Emergency medicine clinics of North America
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Heat-related illness represents a continuum of disorders from minor syndromes such as heat cramps, heat syncope, and heat exhaustion to the severely life-threatening disorder known as heat stroke. It represents an important cause of wilderness-related morbidity and mortality.
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Lightning is persistently one of the leading causes of death caused by environmental or natural disaster. To understand the pathophysiology and treatment of lightning injuries one must first discount the innumerable myths, superstitions, and misconceptions surrounding lightning. ⋯ Reverse triage should be instituted in lightning strike victims because victims in cardiopulmonary arrest might gain the greatest benefit from resuscitation efforts, although there is no good evidence suggesting that lightning strike victims might benefit from longer than usual resuscitation times. Many of the injuries suffered by lightning strike victims are unique to lightning, and long-term sequelae should be anticipated and addressed in the lightning victim.
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As individuals increasingly recreate in wilderness settings, the medical community is faced with increasing numbers of injuries and illnesses occurring in remote and austere locations. In response to this, the specialized and dynamic field of wilderness medicine has developed to care for and counsel those participating in wilderness pursuits. This article adds clarity to the definition of wilderness medicine and examines the current state of wilderness medicine, including the scope of practice in the United States.
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Wilderness emergency medical services (WEMS) systems have components and requirements that are different from those of traditional EMS systems. These differences arise from the extremes of time and environmental exposure and the limited available resources that help define the wilderness environment. Although disaster systems combine wilderness and traditional EMS system components, most WEMS systems have had to develop independently on a localized level and in response to the need of a particular community or location. In many cases, volunteers provide much of the personnel and resources available to law enforcement agencies that are ultimately tasked with the responsibility of oversight for effecting rescues in a wilderness setting.
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As more Americans venture into the wilderness, physicians will be called upon to provide care in the backcountry or austere setting. Additionally, more isolated regions of the world are becoming accessible for trekking and mountaineering. These facts imply a higher rate of injuries and medical problems within a distinct spectrum of disease that are best treated by the well-prepared and continuously educated physician. This article discusses the educational resources that are currently available for physicians to meet these needs in the United States.