Retention of Wilderness
Medicine
Knowledge & Skills
By: Kent Clement, Ph.D.
Nadia Kimmel, M.S.
Consider This Scenario
SCENARIO
You and your friends are hiking on a mountain
trail in mid-August. You are enjoying a beautiful
sunny afternoon with a temperature of 72 F.
You come across a person sitting on the trail
holding his/her right arm. This person is alone and
there are no bystanders. You are 5 miles from the
nearest trailhead where your vehicle is parked. It
is ten miles from the trailhead to the nearest
town. There is no cell reception until you reach
the town limits.
Based on your WFR knowledge and skills what
are some of the things that you should do?
SCENE SIZE – UP & INITIAL
ASSESSMENT
After determining that the scene is
safe, you find out the person’s name
but he/she does no know what
happened. The person is confused
and exhibits a slurred speech. They
complain of pain while guarding
their right arm. No sign of life
threatening trauma is apparent.
WHAT NEXT?
SCENARIO
After asking SAMPLE and taking vitals you find out the following:
S:
A:
M:
P:
L:
E:
Pain in the right arm, pale, confused, slurred speech.
None
None
Diabetes (Type II)
Not sure
Does not recall
HR:
RR:
BP:
LOC:
SCTM:
CSM:
132
30
Strong radial pulse
A & 0 X 1 (Alert & oriented to person only)
Pale, warm & dry
Weak in all four extremities, can feel, does not
respond to commands well but has good pulses
PERRL: Normal
WHAT NEXT?
SCENARIO TREATMENTS
 Glucose administration while protecting the
airway.
 Splint the arm and check CSM before and after.
 Head-to-toe exam (reveals nothing)
 Clear the spine while meeting all criteria
 Formulate an evacuation plan
Average Score
44%
INCOMPLETE SAMPLE
INCOMPLETE VITALS
NO GLUCOSE
ADMINISTRATION
POOR AIRWAY
MANGMENT
10/23
Participants’ Demographics
 34 total
 F-9, M-25
 Age Range
Age
Num.
18-24 25-30
12
8
31-35
36-40
41-50
51-55
56-60
60 up
3
4
3
1
1
2
 Highest WEM Certification – WFR-33, WEMT-1
Study Limitations
 Not generalizable as it stands due to a small
sample size
 Not randomized design – opportunity sampling
 Preliminary study – You can get involved with this
research – details to follow…
More Demographics
 First Obtained WEM Certification in years ago:
Years
Ago
2
3
4
5
6
7
10
11
15
Num.
12
4
1
3
5
1
5
1
1
 Number of Recertification Courses:
ReCert
0
1
2
3
4
Num.
16
8
4
3
2
Still More Demographics
 The Type of Work They Currently Pursue:
 Guides – 19
 Therapy – 1
 Outward Bound – 9
 Outdoor Education – 2
 Volunteer Organization – 1
 Conservation – 1
 Field Biologist – 1
 Why did you get an WEM Cert. in the 1st place?
 Required by job – 29, SAR – 1, Required in School - 3
Results
 Before the scenario, participants were asked to
estimate the percentage of knowledge required to
be fully-qualified as a WEM provider they have
retained. Answer average: 65%, Range: 17.5 to 90.
 Before the scenario, participants were asked to
estimate the percentage of skill required to be
fully-qualified as a WEM provider they have
retained. Answer average: 68%, Range: 20 to 90.
 Remember, accuracy was 44%
More Results
 After the scenario, participants were asked if
they retained as much knowledge required to
be fully-qualified as a WEM provider as they
thought they would. Answer: Yes – 7, No – 27
 After the scenario, participants were asked if
they retained as much skill required to be fullyqualified as a WEM provider as they thought
they would. Answer: Yes – 18, No - 16
Injuries With Which
Participants Dealt:
 ligament sprain
12
 blister(s)
25
 Laceration
22
 immersion foot
6
 muscle sprain
13
 bruise, contusion
18
 Sunburn
29
 Tendonitis
6
 Frostbite
5
 head injury without loss of
 tooth related
5
 Fracture
9
 Burn
14
 eye injury
5
 Dislocation
5
 skin abrasions
25
consciousness
 head injury with loss of
consciousness
10
1
Injuries With Which
Participants Dealt:
 near drowning
3
 shoulder dislocation
7
 life threatening bleed
0
 back injury
5
 “Other” includes: fish hook,
fractured pelvis, sickle cell disease,
ruptured spleen, compound
fracture, snake bite.
Illnesses With Which
Participants Dealt:
 allergic reaction
17
 urinary tract infection
4
 Anaphylaxis
2
 skin infection
10
 Diarrhea
20
 heat cramps
2
 AMS
12
 heat exhaustion
15
 food related illness
9
 heat stroke
1
 HAPE
0
 chest pain or cardiac cond.
2
 HACE
0
 eye infection
2
 upper respiratory illness
2
 non-spec. fever illness 4
Illnesses With Which
Participants Dealt:
 abdominal or other
gastrointestinal problem without
diarrhea
12
 Hyponatremia
3
 dehydration
21
 hypothermia illness
6
 snake bites
1
 heat illness
7
 spider bites
6
 cardiac emergencies 0
 scorpions stings
3
 diabetic emergencies 3
 bee stings
13
 Seizures
3
 red/fire ant stings
5
 Asthma
6
 animal bites
1
 behavioral emerg.
8
 gender spec. issues
4
Illnesses With Which
Participants Dealt:
 toleo (foot rot specific to the
Grand Canyon)
3
 ear infection
0
 Cpr
2
 rescue breathing
1
 Other
0
Are we failing?
Ideas for Improving Retention
 Limit rescuer distraction
 Simplify wilderness medicine curricula
 Emphasize SAMPLE and information gathering skills in wilderness
medicine classes
 Offer continuing education classes on-line as part of the
recertification process
 Look at other medical industry standards for recertification
requirements and lengths
• CPR
• NREMT
• ACLS
• OEC
More Ideas for Improving
Retention
 Recalibrate rescuer overconfidence
 Design curriculum giving precedence to the
activities with which rescuers are most likely to
face in an emergency situation.
 Shorten the re-certification period. (I know, I
know)
 Getting involved with the study: