Hydration Status as Predictor of Summit Success on Mount McKinley
Publication date: September 2014 Source:Wilderness & Environmental Medicine, Volume 25, Issue 3 Author(s): Eric R. Ladd , Katherine M. Shea , Grant S. Lipman , Patrick Bagley , Elizabeth Pirrotta , Hurnan Vongsachang , N. Ewen Wang , Paul S. Auerbach (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Walk High, Sleep Low: An Observational Cohort Study of Altitude Symptoms and Physiological Profiles Over a 6 Day Ascent of Mount Kilimanjaro
Publication date: September 2014 Source:Wilderness & Environmental Medicine, Volume 25, Issue 3 Author(s): Laura G. Nicol , Hannah E. Evans (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

World Journal of Orthopedics
Publication date: September 2014 Source:Wilderness & Environmental Medicine, Volume 25, Issue 3 Author(s): Pearlly Ng (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Scientific Reports
Publication date: September 2014 Source:Wilderness & Environmental Medicine, Volume 25, Issue 3 Author(s): Matthew Stewart (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Journal of Sports Science and Medicine
Publication date: September 2014 Source:Wilderness & Environmental Medicine, Volume 25, Issue 3 Author(s): Matthew Stewart (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Hawai’i Journal of Medicine and Public Health
Publication date: September 2014 Source:Wilderness & Environmental Medicine, Volume 25, Issue 3 Author(s): Heather Beasley (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Australasian Medical Journal
Publication date: September 2014 Source:Wilderness & Environmental Medicine, Volume 25, Issue 3 Author(s): Matthew Stewart (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Extreme Altitude: Words From on High
Publication date: September 2014 Source:Wilderness & Environmental Medicine, Volume 25, Issue 3 Author(s): Harvey V. Lankford Medical science has its own objective language for describing the effects of high altitude. Mountaineers’ words and metaphors tell the story with subjectivity and feeling. This essay will include only limited physiology about lowlanders and high altitude. Instead, the focus will be literary, using the quotations of 20th-century mountaineers and mountaineer physicians to provide color commentary about the hardship. These are Words From on High. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

A Pilot Study of Solar Water Disinfection in the Wilderness Setting
Conclusions The SODIS technique may be applicable in the wilderness setting using tools commonly available in the backcountry. In this limited trial, specific types of containers common in wilderness settings demonstrated similar performance to the standard containers. With further study, solar disinfection in appropriate conditions may be included as a viable treatment option for wilderness water disinfection. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Effect of Ski Mountaineering Track on Foot Sole Loading Pattern
Conclusions The higher impact placed on the valley side foot and the concentration of force placed on the medial ball of the valley side foot suggested the influence of the track on the load pattern of the foot sole. This higher impact may result in upward forces that affect the force distribution in the ankle and knee joints. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Effects of Hiking at Moderate and Low Altitude on Cardiovascular Parameters in Male Patients With Metabolic Syndrome: Austrian Moderate Altitude Study
Conclusions A 3-week hiking vacation at moderate or low altitude is safe for patients with metabolic syndrome and provides several improvements in their cardiovascular parameters. The cardiovascular benefits achieved are more likely to be the result of regular physical activity than the altitude-specific effect of a mountain environment. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Atraumatic Splenic Rupture After Coagulopathy Owing to a Snakebite
Publication date: September 2014 Source:Wilderness & Environmental Medicine, Volume 25, Issue 3 Author(s): Changwoo Kang , Dong Hoon Kim , Seong Chun Kim , Dong Seob Kim , Chi-Young Jeong Among the many complications that may follow envenomation by some species of venomous snakes, coagulopathy is common and well known. However, hemoperitoneum induced by coagulopathy after a snakebite is rare. Atraumatic spontaneous splenic rupture is also an uncommon and life-threatening condition. Here, we report a case of presumptive envenomation by Gloydius spp. that resulted in atraumatic splenic rupture as a probable manifes...
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Concussion Management in the Wilderness
Publication date: September 2014 Source:Wilderness & Environmental Medicine, Volume 25, Issue 3 Author(s): Justin M. Wright , Arthur A. Islas Head trauma accounts for a significant number of injuries in the wilderness setting. Concussions are possible sequelae of falls or encounters with unforeseen obstacles. Although not immediately life-threatening, concussions can be a source of significant short- and long-term morbidity. Diagnosis of a concussion in the wilderness may be challenging as symptoms can often be confused with other conditions, such as altitude illness and hyponatremia. Successful management depend...
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Implementing an Emergency Medical Services System in Kathmandu, Nepal: A Model for “White Coat Diplomacy”
We describe our efforts to support development of an EMS system in the Kathmandu Valley of Nepal, including training the first-ever class of emergency medical technicians in that country. The purpose of this description is to assist others who might attempt similar efforts in other countries and to support the notion that an effective approach to improving foreign relations is assistance such as this, which may be considered a form of “white coat diplomacy.” (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Wilderness Medical Society Practice Guidelines for Basic Wound Management in the Austere Environment
Publication date: September 2014 Source:Wilderness & Environmental Medicine, Volume 25, Issue 3 Author(s): Robert H. Quinn , Ian Wedmore , Eric Johnson , Arthur Islas , Anne Anglim , Ken Zafren , Cindy Bitter , Vicki Mazzorana In an effort to produce best-practice guidelines for wound management in the austere environment, the Wilderness Medical Society convened an expert panel charged with the development of evidence-based guidelines for the management of wounds sustained in an austere (dangerous or compromised) environment. Recommendations are made about several parameters related to wound management. These rec...
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Incidence and Characteristics of Snakebite Envenomations in the New York State Between 2000 and 2010
Conclusions Although not rare, venomous snakebites do not occur commonly in New York State, with a mean of just 7 bites per year; fortunately most snakebites reported are from nonvenomous snakes. Yet even nonvenomous bites have the potential to cause moderately severe outcomes. Medical providers in the state should be aware of their management. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

The Impact of an Ultramarathon on Hormonal and Biochemical Parameters in Men
Conclusions Training for and completing the WSER produced a significant suppression in the HPT axis as seen by decreased levels of testosterone and LH. Additionally, running the WSER continued to influence endocrine function until 2 days after the race. Furthermore, the stress caused by the WSER produced severe muscle damage. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Exercise Limitation of Acetazolamide at Altitude (3459 m)
Conclusions In this study group, and despite higher resting Spo 2, Az may have compromised exercise at 3459 m altitude during early acclimatization, particularly in older subjects. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Sleeping in Moderate Hypoxia at Home for Prevention of Acute Mountain Sickness (AMS): A Placebo-Controlled, Randomized Double-Blind Study
Conclusions Sleeping 14 consecutive nights in normobaric hypoxia (equivalent to 2600 m) reduced symptoms and incidence of AMS 4 days later on exposure to 4500 m. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Doppler Detection in Ama Divers of Japan
Conclusions Intravascular bubbles may be formed after repetitive breath-hold dives with short surface intervals or after a long breath-holding session in Ama divers. Symptoms consistent with neurological accidents in repetitive breath-hold diving may be caused in part by the intravascular presence of bubbles, indicating the need for safety procedures. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Hypoxia – high, low, and far
Publication date: September 2014 Source:Wilderness & Environmental Medicine, Volume 25, Issue 3 Author(s): Scott E. McIntosh , Tracy Cushing , Linda Keyes (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

David OliverRelinSecond Suns: Two Doctors and Their Amazing Quest to Restore Sight and Save Lives2013Random House, IncNew York, NYUS $27.00, 415 pages
Publication date: Available online 12 September 2014 Source:Wilderness & Environmental Medicine Author(s): Buddha Basnyat (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Medical Student Electives in Wilderness Medicine: Curriculum Guidelines
Publication date: Available online 12 September 2014 Source:Wilderness & Environmental Medicine Author(s): Stephanie A. Lareau , Michael J. Caudell , Kiran B. Pandit , Brian C. Hiestand Wilderness medicine has been a part of medical student education for many years and is becoming more popular. To help standardize and improve the student experience, we surveyed current elective directors to gain an understanding of what experts in the field thought were priority elements in a wilderness medicine elective. Although there is a diversity of opinion among leaders in the field, there are multiple topics on which there...
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Student Electives in Wilderness Medicine: Curriculum Guidelines—An Introduction
Publication date: Available online 12 September 2014 Source:Wilderness & Environmental Medicine Author(s): Steve Donelan (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Summer Climbing Incidents Occurring on Fujisan’s North Face from 1989 to 2008
Conclusions This retrospective review describes the demographics of summer climbing incidents on Fujisan’s north face. Additionally, limitations to the current method of incident reporting were identified. More comprehensive recordkeeping would increase understanding of injuries and illness, which could improve resource allocation and reduce the risk of fatalities from out-of-hospital cardiac events. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

An EPAS1 Haplotype Is Associated With High Altitude Polycythemia in Male Han Chinese at the Qinghai-Tibetan Plateau
Conclusions Carriers of this EPAS1 haplotype (G-G-G, rs13419896, rs4953354, and rs1868092) may have a higher risk for HAPC. These results may contribute to a better understanding of the pathogenesis of HAPC in the Han population. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Human Skeletal Muscle mRNA Response to a Single Hypoxic Exercise Bout
Conclusions The improvements in mitochondrial function reported with intermittent hypoxic training may not be explained by a single acute hypoxic exposure, and thus it appears that a longer period of preacclimatization than a single exposure may be required. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Stand-Up Paddleboarding, Artibonite River, Verettes, Haiti
Publication date: Available online 17 September 2014 Source:Wilderness & Environmental Medicine Author(s): Christopher Van Tilburg , Jennifer Donnelly (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

A Lightning Multiple Casualty Incident in Sequoia and Kings Canyon National Parks
Conclusions Exposure to ongoing lightning and a remote wilderness location affected both victims and rescuers in a lightning MCI. Helicopters, the main vehicles of wilderness rescue in SEKI, can be limited by weather, daylight, and terrain. Redundancies in communication systems are vital for episodes of radio failure. Reverse triage should be implemented in lightning injury MCIs. Education of both wilderness travelers and rescuers regarding these issues should be pursued. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

New Zealand Land Search and Rescue Operations: An Analysis of Medical and Traumatic Conditions
Conclusions Search and rescue personnel are exposed to a broad range of medical and traumatic conditions. In New Zealand, they include preexisting cognitive impairment that results in persons lost in urban environments. Notwithstanding this, many subjects will also need to be managed in remote, resource-limited environments for extended periods. First aid training and field equipment should reflect these demands. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Effect of Head and Face Insulation on Cooling Rate During Snow Burial
Conclusions Head and face insulation did not protect the simulated avalanche victim from faster cooling or rewarming. Because the 3 temperature measurement methods correlated, the ingestible capsule may provide an advantageous noninvasive method for snow burial and future hypothermia studies if interruptions in data transmission can be minimized. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Evaluation of a Simulation Training Program for Uncomplicated Fishhook Removal
Conclusions This study is the first to describe a simulation training program for uncomplicated fishhook removal, and to experimentally evaluate physician learning and preferences for fishhook removal techniques. After a brief educational session, physicians could effectively use all techniques except needle cover. Simple retrograde was the overall preferred technique. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Wilderness Image
Publication date: Available online 1 October 2014 Source:Wilderness & Environmental Medicine Author(s): Tom Edward Mallinson (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Characterization of Medical Care at the 161-km Western States Endurance Run
Conclusions This work demonstrates that the medical needs in a 161-km ultramarathon are mostly for minor issues. However, occasional serious issues arise that warrant a well-organized medical system. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Utah Ski Patrol: Assessing Training Types and Resources
Conclusions Utah area ski patrollers frequently see trauma-related injuries and have the resources to assess and provide initial immobilization techniques. Many resorts have affiliated clinics with advanced providers, and all have access to aeromedical support to rapidly transfer patients to trauma centers. Medical directors may be of use for training as well as developing extended scope of practice protocols for advanced airway use or medication administration. Patrols may benefit from additional resort-specific training that addresses other frequently seen injuries or illnesses. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Overlooking. Monte Solaro on the island of Capri in Campania, Italy. Photograph by Jon Conard, DO.
Publication date: Available online 7 October 2014 Source:Wilderness & Environmental Medicine Author(s): Jon Conard (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Controlled Hyperventilation After Training May Accelerate Altitude Acclimatization
Publication date: Available online 14 October 2014 Source:Wilderness & Environmental Medicine Author(s): Geert A. Buijze , Maria T. Hopman (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Glossopharyngeal Insufflation and Breath-Hold Diving: The More, the Worse?
Conclusions Some recommendations, such as limiting the number of maneuvers and performing lung packing in the supine position, should be expressed to avoid injuries secondary to the use of glossopharyngeal insufflation. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Epidemiology of Hunting Stand Injuries Presenting to US Emergency Departments, 2004–2012
Conclusions This study has characterized the epidemiology of hunting stand injuries with most occurring from falls. A fracture was the most common injury with a very low alcohol intoxication rate. These baseline data can now be used to compare other studies of hunting stand injuries and guide prevention strategies, such as education regarding the need for safety measures to prevent falls. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Regarding the Use of Epinephrine Auto-injectors in Remote Settings
Publication date: Available online 14 October 2014 Source:Wilderness & Environmental Medicine Author(s): Ray A. Wolf (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Exercise-Associated Hyponatremic Encephalopathy in an Endurance Open Water Swimmer
We describe a case of exercise-associated hyponatremic encephalopathy presenting as altered conscious state and seizures in a woman who had completed a 20-km open ocean swim. Her serum sodium measured approximately 1 hour after her seizure was 119 mmol/L on point-of-care testing. With ongoing critical care support and the use of hypertonic saline, she was able to be extubated the next day, neurologically intact, and ultimately was discharged from hospital without neurological sequelae. This case emphasizes both the importance of considering exercise-associated hyponatremic encephalopathy as a cause of neurological impairme...
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Symptoms and Treatment of Acute Conjunctivitis Caused by Skin Secretions of Veined Tree Frog (Trachycephalus Venulosus)
Publication date: Available online 14 October 2014 Source:Wilderness & Environmental Medicine Author(s): Levente Tanacs , Etienne Littlefair (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

An Itchy Situation
Publication date: Available online 16 October 2014 Source:Wilderness & Environmental Medicine Author(s): Pratibha Phuyal , Pranawa Koirala , Buddha Basnyat , Ken Zafren (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

A 51-Year-Old Woman Crushed by an Elephant Trunk
We report the case of a 51-year-old woman who sustained multiple systemic traumatic injuries after she was pinned to a fence by an elephant’s trunk. Upon arrival in the emergency department, she was hypothermic with a temperature of 35.1ºC (95.1ºF), hypotensive to 94/60 mm Hg after 5 L crystalloid, tachycardic at 108 beats/min, and intubated with oxygen saturation of 100%. Tranexamic acid was administered in addition to starting a massive transfusion protocol. Injuries included bilateral multiple rib fractures, left abdominal wall degloving injury, right pneumothorax, right hemothorax, left chest wall punct...
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Waterfall Mortality and Morbidity in North Carolina, 2001–2013
Publication date: Available online 30 October 2014 Source:Wilderness & Environmental Medicine Author(s): Aram Attarian (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Search and Rescue Response to a Large-Scale Rockfall Disaster
Conclusions The risk for personnel involved in mountain SAR operations is rarely reported and not easily investigated or quantified. This case exemplifies the importance of a multiskilled team and additional considerations for prehospital management during natural hazard events. Safety plans should include compulsory protective measures and medical monitoring of personnel. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia
Publication date: Available online 31 October 2014 Source:Wilderness & Environmental Medicine Author(s): Ken Zafren , Gordon G. Giesbrecht , Daniel F. Danzl , Hermann Brugger , Emily B. Sagalyn , Beat Walpoth , Eric A. Weiss , Paul S. Auerbach , Scott E. McIntosh , Mária Némethy , Marion McDevitt , Jennifer Dow , Robert B. Schoene , George W. Rodway , Peter H. Hackett , Brad L. Bennett , Colin K. Grissom To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of a...
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research

A Prospective Randomized Blister Prevention Trial Assessing Paper Tape in Endurance Distances (Pre-TAPED)
Conclusions Although paper tape was not found to be significantly protective against blisters, the intervention was well tolerated with high user satisfaction. (Source: Wilderness and Environmental Medicine)
Source: Wilderness and Environmental Medicine - November 6, 2014 Category: Environmental Health Source Type: research