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From: "Keith Conover, M.D., FACEP" <kconover+@pitt.edu>
To: rey_funez <eyekunstler@eee.org>,
        wilderness-emergency-medicine@list.pitt.edu
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On 28 Aug 98, at 13:43, rey_funez wrote:

> i was wondering what emOx is. i saw an ad but the phone was busy so i went
> to net and found you talking about it. please informe. -rEy
> 

emOx is/was a system to produce oxygen from two dry powders and 
some water.  It is a lot lighter than carrying oxygen cylinders, though 
we found some problems (the bottle tended to tip over, pouring a 
nontoxic but yecchy slurry into the patient's oxygen mask).  It 
originated in South Africa.  The company seems to have 
disappeared, I haven't heard anything from them in a while, and last 
I checked the Web site was gone.  Promising, but not quite usable 
for SAR, at least the evaluation unit I got.

--Keith Conover, M.D., FACEP
  http://www.pitt.edu/~kconover
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On 28 Aug 98, at 13:43, rey_funez wrote:

> i was wondering what emOx is. i saw an ad but the phone was busy so i went
> to net and found you talking about it. please informe. -rEy
> 

emOx is/was a system to produce oxygen from two dry powders and 
some water.  It is a lot lighter than carrying oxygen cylinders, though 
we found some problems (the bottle tended to tip over, pouring a 
nontoxic but yecchy slurry into the patient's oxygen mask).  It 
originated in South Africa.  The company seems to have 
disappeared, I haven't heard anything from them in a while, and last 
I checked the Web site was gone.  Promising, but not quite usable 
for SAR, at least the evaluation unit I got.


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i was wondering what emOx is. i saw an ad but the phone was busy so i went
to net and found you talking about it. please informe.
-rEy


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Date: Mon, 17 Aug 1998 17:13:41 -0400 (EDT)
From: Jonnathan Busko <jmbst85+@pitt.edu>
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Subject: Re: W-EMED WEMT- Disinfecting cloths?...
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Linda,

On Sat, 15 Aug 1998 Mkeowl@aol.com wrote:

> Boy, do YOU ever reply fast...

Nothing like a morning off to do that.

> 
> Actually, some of the particulars -- one of the gowning situations is MERSA
> (?) or an air-borne contagious agent where it is in the air or gets on things
> during a sneeze. Dunking my jumpsuit in Hperoxide after I degown is not
> practical 8 hours before my shift ends. 

Actually, as long as you aren't picking your nose after picking a
patient's nose, MRSA shouldn't be all that big a deal (actually, what this
really means is watch where you put your hands after airway management).
Airbornes will be pretty much killed with standard washing regimens;
again, if you have suspicions of a patient's status, watch where you put
your hands.  If you're gowned up and you don't get anything specific on
your jumpsuit, just do what we all should do but occasionally fail to do;
wash your hands before you eat, don't stick anything (pens, tripsheets,
etc.) in your mouth, and wash your uniforms and yourself after each shift.

> I'm refering to both viral, baterial, and ? that we encounter. I run my EMT
> shift with the local Vol. RS and cannot change after every nasty call. Don't
> panic if it is REALLY bad I will change. Scrubs would be easlier but, not
> practical for a local RS.

Yeah, scrubs would be nice.  I once ran at a squad where we wore scrub
shirts and BDU pants.  Boy, was that nice.

> What are the soaking times?

Actually, if I'm just generally worried about the ick to which I'm
exposed, I just wash my clothes with a standard detergent;  sometimes I'll
throw in a hospital laundry disinfectant pack if I'm washing a whole pile
of "patient ick" clothes.

If I get something specific on my uniform (blood and what-not), I take off
that uniform piece, and do a series of 5 minute H2O2 soaks alternating
with first cold water washes (to keep the protein in the blood from
denaturing and permanently staining the uniform) and then hot water rinses
until the ick is gone.  Longer than that and I think the material weakens
and then a bleaching effect occurs.

I also always carry a spare uniform with me.  I've had to shower and wash
uniforms midshift, and it helps if you're still on duty to have a spare
jumpsuit around.


Jonnathan

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From: "Jack T. Grandey" <grandey+@pitt.edu>
To: <wilderness-emergency-medicine@list.pitt.edu>
Subject: RE: W-EMED Status of WEMT courses given by WEMSI??
Date: Sun, 16 Aug 1998 08:52:22 -0400
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The only class that was in question is/was the Fall class sponsored by the
CEM.  That class has  been cancelled.  To the best of my knowledge, all
others are firm as planned.

JTG


Jack T. Grandey, NREMT-P
    Operations  Director
   Wilderness EMS Institute   
    http://www.wemsi.org
                



-----Original Message-----
From: owner-wilderness-emergency-medicine@list.pitt.edu
[mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of
nigel dyson-hudson
Sent: Saturday, August 15, 1998 21:52
To: wilderness-emergency-medicine@list.pitt.edu
Subject: W-EMED Status of WEMT courses given by WEMSI??


I just cruised over to the web site, http://www.wemsi.org/classes.html, and
found out that WEMT classes seem to be up in the air.

1. I am definately interested in October in PA or Spring in Lancaster.

2. I have put up a mail server and DNS for some other projects I am working
on so I can host a mailing list if someone needs to create a new one.

nigel dyson-hudson
nigel dyson-hudson
"mad dogs and Englishmen" and I am both!

MCNE & Internet Fundi
InternetSmiths, Inc.
10 Slators Ln
Newfield, NY 14867-9737
607-564-7983, FAX 607-564-7993
ndh@InternetSmiths.com

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I just cruised over to the web site, http://www.wemsi.org/classes.html, and
found out that WEMT classes seem to be up in the air.

1. I am definately interested in October in PA or Spring in Lancaster.

2. I have put up a mail server and DNS for some other projects I am working
on so I can host a mailing list if someone needs to create a new one.

nigel dyson-hudson
nigel dyson-hudson
"mad dogs and Englishmen" and I am both!

MCNE & Internet Fundi
InternetSmiths, Inc.
10 Slators Ln
Newfield, NY 14867-9737
607-564-7983, FAX 607-564-7993
ndh@InternetSmiths.com

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Boy, do YOU ever reply fast...

Actually, some of the particulars -- one of the gowning situations is MERSA
(?) or an air-borne contagious agent where it is in the air or gets on things
during a sneeze. Dunking my jumpsuit in Hperoxide after I degown is not
practical 8 hours before my shift ends. 

I'm refering to both viral, baterial, and ? that we encounter. I run my EMT
shift with the local Vol. RS and cannot change after every nasty call. Don't
panic if it is REALLY bad I will change. Scrubs would be easlier but, not
practical for a local RS.

What are the soaking times?

Thanks,

Linda in VA
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Date: Sat, 15 Aug 1998 10:54:36 -0400 (EDT)
From: Jonnathan Busko <jmbst85+@pitt.edu>
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Subject: Re: W-EMED WEMT- Disinfecting cloths?...
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I find that immediate application of hydrogen peroxide helps to get the
?>?<?>>>?!!? out fairly well without much bleaching.


Jonnathan

Jonnathan M. Busko, NREMT-P
MS III, University of Pittsburgh School Of Medicine.

-_---__----___-----____------_____-------______--------_______---------_______-
				Primum Non Nocere
-_______---------_______--------______-------_____------____-----___----__---_-


On Sat, 15 Aug 1998 Mkeowl@aol.com wrote:

> For those of us that get exposed to the ?>?<?>>>?!!? in EMT work (infectious
> agents that we gown for but, still have to wear our regular coveralls for the
> rest of the shift... or lots of body fluids...) what/how would you recommend I
> clean and disinfect my clothes without bleaching them white?
> 
> Thanks,
> 
> Linda R. Uihlein, SAR, EMT, WEMT in VA
> Do not reproduce without author's express permission.
> To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine"
> as the body of a message (no subject) To: Majordomo@list.pitt.edu
> Submissions To: wilderness-emergency-medicine@list.pitt.edu
> 

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For those of us that get exposed to the ?>?<?>>>?!!? in EMT work (infectious
agents that we gown for but, still have to wear our regular coveralls for the
rest of the shift... or lots of body fluids...) what/how would you recommend I
clean and disinfect my clothes without bleaching them white?

Thanks,

Linda R. Uihlein, SAR, EMT, WEMT in VA
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Date: Sat, 15 Aug 1998 09:37:15 +0000
To: wilderness-emergency-medicine@list.pitt.edu
From: The Tates <tates@tenforward.com>
Subject: Re: W-EMED WEMT- Disinfecting cloths?...
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We bought some stuff at the local cleaning supply place that works well
although there is probably better stuff now. Try them and see what they
have. BTW the application times depend on the bug you want to kill (HIV is
fast, HBV takes a little while.)

I will find out the name of the place if you need me to.

David Tate




At 11:15 AM 8/15/98 EDT, you wrote:
>Boy, do YOU ever reply fast...
>
>Actually, some of the particulars -- one of the gowning situations is MERSA
>(?) or an air-borne contagious agent where it is in the air or gets on things
>during a sneeze. Dunking my jumpsuit in Hperoxide after I degown is not
>practical 8 hours before my shift ends. 
>
>I'm refering to both viral, baterial, and ? that we encounter. I run my EMT
>shift with the local Vol. RS and cannot change after every nasty call. Don't
>panic if it is REALLY bad I will change. Scrubs would be easlier but, not
>practical for a local RS.
>
>What are the soaking times?
>
>Thanks,
>
>Linda in VA
>Do not reproduce without author's express permission.
>To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine"
>as the body of a message (no subject) To: Majordomo@list.pitt.edu
>Submissions To: wilderness-emergency-medicine@list.pitt.edu
>
>

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Date: Sat, 15 Aug 1998 01:29:50 -0400
To: wemsi-staff@list.pitt.edu
From: Bernie Roche <broche@titan.tcn.net>
Subject: W-EMED A Lovely Dog Needs a Good Home
Cc: wilderness-emergency-medicine@list.pitt.edu
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Hi, all:

A lady in Ohio has Multiple Sclerosis, and is unable to care for her
4-yr.-old short-haired Golden Retreiver.  The dog is purebred, has its
papers, has had all its shots, etc.  I'm told it's a very loving,
mild-mannered dog.

We are trying to find a loving owner for this dog.  Even better, it would
be nice if we could find a temporary home, so that she might have the dog
back if she should become able to care for it in the future.

If you would like to take this dog, on a temporary or permanent basis,
please e-mail me.  I can arrange for the dog to be at Old Timers Reunion on
the Labor Day weekend, for pickup, if this is convenient.  If not, the lady
lives in mid-Ohio, and arrangements can be worked out.




Best Wishes,

Bernie Roche, RN, BScN, W-EMT, OSJ
WEMSI Web Site Administrator

http://www.wemsi.org/
broche@tcn.net
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From: Sol Roter <roter@istar.ca>
To: "'wilderness-emergency-medicine@list.pitt.edu'"
	 <wilderness-emergency-medicine@list.pitt.edu>
Subject: RE: W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)
Date: Tue, 28 Jul 1998 17:47:39 -0400
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Please, no flame wars. Other lists have been seriously ruined by them.

Thanks

-----Original Message-----
From:	Deborah M Gessner [SMTP:pcrs242@Juno.com]
Sent:	Monday, July 27, 1998 12:32 AM
To:	wilderness-emergency-medicine@list.pitt.edu
Subject:	W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)


On Sat, 25 Jul 1998 14:02:21 -0400 Bernie Roche <broche@titan.tcn.net>
writes:
>At 07:26 AM 25/07/98 -0700, you wrote:
>
>>REPLY TO 07/24/98 21:01 FROM 
>wilderness-emergency-medicine@list.pitt.edu:
>>W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)
>
>>Please feel free to reproduce.
>
>>Best wishes,
>>Bob Norris
>
>
> $   (But remember to practice Safe Sex if you do.)...
>
><VERY BIG GRIN>
>
>
> 
>
>Best Wishes,
>
>Bernie Roche, RN, BScN, W-EMT, OSJ
>WEMSI Web Site Administrator
>
>http://www.wemsi.org/
>broche@tcn.net
>Do not reproduce without author's express permission.
>To unsubscribe, send the text "unsubscribe 
>wilderness-emergency-medicine"
>as the body of a message (no subject) To: Majordomo@list.pitt.edu
>Submissions To: wilderness-emergency-medicine@list.pitt.edu
>


The comment maked with the $ sign was uncalled for as a professsional
in the EMS field

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Date: Mon, 27 Jul 1998 20:17:07 -0700
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Subject: Re: W-EMED Re: Seeing through the fog?
References: <199807272221.QAA29502@preytor.ecentral.com> <19980727.155135.10622.24.ray_waugh@juno.com>
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Friends,
    Please forgive me as I did not get this original message, but I believe
that the originator of this strand was correct about this device.  Anyone
hear of a thermal imaging camera?  These can see through fog, smoke, and snow
and give a real image (albeit black and white).  The fire service uses these
when doing search in burning buildings.  The also use them getting to the
scene through heavy smoke and fog, though I'm not familiar with the
range/distance the device is capable of seeing.
    Check out some of the fire sevice journals.  Several manufacturers
advertise these devices there.
Hope this helps,
E. Scheiderer, EMT-P, RN
Mechanicsburg EMS

Raymond W Waugh wrote:

> RADAR does not really "see" through fog.  It sends out a radio frequency
> pulse and receives the reflections (generally from metal surfaces),
> recording the distance and bearing of the reflection.  Depending upon the
> frequency of operation, it may obtain reflections from rock or other
> non-metallic surfaces.  In any event, the typical RADAR display does not
> permit you to distinguish shape or "see" in the conventional
> understanding of the word.
>
> ------------------------------------
>           ray_waugh@juno.com
> ------------------------------------
>
> On Mon, 27 Jul 1998 16:21:54 -0600 "Howard M. Paul" <hmpaul@ecentral.com>
> writes:
> >I remember that it was developed during WWII. Believe it's called
> >RADAR.
> >
> >At 08:04 AM 7/27/98 -0400, you wrote:
> >>FAA question for you.  One of the staff from the Mt. Washington
> >>weather observatory in the White Mouontains of New Hampshire
> >>was giving a talk at the Wilderness Medical Society tonight.  He
> >>said that he thinks that the FAA has a device that can see through
> >>fog.
> >______________________________________
> >H o w a r d  M.  P a u l   <hmpaul@ecentral.com>
> >EMS Director, Alpine Rescue Team, Evergreen, Colo.
> >Public Affairs Mgr., Colorado SAR Board
> >ASTM Committee F32 on SAR
> >                        ______________
> >
> >"You can't teach people to rescue in the mountains
> >until they have learnt to climb...   ...It is a number of
> >small points which have little significance individually
> >that, considered together, spell danger to the
> >experienced rescuer."  -- Hamish MacInnes
> >
> >Do not reproduce without author's express permission.
> >To unsubscribe, send the text "unsubscribe
> >wilderness-emergency-medicine"
> >as the body of a message (no subject) To: Majordomo@list.pitt.edu
> >Submissions To: wilderness-emergency-medicine@list.pitt.edu
> >
>
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From: David Kovar <kovar@webnexus.com>
Message-Id: <199807272312.QAA13103@dalmatian.webnexus.com>
Subject: Re: W-EMED Re: Seeing through the fog?
To: wilderness-emergency-medicine@list.pitt.edu
Date: Mon, 27 Jul 1998 16:12:36 -0700 (PDT)
In-Reply-To: <199807272221.QAA29502@preytor.ecentral.COM> from "Howard M. Paul" at Jul 27, 98 04:21:54 pm
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Yea, radar will do it, but I also saw the beginnings of a special report
on some station last week that allowed the pilot to visually see through
fog. I presume it was something akin to a FLIR camera, but I didn't
catch the details. The film clip they showed looked like a normal
cockpit view, only slightly degraded by fog.

Wish I'd caught the full report.

-David

> 
> I remember that it was developed during WWII. Believe it's called RADAR.
> 
> At 08:04 AM 7/27/98 -0400, you wrote:
> >FAA question for you.  One of the staff from the Mt. Washington 
> >weather observatory in the White Mouontains of New Hampshire 
> >was giving a talk at the Wilderness Medical Society tonight.  He 
> >said that he thinks that the FAA has a device that can see through 
> >fog. 
> ______________________________________
> H o w a r d  M.  P a u l   <hmpaul@ecentral.com>
> EMS Director, Alpine Rescue Team, Evergreen, Colo.
> Public Affairs Mgr., Colorado SAR Board
> ASTM Committee F32 on SAR
>                         ______________
> 
> "You can't teach people to rescue in the mountains
> until they have learnt to climb...   ...It is a number of 
> small points which have little significance individually 
> that, considered together, spell danger to the 
> experienced rescuer."  -- Hamish MacInnes
> 
> Do not reproduce without author's express permission.
> To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine"
> as the body of a message (no subject) To: Majordomo@list.pitt.edu
> Submissions To: wilderness-emergency-medicine@list.pitt.edu
> 

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Date: Mon, 27 Jul 1998 15:51:35 -0700
Subject: W-EMED Re: Seeing through the fog?
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RADAR does not really "see" through fog.  It sends out a radio frequency
pulse and receives the reflections (generally from metal surfaces),
recording the distance and bearing of the reflection.  Depending upon the
frequency of operation, it may obtain reflections from rock or other
non-metallic surfaces.  In any event, the typical RADAR display does not
permit you to distinguish shape or "see" in the conventional
understanding of the word.

------------------------------------
          ray_waugh@juno.com
------------------------------------

On Mon, 27 Jul 1998 16:21:54 -0600 "Howard M. Paul" <hmpaul@ecentral.com>
writes:
>I remember that it was developed during WWII. Believe it's called 
>RADAR.
>
>At 08:04 AM 7/27/98 -0400, you wrote:
>>FAA question for you.  One of the staff from the Mt. Washington 
>>weather observatory in the White Mouontains of New Hampshire 
>>was giving a talk at the Wilderness Medical Society tonight.  He 
>>said that he thinks that the FAA has a device that can see through 
>>fog. 
>______________________________________
>H o w a r d  M.  P a u l   <hmpaul@ecentral.com>
>EMS Director, Alpine Rescue Team, Evergreen, Colo.
>Public Affairs Mgr., Colorado SAR Board
>ASTM Committee F32 on SAR
>                        ______________
>
>"You can't teach people to rescue in the mountains
>until they have learnt to climb...   ...It is a number of 
>small points which have little significance individually 
>that, considered together, spell danger to the 
>experienced rescuer."  -- Hamish MacInnes
>
>Do not reproduce without author's express permission.
>To unsubscribe, send the text "unsubscribe 
>wilderness-emergency-medicine"
>as the body of a message (no subject) To: Majordomo@list.pitt.edu
>Submissions To: wilderness-emergency-medicine@list.pitt.edu
>

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I remember that it was developed during WWII. Believe it's called RADAR.

At 08:04 AM 7/27/98 -0400, you wrote:
>FAA question for you.  One of the staff from the Mt. Washington 
>weather observatory in the White Mouontains of New Hampshire 
>was giving a talk at the Wilderness Medical Society tonight.  He 
>said that he thinks that the FAA has a device that can see through 
>fog. 
______________________________________
H o w a r d  M.  P a u l   <hmpaul@ecentral.com>
EMS Director, Alpine Rescue Team, Evergreen, Colo.
Public Affairs Mgr., Colorado SAR Board
ASTM Committee F32 on SAR
                        ______________

"You can't teach people to rescue in the mountains
until they have learnt to climb...   ...It is a number of 
small points which have little significance individually 
that, considered together, spell danger to the 
experienced rescuer."  -- Hamish MacInnes

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Subject: W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)
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On Sat, 25 Jul 1998 14:02:21 -0400 Bernie Roche <broche@titan.tcn.net>
writes:
>At 07:26 AM 25/07/98 -0700, you wrote:
>
>>REPLY TO 07/24/98 21:01 FROM 
>wilderness-emergency-medicine@list.pitt.edu:
>>W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)
>
>>Please feel free to reproduce.
>
>>Best wishes,
>>Bob Norris
>
>
> $   (But remember to practice Safe Sex if you do.)...
>
><VERY BIG GRIN>
>
>
> 
>
>Best Wishes,
>
>Bernie Roche, RN, BScN, W-EMT, OSJ
>WEMSI Web Site Administrator
>
>http://www.wemsi.org/
>broche@tcn.net
>Do not reproduce without author's express permission.
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>wilderness-emergency-medicine"
>as the body of a message (no subject) To: Majordomo@list.pitt.edu
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>


The comment maked with the $ sign was uncalled for as a professsional
in the EMS field

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With regard to the use of cold on snake bites... Iwas once told that the anti-
venin dosage was in some way based on the amount of swelling and therefore
using a cold compress would interfere with this. Any truth to this? 

Jonathan Silver, WEMT

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At 07:26 AM 25/07/98 -0700, you wrote:

>REPLY TO 07/24/98 21:01 FROM wilderness-emergency-medicine@list.pitt.edu:
>W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)

>Please feel free to reproduce.

>Best wishes,
>Bob Norris


But remember to practice Safe Sex if you do....

<VERY BIG GRIN>


 

Best Wishes,

Bernie Roche, RN, BScN, W-EMT, OSJ
WEMSI Web Site Administrator

http://www.wemsi.org/
broche@tcn.net
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Date:     Sat, 25 Jul 98 07:26:25 PDT
From: "Robert Norris"   <Bob.Norris@Forsythe.Stanford.EDU>
To: wilderness-emergency-medicine@list.pitt.edu
Subject:  Re: W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)
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REPLY TO 07/24/98 21:01 FROM wilderness-emergency-medicine@list.pitt.edu:
W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)

Please feel free to reproduce.

Best wishes,
Bob Norris

To:  wilderness-emergency-medicine@list.pitt.edu
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To: wilderness-emergency-medicine@list.pitt.edu
Cc: Bob.Norris@Forsythe.Stanford.EDU
Date: Fri, 24 Jul 1998 23:54:28 -0400
Subject: W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)
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From: pcrs242@Juno.com (Deborah M Gessner)
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I would like permission to reproduce this that Robert(BOB)Norris wrote
about snake bites for my SAR classes we have to much argument over snake
bites and what to do.
Thank You
Deborah M. Gessner   242
Pulaski County Life Saving Crew
Dublin  Va.



On Mon, 20 Jul 98 13:04:21 PDT "Robert Norris"  
<Bob.Norris@Forsythe.Stanford.EDU> writes:
>REPLY TO 07/17/98 09:33 FROM 
>wilderness-emergency-medicine@list.pitt.edu: Re:
>W-EMED Snake-Bite (Was: Communications Info)
>
>re: the use of ice in pit viper venom poisoning:
>
>There's really two separate issues here:
>1. the use of ice in the form of "cryotherapy" - packing the
>extremity in ice for hours to days to somehow allow the body to
>deactivate the venom in situ
>   - this was practiced in the 50's and 60's and clearly resulted in
>worsened outcomes (more tissue loss/amputations)
>   - it is now clearly condemned by anyone knowledgable in the
>management of these bites
>
>2. the use of ice for "first aid" (local ice pack)
>   - the recommendations here are less rooted in fact/experience
>   - Dr. Jacob Dubnoff did some preliminary, unpublished work using
>radio labelled venom components, and found that they were driven
>deeper into the tissues when the bitten part was cooled (cited by
>Findlay Russell in his text "Snake Venom Poisoning") - obviously
>this needs further work...
>
>The exact time when POSSIBLE beneficial effects from local
>cooling (decreased pain, maybe slight decreased enzymatic function)
>gives way to DEFINITE deleterious effects (decreased local blood
>flow, increased tissue damage) occurs is unknown and that is why
>most authorities recommend avoiding any cooling measures.
>
>Best wishes,
>Bob Norris, MD
>Emergency Medicine
>Stanford University
>
>
>
>
>To:  wilderness-emergency-medicine@list.pitt.edu
>cc:  VENOM(VENOM-L@ICOMM.CA)
>Do not reproduce without author's express permission.
>To unsubscribe, send the text "unsubscribe 
>wilderness-emergency-medicine"
>as the body of a message (no subject) To: Majordomo@list.pitt.edu
>Submissions To: wilderness-emergency-medicine@list.pitt.edu
>

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Date:     Mon, 20 Jul 98 13:04:21 PDT
From: "Robert Norris"   <Bob.Norris@Forsythe.Stanford.EDU>
To: venom-l@icomm.ca, wilderness-emergency-medicine@list.pitt.edu
Subject:  Re: W-EMED Snake-Bite (Was: Communications Info)
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REPLY TO 07/17/98 09:33 FROM wilderness-emergency-medicine@list.pitt.edu: Re:
W-EMED Snake-Bite (Was: Communications Info)

re: the use of ice in pit viper venom poisoning:

There's really two separate issues here:
1. the use of ice in the form of "cryotherapy" - packing the
extremity in ice for hours to days to somehow allow the body to
deactivate the venom in situ
   - this was practiced in the 50's and 60's and clearly resulted in
worsened outcomes (more tissue loss/amputations)
   - it is now clearly condemned by anyone knowledgable in the
management of these bites

2. the use of ice for "first aid" (local ice pack)
   - the recommendations here are less rooted in fact/experience
   - Dr. Jacob Dubnoff did some preliminary, unpublished work using
radio labelled venom components, and found that they were driven
deeper into the tissues when the bitten part was cooled (cited by
Findlay Russell in his text "Snake Venom Poisoning") - obviously
this needs further work...

The exact time when POSSIBLE beneficial effects from local
cooling (decreased pain, maybe slight decreased enzymatic function)
gives way to DEFINITE deleterious effects (decreased local blood
flow, increased tissue damage) occurs is unknown and that is why
most authorities recommend avoiding any cooling measures.

Best wishes,
Bob Norris, MD
Emergency Medicine
Stanford University




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From: "Christopher Magro" <cjm@walrus.com>
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Subject: W-EMED ice + snakebiteeeee
Date: Mon, 20 Jul 1998 11:43:31 -0400
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It is important to note the reason why treatment with ice is strongly =
condemed:
the venom of some snakes(ie. the pit viper for one) is designed to not =
only immobilize and kill the prey but also to digest it (see Mosby's =
Paramedic Textbook).  Therefore, because the tissue is being digested =
and killed the application of ice may further tissue damage and could =
easily cause frostbite.

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<DIV><FONT size=3D2>It is important to note the reason why treatment =
with ice is=20
strongly condemed:</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>the venom of some snakes(ie. the pit =
viper for=20
one) is designed to not only immobilize and kill the prey but also to =
<EM>digest=20
</EM>it (see Mosby's Paramedic Textbook).&nbsp; Therefore, because the =
tissue is=20
being digested and killed the application of ice may further tissue =
damage and=20
could easily cause frostbite.</FONT></DIV></BODY></HTML>

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Subject: RE: W-EMED Re: Backboards -- the ATLS 2-hour rule
Date: Mon, 20 Jul 98 11:08:27 -0000
x-mailer: Claris Emailer 1.1
From: Ropes That Rescue <ropes@sedona.net>
To: "SteveK" <stevek@spectralogic.com>,
        "\"'wilderness-emergency-medicine@list.pitt.edu'\"	" <wilderness-emergency-medicine@list.pitt.edu>,
        <kconover+@pitt.edu>, <EMS-L@listserv.ACNS.NWU.EDU>
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Dear Steve,

I read with interest, you comments on the full body vacuum splint being 
used in the metal stokes litter. 

We have been doing a number of power utility courses where the partially 
or totally hanging trauma patient is packaged high off the ground by 
using just such a means on transmission lines.  There (and in similar 
vertical environments), we have used a "litter scoop" technique in 
conjunction with the full body Hartwell "evac-u-splint" secured in the 
stokes type litter. The lifting effort can be supplied by the 
rescuer/attendant or, more preferably, by the team on the ground. The 
litter is first positioned at the angle that the patient is found hanging 
depending on where their FAS is attached to the harness. 
By coming from below the patient with this combined retrieval adjunct, we 
are able to gently scoop while gently raising as well. The air is 
vacuumed out either up on the tower (either end has an orifice for this 
purpose) or once the patient reaches the ground. 
What is interesting is that this technique outperforms other techniques 
we have used in the air when dropping to the ground is not possible. This 
"rescuer-based" and "team-based" litter scoop with vacuum splint is only 
a tool which needs constant practice. Anyway, thought you might like some 
input. Nothing too deep here.

All the best,

Reed Thorne
Ropes That Rescue Ltd.
eMail: ropes@sedona.net

Web Site:  www.sedona.net/ropes
" T h e  A R T  o f   C l e a n  R i g g i n g "

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From: "Jack T. Grandey" <grandey+@pitt.edu>
To: "WEM" <wilderness-emergency-medicine@list.pitt.edu>
Subject: RE: W-EMED NJ con-ed credit for WEMT
Date: Sun, 19 Jul 1998 11:22:50 -0400
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Thanks for the information, and as I said, I'm happy to work with NJ or any
other state for con-ed credits.  I believe the first issue, though (for the
list) is to find out whether there is sufficient demand to make it worth the
trouble.

If there are enough NJ EMTs and medics that would like the course taught in
NJ, or would like credit for the course, taken elsewhere, we'll pursue it.

Please let me know, directly, not to the list.

JTG
Jack T. Grandey, NREMT-P
     Operations Director
 Wilderness EMS Institute
   http://www.wemsi.org/

> -----Original Message-----
> From: JSilver374@aol.com [mailto:JSilver374@aol.com]
> Sent: Saturday, July 18, 1998 10:52
> To: Jack T. Grandey
> Subject: Re: W-EMED PA con-ed credit for WEMT
>
>
> In a message dated 07/18/1998 09:21:15 AM Eastern Daylight Time,
> grandey+@pitt.edu writes:
>
> > I'd certainly be happy to submit it, if someone can let me know the
> >  necessary process.
> >
> >  JTG
> >
> >  > -----Original Message-----
> >  > Any thought to getting New Jersey OEMS to recognize WEMSI's WEMT
> >  > course? They
> >  > already grant CEUs for SOLO's course. Shouldn't be too hard
> to get 'em on
> >  > board.
> >  >
> >  > Jonathan Silver, WEMT
> >  > Highland Park, NJ
> >
>
> You will need to submit a course curriculum, written exams,
> copies of handouts
> and any visual aids to plus the usual forms. As I recall you also need to
> submit your instructor credentials.
> Contact:
>
> New Jersey Department of Health and Senior Services
> Office of Emergency Medical Services
> PO Box 360
> 50 East State Street
> Trenton, NJ 08625-0360
> Phone: 609-633-7777
> Fax: 609-633-7954
> EMS Education Coordinator: Robert Dinetz
>
> It's not so much for the CEU's that this would be helpful. Most
> local squads
> pick up at least part of the cost for CEU courses.
>
> Thanks,
> Jonathan Silver
>

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From: "Jack T. Grandey" <grandey+@pitt.edu>
To: <wilderness-emergency-medicine@list.pitt.edu>
Subject: RE: W-EMED PA con-ed credit for WEMT
Date: Sat, 18 Jul 1998 09:18:36 -0400
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I'd certainly be happy to submit it, if someone can let me know the
necessary process.

JTG

> -----Original Message-----
> Any thought to getting New Jersey OEMS to recognize WEMSI's WEMT
> course? They
> already grant CEUs for SOLO's course. Shouldn't be too hard to get 'em on
> board.
>
> Jonathan Silver, WEMT
> Highland Park, NJ

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In a message dated 07/16/1998 07:34:59 PM Eastern Daylight Time,
grandey+@pitt.edu writes:

> I am pleased to announce that the PA Dept of Health has granted continuing
>  education credit for WEMSI's WEMT program as follows:
(snip, snip)

Any thought to getting New Jersey OEMS to recognize WEMSI's WEMT course? They
already grant CEUs for SOLO's course. Shouldn't be too hard to get 'em on
board.

Jonathan Silver, WEMT
Highland Park, NJ
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Subject: Re: W-EMED Snake-Bite (Was: Communications Info)
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Every source I've seen says this is a BAD idea.  What is the controversy on your
other listserv?

Seth Collings Hawkins
Carolina Wilderness Medicine
UNC-Chapel Hill School of Medicine

On Fri, 17 Jul 1998 09:34:13 EDT RivrChik@aol.com wrote:

>Would those of you who are responding to this query regarding snakebites
>please address the use of ice on the affected extremity, it seems to be a
>controversial issue with another listserver I am currently involved in.
>Do not reproduce without author's express permission.
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From: "Jack T. Grandey" <grandey+@pitt.edu>
To: <wilderness-emergency-medicine@list.pitt.edu>
Subject: RE: W-EMED PA con-ed credit for WEMT
Date: Fri, 17 Jul 1998 13:16:47 -0400
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Yup.  dat's de way de system works, now.  I'd put the hourse in & suggest to
those who feel they;re not getting their due, to lobby through their EMS
council.

JTG
    -----Original Message-----
    From: owner-wilderness-emergency-medicine@list.pitt.edu
[mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of Bob
Cooney
    Sent: Thursday, July 16, 1998 21:06
    To: wilderness-emergency-medicine@list.pitt.edu
    Subject: RE: W-EMED PA con-ed credit for WEMT


    Jack,

    The amount of credit is substantial, however ALS providers need 18/
year, EMTs 24/3 years and First Responders 16/3years.  You may have
individuals who feel they do not get all the credit since they cannot spread
the hours over two periods of certification;

    Bob Cooney
        -----Original Message-----
        From: owner-wilderness-emergency-medicine@list.pitt.edu
[mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of Jack
T. Grandey
        Sent: Thursday, July 16, 1998 7:34 PM
        To: WEM
        Cc: WEMSI
        Subject: W-EMED PA con-ed credit for WEMT


        I am pleased to announce that the PA Dept of Health has granted
continuing education credit for WEMSI's WEMT program as follows:

        First Responder:        30.0  hr.s
        EMT :                       50.0  hr.s
        Medic/PHRN:           51.5  hr.s

        This applies to all programs taught using the WEMSI curriculum, and
conducted in accord with the policies and procedures specified in the EMS
Continuing Education Manual.

        JTG

        Jack T. Grandey, NREMT-P
        Institute for Quality & Medical Management
Operations Director
                 UPMC Health System
Wilderness EMS Institute
                 http://www.upmc.edu/
http://www.wemsi.org/


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<DIV><SPAN class=3D950031217-17071998><FONT color=3D#0000ff =
face=3D"Times New Roman"=20
size=3D3>Yup.&nbsp; dat's de way de system works, now.&nbsp; I'd put the =
hourse in=20
&amp; suggest to those who feel they;re not getting their due, to lobby =
through=20
their EMS council.</FONT></SPAN></DIV>
<DIV><SPAN class=3D950031217-17071998><FONT color=3D#0000ff =
face=3D"Times New Roman"=20
size=3D3></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D950031217-17071998><FONT color=3D#0000ff =
face=3D"Times New Roman"=20
size=3D3>JTG</FONT></SPAN></DIV>
<BLOCKQUOTE=20
style=3D"BORDER-LEFT: #0000ff solid 2px; MARGIN-LEFT: 5px; PADDING-LEFT: =
5px">
    <DIV class=3DOutlookMessageHeader><FONT face=3D"Times New Roman"=20
    size=3D2>-----Original Message-----<BR><B>From:</B>=20
    owner-wilderness-emergency-medicine@list.pitt.edu=20
    [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]<B>On =
Behalf=20
    Of</B> Bob Cooney<BR><B>Sent:</B> Thursday, July 16, 1998 21:06=20
    <BR><B>To:</B>=20
    wilderness-emergency-medicine@list.pitt.edu<BR><B>Subject:</B> RE: =
W-EMED PA=20
    con-ed credit for WEMT<BR><BR></FONT></DIV>
    <DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
    size=3D3>Jack,</FONT></SPAN></DIV>
    <DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
    size=3D3></FONT></SPAN>&nbsp;</DIV>
    <DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
    size=3D3>The amount of credit is substantial, however ALS providers =
need 18/=20
    year, EMTs 24/3 years and First Responders 16/3years.&nbsp; You may =
have=20
    individuals who feel they do not get all the credit since they =
cannot spread=20
    the hours over two periods of certification;</FONT></SPAN></DIV>
    <DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
    size=3D3></FONT></SPAN>&nbsp;</DIV>
    <DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
    size=3D3>Bob Cooney</FONT></SPAN></DIV>
    <BLOCKQUOTE=20
    style=3D"BORDER-LEFT: #0000ff solid 2px; MARGIN-LEFT: 5px; =
PADDING-LEFT: 5px">
        <DIV class=3DOutlookMessageHeader><FONT face=3D"Times New Roman" =

        size=3D2>-----Original Message-----<BR><B>From:</B>=20
        owner-wilderness-emergency-medicine@list.pitt.edu=20
        [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]<B>On =
Behalf=20
        Of</B> Jack T. Grandey<BR><B>Sent:</B> Thursday, July 16, 1998 =
7:34=20
        PM<BR><B>To:</B> WEM<BR><B>Cc:</B> WEMSI<BR><B>Subject:</B> =
W-EMED PA=20
        con-ed credit for WEMT<BR><BR></FONT></DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3>I am pleased to announce that =
the PA Dept=20
        of Health has granted continuing education credit for WEMSI's =
WEMT=20
        program as follows:</FONT></SPAN></DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3></FONT></SPAN>&nbsp;</DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3>First=20
        Responder:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 30.0&nbsp;=20
        hr.s</FONT></SPAN></DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3></FONT></SPAN><SPAN=20
        class=3D300421923-16071998><FONT color=3D#000000 face=3D"Times =
New Roman"=20
        size=3D3>EMT=20
        =
:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=20
        50.0&nbsp; hr.s</FONT></SPAN></DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3></FONT></SPAN><SPAN=20
        class=3D300421923-16071998><FONT color=3D#000000 face=3D"Times =
New Roman"=20
        =
size=3D3>Medic/PHRN:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;=20
        51.5&nbsp; hr.s</FONT></SPAN></DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3></FONT></SPAN>&nbsp;</DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3>This applies to all programs =
taught using=20
        the WEMSI curriculum, and conducted in accord with the policies =
and=20
        procedures specified in the EMS Continuing Education=20
        Manual.</FONT></SPAN></DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3></FONT></SPAN>&nbsp;</DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3>JTG</FONT></SPAN></DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3></FONT></SPAN><FONT =
color=3D#000000=20
        face=3DArial size=3D2></FONT>&nbsp;</DIV>
        <DIV><FONT color=3D#000000 face=3DArial size=3D2>Jack T. =
Grandey,=20
        NREMT-P</FONT> <BR><FONT color=3D#000000 face=3DArial =
size=3D2>Institute for=20
        Quality &amp; Medical=20
        =
Management&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;=20
        Operations Director</FONT> <BR><FONT color=3D#000000 =
face=3DArial=20
        size=3D2>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; UPMC =
Health=20
        =
System&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n=
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=20
        Wilderness EMS Institute</FONT> <BR><FONT color=3D#000000 =
face=3DArial=20
        size=3D2>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <A=20
        href=3D"http://www.upmc.edu/"=20
        =
target=3D_blank>http://www.upmc.edu/</A>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;=20
        <A href=3D"http://www.wemsi.org/"=20
        target=3D_blank>http://www.wemsi.org/</A></FONT> </DIV>
        <DIV>&nbsp;</DIV></BLOCKQUOTE></BLOCKQUOTE></BODY></HTML>

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Would those of you who are responding to this query regarding snakebites
please address the use of ice on the affected extremity, it seems to be a
controversial issue with another listserver I am currently involved in.   
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To: wilderness-emergency-medicine@list.pitt.edu
Subject: Re: W-EMED Snake-Bite (Was: Communications Info) 
In-reply-to: Your message of "Fri, 17 Jul 1998 09:34:13 EDT."
             <1346279b.35af52d6@aol.com> 
Date: Fri, 17 Jul 1998 09:28:10 PDT
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>Would those of you who are responding to this query regarding
>snakebites please address the use of ice on the affected extremity,
>it seems to be a controversial issue with another listserver I am
>currently involved in.  

*Don't* Do it!!!

I know of no good reference to support that treatment and several
which *strongly* condemn it (eg. _Medicine for Mountaineering_,
Forgey's _Wilderness Medicine_.)  I've never heard a physician
recommend it, all I am aware of strongly recommend against it.

Get a good reference, such as the above, and post information from
that.  If the guys suggesting ice still won't believe you ask them
to provide a medically acceptable reference for their position.

One thing I've not yet seen recommended on this thread is the Sawyer
extractor.  At least on crotalid bites this has been shown effective
if used within the first few minutes of the bite, before the venom
has a change to disperse.

The other missing element in this discussion is *prevention*.  As
far as I'm concerned there is no good excuse for a rescuer to get
bitten by a venomous snake.  Learn the habits of snakes in your
area, let them know you are comming, don't reach into places where
they hide etc.  Our knowledge of treating snake bite should be
reserved for the subjects we help, we should never need it for
ourselves.

The rec.backcountry newsgroup has what I think is a pretty good FAQ
on this.  (I'm not prejudiced at all of course, just because I was
the original author.)  You might check that out.
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From: "Rob Thomas" <ROBERT@medinfo.iplan.co.za>
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Date:          Fri, 17 Jul 1998 08:22:34 GMT+2
Subject:       Re:W-EMED Snake-Bite (Was: Communications Info)
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Greetings all,

In reply to "David C. Kovar" <kovar@webnexus.com> I would like to add
what I have been recently taught regarding Southern African snakes. 

>WMA's Wilderness First Responder Course teaches:
>
>1) Antivenin - A specific treatment, limited to a hospital setting as it
>can cause allergic reaction in rare cases. Most effective during first four
>hours.

SA: Polyvalent Antivenin effective for most Cytotoxic snakes (primarily 
adders) and Neurotoxic snakes (primarily mambas & cobras). Monovalent 
antivenin for Boomslang (Tree-snake - Haemotoxic). No antivenin available 
for twig or vine snake. For Black Mamba bite up to 8 ampoules may be 
administered immediately within the hospital setting. 

>2) Transport - To the hospital, for antivenin. Walking the patient out is
>reasonably safe unless severe systemic signs and symptoms occur. The
>thought being that this will be significantly faster than a carryout. Split
>the affected part if possible.

If this is a neurotoxic snake bite, prepare for possible CPR. People have 
been known to arrest in relatively short periods after a Mamba or Cape 
Cobra bite. Even a Forest Cobra or Egyptian Cobra can have a fast effect 
on a susceptible person (child, elderly, infirm). 

>3) Expect swelling - Remove constricting items.
>
>The underlying belief is that you cannot field treat a venomous snakebite.
>Non-venomous snakebite should be treated as a puncture wound.

>Medicine for Mountaineering suggests wrapping the bitten extremity 
>snugly,
>splinting it and keeping it at the level of the heart. The victim should be
>transported as quickly as possible with as little effort on their part. The
>underlying belief is that this immobilizes the venom at the site. They
>caution that wrapping should not be undertaken unless you are certain that
>the envenomation is known to be moderate or severe - inflicted by large
>snake, pain and swelling appear at once - AND a hospital is many hours or
>days away.

In the South African setting, a fair number of the snake-bites are 
neurotoxic. There is relatively little immediate pain, redness or 
swelling. The first SSS tend to be affection of the cranial and 
respiratory nervous system. For haemotoxic bite, the first SSS can take up 
to 48 hours. In this case there is bruising in the joints and over the 
kidneys and liver. Prepare to administer LOTS of blood (in hospital).

The current orthodox treatment calls for the distal-to-proximal 
bandaging of the affected limb at approx 50mm/hg constriction with a pad 
over the bite. I would recommend this only for neurotoxic and haemotoxic 
snakes. Applied in Cytotoxic snakes this tends to lead to severe localised 
damage. If you like I can provide the exact text from the South African 
Institute for Medical Research's document on snake-bite treatment 
published 1996.

>In short, get them to a hospital as quickly as possible. I'd trade off
>immobility for speed, following WMA's instruction.

Ditto, while still taking cognisance of the differing possible scenarios. 

The problem with getting this to hospital (in this country) is that 
occasionally the medical personnel at the hospital need to be instructed 
in the correct treatment of snake-bite. I have an anecdotal story of a 
handler bitten on the left hand at the ?Nelspruit? snake park and the 
doctors at the hospital wanted to amputate the arm as a preventative 
measure. Apparently they didn't take the refusal of consent too well. Two 
months later the handler had regained full use of his hand. I believe this 
happened during the last 18 months - it was told to me during a course on 
snake identification and snake-bite treatment by the curator of said snake-
park. 

Just my 2c worth, which in South African rands, is bugger all.

Regards

Rob



Rob Thomas

(robert@medinfo.iplan.co.za)

Phone : 450-2957 (Work), Pretoria (012), South Africa (+27)
Cell:   082-652-2540

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From: "Bob Cooney" <Bobcems@epix.net>
To: <wilderness-emergency-medicine@list.pitt.edu>
Subject: RE: W-EMED PA con-ed credit for WEMT
Date: Thu, 16 Jul 1998 21:06:19 -0400
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Jack,

The amount of credit is substantial, however ALS providers need 18/ year,
EMTs 24/3 years and First Responders 16/3years.  You may have individuals
who feel they do not get all the credit since they cannot spread the hours
over two periods of certification;

Bob Cooney
    -----Original Message-----
    From: owner-wilderness-emergency-medicine@list.pitt.edu
[mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of Jack
T. Grandey
    Sent: Thursday, July 16, 1998 7:34 PM
    To: WEM
    Cc: WEMSI
    Subject: W-EMED PA con-ed credit for WEMT


    I am pleased to announce that the PA Dept of Health has granted
continuing education credit for WEMSI's WEMT program as follows:

    First Responder:        30.0  hr.s
    EMT :                       50.0  hr.s
    Medic/PHRN:           51.5  hr.s

    This applies to all programs taught using the WEMSI curriculum, and
conducted in accord with the policies and procedures specified in the EMS
Continuing Education Manual.

    JTG

    Jack T. Grandey, NREMT-P
    Institute for Quality & Medical Management
Operations Director
             UPMC Health System
Wilderness EMS Institute
             http://www.upmc.edu/
http://www.wemsi.org/


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http-equiv=3DContent-Type>
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</HEAD>
<BODY bgColor=3D#ffffff>
<DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
size=3D3>Jack,</FONT></SPAN></DIV>
<DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
size=3D3></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
size=3D3>The amount of credit is substantial, however ALS providers need =
18/ year,=20
EMTs 24/3 years and First Responders 16/3years.&nbsp; You may have =
individuals=20
who feel they do not get all the credit since they cannot spread the =
hours over=20
two periods of certification;</FONT></SPAN></DIV>
<DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
size=3D3></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
size=3D3>Bob Cooney</FONT></SPAN></DIV>
<BLOCKQUOTE=20
style=3D"BORDER-LEFT: #0000ff solid 2px; MARGIN-LEFT: 5px; PADDING-LEFT: =
5px">
    <DIV class=3DOutlookMessageHeader><FONT face=3D"Times New Roman"=20
    size=3D2>-----Original Message-----<BR><B>From:</B>=20
    owner-wilderness-emergency-medicine@list.pitt.edu=20
    [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]<B>On =
Behalf=20
    Of</B> Jack T. Grandey<BR><B>Sent:</B> Thursday, July 16, 1998 7:34=20
    PM<BR><B>To:</B> WEM<BR><B>Cc:</B> WEMSI<BR><B>Subject:</B> W-EMED =
PA con-ed=20
    credit for WEMT<BR><BR></FONT></DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3>I am pleased to announce that the =
PA Dept of=20
    Health has granted continuing education credit for WEMSI's WEMT =
program as=20
    follows:</FONT></SPAN></DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3></FONT></SPAN>&nbsp;</DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3>First=20
    Responder:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 30.0&nbsp;=20
    hr.s</FONT></SPAN></DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3></FONT></SPAN><SPAN=20
    class=3D300421923-16071998><FONT color=3D#000000 face=3D"Times New =
Roman"=20
    size=3D3>EMT=20
    =
:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=20
    50.0&nbsp; hr.s</FONT></SPAN></DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3></FONT></SPAN><SPAN=20
    class=3D300421923-16071998><FONT color=3D#000000 face=3D"Times New =
Roman"=20
    =
size=3D3>Medic/PHRN:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;=20
    51.5&nbsp; hr.s</FONT></SPAN></DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3></FONT></SPAN>&nbsp;</DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3>This applies to all programs =
taught using the=20
    WEMSI curriculum, and conducted in accord with the policies and =
procedures=20
    specified in the EMS Continuing Education =
Manual.</FONT></SPAN></DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3></FONT></SPAN>&nbsp;</DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3>JTG</FONT></SPAN></DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3></FONT></SPAN><FONT =
color=3D#000000 face=3DArial=20
    size=3D2></FONT>&nbsp;</DIV>
    <DIV><FONT color=3D#000000 face=3DArial size=3D2>Jack T. Grandey, =
NREMT-P</FONT>=20
    <BR><FONT color=3D#000000 face=3DArial size=3D2>Institute for =
Quality &amp;=20
    Medical=20
    =
Management&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;=20
    Operations Director</FONT> <BR><FONT color=3D#000000 face=3DArial=20
    size=3D2>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; UPMC =
Health=20
    =
System&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n=
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=20
    Wilderness EMS Institute</FONT> <BR><FONT color=3D#000000 =
face=3DArial=20
    size=3D2>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <A=20
    href=3D"http://www.upmc.edu/"=20
    =
target=3D_blank>http://www.upmc.edu/</A>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;=20
    <A href=3D"http://www.wemsi.org/"=20
    target=3D_blank>http://www.wemsi.org/</A></FONT> </DIV>
    <DIV>&nbsp;</DIV></BLOCKQUOTE></BODY></HTML>

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From: "Jack T. Grandey" <grandey+@pitt.edu>
To: "WEM" <wilderness-emergency-medicine@list.pitt.edu>
Cc: "WEMSI" <wemsi-staff@list.pitt.edu>
Subject: W-EMED PA con-ed credit for WEMT
Date: Thu, 16 Jul 1998 19:33:46 -0400
Message-ID: <000501bdb112$2dbc8860$75169380@pmp4em34.mckee.upmc.edu>
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I am pleased to announce that the PA Dept of Health has granted continuing
education credit for WEMSI's WEMT program as follows:

First Responder:        30.0  hr.s
EMT :                       50.0  hr.s
Medic/PHRN:           51.5  hr.s

This applies to all programs taught using the WEMSI curriculum, and
conducted in accord with the policies and procedures specified in the EMS
Continuing Education Manual.

JTG

Jack T. Grandey, NREMT-P
Institute for Quality & Medical Management                        Operations
Director
         UPMC Health System
Wilderness EMS Institute
         http://www.upmc.edu/
http://www.wemsi.org/


------=_NextPart_000_0006_01BDB0F0.A6AAE860
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	charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable

<!DOCTYPE HTML PUBLIC "-//W3C//DTD W3 HTML//EN">
<HTML>
<HEAD>

<META content=3D"text/html; charset=3Diso-8859-1" =
http-equiv=3DContent-Type>
<META content=3D'"MSHTML 4.72.2106.6"' name=3DGENERATOR>
</HEAD>
<BODY bgColor=3D#ffffff>
<DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000 =
face=3D"Times New Roman"=20
size=3D3>I am pleased to announce that the PA Dept of Health has granted =

continuing education credit for WEMSI's WEMT program as=20
follows:</FONT></SPAN></DIV>
<DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000 =
face=3D"Times New Roman"=20
size=3D3></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000 =
face=3D"Times New Roman"=20
size=3D3>First Responder:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; =
30.0&nbsp;=20
hr.s</FONT></SPAN></DIV>
<DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000 =
face=3D"Times New Roman"=20
size=3D3></FONT></SPAN><SPAN class=3D300421923-16071998><FONT =
color=3D#000000=20
face=3D"Times New Roman" size=3D3>EMT=20
:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=20
50.0&nbsp; hr.s</FONT></SPAN></DIV>
<DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000 =
face=3D"Times New Roman"=20
size=3D3></FONT></SPAN><SPAN class=3D300421923-16071998><FONT =
color=3D#000000=20
face=3D"Times New Roman"=20
size=3D3>Medic/PHRN:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;=20
51.5&nbsp; hr.s</FONT></SPAN></DIV>
<DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000 =
face=3D"Times New Roman"=20
size=3D3></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000 =
face=3D"Times New Roman"=20
size=3D3>This applies to all programs taught using the WEMSI curriculum, =
and=20
conducted in accord with the policies and procedures specified in the =
EMS=20
Continuing Education Manual.</FONT></SPAN></DIV>
<DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000 =
face=3D"Times New Roman"=20
size=3D3></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000 =
face=3D"Times New Roman"=20
size=3D3>JTG</FONT></SPAN></DIV>
<DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000 =
face=3D"Times New Roman"=20
size=3D3></FONT></SPAN><FONT color=3D#000000 face=3DArial =
size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT color=3D#000000 face=3DArial size=3D2>Jack T. Grandey, =
NREMT-P</FONT>=20
<BR><FONT color=3D#000000 face=3DArial size=3D2>Institute for Quality =
&amp; Medical=20
Management&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;=20
Operations Director</FONT> <BR><FONT color=3D#000000 face=3DArial=20
size=3D2>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; UPMC Health=20
System&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n=
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=20
Wilderness EMS Institute</FONT> <BR><FONT color=3D#000000 face=3DArial=20
size=3D2>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <A=20
href=3D"http://www.upmc.edu/"=20
target=3D_blank>http://www.upmc.edu/</A>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;=20
<A href=3D"http://www.wemsi.org/" =
target=3D_blank>http://www.wemsi.org/</A></FONT>=20
</DIV>
<DIV>&nbsp;</DIV></BODY></HTML>

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Date: Thu, 16 Jul 1998 11:04:39 -0700
To: wilderness-emergency-medicine@list.pitt.edu,
        wilderness-emergency-medicine@list.pitt.edu
From: "David C. Kovar" <kovar@webnexus.com>
Subject: Re: W-EMED Communications Info
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At 11:24 AM 7/16/98 -0400, RivrChik@aol.com wrote:
>A question to anyone who can offer some suggestions or answers.  According to
>Wilderness Emergency Medicine....what is the recommended treatment for
>snakebites, both venomous and nonvenomous?

WMA's Wilderness First Responder Course teaches:

1) Antivenin - A specific treatment, limited to a hospital setting as it
can cause allergic reaction in rare cases. Most effective during first four
hours.
2) Transport - To the hospital, for antivenin. Walking the patient out is
reasonably safe unless severe systemic signs and symptoms occur. The
thought being that this will be significantly faster than a carryout. Split
the affected part if possible.
3) Expect swelling - Remove constricting items.

The underlying belief is that you cannot field treat a venomous snakebite.
Non-venomous snakebite should be treated as a puncture wound.

Medicine for Mountaineering suggests wrapping the bitten extremity snugly,
splinting it and keeping it at the level of the heart. The victim should be
transported as quickly as possible with as little effort on their part. The
underlying belief is that this immobilizes the venom at the site. They
caution that wrapping should not be undertaken unless you are certain that
the envenomation is known to be moderate or severe - inflicted by large
snake, pain and swelling appear at once - AND a hospital is many hours or
days away.

In short, get them to a hospital as quickly as possible. I'd trade off
immobility for speed, following WMA's instruction.

MfM suggests antibiotics and tranquilizers if you are several days out.
Pain control with moderate analgesics.

-David

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A question to anyone who can offer some suggestions or answers.  According to
Wilderness Emergency Medicine....what is the recommended treatment for
snakebites, both venomous and nonvenomous?
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To: scanner@qth.net, scan-l@uafsysb.uark.edu, dispatch@tcomeng.com,
        ems-edu-l@informatics.sunnyside.edu, arc-comm@will-flor.com,
        sar-l@islandnet.com, kyscan@lsv.uky.edu, smart@mediccom.org,
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        skywarn@postoffice.cso.uiuc.edu, wx-storm@postoffice.cso.uiuc.edu,
        dmatnews@mediccom.org, dmatcomm@mediccom.org, kyems@hultgren.org,
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        fire-l@cornell.edu
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        ares-races@qth.net, mobile-portable@qth.net, 2m@qth.net, 73cm@qth.net,
        ares@ares.org, tnham@qth.net, ncham@qth.net, ilham@qth.net,
        plug-it@qth.net
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Greetings,

I have just put together a simple home page that includes links to various
wide-coverage Amateur Radio repeater networks across the U.S., primarily for
the purpose of facilitating emergency and public service communications.   

The page is located at:

http://members.aol.com/jhowel/w9sar.html

If anyone has additions or corrections, please let me know.  

Jeff Howell
EMT, W9SAR
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Just some thoughts r/t this subject.  It is a nursing principal of care
to turn all immobile patients q2 hours, we learned this day one in
nursing school.  It matters not whether the patient is backboarded or on
an egg crate or air mattress.  I think that the risk of pressure
necrosis is the same with any of the immobilization devices we all
currently use (I've seen young adults develop early signs of pressure
necrosis in less than 2 hours).  The idea of unpackaging an immobilized
patient seems extreme, why not just turn the board/vacume mattress a few
degrees to the left or right (alternating with the back) q2 hours.  This
will shift the pressure off of bony promininces and allow circulation to
be restored.  One last thought, I've seen few patients with severe
multiple trauma or multisystem organ failure that did not require an
enterostomal therapy consult r/t pressure necrosis, no matter what their
transport time to definitive care.  When the body is so seriously
insulted, the skin is bound to suffer.
Just some ramblings.
Erik Scheiderer, RN, EMT-P
Mechanicsburg EMS
Mechanicsburg, Ohio


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<HTML>
Just some thoughts r/t this subject.&nbsp; It is a nursing principal of
care to turn <U>all</U> immobile patients q2 hours, we learned this day
one in nursing school.&nbsp; It matters not whether the patient is backboarded
or on an egg crate or air mattress.&nbsp; I think that the risk of pressure
necrosis is the same with any of the immobilization devices we all currently
use (I've seen young adults develop early signs of pressure necrosis in
less than 2 hours).&nbsp; The idea of unpackaging an immobilized patient
seems extreme, why not just turn the board/vacume mattress a few degrees
to the left or right (alternating with the back) q2 hours.&nbsp; This will
shift the pressure off of bony promininces and allow circulation to be
restored.&nbsp; One last thought, I've seen few patients with severe multiple
trauma or multisystem organ failure that did not require an enterostomal
therapy consult r/t pressure necrosis, no matter what their transport time
to definitive care.&nbsp; When the body is so seriously insulted, the skin
is bound to suffer.
<BR>Just some ramblings.
<BR>Erik Scheiderer, RN, EMT-P
<BR>Mechanicsburg EMS
<BR>Mechanicsburg, Ohio
<BR>&nbsp;</HTML>

--------------DED199241F0D7E09939D7B76--

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From: "Keith Conover, M.D., FACEP" <kconover+@pitt.edu>
To: cvw@Juno.com (chris v weddle)
Date: Mon, 13 Jul 1998 13:53:40 -0400
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Subject: Re: W-EMED Backboards -- the ATLS 2-hour rule
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On 13 Jul 98, at 11:28, chris v weddle wrote:

> How often do people out there see this problem following a wilderness
> carry-out?

One of our mock cave rescue victims for an NCRC class was on a 
KED and a padded board.  After about 4 hours, when she got out, 
she was in such pain I ended up giving her some IM morphine.

--Keith Conover, M.D., FACEP
  http://www.pitt.edu/~kconover
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Subject: W-EMED Re: Backboards -- the ATLS 2-hour rule
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Sorry, Folks ...

I have to pipe in a little bit here ...

Our protocols for a sp-inal patient who is 2+ hours transport time away 
is to slightly rotate the board every 1.5 - 2 hours, thus eleviating the 
bedore / pressure sore problem.

So long as there is transit occuring, the board is on and strong.  If, 
however, there is a break in the transporting of the patient (read: back 
country), I would expect that the head could be secured and the straps 
loosened to allow for a little less compression.

The rotations are not full lateral, just an inch or two and maintained 
to shift the patients C of G from where they were riding before.

Just my 2 cents worth, but beware, they are Canadian funds .... ;-)

Respectfully

David WHite
Terrace, BC, Canada
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Subject: Re: Backboards -- the ATLS 2-hour rule
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--------
But the main reason for this message is the ATLS message about  
backboards.
 The new course basically says that people shouldn't  be on a backboard 
for
more than 2 hours, even if they have a  known spinal injury, as they'll
likely get bedsores (pressure  necrosis). The ATLS recommendations are 
to
get specialists to  see the patient and take care of the spinal injury
definitively in 2  hours. If this isn't possible, get the patient off 
the
board and onto  something softer, and log-roll onto one side or the 
other
("while  maintaining the integrity of the spine") every 2 hours. 

This seems to be good advice for those caring for people in the
backcountry, too.  I've always been a fan of full-body vacuum  splints
instead of backboards, and here's some ammunition for that idea.  
Certainly
it argues for WEMTs clearing the cervical spine in  the backcountry, 
even
if they arrive in the middle of an evacuation  where first responders 
have
already put someone on a backboard. 
--Keith Conover, M.D., FACEP   http://www.pitt.edu/~kconover 
------

Actually, Wilderness First Responders can clear cervical spine in the 
back
country if the protocols are approved and they went through the right
course. I know that Wilderness Medical Associates course is teaching 
this
and I presume the other WFR courses are as well.

In some of the hypothermic packs I've seen, it takes nearly half an hour
getting someone into the pack. Taking them off the backboard every two
hours would be impractical, to say the least. Is log-rolling them onto 
one
side for a "period of time" sufficient to help minimize this problem?

I would imagine that full body vacuum splits would still result in some
problems of this nature as well.

-David

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Date: Mon, 13 Jul 1998 11:28:12 -0600
Subject: Re: W-EMED Backboards -- the ATLS 2-hour rule
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On Sat, 11 Jul 1998 10:27:16 -0400 "Keith Conover, M.D."
<kconover+@pitt.edu> writes:
>Our hospital (Mercy Hospital of Pittsburgh, a Level I Trauma  
...deletia...
>But the main reason for this message is the ATLS message about  
...deletia...
>where first responders have already put someone on a backboard. 
>Thanks lending your electronic ear. 
>Keith Conover, M.D., FACEP

This is most interesting. While doing long stokes basket carry-outs, I
did not see a need to roll the patient every couple of hours. But for
good reason, our backboards were padded to begin with. We applied a
closed cell foam pad with cement to the board, and then trimmed off the
excess. With careful padding of the patient from that starting point,
carry-outs of many miles and hours could be accomplished without removing
the patient from the stokes basket. An important point is that patients
were always and continually questioned on their comfort level. We
maintained the highest possible degree of patient comfort for the given
circumstances by communicating with the patient and by careful attention
to padding. 

I do appreciate the concern over bed sores, having seen such ghastly
things in hospitals. But I believe that if rescuers are attentive to good
packaging, there should be no reason to expect this occurance in
wilderness transports. There are other reasons that can require
"unpacking" and "repacking" the patient, but the bed sores concern
surprised me.

How often do people out there see this problem following a wilderness
carry-out?

Good day,

Chris Weddle


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Nigel (& ccs, if interested):

Yes, in the NE, the preponderance of courses are in NH & ME.

I would not anticipate a weeklong or 2 weekend course in PA or NY before the
spring one in Lancaster.  We are planning a shortened version of a course to
be presented in Elk County (north central PA) to be delivered during their
rescue training weekend (Oct 9-11). More on that, as it becomes available.
We're also working on other course offerings, but nothing has been
finalized, yet.

Re: recognition, that is always an issue.  For most locations, the benefit
of any WEMT program is the educational content, not the certification.  That
may change.

As an added note, I can say that the WEMSI course has just been approved for
by the PA DOH for EMT, EMT-P, & PHRN con ed.  As soon as I have the exact
number of hours approved, I'll make a separate announcement.

If you have additional questions, feel free to email me directly.

JTG

Jack T. Grandey, NREMT-P
     Operations Director
 Wilderness EMS Institute
   http://www.wemsi.org/


> -----Original Message-----
> From: owner-wilderness-emergency-medicine@list.pitt.edu
> [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of
> nigel dyson-hudson
> Sent: Saturday, July 11, 1998 23:16
> To: wilderness-emergency-medicine@list.pitt.edu
> Subject: W-EMED looking for WEMT courses in the North East
>
>
> 1. It seems like the WEMT courses in the North East are in Maine
> during the
> fall: yours over 2 weekends and an other offered 2 times over an extended
> weekend.
>
> Are there others I don't know about or should I wait until the spring and
> run down to Lancaster, PA?
>
> I am nr. Ithaca, NY so a 2 weekend course only makes sense if it is less
> than about 4hrs away: Lancaster, Philly, NY/NJ metro area.
>
> 2. Being in NY state, where WEMT doesn't seem to be recognized, is it
> really worth taking a WEMT course? I can drive 45 minutes and be in PA so
> any hiking I do in the Loysock Creek area would be in an area where the
> protocols are being modified to require WEMT for backcountry incidents.
>
> FYI: Ithaca gorge rescues are handled by the Ithaca Fire Department. To
> join IFD would require petitioning since I am not in their
> district and 100
> hours of manditory training in the first year. (I  work 30 miles in the
> opposite direction.)
>
> thanks in advance, nigel dyson-hudson, EMT-D
> West Danby Fire & Rescue, Tomkpins County Search & Rescue
> Do not reproduce without author's express permission.
> To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine"
> as the body of a message (no subject) To: Majordomo@list.pitt.edu
> Submissions To: wilderness-emergency-medicine@list.pitt.edu
>

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From: SteveK <stevek@spectralogic.com>
To: "'wilderness-emergency-medicine@list.pitt.edu'"
	 <wilderness-emergency-medicine@list.pitt.edu>,
        kconover+@pitt.edu, EMS-L@listserv.ACNS.NWU.EDU
Cc: sar-l@listserv.islandnet.com, mra@altadena.net, NCRC@ontosystems.com
Subject: RE: W-EMED Re: Backboards -- the ATLS 2-hour rule
Date: Sun, 12 Jul 1998 17:30:23 -0600
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	>> In some of the hypothermic packs I've seen, it takes nearly
half an hour
	>> getting someone into the pack. Taking them off the backboard
every two
	>> hours would be impractical, to say the least. Is log-rolling
them onto one
	>> side for a "period of time" sufficient to help minimize this
problem?

	>> I would imagine that full body vacuum splits would still
result in some
	>> problems of this nature as well.

	The full body vacuum splints we use go on pretty quick and come
off quickly too.  The problem is you then usually put them in a litter,
so the combined removal time becomes a factor.  I would question the
need to perform the "2-hour roll" on a properly applied vacuum spint,
however, as they can be very well formed to the subject; thus
eliminating most of the pressure points you'd have on a backboard.  The
biggest problem with a vac. splint is, of course, poking holes in them
and rendering them useless.

	steve kelleher
	alpine rescue team
	evergreen, co.


> -----Original Message-----
> From:	David C. Kovar [SMTP:kovar@webnexus.com]
> Sent:	Saturday, July 11, 1998 10:01 AM
> To:	kconover+@pitt.edu; EMS-L@listserv.ACNS.NWU.EDU;
> wilderness-emergency-medicine@list.pitt.edu
> Cc:	sar-l@listserv.islandnet.com; mra@altadena.net;
> NCRC@ontosystems.com
> Subject:	W-EMED Re: Backboards -- the ATLS 2-hour rule
> 
> --------
> But the main reason for this message is the ATLS message about
> backboards.
>  The new course basically says that people shouldn't  be on a
> backboard for
> more than 2 hours, even if they have a  known spinal injury, as
> they'll
> likely get bedsores (pressure  necrosis). The ATLS recommendations are
> to
> get specialists to  see the patient and take care of the spinal injury
> definitively in 2  hours. If this isn't possible, get the patient off
> the
> board and onto  something softer, and log-roll onto one side or the
> other
> ("while  maintaining the integrity of the spine") every 2 hours. 
> 
> This seems to be good advice for those caring for people in the
> backcountry, too.  I've always been a fan of full-body vacuum  splints
> instead of backboards, and here's some ammunition for that idea.
> Certainly
> it argues for WEMTs clearing the cervical spine in  the backcountry,
> even
> if they arrive in the middle of an evacuation  where first responders
> have
> already put someone on a backboard. 
> --Keith Conover, M.D., FACEP   http://www.pitt.edu/~kconover 
> ------
> 
> Actually, Wilderness First Responders can clear cervical spine in the
> back
> country if the protocols are approved and they went through the right
> course. I know that Wilderness Medical Associates course is teaching
> this
> and I presume the other WFR courses are as well.
> 
> In some of the hypothermic packs I've seen, it takes nearly half an
> hour
> getting someone into the pack. Taking them off the backboard every two
> hours would be impractical, to say the least. Is log-rolling them onto
> one
> side for a "period of time" sufficient to help minimize this problem?
> 
> I would imagine that full body vacuum splits would still result in
> some
> problems of this nature as well.
> 
> -David
> 
> Do not reproduce without author's express permission.
> To unsubscribe, send the text "unsubscribe
> wilderness-emergency-medicine"
> as the body of a message (no subject) To: Majordomo@list.pitt.edu
> Submissions To: wilderness-emergency-medicine@list.pitt.edu


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	 <wilderness-emergency-medicine@list.pitt.edu>,
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Cc: sar-l@listserv.islandnet.com, mra@altadena.net, NCRC@ontosystems.com
Subject: RE: W-EMED Re: Backboards -- the ATLS 2-hour rule
Date: Sun, 12 Jul 1998 17:30:23 -0600
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	>> In some of the hypothermic packs I've seen, it takes nearly
half an hour
	>> getting someone into the pack. Taking them off the backboard
every two
	>> hours would be impractical, to say the least. Is log-rolling
them onto one
	>> side for a "period of time" sufficient to help minimize this
problem?

	>> I would imagine that full body vacuum splits would still
result in some
	>> problems of this nature as well.

	The full body vacuum splints we use go on pretty quick and come
off quickly too.  The problem is you then usually put them in a litter,
so the combined removal time becomes a factor.  I would question the
need to perform the "2-hour roll" on a properly applied vacuum spint,
however, as they can be very well formed to the subject; thus
eliminating most of the pressure points you'd have on a backboard.  The
biggest problem with a vac. splint is, of course, poking holes in them
and rendering them useless.

	steve kelleher
	alpine rescue team
	evergreen, co.


> -----Original Message-----
> From:	David C. Kovar [SMTP:kovar@webnexus.com]
> Sent:	Saturday, July 11, 1998 10:01 AM
> To:	kconover+@pitt.edu; EMS-L@listserv.ACNS.NWU.EDU;
> wilderness-emergency-medicine@list.pitt.edu
> Cc:	sar-l@listserv.islandnet.com; mra@altadena.net;
> NCRC@ontosystems.com
> Subject:	W-EMED Re: Backboards -- the ATLS 2-hour rule
> 
> --------
> But the main reason for this message is the ATLS message about
> backboards.
>  The new course basically says that people shouldn't  be on a
> backboard for
> more than 2 hours, even if they have a  known spinal injury, as
> they'll
> likely get bedsores (pressure  necrosis). The ATLS recommendations are
> to
> get specialists to  see the patient and take care of the spinal injury
> definitively in 2  hours. If this isn't possible, get the patient off
> the
> board and onto  something softer, and log-roll onto one side or the
> other
> ("while  maintaining the integrity of the spine") every 2 hours. 
> 
> This seems to be good advice for those caring for people in the
> backcountry, too.  I've always been a fan of full-body vacuum  splints
> instead of backboards, and here's some ammunition for that idea.
> Certainly
> it argues for WEMTs clearing the cervical spine in  the backcountry,
> even
> if they arrive in the middle of an evacuation  where first responders
> have
> already put someone on a backboard. 
> --Keith Conover, M.D., FACEP   http://www.pitt.edu/~kconover 
> ------
> 
> Actually, Wilderness First Responders can clear cervical spine in the
> back
> country if the protocols are approved and they went through the right
> course. I know that Wilderness Medical Associates course is teaching
> this
> and I presume the other WFR courses are as well.
> 
> In some of the hypothermic packs I've seen, it takes nearly half an
> hour
> getting someone into the pack. Taking them off the backboard every two
> hours would be impractical, to say the least. Is log-rolling them onto
> one
> side for a "period of time" sufficient to help minimize this problem?
> 
> I would imagine that full body vacuum splits would still result in
> some
> problems of this nature as well.
> 
> -David
> 
> Do not reproduce without author's express permission.
> To unsubscribe, send the text "unsubscribe
> wilderness-emergency-medicine"
> as the body of a message (no subject) To: Majordomo@list.pitt.edu
> Submissions To: wilderness-emergency-medicine@list.pitt.edu
Do not reproduce without author's express permission.
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Date: Sat, 11 Jul 1998 23:16:14 -0400
To: wilderness-emergency-medicine@list.pitt.edu
From: nigel dyson-hudson <ndh@InternetSmiths.com>
Subject: W-EMED looking for WEMT courses in the North East
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1. It seems like the WEMT courses in the North East are in Maine during the
fall: yours over 2 weekends and an other offered 2 times over an extended
weekend.

Are there others I don't know about or should I wait until the spring and
run down to Lancaster, PA?

I am nr. Ithaca, NY so a 2 weekend course only makes sense if it is less
than about 4hrs away: Lancaster, Philly, NY/NJ metro area.

2. Being in NY state, where WEMT doesn't seem to be recognized, is it
really worth taking a WEMT course? I can drive 45 minutes and be in PA so
any hiking I do in the Loysock Creek area would be in an area where the
protocols are being modified to require WEMT for backcountry incidents.

FYI: Ithaca gorge rescues are handled by the Ithaca Fire Department. To
join IFD would require petitioning since I am not in their district and 100
hours of manditory training in the first year. (I  work 30 miles in the
opposite direction.)

thanks in advance, nigel dyson-hudson, EMT-D
West Danby Fire & Rescue, Tomkpins County Search & Rescue
Do not reproduce without author's express permission.
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From: "Tim Kovacs" <tkovacs@goodnet.com>
Subject: Re: W-EMED Re: Backboards -- the ATLS 2-hour rule
Date: Sat, 11 Jul 98 20:00:52 PDT
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I still think that traditional backboards are the most medieval tool we
still carry in EMS.
Vaccuum splints are great, or LOTS OF PADDING on the board FIRST.
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From: "David C. Kovar" <kovar@webnexus.com>
Subject: W-EMED Re: Backboards -- the ATLS 2-hour rule
Cc: sar-l@listserv.islandnet.com, mra@altadena.net,
        NCRC@ontosystems.com (NCRC Discussion List)
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--------
But the main reason for this message is the ATLS message about  backboards.
 The new course basically says that people shouldn't  be on a backboard for
more than 2 hours, even if they have a  known spinal injury, as they'll
likely get bedsores (pressure  necrosis). The ATLS recommendations are to
get specialists to  see the patient and take care of the spinal injury
definitively in 2  hours. If this isn't possible, get the patient off the
board and onto  something softer, and log-roll onto one side or the other
("while  maintaining the integrity of the spine") every 2 hours. 

This seems to be good advice for those caring for people in the
backcountry, too.  I've always been a fan of full-body vacuum  splints
instead of backboards, and here's some ammunition for that idea.  Certainly
it argues for WEMTs clearing the cervical spine in  the backcountry, even
if they arrive in the middle of an evacuation  where first responders have
already put someone on a backboard. 
--Keith Conover, M.D., FACEP   http://www.pitt.edu/~kconover 
------

Actually, Wilderness First Responders can clear cervical spine in the back
country if the protocols are approved and they went through the right
course. I know that Wilderness Medical Associates course is teaching this
and I presume the other WFR courses are as well.

In some of the hypothermic packs I've seen, it takes nearly half an hour
getting someone into the pack. Taking them off the backboard every two
hours would be impractical, to say the least. Is log-rolling them onto one
side for a "period of time" sufficient to help minimize this problem?

I would imagine that full body vacuum splits would still result in some
problems of this nature as well.

-David

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From: "Keith Conover, M.D." <kconover+@pitt.edu>
To: EMS-L@listserv.ACNS.NWU.EDU, wilderness-emergency-medicine@list.pitt.edu
Date: Sat, 11 Jul 1998 10:27:16 -0400
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Subject: W-EMED Backboards -- the ATLS 2-hour rule
CC: sar-l@listserv.islandnet.com, mra@altadena.net,
        NCRC@ontosystems.com (NCRC Discussion List)
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Our hospital (Mercy Hospital of Pittsburgh, a Level I Trauma  
Center) just offered its first Advanced Trauma Life Support (ATLS)  
course based on the "new" (1997) course, and I sat through the  
whole thing.  A much better course than the past version, though I  
found a couple of deficiencies (particularly the lack of a  
methodological description of a selective secondary survey, and it's 
 very skimpy about the proper neurological induction for intubating 
a  head-injured patient).  There are however a number of quite good  
new things in it, including support for the protocol for clearing the  
cervical spine in the wilderness I first proposed in the Journal of  
Wilderness Medicine [<FontFamily><param>MS SANS SERIF</param><smaller>Conover K. EMTs should be able to clear the cervical  
spine in the wilderness [editorial] J Wild Med 1992; 3:339-343<bigger><bigger>.<FontFamily><param>ARIAL</param><smaller>]  
http://www.pitt.edu/~kconover/ftp/spine3.txt 


But the main reason for this message is the ATLS message about  
backboards.  The new course basically says that people shouldn't  
be on a backboard for more than 2 hours, even if they have a  
known spinal injury, as they'll likely get bedsores (pressure  
necrosis). The ATLS recommendations are to get specialists to  
see the patient and take care of the spinal injury definitively in 2  
hours. If this isn't possible, get the patient off the board and onto  
something softer, and log-roll onto one side or the other ("while  
maintaining the integrity of the spine") every 2 hours. 


This seems to be good advice for those caring for people in the  
backcountry, too.  I've always been a fan of full-body vacuum  
splints instead of backboards, and here's some ammunition for that 
 idea.  Certainly it argues for WEMTs clearing the cervical spine in  
the backcountry, even if they arrive in the middle of an evacuation  
where first responders have already put someone on a backboard. 


Thanks lending your electronic ear. 

<nofill>
--Keith Conover, M.D., FACEP
  http://www.pitt.edu/~kconover
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From:     Self <Single-user mode>
To: EMS-L@listserv.ACNS.NWU.EDU,wilderness-emergency-medicine@list.pitt.edu
Subject: Backboards -- the ATLS 2-hour rule
Cc: sar-l@listserv.islandnet.com,mra@altadena.net,NCRC@ontosystems.com (NCRC Discussion List)
Reply-to: kconover+@pitt.edu
MIME-Version: 1.0
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Content-transfer-encoding: 8BIT
Date: Sat, 11 Jul 1998 09:26:57 -0400

Our hospital (Mercy Hospital of Pittsburgh, a Level I Trauma  
Center) just offered its first Advanced Trauma Life Support (ATLS)  
course based on the "new" (1997) course, and I sat through the  
whole thing.  A much better course than the past version, though I  
found a couple of deficiencies (particularly the lack of a  
methodological description of a selective secondary survey, and it's 
 very skimpy about the proper neurological induction for intubating 
a  head-injured patient).  There are however a number of quite good  
new things in it, including support for the protocol for clearing the  
cervical spine in the wilderness I first proposed in the Journal of  
Wilderness Medicine [<FontFamily><param>MS SANS SERIF</param><smaller>Conover K. EMTs should be able to clear the cervical  
spine in the wilderness [editorial] J Wild Med 1992; 3:339-343<bigger><bigger>.<FontFamily><param>ARIAL</param><smaller>]  
http://www.pitt.edu/~kconover/ftp/spine3.txt 


But the main reason for this message is the ATLS message about  
backboards.  The new course basically says that people shouldn't  
be on a backboard for more than 2 hours, even if they have a  
known spinal injury, as they'll likely get bedsores (pressure  
necrosis). The ATLS recommendations are to get specialists to  
see the patient and take care of the spinal injury definitively in 2  
hours. If this isn't possible, get the patient off the board and onto  
something softer, and log-roll onto one side or the other ("while  
maintaining the integrity of the spine") every 2 hours. 


This seems to be good advice for those caring for people in the  
backcountry, too.  I've always been a fan of full-body vacuum  
splints instead of backboards, and here's some ammunition for that 
 idea.  Certainly it argues for WEMTs clearing the cervical spine in  
the backcountry, even if they arrive in the middle of an evacuation  
where first responders have already put someone on a backboard. 


Thanks lending your electronic ear. 


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Date: Fri, 03 Jul 1998 14:08:11 -0500
From: Robert Michael Judy <rjudy@sfasu.edu>
Subject: Re: W-EMED Re: Kayak Polo Injuries, Not a Joke
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High horse + soap box = bruised ego.

Hope you are doing well.  I don't mean to get too weird but it is something I
believe in.
I get into trouble with an Austin kayak instructor who thinks my football
looking helmet and face guard
is "intimidating to students."  She thinks I look like Darth Vader.  I can
agree to an extent, I just reserve the right to feel a little less sympathetic
towards the injured when thay had a means and oppertunity of avoiding the injury.

I understand racing/competitor needs for light-weight and minimal gear
situations but remember an Olympian
getting her face knocked off in Germany about half way down the run, yikes! 
The Austin instructor (and one from Minisota) recommend I get a lighter helmet
(would like to) and removable face guard for teaching, especially flatwater. 
I will concede that the big bucket of water and heavy guard impair my roll somewhat.

I guess it will all fall out like the motorcycle helmet rule with practice
swinging back and forth depending
on personality and who was injured and how badly recently.  I like to think
there could be a negative accident incident.
A zero accident incident if none are reported and a negative accident incident
if people say "I really would have been hurt but,".
I know at least one paddler that got ten facial stitches and still sneers at
face protection, ahh well, as I said
I have a right to feel less sympathy ....

Hope the Hill country gets rain, and you have a good Holiday,

see you on (or near) the water eventually.

rmj

(PS, the day I ever even think of doing the Safari may be the day I turn
myself in for analysis, those 
dogs are way too big for this little pup.)



Lee Deviney wrote:
> 
> Jeeesh!  I can't argue with you w/r/t safety.  Maybe I'll do
> something safer...like the Texas Watrer Safari.  Haven't tried polo
> but have watched in Austin and California...I think it's a hell of a
> good and fun  way to teach fundamentals especially to young aspiring
> competetive paddlers.
> 
> I know there must be a kayak helmet in the garage...no face mask
> though..  Maybe the old
> high school football helmet still fits.
>
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Date: Fri, 03 Jul 1998 10:47:55 -0500
From: Robert Michael Judy <rjudy@sfasu.edu>
Subject: W-EMED Kayak Polo Injuries, Not a Joke
To: Glenn Hart <ghart@eci.state.tx.us>
Cc: canoetx@world.std.com, wilderness-emergency-medicine@list.pitt.edu
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On a more serious note I would like to advise all paddlers to:

	get a face guard and use it.

	install a face shield on your helmet and wear it.                 IF WE SET
AN EXAMPLE OTHERS WILL FOLLOW!!!!

	obtain and use face saving equipment on your paddling helmet.

I hope all the previous humor doesn't prevent people from reading,
understanding, and adopting the above advice.

A lot has been said in the past few months about paddler deaths/injuries and I
will not quote any of it but the jist of the advice is that paddling helmets
should provide protection for the temple and face area.  Several writers have
speculated that some incidents may have been survivable if more protection was
used by the involved paddlers.  

Temple and face injuries often result in short to long term incapacitation
resulting from temporary loss of or reduction in consciousness, short term
shock states induced by sudden blunt trauma, and/or intense pain. 
Disorientation resulting from trauma is a bad state for people upside down in
paddle boats. (period)

There are no good reasons for paddlers not to wear more temple and face protection..

I wish Paddlesport Instructors would make as big a issue of temple/face
protection as they do about PFDs.  I know there are a lot of seemingly good
reasons popping into peoples heads about why temple/face protection is not
such a big deal, why it isn't ALWAYS necessary, etc. and I say the same kind
of reasoning is used by people who don't want to wear PFDs all the time they
are in their boats.

None of us would paddle with someone not wearing a PFD and helmet, none of us
should paddle with someone not wearing a face/temple protective device.

I hate to drag the WEMT guys (CC above) into this but I feel quite strongly
about this and some of them may have arguments/anecdotes which will convince
more of you to adopt face/temple protection for your helmets.

Have a safe weekend, paddle hardy.

Glenn Hart wrote:
> 
> I think that Marco guy is the one who was playing polo on Town Lake the other day, but he left early when someone accidentally hit him with a paddle, giving him a fat lip.
> 
> Glenn Hart
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Date: Fri, 03 Jul 1998 09:54:26 -0400
To: wilderness-emergency-medicine@list.pitt.edu
From: Bernie Roche <broche@titan.tcn.net>
Subject: Re: W-EMED Windows Drivers
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At 10:09 PM 02/07/98 -0400, you wrote:
>Hi, all:
>
>Can't find the Windows driver you need?  Try our WEMSI web site - we've
>added a LONG list of sites which will hopefully be useful.
>
>
>http://www.wesmi.org/win_drivers.html
>
>Best Wishes,
>
>Bernie Roche
>WEMSI Web Site Administrator

Hi, all, again:

I goofed!  I transposed letters while typing the above url.  It should be:


http://www.wemsi.org/win_drivers.html

Sorry about that!

Best Wishes,

Bernie
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Date: Fri, 03 Jul 1998 09:52:15 -0400
To: wilderness-emergency-medicine@list.pitt.edu
From: Bernie Roche <broche@titan.tcn.net>
Subject: Re: W-EMED Windows Drivers
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At 08:00 AM 03/07/98 -0400, you wrote:
>In a message dated 7/2/98 7:15:15 PM Pacific Daylight Time,
>broche@titan.tcn.net writes:
>
>> http://www.wesmi.org/win_drivers.html
> 
>This address received an ERROR. Is there a copy mistake?
>
>Thanks, 
>
>Linda R. Uihlein in VA


Hi, Linda:

Yes, I see I have transposed letters while typing.....it should be wemsi,
not wesmi.  Sorry about that.

Best Wishes,

Bernie
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Date: Thu, 02 Jul 1998 22:11:10 -0400
To: wilderness-emergency-medicine@list.pitt.edu
From: Bernie Roche <broche@titan.tcn.net>
Subject: W-EMED IMPORTANT COURSE ANNOUNCEMENT
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Hi, all:

Please see the announcement on our course schedule page regarding the
upcoming fall courses.


http://www.wemsi.org/classes.html

Best Wishes,

Bernie Roche
WEMSI Web Site Administrator
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Date: Thu, 02 Jul 1998 22:09:03 -0400
To: wilderness-emergency-medicine@list.pitt.edu
From: Bernie Roche <broche@titan.tcn.net>
Subject: W-EMED Windows Drivers
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Hi, all:

Can't find the Windows driver you need?  Try our WEMSI web site - we've
added a LONG list of sites which will hopefully be useful.


http://www.wesmi.org/win_drivers.html

Best Wishes,

Bernie Roche
WEMSI Web Site Administrator
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