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Wilderness Medicine Institute

MEDICINE FOR THE OUTDOORS The Essential Guide to Emergency Medical Procedures and First Aid

Paul S. Auerbach, M.D. 1999 (revised ed.); 499 pp. $22.50. Lyons Press.

If you can't have an experienced emergency physician with you when you're traveling off the beaten path, take this book. And read it first! This book replaces my previous recommendation of a wilderness/ travel medical guidebook, Wilkerson's Medicine for Mountaineering.

The book is intended for use when a medical emergency occurs away from medical care. It includes general medical principles that should apply to all outdoor travel, and things to do before you go. I particularly like Auerbach's statement about carrying appropriate survival supplies: "Minimize the need for improvisation."

The first big section covers major medical problems, such as the approach to the unconscious patient; chest injury; bleeding; shock; head injury; allergic reaction; poisoning; emergency childbirth; and infectious diseases. Next come minor medical problems; then disorders related to specific environments, such as cold or heat injury and illness; altitude-related disorders; animal attacks; underwater diving accidents and near drowning. Last is a miscellaneous section, including administering oxygen; disinfecting water; motion sickness; first-aid kits; transport of injured victims; and ground-to-air distress signals. There are several useful appendices, including information on commonly used drugs and guidelines for prevention of disease transmitted by blood and other bodily fluids. And if a picture is worth a thousand words, the clear and appropriate illustrations double the word count.

Paul Auerbach is a physician at Stanford University's Division of Emergency Medicine, a founder of the Wilderness Medical Society, and an advisor to the Divers Alert Network, the National Ski Patrol system, and the Institute for Preventative Sports Medicine.

"A tourniquet is indicated only in a lift-threatening situation and is best applied by an experienced person. Only in the case of torrential bleeding is a tourniquet more advantageous than continuous pressure. The decision to apply a tourniquet is one in which a limb is sacrificed to save a life.

"In general, it is unwise to manipulate an injured limb. If the extremity is deformed, but the circulation is intact (normal pulses, sensation, temperature, and color), do not attempt to straighten it; instead, splint it in the position in which you found it ("splint `em as they lie"). On the other hand, if the circulation to an extremity is obviously absent (the extremity is numb, cold, and blue or pale), if the victim is in extreme discomfort, or if gross deformity prevents moving the victim out of a dangerous situation or prevents the application of a splint, then an attempt to restore the part to a normal position is justified.... If there is no deformity, splint the injured body part in the "position of function" (the position it would assume if it were at rest).

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