Wondering about Climbing specific Wilderness Medicine? Soliciting questions for upcoming podcast!

I'm collaborating with Wilderness Medicine Updates for a special podcast episode where I’ll interview the host, Dr. Patrick Fink, a physician specializing in wilderness medicine, about his career, experiences, and advice for premed students.

Whether you’re curious about blending a love of the outdoors with medicine, the challenges of practicing in remote settings, or the path to becoming a wilderness medicine expert, now’s your chance to ask!

Drop your questions below (and feel free to let me know the name you’d like to be credited with if your question is used). We’ll cover as many as possible on air.

Looking forward to your thoughts! 

I'd love to know what is his favorite way to perform a field decompression of a collapsed lung and what pieces of climbing gear I could use, in a pinch, to do the same.

(Yes, I'm aware no one should actually try this, but it might still be a fun conversation)

I'm curious about the efficacy of improvised tourniquets. Materials I've heard proposed are slings, carabiners, and nut tools.

Adam Fleming - I'd be worried using a dyneema sling since they are so skinny. I wonder if a nylon sling would be wide enough to consider?  

It will be an interesting podcast for sure.

MIN I wrote:

Adam Fleming - I'd be worried using a dyneema sling since they are so skinny. I wonder if a nylon sling would be wide enough to consider?  

It will be an interesting podcast for sure.

That's been one of my concerns. My friends and I don't carry any 1" nylon these days.

Physicians opinion on med kits to have with you. Obviously it changes with how long you'll be out, how deep in the wilderness,  and your skill level. I carry stuff for boo-boos, basic mid level injuries, and major trauma. 

My reasoning is I can fix a boo-boo and keep climbing, middle level injuries (sprained ankle, fractures) can be stabilized and hiked out but having some grear (sam splint, pain meds etc) is really nice,  and major traumas (hemorrhage) need Immediate intervention. Whole kit that I carry is the volume of a nalgele and weighs maybe a few 100 grams. Can scale up or down for bigger or smaller objectives.

I would like to hear Dr Finks thoughts on equipment and training. Training is Obviously more important than carrying more doodads.

Adam Fleming wrote:

I'm curious about the efficacy of improvised tourniquets. Materials I've heard proposed are slings, carabiners, and nut tools.

I'm qualified to answer, though you may want to hear it from Dr Fink (who I've known for several years and respect highly.) 

The current EBP guidance is that improvised tourniquets have very low efficacy and a proper dedicated tourniquet is, for the most part, irreplaceable if needed. 

NateC wrote:

I'm qualified to answer, though you may want to hear it from Dr Fink (who I've known for several years and respect highly.) 

The current EBP guidance is that improvised tourniquets have very low efficacy and a proper dedicated tourniquet is, for the most part, irreplaceable if needed. 

Last course I took the instructor’s issue with improvised devices was that they wouldn’t be strong enough and very few people really appreciated (before you really need it) just how tight they must be. I would think climbing gear would be pass the strength test, at least.

Are the SWAT tourniquets effective?  Asking because they are a little more multipurpose (and more compact than an ACE wrap).

Tone Loc wrote:

Last course I took the instructor’s issue with improvised devices was that they wouldn’t be strong enough and very few people really appreciated (before you really need it) just how tight they must be. I would think climbing gear would be pass the strength test, at least.

I wish I could find it, but there was a study done not too long ago that found very low success rates of adequate arterial occlusion with improvised TQ's. If I recall correctly, climbing materials were in the sample set. Again, I've slept a few nights since and I didn't buck against the info because it was clear when I read it, but from what I recall you are correct that strength is one issue. Getting it tight enough with improvised materials is another. An additional issue I recall is that the width of the strap matters because a narrow material creates too focal of an occlusion point and the effect can be lost as the patient is moved and shifted. 

Not the study I was trying to find but this study has some excellent information. For me, this bit is particularly convincing that carrying a proper CAT TQ is generally worth it...

(emphasis in bold added by myself)

...simulation work has shown rates of correct improvised tourniquet application of 10% to 40% when applied by trained personnel.24 Kragh et al25 also found that materials potentially used for windlasses in the simulation setting break at a higher rate of 20% to 53%. In the real world, improvised tourniquets have similar high failure rates, with the preeminent example coming from the Boston Marathon bombing during which 27 extremity tourniquets were placed, all improvised and all deemed ineffective on postevent review.21