The Emerging Role of Physical Therapists in Wilderness Medicine

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Original Article From APTA.org
Author: By Paul Beattie, PT, PhD, FAPTA

Limited Resources And The Need To Innovate
In wilderness emergencies, a health care provider may have a large array of equipment specifically designed for medical care. For example, professional backcountry rescue teams might carry "jump kits" that have monitors, oral and injectable medications, equipment for oxygen administration, dressings, splints, and supplies for wound closure. This equipment allows rescuers to perform evaluations and procedures equivalent to what could be provided in a fully stocked ambulance. At other times, however, rescuers might only have what they are carrying in their backpacks — or perhaps just a water bottle and bandana. These situations lead to creative exercises and applications.

There are endless possibilities for confabulated medical equipment. An inverted baseball cap may be used as a cervical collar. A rain jacket might be used as a sling. Fill a baggie with clean water and squeeze it out of a small puncture hole to provide high pressure wound irrigation.

A person's life can be saved by a "hypothermia wrap" using basic backcountry equipment such as sleeping bag on top of a foam sleeping pad that is completely wrapped in a thermal space blanket and tarp to create an insulating "burrito." This wrap will help prevent further heat loss, but it requires an external heat source. One way to provide this is to heat water to near boiling using a portable camp stove. Then fill plastic bottles with the water, seal tightly, and cover with wool socks. Position these hot water bottles near the patient's axillae and groin to facilitate increasing core body temperature.

Making a fire in rain can be challenging. A great backcountry trick is to light petroleum gauze from a first aid kit on a piece of aluminum foil. Small wet sticks will easily catch fire, quickly resulting in flames. When you extinguish the fire, the aluminum foil can be picked up, leaving no trace of the fire.

The Wilderness Physical Therapist
Based on successful involvement in the military and during humanitarian relief operations, PTs can add great value to the field of wilderness medicine. Their nonpharmaceutical and noninvasive core skill sets are useful in virtually every backcountry medical encounter. For example, "wheelhouse" PT skills include in-depth musculoskeletal assessment as well as comprehensive examination of the central and peripheral nervous systems. In addition, the PT examination of the cardiopulmonary and vestibular system can be of profound importance in the backcountry.

Wound care and splint confabulation frequently are needed, as is skillful patient handling and transport. Also important is the PT's ability to provide effective communication for history taking and to keep the patient and rescue team calm and focused. The therapeutic alliance between the provider and the patient is critically important in the wilderness medicine environment, especially when extended emergency care time is needed.

So, what would be good qualifications for a wilderness PT? While the basic physical therapist skill set alone can add great value, wilderness care providers also need advanced first aid skills and must be able to survive in challenging environments.
Advanced first-aid skills include primary assessment, triage, CPR or basic life support, and hemorrhage control as well as management of dehydration, shock, heat illness, hypothermia, blood sugar emergencies, chest wall injuries, and abdominal and pelvic trauma.

Basic backcountry skills include knowledge of survival techniques such as shelter and fire building, water purification, knowledge of hiking and trekking, care of the feet, and land navigation. Climbing and water rescue skills also are desirable.
An additional critical skill is the ability to communicate professionally with emergency personnel off-site to integrate with support systems, remote clinics, and mobile treatment facilities. Interestingly, this communication is starting to be facilitated using drones and telehealth technologies, as reported by Christopher Van Tilburg in the June 2017 issue of Wilderness and Environmental Medicine.

Beyond providing immediate care to someone in the wilderness, PTs can help return patients to their high-demand activities in remote environments with limited resources. Unique functional rehabilitation considerations include carrying a pack over irregular terrain, paddling, and climbing. Other less obvious but hugely important considerations include hygiene and wound care in the backcountry as well as adequate hydration and nutrition.

PTs also can provide backcountry care at adventure races or ultra-marathons. In addition, being an on-site PT for wilderness therapy groups has the potential to be rewarding. Wilderness therapy describes a spectrum of outdoor-based adventure activities geared toward mental health and wellness. Traditionally these programs have been developed for adolescents and young adults to help them address and overcome mental health challenges. More recently, these programs have been offered to returning veterans who are experiencing traumatic brain injury, posttraumatic stress disorder, or other stress disorders.

The backcountry's rough terrain has limited access for people with mobility challenges. In the past several years, however, extraordinary achievements in hiking and climbing by people with substantial physical impairments have inspired others. As barriers to participation drop, individuals with physical challenges are having an opportunity to venture far into the backcountry to enjoy the healing effects of nature. A PT on-site could help make this happen.