Wilderness & Environmental Medicine

INTRODUCTION: Most of the literature on sailing injuries is centered on competitive sailing, often involving a single regatta. The aims of this study were to provide a description of the types of injuries and illnesses sustained during amateur offshore cruising events, estimate their incidence, and investigate potential risk factors for injuries. METHODS: We conducted a cross-sectional survey of self-reported sailing-related injuries and health issues during 4 different events organized by the World Cruising Club between 2014 and 2015...

INTRODUCTION: Wilderness medicine education is one of the fastest growing facets of both graduate and undergraduate medical education. Currently, there are curriculum guidelines for both student electives and fellowships in wilderness medicine. However, there are no guidelines for resident elective curricula. The student/resident education committee of the Wilderness Medical Society (WMS) convened a task force to develop curriculum guidelines for these electives. METHODS: A survey of previously described core wilderness medicine topics was sent to a cohort of educators involved in wilderness medicine resident electives...

Jellyfish stings are the most common cause of marine envenomation in humans. Various species of box jellyfish have been identified around Penang Island, Malaysia, and these include multitentacled and four-tentacled box jellyfish (class Cubozoa). The typical syndrome following envenomation from these jellyfish has been poorly documented, posing a greater challenge when managing an unidentified jellyfish sting from Penang Island. We report a case of a 32-y-old man from Penang Island who was stung by an unidentified jellyfish while walking into the sea...

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INTRODUCTION: There is no published information on the epidemiology of wilderness rescues in California outside of national parks. The objective of this study was to investigate the epidemiology of wilderness search and rescue (SAR) missions in California and identify risk factors for individuals requiring rescue due to accidental injury, illness, or navigation errors in the California wilderness. METHODS: A retrospective review of SAR missions in California from 2018 to 2020 was conducted...

INTRODUCTION: Backcountry skiers and snowboarders are increasingly using avalanche airbags to improve safety. New safety devices can cause risk compensation, the concept in which users take more risks given the larger safety margin provided by the device. This may limit overall benefits. We sought to elucidate attitudes toward risk-taking behaviors and risk compensation in backcountry users relating to avalanche airbags. METHODS: A convenience sample of 144 backcountry skiers and snowboarders was surveyed after a backcountry tour in the Wasatch Mountains of Utah and the Tetons of Wyoming during the winter 2020-21 season...

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The past few decades of military experience have brought major advances in the prehospital care of patients with trauma. A focus on early hemorrhage control with aggressive use of tourniquets and hemostatic gauze is now generally accepted. This narrative literature review aims to discuss external hemorrhage control and the applicability of military concepts in space exploration. In space, environmental hazards, spacesuit removal, and limited crew training could cause significant time delays in providing initial trauma care...

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Ciguatera is a common marine, toxin-borne illness caused by the consumption of fish that contain toxins that activate voltage-sensitive sodium channels. The clinical manifestations of ciguatera are typically self-limited, but chronic symptoms may occur in a minority of patients. This report describes a case of ciguatera poisoning with chronic symptoms, including pruritus and paresthesias. A 40-y-old man was diagnosed with ciguatera poisoning after consuming amberjack while vacationing in the US Virgin Islands...

INTRODUCTION: Annually, approximately 250,000 people climb Mount Fuji in Japan. Nonetheless, only few studies have examined the prevalence of falls and related factors on Mount Fuji. METHODS: We conducted a questionnaire survey of 1061 participants (703 men and 358 women) who had climbed Mount Fuji. The following information was collected: age, height, body weight, luggage weight, experience on Mount Fuji, experience on other mountains, presence or absence of a tour guide, single-day climber or overnight-stay lodger, information on the downhill trail (volcanic gravel, long distance, and the risk of falls), presence or absence of trekking poles, shoe type, shoe sole condition, and fatigue feeling...

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Systemic symptoms resulting from exposure to members of the Lepidoptera order, such as moths, butterflies, and caterpillars, are known as lepidopterism. Most cases of lepidopterism are mild and result from dermal exposure to urticating hairs; ingestion is less common and generally more medically significant because the hairs may get embedded in the patient's mouth, hypopharynx, or esophagus, leading to dysphagia, drooling, edema, and possible airway obstruction. In previous cases of symptomatic caterpillar ingestion reported in the literature, extensive efforts, including direct laryngoscopy, esophagoscopy, and bronchoscopy, were undertaken to remove these hairs...

Women increasingly participate in outdoor activities in wilderness and remote environments. We performed a literature review to address diagnostic and therapeutic considerations during first-trimester pregnancy for remote multiday travel. Pretrip planning for pregnant patients traveling outside access to advanced medical care should include performing a transvaginal ultrasound to confirm pregnancy location and checking D rhesus status. We discuss the risk of potential travel-related infections and recommended vaccinations prior to departure based on destination...

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INTRODUCTION: Point-of-care ultrasound (POCUS) is utilized in austere environments because it is lightweight, durable, battery powered, and portable. In austere settings, weight and space constraints are limitations to carrying dedicated ultrasound gel. Few studies have assessed commonly carried liquids as gel alternatives. The study objective was to assess the suitability of common food and personal care products as ultrasound coupling agents compared with that of commercial gel. METHODS: A noninferiority study compared 9 products to commercial gel...

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Transient acute kidney injury (AKI) following ultraendurance footraces is a common biochemical diagnosis. However, severe AKI requiring renal replacement therapy is uncommon in ultramarathoners. We report 4 runners (3 men; mean age, 44 ± 3 y) who required prolonged (10-42 d) dialysis following the Western States 100 Mile Endurance Run over a 3-y span (0.38% of starters). The maximum ambient temperatures on the race day ranged from 36.6° to 38.3°C. The runners presented to local hospitals 17 to 32 h after running, with laboratories confirming rhabdomyolysis, hyponatremia (mean serum sodium concentration, 127±2 mmol⋅L-1 ), and AKI (mean serum creatinine concentration, 8...