The “Heel Hook”—A Climbing-Specific Technique to Injure the Leg
Publication date: Available online 21 March 2016 Source:Wilderness & Environmental Medicine Author(s): Volker Schöffl, Christoph Lutter, Dominik Popp Acute injuries in rock climbing either come from a fall onto the lower leg or from performing a hard move and injuring the upper extremity. Further evaluations of lower leg injuries in rock climbing athletes have been performed recently finding sport characteristics such as peroneal tendon dislocations or chronic deformations of the feet. One injury mechanism described in case reports is the so-called heel hook position, which is used more frequently today c...
Source: Wilderness and Environmental Medicine - March 21, 2016 Category: Environmental Health Source Type: research

In response to Epidemiology of Search and Rescue in Baxter State Park: Dangers of Descent and Fatigue
Publication date: Available online 21 March 2016 Source:Wilderness & Environmental Medicine Author(s): Aaron Brillhart, Scott McIntosh, Jennifer Dow, Colin Grissom (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 21, 2016 Category: Environmental Health Source Type: research

A Wasp Sting and a Broken Heart
Publication date: Available online 14 March 2016 Source:Wilderness & Environmental Medicine Author(s): James H. Diaz (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 14, 2016 Category: Environmental Health Source Type: research

WITHDRAWN: The Great Earthquake in Nepal—A Personal View
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at (http://www.elsevier.com/locate/withdrawalpolicy). (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 11, 2016 Category: Environmental Health Source Type: research

Acute Interstitial Nephritis Following Snake Envenomation: A Single-Center Experience
Conclusions AIN after snake bite is not uncommon. AIN needs to be considered in patients with persistent renal failure after snake envenomation. Identifying this complication is of utmost importance because of the potentially reversible nature. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 9, 2016 Category: Environmental Health Source Type: research

Expanding Wilderness Medicine Fellowship Eligibility Beyond Emergency Medicine
Publication date: Available online 5 March 2016 Source:Wilderness & Environmental Medicine Author(s): Derek J. Meyer, Megann Young (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 6, 2016 Category: Environmental Health Source Type: research

Twostriped Walkingstick Targets Human Eye With Chemical Defense Spray
We present the case of an older woman exposed to the walkingstick’s painful venom while in her home. The patient presented to an Orlando emergency department with conjunctival injection and tearing that improved with water irrigation. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 6, 2016 Category: Environmental Health Source Type: research

Juvenile gorilla smile, framed by vegetation
Publication date: March 2016 Source:Wilderness & Environmental Medicine, Volume 27, Issue 1 Author(s): Cindy Bitter (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 4, 2016 Category: Environmental Health Source Type: research

Outbreaks of Gastrointestinal Disease Among Rafters
Publication date: March 2016 Source:Wilderness & Environmental Medicine, Volume 27, Issue 1 Author(s): Viroj Wiwanitkit (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 4, 2016 Category: Environmental Health Source Type: research

Poisoning by Herbs and Plants: Rapid Toxidromic Classification and Diagnosis
Publication date: March 2016 Source:Wilderness & Environmental Medicine, Volume 27, Issue 1 Author(s): James H. Diaz The American Association of Poison Control Centers has continued to report approximately 50,000 telephone calls or 8% of incoming calls annually related to plant exposures, mostly in children. Although the frequency of plant ingestions in children is related to the presence of popular species in households, adolescents may experiment with hallucinogenic plants; and trekkers and foragers may misidentify poisonous plants as edible. Since plant exposures have continued at a constant rate, the objecti...
Source: Wilderness and Environmental Medicine - March 4, 2016 Category: Environmental Health Source Type: research

A Novel Application for Cognitive Evaluation in Mountain Ultramarathons: Olfactory Assessment
Conclusions This pilot study showed the feasibility of olfactory evaluation as a minimally invasive cognitive impairment assessment. The test can be used in logistically difficult environments, adding scientific value to this promising method. Although olfaction decreased after prolonged physical activity, further studies are warranted to make the relationship between cognition and external factors (eg, sleep deprivation, dehydration) more clear. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 4, 2016 Category: Environmental Health Source Type: research

Portable Prehospital Methods to Treat Near-Hypothermic Shivering Cold Casualties
Conclusions Near-hypothermic cold casualties are rewarmed with less peripheral cold stress and shivering thermogenesis using a multi-layered MPS survival bag compared with a polyethylene survival bag. Prehospital rewarming is further aided by large chemical heat pads but not by hot drinks. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 4, 2016 Category: Environmental Health Source Type: research

A New Proposal for Management of Severe Frostbite in the Austere Environment
We present 2 cases of frostbite treated with rt-PA at K2 basecamp to illustrate feasibility and important considerations. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 4, 2016 Category: Environmental Health Source Type: research

Risk Determinants of Acute Mountain Sickness and Summit Success on a 6-Day Ascent of Mount Kilimanjaro (5895 m)
Conclusions Our cohort found a lower incidence of AMS and better summit success on a 6-day ascent of Mt Kilimanjaro than previously described in other groups on 4- and 5-day ascents. Female sex and age ≥40 years both predicted failure to summit, but did not increase risk of developing AMS. AMS is a common cause of morbidity on Mt. Kilimanjaro, and although the risk can be mitigated by a slower ascent, there is an ongoing need for education of individual trekkers, tour companies, and local authorities. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 4, 2016 Category: Environmental Health Source Type: research

Primary Care in Extreme Environments: Medical Clinic Utilization at Antarctic Stations, 2013–2014
Conclusions The clinic volume predictably correlated with station population. Insomnia and headache complaints, reported only at the South Pole Station, are likely associated with the increased elevation at that site, although they could be attributable to psychological stress from the isolated environment. Although the majority of cases could not be prevented with current screening, we suggest several changes to the current concept of operations that may decrease medical utilization and provide significant improvements to health care delivery on the ice. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 4, 2016 Category: Environmental Health Source Type: research

Medical Knowledge and Preparedness of Climbers on Colorado’s 14,000-Foot Peaks
Conclusions Most mountain climbers had no formal wilderness medicine training and did worse on the medical knowledge assessment than those who did have training. Consistent with previous studies, participants performed poorly on the medical knowledge assessment. As such, ways to improve wilderness medical knowledge among outdoor recreationalists should be sought. The low rate of helmet use on Colorado’s technical peaks represents an important area for education and injury prevention. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 4, 2016 Category: Environmental Health Source Type: research

Estimating the Burden of Snakebite on Public Hospitals in KwaZulu Natal, South Africa
Conclusions We propose an alternative method to estimate the annual number of snakebite presentations to hospitals. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 4, 2016 Category: Environmental Health Source Type: research

Avalanche Fatalities in the United States: A Change in Demographics
Conclusions Avalanche fatalities have increased. This is most likely related to an overall rise in backcountry utilization. Fatalities have increased among snowmobilers and snowboarders. Despite a rise in backcountry utilization, avalanche fatalities in Colorado are decreasing. A strategy of focused training and education aimed toward at-risk groups could result in lower avalanche fatalities. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 4, 2016 Category: Environmental Health Source Type: research

Skin Diseases Affecting High-Level Competition Sailors: Descriptive Study Carried Out During the 2012 AG2R Transatlantic Boat Race
Conclusions Skin conditions are nearly universal in this maritime population. Further assessments are needed to know if long-term use of protective gear; improved hygiene; use of barrier creams; and proper on-board care of fungal infections, wounds, and burns could reduce the number and severity of skin problems encountered in sport sailors. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 4, 2016 Category: Environmental Health Source Type: research

Is Postevent Intravenous Hydration an Appropriate Service at Endurance Competitions?
Publication date: March 2016 Source:Wilderness & Environmental Medicine, Volume 27, Issue 1 Author(s): Martin D. Hoffman, Tamara Hew-Butler, William O. Roberts, Ian R. Rogers, Mitchell H. Rosner (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 4, 2016 Category: Environmental Health Source Type: research

2015 Wilderness & Environmental Medicine Peer Reviewers
Publication date: March 2016 Source:Wilderness & Environmental Medicine, Volume 27, Issue 1 (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 4, 2016 Category: Environmental Health Source Type: research

Where’s the “E” in WEM?
Publication date: March 2016 Source:Wilderness & Environmental Medicine, Volume 27, Issue 1 Author(s): Martin D. Hoffman (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - March 4, 2016 Category: Environmental Health Source Type: research

Subtle Cognitive Dysfunction in Resolving High Altitude Cerebral Edema Revealed by a Clock Drawing Test
We describe a patient with subtle cognitive dysfunction, likely due to HACE that had not fully resolved. When he initially presented, the patient appeared to have normal mental status and was not ataxic. The diagnosis of HACE was missed initially but was made when further history became available. Cognitive dysfunction was then diagnosed based on abnormal performance of a clock drawing test. A formal mental status examination, using a clock drawing test, may be helpful in assessing whether a patient at high altitude with apparently normal mental status and with normal gait has HACE. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - February 11, 2016 Category: Environmental Health Source Type: research

Risk of Avalanche Involvement in Winter Backcountry Recreation: The Advantage of Small Groups
Conclusions These findings are in accordance with avalanche safety recommendations regarding the higher risk of large groups but not regarding lower risks of people traveling alone in avalanche terrain, which is not recommended and requires great caution. Further studies on backcountry usage are necessary to improve our understanding of human behavior and risk factors. New techniques (eg, video monitoring) may be useful for acquiring reliable data on backcountry usage. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - February 10, 2016 Category: Environmental Health Source Type: research

Chemical and Plant-Based Insect Repellents: Efficacy, Safety, and Toxicity
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 pla...
Source: Wilderness and Environmental Medicine - January 30, 2016 Category: Environmental Health Source Type: research

Ice Climbing Festival in Sochi 2014 Winter Olympics: Medical Management and Injury Analysis
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. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 30, 2016 Category: Environmental Health Source Type: research

The aftermath of a bushfire
Publication date: Available online 27 January 2016 Source:Wilderness & Environmental Medicine Author(s): Ian Rogers (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 30, 2016 Category: Environmental Health Source Type: research

Efficacy of Topical Treatments for Chrysaora chinensis Species: A Human Model in Comparison with an In Vitro Model
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. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 30, 2016 Category: Environmental Health Source Type: research

Barbarian Days: A Surfing Life William Finnegan New York, NY: Penguin Press, 2015 $27.95, 447 pages, clothbound
Publication date: Available online 27 January 2016 Source:Wilderness & Environmental Medicine Author(s): Christopher Van Tilburg (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 30, 2016 Category: Environmental Health Source Type: research

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
Publication date: Available online 27 January 2016 Source:Wilderness & Environmental Medicine Author(s): Aaron D. Campbell (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 30, 2016 Category: Environmental Health Source Type: research

438 Days: An Extraordinary True Story of Survival at Sea Jonathan Franklin New York, NY: Atria Books, 2015 $26, 266 pages, clothbound
Publication date: Available online 27 January 2016 Source:Wilderness & Environmental Medicine Author(s): Christopher Van Tilburg (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 30, 2016 Category: Environmental Health Source Type: research

Should AED Devices Be Routinely Included in Wilderness Medical Kits?
Publication date: Available online 30 December 2015 Source:Wilderness & Environmental Medicine Author(s): Jeremy D Joslin, Amy Sue Biondich (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - January 11, 2016 Category: Environmental Health Source Type: research

Deep Vein Thrombosis and Pulmonary Embolism in a Mountain Guide: Awareness, Diagnostic Challenges, and Management Considerations 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 thrombos...
Source: Wilderness and Environmental Medicine - December 24, 2015 Category: Environmental Health Source Type: research

Acute Mountain Sickness (AMS) Knowledge Among High Altitude Marathon Runners Competing in the Everest Marathon
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. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - December 20, 2015 Category: Environmental Health Source Type: research

Shark Fears and the Media
Publication date: Available online 19 December 2015 Source:Wilderness & Environmental Medicine Author(s): Benjamin Eovaldi, Pell Thompson, Kristen Eovaldi, Robert Eovaldi (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - December 20, 2015 Category: Environmental Health Source Type: research

Storm over the Tetons
Publication date: Available online 19 December 2015 Source:Wilderness & Environmental Medicine Author(s): Jennifer K Rossi (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - December 20, 2015 Category: Environmental Health Source Type: research

Backcountry Skiers, Avalanche Trauma Mortality, and Helmet Use
Publication date: Available online 19 December 2015 Source:Wilderness & Environmental Medicine Author(s): George Vargyas (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - December 20, 2015 Category: Environmental Health Source Type: research

The 6-Minute Walk Test as a Predictor of Summit Success on Denali
Conclusions This study did not show a correlation between postexercise oxygen saturation or 6MWTD and summit success on Denali. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - December 20, 2015 Category: Environmental Health Source Type: research

Scuba-Diving Bugs Can Inflict Envenoming Bites in Swimming Pools, Lakes, and Ponds
Publication date: Available online 10 December 2015 Source:Wilderness & Environmental Medicine Author(s): James H. Diaz (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - December 11, 2015 Category: Environmental Health Source Type: research

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
Publication date: Available online 10 December 2015 Source:Wilderness & Environmental Medicine Author(s): Christopher Van Tilburg (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - December 11, 2015 Category: Environmental Health Source Type: research

Picking edible and medicinal plants: exotic “apples” and “pears”
Publication date: Available online 10 December 2015 Source:Wilderness & Environmental Medicine Author(s): James H. Diaz (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - December 11, 2015 Category: Environmental Health Source Type: research

An Assessment of Coliform Bacteria in Water Sources Near Appalachian Trail Shelters Within the Great Smoky Mountains National Park
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. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - December 8, 2015 Category: Environmental Health Source Type: research

Injuries and Fatalities on Sailboats in the United States 2000–2011: An Analysis of US Coast Guard Data
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. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - December 8, 2015 Category: Environmental Health Source Type: research

Ski Helmets and the Backcountry
Publication date: Available online 4 December 2015 Source:Wilderness & Environmental Medicine Author(s): Robert Williams (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - December 5, 2015 Category: Environmental Health Source Type: research

Bridging the Gap: Introducing Undergraduate Students to Wilderness and Emergency Medicine
Publication date: December 2015 Source:Wilderness & Environmental Medicine, Volume 26, Issue 4 Author(s): Katie E. Joy , Elaine M. Reno, Bonnie Kaplan, Todd Miner, Jay M. Lemery (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 30, 2015 Category: Environmental Health Source Type: research

Epidemiology of the Pennsic Wars 2007–2013: A Medieval Mass Gathering Event
Publication date: December 2015 Source:Wilderness & Environmental Medicine, Volume 26, Issue 4 Author(s): Philip S. Nawrocki, Peter Roolf, Morgan Garvin, John O’Neill (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 30, 2015 Category: Environmental Health Source Type: research

Impact of Previous Concussion on Helmet Use and Risk Compensation
Publication date: December 2015 Source:Wilderness & Environmental Medicine, Volume 26, Issue 4 Author(s): Alison D. Taylor, Megan L. Fix, Jeremy L. Davis, Stuart E. Willick, Graham E. Wagner (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 30, 2015 Category: Environmental Health Source Type: research

Altitude Illness on Mt. Rainier—Incidence and Climbers’ Cognizance
Publication date: December 2015 Source:Wilderness & Environmental Medicine, Volume 26, Issue 4 Author(s): Lisa M. Hile, Aaron S. Birch, Jessica J. Walrath, David C. Hile (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 30, 2015 Category: Environmental Health Source Type: research

Reliance on Technology Among Climbers on Mount Rainier
Publication date: December 2015 Source:Wilderness & Environmental Medicine, Volume 26, Issue 4 Author(s): David C. Hile, Jessica J. Walrath, Aaron S. Birch, Lisa M. Hile (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 30, 2015 Category: Environmental Health Source Type: research

Epidemiological Trends in Search and Rescue Incidents Documented by the Alpine Club of Canada From 1970 to 2005
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. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 30, 2015 Category: Environmental Health Source Type: research