A Physical Therapist's Experience as a Point-of-Contact Care Provider in a Wilderness Environment: A Case Series Report

Abstract

Background Wilderness physical therapists (WPTs) are on-scene primary providers who combine physical therapy, emergency first aid, and wilderness survival skills to manage people with a wide array of injuries and illnesses in remote environments. Case Presentation Patient 1, a 51-year-old female, was unable to bear weight after sustaining a right knee injury from falling into a river while hiking. The WPT immobilized a suspected knee fracture using a SAM® Splint, moved the patient and her group to safer location, and constructed a shelter. Shortly after, patient 2, a 14-year-old male, fell and sustained a forehead laceration. Hemostasis was obtained and the patient was monitored for neurologic abnormalities. Safety was complicated by rainfall, darkness, and the absence of cell service to notify emergency medical services. Outcome and Follow-Up Emergency medical services arrived 4 hours after the initial injury and evacuated both individuals. Plain film radiographs of patient 1's knee were interpreted as normal; however, subsequent magnetic resonance imaging revealed a posterior tibial plateau fracture with ligamentous injury. Following a 20-hour observation period, patient 2 was returned to continue the hike with his group. Discussion This case illustrates the emergency medical, leadership, and situational awareness skills required of a WPT. This case also illustrates the in-field application of the Ottawa knee rules and the importance of careful neurologic assessment in individuals with head trauma. JOSPT Cases 2022;2(3):175–182. Epub: 21 June 2022. doi:10.2519/josptcases.2022.10944