Wilderness & environmental medicine
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Wilderness Environ Med · Dec 2013
Comparative StudyEffect of advanced trauma life support (ATLS) on the time needed for treatment in simulated mountain medicine emergencies.
The number of tourists exploring mountainous areas continues to increase. As a consequence, rescue operations are increasing, especially for trauma and polytrauma victims. The outcome of such patients depends greatly on the duration of the prehospital stabilization. Limited medical training of mountain rescuers may adversely affect the outcome of patients. There is no study investigating high altitude trauma treatment. The aim of this study is to analyze the impact of advanced trauma life support (ATLS) principles in mountain trauma, and to discuss a possible role of ATLS in mountain medicine education programs. ⋯ ATLS principles adapted and implemented for high altitude medicine education may have a positive impact on high altitude trauma treatment and outcomes.
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Wilderness Environ Med · Dec 2013
Management of snakebite and systemic envenomation in rural Ecuador using the 20-minute whole blood clotting test.
In low-income countries, snakebites are frequently managed in rural areas in health centers with severely constrained resources. Many healthcare providers in these settings have limited access to the numerous and relatively expensive laboratory studies used to diagnose envenomation. The relatively simple and inexpensive 20-minute whole blood clotting test (WBCT) has been recommended by several international organizations for the diagnosis of certain venomous snakebites. This study proposes to confirm the utility of the WBCT as the sole laboratory diagnostic tool to determine systemic envenomation in hematotoxic snakebite management in severely resource-constrained areas of the world. ⋯ The WBCT was predictive of the presence or absence of systemic envenomation from snakebite in our region. The WBCT guided the successful management of mild and moderate systemic envenomation, and spared patients with no evidence of systemic envenomation from potential side effects of antivenom.
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Wilderness Environ Med · Sep 2013
ReviewA review of emergency medical services events in US national parks from 2007 to 2011.
Outdoor recreation is growing in the United States, with more than 279 million annual visitors to areas controlled by the National Park Service (NPS). Emergency medical needs in these parks are overseen by the National Park's rangers within the NPS Emergency Medical Services (EMS) system. This study examines medical and traumatic emergencies throughout the NPS over a 5-year period to better understand the types of events and fatalities rangers encounter, both regionally and on a national scale. ⋯ On a national level, the NPS experiences an equal number of medical and traumatic EMS events. This differs from past observed trends that reported a higher incidence of traumatic events than medical events in wilderness settings. Cardiac events and automated external defibrillator usage are relatively infrequent. Traumatic fatalities are more common than medical fatalities in the NPS. Regional variations in events likely reflect differences in terrain, common activities, proximity to urban areas, and access to definitive care between regions. These data can assist the NPS in targeting the regions with the greatest number of incidents and fatalities for prevention, ranger training, and visitor education.
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Wilderness Environ Med · Sep 2013
An analysis of hiker preparedness: a survey of hiker habits in New Hampshire.
Describe hiking habits in a heavily used wilderness area to better target injury prevention and reduce search-and-rescue events. ⋯ One factor that may help reduce rescues is better-prepared individuals able to avoid emergency medical services activation. Most neglect of preparation results from hikers perceiving short trips as less risky. The groups most often underprepared tend to be younger, less fit, and inexperienced. Therefore, education should target younger groups and stress that all hikes, regardless of duration, carry an inherent risk.
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Wilderness Environ Med · Sep 2013
Practice GuidelineWilderness Medical Society practice guidelines for spine immobilization in the austere environment.
In an effort to produce best-practice guidelines for spine immobilization in the austere environment, the Wilderness Medical Society convened an expert panel charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in an austere (dangerous or compromised) environment. Recommendations are made regarding several factors related to spinal immobilization. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks or burdens for each factor according to the methodology stipulated by the American College of Chest Physicians. A treatment algorithm based on the guidelines is presented.