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.

Our SOAP Note’s Form

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

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.

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…)

Nobody likes to be hot and sweaty on the trail. But when things turn from being uncomfortable to becoming downright dangerous, it’s time for quick, on-the-spot emergency action. 

Heat illness is a range of medical conditions that result from the body’s inability to cope with an elevated heat load. When that occurs, it is more commonly referred to as “heat strain.” And whether you’re inactive in a warm, humid environment or participating in strenuous physical activity in the fall or winter, you are at an increased risk of heat illness.

For people who engage in backcountry adventures, heat illness and heat strain are among the many potential health and safety risks. That’s why our instructors at The National Center for Outdoor Adventure Education (NCOAE) include it in our Wilderness Medicine courses. In this post, we bring you up to speed on the basics, including the symptoms to watch for, preventive measures, and treatments to cool an overheated body.

From Bad to Worse on the Heat Illness Spectrum

Heat illness, heat strain, and related injuries occur when the core body temperature becomes elevated, stressing or surpassing the body’s ability to cool itself. Like a nuclear power plant, the human body can suffer serious and potentially fatal damage when its core becomes overheated.

The severity of the condition is on a spectrum generally divided into the following three levels: (more…)

Concussion recognition and treatment has gotten a lot of attention over the last decade, mostly in the context of youth and professional sports such as tackle football and soccer. It’s even a topic for those who serve in our armed forces. However, confusion over its prevention, diagnosis, and treatment remains widespread. 

In an interview with a reporter from the Chicago Sun Times, former National Football League quarterback Brett Favre, who was knocked out cold only once in his 20-year career, claimed that “probably 90 percent” of the tackles he endured left him with a concussion.

He’s most likely correct in that estimation. After all, the definition of “concussion” is broad: “A concussion is a brain injury, a disturbance in brain function induced by traumatic forces, either from a direct blow to the head or a transmitted force from a blow to the body.” It disrupts brain function at the cellular metabolic level but does not result in major structural damage. Conventional MRI or CT scanning will not show evidence of a concussion.

So, how do you know if you or someone else has suffered a concussion while in the backcountry? And, after having made that determination, what should be done? Having clear answers to these two questions is essential for successful recovery and to prevent long-term cognitive and psychological complications. This is true no matter where the concussion takes place, but especially in the backcountry where medical treatment from a full-time team is unavailable. (more…)