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Journal Cover Wilderness & Environmental Medicine
  [SJR: 0.49]   [H-I: 29]   [3 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1080-6032
   Published by Elsevier Homepage  [3039 journals]
  • 2016 Wilderness & Environmental Medicine Peer Reviewers
    • Authors: Alicia Byrne
      Abstract: Publication date: Available online 30 January 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Alicia Byrne

      PubDate: 2017-02-18T01:26:44Z
      DOI: 10.1016/j.wem.2017.01.001
  • Turning Submissions Into a Journal
    • Authors: Neal W. Pollock
      Abstract: Publication date: Available online 2 February 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Neal W. Pollock

      PubDate: 2017-02-05T23:19:28Z
      DOI: 10.1016/j.wem.2017.01.002
  • In reply to Drs Sikri, Bhattachar, and Thapa
    • Authors: James S. Lawrence; Stephen A. Reid
      Abstract: Publication date: Available online 1 February 2017
      Source:Wilderness & Environmental Medicine
      Author(s): James S. Lawrence, Stephen A. Reid

      PubDate: 2017-02-05T23:19:28Z
      DOI: 10.1016/j.wem.2016.11.004
  • Lymphangitis from Scolopendra heros Envenomation: The Texas Redheaded
    • Authors: Shannon E. Essler; Maneesha Julakanti; Andrew L. Juergens
      Abstract: Publication date: Available online 11 January 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Shannon E. Essler, Maneesha Julakanti, Andrew L. Juergens
      Envenomation by Scolopendra heros, the Texas redheaded centipede, can present variably. Although transient pain and erythema are often treated conservatively, complications may include cellulitis, necrosis, myocardial infarction, and rhabdomyolysis. We present a case of an elderly man who came to the emergency department with lymphangitis and dermatitis secondary to a centipede sting that awoke him from sleep. It is important to recognize the potential of centipede envenomation to have severe local and systemic manifestations.

      PubDate: 2017-01-15T21:24:29Z
      DOI: 10.1016/j.wem.2016.11.003
  • Severe Hemorrhagic Syndrome After Lonomia Caterpillar Envenomation in the
           Western Brazilian Amazon: How Many More Cases Are There?
    • Authors: João Hugo A. Santos; Sâmella S. Oliveira; Eliane C. Alves; Iran Mendonça-da-Silva; Jacqueline A.G. Sachett; Antonio Tavares; Luiz Carlos Ferreira; Hui Wen Fan; Marcus V.G. Lacerda; Wuelton M. Monteiro
      Abstract: Publication date: Available online 10 January 2017
      Source:Wilderness & Environmental Medicine
      Author(s): João Hugo A. Santos, Sâmella S. Oliveira, Eliane C. Alves, Iran Mendonça-da-Silva, Jacqueline A.G. Sachett, Antonio Tavares, Luiz Carlos Ferreira, Hui Wen Fan, Marcus V.G. Lacerda, Wuelton M. Monteiro
      Contact with Lonomia caterpillars can cause a hemorrhagic syndrome. In Brazil, Lonomia obliqua and Lonomia achelous are known to cause this venom-induced disease. In the Brazilian Amazon, descriptions of this kind of envenomation are scarce. Herein, we report a severe hemorrhagic syndrome caused by Lonomia envenomation in the Amazonas state, Western Brazilian Amazon. The patient showed signs of hemorrhage lasting 8 days and required Lonomia antivenom administration, which resulted in resolution of hemorrhagic syndrome. Thus, availability of Lonomia antivenom as well as early antivenom therapy administration should be addressed across remote areas in the Amazon.

      PubDate: 2017-01-15T21:24:29Z
      DOI: 10.1016/j.wem.2016.11.001
  • On Rope Looking Up
    • Authors: Joshua E. Lane
      Abstract: Publication date: Available online 10 January 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Joshua E. Lane

      PubDate: 2017-01-15T21:24:29Z
      DOI: 10.1016/j.wem.2016.10.003
  • On Trails: An Exploration, Robert Moor. Simon & Schuster, New
           York, NY (2016)
    • Authors: Cindy Bitter
      Abstract: Publication date: Available online 28 December 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Cindy Bitter

      PubDate: 2017-01-06T20:22:19Z
  • Ethics and Oversight in Publication
    • Authors: Neal W. Pollock
      First page: 449
      Abstract: Publication date: December 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 4
      Author(s): Neal W. Pollock

      PubDate: 2016-12-06T08:56:06Z
      DOI: 10.1016/j.wem.2016.10.001
  • Circadian Rhythm and Sleep During Prolonged Antarctic Residence at Chinese
           Zhongshan Station
    • Authors: Nan Chen; Quan Wu; Yanlei Xiong; Guang Chen; Dandan Song; Chengli Xu
      Pages: 458 - 467
      Abstract: Publication date: December 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 4
      Author(s): Nan Chen, Quan Wu, Yanlei Xiong, Guang Chen, Dandan Song, Chengli Xu
      Objective Residence at Zhongshan Station (69°22′24″S, 76°22′40″E) for over 1 year exposes winter-over members to marked changes of light−dark cycle, ranging from the constant daylight of polar days to the constant darkness of polar nights, in addition to geographic and social isolation. This extreme photoperiodic environment may increase the risk of sleep disturbances and circadian desynchrony. The aim of this study was to investigate the circadian rhythm and sleep phase of Chinese winter-over expeditioners at Zhongshan Station. Methods This study was conducted on 17 healthy male participants before departure from Shanghai and during residence at Zhongshan Station for 1 year (before winter, mid-winter, and end of winter). Sequential urine samples over 48 hours were obtained, 6-sulphatoxymelatonin in urine was assessed, and the circadian rhythm was analyzed by a cosine curve-fitting method. Participants’ sleep parameters were obtained from wrist actigraphy and sleep logs. Morningness-Eveningness Questionnaire and Seasonal Pattern Assessment Questionnaire were completed. Results The acrophase of 6-sulphatoxymelatonin rhythm, sleep onset, sleep offset, and mid-sleep time were delayed significantly (P < .05) in Antarctica relative to departure values. The subjects had greater eveningness preference (P < .05) in mid-winter in Antarctica. The Global Seasonality Score and the prevalence of subsyndromal seasonal affective disorder increased (P < .05) during winter. Conclusions Our results indicate that during polar nights Chinese expeditioners experienced the following problems: delayed circadian rhythm and sleep phase, later chronotype, and incidence of subsyndromal seasonal affective disorder. An appropriate combination of artificial bright light during dark winter months and a strict social schedule are recommended in a winter-over station in Antarctica.

      PubDate: 2016-12-06T08:56:06Z
      DOI: 10.1016/j.wem.2016.07.004
  • Clinical and Epidemiological Aspects of Scorpionism in the World: A
           Systematic Review
    • Authors: Maria S.V. Santos; Cláudio G.L. Silva; Basílio Silva Neto; Cícero R.P. Grangeiro Júnior; Victor H.G. Lopes; Antônio G. Teixeira Júnior; Deryk A. Bezerra; João V.C.P. Luna; Josué B. Cordeiro; Jucier Gonçalves Júnior; Marcos A.P. Lima
      Pages: 504 - 518
      Abstract: Publication date: December 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 4
      Author(s): Maria S.V. Santos, Cláudio G.L. Silva, Basílio Silva Neto, Cícero R.P. Grangeiro Júnior, Victor H.G. Lopes, Antônio G. Teixeira Júnior, Deryk A. Bezerra, João V.C.P. Luna, Josué B. Cordeiro, Jucier Gonçalves Júnior, Marcos A.P. Lima
      Objective Scorpion stings are registered worldwide, but the incidence and the features of the envenomations vary depending on the region. The aim of this review was to summarize the epidemiological, clinical, diagnostic, and therapeutic data worldwide regarding humans stung by scorpions. Methods A systematic review of the literature was conducted through the online databases of the Virtual Health Library (VHL), which hosts Medline and the Latin American and Caribbean Center on Health Sciences Informational (LILACS) database. We selected articles published between January 1, 2002 and July 31, 2014. Results Scorpion envenomation reports were found throughout the world, mainly in subtropical and tropical regions. The clinical manifestations were sympathetically and parasympathetically mediated, depending on the species of scorpion. Some of the most common severe complications of scorpionism included respiratory distress syndrome, pulmonary edema, cardiac dysfunction, impaired hemostasis, pancreatitis, and multiple organ failure. Scorpion envenomation could be classified as mild, moderate, and severe, and the therapeutic approach was based on the case severity. The treatment comprised 3 components: symptomatic measures, vital functions support, and injection of antivenom. Moreover, the time that elapsed between the sting and administration of the appropriate medical care was extremely important to the patient’s prognosis. Conclusions The large number of scorpion stings worldwide is concerning and reaffirms the need for new prevention measures and policies to reduce the incidence, prevalence, morbidity, and mortality rates from these poisonous arachnids.

      PubDate: 2016-12-06T08:56:06Z
      DOI: 10.1016/j.wem.2016.08.003
  • In Response to RECCO in Avalanche Rescue by Grasegger et al
    • Authors: Mathieu Pasquier; Alexandre Gnaegi; Olivier Hugli
      Pages: 533 - 534
      Abstract: Publication date: December 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 4
      Author(s): Mathieu Pasquier, Alexandre Gnaegi, Olivier Hugli

      PubDate: 2016-12-06T08:56:06Z
      DOI: 10.1016/j.wem.2016.06.051
  • Report of a New Human Death Caused by a Giant Anteater in Brazil
    • Authors: Vidal Haddad Junior; Jenerson França Nunes
      Pages: 535 - 537
      Abstract: Publication date: December 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 4
      Author(s): Vidal Haddad Junior, Jenerson França Nunes

      PubDate: 2016-12-06T08:56:06Z
      DOI: 10.1016/j.wem.2016.07.003
  • Peer Review and Wilderness &amp; Environmental Medicine
    • Authors: Neal W. Pollock
      Pages: 353 - 354
      Abstract: Publication date: September 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 3
      Author(s): Neal W. Pollock

      PubDate: 2016-09-03T07:28:12Z
      DOI: 10.1016/j.wem.2016.07.001
  • Pathophysiologic Determination of Frostbite Under High Altitude
           Environment Simulation in Sprague-Dawley Rats
    • Authors: Jie Hu; Hua Li; Xiliang Geng; Lin Jiao; Hongping Song; Lin Lou; Mingke Jiao
      Pages: 355 - 363
      Abstract: Publication date: Available online 7 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Jie Hu, Hua Li, Xiliang Geng, Lin Jiao, Hongping Song, Lin Lou, Mingke Jiao
      Objectives Pathophysiologic changes of frostbite have been postulated but rarely understood, especially the changes caused by chilly high altitude environment. Therefore, we investigated the pathophysiologic changes of high altitude frostbite (HAF) caused by cold and hypoxia. Methods Forty Sprague-Dawley rats were randomly divided into 5 equal groups, namely, control, superficial HAF (S-HAF), partial-thickness HAF (PT-HAF), full-thickness HAF (FT-HAF), and partial-thickness normal frostbite (PT-NF) groups. The S-HAF, PT-HAF, and FT-HAF groups were fed under hypobaric hypoxic conditions simulating an altitude of 5000 m. Then, the PT-NF, S-HAF, PT-HAF, and FT-HAF models were constructed by controlling the duration of the direct freezing by liquid nitrogen. Animal vital signs were measured after the operation, and histopathologic changes were observed after routine hematoxylin and eosin staining. In addition, the microcirculation of frostbite tissues was monitored and compared by contrast ultrasonography during wound healing. Results The S-HAF, PT-HAF, and FT-HAF groups showed significant differences in the microcirculatory and histopathologic changes in the various tissue layers (P < .05). In addition, combined cold and hypoxia caused more damage to frostbite tissue than pure cold. The circulation recovery of HAF models was significantly slower relative to NF models (P < .05). Conclusions A safe and reproducible HAF model was proposed. More important, pathophysiologic determination of HAF provided the foundation and potential for developing novel and effective frostbite therapies.

      PubDate: 2016-07-11T03:54:39Z
      DOI: 10.1016/j.wem.2016.03.004
  • Electrocardiographic Responses to Deer Hunting in Men and Women
    • Authors: Steven D. Verba; Brock T. Jensen; Jeffrey S. Lynn
      Pages: 364 - 370
      Abstract: Publication date: Available online 7 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Steven D. Verba, Brock T. Jensen, Jeffrey S. Lynn
      Objective Deer hunting includes various stimuli resulting in augmented sympathetic activity, increased heart rate (HR) response, and rhythm changes. Collectively, these superimposed stresses may increase an individual’s risk for cardiovascular events. We undertook this study to evaluate HR and rhythm responses in multiple phases of deer hunting in men and women with and without cardiovascular disease (CVD). Methods Nineteen participants age 38.3 ± 13.8 years (mean ± SD) with body mass index 29.2 ± 6.9 kg/m2 followed their normal hunting routine. HR and rhythm were recorded continuously during the hunt using a small leadless electrocardiogram (ECG) patch monitor. Results Data were collected on 13 of 19 hunters while hiking. Three hunters recorded HR ≥85% of their age-predicted heart rate maximum (HRmax) for 1 to 2 minutes. Arrhythmias were detected in both participants with CVD and in 8 without CVD. Recorded rhythms included premature atrial, junctional, and ventricular complexes. Six hunters climbed a tree stand; 3 of them recorded HR ≥85% HRmax with sustained elevated HR response for 2 to 3 minutes with premature junctional contractions. Four of 19 participants dragged deer carcasses. During the drag, 1 male hunter recorded an HR of 91% HRmax, and another male hunter without CVD recorded an exercise-induced ischemic ECG. Fifteen of 19 hunters experienced “buck fever” (acute extreme excitation), with 7 reaching ≥85% HRmax for up to 1 minute. Ventricular bigeminy and trigeminy and ventricular couplets were observed in 1 subject during buck fever. Conclusions Men and women with and without CVD recorded substantial increases in HR and clinically relevant arrhythmias while deer hunting.

      PubDate: 2016-07-11T03:54:39Z
      DOI: 10.1016/j.wem.2016.03.005
  • Association of Cognitive Performance with Time at Altitude, Sleep Quality,
           and Acute Mountain Sickness Symptoms
    • Authors: Amine N. Issa; Nicole M. Herman; Robert J. Wentz; Bryan J. Taylor; Doug C. Summerfield; Bruce D. Johnson
      Pages: 371 - 378
      Abstract: Publication date: Available online 22 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Amine N. Issa, Nicole M. Herman, Robert J. Wentz, Bryan J. Taylor, Doug C. Summerfield, Bruce D. Johnson
      Objective It is well documented that cognitive performance may be altered with ascent to altitude, but the association of various cognitive performance tests with symptoms of acute mountain sickness (AMS) is not well understood. Our objective was to assess and compare cognitive performance during a high-altitude expedition using several tests and to report the association of each test with AMS, headache, and quality of sleep. Methods During an expedition to Mount Everest, 3 cognitive tests (Stroop, Trail Making, and the real-time cognitive assessment tool, an in-house developed motor accuracy test) were used along with a questionnaire to assess health and AMS. Eight team members were assessed pre-expedition, postexpedition, and at several time points during the expedition. Results There were no significant differences (P >.05) found among scores taken at 3 time points at base camp and the postexpedition scores for all 3 tests. Changes in the Stroop test scores were significantly associated with the odds of AMS (P <.05). The logistic regression results show that the percent change from baseline for Stroop score (β = −5.637; P = .032) and Stroop attempts (β = −5.269; P = .049) are significantly associated with the odds of meeting the criteria for AMS. Conclusions No significant changes were found in overall cognitive performance at altitude, but a significant relationship was found between symptoms of AMS and performance in certain cognitive tests. This research shows the need for more investigation of objective physiologic assessments to associate with self-perceived metrics of AMS to gauge effect on cognitive performance.

      PubDate: 2016-07-29T04:34:32Z
      DOI: 10.1016/j.wem.2016.04.008
  • Point-of-use Unit Based on Gravity Ultrafiltration Removes Waterborne
           Gastrointestinal Pathogens from Untreated Water Sources in Rural
    • Authors: Cristóbal Chaidez; Juan R. Ibarra-Rodríguez; José Benigno Valdez-Torres; Marcela Soto; Charles P. Gerba; Nohelia Castro-del Campo
      Pages: 379 - 385
      Abstract: Publication date: September 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 3
      Author(s): Cristóbal Chaidez, Juan R. Ibarra-Rodríguez, José Benigno Valdez-Torres, Marcela Soto, Charles P. Gerba, Nohelia Castro-del Campo
      Objective In developing countries, rural communities often face the lack of potable water infrastructure and must rely on untreated sources for drinking, which are often contaminated with waterborne pathogens. The use of home water treatment devices is seen as one means of reducing the risk of exposure to waterborne pathogens. The aim of this study was to evaluate the microbiological and physicochemical performance of a simple in-home point-of-use device based on gravity ultrafiltration through an ultrafilter membrane. Methods Twenty-five randomly selected households from 2 rural communities in Culiacán, Mexico, were enrolled. Water samples were collected before and after treatment and during storage for a period of 8 weeks. Heterotrophic bacteria, total coliforms, fecal coliforms, Escherichia coli, and Giardia spp were quantified, as well as various physicochemical parameters. Results All of the untreated water samples contained high levels of indicator bacteria, but none were detected in the treated water fulfilling the requirements set by the Mexican Norm (NOM-127-SSA1-1994) and the World Health Organization guidelines for drinking water. However, indicator bacteria (fecal coliforms and E coli) were detected in every sample from water stored 24 hours after treatment. Conclusion This study demonstrated that point-of-use filters using gravity-fed ultrafilters are a low-cost, effective water treatment technology for water of poor microbial quality. However, further identification of the sources and mechanisms by which water is contaminated when stored after treatment will help with designing and implementing better strategies for keeping water safe for domestic use.

      PubDate: 2016-09-03T07:28:12Z
      DOI: 10.1016/j.wem.2016.05.006
  • Thermoregulation During Extended Exercise in the Heat: Comparisons of
           Fluid Volume and Temperature
    • Authors: Walter S. Hailes; John S. Cuddy; Kyle Cochrane; Brent C. Ruby
      Pages: 386 - 392
      Abstract: Publication date: September 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 3
      Author(s): Walter S. Hailes, John S. Cuddy, Kyle Cochrane, Brent C. Ruby
      Objective This study aimed to determine the physiological and thermoregulatory responses of individuals exercising in the heat (US military red flag conditions, wet-bulb globe temperature 31.5–32.2ºC) while consuming varied volumes of ambient temperature water and ice slurry. Methods Participants (N = 12) walked on a treadmill for 3 hours at approximately 40% peak aerobic capacity in a hot environment while consuming ambient temperature (35.5°C) water (W), ice slurry (0°C, two-thirds shaved ice and one-third water) at a ratio of 2 g·kg-1 body mass every 10 minutes (FS), and reduced volume ice slurry as described at a rate of 1 g·kg-1 body mass every 10 minutes (HS). Trials were completed at least 14 days apart, in a randomized, repeated measures design. Results Percent body weight loss was higher during the HS trial (1.8 ± 0.01%) compared with FS (0.5 ± 0.01%; P < .001) and W (0.6 ± 0.01%; P < .001). Mean rectal temperature at 3 hours was lower during FS (37.8 ± 0.7°C) compared with HS (38.1 ± 0.8°C) and W (38.2 ± 0.8°C) (P = .04 vs HS, and P = .005 vs W, main effect for trial). No differences were found in rectal temperature between HS and W. Heart rate was lower at the end of the third hour during FS (141 ± 10 beats/min) compared with HS (157 ± 19 beats/min) and W (154 ± 18 beats/min) (P = .001 and P = .007, respectively, time × trial interaction). There were no differences in heart rate between HS and W. Conclusions The temperature of consumed fluids may be as important as the volume for the management of thermoregulation and other physiological responses for extended work in hot environments.

      PubDate: 2016-09-03T07:28:12Z
      DOI: 10.1016/j.wem.2016.06.004
  • Improvising a Posterior Nasal Pack with Equipment in a Basic First Aid Kit
    • Authors: Allison K. Royer; Mark C. Royer
      Pages: 393 - 396
      Abstract: Publication date: Available online 26 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Allison K. Royer, Mark C. Royer
      Posterior epistaxis is a serious condition that can be difficult to treat in a wilderness setting. The initial standard of care involves packing the affected nostril with a 7 to 9 cm nasal pack to tamponade the bleed. These packs are often unavailable outside of the emergency or operating room. This study set out to determine whether a posterior nasal pack could be constructed from the supplies present in a basic first aid kit in order to control massive nasal hemorrhage in a wilderness setting. A basic first aid kit was utilized to construct a posterior nasal pack that was inserted into an anatomical model and visibly compared with the Rapid Rhino (Posterior, 7.5 cm; Smith & Nephew, Austin, TX) nasal packing. The shape, size, and anatomical areas of compression (ie, into nasopharynx and posterior aspect of inferior turbinate) of this pack was similar to the commercially available posterior nasal pack. Placement in an anatomical model appears to provide similar compression as the commercially available posterior pack. This technique may provide short-term hemorrhage control in cases of serious posterior nasal hemorrhage where standard treatment options are not available.

      PubDate: 2016-07-29T04:34:32Z
      DOI: 10.1016/j.wem.2016.06.001
  • Myopic Changes in a Climber after Taking Acetazolamide and the Use of
           Corrective Lenses to Temporize Symptoms: A Case Report from Mount
    • Authors: Adam D. Hill
      Pages: 397 - 400
      Abstract: Publication date: Available online 5 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Adam D. Hill
      When performing detailed tasks related to climbing or hiking, accurate vision is important for safety. Acetazolamide is a medication commonly used to prevent acute mountain sickness, but it has an uncommon side effect of transient myopia. Reports of this side effect are mainly associated with its use in obstetrics, where it is often prescribed in higher doses than used in acute mountain sickness prophylaxis. We describe the case of a climber taking low-dose acetazolamide who developed transient myopia. We further describe potential mechanisms of this rare side effect as well as a novel approach of field management utilizing possible materials at hand.

      PubDate: 2016-07-06T02:12:41Z
      DOI: 10.1016/j.wem.2016.04.002
  • Inducing Therapeutic Hypothermia in Cardiac Arrest Caused by Lightning
    • Authors: Dane Scantling; Brian Frank; Mathew E. Pontell; Sandra Medinilla
      Pages: 401 - 404
      Abstract: Publication date: Available online 21 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Dane Scantling, Brian Frank, Mathew E. Pontell, Sandra Medinilla
      Only limited clinical scenarios are grounds for induction of therapeutic hypothermia. Its use in traumatic cardiac arrests, including those from lightning strikes, is not well studied. Nonshockable cardiac arrest rhythms have only recently been included in resuscitation guidelines. We report a case of full neurological recovery with therapeutic hypothermia after a lightning-induced pulseless electrical activity cardiac arrest in an 18-year-old woman. We also review the important pathophysiology of lightning-induced cardiac arrest and neurologic sequelae, elaborate upon the mechanism of therapeutic hypothermia, and add case-based evidence in favor of the use of targeted temperature management in lightning-induced cardiac arrest.

      PubDate: 2016-07-23T04:23:32Z
      DOI: 10.1016/j.wem.2016.05.003
  • Significant Traumatic Intracranial Hemorrhage in the Setting of Massive
           Bee Venom–Induced Coagulopathy: A Case Report
    • Authors: Kelsey Stack; Lindsey Pryor
      Pages: 405 - 408
      Abstract: Publication date: Available online 15 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Kelsey Stack, Lindsey Pryor
      Bees and wasps of the Hymenoptera order are encountered on a daily basis throughout the world. Some encounters prove harmless, while others can have significant morbidity and mortality. Hymenoptera venom is thought to contain an enzyme that can cleave phospholipids and cause significant coagulation abnormalities. This toxin and others can lead to reactions ranging from local inflammation to anaphylaxis. We report a single case of a previously healthy man who presented to the emergency department with altered mental status and anaphylaxis after a massive honeybee envenomation that caused a fall from standing resulting in significant head injury. He was found to have significant coagulopathy and subdural bleeding that progressed to near brain herniation requiring emergent decompression. Trauma can easily occur to individuals escaping swarms of hymenoptera. Closer attention must be paid to potential bleeding sources in these patients and in patients with massive bee envenomation.

      PubDate: 2016-07-23T04:23:32Z
      DOI: 10.1016/j.wem.2016.05.005
  • HEMS in Alpine Rescue for Pediatric Emergencies
    • Authors: Stefan Taubenböck; Wolfgang Lederer; Marc Kaufmann; Gunnar Kroesen
      Pages: 409 - 414
      Abstract: Publication date: Available online 1 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Stefan Taubenböck, Wolfgang Lederer, Marc Kaufmann, Gunnar Kroesen
      Objective The objective of this study was to describe the pediatric emergencies encountered by the Christophorus-1 helicopter emergency medical service (HEMS) during a period of 2 years. Methods Emergency treatment of pediatric casualties by HEMS was evaluated at a helicopter base. Children up to 14 years who were treated by HEMS emergency physicians from Christophorus-1 during primary missions in the alpine region were retrospectively enrolled. Results Of the 1314 HEMS operations conducted during a 2-year investigation period, pediatric emergencies accounted for 114 (8.7%). Trauma was the most common emergency indication (91.3%) in alpine areas, and 77.5% of the indications were related to skiing and snowboarding; 11.3% of the prehospital pediatric emergencies were classified as life-threatening. Interventions on site were rendered in 46.3% of cases. Mean and SD intervals for approach were 11.0 ± 3.0 minutes; for treatment, 14.0 ± 6.0 minutes; and for transport, 8.0 ± 4.0 minutes. Intervals on site were significantly longer whenever it was necessary to search for an interim landing place (P < .001) or perform rope extrication (P < .001). Aggravating environmental conditions such as low temperature (78.8%), rocky terrain (18.8%), or precipitation (12.5%) were common. Conclusions Rapid procedures are preferred to sustained on-scene treatment, particularly when surrounding conditions are hostile. HEMS emergency physicians attempt to keep on-site intervals short and treatment and monitoring to the essential to minimize delay in rescue.

      PubDate: 2016-07-06T02:12:41Z
      DOI: 10.1016/j.wem.2016.03.001
  • Epidemiology of Feature-Specific Injuries Sustained by Skiers in a Snow
    • Authors: Luis Carús; María Escorihuela
      Pages: 415 - 420
      Abstract: Publication date: Available online 7 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Luis Carús, María Escorihuela
      Objective The objective of the present case series study was to analyze injury types and injured anatomic locations resulting from skiing in snow park (SP) features and to determine potential risk factors for ski injuries in an SP. Methods The study was conducted during the 2013–2014 winter season in the SP of a major winter resort located in the Spanish Pyrenees. Cases involved skiers who experienced feature-related injuries in the SP. A total of 113 cases met the inclusion criteria. Logistic regression was used to calculate the odds of injury types and injury to anatomic locations on aerial versus nonaerial features. Results The overall injury rate was 0.9 per 1000 skier runs. The proportion of injuries was higher for aerials (1.18% of uses) than for nonaerials (0.66% of uses). Results revealed that the upper extremities were the most commonly injured body region, and sprains/strains/dislocations and fractures were the most common injury type. Conclusions The most commonly injured anatomic location on nonaerial features was the face, while on aerial features it was the head. A higher proportion of fractures was observed on aerial features, while a higher proportion of sprains/strains/dislocations was observed on nonaerial features. Prevention strategies to reduce injury risk include SP redesign, safety and communication policies, instruction on technical skills, and promotion of the use of protective equipment.

      PubDate: 2016-07-11T03:54:39Z
      DOI: 10.1016/j.wem.2016.05.001
  • Ocular Jellyfish Stings: Report of 2 Cases and Literature Review
    • Authors: Chen Mao; Chien-Chin Hsu; Kuo-Tai Chen
      Pages: 421 - 424
      Abstract: Publication date: Available online 18 July 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Chen Mao, Chien-Chin Hsu, Kuo-Tai Chen
      An ocular jellyfish sting is an ophthalmic emergency and is rarely reported in the medical literature. With the evolution of aquatic activities and entertainment in recent decades, we anticipate that more patients with ocular jellyfish stings may be taken to the emergency department. However, most physicians are unaware of the typical presentations, suitable treatments, prognosis, and possible complications of ocular jellyfish stings. We reported 2 cases with ocular jellyfish stings and collected cases series from literature review. The most common clinical features of ocular jellyfish stings were pain, conjunctival injection, corneal lesion, and photophobia. All patients who sustained ocular stings did so during aquatic activities, and the best management at the scene was proper analgesics and copious irrigation of affected eyes with seawater or saline. The ocular lesions were treated with topical cycloplegics, topical steroids, topical antibiotics, topical antihistamines, and removal of nematocysts. The prognosis was good, and all patients recovered without any permanent sequelae. However, symptoms in some patients may last longer than 1 week. Reported complications included iritis, increased intraocular pressures, mydriasis, decreased accommodation, and peripheral anterior synechiae.

      PubDate: 2016-07-23T04:23:32Z
      DOI: 10.1016/j.wem.2016.05.007
  • Survey of Hand and Upper-Extremity Injuries among Rock Climbers
    • Authors: Clayton E. Nelson; Ghazi M. Rayan; Dustin I. Judd; Kai Ding; Julie A. Stoner
      First page: 425
      Abstract: Publication date: September 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 3
      Author(s): Clayton E. Nelson, Ghazi M. Rayan, Dustin I. Judd, Kai Ding, Julie A. Stoner

      PubDate: 2016-09-03T07:28:12Z
      DOI: 10.1016/j.wem.2016.06.006
  • Performance Matters: Training Tools to Improve Medical Team Disaster
           Performance in Austere Environments
    • Authors: Lancer A. Scott; Kemp Anderson; Janelle Sourbeer; Layne Madden; Diann Krywko; Evert Eriksson; Dan Fisher
      Pages: 425 - 426
      Abstract: Publication date: September 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 3
      Author(s): Lancer A. Scott, Kemp Anderson, Janelle Sourbeer, Layne Madden, Diann Krywko, Evert Eriksson, Dan Fisher

      PubDate: 2016-09-03T07:28:12Z
      DOI: 10.1016/j.wem.2016.06.007
  • A Novel Cooling Method and Comparison of Active Rewarming of Mild
    • Authors: Mark L. Christensen; Grant S. Lipman; Dennis A. Grahn; Kate Shea; Joseph Einhorn; Craig Heller
      First page: 426
      Abstract: Publication date: September 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 3
      Author(s): Mark L. Christensen, Grant S. Lipman, Dennis A. Grahn, Kate Shea, Joseph Einhorn, Craig Heller

      PubDate: 2016-09-03T07:28:12Z
      DOI: 10.1016/j.wem.2016.06.008
  • Down to the Wire? Ventilation during Intubated Stretcher Helicopter
    • Authors: John D. Hollott
      First page: 426
      Abstract: Publication date: September 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 3
      Author(s): John D. Hollott

      PubDate: 2016-09-03T07:28:12Z
      DOI: 10.1016/j.wem.2016.06.009
  • Prehospital Interventions during Mass Casualty Events in Afghanistan: A
           Case Series
    • Authors: Steven G. Schauer; Derek Brown; Michael D. April; Erica Simon; Joseph Maddry; Robert Carter; Robert Delorenzo
      First page: 426
      Abstract: Publication date: September 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 3
      Author(s): Steven G. Schauer, Derek Brown, Michael D. April, Erica Simon, Joseph Maddry, Robert Carter, Robert Delorenzo

      PubDate: 2016-09-03T07:28:12Z
      DOI: 10.1016/j.wem.2016.06.010
  • Core Content for Wilderness Medicine Training: Development of a Wilderness
           Medicine Track within an Emergency Medicine Residency
    • Authors: Jonathan Drew; Nicole Battaglioli; Walter A. Schrading
      Pages: 426 - 427
      Abstract: Publication date: September 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 3
      Author(s): Jonathan Drew, Nicole Battaglioli, Walter A. Schrading

      PubDate: 2016-09-03T07:28:12Z
      DOI: 10.1016/j.wem.2016.06.011
  • Prospective Double-Blinded Randomized Field-Based Clinical Trial of
    • Authors: Hillary R. Irons; Renee N. Salas; Salman F. Bhai; N. Stuart Harris
      First page: 427
      Abstract: Publication date: September 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 3
      Author(s): Hillary R. Irons, Renee N. Salas, Salman F. Bhai, N. Stuart Harris

      PubDate: 2016-09-03T07:28:12Z
      DOI: 10.1016/j.wem.2016.06.012
  • Promoting Resilience among Veterans Using Wilderness Therapy
    • Authors: Shauna Joye; Zachary Dietrich
      First page: 427
      Abstract: Publication date: September 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 3
      Author(s): Shauna Joye, Zachary Dietrich

      PubDate: 2016-09-03T07:28:12Z
      DOI: 10.1016/j.wem.2016.06.013
  • Ambulatory Blood Pressure Monitoring Reveals Increased Sleeping Blood
           Pressure in Hypertensive Individuals at High Altitude
    • Authors: David S. Young; Linda E. Keyes; Luke F. Mather; Charles Duke; Nirajam Rejmi; Benoit M. Phelan; Sushil Pant; Jennifer M. Starling; Matthew K. McElwee; Devlin Cole; Theodore McConnell; Purshotam Paudel; Douglas Sallade; Allison L. Sheets; David R. Twillman; Buddha Basynat
      Pages: 427 - 428
      Abstract: Publication date: September 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 3
      Author(s): David S. Young, Linda E. Keyes, Luke F. Mather, Charles Duke, Nirajam Rejmi, Benoit M. Phelan, Sushil Pant, Jennifer M. Starling, Matthew K. McElwee, Devlin Cole, Theodore McConnell, Purshotam Paudel, Douglas Sallade, Allison L. Sheets, David R. Twillman, Buddha Basynat

      PubDate: 2016-09-03T07:28:12Z
      DOI: 10.1016/j.wem.2016.06.014
  • The Effect of Riociguat on Gas Exchange, Exercise Performance, and
           Pulmonary Artery Pressure During Acute Altitude Exposure
    • Authors: Jon Andrews; Stefanie Martina; Michael Natoli; Nicole Harlan; Luke Neilans; Miguel Alvarez Villela; John Freiberger; Aaron Walker; Ishwori Dhakal; Richard Moon
      First page: 428
      Abstract: Publication date: September 2016
      Source:Wilderness & Environmental Medicine, Volume 27, Issue 3
      Author(s): Jon Andrews, Stefanie Martina, Michael Natoli, Nicole Harlan, Luke Neilans, Miguel Alvarez Villela, John Freiberger, Aaron Walker, Ishwori Dhakal, Richard Moon

      PubDate: 2016-09-03T07:28:12Z
      DOI: 10.1016/j.wem.2016.06.015
  • Littered Cans—Death Trap of Snakes
    • Authors: Subhendu Mallik; Sudipta Ranjan Singh; Indramani Nath
      Abstract: Publication date: Available online 15 December 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Subhendu Mallik, Sudipta Ranjan Singh, Indramani Nath

      PubDate: 2016-12-20T13:41:56Z
      DOI: 10.1016/j.wem.2016.10.002
  • In Response to Risk Determinants of Acute Mountain Sickness by Lawrence
           and Reid
    • Authors: Gaurav Sikri; Srinivasa Bhattachar; Bikalp Thapa
      Abstract: Publication date: Available online 6 December 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Gaurav Sikri, Srinivasa Bhattachar, Bikalp Thapa

      PubDate: 2016-12-12T12:24:03Z
      DOI: 10.1016/j.wem.2016.10.005
  • Clinically Significant Envenomation From Postmortem Copperhead
           (Agkistrodon contortrix)
    • Authors: Michael P. Emswiler; F. Phillip Griffith; Kirk L. Cumpston
      Abstract: Publication date: Available online 18 November 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Michael P. Emswiler, F. Phillip Griffith, Kirk L. Cumpston
      Over 14,000 copperhead (Agkistrodon contortrix) bites were reported to United States poison centers between 1983 and 2008, and 1809 cases were reported to poison centers in 2014. The copperhead is primarily found in the southeastern United States and belongs to the pit viper subfamily Crotalinae, which also includes the water moccasin (Agkistrodon piscivorus) and rattlesnakes (Crotalus and Sistrurus genera). Postmortem rattlesnakes have been reported to cause clinically significant envenomation; we report a case of a postmortem copperhead causing clinically significant envenomation after inadvertent puncture with the deceased copperhead fang. The copperhead was transected twice, leaving the snake in 3 separate pieces. While handling the snake head, an inadvertent puncture occurred on the right index finger followed by pain and swelling in the affected extremity necessitating antivenom administration. Care should be taken when handling deceased pit vipers due to the continued risk of envenomation.

      PubDate: 2016-11-21T21:30:34Z
      DOI: 10.1016/j.wem.2016.09.007
  • Inclined Wind Tunnel for the Study of Human and Large Animal Flight
    • Authors: Anton Westman; Peter Georén; Johan Strömberg
      Abstract: Publication date: Available online 18 November 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Anton Westman, Peter Georén, Johan Strömberg

      PubDate: 2016-11-21T21:30:34Z
      DOI: 10.1016/j.wem.2016.08.004
  • In Reply to Drs Pasquier, Gnaegi, and Hugli
    • Authors: Hermann Brugger; Katharina Grasegger; Inigo Soteras; Giacomo Strapazzon
      Abstract: Publication date: Available online 3 November 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Hermann Brugger, Katharina Grasegger, Inigo Soteras, Giacomo Strapazzon

      PubDate: 2016-11-07T20:01:26Z
      DOI: 10.1016/j.wem.2016.09.006
  • Health Supply Utilization at a Boy Scout Summer Camp: An Evaluation for
           Improvement and Preparedness
    • Authors: Ross T. Miller; Bradley E. Barth
      Abstract: Publication date: Available online 3 November 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Ross T. Miller, Bradley E. Barth
      Objective To describe the health conditions treated by a health services center at a Boy Scout summer camp and make recommendations for appropriate resources and supplies. Methods We conducted a retrospective review of health center utilization at a Boy Scout camp in central Missouri during the summers of 2012 and 2013. Health logbook data were compiled and analyzed using descriptive and comparative statistics. Results During the study period 19,771 camp participants made 1586 visits to the health care center. The overall incidence rate of health center visits was 6.20 visits per 1000 camp days. Two-thirds of visits were for illness and the remainder for injury. Over 90% of patients were returned to camp, 7.3% were transferred to another health facility, and 1.6% were advised to leave camp and return home. The most common treatments were rehydration (17.8 %) and administration of analgesics (13.4%) and topical creams (12.3%). Conclusions Summer camps need to be prepared for a wide range of conditions and injuries in youth campers, leaders, and staff members. Over 90% of presenting complaints were managed on site, and the majority of conditions were easily treatable minor injuries and illnesses. We provide recommendations for appropriate medical supplies and suggest opportunities for improvement to aid health centers in planning and treatment.

      PubDate: 2016-11-07T20:01:26Z
      DOI: 10.1016/j.wem.2016.09.004
  • Dull Brains and Frozen Feet: A Historical Essay on Cold
    • Authors: Harvey V. Lankford
      Abstract: Publication date: Available online 3 November 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Harvey V. Lankford
      This essay will review historical and medical aspects of cold exposure, hypothermia, and frostbite during the Napoleonic era. The 19th century writings of Dominique Jean Larrey, Pierre Jean Moricheau-Beaupré, and others are used to provide an evocative supporting narrative to illustrate some of the cold illnesses, physiology, and theory of both an earlier era and the present time. Medical care for over a century followed the how but not the why of treating frostbite and hypothermia slowly with snow or cold water rather than heat. There were 2 main reasons: First was a practical attempt to limit gangrene. Less known, and long forgotten, is a major rationale based on the erroneous theory of heat called “the caloric.” Because of these 2 reasons, the slow method of “cold warming” remained standard medical practice well into the 20th century. Although these recommendations are now known to be flawed, some of the reasons behind them will be discussed, along with early but correct observations on afterdrop and circumrescue collapse. There is a long backstory of treatment from 1812 to the present.

      PubDate: 2016-11-07T20:01:26Z
      DOI: 10.1016/j.wem.2016.09.005
  • Management of Burn Injuries in the Wilderness: Lessons from Low-Resource
    • Authors: Cindy C. Bitter; Timothy B. Erickson
      Abstract: Publication date: Available online 28 October 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Cindy C. Bitter, Timothy B. Erickson
      Burns are a common source of injuries worldwide, with a high burden of disease in low- and middle-income countries. Burns also account for 2%−8% of wilderness injuries. Although many are minor, the potential for serious morbidity and mortality exists, and standard treatments used in high-resource settings are not readily available in the backcountry. A literature review was performed to find evidence from low-resource settings that supports alternative or improvised therapies that may be adapted to care of burns in the wilderness. There is good evidence for use of oral rehydration to support volume status in burn patients. There is moderate evidence to support cold therapy as first aid and adjunct for pain control. Some evidence supports use of alternative dressings such as boiled potato peel, banana leaf, aloe vera, honey, sugar paste, and papaya when standard therapies are not available.

      PubDate: 2016-10-31T18:05:04Z
      DOI: 10.1016/j.wem.2016.09.001
  • Preparing the United States for Zika Virus: Pre-emptive Vector Control and
           Personal Protection
    • Authors: James H. Diaz
      Abstract: Publication date: Available online 27 October 2016
      Source:Wilderness & Environmental Medicine
      Author(s): James H. Diaz
      Discovered in 1947 in a monkey in the Zika forest of Uganda, Zika virus was dismissed as a cause of a mild illness that was confined to Africa and Southeast Asia and transmitted by Aedes mosquitoes. In 2007, Zika virus appeared outside of its endemic borders in an outbreak on the South Pacific Island of Yap. In 2013, Zika virus was associated with a major neurological complication, Guillain-Barré syndrome, in a larger outbreak in the French Polynesian Islands. From the South Pacific, Zika invaded Brazil in 2015 and caused another severe neurological complication, fetal microcephaly. The mosquito-borne transmission of Zika virus can be propagated by sexual transmission and, possibly, by blood transfusions, close personal contacts, and organ transplants, like other flaviviruses. Since these combined mechanisms of infectious disease transmission could result in catastrophic incidences of severe neurological diseases in adults and children, the public should know what to expect from Zika virus, how to prevent infection, and what the most likely failures in preventive measures will be. With federal research funding stalled, a Zika vaccine is far away. The only national strategies to prepare the United States for Zika virus invasion now are effective vector control measures and personal protection from mosquito bites. In addition to a basic knowledge of Aedes mosquito vectors and their biting behaviors, an understanding of simple household vector control measures, and the selection of the best chemical and physical mosquito repellents will be required to repel the Zika threat.

      PubDate: 2016-10-31T18:05:04Z
      DOI: 10.1016/j.wem.2016.07.006
  • Pressures of Wilderness Improvised Wound Irrigation Techniques: How Do
           They Compare?
    • Authors: John B. Luck; Danielle Campagne; Roberto Falcón-Banchs; Jason Montoya; Susanne J. Spano
      Abstract: Publication date: Available online 26 October 2016
      Source:Wilderness & Environmental Medicine
      Author(s): John B. Luck, Danielle Campagne, Roberto Falcón-Banchs, Jason Montoya, Susanne J. Spano
      Objective Compare the pressures measured by improvised irrigation techniques to a commercial device and to prior reports. Methods Devices tested included a commercial 500-mL compressible plastic bottle with splash guard, a 10-mL syringe, a 10-mL syringe with a 14-ga angiocatheter (with needle removed), a 50-mL Sawyer syringe, a plastic bag punctured with a 14-ga needle, a plastic bottle with cap punctured by a 14-ga needle, a plastic bottle with sports top, and a bladder-style hydration system. Each device was leveled on a support, manually compressed, and aimed toward a piece of glass. A high-speed camera placed behind the glass recorded the height of the stream upon impact at its highest and lowest point. Measurements were recorded 5 times for each device. Pressures in pounds per square inch (psi) were calculated. Results The syringe and angiocatheter pressures measured the highest pressures (16–49 psi). The 50-mL syringe (7–11 psi), 14-ga punctured water bottle (7–25 psi), and water bottle with sports top (3–7 psi) all measured at or above the commercial device (4–5 psi). Only the bladder-style hydration system (1–2 psi) and plastic bag with 14-ga needle puncture (2–3 psi) did not reach pressures generated by the commercial device. Conclusions Pressures are consistent with those previously reported. All systems using compressible water bottles and all syringe-based systems provided pressures at or exceeding a commercial wound irrigation device. A 14-ga punctured plastic bag and bladder-style hydration pack failed to generate similar irrigation pressures.

      PubDate: 2016-10-31T18:05:04Z
      DOI: 10.1016/j.wem.2016.09.002
  • Pulling Harder than the Hamate Tolerates: Evaluation of Hamate Injuries in
           Rock Climbing and Bouldering
    • Authors: Christoph Lutter; Andreas Schweizer; Thomas Hochholzer; Thomas Bayer; Volker Schöffl
      Abstract: Publication date: Available online 26 October 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Christoph Lutter, Andreas Schweizer, Thomas Hochholzer, Thomas Bayer, Volker Schöffl
      Objective Hamate hook fractures are rare injuries, comprising 2% to 4% of all carpal fractures. Climbing athletes seem to be affected more frequently than others, as they strain the passive and active anatomical structures of their hands and fingers to maximum capacity during training or competing. This stress is transmitted to the hook of the hamate by tightened flexor tendons, which creates high contact pressure to the ulnar margin of the carpal tunnel. Injuries of the hamate hook, caused by contact pressure of the anatomical structures, are rare and occur nearly exclusively during climbing. Methods We diagnosed 12 athletes with hamate hook fractures who presented with diffuse pain in the wrist joint, which occurred either during or after climbing. Radiographs or computed tomography revealed fractures in the hamate bones in most of the patients; therapy consisted of consequent stress reduction. Results Follow-up investigations found that all athletes were free of symptoms after 10.7 ± 5.1 (6–24) (mean ± standard deviation with range) weeks. Resection of the hamate hook was necessary in 3 patients. All patients regained their preinjury climbing level. Conclusion Climbers with an unspecific, diffuse pain in the wrist need to be examined by radiograph and, if radiograph is unclear, computed tomography or magnetic resonance imaging to detect or exclude the diagnosis of hamate fracture in order to avoid severe complications.

      PubDate: 2016-10-31T18:05:04Z
      DOI: 10.1016/j.wem.2016.09.003
  • Medical Pathologies and Hut Guardians’ Ability to Provide First Aid in
           Mountain Huts: A Prospective Observational Study
    • Authors: Marc Blancher; Jérôme Colonna d’Istria; Amandine Coste; Philippine Saint Guilhem; Antoine Pierre; Flora Clausier; Guillaume Debaty; Jean Luc Bosson; Raphaël Briot; Pierre Bouzat
      Abstract: Publication date: Available online 24 October 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Marc Blancher, Jérôme Colonna d’Istria, Amandine Coste, Philippine Saint Guilhem, Antoine Pierre, Flora Clausier, Guillaume Debaty, Jean Luc Bosson, Raphaël Briot, Pierre Bouzat
      Objective To describe the resources for medical condition management in mountain huts and the epidemiology of such events. Methods We conducted a 3-step study from April 2013 to August 2014 in French mountain huts. The first step consisted of collecting data regarding the first aid equipment available in mountain huts. The second step consisted of a qualitative evaluation of the mountain hut guardian’s role in medical situations through semistructured interviews. Finally, a prospective observational study was conducted in the summer season to collect all medical events (MEs) that occurred during that period. Results Out of 164 hut guardians, 141 (86%) had a basic life support diploma. An automatic external defibrillator was available in 41 (26%) huts, and 148 huts (98%) were equipped with a first aid kit. According to semistructured interviews, hut guardians played a valuable role in first aid assistance. Regarding the observational study, 306 people requested the hut guardian’s help for medical reasons in 87 of the 126 huts included. A total of 501 MEs for approximately 56,000 hikers (0.85%) were reported, with 280 MEs (56%) involving medical pathologies and 221 (44%) MEs involving trauma-related injuries. Conclusions MEs had low prevalence, but the hut guardian played a valuable role as a first aid responder.

      PubDate: 2016-10-31T18:05:04Z
      DOI: 10.1016/j.wem.2016.08.002
  • Dengue and Dengue Hemorrhagic Fever, 2nd edition
    • Authors: Kenneth W. Kizer
      Abstract: Publication date: Available online 18 October 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Kenneth W. Kizer

      PubDate: 2016-10-31T18:05:04Z
      DOI: 10.1016/j.wem.2016.07.005
  • Improvised Cricothyrotomy on a Mountain Using Hiking Gear
    • Authors: Clare A. Johnson; Diana S. Goodwine; Ingrid Passier
      Abstract: Publication date: Available online 18 October 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Clare A. Johnson, Diana S. Goodwine, Ingrid Passier
      We present a case of a 57-year-old man who fell while climbing a mountain in California and sustained severe facial trauma. Three firefighters and 2 emergency physicians witnessed the fall and resuscitated the patient. The patient ultimately required a surgical cricothyrotomy performed with a pocket knife and Platypus hydration pack. The physicians made a makeshift positive pressure airway device using the Platypus hydration pack. We believe this is the first case report describing an improvised cricothyrotomy performed in the wilderness using only hiking gear. This report also discusses indications for cricothyrotomy, the challenges of resuscitation in a low-resource environment, and special considerations in a high-altitude setting.

      PubDate: 2016-10-31T18:05:04Z
      DOI: 10.1016/j.wem.2016.08.001
  • Ruins of a WWI Hospital, Falzarego, The Dolomites, Italy
    • Authors: Tom Edward Mallinson
      Abstract: Publication date: Available online 12 October 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Tom Edward Mallinson

      PubDate: 2016-10-16T13:36:16Z
      DOI: 10.1016/j.wem.2016.07.002
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Heriot-Watt University
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