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).

High-tech simulation is an underused tool for wilderness medicine education. Currently, several barriers exist to its implementation in wilderness medicine. Participants in wilderness courses feel it is an effective tool and would like to see it used more frequently.

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Introduction: Increased out-of-hospital time is associated with worse outcomes in trauma. Sparse literature exists comparing prehospital scene and transport time management intervals between adult and pediatric trauma patients. National Emergency Medical Services guidelines recommend that trauma scene time be less than 10 minutes. The objective of this study was to examine prehospital time intervals in adult and pediatric trauma patients. Methods: We performed a retrospective cohort study of blunt and penetrating trauma patients in a fivecounty region in North Carolina using prehospital records. We included patients who were transported emergency traffic directly from the scene by ground ambulance to a Level I or Level II trauma center between 2013-2018. We defined pediatric patients as those less than 16 years old. Urbanicity was controlled for using the Centers for Medicare and Medicaid's Ambulance Fee Schedule. We performed descriptive statistics and linear mixed-effects regression modeling. Results: A total of 2179 records met the study criteria, of which 2077 were used in the analysis. Mean scene time was 14.2 minutes (95% confidence interval [CI], 13.9-14.5) and 35.3% (n = 733) of encounters had a scene time of 10 minutes or less. Mean transport time was 17.5 minutes (95% CI, 17.0-17.9). Linear mixed-effects regression revealed that scene times were shorter for pediatric patients (p<0.0001), males (p=0.0016), penetrating injury (p<0.0001), and patients with blunt trauma in rural settings (p=0.005), and that transport times were shorter for males (p = 0.02), non-White patients (p<0.0001), and patients in urban areas (p<0.0001). Conclusion: This study population largely missed the 10-minute scene time goal. Demographic and patient factors were associated with scene and transport times. Shorter scene times occurred with pediatric patients, males, and among those with penetrating trauma. Additionally, suffering blunt trauma while in a rural environment was associated with shorter scene time. Males, non-White patients, and patients in urban environments tended to have shorter transport times. Future studies with outcomes data are needed to identify factors that prolong out-of-hospital time and to assess the impact of out-of-hospital time on patient outcomes. [West J Emerg Med. 2020;21(2)455-462.]

The new england journal of medicine Make the incision along existing skin-tension lines Extend the incision Perform blunt dissection of the abscess cavity Place packing material