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Washington State Epinephrine Law WMTC is recognized by Washington State Department of Health as an authorized Epinephrine Auto-injector & Anaphylaxis Training Provider. The law permits healthcare providers to prescribe epinephrine auto-injectors to certified lay providers and REQUIRES the lay provider to report the use of epinephrine within five days of an incident via the departments Epinephrine Auto-injector Incident Reporting Survey online at https://fortress.wa.gov/doh/opinio/s?s=EpinephrineAutoinjector California State Epinephrine Law WMTC is an approved California state epinephrine auto-injector training program. WMTC students issued a WMTC Epinephrine card after April 29, 2019, may apply for a California epinephrine auto-injector certification card and should visit https://emsa.ca.gov/epinephrine_auto_injector/ for information and an application form. Applicants must include a WMTC epinephrine certificate with their application; the certificate is different from the WMTC epinephrine card issued at their course. To obtain a WMTC epinephrine certificate for the State of California application please email office@wildmedcenter.com. Put CA State Epi Certification in the subject line. In the body of the email include:
Upon receipt of the email, our office will verify the student's WMTC epi certification using the above information and send them a pdf file of the certificate for them to print and include in the application for California State Epinephrine Certification; this service is fee of charge to all WMTC graduates. We will also send each student a pdf file summary of our auto-injector curriculum and CA Auto-injector laws. NOTE: California Epinephrine Certificates expire two years from the date a student graduated from their WMTC course. Businesses and other organizations may obtain a prescription and stock epinephrine auto-injectors if they employ or utilize a volunteer that is an EMSA-certified lay rescuer. To receive the epinephrine auto-injector(s), the business must take the EMSA certification card to a physician to receive a prescription. The prescription can then be filled by a pharmacy. A business that stocks epinephrine auto-injectors is required to keep records, create and maintain an operations plan, and report to EMSA when an epinephrine auto-injector is used. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.
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IntroductionThe Act of Drowning Contrary to how it is often depicted in movies, the act of drowning often goes unnoticed. There appear to be three separate actions or body positions people adopt when confronted with the possibility of drowning. Depending on their swimming ability, injuries, or illnesses, some will progress through all three of these stages, while others will not.
Drowning In drowning, the victim is submerged under or immersed in water and requires rescue or assistance; not all drowning victims are unresponsive during their rescue; they may be awake, voice responsive, or pain responsive. Drowning is a process with three possible outcomes:
 Ultimately, drowning patients die from a lack of oxygen. Our lungs cannot extract oxygen from water. Anatomy & Physiology
Pathophysiology Contrary to popular belief, very little water enters the lungs of most drowning victims:
Why so little? When water enters the drowning victim's mouth and nose, their epiglottis immediately closes and covers the trachea and they reflexively swallow. As a result, literally liters of water has been found in the stomachs of fatal drowning victims. This reflexive protection typically remains intact until the patient becomes runs out of oxygen and gasps for air or becomes unresponsive, and even then, little water actually enters the victim's lungs. Unfortunately, it doesn't take much aspirated water to cause problems and interfere with the gas exchange in the alveoli. Patients who have a pulse and are breathing after rescue or resuscitation, may develop respiratory complications severe enough to cause death minutes to hours after the incident if they aspirate enough water.
Basic Life Support Assessment & Treatment
Follow up Assessment, Treatment, & Evacuation
Interested in learning more about wilderness medicine? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. (What are they and should I join one?) With the worldwide increase in natural disasters, wilderness medicine graduates are uniquely poised to help their neighbors in the event of a local disaster. Communities in all 50 states have organized Community Emergency Response Teams (CERT). CERT members are volunteers, and teams are structured so that local managers have the flexibility to adapt the program and their training to the specific needs of their community. The concept originated with the Los Angeles City Fire Department in 1985 and went national through the Federal Emergency Management Agency (FEMA) in 1993. Contact your local fire, police, or sheriff department for more information or visit the CERT website.
You are part of a search and rescue team looking for survivors a day after a devastating wildfire passed through your town. It's been raining non-stop for the past 12 hours making your task more difficult. Mud slides have closed a number of roads slowing evacuation and exacerbating the entire situation. As you walk the shoreline of one of the nearby lakes, you see someone waving in an attempt to attract your attention from an island roughly half a mile from shore. Borrowing an aluminum rowboat from one of the burned-out cabins, you and your partner row to the island. Once there, you are confronted by a 32-year-old mother who is wet, shivering, and seeking help for her six-year-old daughter, Jolene. Jolene is huddled in a leaky, make-shift shelter, swathed in a wet blanket. She responds to your questions with short, mumbled phrases. Her mother, Trish, reports that they fled the fire by swimming to the island yesterday, that both she and Jolene are uninjured, and that they have had no food since early yesterday. Trish said she had to swim with Jolene most of the way. The water temperature is in the mid-60s F. It's now 4:30 pm and the rain is not letting up. You are in communication with Incident Command via satellite phone. What is wrong with Jolene and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. (What to do when someone dies in the backcountry.) Deaths in the backcountry are rare, exactly how rare is up for debate. Much depends on how you define backcountry and where you get your numbers (outside of the National Park Service, accurate statistics are hard to find). That said, a few hundred people appear to die each year while recreating in the outdoors. Given the number of people who play outside annually, statistically, death is pretty rare. While the order often changes annually, the top ten causes of death in the backcountry appear to be:
So what should I do if I'm with a person who is dying? There is no single answer that applies to all people other than support their process to the best of your ability. For many, this means holding their hand and simply being present. For some, it may include praying with or for them. If the person is awake, it may mean taking notes to share with relatives and friends. The specifics vary from individual to individual. How do I know when a person is dead? They will not have any signs of life: no pulse at their carotid artery, no chest rise, and no air coming from their mouth or nose. Over time their body will cool until it reaches the ambient air temperature and rigor mortis and liver mortis will set in. Rigor Mortis: When energy is no longer being produced, muscles contract and stiffen beginning with the small muscles of the face, neck, arms, and shoulders and gradually encompassing larger muscles until the person's body is completely stiff. Rigor is typically fully set within eight hours and remains in place for roughly eighteen hours before reversing itself to pre-rigor status, starting with the large muscles. Liver Mortis: When a person's blood stops circulating after death, gravity causes the red blood cells to settle leaving dark "bruising" in areas of the patient's body that are in contact with the ground. The process begins roughly thirty minutes after death and is fixed after approximately six hours. What should I do after a person is dead? Keep in mind that your first priority is yourself and the living members of your party. Make sure everyone is safe. Then, if possible, note the GPS coordinates of the body's location and notify the local authorities via radio, cell phone, satellite phone, or other communication device and follow their instructions. If the dead person was your patient, complete a SOAP note. If they were a client or student, also complete your program's accident/incident report form. Take pictures of the site and body, especially if the mechanism was trauma, and do your best to preserve the scene for the authorities; most states prohibit moving a dead body from the scene of the accident without the authority of the coroner. Of course, some scenes cannot be preserved due to weather or terrain. If you can't contact and receive direction from local authorities and find you must leave the scene, your photos become evidence and part of any subsequent investigation. If you decide to leave the scene and the body, do your best to protect the body from scavengers and clearly mark its location both visually and on a map. Although rare, some expeditions have decided to transport the body of the deceased out of the backcountry. Treat the body with respect and be sensitive to the cultural mores of the deceased and those around you.  You are leading a three-week summer backpacking trip for 18-21 year-old college students. While on a day hike to a local summit on day 13 of the trip, one of your students, Geoff, falls and cuts his leg on a sharp rock. There is not much bleeding and he can bear weight and walk with minimal pain. You are roughly a mile from your campsite with two days left until your next resupply. What should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You are on a 6-day preseason guide training trip for a commercial river company operating on the Colorado River in the Grand Canyon. There is a party on the 3rd evening of the trip and many of the guides are drinking. When you head for bed around 10 pm there are still a few souls by the fire. An hour and a half later you are awakened by a drunken guide and asked to examine a 28 year-old male trainee who they cannot arouse. You find Jim lying on his side on a sleeping pad near the fire. He is unresponsive with slow, irregular breathing; his pulse rate is 36 and regular, his skin is pale and his nail beds are blue-tinged. The night is slightly cool, likely in the mid-60s °F but it's warm by the fire where Jim is lying. You remember seeing Jim with a beer in hand but no one can remember how much he drank or if he had some of the whisky that had been passed around. Going through Jim's personal belongings reveals a bottle with a number of unidentified tablets. What is wrong with Jim and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You are on a three-week canoe expedition in the boundary waters. One of your students, Ximena, approaches you before breakfast complaining of pain and swelling in her ankles; she thinks it's a reaction to the black fly bites she received a couple of days ago when she forgot to reapply DEET after swimming. Yesterday the bite sites were slightly red and itchy. This morning, upon awakening, both her ankles are swollen with red streaks moving up her lower legs. She is tired and feels sick. Her core temperature is 101º F (38.3º C). It's day 14. What is wrong with Ximena and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You are leading for a week-long rafting trip for a drug addiction program in Costa Rica. It's 6 PM and one of your students, Amalia, does not respond to your call for dinner. A quick search finds her lying in her shelter on her sleeping bag apparently asleep. She does not fully awaken when you call her name and lightly shake her. Her breathing is slow and easy, at 8 breaths per minute and her pulse rate is 46 and regular. Her medical form shows her normal resting pulse is 78 and regular and her normal respiratory rate is 16 and easy. She is in your program for opioid abuse after getting injured in an automobile accident a year ago. What is wrong with Amalia and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.  You are en route to a backcountry lean-to managed by the forest service in the summer. Although the current temperature is in the low single digits after a cold front moved in early this afternoon, the weather yesterday was warm, above freezing, with bouts of hard rain. The snow is crusty and heavy on the forest road leading to the hut. You are two days from your car and it will take another day to reach the lean-to. You are carrying two weeks of supplies and hoping for new snow and fresh tracks after you reach the lean-to. When you arrive at the forest service campground two of the shelters are occupied by a high school group who have been touring in the park the past week leaving an older, half-buried one for you and your friend. After setting up camp and eating dinner, you wander over to the high school group to say "Hi." They are starting to eat dinner when you arrive. The leader, one of the school's teachers, tells you much of their gear is frozen from yesterday's rain. You notice that a student is huddled in their sleeping bag in one of the shelters, everyone else is eating dinner. The group leader tells you the student, a 15-year-old female, was very cold when they arrived, immediately went to bed, and said she wasn't interested in dinner. While your gear is dry, you can see that many of the students' sleeping bags are frozen. The group leader is concerned about the drop in temperature and unsure how to keep the students warm at night. What can you do to help? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. |
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Our public YouTube channel has educational and reference videos for many of the skills taught during our courses. Check it out!
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