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Debating Wilderness-Related Care


Editor's note: The letter was edited for space.

I recently read the article, “Venomous Snakebites” in the June 2014 issue of JEMS. As a practicing EMS professional, certified Wilderness EMT and instructor in wilderness medicine, I wish to share with you several concerns I have with this article.

Unfortunately, while I agree with the authors’ intent and goals in writing this article, they have only underscored already longstanding misconceptions about venomous snakebites.

One error is the authors’ misstatement that “at least one type of venomous snake can be found in every state except Alaska and Hawaii.” According to Maine’s Department of Inland Fisheries & Wildlife, there are no venomous snakes in Maine. So, if one can’t trust even this most basic factual reference, how can one trust the rest of the article?

Another concern of mine focuses on treatment where, among others, the authors assert that in the case of neurotoxic envenomation that a “pressure immobilization method” should be used. I would appreciate if the authors could cite a reference for this recommendation because, according to the Wilderness Medical Society, as I understand it, the research is still inconclusive of its benefits.

These points that I highlight are just a few of many concerns and errors that I see in this article, some of which can get one hurt.

Please understand that I am not normally one to express such criticism, but I hold JEMS in high regard and expect only the best from it. As such, I hope that JEMS will consider these concerns and, going forward, will work to ensure that articles about wilderness medicine matters get the same attention as any other, and be written by authors with real wilderness experience.
Erik Kulick, JD, NREMT, WEMT
Via email

Author Judy Torres, BFA, JD, NREMT-P, responds:
This article was prompted by an episode that actually happened in northern Ohio that has been deemed safe for many years. I researched the information for months and went over everything carefully. I don’t proclaim to be an expert, but I did interview an expert at the Kentucky reptile zoo and he gave me vital information. He confirmed what I had written, but didn’t read the actual article.

The statistics I used to bolster the information were repeated many times in books and legitimate internet sources by multiple authors and studies. I felt safe in using them. When we mentioned venomous snakes can be found in every state except Alaska and Hawaii, we are including snakes people own as pets.

For the pressure immobilization technique and other emergency care information, I referenced the Navy manual entitled Venomous Snakes of the World: A manual for use by U.S. amphibious forces. This is a source I, and others, should trust.

The doctor who read, edited and added to the article, Brian Daley, has written many articles and he was very specific in his revisions. I used an online encyclopedia in areas where it was apparent it was correct. I checked everything as well as I could.

Facebook:  Why are EMS professionals reluctant to talk to the media?
Because everyone is terrified of getting fired for saying something that gets construed as the company’s views. I would love to share my stories, but I’m paranoid that it would somehow get me in hot water. Kerri W.

Because we’re told not to talk to the media and to direct all questions to the PR rep who doesn’t do our job. Tanya L.

Because the media will screw up what they’ve been told and twist it to fit their own purpose. Media are a bunch of vultures preying on whatever gives them higher ratings than their competition! Jay W.

Here’s the deal. Individual providers probably shouldn’t be dealing with the media without guidance from their organization. That said, EMS needs to do a better job of stepping up, regarding the media.

Some folks have suggested the media doesn’t work for EMS’ interests—they work for their own. This isn’t entirely wrong, but neither is it right. Both media and EMS are trying to reach the public. The key is spinning the story in a way that works for you and the media.

In the end EMS benefits from increased positive exposure due to good media relations. Done right, you can do a lot with the media without violating any privacy rules. Robert B.

In the December 2013 article “STEMI Mimics: Five cases that look and sound like a STEMI, but may not be,” by Jeremy Brywczynski, MD; Jared McKinney, MD; Ashley Brown, MD and Corey Slovis, MD, the section on pericarditis contains an error regarding patient symptoms. The article states that patients with pericarditis will typically have worsening chest pain when leaning forward while the pain is relieved by lying down. In fact, although patients with pericarditis may have a worsening of their friction rub when they lean forward, their chest pain improves as they lean forward and will classically complain of worsening pain when lying down. The authors apologize for the error in wording.



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