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  Subjects -> ENVIRONMENTAL STUDIES (Total: 793 journals)
    - ENVIRONMENTAL STUDIES (726 journals)
    - POLLUTION (21 journals)
    - TOXICOLOGY AND ENVIRONMENTAL SAFETY (38 journals)
    - WASTE MANAGEMENT (8 journals)

ENVIRONMENTAL STUDIES (726 journals)            First | 1 2 3 4 5 6 7 8     

Latin American Journal of Management for Sustainable Development     Hybrid Journal  
Legal Studies     Hybrid Journal   (Followers: 3)
Leviathan : A Journal of Melville Studies     Full-text available via subscription   (Followers: 2)
Limnological Review     Open Access   (Followers: 6)
Living Reviews in Landscape Research     Open Access   (Followers: 2)
Local Environment: The International Journal of Justice and Sustainability     Hybrid Journal   (Followers: 7)
Low Carbon Economy     Open Access   (Followers: 4)
Luna Azul     Open Access  
M+A. Revista Electrónica de Medioambiente     Open Access  
Macquarie Journal of International and Comparative Environmental Law     Full-text available via subscription   (Followers: 8)
Madagascar Conservation & Development     Open Access  
Management International Review     Hybrid Journal   (Followers: 5)
Management of Environmental Quality: An International Journal     Hybrid Journal   (Followers: 5)
Management of Sustainable Development     Open Access   (Followers: 2)
Marine Ecology     Hybrid Journal   (Followers: 13)
Marine Environmental Research     Hybrid Journal   (Followers: 12)
Marine Pollution Bulletin     Hybrid Journal   (Followers: 12)
Materials for Renewable and Sustainable Energy     Open Access   (Followers: 9)
Mathematical and Computational Forestry & Natural-Resource Sciences     Free  
Mathematical Population Studies: An International Journal of Mathematical Demography     Hybrid Journal   (Followers: 2)
Medieval Sermon Studies     Hybrid Journal   (Followers: 4)
Medio Ambiente y Urbanizacion     Full-text available via subscription  
Membranes     Open Access   (Followers: 4)
Michigan Journal of Sustainability     Open Access  
Midwest Studies In Philosophy     Hybrid Journal   (Followers: 10)
Mine Water and the Environment     Hybrid Journal   (Followers: 6)
Mitigation and Adaptation Strategies for Global Change     Hybrid Journal   (Followers: 12)
Modern Asian Studies     Hybrid Journal   (Followers: 7)
Modern Cartography Series     Full-text available via subscription   (Followers: 6)
Mountain Research and Development     Open Access   (Followers: 3)
Multequina     Open Access  
Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis     Hybrid Journal   (Followers: 2)
Mutation Research/Genetic Toxicology and Environmental Mutagenesis     Hybrid Journal   (Followers: 7)
Nativa     Open Access  
Natur und Recht     Hybrid Journal   (Followers: 7)
Natural Areas Journal     Full-text available via subscription   (Followers: 7)
Natural Hazards     Hybrid Journal   (Followers: 311)
Natural Resources     Open Access  
Natural Resources and Environmental Issues     Open Access   (Followers: 5)
Nature and Culture     Full-text available via subscription   (Followers: 10)
NeuroToxicology     Hybrid Journal  
Neurotoxicology and Teratology     Hybrid Journal   (Followers: 1)
NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy     Full-text available via subscription   (Followers: 6)
New Zealand Journal of Environmental Law     Full-text available via subscription   (Followers: 3)
NJAS - Wageningen Journal of Life Sciences     Full-text available via subscription   (Followers: 1)
Noise Notes     Full-text available via subscription   (Followers: 3)
Novos Cadernos NAEA     Open Access   (Followers: 1)
Observatorio Medioambiental     Open Access  
Occupational and Environmental Medicine     Full-text available via subscription   (Followers: 7)
Ocean Acidification     Open Access  
Ochrona Srodowiska i Zasobów Naturalnych     Open Access  
Oecologia     Hybrid Journal   (Followers: 29)
Oikos     Hybrid Journal   (Followers: 33)
Open Journal of Ecology     Open Access   (Followers: 11)
Open Journal of Marine Science     Open Access   (Followers: 6)
Open Journal of Modern Hydrology     Open Access   (Followers: 3)
Our Nature     Open Access   (Followers: 2)
Oxford Journal of Legal Studies     Hybrid Journal   (Followers: 18)
Pace Environmental Law Review     Open Access   (Followers: 4)
Packaging, Transport, Storage and Security of Radioactive Material     Hybrid Journal   (Followers: 1)
Palaeobiodiversity and Palaeoenvironments     Hybrid Journal   (Followers: 3)
Particle and Fibre Toxicology     Open Access   (Followers: 2)
Pastos y Forrajes     Open Access  
Pesquisa em Educação Ambiental     Open Access  
Pharmacology & Therapeutics     Hybrid Journal   (Followers: 5)
Pharmacology Biochemistry and Behavior     Hybrid Journal   (Followers: 1)
Philosophical Studies     Hybrid Journal   (Followers: 9)
Physio-Géo     Open Access   (Followers: 2)
Pittsburgh Journal of Environmental and Public Health Law     Open Access   (Followers: 1)
Planet     Open Access   (Followers: 1)
Planning & Environmental Law: Issues and decisions that impact the built and natural environments     Hybrid Journal   (Followers: 7)
Plant Ecology & Diversity     Partially Free   (Followers: 11)
Plant Knowledge Journal     Open Access   (Followers: 2)
Plant, Cell & Environment     Hybrid Journal   (Followers: 4)
Polar Journal     Hybrid Journal   (Followers: 1)
Policy Studies     Hybrid Journal   (Followers: 8)
Policy Studies Journal     Hybrid Journal   (Followers: 5)
Polish Polar Research     Open Access   (Followers: 4)
Political Studies     Hybrid Journal   (Followers: 24)
Political Studies Review     Hybrid Journal   (Followers: 14)
Population and Environment     Hybrid Journal   (Followers: 6)
Population Ecology     Hybrid Journal   (Followers: 9)
Population Studies: A Journal of Demography     Hybrid Journal   (Followers: 8)
Postcolonial Studies     Hybrid Journal   (Followers: 10)
Practice Periodical of Hazardous, Toxic, and Radioactive Waste Management     Full-text available via subscription   (Followers: 2)
Presence Teleoperators & Virtual Environments     Hybrid Journal   (Followers: 1)
Presidential Studies Quarterly     Hybrid Journal   (Followers: 4)
Procedia Environmental Sciences     Open Access   (Followers: 2)
Proceedings of ICE, Waste and Resource Management     Hybrid Journal   (Followers: 2)
Proceedings of the Institution of Mechanical Engineers Part M: Journal of Engineering for the Maritime Environment     Hybrid Journal   (Followers: 1)
Proceedings of the International Academy of Ecology and Environmental Sciences     Open Access   (Followers: 4)
Process Safety and Environmental Protection     Hybrid Journal   (Followers: 5)
Progress in Industrial Ecology, An International Journal     Hybrid Journal   (Followers: 4)
Psychological Assessment     Full-text available via subscription   (Followers: 5)
Public Money & Management     Hybrid Journal   (Followers: 5)
Public Works Management & Policy     Hybrid Journal   (Followers: 6)
Qatar Foundation Annual Research Forum Proceedings     Open Access   (Followers: 3)
Radioactivity in the Environment     Full-text available via subscription   (Followers: 3)
Regional Environmental Change     Hybrid Journal   (Followers: 4)
Regional Studies     Hybrid Journal   (Followers: 6)

  First | 1 2 3 4 5 6 7 8     

Journal Cover   Wilderness & Environmental Medicine
  [5 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1080-6032
   Published by Elsevier Homepage  [2588 journals]
  • The Epidemiology of Caving Fatalities in the United States
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Alejandro C. Stella , J. Priyanka Vakkalanka , Christopher P. Holstege , Nathan P. Charlton



      PubDate: 2015-03-17T01:03:08Z
       
  • A Case Study: Rare Lepiota brunneoincarnata Poisoning
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Murat Kose , Ismail Yilmaz , Ilgaz Akata , Ertugrul Kaya , Kerim Guler
      Amatoxin poisoning from the genus Lepiota may have a deadly outcome, although this is not seen as often as it is from the genus Amanita. In this report, we present a patient who was poisoned by a sublethal dose of Lepiota brunneoincarnata mushrooms. The patient was hospitalized 12 hours after eating the mushrooms. The patient’s transaminase levels increased dramatically starting on day 4. Aspartate transaminase peaked at 78 hours. Starting at 1265 IU/L, alanine transaminase peaked at 90 hours at 5124 IU/L. The patient was discharged on day 8 to outpatient care, and his transaminase levels returned to normal ranges in the subsequent days. A toxin analysis was carried out on the mushrooms that the patient claimed to have eaten. Using reversed-phase high-performance liquid chromatography analysis, an uptake of approximately 19.9 mg of amatoxin from nearly 30 g of mushrooms was calculated. This consisted of 10.59 mg of α-amanitin, 9.18 mg of β-amanitin, and 0.16 mg of γ-amanitin. In conclusion, we present a patient from Turkey who was poisoned by L. brunneoincarnata mushrooms.


      PubDate: 2015-03-17T01:03:08Z
       
  • How Not to Train Your Dragon: A Case of a Komodo Dragon Bite
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Heather A. Borek , Nathan P. Charlton
      Komodo dragons (Varanus komodoensis) are the world’s largest lizards, known for killing prey that exceed their body mass. Reports of bites to humans in the popular press suggest high degrees of morbidity and mortality. Reports in the medical literature are lacking. We describe the case of a zookeeper who was bitten by a Komodo dragon, with a resultant mallet finger. We further discuss the various potential mechanisms of Komodo dragon lethality, including sepsis and venom deposition theories that are useful in guiding management.


      PubDate: 2015-03-17T01:03:08Z
       
  • High Altitude Cerebral Edema—Serial MRI Findings
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Ivaturi Venkata Nagesh , Gopinath Manoj , Madan Gurdarshdeep



      PubDate: 2015-03-17T01:03:08Z
       
  • Prediction of Physiological Responses and Performance at Altitude Using
           the 6-Minute Walk Test in Normoxia and Hypoxia
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Oliver R. Gibson , Alan J. Richardson , Mark Hayes , Ben Duncan , Neil S. Maxwell
      Objective The 6-minute walk test (6MWT) is a reliable and valid tool for determining an individual’s functional capacity, and has been used to predict summit success. The primary aim of the study was to evaluate whether a 6MWT in normobaric hypoxia could predict physiological responses and exercise performance at altitude. The secondary aim was to determine construct validity of the 6MWT for monitoring acclimatization to 3400 m (Cuzco, Peru). Methods Twenty-nine participants performed six 6MWTs in four conditions: normoxic outdoor (NO), normoxic treadmill (NT), and hypoxic treadmill (HT) were each performed once; and hypoxic outdoor (HO) was performed three times, at 42 hours (HO1), 138 hours (HO2), and 210 hours (HO3) after arrival at Cuzco. Results One-way analysis of variance revealed no difference (P > .05) between NO and HO1 for 6MWT distance. HT and HO protocols were comparable for the measurement of delta heart rate (HR) and post-test peripheral oxygen saturation (%Spo 2; P > .05). Acclimatization was evidenced by reductions (P < .05) in resting HR and respiratory rate (RR) between HO1, HO2, and HO3, and preservation of Spo 2 between HO1 and HO2. Postexercise HR and RR were not different (P > .05) with acclimatization. The duration to ascend to 4215 m on a trek was moderately correlated (P < .05) to HR during the trek and the 6MWT distance during HT; no other physiological markers predicted performance. Conclusions The 6MWT is a simple, time-efficient tool for predicting physiological responses to simulated and actual altitude, which are comparable. The 6MWT is effective at monitoring elements of acclimatization to moderate altitude.


      PubDate: 2015-03-17T01:03:08Z
       
  • Electronic Tablet Augmented Simulation: A Pilot Study
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Shane Peterson , Martin Musi , Jonathan L. Bar , Christopher Tedeschi



      PubDate: 2015-03-17T01:03:08Z
       
  • Novel Application of Chemical Cold Packs for Treatment of Exercise-Induced
           Hyperthermia: A Randomized Controlled Trial
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): John B. Lissoway , Grant S. Lipman , Dennis A. Grahn , Vinh H. Cao , Michael Shaheen , Samson Phan , Eric A. Weiss , H. Craig Heller
      Objective Heat-related illness is a common disease with significant morbidity and mortality. Despite no proven efficacy, application of chemical cold packs (CCP) to the skin overlying the large vessels of the neck, groin, and axillae is a traditional recommended cooling modality. The study objective was to compare the cooling rates of CCP applied to these traditional areas vs the glabrous skin surfaces of the cheeks, palms, and soles in exercise-induced hyperthermia. Methods Ten healthy adult male volunteers walked on a treadmill in a heated room (40° ± 0.5°C) while wearing insulated military overgarments until their esophageal temperatures (Tes) reached 39.2°C. Each participant had three heat stress trials on separate days: no treatment followed by randomly ordered traditional (neck, groin, and axillae) cooling and glabrous skin cooling. Results With no treatment, Tes remained stable after the first 5 minutes of the heat trial (ΔTes = 0.12° ± 0.07°C/10 min). Traditional cooling followed a linear decline (ΔTes = 0.17° ± 0.04°C/10 min; P < .001). Glabrous cooling enhanced the treatment effect by a steeper decline (ΔTes = 0.30° ± 0.06°C/10 min; P < .001), significantly different from traditional cooling by 2-way analysis of variance (P < .001). Conclusions Application of CCP to glabrous skin surfaces was more effective for treating exercise-induced heat stress than the traditional CCP cooling intervention. This novel cooling technique may be beneficial as an adjunctive treatment for heat-related illness in the prehospital environment.


      PubDate: 2015-03-17T01:03:08Z
       
  • Electromagnetic Interference From Electronic Devices Used in the
           Management of Type 1 Diabetes Can Impair the Performance of an Avalanche
           Transceiver in Search Mode
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Steven C.M. Miller
      Objective Portable electronic devices play an important role in the management of type 1 diabetes mellitus. Electromagnetic interference from electronic devices has been shown to impair the function of an avalanche transceiver in search mode (but not in transmitting mode). This study investigates the influence of electromagnetic interference from diabetes devices on a searching avalanche beacon. Methods The greatest distance at which an avalanche transceiver (in search mode) could accurately indicate the location of a transmitting transceiver was assessed when portable electronic devices (including an insulin pump and commonly used real-time continuous subcutaneous glucose monitoring system [rtCGMS]) were held in close proximity to each transceiver. Results The searching transceiver could accurately locate a transmitted signal at a distance of 30 m when used alone. This distance was unchanged by the Dexcom G4 rtCGMS, but was reduced to 10 m when the Medtronic Guardian rtCGMS was held close (within 30 cm) to the receiving beacon. Interference from the Animas Vibe insulin pump reduced this distance to 5 m, impairing the searching transceiver in a manner identical to the effect of a cell phone. Conclusions Electromagnetic interference produced by some diabetes devices when held within 30 cm of a searching avalanche transceiver can impair the ability to locate a signal. Such interference could significantly compromise the outcome of a companion rescue scenario. Further investigation using other pumps and rtCGMS devices is required to evaluate all available diabetes electronics. Meantime, all electronic diabetes devices including rtCGMS and insulin pumps should not be used within 30 cm of an avalanche transceiver.


      PubDate: 2015-03-17T01:03:08Z
       
  • Which Improvised Tourniquet Windlasses Work Well and Which Ones
           Won’t?
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): John F. Kragh Jr , Timothy E. Wallum , James K. Aden III , Michael A. Dubick , David G. Baer
      Objective Improvised tourniquets in first aid are recommended when no scientifically designed tourniquet is available. Windlasses for mechanical advantage can be a stick or pencil and can be used singly or multiply in tightening a tourniquet band, but currently there is an absence of empiric knowledge of how well such windlasses work. The purpose of the present study was to determine the performance of improvised tourniquets in their use by the type and number of windlasses to improve tourniquet practice. Methods A simulated Leg Tourniquet Trainer was used as a manikin thigh to test the effectiveness of improvised tourniquets of a band-and-windlass design. Two users made 20 tests each with 3 types of windlasses. Tests started with 1 representative of a given type (eg, 1 pencil), then continued with increasing numbers of each windlass type until the user reached 100% effectiveness as determined by cessation of simulated blood flow. Windlass types included chopsticks, pencils, and craft sticks. Results Effectiveness percentages in stopping bleeding were associated inversely with breakage percentages. Pulse stoppage percentages were associated inversely with breakage. The windlass turn numbers, time to stop bleeding, the number of windlasses, and the under-tourniquet pressure were associated inversely with breakage. The windlass type was associated with breakage; at 2 windlasses, only chopsticks were without breakage. Of those windlass types that broke, 20.7% were chopsticks, 26.1% were pencils, and 53.2% were craft sticks. Conclusions A pair of chopsticks as an improvised tourniquet windlass worked better than pencils or craft sticks.


      PubDate: 2015-03-17T01:03:08Z
       
  • Improvised Method for Increasing the Temperature of an i-STAT Analyzer and
           Cartridge in Cold Environments
    • Abstract: Publication date: Available online 13 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): David Radler , Matthew Wetschler , Mark Christensen , Grant S. Lipman



      PubDate: 2015-03-17T01:03:08Z
       
  • Work Patterns Dictate Energy Demands and Thermal Strain During Wildland
           Firefighting
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): John S. Cuddy , Joseph A. Sol , Walter S. Hailes , Brent C. Ruby
      Objective The purpose of this investigation was to characterize the effects of self-selected work activity on energy expenditure, water turnover, and thermal strain during wildland fire suppression. A secondary aim was to contrast current data with data collected 15 years ago using similar methods to determine whether job demands have changed. Methods Participants (n = 15, 26 ± 3 years, 179 ± 6 cm, 78.3 ± 8.6 kg) were monitored for 3 days for total energy expenditure, water turnover, core and chest skin temperature, physical activity, and heart rate. Participants arrived to the mobile laboratory each morning, submitted a nude weight, ingested a temperature transmitter, provided a urine sample, and were equipped with a physiological and activity monitor. Participants completed live wildland fire suppression during their work shifts. Results Mean core temperature was 37.6° ± 0.2°C, mean chest skin temperature was 34.1° ± 1.0°C, mean heart rate was 112 ± 13 beats/min, and the mean physiological strain index score was 3.3 ± 1.0. Wildland firefighters spent 49 ± 8%, 39 ± 6%, and 12 ± 2% in the sedentary, light, and moderate-vigorous intensity categories, respectively. The mean total energy expenditure was 19.1 ± 3.9 MJ/d, similar to 1997 (17.5 ± 6.9 MJ/d). The mean water turnover in 2012 was 9.5 ± 1.7 L/d, which was higher (P < .05) compared with 1997–98 (7.0 ± 1.7 L/d). Conclusions Wildland firefighters do not induce consistently high cardiovascular and thermal strain while completing arduous work in a hot environment despite fairly high chest skin temperatures. The total energy expenditure in the current study suggests job demands are similar to those of 15 years ago, while the increased water turnover may reflect a change in drinking habits.


      PubDate: 2015-03-17T01:03:08Z
       
  • In Response to Wilderness Search Strategy and Tactics, by Phillips et al
    • Abstract: Publication date: Available online 16 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Donald C. Cooper , John R. Frost



      PubDate: 2015-03-17T01:03:08Z
       
  • EPAS1 Gene Polymorphisms Are Associated With High Altitude Polycythemia in
           Tibetans at the Qinghai-Tibetan Plateau
    • Abstract: Publication date: Available online 16 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Jin Xu , Ying-Zhong Yang , Feng Tang , Qin Ga , Wuren Tana , Ri-Li Ge
      Objective To test the hypothesis that the polymorphisms in the EPAS1 gene are associated with the susceptibility to high altitude polycythemia (HAPC) in Tibetans at the Qinghai-Tibetan Plateau. Methods We enrolled 63 Tibetan HAPC patients and 131 matched healthy Tibetans as a control group, from the Yushu area in Qinghai where the altitude is greater than 3500 m. Eight single-nucleotide polymorphisms (SNPs) of the EPAS1 gene, including rs12619696, rs13420857, rs2881504, rs4953388, rs13419896, rs4953354, rs10187368, and rs7587138, were genotyped by the Sequenom MassARRAY SNP assay. Results The frequencies of the G allele of EPAS1 SNP rs13419896 were significantly higher in the HAPC group than in the control group (P < .05). Moreover, the A alleles of rs12619696 and rs4953354 were prevalent in the HAPC group, and their counterpart homozygotes were prevalent in the normal Tibetan group (P < .05). Conclusions Compared with normal Tibetans, Tibetans with HAPC are maladapted and have a different haplotype in EPAS1 SNPs rs12619696, rs13419896, and rs4953354.


      PubDate: 2015-03-17T01:03:08Z
       
  • Management of a Pediatric Snake Envenomation After Presentation With a
           Tight Tourniquet
    • Abstract: Publication date: Available online 16 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Sean P. Bush , Shannon B. Kinlaw
      We describe an illustrative case of pediatric snake envenomation presenting with a tightly wound tourniquet. A 10-year-old boy presented after a snake bite to the right calf. A tourniquet was in place just below the right knee. The species of snake was unknown. The patient was hemodynamically stable, but the entirety of the right leg distal to the tourniquet was discolored. Over concern for a potential venom bolus effect upon tourniquet removal, the decision was made to start a crotaline Fab antivenom infusion and gradually loosen the tourniquet. The patient tolerated the infusion and removal of the tourniquet without signs of anaphylaxis or decompensation. Dynamic improvements were observed in the right leg and wound site that appeared to be the result of vascular congestion. Tourniquets are generally not recommended for snakebites; however, if a tourniquet is already placed, we avoid removal until prepared to manage acute toxicity or immediate hypersensitivity.


      PubDate: 2015-03-17T01:03:08Z
       
  • Cardiovascular Demands of Deer Retrieval Methods
    • Abstract: Publication date: Available online 11 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Charles J. Fountaine , Mitchell J. Evenson
      Objective The purpose of this study was to compare the cardiovascular (CV) demands of 2 deer retrieval methods. Methods Twelve male participants (weight 86 ± 24 kg, age 21 ± 1 years) performed a maximum treadmill test on day 1 to determine baseline fitness levels. On day 2, all participants first towed, then dragged a 45-kg simulated deer carcass for 457 m at a self-selected pace. The tow condition utilized a shoulder harness system with a 2-m strap connecting the harness to the carcass, allowing the participant to walk upright as he towed the load. The dragging condition required the participants to flex their trunk, grasp the legs of the deer with both hands, and drag the carcass the length of the course. Heart rate and oxygen consumption (Vo 2) from each trial were measured by indirect calorimetry. Results The CV responses of towing were significantly less compared with those of dragging for Vo 2 peak (P = .001), peak heart rate (P = .003), average heart rate (P = .028), and rating of perceived exertion (P < .001). No significant differences were observed for average Vo 2 (P = .91) or time to completion (P = .27). Conclusions The results of this study suggest towing a deer with a shoulder harness results in significant reductions in CV demand and lower perceived exertion compared with traditional deer dragging techniques. Deer hunters who are deconditioned or have CV risk factors are strongly encouraged to consider deer retrieval methods utilizing a shoulder harness and tow rope to mitigate the increased demands commonly found with traditional retrieval methods.


      PubDate: 2015-03-12T00:58:12Z
       
  • Wilderness Image
    • Abstract: Publication date: Available online 11 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Frank Karle III



      PubDate: 2015-03-12T00:58:12Z
       
  • Tough Beginnings on Galapagos, Baby Blue Footed Booby
    • Abstract: Publication date: Available online 7 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Jon Conard



      PubDate: 2015-03-12T00:58:12Z
       
  • An Introduction to Wilderness Emergency Medical Services Medical Director
           Course
    • Abstract: Publication date: Available online 7 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Steve Donelan



      PubDate: 2015-03-12T00:58:12Z
       
  • Rebound Coagulopathy in Patients With Snakebite Presenting With Marked
           Initial Coagulopathy
    • Abstract: Publication date: Available online 7 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Willam R. Witham , Cathy McNeill , Sunny Patel
      Objective An estimated 70% of patients with pit viper snakebites require antivenom to treat serious complications such as coagulopathy. Evidence-based guidance is limited for the appropriate administration of Crotalinae Polyvalent Immune Fab (FabAV) and the duration of laboratory follow-up. The objective of our study was to assess the incidence of marked and recurrent envenomation coagulopathy at our trauma center and identify practice patterns that may prevent serious complications. Methods A retrospective case review was conducted over a 3-year period on patients treated for symptomatic snakebite injury. Case records were reviewed for the inclusion criteria of international normalized ratio (INR) greater than 2.0. The exclusion criterion was limited to patients receiving anticoagulant therapy. Results In all, 61 patients were identified on retrospective chart review and 3 patients (4.9%) met inclusion criteria. Two of the 3 patients had marked rebound coagulopathy requiring readmission and additional treatment. In our small series, 2 patients presenting after crotaline envenomation with increased INR (>6.0), decreased fibrinogen (<60 mg/dL), and decreased platelet count (<100,000/mL) had recurrent coagulopathy and were asymptomatic, and recurrence was noted only with follow-up laboratory testing. All patients responded positively within a matter of hours to repeat FabAV administration, with resolution of rebound coagulopathy. Conclusions We recommend periodic monitoring of patients with increased INR, decreased fibrinogen, and decreased platelet count. Patients should be monitored for 10 to 14 days after envenomation to identify asymptomatic rebound coagulopathy. Prompt readministration of FabAV appears to correct the coagulopathy.


      PubDate: 2015-03-12T00:58:12Z
       
  • Negative Predictive Value of Excluding an Embedded Snake Foreign Body by
           Ultrasonography
    • Abstract: Publication date: Available online 11 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): William F. Rushton , J. Priyanka Vakkalanka , James H. Moak , Nathan P. Charlton
      Objective Numerous reputable sources for healthcare providers advocate routine imaging to rule out an embedded tooth or fang after a snake bite. The objective of this study was to determine whether these foreign bodies can be reliably excluded by bedside ultrasonography. Methods All emergency medicine (EM) residents and faculty at a single institution were invited to participate. Two sets of 5 ultrasound gel phantoms were prepared using a method previously validated to have the same density as human tissue. In the first set of 5 phantoms, 1 snake fang was embedded to simulate a retained foreign body. Similarly, in the second set of 5 phantoms, 1 snake tooth was also embedded. Participants were asked to identify the presence or absence of a foreign body in each phantom using bedside ultrasonography. Year of training and confidence in excluding a snake foreign body were also recorded. Results Each participant (n = 27) performed ultrasound imaging on 10 phantoms for a total of 270 samples. Range of experience included postgraduate year 1 (25.9%), postgraduate year 2 (29.6%), postgraduate year 3 (33.3%), and graduates of EM residency (11.1%). The sensitivity and negative predictive value for ruling out an embedded fang was 92.6% and 98.1%, respectively. The sensitivity and negative predictive value for ruling out an embedded tooth was 77.8% and 93.7%, respectively. Among all the phantoms, there was a sensitivity of 85.2% and a negative predictive value of 96%. Conclusion Bedside ultrasonography performed by an EM physician is a feasible option to rule out embedded foreign bodies after a snake bite if imaging is warranted.


      PubDate: 2015-03-12T00:58:12Z
       
  • Deriving Effective Sweep Width for Air-scent Dog Teams
    • Abstract: Publication date: Available online 5 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Kenneth B. Chiacchia , Heather E. Houlahan , Rebecca S. Hostetter
      Objective We sought to obtain the first effective sweep widths (ESWs) ever measured for an air-scent search dog unit to compare their performance to historical data from human searchers and to initially test the validity of atmospheric convection as a limiting factor in air-scent search. Methods We used GPS tracks and waypoints to measure lateral hit and miss distances for the dog teams during blinded, randomized training tasks during a 6-year period, calculating ESW using the crossover method. During the tasks we collected weather data for determining convection. We used nonparametric statistics and least-square regression to compare the dog ESW data with historical human data and weather conditions. Results The mean value of ESW for the 4 teams under all conditions was 95 m (95% CI, 44 to 145). The dog teams’ performance was statistically superior to human visual searchers in detecting search subjects in low-visibility colors, but not subjects in high-visibility colors. A nonparametric correlation test of ESW vs convection gave P < .05, suggesting that convection may be an operationally significant factor in air-scent dog performance. Conclusions The ESW methodology is applicable to air-scent dog teams, potentially allowing search managers to make decisions in applying resources operationally, as well as improving accuracy of planning calculations. In addition, the methods described appear to be capable, given more widely representative data, of making valid statistical comparisons between different search modalities and weather and other factors.


      PubDate: 2015-03-07T00:52:28Z
       
  • Near-Fatal Outcome From Absence of Information About Exercise-Associated
           Hyponatremia in a Wilderness Medicine Field Guidebook
    • Abstract: Publication date: Available online 6 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Martin D. Hoffman , Thomas M. Myers



      PubDate: 2015-03-07T00:52:28Z
       
  • Finger and Toe Temperature Responses to Cold After Freezing Cold Injury in
           Elite Alpinists
    • Abstract: Publication date: Available online 5 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Shawnda A. Morrison , Jurij Gorjanc , Ola Eiken , Igor B. Mekjavic
      Objective To assess whether previous freezing cold injuries (FCI) would affect digit skin temperatures and rewarming rates during a follow-up cold stress test protocol. Design Nonrandomized control trial. Methods Twenty elite alpinists participated; alpinists with previous FCI requiring digit amputations (injured, INJ: n = 10 total, n = 8 male) were compared with ability-matched, uninjured alpinists (control, CON: n = 10, all male). Digit skin temperature was measured using infrared thermography as an index of peripheral digit perfusion after a cold stress test, which consisted of 30 minutes of immersion in 8°C water. Results The INJ alpinists’ injured toes were warmer (approximately 6%) than their uninjured toes immediately after cold immersion (95% CI, 0.01°C to 1.00°C; P = .05); there were no differences between the rates of rewarming of injured and uninjured toes (INJ, 0.5° ± 0.1°C/min; CON, 0.7° ± 0.3°C/min; P = .16). Although the INJ alpinists had colder injured fingers immediately after the 35°C warm bath compared with their own uninjured fingers (32.2° ± 2.0°C vs 34.5° ± 0.5°C; P = .02), there were no differences observed between the rates of rewarming of injured and uninjured fingers after cold exposure (INJ, 1.1° ± 0.2°C/min; CON, 1.3° ± 0.5°C/min; P = .22). Conclusions Even after FCI that requires digit amputation, there is no evidence of different tissue rates of rewarming between the injured and uninjured fingers or toes of elite alpinists.


      PubDate: 2015-03-07T00:52:28Z
       
  • Smoking Increases the Risk of Acute Mountain Sickness
    • Abstract: Publication date: Available online 4 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Denis Vinnikov , Nurlan Brimkulov , Paul D. Blanc
      Objective We aimed to ascertain risk factors for acute mountain sickness (AMS) in miners exposed to chronic intermittent high altitude conditions. Methods All new hires (2009–2012) for mine employment (4000 m above sea level) were followed up for 12 months after first ascent. Demographics, physiologic data, and cigarette smoking were assessed at preemployment screening. Mine site clinic care for AMS defined incident events. Cox regression analysis estimated risk of AMS associated with smoking and selected covariates. Results There were 46 AMS cases among 569 individuals during the first 12 months of employment. Adjusted for age, sex, and altitude of permanent residence, cigarettes smoked per day before hiring were prospectively associated with AMS (hazard ratio [HR], 1.9; 95% CI, 1.1 to 3.2 per 10 cigarettes smoked). This risk was higher in the subset of workers with less demanding physical work (n = 336; HR, 3.3; 95% CI, 1.7 to 6.3), whereas among those with more physically demanding jobs (n = 233), smoking was not associated with increased risk (HR, 0.6; 95% CI, 0.1 to 2.3). Conclusions In workers newly hired to work at high altitude, smoking increases the likelihood of AMS, but this effect appears to be operative only among those with less physically demanding work duties.


      PubDate: 2015-03-07T00:52:28Z
       
  • Complex Alpine Extrication: Case Report of Mountain and Speleological
           Rescue Cooperation
    • Abstract: Publication date: Available online 4 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Piersandro Sette , Mauro Carlini , Damiano Berti , Igor Rucci , Francesco Marchiori , Fausto Toffali , Alberto Schonsberg , Giorgio Ricci , Stefano Tardivo
      Mountain sporting activities are an increasingly popular practice that exposes mountaineers to a high risk of adverse events. This report describes a unique case of recovery in an austere environment that involved explosives. In June 2012, a 52-year-old man ascended a cliff tower in the Eastern Alps, Italy. A landslide occurred, and a boulder crushed the climber against a large stone located farther down the cliff, causing compression of the lower limbs and the pelvis with consequent severe musculoskeletal trauma. The National Alpine and Cave Rescue Unit (NACRU) arrived and proceeded with stabilization of the injured climber, which took 6 hours and involved a difficult extrication supported by the Cave Rescue division of NACRU. Unfortunately, during transport to the trauma center of Borgo Trento, Verona, the patient exhibited signs of progressive traumatic shock because of crush syndrome, hypovolemia, and acidosis, which led to cardiac arrest and death. Based on an extensive literature review, this report was determined to be the only one of a mountain rescue using explosives for the extrication of a victim in the Northeast Italian Alps. This case describes how a rescue in austere environments can represent a high-risk situation, and it shows how improvisation and cooperation between rescue teams are crucial for a successful recovery.


      PubDate: 2015-03-07T00:52:28Z
       
  • Blisters: The Enemy of The Feet
    • Abstract: Publication date: Available online 4 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Grant S. Lipman , Bernd V. Scheer



      PubDate: 2015-03-07T00:52:28Z
       
  • Epidemiology of Whitewater Fatalities in the Arkansas Headwaters
           Recreation Area
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Leah E. Jacoby , John D. Anderson , Tracy A. Cushing



      PubDate: 2015-02-25T23:56:08Z
       
  • Study Looking at End Expiratory Pressure for Altitude Illness Decrease
           (SLEEP AID): A Randomized Controlled Trial
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Grant S. Lipman , Kristin Fontes , Becky Higbee , Michael Shaheen , Nicholas C. Kanaan , Caleb Phillips , Dave Pomeranz , Patrick Cain , Carolyn Meyer , Sean Wentworth



      PubDate: 2015-02-25T23:56:08Z
       
  • Healthcare Utilization Following Acute and Overuse Injuries Among Outdoor
           Rock Climbers
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Nathan Furst-Nichols , Courtney Jones , Erik Rueckmann , Mark Mirabelli



      PubDate: 2015-02-25T23:56:08Z
       
  • Irukandji-Like Syndrome in the Caribbean Sea, Puerto Rico: Case Report
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Isabel Algaze , Joanna Mercado , Pedro Arroyo



      PubDate: 2015-02-25T23:56:08Z
       
  • Utilization of Wrist Protection by Snowboarders
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): R. Alissa Mussell , Hollynn L. Larrabee , Danielle M. Davidov , Virginia K. Horne , Henderson D. McGinnis



      PubDate: 2015-02-25T23:56:08Z
       
  • Nonsurgical Treatment of Two Cases of Infantile Facial Growths in a
           Resource-Poor Setting
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Ronald Natawidjaja , N. Ewen Wang



      PubDate: 2015-02-25T23:56:08Z
       
  • The Impact of Freeze-Thaw Cycles on Epinephrine
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Heather Beasley , Pearlly Ng , Scott E. McIntosh , Albert Wheeler , William R Smith



      PubDate: 2015-02-25T23:56:08Z
       
  • Polar Predators
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Christina L. Bourne , Simon C. Watson



      PubDate: 2015-02-25T23:56:08Z
       
  • An Itchy Situation
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Pratibha Phuyal , Pranawa Koirala , Buddha Basnyat , Ken Zafren



      PubDate: 2015-02-25T23:56:08Z
       
  • Injury Patterns at Isle Royale National Park: An Epidemiologic Review of
           Injuries and Illnesses Sustained in a Remote Environment
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Kathleen D. Saxon , Jenna M.B. White , Mary M. Eddy , Daniel L. Albertus , Benjamin S. Bassin
      Objective Isle Royale National Park is a remote island in northern Lake Superior that attracts 16,000 visitors annually. The epidemiology of injuries and illnesses sustained by Isle Royale׳s visitors has not been previously studied. The purpose of this study is to examine these data and evaluate them for injury patterns. Methods This is a retrospective observational study examining the epidemiology of injuries and illnesses sustained during the period from 2008 to 2012. Incident reports completed by park rangers were reviewed and the data sorted according to time of year, time of day, type of medical encounter, and whether the patient was stable, unstable, or required transport. Results Two hundred and seventy patient care reports were obtained from the National Park Service. Sixty-four percent of encounters occurred in July and August, and most patients sought care in the afternoon. Care was provided by park rangers, the majority of whom were trained to the level of emergency medical technician. Fifty-eight percent of cases were trauma related, and 20% of all cases were evacuated. Conclusions The majority of incidents were trauma related. The majority of the rangers on the island are trained to the level of emergency medical technician-B and appear to offer appropriate care to the island’s many visitors, utilizing the National Park Service treatment protocols and comprehensive medical kits. In addition, access to advanced medical care is readily available by air and water evacuation.


      PubDate: 2015-02-25T23:56:08Z
       
  • The Effect of Acetazolamide on Saccadic Latency at 3459 Meters
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Olivia K. Faull , Josephine Robertson , Owen Thomas , Arthur R. Bradwell , Chrystalina A. Antoniades , Kyle T.S. Pattinson
      Objective The effect of altitude on brain function is not yet well understood, nor is the influence of height and speed of ascent. Additionally, the relationship between acute mountain sickness (AMS) symptoms and brain function at altitude is unclear. We hypothesized that a deterioration from baseline measures of brain function occurs after rapid, mechanical ascent to 3459 m and would be less pronounced in persons taking acetazolamide. Methods In this double blind, randomized, placebo-controlled study, 20 healthy volunteers (14 men, 6 women; mean age [±SD] 43 ± 16 years) were alternately allocated to acetazolamide 250 mg or to placebo, taken every 12 hours commencing 3 days before ascent. Prosaccadic and antisaccadic eye movements, heart rate, arterial saturation, and Lake Louise AMS scores were assessed at sea level and 15 to 22 hours after ascent to 3459 m. Results Arterial oxygen saturation was significantly lower in the placebo group compared to the acetazolamide group at altitude (Wilcoxon signed-rank test, median [interquartile range]: acetazolamide vs placebo: 92% [5] vs 85% [5]; P = .007), with no differences in prosaccadic latency, heart rate, or Lake Louise score. No differences in saccadic latencies from baseline to altitude were observed in the placebo group, whereas prosaccadic latencies were significantly longer at altitude with acetazolamide (altitude vs baseline: 153 ms [41] vs 176 ms [52], P = .008). Conclusions Brain function, measured by saccadic eye movements, appears to be unimpaired after rapid ascent to 3459 m. Although acetazolamide improves oxygen saturations, it may worsen prosaccades, possibly indicating adverse effects of acetazolamide on brain function at moderate altitude.


      PubDate: 2015-02-25T23:56:08Z
       
  • Search and Rescue Response to a Large-Scale Rockfall Disaster
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Emily Procter , Giacomo Strapazzon , Karla Balkenhol , Ernst Fop , Alessandro Faggionato , Karl Mayr , Markus Falk , Hermann Brugger
      Objective To describe the prehospital management and safety of search and rescue (SAR) teams involved in a large-scale rockfall disaster and monitor the acute and chronic health effects on personnel with severe dolomitic dust exposure. Methods SAR personnel underwent on-site medical screening and lung function testing 3 months and 3 years after the event. Results The emergency dispatch center was responsible for central coordination of resources. One hundred fifty SAR members from multidisciplinary air- and ground-based teams as well as geotechnical experts were dispatched to a provisionary operation center. Acute exposure to dolomite dust with detectable silicon and magnesium concentrations was not associated with (sub)acute or chronic sequelae or a clinically significant impairment in lung function in exposed personnel. Conclusions The risk for personnel involved in mountain SAR operations is rarely reported and not easily investigated or quantified. This case exemplifies the importance of a multiskilled team and additional considerations for prehospital management during natural hazard events. Safety plans should include compulsory protective measures and medical monitoring of personnel.


      PubDate: 2015-02-25T23:56:08Z
       
  • Injury Trends in Rock Climbers: Evaluation of a Case Series of 911
           Injuries Between 2009 and 2012
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Volker Schöffl , Dominik Popp , Thomas Küpper , Isabelle Schöffl
      Objective Rock climbing is a widely performed sport. This prospective single-institution study evaluated the demographics of climbing-related injuries to improve our comprehension of current injury characteristics. Methods During a 4-year period, 836 patients with a total of 911 independent climbing injuries were prospectively evaluated using a standard questionnaire and examination protocol. Results Of all injuries, 833 were on the upper extremities, 58 on the lower. Seventeen injuries were Union International des Associations d’Alpinisme (UIAA) grade 1 injuries, 881 were grade 2, and 13 were grade 3. No higher UIAA graded injuries occurred. Overall, 380 were acute injuries (359 were seen in clinic, 21 were seen through the emergency department), and 531 were overstrain injuries (all seen in clinic). Finger injuries accounted for 52% of all injuries, the shoulder being the second most frequent location. Pulley injuries were the most frequent finger injuries. Of 20 injured young climbers under the age of 15 years, 14 had an epiphyseal fracture (all epiphyseal fractures: mean age 14 years, range 12 to 15 years). Male climbers were significantly older (P < .05), had more climbing years (P < .05), and were climbing at a higher climbing level (P < .01). Older, more experienced climbers had significantly more overstrain injuries than acute injuries (P < .05). Conclusions When comparing this study with our previous study from 1998 to 2001, there are some notable differences. Although pulley injuries are still the most common climbing injury, there are now more A4 pulley injuries than A2. Shoulder injuries are becoming more common, as are epiphyseal fractures among young climbers. It is important to understand current patterns of climbing injuries so that health providers can target interventions appropriately.


      PubDate: 2015-02-25T23:56:08Z
       
  • Exercise-Associated Hyponatremic Encephalopathy in an Endurance Open Water
           Swimmer
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Ian R. Rogers , Stephen Grainger , Yusuf Nagree
      Exercise-associated hyponatremia and its more serious form, known as exercise-associated hyponatremic encephalopathy, are recognized as some of the most important medical problems seen in a variety of different forms of endurance exercise. We describe a case of exercise-associated hyponatremic encephalopathy presenting as altered conscious state and seizures in a woman who had completed a 20-km open ocean swim. Her serum sodium measured approximately 1 hour after her seizure was 119 mmol/L on point-of-care testing. With ongoing critical care support and the use of hypertonic saline, she was able to be extubated the next day, neurologically intact, and ultimately was discharged from hospital without neurological sequelae. This case emphasizes both the importance of considering exercise-associated hyponatremic encephalopathy as a cause of neurological impairment in all athletes and the pivotal role of hypertonic saline in the treatment of this condition.


      PubDate: 2015-02-25T23:56:08Z
       
  • A 51-Year-Old Woman Crushed by an Elephant Trunk
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Ann H. Tsung , Brandon R. Allen
      Wild and exotic animal attacks are not common in the United States. Animal-related injuries in the United States are usually caused by dog bites, followed by cattle and horse injuries. Exotic animal attacks can occur when the animals are provoked, depressed, or housed improperly by owners. We report the case of a 51-year-old woman who sustained multiple systemic traumatic injuries after she was pinned to a fence by an elephant’s trunk. Upon arrival in the emergency department, she was hypothermic with a temperature of 35.1ºC (95.1ºF), hypotensive to 94/60 mm Hg after 5 L crystalloid, tachycardic at 108 beats/min, and intubated with oxygen saturation of 100%. Tranexamic acid was administered in addition to starting a massive transfusion protocol. Injuries included bilateral multiple rib fractures, left abdominal wall degloving injury, right pneumothorax, right hemothorax, left chest wall puncture wound, grade IV splenic laceration, 3 grade III liver lacerations, retroperitoneal hematoma, and degloving injuries to bilateral posterior thighs requiring more than 30 operations. Why should an emergency physician be aware of this? Several factors need to be considered when evaluating animal-related injuries, including type, age, and sex of the animal. Multisystem traumatic injuries should be assumed when a large animal is involved. Prehospital care and transport time are vital to a patient’s survival in both urban and rural settings. During the initial resuscitation, administering antibiotics tailored to the specific animal can greatly decrease risk of infection and morbidity. Additionally, tetanus immunoglobulin, tetanus toxoid, and rabies immunoglobulin and vaccine may be needed, unless the victim has been previously vaccinated.


      PubDate: 2015-02-25T23:56:08Z
       
  • A Lightning Multiple Casualty Incident in Sequoia and Kings Canyon
           National Parks
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Susanne J. Spano , Danielle Campagne , Geoff Stroh , Marc Shalit
      Multiple casualty incidents (MCIs) are uncommon in remote wilderness settings. This is a case report of a lightning strike on a Boy Scout troop hiking through Sequoia and Kings Canyon National Parks (SEKI), in which the lightning storm hindered rescue efforts. The purpose of this study was to review the response to a lightning-caused MCI in a wilderness setting, address lightning injury as it relates to field management, and discuss evacuation options in inclement weather incidents occurring in remote locations. An analysis of SEKI search and rescue data and a review of current literature were performed. A lightning strike at 10,600 feet elevation in the Sierra Nevada Mountains affected a party of 5 adults and 7 Boy Scouts (age range 12 to 17 years old). Resources mobilized for the rescue included 5 helicopters, 2 ambulances, 2 hospitals, and 15 field and 14 logistical support personnel. The incident was managed from strike to scene clearance in 4 hours and 20 minutes. There were 2 fatalities, 1 on scene and 1 in the hospital. Storm conditions complicated on-scene communication and evacuation efforts. Exposure to ongoing lightning and a remote wilderness location affected both victims and rescuers in a lightning MCI. Helicopters, the main vehicles of wilderness rescue in SEKI, can be limited by weather, daylight, and terrain. Redundancies in communication systems are vital for episodes of radio failure. Reverse triage should be implemented in lightning injury MCIs. Education of both wilderness travelers and rescuers regarding these issues should be pursued.


      PubDate: 2015-02-25T23:56:08Z
       
  • Presence of L-Canavanine in Hedysarum alpinum Seeds and Its Potential Role
           in the Death of Chris McCandless
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Jon Krakauer , Ying Long , Andrew Kolbert , Shri Thanedar , Jonathan Southard
      Objective For the past 2 decades there has been vigorous disagreement over the purported toxicity of Hedysarum alpinum seeds, and whether the consumption of such seeds was a factor in the 1992 death of Chris McCandless, the subject of the book Into the Wild. Our objective was to confirm or disprove the presence of L-canavanine (a nonprotein amino acid known to induce systemic lupuslike symptoms in humans) in H alpinum seeds. Methods Liquid chromatography–tandem mass spectrometry analysis of H alpinum seeds was performed. Results Our analysis confirmed the presence of L-canavanine in H alpinum seeds and demonstrated that it is a significant component of the seeds, with a concentration of 1.2% (weight/weight), roughly half of that found in Canavalia ensiformis. Conclusions The data led us to conclude it is highly likely that the consumption of H alpinum seeds contributed to the death of Chris McCandless.


      PubDate: 2015-02-25T23:56:08Z
       
  • Characterization of Medical Care at the 161-km Western States Endurance
           Run
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Vanessa McGowan , Martin D. Hoffman
      Objective To examine the medical care at a highly competitive 161-km mountain ultramarathon. Methods Encounter forms from the 2010 through 2013 Western States Endurance Run were analyzed for trends in consultation and use of intravenous fluids. Results A total of 63 consultations (8.2% of starters) were documented in 2012 and 2013, of which 10% involved noncompetitors. Most (77%) of the consultations with competitors occurred on the course rather than at the finish line, and were generally during the middle third of the race. Of the on-course consultations, the runner was able to continue the race 55% of the time, and 75% of those who continued after consultation ultimately finished the race. Relative number of consultations did not differ among competitors within 10-year age groups (P = .7) or between men and women (P = .2). Overall, consultations for medical issues were predominant, and nausea and vomiting accounted for the single highest reason for consultation (24%). Although there was an overall decrease in finish line consultations and intravenous fluid use from 2010 through 2013 (P < .0001 for both) that was independent of maximum ambient temperature (P = .3 and P = .4), the proportion of those being treated with intravenous fluids relative to those receiving consultation at the finish line was directly related to maximum ambient temperature (r = .93, P = .037). Both 2012 and 2013 had a single medical emergency that required emergency evacuation. Conclusions This work demonstrates that the medical needs in a 161-km ultramarathon are mostly for minor issues. However, occasional serious issues arise that warrant a well-organized medical system.


      PubDate: 2015-02-25T23:56:08Z
       
  • Effect of Head and Face Insulation on Cooling Rate During Snow Burial
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Scott E. McIntosh , Andre K. Crouch , Andrew Dorais , Marion McDevitt , Courtney Wilson , Chris H. Harmston , Marty I. Radwin , Colin K. Grissom
      Objectives Avalanche victims are subjected to a number of physiological stressors during burial. We simulated avalanche burial to monitor physiological data and determine whether wearing head and face insulation slows cooling rate during snow burial. In addition, we sought to compare 3 different types of temperature measurement methods. Methods Nine subjects underwent 2 burials each, 1 with head and face insulation and 1 without. Burials consisted of a 60-minute burial phase followed by a 60-minute rewarming phase. Temperature was measured via 3 methods: esophageal probe, ingestible capsule, and rectal probe. Results Cooling and rewarming rates were not statistically different between the 2 testing conditions when measured by the 3 measurement methods. All temperature measurement methods correlated significantly. Conclusions Head and face insulation did not protect the simulated avalanche victim from faster cooling or rewarming. Because the 3 temperature measurement methods correlated, the ingestible capsule may provide an advantageous noninvasive method for snow burial and future hypothermia studies if interruptions in data transmission can be minimized.


      PubDate: 2015-02-25T23:56:08Z
       
  • Protection Against Cold in Prehospital Care: Wet Clothing Removal or
           Addition of a Vapor Barrier
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Otto Henriksson , Peter J. Lundgren , Kalev Kuklane , Ingvar Holmér , Gordon G. Giesbrecht , Peter Naredi , Ulf Bjornstig
      Objective The purpose of this study was to evaluate the effect of wet clothing removal or the addition of a vapor barrier in shivering subjects exposed to a cold environment with only limited insulation available. Methods Volunteer subjects (n = 8) wearing wet clothing were positioned on a spineboard in a climatic chamber (–18.5°C) and subjected to an initial 20 minutes of cooling followed by 30 minutes of 4 different insulation interventions in a crossover design: 1) 1 woolen blanket; 2) vapor barrier plus 1 woolen blanket; 3) wet clothing removal plus 1 woolen blanket; or 4) 2 woolen blankets. Metabolic rate, core body temperature, skin temperature, and heart rate were continuously monitored, and cold discomfort was evaluated at 5-minute intervals. Results Wet clothing removal or the addition of a vapor barrier significantly reduced metabolic rate (mean difference ± SE; 14 ± 4.7 W/m2) and increased skin temperature rewarming (1.0° ± 0.2°C). Increasing the insulation rendered a similar effect. There were, however, no significant differences in core body temperature or heart rate among any of the conditions. Cold discomfort (median; interquartile range) was significantly lower with the addition of a vapor barrier (4; 2–4.75) and with 2 woolen blankets (3.5; 1.5–4) compared with 1 woolen blanket alone (5; 3.25–6). Conclusions In protracted rescue scenarios in cold environments with only limited insulation available, wet clothing removal or the use of a vapor barrier is advocated to limit the need for shivering thermogenesis and improve the patient’s condition on admission to the emergency department.


      PubDate: 2015-02-25T23:56:08Z
       
  • Mt Everest Base Camp Medical Clinic “Everest ER”: Epidemiology
           of Medical Events During the First 10 Years of Operation
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Mária Némethy , Andrew B. Pressman , Luanne Freer , Scott E. McIntosh
      Objectives As the highest peak on the planet, Mt Everest provides a truly austere environment in which to practice medicine. We examined records of all visits to the Everest Base Camp Medical Clinic (Everest ER) to characterize the medical problems that occur in these patients. Methods A retrospective analysis of medical records from the first 10 years of operation (2003 to 2012) was performed. Results Medical reasons accounted for 85.3% (3045) of diagnoses, whereas 14.0% (500) were for trauma. The most common medical diagnoses were pulmonary causes such as high altitude cough and upper respiratory infection, comprising more than 38% of medical diagnoses. For traumatic diagnoses, 56% were for dermatologic causes, most commonly for frostbite and lacerations. Pulmonary and dermatologic diagnoses were also the most frequent causes for evacuation from Everest Base Camp, most commonly for high altitude pulmonary edema and frostbite, respectively. Conclusions Medical professionals treating patients at extreme altitude should have a broad scope of practice and be well prepared to deal with serious trauma from falls, cold exposure injuries, and altitude illness.


      PubDate: 2015-02-25T23:56:08Z
       
  • What is Wilderness Medicine?
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Scott E. McIntosh , Tracy A. Cushing , Linda E. Keyes , Neal W. Pollock



      PubDate: 2015-02-25T23:56:08Z
       
  • 2014 Wilderness &amp; Environmental Medicine Peer Reviewers
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1




      PubDate: 2015-02-25T23:56:08Z
       
  • Differing Levels of Acute Hypoxia Do Not Influence Maximal Anaerobic Power
           Capacity
    • Abstract: Publication date: Available online 23 December 2014
      Source:Wilderness & Environmental Medicine
      Author(s): Jesús Álvarez-Herms , Sonia Julià-Sánchez , Hannes Gatterer , Ginés Viscor , Martin Burtscher
      Objective The purpose of this study was to determine the effects of different inspired oxygen fractions (Fio 2) on average and peak power capacity during consecutive jumps to assess the effectiveness of a hypoxic explosive-strength program. Methods Eight physically active subjects (aged 33.62 ± 4.07 years; height, 1.77 ± 0.05 m; weight, 74.38 ± 6.86 kg) completed a Bosco jump test, consisting of a series of 15-second “all-out” jumps with 3 minutes of recovery, performed in a normoxia condition (N [Fio 2 = 21%]) and in two hypoxic conditions: moderate hypoxia (MH [Fio 2 16.5% o 2]) and high hypoxia (HH [13.5% o 2]). A force platform provided the average and the maximal power output (W) generated during consecutive jumps. Measurements were also taken of lactate, creatine kinase, arterial oxygen saturation, and perceived exertion using the Borg fatigue scale. Results The average power outputs throughout the entire sets were similar between N (3187 ± 46) and MH (3184 ± 15; P > .05), but slightly greater with HH (3285 ± 43) compared with N (P < .05). Values for lactate during N (7.5 ± 3.0), MH (7.7 ± 4.0), and HH (7.9 ± 3.0; P > .05), and for creatine kinase (values before, 69.8 ± 15; and 24 hours after in N [79.4 ± 15.60], MH [85.2 ± 26.7], and HH [84.3 ± 47.2]; P > .05) were similar for all conditions. Only during exercise in hypoxia were moderate and severe hypoxemia induced as the sets increased and Fio 2 was lower (P < .05). At the same time, the perceived exertion reported by subjects was substantially higher at HH (8.9 ± 1.1) than at N (7.1 ± 1.9; P < .05). Conclusions Jumping power output was not negatively affected by mild or high hypoxia in comparison with normoxia during an anaerobic workout despite having higher hypoxemia and a greater perception of exertion.


      PubDate: 2014-12-24T15:12:41Z
       
 
 
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