Connect with Moose: Website Blue Sky Instagram Substack Book: Searching Book: When Accidents Happen Did you enjoy this episode? Contribute to YOSAR! Links from the show: The Stress Continuum Responder Alliance Quell Foundation Dr. Nicola Lester: trauma informed practice More Reading: Ranger Confidential Nature Noir The Cold Vanish The Last Season CHAPTERS 00:00 Introduction and Guest Welcome 00:19 Moose Motlow's Background and Career 01:58 Challenges in Search and Rescue 02:58 The Importance of National Parks 05:23 Moose's Nickname and Early Career 07:07 Transition to the US and Outdoor Adventures 10:54 Search and Rescue Experiences 15:20 Swift Water Rescue Operations 19:38 Training and Mentorship in SAR 30:18 Role of Family Liaison Officer 45:24 Managing Emotional Burden as a Liaison Officer 47:12 Recognizing and Addressing Trauma 48:36 The Importance of Peer Support 49:44 Cultural Norms and Vulnerability 51:05 The Cost of Ignoring Trauma 53:37 Building Resilience and Longevity in Careers 58:51 Mentorship and Knowledge Sharing 01:03:11 The Role of Family Liaison Officers 01:05:50 Training and Communication Skills 01:17:52 Lighthearted Stories from the Field 01:23:14 Recommended Resources and Final Thoughts As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 dive into one of the most overlooked but deadly hazards in deep powder skiing: snow immersion suffocation (NARSID) . Unlike avalanches, snow immersion deaths happen silently—often within feet of a groomed run—when skiers and snowboarders fall into deep snow or tree wells and become trapped. We explore the research behind these incidents, where and how they occur, who is most at risk, and the tragic mechanics of asphyxiation in deep snow. Using studies from Van Tilburg, Baugher, and Cadman, we break down ra eal survival story, discuss prevention strategies, and how both bystanders and professional rescuers should respond. Whether you’re a backcountry adventurer, resort skier, or ski patroller, this episode will change the way you think about deep snow safety. Stay aware, ski with a partner, and stay out of tree wells. Must Watch: GoPro Awards: Tree Well Rescue Citations Baugher, P. (2006). Risk trends at U.S. and British Columbia ski areas: An evaluation of the risk of snow immersion versus avalanche burials. In Proceedings of the 2006 International Snow Science Workshop (pp. 584–591). International Snow Science Workshop. URL: https://arc.lib.montana.edu/snow-science/item/2076 Cadman, R. (1999). Eight nonavalanche snow-immersion deaths: A 6-year series from British Columbia ski areas. The Physician and Sportsmedicine, 27(13) , 31–43. URL: (No publicly available link found—may be available through institutional access) Van Tilburg, C. (2010). Non–avalanche-related snow immersion deaths: Tree well and deep snow immersion asphyxiation. Wilderness & Environmental Medicine, 21(3) , 257–261. URL: https://doi.org/10.1016/j.wem.2010.04.004 Van Tilburg, C. S., Grissom, C. K., Zafren, K., McIntosh, S. E., Radwin, M. I., Paal, P., et al. (2017). Wilderness Medical Society practice guidelines for the prevention and management of avalanche and non-avalanche snow burial accidents. Wilderness & Environmental Medicine, 28(1) , 23–42. URL: https://doi.org/10.1016/j.wem.2016.10.001 Chapters 00:00 Introduction: The Hidden Dangers of Snow Immersion 00:37 Understanding Snow Immersion Suffocation 02:58 Historical Context and Research 03:09 Where and How Snow Immersion Happens 04:54 Mechanics of Snow Immersion Traps 06:23 Risk Factors and Victim Profiles 09:27 Prevention and Safety Measures 11:48 Rescue Techniques and Immediate Response 13:34 Professional Rescuer Guidelines 16:12 Advanced Medical Care and Resuscitation 20:11 Conclusion and Final Thoughts As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 .

King Tube vs IGEL for Airway Management In this episode of Wilderness Medicine Updates, Dr. Patrick Fink addresses a listener's question on whether to use a King Tube or an IGEL as an out-of-hospital airway adjunct. The episode begins with an overview of airway management techniques from mouth-to-mouth resuscitation to supraglottic airway devices. Dr. Fink explains the benefits and drawbacks of various airway adjuncts, including oral and nasal pharyngeal airways. The discussion then shifts to a detailed comparative analysis of King Tubes and IGELs based on retrospective and prospective studies. Dr. Fink evaluates the evidence indicating that IGEL may be more effective and easier to use than King Tubes, particularly in pre-hospital cardiac arrest situations. The episode concludes with recommendations for pre-hospital providers and an encouragement for listeners to share their questions and feedback. Links: iGel LMA King Tube Smida T, Menegazzi J, Scheidler J, et al. A retrospective comparison of the King Laryngeal Tube and iGel supraglottic airway devices: A study for the CARES surveillance group. Resuscitation . 2023;188:109812. doi: 10.1016/j.resuscitation.2023.109812 Smida, Tanner & Menegazzi, James & Crowe, Remle & Scheidler, James & Salcido, David & Bardes, James. (2023). A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehospital emergency care. 28. 1-13. 10.1080/10903127.2023.2169422. Lønvik, M.P., Elden, O.E., Lunde, M.J. et al. A prospective observational study comparing two supraglottic airway devices in out-of-hospital cardiac arrest. BMC Emerg Med 21, 51 (2021). https://doi.org/10.1186/s12873-021-00444-0 Chapters 00:00 Introduction and Listener Question 00:55 Understanding Airway Adjuncts 02:12 Basic Airway Management Techniques 06:34 Advanced Airway Devices: King Tube and LMA 11:35 Comparative Studies on Airway Devices 17:35 Prospective Data and Final Thoughts 25:24 Conclusion and Listener Engagement As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 .

Exploring Methoxyfluorane for Wilderness Pain Management with Dr. Ross Hofmeyr In this episode of Wilderness Medicine Updates, host Dr. Patrick Fink discusses the use of methoxyfluorane, an anesthetic gas for pain management in wilderness settings. Joined by guest Dr. Ross Hofmeyr, an anesthesiologist and wilderness medicine expert from South Africa, the episode delves into the history, usage, benefits, and limitations of methoxyfluorane. Highlighting its efficacy, ease of use, and safety, especially for pre-hospital scenarios, Dr. Hofmeyr shares insights into its ideal applications, contraindications, and personal experiences. The episode underscores the significance of methoxyfluorane as a potent analgesic suitable for acute traumatic pain and procedural analgesia in austere environments. Links Wild Medix Ross Hofmyer on Instagram The Inhaler Device Methoxyflurane at Altitude - Case Report Methoxyflurane in the Outback - Survivor Clip WMS Pain Management Guidelines Chapters: 00:00 Welcome to Wilderness Medicine Updates 00:55 Meet Dr. Ross Hofmeyr 03:14 Dr. Hoffmeier's Background in Wilderness Medicine 04:45 Methoxyfluorine: An Overview 12:20 The Mechanics of Methoxyfluorine Inhaler 20:15 Practical Applications in Pre-Hospital Pain Control 20:53 Analgesic Intervention: Quick and Effective 21:09 Using Methoxyfluorane in Wilderness Settings 22:42 Training Non-Medical Personnel 23:49 Procedural Analgo-Sedation 24:30 Regulatory Considerations and Prescriptions 26:33 Combining Methoxyfluorane with Other Medications 28:10 Monitoring and Safety 29:09 Ambulating Patients with Methoxyfluorane 31:31 Environmental Considerations: Temperature and Altitude 40:10 Cost and Practical Downsides 41:45 Conclusion and Final Thoughts As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 .

Ketamine Use in Wilderness Pain Management: An Interview with Dr. Chris Van Tilburg In this episode of Wilderness Medicine Updates, host Patrick Fink discusses wilderness pain control with guest Dr. Chris Van Tilburg, focusing on the effective use of ketamine. The episode delves into how ketamine serves as a versatile medication for pain management, sedation, and intubation in emergency and wilderness environments. Dr. Van Tilburg, an expert in wilderness medicine with extensive field experience, shares insights on administering ketamine in challenging rescue scenarios, the limitations and benefits of various medications, and practical considerations for field use. The conversation touches on dose ranges, administration techniques, and patient management during rescues. Additionally, Dr. Van Tilburg talks about his soon-to-be-released book, 'Crisis on Mount Hood: Stories from 100 Years of Mountain Rescue,' celebrating the centennial of the Crag Rats, America's oldest mountain rescue team. Links WMS Guideline: Avalanche and Nonavalanche Snow Burial WMS Guideline: Pain Management in Austere Environments Chris’s Linktree Contact Chris through LinkedIn Preorder Chris’s book “Crisis on Mt Hood” Chris on Wikipedia Crag Rats Mountain Rescue Chapters: 00:00 Welcome and New Year Greetings 00:29 Introducing Today's Guest: Dr. Chris Van Tilburg 03:07 Podcast Shoutouts and Listener Appreciation 03:37 In Conversation with Dr. Chris Van Tilburg 05:58 Challenges of Wilderness Pain Management 09:37 Pain Management Strategies 14:23 Ketamine vs. Other Pain Medications 18:01 Ketamine Dosage and Administration 22:16 Nitty Gritty Tactics: Needle Sizes and Administration 23:02 Intramuscular Injection Sites and Techniques 24:22 Timing and Dosage of Ketamine Administration 25:16 Challenges in Mountain Rescue Situations 27:17 Case Study: Seizure Patient and Ketamine Use 29:18 Considerations for Head Injuries and Ketamine 33:03 Medications in Wilderness Medical Kits 34:02 The Art of Wilderness Medicine 37:54 Protecting Medications in the Field 38:55 Wrapping Up: Upcoming Book and Final Thoughts As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. 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 .