Wilderness Medicine Clinical Practice Guidelines
Tracy Cushing, MD, MPH, FAWM
The WMS Practice Guidelines for Wilderness Emergency Care were originally published in 1987 and updated 5 times by 2006 in a chapter-based book format to provide WMS members with an “official statement” of the best methods of handling wilderness related trauma, environmental illnesses, and managing medical problems in the wilderness. While a valuable source of practical information to WMS members, as the book was coming up for revision in 2007, the WMS decided to move towards a more evidence-based, expert panel driven consensus of clinical practice guidelines that could be referenced in the medical literature as well as accessed by those outside of the society.
With the publication of “Recommendations on the Use of Epinephrine in Outdoor Education and Wilderness Settings” the new format of the WMS Clinical Practice Guidelines (WMS CPGs) was born. The guidelines are published in Wilderness & Environmental Medicine (WEM), the official journal of the WMS, and as such are available on PubMed and to individuals outside of the WMS.
The process of developing useful, unbiased CPGs is a challenge, as noted by the Institute of Medicine (IOM) in their report “Clinical Practice Guidelines We Can Trust,” as well as editorials in JAMA and Archives of Internal Medicine that raise questions as to the ability of guidelines to be developed free from bias, with external review, and with a transparent process for both author and literature inclusion. The WMS CPG committee reviews proposals for potential topics and panels, and seeks to ensure broad representation from amongst our membership in our expert panels. The literature is reviewed and graded based on the American College of Chest Physicians (ACCP) classification scheme for grading evidence and recommendations in clinical guidelines. While this grading system satisfies all recommendations of the IOM for how to grade evidence, there remains a dearth of high quality, randomized, or prospective trials in much of the wilderness medicine literature, and thus we rely also on the expertise of our authors to make recommendations based on their collective experience. The process of developing the WMS CPGs is discussed in more detail in this 2019 editorial from the CPG co-editors.
Every 5 years, author groups of each CPG will evaluate whether the CPG should be updated based on new or updated recommendations. If new evidence has become available since last publication, the author group is required to update the CPG and submit it for publication to WEM. If a CPG is determined to not need updating, it will not be updated or published in the supplement. (Years of publication for CPG supplements: 2014, 2019, 2024, 2029, 2034, etc.)
The WMS CPGs will continue to be published in a peer-reviewed, index-searchable journal. Currently in development are CPGs on fluid resuscitation, cardiovascular emergencies, ultrasound, wilderness behavioral emergencies, pediatrics, blister management, concussion/TBI, gastroenteritis, and burns.
We hope the WMS CPGs will serve as both a practical resource and as a guide for where future research in the wilderness medicine literature is needed. The CPG committee welcomes ideas and suggestions for future articles. Please contact our managing editor Anna Russell.
(Updated May 2022)
Full CPG Collection
Summaries of CPGs