Backcountry medicine – treating patients in the sometimes-not-so-great outdoors

Dr. Jel Coward, left, encourages a participant to feel for a pulse on his “patient” after using hand pressure to reduce blood flow from the upper arm

At the Backcountry Medicine session at the Society of Rural Practitioners of Canada’s 2012 Rural and Remote Medicine Course, the standing room-only crowd of more than 100 people was staring intently as Dr. Jel Coward, the presenter, balanced precariously on one foot while strapping a folded tent pole to his leg.

“In the backcountry, you won’t always have the tools you need to treat a patient, so you must make do with what you have at hand.”

The demonstration of improvised splintage, joint reduction and other techniques was creative, unorthodox and pointed: a physician treating a patient on a snowy mountainside won’t have access to a full complement of ER tools or supplies. How, then, does a physician approach backcountry medicine?

Dr. Coward notes that the best skills a health care practitioner can bring to a wilderness medical situation are those of decision-making and rescue facilitation. “Medicine should not stand in the way of rescue.  If one believes ‘oh, I must do this procedure’ but that decision is made not in concert with the rescue/environmental situation then that is likely not a good decision. If treatment doesn’t facilitate the rescue, then bad things are likely to happen and you may well end up spending the night on the mountain in the snow. It can be very difficult to blend medicine with rescue unless you have an understanding of rescue, the environment, the terrain, and the pressures faced by care givers up there on the mountain when it’s starting to get dark.”

The practice of wilderness medicine involves a great deal of risk-benefit analysis. Procedures that can seem simple on the surface, such as a stretcher carry, can take on a very different aspect out in the backcountry. “It is not always  obvious that it can take at least 12  people to move a stretcher any significant distance in the backcountry. It can also take three or four times longer than most would expect.”  Training and experience with wilderness medicine and rescue can greatly enhance a practitioner’s ability to make a balanced decision in what are often challenging conditions.

What, then, is the appeal of practicing medicine in the wilderness? “It’s good, old-fashioned hands-on medicine,” Dr. Coward enthuses, “You’re using your clinical skills because you don’t have any diagnostic tests or imaging. That’s the appeal – you’re back to living on your wits.”

How can an aspiring wilderness health care provider become involved in the practice of backcountry medicine?  There are courses available from experienced practitioners, such as those offered by the Canadian Society of Mountain Medicine and the Wilderness Emergency Medical Services Institute – International. Beyond coursework, experience is the best teacher. “I feel lucky to have been involved in wilderness medicine over many years.  Currently, I work with the Pemberton Search and Rescue team,” says Dr. Coward.

Dr. Jel Coward is a rural physician in Pemberton, BC. He is one of the co-founders of The CARE Course and CAREbc, a founding member of the Canadian Society for Mountain Medicine and Medical Director of the volunteer organization, WEMSI-International.

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