RiverMedic171

03/26/2026

RiverMed snippet for the day. I carry these instead of oral glucose for hypoglycemia. Why?
They are roughly the same calorie and carbohydrate content of the more expensive and less tasty oral glucose. When they expire, I just eat them. They aren’t paste, so you have to chew them. If you can’t chew them, your mental status is likely decreased enough that I shouldn’t put something in your mouth.

They’re also nice if someone has a cold swim. It gives them a tasty treat and some energy. One has caffeine, one doesn’t. I usually save the no caffeine one for me and the other for med uses.

02/26/2026

I'll admit I hadn't really thought of this as a hazard of carrying your knife on the outside of your PFD. Bizarre freak accident, great response on the part of his fellow students. I carry my folding knife inside my PFD. I have previously done outside carry, but it's been a long time.

An accident during a training exercise left Noah Pressler bleeding from the neck. His fellow first responders stepped in with bleeding control skills.

01/22/2026

Good case study.
Would you manage it the same way?

The Setting

12/23/2020

Raft Guides and Outfitters, I have a question.

What is the minimum first aid and medical training requirement for commercial raft guides in your state?

Also, if you have any information on what is required in medical kits, that would be appreciated. I'm doing a little personal curiosity research. Thanks.

12/07/2020

Today’s quick and dirty river gear suggestion. This is one of my solutions for a compact pin kit. It fits into the Astral throw bag pouch. I had an extra one. I know some don’t care for the rope, so this is a great way to repurpose the pouch. Contents list:

15’ 9/16” tubular webbing for anchor.

3 prusiks. For a z-drag, you only need two, but they’re handy to have, like extras snacks.

2 pulleys. A third is nice for change of direction, but not mandatory. We’re keeping it light here.

3 carabiners. You can do a z-drag with 2, but an extra is handy. One is a mini-munter carabiner. The Munter Hitch is a useful and cool knot.

Throw in a good rope and you’ve got a system to unpin some boats. If you go for 1/4” ropes, I suggest Spectra and no poly due to strength concerns.

This is a light duty kit, intended for kayaks or small raft. It you pin an 18 foot gear boat, you’re going to need some big boy toys.

10/30/2020

Yes, they need to go away. The science doesn’t support the old dogma.

Explore alternative spinal stabilization strategies.

10/30/2020

Good article on C-Collars. I hope they soon will be gone, like backboards.

Much like backboards, the evidence is mounting against their frequent use.

10/01/2020

Thursday night wilderness medicine quiz, with a wildmed river p**n video.

Shoulder injuries/dislocations. Ouch!

Which is more common, anterior or posterior dislocation?

What mechanism of injury is more common in kayaking? Direct impact or indirect forces?

Scenario: You are on a remote river which definitely meets wilderness criteria for medical concerns. A kayaker in your party has taken a bad swim and struck some rocks with his shoulder. You note some deformity to the right shoulder, as well as ecchymosis and edema. Pulses and sensation are present in the right arm. No other injuries are present.

Using your well honed skills, would you treat this as a shoulder dislocation and attempt to reduce (put back in place) this injury or not? Tell me why.

Ready, set, go! Save a life!

My friend and long time paddling partner dislocated his left arm in Tunnel Falls on the Colorado River. A rapid located in the the middle of Gore Canyon and ...

09/24/2020

Whitewater rescue scenario...let's play.

You and your paddling crew have just completed the rescue and kayak unpinning of one of your party, taking about an hour. A WFR in your group has just reduced and applied a sling to his right shoulder dislocation. In addition to some right should pain, your patient complains of a headache (tagged a rock with his head during the swim), cervical spine pain and tenderness, as well as being wet and cold. He is a conscious, alert, oriented, 30 year old male with no complicating medical history, is able to walk unassisted, has no neurological deficits and did not lose consciousness. Medically, your situation is stable and under control. Taco, your Class V rated river dog is providing needed K9 therapy to the injured and rescuers alike.

You are halfway through a ten mile Class IV river trip with several significant, but straightforward rapids ahead. You have about three hours of good daylight left, the water is 55 degrees, the weather is dry, with air temperature in the 70's with 50's and deteriorating weather forecast overnight. You have one oar rig raft, one paddle raft and now four kayakers. Your crew is wearing a mix of drysuits, drytops and wetsuits. Several people got very wet and cold during the rescue. You don't have much extra clothing, but you can make fire. There is no cell service, no satellite phone, and the area is remote. There is a steep and rocky 3 mile trail, which leads to a fire road, near your location.

Your patient assessment findings cannot reliably rule out a spinal injury. Given these findings, group situation and location, you must now determine the safest way to evacuation your patient. Taco is enjoying all the attention, but he says it's time to execute a plan. Trust the river dog, always.

What's your plan?

What factors influence your planned evacuation method?

Do you need any more information to make your decision?

09/24/2020

This is still one of my favorite Nealy illustrations. Take wilderness first aid class. Learn things.

09/24/2020

It’s starting to get chilly out there. Review hypothermia management with the Wilderness Medical Society clinical practice guidelines.

To provide guidance to clinicians, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide rec...