To the Editor:
One aspect of advanced training in wilderness medicine is that experience in managing wilderness medical conditions can be difficult to acquire in training. Wilderness is defined by its lack of people, infrastructure, and resources. Those needing medical care in the wilderness are usually difficult to access. Additionally, patients with serious conditions in wilderness environments often first require search and rescue expertise,
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a set of team-based skills and disciplines primarily devoted to patient location and transport. An informed evaluation and treatment of medical problems that arise in the wilderness clearly has the potential to save lives2
and can be tremendously valuable for many reasons. However, in cases where an individual was not already part of the group, the chances that a wilderness medicine specialist and a patient requiring medical care in the wilderness will be in the same place at the same time are small.Fellowship training
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in wilderness medicine in the United States is currently offered in 18 programs, all but one of them within academic emergency medicine departments,4
at various hospitals and universities across the country. Although wilderness medicine fellowship training may focus on many areas (eg, pre-trip evaluation, race support, wilderness emergency medical services/search and rescue support, and wilderness medicine education), at present, one of the most specific applications of wilderness fellowship training is to accompany expeditions to wilderness settings. However, the groups intentionally seeking out remote wilderness, or extreme environmental conditions, such as in deserts, polar regions, or at high altitude, tend to be limited in number; in this circumstance, a healthcare provider with expertise in wilderness medicine could be seen almost as a form of insurance rather than a resource that will definitely be required. We believe that going forward, the most efficient and effective means for providing medical care to those in wilderness or austere settings will be virtually.The world is evermore connected; it has been noted that soon there will be very few places on the face of the planet that will be inaccessible to inexpensive, satellite-based broadband communication.
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The implication of this for the growing number of people who seek out the wilderness is that, in the not too distant future, it will be possible to access real-time expertise from wilderness medicine specialists6
virtually from anywhere. The COVID-19 pandemic has dramatically increased use and acceptance of telemedicine as a safe, efficient, effective way for patients to access medical care; its adoption in wilderness medicine seems all but preordained, since in this way those with expertise in wilderness medicine will be available, in principle, to anyone needing their care.Telemedicine use has evolved rapidly. Some have speculated it may lead to the proliferation of virtual ERs (ie, emergency care outside of brick-and mortar facilities); at least one existing program is trying this approach.
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Training in telemedicine is quickly becoming recognized as a critical skill for trainees and experienced practitioners. The American Association of Medical Colleges recently released expert consensus on telehealth competencies.8
Telehealth skills and competencies will soon be integrated into medical student and residency curricula. Telemedicine is also being increasingly adapted to wilderness settings6
and austere environments.9
Associated with telemedicine is the growing adoption of tele-ultrasound,10
which has the capacity to extend remote evaluations by wilderness specialists of patients in austere environments.We recently created a hybrid fellowship in wilderness/telemedicine at the George Washington University School of Medicine. Fellows spend 18 m to 2 y exploring a wide-ranging curriculum including course work in specific wilderness medicine topics,
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such as high altitude, dive, survival, search, and rescue. They also master in-depth applications of telehealth including use cases, training, optimization, implementation, and quality assurance. The department’s long-standing maritime medical access program provides fellows the opportunity to apply skills via phone, video, and asynchronous communication to mariners located in remote and austere environments for prolonged periods of time. The fellowship includes a requirement that a scholarly project merging aspects of wilderness and telemedicine be completed. These might include pilot projects involving various kinds of remote telemetry, the innovative use of mobile phone communication for medical purposes in remote environments, or examining instances where telemedicine is already being used in remote areas.We believe that the future of wilderness medicine is in remote evaluation because this will ultimately provide the greatest benefit to patients in austere environments. We also believe that the practice of this specialty will come into its own with the growth of communication technologies, remote diagnostic capabilities, and the adoption of telemedicine techniques and practices
References
- An introduction to mountain search and rescue.Emerg Med Clin North Am. 2004; 22: 511-524
- Extreme, expedition, and wilderness medicine.Lancet. 2015; 386: 2520-2525
- Core content for wilderness medicine fellowship training of emergency medicine graduates.Acad Emerg Med. 2014; 21: 204-207
- A national survey of wilderness medicine curricula in United States emergency medicine residencies.Wilderness Environ Med. 2021; 32: 187-191
Earley LD. Communication in challenging environments: application of LEO/MEO satellite constellation to emerging aviation networks. In: 2021 Integrated Communications Navigation and Surveillance Conference (ICNS). IEEE; 2021:1–8.
- Telemedicine for patient management on expeditions in remote and austere environments: a systematic review.Wilderness Environ Med. 2021; 32: 102-111
- The availablists: emergency care without the emergency department.NEJM Catal Innov Care Deliv. 2021; 2
- Telehealth Competencies Across the Learning Continuum.2021 (Available at:)
- High-altitude mountain telemedicine.J Telemed Telecare. 2022; 28: 135-145
- Point-of-care teleultrasound: a systematic review.Telemed J E Health. 2020; 26: 1314-1321
Article info
Publication history
Published online: September 18, 2022
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© 2022 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.
