Imagine yourself deep in the heart of the Amazon rainforest, far from bustling urban centers and the comfort of modern hospitals. For me, this is where I find my true calling. After years of navigating the high-pressure environments of emergency rooms and trauma centers across Brazil, I am drawn to the unique challenges and profound rewards of remote medicine.

As a member of the Brazilian Association of Remote Area Medicine and Adventure Sports, I have participated in medical expeditions in some of the most isolated regions of the world—from India to Fiji, Israel, Africa, and the Amazon rainforest. With qualifications like Advanced Wilderness Life Support (AWLS), I have learned to lead with adaptability, improvisation, and humanism in resource-scarce environments. Now living in Israel and pursuing a master’s degree in emergency and disaster management, I continue to embrace the intersection of leadership, teamwork, and cultural diversity in medicine.
Case Study: Remote Area Trauma Management
Let me take you to one of the most challenging cases I’ve faced, set in the hinterlands of Brazil—the breathtaking but unforgiving region of Sertão do Piauí.
The Patient
Picture this: a 40-year-old man, injured in a collision between a horse and a motorcycle, arrives unconscious, tachycardic, and tachypneic, with severe cranial and mandibular injuries and active bleeding. His vital signs are critical:
Blood Pressure: 80/50 mmHg
O2 Saturation: 89%
Heart Rate: 120 bpm
Respiration Rate: 28/min
Time is of the essence in such cases. As the leader of the medical team, I delegated tasks while simultaneously coordinating care and contacting rescue teams for evacuation.
Scene Survey
Before diving into treatment, safety is paramount. Assessing the scene—whether for hazards like animals, unstable terrain, or vehicle traffic—ensures the safety of both the patient and the medical team. In this case, the scene was safe, allowing us to focus on stabilizing the patient.
For responsive patients, always obtain consent before treatment. We use the AVPU scale (Alert, Verbal response, Pain response, Unresponsive) to assess responsiveness, repeating evaluations as necessary. Triage, if applicable, helps prioritize care. In this case, triage wasn’t required, but we applied a systematic approach to ensure all critical injuries were addressed.

Primary Survey
The primary survey aims to address life-threatening conditions immediately. In remote medicine, we follow the MARCH protocol:
Massive Hemorrhage: Direct pressure and IV fluids stabilized the patient’s blood pressure. Establishing two IV lines and administering 0.9% saline raised his blood pressure significantly after 1 liter.
Airway with C-Spine Stabilization: The patient’s airway was compromised due to a mandibular fracture. Using polypropylene sutures, we cleared the airway, leading to an immediate improvement in oxygen saturation. Cervical spine stabilization was maintained using the jaw-thrust technique.
Respiration: Airway management resolved tachypnea, and lung auscultation confirmed clear airways.
Circulation: Bleeding was controlled, and thorough inspection ruled out additional sources of hemorrhage. While the patient remained tachycardic, pulses were stable.
Hypo/Hyperthermia and Evacuation: Protecting the patient from environmental conditions and coordinating with rescue teams ensured safe transport.
Secondary Survey
With the patient stabilized, we conducted a secondary survey to identify less critical but potentially serious injuries. Using the CARTS acronym (Chest, Abdomen/Pelvis, Renal/Retroperitoneum, Thigh, Skin/Street), we ruled out additional bleeding and detected only minor abrasions.
Evacuation and Follow-Up
Transporting the patient from Serra do Inácio presented unique challenges. With no ambulance access, we coordinated with local rescue teams and improvised a rigid board using wood, ropes, and cardboard for transport. Continuous monitoring ensured the patient’s stability during the 35-minute journey to meet the rescue team.
At the regional hospital, imaging revealed mandibular and rib fractures, which were managed conservatively. Follow-up care included dental treatment for trauma-induced tooth loss. Days later, the patient returned to our base, recovering well.
Conclusion
This case underscores the critical importance of structured protocols and effective leadership in remote trauma management. By adhering to these principles, we achieved the best possible outcome for the patient under challenging circumstances.
Remote area medicine demands adaptability, quick thinking, and teamwork. It challenges us to innovate and excel in the face of adversity. Can you see yourself in this scenario, making life-saving decisions in the most unpredictable environments? This is the essence of answering the call of the wild.
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