President's Note – Michael Caudell, MD, FACEP, FAWM, DiMM

I am honored to begin my term as President of ACWM and am looking forward toseeingusbecome even more active in our region. We typically don’t join in on things we aren’t interested in doing, right?  So I know everyone receiving this newsletter is interested in wilderness medicine, and is also interested in promoting communication and relationships within our region. So what’s happening?  Are we getting to busy?  Spreading ourselves too thin? I don’t know…
Prioritizing is what I have to do, and I place wilderness medicine in the Appalachian region as a very high priority.  Since you are reading this, I’m sure you do to.  So what can we do to get you to be more active with ACWM?  Give us ideas!  We have a committee structure that has been in place for a couple of years now – you should join a committee.  Please read the committee reports in this newsletter and choose to become involved.
As, part of the effort to get you to become more engaged, we decided to look at our Advisory Council and determine the best way to reach everyone.   I would like to announce that Dr. Taylor Haston, at taylor@appwildmed.org, is taking the lead on this initiative and has been named chair of the Advisory Council.  Dr. Haston completed an Emergency Medicine Residency and a Wilderness Medicine Fellowship, and currently serves as faculty for both at the Medical College of Georgia.
Lets all get involved! michael@appwildmed.org


Updates and Committee Reports:


Research Committee - Michael Caudell, MD, FACEP, FAWM, DiMM The Research Committee has submitted a paper entitled “Event Medicine in Challenging or Austere Environments: Recommendations for the Organization of Out-of-Hospital Care during Obstacle, Adventure, and Endurance Competitions” for publication.   This project was initiated via ACWM committee members led by Linda Laskowski-Jones and has resulted in an outstanding collaborative effort and product.  The paper is a great example of how interests in our region can result in new educational insights and potentially improve care in austere settings everywhere.  If you have an idea for a research project, or even an interesting wilderness medical question, or want to become involved in wilderness medicine research, please contact me atmichael@appwildmed.org

Operations Committee : We are pleased to announced we've ordered new shirts and stickers which will be available in the upcoming month on the website and at the AWLS course.

Training Committee: The annual ACWM AWLS course will be Sept 30 - Oct 2, 2016 at Wilderness Adventure outside of Roanoke, VA. This location provides tons of nearby hiking and excellent mountain biking - plus paddling opportunities on-site. As always, we'll have an awesome line up of instructors and practical scenarios. New this year we will offer Wilderness First Aid (WFA) onsite during the AWLS course. This course is appropriate for non-medical outdoor enthusiasts - so we encourage you to bring your significant others and kids (high school and up only). Lodging and food are provided in course fees. For more information: http://www.appwildmed.org/awls-course
On September 14th, 2016 from 6p- 8p at Bennett Springs Lot, Carvins Cove, Roanoke, VA the ACWM will offer a free trailside first aid workshop in conjunction with Roanoke Parks and Rec. If you are interested in helping please contact Stephanie@appwildmed.org

Advisory Council Committee : Taylor Haston, DO, MPH, DiMM Hello everyone! The ACWM is redefining what it means to be a member of the Advisory Council. I am honored to have been asked to serve as the chair for the Advisory Council for ACWM as the Center makes these changes. I am looking forward to working with everyone to get members more involved with the Center. I will be looking at different available options such as teaching opportunities, newsletter contributions, committee membership and other various activities as ways to reach more people and have more involvement.  I want your input as well and look forward to hearing any ideas, big or small, that you may have. I am excited for this opportunity.  Thanks everyone!  taylor@appwildmed.org

Newsletter Update
Do you have a cool case? Interesting photos? If you have a wilderness or environmental issue that may be of interest, please forward it to the ACWM editorial committee for inclusion in an upcoming issue of the newsletter.Please submit to Richard Salkowe at: rsalkowe@usf.edu

Medicinal and Edible Plants

Wood Sorrel
Wood Sorrel or "sourgrass" (Oxalis montana) is a North American native species and is found throughout the hardwood and remaining spruce-fir forests of southern Appalachia. The name "sourgrass" is attributable to the oxalic acid content in the plant which has a noticeable sour taste. However, this common plant has been historically utilized as a wilderness edible for millennia. Additionally, Native American Cherokee and Iroquois used wood sorrel to alleviate sore throats and nausea. The plant is identified by 3 small heart shaped leaves and grows to a maximum of approximately 15 inches. Apply wood sorrel as a seasoning by sprinkling the freshly picked flowers, seeds and leaves to fish, meat and wild greens.

Duke, J.A. 2000. Handbook of Edible Weeds. New York: CRC Press Wild Edible. 2016. http://www.wildedible.com/wild-food-guide/wood-sorrel
If you have a natural remedy or wild edible that may be of interest please forward it to the ACWM editorial committee for inclusion in an upcoming issue of the newsletter.


Blister Brief

One of the most common injuries encountered in the back country in hikers, runners and endurance athletes is a friction foot blister.  There is an estimated 30.4 million runners and 28.6 million hikers in the United States affected annually.1In military recruits, a high incidence of blister formation occurs as well (up to 93%) and those with blisters were 50% more likely to experience an additional injury due to blister formation.2,3

I’m sure most of you have experienced one in your career and know how it changes your pace, limits your distance and can sometimes end a trip.  These blisters form as a result of friction and sheer stress between epidermal layers of the skin.  The progression from hotspot to blister can sometimes occur prior to the realization one even has a problem.  There have been multiple ways to combat this ubiquitous problem.
Prevention is obviously the best method to implore to try and stop the problem before its starts.  Double layering of socks, toe-socks and preventative paper taping have all been effective ways of prevention.  But what the do you do when that burning hot spot or blister does appear?  There are many schools of thoughts on the best treatment.  I much prefer a multilayer system.  If a hot spot forms a base layer of paper tape that is breathable is preferred to be applied first if the skin is intact. If there is a clear-fluid exudate, sterile drainage is a good option to help minimize worsening friction.  This can be easily achieved with a sterilized safety pin prepped with an alcohol pad.   In more advance blister where there may be skin covering loss, I recommend a “second skin” covering with a hydrogel to act as a new breathable barrier, followed by paper tape to prevent skin tearing and a tougher adhesive layering on top such as Elastikon™. This multilayer closure works to minimize the sheer stress and get you back on the trail.


1. National Sporting Goods Association. http://www.nsga.org/i4a/pages/index.cfm? pageID=3346 2. Sian-Wei Tan S, Kok SK, Li JKY. Efficacy of a new blister prevention plaster under tropical conditions. Wilderness Environ Med, 2008; 19, 77-81 3. Akers W, Sulzberger M, The friction blister. Military Medicine, January 1972.