Wilderness & Environmental Medicine最新文献

IntroductionMountain biking is a fast-growing recreational activity. Electronic mountain bikes (EMTBs) are becoming more common and can attract a different demographic to traditional mountain bikes. The difference in bike design could lead to a differing injury profile. This study examined acute EMTB injuries, an unstudied area.MethodsA voluntary online survey collected data on EMTB injuries sustained by riders in the Australian Capital Territory and New South Wales. Descriptive statistics were used to analyze injury events.ResultsOver the study period (November 2022-June 2023) 67 injuries were recorded across 46 injury events. The median age of participants was 49 y (range, 20-67 y), and respondents were predominantly male (males 63%, females 35%, other 2%). Common injuries were superficial skin injuries (42%), mainly to the limbs. The study recorded 7 fractures to the limbs and 7 to the head and trunk. Most injuries were sustained from collisions or obstacles (49%). Most occurred traveling downhill (63%) on blue graded single tracks (65%), and 22% injuries occurred whilst traveling uphill. Injury management were spread across self-managed (44%), Emergency Department care (31%) and other health providers (26%). In the 7-d period following the injury 59% of riders experienced moderate to severe pain, and 50% were unable to participate in MTB riding.ConclusionElectronic mountain biking participants have a similar injury profile to traditional mountain bikers, but their demographics may differ. More research is needed to determine whether there is increased representation of female and older riders in electronic mountain biking.

ObjectiveThe aim of this convenience sampling study was to analyze incidents and accidents occurring in the context of canyoning so as to understand their causes, resulting injuries, and severity.MethodsThe sample consisted of 179 individuals (104 males, 75 females, age 35±9 y) who experienced an incident or accident while practicing canyoning and voluntarily participated in this convenience sampling study. The methods employed included the collection of information regarding incidents and accidents reported by canyoning practitioners. The most frequently associated activities for these events were identified as well as the body parts most affected by injuries. Additionally, an examination of the causes that posed a higher risk of accidents and injuries was conducted.ResultsOur results revealed that 21% of participants were beginners, among whom 23% were involved in accidents and 16% in incidents. In contrast, 79% of participants were experienced, with 84% involved in incidents and 78% in accidents. Additionally, 32% of accidents occurred during jumping progression, and 28% occurred while walking. Rope progression was the third most frequently associated activity with accidents, accounting for 24% of cases. Regarding incidents, rope progression was the most common activity, representing 49%, followed by water progression at 22%. Lower limb injuries were the most prevalent, particularly 25% affecting the tibia/fibula and 24% the ankles.ConclusionsThe main causes of accidents were jumping and walking progression, with rope progression being the most common in incidents. Lower limb injuries, especially to the tibia, fibula, and ankle, were most frequent. There is a need to increase awareness among canyoning practitioners about the risks of these activities.

IntroductionAmputations and avulsion injuries due to horse-associated activity are rare, yet they can result in significant impairment. The purpose of this study was to further investigate such injuries using a national emergency department database.MethodsThe US National Electronic Injury Surveillance System (NEISS) was used to identify horse-associated amputation and avulsion injuries occurring between 2000-2023. Demographic data of age, sex, and injury details were collected.ResultsThere were 34,091 emergency department visits for equine-associated injuries, with 120 (0.35%) due to amputations/avulsions; 53 (44%) patients sustained amputations, and 67 patients (56%) sustained avulsions. The average age was 37 (SD = 21 years). There were 78 female and 42 male patients. The most common mechanism of injury was riding the horse, with further details not specified (31%), followed by equipment issues (19%), bucked/thrown/kicked off the horse (15%), falling off the horse (11%), and others (6%). A rope/chain was involved in 29 patients (24%). There were 55 amputations involving the finger (40), thumb (13), and others (2). Rope-related injuries were more commonly involved in those sustaining amputations versus avulsions (42% vs 10%, P < .001). Males had more rope-associated injuries (36% vs 18%, P = .043).ConclusionsThis is the largest study to date of amputations and/or avulsions due to horse-associated injuries. There were multiple mechanisms of injury, with ropes involved in one-quarter. This baseline data can be useful for evaluating the effectiveness of future prevention programs.

The Veratrum genus of plants contains multiple toxic alkaloid compounds, and ingestion of Veratrum species may result in clinically significant human illness. Although many cases of Veratrum ingestion have been reported in the Eastern United States and Europe, no case report of human toxicity from the most common California species, Veratrum californicum, exists in the literature. We report on the clinical course and treatment of a patient with a known Veratrum californicum ingestion. We discuss the identification of the Veratrum species and compare our case to other cases of Veratrum ingestions reported in the literature. We find that similar to ingestions of other Veratrum species, our patient became hypotensive and bradycardic, requiring fluid resuscitation. Similar to other reports, our patient responded to treatment with atropine and was able to safely discharge after a short hospital stay. Our case adds the first reported ingestion of Veratrum californicum to the literature of other Veratrum ingestions and suggests that this toxicity similarly responds to atropine and hemodynamic support.

Lyme carditis, primarily caused by Borrelia burgdorferi, affects 1 to 10% of patients with untreated Lyme disease. This study reviewed 3 cases of Lyme carditis that presented to a tertiary hospital's emergency department in the northeastern United States during the summer months. The cases involved patients with varying degrees of atrioventricular (AV) block: first-degree, second-degree Type 2, and complete heart block. Case 1 involved a 19-y-old male presenting with syncope and diagnosed with first-degree AV block. He received intravenous (IV) ceftriaxone, resulting in resolution of the AV block. Case 2 was a 22-y-old male who experienced an unresponsive episode with bystander chest compressions. He had discrete erythematous patches and was diagnosed with Type 2 second-degree AV block. IV ceftriaxone followed by doxycycline resolved his condition without further incident. Case 3 described a 32-y-old male with lightheadedness and syncope, diagnosed with complete heart block. A temporary pacing lead and IV ceftriaxone were employed, transitioning to doxycycline, which effectively resolved the heart block. All three patients tested positive for Lyme antibodies with reflex Western blot. Lyme carditis presents variably, often without a clear history of tick exposure or erythema migrans. Prompt recognition and treatment in endemic areas are critical to prevent implantation of unnecessary permanent pacemakers. This paper underscores the importance of high clinical suspicion and reviews appropriate management in the emergency department setting for patients with potential Lyme carditis presenting with unexplained cardiac symptoms.

Those with an interest in the history of mountaineering are aware of the visionary achievement of the first ascent of the West Ridge of Everest-and first traverse of the mountain-by Tom Hornbein and Willi Unsoeld during the 1963 American Mount Everest expedition led by Norman Dyrunfurth. In many respects, this climb defined Hornbein (1930-2023) in the eyes of the international mountaineering community. One aspect of his career in high altitude mountaineering that also reflected his professional interests has received scant attention. This largely overlooked contribution was that of the design and development, in the years and months leading up to the American expedition to Everest, of a more capable and comfortable mask for use with an open-circuit supplemental oxygen system. The primary intent of this paper was to relate the story of what came to be known as the Maytag mask, but the authors also provide a brief backdrop to Hornbein's life and times to give perspective to his endeavors in the valleys as well as on the peaks.

Climate change presents a multifaceted challenge with profound implications across various sectors, necessitating a comprehensive response from educational institutions. This study aims to investigate the perspectives of graduate and professional students at The Ohio State University (OSU) regarding sustainability education within their curriculum and the impact of educational symposiums related to sustainability and climate change. Utilizing a questionnaire at an interprofessional sustainability-focused event, we gathered insights into students' viewpoints on climate change and sustainability, identified potential gaps in integrating these topics into higher education, and observed the role of topic-focused seminars in educational settings. Thirty-six graduate and professional students completed a 28-item questionnaire related to sustainability and climate education after a sustainability-focused event. Only 25% of students felt their academic program offered adequate engagement with climate change, and over 70% of students were either unaware of or did not believe that their specific programs' learning objectives included content related to sustainability and climate. Additionally, 47% did not feel adequately prepared to effectively navigate sustainability-related challenges within their profession. After the event, 94% of students felt that more interprofessional events are needed to better educate students on the effects of climate change on their respective careers. Additionally, 94% of students reported feeling more confident about integrating sustainability into their future professions and felt inspired to lead workshops or webinars of their own. This study highlights the pressing need for enhanced integration of sustainability and climate change education within graduate and professional curricula at academic institutions, while underscoring the importance of interdisciplinary collaboration and the role of large-scale educational events in fostering students' understanding and engagement with climate-related topics.

BackgroundThe Diploma in Mountain Medicine (DiMM) is an educational program designed to enable healthcare professionals to adapt their practice to the mountain environment. The purpose and nature of student assessment are not explained in the regulations. Understanding the intentions of the administrators who wrote the assessment regulations would enable students to be assessed more consistently and in keeping with the objectives of the program.MethodThis study used qualitative methods. Interviews were used to collect the opinions of members of the DiMM program administrative group. Thematic analysis was used to identify themes in the data and to produce a narrative description concerning the purpose, nature, and challenges of assessment.ResultsThe major themes identified included the importance of using assessment to measure student progress and outcome, the intention to assess competency, the importance of standardization in assessment, and the identification of core knowledge and skills. The need to be sensitive to cultural differences in education was a complex issue that limited the development of learning outcomes and the definition of a level of learning for the program.ConclusionsThere is variation in the content, level of learning, and outcomes assessed on DiMM courses. Cultural and educational diversity of the courses were complex issues that confounded consistent student assessment. In the future, clear statements about the aims of assessment, the academic level of study, and the content of learning would enhance the educational rigor and value of the program. The use of consensus methodology would be beneficial in achieving these objectives.

IntroductionA multifaceted approach to wilderness medicine education and training is necessary to provide a high-quality learning experience, often requiring innovative instructional techniques. Using volunteers to act as patients in medical education is a well-established practice that helps teach crucial skills. However, more is needed to know if there is potential knowledge acquisition through participation. This study examined the educational benefits for medical students serving as a simulated patient (SP), hypothesizing that these individuals will improve self-assessed knowledge and confidence and demonstrate improved performance of injury-management skills while participating in a medical education course.MethodsA descriptive feasibility pilot study was conducted with 10 SPs to assess knowledge and skill acquisition. Study participants were evaluated before and after participating as an SP in 2 scenarios involving hemorrhage control and wrist injury assessment and management, with a subjective confidence survey and an objective skill and knowledge demonstration, as measured by a critical action checklist.ResultsThe subjects all reported self-assessed knowledge improvement from the pre- to postintervention survey, with an average increase of 17 points. They also demonstrated improved objective skill and knowledge demonstration, with an average increase of 4.6 points for the wrist injury scenario and 2.5 points for the hemorrhage control scenario.ConclusionsThis study demonstrated that volunteer medical students acting as SPs in a medical training course passively acquire knowledge and improve their medical skills and self-perceived confidence. The findings contribute to a broader understanding of medical education, suggesting that participating as SPs offers educational benefits. The results encourage consideration of simulated patient roles as a valuable adjunct to medical education, warranting further scholarly exploration to substantiate and expand on these preliminary findings.