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Todd Mullenix

SOAP Notes Keep Wilderness Medicine Clean

By Todd Mullenix October 19, 2023

Wilderness Medicine

In the context of wilderness medicine, soap and SOAP are both indispensable. An explanation is in order. We’re all familiar with lower-case soap. This noun refers to a substance that’s added to water to remove dirt, grease, grime, and germs from various surfaces, including skin, hair, clothing, pots and pans, and so on.

Soap In The Wilderness

Traditional soap works in two ways — as a surfactant to break water tension, improving water’s ability to penetrate surfaces, and as a molecule that has a love-hate relationship with water. Soap molecules have two ends, one that’s hydrophilic (loves water) and the other that’s hydrophobic (hates water). The hydrophilic end binds to water, while the hydrophobic end binds to anything other than water — dirt, grease, grime, germs. Imagine soap molecules as tiny carabiners that shackle dirt molecules to water molecules to enable the water molecules to usher them away.

In backcountry and wilderness settings, soap plays a vital role in preventing infection and transmission of disease. In fact, scrubbing vigorously with soap and water may be among the most important risk-management technique you practice during your time in the wilderness.

SOAP (Subjective, Objective, Assessment, Plan)

Now let’s move on to the other SOAP — all uppercase — which is an acronym for Subjective, Objective, Assessment, and Plan. As an outdoor educator, field instructor, or wilderness guide, this note-taking procedure is nearly as important as scrubbing your hands regularly with soap and water. This is especially true when you’re dealing with a client injury or illness in a remote setting

SOAP Notes, which I’ll be covering in this post, separate important information from the chaos and fog of emotion in order to provide clean, uncluttered details for making informed medical decisions and emergency response plans. 

With SOAP Notes in hand, field instructors and outdoor educators trained in wilderness medicine, as well as backcountry guides, are better prepared to respond to a medical emergency. They do this by:

  • Following an organized, methodical process
  • Tracking changes in a patient’s health status
  • Keeping a record of assessments, anticipated problems, and any interventions already provided
  • Communicating with emergency responders
  • Ensuring a seamless transfer of patient care to next-level healthcare providers
  • Documenting cases and care for improving organizational outcomes

Here at The National Center of Outdoor Adventure and Education (NCOAE), we developed the SOAP Note form shown below.

NCOAE's SOAP (Subjective, Objective, Assessment, Plan) note planner

Our SOAP Note’s Form

Our SOAP Note form consists of the following seven sections (more…)

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Let’s Add Humble to the 5 ‘Umbles’ of Hypothermia

By Todd Mullenix January 23, 2023

Risk Management

Hypothermia is deadly. There, I said it! This potentially dangerous drop in body temperature is commonly defined as a core body temperature below 95 degrees Fahrenheit (35 degrees Celsius) after dropping from a healthy temperature of about 98.6 degrees Fahrenheit or 37 degrees Celsius.

The slightest variance from the “normal” range can disrupt the body’s ideal operating conditions, known as homeostasis. The negative impact of hypothermia on homeostasis is dramatic and therefore should not be underestimated. Hypothermic progression follows a path, moving first more slowly, then more rapidly toward non-movement and when properly treated, onto death.

The author, NCOAE Director of Wilderness Medicine Education Todd Mullenix, moving and staying warm.

Movement is life. Living things grow, evolve, learn and work to improve their circumstances. Non-living things hold fast to current circumstances unless acted upon by an outside force. As we’ve all experience, movement generates warmth, and this case, it combats hypothermia. A creature that has the appropriate amounts of items necessary for movement will generally maintain a body temperature conducive for life. 

These items required for movement include nutrients, health, fitness, clothing, and sometimes technical outdoor tools such as an ice axe and crampons. A breakdown of these items leads to decreased movement and reduced temperature. In this post, we will look at the hypothermic process using the five umbles: (more…)

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