Remote Medical International Blog

Helping Student Groups Abroad Travel Safely

tmilne@remotemedical.com (Tom Milne) — Tue, 23 Sep 2008 20:14:46 -0500

As a student traveling abroad years ago, I didn’t dwell on safety issues. My focus was on enjoying new experiences, and I trusted that if any challenges came up, they would simply be worked out. Good stuff, eh?

Fast forward to the present. I’m now a father of two, a certified W-EMT, and have ten years of experience as an international mountain guide under my belt. I’ve always loved travel and adventure, and know first-hand how valuable these influences are on young lives. Yet I’m also realistic about the inherent risk in these activities, and the responsibility of program leaders and guides to participants who don’t have the same experience that they do. As a parent, I’m that much more invested in doing the best I can to offer safety, while still allowing the freedom necessary for growth. Now in my work at Remote Medical as an account manager, I get to use my experience and client care focus to help groups manage their medical challenges. Every client is different, but the general process remains the same. Here’s a recent example for illustration:

Case Study: International Youth Adventure Travel

You run a large adventure travel program for American teens, with multiple teams traveling simultaneously in locations ranging from the high mountains of the Andes to tropical Asia. Safety of the participants is your top concern, yet a variety of scenarios is possible, from common incidents worst case situations. You have had success in the past due to effective staff hiring and training, well thought out itineraries, and logistical support systems, yet you want to stay proactive regarding managing medical risk. You need support available around the clock that is easily accessible by phone, access to a worldwide network of evacuation services, and medical kits substantial enough to manage issues that require the right response within the first hour. Where do you begin when trying to tackle this logistical nightmare?

Identify the Specific Challenges

Tackling this challenge requires knowing the territory. First thoughts: identify the chief challenges in order to help define what’s needed from the solution. In this case these include:

Large numbers of participants to be managed
International scope of program
Diverse locations and environments- from tropics to high altitude
Creating useful medical kits
Liability concerns
Budget realities
Common medical issues- blisters, gastrointestinal, altitude illness, infections
Worst case issues- medical emergency requiring immediate assistance then later evacuation

Consider the Options

Specific options for managing such groups are pretty diverse, and could range from a basic medical kit and a short training to sending a paramedic equipped with a full kit along with each group. Another option might be a medical evacuation service subscription.

Weeding Out Imperfect Solutions

Obviously, just sending groups out with a basic kit isn’t going to cut it, or could be considered hopeful at best. When traveling abroad, things can happen and access to Western-level medical care may not be an option, so it’s important to be self-sufficient to some degree. Risk management and liability concerns also are an issue: you must demonstrate that your program’s risk management systems are at or above the standard level of care of your peers’. At the other end of the spectrum sending a paramedic along would be great, but for most programs is cost-prohibitive, to put it lightly. Having a medevac service subscription may make a lot of sense, but it doesn’t help to manage life threats that require quick resolution such as anaphylaxis from a common bee sting. In other words, relying on a medevac service alone is not a complete solution.

What’s Needed

What’s required in this case is a medical support system that is dynamic, allows the teams a degree of self sufficiency, and can be of assistance in medical emergencies. Something that augments and supports their existing training and systems without confusing staff, or getting in the way. As a director or employee of such a program, you know how to deliver great travel experiences. You need to develop a system or find a qualified partner who can, to help you deliver great, safe, travel experiences!

The Solution

We took into account the group’s goals, mission, and budget. Using these as a starting point, we did the front-end work required to give them the best possible solution, utilizing extensive risk-management, outdoor education and guiding, and wilderness medical care experience. Services generated for this group’s solution included:

Single point of contact to manage their services
Generating custom medical kits that handled wound management and contain select antibiotics and medications to manage medical issues, specific to each group’s location
A way to regulate use of the prescription elements and track incidents
24/7 access to higher level medical backup including American Emergency Physicians from anywhere in the world, with ability to keep contact and logistical info for each group easily accessible
Access to evacuation services worldwide
Worldwide restock of medical kits, with automatic tracking of expired medications
Simplicity: complex systems don’t get used, and can be confusing during an emergency.

Results

How did it go? This summer’s season is over, and the upgrade was a big success for the program. Direct benefits included:

The telemedicine service fielded calls from across the globe. Team leaders valued having immediate access to higher level medical support, and the participants were comforted knowing that they could speak with a doctor any time, regardless of the severity of their situation
Contact information was appended to each team’s file on record, so that in the case of a medical emergency, appropriate contacts could be made simultaneous to delivery of support
Custom built medical kits were delivered packed according to the group’s exact specifications, within their timeline. Groups’ kit contents lists were uploaded to their information files to help the telemedicine support their care efficiently
A single point of contact managed all of their communications. As is common, things came up and changes needed to be made. Understanding that, we stayed on top of the project, knowing that the participants’ safety was the top priority
Provisioning, billing and shipping were managed closely via CRM software to ensure organization and accountability

These benefits were a big upgrade that spoke directly to the group’s initial needs when they first approached us. Indirect benefits were also realized, including:

Documentable evidence of investment in risk management
A way to allay parents’ (or prospective participants’ parents’) concerns about safety of their kids
Peace of mind for program directors, field staff, and participants

Conclusion

Adventure travel programs have so much to offer to youth. It’s valuable work that helps develop responsibility and character and expand horizons. While challenge is an important element, preparedness is a basic prerequisite. Managing safety and medical concerns is a big part of the program’s responsibility. To avoid being overwhelmed, break the process down into steps, and if your hands are already full with operations, consider partnering with a qualified provider of medical support services. It’s impossible to eliminate risk, but by being proactive and systematic, enhanced safety and peace of mind can be attained.

Tom Milne

Remote Medical ACCESS Account Manager

tmilne@remotemedical.com

Outfitting for the Open Seas

tmilne@remotemedical.com (Tom Milne) — Mon, 15 Sep 2008 17:40:54 -0500

I recently had the pleasure of helping a family prepare themselves and their 55’ boat for a multi-year around the world journey. It was a lot of fun working with them and a great example of how the work we do at Remote Medical International can support people as they explore the far corners of our world.

Many passage makers and yacht owners are drawn to adventure, but must be calculating with regards to preparations and provisioning. With regard to medical preparations the challenge is putting together a system that is comprehensive, user friendly, and relatively compact. When the family first contacted me, they were interested in our ACCESS telemedicine service and a custom medical kit for their boat to give them back up when help could be hours or days away. As we consulted on the provisioning, they decided that the best way to implement their medical system was to have a RMI instructor give them a custom course in maritime medicine on board their boat.

Anyone who has set out for an extended journey from home knows that preparations can take a long time. Their case was no exception, as securing and testing parts kept moving their start date back. I enjoyed regular communications with them to stay on top of medical kit additions, and having a custom medical training planned allowed us to work with their schedule, rather than vise versa. Once they had a firm target date for arrival in Mexico, we bought the instructor’s plane ticket. The instructor, an ER tech and ski patroller with work experience from the South Pacific to Antarctica from Colorado was more than happy leave the snow for a few days to jet down to Mexico to lead the course.

Training consisted of a custom curriculum, a 16 hour hands-on course teaching assessment and management of common injuries as well as life threatening situations. An additional day was added that included CPR, suturing and IV starts, as well as orientation to the telemedicine service and extensive medical kit for their boat. Training went really well, and used the most relevant location available, the boat that they would be living and traveling in. It also served as a great way for them to prepare mentally for the challenges and responsibilities directly ahead.

They now have a dynamic system in place to handle medical issues, and can relax and focus on enjoying their journey. Firstly, hands-on training gives them the ability to assess cases with confidence and handle a broad range of issues. Their telemedicine subscription service gives them an unprecedented backup system, with Emergency Physicians available to answer their call and lend support 24/7. They can also use the system for prescription replacement worldwide, evacuation assistance, and travel alerts. Next, their comprehensive medical kit gives them in essence a mobile clinic, so they have the supplies and medicine they need on hand to support the first aid they administer and the telemedicine Emergency Physicians’ advice. Lastly, they have a seaworthy defibrillator and an oxygen concentrator on board for additional peace of mind.

It has been great working with them to support their adventure. We wish them safe travels, and the trip of a lifetime!

**Update: they have successfully completed their first long passage from Mexico to the Marquesas in just over 16 days at sea. After some time enjoying the islands, they are on to the next leg of their journey. We have coordinated a medical kit resupply for them in American Samoa to coincide with their arrival there in a few months.

Tom Milne

Remote Medical ACCESS™ Account Manager

tmilne@remotemedical.com

RMI Staff Member Receives National Recognition for Creative Commuting

noreply@blogger.com (Kevin Thompson) — Tue, 29 Jul 2008 18:34:29 -0500

Remote Medical International Account Manager, Tom Milne, has been receiving some face time on various news channels and websites, both locally here in Seattle and through some national media in recent weeks. In response to the price of gas, Tom began riding his bike to work daily earlier this year, from his house in West Seattle to the RMI office located at Fisherman's Terminal in Ballard.

Recently, though, Tom took this a step further and began commuting to work approximately 13 miles in his Kayak each way. Somehow, King 5 News here in Seattle found out that Tom was doing this and ran a story on their nightly news and website. From there, the story has been syndicated all over the internet, and most recently, Forbes.com ran a feature on Tom's commute. To Check out the clips click here:

Forbes.com
King 5 News

We all think this is great here at RMI, but just hope that Tom buys himself a more appropriate kayak soon, as his Sit-On-Top is arguably not the most efficient choice...

Remote Medical Instructor Guides Everest Climb, for a Cause

noreply@blogger.com (Kevin Thompson) — Mon, 21 Apr 2008 11:46:56 -0500

Remote Medical International lead instructor, Melissa Arnot, is part of a team that has embarked on an expedition to summit Mount Everest this Spring, in support of the (RED) campaign. EVEREST TEAM INSPI(RED), as they are called, are hoping to inspire individuals to support (RED), as they attempt to reach the summit of the highest peak in the world, at 29,028 feet.

The (RED) campaign was created in order raise awareness and money for The Global Fund by teaming up with the world's most iconic brands to produce (PRODUCT)RED branded products. A percentage of each (PRODUCT)RED product sold is given to The Global Fund. The money helps women and children affected by HIV/AIDS in Africa.

You can follow EVEREST TEAM INSPI(RED) on their journey by visiting their blog at http://joinred.spaces.live.com/, which features regular dispatches from the climb, pictures, as well as ways for you to support (RED).

All of the staff at Remote Medical International wish Melissa and the rest of EVEREST TEAM INSPI(RED) the best of luck in reaching their goal.

Spring 08 WFR Course Announced in Boulder, Colorado

noreply@blogger.com (Kevin Thompson) — Mon, 21 Apr 2008 11:47:37 -0500

Remote Medical International is pleased to be teaming up with the Colorado Mountain School & Boulder Rock Club to offer a Wilderness First Responder course in Boulder, Colorado on May 12-22, 2008.

Although we’ve held several private wilderness medicine courses in Colorado, this course represents our first course open to the public in this area. We’re really excited to offer our high level of Wilderness First Responder training to the thriving outdoor community in Boulder and the surrounding area, and also to be working with the Colorado Mountain School & Boulder Rock Club to bring our courses to Boulder.

For more information, check out the course info page at: www.remotemedical.com/Boulder

Remote Medical International Takes an Environmental Leadership Position by Joining Carbonfund.org’s CarbonFree Program

noreply@blogger.com (Kevin Thompson) — Mon, 08 Oct 2007 15:15:59 -0500

Remote Medical International recently partnered with Carbonfund.org, the country’s leading carbon solutions organization, to offset our carbon emmissions. This commitment places us as an environmental leader in the Northwest and demonstrates proactive steps being taken in the fight against global climate change.

At Remote Medical International, we're very concerned with global warming. Considering the implications of climate change, carbon offsets through Carbonfund.org are a natural extension of the work we do.

"I believe strongly in corporate responsibility, and as a company we strive to ensure both our staff and environment are taken care of in a sustainable way" says Remote Medical International CEO Andrew Cull. "In that commitment, we have significantly limited our paper use, provide shower facilities for bike-commuters, use low-energy lighting, use blackle, and allow staff to work from home. We needed a way to account for the number of flights and driving to wilderness medicine courses, and we now can at least offset those emissions. I am very excited about the partnership between Remote Medical International and Carbonfund.org."

Carbonfund.org is a non-profit organization whose goal is to make carbon offsets and climate protection easy, affordable and a normal way of life for every individual and business. Carbon offsets enable individuals and businesses to reduce carbon dioxide emissions to offset the emissions they are responsible for in their normal activities, like home, office, driving or air travel emissions.

Carbonfund.org is the country’s leading carbon reduction and offset organization. Carbonfund.org educates the public about the dangers of climate change and makes it easy and affordable for individuals, businesses and organizations to reduce their climate impact. Carbonfund.org works with 300 corporate and non-profit partners including Discovery, Dell, Yakima, Orbitz, Environmental Defense, Lancome and Working Assets.

For more information, See our Webpage at Carbonfund.org.

Summer Wilderness EMT Course Ends with Great Results

noreply@blogger.com (Kevin Thompson) — Fri, 31 Aug 2007 17:19:09 -0500

Remote Medical International recently wrapped up another great Wilderness EMT course this past August with terrific results. 100% of our students passed the National Registry EMT-B exam on their first try. This brings our cumulative average on the exam from all of our past WEMT courses up to almost 99%. Compare this to the National average of a 72% pass rate (January - May 2007) and I think it’s clear that we’re teaching great courses.

In my opinion, our high success rate in Wilderness Emergency Medical Technician training can be attributed to several factors. First and foremost, our instructors are not only great teachers, but also are actively working providing medical care in remote and challenging settings. This gives them a unique perspective when teaching the skills, as you can be assured they’ve actually seen what they’re teaching and dealt with it in a remote environment. Pairing this experience with the only Wilderness EMT curriculum exclusively focused on remote care, and you have an outstanding learning environment for students.

Furthermore, the use of advanced training tools in the course, such as ALS manikins, foley catheritization simulators, and suture arms provide students with the most realistic scenarios and practice opportunities possible.

Finally, as with our past WEMT courses, I have to give our students a lot of the credit. We had a great group of students at this course that, despite some long and stressful days, maintained their motivation and finished with great success.

Read other students reviews of our Wilderness EMT course here.

Ratings and Reviews for Wilderness Medicine Courses

noreply@blogger.com (Andrew Cull) — Fri, 24 Aug 2007 19:41:48 -0500

For a long time I have made it a project to get our product ratings and reviews up on our site. In my mind, the most rewarding part of my job is learning from our clients. As a Tactical/Remote Area Paramedic I am still very active as a remote medical care provider, and I sincerely value the information, expertise and feedback that I've received on techniques and gear.

On that note, we decided several weeks ago to extend our ratings and reviews to our courses as well. This allows our students to review our courses for the whole world to see. I hope that it allows perspective students to evaluate their options, and make the best choice in the type of course as well as the course provider - which I obviously am biased.Thank you for the great feedback we have received already, and I look forward to more feedback by the over 4000 students we have trained so far.

Wilderness First Aid
Wilderness First Responder
Wilderness First Responder Recertification
Wilderness EMT
Remote Medicine for the Advanced Provider™

Product Ratings & Reviews - Win $150 each week

noreply@blogger.com (Andrew Cull) — Fri, 03 Aug 2007 19:08:40 -0500

One of the most rewarding aspects of working at Remote Medical International is learning from our clients, whether it be on training courses, or hearing the different ways that wilderness medical care providers are using gear.

On that note, I embarked on a personal project to increase the visibility of these conversations, expertise, and opinions that we so personally value here at RMI by implementing Product Ratings and Reviews. These reviews allow our website users to rate products and courses, and give their feedback and opinion visibly on the site. On the flip-side, users will finally have access to these great ideas and opinions linked into the product page - you can see what people thought about the product, what that application was, how it worked for them, etc. I am very excited about this, and RMI staff have already started reviewing our favorite and not-so-favorite products (we have a special staff badge so you can see which ones are from us). To get this project started, we created a promotion:

Win $150 Each Week
Through the end of August, we have a promotion going. Each friday, we randomly choose a review (staff excluded). The author of that review receives a $150 credit. Simply, the more reviews you do, the better your chances. Below is more information, or check out our Product Ratings and Reviews page.

Earn University Credit & Use Financial Aid for RMI Courses

noreply@blogger.com (Chris Kenney, Director of Sales) — Tue, 15 May 2007 16:55:39 -0500

In an ongoing effort to make our courses accessible to as many students as possible, we have partnered with City University to offer both undergraduate and graduate credit for our courses.

This partnership also allows our students to use many forms of financial aid including VA benefits, scholarships, and educational awards. Additionally, Remote Medical International is a licensed vocational school in the state of Washington.

Course credit is awarded as follows:

Wilderness First Responder: 5 College Credits
Wilderness EMT: Up to 20 College Credits
Remote Medicine for Advanced Provider: 5 Credits

Download the university credit registration packet here.

If you have any questions, or would like to utilize your VA benefits, scholarships, or other educational awards please contact our office at (800) 597-4911.

Informal King LT-D® Study

noreply@blogger.com (Andrew Cull) — Thu, 29 Mar 2007 18:05:46 -0500

At a recent course we conducted an informal study of the King LT-D Airway. Utilizing the difficult airway head on an ALS mannequin, we had a single student manage the airway by pre-oxygenating, then inserting an airway device and providing positive-pressure ventilations.

First of all, the study wasn’t fair. Students had completed the Washington State Combitube® course, had ample opportunity to use the Combitube® or EasyTube® throughout the previous 20 days of the course, while only having a fifteen minute orientation to the King LT-D. Second, in addition, we had a 20cc syringe to fill the King LT, instead of the standard syringe, which pushes all 60cc of air in a single shot.

With a dual-lumen airway device, I generally have a difficult time getting a proper seal on the difficult airway head. That said, I was blown away at how fast a student could secure a solid airway with the King LT-D. We had 11 different students individually attempt to get an patent airway with the King LT-D and timed the interval from the last breath delivered during pre-oxygenation to the first breath with chest rise.

Our results were as follows:

King LT-D®
Average Time to First Breath: 11.4 seconds
Success Rate: 100%

Combitube®/Easy-Tube®
Average Time to First Breath: 47.3 seconds
Success Rate: 63.6%

I personally think that the King LT-D will rapidly become the de facto standard in BLS airway management and the rescue device of choice for paramedics. Our anesthesiologist was very impressed with the King LT-D since it is simple and seals very well. For field use it is lightweight, less prone to user error, and substantially faster to insert.

100% Pass Rate on the EMT-B Exam

noreply@blogger.com (Andrew Cull) — Tue, 03 Apr 2007 11:51:39 -0500

I talked with WA State EMS today and was pleased to find out that 100% of our students passed the EMT-B exam on their first attempt this March. In keeping with our tradition, we maintain one of the highest pass rates in the county, averaging 100% on WA State Exam, and over 98% on the National Registry EMT-B, on first attempt. I personally believe that students do much better when they truly understand the rationale for interventions, and have ample opportunity for practice in realistic environments on realistic simulators. Furthermore, we just have great students. Congratulations to the March 2007 WEMT Class for a job well done.

For more information on our Wilderness EMT-B a.k.a WEMT-B, please visit our WEMT page on our website or call our office at (800) 597-4911.

The RMAP™ Promise

noreply@blogger.com (Andrew Cull) — Wed, 21 Mar 2007 14:05:22 -0500

During the last six months, I have attended a number of training courses and conferences; several of our remote area paramedics are recertifying this year and we tend to all get interested in the same courses, which means that we end up with a lot of extra CME credit each period. At any rate, most of these courses follow the same format where you watch PowerPoint slides displaying verbatim what the instructor is saying, and then a symbolic “scenario” where you play with a new device or gadget, one member of the group actually uses the thing on a simulator and the course is over. Most recently, I had a physician-instructor let us know that he had never actually used the device he was teaching us about.

First of all, if you ever walk away from any course of ours with this impression, please call the office and ask for me – I will personally provide you with a full-refund and sincere apology. The whole goal of medical education is to enable a person to act and understand what they are doing, and most importantly, make clinical decisions regarding interventions, treatment, and evacuation. In our case – all of our training is very specific to the remote setting where you must take care of a patient for multiple hours, days, or even weeks.

No course defies the standard training experience, or emphasizes our goals more so than the Remote Medicine for the Advanced Provider™(RMAP™) course. Every course we run is conducted in a remote setting, Costa Rica, China, and the Cascade Mountains routinely, as well as locations across the U.S. Lately, we have seen a dramatic rise in wilderness medicine courses for “ALS Providers” taught by EMT-Basics, where participants learn about improvised splinting, and basic emergency medicine. The RMAP™ is based on our collective experience providing ALS care in some of the most remote regions of the planet. Our instructors are remote area paramedics and physicians who have an on-going and uncommon experience providing medical care and rescue in unconventional, wilderness, disaster, and open-ocean settings. Discussions on realistic airway management, environmental emergencies, trauma care, medical emergencies, medical kits are all based on our current practices, research, and experience – and practiced in depth, with real equipment, outside. Lectures are interactive, with the classroom lights on, drawing from the rich body of knowledge that our students and staff possess.

I am no doubt a biased source on this issue, though our post-course reviews by students have yet to be less than an “Extremely Satisfied” and we have never had a student who did not check the “I would recommend this course to a friend” box. A military officer recently commented, “This is the best training course I have taken as far as usability, and applicable knowledge.” As a colleague, I invite you to a course you can look forward to, and personally promise that the RMAP™ will provide a positive and eminently useful educational experience whether you work in disasters, offshore, on expeditions, or you just have a general interest in wilderness medicine.

If you have any questions about this or other training courses, please don’t hesitate to call our office or visit our website.

Dispatch from the Wilderness EMT

noreply@blogger.com (Melissa Arnot) — Mon, 26 Feb 2007 23:10:30 -0600

Can you believe that it is already day twenty-three of the Wilderness EMT course in the North Cascades? We have spent the past month surrounded by people who surround themselves with remote settings, where medical care is anywhere from a few hours to a few weeks away. It has been an amazing course and the students have really developed their assessment skills, treatment practices and leadership styles.

The first week of the course defined who the students would become as Wilderness EMTs , we gave them a solid foundation in patient assessment to take them through the course. Starting with simple airway management (or maybe not so simple... when your fellow students are 'fake' vomiting apples and granola on you!), and continued full swing with some advanced skills for remote settings, such as suturing. The students got their suture practice on pigs feet (no pigs were harmed, only healed), while gaining a valuable skill for truly remote patient care!

The course cruised along into week two, after students got their first glance at real patient care in the clinical rotations. Each student went for a ride along shift on Skagit County Medic One Ambulance, and an emergency room rotation at Skagit Valley Hospital. The urban skills of the EMT Basic, such as spinal immobilization, and the long-term remote skills, like care of a seizing patient following a head injury really came together. Everyone started to gain an appreciation for how the long term patient management skills can really make you a better urban care provider. Somewhere between the head and spinal trauma, chest injuries, bleeding, and unresponsive patients, we began honing some of the more advanced skills. The Medical Person In Charge (MPIC) certification encompasses some advanced skills that can make the difference for critical patients in remote settings. The advanced skills spanned everything from IV initiation, nasogastric tubes and foley catheters to airway management with the King LT-Ds and the Rusch Easy-Tube.

Urban, remote, and advanced skills all merged as we headed into week three. Night-time rescue scenario? No problem, as the students professionally calmed and cared for frantic patients into the dark night time hours. Five person vehicle extrication? Not to worry, they had the patients packaged for transport in a half hour, while still paying attention to the 'soft skills'. Truly solid care providers emerged as we delved into the complexities of cardiology and respiratory emergencies.
And here we are, week four. Emergency child birth, high angle rescue systems, and all of the skills from the previous weeks, and as you can see, we have been busy! Leaders have grown from the curious students on the first day. We were introduced to people who spend their time on the vast glaciers of the arctic and antarctic, wilderness trip leaders, and active military personal all blended in with ski patrol, lifetime divers, park rangers, physicians, law enforcement and wildland firefighters. After a month spent in such an exciting course filled with hands on assessment practice and field treatment, I am certain that the students are armed with medical skills that they can use in an ambulance or in the arctic. I can only hope my next course is in as beautiful of a location as the North Cascades!

Until next time,

Melissa

ALS Training Simulators in RMI Courses

noreply@blogger.com (Andrew Cull) — Tue, 20 Feb 2007 12:18:53 -0600

Remote Medical International recently welcomed a group of new assistant instructors to the Training Group, increasing the realism and reinforcing advanced skills practice in RMI courses.

As the CEO and an active instructor, realistic scenarios have been not only a goal, but a cornerstone of our courses. We believe strongly that students should learn skills in the most realistic environment possible and over the past year, we've searched hard for ALS training simulators which we could take outside, haul up cliffs, and reinforce the skills learned in the RMAP™ and our Wilderness EMT courses.

In the most recent Wilderness EMT course, students had the opportunity to provide advanced care to simulated patients in the wilderness while providing litter evacuations including airway adjuncts, the King LT-D Airway, Easy-Tube, IV Starts, IM/SQ Injections and more. In the RMAP™ course, students practice surgical cricothyrotomy, needle decompression, and chest tubes while managing the unique challenges seen in out-of-hospital, remote care.

Don't Drink the Water - The Truth About Hyponatremia

noreply@blogger.com (Steve Guthrie, Instructor) — Wed, 17 Jan 2007 13:25:25 -0600

We hear it over and over, Drink regularly and often, or even more ominously, Hydrate or Die. Instruction manuals, instructors and guides, and even wilderness medicine instructors emphasize the need for constant hydration. While this advice is true, it is possible to over-hydrate. Long exposure to heat challenge and/or over-hydrating during exercising, without replacing sodium lost from sweat, is a very bad thing. Hyponatremia is a condition resulting from sodium concentration levels in the blood dropping too low. In the athletic community this condition has been identified as a serious and common malady. An article titled, Hyponatremia among Runners in the Boston Marathon, in the April 14, 2005 issue of the New England Journal of Medicine puts more of a fine point by stating, Hyponatremia has emerged as an important cause of race-related death and life-threatening illness among marathon runners. The article detailed a study of runners in the 2002 Boston Marathon. Blood tests taken from 488 runners at the finish line found that 13 percent had hyponatremia. Running a marathon would probably cause my death from a variety of causes, but we should all pay attention to a condition that affects such a high percentage of trained athletes.

Signs and symptoms are dependent upon the patient and the amount of sodium lost. Mild to moderate signs and symptoms may include: Headache, nausea, possibly vomiting, dizziness or light-headedness, muscle cramps, mild confusion or anxiety, normal temperature and color, sweaty skin, and either a normal pulse, or very slightly elevated. These signs and symptoms, especially in a heat challenge environment, may erroneously lead the caregiver to assume heat exhaustion as the cause. Heat exhaustion is fluid volume depletion, which is treated by re-hydrating the patient. This will only make the hyponatremic patient worse. As the condition progresses the patient may become disoriented, irritable, and combative, and if unresolved, will eventually lead to seizures, unresponsiveness, and death.

The key to proper assessment and treatment is a complete and accurate patient history. Large amounts of fluids consumed and very little, or no food, lack of thirst, and regular urination that is clear and copious indicate hyponatremia and are different from those seen in heat exhaustion. A patient suffering from heat exhaustion would be thirsty and have darkly colored urine in low volumes.

Treatment for mild-to-moderate hyponatremia in a patient without an altered mental state needs to start immediately: No fluids, removal from the hot environment, and intake of salty foods. Introducing the food gradually will make it easier for the patient to tolerate. Be careful not to rely on electrolyte replacement drinks alone. They are low enough in sodium concentration that we are mostly adding water to our completely saturated patient. The condition is resolved when the patient re-develops their thirst, becomes hungry, and urine output becomes normal. Patients with an altered mental state must be evacuated to definitive medical care immediately.

Prevention is simple and easy: Eat! Salty snacks, crackers, trail-mix, along with regular meals will provide you with plenty of sodium to stave off hyponatremia. Dealing with a potentially life-threatening illness in the wilderness is always scary and difficult, and prevention should always be foremost in our backcountry decision-making, especially when prevention is so easy and fun: Just eat more food!

Remote Medical Awarded Federal Supply Schedule (GSA/VA) Contract

noreply@blogger.com (Chris Kenney, Director of Sales) — Mon, 12 Feb 2007 23:27:19 -0600

Remote Medical International has been awarded an open and continuous contract from the VA National Acquisition Center for Medical Equipment and Supplies. With over 200 items and more being added monthly, this contract allows RMI to better serve our federal customers as well as customers purchasing using federal grants. Our contract includes items from leading manufacturers such as Waismed, First Care, Patus, Rusch, Philips Medical Systems, and SAM Medical. RMI's CEO, Andrew Cull commented, "This contract allows us to streamline the purchasing process for Federal Buyers, especially FEMA, NDMS, and the DoD who regularly purchase for emergency procurement. We are very excited about the opportunity to better serve our government clients."

Federal Supply Schedule pricing is seamlessly integrated into our website and customer service center. If you are eligible to purchase on the United States Federal Supply Schedule, please contact us to have FSS pricing applied to your account.

Remote Medical International's Federal Supply Schedule Contract Number V797P-4982a for products awarded under Open and Continuous Solicitation Number RFP-797-FSS-0025-R4, FSC Group 65, Part II, Section A, for Medical Equipment and Supplies.

Teaching Prevention in Wilderness Medicine Courses

noreply@blogger.com (Andrew Cull) — Fri, 17 Nov 2006 16:44:30 -0600

Remote Medical International was recently referenced at a conference during a panel discussion on Wilderness Medicine and Outdoor Education. One of the members of the panel made reference to our company as, "Only training people who actually practice these skills," in the context of the importance of prevention. I should start by explaining that we accept this criticism as one of our highest complements, that those who actually use their skills choose Remote Medical International as a training provider.

As far as prevention is concerned, students will find in all our classes that it is a key focus when applied to specific injuries and illness. We believe that it is flat-out irresponsible to teach treatment without prevention, and in fact, prevention should be the first step in pro-active treatment. This is evident by the first pages of our Wilderness First Responder Field Guide, starting off the course with the concept of the "Medical Officer" as the person in charge of health and emergency planning in various phases of the operation. This is taken directly from our Medical & Rescue Support group and our experience providing medical and rescue support for large groups in very remote settings. Field practices, medical protocols and operations are the domain of wilderness risk management courses, not wilderness medicine training.

One of the distinguishing factors in our training is that we pro-actively emphasize pre-planning, and the role of our students in leading this effort. This common theme is an ever-present dimension of each course, from Wilderness First Aid to Remote Medicine for Advanced Providers.

While hiring a physician for medical support, one of our staff physicians commented that, "We need a doctor who would go to Africa and build a water treatment system instead of prescribe antibiotics to the entire town for water-borne illness." Perhaps this is why our main challenge in medical support projects is explaining to the client why the injury rate falls so drastically when our medics are there - that the role of the Wilderness First Responder, or any Wilderness Medical provider is to first and foremost pro-actively ensure the safety of her team. However, should an emergency occur, they should respond with the best training and skill-set possible.

Which wilderness medicine course should I take?

noreply@blogger.com (Matt Walker) — Mon, 12 Feb 2007 23:31:46 -0600

If you are someone who spends time in wilderness or remote settings for work or play, you might already know that wilderness medicine is categorically different from urban care. The major differences are that remote medicine typically happens two or more hours from a hospital whereas urban care has timely access to medical facilities, remote medicine generally has limited equipment on hand which necessitates improvisation, remote medicine may include difficult access to the patient and the need for advanced skills with limited time to train.

The first and easiest way to choose is to look at where,, how and why you find yourself in remote environments. Do you backpack, climb, or paddle or are you working in the outdoor industry and need training for employment? If you are an outdoor educator or mountain guide, the Wilderness First Responder course is the standard in the industry and in many cases, a requirement for employment. If you are looking to start a career in emergency medicine or as a remote site medic, such as ski patrol, a climbing ranger or Ambulance EMT, the Wilderness EMT is a solid way to start.

Often, US Forest Service and National Park personnel are required to have Wilderness First Aid, though many times the agency you work for will provide this course for you.

For individuals looking for training in wilderness medicine - we have the following recommendations:

If you:

Are a recreational hiker, boater, climber and/or skier

Are occasionally more than two hours or more from the hospital (time calculated from onset of injury)
We recommend the Wilderness First Aid or "WFA"

16 hour course

Provides student with strong basic skills far beyond those taught in basic first aid

Examples of skills taught: long term wound care; joint relocation; patient assessment; assessment and recognition of medical conditions including cardiac issues, respiratory emergencies, allergic reactions; building medical kits; splinting fractures and taping joint injuries.

If you:

regularly recreate or travel far from medical care or in developing countries

We recommend the Wilderness First Responder

80 hour course

Provides skills to deal with the majority of medical emergencies as well as common medical complaints

Examples of skills taught: all skills taught in WFA, wound closure, fracture management, dislocations

Taught by medical professionals experienced in providing medicine to patients in remote settings, on expeditions, search and rescue, and in our medical support division.

Included in the course is the American Heart Association CPR for the Professional Rescuer which includes infant, child, and adult CPR, use of the bag-valve-mask and Automated External Defibrillator.

If you:

Are a profession provider or preparing to be a professional provider of remote and wilderness care such as ski patrol, EMT-B on ambulances, remote medics in National Parks, wildland fire crews, or ambulatory services for outdoor related incidents

We recommend the Wilderness EMT Course

Taught by doctors, nurses, paramedics, and experienced WEMTs

Designed to give you a skill set based on years of real field experience

Examples of skills taught: suturing, fluid resuscitation, eye emergencies, antibiotic and drug administration, foley catheters, orthopedic assessment and treatment, and other long-term care skills essential for a remote provider.

To learn more about our Wilderness EMT course, please click here.

If you:

Are an Advanced Life Support practitioner

We recommend the Remote Medicine for the Advanced Provider™

This is a unique course that offers Advanced Life Support practitioners an opportunity to learn remote medicine with their peers.

Taught entirely by ALS providers who work professionally in a remote setting with our Medical Support Division

Examples of skills taugh: care for environmental emergencies, rescue care, and long term patient care with limited resources in an experiential setting.

Continuing education credits are available for this course.

Whichever course you choose - you can be assured that we will provide a comprehensive curriculum to give you the confidence to venture further into the backcountry with a solid foundation of remote medical skills and knowledge. If you would like assistance is choosing a course that meets your needs, please feel free to contact us by clicking the link, or calling toll-free at (800) 597-4911.

Celox Blood Stopping Powder

noreply@blogger.com (Andrew Cull) — Mon, 12 Feb 2007 23:39:26 -0600

For a long time we have been waiting for a worthwhile hemostatic agent/tool worth including in our Equipment & Supply Division, and at last CELOX™ is here. I recently saw this stuff at the Wilderness Medicine National Conference with our friends at SAM Medical Products, and have been eagerly awaiting FDA approval.

The unusual properties of CELOX™ have been confirmed in wound models, where they have repeatedly demonstrated the ability to control major arterial bleeding, without cautery from traumatic wounds. The granular presentation provides a simple, quick way to stop bleeding and is particularly useful in treating difficult and deep wounds. A clot forms at the site of the injured blood vessel within minutes after pouring the powder into the wound. The granules transform into a gelled clot. The gelled clot is easy to remove.

CELOX™ has no known side effects, doesn't generate heat, and it it works on all blood temperatures and blood, including heparnized blood, and is a natural antimicrobial agent. The best part, is the cost is much lower than any of its competing products.

Celox™ is available in 15g and 35g packs.

In our Medical & Rescue Support Division, we have always had blood stopping powder in our clinics and emergency bags. Neither compare to CELOX™ in effectiveness, cost, or side effects. We are excited to add this remarkable product into our Equipment & Supply Division.

If you are interested in CELOX™ for your agency or organization, please Contact our Equipment & Supply Division

Teach for Remote Medical International - Now Hiring Instructors

noreply@blogger.com (Andrew Cull) — Fri, 16 Jun 2006 14:42:30 -0500

Remote Medical International is currently seeking qualified instructors for part-time and full-time positions teaching wilderness medicine around the world. The position is open until 15 July 2006.

It is important to note that Remote Medical International is committed to hiring only instructors who have real-life experience in remote care and who have actually performed the techniques that they will teach on real-life patients.

Successful candidates are those individuals who:
- have experience in remote or wilderness areas
- have significant medical training and experience, EMT-Basic minimum requirement
- have an easy-going, flexible personality
- are dynamic educators
- are extremely professional in a variety of settings

There are several full-time positions opening up for instructors wishing to work on medical support projects. The job will entail deployments around the world for medical support with opportunities to teach between deployments. This is a benefited, full-time, salaried position. Currently, only Offshore paramedics are needed in this position; however, we are working opening this opportunity for Wilderness EMTs as well.

Courses taught by Remote Medicine International include:
- Wilderness First Responder (80 hrs)*
- Wilderness First Aid (16 hours)
- Wilderness EMT (220 hrs)*
- Remote Medicine for the Advanced Provider™(56 hrs)*
*courses with residential options

Courses are conducted all over the country as well as internationally in Greenland, Europe, Haiti, the South Pacific, and South America. In addition, we conduct custom courses in wilderness medicine and high-angle rescue world-wide.

Once an application has been submitted, interviews will be conducted over telephone and qualified applicants will be invited to attend our instructor course. All applicants are required to have completed wilderness medicine training. If you are not currently certified, there will be an RMAP™ course this September in Seattle, WA. Please contact our office for more information. We can make special accommodations for individuals who are selected following interviews.

During the Instructor course, participants teach selected topics and work with advisors to develop their skills as instructors. In addition participants are introduced to company business systems and meet other staff members. Following the course, instructors are placed on courses as assistant instructors. All new instructors must complete the instructor course prior to teaching, there are no exceptions, including lateral transfers from other companies.

Due to the fact that we invest a significant amount of time and resources in our instructors, we do not allow our instructors to work for other companies teaching wilderness medicine. You will find that our salary and benefits package is the most comptetive in the industry, and we provide our instructors with opportunities not available with other companies. If you have any questions, please contact our office.

Please click here to download the Instructor Application for more information.

Wilderness EMT Course Changes

noreply@blogger.com (Andrew Cull) — Sat, 10 Jun 2006 14:42:35 -0500

We recently conducted a review of our curriculums to ensure that they are up to date and pertinent to the skills and experiences of a remote provider. As you may already know there are not national standards in wilderness medicine training. Virtually anyone can start teaching a course and call it "Wilderness First Responder" or " Wilderness EMT". In short, it is up to the consumer to choose, and the responsibility of the course provider to be honest about the curriculum and instructor level.

I recently noticed that there is a WEMT course out there that doesn't get you an actual EMT-B certification, and the instructional staff do not possess the appropriate credentials to teach an EMT-B course anyway. Furthermore, it is frustrating to me that many WEMT courses are combined Wilderness First Responders and EMT-Basic courses. We are taking a new direction, catering to individuals who must perform medical and rescue skills in remote settings, which is categorically different than the urban setting. While our course has always placed emphasis on the wilderness side, we are pursuing this objective by adding several skills that we believe critical to remote medical care. It is important to note that Remote Medical International has never, and will never accept an urban EMT course and Wilderness First Responder combined for a Wilderness EMT.

The Wilderness EMT from Remote Medical International course now includes:

National Registry EMT-Basic
Washington State EMT-B (optional)
AHA CPR for the Healthcare Provider
US Coast Guard Medical Person in Charge
Remote Medical International Wilderness EMT Certification

This means that we have formalized subjects including foley catheter insertion, IV therapy, suturing, dive emergencies, antibiotic administration, airway management, and pain management/narcotic administration. Additionally, Remote Medical International recently supplemented the W-EMT training equipment to include foley trainers, IV arms, and 2 Advanced Trauma Mannequins which allow students to perform advanced invasive skills in a scenario environment. Our instructor requirements remains the same, all Wilderness EMT courses are led by Remote Site Paramedics who also work in our Medical Support Division. Lectures are also conducted by other Offshore Paramedics, Emergency Nurses, Physicians, and Dentists.

In addition, WEMT students will have opportunities to interface with our new tele-medicine program - having the opportunity to work with online ER physicians during simulations via satellite phone and telex connections. We believe strongly that WEMTs should have the skills to care for patients in a wilderness environment - which means that training should emphasis the high level of knowledge, confidence, and skill required to do so. As always, our courses are hands-on, with an emphasis on information gathering, and building a solid foundation.

For more information on our WEMT course, click here, or call our office at (800) 597-4911 or (206) 686-4878.

Choosing a Medical Kit for Wilderness Medicine

noreply@blogger.com (Andrew Cull) — Sat, 10 Jun 2006 07:54:58 -0500

We are often asked by students and customers about the "perfect medical kit" - to which there really is no answer. In choosing a medical kit for a particular purpose, there are several points to consider:

1. Purchasing a pre-made kit vs. making your own:

First of all, we have customer after customer who believe that making a kit from scratch is cheaper, and this has never been the case. Commercial kits, in our experience, are much, much cheaper, especially since it is often difficult to purchase items in smaller quantities. Commercial kits, like the ones below can have well over 125 different items. The exception is if you use the equipment on a regular basis, where it makes sense to purchase higher quantities of supplies. We often do this for rescue teams, ski patrols, and outdoor programs who operate large programs. If you are interested in these types of kits, please contact Chris Kenney, Equipment & Supply Division Manager.

The other exception are individuals or organizations that wish to carry prescription medications with them. We accommodate this, and with our tele-medicine program, can provide those medications as well as an advanced kit and satellite phone for direct access to Emergency Physicians and Remote Site Paramedics.

2. What are you using this kit for:

Knowing that, by definition, you won't ever have the perfect kit, how much are you willing to carry, and what are the risks associated with your activities. For example, I love alpine climbing, and I am a remote site paramedic. I carry a modified version of the Adventurer Light & Fast, with some added medications and extra athletic tape. I won't carry anything over 2 lbs to keep my overall pack weight down. I believe that a lighter pack is safer while climbing, and I expect that if a serious accident should occur, I will improvise with my own gear, like the closed-cell foam in my pack and clothes for a splint, or a t-shirt for bleeding control, which brings us to the next point.

Another important note for institutional programs, your medications should be in individual packets to meet OSHA requirements. Individual packets are labeled so that adults can make their own decisions about whether to take the medication or not. Also, it ensures that medications haven't been altered or tampered with.

3. If you are going to invest money in the medical side of things, invest in training first.

Solid training by experienced professionals is the single most important thing you can do for taking care of medical issues in the wilderness. I would much rather have great training than the latest and greatest medical toys. Your courses should teach you to think, adapt, and improvise. A basic first aid course will not suffice in this case, I strongly recommend Wilderness First Aid or Wilderness First Responder training for individuals who spend any significant time away from the urban setting.

On that note, you should confirm that your instructors are experienced in Wilderness Medicine. Working in the urban setting on an ambulance or in a hospital is great, but categorically different than working in remote environments, expeditions, or in developing countries where you have to regularly improvise, and have extended contact with patients.

Below are some kits that I really like. At Remote Medical International, we have a great relationship with Adventure Medical Kits. They make good kits for wilderness medicine, and especially for marine medicine:

First of all, in my experience on expeditions and doing remote site support, dental issues are very common. I would guess that about 30% of the illness I deal with in the wilderness is dental related. For simple issues, the Dental Medic provides the tools to replace crowns, deal with lost fillings, as well as cracked and broken teeth. I think that a simple dental kit is essential for any wilderness medical kit, especially since with the right equipment a dental emergency can be converted to simple discomfort, and save the expedition.

Medical Kits for Open-Ocean Medicine
A lot of us are open-ocean sailors or racers. The beauty of sailboats is that they are slow, recently I was about 400 NM offshore when a carbon-fiber boom shattered, with a big chunk came within inches of the captains head. So motoring, at 5 knots, it would take us 69.5 hours to get to land - which was the coast of Mexico at the time. Looking at charts, it would have taken us over 100 hours of straight motoring to get to a clinic. Therefore, a open ocean medical kit must be comprehensive and contain items for long term care like suturing, foley catheters, and a good supply of bandages and dressings. We built a lot of custom medical kits prior to Adventure Medical Kits releasing the Marine Series, which is a great solution for recreational boaters as well as offshore sailors, especially the Marine 2000 from Adventure Medical Kits . I would recommend adding some prescription medications the the kit though. If you are taking care of a larger crew, the Marine 3000 contains more supplies than the Marine 2000.
Medical Kit for Travellers & Developing Countries
When traveling in developing countries, having a small kit that is easily packed is essential,
World Traveler Medical Kit can make your life much easier when dealing with simple medical problems. The World Traveler is a great kit for that, and it contains a sterile kit with IV needles, sutures, and syringes which you can give to the care provider to ensure the equipment is sterile.

Lightweight medical kit for climbing, adventure racing, mountain biking, cycling, and hiking
Out of all the small kits out there, the Adventurer Light & Fast by Adventure Medical Kits is hands-down the best one out there. It is small, with the right supplies and packable into a camelbak.

Medical Kits for Outdoor Education & Guide Services
Working with a lot of outdoor programs and guide services, the Guide I is a solid kit for caring for a group, or on a mountaineering expedition. It is well-stocked and very well organized built for the Wilderness First Responder or Wilderness EMT. The kit bag fits everything you need, but still fits into any pack.

Medical Kits for Professional Rescue
Finally, EMTs and WFRs on mountain rescue teams, and SAR always ask about good kits. To find that answer, I recently used the Mountain Medic II on a medical support operation as my hip pack. I have to say that I was impressed, what a great kit for the price, it carries well and has a solid stock of equipment. I would add a suction device, and I added my IV supplies into the bottom pouch, with plenty of room left, I was fairly impressed as it is uncommon to see a good commercial kit for professional use.

If you would like further assistance choosing the proper medical kit for your activity, please don't hesitate to contact us for assistance. Good luck on your Wilderness adventures.

Advanced Practice & Remote Site Paramedics

noreply@blogger.com (Andrew Cull) — Sat, 10 Jun 2006 07:56:15 -0500

Remote Medical International uses Remote Site Paramedics for offshore and remote site operations. In our experience, the street sense for rescue, independence, and hands-on skills provide a solid foundation, we also require extended expedition experience and an ability to get along with all types of people under conditions of isolation and intense stress. My point though is to develop the discussion of Advanced Practice Paramedics. Our medics suture, administer antibiotics, conduct in depth primary-care type examinations and perform other advanced skills. They are certified as extended providers in Advanced Trauma Life Support, Critical Care Paramedic, and a variety of other courses and certifications, including our own Remote Medicine for the Advanced Provider (RMAP™) and internal physician-taught courses.

Our experience has been great so far, supported by an Anesthesiologist, Emergency Physician, and a Dentist, the teams seem to work very well. We work hard to make sure that open communication exists between all parties, and in a remote setting, often as a single care provider, patient outcomes are very easy to document, so we have an environment and outcomes that prove our model works. The military uses a similar model with 18D Medics, and in England, the HSE has the Offshore Medic program which certifies paramedics and nurses to work in the Oil & Gas Industry.

It is apparent that in the wilderness setting, there is a need for individuals to have advanced training in certain practices and procedures, and this should be evidence-based, but normalized for the wilderness or disaster setting. The applications for disaster scenes, wild-land fire, rural areas, homeless clinics and remote site operations I think are well warranted as well as tactical medics working for the government and SWAT teams as the job is categorically different than the in-hospital equivalents.

Risk Management & Emergency Response Plans for Outdoor Education and Guide Services

noreply@blogger.com (Andrew Cull) — Tue, 06 Jun 2006 08:39:43 -0500

We recently finished several consulting projects for high-profile clients developing risk management systems for remote site operations, one was for a guide service that works internationally. My favorite aspect of working with clients is watching the way they think about their operation change. It seems in business, project management, and probably life in general, that we are always reacting to a set of external circumstances. I find that it is rare to see companies who work to proactively manage risk, and often the clients we work with have already taken these steps and are looking to solidify existing systems, but they took the first step on their own.

At Remote Medical International, I believe we have a very different and unique view on both risk management and emergency response because we use these systems on an on-going and daily basis. For example, at the writing of this blog, I am on the summit of the Greenland Ice Sheet providing ALS Medical Support as well as high-angle rescue. We have another medic in the Bering Sea doing the same thing, a Nurse and Doctor in Haiti, and another Doctor at the Subaru Primal Quest, one of the longest adventure races in North America. For these operations, our pre-planning, logistics, and risk management and evacuation systems must be robust, and we have the unique opportunity to use them on an on-going basis as well as interfacing with rescue teams and other resources on a daily basis.

With a passion for remote places, and enabling individuals to safely operate in those places, I really enjoy translating our experience to usable and simple risk management systems for organizations involved in outdoor education, guiding, and research, as well as other companies that operation far away from hospitals and rescue services. More importantly, my reward is watching an organization change towards a more proactive mentality, as well as feeling confident in their ability to not only respond to an emergency in the field, but provide an administrative response to ensure that the individuals involved are well taken care of, families are supported, the media is informed, and that the inevitable field emergency that is inherent in our operations, provides an opportunity for the organization to show what it is made of, and build credibility through the ordeal which works for both the organization's reputation as well as the moral of staff.

If one spends enough time in the wilderness, an emergency is inevitable, whether it be a dental infection or traumatic accident. As an organization, these incidents define who you are to your staff, the public, and the victims. I believe that one of the best investments one can make in such an organization is a comprehensive risk management and emergency response plan. Whether you use our outdoor risk management consulting services or write your own, the small investment can be the difference between success and failure during an accident and often the needed difference in organizational survival following these incidents.