Wilderness & Environmental Medicine最新文献

IntroductionMembers of the military are regularly exposed to austere environmental conditions that may create clothing saturation in cold conditions. This study sought to determine whether immediate ruck initiation is superior in maintaining rectal temperature (T_re), improving skin temperatures, and augmenting thermal comfort compared with remaining static and/or delayed ruck initiation when wet in cold air.MethodsEleven healthy adults (10 males and 1 female, 26±9 y old, 22.5±8.6% body fat) participated in this study. Volunteers were immersed in warm water (34.0±0.3°C) before entering the cold chamber (5.3±0.4°C) and began immediately rucking (IR) or stood statically for 60 min (Static) before rucking (delayed rucking [DR]) for 60 min.ResultsIR initiation was superior in elevating T_re compared with Static at 20 min (37.6±0.4 vs 37.3±0.2°C, P=0.033), 40 min (37.9±0.4 vs 37.5±0.2°C, P=0.012), and 60 min (37.9±0.4 vs 37.6±0.3°C, P=0.016). IR T_re was also greater than DR at 40 min (37.9±0.4 vs 37.4±0.5°C, P=0.002) and 60 min of wet-cold exposure (37.9±0.4 vs 37.5±0.5°C, P<0.001). Consequently, IR tended to improve thermal sensation ratings compared with both DR and Static. Yet, IR was no more sufficient in overcoming wet-cold decrements in skin temperatures than Static, especially at the finger (P>0.05).ConclusionsCompared with DR and Static, IR is effective at elevating deep body temperature and improving thermal perceptions but is significantly less effective at improving wet-cold skin temperatures compared with Static.

IntroductionDrowning is a global public health concern, with over 300,000 deaths annually. In Japan, approximately 700 drowning-related fatalities occur each year, increasingly involving older adults during marine leisure activities. However, limited data are available on the clinical characteristics of such incidents at tourist destinations. This study describes the characteristics and outcomes of drowning-related out-of-hospital cardiac arrest (OHCA) cases on a remote tourist island in Japan.MethodsThis retrospective, single-center descriptive case series reviewed OHCA cases due to drowning at Yaeyama Hospital between June 2021 and December 2023. Patient demographics, incident details, and outcomes were collected. Key variables included age, type of activities, bystander cardiopulmonary resuscitation (CPR), instructor presence, time to hospital arrival, and neurological outcomes based on the Cerebral Performance Category (CPC) scale.ResultsAmong 31 OHCA cases, 90% (28 cases) involved tourists. The median age was 50 years, with most incidents related to snorkeling (10 cases) or scuba diving (9 cases). Bystander CPR was performed in 14 cases; 7 patients achieved return of spontaneous circulation. Instructors were present in 9 adult cases; however, whether they performed CPR could not be confirmed. At discharge, one adult had a CPC score of 1, and one had CPC 4. All 5 pediatric patients had CPC 1. The mean time from incident recognition to hospital arrival was 52 min.ConclusionThis case series highlights demographic and situational patterns in drowning-related OHCA during marine activities. Further research is needed to identify risk factors and improve prevention strategies in resource-limited island settings.

This case report describes a unique incident involving a boar attack in a wilderness setting, resulting in a traumatic knee arthrotomy in a pediatric patient. The patient presented to the emergency department with a laceration caused by a wild boar attack while hunting. Initial assessment revealed a deep laceration over his anterior knee and radiographs demonstrated significant air within the knee joint, consistent with a traumatic knee arthrotomy. The patient was placed on empiric, broad-spectrum antibiotics and underwent urgent surgical irrigation and debridement. Intraoperative cultures were sent, and infectious disease was consulted. Intraoperative cultures obtained grew Aspergillus and Stenotrophomonas maltophilia, although the Aspergillus was ultimately thought to be a contaminant. The patient was then placed on sulfamethoxazole-trimethoprim (SMX-TMP) for targeted antibiotic treatment. The patient responded well to the treatment regimen, with no signs of infection or further complications. Follow-up examinations have demonstrated full, painless knee range of motion and no adverse postoperative events. This case demonstrates a rare but significant injury in a pediatric patient secondary to a wild boar attack. Furthermore, though a systematic review was not conducted, no similar cases were identified in the available literature describing these bacterial isolates from a wild boar tusk within a traumatic arthrotomy. These findings may assist orthopedic surgeons, emergency physicians, and infectious disease specialists in antibiotic selection when these injuries are encountered to prevent subsequent complications.

IntroductionSearch and rescue (SAR) personnel in the United States are mostly volunteers, many of whom work in nonmedical professions. Because SAR volunteers respond to missions intermittently, their opportunities to provide patient care and maintain medical skills are limited, highlighting the need for ongoing training. This study explored the effect of high-fidelity simulation training on the medical skill comfort level of SAR volunteers.MethodTwenty SAR volunteers participated in high-fidelity training scenarios in an academic medical simulation center. The scenarios included care of both a trauma and a medical patient along with dedicated time to practice perishable medical skills. Participant comfort level in performing patient assessments and medical skills was measured using a 5-point Likert scale, via surveys administered before and after the simulation training.ResultsA significant increase (P<0.05) in participants' comfort level was observed across nearly all measured medical skills when comparing pre- and post-training survey responses. Participants reported the highest comfort level in obtaining vital signs and the lowest comfort level in splinting a fractured extremity. All participants stated that they would like more SAR trainings in this format in the future and that the training modality helped identify gaps in their medical skills.ConclusionsHigh-fidelity simulation training improved the comfort level of SAR volunteers in executing medical skills. For SAR volunteers with limited opportunities to provide direct patient care, simulation training showed promise as a modality for continuing medical education to improve confidence, reinforce team dynamics, and refresh skills.

IntroductionWilderness medicine specializes in delivering clinical care in austere environments, far from healthcare facilities, with limited resources. There is no standardized wilderness medicine training for medical students within the United Kingdom. The aim of this research was to identify what wilderness medicine training is being delivered to undergraduate medical students in the United Kingdom to guide future educational research.MethodA scoping review following a PRISMA-ScR protocol was undertaken in the Medline and Scopus databases. This was supported by a digital survey sent to all UK university medical schools wilderness medicine interest groups to identify wilderness medicine teaching both within the curriculum and extracurricularly.ResultsOf the initial 1186 articles identified, 23 met the inclusion criteria. Seven represented practices in UK universities, and 21 represented a teaching module delivered to undergraduate students. Nineteen of the articles (91%) described faculty-delivered modules; two peer-led modules were both from UK universities. Thirty-one UK based wilderness medicine interest groups members responded to the online survey representing 13 different UK universities. All had been involved with extracurricular peer-led wilderness medicine teaching compared with 10% who received curriculum-based faculty-led teaching.ConclusionMost UK wilderness medicine training is extracurricular and peer led. Current research into this field provides excellent examples of wilderness medicine within UK medical schools but no comparisons between the methodologies for outcomes or cost efficiency. This review recommends more structured investigation to determine the optimal introduction to wilderness medicine for undergraduate medical students.

IntroductionWilderness medicine (WM) tracks provide residents with a framework to foster their interests in wilderness medicine. However, there is little literature specific to WM tracks. We sent surveys to all 287 ACGME-recognized emergency medicine residencies in the United States to obtain data on the prevalence and characteristics of these tracks.MethodsA survey was distributed via the Society for Academic Emergency Medicine and American College of Emergency Physicians listservs with follow-up emails sent to nonrespondents. The survey included questions regarding program demographics, the presence of a WM track, and the characteristics of the track. Residencies lacking a track were asked about their interest, and challenges faced, in creating a track. We evaluated differences between 3-y and 4-y residency programs, smaller and larger programs, and scholarly activity production using the χ² test, where P < 0.05 was considered significant. We evaluated the differences between academic, community/county, and military centers using the ANOVA test, where P < 0.05 was considered significant.ResultsThe response rate was 28%; 24% of respondents had a WM track, and the majority of these were offered at academic centers, 4-year programs, or larger programs. Track participation, administration, and requirements varied significantly. Among programs without a WM track, a minority (35%) reported planning to develop one in the next few years.ConclusionsDespite the popularity of wilderness medicine, many residency programs do not have a WM scholarly track. Their engagement, administration, funding, scholarly productivity, and requirements are quite variable.

In 1951, Riley's classic 3-compartment model of gas exchange estimated pulmonary shunt, alveolar dead space, and an effective compartment representing the functioning lung. But trial-and-error steps and conversion charts made its application impractical. We implemented estimates of alveolar and effective PCO₂ to simplify computations, making it useful when more advanced technologies are unavailable. Using stepwise computations, we studied 10 healthy individuals and 43 outpatients with mild to severe chronic obstructive pulmonary disease and, in another study, 32 healthy subjects during 12 h of hypobaric hypoxia at 426 mm Hg (ALT). The "effective" PaCO₂ due to pulmonary shunt and Haldane effect when breathing increased O₂ was calculated via the CO₂ dissociation curve. The model was applied while breathing air and 25% O₂ to simulate sea level in outpatients at 1620 m. Pulmonary shunt rose significantly with increasing hypoxemia (P<0.001), whereas alveolar dead space remained high. Breathing 25% O₂ reduced the shunt (P<0.001) by elevating systemic PO₂. The effective compartment in healthy subjects was 0.87, but only 0.41 in patients with severe hypoxemia, increasing to 0.45 on 25% O₂ (P=0.031). In ALT, a scoring system demonstrated that 16 subjects experienced acute mountain sickness (AMS) after 1 h with a significant increase in pulmonary shunt compared with 16 subjects without AMS. The model shows that hypoxemia in patients is associated with perfusion redistribution from high to low V/Q regions, consistent with reports using more sophisticated techniques. Subjects susceptible to AMS also increased shunt, suggesting autonomic instability.

BackgroundIn India, emergency medicine is a developing specialty and is not yet integrated into undergraduate medical education (bachelor of medicine and bachelor of surgery [MBBS]). Against this backdrop, introducing wilderness medicine may seem premature, but its relevance is clear given the country's vast rural geography and limited prehospital care. This study evaluated the impact of a 1-d wilderness medicine elective on medical students' motivation, self-directed learning, and satisfaction.MethodThis mixed-methods study involved 53 MBBS students from a tertiary care teaching institute divided into 3 independent batches that sequentially underwent wilderness medicine training across 3 curricular iterations. Data collection included pre- and post-tests, surveys using validated scales, and qualitative feedback from focus group discussions.ResultsConfidence improved significantly (P<0.001) in scene size-up (2.66±0.99 to 4.22±0.53), first aid (2.66±0.99 to 4.22±0.53), identification of life-threatening emergencies (2.66±0.94 to 4.20±0.51), and first aid kit preparation (2.39±1.07 to 4.29±0.72, all scores out of 5). The module was highly valued, with strong support from the learners for its inclusion in the curriculum (4.14±0.94 to 4.86±0.35; P<0.001) and reported high satisfaction and demonstrated intrinsic motivation.ConclusionsThe elective module enhanced students' confidence and engagement, supporting its integration into undergraduate curricula. Further research is warranted to assess long-term impact and scalability. Further research is needed to validate these findings and assess the long-term effects on clinical practice.