Conference opens at 16:00 PDT / 17:00 MDT / 18:00 CDT / 19:00 EDT

As sea ice recedes across the Arctic, polar bears are spending more time on the land. Concurrently, human activity in the Arctic in the form of shipping, tourism, research, and industrial activities is also increasing. This has led to increased human-polar bear conflict. Wilderness medicine practitioners can play an important role in minimizing human-polar bear conflict by modelling good behaviour when travelling in the polar bear’s range and when advising expedition teams in their pre-departure planning. This presentation will summarize the recently published scientific literature on polar bear attacks against humans and will review best practices for expeditions to reduce the chances of a polar bear encounter.

In 2018/19 the Canadian Armed Forces deployed the CMERT (Canadian Medical Emergency Response Team) to Gao, Mali as part of the UN peace-keeping mission, MINUSMA. This was a significant contribution to stability, rebuilding and promotion of human rights in sub-Saharan Africa by supporting UN troops on the ground. The purpose of CMERT is to provide DCR (damage control resuscitation) within an hour in, at times, a non-permissive and harsh environment. CMERT consists of a trauma physician, critical care nurse and 2 medics operating as a resuscitation team for up to 7 patients inside of a CH147 Chinook Helicopter with surrounding force protection. There are many points of intersection with mountain medicine: harsh weather, balance of on-scene/in transit/at destination care, communication and crisis resource management, early advanced medical decision making and the requirement of technical safety skills. Challenges also include advanced medical procedures such as ultrasound use, chest decompression, advanced airway management, and transfusion in austere environments. Providing advanced medical care in and around helicopters in hazardous environments by CMERT is another alignment with mountain medicine in many areas. This talk will highlight these aspects and provide overview to the past mission and this unique Canadian medical team.

Wilderness Medicine (WM) education is in its infancy in Canada with much room for growth. Importantly, while WM electives have become increasingly popular around the world, there remain few elective options within Canada. This presentation will discuss WM electives and include three parts: 1) review what WM electives are, including recent research on how they influence long-term career involvement; 2) summarize current opportunities for WM education among medical trainees in Canada, comparing this to the US; and 3) discuss opportunities for a Canadian medical school-affiliated WM elective.

This presentation will provide a brief overview of the epidemiology of Borrelia burgdorferi, rickettsial infections, common viral vector-borne infections such as Dengue, Chikungunya and Zika, as well as Malaria. We will also cover clinical aspects including presentation, diagnosis and clinical management, focusing on practical advice and resources.

Kluane National Park, in the southwest Yukon, is home to Canada’s highest peak (5, 959 m Mount Logan) and largest icefield. Travellers from around the world come to climb the peaks and are expected to be entirely self-sufficient and capable of self-rescue. What happens when you need a rescue? Learn about the challenges to mountain rescue and high altitude medical care in this region and elevation. Parks Canada’s visitor safety rescue team members will present how the response capabilities have changed over the years and the risk management framework used to guide responses.

Conference opens at 06:30 PDT / 07:30 MDT / 08:30 CDT / 09:30 EDT

Active engagement in the creation of scientific literature can hone critical thinking, reading, and writing skills; all useful to advance most professional careers. Scientific writing has both rules and rhythms, and understanding them can improve the art found in the best work. This presentation will review the key elements to help sharpen insightful efforts.

One need not go far into the Twitter-verse to find the ED physician wielding ultrasound memes and the reputation is probably justified by the profession’s near-universal enthusiasm for the modality. Alongside emergency department staff, wilderness medicine experts and amateurs alike have embraced many a POCUS function. On review of the literature however, there is a paucity of data involving the application of MSK ultrasound to wilderness medicine scenarios.

This presentation will be case-based and provide an introduction to which injuries are amenable to point-of-care ultrasound. Some pathology containing images will be included to illustrate the simplicity of many MSK ultrasound functions. The content will be at a level accessible to all medical learners, including non-physicians. The intent is that after this presentation participants will consider MSK ultrasound a possible wilderness medicine adjunct.

A filmed field scenario with instructional demonstration will introduce and review difficult airway identification and management in low resource contexts. Demonstration of management techniques include a) face to face intubation – possibly useful in confined space settings, b) digital intubation – in situations where standard endotracheal are impractical, and c) SALAD intubation for difficult airway suctioning. Simulation and instruction are filmed at the Six Nations of the Grand River indigenous reserve.

When I think of wilderness medicine I think about a critical medical situation requiring the creative use of limited resources in a remote part of the world. It’s about getting the patient out of the wilderness and then stabilized in a hospital setting. But what happens once they’ve been discharged? Enter the realm of the sometimes long and difficult rehab process. In this session we’ll use recent evidence to explore how a rock climber might go about rehabbing their injuries. We’ll touch on the nitty gritty details while also exploring what any healthcare provider can do to get their patient on the right track. My job today is to help you make my job easier tomorrow.

Medical equipment and point-of-care diagnostic tests are largely designed for the controlled environmental conditions of hospitals and clinics. When providing care on expedition, wilderness rescue, and other remote settings, medical materials are subjected to environmental conditions which alter their normal behavior. Clinicians who work in remote environments should therefore understand the specific interactions between the environment and medical equipment which can dramatically alter the expected behavior of many medical tools and tests. This session will review how extreme environments impact the medical care in extreme environments as well as potential solutions.

Climate change has resulted in the extension of several tick species to Canada. While most of us are familiar with Lyme disease, four other tick-borne illnesses are emerging as clinically relevant, including Anaplasmosis, Ehrlichiosis, Powassan virus and Borellia miyamotoi. When working in an austere setting in tick endemic areas it is essential to know which species of tick are prevalent and the diseases they carry. Medical providers must also be knowledgeable regarding the prevention of tick exposure and how to treat individuals if they become infected. Similarly, recognizing severe complications of tick-borne illness and identifying when infected individuals require transfer to a monitored clinical setting can be paramount. This talk will review Canadian resources for the prevention and treatment of tick-borne illness.

Drowning is a marine wilderness emergency. While drowning represents 360 000 yearly deaths worldwide, and can inflict significant emotional and physical morbidities for survivors, there have been few updates in recent years to describe optimal pre-hospital management for these patients. This presentation will provide a review of the current literature and WMS Society recommendations surrounding rescue and initial management in drowning using a case-based approach. A scenario will be presented to field discussion points about drowning management. To begin, the epidemiology and pathophysiology of drowning will be described. The talk will then explore the rescue options available for drowning patients, including on-land and in-water approaches. This will also include a discussion of search and rescue resources available in Canada and their various approaches to rescue. An approach to resuscitation and special considerations for pre-hospital management in drowning patients will be described. Importantly, prevention strategies will be explored from a public health lens to prevent drowning emergencies in the backcountry and wilderness. These discussion points will allow the case to come to a logical conclusion. I hope to draw on personal training notes from my search and rescue placement with the Canadian Coast Guard to bring context to the presentation.

For those of us who spend our lives in the mountains, injuries often come with the territory. As wilderness medical professionals we discuss physical injuries at length, understanding injury mechanisms, extrication methods and treatment techniques for both recreational and professional practice. However, the mental side of such injuries is rarely discussed. After the patient is off the mountain, the journey has only just begun. Often that journey involves ongoing pain, a lengthy rehabilitation period and time away from mountain sport, as well as the mental distress that comes with it. Both professional and weekend warrior athletes are at risk for developing post-injury mental distress and illness, which can exacerbate suffering, affect rehabilitation engagement and ultimately return to sport. If we understand that grief process of sport injury and normalize the mental health impacts, we as mountain medical professionals can properly support our patients, friends, colleagues and ourselves going through sport injuries.

In this short presentation, I will discuss some of the statistics and research in the field of sport injury psychology in terms of normalizing the grief process that follows injury. I will discuss the recognition of when normal grief begins to affect an athlete’s ability to rehabilitate and practical ways to assist an athlete in transitioning mental distress into strength and goal orientated focus.

This presentation will give CAWM participants a snapshot of the current state of frostbite care in Canada and an understanding of existing gaps in Canadian knowledge, leading to research opportunities and increased pan-Canadian collaboration.

Frostbite care across Canada is inconsistent, and there is presently little information on best practices for treatment and patient outcomes. Based on a scoping review of the most up-to-date literature, this presentation will make the case for improved pan-Canadian collaboration in frostbite care through the formation of a national frostbite protocol. Using brief comparative vignettes we will highlight common presentations of frostbite in Canada and discuss current medical and surgical management options. The efficacy of care protocols and pre-printed order sets, as well as the use of iloprost as a pharmaceutical agent for severe frostbite will be reviewed. This presentation will conclude with a discussion of work that is currently underway to create a national frostbite protocol and community of practice, which aims to address the needs in frostbite care discussed throughout the presentation.

Warning backcountry recreationists about the risks from snow avalanches is a particularly challenging communication task due to the complexity of the phenomenon, the repeated and voluntary nature of the exposure, and the diversity of activities and risk management skills. To better understand the effectiveness of public avalanche bulletins, we conducted 46 semi-structured interviews with a diverse sample of recreationists in southwestern British Columbia and a large-scale survey across North America to shed light onto how backcountry travel decisions are made and how avalanche information is incorporated. The identified bulletin use patterns reveal a clear hierarchy in the complexity of how recreationists understand and apply the information that is consistent with the Structure of Observed Learning Outcomes (SOLO) Taxonomy, a well-established theory in the education literature. The combined findings from these studies suggest that risk communication campaigns could be more effective if they were not only viewed as conditions reports, but rather as educational tools that explicitly define how they improve users’ ability to conceptualize and manage the risk. The results demonstrate that an in-depth understanding of people’s existing risk management needs and processes offers valuable insight into how to provide a diverse public with the information they need in a form that is useful to them.

Dr. Paul Dhillon was the physician tasked to be the on-ground support for the Antarctica Marathon in 2019. He joined the ship leaving for Antarctica in Chile and provided medical care for participants across the Drake Passage and then from a tent on the ground in Antarctica. The Covid-19 Pandemic forced the cancellation of the 2020 Marathon and there has not been an official race down there since then. Learn about the challenges and unique operating environment of endurance racing in one of the most austere and remote environments in the world.

Shoulder dislocations are a common ski hill injury. Rapid reduction of these dislocations are associated with favorable outcomes, both in terms of pain relief and avoiding long- term sequela. Due to the location of many ski hills, time to definitive treatment of shoulder dislocations is often prolonged. During the 2017-2018 ski season, the Sunshine Village Ski Patrol implemented a program to train professional ski patrollers with first-responder level medical training to identify and safely reduce anterior shoulder dislocations without the need for procedure sedation. This presentation outlines the training program, the reduction techniques used, and the results of a retrospective study investigating the safety and effectiveness of training these first-responders to reduce shoulder dislocations in an alpine environment.

In cases of hypothermia, providers generally expect that a patient’s clinical presentation and physiologic abnormalities will correlate with their core temperature. However, this is not always the case. During this presentation, we will explore a case of severe hypothermia in a young healthy male that did not follow the guidelines. We will start with the case, presented by the patient himself and his first responder. We will review basic hypothermia and expected clinical presentations. We will then explore the factors that may lead to physiologic outliers, such as faster than expected cooling rates, rapid rewarming rates, and shivering at very low core temperatures, all of which were present in this case. This presentation is complemented by input from leading hypothermia experts (Dr. Gordon Geisbrecht, Dr. Doug Brown, and Dr. Matthew White). The patient and his first responder are planning to be available for questions.

Guests and guides partaking in commercial mechanized backcountry skiing are exposed to numerous natural hazards that can result in injury or death, but detailed quantitative risk estimates are rare. This represents a considerable barrier for evaluating existing risk management practices and implementing evidence-based interventions. We collected historical incident and exposure information from helicopter- and snowcat-skiing operations in Canada to perform a retrospective risk analysis. Our results show that avalanches are the largest contributor of the overall risk of death in mechanized skiing, followed by tree wells and other non-avalanche related deep snow immersions. However, the risk of death from avalanches decreased substantially over the entire study period from the 1970 to the 2016 winter season. Avalanche risk is substantially higher in helicopter skiing than in snowcat-skiing, but other snow immersion fatalities are more common in snowcat-skiing. The risk of major injury is primarily associated to unforced skiing accidents and collisions and shows higher values for guides in snowcat-skiing than helicopter-skiing.

Conference opens at 06:30 PST / 07:30 MST / 08:30 CST / 09:30 EST

The Canadian Frostbite Collaborative project is aimed at understanding the frostbite patient care needs and current practices in Canada to inform national quality improvement in frostbite care. This session will review preliminary research findings, facilitate discussion, and invite future participation in the development of a Canadian Frostbite Care Network in collaboration with the Canadian Association of Wilderness Medicine.

Scientific principles of frostbite pathophysiology and treatment in a Canadian context will be reviewed. Initial results from a national frostbite care survey identifying and describing frostbite care practices and protocol implementation in Canada will be presented. Participants will be invited to discuss the challenges and opportunities of implementing frostbite care best practices in rural and urban Canadian centres. Opportunities for participation in the development of a Canadian Frostbite Care Network to facilitate future quality improvement and research in frostbite care will be identified and discussed.

While more and more women are getting involved in the outdoors, there is still a heavy male predominance on most expeditions, particularly when it comes to guides and trip leaders. This can make it an intimidating environment for many women in general, particularly when it comes to dealing with the less-discussed (or not at all discussed) topics of an expedition such as how to comfortably manage menstruation in the wilderness. Even for those of us who feel very confident in a wilderness environment there are female-specific considerations on an expedition, particularly in the pre-expedition planning phase, which are often neglected or not thought of at all. This talk is, I hope, a pragmatic approach to making the wilderness experience a more positive and comfortable one for women by encouraging all of us to openly discuss the challenges specific to women in the wilderness and share ideas for managing these challenges.

Ultrasound is a powerful, portable, tele-transmissible imaging modality, with a well-established paradigm wherein image-capture is separate from image interpretation, which can be expanded to remote experts guiding and interpreting image generation by inexperienced users not actually on the same planet as on the International Space Station, known as remote tele-mentored ultrasound (RTM). Space medicine illustrated the first experiences with intelligent but naïve users being guided to self-image. We attempted to “spin-off” this technique to help manage all manner of critical medical/traumatic injuries including the SARS-CoV-2 pandemic. Our initial efforts in RTM involved fixed internet connections between rural hospitals and referral centers with an “emergency telementoring” station in the tertiary care hospital. While a number of “firsts” were described, this paradigm was ultimately impractical for the real world due to delays involved, as responses to the most urgent conditions must be immediate. Subsequently we have attempted to simplify the logistics involved by using hand-held cellular technologies typically found in most health care providers pockets. This has allowed “just-in-time” immediate responses to be provided world-wide wherever there is internet connectivity for cellular phones and tablets. We have thus mentored military medics, ski patrollers, firefighters, and even ski patrollers to perform diagnostic RTM mentored by single or virtual panels of mentors located across many time zones, or even airborne. Over a decade of experience has demonstrated that the technology is completely capable and improving every year, but that the human factors involved in mentoring effectively are not innate and this is a science like any other that requires immense further study. Finally, remote self-performed RTM is a further refinement of the technique that empowers the lone explorer, worker, or athlete who is required to administer self-care in extreme circumstances. We have further partnered with SAIT to demonstrate the drone delivery of RTM equipment to guide just in time self RTM examinations. We feel this one application represents the tip of the iceberg.

Rock climbing diversified from mountaineering with various forms of activities, such as sport climbing or deep water soloing. The overall climbing performance is depending on physiological factors (e.g. finger strength, BMI), mental capability and technique. Climbing sports can be performed from a young age up to a very advanced age. The overall injury rate is low, with most injuries being of minor severity. Nevertheless the risk of a fatal injury is always present. Both, injury rate and fatality rate vary from the different sub-disciplines performed and are the lowest for indoor climbing, bouldering or sport climbing. They are naturally higher for alpine climbing or free solo climbing. External factors as objective danger through e.g. wind chill or rock fall add to the risk. Most injuries and overstrain are on the upper extremity, mostly at the hand and fingers. The most common injuries will be discussed and presented.

In 2010 two of our presenters (Boyd, McLaughlin) published the AvSORT algorithm as a practical tool to assist with the challenging task of multi-casualty avalanche triage during avalanche rescue. AvSORT II updates the sound concepts introduced in the original algorithm to current international and ICAR standards. In contrast to the European experience where distances and rescue times are considerably shorter and rescue resources are plentiful, avalanche incident response in Canada is often complicated by the needs of victims overwhelming rescue resources. The AvSORT II project has undergone peer review through presentation to avalanche industry professionals and also accepted for presentation at ISMM 2021. With the AvSORT II algorithm as a framework, the presenters will introduce the concepts of tactical avalanche rescue triage including terrain, burial depth and extrication triage. Subject assessment factors that determine medical triage designations are reviewed within the algorithm. Produced as a weatherproof field worthy card it includes updated protocols for the field treatment of severe hypothermia and mountainside CPR as further reference on the reverse side and these protocols will also be reviewed with participants during the presentation.

This will be a case report-based presentation on a 68-year-old female who presented to the Kelowna Emergency Department with complaints of general malaise, fever, weakness, confusion, headache and diplopia, with neuro findings on initial assessment. She clinically deteriorated and was admitted to the ICU, where she was initially a diagnostic dilemma. She was ultimately diagnosed with Powassan encephalitis, a tick-borne illness contracted while vacationing in Quebec several weeks prior to her presentation to the Kelowna ED. She began to improve 5 days after her admission and at her three-month follow-up, she showed good functional recovery but had some residual symptoms secondary to a motor neuropathy. This presentation will focus on the Powassan virus and in addition to discussing the above case, the presentation will give a brief overview on how climate change affects tick-borne illnesses through several different mechanisms including increased tick survival and reproduction, host/reservoir factors, and human behavioural changes that increase potential exposure to ticks. Furthermore, the management of patients who present with tick bites, including tick prevention strategies, tick removal, and indication for antibiotics, will be addressed. The presentation will conclude with a mention of changes to tick surveillance due to the COVID 19 pandemic (using the current hold on the Alberta submit-a-tick program as an example).

Managing blood glucose is challenging at best when in controlled environments. During extended periods of physical exertion with altered caloric intake, maintaining strict serum glucose levels becomes significantly more difficult. For tens of millions of North Americans, diabetes management during intense or prolonged physical exercise is a complicated endeavour.

This presentation will focus on diabetes management in athletes, particularly during times of extended exertion in austere environments. It will begin with an overview of the physiology of glucose management during exercise, contrasting the differences between aerobic, anaerobic, and prolonged periods of exertion, highlighting the abnormalities present in individuals with diabetes. Building on this, the presentation will describe the effects of austere environmental conditions on the body’s ability to manage serum glucose, with a focus on extreme temperatures and altitudes (for example, identifying and managing hypoglycemia in the context of hypothermia and acute mountain sickness).

The remainder of the presentation will focus on how to anticipate and implement medication and glucose intake adjustments during wilderness excursions - emphasizing the importance of preparation with respect to insulin and glucose monitoring equipment. The information provided in this presentation will be particularly relevant to medical professionals who counsel patients with diabetes prior to wilderness excursions and to wilderness guides who may be directly involved in the treatment of diabetic emergencies in the backcountry.

This presentation will give an overview of drowning injury as it applies to Emergency Medicine. It will briefly cover the epidemiology of Drowning injury in Canada for context, followed by clarification of accepted terminology compared to “old” terminology that is still in use throughout the literature. It will discuss basic pathophysiology of drowning and how it relates to outdated terminology. It will then cover some special cases including saltwater vs freshwater drowning and cold water submersion / immersion as they are related to the ED management of drowning victims. Finally, it will cover the guidelines and recommendations for ED management of both stable and unstable drowning patients.

When traveling to an endemic region, malaria is the most prevalent life-threatening infection facing Canadian travellers. Wilderness medicine practitioners must perform a careful geographical, activity and traveler characteristic risk assessment to choose appropriate chemoprophylaxis and personal protective measures for those under their care. Early recognition and treatment of malaria symptoms in a traveler to an endemic area is important, especially in remote settings. This talk will also provide an overview of Canadian resources for healthcare professionals for prevention and treatment of malaria.

Follow an emergency physician as he goes on a mid-life journey from his career practising in-hospital emergency medicine to volunteer work in a challenging search and rescue environment, and the lessons he learned along the way to aid in this transition.

This presentation will provide an introduction to North Shore Rescue (NSR), one of Canada’s busiest search and rescue teams. Data from 25 years of NSR medical calls will be reviewed, as well as a discussion of how NSR currently manages medical calls. The use of three paradigms for an organized approach to SAR medical calls will be considered, and the utility of these paradigms will be demonstrated by applying them to several real calls. The presentation will thus be a combination of SAR medical facts and data, an organizational framework for SAR medical practice, and real life examples of SAR medical calls, using photographs from the actual calls and clinical information regarding the actual patient outcomes to enrich the stories told.

If I were to ask a medical first responder what they would anticipate after a pedestrian versus car collision, or a diving board accident, how quickly would they be able to describe the likely mechanism of injury and potential injuries? Would you expect the same ability if I asked about responding to a suburb struck by a landslide?

Landslides occur frequently and commonly throughout the world everyday, many of which have zero impact on human life. However, landslides can become catastrophic events if they occur on the wilderness/human interface. As wilderness medical enthusiasts, this interface is our home, workplace and playground. This presentation introduces the basics of landslide 'anatomy' and develops the geological phenomenon into a medical mechanism of injury. Using publically available case studies, post-mortem reports and resources, the presentation aims to introduce the medical first responder to landslides and how to prepare for the care of treatment of landslide victims. Originally developed for medical specialists within a heavy urban search and rescue (HUSAR) team, the information may be equally valuable for wilderness medical professionals. 

The topic of Wilderness Medicine is not widely covered in core medical school curricula across Canada. As such, one of the only ways medical students can learn about wilderness medicine is through extracurricular clubs and voluntary electives. We conducted a survey of pre-clerkship medical students at the University of Alberta before and after they completed a wilderness medicine elective. Our study assessed how participants’ self-reported knowledge of wilderness medicine topics changed over the course of taking the elective. We further documented participant demographics, identified barriers to participation in the elective, and solicited suggestions for improvement in future iterations of the elective. In this presentation we will report the main findings from our study, discuss the structure and content of the elective, and make key recommendations for the development of other wilderness medicine electives.

A brief overview of the history of anesthesia delivered at altitude. This talk will review the physical changes that occur at altitude (hypobaric environment) and their effect on commonly used equipment in anesthesia, including anesthetic vaporizers, gas analyzers, oxygen delivery rotameters, and Venturi masks. It will also include some of the effects of commonly used adjunct medications, including opioids and ketamine, at altitude and their dosing requirements and changes. Finally, it will cover anesthetic alternatives to general anesthesia and sedation, such as regional and neuraxial anesthesia, and their considerations at altitude.

The July 18th Columbia Icefields MCI was one of the most isolated MCIs in Alberta History. It presented many unique challenges and required a multifaceted province wide response. Through this presentation the presenters will explore details of the event including the successful integration of multiple pre-hospital agencies providing patient care, as well as the specific challenges posed by this wilderness MCI. The presenters can provide unique perspectives surrounding the management of wilderness mass casualty incidents as providers involved in various phases of patient care during this event (Parks Rescue Specialists, EMS, and critical care air ambulance).