Monday, June 19, 2017

NOLS Wilderness Medicine Curriculum eNews for June 2017.

The following e-news announcements was prepared and edited by Tod Schimelpfenig, who is the curriculum director for NOLS Wilderness Medicine in Lander, WY.

Curriculum Content - Tincture of Benzoin

The standard wound care demonstration by NOLS Wilderness Medicine instructors has been to clean the wound, use steri-strips for temporary closure and a transparent dressing supplemented with generous application of Benzoin. This can generate a topical allergic response.

NOLS Wilderness Medicine Curriculum Director, Tod Schimelpfenig, has noted enough of these reactions to announce that instructors should no longer demonstrate the use of benzoin under the transparent dressing. Benzoin will remain in the wound demo kit. It should be shown to students and taught with these curriculum points:

- Benzoin is used to augment tape and dressing adhesives in situations where the adhesive on a tape or dressing is not sticky, where motion (e.g. a dressing over an elbow) or where moisture (e.g. sweaty feet, wet environment) challenges the adhesive’s effectiveness.

- Some people have a topical allergic response to benzoin, or to any tape or dressing adhesive. Assess for this and if it develops, wash the benzoin and adhesive from the skin.

Continue with the standard wound cleaning, closure and dressing demo, without the application of benzoin.

Curriculum Style - Auto Injector Incident

On a recent course, an instructor handed students a set of EpiPen® auto-injector trainers with, “Don’t worry, no needles, no drugs, they’re all trainers.“  He had accumulated these over the years.  As he briefed the scenario a student presented with a confused and mildly anxious look on his face. He held up his “trainer” - a dripping needle protruding from the business end. He had injected himself with a live epinephrine auto-injector. 

The auto-injector expired November, 2007, and the epinephrine was “as amber as a tasty IPA.” Nearly 10 years beyond the expiration date it was still effective, albeit probably not quite as strong. The student is fine. There was mild pain at the injection site which resolved quickly. HR was 80 bpm soon after the injection, a little over 100 bpm during the scenario, and down to 60 bpm several hours later. He was mildly anxious.

The point isn’t that epinephrine is effective long after its expiration date, it is to remind all of us to be careful with needles. We have no idea how this live auto-injector ended up in this personal prop set. This live EpiPen® may have been in the set for a long time, yet never deployed. Take home point - We need to model checking and double checking any medication, real or prop, all the time.

Other stuff

In the current edition of the Journal of Outdoor Recreation, Education and Leadership (JOREL) is a paper titled “Evidence-Based Review of Wilderness First Aid Practices.” This is a review of the medical evidence supporting WFA practices. The conclusions are not new; there is very little medical science supporting first aid practices. If you want to read the paper the reference is below. I also posted it on Rendezvous.

Schimelpfenig T, Johnson D, Lipman G, McEvoy D, Bennett B. Evidence-Based Review of Wilderness First Aid Practices. Journal of Outdoor Recreation, Education, and Leadership. 2017, Vol. 9, No. 2, pp. 217–239

Monday, April 03, 2017

NOLS Wilderness Medicine Curriculum eNews for April 2017.

The following e-news announcements was prepared and edited by Tod Schimelpfenig, who is the curriculum director for NOLS Wilderness Medicine in Lander, WY.

Curriculum Content - Hands over the eyes for a pupil response check.

Some of us teach students, in the context of checking pupil response, to have the patient close their eyes, then the rescuer places their hands over the patient’s eyes. This is unnecessary. 

Let’s stop teaching this practice. Simply ask the alert patient to close their eyes for a few seconds.

Curriculum Content - Anaphylaxis

Q - What is up with the sharp increase in anaphylaxis incidents on NOLS Field Courses?

Historically anaphylaxis incidents on NOLS field courses have been rare - six cases between 2005 and 2014. However, in the last year there were 12 incidents. I don’t know what to make of this; isolated spike or trend? Time will tell.

Q - Outside of NOLS, how common is anaphylaxis?

We don’t know. Most wilderness programs don't report or share data, so their experiences remain lore. In the medical literature anaphylaxis frequency numbers vary widely, some suggesting it is common, others rare. I’ve been looking at these numbers trying to find a way to present them to students so they have meaning and can be compared accurately to a useful reference, but alas, I can’t do this.

Q - How often are personal auto-injectors used versus a syringe with vial or ampule system?

At NOLS personal auto-injectors have been used 10 times, syringe and vials have been used 7 times.

Available articles on managing anaphylaxis in the wilderness:

Management of anaphylaxis in an austere or operational environment. Ellis, B.C. and Brown, S. G (2014) J Spec Oper Med. 2014 Winter; 14(4):1-5

Managing anaphylaxis in a jungle environment. Stokes, S. and Hudson, S. (2012) Wilderness Environ Med. 2012 Mar; 23(1):51-5

Wednesday, March 08, 2017

Storm Gathering USA 2017 - Event Video

Storm Gathering USA 2017 - Event Video. 
Produced by Helen Wilson
Storm Gathering events are sea kayak symposiums designed for those wanting to take their skills to the next level. The UK SGS and the SGS USA events are presented by

The symposium featured in this video took place in Trinidad, California from March 3 to 5, 2017. The next UK event takes place next March 2018 in Pembrokeshire, Wales. The next USA event takes place March 8 to 10, 2019 in Trinidad, California.

Get in touch if you want more information about either event -

Wednesday, February 22, 2017

Kokatat - Pure Gold

We are pleased to announce that Kokatat Watersports Wear will be the major presenting sponsor at Storm Gathering USA 2017.
Kokatat began making paddle sports apparel and gear in 1971 and has since gone on to be one of the most trusted brands of sea kayak clothing and equipment internationally. Today, more than 90% of Kokatat’s global sales are generated from apparel and accessories manufactured locally by locals in Arcata, CA.
Both Helen and Mark have been Kokatat Brand Ambassadors since 2008, and throughout all our teaching and travel adventures, we have found that Kokatat is the finest and most durable paddling apparel in the world.

Kokatat has also been supporting both UK Storm Gathering and Storm Gathering USA symposiums as far back as 2008, and we feel honored to be continually connected with this great Humboldt-based manufacturer.
This year, Kokatat will be opening up it’s factory to symposium participants, providing a unique insight into how it’s all done behind the scenes. 
Jeff Turner, Kokatat’s Sales/Marketing/Design Manager will speaking on the Saturday evening about the history of the company and it’s continued impact on the paddlesports community. 
Kokatat has also provide some major prizes for the event raffle including a Passage Anorak, a OuterCore Habanero Liner, a Poseidon PFD, a Tactic pack AND hydration reservoir, and Woolcore Long Sleeve Shirt.
So now is the time to get into the water with Storm Gathering USA 2017 and Kokatat this March in Trinidad, CA. See you soon Storm Paddlers!
Contact us directly if you still wish to attend the event.

Friday, February 17, 2017

Who’s Teaching You? Ben Lawry.

The rather bodacious Ben Lawry will be instructing these classes during Storm Gathering USA 2017 this March.
Session 1: Storm Paddling Essentials (with Mark Tozer)

Session 3: Moderate Water Boat Handling (with Jeff Laxier)
Saturday Evening: Master of Ceremony
Session 4: Developing Boat Control

Sign up today while there are still spaces - SGS USA 2017 How To Register