Unfortunately the patient did not get better. Over the next 24 hours he developed a cough, and began to hack up a pale yellow phlegm. His headache persisted despite hydration and ibuprofen, as did his muscle aches and general malaise. The fever stayed at 100°F (37.4°C). His appetite did not improve and the nausea persisted.
You understand that none of his s/s yet triggered your program's evacuation guidelines, and you would like to wait another day to see if he feels any better. It would be unfortunate to leave the field and this great trip and then feel better in another day. But, at the same time you are worried about the route ahead, which crosses a high pass and moves much further from the trailhead. Also, the patient has been asking to go home. He thinks it is going to take a long time to feel better, and he doesn’t want to be in the field feeling this miserable.
Your decision is to walk him to the trailhead tomorrow. You’re hoping that without a pack he can manage the three miles. Your support group of five will be able to react if he is unable to walk.
The data NOLS has been keeping for over 27 years on field medical incidents tells us that flu-like illness (colds, upper respiratory infections, sore throat, fever, headaches) are among the most common medical complaints. Together with gastrointestinal problems (nausea, vomiting, diarrhea, constipation), flu-like illnesses account for 4 of every 10 reported illness incidents. This theme is seen in other publications on incidents on wilderness trips.
Often these illnesses are a viral infection of the nasal passages and throat that causes a runny nose, sore throat, cough, sneezing, headache, mild fever, muscle aches, and malaise. We believe they are most often transmitted by contaminated hands, and less commonly, although possible, as an aerosol. Wash your hands! Cough into your sleeve, not your hand.
These symptoms are common to many different medical presentations and can occasionally be the initial symptoms of more serious clinical conditions. Gastrointestinal symptoms (nausea, vomiting, and diarrhea) are usually caused by a "stomach bug" or "stomach flu." Respiratory symptoms (cough, congestion, runny nose, sore throat) are usually upper respiratory viral infections. All viral illnesses can also cause a headache, malaise, fatigue, low-grade fever, muscle aches, body aches, etc.--what we refer to as a cold or flu. (Technically the flu is a specific diagnosis and cold is non-specific and colloquial; thus we use the term "flu-like.")
The challenge to the wilderness leader is knowing how to manage these, and deciding when someone is sick enough to warrant an evacuation. You may have months of experience traveling to the ends of the earth and back, but very little experience looking at someone who is obviously sick and lacking any of the dramatic medical problems you studied in your WFR: things like pulmonary embolus, pneumonia, or heart attack.
Whether someone stays in the field or goes home depends in part on how much discomfort they are willing to tolerate. We’re often miserable when we have a flu-like illness, and the misery seems compounded when we’re camping. Also, while many of these illnesses are self-limiting, they can linger for days or weeks, despite all of our remedies. Our wilderness trips often have timetables. Patience and rest are not on the schedule.
In the midst of the influence of these human factors, we can try to base our decision on some guidelines. These are based on expert opinion, and have served NOLS field instructors well.
Evacuation is recommended for flu-like illness if:
Treatment Principles for Flu-Like Illness
The management for flu-like illness is based on treating symptoms to help the patient feel better while these illnesses run their course.