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