Retention of wilderness medicine knowledge skills
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Retention of Wilderness Medicine Knowledge & Skills. By: Kent Clement, Ph.D. Nadia Kimmel, M.S. Consider This Scenario. SCENARIO.

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Retention of Wilderness Medicine Knowledge & Skills

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Retention of wilderness medicine knowledge skills

Retention of Wilderness Medicine Knowledge & Skills

By: Kent Clement, Ph.D. Nadia Kimmel, M.S.


Consider this scenario

Consider This Scenario


Scenario

SCENARIO

You and your friends are hiking on a mountain trail in mid-August. You are enjoying a beautiful sunny afternoon with a temperature of 72 F. You come across a person sitting on the trail holding his/her right arm. This person is alone and there are no bystanders. You are 5 miles from the nearest trailhead where your vehicle is parked. It is ten miles from the trailhead to the nearest town. There is no cell reception until you reach the town limits.

Based on your WFR knowledge and skills what are some of the things that you should do?


Scene size up initial assessment

SCENE SIZE – UP & INITIAL ASSESSMENT

After determining that the scene is safe, you find out the person’s name but he/she does no know what happened. The person is confused and exhibits a slurred speech. They complain of pain while guarding their right arm. No sign of life threatening trauma is apparent.

WHAT NEXT?


Scenario1

SCENARIO

After asking SAMPLE and taking vitals you find out the following:

S: Pain in the right arm, pale, confused, slurred speech.

A:None

M: None

P: Diabetes (Type II)

L: Not sure

E: Does not recall

HR:132

RR: 30

BP: Strong radial pulse

LOC:A & 0 X 1 (Alert & oriented to person only)

SCTM:Pale, warm & dry

CSM: Weak in all four extremities, can feel, does not respond to commands well but has good pulses

PERRL:Normal

WHAT NEXT?


Scenario treatments

SCENARIO TREATMENTS

  • Glucose administration while protecting the airway.

  • Splint the arm and check CSM before and after.

  • Head-to-toe exam (reveals nothing)

  • Clear the spine while meeting all criteria

  • Formulate an evacuation plan


Average score 44

Average Score44%

INCOMPLETE SAMPLE

INCOMPLETE VITALS

NO GLUCOSE ADMINISTRATION

POOR AIRWAY MANGMENT

10/23


Participants demographics

Participants’ Demographics

  • 34 total

  • F-9, M-25

  • Age Range

  • Highest WEM Certification – WFR-33, WEMT-1


Study limitations

Study Limitations

  • Not generalizable as it stands due to a small sample size

  • Not randomized design – opportunity sampling

  • Preliminary study – You can get involved with this research – details to follow…


More demographics

More Demographics

  • First Obtained WEM Certification in years ago:

  • Number of Recertification Courses:


Still more demographics

Still More Demographics

  • The Type of Work They Currently Pursue:

    • Guides – 19

    • Therapy – 1

    • Outward Bound – 9

    • Outdoor Education – 2

    • Volunteer Organization – 1

    • Conservation – 1

    • Field Biologist – 1

  • Why did you get an WEM Cert. in the 1st place?

    • Required by job – 29, SAR – 1, Required in School - 3


Results

Results

  • Before the scenario, participants were asked to estimate the percentage of knowledge required to be fully-qualified as a WEM provider they have retained. Answer average: 65%, Range: 17.5 to 90.

  • Before the scenario, participants were asked to estimate the percentage of skill required to be fully-qualified as a WEM provider they have retained. Answer average: 68%, Range: 20 to 90.

  • Remember, accuracy was 44%


More results

More Results

  • After the scenario, participants were asked if they retained as much knowledge required to be fully-qualified as a WEM provider as they thought they would. Answer: Yes – 7, No – 27

  • After the scenario, participants were asked if they retained as much skill required to be fully-qualified as a WEM provider as they thought they would. Answer: Yes – 18, No - 16


Injuries with which participants dealt

Injuries With Which Participants Dealt:

  • ligament sprain12

  • Laceration22

  • muscle sprain13

  • Sunburn29

  • Frostbite5

  • tooth related5

  • Fracture9

  • Burn14

  • Dislocation5

  • blister(s)25

  • immersion foot6

  • bruise, contusion18

  • Tendonitis6

  • head injury without loss of consciousness10

  • head injury with loss of consciousness1

  • eye injury5

  • skin abrasions25


Injuries with which participants dealt1

Injuries With Which Participants Dealt:

  • near drowning 3

  • shoulder dislocation7

  • life threatening bleed0

  • back injury5

  • “Other” includes: fish hook, fractured pelvis, sickle cell disease, ruptured spleen, compound fracture, snake bite.


Illnesses with which participants dealt

Illnesses With Which Participants Dealt:

  • allergic reaction17

  • Anaphylaxis2

  • Diarrhea20

  • AMS12

  • food related illness9

  • HAPE0

  • HACE0

  • non-spec. fever illness4

  • urinary tract infection4

  • skin infection10

  • heat cramps2

  • heat exhaustion15

  • heat stroke1

  • chest pain or cardiac cond.2

  • eye infection2

  • upper respiratory illness 2


Illnesses with which participants dealt1

Illnesses With Which Participants Dealt:

  • abdominal or other gastrointestinal problem without diarrhea12

  • hypothermia illness 6

  • heat illness7

  • cardiac emergencies0

  • diabetic emergencies3

  • Seizures3

  • Asthma6

  • behavioral emerg.8

  • Hyponatremia3

  • dehydration 21

  • snake bites1

  • spider bites6

  • scorpions stings3

  • bee stings13

  • red/fire ant stings5

  • animal bites1

  • gender spec. issues4


Illnesses with which participants dealt2

Illnesses With Which Participants Dealt:

  • toleo (foot rot specific to the Grand Canyon)3

  • ear infection0

  • Cpr2

  • rescue breathing1

  • Other0


Are we failing

Are we failing?


Ideas for improving retention

Ideas for Improving Retention

  • Limit rescuer distraction

  • Simplify wilderness medicine curricula

  • Emphasize SAMPLE and information gathering skills in wilderness medicine classes

  • Offer continuing education classes on-line as part of the recertification process

  • Look at other medical industry standards for recertification requirements and lengths

  • CPR

  • NREMT

  • ACLS

  • OEC


More ideas for improving retention

More Ideas for Improving Retention

  • Recalibrate rescuer overconfidence

  • Design curriculum giving precedence to the activities with which rescuers are most likely to face in an emergency situation.

  • Shorten the re-certification period. (I know, I know)


Retention of wilderness medicine knowledge skills

The End

  • Getting involved with the study:


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