Wilderness medicine is plagued by myths and dogmatic teachings not supported by evidence. This article focuses particularly on those teachings and tools that would be most likely used in archaeological fieldwork. It lays out 10 of the most common and concerning myths taught in wilderness medicine and wilderness emergency medical services, both in terms of first aid and preparation of medical kits. The myths described are provide a structure for the main purpose of the article: to explain interventions and medical kit contents that are more evidence based and supported by modern understandings of wilderness medicine and fieldwork risk management. The list of top 10 myths includes (1) the use of medications other than epinephrine for anaphylaxis and (2) the availability and proper use of epinephrine auto-injectors, (3) the use of suction devices and tourniquets for snakebites, (4) the use of spinal immobilization for neck injuries, (5) the identification and treatment of heat illnesses, (6) the use of CPR in remote areas, (7) the appropriateness of dislocation reduction in remote areas, (8) the use and choice of tourniquets for arterial bleeding, (9) the initial definition and management of drowning patients, and (10) wound management myths.

Wilderness medicine classes are widely available to archaeologists and field scientists, but because wilderness medicine is an unregulated field, knowing what the various courses and products mean can be difficult. Based on the education chapter in the recently published textbook Wilderness EMS, this article—written by same two authors as the book—explores a number of topics relevant for the field scientist, program director, or administrator seeking to obtain wilderness medicine training for archaeologists. The article first explores the history of wilderness medicine products and certificates available to interested parties. It then differentiates between the various products available today along with their benefits and limitations for the end user. Products and trainings described include certifications (including Wilderness First Aid [WFA], Wilderness Advanced First Aid [WAFA], Advanced Wilderness First Aid [AWFA], and Wilderness First Responder [WFR]), as well as single use or continuing education trainings (including Stop the Bleed, CPR, conference courses, and field schools). Particular attention is paid to the specific and actionable needs of a field scientist in remote areas.

The case of a patient with a zone II penetrating neck injury who was intubated successfully utilizing the gum elastic bougie (GEB) is reported. He presented at a forward operational base in Afghanistan with a shrapnel wound in his neck as well as a cough and hoarseness. There were two wounds on each side of his laryngeal cartilages. The patient's breathing rate gradually increased and labored inhalation developed while the aeromedical evacuation was delayed for tactical reasons. Subcutaneous emphysema and edema concealed the anatomical landmarks, making a cricothyrotomy unsafe, and no fiber optic devices were available on site. Intratracheal intubation was decided upon by the doctors involved. Because of the anticipated difficultly of intubation, the GEB was used from the outset. During direct laryngoscopy, edema, blood, and mucus concealed the anatomic reliefs of the larynx. The glottis was not visible. On the second attempt, “clicks” were clearly perceived and the tube was railroaded over the bougie. Finally, the patient was evacuated to an Afghan military hospital.

In this report, the benefit-risk balance for the use of the GEB in penetrating neck trauma is discussed. Although the use of the GEB cannot be recommended in all cases of penetrating neck injury, it should be considered as an option. This technique is not without risk, but in very remote settings or hostile environments, especially when cricothyrotomy is not possible, it can be lifesaving.

Daniel Y, de Regloix S, Kaiser E. Use of a Gum Elastic Bougie in a Penetrating Neck Trauma. Prehosp Disaster Med. 2014;29(2):1-2 .