In this episode of Wilderness Medicine Updates, host Patrick Fink interviews Moose Mutlow, an experienced outdoor educator and search and rescue professional with nearly four decades of experience globally. Moose discusses his extensive career from being an Outward Bound instructor to working with Yosemite Search and Rescue, and his role as a Family Liaison Officer for the National Park Service. The conversation touches on the challenges faced by search and rescue teams, the importance of robust communication skills, and how to build resilience against trauma in high-stress professions. Moose also shares his personal experiences, reflecting on the value of mentorship, the significance of team dynamics, and the essential need for compassionate support during crises. The episode includes practical advice for those in the field of wilderness medicine and search and rescue, highlighting the necessity of emotional balance and continuous learning.

Connect with Moose:
Website
Blue Sky
Instagram
Substack
Book: Searching
Book: When Accidents Happen

Did you enjoy this episode? Contribute to YOSAR!

Links from the show:
The Stress Continuum
Responder Alliance
Quell Foundation
Dr. Nicola Lester: trauma informed practice

More Reading:
Ranger Confidential
Nature Noir
The Cold Vanish
The Last Season

CHAPTERS
00:00 Introduction and Guest Welcome
00:19 Moose Motlow's Background and Career
01:58 Challenges in Search and Rescue
02:58 The Importance of National Parks
05:23 Moose's Nickname and Early Career
07:07 Transition to the US and Outdoor Adventures
10:54 Search and Rescue Experiences
15:20 Swift Water Rescue Operations
19:38 Training and Mentorship in SAR
30:18 Role of Family Liaison Officer
45:24 Managing Emotional Burden as a Liaison Officer
47:12 Recognizing and Addressing Trauma
48:36 The Importance of Peer Support
49:44 Cultural Norms and Vulnerability
51:05 The Cost of Ignoring Trauma
53:37 Building Resilience and Longevity in C

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode, we dive into one of the most overlooked but deadly hazards in deep powder skiing: snow immersion suffocation (NARSID). Unlike avalanches, snow immersion deaths happen silently—often within feet of a groomed run—when skiers and snowboarders fall into deep snow or tree wells and become trapped. We explore the research behind these incidents, where and how they occur, who is most at risk, and the tragic mechanics of asphyxiation in deep snow. Using studies from Van Tilburg, Baugher, and Cadman, we break down ra eal survival story, discuss prevention strategies, and how both bystanders and professional rescuers should respond. Whether you’re a backcountry adventurer, resort skier, or ski patroller, this episode will change the way you think about deep snow safety. Stay aware, ski with a partner, and stay out of tree wells.

Must Watch: GoPro Awards: Tree Well Rescue

Citations

Baugher, P. (2006). Risk trends at U.S. and British Columbia ski areas: An evaluation of the risk of snow immersion versus avalanche burials. In Proceedings of the 2006 International Snow Science Workshop (pp. 584–591). International Snow Science Workshop.
URL: https://arc.lib.montana.edu/snow-science/item/2076

Cadman, R. (1999). Eight nonavalanche snow-immersion deaths: A 6-year series from British Columbia ski areas. The Physician and Sportsmedicine, 27(13), 31–43.
URL: (No publicly available link found—may be available through institutional access)

Van Tilburg, C. (2010). Non–avalanche-related snow immersion deaths: Tree well and deep snow immersion asphyxiation. Wilderness & Environmental Medicine, 21(3), 257–261.
URL: https://doi.org/10.1016/j.wem.2010.04.004

Van Tilburg, C. S., Grissom, C. K., Zafren, K., McIntosh, S. E., Radwin, M. I., Paal, P., et al. (2017). Wilderness Medical Society practice guidelines for the prevention and management of avalanche and non-avalanche snow burial accidents. Wilderness & Environmental Medicine, 28(1), 23–42.
URL: https://doi.org/10.1016/j.wem.2016.10.001

Chapters
00:00 Introduction: The Hidden Dangers of Snow Immersion
00:37 Understanding Snow Immersion Suffocation
02:58 Historical Context and Research
03:09 Where and How Snow Immersion Happens
04:54 Mechanics of Snow Immersion Traps
06:23 Risk Factors and Victim Profiles
09:27 Prevention and Safety Measures
11:48 Rescue Techniques and Immediate Response
13:34 Professional Rescuer Guidelines
16:12 Advanced Medical Care and Resuscitation
20:11 Conclusion and Final Thoughts

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

King Tube vs IGEL for Airway Management

In this episode of Wilderness Medicine Updates, Dr. Patrick Fink addresses a listener's question on whether to use a King Tube or an IGEL as an out-of-hospital airway adjunct. The episode begins with an overview of airway management techniques from mouth-to-mouth resuscitation to supraglottic airway devices. Dr. Fink explains the benefits and drawbacks of various airway adjuncts, including oral and nasal pharyngeal airways. The discussion then shifts to a detailed comparative analysis of King Tubes and IGELs based on retrospective and prospective studies. Dr. Fink evaluates the evidence indicating that IGEL may be more effective and easier to use than King Tubes, particularly in pre-hospital cardiac arrest situations. The episode concludes with recommendations for pre-hospital providers and an encouragement for listeners to share their questions and feedback.

Links:

iGel LMA

King Tube

Smida T, Menegazzi J, Scheidler J, et al. A retrospective comparison of the King Laryngeal Tube and iGel supraglottic airway devices: A study for the CARES surveillance group. Resuscitation. 2023;188:109812. doi:10.1016/j.resuscitation.2023.109812

Smida, Tanner & Menegazzi, James & Crowe, Remle & Scheidler, James & Salcido, David & Bardes, James. (2023). A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehospital emergency care. 28. 1-13. 10.1080/10903127.2023.2169422.

Lønvik, M.P., Elden, O.E., Lunde, M.J. et al. A prospective observational study comparing two supraglottic airway devices in out-of-hospital cardiac arrest. BMC Emerg Med 21, 51 (2021). https://doi.org/10.1186/s12873-021-00444-0

Chapters

00:00 Introduction and Listener Question

00:55 Understanding Airway Adjuncts

02:12 Basic Airway Management Techniques

06:34 Advanced Airway Devices: King Tube and LMA

11:35 Comparative Studies on Airway Devices

17:35 Prospective Data and Final Thoughts

25:24 Conclusion and Listener Engagement

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.