for Journals by Title or ISSN
for Articles by Keywords
help
  Subjects -> ENVIRONMENTAL STUDIES (Total: 832 journals)
    - ENVIRONMENTAL STUDIES (758 journals)
    - POLLUTION (24 journals)
    - TOXICOLOGY AND ENVIRONMENTAL SAFETY (40 journals)
    - WASTE MANAGEMENT (10 journals)

ENVIRONMENTAL STUDIES (758 journals)            First | 1 2 3 4 5 6 7 8     

Journal of Sustainable Development Studies     Open Access   (Followers: 9)
Journal of Sustainable Society     Open Access   (Followers: 6)
Journal of the American Planning Association     Hybrid Journal   (Followers: 22)
Journal of the Association of Environmental and Resource Economists     Full-text available via subscription  
Journal of the Atmospheric Sciences     Full-text available via subscription   (Followers: 27)
Journal of the IEST     Full-text available via subscription  
Journal of the North Atlantic     Full-text available via subscription   (Followers: 1)
Journal of Theological Studies     Open Access   (Followers: 10)
Journal of Tropical Ecology     Hybrid Journal   (Followers: 11)
Journal of Urban and Environmental Engineering     Open Access   (Followers: 1)
Journal of Vietnamese Environment     Open Access   (Followers: 2)
Journal of Water Security     Open Access  
Journal of Wetlands Environmental Management     Open Access   (Followers: 1)
Julius-Kühn-Archiv     Open Access  
Kleio     Full-text available via subscription   (Followers: 2)
Knowledge Management Research & Practice     Hybrid Journal   (Followers: 17)
Koedoe : African Protected Area Conservation and Science     Open Access   (Followers: 7)
L1-Educational Studies in Language and Literature     Open Access   (Followers: 2)
Lake and Reservoir Management     Hybrid Journal   (Followers: 5)
Landscape Ecology     Hybrid Journal   (Followers: 44)
Landscapes     Hybrid Journal   (Followers: 18)
Large Marine Ecosystems     Full-text available via subscription  
Latin American and Caribbean Ethnic Studies     Hybrid Journal   (Followers: 5)
Latin American Journal of Management for Sustainable Development     Hybrid Journal   (Followers: 1)
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: 9)
Madagascar Conservation & Development     Open Access  
Management International Review     Hybrid Journal   (Followers: 7)
Management of Environmental Quality: An International Journal     Hybrid Journal   (Followers: 6)
Management of Sustainable Development     Open Access   (Followers: 2)
Marine Ecology     Hybrid Journal   (Followers: 22)
Marine Environmental Research     Hybrid Journal   (Followers: 21)
Marine Pollution Bulletin     Hybrid Journal   (Followers: 21)
Materials for Renewable and Sustainable Energy     Open Access   (Followers: 10)
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: 3)
Medio Ambiente y Urbanizacion     Full-text available via subscription  
Membranes     Open Access   (Followers: 6)
Michigan Journal of Sustainability     Open Access  
Midwest Studies In Philosophy     Hybrid Journal   (Followers: 12)
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: 9)
Modern Cartography Series     Full-text available via subscription   (Followers: 4)
Mountain Research and Development     Open Access   (Followers: 4)
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: 9)
Natural Hazards     Hybrid Journal   (Followers: 113)
Natural Resources     Open Access  
Natural Resources and Environmental Issues     Open Access   (Followers: 5)
Nature and Culture     Full-text available via subscription   (Followers: 11)
NeuroToxicology     Hybrid Journal   (Followers: 1)
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: 4)
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: 2)
Observatorio Medioambiental     Open Access  
Occupational and Environmental Medicine     Full-text available via subscription   (Followers: 10)
Ocean Acidification     Open Access   (Followers: 1)
Ochrona Srodowiska i Zasobów Naturalnych : Environmental Protection and Natural Resources     Open Access  
Oecologia     Hybrid Journal   (Followers: 44)
Oikos     Hybrid Journal   (Followers: 41)
Open Journal of Ecology     Open Access   (Followers: 10)
Open Journal of Marine Science     Open Access   (Followers: 7)
Open Journal of Modern Hydrology     Open Access   (Followers: 4)
Our Nature     Open Access   (Followers: 3)
Oxford Journal of Legal Studies     Hybrid Journal   (Followers: 21)
Pace Environmental Law Review     Open Access   (Followers: 6)
Pace Environmental Law Review Online Companion     Open Access   (Followers: 1)
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: 8)
Physio-Géo     Open Access   (Followers: 2)
Pittsburgh Journal of Environmental and Public Health Law     Open Access   (Followers: 1)
Planet     Open Access   (Followers: 3)
Planning & Environmental Law: Issues and decisions that impact the built and natural environments     Hybrid Journal   (Followers: 7)
Plant Ecology & Diversity     Partially Free   (Followers: 14)
Plant Knowledge Journal     Open Access   (Followers: 3)
Plant, Cell & Environment     Hybrid Journal   (Followers: 5)

  First | 1 2 3 4 5 6 7 8     

Journal Cover Wilderness & Environmental Medicine
  [2 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1080-6032
   Published by Elsevier Homepage  [2801 journals]
  • Chemical and Plant-Based Insect Repellents: Efficacy, Safety, and Toxicity
    • Abstract: Publication date: Available online 27 January 2016
      Source:Wilderness & Environmental Medicine
      Author(s): James H. Diaz
      Most emerging infectious diseases today are arthropod-borne and cannot be prevented by vaccinations. Because insect repellents offer important topical barriers of personal protection from arthropod-borne infectious diseases, the main objectives of this article were to describe the growing threats to public health from emerging arthropod-borne infectious diseases, to define the differences between insect repellents and insecticides, and to compare the efficacies and toxicities of chemical and plant-derived insect repellents. Internet search engines were queried with key words to identify scientific articles on the efficacy, safety, and toxicity of chemical and plant-derived topical insect repellants and insecticides to meet these objectives. Data sources reviewed included case reports; case series; observational, longitudinal, and surveillance studies; and entomological and toxicological studies. Descriptive analysis of the data sources identified the most effective application of insect repellents as a combination of topical chemical repellents, either N-diethyl-3-methylbenzamide (formerly N, N-diethyl-m-toluamide, or DEET) or picaridin, and permethrin-impregnated or other pyrethroid-impregnated clothing over topically treated skin. The insecticide-treated clothing would provide contact-level insecticidal effects and provide better, longer lasting protection against malaria-transmitting mosquitoes and ticks than topical DEET or picaridin alone. In special cases, where environmental exposures to disease-transmitting ticks, biting midges, sandflies, or blackflies are anticipated, topical insect repellents containing IR3535, picaridin, or oil of lemon eucalyptus (p-menthane-3, 8-diol or PMD) would offer better topical protection than topical DEET alone.


      PubDate: 2016-01-31T11:03:05Z
       
  • The aftermath of a bushfire
    • Abstract: Publication date: Available online 27 January 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Ian Rogers



      PubDate: 2016-01-31T11:03:05Z
       
  • Ice Climbing Festival in Sochi 2014 Winter Olympics: Medical Management
           and Injury Analysis
    • Abstract: Publication date: Available online 27 January 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Evgeny Mashkovskiy, James Marc Beverly, Urs Stöcker, Sergey Bychkovskiy
      Objective Sports ice climbing (SIC) is developing rapidly as an independent sport with Olympic potentials. To date there has been no prior systematic evaluation of injury risks and injury patterns in a SIC-specific setting. Methods This paper reports injury statistics the statistics collected during the Ice Climbing Festival, which was held during the XXII Winter Olympics in Sochi, Russia. More than 2500 amateur climbers and 53 professional athletes climbed during 16 days on a dry tooling lead-difficulty, and a 17-m vertical ice wall (grade M4/M5 or Union Internationale des Associations d’Alpinisme [UIAA] V+/VI–). Results The injury incidence rates were 0.82/100 in lead-difficulty and 0.83/100 in speed ice climbing with an overall incidence rate of 0.83/100. The injury risk in amateur climbers was 248 injuries per 1000 hours of sports activities. There were no major accidents or fatalities during the event. SIC could be graded I according to UIAA Fatality Risk Classification. Penetrating and superficial soft tissue injuries (cuts and bruises) were the most common. The anteromedial aspects of the thigh and knee were the most typical injury locations. Conclusions The findings from this study provide an opportunity to compare injury patterns in SIC with what has previously been reported for traditional ice climbing. SIC has lower fatality risks, higher minor injury rates, and comparable injury severity to traditional ice climbing. The main limitation of our findings is that they were obtained on a population of amateur ice climbers with no previous experience. Further research should be performed to define injury risks in professional competitive ice climbers, and standard methodologies for reporting injuries should be considered.


      PubDate: 2016-01-31T11:03:05Z
       
  • 438 Days: An Extraordinary True Story of Survival at Sea Jonathan Franklin
           New York, NY: Atria Books, 2015 $26, 266 pages, clothbound
    • Abstract: Publication date: Available online 27 January 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Christopher Van Tilburg



      PubDate: 2016-01-31T11:03:05Z
       
  • Training for the New Alpinism: A Manual for the Climber as Athlete Steve
           House and Scott Johnston Ventura, CA: Patagonia Books, 2014 $35.00, 464
           pages, paperback
    • Abstract: Publication date: Available online 27 January 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Aaron D. Campbell



      PubDate: 2016-01-31T11:03:05Z
       
  • Barbarian Days: A Surfing Life William Finnegan New York, NY: Penguin
           Press, 2015 $27.95, 447 pages, clothbound
    • Abstract: Publication date: Available online 27 January 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Christopher Van Tilburg



      PubDate: 2016-01-31T11:03:05Z
       
  • Efficacy of Topical Treatments for Chrysaora chinensis Species: A Human
           Model in Comparison with an In Vitro Model
    • Abstract: Publication date: Available online 27 January 2016
      Source:Wilderness & Environmental Medicine
      Author(s): Matthieu P. DeClerck, Yvonne Bailey, David Craig, Michelle Lin, Lauren J. Auerbach, Olivia Linney, Doug E Morrison, Wyatt Patry, Paul S Auerbach
      Objectives This study sought to create a model for testing topical treatment of jellyfish stings. It sought to determine which treatments 1) stimulate/inhibit nematocyst discharge; 2) decrease pain; and 3) decrease skin inflammation; it also sought to discover whether there is a clinical correlation between stimulated nematocyst discharge observed in vitro to the pain and erythema experienced by humans stung by a particular species of jellyfish, C chinensis. Methods Chrysaora chinensis stung 96 human subjects, who were then treated with isopropyl alcohol, hot water, acetic acid, papain meat tenderizer, lidocaine, or sodium bicarbonate. Pain and erythema were measured. In a separate experiment, nematocysts were examined microscopically after exposure to the same topical treatments used in the human experiment. Results Forearms treated with papain showed decreased mean pain over the first 30 minutes after being stung, relative to placebo, although only by a small amount. The other topical treatments tested did not reach statistical significance. Sodium bicarbonate may reduce erythema after 30 minutes of treatment; sodium bicarbonate and papain may reduce erythema at 60 minutes. The other topical treatments tested did not reach statistical significance. Nematocyst discharge in vitro occurred when tentacles of C chinensis were exposed to acetic acid or isopropyl alcohol. Sodium bicarbonate, papain, heated water, and lidocaine did not induce nematocyst discharge. Conclusions Papain-containing meat tenderizer used as a topical treatment for C chinensis stings may decrease pain. Although there is published experimental support for the concept that in vitro nematocyst discharge correlates with in vivo human pain perception, no definitive randomized controlled trial, including ours, has yet provided incontrovertible evidence of this assertion. Despite this study’s limitations, it presents a viable basis for future human studies looking at the efficacy of topical treatments for jellyfish stings.


      PubDate: 2016-01-31T11:03:05Z
       
  • Should AED Devices Be Routinely Included in Wilderness Medical Kits?
    • Abstract: Publication date: Available online 30 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Jeremy D Joslin, Amy Sue Biondich



      PubDate: 2015-12-31T02:34:09Z
       
  • Deep Vein Thrombosis and Pulmonary Embolism in a Mountain Guide:
           Awareness, Diagnostic Challenges, and Management Considerations at
           Altitude
    • Abstract: Publication date: Available online 23 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Claire M. Hull, Dévan Rajendran, Arturo Fernandez Barnes
      High intensity exercise is associated with several potentially thrombogenic risk factors, including dehydration and hemoconcentration, vascular trauma, musculoskeletal injuries, inflammation, long-distance travel, and contraceptive usage. These are well documented in case reports of venous thrombosis in track and field athletes. For mountaineers and those working at high altitude, additional risks exist. However, despite there being a high degree of vigilance for “classic” conditions encountered at altitude (eg, acute mountain sickness, high altitude pulmonary edema, and high altitude cerebral edema), mainstream awareness regarding thrombotic conditions and their complications in mountain athletes is relatively low. This is significant because thromboembolic events (including deep vein thrombosis, pulmonary embolism, and cerebral vascular thrombosis) are not uncommon at altitude. We describe a case of deep vein thrombosis and pulmonary embolism in a male mountain guide and discuss the diagnostic issues encountered by his medical practitioners. Potential risk factors affecting blood circulation (eg, seated car travel and compression of popliteal vein) and blood hypercoagulability (eg, hypoxia, environmental and psychological stressors [avalanche risk, extreme cold]) relevant to the subject of this report and mountain athletes in general are identified. Considerations for mitigating and managing thrombosis in addition to personalized care planning at altitude are discussed. The prevalence of thrombosis in mountain athletes is uncharted, but lowlanders increasingly go to high altitude to trek, ski, or climb. Blood clots can and do occur in physically active people, and thrombosis prevention and recognition will demand heightened awareness among participants, healthcare practitioners, and the altitude sport/leisure industry at large.


      PubDate: 2015-12-26T02:28:53Z
       
  • Shark Fears and the Media
    • Abstract: Publication date: Available online 19 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Benjamin Eovaldi, Pell Thompson, Kristen Eovaldi, Robert Eovaldi



      PubDate: 2015-12-21T02:22:21Z
       
  • The 6-Minute Walk Test as a Predictor of Summit Success on Denali
    • Abstract: Publication date: Available online 19 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Katherine M. Shea, Eric R. Ladd, Grant S. Lipman, Patrick Bagley, Elizabeth A. Pirrotta, Hurnan Vongsachang, N. Ewen Wang, Paul S. Auerbach
      Objective To test whether the 6-minute walk test (6MWT), including postexercise vital sign measurements and distance walked, predicts summit success on Denali, AK. Methods This was a prospective observational study of healthy volunteers between the ages of 18 and 65 years who had been at 4267 m for less than 24 hours on Denali. Physiologic measurements were made after the 6MWT. Subjects then attempted to summit at their own pace and, at the time of descent, completed a Lake Louise Acute Mountain Sickness Questionnaire and reported maximum elevation reached. Results One hundred twenty-one participants enrolled in the study. Data were collected on 111 subjects (92% response rate), of whom 60% summited. On univariate analysis, there was no association between any postexercise vital sign and summit success. Specifically, there was no significant difference in the mean postexercise peripheral oxygen saturation (Spo 2) between summiters (75%) and nonsummiters (74%; 95% CI, –3 to 1; P = .37). The distance a subject walked in 6 minutes (6MWTD) was longer in summiters (617 m) compared with nonsummiters (560 m; 95% CI, 7.6 to 106; P = .02). However, this significance was not maintained on a multivariate analysis performed to control for age, sex, and guide status (P = .08), leading to the conclusion that 6MWTD was not a robust predictor of summit success. Conclusions This study did not show a correlation between postexercise oxygen saturation or 6MWTD and summit success on Denali.


      PubDate: 2015-12-21T02:22:21Z
       
  • Storm over the Tetons
    • Abstract: Publication date: Available online 19 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Jennifer K Rossi



      PubDate: 2015-12-21T02:22:21Z
       
  • Acute Mountain Sickness (AMS) Knowledge Among High Altitude Marathon
           Runners Competing in the Everest Marathon
    • Abstract: Publication date: Available online 19 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Abigail Letchford, Rudra Paudel, Owen D. Thomas, Adam S. Booth, Christopher H.E. Imray
      Objective Although there are a number of studies on trekkers’ knowledge of acute mountain sickness (AMS), there is little current literature on other groups at altitude, for example, marathon runners. Increased knowledge of AMS is associated with a lower incidence of AMS. The purpose of this study was to determine AMS knowledge of marathon runners with an aim to improve AMS information distribution. Incidence of AMS was also determined. Methods Participants completed a self-assessment AMS knowledge questionnaire in Kathmandu before starting the acclimatization trek for the Tenzing Hillary Everest Marathon in Nepal. Lake Louise Scoring questionnaires were completed every day of the 12-day acclimatization trek. Results The majority (86%; 43 of 50) of participants obtained information about AMS before the marathon, with the Internet providing the most common source (50%; 25 of 50). Ninety-two percent (46 of 50) of participants rated their knowledge as average or above, and self-assessment correlated with knowledge questionnaire scores (r = .479, P < .001). However, 48% (24 of 50) did not know it was unsafe to ascend with mild AMS symptoms, and 66% (33 of 50) thought it was safe to go higher with symptoms relieved by medication. Only 50% (25 of 50) knew AMS could occur from 2500 m. Thirty-eight percent (19 of 50) of participants had AMS during the acclimatization trek, and 6% (3 of 50) experienced it during the race. Conclusions This study adds to previous literature regarding knowledge and incidence of AMS. It further highlights that more needs to be done to improve knowledge through better information dissemination, with inclusion of scenario-based information to aid application of this knowledge to practical situations.


      PubDate: 2015-12-21T02:22:21Z
       
  • Backcountry Skiers, Avalanche Trauma Mortality, and Helmet Use
    • Abstract: Publication date: Available online 19 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): George Vargyas



      PubDate: 2015-12-21T02:22:21Z
       
  • An Assessment of Coliform Bacteria in Water Sources Near Appalachian Trail
           Shelters Within the Great Smoky Mountains National Park
    • Abstract: Publication date: Available online 7 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Brian C. Reed, Mark S. Rasnake
      Objective Hikers and campers are exposed to risks while in the wilderness. One of these risks is the possibility of contracting an illness, including infectious diarrhea. This project tested for coliform bacteria in water samples taken near popular Appalachian Trail shelters. Methods Water was collected from access points within the Great Smoky Mountains National Park. Samples were collected in sterile bottles and inoculated on a commercially available coliform detection kit for quantitative determination of total coliform and Escherichia coli counts. Results Water samples were taken during summer and fall seasons. During summer, 7 of 10 samples were positive for coliform bacteria and 6 of those 7 for E coli. The most probable number (MPN) of colony-forming units (CFU) for coliform bacteria ranged from 0 to 489 CFU/100 mL, with the MPN for E coli varying from 0 to 123 CFU/100 mL. These data differed from the fall collection, revealing 3 of 7 samples positive for coliform bacteria and 1 of those 3 for E coli. The MPN of CFU for coliform bacteria in fall samples varied from 0 to 119 CFU/100 mL and 0 to 5 to CFU/100 mL for E coli. Conclusions Environmental Protection Agency drinking water standards set the standard of 0 CFU/100 mL to be considered safe. This analysis of water samples along the Appalachian Trail emphasizes that the majority of water access points require treatment during the summer season. Coliform burden was not as high through the fall months. These data suggest one infectious disease risk for wilderness travelers.


      PubDate: 2015-12-11T01:45:22Z
       
  • Accidents in North American Mountaineering 2015Dougald MacDonald,
           editorGolden, CO: American Alpine Club Press, 2015US $12.95 (paperback),
           128 pagesThe American Alpine Club Journal 2015Dougald MacDonald,
           editorGolden, CO: American Alpine Club Press, 2015US $35 (paperback), 400
           pages
    • Abstract: Publication date: Available online 10 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Christopher Van Tilburg



      PubDate: 2015-12-11T01:45:22Z
       
  • Scuba-Diving Bugs Can Inflict Envenoming Bites in Swimming Pools, Lakes,
           and Ponds
    • Abstract: Publication date: Available online 10 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): James H. Diaz



      PubDate: 2015-12-11T01:45:22Z
       
  • Injuries and Fatalities on Sailboats in the United States 2000–2011:
           An Analysis of US Coast Guard Data
    • Abstract: Publication date: Available online 7 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Kevin M. Ryan, Andrew T. Nathanson, Janette Baird, Jenna Wheelhouse
      Background Prior sailing injury studies have been small, focused investigations. This large, population-based study examined the mechanisms and factors contributing to sailboat-related injuries and deaths. Methods A retrospective data analysis of the Boating Accident Report Database compiled by the US Coast Guard between 2000 and 2011 was performed. The database was analyzed looking at frequency of events. For each subgroup, proportions were determined and 95% CIs were calculated. These data, used in conjunction with the 2011 US Coast Guard National Recreational Boating Survey, were used to estimate a fatality rate. Results Two hundred seventy-one sailing-related fatalities and 841 injuries were reported. A fatality rate was calculated at 1.19 deaths per million sailing person-days. Weather or hazardous waters were listed as primary contributing factors in 28.0% (95% CI, 22.7–33.4) of deaths; 70.1% (95% CI, 64.7–75.6) of deaths occurred after falling overboard or capsizing. Drowning was the most common cause of death (73.1%; 95% CI, 67.8–78.4), and 81.6% of victims were not wearing a life jacket. Alcohol intoxication contributed to 12.2% (95% CI, 8.3–16.1) of deaths. Operator- or passenger-preventable factors contributed to 52.7% (95% CI, 49.3–56.1) of all injuries; 51.6% (95% CI, 46.1–57.1) of injuries on nonmotorized sailboats were the result of capsizing, and 46.4% (95% CI, 42.1–50.7) of all injuries on motorized sailboats were the result of collisions or grounding. Conclusions The calculated fatality rate is similar to that of alpine skiing. Falls overboard and capsizing were the most common fatal accidents. Operator inattention, inexperience, and alcohol use were common preventable factors contributing to fatal and nonfatal injury.


      PubDate: 2015-12-11T01:45:22Z
       
  • Picking edible and medicinal plants: exotic “apples” and
           “pears”
    • Abstract: Publication date: Available online 10 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): James H. Diaz



      PubDate: 2015-12-11T01:45:22Z
       
  • Ski Helmets and the Backcountry
    • Abstract: Publication date: Available online 4 December 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Robert Williams



      PubDate: 2015-12-06T01:12:03Z
       
  • General Consideration in the History, Physical Examination, and Safety
           Determination
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4, Supplement
      Author(s): Jonathan Buchanan, William Dexter, Amy Powell, Justin Wright
      A thorough medical history is perhaps the most important aspect when evaluating an athlete before wilderness adventure. A physical examination should follow focusing on conditions that may be affected by changes in atmospheric pressure, extremes of temperature, or altitude. This information can then be used to make safety recommendations ensuring that adventurers are able to safely enjoy participation in the wilderness pursuit of their choice.


      PubDate: 2015-12-01T01:00:38Z
       
  • Medical Clearance for Desert and Land Sports, Adventure, and Endurance
           Events
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4, Supplement
      Author(s): Peter E. Sedgwick, George C. Wortley, Justin M. Wright, Chad Asplund, O. Roberts William, Saif Usman
      Endurance events are increasing in popularity in wilderness and remote settings, and participants face a unique set of potential risks for participation. The purpose of this article is to outline these risks and allow the practitioner to better guide the wilderness adventurer who is anticipating traveling to a remote or desert environment.


      PubDate: 2015-12-01T01:00:38Z
       
  • A Novel Method to Decontaminate Surgical Instruments for Operational and
           Austere Environments
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4
      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: 2015-12-01T01:00:38Z
       
  • Risk Stratification for Athletes and Adventurers in High-Altitude
           Environments: Recommendations for Preparticipation Evaluation
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4, Supplement
      Author(s): Aaron D. Campbell, Scott E. McIntosh, Andy Nyberg, Amy P. Powell, Robert B. Schoene, Peter Hackett
      High-altitude athletes and adventurers face a number of environmental and medical risks. Clinicians often advise participants or guiding agencies before or during these experiences. Preparticipation evaluation (PPE) has the potential to reduce risk of high-altitude illnesses in athletes and adventurers. Specific conditions susceptible to high-altitude exacerbation also important to evaluate include cardiovascular and lung diseases. Recommendations by which to counsel individuals before participation in altitude sports and adventures are few and of limited focus. We reviewed the literature, collected expert opinion, and augmented principles of a traditional sport PPE to accommodate the high-altitude wilderness athlete/adventurer. We present our findings with specific recommendations on risk stratification during a PPE for the high-altitude athlete/adventurer.


      PubDate: 2015-12-01T01:00:38Z
       
  • Preparticipation Evaluation for Climbing Sports
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4, Supplement
      Author(s): Aaron D. Campbell, Christopher Davis, Ryan Paterson, Tracy A. Cushing, Pearlly Ng, Charles S. Peterson, Peter E. Sedgwick, Scott E. McIntosh
      Climbing is a popular wilderness sport among a wide variety of professional athletes and amateur enthusiasts, and many styles are performed across many environments. Potential risks confront climbers, including personal health or exacerbation of a chronic condition, in addition to climbing-specific risks or injuries. Although it is not common to perform a preparticipation evaluation (PPE) for climbing, a climber or a guide agency may request such an evaluation before participation. Formats from traditional sports PPEs can be drawn upon, but often do not directly apply. The purpose of this article was to incorporate findings from expert opinion from professional societies in wilderness medicine and in sports medicine, with findings from the literature of both climbing epidemiology and traditional sports PPEs, into a general PPE that would be sufficient for the broad sport of climbing. The emphasis is on low altitude climbing, and an overview of different climbing styles is included. Knowledge of climbing morbidity and mortality, and a standardized approach to the PPE that involves adequate history taking and counseling have the potential for achieving risk reduction and will facilitate further study on the evaluation of the efficacy of PPEs.


      PubDate: 2015-12-01T01:00:38Z
       
  • Circadian and Sex Differences After Acute High-Altitude Exposure: Are
           Early Acclimation Responses Improved by Blue Light?
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4
      Author(s): Juan A. Silva-Urra, Cristian A. Núñez-Espinosa, Oscar A. Niño-Mendez, Héctor Gaitán-Peñas, Cesare Altavilla, Andrés Toro-Salinas, Joan R. Torrella, Teresa Pagès, Casimiro F. Javierre, Claus Behn, Ginés Viscor
      Objective The possible effects of blue light during acute hypoxia and the circadian rhythm on several physiological and cognitive parameters were studied. Methods Fifty-seven volunteers were randomly assigned to 2 groups: nocturnal (2200–0230 hours) or diurnal (0900–1330 hours) and exposed to acute hypoxia (4000 m simulated altitude) in a hypobaric chamber. The participants were illuminated by blue LEDs or common artificial light on 2 different days. During each session, arterial oxygen saturation (Spo 2), blood pressure, heart rate variability, and cognitive parameters were measured at sea level, after reaching the simulated altitude of 4000 m, and after 3 hours at this altitude. Results The circadian rhythm caused significant differences in blood pressure and heart rate variability. A 4% to 9% decrease in waking nocturnal Spo 2 under acute hypoxia was observed. Acute hypoxia also induced a significant reduction (4%–8%) in systolic pressure, slightly more marked (up to 13%) under blue lighting. Women had significantly increased systolic (4%) and diastolic (12%) pressures under acute hypoxia at night compared with daytime pressure; this was not observed in men. Some tendencies toward better cognitive performance (d2 attention test) were seen under blue illumination, although when considered together with physiological parameters and reaction time, there was no conclusive favorable effect of blue light on cognitive fatigue suppression after 3 hours of acute hypobaric hypoxia. Conclusions It remains to be seen whether longer exposure to blue light under hypobaric hypoxic conditions would induce favorable effects against fatigue.


      PubDate: 2015-12-01T01:00:38Z
       
  • Wilderness Medical Society Practice Guidelines for the Treatment of
           Pitviper Envenomations in the United States and Canada
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4
      Author(s): Nicholas C. Kanaan, Jeremiah Ray, Matthew Stewart, Katie W. Russell, Matthew Fuller, Sean P. Bush, E. Martin Caravati, Michael D. Cardwell, Robert L. Norris, Scott A. Weinstein



      PubDate: 2015-12-01T01:00:38Z
       
  • General Medical Considerations for the Wilderness Adventurer: Medical
           Conditions That May Worsen With or Present Challenges to Coping With
           Wilderness Exposure
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4, Supplement
      Author(s): Tracy A. Cushing, William O. Roberts, Peter Hackett, William W. Dexter, Jeff S. Brent, Craig C. Young, Jessie R. Fudge, Seth C. Hawkins, Thomas G. DeLoughery, Benjamin J. Thomas, Geoffrey C. Tabin, Leah E. Jacoby, Chad A. Asplund
      Participation in wilderness and adventure sports is on the rise, and as such, practitioners will see more athletes seeking clearance to participate in these events. The purpose of this article is to describe specific medical conditions that may worsen or present challenges to the athlete in a wilderness environment.


      PubDate: 2015-12-01T01:00:38Z
       
  • Setting, Structure, and Timing of the Preparticipation Examination: The
           Wilderness Adventure Consultation
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4, Supplement
      Author(s): Gary A. Green
      Patients pursue wilderness experiences throughout the entire life cycle, and while outdoor pursuits are relatively safe, injuries do occur. Many of these adverse events can be anticipated, identified, and prevented through a wilderness preparticipation examination (PPE). To accomplish this, it is incumbent on the physician to assess the extrinsic and intrinsic factors faced by the patient and attempt to correct them to ensure an enjoyable experience in the outdoors. This article outlines the goals of the PPE along with identification of various risk factors that can influence a trip. Most injuries and rescues occur from underestimating the risks from extrinsic, environmental factors, and/or overestimating one’s intrinsic skills. By matching the patient’s fitness and skill level to the environment, the physician can help reduce the risk of serious injury.


      PubDate: 2015-12-01T01:00:38Z
       
  • Lyme Disease: What the Wilderness Provider Needs to Know
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4
      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: 2015-12-01T01:00:38Z
       
  • Epidemiological Trends in Search and Rescue Incidents Documented by the
           Alpine Club of Canada From 1970 to 2005
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4
      Author(s): Gwynn M. Curran-Sills, Amalia Karahalios
      Objective To provide a descriptive review of the epidemiology of search and rescue (SAR) incidents across Canada as documented in the Alpine Club of Canada (ACC) database. Methods A retrospective, cross-sectional review of SAR reports collected by the ACC with incidents dating from January 1, 1970 to June 12, 2005, was analyzed. Results The ACC database contained 1088 incidents with 1377 casualties. Casualties had 944 (68.6%; 95% CI, 64.2 to 73.1) injuries or illness, and 433 (31.4%; 95% CI, 28.6 34.6) fatalities. Males accounted for 76.1% of all casualties and 82.3% of the fatalities when sex was reported. A bimodal distribution of casualties was seen, with the peaks around February and August. Hiking and mountaineering resulted in more than half of all casualties that yielded any type of morbidity, whereas mountaineering and skiing, ski mountaineering, or snowboarding accounted for almost two thirds of all fatalities. Human error and slips and falls were the major contributors to the presumptive cause of incidents. The lower limb was the most common anatomic location of traumatic injury, accounting for 41.6% (95% CI, 37.6 to 45.9) of these injuries. Hypothermia, exhaustion, frostbite, and dehydration represented the majority of all nontraumatic conditions. British Columbia and Alberta accounted for 91.6% (95% CI, 86.0 to 97.5) of the incidents in the database. Conclusions The study serves to illustrate trends in SAR epidemiology that may be encountered by SAR personnel within British Columbia and Alberta. Furthermore, it highlights the need for additional Canadian-based studies to better understand this area of prehospital medical encounters.


      PubDate: 2015-12-01T01:00:38Z
       
  • Counseling for the Wilderness Athlete and Adventurer During a
           Preparticipation Evaluation for Preparation, Safety, and Injury Prevention
           
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4, Supplement
      Author(s): Justin Mark J. Young, Aaron D. Campbell, Kate K. Raastad
      Wilderness sports and adventures continue to increase in popularity. Counseling is an essential element of the preparticipation evaluation (PPE) for athletes in traditional sports. This approach can be applied to and augmented for the wilderness athlete and adventurer. The authors reviewed the literature on counseling during PPEs and gathered expert opinion from medical professionals who perform such PPEs for wilderness sports enthusiasts. The objective was to present findings of this review and make recommendations on the counseling component of a wilderness sports/adventure PPE. The counseling component of a PPE for wilderness sports/adventures should take place after a basic medical evaluation, and include a discussion on sport or activity-specific injury prevention, personal health, travel recommendations, and emergency event planning. Counseling should be individualized and thorough, and involve shared decision making. This should take place early enough to allow ample time for the athlete or adventurer to further prepare as needed based on the recommendations. Resources may be recommended for individuals desiring more information on selected topics.


      PubDate: 2015-12-01T01:00:38Z
       
  • Wilderness Preparticipation Evaluation and Considerations for Special
           Populations
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4, Supplement
      Author(s): Elizabeth Joy, Karin Van Baak, Katherine L. Dec, Barbara Semakula, Ashlea D. Cardin, Jay Lemery, George C. Wortley, Michael Yaron, Christopher Madden
      Children, older adults, disabled and special needs athletes, and female athletes who participate in outdoor and wilderness sports and activities each face unique risks. For children and adolescents traveling to high altitude, the preparticipation physical evaluation should focus on risk assessment, prevention strategies, early recognition of altitude-related symptoms, management plans, and appropriate follow-up. As the risk and prevalence of chronic disease increases with age, both older patients and providers need to be aware of disease and medication-specific risks relative to wilderness sport and activity participation. Disabled and special needs athletes benefit from careful pre-event planning for the potential medical issues and equipment modifications that may affect their health in wilderness environments. Issues that demand special consideration for female adventurers include pregnancy, contraceptive use, menses, and ferritin levels at altitude. A careful preparticipation evaluation that factors in unique, population- specific risks will help special populations stay healthy and safe on wilderness adventures. The PubMed and SportDiscus databases were searched in 2014 using both MeSH terms and text words and include peer-reviewed English language articles from 1977 to 2014. Additional information was accessed from Web-based sources to produce this narrative review on preparticipation evaluation for special populations undertaking wilderness adventures. Key words include children, adolescent, pediatric, seniors, elderly, disabled, special needs, female, athlete, preparticipiation examination, wilderness medicine, and sports.


      PubDate: 2015-12-01T01:00:38Z
       
  • Medical Evaluation for Exposure Extremes: Heat
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4, Supplement
      Author(s): Riana R. Pryor, Brad L. Bennett, Francis G. O’Connor, Justin M.J. Young, Chad A. Asplund
      Exertional heat illness can be a serious consequence of sports or exercise in hot environments. Participants can possess intrinsic or face extrinsic risk factors that may increase their risk for heat-related illness. Knowledge of the physiology and pathology of heat illness, identification of risk factors, and strategies to combat heat accumulation will aid both the practitioner and the participant in preparing for activities that occur in hot environments. Through preparation and mitigation of risk, safe and enjoyable wilderness adventure can be pursued.


      PubDate: 2015-12-01T01:00:38Z
       
  • Prolonged Exposure Dermatosis: Reporting High Incidence of an Undiagnosed
           Facial Dermatosis on a Winter Wilderness Expedition
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4
      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: 2015-12-01T01:00:38Z
       
  • The Effects of Sympathetic Inhibition on Metabolic and Cardiopulmonary
           Responses to Exercise in Hypoxic Conditions
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4
      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: 2015-12-01T01:00:38Z
       
  • Medical Evaluation for Exposure Extremes: Cold
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4, Supplement
      Author(s): Jessie R. Fudge, Brad L. Bennett, Juris P. Simanis, William O. Roberts
      Risk of injury in cold environments is related to a combination of athlete preparedness, preexisting medical conditions, and the body’s physiologic response to environmental factors, including ambient temperature, windchill, and wetness. The goal of this section is to decrease the risk of hypothermia, frostbite, and nonfreezing cold injuries as well as to prevent worsening of preexisting conditions in cold environments using a preparticipation screening history, examination, and counseling. Cold weather exercise can be done safely with education, proper preparation, and appropriate response to changing weather conditions.


      PubDate: 2015-12-01T01:00:38Z
       
  • The Impact of Freeze-Thaw Cycles on Epinephrine
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4
      Author(s): Heather Beasley, Pearlly Ng, Albert Wheeler, William R. Smith, Scott E. McIntosh
      Objectives Epinephrine is the first-line medical treatment for anaphylaxis, a life-threatening allergic syndrome. To treat anaphylaxis, backcountry recreationalists and guides commonly carry epinephrine autoinjectors. Epinephrine may be exposed to cold temperatures and freezing during expeditions. An epinephrine solution must contain 90% to 115% of the labeled epinephrine amount to meet United States Pharmacopeia standards. The purpose of this study was to determine whether freeze-thaw cycles alter epinephrine concentrations in autoinjectors labeled to contain 1.0 mg/mL epinephrine. A further objective was to determine whether samples continued to meet United States Pharmacopeia concentration standards after freeze-thaw cycles. Methods Epinephrine from 6 autoinjectors was extracted and divided into experimental and control samples. The experimental samples underwent 7 consecutive 12-hour freeze cycles followed by 7 12-hour thaw cycles. The control samples remained at an average temperature of 23.1°C for the duration of the study. After the seventh thaw cycle, epinephrine concentrations were measured using a high-performance liquid chromatography assay with mass spectrometry detection. Results The mean epinephrine concentration of the freeze-thaw samples demonstrated a statistically significant increase compared with the control samples: 1.07 mg/mL (SD ± 8.78; 95% CI, 1.04 to 1.11) versus 0.96 mg/mL (SD ± 6.81; 95% CI, 0.94 to 0.99), respectively. The maximal mean epinephrine concentration in the experimental freeze-thaw group was 1.12 mg/mL, which still fell within the range of United States Pharmacopeia standards for injectables (0.90 to 1.15 mg/mL). Conclusions Although every attempt should be made to prevent freezing of autoinjectors, this preliminary study demonstrates that epinephrine concentrations remain within 90% to 115% of 1.0 mg/mL after multiple freeze-thaw cycles.


      PubDate: 2015-12-01T01:00:38Z
       
  • Ethical, Legal, and Administrative Considerations for Preparticipation
           Evaluation for Wilderness Sports and Adventures
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4, Supplement
      Author(s): Craig C. Young, Aaron D. Campbell, Jay Lemery, David S. Young
      Preparticipation evaluations (PPEs) are common in team, organized, or traditional sports but not common in wilderness sports or adventures. Regarding ethical, legal, and administrative considerations, the same principles can be used as in traditional sports. Clinicians should be trained to perform such a PPE to avoid missing essential components and to maximize the quality of the PPE. In general, participants’ privacy should be observed; office-based settings may be best for professional and billing purposes, and adequate documentation of a complete evaluation, including clearance issues, should be essential components. Additional environmental and personal health issues relative to the wilderness activity should be documented, and referral for further screening should be made as deemed necessary, if unable to be performed by the primary clinician. Travel medicine principles should be incorporated, and recommendations for travel or adventure insurance should be made.


      PubDate: 2015-12-01T01:00:38Z
       
  • Pre-Participation Medical Evaluation for Adventure and Wilderness
           Watersports
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4, Supplement
      Author(s): Andrew T. Nathanson, Justin Mark J. Young, Craig Young
      A request for a preparticipation medical evaluation for wilderness watersports may be made by guiding agencies, instructional camps, or by patients presenting for an annual visit. Although guidelines have been published regarding preparticipation physical evaluation for traditional competitive high school and collegiate sports, little has been written about medical evaluations for those wishing to engage in wilderness and adventure watersports. in this article, we offer guidance based on literature review and expert opinion. Watersports are among the most common recreational activities in the United states and are generally safe. Drowning, however, is a significant risk, particularly in small, self-propelled craft, and among children. Medical counseling before participation in watersports should include screening for medical conditions which may impair swimming ability, including a history of seizures, heart disease, and lung disease. Physicians should also promote preventive health measures such as use of lifejackets and sun protection, as well as alcohol avoidance. Swim testing tailored to specific activities should be strongly considered for children and those with questionable swimming ability.


      PubDate: 2015-12-01T01:00:38Z
       
  • Preparticipation Evaluation of the Wilderness Athlete and Adventurer
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4, Supplement
      Author(s): Chad A. Asplund, Chris Madden, Aaron Campbell, Arthur A. Islas



      PubDate: 2015-12-01T01:00:38Z
       
  • Can We Get There From Here?
    • Abstract: Publication date: December 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 4
      Author(s): Martin D. Hoffman



      PubDate: 2015-12-01T01:00:38Z
       
  • Epidemiology of Search and Rescue in Baxter State Park: Dangers of Descent
           and Fatigue
    • Abstract: Publication date: Available online 21 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Chris R. Welter, J. Matthew Sholl, Tania D. Strout, Ben Woodard
      Objective The purpose of this study was to determine the epidemiology of injury in Baxter State Park, Maine, and to better tailor search and rescue (SAR) resources, personnel, and training to acute needs in the park. Methods We conducted a retrospective review of all SAR incident reports in Baxter State Park from July 1992 through June 2014. For each event, demographics, location, time, activity before the incident, incident details, and evacuation means were recorded and analyzed. Results In all, 754 incidents of SAR or medical need were identified. Mean age was 38.9 years; mean age for subjects with fatigue as the primary complaint was 48.7 years. A majority (60.5%) of victims were male. Nineteen fatalities occurred during the study. Traumatic injuries precipitated 51% of SAR incidents, and an additional 30% were initiated for late or lost parties. Slips or falls while hiking were the most common causes of injury (67%), with the lower extremity being the most common injury site (31%). When applicable, 84.4% of acute need occurred while descending, as opposed to ascending, a mountain. Fatigue was the most commonly reported medical emergency, causative in 66% of medical SAR events. Conclusions Fatigue is a major factor in SAR events, both as a discreet cause and as a contributor to other injuries. Search and rescue need is more likely to occur during mountain descent, and lower extremity injuries are the most common etiology. Efforts should be focused on training rescuers in lower extremity and fatigue treatment, and more rescuers should be available when many are descending.


      PubDate: 2015-10-23T07:12:07Z
       
  • California Sea Lion (Zalophus californianus) and Harbor Seal (Phoca
           vitulina richardii) Bites and Contact Abrasions in Open-Water Swimmers: A
           Series of 11 Cases
    • Abstract: Publication date: Available online 23 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Thomas J. Nuckton, Claire A. Simeone, Roger T. Phelps
      Objective To review cases of bites and contact abrasions in open-water swimmers from California sea lions (Zalophus californianus) and harbor seals (Phoca vitulina richardii). Methods Open-water swimmers from a San Francisco swimming club were questioned about encounters with pinnipeds (seals and sea lions) that resulted in bites or contact abrasions. When possible, wounds were documented with photographs. Medical follow-up and treatment complications were also reviewed. Results From October 2011 to December 2014, 11 swimmers reported bites by a sea lion (n = 1), harbor seal (n = 7), or unidentified pinniped (n = 3). Ten of the encounters occurred in San Francisco Bay; 1 occurred in the Eld Inlet, in Puget Sound, near Olympia, WA. None of the swimmers were wearing wetsuits. All bites involved the lower extremities; skin was broken in 4 of 11 bites and antibiotics were prescribed in 3 cases. One swimmer, who was bitten by a harbor seal, also had claw scratches. A treatment failure occurred with amoxicillin/clavulanate in another swimmer who was bitten by an unidentified pinniped; the wound healed subsequently with doxycycline, suggesting an infection with Mycoplasma spp. There were no long-lasting consequences from any of the bites. The majority of cases occurred at low tide, and bumping of the swimmer by the animal before or after a bite was common, but no clear tide or attack pattern was identified. Conclusions Bites and contact abrasions from sea lions and harbor seals are reported infrequently in open-water swimmers and typically involve the lower extremities. Because of the risk of Mycoplasma infection, treatment with a tetracycline is recommended in pinniped bites with signs of infection or serious trauma. Attempting to touch or pet sea lions or seals is inadvisable and prohibited by the Marine Mammal Protection Act. Swimmers should leave the water as soon as possible after a bite or encounter.


      PubDate: 2015-10-23T07:12:07Z
       
  • Civilian Helicopter Search and Rescue Accidents in the United States: 1980
           Through 2013
    • Abstract: Publication date: Available online 9 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Gordon H. Worley
      Objective Helicopters are commonly used in search and rescue operations, and accidents have occurred during helicopter search and rescue (HSAR) missions. The purposes of this study were to investigate whether the HSAR accident rate in the United States could be determined and whether any common contributing factors or trends could be identified. Methods Searches were conducted of the National Transportation Safety Board aviation accident database, the records of the major search and rescue and air medical organizations, and the medical and professional literature for reports of HSAR accidents. Results A total of 47 civilian HSAR accidents were identified during the study. Of these, 43% involved fatal injuries, compared with a 19% fatality rate for US helicopter general aviation accidents during the same time period and a 40% rate for helicopter emergency medical services. The HSAR accidents carried a significantly higher risk of fatal outcomes when compared with helicopter general aviation accidents (2-tailed Fisher’s exact test, P < .0005). Accidents that occurred at night and under instrument meteorological conditions did not have a statistically significant increase in percentage of fatal outcomes (P > .05). The number of HSAR missions conducted annually could not be established, so an overall accident rate could not be calculated. Conclusions Although the overall number of HSAR accidents is small, the percentage of fatal outcomes from HSAR accidents is significantly higher than that from general helicopter aviation accidents and is comparable to that seen for helicopter emergency medical services operations. Further study could help to improve the safety of HSAR flights.


      PubDate: 2015-10-11T01:58:07Z
       
  • A Case Study: What Doses of Amanita phalloides and Amatoxins Are Lethal to
           Humans?
    • Abstract: Publication date: Available online 9 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Ismail Yilmaz, Fatih Ermis, Ilgaz Akata, Ertugrul Kaya
      There are few data estimating the human lethal dose of amatoxins or of the toxin level present in ingested raw poisonous mushrooms. Here, we present a patient who intentionally ingested several wild collected mushrooms to assess whether they were poisonous. Nearly 1 day after ingestion, during which the patient had nausea and vomiting, he presented at the emergency department. His transaminase levels started to increase starting from hour 48 and peaking at hour 72 (alanine aminotransferase 2496 IU/L; aspartate aminotransferase 1777 IU/L). A toxin analysis was carried out on the mushrooms that the patient said he had ingested. With reversed-phase high-performance liquid chromatography analysis, an uptake of approximately 21.3 mg amatoxin from nearly 50 g mushroom was calculated; it consisted of 11.9 mg alpha amanitin, 8.4 mg beta amanitin, and 1 mg gamma amanitin. In the urine sample taken on day 4, 2.7 ng/mL alpha amanitin and 1.25 ng/mL beta amanitin were found, and there was no gamma amanitin. Our findings suggest that the patient ingested approximately 0.32 mg/kg amatoxin, and fortunately recovered after serious hepatotoxicity developed.


      PubDate: 2015-10-11T01:58:07Z
       
  • Predictive Factors for Determining the Clinical Severity of Pediatric
           Scorpion Envenomation Cases in Southeastern Turkey
    • Abstract: Publication date: Available online 1 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Aykut Çağlar, Halil Köse, Aslan Babayiğit, Taliha Öner, Murat Duman
      Objective The aim of this study was to define the epidemiological, clinical, and laboratory manifestations of scorpion envenomation and to identify factors that are predictive of severe cases. Methods The medical files of 41 scorpion envenomation cases were reviewed retrospectively. The cases were classified as mild-moderate or severe. The epidemiological, clinical, and laboratory findings of patients were recorded. Results There were 27 patients (65.9%) in the mild-moderate group and 14 patients (34.1%) in the severe group. The median age of all patients was 48 months. The most common systemic finding was cold extremities (41.5%). In all patients, the most commonly observed dysrhythmia was sinus tachycardia (34.1%). Two patients (4.9%) had pulseless ventricular tachycardia and died. Pulmonary edema and myocarditis were observed in 9 patients (22%). Median values of leukocyte and glucose levels were markedly increased in the severe group. Additionally, the mean thrombocyte level (540,857 ± 115,261 cells/mm3) in the severe group was significantly increased compared with the mild-moderate group (391,365 ± 150,017 cells/mm3). Thrombocyte levels exhibited a positive correlation with leukocyte and glucose values and a negative correlation with patient left ventricular ejection fraction. Multivariate analysis of laboratory parameters indicated that the most predictive factor for clinical severity is thrombocytosis (odds ratio 23.9; 95% CI: 1.6–353.5, P = .021). Conclusions Although our results share some similarities with those of other reports, thrombocytosis was markedly increased in the severe group and served as the most predictive laboratory factor of clinical severity.


      PubDate: 2015-10-03T00:21:12Z
       
  • An Elderly Man from Solukhumbu, Nepal, with a Rash
    • Abstract: Publication date: Available online 1 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Nishant Raj Pandey, Abhijit Adhikary, Sanjaya Karki



      PubDate: 2015-10-03T00:21:12Z
       
  • Marked Hypofibrinogenemia and Gastrointestinal Bleeding After Copperhead
           (Agkistrodon contortrix) Envenomation
    • Abstract: Publication date: Available online 1 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Kathryn T. Kopec, May Yen, Matthew Bitner, C. Scott Evans, Charles J. Gerardo
      Compared with other crotaline envenomations, copperhead envenomations have historically been reported as having less severe hematologic venom effects and rarely hemorrhage. We report a case of clinically significant gastrointestinal bleeding after a copperhead (Agkistrodon contortrix) envenomation. A 52-year-old woman with a history of systemic lupus erythematosus was bitten on her right medial ankle after which hypofibrinogenemia and hematochezia developed. The symptoms resolved after repeated administration of Crotalidae polyvalent immune Fab (ovine) antivenom. She was discharged without further complications 2 days later. Although copperhead envenomations are classically considered less severe than other crotaline envenomations, this case demonstrates the potential of the venom to produce clinically significant hematologic effects.


      PubDate: 2015-10-03T00:21:12Z
       
  • Emergency Medical Service in the US National Park Service: A
           Characterization and Two-Year Review, 2012–2013
    • Abstract: Publication date: Available online 16 September 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Jeffrey P. Lane, Bonnaleigh Taylor, William R. Smith, Albert R. Wheeler
      Objective Visitors to US National Park Service (NPS) units have a unique set of needs in terms of emergency medical care. The purpose of this review is to quantify and characterize emergency medical services (EMS) activities in the NPS to elaborate on its unique aspects, establish trends, and benchmark these data against a sample of national EMS data. Methods The EMS data for calendar years 2012 and 2013 were queried from national NPS reports. Results The EMS responses totaled 40 calls per million visitors in 2012 and 34 calls per million visitors in 2013. Of those, 75% required a basic life support level of care. There were comparable incidences of transported EMS trauma calls (49%) and medical calls (51%). Of a total of 137 sudden cardiac arrest events, 65% of patients received defibrillation and 26% survived to hospital release. There were 262 total fatalities in 2012 and 238 in 2013, with traumatic fatalities occurring approximately twice as often as nontraumatic fatalities. Conclusions Across the country, the NPS responded to a large number of EMS calls each year, but with a relatively low frequency, considering the large number of visitors. This is a challenging setting in which to provide consistent EMS care throughout various NPS administered areas. The typical NPS EMS response provided basic life support level care to visitors with traumatic injuries. The NPS caregivers must be prepared, however, to respond to a varied and diverse range of EMS calls.


      PubDate: 2015-09-19T19:19:22Z
       
 
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
 
About JournalTOCs
API
Help
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-2015