Wilderness & Environmental Medicine最新文献

As backcountry recreation grows in popularity, so too does reliance on avalanche safety equipment such as transceivers and airbags. While these tools have demonstrably improved survival rates, their presence may unintentionally alter user behavior, a phenomenon known as risk compensation. This review examines the extent to which safety equipment influences decision making in avalanche terrain, drawing on existing literature, risk-cost analysis, and behavioral research. Findings suggest that users often overestimate the protective capabilities of their gear, leading to increased exposure to hazardous conditions, particularly among recreational users. Trauma-related fatalities, which remain largely unaffected by current technologies, underscore the limitations of relying solely on equipment for safety. Survey data and scenario-based studies reveal that both experienced and inexperienced users may adjust their risk thresholds based on perceived safety, sometimes engaging in behavior that exceeds the mitigation capacity of their gear. The analysis concludes that avalanche education must explicitly address risk compensation and promote a cautious mindset.

IntroductionActively recreating in natural environments enhances physical and mental health but also carries risk. We aimed to characterize wilderness day hikers and trail runners and examine factors that predict preparedness.MethodsWe conducted a cross-sectional survey in 4 distinct areas of Rocky Mountain National Park in Colorado during June to August of 2024. English-speaking adults returning from a day hike or trail run were invited to participate. We classified visitors as prepared based on the gear they reported carrying.ResultsOf 801 potential participants approached, 586 day hikers (82.3%) and 68 trail runners (76.4%) agreed to participate. The overall average age was 40.7 y (range 18-82 y), 50.1% were female, and the most common state of residence was Colorado (47.3%). Day hikers tended to be older, travel in larger groups, and spend fewer days in the wilderness per year, whereas trail runners reported higher levels of experience and wilderness preparedness and were more likely to experience "close calls." A minority of participants met our definition of wilderness prepared, about half were altitude prepared, and approximately a quarter did not tell anyone where they were going or when they expected to return. Several measures of experience were associated with preparedness.ConclusionBoth equipment and knowledge are important for safely when enjoying and leaving wilderness settings. Yet, many wilderness users in Rocky Mountain National Park did not meet our definition of adequate preparation, especially those with less experience. Additional efforts to increase the proportion of wilderness day users who are prepared may help further improve visitor safety.

IntroductionThe global increase in recreational and sports activities in mountainous regions has led to a rise in accidents in these environments. Unlike urban areas, mountain incidents typically occur in remote, hazardous locations with limited access, significantly impacting both patient outcomes and the efficiency of rescue operations, ultimately increasing healthcare costs. In such high-stress situations, cognitive overload, fear, and uncertainty can impair decision making. Tools such as checklists may help compensate for human limitations and support effective response actions.ObjectiveThis study aimed to develop a practical checklist to guide laypersons, regardless of medical background, in the initial management of mountain accident victims. The goal was to enhance patient stabilization, support clinical progression, and potentially reduce strain on healthcare systems.MethodsThe checklist was developed through 2 main phases. First, it was conceptually designed in response to the rising number of mountain-related accidents and the need for a simple cognitive aid. Second, a narrative review of the literature and official guidelines on prehospital trauma care and wilderness first aid was conducted to inform the checklist structure and content.ResultsThe final checklist includes 71 items organized into 6 categories: scene assessment (6 items), alert (9), primary survey (36), secondary survey (13), continuous reassessment (2), and preliminary advice (5).ConclusionThe proposed checklist addresses a wide range of potential scenarios in mountainous environments, encompassing scene and victim safety assessment, emergency medical services activation and early critical interventions.

IntroductionPharmaceutical stability is a key concern for space missions, where radiation, microgravity, and prelaunch repackaging may accelerate drug degradation. While prior studies examined medications in environmentally controlled spacecraft, data on vacuum exposure are limited. The Polaris Dawn mission provided an opportunity to evaluate drug content following depressurization of the Dragon spacecraft and exposure to the vacuum of space during extravehicular activity.MethodsNineteen medications (13 repackaged solid, 6 liquid) flew as part of the SpaceX medical kit and were analyzed with lot-matched terrestrial controls. All samples underwent ultra-performance liquid chromatography mass spectrometry analysis upon return. The primary outcome was the percent difference in active pharmaceutical ingredient (API) between vacuum exposure and ground controls. A secondary outcome was the absolute API content expressed as a percentage of labeled dosage.ResultsSeventeen of the 19 flown medications demonstrated a < 5% mean API difference between spaceflight and lot-matched terrestrial controls, remaining within the prespecified threshold for clinical significance. Seven medications showed statistically significant differences (p < 0.05) between the 2 groups, yet all but one medication remained within this 5% range. Against the narrow 95%-105% of labeled dosage criterion, 10 ground controls and 11 spaceflight-exposed medications fell outside this range. Expanding to the broader 80%-120% range, nearly all medications were within acceptable limits.ConclusionsShort-duration spaceflight with vacuum exposure resulted in modest differences in drug content between spaceflight and terrestrial samples. However, high concordance suggests no clinically meaningful degradation, supporting the feasibility of repackaged pharmaceuticals for commercial and exploratory missions.

Anomalous perceptual experiences (APEs) have been reported anecdotally in ultra-endurance athletes. These experiences occur in the absence of psychiatric illness and may reflect the effects of extreme physiologic and environmental stressors. However, the literature is fragmented and terminology inconsistent, limiting understanding of the nature, prevalence, and mechanisms of these experiences. The aim of this study was to systematically review the literature describing APEs during ultra-endurance sport in an attempt to characterize their phenomenology, contextual features, and contributing factors. This review was registered prospectively (PROSPERO CRD420251079013) and conducted in accordance with PRISMA guidelines. A systematic search of Medline, Embase, and PsycINFO via the Ovid platform was completed in August 2025. Eligible studies reported APEs in adults participating in ultra-endurance sports lasting ≥6 h. Included studies were appraised for quality, and data were extracted for narrative synthesis. Fourteen studies met inclusion criteria: 4 case reports, 4 case series, 4 field studies, and 2 cross-sectional surveys. APEs were reported across diverse disciplines, including mountaineering, ultramarathon running, solo sailing, marathon volleyball, and dogsled racing. Experiences were commonly visual but also included auditory, somatic, and "sensed presence" phenomena. Sleep deprivation was the most consistent contributing factor, followed by exhaustion and low-light conditions. Symptoms typically emerged after ≥24 h of exertion, especially in darkness. Interpretations ranged from distressing to neutral or even supportive. No long-term psychiatric sequelae were reported. APEs appear to be transient nonpathologic phenomena triggered by extreme stress. Consistent terminology and categorization frameworks are needed. Findings have implications for athlete safety, event planning, and future research.

IntroductionPodcasts are a popular medical education tool, especially for the review of journal articles, but production requires significant resources. The objectives of this study were to determine the feasibility of a trained artificial intelligence (AI) model generating well-received educational podcasts based on journal articles and to assess listener comprehension with knowledge-based questions.MethodsGoogle Gemini 2.0 Flash AI was trained on 12 Wilderness and Environmental Medicine journal articles to generate 3 distinct educational podcasts (4 articles per podcast). These podcasts featured 2 AI-generated host voices in a journal club format. Participants from the Wilderness Medical Society Student/Resident Committee, the Virginia Tech Carilion Wilderness Medicine Fellowship Program, and a convenience sample of students and residents were randomly assigned to listen to 1 podcast, blinded to its AI origin. They then completed a 5-point Likert perception survey and a knowledge assessment with continuing medical education-style multiple-choice questions based on the discussed articles.ResultsThirty-one participants completed the study. Participant perception was highly positive: 87.5% agreed or strongly agreed that the content was accurate and relevant (mean Likert score 4.37), and 81.25% agreed or strongly agreed that the podcasts aided journal article review and learning (mean Likert score 4.14). The mean knowledge assessment score was 88.7% correct (SD 5.0%).ConclusionsDespite limitations, including a small sample size and lack of a control group, AI-generated podcasts were positively received and effectively conveyed educational content, as evidenced by high knowledge assessment scores.

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.