3
FOREWORD
The Guidelines are written for physician use at the generalist level. Many specialists
(anesthesiologists, cardiovascular surgeons, orthopedists) may well diagnose conditions
and determine that more aggressive measures are indicated in certain circumstances and
that they have the means to achieve them. The Guidelines propose the best methodology
for handling prehospital care for illness and injury occurring in wilderness areas. These
protocols do not form the legal basis for training non-physicians, although many of the
techniques discussed have been incorporated into various proprietary wilderness first aid
(WFA), wilderness first responder (WFR), and EMT-W training programs. The
standardizations or legalization of these courses is not the purview of this document.
The first version of the Wilderness Medical Society Practice Guideline (published as
"position papers") was published in July 1987 as an insert into the Society's newsletter. It
encompassed eight topics, namely: CPR, Medical Evacuation, Helicopter Evacuation,
Hypothermia, High Altitude Illness, Snakebite, Field Water Disinfection, and Oral Fluid
and Electrolytes. There were 23 authors cited all of whom are acknowledged in the
author list below.
The second edition was expanded to 15 topics. This document was published as an insert
in the Society newsletter in 1989, under the editorship of Ken Iserson with 13 authors,
also cited below. These first two editions included levels of care, with different
techniques being proscribed for non-EMT, EMT level, and physician level responders.
Levels of care were removed from the third iteration of this project, published in 1995 by
ICS Books (now Globe Pequot Press, the current publisher). Expanded to 23 topics, this
edition also included the results of the Wilderness Medical Society Prehospital
Committee study prepared by its members E. Otten (Chair), W. Bowman, P. Hackett, M.
Spadafora, and D. Tauber). This report, titled "Wilderness Prehospital Emergency Care
(WPHEC) Curriculum" was a model curriculum, the components of which it was hoped
would be extracted for various levels of prehospital wilderness medical training.
The Society published the fourth edition of its guidelines (labeled 2
nd
Edition by the
publisher, Globe Pequot Press), in 2001. Three new topics had been added: wilderness
eye injuries, botanical encounters (contact and ingestion issues), and marine
envenomations and poisonings.
This, the 5
th
edition of the Wilderness Medical Society guidelines, presents what the
WMS Panel of Expert Reviewers feels is the best approach for the management of remote
area injuries and illness. This edition nudges the Guidelines towards evidence based
medicine with category stratification of its recommendations. The following criteria have
been implemented:
·
Category 1A: Strongly recommended for implementation and strongly supported
by well-designed experimental, clinical, or epidemiological studies.
