Wilderness medicine is the practice of resource-limited medicine under austere conditions. In 2003, the first wilderness medicine fellowship was established, and as of March 2013, a total of 12 wilderness medicine fellowships exist. In 2009 the American College of Emergency Physicians Wilderness Medicine Section created a Fellowship Subcommittee and Taskforce to bring together fellowship directors, associate directors, and other interested stakeholders to research and develop a standardized curriculum and core content for emergency medicine (EM)-based wilderness medicine fellowships. This paper describes the process and results of what became a 4-year project to articulate a standardized curriculum for wilderness medicine fellowships. The final product specifies the minimum core content that should be covered during a 1-year wilderness medicine fellowship. It also describes the structure, length, site, and program requirements for a wilderness medicine fellowship. ACADEMIC EMERGENCY MEDICINE 2014; 21:204-207 © 2014 by the Society for Academic Emergency MedicineW ilderness medicine is the practice of resource-limited medicine under austere conditions. These conditions are commonly found in remote wilderness areas, in the developing world, and in urban areas following natural disasters. It is a body of knowledge and applied skills used by clinicians that is related to the physiology and pathophysiology of humans who encounter environments with limited resources.1 The field is focused on the prevention of injuries as well as the evaluation, initial treatment, and evacuation of acutely injured or ill patients. Wilderness medicine also encompasses the unique knowledge of circumstances and medical events encountered in wilderness settings.Wilderness medicine shares many of the qualities and characteristics inherent to emergency medicine (EM).

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BackgroundWith increasing rates of obesity and its link with cardiovascular disease, there is a need for better understanding of the obesity‐outcome relationship. This study explores the association between categories of obesity with treatment times and mortality for patients experiencing ST‐segment elevation myocardial infarction.Methods and ResultsWe examined 8725 patients with ST‐segment elevation myocardial infarction who underwent primary percutaneous coronary intervention and used regression models to analyze the relationship between 6 categories of body mass index with key door‐to‐balloon time, total ischemic time, and in‐hospital mortality. We relied on data from the Mission: Lifeline North Texas program, consisting of 33 percutaneous coronary intervention–capable hospitals in 6 counties surrounding Dallas, Texas. Data were extracted from the National Cardiovascular Data Registry for each participating hospital. Of the samples, 76% were overweight or obese. Comparing the univariate differences between the normal‐weight group and the pooled sample, we observed a U‐shaped association between body mass index and both mortality and door‐to‐balloon times. The most underweight and severely obese had the highest mortality and median door‐to‐balloon time, respectively. These differences persisted after multivariate adjustments for door‐to‐balloon time, but not for mortality.ConclusionsExtremely obese patients have longer treatment time delays than other body mass index categories. However, this did not extend to significant differences in mortality in the multivariate models. We conclude that clinicians should incorporate body mass assessments into their diagnosis and treatment plans to mitigate observed disparities.

The provision of emergency care in the United States, regionalized or not, depends on an adequate workforce. Adequate must be defined both qualitatively and quantitatively. There is currently a shortage of emergency care providers, one that will exist for the foreseeable future. This article discusses what is known about the current emergency medicine (EM) and non-EM workforce, future trends, and research opportunities.ACADEMIC EMERGENCY MEDICINE 2010; 17:1286-1296 ª 2010 by the Society for Academic Emergency Medicine A well-trained, efficiently distributed workforce is critical to provide for the nations' emergency care needs. This includes any regionalized system of emergency care. The cognitive and technical skills of emergency care providers are vital resources in ensuring delivery of timely, high-quality emergency care to all Americans. Currently, 120 million patients go to our nation's emergency departments (EDs) each year. Historic trends have shown that the demand for emergency care continues to rise, 1 even with health care reform and a push toward universal insurance coverage.2 This reflects a growing, aging population with many chronic diseases. This rising demand is likely to increase the need for emergency care providers. There is currently a shortage and mal-distribution of emergency medicine (EM) residency-trained and board-certified physicians (emergency physicians [EPs]). 3-7The 2010 Academic Emergency Medicine consensus conference on regionalization of emergency care focused on getting the right care to the right patient at the right time. We describe the current state of the emergency care workforce, potential solutions, and a vision for the future. Our discussion looks at EPs, non-EM-trained physician providers, and nonphysician providers. We identify gaps in knowledge that form the basis of an emergency care workforce research agenda. Our discussion focuses on the goal of improved access to high-quality emergency care for all acutely ill or injured patients across the entire United States. Under any regionalization plan, an efficiently distributed, qualified workforce will ensure a sufficient number of providers with appropriate training for their practice environments and will be distributed according to patient need throughout the system.