First-ever wilderness medicine fellowship established

STANFORD, Calif. - Stanford University Medical Center has established the first fellowship in wilderness medicine, a growing field that encompasses everything from snakebites and heat exhaustion to altitude sickness and the bends.

The yearlong fellowship created by Eric A. Weiss, MD, assistant professor of surgery (emergency medicine) at the Stanford School of Medicine, provides comprehensive, in-depth training and hands-on experience in all aspects of wilderness medicine, preparing the fellow to provide care in settings from the Amazon jungle to the heights of Mount Everest to the depths of the ocean.

Weiss, himself a wilderness medicine pioneer, envisions that those who complete the fellowship will go on to advance the field through original research, educating other physicians, and serving as a resource for organizations such as Doctors without Borders or the National Association for Search and Rescue. Those eligible for the fellowship must have completed previous training in emergency medicine.

“This program offers a great opportunity for a physician to get an in-depth education in wilderness medicine and also give back to the field by furthering our knowledge,” said Weiss, who teaches a wilderness medicine course at Stanford and gives lectures nationally on the subject.

Arthur Kaminski, MD, an emergency medicine physician from Detroit who’s had a lifelong involvement in camping and adventure travel, arrived at Stanford in July to begin his tenure as the school’s first wilderness medicine fellow. Though his particular interest is in diving medicine, he said he’s enjoying learning about all aspects of the field. “I’m here to gain knowledge of what I’d need to do in any given situation,” said Kaminski, who once improvised a splint for an arm fracture that his friend sustained while the two of them were hiking in the Amazon jungle in Brazil. “What’s great about this fellowship is that it unifies all the different niches of wilderness medicine under one program.”

Weiss said the time is right for a wilderness medicine fellowship, given the significant increase in camping, backpacking and adventure travel in recent years. He cited statistics showing that visits to U.S. national parks have increased from 220 million in 1983 to more than 400 million in 2000. “As people are spending more time in the outdoors, it’s incumbent on health-care providers to be familiar with the medical problems that can arise,” he said.

A subspecialty of emergency medicine, wilderness medicine encompasses several different areas including travel medicine, trauma management, plant- and animal-related ailments, and environmental medicine including the treatment of heat illness, hypothermia and high-altitude sickness. Although wilderness medicine has its own peer-reviewed journal, national society and annual conferences, there are few in-depth educational programs through which to learn about the field. Stanford is one of just a handful of medical schools that offer a wilderness medicine course.

The curriculum combines didactic training, research work and hands-on experience both at Stanford and off-site. Kaminski is working weekly shifts at Stanford Hospital’s emergency department, focusing on wilderness-medicine cases when they arise. In addition, he is meeting regularly for didactic sessions with Weiss and other Stanford physicians who have expertise in wilderness medicine. Kaminski will design and conduct a research project focusing on a selected area of interest – likely diving medicine. He is also learning teaching skills, which he will apply this spring when he helps teach Stanford’s wilderness medicine course.

Finally, the program includes a two-month off-site experience during which the fellow can apply and enhance his wilderness medicine knowledge. This off-site experience, Weiss explained, is designed to take advantage of Stanford’s numerous affiliations with wilderness medicine projects and expeditions around the world. The fellow, for example, could spend two months working with the Himalayan Rescue Association at the Mount Everest base camp, which is regularly staffed by Stanford faculty. Or he could provide medical care for a National Geographic expedition in Belize that is excavating Mayan ruins – an expedition for which Weiss has provided medical care in the past.

Kaminski isn’t yet sure which off-site experiences he will pursue. And he isn’t exactly sure what he wants to do after the Stanford program – though he’s considered guiding deep-sea diving trips or expeditions through the Amazon jungle. Whatever happens, though, “I know this fellowship will be helpful to me – and a lot of fun,” he said.