An Analysis of Training of the Remote Medical Provider and Recommended Standards
Main Article Content
Abstract
This article summarizes the mindset, educational requirements, different training aspects, and specific treatment protocols that help establish the Remote Medical Provider (RMP) concept's baseline proficiency criteria and recommended institutional standards and provide a foundation resource for policymakers and academic leaders. The remote medical provider is any level of a practitioner who provides health care or service in a remote setting, defined as isolation from ‘routine’ healthcare service due to limited resources, physical distance, mission parameters, travel time, or sociopolitical constraints. A remote setting is described within these five disciplines: austere, disaster/humanitarian, expedition, military, and wilderness medicine. The remote medical provider requires a multidisciplinary knowledge base with an advanced skill set to deliver innovative treatment methods with limited diagnostic support or advanced services. The remote medical provider should also be well-versed in both independent duty care and collaborative telehealth - telemedicine. The remote medical provider requires competence in progressively higher levels of care with a seasoned level of understanding, responsibility, and resourcefulness. The remote medical provider needs to have an adaptive mindset, a robust public-global health perspective with cross-cultural understanding, and enduring resilience to the harshness of the environment.
Keywords:
austere, disaster, expedition, extreme, humanitarian, military, mindset, prolonged field care, remote, tactical emergency/combat casualty care, training, wilderness medicine
Article Details
How to Cite
CHRISTENSEN, Jon B. et al.
An Analysis of Training of the Remote Medical Provider and Recommended Standards.
Medical Research Archives, [S.l.], v. 13, n. 1, jan. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6257>. Date accessed: 10 feb. 2025.
doi: https://doi.org/10.18103/mra.v13i1.6257.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Smith J, Hays R. Is rural medicine a separate discipline? The Australian journal of rural health. 2004;12(2):67-72. doi:10.1111/j.1038-5282.2004.00556.x
2. Smith JD, Margolis SA, Ayton J, et al. Defining remote medical practice. The Medical Journal of Australia. 2008;188(3):159-161. doi:10.5694/j.1326 -5377.2008.tb01561.x
3. Wakerman J. Defining remote health. The Australian journal of rural health. 2004;12(5):210-214. doi:10.1111/j.1440-1854.2004.00607.x
4. Smith JD, Margolis SA, Ayton J, et al. Defining remote medical practice A consensus viewpoint of medical practitioners working and teaching in remote practice. The Medical Journal of Australia. 2008;188.
5. Christensen JB. How the International Special Training Centre Is Training World-Class Medics: An Outline of the NATO Special Operations Combat Medic Course. J Spec Oper Med. 2018;18(3):103-108.
6. Morton PM, Kummerfeldt P. Wilderness survival. Emergency Medicine Clinics of North America. 200 4;22(2):475-509. doi:10.1016/j.emc.2004.01.009
7. Christensen PA. Medicine on the Edge of Darkness. J Spec Oper Med. 2018;18(1):150-154.
8. Giannoudis PV, Giannoudis VP, Horwitz DS. Time to think outside the box: ‘Prompt-Individualised -Safe Management’ (PR.I.S.M.) should prevail in patients with multiple injuries. Injury. 2017;48(7): 1279-1282. doi:10.1016/j.injury.2017.05.026
9. Anagnostou E, Michas A, Giannou C. Practicing Military Medicine in Truly Austere Environments: What to Expect, How to Prepare, When to Improvise. Military Medicine. 2020;185(5-6):e656-e661. doi:10.1093/milmed/usz467
10. Iserson KV. What Is Improvised Medicine? What Is Improvised Medicine? 2nd ed. McGraw-Hill Education; 2016. accessmedicine.mhmedical.com /content.aspx?aid=1124425888 Accessed Dec 17, 2024.
11. Freer L. Essay: Wilderness medicine and creativity. The Lancet (British edition). 2006;368: S44-S45. doi:10.1016/S0140-6736(06)69924-8
12. Vinson ED. Improvised chest tube drain for decompression of an acute tension pneumothorax. Mil Med. 2004;169(5):403-405. doi:10.7205/milme d.169.5.403
13. Catmull SP, Ashurst JV. Autotransfusion. Autotransfusion. StatPearls Publishing; 2021. http://www.ncbi.nlm.nih.gov/books/NBK541014/ Accessed Dec 17, 2024.
14. Navsaria P, Thoma M, Nicol A. Foley catheter balloon tamponade for life-threatening hemorrhage in penetrating neck trauma. World J Surg. 2006; 30(7):1265-1268. doi:10.1007/s00268-005-0538-3
15. Scarborough T, Turconi M, Callaway DW. Case Presentation: Creation and Utilization of a Novel Field Improvised Autologous Transfusion System in a Combat Casualty. J Spec Oper Med. 2019;19 (2):134-137.
16. Coss Catherine. Creating Your Own Walking Blood Bank. www.wms.org Web site. https://wms.org/magazine/magazine/1300/walking-blood-bank.html/default.aspx Updated 2021. Accessed Dec 17, 2024.
17. Whole Blood Field Transfusion Course. THOR Network Website. https://thor.podia.com/thor-whole-blood-transfusion-course Accessed Dec 17, 2024. 18. Cap AP, Pidcoke HF, DePasquale M, et al. Blood far forward: Time to get moving! J Trauma Acute Care Surg. 2015;78(6 Suppl 1):2. doi:10.1097/TA.0000000000000626
19. United States Army Northern Warfare Training Center. Basic Military Mountaineer Course Student Handout.https://api.army.mil/e2/c/downloads/440625.pdf. Updated 2015. Accessed Dec 17, 2024.
20. Silveira Santos L. Disaster ethics and the touching case of Thai boys trapped in a cave. 2018.
21. Good JJ, Rabener MJ. ACLS interventional skills: Are we as good as we should be? Journal of the American Academy of PAs. 2021;34(4):40–45. doi:10.1097/01.JAA.0000735764.43931.0c
22. Hetz SP. Introduction to Military Medicine: A Brief Overview. Surgical Clinics. 2006;86(3):675-688. doi:10.1016/j.suc.2006.02.011
23. Hsu MM, Coffey CH, Witucki P, Sloane C. Medical professionals in remote and extreme environments: a mission to Mars. 2018. https://escholarship.org/uc/item/8n766294.Accessed Dec 17, 2024.
24. Butler FK. Tactical Combat Casualty Care: Beginnings. Wilderness Environ Med. 2017;28(2S): S12-S17. doi:10.1016/j.wem.2016.12.004
25. Butler FK. TCCC Updates: Two Decades of Saving Lives on the Battlefield: Tactical Combat Casualty Care Turns 20. J Spec Oper Med. 2017; 17(2):166-172.
26. Bennett, Brad, PhD, EMT-P, FAWM, Wedmore I, MD, Butler F, MD. Tactical Combat Casualty Care: Transitioning Battlefield Lessons Learned to Other Austere Environments. Wilderness & environmental medicine. 2017;28(2):S3-S4. doi:10. 1016/j.wem.2017.01.003.
27. Keenan S, Riesberg JC. Prolonged Field Care: Beyond the "Golden Hour". Wilderness Environ Med. 2017;28(2S):S135-S139. doi:10.1016/j.wem. 2017.02.001
28. Allen CJ, Straker RJ, Murray CR, et al. Recent Advances in Forward Surgical Team Training at the U.S. Army Trauma Training Department. Mil Med. 2016;181(6):553-559. doi:10.7205/MILMED-D-15-00084
29. Northern M, Baker J, Filak K, et al. Joint Trauma System Clinical Practice Guideline: Austere Resuscitative and Surgical Care - 30 October 2019. J Spec Oper Med. 2020;20(2):25-42.
30. Rush S. Recent consideration in tactical medicine. J Spec Oper Med. 2013;13(2):54-58.
31. Kosequat J, Rush SC, Simonsen I, et al. Efficacy of the Mnemonic Device "MARCH PAWS" as a Checklist for Pararescuemen During Tactical Field Care and Tactical Evacuation. J Spec Oper Med. 2017;17(4):80-84.
32. Mohr CJ, Keenan S. Prolonged Field Care Working Group Position Paper: Operational Context for Prolonged Field Care. J Spec Oper Med. 2015;15(3):78-80.
33. Ball JA, Keenan S. Prolonged Field Care Working Group Position Paper: Prolonged Field Care Capabilities. J Spec Oper Med. 2015;15(3):76-77.
34. Butler FK, Holcomb JB, Shackelford S, et al. Advanced Resuscitative Care in Tactical Combat Casualty Care: TCCC Guidelines Change 18-01:14 October 2018. J Spec Oper Med. 2018;18(4):37-55.
35. Pennardt A. Mastering the Basics Makes the Best Medics in the World: An Interview With Shawn Kane, SWMG (A) Commander and Dean of the JSOMTC. J Spec Oper Med. 2017;17(4):128-129.
36. Imray, Christopher H E, Prof, Grocott, Michael P W, Prof, Wilson, Mark H, FRCS [SN], Hughes A, BMBS, Auerbach PS, Prof. Extreme, expedition, and wilderness medicine. The Lancet (British edition). 2015;386(10012):2520-2525. doi:10.1016 /S0140-6736(15)01165-4
37. Macias DJ, Williams J. Austere, remote, and disaster medicine missions: an operational mnemonic can help organize a deployment. South Med J. 2013;106(1):89-93. doi:10.1097/SMJ.0b013e31827c5a2e.
38. Driskell JE, Johnston JH. Stress exposure training. Making decisions under stress: Implications for individual and team training. 2004:191-217.
39. Jackson SE, Baity MR, Thomas PR, et al. Stress Inoculation Training (SIT-NORCAL), Part 2: A Pilot Study Among Explosive Ordnance Disposal Special Warfare Enablers. J Spec Oper Med. 2021;21(4):46-53.
40. Al-Hakim L, Sevdalis N, Maiping T, Watanachote D, Sengupta S, Dissaranan C. Human error identification for laparoscopic surgery: Development of a motion economy perspective. Applied Ergonomics. 2015;50:113-125. doi:10.101 6/j.apergo.2015.03.005
41. Kellett J, Sebat F. Make vital signs great again – A call for action. European Journal of Internal Medicine. 2017;45:13-19. doi:10.1016/j.ejim.2017.09.018
42. Fisher AD, Washbum G, Powell D, et al. Damage Control Resuscitation in Prolonged Field CareDamage Control Resuscitation in Prolonged Field Care. J Spec Oper Med. 2018;18(3):109-119
43. Jd M, Md P. Impact of a 4-hour Introductory eFAST Training Intervention Among Ultrasound-Naïve U.S. Military Medics. Military medicine. 2020;185(5-6). doi:10.1093/milmed/usaa014
44. Shabaan M, Arshid K, Yaqub M, et al. Survey: smartphone-based assessment of cardiovascular diseases using ECG and PPG analysis. BMC medical informatics and decision making. 2020;20(1):177. doi:10.1186/s12911-020-01199-7
45. Banik S, Melanthota SK, Arbaaz n, et al. Recent trends in smartphone-based detection for biomedical applications: a review. Anal Bioanal Chem. 2021;413(9):2389-2406. doi:10.1007/s0021 6-021-03184-z
46. Banik S, Mahato KK, Antonini A, Mazumder N. Development and characterization of portable smartphone-based imaging device. Microscopy Research and Technique. 2020;83(11):1336-1344. doi:10.1002/jemt.23525
47. Ozer T, Henry CS. Paper-based analytical devices for virus detection: Recent strategies for current and future pandemics. Trends Analyt Chem. 2021;144:116424. doi:10.1016/j.trac.2021.116424
48. Venticinque S, Grathwohl K. Critical care in the austere environment: Providing exceptional care in unusual places. Critical care medicine. 2008;36(7 Suppl):S284-S292. doi:10.1097/CCM.0b013e31817da8ec
49. Della-Giustina D, Ingebretsen R. Advanced Wilderness Life Support (AWLS). 9th ed. ; 2016.
50. Smith, William “Will” R., MD, Paramedic, FAWM. Integration of Tactical EMS in the National Park Service. Wilderness & environmental medicine. 2017;28(2):S146-S153. doi:10.1016/j.wem.2017.03.002
51. DHS. Austere Emergency Medical Support (AEMS) Field Guide. Department of Homeland Security. :1-298.
52. Pingree CS, Newberry TR, McMains KC, Holt GR. Medical Ethics in Extreme and Austere Environments. HEC Forum. 2020;32(4):345-356. doi:10.1007/s10730-020-09405-9.
53. McLean M, McKimm J, Gibbs T. Medical education in difficult circumstances: A global responsibility to contribute. Medical teacher. 2017;39(1):4-6. doi:10 .1080/0142159X.2017.1254758
54. Ciottone GR. Introduction to Disaster Medicine. Ciottone's Disaster Medicine. 2016:2-5. doi:10.1 016/B978-0-323-28665-7.00001-7
55. Makwana N. Disaster and its impact on mental health: A narrative review. J Family Med Prim Care. 2019;8(10):3090-3095. doi:10.4103/jfmpc.jfmpc_893_19
56. Shilkofski N, Agueh M, Fonseka M, Tan A, Cembrano JR. Pediatric Emergency Care in Disaster-Affected Areas: A Firsthand Perspective after Typhoons Bopha and Haiyan in the Philippines. Journal of pediatric intensive care. 2017;6(1):19. doi:10.1055/s-0036-1584910.
57. D’Alonzo GE. Making Disaster Medicine Every Physician's Second Specialty. Disaster medicine and public health preparedness. 2010;4(2):108-109. doi:10.1001/dmphp.4.2.108.
58. Walsh L, Subbarao I, Gebbie K, et al. Core Competencies for Disaster Medicine and Public Health. Disaster medicine and public health preparedness. 2012;6(1):44-52. doi:10.1001/dmp.2012.4
59. Salzman SM, Fuentes RWC. EMS National Incident Management System. StatPearls Publishing; 2021.https://www.ncbi.nlm.nih.gov/books/NBK551710/. Accessed Nov 6, 2021.
60. Callaway, David W., MD, FACEP. Translating Tactical Combat Casualty Care Lessons Learned to the High-Threat Civilian Setting: Tactical Emergency Casualty Care and the Hartford Consensus. Wilderness & environmental medicine. 2017;28(2): S140-S145. doi:10.1016/j.wem.2016.11.008
61. Smith ER, Bobko JP, Shapiro GS, Callaway DW. Bystander Response. Leveraging bystanders as medical force multipliers in high-threat incidents. JEMS. 2016;41(8):32-36.
62. Bourdeaux ME, Lawry L, Bonventre EV, Burkle FM. Involvement of the US Department of Defense in Civilian Assistance, Part I: a quantitative description of the projects funded by the Overseas Humanitarian, Disaster, and Civic Aid Program. Disaster Med Public Health Prep. 2010;4(1):66-73. doi:10.1017/s1935789300002445
63. Lucchini RG, McDiarmid M, Van der Laan G, et al. Education and Training: Key Factors in Global Occupational and Environmental Health. Ann Glob Health. 2018;84(3):436-441. doi:10.29024/aogh.2328
64. Drifmeyer J, Llewellyn C. Overview of overseas humanitarian, disaster, and civic aid programs. Mil Med. 2003;168(12):975-980.
65. Al-Shakarchi N, Obolensky L, Walpole S, Hemingway H, Banerjee A. Global health competencies in UK postgraduate medical training: a scoping review and curricular content analysis. BMJ Open. 2019;9(8):e027577. doi:10.11 36/bmjopen-2018-027577
66. Alderman S, Christensen J, Crawford I. Medical seminars: a new paradigm for SOF counterinsurgency medical programs. J Spec Oper Med. 2010;10(1):16-22.
67. Chapter 12 | Defense Security Cooperation Agency. https://samm.dsca.mil/chapter/chapter-12.
68. Hollon JR, Hickey PW. Select clinical recommendations for military medical practitioners conducting humanitarian and civic assistance activities. Military medicine. 2010;175(9):647-654. doi:10.7205/MILMED-D-10-00005
69. Médicins Sans Frontières/Doctors Without Borders. World in Crisis. Taylor and Francis; 2013.
70. Kirsch T, Keim M, Strauss-Riggs K. Characterizing the Current State of Training Courses Available to US Disaster Professionals. Disaster Med Public Health Prep. 2019;13(5-6):920 -926. doi:10.1017/dmp.2019.15
71. Burstein JL. The myths of disaster education. Ann Emerg Med. 2006;47(1):50-52. doi:10.1016/ j.annemergmed.2005.11.023
72. Wilson MH, Dr, Habig K, MBBS, Wright C, FCEM, Hughes A, MCEM, Davies G, MRCP, Imray, Chirstopher H E, FRCS. Pre-hospital emergency medicine. The Lancet (British edition). 2015;386(10 012):2526-2534. doi:10.1016/S0140-6736(15)00985-X
73. Mellor A, Dodds N, Joshi R, et al. Faculty of Prehospital Care, Royal College of Surgeons Edinburgh guidance for medical provision for wilderness medicine. Extrem Physiol Med. 2015;4: 22. doi:10.1186/s13728-015-0041-x
74. Expedition Medicine | Wilderness Medicine | World Extreme Medicine. worldextrememedicine.com Website. https://worldextrememedicine.com/. Accessed Dec 17, 2024. .
75. Sward DG, Bennett BL. Wilderness medicine. World J Emerg Med. 2014;5(1):5-15. doi:10.5847 /wjem.j.issn.1920-8642.2014.01.001
76. Guly, Henry R., FRCP, FCEM. The Role of the Expedition Doctor: Lessons From 100 Years Ago. Wilderness & environmental medicine. 2012;23(2): 170-174. doi:10.1016/j.wem.2012.02.011
77. Kidd L, Hillebrandt D. First steps in expedition medicine. BMJ. 2013:f3791. doi:10.1136/bmj.f3791
78. Tuhovsky I. Communication skills. Vol 9. CreateSpace Independent Publishing Platform; 2015.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4413084/
79. Powell D, McLeroy RD, Riesberg J, et al. Telemedicine to Reduce Medical Risk in Austere Medical Environments: The Virtual Critical Care Consultation (VC3) Service. Journal of special operations medicine. 2016;16(4):102-109. https://www.ncbi.nlm.nih.gov/pubmed/28088828
80. Nettesheim N, Powell D, Vasios W, et al. Telemedical Support for Military Medicine. Mil Med. 2018;183(11-12):e462-e470. doi:10.1093/milmed/usy127
81. Vasios 3, William N, Pamplin JC, Powell D, Loos PE, Riesberg J, Keenan S. Teleconsultation in Prolonged Field Care Position Paper. Journal of special operations medicine. 2017;17(3):141-144. https://www.ncbi.nlm.nih.gov/pubmed/28910484
82. Lechner R, Küpper T, Tannheimer M. Challenges of Military Health Service Support in Mountain Warfare. Wilderness & environmental medicine. 20 18;29(2):266-274. doi:10.1016/j.wem.2018.01.006
83. Diploma in Mountain Medicine – UIAA. https://www.theuiaa.org/mountain-medicine/diploma-in-mountain-medicine/ Accessed Dec 17, 2024.
84. Schulz J, Warrington J, Maguire C, Georgi T, Hearn R. Implementing Wilderness Medicine Training for Undergraduate Medical Students in the UK. Wilderness & Environmental Medicine. 2020;31(1):63-70. doi:10.1016/j.wem.2019.11.007
85. Matt Wilkes. How to choose an expedition medicine course. BMJ: British Medical Journal. . https://www.jstor.org/stable/26944433
86. Auerbach PS, Cushing TA, Harris NS. Auerbach's Wilderness Medicine E. 7th ed. Elsevier Health Sciences; 2017.
87. Cushing, Tracy, MD, MPH, Quinn R, MD. WMS Practice Guidelines Development: Commentary from the Co-Chairs of the WMS Practice Guidelines Committee. Wilderness & environmental medicine. 2013;24(4):307-308. doi:10.1016/j.wem.2013.08.004
88. 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;9: 217-239. doi:10.18666/JOREL-2017-V9-I2-8226
89. Millin MG, Johnson DE, Schimelpfenig T, et al. Medical Oversight, Educational Core Content, and Proposed Scopes of Practice of Wilderness EMS Providers: A Joint Project Developed by Wilderness EMS Educators, Medical Directors, and Regulators Using a Delphi Approach. Prehosp Emerg Care. 2017;21(6):673-681. doi:10.1080/100 903127.2017.1335815
91. Meyer DJ, Young M. Expanding Wilderness Medicine Fellowship Eligibility Beyond Emergency Medicine. Wilderness & Environmental Medicine. 2016;27(2):338-340. doi:10.1016/j.wem.2015.12.008
92. Lipman GS, Weichenthal L, Stuart Harris N, et al. Core content for wilderness medicine fellowship training of emergency medicine graduates. Academic Emergency Medicine. 2014;21(2):204-207.
93. Schrading WA, Battaglioli N, Drew J, McClure SF. Core Content for Wilderness Medicine Training: Development of a Wilderness Medicine Track Within an Emergency Medicine Residency. Wilderness and Environmental Medicine. 2018;29(1):78-84.
94. Goldflam K, Coughlin RF, Cotton Widdicombe A, Della-Giustina D. A National Survey of Wilderness Medicine Curricula in United States Emergency Medicine Residencies. Wilderness & environmental medicine. 2021;32(2):187-191. doi: 10.1016/j.wem.2021.02.005
95. Aronstam EJ, Christensen ML, Williams MP, Overton DT. Wilderness medicine curricular content in emergency medicine residency programs. Wilderness and Environmental Medicine. 2015;26(4):577-579.
97. Lischner B, MD, Evju, Anne Svelstad, RN, MS, Håkon Evju S, MD. Using Wilderness Medical Training as a Recruitment Tool and Competence Enhancer for Nursing Students at a Rural Nursing College in Arctic Scandinavia. Wilderness & environmental medicine. 2013;24(4):475-476. doi: 10.1016/j.wem.2013.07.006
98. Cordes DH, Rea DF, Gerhauser R. Wilderness medicine: a clinical introduction for medical students. Journal of Wilderness Medicine. 1992;3(4 ):367-371. doi:10.1580/0953-9859-3.4.367
99. McIntosh SE, Cushing TA, Keyes LE, Pollock NW. What is wilderness medicine? Wilderness Environ Med. 2015;26(1):1. doi:10.1016/j.wem.2015.01.001
100. Alexander W, Bright S, Burns P, Townes D. Wilderness Medicine. Med Clin North Am. 2016; 100(2):345-356. doi:10.1016/j.mcna.2015.09.003
101. Chima AM, Koka R, Lee B, et al. Medical Simulation as a Vital Adjunct to Identifying Clinical Life-Threatening Gaps in Austere Environments. J Natl Med Assoc. 2018;110(2):117-123. doi:10.1016 /j.jnma.2017.12.003
102. Launching Innovation through Medical Modeling and Simulation Technologies. https://csiac.org/articles/launching-innovation-through-medical-modeling-and-simulation-technologies/ Accessed Dec 17, 2024.
103. Hawkins SC, Winstead C. Wilderness Medicine Education: How to Choose the Right Resources for Archaeology Field Programs. Advances in Archaeological Practice. 2021;9(1):49-55. doi:10.1017/aap.2020.48
2. Smith JD, Margolis SA, Ayton J, et al. Defining remote medical practice. The Medical Journal of Australia. 2008;188(3):159-161. doi:10.5694/j.1326 -5377.2008.tb01561.x
3. Wakerman J. Defining remote health. The Australian journal of rural health. 2004;12(5):210-214. doi:10.1111/j.1440-1854.2004.00607.x
4. Smith JD, Margolis SA, Ayton J, et al. Defining remote medical practice A consensus viewpoint of medical practitioners working and teaching in remote practice. The Medical Journal of Australia. 2008;188.
5. Christensen JB. How the International Special Training Centre Is Training World-Class Medics: An Outline of the NATO Special Operations Combat Medic Course. J Spec Oper Med. 2018;18(3):103-108.
6. Morton PM, Kummerfeldt P. Wilderness survival. Emergency Medicine Clinics of North America. 200 4;22(2):475-509. doi:10.1016/j.emc.2004.01.009
7. Christensen PA. Medicine on the Edge of Darkness. J Spec Oper Med. 2018;18(1):150-154.
8. Giannoudis PV, Giannoudis VP, Horwitz DS. Time to think outside the box: ‘Prompt-Individualised -Safe Management’ (PR.I.S.M.) should prevail in patients with multiple injuries. Injury. 2017;48(7): 1279-1282. doi:10.1016/j.injury.2017.05.026
9. Anagnostou E, Michas A, Giannou C. Practicing Military Medicine in Truly Austere Environments: What to Expect, How to Prepare, When to Improvise. Military Medicine. 2020;185(5-6):e656-e661. doi:10.1093/milmed/usz467
10. Iserson KV. What Is Improvised Medicine? What Is Improvised Medicine? 2nd ed. McGraw-Hill Education; 2016. accessmedicine.mhmedical.com /content.aspx?aid=1124425888 Accessed Dec 17, 2024.
11. Freer L. Essay: Wilderness medicine and creativity. The Lancet (British edition). 2006;368: S44-S45. doi:10.1016/S0140-6736(06)69924-8
12. Vinson ED. Improvised chest tube drain for decompression of an acute tension pneumothorax. Mil Med. 2004;169(5):403-405. doi:10.7205/milme d.169.5.403
13. Catmull SP, Ashurst JV. Autotransfusion. Autotransfusion. StatPearls Publishing; 2021. http://www.ncbi.nlm.nih.gov/books/NBK541014/ Accessed Dec 17, 2024.
14. Navsaria P, Thoma M, Nicol A. Foley catheter balloon tamponade for life-threatening hemorrhage in penetrating neck trauma. World J Surg. 2006; 30(7):1265-1268. doi:10.1007/s00268-005-0538-3
15. Scarborough T, Turconi M, Callaway DW. Case Presentation: Creation and Utilization of a Novel Field Improvised Autologous Transfusion System in a Combat Casualty. J Spec Oper Med. 2019;19 (2):134-137.
16. Coss Catherine. Creating Your Own Walking Blood Bank. www.wms.org Web site. https://wms.org/magazine/magazine/1300/walking-blood-bank.html/default.aspx Updated 2021. Accessed Dec 17, 2024.
17. Whole Blood Field Transfusion Course. THOR Network Website. https://thor.podia.com/thor-whole-blood-transfusion-course Accessed Dec 17, 2024. 18. Cap AP, Pidcoke HF, DePasquale M, et al. Blood far forward: Time to get moving! J Trauma Acute Care Surg. 2015;78(6 Suppl 1):2. doi:10.1097/TA.0000000000000626
19. United States Army Northern Warfare Training Center. Basic Military Mountaineer Course Student Handout.https://api.army.mil/e2/c/downloads/440625.pdf. Updated 2015. Accessed Dec 17, 2024.
20. Silveira Santos L. Disaster ethics and the touching case of Thai boys trapped in a cave. 2018.
21. Good JJ, Rabener MJ. ACLS interventional skills: Are we as good as we should be? Journal of the American Academy of PAs. 2021;34(4):40–45. doi:10.1097/01.JAA.0000735764.43931.0c
22. Hetz SP. Introduction to Military Medicine: A Brief Overview. Surgical Clinics. 2006;86(3):675-688. doi:10.1016/j.suc.2006.02.011
23. Hsu MM, Coffey CH, Witucki P, Sloane C. Medical professionals in remote and extreme environments: a mission to Mars. 2018. https://escholarship.org/uc/item/8n766294.Accessed Dec 17, 2024.
24. Butler FK. Tactical Combat Casualty Care: Beginnings. Wilderness Environ Med. 2017;28(2S): S12-S17. doi:10.1016/j.wem.2016.12.004
25. Butler FK. TCCC Updates: Two Decades of Saving Lives on the Battlefield: Tactical Combat Casualty Care Turns 20. J Spec Oper Med. 2017; 17(2):166-172.
26. Bennett, Brad, PhD, EMT-P, FAWM, Wedmore I, MD, Butler F, MD. Tactical Combat Casualty Care: Transitioning Battlefield Lessons Learned to Other Austere Environments. Wilderness & environmental medicine. 2017;28(2):S3-S4. doi:10. 1016/j.wem.2017.01.003.
27. Keenan S, Riesberg JC. Prolonged Field Care: Beyond the "Golden Hour". Wilderness Environ Med. 2017;28(2S):S135-S139. doi:10.1016/j.wem. 2017.02.001
28. Allen CJ, Straker RJ, Murray CR, et al. Recent Advances in Forward Surgical Team Training at the U.S. Army Trauma Training Department. Mil Med. 2016;181(6):553-559. doi:10.7205/MILMED-D-15-00084
29. Northern M, Baker J, Filak K, et al. Joint Trauma System Clinical Practice Guideline: Austere Resuscitative and Surgical Care - 30 October 2019. J Spec Oper Med. 2020;20(2):25-42.
30. Rush S. Recent consideration in tactical medicine. J Spec Oper Med. 2013;13(2):54-58.
31. Kosequat J, Rush SC, Simonsen I, et al. Efficacy of the Mnemonic Device "MARCH PAWS" as a Checklist for Pararescuemen During Tactical Field Care and Tactical Evacuation. J Spec Oper Med. 2017;17(4):80-84.
32. Mohr CJ, Keenan S. Prolonged Field Care Working Group Position Paper: Operational Context for Prolonged Field Care. J Spec Oper Med. 2015;15(3):78-80.
33. Ball JA, Keenan S. Prolonged Field Care Working Group Position Paper: Prolonged Field Care Capabilities. J Spec Oper Med. 2015;15(3):76-77.
34. Butler FK, Holcomb JB, Shackelford S, et al. Advanced Resuscitative Care in Tactical Combat Casualty Care: TCCC Guidelines Change 18-01:14 October 2018. J Spec Oper Med. 2018;18(4):37-55.
35. Pennardt A. Mastering the Basics Makes the Best Medics in the World: An Interview With Shawn Kane, SWMG (A) Commander and Dean of the JSOMTC. J Spec Oper Med. 2017;17(4):128-129.
36. Imray, Christopher H E, Prof, Grocott, Michael P W, Prof, Wilson, Mark H, FRCS [SN], Hughes A, BMBS, Auerbach PS, Prof. Extreme, expedition, and wilderness medicine. The Lancet (British edition). 2015;386(10012):2520-2525. doi:10.1016 /S0140-6736(15)01165-4
37. Macias DJ, Williams J. Austere, remote, and disaster medicine missions: an operational mnemonic can help organize a deployment. South Med J. 2013;106(1):89-93. doi:10.1097/SMJ.0b013e31827c5a2e.
38. Driskell JE, Johnston JH. Stress exposure training. Making decisions under stress: Implications for individual and team training. 2004:191-217.
39. Jackson SE, Baity MR, Thomas PR, et al. Stress Inoculation Training (SIT-NORCAL), Part 2: A Pilot Study Among Explosive Ordnance Disposal Special Warfare Enablers. J Spec Oper Med. 2021;21(4):46-53.
40. Al-Hakim L, Sevdalis N, Maiping T, Watanachote D, Sengupta S, Dissaranan C. Human error identification for laparoscopic surgery: Development of a motion economy perspective. Applied Ergonomics. 2015;50:113-125. doi:10.101 6/j.apergo.2015.03.005
41. Kellett J, Sebat F. Make vital signs great again – A call for action. European Journal of Internal Medicine. 2017;45:13-19. doi:10.1016/j.ejim.2017.09.018
42. Fisher AD, Washbum G, Powell D, et al. Damage Control Resuscitation in Prolonged Field CareDamage Control Resuscitation in Prolonged Field Care. J Spec Oper Med. 2018;18(3):109-119
43. Jd M, Md P. Impact of a 4-hour Introductory eFAST Training Intervention Among Ultrasound-Naïve U.S. Military Medics. Military medicine. 2020;185(5-6). doi:10.1093/milmed/usaa014
44. Shabaan M, Arshid K, Yaqub M, et al. Survey: smartphone-based assessment of cardiovascular diseases using ECG and PPG analysis. BMC medical informatics and decision making. 2020;20(1):177. doi:10.1186/s12911-020-01199-7
45. Banik S, Melanthota SK, Arbaaz n, et al. Recent trends in smartphone-based detection for biomedical applications: a review. Anal Bioanal Chem. 2021;413(9):2389-2406. doi:10.1007/s0021 6-021-03184-z
46. Banik S, Mahato KK, Antonini A, Mazumder N. Development and characterization of portable smartphone-based imaging device. Microscopy Research and Technique. 2020;83(11):1336-1344. doi:10.1002/jemt.23525
47. Ozer T, Henry CS. Paper-based analytical devices for virus detection: Recent strategies for current and future pandemics. Trends Analyt Chem. 2021;144:116424. doi:10.1016/j.trac.2021.116424
48. Venticinque S, Grathwohl K. Critical care in the austere environment: Providing exceptional care in unusual places. Critical care medicine. 2008;36(7 Suppl):S284-S292. doi:10.1097/CCM.0b013e31817da8ec
49. Della-Giustina D, Ingebretsen R. Advanced Wilderness Life Support (AWLS). 9th ed. ; 2016.
50. Smith, William “Will” R., MD, Paramedic, FAWM. Integration of Tactical EMS in the National Park Service. Wilderness & environmental medicine. 2017;28(2):S146-S153. doi:10.1016/j.wem.2017.03.002
51. DHS. Austere Emergency Medical Support (AEMS) Field Guide. Department of Homeland Security. :1-298.
52. Pingree CS, Newberry TR, McMains KC, Holt GR. Medical Ethics in Extreme and Austere Environments. HEC Forum. 2020;32(4):345-356. doi:10.1007/s10730-020-09405-9.
53. McLean M, McKimm J, Gibbs T. Medical education in difficult circumstances: A global responsibility to contribute. Medical teacher. 2017;39(1):4-6. doi:10 .1080/0142159X.2017.1254758
54. Ciottone GR. Introduction to Disaster Medicine. Ciottone's Disaster Medicine. 2016:2-5. doi:10.1 016/B978-0-323-28665-7.00001-7
55. Makwana N. Disaster and its impact on mental health: A narrative review. J Family Med Prim Care. 2019;8(10):3090-3095. doi:10.4103/jfmpc.jfmpc_893_19
56. Shilkofski N, Agueh M, Fonseka M, Tan A, Cembrano JR. Pediatric Emergency Care in Disaster-Affected Areas: A Firsthand Perspective after Typhoons Bopha and Haiyan in the Philippines. Journal of pediatric intensive care. 2017;6(1):19. doi:10.1055/s-0036-1584910.
57. D’Alonzo GE. Making Disaster Medicine Every Physician's Second Specialty. Disaster medicine and public health preparedness. 2010;4(2):108-109. doi:10.1001/dmphp.4.2.108.
58. Walsh L, Subbarao I, Gebbie K, et al. Core Competencies for Disaster Medicine and Public Health. Disaster medicine and public health preparedness. 2012;6(1):44-52. doi:10.1001/dmp.2012.4
59. Salzman SM, Fuentes RWC. EMS National Incident Management System. StatPearls Publishing; 2021.https://www.ncbi.nlm.nih.gov/books/NBK551710/. Accessed Nov 6, 2021.
60. Callaway, David W., MD, FACEP. Translating Tactical Combat Casualty Care Lessons Learned to the High-Threat Civilian Setting: Tactical Emergency Casualty Care and the Hartford Consensus. Wilderness & environmental medicine. 2017;28(2): S140-S145. doi:10.1016/j.wem.2016.11.008
61. Smith ER, Bobko JP, Shapiro GS, Callaway DW. Bystander Response. Leveraging bystanders as medical force multipliers in high-threat incidents. JEMS. 2016;41(8):32-36.
62. Bourdeaux ME, Lawry L, Bonventre EV, Burkle FM. Involvement of the US Department of Defense in Civilian Assistance, Part I: a quantitative description of the projects funded by the Overseas Humanitarian, Disaster, and Civic Aid Program. Disaster Med Public Health Prep. 2010;4(1):66-73. doi:10.1017/s1935789300002445
63. Lucchini RG, McDiarmid M, Van der Laan G, et al. Education and Training: Key Factors in Global Occupational and Environmental Health. Ann Glob Health. 2018;84(3):436-441. doi:10.29024/aogh.2328
64. Drifmeyer J, Llewellyn C. Overview of overseas humanitarian, disaster, and civic aid programs. Mil Med. 2003;168(12):975-980.
65. Al-Shakarchi N, Obolensky L, Walpole S, Hemingway H, Banerjee A. Global health competencies in UK postgraduate medical training: a scoping review and curricular content analysis. BMJ Open. 2019;9(8):e027577. doi:10.11 36/bmjopen-2018-027577
66. Alderman S, Christensen J, Crawford I. Medical seminars: a new paradigm for SOF counterinsurgency medical programs. J Spec Oper Med. 2010;10(1):16-22.
67. Chapter 12 | Defense Security Cooperation Agency. https://samm.dsca.mil/chapter/chapter-12.
68. Hollon JR, Hickey PW. Select clinical recommendations for military medical practitioners conducting humanitarian and civic assistance activities. Military medicine. 2010;175(9):647-654. doi:10.7205/MILMED-D-10-00005
69. Médicins Sans Frontières/Doctors Without Borders. World in Crisis. Taylor and Francis; 2013.
70. Kirsch T, Keim M, Strauss-Riggs K. Characterizing the Current State of Training Courses Available to US Disaster Professionals. Disaster Med Public Health Prep. 2019;13(5-6):920 -926. doi:10.1017/dmp.2019.15
71. Burstein JL. The myths of disaster education. Ann Emerg Med. 2006;47(1):50-52. doi:10.1016/ j.annemergmed.2005.11.023
72. Wilson MH, Dr, Habig K, MBBS, Wright C, FCEM, Hughes A, MCEM, Davies G, MRCP, Imray, Chirstopher H E, FRCS. Pre-hospital emergency medicine. The Lancet (British edition). 2015;386(10 012):2526-2534. doi:10.1016/S0140-6736(15)00985-X
73. Mellor A, Dodds N, Joshi R, et al. Faculty of Prehospital Care, Royal College of Surgeons Edinburgh guidance for medical provision for wilderness medicine. Extrem Physiol Med. 2015;4: 22. doi:10.1186/s13728-015-0041-x
74. Expedition Medicine | Wilderness Medicine | World Extreme Medicine. worldextrememedicine.com Website. https://worldextrememedicine.com/. Accessed Dec 17, 2024. .
75. Sward DG, Bennett BL. Wilderness medicine. World J Emerg Med. 2014;5(1):5-15. doi:10.5847 /wjem.j.issn.1920-8642.2014.01.001
76. Guly, Henry R., FRCP, FCEM. The Role of the Expedition Doctor: Lessons From 100 Years Ago. Wilderness & environmental medicine. 2012;23(2): 170-174. doi:10.1016/j.wem.2012.02.011
77. Kidd L, Hillebrandt D. First steps in expedition medicine. BMJ. 2013:f3791. doi:10.1136/bmj.f3791
78. Tuhovsky I. Communication skills. Vol 9. CreateSpace Independent Publishing Platform; 2015.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4413084/
79. Powell D, McLeroy RD, Riesberg J, et al. Telemedicine to Reduce Medical Risk in Austere Medical Environments: The Virtual Critical Care Consultation (VC3) Service. Journal of special operations medicine. 2016;16(4):102-109. https://www.ncbi.nlm.nih.gov/pubmed/28088828
80. Nettesheim N, Powell D, Vasios W, et al. Telemedical Support for Military Medicine. Mil Med. 2018;183(11-12):e462-e470. doi:10.1093/milmed/usy127
81. Vasios 3, William N, Pamplin JC, Powell D, Loos PE, Riesberg J, Keenan S. Teleconsultation in Prolonged Field Care Position Paper. Journal of special operations medicine. 2017;17(3):141-144. https://www.ncbi.nlm.nih.gov/pubmed/28910484
82. Lechner R, Küpper T, Tannheimer M. Challenges of Military Health Service Support in Mountain Warfare. Wilderness & environmental medicine. 20 18;29(2):266-274. doi:10.1016/j.wem.2018.01.006
83. Diploma in Mountain Medicine – UIAA. https://www.theuiaa.org/mountain-medicine/diploma-in-mountain-medicine/ Accessed Dec 17, 2024.
84. Schulz J, Warrington J, Maguire C, Georgi T, Hearn R. Implementing Wilderness Medicine Training for Undergraduate Medical Students in the UK. Wilderness & Environmental Medicine. 2020;31(1):63-70. doi:10.1016/j.wem.2019.11.007
85. Matt Wilkes. How to choose an expedition medicine course. BMJ: British Medical Journal. . https://www.jstor.org/stable/26944433
86. Auerbach PS, Cushing TA, Harris NS. Auerbach's Wilderness Medicine E. 7th ed. Elsevier Health Sciences; 2017.
87. Cushing, Tracy, MD, MPH, Quinn R, MD. WMS Practice Guidelines Development: Commentary from the Co-Chairs of the WMS Practice Guidelines Committee. Wilderness & environmental medicine. 2013;24(4):307-308. doi:10.1016/j.wem.2013.08.004
88. 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;9: 217-239. doi:10.18666/JOREL-2017-V9-I2-8226
89. Millin MG, Johnson DE, Schimelpfenig T, et al. Medical Oversight, Educational Core Content, and Proposed Scopes of Practice of Wilderness EMS Providers: A Joint Project Developed by Wilderness EMS Educators, Medical Directors, and Regulators Using a Delphi Approach. Prehosp Emerg Care. 2017;21(6):673-681. doi:10.1080/100 903127.2017.1335815
91. Meyer DJ, Young M. Expanding Wilderness Medicine Fellowship Eligibility Beyond Emergency Medicine. Wilderness & Environmental Medicine. 2016;27(2):338-340. doi:10.1016/j.wem.2015.12.008
92. Lipman GS, Weichenthal L, Stuart Harris N, et al. Core content for wilderness medicine fellowship training of emergency medicine graduates. Academic Emergency Medicine. 2014;21(2):204-207.
93. Schrading WA, Battaglioli N, Drew J, McClure SF. Core Content for Wilderness Medicine Training: Development of a Wilderness Medicine Track Within an Emergency Medicine Residency. Wilderness and Environmental Medicine. 2018;29(1):78-84.
94. Goldflam K, Coughlin RF, Cotton Widdicombe A, Della-Giustina D. A National Survey of Wilderness Medicine Curricula in United States Emergency Medicine Residencies. Wilderness & environmental medicine. 2021;32(2):187-191. doi: 10.1016/j.wem.2021.02.005
95. Aronstam EJ, Christensen ML, Williams MP, Overton DT. Wilderness medicine curricular content in emergency medicine residency programs. Wilderness and Environmental Medicine. 2015;26(4):577-579.
97. Lischner B, MD, Evju, Anne Svelstad, RN, MS, Håkon Evju S, MD. Using Wilderness Medical Training as a Recruitment Tool and Competence Enhancer for Nursing Students at a Rural Nursing College in Arctic Scandinavia. Wilderness & environmental medicine. 2013;24(4):475-476. doi: 10.1016/j.wem.2013.07.006
98. Cordes DH, Rea DF, Gerhauser R. Wilderness medicine: a clinical introduction for medical students. Journal of Wilderness Medicine. 1992;3(4 ):367-371. doi:10.1580/0953-9859-3.4.367
99. McIntosh SE, Cushing TA, Keyes LE, Pollock NW. What is wilderness medicine? Wilderness Environ Med. 2015;26(1):1. doi:10.1016/j.wem.2015.01.001
100. Alexander W, Bright S, Burns P, Townes D. Wilderness Medicine. Med Clin North Am. 2016; 100(2):345-356. doi:10.1016/j.mcna.2015.09.003
101. Chima AM, Koka R, Lee B, et al. Medical Simulation as a Vital Adjunct to Identifying Clinical Life-Threatening Gaps in Austere Environments. J Natl Med Assoc. 2018;110(2):117-123. doi:10.1016 /j.jnma.2017.12.003
102. Launching Innovation through Medical Modeling and Simulation Technologies. https://csiac.org/articles/launching-innovation-through-medical-modeling-and-simulation-technologies/ Accessed Dec 17, 2024.
103. Hawkins SC, Winstead C. Wilderness Medicine Education: How to Choose the Right Resources for Archaeology Field Programs. Advances in Archaeological Practice. 2021;9(1):49-55. doi:10.1017/aap.2020.48