Wilderness & Environmental Medicine最新文献

A 46-y-old male was swimming in the Connecticut River near Hatfield, Massachusetts, when he suffered an unprovoked attack from a North American beaver (Castor canadensis). The beaver attacked the man 3 separate times, inflicting multiple bite wounds to his arms and torso, ultimately attaching itself to his arm without releasing. The patient was brought to our emergency department, where the wounds were treated, and rabies postexposure prophylaxis was begun. The beaver tested positive for rabies shortly thereafter. Here we review the case of an unprovoked attack by a beaver and clinical risk assessment for rabies, along with management including postexposure prophylaxis, tetanus immunization, and wound care.

Introduction—: Mount Aconcagua (6961 m) in Argentina is the highest peak in the Americas, and more than 3000 climbers attempt to summit annually. High altitude pulmonary edema (HAPE) is a leading cause of mortality and evacuation on Aconcagua.

Objective—: This study sought to describe the characteristics of climbers who developed HAPE on Aconcagua to aid in future prevention efforts.

Methods—: Climbers diagnosed with HAPE in January 2024 were surveyed regarding demographics, preparation, acclimatization, and illness. Healthy climbers on Aconcagua also were surveyed for the same period, providing a control population.

Results—: Seventeen climbers were diagnosed with HAPE. These climbers were similar to climbers without HAPE in age, sex, origin, home elevation, hypoxic tent use, staged ascent, recent virus exposure, fitness metrics, and ascent-rate plans. Climbers with HAPE spent fewer nights at the 4300-m base camp (3.6 vs 5.0 nights). Prior to developing HAPE, 71% of patients reported unresolved acute mountain sickness symptoms. HAPE onset median elevation was 5500 m, with a median of 8.0 days over 3000 m and a median lowest SpO₂ of 60% at diagnosis. There was a nonsignificant trend between acetazolamide use and increased HAPE. All surveyed HAPE patients descended, required helicopter evacuation, and survived.

Conclusion—: This study examined climbers who developed HAPE on Mount Aconcagua, yielding implications for high altitude illness prevention efforts and further study. HAPE cases were associated with insufficient nights at the 4300-m base camp and unresolved acute mountain sickness symptoms. The relationship between acetazolamide and HAPE warrants further study on Aconcagua.

According to the US Census, for the first time in history, older adults are projected to exceed the number of children by 2035. These seniors are headed to the outdoors in increasing numbers and face unique risks. They benefit from careful pre-event evaluation planning to maintain their health in wilderness environments. Climate change is affecting all of us, but seniors are considered an especially vulnerable group. This vulnerability needs to be addressed not only when older adults head into the wilderness but also when the wilderness "comes to them" in areas where wilderness medicine and disaster medicine overlap. Education of both providers and patients is vital. This article aims to discuss the special needs of older adults/seniors /elders (defined as those over 65 unless otherwise indicated) in the wilderness as well as the vulnerability of older adults to climate change, both during planned wilderness activities and when the wilderness "comes to them" because of climate change, and to identify opportunities for education and adaptation of patients and education of physicians and wilderness and disaster responders to care for these older patients. The PubMed and Google Scholar Database search engines were utilized to review relevant English language publications between 2000 and 2023 that addressed individuals over 65 and explored the overlap of geriatrics (aged over 65), wilderness and disaster medicine, and climate change and create a perspective summary. Because of increased numbers of older adults heading into the wilderness for outdoor activities or having wilderness thrust upon them due to climate change, cross training of all specialties including the fields of emergency, geriatrics, wilderness medicine, and disaster medicine is needed in collaboration with other organizations and search and rescue. Response agencies must recognize that training in wilderness medicine provides a background for practitioners working in dangerous and remote settings and ought to seek out individuals with such skills when placing responders in the field. Climate change is making these intersections and the need for this education more urgent with time.

The imminent climate crisis has been labeled as the biggest health threat humanity must deal with. Vector-borne disease distribution and transmission as well as the population at risk are influenced to a great degree by environmental and climactic factors affecting both the vectors themselves and the causative pathogens. Paired with an increase in worldwide travel, urbanization, and globalization, along with population displacements and migration, elucidating the effects of anthropogenic climate change on these illnesses is therefore of the essence to stave off potential negative sequelae. Outcomes on different vector-borne diseases will be diverse, but for many of them, these developments will result in a distribution shift or expansion with the possibility of (re-)introduction of vector and pathogen species in previously nonendemic areas. The consequence will be a growing likelihood for novel human, vector, and pathogen interactions with an increased risk for infection, morbidity, and mortality. Wilderness medicine professionals commonly work in close relationship to the natural environment and therefore will experience these alterations most strongly in their practice. Hence, this article attempts to bring awareness to the subject at hand in a wilderness medicine context, with a focus on malaria, the most burdensome of arthropod-borne diseases. For prevention of the potentially dire consequences on human health induced by climate change, concerted and intensified efforts to reduce the burning of fossil fuels and thus greenhouse gas emissions will be imperative on a global scale.

Airway devices may be scarce in limited resource situations, such as prehospital settings or austere environments. Tube tip in pharynx (TTIP) ventilation is a simple, one-handed technique that may prove valuable for ensuring airway control in a life-threatening situation. The technique only requires a standard cuffed endotracheal tube and a self-inflating bag. This case report illustrates a scenario where both bag-valve-mask (BVM) ventilation and intubation failed, and the TTIP technique was utilized successfully several times during the case management. This case report illustrates that TTIP may be a useful technique, especially in limited resource settings. It is easy to learn, takes seconds to perform, and has minimal equipment requirements. The case report is reported according to the CARE guidelines. Informed consent from the patient is obtained.

A full century has passed since George Leigh-Mallory and Andrew (Sandy) Irvine disappeared on the upper reaches of Mount Everest in June 1924. Theodore Howard Somervell (April 16, 1890-January 23, 1975), mountaineer, surgeon, and medical missionary, also was a key player in the 1924 expedition-as well as the 1922 Everest expedition where he was a member of the first ever team of climbers to break the 8000-m barrier. More commonly known as Howard or T.H., Somervell was one of those rare individuals whose multiple talents qualified him as nothing short of a polymath while simultaneously providing an example of outstanding humanitarian qualities. British born, he was resident in India for nearly 40 y while working there as a medical missionary. He bore witness as a battlefield surgeon to the horrors of the First World War after receiving his medical training at University College, London. An active climber for much of his early life, he made notable ascents not only in the Himalaya but also closer to home in the mountains of the United Kingdom and mainland Europe. Somervell contributed numerous articles to the medical literature, but he is perhaps best known for 3 books published between 1936 and 1947 that touch largely on his experiences as a medical missionary. His decades of practice as a medical missionary in service to the poor of India allowed him to save lives on a scale approaching that of the slaughter he witnessed years earlier as an Army medical officer.

The rising occurrence of natural disasters linked to climate change has drawn the attention of disaster response leaders to the significance of addressing operational stress injuries among disaster response personnel. We define and describe operational stress injuries in this workforce and explore theoretical frameworks that can inform the development of programs and interventions to mitigate these effects. We aim to establish a conceptual framework for understanding an operational stress injury by introducing a model specific to disaster responders. We also emphasize strategies that can be employed within a stress injury awareness framework to promote the mental well-being of those who respond to climate-related disasters.

In Hawaii, impacts from climate change, such as sea-level rise and flooding, increased hurricanes and wildfires, and warmer temperatures, intersect with aging infrastructure, toxicities from the built environment, and pathogens to threaten the health of recreational ocean users via reduced water quality, severe weather and flooding, environmental degradation, and food systems impacts. An examination of climate-driven threats to water safety is a pertinent review of threats to coastal residents globally.

Introduction: Motorcyclists are particularly vulnerable to injury when encountering large animals such as deer in the roadway. The frequency of these events, factors associated with their occurrence, and the extent of injuries sustained from such crashes are not yet well described.

Methods: A review of 10 years (2012-2021) of statewide motorcycle crash reports from a single state with a large deer population was performed to ascertain the frequency of deer-associated motorcycle crashes. Environmental and roadway conditions, as well as motorcyclist age, gender, and helmet usage, were identified to determine if associations exist with the severity of injuries sustained.

Results: Statewide, 8.5% of reported motorcycle crashes involved deer. Excluding the two most densely populated counties, this rose to 10.7%, with 24.1% of crashes occurring during non-daylight hours being deer related. Factors associated with increased frequency of more severe injury and death included not wearing a helmet, female gender, and rural county crash location. Death and severe injuries were reported in more than twice as many riders who were unhelmeted compared to those wearing helmets (36.1 vs 16.6%; p < 0.01).

Conclusion: In a single midwestern state, deer represent a significant danger to motorcyclists, especially in rural settings during non-daylight hours. A cautious approach to riding during this time, utilizing available safety precautions to minimize risk of severe injury and death, and further exploration of viable interventions to reduce the likelihood of these occurrences should be considered.