The difference between wilderness and urban medicine…

… is often described as patient care in austere environments with limited equipment, prolonged transport and poor communication.  An understated difference is the decisions we have to make in wilderness whether the patient needs to be evacuated to a physician’s care, and if so, with what urgency. As an ambulance EMT I make an assessment, provide necessary treatment by protocols and in most cases transport the patient.  I rarely make a decision whether or not the patient needs to see the doctor.
 
Yet in the wilderness this may be my decision to make.  My judgment can affect the patient’s health, the safety of my expedition members and rescue personnel, and the quality and success of our planned wilderness  journey.     
 
We  find decisions and judgment a fascinating area of study and have gathered some thoughts in an article on medical decision making that you can access at:
 
https://rendezvous.nols.edu/content/view/1748/713/
 
Tod Schimelpfenig
Curriculum Director –Wilderness Medicine Institute of NOLS
Fellow of the Academy of Wilderness Medicine