1
|
Falla M, van Veelen MJ, Falk M, Weiss EM, Roveri G, Masè M, Weber B, Randi A, Brugger H, Hüfner K, Strapazzon G. Effect of oxygen supplementation on cognitive performance among HEMS providers after acute exposure to altitude: the HEMS II randomized clinical trial. Scand J Trauma Resusc Emerg Med 2024; 32:65. [PMID: 39075543 PMCID: PMC11287850 DOI: 10.1186/s13049-024-01238-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
IMPORTANCE Emergency medical services (EMS) providers transiently ascend to high altitude for primary missions and secondary transports in mountainous areas in helicopters that are unpressurised and do not have facilities for oxygen supplementation. The decrease in cerebral oxygen saturation can lead to impairment in attention and reaction time as well as in quality of care during acute exposure to altitude. OBJECTIVE The primary aim of the current study was to investigate the effect of oxygen supplementation on cognitive performance in Helicopter EMS (HEMS) providers during acute exposure to altitude. DESIGN, SETTING, AND PARTICIPANTS This interventional, randomized, controlled, double-blind, cross-over clinical trial was conducted in October 2021. Each trial used a simulated altitude scenario equivalent to 4000 m, in which volunteers were exposed to hypobaric hypoxia with a constant rate of ascent of 4 m/s in an environmental chamber under controlled, replicable, and safe conditions. Trials could be voluntarily terminated at any time. Inclusion criteria were being members of emergency medical services and search and rescue services with an age between 18 and 60 years and an American Society of Anesthesiologists physical status class I. EXPOSURES Each participant conducted 2 trials, one in which they were exposed to altitude with oxygen supplementation (intervention trial) and the other in which they were exposed to altitude with ambient air supplementation (control trial). MAIN OUTCOMES AND MEASURES Measurements included peripheral oxygen saturation (SpO2), cerebral oxygenation (ScO2), breathing and heart rates, Psychomotor Vigilance Test (PVT), Digit-Symbol Substitution Test (DSST), n-Back test (2-BACK), the Grooved Pegboard test, and questionnaires on subjective performance, stress, workload, and positive and negative affect. Paired t-tests were used to compare conditions (intervention vs. control). Data were further analyzed using generalized estimating equations (GEE). RESULTS A total of 36 volunteers (30 men; mean [SD] age, 36 [9] years; mean [SD] education, 17 [4] years) were exposed to the intervention and control trials. The intervention trials, compared with the control trials, had higher values of SpO2 (mean [SD], 97.9 [1.6] % vs. 86 [2.3] %, t-test, p = 0.004) and ScO2 (mean [SD], 69.9 [5.8] % vs. 62.1 [5.2] %, paired t-test, p = 0.004). The intervention trials compared with the control trials had a shorter reaction time (RT) on the PVT after 5 min (mean [SD], 277.8 [16.7] ms vs. 282.5 [15.3] ms, paired t-test, p = 0.006) and after 30 min (mean [SD], 276.9 [17.7] ms vs. 280.7 [15.0] ms, paired t-test, p = 0.054) at altitude. While controlling for other variables, there was a RT increase of 0.37 ms for each % of SpO2 decrease. The intervention trials showed significantly higher values for DSST number of correct responses (with a difference of mean [SD], 1.2 [3.2], paired t-test, p = 0.035). Variables in the intervention trials were otherwise similar to those in the control trials for DSST number of incorrect responses, 2-BACK, and the Grooved Pegboard test. CONCLUSIONS AND RELEVANCE This randomized clinical trial found that oxygen supplementation improves cognitive performance among HEMS providers during acute exposure to 4000 m altitude. The use of oxygen supplementation may allow to maintain attention and timely reaction in HEMS providers. The impact of repeated altitude ascents on the same day, sleep-deprivation, and additional stressors should be investigated. Trial registration NCT05073406, ClinicalTrials.gov trial registration.
Collapse
Affiliation(s)
- Marika Falla
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Neurology/Stroke Unit, Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
- Center for Mind/Brain Sciences, University of Trento, Rovereto, Italy
| | - Michiel J van Veelen
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Sport Science, Medical Section, University of Innsbruck, Innsbruck, Austria
| | - Markus Falk
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Elisabeth M Weiss
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Giulia Roveri
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
- Department of Anaesthesiology and Intensive Care Medicine, Hospital of Merano (SABES-ASDAA), Merano, Italy
| | - Michela Masè
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Cellular, Computational, and Integrative Biology, CIBIO, Trento, Italy
| | - Bernhard Weber
- Department of Psychology, University of Graz, Graz, Austria
| | - Anna Randi
- Center for Mind/Brain Sciences, University of Trento, Rovereto, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Katharina Hüfner
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.
| |
Collapse
|
2
|
Park-Ross JF, Howard I, Hodkinson P. Rescue Activity of a Civilian Helicopter Emergency Medical Service in the Western Cape, South Africa: A 5-Year Retrospective Review. Wilderness Environ Med 2022; 33:437-445. [PMID: 36229384 DOI: 10.1016/j.wem.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Helicopter search and rescue (SAR) in Africa is conducted primarily by military organizations. Since 2002, the Western Cape of South Africa has had a dedicated contracted civilian helicopter emergency medical service (HEMS) conducting air ambulance, terrestrial, and aquatic rescue. To our knowledge, this is the first description of the operations of an African helicopter rescue service. METHODS A 5-y retrospective review of the terrestrial and aquatic helicopter rescue activity of a civilian-operated HEMS in the Western Cape, South Africa, from January 1, 2012 through December 31, 2016, was conducted. Data were extracted from the organization's operational database, aviation documents, rescue reports, and patient care records. Patient demographics and activity at the time of rescue, temporal and geographical distribution, crewing compositions, patient injury, triage, clinical interventions, and rescue techniques were analyzed. RESULTS A total of 581 SAR missions were conducted, of which 451 were terrestrial and 130 were aquatic rescues. The highest volume of rescues was conducted within the urban Cape Peninsula. Hoisting using a rescue harness was the most common rescue technique used. A total of 644 patients were rescued, with no or minor injuries representing 79% of the sample. Trauma (33%, 196/644) was the most common medical reason for rescue, with lower limb trauma predominant (15%, 90/644). The most common clinical interventions performed were intravenous access (n=108, 24%), spinal immobilization (n=92, 21%), splinting (n=76, 17%), and analgesia administration (n=58, 13%). CONCLUSIONS The rescue techniques utilized are similar to those described in high-income settings. Uninjured patients comprised the majority of the patients rescued.
Collapse
Affiliation(s)
- Jocelyn Frances Park-Ross
- Department of Emergency Medicine, University of Cape Town, Cape Town; Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.
| | - Ian Howard
- Department of Emergency Medicine, University of Cape Town, Cape Town
| | - Peter Hodkinson
- Department of Emergency Medicine, University of Cape Town, Cape Town
| |
Collapse
|
3
|
A Geographical Analysis of Access to Trauma Centers from US National Parks in 2018. Prehosp Disaster Med 2022; 37:794-799. [PMID: 36263736 DOI: 10.1017/s1049023x22001431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Millions of people visit US national parks annually to engage in recreational wilderness activities, which can occasionally result in traumatic injuries that require timely, high-level care. However, no study to date has specifically examined timely access to trauma centers from national parks. This study aimed to examine the accessibility of trauma care from national parks by calculating the travel time by ground and air from each park to its nearest trauma center. Using these calculations, the percentage of parks by census region with timely access to a trauma center was determined. METHODS This was a cross-sectional study analyzing travel times by ground and air transport between national parks and their closest adult advanced trauma center (ATC) in 2018. A list of parks was compiled from the National Parks Service (NPS) website, and the location of trauma centers from the 2018 National Emergency Department Inventory (NEDI)-USA database. Ground and air transport times were calculated using Google Maps and ArcGIS, with medians and interquartile ranges reported by US census region. Percentage of parks by region with timely trauma center access-defined as access within 60 minutes of travel time-were determined based on these calculated travel times. RESULTS In 2018, 83% of national parks had access to an adult ATC within 60 minutes of air travel, while only 26% had timely access by ground. Trauma center access varied by region, with median travel times highest in the West for both air and ground transport. At a national level, national parks were unequally distributed, with the West housing the most parks of all regions. CONCLUSION While most national parks had timely access to a trauma center by air travel, significant gaps in access remain for ground, the extent of which varies greatly by region. To improve the accessibility of trauma center expertise from national parks, the study highlights the potential that increased implementation of trauma telehealth in emergency departments (EDs) may have in bridging these gaps.
Collapse
|
4
|
Kuo CY, Ho CY, Shih HM, Lin WL, Hsu TY, Chen WK, Chen HC. Accessory Climbing Routes Associated With More Rescue Operations Than the Main Climbing Route: A Retrospective 12-Year Report of Yushan National Park. Wilderness Environ Med 2022; 33:304-310. [PMID: 35843857 DOI: 10.1016/j.wem.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/04/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study compared the casualties and types of rescues conducted on the main climbing route (MCR) and accessory climbing routes (ACRs) in Yushan National Park (YSNP) between 2008 and 2019. METHODS We collected the following information for all documented mountain rescue operations conducted on the MCRs and ACRs in YSNP between 2008 and 2019: accident location, casualty type, victim number, and type of rescue. The victims were categorized as to injury, illness, mortality, or no medical problem (NMP) groups according to their condition at the time of rescue. RESULTS Two-hundred forty-four rescue operations involving 329 victims were conducted during the 12-y study period. Among them, 105 (32%) did not require medical treatment, 102 (31%) were injured, 82 (25%) were ill, and 40 (12%) were deceased. Of the 82 individuals with illness, 69 (84%) had acute altitude sickness. The accident and mortality rates on the ACRs were significantly higher than those on the MCR (P<0.001; χ2). The ACR incidents involved significantly higher percentages of helicopter-based rescues and victims in the NMP group (P<0.001). CONCLUSIONS Acute altitude sickness accounted for most of the rescues. ACRs had higher injury and mortality rates and required more helicopter-based rescues for patients who did not have medical problems. This study may serve as a reference to reduce casualties and overuse of helicopters by educating tourists on the appropriate use of maps and the evaluation of trails in relation to weather conditions.
Collapse
Affiliation(s)
- Chun-Yen Kuo
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Yi Ho
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Hong-Mo Shih
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan
| | - Wei-Ling Lin
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Tai-Yi Hsu
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan
| | - Wei-Kung Chen
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Hang-Cheng Chen
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan.
| |
Collapse
|
5
|
Ettinger S, Long A, Ganti A, Mortimer RB, Chiang W, Spano S. Search and Rescue in the Pacific West States. Wilderness Environ Med 2021; 33:43-49. [PMID: 34955362 DOI: 10.1016/j.wem.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The training practices and the level of medical oversight of search and rescue (SAR) organizations in the US National Park Service (NPS) Pacific west region is not known. METHODS A database of SAR teams in the NPS Pacific west region was assembled using public sources. SAR team leaders received an electronic survey between May and December 2019. A descriptive analysis characterizing team size, technical and medical training protocols, and medical oversight was completed. Results are reported as median (interquartile range, range). RESULTS Of the 250 SAR teams contacted, 39% (n=97) completed our survey. Annual mission volume was 25 (10-50, 1-200). Team size was 30 members (22-58, 1-405). SAR teams most frequently trained in helicopter operations (77%), low-angle rope rescue (75%), and avalanche rescue (43%). Nearly all teams (99%) had members with some medical training: first aid or cardiopulmonary resuscitation (89%), emergency medical technicians (75%), registered nurses or midlevel providers (52%), and physicians (40%). SAR members administered field medical care (84%), often in coordination with EMS (77%). Medical direction was present on a minority of teams (45%), most frequently by a provider specialized in emergency medicine (68%). Expanded medical procedures were permitted on 21% of SAR teams. CONCLUSIONS SAR teams across the NPS Pacific west region had composition and training standards similar to those surveyed previously in the US intermountain states. Healthcare professionals were present on most teams, typically as team members, not as medical directors. Few SAR teams use medical protocols in remote care environments.
Collapse
Affiliation(s)
- Stephen Ettinger
- University of California San Francisco School of Medicine, San Francisco, California.
| | - Andrea Long
- University of California San Francisco Fresno, Fresno, California
| | - Arun Ganti
- University of California San Francisco Fresno, Fresno, California; Valley Medical Center, Renton, Washington
| | - Roger B Mortimer
- University of California San Francisco Fresno, Fresno, California
| | - William Chiang
- University of California San Francisco Fresno, Fresno, California
| | - Susanne Spano
- University of California San Francisco Fresno, Fresno, California
| |
Collapse
|
6
|
Lu ZN, Briggs A, Saadat S, Algaze IM. The Associations Between Visitation, Social Media Use, and Search and Rescue in United States National Parks. Wilderness Environ Med 2021; 32:463-467. [PMID: 34629292 DOI: 10.1016/j.wem.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Search and rescue (SAR) is vital for visitor safety in US national parks, which are popular destinations for tourists. Previous studies have described SAR and seasonal visitation patterns, but not in the context of overall visitation. In addition, studies on the association between SAR and developed park areas remain limited. Concurrently, social media can be valuable for sharing information about conservation awareness and the joy of being outdoors. However, social media can potentially be an avenue for users to share risky and dangerous behaviors performed during attempts to obtain photos and videos. The associations between SAR and social media have not been discussed in existing literature. METHODS Variables included recreational visits, developed site stay visits, backcountry visits, SAR incidents, and tweets. Data from 2017 were obtained from National Park Service visitor use statistics, the SAR incident dashboard, and the University of California, Irvine, Cloudberry application. Correlation analysis was performed using nonparametric Kendall rank correlation coefficients. RESULTS Recreational visits were correlated with SAR incidents (rτ=0.415, P<0.001). Developed site stays were similarly correlated with SAR incidents (rτ=0.447, P<0.001), as were backcountry visits (rτ=0.428, P<0.001). Backcountry visits had a stronger correlation with fatalities (rτ=0.380, P<0.001) compared to developed site stays (rτ=0.304, P<0.001). Tweets were correlated with SAR incidents (rτ=0.468, P<0.001), recreational visits (rτ=0.403, P<0.001), and fatalities (rτ=0.367, P<0.001). CONCLUSIONS Our findings demonstrate associations between national park visitation, SAR incidents, fatalities, and Twitter use and provides a concept framework for future prospective studies to further investigate the relationships between visitation, SAR, and social media.
Collapse
Affiliation(s)
- Zachary N Lu
- Department of Emergency Medicine, University of California, Irvine, Irvine, California.
| | - Amy Briggs
- Department of Emergency Medicine, University of California, Irvine, Irvine, California
| | - Soheil Saadat
- Department of Emergency Medicine, University of California, Irvine, Irvine, California
| | - Isabel M Algaze
- Department of Emergency Medicine, University of California, Irvine, Irvine, California
| |
Collapse
|
7
|
Drones to the rescue? Exploring rescue workers' behavioral intention to adopt drones in mountain rescue missions. INTERNATIONAL JOURNAL OF PHYSICAL DISTRIBUTION & LOGISTICS MANAGEMENT 2021. [DOI: 10.1108/ijpdlm-01-2020-0025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeMountaineering and related activities are increasingly becoming popular and are accompanied by an increase in medical incidents. Emergency operations in mountainous terrain are time-critical and often pose major logistical challenges for rescuers. Drones are expected to improve the operational performance of mountain rescuers. However, they are not yet widely used in mountain rescue missions. This paper examines the determinants that drive the behavioral intention of mountain rescuers to adopt drones in rescue missions.Design/methodology/approachThis is a behavioral study that builds upon an extended model of the unified theory of acceptance and use of technology (UTAUT) and investigates the relationship between individual attitudes, perceptions, and intentions for drone adoption. Original survey data of 146 mountain rescuers were analyzed using moderated ordinary least squares (OLS) regression analysis.FindingsResults indicate that the behavioral intention to use drones in mountain rescue missions is driven by the expected performance gains and facilitating conditions. Favorable supporting conditions and experience with drones further moderate the relationship between performance expectancy and behavioral intention. The effects for effort expectancy, social influence, and demonstrations were not significant.Practical implicationsRescue organizations and stakeholders are recommended to consider the identified determinants in the implementation of drones in emergency logistics. Drone manufacturers targeting mountain rescue organizations are advised to focus on operational performance, provide sufficient support and training, and promote the gathering of practical experience.Originality/valueA tailored-model that provides first empirical results on the relevance of personal and environmental factors for the acceptance of drones in emergency logistics is presented.
Collapse
|
8
|
Martínez-Caballero CM, Sierra Quintana E. Epidemiology of Cardiac Events During Prehospital Care in Mountain Rescues Conducted in Aragón. Wilderness Environ Med 2019; 30:22-27. [PMID: 30737154 DOI: 10.1016/j.wem.2018.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 10/22/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Cardiac events are one of the leading causes of death in the Spanish population. Given the increase in the nontraumatic medical conditions found in mountain rescues, the objective of this study was to report on the heart conditions of patients rescued in the mountains of Aragón in the Spanish Pyrenees. METHODS We conducted a retrospective observational study based on data collected from patients' medical histories for rescues undertaken in from 2010 to 2016 (at altitudes between 500 m [1640 ft] and 3404 m [11,168 ft]). RESULTS Of the 2079 individuals rescued from 2010 to 2016, 34 (2%) were diagnosed with heart conditions, accounting for 21% of all nontraumatic medical conditions. The data showed a statistically significant increase in the age of the rescued patients with heart conditions (55±15 y) and those with acute coronary syndrome/sudden death (60±8 y). Eighty-five percent of the rescued patients with heart conditions were men, 62% were rescued above 2000 m (6500 ft), 42% had acute coronary syndrome (of whom 56% had inferior infarction), and 35% died suddenly. CONCLUSIONS Aragón mountain rescues show an increase in patient age in recent years. The most common medical case among rescued individuals with heart conditions was a hiker over the age of 50 y with cardiovascular risk factors, inferior infarction, and occurrence at an altitude above 2000 m. Based on our observations, appropriate training should be undertaken, especially by older hikers, who may also benefit from cardiac screening, and rescue vehicles/personnel and mountain huts should be equipped with semiautomatic external defibrillators.
Collapse
|
9
|
Procter E, Brugger H, Burtscher M. Accidental hypothermia in recreational activities in the mountains: A narrative review. Scand J Med Sci Sports 2018; 28:2464-2472. [PMID: 30203539 DOI: 10.1111/sms.13294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/03/2018] [Accepted: 09/05/2018] [Indexed: 01/16/2023]
Abstract
The popularity of recreational activities in the mountains worldwide has led to an increase in the total number of persons exposed to cold and extreme environments through recreation. There is little conclusive evidence about the risk of hypothermia for specific activities or populations, nor is it clear which activities are represented in the literature. This is a non-systematic review of accidental hypothermia in different recreational activities in the mountains, with a specific focus on outdoor or winter activities that potentially involve cold exposure. Cases of hypothermia have been reported in the literature in mountaineering, trekking, hiking, skiing, activities performed in the backcountry, ultra-endurance events, and databases from search and rescue services that include various types of recreation. Of these activities, hypothermia as a primary illness occurs most commonly during mountaineering in the highest elevation areas in the world and during recreation practiced in more northern or remote areas. Hypothermia in skiers, snowboarders, and glacier-based activities is most often associated with accidents occurring off-piste or in the backcountry (crevasse, avalanche). Organizers of outdoor events also have a role in reducing the incidence of hypothermia through medical screening and other preparedness measures. More complete collection and reporting of data on mild hypothermia and temperature measurement would improve our understanding of the incidence of hypothermia in outdoor recreation in future.
Collapse
Affiliation(s)
- Emily Procter
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bozen/Bolzano, Italy
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Austrian Society for Alpine and Mountain Medicine, Innsbruck, Austria
| |
Collapse
|
10
|
Small ER, Burbank SR, Lorme JM, Carlson K, Erickson TB, Young DS. Apostle Islands National Lakeshore: A Review of Search and Rescue and Emergency Medical Services Operations, 2006-2015. Wilderness Environ Med 2018; 29:463-470. [PMID: 30293698 DOI: 10.1016/j.wem.2018.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 06/20/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Apostle Islands National Lakeshore (APIS) lies at the northern tip of Wisconsin and is home to a network of 21 islands along Lake Superior. The goal of this report is to investigate search and rescue (SAR) and emergency medical services (EMS) trends at APIS in an effort to improve visitor safety and resource allocation. METHODS This study is a retrospective analysis reviewing APIS SAR reports and annual EMS summary reports from January 1, 2006, to December 31, 2015. Information related to incident type, incident date, individual demographic characteristics and activities, injury/illness type, cost, and contributing factors were recorded and analyzed in frequency tables. RESULTS From 2006 to 2015, APIS SAR conducted 133 total missions assisting 261 individuals-200 not injured/ill, 57 injured/ill, and 4 fatalities. Median cost per SAR incident involving aircraft totaled $21,695 (range: $2,993-141,849), whereas incidents not involving aircraft had a median cost of $363 (range: $35-8,830). Nonmotorized boating was the most common activity resulting in SAR incidents. All 4 fatalities were attributed to drowning while kayaking or swimming. Cold-related injury/illness accounted for nearly half of all injuries/illnesses (45%) with the most commonly reported contributing factor being high winds. EMS responded to a total of 134 incidents. Trauma and first aid accounted for 43% and 34% of EMS workload, respectively. CONCLUSIONS Overall, this study highlights the hazards associated with the frigid and rough conditions of Lake Superior. The reported results aim to help APIS personnel more saliently convey risks to visitors and plan appropriately in an effort to decrease the need for future rescues.
Collapse
Affiliation(s)
- Elan R Small
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL (Mr Small, Ms Burbank, and Ms Lorme).
| | - Sarah R Burbank
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL (Mr Small, Ms Burbank, and Ms Lorme)
| | - Jeanette M Lorme
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL (Mr Small, Ms Burbank, and Ms Lorme)
| | - Karl Carlson
- Apostle Islands National Lakeshore, Bayfield, WI (Mr Carlson)
| | - Timothy B Erickson
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women's Hospital, Harvard Medical School, Harvard Humanitarian Initiative, Boston, MA (Dr Erickson)
| | - David S Young
- Department of Emergency Medicine, University of Colorado, Denver, CO (Dr Young)
| |
Collapse
|
11
|
Heggie TW, Küpper T. Pediatric and adolescent injury in wilderness and extreme environments. Res Sports Med 2018; 26:186-198. [DOI: 10.1080/15438627.2018.1438280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Travis W. Heggie
- School of Human Movement, Sport and Leisure Studies, Bowling Green State University, Bowling Green, OH, USA
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, QLD, Australia
| | - Thomas Küpper
- Institute of Occupational and Social Medicine, RWTH Aachen Technical University, Aachen, Germany
| |
Collapse
|
12
|
Gundacker ND, Rolfe RJ, Rodriguez JM. Infections associated with adventure travel: A systematic review. Travel Med Infect Dis 2017; 16:3-10. [PMID: 28351605 PMCID: PMC7185378 DOI: 10.1016/j.tmaid.2017.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 12/16/2022]
Abstract
AIM To review infections associated with adventure travel. METHODS The PubMed, Embase and Scopus databases were searched combining the words infection with the following keywords: rafting, whitewater, surfing, (surfer* or windsurf*), (caves or caving or spelunking), (triathlon or trekking) or (hiking or adventure race), bicycling, backpacking, (mountain climb* or bouldering), horseback riding, orienteering, trekking, and skiing. RESULTS Adventure travel is becoming much more common among travelers and it is associated with a subset of infectious diseases including: leptospirosis, schistosomiasis, viral hemorrhagic fevers, rickettsial diseases and endemic mycosis. Caving and whitewater rafting places individuals at particular risk of leptospirosis, schistosomiasis and endemic mycosis, while adventure races also place individuals at high risk of a variety of infections including campylobacter, norovirus and leptospirosis. CONCLUSION Travel practitioners need to be aware of the risks associated with adventure travel and should educate individuals about the risks associated with various activities. Doxycycline prophylaxis should be considered for travelers who are susceptible to leptospirosis due to participation in high-risk sports such as whitewater rafting, caving or adventure races.
Collapse
Affiliation(s)
- Nathan D Gundacker
- University of Alabama at Birmingham, 1900 University Blvd, THT 229, Birmingham, AL 35294, United States.
| | - Robert J Rolfe
- University of Alabama at Birmingham, 1900 University Blvd, THT 229, Birmingham, AL 35294, United States.
| | - J Martin Rodriguez
- University of Alabama at Birmingham, 1900 University Blvd, THT 229, Birmingham, AL 35294, United States.
| |
Collapse
|
13
|
Sadeghi R, Konwinski JC, Cydulka RK. Adirondack Park Incidents: A Retrospective Review of Search and Rescue Reports From 2008 and 2009. Wilderness Environ Med 2015; 26:159-63. [DOI: 10.1016/j.wem.2014.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 08/07/2014] [Accepted: 08/14/2014] [Indexed: 11/16/2022]
|
14
|
Retrospective Study on Search and Rescue Operations in Two Prealps Areas of Italy. Wilderness Environ Med 2015; 26:150-8. [DOI: 10.1016/j.wem.2014.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 10/10/2014] [Accepted: 10/16/2014] [Indexed: 11/19/2022]
|
15
|
Visser JT, Campbell AFR. New Zealand land search and rescue operations: an analysis of medical and traumatic conditions. Wilderness Environ Med 2014; 25:401-8. [PMID: 25281590 DOI: 10.1016/j.wem.2014.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 04/10/2014] [Accepted: 05/27/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to describe the range and types of medical and traumatic conditions encountered in land search and rescue operations in New Zealand. METHODS Twenty months (May 2010 to December 2011) of land search and rescue operations were analyzed. Data on medical and traumatic conditions were extracted from the New Zealand Police search and rescue database. RESULTS During the period audited, New Zealand Police coordinated 1490 land-based search and rescue operations, from which 611 persons fulfilled the study inclusion criteria. Males accounted for 60.5% of the subjects, and a trauma-related injury was the most commonly encountered condition (37.3% of all). The lower limb was the most commonly injured body site, and most injuries occurred as the result of a slip or fall. Medical conditions were recorded in 11.6% of operations and included a wide spread of conditions, with cardiovascular events being seen most frequently. Hypothermia was diagnosed in 9.3% of all operations, and fatalities made up 5.6% of the sample. Thirty percent of all operations were for persons with cognitive impairment who had wandered away from their usual place of residence. These were almost entirely urban searches and concentrated in districts with large populations. 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.
Collapse
Affiliation(s)
- Jenny T Visser
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand (Dr Visser).
| | - Adam F R Campbell
- Medical Student, University of Otago, Wellington, New Zealand (Mr Campbell)
| |
Collapse
|
16
|
Abstract
BACKGROUND Human activity in wilderness areas has increased globally in recent decades, leading to increased risk of injury and illness. Wilderness medicine has developed in response to both need and interest. METHODS The field of wilderness medicine encompasses many areas of interest. Some focus on special circumstances (such as avalanches) while others have a broader scope (such as trauma care). Several core areas of key interest within wilderness medicine are discussed in this study. RESULTS Wilderness medicine is characterized by remote and improvised care of patients with routine or exotic illnesses or trauma, limited resources and manpower, and delayed evacuation to definitive care. Wilderness medicine is developing rapidly and draws from the breadth of medical and surgical subspecialties as well as the technical fields of mountaineering, climbing, and diving. Research, epidemiology, and evidence-based guidelines are evolving. A hallmark of this field is injury prevention and risk mitigation. The range of topics encompasses high-altitude cerebral edema, decompression sickness, snake envenomation, lightning injury, extremity trauma, and gastroenteritis. Several professional societies, academic fellowships, and training organizations offer education and resources for laypeople and health care professionals. CONCLUSIONS THE FUTURE OF WILDERNESS MEDICINE IS UNFOLDING ON MULTIPLE FRONTS: education, research, training, technology, communications, and environment. Although wilderness medicine research is technically difficult to perform, it is essential to deepening our understanding of the contribution of specific techniques in achieving improvements in clinical outcomes.
Collapse
Affiliation(s)
- Douglas G. Sward
- Department of Emergency Medicine, University of Maryland School of Medicine, Hyperbaric Medicine, Shock Trauma Center, Baltimore, Maryland, USA
| | - Brad L. Bennett
- Military & Emergency Medicine Department, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| |
Collapse
|
17
|
DeClerck MP, Atterton LM, Seibert T, Cushing TA. A Review of Emergency Medical Services Events in US National Parks From 2007 to 2011. Wilderness Environ Med 2013; 24:195-202. [DOI: 10.1016/j.wem.2013.01.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 01/15/2013] [Accepted: 01/25/2013] [Indexed: 11/30/2022]
|
18
|
Boore SM, Bock D. Ten Years of Search and Rescue in Yosemite National Park: Examining the Past for Future Prevention. Wilderness Environ Med 2013; 24:2-7. [DOI: 10.1016/j.wem.2012.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 08/28/2012] [Accepted: 09/02/2012] [Indexed: 10/27/2022]
|
19
|
Carpenter J, Thomas F. A 10-year analysis of 214 HEMS backcountry hoist rescues. Air Med J 2013; 32:98-101. [PMID: 23452369 DOI: 10.1016/j.amj.2012.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 09/07/2012] [Accepted: 10/21/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Few published studies on civilian helicopter emergency medical services (HEMS) hoist programs exist. This study provides a demographic analysis of hoist rescue operations performed by the only FAA Part 135 hoist-approved civilian HEMS operator in the United States. METHODS All persons hoisted between May 29, 2001, and May 28, 2011, were retrospectively analyzed. RESULTS Over a 10-year period, 212 of 214 victims were hoisted. The most common indications were fall injuries (38%) and being stranded (21%). Victim demographics showed an average age of 35 ± 17years, predominantly male (79%), often associated with trauma (66%), with a majority (68%) of all victims requiring subsequent transport to a hospital by ground ambulance (24%) or flown by Life Flight (44%). Hoists occurred most often in the afternoon (14:07 ± 3:47 hours), during the weekend (53%), in the months of May-September (71%), at an altitude of 7,488 ± 1487 feet, with the seat harness (39%) being the most common mode of victim extraction. Hoist insertion of search and rescue (SAR) personnel occurred infrequently (5%). CONCLUSION The results from this demographic study on hoist operations can provide important demographic information for HEMS contemplating backcountry hoist operations and programs that interface with SAR agencies.
Collapse
Affiliation(s)
- Judi Carpenter
- Intermountain Life Flight, Intermountain Healthcare, Salt Lake City, UT 84116, USA.
| | | |
Collapse
|
20
|
Westhoff JL, Koepsell TD, Littell CT. Effects of experience and commercialisation on survival in Himalayan mountaineering: retrospective cohort study. BMJ 2012; 344:e3782. [PMID: 22695902 PMCID: PMC3374484 DOI: 10.1136/bmj.e3782] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether previous Himalayan experience is associated with a decreased risk of climbing death, and whether mountaineers participating in commercial expeditions differ in their risk of death relative to those participating in traditional climbs. DESIGN Retrospective cohort study. SETTING Expeditions in the Nepalese Himalayan peaks, from 1 January 1970 to the spring climbing season in 2010. PARTICIPANTS 23,995 non-porters venturing above base camp on 39,038 climbs, 23,295 on 8000 m peaks. OUTCOME Death. RESULTS After controlling for use of standard route, peak, age, season, sex, summit success, and year of expedition, increased Himalayan experience was not associated with a change in the odds of death (odds ratio 1.00, 95% confidence interval 0.96 to 1.05, P = 0.904). Participation in a commercial climb was associated with a 37% lower odds of death relative to a traditional venture, although not significantly (0.63, 0.37 to 1.09, P = 0.100). Choice of peak was clearly associated with altered odds of death (omnibus P<0.001); year of expedition was associated with a significant trend toward reduced odds of death (0.98, 0.96 to 0.99, P = 0.011). CONCLUSIONS No net survival benefit is associated with increased Himalayan experience or participation in a traditional (versus commercial) venture. The incremental decrease in risk associated with calendar year suggests that cumulative, collective knowledge and general innovation are more important than individual experience in improving the odds of survival.
Collapse
Affiliation(s)
- John L Westhoff
- Department of Preventive Medicine, Madigan Healthcare System, Tacoma, WA 98431-1100, USA.
| | | | | |
Collapse
|
21
|
Corniche J, Pasquier M, Yersin B, Kern C, Schoettker P. Helicopter rescue involving the winching of a physician. Air Med J 2012; 31:87-91. [PMID: 22386101 DOI: 10.1016/j.amj.2011.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Accepted: 08/19/2011] [Indexed: 05/31/2023]
Abstract
INTRODUCTION We sought to study the operational and medical aspects of helicopter rescue missions involving the use of a winch. SETTING A single helicopter-based medical service of a pre-alpine region of Switzerland. METHODS We prospectively studied consecutive primary rescue interventions involving winching of a physician, from October 1, 1998 to October 1, 2002. Demographic, medical and operational aspects as well as outcome at 48 hours were analyzed. RESULTS We included 133 patients. Most (74%) were male, with traumatic injuries (77%). The median scene time of the nine severely injured patients (Injury Severity Scale [ISS] > 15) was significantly longer compared with the other patients (54 vs 37 minutes; P < .05). The main medical procedures performed were orotracheal intubation (n = 5), fracture reductions (n = 5), major analgesia with sedation (n = 4), and intravenous fluid administration of more than 1,500 mL (n = 4). Fourteen (10%) patients suffering from minor injuries were triaged by the physician and not airlifted to the hospital. All 133 patients were alive at 48 hours. Sixty-nine (52%) were still hospitalized. No secondary interhospital transfer was required. CONCLUSION Our study provides a better knowledge of injury profile, medical aspects, and outcomes of patients rescued necessitating a winching procedure.
Collapse
Affiliation(s)
- Jocelyn Corniche
- Anesthesiology Department, University Hospital Center, Lausanne, Switzerland.
| | | | | | | | | |
Collapse
|
22
|
|
23
|
Abstract
Wilderness trips have become increasingly popular, especially in the adolescent population. The wilderness can be a source of rejuvenation while being mentally and physically challenging; however, it is also fraught with the potential for injury, illness, and even death. Epidemiologic studies of injuries and illnesses from hikers are not extensive, but there are sufficient data to identify the most common risk factors to offer some strategies for prevention. Many youth will have a medical visit or preparticipation physical assessment before an organized wilderness experience. This article highlights commonly seen wilderness injuries and illnesses and provides guidance for proper planning and problem solving.
Collapse
Affiliation(s)
- David Angert
- Department of Physiology, Cardiovascular Research Center, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | | |
Collapse
|
24
|
Heggie TW, Heggie TM. Saving tourists: the status of emergency medical services in California's National Parks. Travel Med Infect Dis 2009; 7:19-24. [PMID: 19174296 DOI: 10.1016/j.tmaid.2008.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 11/27/2008] [Accepted: 12/04/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Providing emergency medical services (EMS) in popular tourist destinations such as National Parks requires an understanding of the availability and demand for EMS. This study examines the EMS workload, EMS transportation methods, EMS funding, and EMS provider status in California's National Park Service units. METHODS A retrospective review of data from the 2005 Annual Emergency Medical Services Report for National Park Service (NPS) units in California. RESULTS Sixteen NPS units in California reported EMS activity. EMS program funding and training costs totaled USD $1,071,022. During 2005 there were 84 reported fatalities, 910 trauma incidents, 663 non-cardiac medicals, 129 cardiac incidents, and 447 first aid incidents. Sequoia and Kings Canyon National Parks, Yosemite National Park, Golden Gate National Recreation Area, and Death Valley National Park accounted for 83% of the total EMS case workload. Ground transports accounted for 85% of all EMS transports and Emergency Medical Technicians with EMT-basic (EMT-B) training made up 76% of the total 373 EMS providers. CONCLUSIONS Providing EMS for tourists can be a challenging task. As tourist endeavors increase globally and move into more remote environments, the level of EMS operations in California's NPS units can serve as a model for developing EMS operations serving tourist populations.
Collapse
Affiliation(s)
- Travis W Heggie
- Recreation & Tourism Studies Program, University of North Dakota, University Mail Stop #7116, Grand Forks, ND 58202, USA.
| | | |
Collapse
|