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  Subjects -> ENVIRONMENTAL STUDIES (Total: 804 journals)
    - ENVIRONMENTAL STUDIES (734 journals)
    - POLLUTION (21 journals)
    - TOXICOLOGY AND ENVIRONMENTAL SAFETY (40 journals)
    - WASTE MANAGEMENT (9 journals)

ENVIRONMENTAL STUDIES (734 journals)            First | 1 2 3 4 5 6 7 8     

Lake and Reservoir Management     Hybrid Journal   (Followers: 4)
Landscape Ecology     Hybrid Journal   (Followers: 30)
Landscapes     Hybrid Journal   (Followers: 20)
Large Marine Ecosystems     Full-text available via subscription  
Latin American and Caribbean Ethnic Studies     Hybrid Journal   (Followers: 4)
Latin American Journal of Management for Sustainable Development     Hybrid Journal  
Legal Studies     Hybrid Journal   (Followers: 4)
Letras Verdes. Revista Latinoamericana de Estudios Socioambientales     Open Access  
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: 6)
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: 11)
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: 11)
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: 8)
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: 115)
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: 5)
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 Mapping     Open Access  
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: 9)
Ocean Acidification     Open Access   (Followers: 1)
Ochrona Srodowiska i Zasobów Naturalnych : Environmental Protection and Natural Resources     Open Access  
Oecologia     Hybrid Journal   (Followers: 34)
Oikos     Hybrid Journal   (Followers: 34)
Open Journal of Ecology     Open Access   (Followers: 11)
Open Journal of Marine Science     Open Access   (Followers: 7)
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: 5)
Pace Environmental Law Review Online Companion     Open Access  
Packaging, Transport, Storage & Security of Radioactive Material     Hybrid Journal   (Followers: 1)
Palaeobiodiversity and Palaeoenvironments     Hybrid Journal   (Followers: 4)
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: 5)
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: 16)
Population and Environment     Hybrid Journal   (Followers: 6)
Population Ecology     Hybrid Journal   (Followers: 10)
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)
Present Environment and Sustainable Development     Open Access  
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)

  First | 1 2 3 4 5 6 7 8     

Journal Cover   Wilderness & Environmental Medicine
  [3 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1080-6032
   Published by Elsevier Homepage  [2812 journals]
  • Oxidized Low Density Lipoprotein Among the Elderly in Qinghai-Tibet
           Plateau
    • Abstract: Publication date: Available online 26 July 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Ryota Sakamoto, Kiyohito Okumiya, Hongxin Wang, Qingxiang Dai, Michiko Fujisawa, Taizo Wada, Hissei Imai, Yumi Kimura, Yasuko Ishimoto, Eriko Fukutomi, Wingling Chen, Kwanchit Sasiwongsaroj, Emiko Kato, Ri-Li Ge, Kozo Matsubayashi
      Objective Several environmental factors including hypoxia have been reported to contribute to oxidative stress in individuals living in the highlands. However, little is known about the role of oxidized low-density lipoprotein (ox-LDL) among community-dwelling elderly in the Qinghai-Tibet plateau. Methods The study population comprised 168 community-dwelling elderly subjects aged 60 years or older (male to female ratio, 70:98; mean age, 65.8 years) living in Haiyan County, located 3000 to 3200 m above sea level, 30 km northwest of Xining, Qinghai. The subjects were volunteers who joined a Comprehensive Geriatric Assessment. Plasma ox-LDL was measured in 168 community-dwelling elderly subjects aged 60 years or older (23 Tibetans and 145 Hans) with a monoclonal antibody-based enzyme-linked immunosorbent assay. Results Mean ox-LDL level was higher among Tibetan elderly than Han elderly (Tibetan, 79.0 ± 29.6 U/L; Han, 62.8 ± 23.5 U/L; P = .003). Tibetan ethnicity was significantly associated with ox-LDL levels after adjusting for LDL cholesterol levels. In addition, high ox-LDL levels (≥70 U/L) were significantly associated with a homeostasis model assessment insulin resistance index of at least 1.6 (odds ratio [OR], 2.82; 95% confidence interval [95% CI], 1.11 to 7.15; P = .029) and ankle brachial pressure index of less than 1.0 (OR, 4.85; 95% CI, 1.14 to 10.00; P = .028), after adjusting for age, sex, and ethnicity. Conclusions Our findings support the hypothesis that ox-LDL levels are higher among Tibetan elderly highlanders compared with those among Han elderly. As ox-LDL levels can affect insulin resistance and arteriosclerosis, further research is needed to determine how oxidative stress influences the health situation among elderly individuals at high altitudes.


      PubDate: 2015-07-27T03:56:47Z
       
  • Prolonged Exposure Dermatosis: Reporting High Incidence of an Undiagnosed
           Facial Dermatosis on a Winter Wilderness Expedition
    • Abstract: Publication date: Available online 10 July 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Jodie E. Totten , Douglas M. Brock , Tod D. Schimelpfenig , Justin L. Hopkin , Roy M. Colven
      Objective Previously unclassified inflammatory skin lesions referred to as sun bumps have been observed throughout the year on participants of wilderness trips; however, the underlying cause and diagnosis remain unclear. The purpose of this prospective observational study was to document the incidence, characteristics, and risk factors associated with these skin lesions as they occurred on a winter wilderness expedition. Methods For this study, the lesions were defined as pruritic or erythematous skin lesions occurring while in the wilderness. Seventy-four participants in a wilderness ski touring course in Wyoming fully completed a 44-question written survey concerning occurrence and risk factors for these lesions. Weather information and photographs were collected. Results Twenty-six percent of participants had similar lesions. The lesions were described as edematous pale papules and plaques with erosions and crusts on an erythematous background. The face was involved in 90% of affected persons. Lesions occurred after an average of 8.7 days in the wilderness and resolved 10.6 days later. Skin that was less prone to sunburn was associated with a decreased incidence (odds ratio 0.44). No association could be found between lesion incidence and history of polymorphous light eruption, sun exposure, ambient temperature, affected contacts, sex, or body mass index. Conclusions Overall, the lesions were common among study participants but occurred only after prolonged exposure to wilderness conditions. It was not possible to classify the skin condition as an example of any known diagnosis. We propose the name “prolonged exposure dermatosis” for this condition until further studies better define its etiology, prevention, and treatment.


      PubDate: 2015-07-14T06:38:21Z
       
  • Race Medicine: A Novel Educational Experience for GME Learners
    • Abstract: Publication date: Available online 10 July 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Jeremy Joslin , Joshua Mularella , Susan Schreffler , William F Paolo



      PubDate: 2015-07-14T06:38:21Z
       
  • A Novel Method to Decontaminate Surgical Instruments for Operational and
           Austere Environments
    • Abstract: Publication date: Available online 10 July 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Randy W. Knox , Samandra T. Demons , Cord W. Cunningham
      Objective The purpose of this investigation was to test a field-expedient, cost-effective method to decontaminate, sterilize, and package surgical instruments in an operational (combat) or austere environment using chlorhexidine sponges, ultraviolet C (UVC) light, and commercially available vacuum sealing. Methods This was a bench study of 4 experimental groups and 1 control group of 120 surgical instruments. Experimental groups were inoculated with a 106 concentration of common wound bacteria. The control group was vacuum sealed without inoculum. Groups 1, 2, and 3 were first scrubbed with a chlorhexidine sponge, rinsed, and dried. Group 1 was then packaged; group 2 was irradiated with UVC light, then packaged; group 3 was packaged, then irradiated with UVC light through the bag; and group 4 was packaged without chlorhexidine scrubbing or UVC irradiation. The UVC was not tested by itself, as it does not grossly clean. The instruments were stored overnight and tested for remaining colony forming units (CFU). Results Data analysis was conducted using analysis of variance and group comparisons using the Tukey method. Group 4 CFU was statistically greater (P < .001) than the control group and groups 1 through 3. There was no statistically significant difference between the control group and groups 1 through 3. Conclusions Vacuum sealing of chlorhexidine-scrubbed contaminated instruments with and without handheld UVC irradiation appears to be an acceptable method of field decontamination. Chlorhexidine scrubbing alone achieved a 99.9% reduction in CFU, whereas adding UVC before packaging achieved sterilization or 100% reduction in CFU, and UVC through the bag achieved disinfection.


      PubDate: 2015-07-14T06:38:21Z
       
  • The Effects of Sympathetic Inhibition on Metabolic and Cardiopulmonary
           Responses to Exercise in Hypoxic Conditions
    • Abstract: Publication date: Available online 14 July 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Rebecca L. Scalzo , Garrett L. Peltonen , Scott E. Binns , Anna L. Klochak , Steve E. Szallar , Lacey M. Wood , Dennis G. Larson , Gary J. Luckasen , David Irwin , Thies Schroeder , Karyn L. Hamilton , Christopher Bell
      Objective Pre-exertion skeletal muscle glycogen content is an important physiological determinant of endurance exercise performance: low glycogen stores contribute to premature fatigue. In low-oxygen environments (hypoxia), the important contribution of carbohydrates to endurance performance is further enhanced as glucose and glycogen dependence is increased; however, the insulin sensitivity of healthy adult humans is decreased. In light of this insulin resistance, maintaining skeletal muscle glycogen in hypoxia becomes difficult, and subsequent endurance performance is impaired. Sympathetic inhibition promotes insulin sensitivity in hypoxia but may impair hypoxic exercise performance, in part due to suppression of cardiac output. Accordingly, we tested the hypothesis that hypoxic exercise performance after intravenous glucose feeding in a low-oxygen environment will be attenuated when feeding occurs during sympathetic inhibition. Methods On 2 separate occasions, while breathing a hypoxic gas mixture, 10 healthy men received 1 hour of parenteral carbohydrate infusion (20% glucose solution in saline; 75 g), after which they performed stationary cycle ergometer exercise (~65% maximal oxygen uptake) until exhaustion. Forty-eight hours before 1 visit, chosen randomly, sympathetic inhibition via transdermal clonidine (0.2 mg/d) was initiated. Results The mean time to exhaustion after glucose feeding both with and without sympathetic inhibition was not different (22.7 ± 5.4 minutes vs 23.5 ± 5.1 minutes; P = .73). Conclusions Sympathetic inhibition protects against hypoxia-mediated insulin resistance without influencing subsequent hypoxic endurance performance.


      PubDate: 2015-07-14T06:38:21Z
       
  • A Rare Case of Vaginal Bleeding in a Child Due to a Leech Bite and Review
           of the Literature
    • Abstract: Publication date: Available online 2 July 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Anuruddha H. Karunaratne , Buddhika T.B. Wijerathne , Ravihar S. Wickramasinghe , Anura K. Wijesinghe , Aloka S.D. Liyanage



      PubDate: 2015-07-04T06:23:46Z
       
  • The UPLOADS Project: Development of an Australian National Incident
           Dataset for Led Outdoor Activities
    • Abstract: Publication date: Available online 2 July 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Natassia Goode , Paul M. Salmon , Michael G. Lenné , Caroline F. Finch



      PubDate: 2015-07-04T06:23:46Z
       
  • Lyme Disease: What the Wilderness Provider Needs to Know
    • Abstract: Publication date: Available online 2 July 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Joseph D. Forrester , J. Priyanka Vakkalanka , Christopher P. Holstege , Paul S. Mead
      Lyme disease is a multisystem tickborne illness caused by the spirochete Borrelia burgdorferi and is the most common vectorborne disease in the United States. Prognosis after initiation of appropriate antibiotic therapy is typically good if treated early. Wilderness providers caring for patients who live in or travel to high-incidence Lyme disease areas should be aware of the basic biology, epidemiology, clinical manifestations, and treatment of Lyme disease.


      PubDate: 2015-07-04T06:23:46Z
       
  • Wilderness Medicine Curricular Content in Emergency Medicine Residency
           Programs
    • Abstract: Publication date: Available online 30 June 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Elizabeth J. Aronstam , Mark L. Christensen , Michael P. Williams , David T. Overton



      PubDate: 2015-07-04T06:23:46Z
       
  • Comparison of Distal Limb Warming With Fluidotherapy and Warm Water
           Immersion for Mild Hypothermia Rewarming
    • Abstract: Publication date: Available online 24 June 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Parveen Kumar , Gerren K. McDonald , Radhika Chitkara , Alan M. Steinman , Phillip F. Gardiner , Gordon G. Giesbrecht
      Objective The purpose of the study was to determine the effectiveness of Fluidotherapy rewarming through the distal extremities for mildly hypothermic, vigorously shivering subjects. Fluidotherapy is a dry heat modality in which cellulose particles are suspended by warm air circulation. Methods Seven subjects (2 female) were cooled on 3 occasions in 8˚C water for 60 minutes, or to a core temperature of 35°C. They were then dried and rewarmed in a seated position by 1) shivering only; 2) Fluidotherapy applied to the distal extremities (46 ± 1°C, mean ± SD); or 3) water immersion of the distal extremities (44 ± 1°C). The order of rewarming followed a balanced design. Esophageal temperature, skin temperature, heart rate, oxygen consumption, and heat flux were measured. Results The warm water produced the highest rewarming rate, 6.1°C·h−1, 95% CI: 5.3–6.9, compared with Fluidotherapy, 2.2°C·h−1, 95% CI: 1.4–3.0, and shivering only, 2.0°C·h−1, 95% CI: 1.2–2.8. The Fluidotherapy and warm water conditions increased skin temperature and inhibited shivering heat production, thus reducing metabolic heat production (166 ± 42 W and 181 ± 45 W, respectively), compared with shivering only (322 ± 142 W). Warm water provided a significantly higher net heat gain (398.0 ± 52 W) than shivering only (288.4 ± 115 W). Conclusions Fluidotherapy was not as effective as warm water for rewarming mildly hypothermic subjects. Although Fluidotherapy is more portable and technically simpler, it provides a lower rate of rewarming that is similar to shivering only. It does help decrease shivering heat production, lowering energy expenditure and cardiac work, and could be considered in a hospital setting, if convenient.


      PubDate: 2015-06-29T06:15:49Z
       
  • A Chemical Heat Pack–Based Method For Consistent Heating of
           Intravenous Fluids
    • Abstract: Publication date: Available online 19 June 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Matthieu P. DeClerck , Grant S. Lipman , Dennis A. Grahn , Vinh Cao , Mark Wieland , Tom Troxel , H. Craig Heller
      Background Transfusion of cold intravenous fluids (IVF) can exacerbate hypothermia. Civilian and military guidelines recommend heated IVF for hypothermic patients; however, there is currently no ideal IVF heating system for use in resource-limited settings. Objective Development of a system that uses flameless ration heaters (FRH) and an insulated sleeve for the consistent delivery of IVF at physiologically appropriate temperatures (40°–42°C) over the range of ambient conditions typical of the prehospital and wilderness environments. Methods The temperatures of 0.9% normal saline (NS) 1-L bags were measured under 3 ambient conditions: 3°C, 10°C, and 20°C. The IVF was placed in an insulated pouch along with a predetermined number of activated FRH (5 FRH for 3°C, 4 FRH for 10°C, and 3 FRH for 20°C) for 10 minutes before removing the FRHs. The insulated IVF bag was drained through 280 cm of intravenous tubing at a flow rate of 77 mL/min. Raw temperature data for internal and delivery temperatures were collected and analyzed. Results The temperature of the IVF throughout the delivery of 1 L of NS under the 3 ambient conditions was as follows (mean ± SD): at 3°C ambient, 47° ± 2.1°C internal and 42.6°C ± 1.4°C at delivery; at 10°C ambient, 52.3° ± 2.7°C and 45.2° ± 1.6°C; and at 20°C ambient, 45.5° ± 1°C and 39.7° ± 0.7°C. Conclusions The IVF heating system described here reliably delivered physiologically appropriate temperature intravenous fluids in 2 of the 3 ambient treatment conditions. With the appropriate number of FRH for the ambient conditions, this system enables the delivery of warmed IVF to provide active warming, which may be clinically beneficial in the prevention and treatment of hypothermia.


      PubDate: 2015-06-23T06:08:58Z
       
  • Smartphones in the Wild: Can Technology Improve Emergency Care in Remote
           Settings?
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Robert Katzer , Tanya Wilcox , Merrick Brodsky , Monica Straatman , Nitish Nag , Justin Yanuck



      PubDate: 2015-05-29T08:20:03Z
       
  • Cutaneous Exposure to Cobra Venom: An Uncommon Presentation
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Shao Hui Koh , R. Ponampalam , Swee Han Lim , Dinesh Visva Gunasekeran



      PubDate: 2015-05-29T08:20:03Z
       
  • Reply to “In Response to Wilderness Search Strategy and
           Tactics”
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Ken Phillips , Maura J. Longden , Bil Vandergraff , David C. Weber , Scott E McIntosh , William R. Smith , Albert R. Wheeler III



      PubDate: 2015-05-29T08:20:03Z
       
  • Ritualistic Envenomation by Bullet Ants Among the Sateré-Mawé
           Indians in the Brazilian Amazon
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Anand N. Bosmia , Christoph J. Griessenauer , Vidal Haddad Jr , R. Shane Tubbs



      PubDate: 2015-05-29T08:20:03Z
       
  • Survey of Illnesses and Injuries in Offshore Great Lake Sailboat Racing
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Thomas Kopp , David Ledrick , Julie Stausmire , Kari Stausmire



      PubDate: 2015-05-29T08:20:03Z
       
  • Paper Tape Prevents Foot Blisters: Randomized Prevention Trial Assessing
           Paper Tape in Endurance Distances II (Pre-TAPED II)
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Grant S. Lipman , Mark Christensen , Alexandra DiTullio , Katherine Shea , Louis J. Sharp , Andrew Dalton , Caleb Phillips , Pearlly Ng , Jennifer Shangkuan , Brian J. Krabak



      PubDate: 2015-05-29T08:20:03Z
       
  • “Out of the Box” Disaster Training: Low-Cost Training Tools
           Improve Medical Team Disaster Performance
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Lancer A. Scott , Layne Madden , Judy Staub , Jason Crumpler , Jamal Jones , Simon Watson , Wade Manaker , Blake Willis



      PubDate: 2015-05-29T08:20:03Z
       
  • Clinical Journal of Sports Medicine
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2




      PubDate: 2015-05-29T08:20:03Z
       
  • Environmental Science &amp; Technology Letters
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2




      PubDate: 2015-05-29T08:20:03Z
       
  • Journal of The American College of Cardiology
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2




      PubDate: 2015-05-29T08:20:03Z
       
  • Journal of Trauma and Acute Care Surgery
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2




      PubDate: 2015-05-29T08:20:03Z
       
  • Injury and Illness at Resident Summer Camps: An Evaluation for Improvement
           and Preparedness
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Ross T. Miller , Bradley E. Barth



      PubDate: 2015-05-29T08:20:03Z
       
  • Winter Wilderness Medicine Race: An Innovative Educational Tool
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Leah M. Feazel , Jason M. Block , Christopher T. Buresh



      PubDate: 2015-05-29T08:20:03Z
       
  • Wilderness Emergency Medical Services Medical Director Course: Core
           Content Developed With Delphi Technique
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Michael G. Millin , Seth Hawkins , Anthony Demond , Gregory Stiller , Henderson D. McGinnis , Janna Baker Rogers , William R. Smith
      The National Association of Emergency Medical Services Physicians’ (NAEMSP) position on the role of medical oversight within an operational Emergency Medical Service (EMS) program highlights the importance of integrating specially trained medical directors within the structure of these programs. In response, the NAEMSP Wilderness EMS (WEMS) Committee recognized the need for the development of an educational curriculum to provide physicians with the unique skills needed to be a medical director for a WEMS agency. This paper describes the Delphi process used to create the subject matter core content, as well as the actual core content developed. This core content was the foundation for the development of a specific WEMS medical director curriculum, the Wilderness EMS Medical Director Course.


      PubDate: 2015-05-29T08:20:03Z
       
  • Clinical Journal of Sports Medicine
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2




      PubDate: 2015-05-29T08:20:03Z
       
  • Application of Current Hemorrhage Control Techniques for Backcountry Care:
           Part One, Tourniquets and Hemorrhage Control Adjuncts
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Brendon Drew , Brad L. Bennett , Lanny Littlejohn
      Decade-long advancements in battlefield medicine have revolutionized the treatment of traumatic hemorrhage and have led to a significant reduction in mortality. Older methods such as limb elevation and pressure points are no longer recommended. Tourniquets have had a profound effect on lives saved without the commonly feared safety issues that have made them controversial. Unique tourniquet designs for inguinal and abdominal regions are now available for areas not amenable to current fielded extremity tourniquets. This article, the first of two parts, reviews the literature for advancements in prehospital hemorrhage control for any provider in the austere setting. It emphasizes the significant evidence-based advances in tourniquet use on the extremities that have occurred in battlefield trauma medicine since 2001 and reviews the newer junctional tourniquet devices. Recommendations are made for equipment and techniques for controlling hemorrhage in the wilderness setting.


      PubDate: 2015-05-29T08:20:03Z
       
  • Application of Current Hemorrhage Control Techniques for Backcountry Care:
           Part Two, Hemostatic Dressings and Other Adjuncts
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Lanny Littlejohn , Brad L. Bennett , Brendon Drew
      Decade-long advances in battlefield medicine have revolutionized the treatment of traumatic hemorrhage and have led to a significant reduction in mortality. Part one of this review covered the use of tourniquets on the extremities and the newer devices for use in junctional areas. Part two focuses on the use of hemostatic agents or dressings, pelvic binders, and tranexamic acid. Field applicable hemostatic dressings are safe and effective in controlling hemorrhage not amenable to extremity tourniquet application, and newer agents with increasing efficacy continue to be developed. Most of these agents are inexpensive and lightweight, making them ideal products for use in wilderness medicine. The use of pelvic binders to stabilize suspected pelvic fractures has gained new interest as these products are developed and refined, and the prehospital use of tranexamic acid, a potent antifibrinolytic, has been found to be life saving in patients at risk of death from severe hemorrhage. Recommendations are made for equipment and techniques for controlling hemorrhage in the wilderness setting.


      PubDate: 2015-05-29T08:20:03Z
       
  • An Investigation of Ultramarathon-Associated Visual Impairment
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Tracy B. Høeg , Genevieve K. Corrigan , Martin D. Hoffman
      Objective The purpose of this study was to investigate the characteristics under which ultramarathon-associated visual impairment occurs and to seek to identify its physiological basis and risk factors. Methods Through an online questionnaire, distributed worldwide, we obtained information from 173 self-identified ultramarathon runners who had experienced visual impairment during an ultramarathon. We attempted to characterize this vision impairment—its symptoms, duration, and the conditions under which it occurs. Select characteristics were compared with a reference group of 412 registrants of the 161-km Western States Endurance Run. Results Ultramarathon-associated visual impairment was typically characterized as painless clouding of vision that resolved either during (13.5%) or after racing within a median of 3.5 hours (range 0 to 48 hours) upon cessation of running. The mean (±SD) distance at which vision impairment occurred was 73 ± 40 km, and the 161-km distance was the most frequent race distance (46.8%) in which visual impairment occurred. Visual impairment was often recurrent, with respondents reporting having it develop during a median of 2 races. Respondents with a history of refractive surgery had more episodes than those without such history (median 3.5 vs 2 episodes, P = .010). Compared with the reference group, runners with visual impairment were nearly twice as likely (23.7% vs 12.1%, P < .001) to have had refractive surgery. Conclusions Ultramarathon-associated visual impairment typically presents as a painless clouding of vision that is self-limited but tends to recur in certain runners. Risk appears higher among those with a history of refractive surgery, which is relevant for ultramarathon runners who are considering, or who have a history of, refractive surgery.


      PubDate: 2015-05-29T08:20:03Z
       
  • Three Cases of Severe Hyponatremia During a River Run in Grand Canyon
           National Park
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Emily A. Pearce , Thomas M. Myers , Martin D. Hoffman
      We present 3 cases of severe hyponatremia occurring on a commercially guided river rafting trip on the Colorado River in Grand Canyon National Park. All 3 women appeared to have been overhydrating because of concern about dehydration and required evacuation within 24 hours of each other after the staggered onset of symptoms, which included fatigue and emesis progressing to disorientation or seizure. Each was initially transferred to the nearest hospital and ultimately required intensive care. Imaging and laboratory data indicated all 3 patients had hypervolemic hyponatremia. Unlike the well-documented exercise-associated hyponatremia cases commonly occurring in prolonged endurance athletic events, these 3 unique cases of acute hyponatremia were not associated with significant exercise. The cases illustrate the diagnostic and treatment challenges related to acute hyponatremia in an austere setting, and underscore the importance of preventive measures focused on avoidance of overhydration out of concern for dehydration.


      PubDate: 2015-05-29T08:20:03Z
       
  • Smoking Increases the Risk of Acute Mountain Sickness
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      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: 2015-05-29T08:20:03Z
       
  • Complex Alpine Extrication: Case Report of Mountain and Speleological
           Rescue Cooperation
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      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: 2015-05-29T08:20:03Z
       
  • Retrospective Study on Search and Rescue Operations in Two Prealps Areas
           of Italy
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Marta Ciesa , Stefano Grigolato , Raffaele Cavalli
      Objectives The rising number of people involved in outdoor recreation and tourism in mountain forest and wilderness areas close to urban areas has led to an increase of rescue efforts in the last decades. The study analyzes rescue operations in 2 mountain areas of the Veneto Prealps in Italy. Methods A retrospective review of search and rescue incident reports for a 20-year period was performed. The study also takes into consideration any differences between accidents in the 2 areas in relation to the morphology and mountain activities involved. Results There has been an increase in accidents, and the greater participation in mountain activities does not seem to be accompanied by an improvement in knowledge of the specific risks in this kind of environment. Inexperience is reflected in many reasons for callouts and is related to the remarkable rise in the number of rescued but uninjured people; the trend of fatalities and injuries is otherwise stable. Comparison of the 2 areas reveals differences in accidents mainly attributable to diversities in mountain activities involved that led to different health consequences. Conclusions Search and rescue missions in mountain areas are dangerous for rescuers and made difficult by the severe environment. The knowledge of accident characteristics is therefore very important and is necessary to reduce risks for tourists and healthcare costs. To tackle the problem of safety there is also a need for more information in the form of preventive education and publicity about the typical hazards.


      PubDate: 2015-05-29T08:20:03Z
       
  • Positive Association of D Allele of ACE Gene With High Altitude Pulmonary
           Edema in Indian Population
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Shuchi Bhagi , Swati Srivastava , Arvind Tomar , Shashi Bala Singh , Soma Sarkar
      Objective High altitude pulmonary edema (HAPE) is a potentially fatal high altitude illness occurring as a result of hypobaric hypoxia with an unknown underlying genetic mechanism. Recent studies have shown a possible association between HAPE and polymorphisms in genes of the renin-angiotensin-aldosterone system (RAAS), which play a key role in sensitivity of an individual toward HAPE. Methods For the present investigation, study groups consisted of HAPE patients (HAPE) and acclimatized control subjects (rCON). Four single-nucleotide polymorphisms (SNPs) were genotyped using restriction fragment length polymorphism (RFLP) analysis in genes of the RAAS pathway, specifically, renin (REN) C(–4063)T (rs41317140) and REN i8–83 (rs2368564), angiotensin (AGT) M(235)T (rs699), and angiotensin-converting enzyme (ACE) insertion/deletion (I/D) (rs1799752). Results Only the I/D polymorphism of the ACE gene showed a significant difference between the HAPE and rCON groups. The frequency of the D allele was found to be significantly higher in the HAPE group. Arterial oxygen saturation levels were significantly lower in the HAPE group compared with the rCON group and also decreased in the I/D and D/D genotypes compared with the I/I genotype in these groups. The other polymorphisms occurring in the REN and AGT genes were not significantly different between the 2 groups. Conclusions These findings demonstrate a possible association of the I/D polymorphism of the ACE gene with the development of HAPE, with D/D being the at-risk genotype.


      PubDate: 2015-05-29T08:20:03Z
       
  • Effectiveness of A Clinical Protocol Implemented To Standardize Snakebite
           Management In Iran: Initial Evaluation
    • Abstract: Publication date: June 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 2
      Author(s): Seyed Mostafa Monzavi , Amir Ahmad Salarian , Ali Reza Khoshdel , Bita Dadpour , Reza Afshari
      Objective This study was designed to evaluate the effectiveness of a new protocol implemented to standardize snakebite management in Iran. Methods In this study, 27 patients treated according to the new protocol in 2012 (P+) were compared with 22 patients treated according to the previous modality in the year before implementation of the protocol (P–) in Mashhad Medical Toxicology Centre (MTC). Demographic characteristics and treatment details of all patients were recorded prospectively. Envenomation severity of each victim was assessed according to snakebite severity score (SSS). Results After implementation of the protocol, a smaller percentage of patients received antivenom (AV) therapy (78% vs 95%; P = .079). In spite of no significant difference in baseline severity of envenomation between the 2 groups (SSS [mean ± SD], 34.8 ± 18.1 vs 35.5 ± 17.4; P = .801), the P+ group received significantly fewer AV vials (8.4 ± 6.8 vs 12.1 ± 5.6 vials; P = .042) and had a significantly shorter length of hospital stay (2.2 ± 1.5 vs 3.2 ± 1.8 days; P = .027). Moreover, smaller proportion of P+ patients experienced recurrence of venom-induced effects; however, the difference was not significant (18.5% vs 36%; P = .159). The reduction in use of antiallergy treatments to prevent or treat acute hypersensitivity reactions approached statistical significance (41% vs 68%; P = .051). These findings denote a reduction in AV use of approximately 4 vials and a reduction in hospital stay of 1 day for each patient, which translates to approximately $196/patient in healthcare cost savings. Conclusions Implementation of a snakebite management protocol at MTC reduced overall antivenom usage, use of antiallergy interventions, and length of hospital stay.


      PubDate: 2015-05-29T08:20:03Z
       
  • Bites, Bugs, and Blood
    • Abstract: Publication date: Available online 18 April 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Scott E. McIntosh , Tracy A. Cushing , Linda E. Keyes , Neal W. Pollock



      PubDate: 2015-05-08T11:03:54Z
       
  • Diabetic Ketoacidosis and Acute Mountain Sickness: Case Report and Review
           of Treatment Options in Type 1 Diabetes Mellitus
    • Abstract: Publication date: Available online 18 April 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Steven C.M. Miller
      A 30-year-old man with a 20-year history of well-controlled type 1 diabetes mellitus and no microvascular complications traveled from near sea level to an altitude of 3000 m within 6 hours. At altitude, his blood glucose levels began to rise, necessitating increased insulin delivery. Typical symptoms of acute mountain sickness (AMS) developed, and he became increasingly hyperglycemic and unwell. Upon presentation to an emergency clinic, diabetic ketoacidosis (DKA) was diagnosed and was managed with insulin, intravenous fluids with potassium, and acetazolamide orally. No other potential causes for diabetic ketoacidosis were identified. Hyperglycemia, ketosis, and acidosis resolved with treatment as expected, but an increased insulin requirement was noted for the next 48 hours, until returning to expected levels when acetazolamide was discontinued. This case describes an episode of mild diabetic ketoacidosis potentially precipitated by moderate to severe acute mountain sickness, and an apparent hyperglycemic effect of acetazolamide. Individuals with type 1 diabetes traveling to altitude and their physicians should be vigilant for this complication and should be aware of the effects of conventional first-line therapies for acute mountain sickness on insulin requirement, glycemic control, and preexisting microvascular diabetes complications.


      PubDate: 2015-05-08T11:03:54Z
       
  • Cerebral Hemodynamics at Altitude: Effects of Hyperventilation and
           Acclimatization on Cerebral Blood Flow and Oxygenation
    • Abstract: Publication date: Available online 18 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Matthew R. Sanborn , Mark E. Edsell , Meeri N. Kim , Rickson Mesquita , Mary E. Putt , Chris Imray , Heng Yow , Mark H. Wilson , Arjun G. Yodh , Mike Grocott , Daniel S. Martin
      Objective Alterations in cerebral blood flow (CBF) and cerebral oxygenation are implicated in altitude-associated diseases. We assessed the dynamic changes in CBF and peripheral and cerebral oxygenation engendered by ascent to altitude with partial acclimatization and hyperventilation using a combination of near-infrared spectroscopy, transcranial Doppler ultrasound, and diffuse correlation spectroscopy. Methods Peripheral (Spo 2) and cerebral (Scto 2) oxygenation, end-tidal carbon dioxide (ETCO 2), and cerebral hemodynamics were studied in 12 subjects using transcranial Doppler and diffuse correlation spectroscopy (DCS) at 75 m and then 2 days and 7 days after ascending to 4559 m above sea level. After obtaining baseline measurements, subjects hyperventilated to reduce baseline ETCO2 by 50%, and a further set of measurements were obtained. Results Cerebral oxygenation and peripheral oxygenation showed a divergent response, with cerebral oxygenation decreasing at day 2 and decreasing further at day 7 at altitude, whereas peripheral oxygenation decreased on day 2 before partially rebounding on day 7. Cerebral oxygenation decreased after hyperventilation at sea level (Scto 2 from 68.8% to 63.5%; P < .001), increased after hyperventilation after 2 days at altitude (Scto 2 from 65.6% to 69.9%; P = .001), and did not change after hyperventilation after 7 days at altitude (Scto 2 from 62.2% to 63.3%; P = .35). Conclusions An intensification of the normal cerebral hypocapnic vasoconstrictive response occurred after partial acclimatization in the setting of divergent peripheral and cerebral oxygenation. This may help explain why hyperventilation fails to improve cerebral oxygenation after partial acclimatization as it does after initial ascent. The use of DCS is feasible at altitude and provides a direct measure of CBF indices with high temporal resolution.


      PubDate: 2015-04-02T01:16:10Z
       
  • Adirondack Park Incidents: A Retrospective Review of Search and Rescue
           Reports From 2008 and 2009
    • Abstract: Publication date: Available online 19 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Rokhsanna Sadeghi , Joseph C. Konwinski , Rita K. Cydulka
      Background The Adirondack Park is a 6 million acre recreational area in northeastern New York used for activities such as hiking, camping, canoeing, hunting, fishing, snowmobiling, skiing, and rock climbing. Given the large number of people who use the Adirondacks for recreation, there exists the potential for many accidents, injuries, and illnesses to occur in areas ranging from state-operated campgrounds to remote backcountry. Objective The aim of this study was to gain insight into the demographics of search and rescue (SAR) operations in the Adirondack Park. Methods This study is a retrospective review of the Adirondack Park Forest Ranger SAR reports from January 1, 2008, through December 31, 2009. Epidemiologic data were gathered from the NY State Department of Environmental Conservation for each report, including victim demographics, incident, reason for injury, medical care needed, preparation of victim, and prior medical conditions. Results In all, 239 SAR missions were carried out involving at least 349 victims. Of all cases, 28% (66) involved an injured victim, and 9% (21) involved illness; 56% (10) of the victims had a known prior illness or medical condition; and 21% (27) of cases were due to victims exceeding their abilities. Of the search missions, 54% of victims (93) had little experience with the activity, and 9% (15) had no experience. Only 43% (62) of victims had any form of orientation equipment. Conclusions This study portrays the initial demographics of SAR efforts in Adirondack Park. It will aid in educating people on preparing for wilderness activities, as well as tailoring SAR resources to the demographics of injury and illness within the park.


      PubDate: 2015-04-02T01:16:10Z
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
 
 
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