Wilderness Medicine Quo Vadis?

Back in the early 1980s Paul Auerbach and I went for a run at a conference. He asked what I thought about starting a medical society based on wilderness medicine. I, of course, told him it was a bad idea. We had enough meetings and conferences to attend without another one and besides, there was no such thing as “wilderness medicine.” Except for perhaps Peter Hackett and Charlie Houston, no one I knew was doing research or publishing on wilderness medicine topics.

Thankfully, Paul ignored my advice and, along with 2 other emergency physicians Ed Geehr and Ken Kizer, founded the Wilderness Medical Society. Paul recognized that the evolution of wilderness medicine paralleled that of its largest group of practitioners: emergency medicine. Both had a late start in the house of medicine. Neither had a research or academic basis for defining the specialty. Neither was accepted by the existing specialties. Paul was both a prophet and a genius and understood how to overcome these obstacles: First, publish a textbook. Then, have conferences in beautiful areas and invite speakers with some knowledge or background in wilderness medicine (the contributors to the textbook, for the most part). Medical professionals who had hobbies of mountaineering, scuba diving, and backpacking could now justify their love of the outdoors with continuing education. The money raised from conferences and memberships could then be used to fund research and publications.

Practitioners from other specialties shared our interest. Along with emergency medicine, we had cardiologists, hematologists, cardiovascular surgeons, dermatologists, and other medical specialties on board. But Paul realized early on that it wasn’t just physicians who cared for people in the wilderness but first responders. He asked me to chair a prehospital committee that would create a curriculum and educational material for them. There were a few people already doing this and I recruited Warren Bowman from the National Ski Patrol, Bruce Paton from Outward Bound, Tod Schimelpfenig from NOLS, and Peter Goth from National Association For Search And Rescue. I asked Peter Hackett, Keith Conover, and Dave Tauber to lend their expertise. This project also helped to increase the membership of the Society.

Paul had other insights. Besides the textbook that he and Ed Geehr had written, there was not much in the way of publications in wilderness medicine. Paul decided that we needed to have some way of educating people not attending the conferences, so he formed a publications committee, and asked me to chair that, as well. It was an easy target. We started by asking our speakers at the conference, usually the same 6 or 7 people, to make slide programs of their lectures, which we then made available at cost to anyone interested in the various topics. Each speaker usually gave 2 lectures and 2 workshops at each conference, so we could produce quite a few of these educational programs. Ken Iserson and Bill Forgey edited a collection of position statements, and Howard Backer edited a newsletter. Paul managed to find a publisher willing to take a chance on a journal to publish wilderness articles and with many aches and pains the Journal of Wilderness Medicine was born in 1990. To stimulate research for the journal, Robert “Brownie” Schoene and Colin Grissom instituted research grants to partially fund projects.

As the WMS grew in the early years, we had to be rescued several times. Once, Blair Erb asked the board members to donate $5,000 each to keep us solvent, and later we asked Jim Whitehead, from the American College of Sports Medicine, to keep us afloat.

The WMS was open to everyone from its inception, and women played a significant role in the development of the WMS. Every meeting had presentations from Annie Dickison, Lily Conrad, Mary Ann Cooper, Susan Snider, Linda Lindsey, Susie Dillon, Kimberly Johnson and Luanne Freer. Several chapters of the first edition of Auerbach’s Wilderness Medicine were authored by these pioneering women. The actual “glue” that held the Society together during these formative years was the one and only Dian Simpkins, the sole administrator and manager in the early years. Dian did everything from conference planning, travel, publications, photography, record keeping, and keeping the board on time and on target. There would not be a WMS without Dian.

As in the early stages of emergency medicine, the WMS continued to identify opportunities for growth and evolved as it adapted to change. Frank Butler, who developed Tactical Combat Casualty Care (TCCC), asked us for a spot at a conference. Ken Zafren first invited him to an Alaskan regional conference and then the WMS’s first international conference (1991) in Whistler, British Columbia. TCCC is now the most widely practiced treatment for casualties both military and civilian in the world. Other innovations helped promote the WMS, as well. In 2005, the development of the Fellowship in the Academy of Wilderness Medicine brought in new members and led to increasing expertise in our growing field. Additionally, numerous medical student interest groups and electives were created and generated interest in the field of wilderness medicine. The popularity of the field assisted in recruiting new members and has contributed to the burgeoning growth in wilderness medicine fellowships. There are many more people who made the WMS thrive and they should be proud of their contributions.

The current WMS, with approximately 4,100 members from nearly 50 countries, is hardly recognizable from the humble original. Now there are several meetings/conferences a year, mountain medicine and diving and marine medicine diplomas, joint meetings with other medical groups, expeditions to Everest Base Camp and the British Virgin Islands, a magazine and a newsletter, a modern web site, a highly respected peer reviewed journal, a staff of administrators, and a new logo.

We have a strong environmental ethic that has continued since the beginning but is just now getting interest from the rest of medicine. Climate change is a medical problem and we have been part of the solution. The number of nonphysicians has increased which is an excellent way to bring wilderness medicine to the patients who need it. We now have more than 20 committees addressing every issue in wilderness medicine. We support Wongchhu Sherpa Memorial Hospital in Nepal, probably the most important way of giving back that the WMS can do.

Back in the day, the WMS, like emergency medicine, was breaking new ground. We felt as if we were inventing the specialty. We made mistakes and learned from them. There was enthusiasm and a sense of camaraderie among the early members. We all knew one another, and we put a great deal of time and effort into shaping the WMS into its current configuration. Calling on the creativity and institutional knowledge of longtime members of the WMS is an enormous opportunity that must not be lost. Building on the strengths and lessons learned from the past will help guide the WMS’s future direction as the baton is passed on to the next generation.

On this 40th anniversary of the WMS, it is important to understand where we are going—quo vadis—through the lens of where we have been.

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Published online: April 27, 2023

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DOI: https://doi.org/10.1016/j.wem.2023.04.006

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© 2023 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

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