Wilderness Medicine Practices and Protocols
Tod Schimelpfenig, Curriculum Director
Wilderness Medicine Institute of NOLS
In our curriculum we do speak to administering over-the-counter (OTC) and prescription medications in a wilderness context. The non-prescription medications we suggest relieve minor pain, stomach upset, diarrhea, sneezes and sniffles. They are taken by mouth and serious side effects are rare. We teach our students to be prudent with medication use, and regardless of whether the medication is prescription or OTC, to make sure it’s the right drug, for the right patient in the right dose and for the right reasons.
Administering prescription medications is usually restricted to licensed medical professionals or individuals acting within established EMS systems. EMTs and Paramedics for example, administer medications under the supervision of a medical director and within state regulations. There are organized groups in remote circumstances who may carry prescription medication, often for managing pain, infection or altitude illness, as a component of their medical supplies. These expeditions often use written protocols developed by physician adviser to guide their use of these medications. With modern communication technology it is often possible to consult directly with a physician before administering a prescription medication. The legalities of this unusual practice vary with the state and the country in which the expedition travels and are beyond the scope of this document to discuss.
The prescription medication carried more commonly by wilderness trips is epinephrine, most often in auto-injectors, for life-threatening allergic reactions. Its use is supported by the Wilderness Medical Society, and other experts on anaphylaxis, yet it remains a prescription medication, and as such there are legal constraints to its use. Most commonly the epinephrine administered is the patient’s, and the care giver assists the patient. However, there are examples of new onset anaphylaxis in outdoor programs that have been treated by epinephrine carried by the program.
We teach students to recognize a severe allergic reaction and to correctly administer the epinephrine. There are an increasing number of state laws that allow for the administration of epinephrine by a “lay person” to an individual experiencing a life threatening allergic reaction. This is likely to be an area of continued discussion and evolving laws and regulations in ensuing years.