Wilderness Medicine Updates
Wilderness Medicine Updates is a podcast for medical providers working in remote or extreme environments. It delivers concise, digestible updates on the latest developments in wilderness medicine, wilderness EMS, and search and rescue. The show aims to keep healthcare professionals informed about the growing edge of this specialized field.
Episodes
Ep. 34 - Icy Hot, a case of Heat Illness with Dr. Gavin Clark and Dr. Nick Daniel
Dr. Patrick Fink interviews Dr. Nick Daniel and Dr. Gavin Clark about an in-hospital case of exertional heat stroke in a mid-20s runner who collapsed just before the finish of an October New England half marathon in 45°F weather. EMS treated presumed SVT with adenosine, but in the ED the patient was hypotensive, profoundly diaphoretic, and altered; an oral temperature was normal while a rectal cor
Fast Push #5 - TCCC Tourniquet Update
Forty to seventy-five percent of tourniquets placed in the field are never actually needed. In Ukraine, tourniquets left on too long during delayed evacuations have cost people limbs that the original wound never would have.This fast push covers the new May 2026 TCCC Guidelines update and two CoTCCC training briefs on tourniquets, built around lessons from prolonged evacuations in the Russo-Ukrain
Ep. 33 - Heat Illness Fundamentals: Recognize the Spectrum, Cool First, Transport Second
Dr. Patrick Fink reviews the spectrum of heat illness using 2024 Wilderness Medical Society guidelines, covering recognition, physiology, field treatment, and key mimics. He distinguishes heat edema, heat cramps (salt-depletion vs exercise-associated), heat syncope and exercise-associated collapse, and defines heat exhaustion by preserved mental status versus heat stroke by altered mental status i
Fast Push #4: Expired Resuscitation Medications
That EpiPen in your kit expired eighteen months ago. Anaphylaxis is happening. Do you use it?This episode digs into a 2025 systematic review from the American Red Cross Scientific Advisory Council that asked a question most of us have quietly wondered about: do expired resuscitation medications still work? We walk through the evidence on the four drugs that matter most in the field — albuterol, as
Ep. 32 - Airway Fundamentals for Austere Settings
Prehospital Airway Fundamentals for BLS: Positioning, Pocket Mask, NPA/OPA, BVM, and LMADr. Patrick Fink presents a BLS-focused airway fundamentals episode for prehospital and wilderness/SAR responders, emphasizing an ingrained, stepwise approach to stave off respiratory badness. Links:Airway Fundamentals VideoIntersurgical iGel LMAChapters:00:00 Airway Basics Overview01:52 Questions And Upcoming
Ep. 31: Hypothermia Basics
In this episode, Dr. Patrick Fink reviews accidental hypothermia for wilderness providers, building on Ep. 27 Thermoregulation, explaining physiologic changes as core temperature falls and why accurate core temperatures are difficult to obtain in the field. We learn the modified Swiss staging system (0–4) based on signs and symptoms and outlines field management: - 0 cold stress (shelter, dry/ins
Ep. 30 - Rethinking Spinal Immobilization: EMS Evidence Update
Reevaluating Spinal Motion Restriction: Evidence UpdateIn this episode of Wilderness Medicine Updates, host Dr. Patrick Fink delves into the evolving guidelines and practices concerning spinal motion restriction. Drawing from historical dogma and modern research, Patrick explores the inefficacies and potential harms of traditional spinal immobilization tools like rigid spine boards and cervical co
Ep. 29 - Wilderness Orthopedics with Dr. Chris Healy
Wilderness Orthopedics: Managing Trauma in Remote Environments with Dr. Chris HealyIn this episode of Wilderness Medicine Updates, host Dr. Patrick Fink tackles orthopedic injuries in the wilderness with Dr. Chris Healy, an orthopedic surgeon and outdoor enthusiast. They explore the management of long bone fractures, traction for femur, pelvic binders, and the nuances of treating injuries in limit
Ep. 28 - Laura McGladrey, Responder Alliance, and Stress Injury: How to Get Back to Green and Save Living While Saving Lives.
Understanding Stress Injuries in First Line Responders with Laura McGladreyThis episode of Wilderness Medicine Updates, hosted by Patrick Fink, features a conversation with Laura McGladrey, founder of the Responder Alliance. They discuss the critical issue of stress injuries among first line responders, including professional ski patrollers, healthcare workers, and rescue team members. Through per
Ep. 27 - Thermoregulation: The Physics and Physiology of Body Temperature Regulation
In this episode of Wilderness Medicine Updates, host Patrick Fink delves into the topic of thermoregulation, explaining how our bodies regulate temperature in response to environmental changes. Listeners will learn about methods of heat exchange (conduction, convection, radiation, and evaporation), how to measure core temperature, and the body's physiological responses—such as shivering, swea
Fast Push #3: Safeback SBX for Avalanche Asphyxia Prevention
In this episode of Wilderness Medicine Updates, host Patrick Fink delves into groundbreaking technology designed to improve safety during avalanche events. The focus is on SafeBack SBX, a Norwegian-developed device that supplies air to users buried in avalanches, potentially extending survival time. Patrick reviews new research published in the Journal of the American Medical Association, which de
Ep. 26 - Physical Training for Mountain Rescue Professionals with Rob Shaul of Mountain Tactical Institute
On this episode of Wilderness Medicine Updates, host Patrick Fink shifts focus from the science and literature of wilderness medicine to practical fitness tips for search and rescue personnel, ski patrollers, and outdoor rescuers. Patrick interviews Rob Shaw, founder and head coach of the Mountain Tactical Institute, about his specialized training programs for various types of mountain athletes, i
Ep. 25 - Tree Well Burial Study / Wilderness Med Careers AMA with Zack Majd
In this episode of Wilderness Medicine Updates, host Patrick Fink breaks down a recent research paper on the differences between simulated avalanche burial and tree well burial, analyzing the findings and their implications for skiers and outdoor rescue personnel. We then transition to a special Q&A session with pre-med student Zack Majd, tackling questions about forming a career in wilderness
Ep. 24 - Airway Management in Austere Environments with Dr. Nicholas Weinberg
In this episode of Wilderness Medicine Updates, Dr. Patrick Fink discusses airway management in austere situations with Dr. Nicholas Weinberg. They explore two cases published in the Wilderness Medicine Journal, detailing the decision-making processes in managing critically injured patients. Dr. Weinberg shares his background in emergency and wilderness medicine, and highlights the importance of f
Ep. 23 - Inhaled Xenon Gas for Altitude Adaptation
Exploring Xenon Gas for Altitude Acclimatization and Sport PerformanceIn this episode of Wilderness Medicine Updates, host Patrick Fink delves into the use of inhaled xenon gas for sports performance enhancement and altitude acclimatization. The discussion is prompted by a recent claim from a UK climbing team that xenon helped them achieve a rapid ascent of Mount Everest. Xenon, a noble gas tradit
Ep. 22 - Moose Mutlow: Yosemite Swiftwater SAR, Family Liaison Officer, and longevity in rescue.
In this episode of Wilderness Medicine Updates, host Patrick Fink interviews Moose Mutlow, an experienced outdoor educator and search and rescue professional with nearly four decades of experience globally. Moose discusses his extensive career from being an Outward Bound instructor to working with Yosemite Search and Rescue, and his role as a Family Liaison Officer for the National Park Service. T
Ep. 21 - Snow Immersion Suffocation
In this episode, we dive into one of the most overlooked but deadly hazards in deep powder skiing: snow immersion suffocation (NARSID). Unlike avalanches, snow immersion deaths happen silently—often within feet of a groomed run—when skiers and snowboarders fall into deep snow or tree wells and become trapped. We explore the research behind these incidents, where and how they occur, who is most at
Ep. 20 - Out of Hospital Airway Adjuncts: King Tube vs LMA
King Tube vs IGEL for Airway ManagementIn this episode of Wilderness Medicine Updates, Dr. Patrick Fink addresses a listener's question on whether to use a King Tube or an IGEL as an out-of-hospital airway adjunct. The episode begins with an overview of airway management techniques from mouth-to-mouth resuscitation to supraglottic airway devices. Dr. Fink explains the benefits and drawbacks o
Ep. 19 - Methoxyflurane, the Green Whistle, with Dr. Ross Hofmeyr
Exploring Methoxyfluorane for Wilderness Pain Management with Dr. Ross HofmeyrIn this episode of Wilderness Medicine Updates, host Dr. Patrick Fink discusses the use of methoxyfluorane, an anesthetic gas for pain management in wilderness settings. Joined by guest Dr. Ross Hofmeyr, an anesthesiologist and wilderness medicine expert from South Africa, the episode delves into the history, usage, bene
Ep. 18 - Ketamine for Wilderness Pain Management with Dr. Christopher Van Tilburg
Ketamine Use in Wilderness Pain Management: An Interview with Dr. Chris Van TilburgIn this episode of Wilderness Medicine Updates, host Patrick Fink discusses wilderness pain control with guest Dr. Chris Van Tilburg, focusing on the effective use of ketamine. The episode delves into how ketamine serves as a versatile medication for pain management, sedation, and intubation in emergency and wildern
Ep. 17 - Resuscitation of the Buried Avalanche Victim, Part 2: The Rescue Algorithm
In episode 17 of Wilderness Medicine Updates, host Patrick Fink delves into the ICAR resuscitation algorithm for buried avalanche victims. The episode reviews the physiology of avalanche burial and discusses critical determinants of survival, such as duration of burial, airway patency, signs of life, and lethal injuries. The Basic Life Support (BLS) and Advanced Life Support (ALS) algorithms are e
Ep. 16 - Medications for Alpine Hut Trips
In this episode, I share an intense story of dealing with a suprise medical condition during a backcountry hut trip in Colorado. I walk through the diagnostic process, treatment options, and the importance of preparation for stays in remote places. Essential medications and tools needed for handling such emergencies in remote settings are discussed, along with advice on how to prepare for future e
Ep. 15 - Airway Patency in Avalanche Victims
This episode, I look at a study from the Eurac research group on rates of airway occlusion in critically buried avalanche victims. Eurac looked at this critical feature of avalanche resuscitation triage as it both affects the way we treat buried avalanche victims, and it helps us to better understand whether technologies like the black diamond Avalung (retired) and the Safeback SBX can help us sur
Ep. 14 - Spinal Immobilization Guidelines Update
Today, we discuss updates in the WMS guidelines regarding the protection of patients with suspected spinal injuries.The Wilderness Medicine Society Clinical Practice Guidelines are all open-access, and you can find links to all of these guidelines on the right sidebar of this page.The education in this episode is based on the:Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord
Ep. 13 - The High Route: Arguments for Avalanche Airbags
This episode is a repost of an interview that was first posted on The High Route Podcast. Hosted by the editor of The-High-Route.com, Jason Albert, we discuss my background in wilderness medicine, and then move on to discuss the research that support my argument and assertion that the avalanche airbag backpack should be standard equipment for backcountry skiers, snowboarders, snowmobilers, and any
Ep. 12 - Resuscitation of the Buried Avalanche Victim, Part 1: Physiology
This is part 1 of a multi-part series on the resuscitation of critically buried avalanche victims. In this episode we learn the physiology that we need to understand the resuscitation algorithm. To learn the necessary biology, we follow a rider as they are carried in an avalanche, subjected to traumatic injury, and are then buried and begin to asphyxiate and cool. The background of this episode is
Ep. 11 - After the Avalanche with Michael Buchanan
Episode 11 brings you my conversation with Michael Buchanan is a flight paramedic and senior firefighter / paramedic at the West Valley City Fire Department. He is the founder and operation of Mountain Medical Academy, a passion-driven backcountry medical care education company. We discuss the medical care of avalanche victims which Michael has made accessible to recreational skiers and riders w
Ep. 10 - Tourniquets from Space Blankets
In this episode, I discuss the article "Arterial Occlusion Effectiveness of Space Blanket-Improvised Tourniquets for the Remote Setting". In this short blast I get into the meat of this article, and though the authors would tell you that space blankets aren't ready for primetime, I have some thoughts on the matter. In the podcast, I mistakenly say that you need to be a WMS member to
Ep. 9 - FEMA Urban Search and Rescue with Dr Graham Brant-Zawadzki
In this episode Dr BZ is back to talk about his experience deploying with the Federal Emergency Management Agency (FEMA) Urban Search and Rescue Task Force (USAR). Dr BZ just returned from a deployment with FEMA USAR to Lahaina, HI, where he served as a team physician supporting rescue and recovery efforts there.We touch on:-Training and gear-Deployments and schedule-Compensation-The care of canin
Ep. 8 - SAR Provider Injuries & Traveler's Diarrhea Treatment
In this two-part episode, I review an article from the Annals of Emergency Medicine "Occupational Accidents Among Search and Rescue Providers During Mountain Rescue Operations and Training Events" https://doi.org/10.1016/j.annemergmed.2022.12.015In the second half, we review the treatment of diarrhea in the returning traveler.As always, thanks for listening to Wilderness Medicine Updates
Fast Push #2.2 - Safety Third
In this second Fast Push, you get a riff on a great article from JEMS entitled "Safety is Third, Not First, and We All Know It Should Be" by Christopher Davis MD et al.Apologies to all who got V1.0-- something weird happened in post that made me sound like a chipmunk. I might be a medical professional, but I'm no AV specialist. Summary:1. Get the Job Done2. Have Fun3. Safety ThirdAs
Ep. 7 - Wildfire Smoke and Your Health
In this episode I go deep on the health effects of wildfire smoke, answering some key questions that are relevant to recreational athletes, outdoors professionals, wildland firefighters, and industrial athletes alike:Why is wildfire smoke harmful?Is there a safe level of exposure?Can we trust the EPA's guideline levels? (Spoiler: no)Does the benefit of exercise outweigh the damage of smoke ex
Ep. 6 - EMS at the Wilderness Boundary with Dr. Graham Brant-Zawadzki
In this inaugural interview episode I have the pleasure of grilling Dr. Brant-Zawadzki about operating an urban EMS system at a wilderness boundary.We talk about:- Improvising outside the protocol- Interfacing with SAR, rangers, and road workers- How response kit and expectations are changed beyond the pavement- What a fellowship in Wilderness Medicine can do for you careerAnd more!Show Links:EMS
Ep. 5 - Mechanical CPR for Ski Patrol and Mountain Rescue
In this episode we review the available evidence, and the pros and cons, of using mechanical CPR devices like the LUCAS or Autopulse for ski patrol and mountain rescue applications. Episode links:CPR With a Lucas Device - An example video from EMS trainingViglino et. al. - Outcomes of On-Hill Cardiac Arrests - More saves, probably because of younger patients, bystander CPR, shockable rhythms, and
Ep. 4 - HOPE Score for Severe Hypothermia
In this episode we discuss the HOPE score, a tool that improves our ability to select the severely hypothermic patients who can benefit from warming with extracorporeal life support (ECLS). We begin the with the case of Tayyab Jafar, a young man who was successfully resuscitated from severe hypothermia with both cardiopulmonary bypass and ECMO, but not without incident. We then discuss the deriva
Fast Push #1 - Beacon Interference
For today, a new format, the Fast Push: Quick updates that you need to know sooner rather than later.This fast push tackles the growing issue of avalanche beacon interference. To see the source post and useful graphics, check out this link to the Utah Avalanche Center:https://utahavalanchecenter.org/blog/74828TL:DR-Electronics, magnets, heated/foil line clothes near your beacon are bad. -They need
Ep. 3 - Methoxyflurane for Prehospital Analgesia
Methoxyflurane: inhaled gas of the past and prehospital analgesic of the future? Only if we’re talking about ‘the future’ in North America. Used in Australian EMS for almost half a century, this safe and effective medication is only now starting to get the attention that it deserves outside of the down-under.Today’s paper:Trimmel, H., Egger, A., Doppler, R. et al. Usability and effectiveness of in
Ep. 2 - Pain Management for Scorpion Stings
Today we look at IV acetaminophen vs IV NSAID vs topical lidocaine vs placebo for treatment of pain due to scorpion stings, with some bonus learning on tramadol.Turgut K, Yavuz E, Gülaçtı U, Aydın İ, Sönmez C, Aktaş N, Arslan E. Comparison of Intravenous Paracetamol, Dexketoprofen Trometamol, or Topical Lidocaine Use for Pain Relief in Scorpion Stings: A Placebo-Controlled, Randomized Study. Wilde
Ep. 1 - Fentanyl on the Ski Hill?
Is intranasal fentanyl safe and effective for the treatment of acute severe pain on the ski hill?Lynch TV, Callas PW, Peterson TD, Schlein SM. Intranasal Fentanyl for On-the-Hill Analgesia by Ski Patrol. Wilderness Environ Med. 2022 Sep;33(3):296-303. doi: 10.1016/j.wem.2022.05.003. Epub 2022 Jul 16. PMID: 35851192.DOI: 10.1016/j.wem.2022.05.003As always, thanks for listening to Wilderness Medicin
Ep.0 - An Introduction
Welcome to Wilderness Medicine Updates! This podcast, new for 2023, delivers brief reviews of research in wilderness medicine, SAR, disaster/austere medicine, and wilderness EMS to help you stay current and provide the best care to patients in challenging environments. As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at wilder
