Wilderness & Environmental Medicine最新文献

BackgroundHeat stroke represents a growing public health concern, exacerbated by rising temperatures and prolonged heat waves. This study examines the clinical profile, prognostic markers, and outcomes of heat stroke patients presenting to a tertiary care center in India and compares findings with previous global studies.ObjectiveTo analyze the clinical profile, prognostic markers, and outcomes of heat stroke patients presenting to a tertiary care center in India and to compare findings with previous global studies.MethodsA retrospective study was conducted between March to July 2024. Data on demographics, clinical parameters, laboratory values, and outcomes were collected and analyzed. Primary outcomes were mortality and functional recovery. Statistical tests included chi-square, Mann-Whitney U test, and multivariate logistic regression.ResultsAmong 43 patients, the mean age was 57 years, and 67% were male. The overall mortality rate was 21%. Significant predictors of mortality included hypotension (SBP <100 mm Hg, p = 0.040), tachypnea (RR >20/min, p = 0.001), Glasgow Coma Scale score <9 (p < 0.001), elevated creatinine, and multi-organ dysfunction syndrome (MODS) involving renal and CNS systems (p < 0.01). Middle-aged, active individuals were disproportionately affected due to occupational exposure to high ambient temperatures.ConclusionOur findings highlight key clinical and biochemical predictors of poor outcomes in heat stroke. Indian patients who are middle-aged individuals, possibly exposed due to outdoor occupations, may face greater exposure to high ambient temperatures.

Debate exists regarding safety and optimal technique for ski patrollers performing cardiopulmonary resuscitation (CPR) on cardiac arrest patients in a moving toboggan during rescue evacuation. Cases of successful outcomes after toboggan-transport (in-sled) manual (hands-on) or mechanical CPR by ski patrollers have not been described in the medical literature. This case series presents 3 adult resort skiers who experienced medical cardiac arrest in Vermont over the years 2024-25, and who received manual CPR in a moving rescue toboggan, leading to return of spontaneous circulation and subsequent neurologically intact hospital discharge. One case displayed signs of cognitive activity only during chest compressions, which suggests that manual CPR in a moving rescue toboggan can create brain perfusion. This study documents that after an initial period of on-scene stationary CPR and defibrillation, manual CPR may be safely continued in the appropriate circumstance by ski patrollers in a moving toboggan and can lead to successful outcomes for medical cardiac arrest. An educational opportunity exists. Practical suggestions and techniques are discussed for the implementation of safe and effective toboggan-transport CPR when indicated.

A 64-y-old male went caving and packrafting in Chiapas, Mexico. On return, he developed fever, headaches, and nausea and was treated empirically for leptospirosis with ceftriaxone and doxycycline. Convalescent IgM titers returned positive for leptospirosis. Other work-up was negative. As the symptoms of leptospirosis abated, the patient developed an areflexic quadriparesis. Nerve conduction velocities confirmed acute motor axonal neuropathy consistent with Guillain-Barré syndrome. Serologic work-up disclosed anti-GD1a antibodies. He was treated with intravenous immune globulin for 5 d and then did extensive rehabilitation. Three years after diagnosis, he is once again exploring caves.

IntroductionWilderness medicine (WM) is the study of medicine in austere environments. There are several US multidisciplinary courses that teach WM to people from varying medical backgrounds. However, WM topics are covered to different extents. This study's purpose was to compare WM components among US multidisciplinary training courses.MethodsThe American College of Emergency Physicians WM fellowship curriculum's 19 components and the Fellowship of the Academy of Wilderness Medicine's 12 core and 16 elective competencies and their credits were used as two control lists. Curricula from 10 US multidisciplinary courses were analyzed for WM components. Using descriptive analysis, each course curriculum was compared with the controls.ResultsThis study examines WM components in 10 courses. The greatest number of American College of Emergency Physicians WM fellowship topics (14 of 19) was covered by the Paramedic course and the fewest number (4 of 19) by the Tactical Combat Casualty Care-Combat Lifesaver course. The greatest number of Fellowship of the Academy of Wilderness Medicine core credits (56) was offered by the Paramedic course and the fewest number (24) by the Tactical Combat Casualty Care-Medical Personnel course. The greatest number of Fellowship of the Academy of Wilderness Medicine elective credits (83) was offered by the Paramedic course and the fewest number (25) by the Tactical Combat Casualty Care-Combat Lifesaver course.ConclusionThis research analyzed WM components in US multidisciplinary courses and demonstrated that each covers WM topics to varying extents. This shows an opportunity for these courses to expand their WM education within their scope. It also demonstrates competencies offered by different courses for interested trainees.

Introduction-Decision-making in clinical environments is often impacted by cognitive biases and exacerbated by high stakes, time pressures, and unreliable feedback-characteristics of a "wicked learning environment," as defined by Robin Hogarth.^1,2 Traditional medical education inadequately addresses these biases, relying primarily on passive, lecture-based instruction. Objective-To bridge this gap, we designed and piloted an experiential learning workshop for first-year medical students, integrating backcountry skiing as a parallel wicked learning environment to teach decision-making biases, fallacies, and heuristics. Methods-The study employed a qualitative questionnaire to better understand student experience and measured learning outcomes. Results-Twenty-six students participated in the classroom-based components, and of those 26, 8 participated in the experiential learning component. Qualitative questionnaire responses suggest an elevated understanding of how backcountry decision-making informs clinical decision-making and the importance of decision-making within patient care. Discussion-There is clear potential for the programming to be expanded and applied to other forms of the outdoor recreation experience. Results suggest that applying the experiential learning model provides an additional and broader understanding of how decision-making biases may intersect with practical applications in medical settings. Despite limitations, including a low response rate, the results suggest that this novel approach enhances the understanding of cognitive biases and decision-making in clinical settings. Future iterations will aim to scale participation, include quantitative assessments, and explore alternative wicked learning environments. Conclusion-This pilot program demonstrates the potential of combining outdoor experiential learning with medical education to address critical gaps in teaching decision-making biases and improve clinical practice.

IntroductionHemorrhage control in austere environments is challenging, particularly for wounds that are not amenable to tourniquets. Hemostatic gauzes are crucial in such settings, but their efficacy may be compromised by suboptimal storage conditions, including extreme temperatures, where discoloration has been observed. This study evaluated the impact of extreme temperature exposure on the efficacy of hemostatic gauze using thromboelastography.MethodsBlood from 30 healthy adults was diluted by 30% with hetastarch to mimic trauma-induced coagulopathy. Kerlix and QuikClot Combat Gauze stored for 3 weeks in cold (-10°C), hot (70°C), and room-temperature (22°C) environments were compared in the thromboelastography parameters of R (time to initiation of clot formation), K (clot amplification), α angle (clot formation rate), and MA (maximum amplitude of clot).ResultsCompared with whole blood, diluted blood had weaker clots with slower clot-formation kinetics (MA=58  vs 43 mm, P<0.0001; K=2.6 vs 4.0 min, P<0.0001; α angle=55 vs 47 degrees, P<0.0003) but faster clot initiation times (R=8.7 vs 7.1 min, P<0.0001). Addition of either gauze shortened clot initiation times (Kerlix: 7.1 vs 5.0 min, P<0.0001; QuikClot Combat Gauze: 7.1 vs 2.7 min, P<0.0001), with QuikClot Combat Gauze significantly shortening R compared with Kerlix. Reductions in R values were consistent across temperature extremes (P<0.05). The other parameters were consistently unaffected (P>0.05).ConclusionsThis in vitro laboratory study demonstrated that hemostatic gauze retained its ability to initiate clotting in vitro even after prolonged exposure to temperature extremes.

IntroductionThe Boundary Waters Canoe Area (BWCA) is a backcountry recreation area. This study aimed to characterize injuries sustained in the BWCA.MethodsA single reviewer completed a retrospective chart review of trauma admissions to Essentia Health from January 1, 2014 to February 25, 2023. Patients were included if their injury was documented to have occurred in the BWCA and they had not opted out of research.ResultsEighteen patients were found to have sustained injury in the BWCA. Most were adult males (78%), White (89%), and nonsmokers (94%). Most patients had no alcohol (83.3%) or drug (94.4%) use related to the injury. Seven patients self-extricated out to the BWCA, 6 were transported by ground Emergency Medical Services, and 5 required flight extrication. Median time from notification of injury to Emergency Medical Services arrival was 64 min. Time from notification of injury to hospital arrival was a median of 131 min. Falls were the main mechanism of injury (61%), followed by strike injury (22%) and water injury (17%). A few patients required lifesaving interventions (eg, prehospital intubations, needle thoracostomy, and blood transfusion). Twelve patients required a procedure (eg, <5 chest tubes and 10 surgeries). All 18 patients were alive at discharge.ConclusionThe most common injuries sustained in the BWCA were from falls, strikes, and water injuries. In collaboration with forest ranger stations, we plan to provide this information to backpackers to assist in their preparation for backcountry emergencies.