Abstract
This supplement of Wilderness & Environmental Medicine presents the third update of the Wilderness Medical Society clinical practice guidelines (CPGs). This update includes a new evidence grading system and marks the official change of section editors. This edition also contains updates to several prior CPGs, with additional updates coming in the next year.
Our goal as CPG section editors has been to hold authors to a high standard of evidence-based recommendations, to consider pre- and in-hospital data to support guidelines, and to keep our guidelines relevant and up-to-date. As we balance the need for timely updates and new evidence, the timing of updates and the incorporation of new recommendations are continuously revisited.
In that spirit, the CPG section editors and the evidence grading guidelines have both been updated with this supplement. Dr. Tracy Cushing has served as the WMS CPG section editor since the WMS began to publish clinical practice guidelines. She helped create the CPG committee, set the vision for adaptation of William Forgey's book of WMS practice guidelines into an evidence-based peer-reviewed journal series, and has helped the society create its most cited and read publications. After over a decade of service to the Society and work on the CPGs, with this supplement, she will be stepping down as the CPG section editor, with Dr. Hillary Irons ascending to the co-section editor position in partnership with Dr. Michael Caudell. Hillary Irons, MD, PhD has been involved in wilderness medicine research and education for over a decade. After many years as a peer reviewer with WEM, she is excited to take on this new role as co-section editor.
In addition, we have updated the verbiage and presentation of our recommendations based on the 2018 updated American College of Chest Physicians (ACCP) evidence grading guidelines. 1 The new grading system removes previous numeric classifications, and replaces them with the standard GRADE approach. This change keeps our CPGs current with other societies and publications and allows for more nuanced and specific recommendations based both on the quality and expert interpretation of the evidence.
In our previous update, we outlined our process for CPG creation, review, selection and publication. 2 In the interim, the series has published 3 new CPGs (nonfreezing cold injuries, anaphylaxis, and tick-borne illness) and the WMS has revised the structure of the Wilderness Medical Society clinical practice guidelines committee. We continue to strive for excellence as the committee reviews and revises criteria for updates, in order to provide the most meaningful and current information for wilderness medicine practitioners.