Hello everybody, happy Earth Day and welcome to today's program, Nursing in the Wild. I'm Kelly George, Director of Membership, Marketing and Communications at the Wilderness Medical Society. And we're pleased to be partnering with the Emergency Nurses Association for today's webinar. As we gather together on a day dedicated to environmental stewardship and appreciation for our planet, we are excited to dive into the intersection of emergency care and wilderness environments. We have two experts in the field who have joined us today to share a bit about their wilderness medicine journeys and different lessons learned along the way. Before I hand it over to our first presenter, I have just a few housekeeping notes. Today's program is being recorded and will be sent out by the end of the week, along with links to many of the resources shared today. If you haven't already done so, we encourage you to share where you're coming from in the chat. You may also submit questions at any time during the webinar using the chat feature and we'll have a formal Q&A time following each speaker. Please remain on mute until then and please reserve the chat for questions and comments that will benefit the larger group. Feel free to message me directly if you have any technical issues. Now, it's my pleasure to turn it over to Linda Lispowski-Jones, so she can introduce herself and jump right in. Linda, please go ahead. Thank you very much, Kelly. I really appreciate the opportunity to be here. So, gosh, I'm an ENA member, longstanding, probably joined in the 1980s, have been a member ever since, and I'm also a longstanding member of the Wilderness Medical Society. So it's really amazing that we have brought the organizations together for this webinar. We really appreciate that you're joining us today. We hope that you will, as you see, listen, learn, and connect, and consider some wilderness nursing opportunities to expand your career as an emergency nurse, or at least expand your options to learn more and to get potentially involved in this if you really like it. So check out the Wilderness Medical Society, it's WMS.org, as well as, of course, the Emergency Nurses Association if you're not already a member. And a little bit about me. I'll just start here with this slide. So currently, I am the Editor-in-Chief of Nursing. It's Nursing 24, 2024. Longstanding nursing journal, maybe some of you are familiar with it. But my background is 36 years in the hospital, in emergency and trauma nursing, and since that time, I'm still deeply involved in emergency and trauma nursing, but in a bit of a different capacity. I'm the State Chair of the Trauma Quality Committee for Delaware. I am a Trauma Center Accreditation Nurse, as well. I work with the state of Colorado, and have also been involved in numerous volunteer opportunities to provide care to patients in various settings, including wilderness settings. And I'm gonna tell you a little bit about that journey. So some things that I've done when we're sort of thinking about, okay, you know, who are we? I hiked halfway across England, I've done 100 miles on the Appalachian Trail, and a backpacking trip, and one journey. Emergency and trauma care are part of my heart and soul, and it was really a natural connection with the wilderness medicine community. And I also earned the button, I swapped spit with a wolf. Not something that you hear every day, but I'll tell you a little bit about that. So I have always loved the outdoors. I've always found the outdoors to be a healing environment. And, you know, over the years in practice in ICU, trauma ICU at University of Maryland Shock Trauma, in a county emergency department in Baltimore, and then through my career in various capacities as a educator, trauma clinical nurse specialist, trauma program manager, flight and ground transport nurse, ED director, and ultimately an ED vice president running a level one trauma center that solved 5,000 traumas a year, and about 112,000 patients for one site. Another urban ED was a level three trauma center and a freestanding, as well as an aeromedical and ground transport program, and an observation unit staffed by advanced practice nurses. Having responsibility for those areas was very, very stressful. And I believe that I stayed in this field 100% because I was able to go outside. And then I went to a wilderness medicine conference and it just seemed like, like with emergency nurses, I was with my people. And it's sort of like I found another home. So I think that obviously nurses heal the sick and injured. And I believe strongly that mother nature heals nurses. So how do we combine that practice, you know, so that we actually can do things outside of work where we can actually use our knowledge, skills, and abilities as nurses and still be in that environment where we also are fulfilled and are being healed. So these are some pictures that I've added that sort of tell a little bit about, you know, my own wilderness journey, as Kelly said. And one thing that has really influenced, in fact, this is what sort of actually drove me to the first wilderness medicine conference I ever attended, is I'm a member of the National Ski Patrol. On Saturday of this past weekend, I received my 35 year service award. So 35 years of actually working with my husband who made it part of our wedding vows that I would join the ski patrol. And I found that I learned a ton of improvised ways of managing emergencies on the ski slopes. So whether the person was over the edge and we had to somehow get them back and do it safely, there's improvised techniques you use on that. You had to know how to live and work in the cold weather environment and survive. So then we started getting into winter camping and backpacking, and that was amazing too. So everything was just a learning experience. I found that when I needed stress relief, I went hiking. I looked for areas around my own local, my home, but also if we were traveling for any reason, even to a conference that maybe involved nursing, I would look to see if there was an extra day or two I could go explore somewhere that was a really cool environment. I found that wolves are actually very healing as well. So a friend of mine who was also a nurse, a trauma nurse, got me involved with one of the wolf refuges in Colorado. And I actually went in and spent time up close and personal. And since that time, I have tried to look for wolf refuges where they would allow that experience. You need to sign your life away and go in. And these are wild animals. These are not hybrids. These are wild animals. And they're all wolf, at least in the settings that I've been to. And a number of them are wolf hybrids, but with dogs. But this was the real deal. So, you know, it's a whole way of approaching the animal. And this is how I wound up swapping spit with a wolf. So they just represent the wilderness to me. You know, snorkeling in the Caribbean to then having the opportunity to provide the medical coverage for the Delaware Marathon. So I decided to involve my emergency department staff and for anyone who wanted to, as a volunteer opportunity, we would staff the Delaware Marathon. And we did that for about 15 years. And I had staff who absolutely loved the experience. They got out. We had some really beautiful days. And they went out into the course. And then we had a medical tent. And we dealt with some really serious illnesses and injuries, including saving two marathon runners' lives through our efforts. We had all the ALS capabilities. I went on up ultimately later importing some emergency physicians and also some sports medicine physicians. And we worked as a really well-coordinated team. Then came the kayaking. So I've been a kayaker for a long time. We started covering triathlons on the swim portion and, you know, being out with the swimmers and making sure that they were safe in their journey. And ultimately, I really had on my bucket list to get to Alaska and to do some hiking in Alaska. And that last picture there is our, one of our places that we went. It's in Alyeska and just a gorgeous view. So wherever I can go, where I can hike, I'm all about it. So what actually is wilderness nursing? So wilderness nursing really involves knowing how to provide care in a wilderness setting or an austere environment. You don't have that traditional access to healthcare resources. So you are truly on your own. And you've got to think about what you have with you, what is in your environment, what might be on another member of your party as far as their equipment and supplies, where you can actually help a person in a setting where there is no other help immediately available. Some examples, and these really run the gamut, it could be disaster aid work where you decide to go and volunteer with a disaster medical team and you're helping people in a devastated environment and you're dealing with all manner of illnesses and issues, trauma wrought by that disaster. What do you have with you? What can you use? And then how do you keep yourself safe in all of that as well and work well with the culture of the people that you're helping? You can do these coverages for these outdoor adventures, which could be anything from an adventure race where maybe someone is going out and running up a mountain, carrying a load and going through all kinds of obstacles. It's the mud runs. It's all of that. And that's also kind of part of the event medical team. Or it could be something just short and they just need someone to cover that event. You may be interested in becoming an expedition medical team member where you're going out, it could be anything, to a research station out in Alaska or in the Arctic Circle or maybe something much more close to home, but they need someone who can provide that care. It also may be that you have an interest in going out and practicing in a medical setting. Maybe it's a little tiny clinic in a very austere environment and you just want to go do a stint there because it seems like a fascinating thing to do. You could also just be out enjoying your vacation and you're in the middle of nowhere and now you've either encountered a person or a member of your party has something happen, whether it's an illness or an injury. How do you manage that when healthcare is a real distance away and you've got to manage on your own for a while? So wilderness nursing sort of teaches all of you that and teaches all of that. And here again are just some of the pictures of some of the medical coverages I've done. So again, staging for a swim portion of a triathlon, covering one of the Spartan races that was held at our ski area. And there's all manner of obstacles there that people encounter where you may actually have to go in and affect some sort of rescue. People jump over fire and some of these events, not that one, but they have to run and they encounter electrical wires that are hanging and some people don't do real well with that and wind up needing medical attention. There's water events. So you're using those skills. And also, I mentioned the marathon. The lower picture is me with another woman who is a nurse. Also, she's an emergency nurse from a different hospital, but a number of the medical providers from the ski patrol wound up joining in and covering that event. But wilderness medicine, as far as what is it, wilderness medicine, wilderness nursing, wilderness medicine is sort of the big kind of umbrella over all of it. It is all about understanding what is in your environment. This is the information that you don't get necessarily in nursing school. It's what you don't hear about. Now, emergency nurses definitely have a greater grasp on a lot of this because if you take the CEN exam, certified emergency nursing exam, some of these areas are covered in that exam. So for example, the first picture is of a black widow spider and you do learn about black widow spider bites and you may see them in your practice setting. But you will learn about the toxins and what to do about that spider. There are plenty of other insects and arachnids and arthropods out there that have healthcare or medical implications. And again, the whole body of wilderness medicine, wilderness nursing kind of clues into all of those things. It could be how to actually secure someone so that they can be carried out if they need rescue and are unable to safely ambulate. And this is one example of a rope litter that we put together at one of the wilderness courses that I took. And you work with a team and you feel a whole lot more confident in your skills. Like, what would we do? How would we actually make this rope litter with what we have in the environment that we happen to be in? You also learn about some of the poisonous or toxic plants in your area. So for example, a few weeks ago, took a picture of this. It is actually a seed pod from jimson weed. What is going to happen is this seed pod is going to open up and a beautiful flower will grow out of it. And this flower is white. It may be referred to as hell's belts. So jimson weed is deterostremonium, excuse me. And interestingly, each seed contains 0.1 milligrams of atropine. If people consume these seeds, they are hallucinogens. There's also scopalamine and other substances in there. And there are fatal doses from this plant. This plant grows all over the place in areas where I hike regularly. So, you know, knowing about that, and certainly that would help you in the emergency department when you start to see some of the signs and symptoms of people coming in after they have recreationally tried jimson weed, which I saw definitely in the emergency department, you know, where I practiced. So, and the next is the snake. You know, lots of folks don't like snakes. I'm actually pretty fascinated by them. We only have the copperheads in Delaware, but I've certainly been a lot of places where all of the cotton, or the pit vipers, you know, are located. So rattlesnakes, cottonmouths, or water moccasins, or rattlesnakes, cottonmouths, or water moccasins, and coral, excuse me, copperheads. So this is actually a water moccasin, and it was right behind the kayak of a friend who, if some of you have been following wilderness medicine, a physician named Seth Hawkins, he's a good friend, and he took this picture and he said, you can use it. So that was pretty intimidating to have a water moccasin chase your kayak as you're going along. And then water purification techniques. How do you make the water safe? And this would certainly be important if you're going into like an expedition setting. So, you know, we teach these things and they will help protect us, the members of our party. And it's super interesting information. This was the grizzly bear that approached us. Now, we were in a tour bus, but we were in Alaska. We were in Denali. And my window happened to be open, and this bear was right underneath the window. It was so close that as my husband was taking some pictures out the window, he didn't see the bear. I'm looking down as the bear is coming up. So I'm trying to get the window down. He's trying to figure out why I'm trying to close the window when he's getting pictures. So anyway, you have to have awareness, situational awareness. The other picture below, this is a person who came into our emergency department and actually was the victim of a lightning strike. And you can recognize that the necklace she was wearing superheated, and you have skin burns. And it's hard to see probably on the slides, but she had something known as coronagraphic markings, which are the branching and ferting markings of a lightning strike, the skin reaction, essentially, the skin manifestations of a lightning strike. So we were able to resuscitate her, and fortunately, she is doing quite well. The middle picture, I'm not wearing gloves because it is my husband. He had an avocado injury after we stopped for a bite of lunch while kayaking. So it is managing wilderness wounds. And then in the next slide with the case of envenomation, this was from a snake bite he had from a backyard snake. The snake was caught in our blueberry netting. He decided to rescue it using my hair shears. And he found that when the snake bit his finger, it was easier to hold his hand up and cut the blueberry netting away from the snake and let the snake go free. But it was an eastern garter snake of the Thymnophis sirtalis variety. And apparently, this particular eastern garter snake, when it latches on and holds for a while, it actually injects a primitive venom. And he had a venom reaction, and ultimately, he swelled up to his shoulder. And I got a publication in the Wilderness Medicine magazine as a result. So that was at least one thing that came out of it. He's like, I should have been an author. It's like, no, you were actually the victim who we were treating. And then hiking across England, knowing about survival, knowing how to take care of yourself when you're in an unknown environment. And we were, this was our, we did about 119, 120 miles on that trip. So wilderness nurses have the knowledge, skills, and abilities to care for themselves. They're members of the party. And anytime that immediate care will be delayed or unavailable. And this is what the content in the courses that you can take and the society believes in in general. The Wilderness Medical Society and the practice of wilderness medicine, wilderness nursing. It really sort of involves pulling together the emergency background. If you have a desire to be in the outside, it gives you that knowledge to be able to do this. And in this particular slide, we have some education and certification opportunities you have to consider. Now, these are certainly not necessary, but if you want to take it one step further and actually sort of do a deep dive, there is a diploma in mountain medicine that is available. And essentially this is a standardized curriculum. It is rigorous. So people need some background and the website, the WMS.org does have a place. If you look at certifications and you drop that down, it gives you a ton of information about each of these. But in a nutshell, the diploma in mountain medicine is a full curriculum in all of the mountain medicine rescue techniques, the theory and the didactic piece of it that you would need. And it is also taking you out and having you do hands-on skills so that you know how to climb, rock climb, ice climb, rescue someone who was in one of those situations and then improve your own skills in mountaineering as you're part of that team that's doing that rescue, for example. It is rigorous. There is testing and training, but it is an option. It encompasses four week long segments. And in those four segments, it's best to complete those over the course of like two to three years in order to get that done. There's also a diploma in diving and marine medicine. That is a newer certification. And if you have an interest in boating, if you have an interest in marine medicine, diving, that sort of thing, that's where your diploma in diving and marine medicine, excuse me, fall in. So they do have the prerequisites for that also on the website. I have not done the DIMM or DIDMM, but I have done the next one, the Fellowship in the Academy of Wilderness Medicine. And what that is is a curriculum that lays out exactly the coursework you need. And it is a full curriculum in wilderness medicine. So it covers all of the key topics, combination of lecture skills. So you get those hands-on experiences, but also there are requirements for like your life experience. And so for example, if you're writing something that is published on a wilderness medicine topic, you are doing volunteer work in an area that would be included in that wilderness medicine overall type of setting. There's those sorts of things that would also be given credit for that life experience. And all of that is listed out again on the Wilderness Medical Society page. So it's about a hundred credits for completion of your form. And my husband and I did it, I think we finished in 2010, and it was a really great experience. And that program has evolved from when we first started where the WMS didn't really have a great way of tracking. And so you're tracking all this yourself. Now, every time you do something that falls into one of the form credit areas, if you're in that program, you can actually see where you still need to target your credits, whether it's in anything from women in the wilderness to going and getting more skills in spinal immobilization or stabilization, improvised splinting, things like that. So it tells you where you should be picking up those credits and the Wilderness Medical Society offers conferences where you can actually go and get those classes and those hands-on experiences as well. So these are some options. And I thought I, maybe I missed one, maybe not. So about the Wilderness Medical Society. So it is a nonprofit. It was established in 1983. Interestingly, that was the year I graduated from nursing school. I wish I knew about it before I did. I joined in 2005. So you can see the mission and it's really about encouraging fostering and supporting, conducting activities to improve scientific knowledge of the members and the general public, because many of the members are not necessarily in a healthcare field. They may be lawyers. They may be people in climatology. There's a really rich membership. And I think what everyone has in common is a love for the outdoors. And also those of us who are in healthcare fields, have a love for practicing in these settings. And the membership is completely interdisciplinary. And in fact, all of those certifications, the Diploma in Mountain Medicine or Dive Medicine and FOM, nurses, RNs and advanced practice nurses are welcome to do all of that. So you go in, like my name is Linda, right? And the person next to me who's a physician, it's Seth or whoever it happens to be. And it's a very inclusive group. So that is the other thing that has always drawn me to it is I feel like I'm with people who are very like-minded and they have a passion for the subject, this topic, and overall this area of practice and working with each other and networking and kind of doing some cool things. Now, the important thing about the Wilderness Medical Society, it is evidence-based, okay? It is a scientific organization. You can go get a lot of wilderness education from a lot of different places. And the issue is that, you know, it's still fun and it's certainly the thing to do if this is what you wanna do. But if you're interested in evidence-based practice and those who are setting the standards through high-level research, then WMS has that piece of it. But they also have everything else too. So they've got the fun, they've got the networking, they've got cool opportunities to do great stuff, whether it's hiking up to Everest Base Camp and maybe being part of a team at Everest Base Camp to going out and doing a med sale in the Caribbean. So, you know, the sky's the limit and you just have to kind of look and see what's available. There is a scientific journal and I love that because it has informed a number of my articles. I write a lot. There is a magazine. There's also, as I mentioned, plenty of the adventure opportunities. And it can be your path and it can be your path if you're an experienced RN, a PRN, or a new grad. Again, these are some of the topic areas I talked about just, you know, briefly for humanitarian aid. This weekend, I did a coverage for a cycling event called the Monkey Knife Fight. It had nothing to do with monkeys knife fighting, you know? So people are like, are you doing what? And they're imagining some horrible, horrible scene. It's like, no, seriously, I don't know why it's called that, but it is a cycling event to benefit, sort of like, it's kind of like a make-a-wish benefit where it's for children with serious or devastating injuries or illnesses and trying to make their dream come true. Travel nursing and military nursing, which Jason is going to talk about in just a moment. And then there's also other areas for membership participation, such as committees and continuing medical education. There's, you know, you can decide you're going to go and be an outdoor recreation guide, right, where maybe you want to be leading a group of people into the wilderness and need the education and certifications to do that. Research opportunities, grant opportunities, you know, for the scientific part of the society. And then, of course, things that many of you may be interested in, such as search and rescue or expedition medicine, again, where you're that team member, you're the provider, right, with the group. And it may be, you know, staffing some of the different events or clinics or, you know, whatever is available. And the adventure races, where people not only are doing the small scale, but also the large scale, where you're running a hundred plus miles through deserts and into high mountainous areas. So it's all of that. And I think, you know, it really broadens your mind about how to improvise, how to see things differently and sort of getting out of your normal, you know, four walls of a hospital setting. And, you know, there's lots of courses. There are affiliates to wilderness, the WMS, such as like National Outdoor Leadership School for Wilderness First Responder Training, if you're brand new to this whole thing, or AdventureMed. And that would be, for example, Wilderness Life Support for the Medical Professional. I'm an instructor in that and regularly teach doctors, nurses, APRNs, PAs, EMTs, paramedics, nurses, you know, everyone, those skills to save a life in a wilderness setting. So you can check out these groups as well as many others. You can also check those out on WMS.org if you have an interest. My advice is to follow your dreams, to try new things and don't let challenges become barriers. And I will disclose one thing here that I think is important to know. So a few years ago, I partially paralyzed my right leg. I wear an exoskeleton on that leg. I couldn't ski at the point where I did this. I'm not ruling it out for the future, but for now I'm doing work in the aid room of the ski area and doing all, teaching outdoor emergency care. I am still hiking. I am still kayaking. And I'm doing every single thing that I can to kind of push past that barrier. And honestly, wilderness medicine has helped, you know, kind of keep me focused on the things that I really enjoy. So don't let those challenges become barriers. Pay attention to your intuition and your surroundings. You learn how to do that, how to keep yourself safe. Learn everything you can and network and you'll meet some very, very cool people. So I think because I want to turn this over to Jason, why don't we move into his talk next? I'm going to advance the slides for him and we will answer questions at the end. And you can also email me and I'm happy to connect with anybody who really wants to talk more about this. Okay, so Jason. All right, thanks so much, Linda. It's always hard to follow you. You've had such an awesome life and career. And so, you know, kind of leading into one of my fun facts, I remember the last time we gave this talk, I saw the wolves and I was like, oh man, I'm going to start hanging out with more apex predators to be like Linda. So, you know, sharks I have found out are a little bit friendlier than you think. My name is Jason Muse. I'm an army nurse by trade, as you can see from the get up today. I've been a nurse in the army for the last 12 years. So just over a decade. My first three years were spent as a med surge nurse at the military's premier level one trauma center in Texas, Brooke Army Medical Center. I spent time on a trauma ward there, the ER, the burn center. So I got a really well-rounded base of knowledge before deploying to Afghanistan in 2014. From that point on, I spent the next seven years doing, you know, what we'd call austere nursing or wilderness nursing full-time. Working everywhere from here in the States, in the Mojave Desert, the high desert of Eastern Washington, the Philippines, Indonesia, Palau, kind of all over the Indo-Pacific. After that, these last three years, I spent a year at what would be akin to our corporate headquarters up in DC at the Pentagon, working policy and then some high-level planning for things like, you know, I was there in 2021. So we had COVID vaccine rollout, which the army handled a lot of the movement and logistics for that, the withdrawal from Afghanistan. So there's a lot of complicated austere nursing issues associated with that. We did not anticipate the need for as many OBGYN nurses to go help deliver babies for refugees that were coming over. After that, I went to Kansas, where I worked on a couple of master's degrees. At one time, academically challenging, but very interesting. And now I'm here in Las Vegas, Nevada, where I help run our regional office for talent acquisition. So, you know, for those that are looking to do the full-time wilderness nursing and you think the military might be the route you wanna take, we'd be happy to help you explore that. And so it's an awesome field as I'm sure you're gonna see here in a second. So what gets me into the outdoors the most? I am a climber. I do identify as a, you know, a trad dad climber. I love getting outside. This is a great place to do it. We got Red Rock Canyon here. Moab's, you know, a short six-hour drive away. We've got Zion a couple hours away. So Vegas is a great base to get into the outdoors. Next slide, please. So standard DOD disclaimer, I'm gonna talk a lot about Jason's opinions today, not major amuse or the Department of the Army, Department of Defense, and I have no financial investment in this. Next slide. So let's talk about Jerry for a minute. You see Jerry in the ER all the time, right? Jerry's, Jerry, you know, if you didn't get hurt, you aren't trying hard enough. I think it's really important right now for nurses to really expand their horizons when it comes to wilderness medicine, because during COVID, we saw a significant uptick in the number of outdoor users. I mean, it has been wild. I'm sure Linda's Ski Hill has been absolutely mobbed. I was out at Red Rocks climbing a couple months ago with some friends, and I was just shocked at the sheer number of people out there. And those people don't always come into these sports with any kind of training or education. They run down to their local REI, they buy a bunch of gear, they watch a couple of YouTube videos, and then you see them up there on the wall doing a lot of unsafe things. And so as nurses, you know, if you've got an outdoor hobby that you're into, you know, you can come at this from an education standpoint. I mean, these are patients waiting to happen. And so you can certainly get involved in what I call PSAR, preventative search and rescue. So this is definitely an opportunity, I think, for everyone. If you're not sure where to get involved, if it's search and rescue or the military route or ski patrol, even just having kind of a basic awareness when you're going into the outdoors and being willing to walk up to a stranger and strike up a conversation when you see something unsafe can go a long way. Next slide, please. So getting into my journey in wilderness medicine. So it started a little bit from a selfish reason. I've been in the outdoors since I was a young kid. I was a boy scout. I got some first aid training there. I have always been super passionate about things outside. So I climb, I dive, I ski, I get up into the mountains, I go horseback riding. Now I'm shark diving, which has presented a whole new world of risks. And so all of those risks are something to think about when you're outside, right? Because when you're new to a sport, you don't really know what you don't know. And so the more you get involved with it, the more training you have, the more you learn about wilderness medicine, you start to see those risks. But thankfully for me, what my full-time job was for a good seven years of my military career was the risk mitigation side of things. You can go to the next slide. So in the Army, we call it force health protection. And it's where we look at the environments that we're operating in and try to figure out what are the threats? Clearly from a military standpoint, there's a military threat. But what we see in conflict and in our training is that that's not why soldiers always get hurt or ill. It's disease and non-battle injuries. So there are car accidents out in the wilderness. A friend of mine out of Fort Irwin, California, in the Mojave, treated patients in the field. It was a head-on collision between two Humvees. So he was treating two trauma patients out there with a backpack. He's a CRNA, and so he's out there with his backpack doing that. In Southeast Asia, we've got plenty of tropical disease, snake bites, you name it. This top left picture, as you look at it, this is a private Andrea House at the time. She's a sergeant now. But she was on lifeguard duty because we were trying a new amphibious operation and we had a lot of soldiers in the water that weren't the strongest swimmers. So for us in the military, it's all about how do we mitigate the risk? How do we minimize it? And that's through education. A lot of times it's through training young soldiers or new outdoor users, what not to do, what to avoid, looking at, hey, you may not know how to do some snow studies, that advanced avalanche training, but you can look at an avalanche forecast, right? Teaching people how to read an avalanche forecast. The other side of this is understanding where's the most appropriate place to have the most appropriate medical resource. I know when I first came into wilderness nursing, I wanted to be right there at the point of injury, as we would say in the army, but that's not always the most appropriate place for me. Sometimes I need to be a couple layers back in that chain of survival. So we'll go to the next slide. So Mount Rainier National Park, this is kind of a little segue here. So very accessible national park. This was my playground for the better part of seven years. And we saw a lot of both new and experienced, outdoor users getting hurt here. It's a very unforgiving environment. You can be down in Tacoma or Seattle and it's beautiful weather. It's probably a little gray, a little drizzly. You drive up to Mount Rainier, you got your snow shoes and your backpack full of snacks and goodies, and you want to go hiking, and you get above that cloud layer up to Camp Muir at about, I think it's 7,000 feet, or not Camp Muir, but the Paradise parking lot, you go hike up to Camp Muir. Camp Muir's about 10,000 feet, and it's beautiful weather now. You're up above the cloud layer. But that weather can change in an instant. I've seen, guiding up there, I was guiding a group of would-be summiteers, and we had the weather change on us from beautiful bluebird skies to complete whiteout in about 15 minutes. So again, it's that, like Linda spoke to, understanding survival for you and your group, understanding how to treat injuries, whether they be frostbite or hypothermia, because things can change, especially in the mountains, really quickly. We go to the next slide. So speaking of that, right, so when we look at the chain of survival in the outdoors, so as it currently stands in most places, if somebody gets hurt or injured or ill in the outdoors, they're gonna be treated by some kind of first responder. That's typically, if it's a guide, typically gonna be wilderness first responder or mountain rescue first responder that might be an EMTB. They're gonna get passed off to either a Advanced Life Support Mountain Rescue Service, like Tacoma Mountain Rescue, or some county EMS service, and that's when they make it into your ER. And then beyond that is that rehab space. So, you know, when I look at wilderness nursing, I look at where are the gaps, and those gaps are not the same in every place. Some places, you know, Washington State's got very robust mountain rescue services, very robust first responder services. You know, you've got climbing rangers on Mount Rainier that are very well-trained. So where do we as nurses fit in? Sometimes that's that educational space, so that preventive search and rescue, you know, interacting with users at the trailhead before they even step off. I know that we've got a lot of good backcountry skiing in Washington State, and we had, you know, our backcountry ski patrollers, instead of being out, you know, searching for folks that are about to trigger an avalanche, they'd station themselves at the trailhead, check for shovels, probes, and beacons, make sure that people were tracking what the avalanche forecast was. So that may be one space where, you know, you as a nurse in your community, your outdoor space can eject yourself. The other side, you know, we talked about the rehab space. I know that, you know, folks that suffer, you know, accidents in the wilderness, it's pretty hard to get back out there. Personally, I had a pretty severe climbing accident back in 2018, where I fell 90 feet, my belayer did not catch me, he burned his hand because he was belaying incorrectly, and then, you know, just in the nick of time, I had the presence of mind to lock down his belay strand, but I was a very experienced climber, I was a guide, and now I was scared to go rock climbing. And so, you know, another friend of mine who was a nurse, you know, picked up all those psychosocial, or, you know, those psych nursing skills, and was like, all right, we're gonna get back out there, we're gonna get you resilient again, we're gonna rehab you in the outdoors. And I really appreciated that. And so there's, I think, some space for that. But anywhere in this chain, right, you know, if you can find that gap and inject yourself, there's a lot of austere locations, you know, these national parks, Mesa Verde is one that comes to mind, it's kind of in the middle of nowhere, Colorado, that are serviced by volunteer EMS services. And we've all interacted as emergency nurses with, you know, EMS services, and there's definitely a wide range of skills. Your folks that are delivering patients to Baltimore shock trauma every day are gonna have a very different set of skills than the, you know, where I grew up, the volunteer EMS service, you know, not everyone, you know, carrying a pager is gonna have, you know, that same level of training. So finding those spaces where you can maybe go in and do some education, volunteer with your local EMS service, or even just having that awareness in the ER. Maybe you work somewhere that sees a lot of these cases. And so rounding out your best, your clinical best practices in the hospital, because wilderness medicine doesn't stop as soon as the patient hits the door. You know, we see a lot of variation in treatment of things like frostbite all around the country. We see, you know, when we do the research on high altitude pulmonary edema, you know, we see some mistakes that are made initially. You know, we didn't take a good history and we don't understand what we're treating. So there are spaces, there are gaps in every system. As ER nurses, we know that, you know, that's something that we work to remedy in our own ERs. So look at your system holistically and find those spaces where you can be value added. You can go to the next slide. So other opportunities. I know Linda touched on some of these. I'll hit some of the high points on some of these. So flight nursing, clearly. Occupational health nursing. So this is something I didn't know a lot about until I started doing it. It's definitely, it can be austere, right? So you've got oil rigs out in the middle of the Gulf. Different kind of construction operations that are in austere environments. So that occupational health nurse is doing a little bit of emergency medicine, a little bit of industrial hygiene. But there definitely is some opportunity to do that wilderness nursing in that kind of role. Pitch for the federal government, the state department, the Central Intelligence Agency, they have occupational health nurses too. And there's definitely a trauma and environmental medicine component to that. Again, I talked about education. Where can you be value added in your programs? For those that are very passionate about search and rescue, one roadblock I ran into. So I'm an army nurse. When I'm working with the army, I can do what my doctor tells me to do. And the environments I've worked in, it's not uncommon to see an 18 year old EMTB throw a chest tube in someone. And so I was used to a very wide scope of practice based on my training, not on my license. Trying to get into search and rescue, I kept hitting this brick wall because I was not an EMT, I was not a paramedic, I was not a nurse practitioner, I was not a doctor. And so if you're really passionate about getting into search and rescue, look at what your state has available for you as far as your licensure outside of the hospital goes. For your search and rescue teams, if they're looking for EMTs, there are accelerated RN to EMTP programs out there that you can complete so that you have the licensure appropriate to participate in these organizations beyond education only. For pre-hospital RNs, this is a question I get asked a lot. And so I figured we'd talk about it a little bit today. This is a relatively new in the grand scheme of nursing history. It is very different state to state. So I would encourage you to look at what is specific in your state. If you are super passionate about this, clearly licensure requires some legislative changes, but these should be collaborative efforts, right? And so that's getting involved with WMS and ENA. I know another organization that's working on this is a special operations medical association. So how do we clearly delineate what is a pre-hospital RN? What are they licensed to do outside of the hospital? What are they licensed to do when they step out of the helicopter or the ambulance? Those are definitely things to look into. All right, next slide. So this kind of rounds it out for me. How do I view wilderness medicine or wilderness nursing? I really view it as austere nursing. Linda did a great job covering this as well, but there are certainly places to inject yourself, whether it's in the wilderness, whether you're an expedition team member on a climbing expedition somewhere, or a backpacking expedition or whitewater rafting expedition, being able to take care of the folks that you're with, humanitarian and disaster medicine, that's got a near and dear place to my heart. Before becoming an army nurse, I got to work in remote clinics in the Bahamas and Uganda, and there's definitely places to be value added. And you learn a lot from the local system. We think we have our way of doing things, and then you step into some of these remote clinics and our way doesn't work anymore. And you have to learn from the nurses that are on the ground there, and it's incredible. There's flight nursing, occupational health nursing, which I'll lump into military nursing. There's the U.S. Public Health Service works with the Coast Guard, Army, Navy, Air Force. We all have very different missions, so that's something to consider if you or someone you know is interested in that. Contrary to popular belief, all the rotor wing flight nursing is done by the Army, not the Air Force. If you're interested in fixed wing flight nursing, you should look at the Air Force, although the Army does do a little bit of that too with our burn team. So in the interest of time, so that we have time for questions, I will wrap it up with a little bit of advice. Next slide, please. So don't wait for someone to write your life story. It's you, you're the author. So if something looks cool to you, it is, go do it and write your story. And then don't underestimate your own experience. Imposter syndrome is real. I'll be honest, I'm 35. The last time I gave this talk, I think I was 32, 31, but I didn't really take stock until it was time to sit down and do this, the amount of experience I had. And as nurses, our experience is very translatable, especially in the ER. We're used to doing a lot with a little bit and having to improvise sometimes, sitting on that critical patient in the ER for 12 hours because the ICU is full. So yeah, don't underestimate yourself. You know what to do, and it's really a decision about, in the wilderness of what can I do, because donors always have all the tools. So do that triage. That's all I got. All right, so we are open, and let's see what's in the chat. Hi, Linda, I saw someone had asked what mountain you do ski patrol with. And I also will mention that if you're interested in ski patrol, in particular, we are doing a WMS Fireside Chat for members probably in August or September specifically on ski patrol. So look out for that as well. But Linda, what about you? Sure, so I've been a member of Blue Mountain Ski Patrol. It is in Palmerton, Pennsylvania. It's part of the Poconos. It's one of the largest areas in that region. Lot of high skier density, so much potential. And I wanted to add, I did not partially paralyze my leg doing anything wilderness medicine or ski patrol related. I did it in the basement of my house exercising. So I don't even have a story to share about it, but anyway. Thank you for your honesty. At least you were exercising, right? And a good question here from, I believe it was Scott. He says, I'm an experienced RN paramedic headed to Yellowstone National Park next week to work for the summer in Mammoth Clinic and volunteer as a paramedic for the park service until October. Curious, what is the top one or two suggestions that you each would have for a first time wilderness nurse? I have some ideas. I'm going to turn it over to Jason for his. But first of all, I would talk to the people who were there. There's probably some stable staff that are there through the seasons and find out from them what are the most frequent illnesses and injuries to be encountered, and then read on those areas. You certainly can get in any number of things when you're dealing with that type of setting, but just go in, be open, and learn as much as you possibly can. Jason? Yeah, no, and a perfect piggyback off of that is understanding your systems, your SOPs in the park, understanding how your ambulance is packed, how your aid bags are packed. That stuff should be second nature when you roll up. And you're an experienced paramedic, so these are things you know, but you're going to be presented with new situations, right? So you're not rolling up to an MVC necessarily. And so those stressors that you're normally used to are now novel. And so really being familiar with that. But yeah, I think that about covers it. Thank y'all. The next question is, in your opinion and experience, does having the specific ER or trauma ICU experience give you more credibility when looking for wilderness nursing opportunities? My personal feeling is that particularly emergency nursing does give you a lot more credibility because you're used to dealing with uncontrolled situations. And you know, you learn the skills that are going to be applicable to any serious illness or injury in a wilderness setting. But you may just slightly have to modify them based on where you are and what you actually have with you. Jason, anything? Yeah, no, the experience is there. Like you said, you know what you're doing, it's just how do I do it with, instead of having, you know, some nice ortho glass, I got a couple of trekking poles and some webbing from my climbing rack. With that being said though, you know, I definitely encourage anyone, even if you have no experience, you know, start taking some courses through WMS. I think that, you know, especially like our Advanced Wilderness Life Support, they do a great job of providing that context and taking what you learned in nursing school and applying it to the outdoors. Because like I said earlier, a huge component of wilderness nursing is understanding what you can't do. There's a lot of stuff in the outdoors you're just not going to be able to do. And so, you know, it's peeling that layer back. The other side of it is the improvisation, and there's certainly more than one way to skin a cat. As a nurse, you know that a broken bone needs to be splinted, right? And so it's, what do I have to splint now? So, or making a decision on evacuation. That's another thing that a lot of folks wait on. You know, if you're an ER nurse that's been doing triage and you know that that patient needs to come back sooner than later, it's the same thing with evacuation. Something, you know, these little pearls that you get from the courses of carrying a pregnancy test in your aid bag. A lot of my junior 68 Whiskey Combat medics are like, sir, why do you have pregnancy tests in your aid bag? We don't need that for combat. I'm like, yeah, but if I've got a, you know, childbearing age person, you know, who's got abdominal pain, maybe I want to rule out an ectopic pregnancy when I'm making an evacuation determination if I've only got one helicopter. So there's a lot of little pearls that may not translate from the ER at all that you can pick up from these courses. And there's definitely a lot of wisdom that even just from nursing school, you know, you're gonna be okay. So definitely check out the courses and get that context. And I love how we've got some crowdsourcing going on in the chat here. So thank you all for who are helping out Scott and providing some contacts and advice as well. We might need to follow that same method for this next question, because we get it quite often. Leah asked what are some sites to go to for wilderness medicine job postings? So I'll add on a little bit, but Linda and Jason, if you want to go ahead first and if you have any advice there. Well, even beyond the postings, it's actually the networking that also can give you the information before the posting even goes up. So here's where like WMS has all of these different groups that you can join. And there's like a blog posts and, you know, you get an email if you have your settings set up that way where you can follow the discussion. And oftentimes in that discussion, there are opportunities that are mentioned that you may want to apply to. So that and, you know, wilderness medical society, you know, does have resources where you can look into it or you can contact somebody, maybe who works in that area who can also fill you in directly. Yeah, from my perspective, networking is huge. You know, it's, I think, especially a lot of the overseas assignments, if you're looking to do some of the overseas austere work, your reputation is huge. And so getting into the, you know, organizations like WMS and being an active member will certainly open a lot of doors for you. On the government side, so, you know, we talked National Park Service earlier, Department of State, USAJOBS, that is the job posting, you know, site for all federal jobs, you know, for the military services, it's obviously our goarmy.com or I think it's gonavy.com, but for, you know, the government jobs, USAJOBS is a site to search, but definitely be discerning. There's a lot of registered nursing jobs for the federal government. Some of them are with the VA, some of them are with the National Park Service. So, but yeah, the networking I think is huge. You know, as you build your experience level and you get to know folks and they know, hey, this person would be solid to do this job working on oil rigs in the Gulf. Yeah, that was one of the big things that I was gonna mention as well. People wanna bring their friends along to these cool gigs that they get. And so the networking through in-person conferences and our online engagement platform, I think goes a really long way. I will say at many of our conferences, we have people that are recruiting as well. I know we've had the CIA, we've had U.S. Department of State, Wilderness Medical Staffing. I think there might be one other, I'm forgetting, but several different, actually the National Aquarium was recently, was hiring at one of our conferences. So there's definitely opportunities that arise. We do have a job board that's available at jobs.wms.org. It taps into a network with other job networks. And so most of them are probably not wilderness medicine specific, but if you do have a position that you're aware of, we would love for you to post that there. And then we do communicate that with our members. But yeah, it's mostly gonna be, I think a lot of word of mouth. And like I said, different organizations that reach out to us directly at our in-person events. We have a couple of resources that we shared, but mainly just wanna send a huge shout out to our speakers. In addition to being Earth Day, this month is National Volunteer Month, and we could not have done this webinar without Linda and Jason volunteering their time. So please join me once again in thanking them. I always love hearing your stories and your advice, Linda and Jason. You both truly epitomize the WMS values of inclusivity, nature, education, service, and kindness. So thank you for all that you do. We hope that you all have benefited from the insights and experiences shared today, and have found this webinar to be as informative, inspiring, and engaging as I've had. If you aren't already a member of the WMS or ENA, we would love for you to join us and get more involved. You can use the code ENAWMS15 for a special discount. And there are several other articles and resources that we recommend checking out, and we'll send those links out in the follow-up email with the recording by the end of the week. That concludes our program. Thank you all for joining us, and have a great day.

Kelly George

Linda Lispowski-Jones

Wilderness Medical Society

emergency care

wilderness environments

Earth Day

trauma nursing

National Ski Patrol

Army nurse

wilderness medicine