Medicine for Mountaineering: And Other Wilderness Activities [Paperback]

At the outset, I will openly state my perspective on this and related books. I am not a medical professional. At the same time, I have long been an outdoor enthusiast, active in a number of different outdoor sports. I firmly believe that all active outdoor enthusiasts should seek and learn information to be able to provide reasonable self-care and care for members of their group who may become ill or injured. In prior instances I have been called upon to make use of some of my knowledge to treat myself and others, but fortunately not in severe or life threatening cases. My experience has been enough to give me a keen appreciation of how important good references are. With that general background in mind, I have found the topic of Wilderness First Aid and Medicine to be one of several survival related topics that is fascinating.

The sixth edition of Medicine for Mountaineering is the third edition of this work I have purchased. In many ways I believe the work has been improved. The organization of the book has been, and continues to be very well thought out, rendering the information accessible. The writing and editing are top notch, such that the actual content is clearly presented. Also, the expansion and addition of a number of chapters was well executed such that valuable additional information has been added in the characteristically clear style. (These expansions include new or expanded chapters on Rescue and Evacuation, drowning, lightning injuries, avalanche injuries, expansion and division of the chapter on bites and stings, and other chapters.) Oddly the one feature which would significantly improve the rapid utilization of this book in the field, diagnostic and treatment algorithm charts, is largely missing. There are a few, but they are not really sufficient. (The best set of these charts in a reference for lay outdoorsmen I have seen is in the AAOS Wilderness First Aid manual.) In some instances the same or similar information is presented in Medicine for Mountaineering via charts or tables, but for rapid access an algorithm chart would be better. Nonetheless, the information is clearly better organized than some other works, such as the Fifth Edition of Medicine for the Outdoors by Dr. Auerbach. (In some places the content in Auerbach's book seems more complete, but the grouping of chapters in that work into Major, Minor, and Environmental, and Miscellaneous problems seems arbitrary. Both Medicine for Mountaineering and Dr. Forgey's book, Wilderness Medicine, are more sensibly organized by organ system and/or type of injury. As injuries and illnesses frequently flow from a minor injury to more significant condition, having them grouped sequentially can substantially aid a care provider in determining the precise level of injury or illness, treatment, and what to look for in terms of potential worsening.)

The largest criticism I have is the decision, noted in the Introduction to the Sixth Edition to delete the dosing information for most of the drugs listed in the Medications Appendix while still providing information on indications and contraindications. This decision is nonsensical at best for a number of reasons. First, if as explained in the Introduction, all relevant information concerning dosing should be obtained from the prescribing physician, the same should be said for the indications and contraindications. Moreover, there are several scenarios and factors which are far from obscure which come to mind and support the inclusion of such information as follows:
1. Based on my experience in obtaining prescriptions for use in outdoor medical kits, the conversation with the physician never seems to cover all of the possibilities likely to be encountered. For example, different dosing regimens which might be used for the same drug for different conditions usually are not conveyed. (The Fifth Edition correctly addressed this, with just a couple of examples being the information on metranidazole, benzodiazepines, and acetazolamide.)
2. In reality, frequently medications in a wilderness medicine kit may be used for an individual who is not the person for whom they were originally prescribed. Is this perfect, no, but it will happen. Thus, the dosage information should be included so that if the medication ends up being administered to a different individual the correct dosage can be calculated. (Example from the Fifth Edition, chloramphenicol)
3. The assumption made in the editorial decision is that the individual who received the prescription and had the discussion with the physician will be available or is not the injured party. Murphy's law can rapidly disrupt this assumption.
4. Wilderness medicine is now commonly defined as including remote care more than one hour from definitive medical care, including recreational pursuits, remote living, remote work sites, disasters, and military situations. I will disregard the military as they generally produce their own references. Given the broad definition of what is to be addressed, the smarter option would be to have included less, not more information concerning the drugs. In disasters, for example, the only option may be scrounging drugs from available sources such that there is no opportunity for a consultation and the only opportunity to gain accurate information would be the reference in hand. While this may seem a remote possibility, having lived in New Orleans since 1991, it is not a remote possibility at all to my mind. Obviously, similar problems can occur with travel to other countries in which either the supply of medication brought from home is exhausted or an unforeseen need arises and a local purchase must be made. In many locales drugs that are sold as prescription only in the US are more readily available. Obviously, information should be sought from the doctor or pharmacist if possible, but having a written reference might make a difference.

Closely related to the deletion of the dosing information for medication is the omission or limitation of alternative drug listings for some diseases and conditions. Once again, given the limitations on available medications in wilderness or austere settings, the first or second choice may not be available. Auerbach gives more depth on drug options in his work on a number of diseases and conditions, although Forgey generally does not.

Ultimately, the new edition is a very thorough and complete in its coverage, with the exception of the above noted criticisms. The new edition clearly has a place on the bookshelf of any outdoor enthusiast. On the other hand, without the information noted above, it is no longer a single volume reference that will answer all needs. At a minimum, some drug reference material would now have to be carried with it for complete coverage.

I'm an ICU nurse who backpacks, skis, and sea kayaks. I help take groups of new backpackers into the woods twice a year. I came across an old addition of this book at a lodge in the Adirondacks and liked it very much. I've since bought this addition and after having it out at work some co-workers have bought it as well.

The book is extremely practical and realistic. Those in the medical field will be very comfortable with the jargon / text book style and will appreciate some of the practical solutions to things like how to make a seal for your home made chest tube out of the finger of a rubber glove... all the while muttering about how if it's gotten to that point you really are screwed. Readers without a medical background would still get the majority of the important stuff, practical splits, reductions, how to sled someone out, etc.

Since it was brought up in another review I will mention this: I think providing indication / contraindication is merely a prompt to inform you what you might need to then inquire about before you head out. I kind of think that not having the medication dosing isn't such a bad thing. If you are really that interested, there are better ways to get this info: the best being your primary care physician. Remember, you may not fall into standard dosing range. Also there may be untoward side effects which might affect you more than the average individual. Or a drug interaction with another medication you are taking which could mess you up even worse than you began. If you were in a pinch you should just use the standard dose of an indicated drug. If you are bringing meds with you in the event you might need them, dosing info should be included and could be used for anyone else needing the med in a pinch. Don't forget, in an emergency you will forget. If you knew it was safe, and you were in a place where buying those medications without prescription was an option, the local population should be able to help with an appropriate dose for you -I would assume this because that's how everyone else in that area would be figuring out their dosages.

One person had their first grand mal seizure last time we were out in the Adirondacks. Copper evacuation was very tight. Having read that brief section helped it go smoothly... Many thanks to the authors.

Last word: medical background + a day or more from the nearest road + looking for a wilderness manual = this book.

While I have no experience with previous editions, I must offer substantial praise for this book. Like the previous reviewer, my medical library also includes Auerbach's Medicine for the Outdoors and Forgey's Wilderness Medicine. All three texts have their strengths with this text ranking only slightly behind Auerbach's in my opinion.

In short, Forgey's text is much shorter but includes very practical tips for gear and medications, detailing alternative uses for most everything. It would be easier to pack than the other two and is easy to reference.

Auerbach and Wilkerson provide more extensive medical information. Wilkerson's layout is easy to navigate and can also be quickly referenced. However, I personally find Auerbach easier to read and his diagrams more helpful. Auerbach's medication index provides a quick dosing reference (lacking in this text) and is well organized by symptoms/indications but does not provide any further info or contraindications (included in this text).

Finally, certain advanced techniques such as suturing seem unnecessary in these books. The layperson should not be attempting such skills, especially in a wilderness setting, and especially if they are learning them from a textbook alone; and advanced providers with proper training probably don't need the reference at all. This and other examples may require an untrained reader to filter out information that would not be terribly relevant. There are numerous alternatives for wound closure and I can think of no 'last resort' situation that would require an amateur suture attempt in the field. However, for general knowledge of such procedures, these texts provide excellent background.

Comparisons aside, Medicine for Mountaineering serves its purpose as an instructional and reference text. You can't be too prepared. As mentioned in the previous reviewer's excellent commentary, perhaps no book has all the answers. This is an excellent place to start.