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Journal Cover Wilderness & Environmental Medicine
  [SJR: 0.49]   [H-I: 29]   [4 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1080-6032
   Published by Elsevier Homepage  [3044 journals]
  • Sudden Death in a Diver: A Diagnostic Conundrum
    • Authors: Scott Dougherty; Maziar Khorsandi; Myra Adelbai; Vipin Zamvar; James Francis
      Pages: 225 - 229
      Abstract: Publication date: September 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 3
      Author(s): Scott Dougherty, Maziar Khorsandi, Myra Adelbai, Vipin Zamvar, James Francis
      We discuss the case of an experienced diver who ran out of air during his final ascent while scuba diving. He lost consciousness rapidly after surfacing and despite immediate cardiopulmonary resuscitation, could not be revived. On arrival at the emergency department he was noted to have copious amounts of blood in his upper airway and had developed extensive subcutaneous emphysema. Large amounts of air were observed in the central circulation following a postmortem computerized tomography scan as well as pneumomediastinum, a small right-sided hemothorax, and extensive subcutaneous emphysema. We discuss several potential pathophysiological mechanisms that might explain these findings. Finally, we end with a recommendation for an expedient whole-body postmortem computerized tomography scan and autopsy by a suitably qualified pathologist in the investigation of all dive-related fatalities, where possible.

      PubDate: 2017-09-09T23:44:38Z
      DOI: 10.1016/j.wem.2017.03.012
       
  • Faculty Biographies
    • Authors: Alicia Byrne
      Abstract: Publication date: June 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 2, Supplement
      Author(s): Alicia Byrne


      PubDate: 2017-06-08T06:28:41Z
      DOI: 10.1016/j.wem.2017.01.029
       
  • Norman E. McSwain Jr., MD, FACS (1937–2015)
    • Authors: Brad L. Bennett; Frank K. Butler; Ian S. Wedmore
      Abstract: Publication date: June 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 2, Supplement
      Author(s): Brad L. Bennett, Frank K. Butler, Ian S. Wedmore


      PubDate: 2017-06-08T06:28:41Z
      DOI: 10.1016/j.wem.2017.01.004
       
  • The Symbiotic Relationship Between Operational Military Medicine, Tactical
           Medicine, and Wilderness Medicine: A View Through a Personal Lens
    • Authors: Craig H. Llewellyn
      Abstract: Publication date: June 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 2, Supplement
      Author(s): Craig H. Llewellyn
      There are direct and indirect linkages and a form of symbiosis between operational military medicine from World War II and present wilderness medicine, from the beginnings to contemporary practice, and the more recently evolved field of tactical emergency medical support. Each of these relationships will be explored from the historical perspective of the Department of Military & Emergency Medicine, Uniformed Services University of the Health Sciences from 1982 to the present.

      PubDate: 2017-06-08T06:28:41Z
      DOI: 10.1016/j.wem.2016.12.008
       
  • Functional and Sports-Specific Outcome After Surgical Repair of Rotator
           Cuff Tears in Rock Climbers
    • Abstract: Publication date: Available online 20 September 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Michael Simon, Dominik Popp, Christoph Lutter, Volker Schöffl
      Objective The purpose of this study was to analyze the general (Constant Murley score) and sports-specific (change in International Climbing and Mountaineering Federation [UIAA] grade) outcome after surgical repair of rotator cuff injuries in rock climbers. Methods In a retrospective study, 12 rock climbers (10 men, 2 women; age 55 years; SD±9; range 28–66 years [mean±SD with range] with rotator cuff lesions were re-evaluated 27±16 (12–72) months after arthroscopic surgical repair of the rotator cuff of the shoulder. The etiology of the rotator cuff pathology was equally chronic (age 61±12 [28–66] years) and acute (age 53±5 [51–65] years). The postoperative general outcome, including the Constant Murley score, was assessed with a standardized questionnaire and clinical examination. The postoperative sports-specific outcome was analyzed using the UIAA metric scale. Results The postoperative Constant Murley score was 92±7 (80–98). All participants had already started climbing again; 11 of 12 climbers regained a climbing level within ±1.33 UIAA metric grades of their initial capability. Conclusion Arthroscopic repair of acute and chronic rotator cuff tears shows a good functional outcome, enabling most patients to regain a high level of rock climbing ability.

      PubDate: 2017-09-21T03:08:32Z
       
  • ERRATUM
    • Abstract: Publication date: Available online 20 September 2017
      Source:Wilderness & Environmental Medicine


      PubDate: 2017-09-21T03:08:32Z
       
  • Pulmonary Injury from Waterproofing Spray During a Hike
    • Abstract: Publication date: Available online 15 September 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Tomonori Harada, Yukio Hirabayashi, Yuriko Takayama-Isagawa, Hiroto Sakamoto, Makoto Kawaishi, Hiroyuki Hara, Shin Aizawa
      A 48-year-old man developed general fatigue, dyspnea, and fever at an altitude of 1562 m from the morning of the first day of a 3-day hike. Despite pharyngeal discomfort and mild general fatigue, he felt that the symptoms were not sufficient to abandon his plan. He usually required 1.5 hours to reach Tokusawa (6.4 km from the starting point at an altitude of 1500 m), but this time he required 2.5 hours and slept briefly upon arrival at Tokusawa due to extreme fatigue and respiratory discomfort. His symptoms became aggravated, so he presented at a mountain clinic with oxygen saturation at 80% and body temperature of 37.6ºC. He was diagnosed with hypoxemia due to pneumonia and/or other disease(s) and was evacuated to a hospital where a chest computed tomography scan revealed ground glass opacity and infiltrative shadows. He was treated for pneumonia, but another doctor discovered during follow-up that the patient had sprayed 300 mL of a waterproofing aerosol on mountain equipment in a nonventilated, enclosed area of his home on the night before starting out on the hike. Therefore, waterproofing spray was considered to have caused pulmonary damage. Self-reporting or appropriate questionnaires are the only means of identifying this type of injury. The differential diagnosis of pulmonary problems in an outdoor setting should include toxic aerosol exposure from waterproofing spray.

      PubDate: 2017-09-16T01:06:52Z
       
  • Improvised Hand Injury Treatment Using Traditional Veterinary Medicine in
           Ethiopia
    • Abstract: Publication date: Available online 14 September 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Raf Aerts, Eva J.J. November, Maissa Rayyan
      In remote wilderness environments, local people with traditional knowledge of medicinal plants are potentially important first-line health care providers. We present a case of a 31-year-old man who fell off a horse while trekking through a remote mountain landscape in Ethiopia and sustained blunt force trauma to the hand. A local mountain hut keeper examined the patient’s hand and used heated leaves of the succulent plant Kalanchoe petitiana to treat a suspected metacarpal fracture. As first responder in a low-resource setting, the hut keeper relied on his traditional knowledge of ethnoveterinary medicine to improvise a treatment for a human injury in a remote mountain environment. Although in this case the outcome of the traditional intervention was positive, our analysis shows that the massage component of the intervention could have led to complications. Conversely, reports from the use of related Kalanchoe species suggest that heated Kalanchoe leaves could be useful in the compression component of traditional care for hand injuries. Validation of traditional remedies and their therapeutic potential are needed if they are to complement wilderness wound care safely and reliably. The documentation and validation of these remedies are urgently needed, as many medicinal plants and indigenous knowledge of how to use these valuable natural resources are being lost.

      PubDate: 2017-09-16T01:06:52Z
       
  • Trends in Skin and Soft Tissue-Related Injuries in NOLS Wilderness
           Expeditions from 1984 to 2012
    • Authors: Kimberly A. Stanford; Lara Phillips; Yuchiao Chang; Drew Leemon; Tod Schimelpfenig; N. Stuart Harris
      Abstract: Publication date: Available online 4 September 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Kimberly A. Stanford, Lara Phillips, Yuchiao Chang, Drew Leemon, Tod Schimelpfenig, N. Stuart Harris
      Objective Wilderness expeditions inevitably involve risk to participants. Understanding of expedition-related illnesses and injuries allows institutions and individuals to develop strategies to mitigate risk. We describe findings and trends in soft tissue injuries, the second-most common type of injury, among participants in the National Outdoor Leadership School expeditions from 1984 to 2012. Methods Injuries and illnesses sustained by students and staff have been recorded continuously since 1984 in the extensive National Outdoor Leadership School database. We performed a retrospective analysis of incidence of soft tissue injuries in this population. Data before 1996 were standardized in order to make use of the entire dataset. Results Of 9734 total reported incidents, 2151 (22%) were soft tissue related, 707 (33%) of which required evacuation. The sex distribution of incidents was similar to the sex distribution of participants. The largest incidence of soft tissue injuries occurred independent of activity (711 incidents, 33%). The most commonly associated activities were hiking (528 incidents, 25%), camping (301 incidents, 14%), and cooking (205 incidents, 10%). Over the study period, rates of injury declined overall and in every individual category except cooking. Conclusions Over this 28-year period, the incidence of soft tissue injuries associated with the most common activities decreased. Incidence of activity-independent injuries did not change significantly, but reported severity decreased. These data provide unique insights to help improve wilderness risk management for institutions and individuals and suggest areas in which educational efforts may further reduce risk.

      PubDate: 2017-09-09T23:44:38Z
      DOI: 10.1016/j.wem.2017.06.005
       
  • ERRATUM
    • Abstract: Publication date: September 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 3


      PubDate: 2017-09-09T23:44:38Z
       
  • Bite Wounds Caused by a Wild Boar: A Case Report
    • Authors: Hiroki Nagasawa; Kazuhiko Omori; Hiroyuki Maeda; Ikuto Takeuchi; Suguru Kato; Takashi Iso; Kei Jitsuiki; Toshihiko Yoshizawa; Kouhei Ishikawa; Hiromichi Ohsaka; Youichi Yanagawa
      Abstract: Publication date: Available online 1 September 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Hiroki Nagasawa, Kazuhiko Omori, Hiroyuki Maeda, Ikuto Takeuchi, Suguru Kato, Takashi Iso, Kei Jitsuiki, Toshihiko Yoshizawa, Kouhei Ishikawa, Hiromichi Ohsaka, Youichi Yanagawa
      A 74-year-old man was attacked by a wild boar while on his way home from his farm in the daytime in winter 2017 on the rural Izu peninsula. He did not provoke the boar; however, hunters were hunting animals in the mountains near the farm around the same time. The boar bit his left leg, and the man fell to the ground. The boar continued biting the man’s left leg, and the man delivered a few kicks to the boar’s face with his right leg. The boar then bit his right foot and ran away. The man was taken to a hospital, and a physical examination revealed 3 bite wounds on his left leg and right foot. The wounds were irrigated with sterilized saline and closed with sutures under local anesthesia. He received antibiotics and a tetanus toxoid booster. The next day, his wounds were found to be infected, and pus was drained from them. After these treatments, his wounds healed successfully. Animal bite wounds are frequently contaminated. Accordingly, in addition to early proper wound treatment, close observation of the wound is required for both the early detection of any signs of infection and early medical intervention, including appropriate drainage of pus and irrigation as necessary.

      PubDate: 2017-09-03T22:07:33Z
      DOI: 10.1016/j.wem.2017.06.004
       
  • Channel 7-7 PMR: A Radio Communication Initiative in Mountain-Related
           Emergencies in Spain
    • Authors: Sendoa
      Abstract: Publication date: Available online 1 September 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Sendoa Ballesteros-Peña


      PubDate: 2017-09-03T22:07:33Z
       
  • Avalanche Accident Resulting in Leg Amputation
    • Authors: Mathieu Pasquier; Christos Karatzios; Olivier Borens; Fabrice Coppex
      Abstract: Publication date: Available online 1 September 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Mathieu Pasquier, Christos Karatzios, Olivier Borens, Fabrice Coppex


      PubDate: 2017-09-03T22:07:33Z
      DOI: 10.1016/j.wem.2017.06.011
       
  • Inappropriate Dexamethasone Use by a Trekker in Nepal: A Case Report
    • Authors: Nicholas R. Haslam; Rachel Garth; Nicola Kelly
      Abstract: Publication date: Available online 1 September 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Nicholas R. Haslam, Rachel Garth, Nicola Kelly
      We present a case of inappropriate dexamethasone use in a trekker in the Everest region of Nepal. We aim to increase awareness among health professionals of the possible use of this medication by trekkers and promote knowledge of potential complications. In this case, a previously altitude-naive trekker was prescribed prophylactic dexamethasone by physicians in a Western travel clinic before high-altitude trekking in Nepal. There were no indications for prophylactic medication nor for the use of dexamethasone. The trekker reported that no discussion regarding risks and benefits, alternatives, side effects, contraindications, or dose tapering on completion of the course had occurred before travel. Side effects were temporary, but serious complications may have ensued if it not for timely interventions by doctors at the International Porter Protection Group rescue post. The events leading to inappropriate dexamethasone use in this case cannot be known for certain. However, it is clear that the trekker lacked the knowledge to use the medication safely. Although the efficacy of dexamethasone in the prevention of acute mountain sickness is undisputed, associated side effects and other limitations make acetazolamide the prophylactic drug of choice. Inappropriate use of dexamethasone can lead to severe complications, and such a case has been reported from Mount Everest. Clinicians prescribing dexamethasone must understand the indications and risks, and health professionals at altitude should be aware of its use by trekkers and the potential complications.

      PubDate: 2017-09-03T22:07:33Z
      DOI: 10.1016/j.wem.2017.06.007
       
  • In Response to Avalanche Fatalities in the United States by Jekich et al
    • Authors: Karl W. Birkeland; Ethan M. Greene; Spencer Logan
      Abstract: Publication date: Available online 30 August 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Karl W. Birkeland, Ethan M. Greene, Spencer Logan


      PubDate: 2017-09-03T22:07:33Z
      DOI: 10.1016/j.wem.2017.06.009
       
  • Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in
           Multistage Ultramarathons
    • Authors: Brian J. Krabak; Grant S. Lipman; Brandee L. Waite; Sean D. Rundell
      Abstract: Publication date: Available online 7 August 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Brian J. Krabak, Grant S. Lipman, Brandee L. Waite, Sean D. Rundell
      Objective Dysnatremia and altered hydration status are potentially serious conditions that have not been well studied in multistage ultramarathons. The purpose of this study was to assess the incidence and prevalence of exercise-associated hyponatremia (EAH) (Na+ <135 mmol·L-1) and hypernatremia (Na+ >145 mmol·L-1) and hydration status during a multistage ultramarathon. Methods This study involved a prospective observational cohort study of runners competing in a 250-km (155-mile) multistage ultramarathon (in the Jordan, Atacama, or Gobi Desert). Prerace body weight and poststage (stage [S] 1 [42 km], S3 [126 km], and S5 [250 km]) body weight and serum sodium concentration levels were obtained from 128 runners. Results The prevalence of EAH per stage was 1.6% (S1), 4.8% (S3), and 10.1% (S5) with a cumulative incidence of 14.8%. Per-stage prevalence of hypernatremia was 35.2% (S1), 20.2% (S3), and 19.3% (S5) with a cumulative incidence of 52.3%. Runners became more dehydrated (weight change <–3%) throughout the race (S1=22.1%; S3=51.2%; S5=53.5%). Body weight gain correlated with EAH (r=–0.21, P = .02). Nonfinishers of S3 were significantly more likely to have EAH compared with finishers (75% vs 5%, P = .001), but there was no difference in either EAH or hypernatremia between nonfinishers and finishers of S5. Conclusions The incidence of EAH in multistage ultramarathons was similar to marathons and single-stage ultramarathons, but the cumulative incidence of hypernatremia was 3 times greater than that of EAH. EAH was associated with increased weight gain (overhydration) in early stage nonfinishers and postrace finishers.

      PubDate: 2017-09-03T22:07:33Z
      DOI: 10.1016/j.wem.2017.05.008
       
  • Descriptive Epidemiology, Medical Evaluation, and Outcomes of Rock
           Climbing Injuries
    • Authors: James W. McDonald; A. Michael Henrie; Masaru Teramoto; Edward Medina; Stuart E. Willick
      Abstract: Publication date: Available online 26 July 2017
      Source:Wilderness & Environmental Medicine
      Author(s): James W. McDonald, A. Michael Henrie, Masaru Teramoto, Edward Medina, Stuart E. Willick
      Objective To gather epidemiologic data on injury type, treatment, and recovery from rock climbing injuries. Methods Design: retrospective cross-sectional study. Setting: web-based survey. Participants: rock climbers who sustained a climbing-related injury during the prior 24 months. Criteria for inclusion: aged ≥18 years; participation in rock climbing at least 4 times per year in the United States. Interventions: none. Main outcome measures: percentage of injured climbers seeking medical care, providers seen, subspecialty referral, development of chronic problems, factors affecting return to climbing, injuries by climbing type, body region, and injury type. Results Data were collected over a 60-day period using the Research Electronic Data Capture (REDCap) survey system. Seven hundred and eight surveys were collected from 553 male and 155 female climbers. Thirteen hundred ninety seven injuries were reported, and 975 injuries were suitable for analysis. The most common provider initially seen was a primary care provider. Subspecialty referral was commonly obtained. Injury patterns differed by climbing type. The percentage of respondents that returned to climbing before their injury was fully healed was 51.1%, and 44.9% of respondents developed chronic problems related to their climbing injury. Twenty-eight percent of respondents were unable to return to their previous level of climbing performance. Several factors were associated with delayed recovery from climbing injury. Conclusions A significant number of climbers sought healthcare after injury. A majority of climbers who sought treatment were referred to subspecialist providers. About one-half of climbers were symptomatic when they returned to climbing and developed chronic problems after injury. Factors associated with slower return to climbing included increasing age, smoking, fractures, and surgery.

      PubDate: 2017-08-04T15:12:52Z
      DOI: 10.1016/j.wem.2017.05.001
       
  • Prolonged Coagulopathy, Ecchymoses, and Microangiopathic Hemolytic Anemia
           Following Hump-Nosed Pit Viper (Hypnale hypnale) Bite in Sri Lanka
    • Authors: Rathnayaka Mudiyanselage M.K. Namal Rathnayaka; Senanayake A.M. Kularatne; Anusha Nishanthi Ranathunga; Mahinda Kumarasinghe; Jayantha Rajapakse; Shirani Ranasinghe
      Abstract: Publication date: Available online 26 July 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Rathnayaka Mudiyanselage M.K. Namal Rathnayaka, Senanayake A.M. Kularatne, Anusha Nishanthi Ranathunga, Mahinda Kumarasinghe, Jayantha Rajapakse, Shirani Ranasinghe
      A 74-year-old previously healthy woman was bitten by a hump-nosed pit viper (Hypnale hypnale) at dusk causing incoagulable blood lasting for 6 days. Further, she developed ecchymoses over her forearms, upper arms, hands, and lower back on day 4 after the snakebite, and microangiopathic hemolytic anemia (MAHA). Features of this nature are rare after hump-nosed pit viper bite.

      PubDate: 2017-08-04T15:12:52Z
      DOI: 10.1016/j.wem.2017.05.005
       
  • Promoting High-Quality Research
    • Authors: Neal W. Pollock
      Abstract: Publication date: Available online 26 July 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Neal W. Pollock


      PubDate: 2017-08-04T15:12:52Z
      DOI: 10.1016/j.wem.2017.06.006
       
  • Medical Emergencies Caused by Aquatic Animals: A Zoological and Clinical
           Guide, 1st edition, Vidal Haddad Jr.. Springer International Publishing
           AG, New York (2016)
    • Authors: Kenneth Kizer
      Abstract: Publication date: Available online 26 July 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Kenneth W. Kizer


      PubDate: 2017-08-04T15:12:52Z
       
  • Suicide Attempt by Ingestion of Rotenone-Containing Plant Extracts in
           French Polynesia: A Case Report
    • Authors: R. Torrents; B. Domangé; C. Schmitt; A. Boulamery; L. De Haro; N. Simon
      Abstract: Publication date: Available online 26 July 2017
      Source:Wilderness & Environmental Medicine
      Author(s): R. Torrents, B. Domangé, C. Schmitt, A. Boulamery, L. De Haro, N. Simon


      PubDate: 2017-07-26T11:33:51Z
      DOI: 10.1016/j.wem.2017.03.017
       
  • Blister Mystery
    • Authors: Buddhika T.B. Wijerathne
      Abstract: Publication date: Available online 26 July 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Buddhika T.B. Wijerathne


      PubDate: 2017-07-26T11:33:51Z
      DOI: 10.1016/j.wem.2017.03.008
       
  • Prehospital Emergency Medicine at the Beach: What Is the Effect of Fins
           and Rescue Tubes in Lifesaving and Cardiopulmonary Resuscitation After
           Rescue'
    • Authors: Cristian Abelairas-Gómez; Roberto Barcala-Furelos; Marcos Mecías-Calvo; Ezequiel Rey-Eiras; Sergio López-García; Javier Costas-Veiga; Antonio Bores-Cerezal; Jose Palacios-Aguilar
      Abstract: Publication date: Available online 26 July 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Cristian Abelairas-Gómez, Roberto Barcala-Furelos, Marcos Mecías-Calvo, Ezequiel Rey-Eiras, Sergio López-García, Javier Costas-Veiga, Antonio Bores-Cerezal, Jose Palacios-Aguilar
      Objective To analyze the influence of fins and rescue tube use in a water rescue, assessed by time and distance to salvage position, physiological parameters, and cardiopulmonary resuscitation (CPR). Methods Twenty professional lifeguards (10 men, 10 women) conducted 3 tests: a baseline test of 5 minutes of CPR and 2 water rescues, 1 without rescue equipment (NRE), and the other with fins and rescue tube (FRT). They also had to perform 5 minutes of CPR after each rescue. Time and distance of the rescues, physiological parameters (blood lactate concentration and heart rate), and quality of CPR were analyzed. Results CPR quality worsened by 26 to 28% (P < .001) after rescue. However, there were no differences using FRT. The use of rescue equipment reduced the time (FRT: 216±57 seconds; NRE: 319±127 seconds; P < .001) and distance covered (FRT: 265±52 m; NRE: 326±41 m; P < .001). No differences were found in lactate levels between FRT and NRE just after the rescues, but there were some after 5 minutes of subsequent CPR (FRT: 10.7±2.2 mmol/L; NRE: 12.6±1.8 mmol/L; P < .001). Comparing women with men, we found significant differences in lactate concentrations only in FRT (women: 9.6±1.4 mmol/L; men: 8.1±1.2 mmol/L; P = .031). Conclusions The use of fins and rescue tube provides a comprehensive benefit in an aquatic emergency. However, FRT did not have any effect on the quality of the postrescue CPR.

      PubDate: 2017-07-26T11:33:51Z
      DOI: 10.1016/j.wem.2017.03.013
       
  • Blood Hemostatic Changes During an Ultraendurance Road Cycling Event in a
           Hot Environment
    • Authors: Brian R. Kupchak; Josh B. Kazman; Jakob L. Vingren; Danielle E. Levitt; Elaine C. Lee; Keith H. Williamson; Lawrence E. Armstrong; Patricia A. Deuster
      Abstract: Publication date: Available online 22 July 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Brian R. Kupchak, Josh B. Kazman, Jakob L. Vingren, Danielle E. Levitt, Elaine C. Lee, Keith H. Williamson, Lawrence E. Armstrong, Patricia A. Deuster
      Objective This study aims to examine blood hemostatic responses to completing a 164-km road cycling event in a hot environment. Methods Thirty-seven subjects (28 men and 9 women; 51.8±9.5 [mean±SD] y) completed the ride in 6.6±1.1 hours. Anthropometrics (height, body mass [taken also during morning of the ride], percent body fat [%]) were collected the day before the ride. Blood samples were collected on the morning of the ride (PRE) and immediately after (IP) the subject completed the ride. Concentrations of platelet, platelet activation, coagulation, and fibrinolytic markers (platelet factor 4, β-thromboglobulin, von Willebrand factor antigen, thrombin-antithrombin complex, thrombomodulin, and D-Dimer) were measured. Associations between changes from PRE- to IP-ride were examined as a function of event completion time and subject characteristics (demographics and anthropometrics). Results All blood hemostatic markers increased significantly (P < .001) from PRE to IP. After controlling for PRE values, finishing time was negatively correlated with platelet factor 4 (r = 0.40; P = .017), while percent body fat (%BF) was negatively correlated with thrombin-antithrombin complex (r = –0.35; P = .038) and to thrombomodulin (r = –0.36; P = .036). In addition, male subjects had greater concentrations of thrombin-antithrombin complex (d = 0.63; P < .05) and natural logarithm thrombomodulin (d = 6.42; P < .05) than female subjects. Conclusion Completing the 164-km road cycling event in hot conditions resulted in increased concentrations of platelet, platelet activation, coagulation, and fibrinolytic markers in both men and women. Although platelet activation and coagulation occurred, the fibrinolytic system markers also increased, which appears to balance blood hemostasis and may prevent clot formation during exercise in a hot environment.

      PubDate: 2017-07-26T11:33:51Z
      DOI: 10.1016/j.wem.2017.05.002
       
  • L-arginine Attenuates Hypobaric Hypoxia-Induced Increase in Ornithine
           Decarboxylase 1
    • Authors: Li Yuhong; Bai Zhengzhong; Tang Feng; Yang Quanyu; Ri-Li Ge
      Abstract: Publication date: Available online 21 July 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Li Yuhong, Bai Zhengzhong, Tang Feng, Yang Quanyu, Ri-Li Ge
      Background Chronic hypoxia-induced pulmonary hypertension and vascular remodeling have been shown to be associated with ornithine decarboxylase 1 (ODC1). However, few animal studies have investigated the role of ODC1 in acute hypoxia. Objectives We investigated ODC1 gene expression, morphologic and functional changes, and the effect of L-arginine as an attenuator in lung tissues of rats exposed to acute hypobaric hypoxia at a simulated altitude of 6000 m. Methods Sprague-Dawley rats exposed to simulated hypobaric hypoxia (6000 m) for 24, 48, or 72 hours were treated with L-arginine (L-arginine group, 20 mg/100 g intraperitoneal; n=15) or untreated (non–L-arginine group, n=15). Control rats (n=5) were maintained at 2260 m in a normal environment for the same amount of time but were treated without L-arginine. The mean pulmonary artery pressure was measured by PowerLab system. The morphologic and immunohistochemical changes in lung tissue were observed under a microscope. The mRNA and protein levels of ODC1 were measured by real-time polymerase chain reaction and Western-blot, respectively. Results Hypobaric hypoxia induced pulmonary interstitial hyperemia and capillary expansion in the lungs of rats exposed to acute hypoxia at 6000 m. The mean pulmonary artery pressure and the mRNA and protein levels of ODC1 were significantly increased, which could be attenuated by treatment with L-arginine. Conclusions L-arginine attenuates acute hypobaric hypoxia-induced increase in mean pulmonary artery pressure and ODC1 gene expression in lung tissues of rats. ODC1 gene contributes to the development of hypoxic pulmonary hypertension.

      PubDate: 2017-07-26T11:33:51Z
      DOI: 10.1016/j.wem.2017.05.009
       
  • Around Manaslu Ultramarathon: Diarrhea Is Still the King
    • Authors: Yogesh Subedi
      Abstract: Publication date: Available online 21 July 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Yogesh Subedi


      PubDate: 2017-07-26T11:33:51Z
      DOI: 10.1016/j.wem.2017.06.001
       
  • Health of High Altitude Pilgrims: A Neglected Topic
    • Authors: Sanjeeb Sudarshan Bhandari; Pranawa Koirala
      Abstract: Publication date: Available online 18 July 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Sanjeeb Sudarshan Bhandari, Pranawa Koirala
      xxx

      PubDate: 2017-07-19T09:37:54Z
      DOI: 10.1016/j.wem.2017.04.008
       
  • Two Cases of Acute Kidney Injury Due to Multiple Wasp Stings
    • Authors: Sanjay Vikrant; Anupam Parashar
      Abstract: Publication date: Available online 18 July 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Sanjay Vikrant, Anupam Parashar
      Acute kidney injury (AKI) is an unusual complication of wasp stings. Treatment of established AKI is largely supportive but the preventive strategies are not well documented. This is a report of 2 human cases that developed AKI after multiple wasp stings (Vespa magnifica). Each patient reached the hospital early in their clinical course and was treated with intravenous hydration and urine alkalization. In both the cases the severity of AKI, morbidity, and duration of hospitalization were reduced. The requirement of dialysis therapy was avoided. We propose early treatment with intravenous hydration, diuretic administration, and urine alkalization in such cases to prevent systemic and renal complications.

      PubDate: 2017-07-19T09:37:54Z
      DOI: 10.1016/j.wem.2017.05.007
       
  • Similarities Between Large Animal-Related and Motor Vehicle Crash-Related
           Injuries
    • Authors: Abigail M. Tremelling; Robert A. Marley; Mackenzie B. Marley; Christina M. Woofter; Courtney Docherty; Ann E. Salvator; Farid F. Muakkassa
      Abstract: Publication date: Available online 14 July 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Abigail M. Tremelling, Robert A. Marley, Mackenzie B. Marley, Christina M. Woofter, Courtney Docherty, Ann E. Salvator, Farid F. Muakkassa
      Objective Many Americans sustain large animal-related injuries (LARIs) from blunt trauma. We compare the injuries and management of LARI in our region of the United States with those of motor vehicle crashes (MVCs). Methods A 15-year retrospective study of trauma patients with LARI matched to MVC controls by Injury Severity Score (ISS), age, and sex was conducted. Values were statistically compared, and differences were considered statistically significant at P < .05. Results There were 156 LARI cases, of which 87% were related to horses, 8% to bulls, and the remainder to deer, mules, bison, cows, and rams. In the LARI group, the age was 42±18 years (mean±SD), ISS was 7±4, and 61% were females. The MVC group had a significantly longer length of hospital stay (5±5 vs 4±3 days) and blood alcohol concentration (35±84 vs 3±20 g/L). There were no significant differences in injury patterns between LARI and MVC; however, additional radiological studies (RS) were performed on MVC (9±6 vs 7±5). LARI patients were more often transferred from rural locations (39% vs 25%) and traveled further to our trauma center (40±32 vs 24±29 km) than did MVC patients. Conclusions LARI has a similar pattern of injury to MVC, but fewer RS. LARI typically occurred further away, requiring transfer from rural areas to our institution. We recommend a similar approach for the evaluation of LARI and MVC.

      PubDate: 2017-07-19T09:37:54Z
      DOI: 10.1016/j.wem.2017.05.004
       
  • Scorpion Stings in Jordan: An Update
    • Authors: Zuhair S. Amr; Renad Al Zou’bi; Nour Abdo; Rihan Bani Hani
      Abstract: Publication date: Available online 6 July 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Zuhair S. Amr, Renad Al Zou’bi, Nour Abdo, Rihan Bani Hani
      Objective Scorpionism is an endemic public health problem in Jordan encountered by health providers in all parts of the country. This study updates epidemiological data on scorpion sting encounters in Jordan. Methods Data on scorpion sting encounters were obtained from government and military hospitals around the country, and the National Drug and Poison Information Center (NDPIC). P values and 95% confidence intervals (CIs) were calculated using SPSS Professional Statistics Package version 22 (IBM Corp., Armonk, NY) program. Results Epidemiological data on 1205 scorpion sting cases reported between 2006 and 2012 are reported. Male to female ratio was 1.18:1, aged 23.3±16 (mean±SD) and 26.4±16.9 years for males and females, respectively. Age groups between 1 to 20 years old constituted 44.6% of the total sting encounters, while adults aged >30 years constituted 30%. Scorpion sting encounters peaked in July (22.5%) and August (23%), with the lowest numbers of recorded cases in February and January (1.6 and 1.9%, respectively). Scorpion stings occurred mostly outdoors (66%). Medical complications associated with scorpion sting cases included fever, difficulty in breathing, drowsiness and dizziness, and numbness, while severe complications include respiratory failure and tachycardia. Hospitalization required 1 to 3 days among admitted patients with no fatalities. Conclusions Scorpion stings remain a medical problem in Jordan that requires more attention by health providers. Reporting of scorpion sting cases should be enforced from all healthcare centers throughout the country to better understand the epidemiology and health implications of human encounters.

      PubDate: 2017-07-19T09:37:54Z
      DOI: 10.1016/j.wem.2017.05.003
       
  • Cervical Spine Alignment in Helmeted Skiers and Snowboarders with
           Suspected Head and Neck Injuries: Comparison of Lateral C-spine
           Radiographs Before and After Helmet Removal and Implications for Ski
           Patrol Transport
    • Authors: Jared Murray; David A. Rust
      Abstract: Publication date: Available online 3 July 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Jared Murray, David A. Rust
      Objective Current protocols for spine immobilization of the injured skier/snowboarder have not been scientifically validated. Observing changes in spine alignment during common rescue scenarios will help strengthen recommendations for rescue guidelines. Methods Twenty-eight healthy volunteers (18 men, 10 women) age 47±17 (range 20–73) (mean ±SD with range) underwent a mock rescue in which candidate patrollers completing an Outdoor Emergency Care course performed spine immobilization and back boarding in 3 scenarios: 1) Ski helmet on, no c-collar; 2) helmet on, with c-collar; and 3) helmet removed, with c-collar. After each scenario, a lateral radiograph was taken of the cervical spine to observe for changes in alignment. Results Compared with the control group (helmet on, no collar), we observed 9 degrees of increased overall (occiput–C7) cervical extension in the helmet on, with collar group (P < .001), and 17 degrees in the helmet off, with collar group (P < .001). There was increased extension at the occiput–C2 intersegment in the helmet on, with collar group (9 degrees, P < .001) and at both the occiput–C2 (9 degrees, P < .001) and C2–C7 (8 degrees, P < .001) intersegments in the helmet off, with collar group. Conclusion Ski helmet removal and c-collar application each leads to increased extension of the cervical spine. In the absence of other clinical factors, our recommendation is that helmets should be left in place and c-collars not routinely applied during ski patrol rescue.

      PubDate: 2017-07-19T09:37:54Z
      DOI: 10.1016/j.wem.2017.03.009
       
  • “Ice Axe Wrist”: A Case Report of Intersection Syndrome in 2
           Climbers
    • Authors: Anna L. Tobin
      Abstract: Publication date: Available online 30 June 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Anna L. Tobin
      Intersection syndrome is an inflammatory condition located at the crossing point between the first and second dorsal compartments in the wrist. It is an uncommon presentation but has been recognized as an injury typical of rowers (when it is named oarsman’s wrist) and other sports such as racquet sports, baseball, cycling, hockey, golf, ice hockey, skiing, and softball. It has not been previously described in climbers. This report details 2 cases of intersection associated with the use of an ice axe. The first presentation was in a female climber who was using an ice axe for climbing in the Nepal Himalayas and the second was in a male climber using an ice axe for winter climbing training in the Alps. Both climbers presented with wrist pain, swelling, and crepitus over the dorsum of the wrist, about 5 cm proximal to Lister’s tubercle. Although well documented in other sporting populations, there seems to be limited reporting of intersection syndrome in the climbing population. It may be worth considering a diagnosis of “ice axe wrist” as a differential in patients who have been using ice axes in climbing or mountaineering.

      PubDate: 2017-07-03T13:44:18Z
      DOI: 10.1016/j.wem.2017.03.016
       
  • High Altitude Pulmonary Edema in a Mining Worker With an Abnormal Rise in
           Pulmonary Artery Pressure in Response to Acute Hypoxia Without Prior
           History of High Altitude Pulmonary Edema
    • Authors: Almaz Ch. Akunov; Meerim A. Sartmyrzaeva; Abdirashit M. Maripov; Kubatbek Muratali uulu; Argen T. Mamazhakypov; Akylbek S. Sydykov; Akpay Sh. Sarybaev
      Abstract: Publication date: Available online 30 June 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Almaz Ch. Akunov, Meerim A. Sartmyrzaeva, Abdirashit M. Maripov, Kubatbek Muratali uulu, Argen T. Mamazhakypov, Akylbek S. Sydykov, Akpay Sh. Sarybaev
      High altitude pulmonary edema (HAPE) is a potentially life-threatening form of noncardiogenic pulmonary edema that may develop in otherwise healthy individuals upon ascent to high altitude. A constitutional susceptibility has been noted in some individuals, whereas others appear not to be susceptible at all. In our report, we present a case of HAPE triggered by concurrent respiratory tract infection and strenuous exercise in a mining worker with an abnormal rise in pulmonary artery pressure in response to acute hypoxia, without a prior history of HAPE during almost a year of commuting between high altitude and lowland areas.

      PubDate: 2017-07-03T13:44:18Z
      DOI: 10.1016/j.wem.2017.04.003
       
  • The Ham and Eggs Plant, Lantana camara
    • Authors: James H. Diaz
      Abstract: Publication date: Available online 30 June 2017
      Source:Wilderness & Environmental Medicine
      Author(s): James H. Diaz


      PubDate: 2017-07-03T13:44:18Z
      DOI: 10.1016/j.wem.2017.05.006
       
  • Chemical Hand Warmer Packet Ingestion: A Case of Elemental Iron Exposure
    • Authors: Jessica L. Weiland; Leighanne K. Sherrow; Deepak A. Jayant; Kenneth D. Katz
      Abstract: Publication date: Available online 17 June 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Jessica L. Weiland, Leighanne K. Sherrow, Deepak A. Jayant, Kenneth D. Katz
      For individuals who work outdoors in the winter or play winter sports, chemical hand warmers are becoming increasingly more commonplace because of their convenience and effectiveness. A 32-year-old woman with a history of chronic pain and bipolar disorder presented to the emergency department complaining of a “warm sensation” in her mouth and epigastrium after reportedly ingesting the partial contents of a chemical hand warmer packet containing between 5 and 8 g of elemental iron. She had been complaining of abdominal pain for approximately 1 month and was prescribed unknown antibiotics the previous day. The patient denied ingestion of any other product or medication other than what was prescribed. A serum iron level obtained approximately 6 hours after ingestion measured 235 micrograms/dL (reference range 40–180 micrograms/dL). As the patient demonstrated no new abdominal complaints and no evidence of systemic iron toxicity, she was discharged uneventfully after education. However, the potential for significant iron toxicity exists depending on the extent of exposure to this or similar products. Treatment for severe iron toxicity may include fluid resuscitation, whole bowel irrigation, and iron chelation therapy with deferoxamine. Physicians should become aware of the toxicity associated with ingestion of commercially available hand warmers. Consultation with a medical toxicologist is recommended.

      PubDate: 2017-06-22T10:01:43Z
      DOI: 10.1016/j.wem.2017.04.006
       
  • Glycemic Control and Muscle Damage in 3 Athletes with Type 1 Diabetes
           During a Successful Performance in a Relay Ultramarathon: A Case Report
    • Authors: Taisa Belli; Denise V. de Macedo; Pedro P.M. Scariot; Gustavo G. de Araújo; Ivan G.M. dos Reis; Fernanda L. Lazarim; Lázaro A.S. Nunes; René Brenzikofer; Claudio A. Gobatto
      Abstract: Publication date: Available online 17 June 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Taisa Belli, Denise V. de Macedo, Pedro P.M. Scariot, Gustavo G. de Araújo, Ivan G.M. dos Reis, Fernanda L. Lazarim, Lázaro A.S. Nunes, René Brenzikofer, Claudio A. Gobatto
      Ultramarathon races are fairly demanding and impose substantial physiological stress on healthy athletes. These competitions may thus be considerably more challenging for individuals with diabetes. This case study aims to describe glycemic control, muscle damage, inflammation, and renal function in 3 athletes with type 1 diabetes during a successful performance in a relay ultramarathon. The team completed the race in 29 hours and 28 minutes, earning third place. The total distance covered by each athlete was 68.7, 84.5, and 65.1 km. Most blood glucose levels showed that athletes were in a zone where it was safe to exercise (90–250 mg/dL or 5.0–13.9 mmol/L). Creatine kinase, lactate dehydrogenase, and aspartate aminotransferase serum levels increased 1.2- to 50.7-fold prerace to postrace, and were higher than the reference ranges for all the athletes postrace. Blood leukocytes, neutrophils, and serum C-reactive protein (CRP) increased 1.6- to 52-fold prerace to postrace and were higher than the reference ranges for 2 athletes after the race. Serum creatinine increased 1.2-fold prerace to postrace for all the athletes but did not meet the risk criteria for acute kidney injury. In conclusion, our main findings show evidence of satisfactory glycemic control in athletes with type 1 diabetes during a relay ultramarathon. Moreover, elevation of muscle damage and inflammatory biomarkers occurred without affecting renal function and challenging the maintenance of blood glucose among athletes. These findings are novel and provide an initial understanding of the physiological responses in athletes with type 1 diabetes during ultramarathon races.

      PubDate: 2017-06-22T10:01:43Z
      DOI: 10.1016/j.wem.2017.04.005
       
  • The Provision of Prescription-Only Medicines for Use on UK-based Overseas
           Expeditions
    • Authors: James K. Moore; Matthew Ladbrook; Larry Goodyer; Jon Dallimore
      Abstract: Publication date: Available online 17 June 2017
      Source:Wilderness & Environmental Medicine
      Author(s): James K. Moore, Matthew Ladbrook, Larry Goodyer, Jon Dallimore
      Expedition teams without accompanying medical professionals traveling overseas from the UK frequently carry medical kits containing prescription-only medicines (POMs). Access to safe, basic POMs whilst on expedition is important, as the quality and availability of medicines in-country may not be acceptable, and delay in treatment may be hazardous. At present, there is no published guidance relating to drug acquisition and administration in these situations. In the UK, a number of different practices are currently in use, with uncertainty and medicolegal concerns currently hampering safe and efficient provision of POMs on overseas expeditions. A guideline is proposed for the management of prescription-only medications in an expedition setting.

      PubDate: 2017-06-22T10:01:43Z
      DOI: 10.1016/j.wem.2017.03.015
       
  • Bruno Ernst Durrer, MD: January 14, 1953 to December 5, 2016
    • Abstract: Publication date: Available online 5 May 2017
      Source:Wilderness & Environmental Medicine


      PubDate: 2017-05-09T02:35:06Z
       
  • Prophylactic Acetaminophen or Ibuprofen Result in Equivalent Acute
           Mountain Sickness Incidence at High Altitude: A Prospective Randomized
           Trial
    • Authors: Nicholas C. Kanaan; Alicia L. Peterson; Matiram Pun; Peter S. Holck; Jennifer Starling; Bikash Basyal; Thomas F. Freeman; Jessica R. Gehner; Linda Keyes; Dana R. Levin; Catherine J. O’Leary; Katherine E. Stuart; Ghan B. Thapa; Aditya Tiwari; Jared L. Velgersdyk; Ken Zafren; Buddha Basnyat
      Abstract: Publication date: Available online 4 May 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Nicholas C. Kanaan, Alicia L. Peterson, Matiram Pun, Peter S. Holck, Jennifer Starling, Bikash Basyal, Thomas F. Freeman, Jessica R. Gehner, Linda Keyes, Dana R. Levin, Catherine J. O’Leary, Katherine E. Stuart, Ghan B. Thapa, Aditya Tiwari, Jared L. Velgersdyk, Ken Zafren, Buddha Basnyat
      Objective Recent trials have demonstrated the usefulness of ibuprofen in the prevention of acute mountain sickness (AMS), yet the proposed anti-inflammatory mechanism remains unconfirmed. Acetaminophen and ibuprofen were tested for AMS prevention. We hypothesized that a greater clinical effect would be seen from ibuprofen due to its anti-inflammatory effects compared with acetaminophen’s mechanism of possible symptom reduction by predominantly mediating nociception in the brain. Methods A double-blind, randomized trial was conducted testing acetaminophen vs ibuprofen for the prevention of AMS. A total of 332 non-Nepali participants were recruited at Pheriche (4371 m) and Dingboche (4410 m) on the Everest Base Camp trek. The participants were randomized to either acetaminophen 1000 mg or ibuprofen 600 mg 3 times a day until they reached Lobuche (4940 m), where they were reassessed. The primary outcome was AMS incidence measured by the Lake Louise Questionnaire score. Results Data from 225 participants who met inclusion criteria were analyzed. Twenty-five participants (22.1%) in the acetaminophen group and 18 (16.1%) in the ibuprofen group developed AMS (P = .235). The combined AMS incidence was 19.1% (43 participants), 14 percentage points lower than the expected AMS incidence of untreated trekkers in prior studies at this location, suggesting that both interventions reduced the incidence of AMS. Conclusions We found little evidence of any difference between acetaminophen and ibuprofen groups in AMS incidence. This suggests that AMS prevention may be multifactorial, affected by anti-inflammatory inhibition of the arachidonic-acid pathway as well as other analgesic mechanisms that mediate nociception. Additional study is needed.

      PubDate: 2017-05-09T02:35:06Z
      DOI: 10.1016/j.wem.2016.12.011
       
  • Research and Research Communication
    • Authors: Neal W. Pollock
      Abstract: Publication date: Available online 4 May 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Neal W. Pollock


      PubDate: 2017-05-09T02:35:06Z
      DOI: 10.1016/j.wem.2017.04.004
       
  • Belts Evaluated as Limb Tourniquets: BELT Study Comparing Trouser
           Supporters Used as Medical Devices in a Manikin Model of Wound Bleeding
    • Authors: Blake W. Bequette; John F. Kragh; James K. Aden; Michael A. Dubick
      Abstract: Publication date: Available online 20 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Blake W. Bequette, John F. Kragh, James K. Aden, Michael A. Dubick
      Objective The purpose of the present study is to compare several models of commercially designed belts as used as a tourniquet. Methods In the Belts Evaluated as Limb Tourniquets (BELT) study, an experiment was designed to test the effectiveness of pants belts as nonimprovised medical devices to control hemorrhage in a manikin. Models of belts included Tourni-belt, Tourniquet Belt, ParaBelt, and Battle Buddy. Data collected included effectiveness, time to stop bleeding, total time of application, pressure, blood loss, and composite results (score count of good results; composite outcome good if every component was good). Results Differences in effectiveness percentages among models were not statistically significant. The difference in mean between users was statistically significant for stop time, total time, pressure, blood loss, composite score, and composite outcome. Mean time to stop bleeding differed for only 1 pair of models after the Tukey-Kramer adjustment; ParaBelt was faster than Tourniquet Belt. Mean total time of application differed between ParaBelt–Tourniquet Belt and Tourni-belt–Tourniquet Belt; the former model in both pairs was faster. No significant difference in mean blood loss measured by model was found. For composite outcome score, no pairwise difference between models was significant. For composite outcome (good-bad), ParaBelt had good results in 75% of tests; the other 3 models had significantly worse results. Conclusions In a preliminary laboratory analysis of belt tourniquet models using a manikin, performance differed by model. ParaBelt performed better than other models for the composite outcome.

      PubDate: 2017-04-26T21:52:15Z
      DOI: 10.1016/j.wem.2017.01.030
       
  • Tactical Combat Casualty Care: Transitioning Battlefield Lessons Learned
           to Other Austere Environments
    • Authors: Brad Bennett; Ian Wedmore; Frank Butler
      Abstract: Publication date: Available online 9 March 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Brad Bennett, Ian Wedmore, Frank Butler


      PubDate: 2017-03-10T08:53:03Z
      DOI: 10.1016/j.wem.2017.01.003
       
  • Tactical Combat Casualty Care: Beginnings
    • Authors: Frank K. Butler
      Abstract: Publication date: Available online 9 March 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Frank K. Butler
      Tactical Combat Casualty Care (TCCC) is a set of evidence-based, best-practice prehospital trauma care guidelines customized for use on the battlefield. The origins of TCCC were nontraditional. The TCCC program began as a Naval Special Warfare biomedical research effort launched after the realization that extremity hemorrhage, a leading cause of preventable death on the battlefield, was not being treated with a readily available and highly effective intervention: the tourniquet. This insight prompted a systematic reevaluation of all aspects of battlefield trauma care that was conducted from 1993 to 1996 as a joint effort by special operations medical personnel and the Uniformed Services University of the Health Sciences. The product of that 3-year research project was TCCC, the first-ever set of battlefield trauma care guidelines designed to combine good medicine with good small-unit tactics.

      PubDate: 2017-03-10T08:53:03Z
      DOI: 10.1016/j.wem.2016.12.004
       
  • The Transition to the Committee on Tactical Combat Casualty Care
    • Authors: Stephen D. Giebner
      Abstract: Publication date: Available online 6 March 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Stephen D. Giebner
      The original Tactical Combat Casualty Care (TCCC) guidelines were published in a special supplement to Military Medicine in 1996 as the terminal deliverable of a 2-year development project funded by the United States Special Operations Command (USSOCOM). Two years later, the USSOCOM Biomedical Initiatives Steering Committee (BISC) promulgated its Task Statement 5-98, in which it called for the formation of a panel of subject matter experts to update the TCCC guidelines. This article discusses the formation of the Committee on Tactical Combat Casualty Care (CoTCCC) and the changes to the original guidelines that constituted the first update.

      PubDate: 2017-03-10T08:53:03Z
      DOI: 10.1016/j.wem.2016.11.005
       
 
 
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