Wilderness & Environmental Medicine最新文献

IntroductionThe COVID-19 pandemic affected the ski industry globally, including limiting access to ski resorts and prompting more skiers and snowboarders to explore the backcountry. In this study, we quantified the willingness to take risks (risk propensity) and self-perceived ability to assess hazards in the backcountry and to explore correlations between these factors.MethodsWe based our study on a previously reported data set gathered under the supervision of our senior author, who collected anonymous responses to a 29-question online survey completed by 4792 self-identified backcountry skiers and snowboarders (aged ≥18 yr) in the United States and Canada. The survey was distributed primarily through regional avalanche centers, education providers, and skiing organizations. Pearson correlation coefficients and multivariable linear regression models were used to analyze associations among variables. More specifically, we examined the relationships among confidence in assessing avalanche terrain and willingness to take risks, level of avalanche training, years of experience, and days per season of backcountry skiing.ResultsWe identified a positive correlation between confidence in assessing avalanche terrain and willingness to take risks, level of avalanche training, years of experience, and days per season of backcountry skiing. Female respondents demonstrated lower risk willingness and self-reported ability to assess avalanche risk compared to males. Over 30% of individuals lacking level 1 avalanche training expressed confidence in appraising complex terrain. Our findings demonstrated a positive correlation between greater risk propensity, formal avalanche education, and increasing confidence in assessing avalanche terrain. However, we also observed concerningly high confidence levels among skiers with minimal or no training.ConclusionsAvalanche education should focus on aligning skiers' confidence with their actual abilities to reduce overconfidence and enhance safety. We recommend that future research aim to include a more diverse sample, especially those less engaged in formal avalanche education.

Wilderness medicine elective rotations for graduate medical students are gaining popularity. The number of electives continues to grow, each with varying curriculum, format, and means of assessment. Previous curriculum guidelines attempted to standardize the knowledge-based competency for medical students in this field. Concurrently, medical education has evolved, emphasizing learner-centric and outcome-based observable competencies. Competencies based on individual qualities have since been complemented by practice-specific activities called entrustable professional activities (EPAs), which may consist of smaller observable practice activities (OPAs). This has allowed educators to use a holistic approach to determine that an individual can be fully entrusted to carry out an unsupervised activity. We surveyed current graduate-level wilderness medicine elective directors to determine expert panel recommendations for the EPAs of wilderness medicine for graduate medical students. The aim was to create EPAs and OPAs that experts deem fundamental for a wilderness medicine elective rotation and align them under the framework of entrustable practice in medical education. By mapping wilderness medicine EPAs and OPAs to competencies, we can better measure developmental progression and degree of entrustment in graduate wilderness medicine electives.

Introduction-Wilderness medicine (WM) is a growing field offering advanced training and recognition through graduate medical education (GME) WM fellowships and the Fellow of the Academy of Wilderness Medicine (FAWM) professional designation. GME fellowships, introduced in 2004, provide immersive, structured training and experiential learning opportunities. The FAWM designation, established in 2005, is earned through approved educational activities. This study compared alumni outcomes between these pathways.Methods-A cross-sectional survey was conducted among GME fellowship graduates and FAWM recipients. Inclusion criteria were GME fellowship alumni or individuals with FAWM recognition. Exclusion criteria included incomplete surveys. Respondents were surveyed on demographics, academic output, and satisfaction with their training. Data analysis included χ² tests for categorical data, analysis of variance for publication comparisons, and ordinal Likert scales for satisfaction.Results-Of 321 responses, 281 were included. GME alumni expressed greater satisfaction with mentorship and research opportunities; 95% of FAWM-only respondents reported exposure to career opportunities unknown prior to fellowship. There was no detectable difference (P=0.523) between FAWM-only respondents' number of WM-related publications. Overall, 93% of FAWM-only respondents and 76% of GME alumni would repeat their fellowship. Both groups demonstrated high proficiency in WM, with 89% feeling proficient.Conclusion-Both GME and FAWM pathways support WM education and career development. However, GME fellowships provide enhanced academic involvement, mentorship, and performance of relevant clinical skills. FAWM introduced new wilderness careers and had higher alumni satisfaction. These findings highlight the complementary roles of GME fellowships and FAWM recognition in advancing proficiency and professional growth.

This case report describes iloprost infusion initiated in the prehospital setting to treat frostbite. Two cases were managed under a structured helicopter emergency medical services (HEMS) protocol during an extreme cold weather endurance race in the Yukon Territory in northern Canada. These cases demonstrate that intravenous iloprost delivery is operationally feasible in the prehospital setting. Administration was initiated on site and continued during helicopter transport following field rewarming and was completed in the hospital without complication. In remote or austere settings, field administration of iloprost can lower the time to treatment of frostbite injuries and may reduce warm ischemia time.

IntroductionPhysicians frequently take on leadership roles in many different healthcare teams and settings. Developing such leadership skills as situational control, resource utilization, and conflict management is a vital part of medical education. Wilderness medicine focuses on the delivery of care in remote environments where situations are often tenuous, resources are scarce, and effective leadership and teamwork are essential. Wilderness medicine education during medical school may provide tools and knowledge to improve leadership ability. This study evaluated the perceived effect of a 1-mo wilderness medicine elective on medical students' leadership skills.MethodsFourth year medical students taking a 1-mo wilderness medicine elective between 2019 and 2023 were asked to take pre- and postcourse surveys evaluating their perceptions of their leadership skills. A different group of students taking an art of medicine through the humanities elective were used as a control group. The results were evaluated for pre- and postsurvey differences as well as between-group differences.Results and ConclusionsSeveral pre- and post-course survey questions aimed at assessing perceived skill improvement in situational control, resource utilization, and conflict management showed statistically significant differences in the students taking the wilderness medicine elective, whereas this was not found in the control group. This suggests that students taking the wilderness medicine course perceived an improvement in their leadership skills after participating in a wilderness medicine course, whereas students taking the art of medicine through the humanities course did not perceive this improvement. This suggests that wilderness medicine education can provide value to medical student education.

BackgroundSwimming-induced pulmonary edema (SIPE) is an underrecognized cause of acute respiratory distress in healthy individuals engaged in open-water activities. Often misdiagnosed or overlooked, SIPE poses significant risks in both athletic and military settings. This review aims to consolidate current understanding of the pathophysiology, clinical presentation, risk factors, and emergency management of SIPE, with an emphasis on evidence relevant to emergency medicine practice.MethodsA scoping literature review was conducted using PRISMA extension for scoping reviews analysis employing PubMed to identify studies, case reports, and clinical guidelines on SIPE. Data were extracted on proposed pathophysiologic mechanisms, diagnostic strategies, epidemiologic trends, and treatment modalities. Special focus was given to recent research on lung ultrasound, hemodynamic factors, and recurrence prevention.ResultsSIPE is characterized by acute dyspnea, cough, and occasionally hemoptysis during or shortly after swimming, particularly in cold water. Pathophysiology involves increased pulmonary capillary pressures from central blood pooling, cold-induced vasoconstriction, and exercise-driven cardiac output. Risk factors include hypertension, female sex, cold-water exposure, tight wetsuits, and prior episodes of SIPE. Lung ultrasound demonstrates promise as a rapid, noninvasive diagnostic tool. Current management is supportive, focusing on rapid removal from water, oxygen therapy, and, in some cases, positive airway pressure. Despite rapid resolution in most cases, recurrence rates are significant, with long-term preventive strategies still under investigation.ConclusionSIPE is a life-threatening but reversible condition requiring heightened awareness in emergency and prehospital settings. Prompt recognition, accurate differentiation from other aquatic and cardiopulmonary emergencies, and appropriate supportive care are critical to favorable outcomes. Further research is essential to develop standardized diagnostic criteria, explore genetic or physiologic predispositions, and guide evidence-based prevention and treatment protocols.

High altitude cerebral edema (HACE) is a rare but potentially fatal condition previously understudied in pediatric populations. We present a case of HACE in a previously healthy 10-y-old boy who rapidly developed neurologic symptoms at 4000 m on Mount Kilimanjaro. The child experienced headache, nausea, impaired consciousness, and ataxia before requiring assisted evacuation. Immediate descent of 2295 m resulted in complete recovery within 24 h with no long-term sequelae. A literature review of HACE in children revealed only 1 prior case series of 2 patients aged 12 and 16 y. This case report and literature review illustrate the challenges of recognizing and managing pediatric HACE in field conditions without medical support. Treatment guidelines for HACE in children suggest descent, supplemental oxygen, and dexamethasone, although these recommendations are extrapolated from adult data. Early recognition and descent remain the cornerstones of pediatric HACE management.

IntroductionThe United States Antarctic Program relies on a civilian-military partnership for medical evacuation (MEDEVAC). An attempt to comprehensively analyze US aeromedical evacuations from Antarctica, reconciling both civilian and Department of Defense records across multiple seasons, has not been described previously.MethodsWe retrospectively analyzed Antarctic MEDEVACs from 2015 to 2023 using United States Antarctic Program MEDEVAC records and Transportation Command Regulating and Command and Control Evacuation System (TRAC2ES) movement data. Deidentified aeromedical evacuation records involving a patient within/from Antarctica or labeled "Operation Deep Freeze" were obtained from the TRAC2ES database. National Science Foundation records were extracted in person at the University of Texas Medical Branch (UTMB). The authors extracted deidentified medical data, including medical history, diagnosis, medical treatments, destination, and enroute interventions. Datasets were reconciled using dates, origin/destination, diagnosis category, and narratives.ResultsSixty-nine TRAC2ES records and 93 UTMB records were included in the final analysis (n=162). Linkage identified 126 distinct movements: 36 cross-source matches, 33 TRAC2ES only, and 57 UTMB only. Patterns of MEDEVACs demonstrated austral-summer clustering with limited winter-over activity. The most common indication was musculoskeletal conditions (35 records), followed by gastrointestinal (18), genitourinary/reproductive (16), cardiac (15), neurologic (12), and respiratory (11) categories.ConclusionThis study suggests that the National Science Foundation, Department of Defense, and UTMB work cooperatively to transport patients with a wide variety of medical pathologies out of Antarctica. Dual-source reconciliation improves visibility across the evacuation continuum. Findings align with experience with disease nonbattle injuries in austere environments.

Shoulder dislocations are prevalent on Earth and pose unique challenges in spaceflight and spaceflight training, particularly during extravehicular activities (EVAs). This case report describes a 50-year-old male who experienced an anterior shoulder dislocation while performing an emergency egress exercise in a SpaceX EVA suit. The report describes the medical thought process, the operational constraints, and the reduction techniques employed to achieve a successful shoulder reduction without fully removing or damaging the suit. NASA estimates a high likelihood of shoulder injuries during long-duration lunar missions, emphasizing the importance of suit designs and rescue protocols. Quick and effective medical intervention is crucial, as delays can lead to complications. This Earth-based case report provides some insight into reduction technique considerations for suited spaceflight operations in varying gravitational environments.