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Journal Cover Wilderness & Environmental Medicine
  [SJR: 0.49]   [H-I: 29]   [4 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1080-6032
   Published by Elsevier Homepage  [3042 journals]
  • Faculty Biographies
    • Authors: Alicia Byrne
      Abstract: Publication date: June 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 2, Supplement
      Author(s): Alicia Byrne


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


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

      PubDate: 2017-06-08T06:28:41Z
      DOI: 10.1016/j.wem.2016.12.008
       
  • Tranexamic Acid Use in Prehospital Uncontrolled Hemorrhage
    • Authors: Benjamin R. Huebner; Warren C. Dorlac; Chris Cribari
      Abstract: Publication date: June 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 2, Supplement
      Author(s): Benjamin R. Huebner, Warren C. Dorlac, Chris Cribari
      The use of tranexamic acid (TXA) in the treatment of trauma patients was relatively unexplored until the landmark Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage-2 (CRASH-2) trial in 2010 demonstrated a reduction in mortality with the use of TXA. Although this trial was a randomized, double-blinded, placebo-controlled study incorporating >20,000 patients, numerous limitations and weaknesses have been described. As a result, additional studies have followed, delineating the potential risks and benefits of TXA administration. A systematic review of the literature to date reveals a mortality benefit of early (ideally <1 hour and no later than 3 hours after injury) TXA administration in the treatment of severely injured trauma patients (systolic blood pressure <90 mm Hg, heart rate >110). Combined with abundant literature showing a reduction in bleeding in elective surgery, the most significant benefit may be administration of TXA before the patient goes into shock. Those trials that failed to show a mortality benefit of TXA in the treatment of hemorrhagic shock acknowledged that most patients received blood products before TXA administration, thus confounding the results. Although the use of prehospital TXA in the severely injured trauma patient will become more clear with the trauma studies currently underway, the current literature supports the use of prehospital TXA in this high-risk population. We recommend considering a 1 g TXA bolus en route to definitive care in high-risk patients and withholding subsequent doses until hyperfibrinolysis is confirmed by thromboelastography.

      PubDate: 2017-06-08T06:28:41Z
      DOI: 10.1016/j.wem.2016.12.006
       
  • Awake Cricothyrotomy: A Novel Approach to the Surgical Airway in the
           Tactical Setting
    • Authors: Robert L. Mabry; Chetan U. Kharod; Brad L. Bennett
      Abstract: Publication date: June 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 2, Supplement
      Author(s): Robert L. Mabry, Chetan U. Kharod, Brad L. Bennett
      Airway obstruction on the battlefield is most often due to maxillofacial trauma, which may include bleeding and disrupted airway anatomy. In many of these cases, surgical cricothyrotomy (SC) is the preferred airway management procedure. SC is an emergency airway procedure performed when attempts to open an airway using nasal devices, oral devices, or tracheal intubation have failed, or when the risks from intubation are unacceptably high. The aim of this overview is to describe a novel approach to the inevitably surgical airway in which SC is the first and best procedure to manage the difficult or failed airway. The awake SC technique and supporting algorithm are presented along with the limitations and future directions. Awake SC, using local anesthetic with or without ketamine, will allow the knowledgeable provider to manage patients with a compromised airway across the continuum of emergency care ranging from remote/en route care, austere settings, and prehospital to the emergency department.

      PubDate: 2017-06-08T06:28:41Z
      DOI: 10.1016/j.wem.2017.02.003
       
  • Treatment of Thoracic Trauma: Lessons From the Battlefield Adapted to All
           Austere Environments
    • Authors: Lanny F. Littlejohn
      Abstract: Publication date: June 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 2, Supplement
      Author(s): Lanny F. Littlejohn
      Severe thoracic trauma in the backcountry can be a formidable injury pattern to successfully treat. Traumatic open, pneumo-, and hemothoraces represent some of the most significant patterns for which advanced equipment and procedures may help leverage morbidity and mortality, particularly when evacuation is delayed and environmental conditions are extreme. This paper reviews the development of successful techniques for treating combat casualties with thoracic trauma, including the use of vented chest seals and the technique of needle thoracentesis. Recommendations are then given for applying this knowledge and skill set in the backcountry.

      PubDate: 2017-06-08T06:28:41Z
      DOI: 10.1016/j.wem.2017.01.031
       
  • Fluid Resuscitation in Tactical Combat Casualty Care: Yesterday and Today
    • Authors: Frank K. Butler
      Abstract: Publication date: June 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 2, Supplement
      Author(s): Frank K. Butler
      The prevailing wisdom for the prehospital fluid resuscitation of trauma victims in hemorrhagic shock in 1992 was to administer 2 L of crystalloid solution as rapidly as possible. A review of the fluid resuscitation literature found that this recommendation was not well supported by the evidence at the time. Prehospital fluid resuscitation strategies were reevaluated in the 1993–1996 Tactical Combat Casualty Care (TCCC) research program. This article reviews the advances in prehospital fluid resuscitation as recommended by the original TCCC Guidelines and modified over the following 2 decades. These advances include hypotensive resuscitation, use of prehospital whole blood or blood components when feasible, and use of Hextend or selected crystalloids when logistical considerations make blood or blood component use not feasible.

      PubDate: 2017-06-08T06:28:41Z
      DOI: 10.1016/j.wem.2016.12.007
       
  • Field Wound Care: Prophylactic Antibiotics
    • Authors: Clinton K. Murray
      Abstract: Publication date: June 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 2, Supplement
      Author(s): Clinton K. Murray
      Adequate management of wounds requires numerous interventions, one of which is the appropriate use of antimicrobials to attempt to minimize the risk of excess morbidity or mortality without increasing toxicity or multidrug resistant bacterial acquisition. There are numerous recommendations and opinions for not only the use of systemic prophylactic antimicrobials, but also the agent, dose, route, and duration. To best address the implementation of systemic antimicrobials in a field scenario, one must weigh the factors that go into that decision and then determine the best agents possible. The epidemiologic triangle (ie, the host, the agent, and the environment) forms the basis for selecting the correct prophylactic antibiotic for field wound care. Extreme conditions can be encountered in both military and nonmilitary systems, requiring a unique selection process to make the right antibiotic choice. A modifiable weighted matrix, recommended previously for point of injury combat casualty care, assists in selecting the best oral and intravenous/intramuscular agent based on the epidemiologic risk determination.

      PubDate: 2017-06-08T06:28:41Z
      DOI: 10.1016/j.wem.2016.12.009
       
  • The Care of Thermally Injured Patients in Operational, Austere, and Mass
           Casualty Situations
    • Authors: Booker T. King; Wylan C. Peterson
      Abstract: Publication date: June 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 2, Supplement
      Author(s): Booker T. King, Wylan C. Peterson
      Burn injury affects a half million people in the United States annually. The severe thermal injury can have long-term debilitating effects. The management of burn patients in austere and operational environments is more complex. Mass casualty incidents can result in a large number of patients with multiple traumatic injuries, which often include burn injury. Appropriate triage of casualties is essential. Severely burned patients should be evacuated to a burn center if possible. Airway management and fluid resuscitation of burn patients present unique challenges. Supplies, resources, and expertise to maintain a definitive airway may not be readily available. Airway adjuncts can be helpful but judicious use of resources is warranted in the austere setting. Traditional resuscitation of severe thermal injury is not practical in the austere environment. Oral resuscitation and in rare cases rectal hydration may be utilized until the patient can be transported to a medical facility. Much has been learned about the management of burn and polytraumatized patients after mass casualty incidents such as the September 11, 2001 terror attacks and the Pope Air Force Base disaster. A well-coordinated emergency preparedness plan is essential. The care of burn patients in austere, operational, and mass casualty situations can tax resources and manpower. The care of these patients will require creativity and ingenuity. Burn patients can be difficult to manage under normal circumstances but the care of these patients under the above situations complicates the management severalfold.

      PubDate: 2017-06-08T06:28:41Z
      DOI: 10.1016/j.wem.2017.03.011
       
  • Battlefield Analgesia in Tactical Combat Casualty Care
    • Authors: Ian S. Wedmore; Frank K. Butler
      Abstract: Publication date: June 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 2, Supplement
      Author(s): Ian S. Wedmore, Frank K. Butler
      At the start of the Afghanistan conflict, battlefield analgesia for US military casualties was achieved primarily through the use of intramuscular (IM) morphine. This is a suboptimal choice, since IM morphine is slow-acting, leading to delays in effective pain relief and the risk of overdose and death when dosing is repeated in order to hasten the onset of analgesia. Advances in battlefield analgesia, pioneered initially by Tactical Combat Casualty Care (TCCC), and the Army’s 75th Ranger Regiment, have now been incorporated into the Triple-Option Analgesia approach. This novel strategy has gained wide acceptance in the US military. It calls for battlefield analgesia to be achieved using 1 or more of 3 options depending on the casualty’s status: 1) the meloxicam and acetaminophen in the combat wound medication pack (CWMP) for casualties with relatively minor pain that are still able to function effectively as combatants if their sensorium is not altered by analgesic medications; 2) oral transmucosal fentanyl citrate (OTFC) for casualties who have moderate to severe pain, but who are not in hemorrhagic shock or respiratory distress, and are not at significant risk for developing either condition; or 3) ketamine for casualties who have moderate to severe pain, but who are in hemorrhagic shock or respiratory distress or are at significant risk for developing either condition. Ketamine may also be used to increase analgesic effect for casualties who have previously been given opioid medication. The present paper outlines the evolution and evidence base for battlefield analgesia as currently recommended by TCCC. It is not intended to be a comprehensive review of all prehospital analgesic options.

      PubDate: 2017-06-08T06:28:41Z
      DOI: 10.1016/j.wem.2017.04.001
       
  • Remote Damage Control Resuscitation in Austere Environments
    • Authors: Ronald Chang; Brian J. Eastridge; John B. Holcomb
      Abstract: Publication date: June 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 2, Supplement
      Author(s): Ronald Chang, Brian J. Eastridge, John B. Holcomb
      Hemorrhage is the leading cause of preventable military and civilian trauma death. Damage control resuscitation with concomitant mechanical hemorrhage control has become the preferred in-hospital treatment of hemorrhagic shock. In particular, plasma-based resuscitation with decreased volumes of crystalloids and artificial colloids as part of damage control resuscitation has improved outcomes in the military and civilian sectors. However, translation of these principles and techniques to the prehospital, remote, and austere environments, known as remote damage control resuscitation, is challenging given the resource limitations in these settings. Rapid administration of tranexamic acid and reconstituted freeze-dried (lyophilized) plasma as early as the point of injury are feasible and likely beneficial, but comparative studies in the literature are lacking. Whole blood is likely the best fluid therapy for traumatic hemorrhagic shock, but logistical hurdles need to be addressed. Rapid control of external hemorrhage with hemostatic dressings and extremity tourniquets are proven therapies, but control of noncompressible hemorrhage (ie, torso hemorrhage) remains a significant challenge.

      PubDate: 2017-06-08T06:28:41Z
      DOI: 10.1016/j.wem.2017.02.002
       
  • Animal, Microbial, and Fungal Borne Skin Pathology in the Mountain
           Wilderness: A Review
    • Authors: William E. Brandenburg; William Levandowski; Tom Califf; Cory Manly; Cecilia Blair Levandowski
      Pages: 127 - 138
      Abstract: Publication date: June 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 2
      Author(s): William E. Brandenburg, William Levandowski, Tom Califf, Cory Manly, Cecilia Blair Levandowski
      Mountains are home to numerous organisms known to cause skin disease. Bites, stings, poisons, chemicals, toxins, trauma, and infections all contribute to this end. Numerous plants, animals, fungi, bacteria, viruses, and protozoa are responsible. This paper aims to review skin illness and injury sustained from organisms in the mountains of North America. Other factors such as increased ultraviolet radiation, temperature extremes, and decreasing atmospheric pressure along with human physiologic parameters, which contribute to disease severity, will also be discussed. After reading this review, one should feel more comfortable identifying potentially harmful organisms, as well as diagnosing, treating, and preventing organism-inflicted skin pathology sustained in the high country.

      PubDate: 2017-06-13T07:14:19Z
      DOI: 10.1016/j.wem.2017.02.007
       
  • Prevention of Friction Blisters in Outdoor Pursuits: A Systematic Review
    • Authors: Robert M. Worthing; Raechel L. Percy; Jeremy D. Joslin
      Pages: 139 - 149
      Abstract: Publication date: June 2017
      Source:Wilderness & Environmental Medicine, Volume 28, Issue 2
      Author(s): Robert M. Worthing, Raechel L. Percy, Jeremy D. Joslin
      The purpose of this systematic review was to determine if sock, antiperspirant, or barrier strategies were effective in prevention of friction blisters in wilderness and outdoor pursuits. A search of PubMed and EMBASE was conducted. Title, abstract, and full text articles were screened by 2 authors using predetermined inclusion and exclusion criteria to identify prospective controlled trials investigating prevention methods for friction blisters involving the foot. Only blisters associated with wilderness and outdoor pursuits (running, hiking, marching, etc.) were considered. Extraction of a predetermined data set was accomplished using a piloted form. Confidence in effect estimates were determined utilizing the Scottish Intercollegiate Guidelines Network methodology checklist. Literature search resulted in 806 discrete articles. After screening, 11 studies were identified for inclusion in systematic review. Included studies investigated 5 sock, 3 antiperspirant, and 3 barrier strategies. Only 2 articles were determined to have moderate confidence in effect estimate. Clinical and methodologic diversity precluded meta-analysis. Despite the high frequency, discomfort, and associated cost there is a paucity of high-quality quality evidence in support of socks, antiperspirants, or barriers for the prevention of friction blisters. Moderate confidence in effect estimate suggests that paper tape may be an effective form of barrier prevention.

      PubDate: 2017-06-13T07:14:19Z
      DOI: 10.1016/j.wem.2017.03.007
       
  • Health of High Altitude Pilgrims: A Neglected Topic
    • Authors: Sanjeeb Sudarshan Bhandari; Pranawa Koirala
      Abstract: Publication date: Available online 18 July 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Sanjeeb Sudarshan Bhandari, Pranawa Koirala
      xxx

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

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

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

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

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

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

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


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

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

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

      PubDate: 2017-06-22T10:01:43Z
      DOI: 10.1016/j.wem.2017.03.015
       
  • A Novel Cooling Method and Comparison of Active Rewarming of Mildly
           Hypothermic Subjects
    • Authors: Mark L. Christensen; Grant S. Lipman; Dennis A. Grahn; Kate M. Shea; Joseph Einhorn; H. Craig Heller
      Abstract: Publication date: Available online 12 May 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Mark L. Christensen, Grant S. Lipman, Dennis A. Grahn, Kate M. Shea, Joseph Einhorn, H. Craig Heller
      Objective To compare the effectiveness of arteriovenous anastomosis (AVA) vs heated intravenous fluid (IVF) rewarming in hypothermic subjects. Additionally, we sought to develop a novel method of hypothermia induction. Methods Eight subjects underwent 3 cooling trials each to a mean core temperature of 34.8±0.6 (32.7 to 36.3°C) by 14°C water immersion for 30 minutes, followed by walking on a treadmill for 5 minutes. Core temperatures (Δtes) and rates of cooling (°C/h) were measured. Participants were then rewarmed by 1) control: shivering only in a sleeping bag; 2) IVF: shivering in sleeping bag and infusion of 2 L normal saline warmed to 42°C at 77 mL/min; and 3) AVA: shivering in sleeping bag and circulation of 45°C warmed fluid through neoprene pads affixed to the palms and soles of the feet. Results Cold water immersion resulted in a decrease of 0.5±0.5°C Δtes and 1±0.3°C with exercise (P < .01); with an immersion cooling rate of 0.9±0.8°C/h vs 12.6±3.2°C/h with exercise (P < .001). Temperature nadir reached 35.0±0.5°C. There were no significant differences in rewarming rates between the 3 conditions (shivering: 1.3±0.7°C/h, R 2 = 0.683; IVF 1.3±0.7°C/h, R 2 = 0.863; and AVA 1.4±0.6°C/h, R 2 = 0.853; P = .58). Shivering inhibition was greater with AVA but was not significantly different (P = .07). Conclusions This study developed a novel and efficient model of hypothermia induction through exercise-induced convective afterdrop. Although there was not a clear benefit in either of the 2 active rewarming methods, AVA rewarming showed a nonsignificant trend toward greater shivering inhibition, which may be optimized by an improved interface.

      PubDate: 2017-05-14T04:08:16Z
      DOI: 10.1016/j.wem.2017.02.009
       
  • Managing Traumatic Brain Injury: Translating Military Guidelines to the
           Wilderness
    • Authors: Edward J. Otten; Warren C. Dorlac
      Abstract: Publication date: Available online 10 May 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Edward J. Otten, Warren C. Dorlac
      Traumatic brain injury (TBI) is a common injury on the battlefield. Much of what medics do to manage these injuries on the battlefield can be translated to other austere environments, such as wilderness or disaster settings. The recognition and diagnosis of TBI can be difficult even in the hospital, but basic understanding of how to define a TBI and prevent secondary injuries can be accomplished with relatively few resources and little training. This article outlines what a TBI is and how to manage it in the field.

      PubDate: 2017-05-14T04:08:16Z
      DOI: 10.1016/j.wem.2017.02.008
       
  • Battlefield Trauma-Induced Hypothermia: Transitioning the Preferred Method
           of Casualty Rewarming
    • Authors: Brad L. Bennett; John B. Holcomb
      Abstract: Publication date: Available online 5 May 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Brad L. Bennett, John B. Holcomb
      For centuries, cold and wet weather has affected military combat operations leading to tremendous loss of manpower caused by cold–weather-related injuries including trench foot, frostbite, and hypothermia. The initial battlefield management of hypothermia in military personnel had not advanced significantly following many wars and conflicts until 2006. The aim of this review is to: 1) provide an overview of trauma-induced hypothermia (TIH); 2) highlight the Department of Defense strategy for the implementation of a hypothermia clinical management program for battlefield (prehospital) casualties; 3) highlight the research and development of the Hypothermia Prevention and Management Kit (HPMK) as the preferred field rewarming system for battlefield TIH; and 4) emphasize how the HPMK can be easily transitioned to the civilian sector for active rewarming of both accidental and TIH patients. The HPMK is ideal for those working in civilian Emergency Medical Services and austere prehospital care environments. This kit is a low cost, lightweight, small dimension commercial product that can provide effective passive management or active rewarming for both accidental (primary) and trauma-induced (secondary) hypothermia patients.

      PubDate: 2017-05-09T02:35:06Z
      DOI: 10.1016/j.wem.2017.03.010
       
  • Interfang Distances of Rattlesnakes: Sexual, Interspecific, and Body
           Size-related Variation, and Implications for Snakebite Research and
           Management
    • Authors: William K. Hayes; Aaron G. Corbit; Michael D. Cardwell; Shelton S. Herbert
      Abstract: Publication date: Available online 5 May 2017
      Source:Wilderness & Environmental Medicine
      Author(s): William K. Hayes, Aaron G. Corbit, Michael D. Cardwell, Shelton S. Herbert
      Objectives Snakebite severity corresponds to size of snake because the amount of venom a snake injects is positively associated with snake size. Because fang marks are often present on snakebite patients, we tested whether the relationship between snake length and distance between fang puncture wounds can be generalized for rattlesnakes of genus Crotalus. Methods We measured 2 interfang distances from 79 rattlesnakes of both sexes, 5 species, and varying body length: 1) distance between fang bases in anesthetized snakes, and 2) distance between fang punctures in a membrane-covered beaker bitten defensively. Results Statistical analyses supported our 2 hypotheses, that 1) body size-related fang divergence during fang protraction (ie, anterolateral movement during fang erection), and 2) the relationship between snake length and interfang distance are similar between the sexes and among different rattlesnake species. We therefore derived a general equation to estimate snake length based on distance between fang marks, and recommended 5 snake size categories: very small (<10 mm), small (10–15 mm), medium (15–20 mm), large (20–25 mm), and very large (>25 mm). Conclusions The distance between fang marks on a snakebite patient may be used to estimate the size or size category of the offending snake, which in some cases may have predictive value for overall clinical severity of a given envenomation. Assessing interfang distance from puncture wounds can improve snakebite research and anticipation of snakebite severity.

      PubDate: 2017-05-09T02:35:06Z
      DOI: 10.1016/j.wem.2017.03.006
       
  • Bruno Ernst Durrer, MD: January 14, 1953 to December 5, 2016
    • Abstract: Publication date: Available online 5 May 2017
      Source:Wilderness & Environmental Medicine


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

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


      PubDate: 2017-05-09T02:35:06Z
      DOI: 10.1016/j.wem.2017.04.004
       
  • Don’t Kick the Coral!
    • Authors: Peter J. Ceponis; Rebecca Cable; Lindell K. Weaver
      Abstract: Publication date: Available online 25 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Peter J. Ceponis, Rebecca Cable, Lindell K. Weaver


      PubDate: 2017-04-26T21:52:15Z
      DOI: 10.1016/j.wem.2017.01.025
       
  • Upper Body Compression Garment: Physiological Effects While Cycling in a
           Hot Environment
    • Authors: Iker Leoz-Abaurrea; Roberto Aguado-Jiménez
      Abstract: Publication date: Available online 25 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Iker Leoz-Abaurrea, Roberto Aguado-Jiménez
      Objective The purpose of the present study was to investigate the effects of an upper body compression garment (UBCG) on physiologic and perceptual responses while cycling in a hot environment. Methods Twenty recreational road cyclists were pair-matched for age, anthropometric data, and fitness level (V̇O2max) and randomly assigned to a control (CON) group (n=10) of cyclists who wore a conventional t-shirt or to a group (n=10) of cyclists who wore UBCG. Test session consisted of cycling at a fixed load (~50% V̇O2max) for 30 minutes at an ambient temperature of ~40ºC (39.9±0.4ºC), followed by 10 minutes of recovery. Results Significantly greater (P = .002) rectal temperature (T rec) was observed at the end of exercise in the UBCG group (38.3±0.2ºC) versus CON group (37.9±0.3ºC). Significantly greater heart rate (HR) was observed in the UBCG group at minute 15 (P = .01) and at the end of exercise (187±9 vs 173±10 beats/min; P = .004) for UBCG and CON, respectively. Furthermore, participants who wore UBCG perceived a significantly greater (P = .03) thermal sensation at the end of exercise. During recovery HR and T rec remained significantly greater (P < .05) in the UBCG group. Conclusions The use of an UBCG increased cardiovascular and thermoregulatory strain during cycling in a hot environment and did not aid during recovery.

      PubDate: 2017-04-26T21:52:15Z
      DOI: 10.1016/j.wem.2017.02.005
       
  • Residence at Moderate Versus Low Altitude Is Effective at Maintaining
           Higher Oxygen Saturation During Exercise and Reducing Acute Mountain
           Sickness Following Fast Ascent to 4559 m
    • Authors: Eva Bernardi; Luca Pomidori; Davide Cavallari; Gaia Mandolesi; Annalisa Cogo
      Abstract: Publication date: Available online 25 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Eva Bernardi, Luca Pomidori, Davide Cavallari, Gaia Mandolesi, Annalisa Cogo
      Objective To continuously monitor oxygen saturation (SpO2) by pulse oximeter and assess the development of acute mountain sickness (AMS) using the Lake Louise Score (LLS) during ascent from 1154 to 4559 m in 2 groups of subjects: 10 moderate-altitude residents (MAR; ≥1000–≤2500 m) and 34 low-altitude residents (LAR). MAR are reported to have a lower incidence of AMS during ascent to higher altitudes compared with LAR. Whether this is related to higher SpO2 is still open to debate. Methods Seventy subjects were recruited; 24-hour SpO2 monitoring with finger pulse oximetry was performed. All subjects rode a cable car from 1154 to 3275 m and then climbed to 3647 m, where 60 subjects (LAR) overnighted. The second day, 34/60 LAR reached the highest altitude. Ten subjects who lived permanently at 1100 to 1400 m (MAR) climbed directly to 4559 m without an overnight stop. Results One LAR was excluded from the analysis because he performed a preacclimatization. We compared data of 10 MAR with data of 33 LAR who reached 4559 m. Two MAR had an LLS of 3, and 8 scored <3. Six LAR had an LLS of 3 to 4, 8 scored ≥5, and 19 scored <3. SpO2 monitoring showed higher mean SpO2 in MAR during ascent above 3600 m compared with LAR (MAR, 79±4% vs LAR, 76±5%; analysis of variance, P = .03). Conclusions The results of this preliminary study suggest that residence at moderate altitude allows maintenance of higher SpO2 and reduces risk of developing AMS during rapid ascent to higher altitude.

      PubDate: 2017-04-26T21:52:15Z
      DOI: 10.1016/j.wem.2017.02.004
       
  • Erratum in Wilderness Environ Med. 2016
    • Abstract: Publication date: Available online 25 April 2017
      Source:Wilderness & Environmental Medicine


      PubDate: 2017-04-26T21:52:15Z
       
  • Traumatic Pneumothorax Associated With Penetrating Neck Injury Caused by a
           Stingray: A Case Report
    • Authors: Toshinao Suzuki; Toshihiko Takada; Junmei Fudoji
      Abstract: Publication date: Available online 25 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Toshinao Suzuki, Toshihiko Takada, Junmei Fudoji
      We describe a patient with missed traumatic pneumothorax due to penetrating neck injury that was presumably caused by a stingray while diving. The barb can result in significant injuries to deep structures and organs despite a deceptively small entrance wound. This case underscores the importance of performing a thorough examination and having a high suspicion of distant injury in patients with penetrating neck injuries.

      PubDate: 2017-04-26T21:52:15Z
      DOI: 10.1016/j.wem.2017.02.006
       
  • Unusual Kissing Lesions: Lessons From Rural Tanzania
    • Authors: Samantha J. Moore; Harriet J. Blundell
      Abstract: Publication date: Available online 21 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Samantha J. Moore, Harriet J. Blundell


      PubDate: 2017-04-26T21:52:15Z
      DOI: 10.1016/j.wem.2017.01.026
       
  • Belts Evaluated as Limb Tourniquets: BELT Study Comparing Trouser
           Supporters Used as Medical Devices in a Manikin Model of Wound Bleeding
    • Authors: Blake W. Bequette; John F. Kragh; James K. Aden; Michael A. Dubick
      Abstract: Publication date: Available online 20 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Blake W. Bequette, John F. Kragh, James K. Aden, Michael A. Dubick
      Objective The purpose of the present study is to compare several models of commercially designed belts as used as a tourniquet. Methods In the Belts Evaluated as Limb Tourniquets (BELT) study, an experiment was designed to test the effectiveness of pants belts as nonimprovised medical devices to control hemorrhage in a manikin. Models of belts included Tourni-belt, Tourniquet Belt, ParaBelt, and Battle Buddy. Data collected included effectiveness, time to stop bleeding, total time of application, pressure, blood loss, and composite results (score count of good results; composite outcome good if every component was good). Results Differences in effectiveness percentages among models were not statistically significant. The difference in mean between users was statistically significant for stop time, total time, pressure, blood loss, composite score, and composite outcome. Mean time to stop bleeding differed for only 1 pair of models after the Tukey-Kramer adjustment; ParaBelt was faster than Tourniquet Belt. Mean total time of application differed between ParaBelt–Tourniquet Belt and Tourni-belt–Tourniquet Belt; the former model in both pairs was faster. No significant difference in mean blood loss measured by model was found. For composite outcome score, no pairwise difference between models was significant. For composite outcome (good-bad), ParaBelt had good results in 75% of tests; the other 3 models had significantly worse results. Conclusions In a preliminary laboratory analysis of belt tourniquet models using a manikin, performance differed by model. ParaBelt performed better than other models for the composite outcome.

      PubDate: 2017-04-26T21:52:15Z
      DOI: 10.1016/j.wem.2017.01.030
       
  • The Dallol Volcano
    • Authors: Raf Aerts; Eva J.J. November
      Abstract: Publication date: Available online 18 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Raf Aerts, Eva J.J. November


      PubDate: 2017-04-19T20:40:40Z
      DOI: 10.1016/j.wem.2017.03.001
       
  • First described envenomation by Centruroides pococki scorpion in the
           French Caribbean Island Guadeloupe
    • Authors: Corinne Schmitt; Romain Torrents; Nicolas Simon; Luc de Haro
      Abstract: Publication date: Available online 18 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Corinne Schmitt, Romain Torrents, Nicolas Simon, Luc de Haro


      PubDate: 2017-04-19T20:40:40Z
      DOI: 10.1016/j.wem.2017.03.005
       
  • Hypersensitivity Reaction to Yellow Jacket Sting in a Previously
           Nonallergic Patient Taking an Angiotensin Receptor Blocker
    • Authors: James H. Diaz
      Abstract: Publication date: Available online 3 April 2017
      Source:Wilderness & Environmental Medicine
      Author(s): James H. Diaz


      PubDate: 2017-04-04T18:21:42Z
      DOI: 10.1016/j.wem.2017.01.024
       
  • Bleeding Control Using Hemostatic Dressings: Lessons Learned
    • Authors: Brad L. Bennett
      Abstract: Publication date: Available online 17 March 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Brad L. Bennett
      Based on lessons learned, many military battlefield trauma advances ultimately transition to enhance civilian trauma care. However, even with major strides to enhance battlefield hemorrhage control, it is unclear how effectively these techniques and products are being translated to civilian trauma. The purpose of this brief review is to present the evidence of current hemostatic product effectiveness, determine the evidence for transitioning of this technology to prehospital civilian application, and provide recommendations about potential use in the wilderness/austere setting. It is concluded that there is adequate evidence of hemorrhage control effectiveness in both military and civilian preclinical studies and clinical case series. The Committee on Tactical Combat Casualty Care recommends implementing approved hemostatic dressings as one part of a comprehensive hemorrhage control training and clinical management program. These recommendations for hemostatic dressings use by public safety and laypersons should be applied in acute transport urban settings or during prolonged care in austere environments.

      PubDate: 2017-03-17T11:20:17Z
      DOI: 10.1016/j.wem.2016.12.005
       
  • First Report of Using Portable Unmanned Aircraft Systems (Drones) for
           Search and Rescue
    • Authors: Christopher Van Tilburg
      Abstract: Publication date: Available online 17 March 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Christopher Van Tilburg
      Unmanned aircraft systems (UAS), colloquially called drones, are used commonly for military, government, and civilian purposes, including both commercial and consumer applications. During a search and rescue mission in Oregon, a UAS was used to confirm a fatality in a slot canyon; this eliminated the need for a dangerous rappel at night by rescue personnel. A second search mission in Oregon used several UAS to clear terrain. This allowed search of areas that were not accessible or were difficult to clear by ground personnel. UAS with cameras may be useful for searching, observing, and documenting missions. It is possible that UAS might be useful for delivering equipment in difficult areas and in communication.

      PubDate: 2017-03-17T11:20:17Z
      DOI: 10.1016/j.wem.2016.12.010
       
  • Tactical Combat Casualty Care: Transitioning Battlefield Lessons Learned
           to Other Austere Environments
    • Authors: Brad Bennett; Ian Wedmore; Frank Butler
      Abstract: Publication date: Available online 9 March 2017
      Source:Wilderness & Environmental Medicine
      Author(s): Brad Bennett, Ian Wedmore, Frank Butler


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

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

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