1
|
Davis CA, Schmidt AC, Sempsrott JR, Hawkins SC, Arastu AS, Giesbrecht GG, Cushing TA. Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2024 Update. Wilderness Environ Med 2024; 35:94S-111S. [PMID: 38379489 DOI: 10.1177/10806032241227460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
The Wilderness Medical Society convened a panel to review available evidence supporting practices for acute management of drowning in out-of-hospital and emergency care settings. Literature about definitions and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded available evidence supporting practices according to the American College of Chest Physicians criteria and then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking. This is the second update to the original practice guidelines published in 2016 and updated in 2019.
Collapse
Affiliation(s)
- Christopher A Davis
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Andrew C Schmidt
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
| | | | - Seth C Hawkins
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ali S Arastu
- Division of Pediatric Critical Care, Stanford University School of Medicine, Palo Alto, CA
| | - Gordon G Giesbrecht
- Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation, University of Manitoba, Winnipeg, Manitoba, Canada
| | | |
Collapse
|
2
|
Backer HD, Derlet RW, Hill VR. Wilderness Medical Society Clinical Practice Guidelines on Water Treatment for Wilderness, International Travel, and Austere Situations: 2024 Update. Wilderness Environ Med 2024; 35:45S-66S. [PMID: 38379474 PMCID: PMC10961906 DOI: 10.1177/10806032231218722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
To provide guidance to medical providers, wilderness users, and travelers, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for treating water in situations where the potability of available water is not assured, including wilderness and international travel, areas impacted by disaster, and other areas without adequate sanitation. The guidelines present the available methods for reducing or eliminating microbiological contamination of water for individuals, groups, or households; evaluation of their effectiveness; and practical considerations. The evidence base includes both laboratory and clinical publications. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians.
Collapse
Affiliation(s)
| | - Robert W. Derlet
- Emergency Department, University of California, Davis, Sacramento, CA
| | - Vincent R. Hill
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
3
|
Woll C. In Reply to "A Symptom-Driven Mitigation Protocol for SARS-CoV-2 in a Wilderness Medicine Elective". Wilderness Environ Med 2024; 35:106. [PMID: 38379479 DOI: 10.1177/10806032231222358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Christopher Woll
- Departments of Emergency Medicine and Pediatrics, Albany Medical Center Albany, NY
| |
Collapse
|
4
|
Hawkins SC, Williams J, Bennett BL, Islas A, Quinn R. Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection: 2024 Update. Wilderness Environ Med 2024; 35:78S-93S. [PMID: 38379496 DOI: 10.1177/10806032241227232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2023, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to American College of Chest Physicians methodology. Key recommendations include the concept that interventions should be goal-oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique-oriented (immobilization). An evidence-based, goal-oriented approach excludes the immobilization of suspected spinal injuries via rigid collars or backboards.
Collapse
Affiliation(s)
- Seth C Hawkins
- Department of Emergency Medicine, Wake Forest University, Winston-Salem, NC
| | - Jason Williams
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM
| | - Brad L Bennett
- Military & Emergency Medicine Department, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Arthur Islas
- Department of Family and Community Medicine, University of Nevada, Reno School of Medicine, Reno, NV
| | - Robert Quinn
- Department of Orthopaedic Surgery, University of Texas Health Science Center, San Antonio, TX
| |
Collapse
|
5
|
Paterson R, Drake B, Tabin G, Cushing T. Wilderness Medical Society Clinical Practice Guidelines for Treatment of Eye Injuries and Illnesses in the Wilderness: 2024 Update. Wilderness Environ Med 2024; 35:67S-77S. [PMID: 38425236 DOI: 10.1177/10806032231223008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
A panel convened to develop an evidence-based set of guidelines for the recognition and treatment of eye injuries and illnesses that may occur in the wilderness. These guidelines are meant to serve as a tool to help wilderness providers accurately identify and subsequently treat or evacuate for a variety of ophthalmologic complaints. Recommendations are graded based on the quality of their supporting evidence and the balance between risks and benefits according to criteria developed by the American College of Chest Physicians.
Collapse
Affiliation(s)
- Ryan Paterson
- Department of Emergency Medicine, Denver Health Medical Center/University of Colorado School of Medicine, Denver, CO, USA
- Department of Emergency Medicine, Kaiser Permanente Medical Group - Colorado, Glenwood Springs, CO, USA
| | | | - Geoffrey Tabin
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - Tracy Cushing
- Department of Emergency Medicine, Denver Health Medical Center/University of Colorado School of Medicine, Denver, CO, USA
| |
Collapse
|
6
|
2023 Wilderness & Environmental Medicine Peer Reviewers. Wilderness Environ Med 2024; 35:3-4. [PMID: 38425265 DOI: 10.1177/10806032241228016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
|
7
|
Hill AD, Lebuhn R, Votta K. A Symptom-Driven Mitigation Protocol for SARS-CoV-2 in a Wilderness Medicine Elective. Wilderness Environ Med 2024; 35:104-106. [PMID: 38379472 DOI: 10.1177/10806032231220402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Adam D Hill
- Section of Wilderness & Environmental Medicine Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York, NY
| | - Ryan Lebuhn
- Emergency Medicine Residency Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York, NY
| | - Kaitlyn Votta
- Section of Wilderness & Environmental Medicine Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York, NY
| |
Collapse
|
8
|
Eifling KP, Gaudio FG, Dumke C, Lipman GS, Otten EM, Martin AD, Grissom CK. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update. Wilderness Environ Med 2024; 35:112S-127S. [PMID: 38425235 DOI: 10.1177/10806032241227924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The Wilderness Medical Society (WMS) convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. The current panel retained 5 original members and welcomed 2 new members, all of whom collaborated remotely to provide an updated review of the classifications, pathophysiology, evidence-based guidelines for planning and preventive measures, and recommendations for field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality. This is an updated version of the WMS clinical practice guidelines for the prevention and treatment of heat illness published in Wilderness & Environmental Medicine. 2019;30(4):S33-S46.
Collapse
Affiliation(s)
- Kurt P Eifling
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR
| | - Flavio G Gaudio
- Department of Emergency Medicine, New York-Presbyterian Hospital / Weill Cornell Medical College, New York, NY
| | - Charles Dumke
- School of Integrative Physiology and Athletic Training, University of Montana, Missoula, MT
| | | | - Edward M Otten
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH
| | - August D Martin
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR
| | - Colin K Grissom
- Pulmonary and Critical Care Division, Intermountain Medical Center and the University of Utah, Salt Lake City, UT
| |
Collapse
|
9
|
Binder WD. Provider Engagement and Wilderness Medicine. Wilderness Environ Med 2024; 35:1-2. [PMID: 38425266 DOI: 10.1177/10806032241228038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
|
10
|
Albala L, Harris NS, Srivastava S, Lareau SA, Binder W. An Unusual Mountain Biking Injury: Case Records of the Massachusetts General Hospital Wilderness Medicine Fellowship. Wilderness Environ Med 2023; 34:576-579. [PMID: 37696721 DOI: 10.1016/j.wem.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/12/2023] [Accepted: 07/15/2023] [Indexed: 09/13/2023]
Affiliation(s)
- Lorenzo Albala
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
| | - N Stuart Harris
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Sunita Srivastava
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Stephanie A Lareau
- Carilion Clinic Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - William Binder
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| |
Collapse
|
11
|
Thurman JT, Hawkins SC, Fifer D, Clark JR, Abo B. Wilderness Paramedic-A Practice Analysis. PREHOSP EMERG CARE 2023; 28:646-655. [PMID: 37943634 DOI: 10.1080/10903127.2023.2281372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
Emergency medical services (EMS) has existed in its modern form for over 50 years. EMS has become a critical public safety net and access point to the larger health care system. Mature EMS systems are in place in most urban areas. However, EMS systems are not as developed in wilderness areas. A barrier to further development of these systems is the lack of an agreed-upon standard of minimum competence and validation of specialized practice. A practice analysis was completed to create such standards. The practice analysis was completed using a multi-step process. A group of subject matter experts constructed a survey of tasks and knowledge needed for wilderness EMS (WEMS) specialty practice. The tasks and knowledge were validated through an industry survey. A total of 947 surveys were submitted for analysis. Of these, 196 were at least 55% complete and used for analysis. North America was heavily represented as a primary practice location with 177 (90.3%) responses out of the 196 total. Of these 177 responses, 164 (92.7%) were from the United States and 12 (6.8%) were from Canada. One hundred seven of the 116 tasks identified by the subject matter expert group were passed by the survey group, and 164 of the 175 knowledge statements were passed by the survey group. An index of agreement (IOA) was calculated and found to be greater than 0.9 for each task and knowledge statement across all subgroups. A content coverage rating was also calculated and the results indicate survey participants felt the content was "adequate" to "well" covered. The survey results were used to construct a pilot examination. Beta testing of the pilot examination was performed. The beta test results were analyzed and a cut score was determined using the Angoff method with a Beuk compromise. The final product of this process is a defensible exam that will certify candidates' cognitive knowledge of the specialty of WEMS. Completion of this practice analysis solidifies WEMS as distinct subspecialty of out-of-hospital medicine. Additionally, it establishes a consensus definition of wilderness paramedicine and standards that may be used by WEMS systems and regulatory entities.
Collapse
Affiliation(s)
- Jeffrey T Thurman
- International Board of Specialty Certification, Red Rock, Texas
- Clinical Faculty (Gratis), Department of Emergency Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Seth C Hawkins
- Department of Emgergency Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - David Fifer
- Department of Paramedic Science, Eastern Kentucky University, Richmond, Kentucky
| | - John R Clark
- International Board of Specialty Certification, Red Rock, Texas
| | - Benjamin Abo
- International Board of Specialty Certification, Red Rock, Texas
- Department of Emergency Medicine, Florida State University College of Medicine, Tallahassee, Florida
| |
Collapse
|
12
|
Zafren K, Hollis S, Weiss EA, Danzl D, Wilburn J, Kimmel N, Imray C, Giesbrecht G, Tipton M. Prevention and Treatment of Nonfreezing Cold Injuries and Warm Water Immersion Tissue Injuries: Supplement to Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite. Wilderness Environ Med 2023; 34:172-181. [PMID: 37130771 DOI: 10.1016/j.wem.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 01/26/2023] [Accepted: 02/15/2023] [Indexed: 05/04/2023]
Abstract
We convened an expert panel to develop evidence-based guidelines for the evaluation, treatment, and prevention of nonfreezing cold injuries (NFCIs; trench foot and immersion foot) and warm water immersion injuries (warm water immersion foot and tropical immersion foot) in prehospital and hospital settings. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians. Treatment is more difficult with NFCIs than with warm water immersion injuries. In contrast to warm water immersion injuries that usually resolve without sequelae, NFCIs may cause prolonged debilitating symptoms, including neuropathic pain and cold sensitivity.
Collapse
Affiliation(s)
- Ken Zafren
- Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK; Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA; International Commission for Mountain Emergency Medicine (ICAR MEDCOM), Zürich, Switzerland.
| | - Sarah Hollis
- Regional Occupational Health Team, Defence Medical Services MOD, Catterick Garrison, UK
| | - Eric A Weiss
- Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA
| | - Daniel Danzl
- Department of Emergency Medicine, University of Louisville School of Medicine, Louisville, KY
| | - Jessie Wilburn
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | | | - Chris Imray
- Coventry National Institute for Health Research, Clinical Research Facility, University Hospital Coventry & Warwickshire, NHS Trust, Coventry, UK
| | - Gordon Giesbrecht
- Faculty of Kinesiology and Recreation Management and Departments of Emergency Medicine and Anesthesia, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mike Tipton
- Extreme Environments Laboratory, School of Sport, Health & Exercise Science, University of Portsmouth, Portsmouth, UK
| |
Collapse
|
13
|
Binder WD, Kenefick RW, Rodway GW, Spano SJ. Changing Times and Shifting Priorities: Promoting Gender Equity at Wilderness & Environmental Medicine. Wilderness Environ Med 2023; 34:3-4. [PMID: 36931738 DOI: 10.1016/j.wem.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
|
14
|
Davis CA, Lareau S, Haston T, Ganti A, Spano SJ. Implementation of a Specialty Society‒Sponsored Wilderness Medicine Fellowship Match. Wilderness Environ Med 2023; 34:72-76. [PMID: 36526517 DOI: 10.1016/j.wem.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/12/2022] [Accepted: 10/19/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Previously, wilderness medicine (WM) fellowships offered spots to applicants using an offer date. Due in part to increases in the number of WM fellowships and applicants, in 2021, the WM program directors (PDs) agreed to conduct the first WM fellowship match through the Wilderness Medical Society graduate medical education committee. This article outlines the process used and demonstrates its feasibility. METHODS To create an independent matching process, a simulation was performed using imaginary programs and participants. Using the same algorithm utilized by the National Resident Matching Program, this process was completed manually and by computer to ensure accuracy. The PDs shared an email with the applicants they interviewed and submitted their names. Applicants registered for the match and generated a match list. The PDs then submitted a rank list of applicants they interviewed through a similar Google form. These lists were used to run the matching algorithm both manually and by computer. Any programs that did not "fill" or applicants who did not "match" were contacted to participate in a secondary match. Following the match, a survey was sent to PDs and participants for process improvement. RESULTS The match filled 11 of 14 participating programs and 15 of 19 applicants. The results obtained via a computer algorithm were consistent with multiple human validations. The survey results were mostly positive, with 2 neutral responses and no negative responses. CONCLUSIONS The inaugural WM fellowship match was successful in matching the majority of programs and participants and was well-received by both directors and applicants.
Collapse
Affiliation(s)
- Christopher A Davis
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston- Salem, NC.
| | - Stephanie Lareau
- Department of Emergency Medicine, Virginia Tech‒Carilion Clinic, Roanoke, VA
| | - Taylor Haston
- Department of Emergency Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | | | - Susanne J Spano
- Department of Emergency Medicine, University of California San Francisco Fresno, Fresno, CA
| |
Collapse
|
15
|
2022 Wilderness & Environmental Medicine Peer Reviewers. Wilderness Environ Med 2023; 34:5-6. [PMID: 36931739 DOI: 10.1016/j.wem.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
|
16
|
Liu A, Whiteis A. Wilderness Medicine: Impacts from the Weather, Water, and World. Pediatr Ann 2022; 51:e212-e217. [PMID: 35667101 DOI: 10.3928/19382359-20220407-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pediatricians play an important role in the prevention of injuries and provide families with anticipatory guidance regularly. As more families are traveling and spending time outdoors, we must be adept at providing them with knowledge and resources to set them up for success on their adventures. Prevention and preparation frequently can help limit injuries sustained in the wilderness. This article will focus specifically on injuries related to the environment (eg, cold weather injuries, heat-related illnesses) and travel location (eg, high-altitude illness, marine-related injuries, diving medicine). [Pediatr Ann. 2022;51(6):e212-217.].
Collapse
|
17
|
Diaz JH. Regional Rodent-Borne Infectious Diseases in North America: What Wilderness Medicine Providers Need to Know. Wilderness Environ Med 2021; 32:365-376. [PMID: 34215513 DOI: 10.1016/j.wem.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/08/2021] [Accepted: 03/25/2021] [Indexed: 11/18/2022]
Abstract
Rodents can transmit infectious diseases directly to humans and other animals via bites and exposure to infectious salivary aerosols and excreta. Arthropods infected while blood-feeding on rodents can also transmit rodent-borne pathogens indirectly to humans and animals. Environmental events, such as wet winters, cooler summers, heavy rains, and flooding, have precipitated regional rodent-borne infectious disease outbreaks; these outbreaks are now increasing with climate change. The objectives of this review are to inform wilderness medicine providers about the environmental conditions that can precipitate rodent-borne infectious disease outbreaks; to describe the regional geographic distributions of rodent-borne infectious diseases in North America; and to recommend prophylactic treatments and effective prevention and control strategies for rodent-borne infectious diseases. To meet these objectives, Internet search engines were queried with keywords to identify scientific articles on outbreaks of the most common regional rodent-borne infectious diseases in North America. Wilderness medicine providers should maintain high levels of suspicion for regional rodent-borne diseases in patients who develop febrile illnesses after exposure to contaminated freshwater after heavy rains or floods and after swimming, rafting, or paddling in endemic areas. Public health education strategies should encourage limiting human contact with rodents; avoiding contact with or safely disposing of rodent excreta; avoiding contact with contaminated floodwaters, especially contact with open wounds; securely containing outdoor food stores; and modifying wilderness cabins and campsites to deter rodent colonization.
Collapse
Affiliation(s)
- James H Diaz
- LSU School of Public Health, Louisiana State University Health Sciences Center in New Orleans, New Orleans, Louisiana.
| |
Collapse
|
18
|
Abstract
With more families spending time outdoors or embarking on wilderness adventures, pediatricians may be tasked with providing appropriate counseling to parents and children. Although the breadth of wilderness medicine can be extensive, this article will focus on preventive measures, common injuries, and injury treatment options in an outdoor environment. [Pediatr Ann. 2021;50(6):e234-e239.].
Collapse
|
19
|
Ting L, Wilkes M. Telemedicine for Patient Management on Expeditions in Remote and Austere Environments: A Systematic Review. Wilderness Environ Med 2021; 32:102-111. [PMID: 33423896 DOI: 10.1016/j.wem.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 08/05/2020] [Accepted: 09/22/2020] [Indexed: 11/19/2022]
Abstract
Telemedicine potentially offers enormous value to expeditions to remote environments. For healthcare professionals, telemedicine can provide access to specialist advice. Where no healthcare professionals are present, telemedicine may be the sole source of expert care. This systematic review appraises and summarizes the current literature regarding telemedicine in patient management on expeditions to remote locations and identifies areas for future research. MEDLINE and EMBASE were systematically searched for relevant articles from 1980 through February 2018. Data were handled according to the PRISMA process and analyzed using type-specific critical appraisal checklists where possible. Two hundred twenty-five articles were identified, 33 of which were included in this systematic review. They encompassed a variety of remote environments, including maritime (13), polar (9), mountainous (5), jungle (1), and multiple austere environments (6). Although some environments were better reported than others, many overarching concepts were generalizable. Through channels of communication that included telephone, radio, videoconferencing, and email, telemedicine has been used effectively in a range of environments to initiate treatment, follow up with patients, and determine the appropriateness of evacuation. Telementoring, in which a remote expert guides a local care provider in performing a procedure or task, is a promising aspect of telemedicine that is currently being developed. As technology advances, the scope of telemedicine will continue to expand. However, each new telemedical development must be shown to do more than simply function in a remote environment. Instead, new technologies should be tested for improved patient, practitioner, or expedition outcomes, within a telemedical system.
Collapse
Affiliation(s)
- Louise Ting
- Great Western Hospitals NHS Foundation Trust, Swindon, United Kingdom.
| | - Matt Wilkes
- Extreme Environments Laboratory, University of Portsmouth, Portsmouth, United Kingdom
| |
Collapse
|
20
|
Jong M, Lown EA, Schats W, Mills ML, Otto HR, Gabrielsen LE, Jong MC. A scoping review to map the concept, content, and outcome of wilderness programs for childhood cancer survivors. PLoS One 2021; 16:e0243908. [PMID: 33406103 PMCID: PMC7787391 DOI: 10.1371/journal.pone.0243908] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/30/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Systematic mapping of the concept, content, and outcome of wilderness programs for childhood cancer survivors. DESIGN Scoping review. SEARCH STRATEGY Searches were performed in 13 databases and the grey literature. Included studies describe participation of childhood cancer survivors in wilderness programs where the role of nature had a contextual and therapeutic premise. At least two authors independently performed screening, data extraction and analysis. RESULTS Database searches yielded 1848 articles, of which 15 met the inclusion criteria. The majority of programs (73%) employed adventure therapy. Five activity categories were identified as components of wilderness programs: challenge/risk, free time/leisure, experiential learning, physical activity and psychotherapeutic activities. A majority of the participating childhood cancer survivors were female, white, aged 8-40 years, with a wide range of cancer diagnoses. Reported outcomes included increased social involvement, self-esteem, self-confidence, self-efficacy, social support, and physical activity. Key gaps identified included the absence of randomized controlled trials (RCTs), lack of studies on long-term effects, lack of information on the multicultural aspects of programs, and missing information on engagement in nature activities after the program ended. CONCLUSIONS This scoping review guides childhood cancer survivors, their families, practitioners, clinicians and researchers in the development and optimization of wilderness programs for childhood cancer survivors. In addition, it informs the utilization of these programs, and identifies gaps in the evidence base of wilderness programs. It is recommended that future study reporting on wilderness programs include more detail and explicitly address the role of nature in the program. Performing RCTs on wilderness programs is challenging, as they occur in real-life contexts in which participants cannot be blinded. Creative solutions in the design of pragmatic trials and mixed method studies are thus needed for further investigation of the effectiveness and safety of wilderness programs in childhood cancer survivors.
Collapse
Affiliation(s)
- Mats Jong
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - E. Anne Lown
- Department of Social and Behavioral Sciences and Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Winnie Schats
- Scientific Information Service, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michelle L. Mills
- Department of Social and Behavioral Sciences and Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Heather R. Otto
- See you at the Summit, Portland, OR, United States of America
| | - Leiv E. Gabrielsen
- Department for Child and Adolescent Mental Health, Sørlandet Hospital Health Enterprise, Kristiansand, Norway
| | - Miek C. Jong
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
- Department of Community Medicine, Faculty of Health Sciences, National Research Center in Complementary and Alternative Medicine (NAFKAM), The Arctic University of Norway (UiT), Tromsø, Norway
| |
Collapse
|
21
|
Korr M. Q&A with Dean Winslow, MD, on Volunteering in Antarctica Currently the only continent without confirmed cases of COVID-19 during COVID-19 Pandemic. R I Med J (2013) 2020; 103:85-88. [PMID: 32481790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
22
|
Pollock NW. The Insignificance of Significance in Scientific Reporting. Wilderness Environ Med 2019; 30:225-226. [PMID: 31399348 DOI: 10.1016/j.wem.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 11/17/2022]
|
23
|
Pollock NW. The Evolution to Prospective Research in Wilderness Medicine. Wilderness Environ Med 2019; 30:111-112. [PMID: 31023508 DOI: 10.1016/j.wem.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 11/28/2022]
|
24
|
Browne E, Peeters F, Priston M, Marquis PT. Expired Drugs in the Remote Environment. Wilderness Environ Med 2019; 30:28-34. [PMID: 30718138 DOI: 10.1016/j.wem.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/23/2018] [Accepted: 11/05/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The British Antarctic Survey Medical Unit works in a very remote area of the world, with several Antarctic bases receiving only a single annual resupply of consumable goods. Pharmaceuticals supplied in this manner will often be approaching or past the end of their nominal shelf life before the following year's resupply. Drugs are transported from the UK via ship; the hold is not temperature controlled, and the ship crosses through the tropics (air temperature 25-30°C for approximately 3 wk). The drugs then must be transported from the ship to the base, often in temperatures substantially below freezing. This study assessed the stability of 5 expired drugs (atropine, nifedipine, flucloxacillin, naproxen, and bendroflumethiazide) returned from Antarctic bases. METHODS Drugs were opportunistically obtained and tested using stability-indicating assays. RESULTS All tested drugs were stable. CONCLUSIONS The results suggest that the studied drugs may be stable beyond expiry, even when not maintained in strictly temperature-controlled conditions.
Collapse
Affiliation(s)
- Emma Browne
- British Antarctic Survey Medical Unit, Plymouth, UK.
| | - Frank Peeters
- Centre for Life Sciences (LIFE), Royal Military Academy, Brussels, Belgium
| | - Melanie Priston
- Pharmacy Research Laboratory, Derriford Hospital, Plymouth, UK
| | - P T Marquis
- British Antarctic Survey Medical Unit, Plymouth, UK
| |
Collapse
|
25
|
Juergens AL, Odom BW, Ren CE, Meyers KE. Success Rates with Digital Intubation: Comparing Unassisted, Stylet, and Gum-Elastic Bougie Techniques. Wilderness Environ Med 2019; 30:52-55. [PMID: 30711420 DOI: 10.1016/j.wem.2018.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/31/2018] [Accepted: 11/12/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The utility of digital intubation, especially in an austere environment with limited equipment, has been previously described. However, evidence supporting best practices for its technique is limited. We seek to quantify the time to intubation and the rate of successful placement of the tube for digital intubation using different approaches and assistance devices. METHODS Using a manikin, digital intubation was performed with an endotracheal tube alone, with an endotracheal tube and a 14-French stylet, or with a gum-elastic bougie. All 3 techniques were performed in a crossover fashion at the manikin's side and head. Three trials per technique and position were performed. Outcomes measured were the time to intubation and the successful placement of the tube. RESULTS A total of 72 timed trials were performed. A significant difference did not exist between practitioners being positioned at the head vs side in terms of time or successful placement rate. There was no difference between the time to intubation in the tube-only and stylet-assisted groups, but the bougie-assisted group was significantly slower than the others. The stylet-assisted technique was significantly more successful than the other 2 techniques. CONCLUSIONS In a manikin model, stylet-assisted digital intubation was the most successful technique tested and allowed intubation to be accomplished just as quickly as with an endotracheal tube alone. Bougie-assisted digital intubation was slower and may not be as helpful as when it is used as an adjunct with direct laryngoscopy. Further research is needed to determine the utility of these adjuncts on live subjects.
Collapse
Affiliation(s)
| | | | | | - Kirk E Meyers
- Texas A&M Health Science Center, College Station, TX
| |
Collapse
|
26
|
Nathanson A. Sailing Injuries: A Review of the Literature. R I Med J (2013) 2019; 102:23-27. [PMID: 30709070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sailors are at risk for acute injuries, overuse injuries, environmental injuries, and sailing-related illnesses. Sailing-related injury rates vary from 0.29 to 5.7 per 1,000 hours which is lower than many other land-based sports. However, the fatality rate of 1.19 per million sailing-days is relatively high. The most common injuries are contusions and lacerations predominantly to the upper and lower extremities. Falls and impacts from various parts of the sailboat are the most common mechanisms of traumatic injury. High winds, operator inexperience, and operator inattention are the most common contributing factors for injury. Among Olympic-class sailors, overuse injuries to the back (29-45%) and knees (13-22%) are commonly reported. As many as seventy-three percent of sailing-related deaths are due to drowning as a result of falls overboard (39-44%) or capsizing the vessel (20-40%). Eighty-two percent of sailing-related drowning victims in US waters were not wearing a lifejacket. Leading contributing factors to fatal sailing accidents are high winds (12-27%), alcohol use (10-15%), and operator inexperience (8%). [Full article available at http://rimed.org/rimedicaljournal-2019-02.asp].
Collapse
Affiliation(s)
- Andrew Nathanson
- Clinical Professor of Emergency Medicine, Department of Emergency Medicine, Alpert Medical School of Brown University
| |
Collapse
|
27
|
Wu DJ, Lee J, Chavez A, Kawaoka JC. Wilderness Dermatology: Bugs, Plants, and Other Nuisances That May Ruin Your Hike. R I Med J (2013) 2019; 102:16-22. [PMID: 30709069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Spending time outdoors can be rewarding. However, exposure to the sun, insect bites, and plant exposures may result in a wide range of dermatologic manifestations. In this article, we describe potential cutaneous manifestations of common wilderness exposures in New England including photodermatoses from prolonged sun exposure, phytodermatoses from plant exposures, and arthropod-bite reactions from common insects (mosquitos, spiders, ticks, hymenoptera, mites and chiggers). The article will also address preventive and treatment strategies which may help physicians and their patients better prepare for spending time in the wilderness. [Full article available at http://rimed.org/rimedicaljournal-2019-02.asp].
Collapse
Affiliation(s)
- Dominic J Wu
- Cambridge Health Alliance Department of Family Medicine
| | | | | | | |
Collapse
|
28
|
Pollock NW. Ethics Authorization for Research Reporting. Wilderness Environ Med 2018; 29:149-150. [PMID: 29631766 DOI: 10.1016/j.wem.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 11/30/2022]
|
29
|
Kelly BD. Charlie Gard and the limits of medicine. Lancet 2017; 390:1734. [PMID: 29047440 DOI: 10.1016/s0140-6736(17)32454-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/05/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Brendan D Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin, D24 NR0A, Ireland.
| |
Collapse
|
30
|
Hjuler KF, Bay B. [Mountain medicine - an introduction. I]. Ugeskr Laeger 2016; 178:V05160367. [PMID: 27808056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Tourism to high-altitude areas is increasingly popular even from low-lying regions such as Denmark. Mountain sports include skiing, mountaineering, and ski touring. The young, elderly and at-risk individuals with pre-existing illnesses engage in recreational mountain activities. Thus, risk assessment and counselling regarding altitude exposure is increasingly relevant to all healthcare providers. In this first article of two in a review series, we summarize the state of the art of altitude physiology, alpine dangers and avalanches, and medical aspects of the increased UV-exposure at altitude.
Collapse
|
31
|
Abo B, Selde W. INTO THE WILD. JEMS 2016; 41:28-33. [PMID: 27505931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
32
|
Blakemore S, Moore J. Joys of the journey. Emerg Nurse 2016; 24:39. [PMID: 27056017 DOI: 10.7748/en.24.1.39.s26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
33
|
Abstract
Extreme, expedition, and wilderness medicine are modern and rapidly evolving specialties that address the spirit of adventure and exploration. The relevance of and interest in these specialties are changing rapidly to match the underlying activities, which include global exploration, adventure travel, and military deployments. Extreme, expedition, and wilderness medicine share themes of providing best available medical care in the outdoors, especially in austere or remote settings. Early clinical and logistics decision making can often have important effects on subsequent outcomes. There are lessons to be learned from out-of-hospital care, military medicine, humanitarian medicine, and disaster medicine that can inform in-hospital medicine, and vice-versa. The future of extreme, expedition, and wilderness medicine will be defined by both recipients and practitioners, and empirical observations will be transformed by evidence-based practice.
Collapse
Affiliation(s)
- Christopher H E Imray
- Division of Translational Medicine, Warwick Medical School, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
| | - Michael P W Grocott
- Faculty of Medicine, University of Southampton, Southampton, UK; Anaesthesia and Critical Care Research Unit, University Hospital, Southampton NHS Foundation Trust, Southampton, UK; Critical Care Research Area, NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
| | - Mark H Wilson
- Institute of Pre-Hospital Care, London's Air Ambulance, The Royal London Hospital, UK; Imperial College, St Mary's Major Trauma Centre, London, UK
| | - Amy Hughes
- UK-Med Ebola Response Team, UK International Emergency Trauma and Medical Register, University of Manchester, Manchester, UK
| | - Paul S Auerbach
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
34
|
Winchester J, Coombs B. Medical reconnaissance for the Defence Medical Services Dhaulagiri Expedition 2016. J R Nav Med Serv 2015; 101:134-137. [PMID: 26867413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The formation of a clear and well-informed medical plan is critical to the safe planning and execution of any expedition in remote locations. We performed a reconnaissance of medical facilities in Nepal in March 2015 prior to a large Defence Medical Services (DMS) expedition to the Dhaulagiri area in 2016. Visiting relevant medical facilities in person provides invaluable information and experience of what healthcare services may be relied upon in managing an expedition casualty, in scenarios ranging from minor illness to major trauma. We describe the principles, practice and level of detail required for performing such a medical reconnaissance and illustrate this with examples of our findings from Nepal.
Collapse
|
35
|
Wilkins D, Handford C, Nicol A. A practical guide to expedition medical planning. J R Nav Med Serv 2015; 101:129-133. [PMID: 26867412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Expedition medical planning is integral in ensuring participant safety and maximising the likelihood of achieving the expedition aims. The task of producing a medical plan will often fall to a medical officer of limited experience. The aim of this article is to provide a concise, practical guide to aid junior medical officers (MOs) in forming a robust and pragmatic medical plan.
Collapse
|
36
|
Mathias J. Guerrillas in the mist: how I met a Colombian rebel leader. BMJ 2014; 349:g4816. [PMID: 25069657 DOI: 10.1136/bmj.g4816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
37
|
Givens ML, Lynch JH. This is Africa: an introduction to medical operations on the African continent. J Spec Oper Med 2014; 14:107-110. [PMID: 25344718 DOI: 10.55460/hkx2-ft8u] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2014] [Indexed: 06/04/2023]
Abstract
This article regarding Special Operations Forces (SOF) medical operations in Africa is an introduction to a follow-on series of articles that will address in more detail pertinent medical topics which pertain to operations on the African continent. Medical operations in Africa require dynamic and systematic approaches that consider the myriad challenges, yet offer flexible solutions applied as situations and environments dictate. We believe this series of articles will be of high interest to readers and provide key information that will be germane to future SOF operations.
Collapse
|
38
|
Hedelin H, Thomassen Ø. [ Wilderness Medicine requires improvisation and evidence-based knowledge]. Lakartidningen 2013; 110:1230-1231. [PMID: 23865267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
39
|
Ramsey DO. The urban jungle wilderness medicine meets non-rural EMS. JEMS 2010; 35:48-55. [PMID: 20451057 DOI: 10.1016/s0197-2510(10)70121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|