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Chapter 23
SUBSTANCE ABUSE IN WILDERNESS SETTINGS
Recommendations are considered Category 2 by the WMS Panel of Expert Reviewers.
I. GENERAL INFORMATION
Although data are sparse, it has been suggested that alcohol places a person at risk for
injury or death, particularly in wilderness areas close to roads. (Goodman, Iserson and
Strich. Wilderness Mortalities: A 13-year Experience. Annals of Emergency Medicine.
37:3 pp279-283. March 2001) Data on the involvement of alcohol and non-prescribed or
non-medically indicated use of mood- and mind-altering chemicals on trauma in
wilderness areas is sparse and it is difficult to draw conclusions. However, the
involvement of drug and alcohol misuse is a well known contributor to trauma outside the
wilderness. Practioneers should be aware of this and be alert for acute or chronic
intoxication, accidental overdoses, and withdrawal in patients in wilderness settings.
II. GUIDELINES FOR ASSESSMENT AND TREATMENT
In any individual with an illness or injury in the wilderness, mind- or mood-altering drugs
may complicate assessment and treatment. Consideration must be given to whether the
patient's senses are so altered as to be unaware of his or her true physical state, including
the presence of pain or imminent danger. If substance abuse is suspected, take extra time
to assess the patient, and give additional consideration to stabilization and care.
Working with people who are under the influence of drugs (including ethanol) is
often difficult because such individuals may have radical alterations in personality, rapid
mood swings, and irrational behavior patterns. A calm, unhurried, yet authoritative
approach, especially with the use of a friend of the patient, can be effective in gaining the
patient's confidence (or at least the patient's ear) and having him/her acquiesce to
treatment.
In addition to the above, advanced providers may have two additional modalities:
antidotes and sedation. Naloxone (0.4 to 4.0 mg IV, SQ), if available, will reverse the
effects of narcotics and narcotic analogues. Sedation with antipsychotics (haloperidol,
chlorpromazine) or benzodiazepines (diazepam, lorazepam) can be used if patients are in
danger of harming themselves or others. Extreme care must be exercised to avoid
depressing the respiratory drive in such individuals.
