Wilderness & Environmental Medicine最新文献

Introduction: French Guiana is a French territory in South America covered by 90% of tropical forest. Despite regular first aid standards training, some of the workers in isolated areas remain untrained in common problems they may encounter. We present here the knowledge assessment of these workers concerning first aid and a new training program.

Methods: Thirty-two workers operating in remote areas attended a 1-d training course. The program covered infectious diseases, wildlife envenomation, and first aid and basic life support with a wilderness medicine focus. Questionnaires were issued to assess their knowledge and satisfaction with the course.

Results: The learners were 78% male and of intermediate age (26-55 y). The most common profession was forester (53%). Professionals had been working in remote areas for 12 (4-19) y, and 91% had already received first aid training. The common life-threatening emergencies were not well known; only 6 learners (19%) knew how to recognize a cardiac arrest, 7 (22%) recognized symptoms of severe anaphylaxis, and 23 (72%) performed maneuvers not recommended in cases of upper airway partial obstruction. A total of 26 learners (81%) completed the satisfaction questionnaire. The training met the learners' expectations. However, 92% would like further training, and 96% requested regular renewal.

Conclusions: This training was the first step toward the creation of a specialized wilderness first aid course. This work supports the need to reinforce training for nonmedical personnel by integrating regionally specific topics. This experience permitted the rise of a working group that proposed a medical kit as well as first aid protocols for workers in isolated areas.

Okinawa prefecture is at risk for emerging infectious diseases due to its subtropical climate and its location within the Indo-Pacific region. Understanding the existing vectors and infectious agents contextualizes current threats, guides treatment, and informs prevention, and may be of unique concern in the setting of complex emergencies.

Introduction: Outdoor recreation and tourism providers, education programs, and outdoor recreation facilities are experiencing the effects of climate change and severe weather firsthand. This research assessed the impact that climate change was having on these operations in 2023.

Methods: Respondents from 127 outdoor organizations completed an online survey assessing the impacts of climate change and severe weather. Any outdoor operation that owed a duty of care to clients who they take outdoors or host at their facilities was invited to participate. This included outdoor tourism and recreation providers, outdoor education programs (both school and expedition based), groups involved in conservation work, and facilities such as parks, ski areas, and other outdoor recreation facilities. Respondents were from Canada's far north to Mexico, with 14% from further international locations.

Results: Climate change is having moderate to serious impacts on outdoor operations. Extreme heat and air quality were of primary concern, with storm event flooding, wildfires, snowpack, and changes in the ranges of disease-carrying insects top concerns. Fewer than half the operations have established criteria to aid in decision making, yet most had to revise operational plans in 2023 due to extreme weather.

Conclusions: There was pervasive uncertainty regarding decisions involving extreme heat and air quality, particularly the short-term health impacts on clients and the long-term health impacts on workers. There was uncertainty regarding trusted sources for guidance and the many overlapping or contradictory jurisdictional recommendations. Practical direction is required for operations and decision makers, as is further research specific to this sector's needs.

Background: India has a high incidence of snakebite-related mortality, making effective snakebite management crucial. This study aimed to explore current practices, challenges, and opportunities for improvement in snakebite management across India.

Methods: A cross-sectional survey was conducted among physicians in India covering aspects such as scope of practice, snake identification, first aid measures, institutional management, and specific management practices for hump-nosed pit viper (Hypnale hypnale) bites. The survey included 37 questions across 5 sections, with data collected via emails, professional networks, and online platforms. Statistical analysis was performed using SPSS Statistics 23 (IBM Corp, Armonk, NY), and manual thematic analysis was applied to open-ended responses.

Results: The survey revealed a discrepancy between physicians' confidence and accuracy in snake identification, with some still reporting outdated first aid and treatment practices. Despite recognizing the importance of snake species identification, a significant portion of respondents incorrectly identified the snakes. The study highlighted variability in institutional practices for snakebite management, such as administering prophylactic antibiotics and tetanus prophylaxis and monitoring periods for asymptomatic patients. In managing H hypnale viper bites, a demand for specific guidelines and a monovalent antivenom was evident because the current polyvalent antivenom is ineffective for this species.

Conclusions: The survey emphasizes the need for improved training in snake identification, standardized treatment protocols, and the development of region-specific antivenoms. It emphasizes the necessity of updating guidelines to address the unique challenges of snakebite management in India, particularly for species not covered by existing antivenoms.

Introduction: Providers can evaluate patients who sustain trauma during outdoor activities by using the extended focused assessment with sonography for trauma (FAST) and the limited knee ultrasound. Remote tele-mentored ultrasound (RTMUS) can help minimally trained providers in the wilderness if they have difficulty obtaining a view or have questions about the interpretation of an image. The goal of our study was to determine the feasibility of using RTMUS to teach the FAST exam and knee ultrasound exam to ultrasound-naive medical students during a wilderness medicine outdoor activity.

Methods: Medical students from two large academic institutions were randomized to receive either in-person or RTMUS education during a wilderness activity 1 d before completion of FAST and knee ultrasound exams. All students received limited ultrasound instruction before the event. The images obtained by the students were compared. Two ultrasound-trained emergency physicians evaluated the images for their ability to identify structures and support a diagnosis from the images. Simple descriptive statistics were performed.

Results: There was a statistically significant difference between the RTMUS group and the in-person group. The images captured by the in-person group were more likely to identify structures and support a diagnosis than those captured by the RTMUS group.

Conclusions: In this study, ultrasound-naive medical students who received in-person education on conducting the knee exam and FAST exam obtained higher-quality images than students who received RTMUS education. This study suggests that if RTMUS is used for medical purposes, increased ultrasound training may be needed prior to initiation of RTMUS.

The impact and severity of natural disasters and hazards have been increasing in the United States and throughout the world. With our mounting reliance and dependence on technology in our industrialized society, technological disasters also have become more commonplace. Although disasters may occur with little to no warning, these risks are felt to be acceptable despite their ability to impact large populations. Natural and technological disasters disproportionately affect vulnerable populations, including those with end-stage kidney disease (ESKD). The impact of natural and technological disasters on the ESKD community has been closely examined via numerous case studies and through the lens of particular disasters, but there is a paucity of data exploring the impacts of natural and technological disasters on the ESKD community by disaster type. A comprehensive literature search was performed using PubMed and Google Scholar, and relevant articles pertaining to the impacts of natural and technological disasters on the ESKD community were reviewed. More than 50 studies were reviewed in total. This review aimed to identify common patterns and trends observed in the impacts of different disaster types on the ESKD community to better prepare patients and their providers before the next disaster strikes.