BOOK
Auerbach's Wilderness Medicine E-Book
Paul S. Auerbach | Tracy A Cushing | N. Stuart Harris
(2016)
Additional Information
Book Details
Abstract
Now in its 7th edition, Auerbach’s Wilderness Medicine continues to help you quickly and decisively manage medical emergencies encountered in any wilderness or other austere setting! World-renowned authority Dr. Paul Auerbach and 2 new associate editors have assembled a team of experts to offer proven, practical, visual guidance for effectively diagnosing and treating the full range of issues that can occur in situations where time and resources are scarce. This indispensable resource equips physicians, nurses, advanced practice providers, first responders, and rescuers with the essential knowledge and skills to effectively address and prevent injuries and illnesses – no matter where they happen!
- Face any medical challenge in the wilderness with expert guidance from hundreds of outstanding world experts edited by Dr. Auerbach and 2 new associate editors, Drs.Tracy Cushing and N. Stuart Harris.
- New and expanded chapters with hundreds of new photos and illustrative drawings help increase your visual understanding of the material.
- Acquire the knowledge and skills you need with revised chapters providing expanded discussions of high-altitude medicine, improvisation, technical rescue, telemedicine, ultrasound, and wilderness medicine education.
- Ten new chapters cover Acute High-Altitude Medicine and Pathophysiology; High Altitude and Pre-Existing Medical Conditions; Cycles, Snowmobiles, and other Wilderness Conveyances; Medical Wilderness Adventure Races (MedWAR); Canyoneering and Canyon Medicine; Evidence-Based Wilderness Medicine; National Park Service Medicine; Genomics and Personalized Wilderness Medicine; Forestry; and Earth Sciences.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| IFC_Expert Consult page | IFC2 | ||
| Auerbach's Wilderness Medicine, 2-Volume Set | i | ||
| Copyright Page | iv | ||
| Contributors | v | ||
| Foreword | xix | ||
| References | xxi | ||
| Preface | xxiii | ||
| Table Of Contents | xxv | ||
| Video Contents | xxix | ||
| Photo Credits | xxxi | ||
| Front and Back Cover, Spine, Part 17 | xxxi | ||
| Parts 1 to 5, 9, 12, 14, 16 | xxxi | ||
| Part 6 | xxxi | ||
| Parts 7, 15 | xxxi | ||
| Part 8 | xxxi | ||
| Part 10 | xxxi | ||
| Part 11 | xxxi | ||
| Part 13 | xxxi | ||
| 1 Mountain Medicine | 1 | ||
| 1 High-Altitude Physiology | 2 | ||
| Definitions | 2 | ||
| High Altitude (1500 to 3500 meters [4921 to 11,483 feet]) | 2 | ||
| Very High Altitude (3500 to 5500 meters [11,483 to 18,045 feet]) | 2 | ||
| Extreme Altitude (higher than 5500 meters [18,045 feet]) | 2 | ||
| The Environment of High Altitude | 2 | ||
| Acclimatization to High Altitude | 2 | ||
| Ventilation | 4 | ||
| Circulation | 4 | ||
| Systemic Circulation | 4 | ||
| Pulmonary Circulation | 5 | ||
| Cerebral Circulation | 5 | ||
| Blood | 5 | ||
| Hematopoietic Responses to Altitude | 5 | ||
| Oxyhemoglobin Dissociation Curve | 6 | ||
| Tissue Changes | 7 | ||
| Exercise | 7 | ||
| Training at High Altitude | 8 | ||
| References | 8 | ||
| References | 8.e1 | ||
| 2 High-Altitude Medicine and Pathophysiology | 8 | ||
| High-Altitude Syndromes | 8 | ||
| Acute Cerebral Hypoxia | 8 | ||
| High-Altitude Headache | 9 | ||
| Pathophysiology | 10 | ||
| Prevention and Treatment | 10 | ||
| Acute Mountain Sickness | 10 | ||
| Epidemiology and Risk Factors | 10 | ||
| Diagnosis | 12 | ||
| Differential Diagnosis | 12 | ||
| Pathophysiology | 13 | ||
| Mechanisms of Acute Mountain Sickness. | 13 | ||
| The Tight-Fit Hypothesis. | 13 | ||
| Intracranial Pressure. | 13 | ||
| Treatment | 13 | ||
| Prevention | 15 | ||
| Acetazolamide Prophylaxis. | 16 | ||
| Dexamethasone Prophylaxis. | 16 | ||
| Other Preventive Agents. | 17 | ||
| High-Altitude Cerebral Edema | 17 | ||
| Clinical Presentation | 17 | ||
| Pathophysiology | 18 | ||
| Treatment and Prevention | 19 | ||
| Focal Neurologic Conditions without Acute Mountain Sickness or Cerebral Edema | 19 | ||
| Cerebrovascular Accident (Stroke) | 19 | ||
| Cognitive Changes at High Altitude | 19 | ||
| High-Altitude Pulmonary Edema | 20 | ||
| Clinical Presentation | 20 | ||
| Hemodynamics | 21 | ||
| Laboratory Studies | 21 | ||
| Radiographic Findings | 21 | ||
| Pathologic Findings | 21 | ||
| Mechanisms of High-Altitude Pulmonary Edema | 22 | ||
| Role of Pulmonary Hypertension. | 22 | ||
| Overperfusion and Capillary Leak. | 23 | ||
| Alveolar Fluid Balance. | 23 | ||
| Control of Ventilation. | 23 | ||
| Susceptibility to High-Altitude Pulmonary Edema | 23 | ||
| Genetics of High-Altitude Pulmonary Edema | 24 | ||
| Treatment | 24 | ||
| Prevention | 25 | ||
| Problems of Lifelong or Long-Term Residents of High Altitude | 25 | ||
| Reentry Pulmonary Edema. | 25 | ||
| Chronic Mountain Sickness. | 25 | ||
| Symptomatic High-Altitude Pulmonary Hypertension. | 26 | ||
| Children at High Altitude | 26 | ||
| Other Medical Concerns at High Altitude | 26 | ||
| Carbon Monoxide Poisoning | 26 | ||
| High-Altitude Deterioration | 26 | ||
| High-Altitude Syncope | 27 | ||
| Alcohol at High Altitude | 27 | ||
| Thrombosis: Coagulation and Platelet Changes | 27 | ||
| Peripheral Edema | 28 | ||
| Immunosuppression | 28 | ||
| Sleep at High Altitude | 28 | ||
| Periodic Breathing | 28 | ||
| Pharmaceutical Aids for Sleep | 28 | ||
| High-Altitude Pharyngitis, Bronchitis and Cough | 29 | ||
| References | 29 | ||
| References | 29.e1 | ||
| 3 High Altitude and Preexisting Medical Conditions | 29 | ||
| A General Framework for Evaluating Travelers with Underlying Medical Conditions | 30 | ||
| Mitigating Risk with Planned Ascent | 30 | ||
| Specific Medical Conditions at High Altitude | 30 | ||
| Respiratory Diseases | 30 | ||
| Chronic Obstructive Pulmonary Disease | 30 | ||
| Interstitial Lung Disease | 32 | ||
| Asthma | 32 | ||
| Cystic Fibrosis | 32 | ||
| Pulmonary Hypertension | 33 | ||
| Sleep-Disordered Breathing | 33 | ||
| Cardiovascular Conditions | 33 | ||
| Hypertension | 33 | ||
| Coronary Artery Disease | 34 | ||
| Heart Failure | 34 | ||
| Congenital Heart Disease | 35 | ||
| Arrhythmia | 35 | ||
| Hematologic Diseases | 35 | ||
| Hypercoagulable States | 35 | ||
| Hemoglobinopathy | 36 | ||
| Anemia | 36 | ||
| Polycythemia Vera | 36 | ||
| Neurologic Disorders | 36 | ||
| Headaches | 36 | ||
| Seizures | 36 | ||
| Cerebrovascular Diseases | 36 | ||
| Diabetes Mellitus | 36 | ||
| Acclimatization and Risk of Altitude Illness | 36 | ||
| Insulin Requirements and Glycemic Control | 37 | ||
| Glucometer Function | 37 | ||
| Insulin Pumps | 37 | ||
| Retinal Disease | 37 | ||
| Obesity | 37 | ||
| Gastrointestinal Diseases | 38 | ||
| Gastrointestinal Bleeding | 38 | ||
| Cirrhosis | 38 | ||
| Ophthalmologic Conditions | 38 | ||
| Refractive Error Surgery Patients | 38 | ||
| Glaucoma | 38 | ||
| Pregnancy | 38 | ||
| Medication Considerations in High-Altitude Travelers with Underlying Medical Problems | 39 | ||
| References | 39 | ||
| References | 39.e1 | ||
| 4 Avalanches | 40 | ||
| Properties of Snow | 40 | ||
| Snow Climates | 40 | ||
| Physical Properties | 40 | ||
| Kinetic Metamorphism | 42 | ||
| Equilibrium Metamorphism | 42 | ||
| Avalanche Types | 43 | ||
| Slab Avalanche Formation | 43 | ||
| Mechanical Properties: How Snow Deforms on a Slope | 44 | ||
| Avalanche Dynamics | 45 | ||
| Identifying Avalanche Terrain | 47 | ||
| Slope Angle | 47 | ||
| Orientation | 47 | ||
| Avalanche Terrain Paths | 47 | ||
| Vegetation | 48 | ||
| Factors That Contribute to Avalanche Formation | 48 | ||
| Snowfall | 48 | ||
| Snowfall Intensity | 48 | ||
| Rain | 48 | ||
| New Snow Density and Crystal Type | 48 | ||
| Wind Speed and Direction | 48 | ||
| Temperature | 49 | ||
| Depth of Snow Cover | 49 | ||
| Weak Layers | 49 | ||
| Safe Travel in Avalanche Terrain | 50 | ||
| Identifying Avalanche Terrain | 50 | ||
| Route Finding | 50 | ||
| Crossing Avalanche Slopes | 50 | ||
| Stability Evaluation Tests | 50 | ||
| Avalanche Rescue Equipment | 53 | ||
| Shovel | 53 | ||
| Probe | 53 | ||
| Avalanche Rescue Transceiver | 53 | ||
| Avalanche Airbag | 54 | ||
| AvaLung | 57 | ||
| Avalanche Rescue | 58 | ||
| Individual Rescue (Self-Rescue) | 58 | ||
| Escaping to the Side | 58 | ||
| Actions during the Slide | 58 | ||
| Small-Team Rescue (Companion Rescue) | 58 | ||
| Calling for Help | 58 | ||
| Marking the Last-Seen Area | 58 | ||
| Initiate Search and Scan for Clues | 58 | ||
| Rescue Transceivers | 58 | ||
| Probing after Transceiver Search | 59 | ||
| Shoveling Techniques | 59 | ||
| Strategic Shoveling. | 59 | ||
| V-Shaped Conveyor Belt. | 59 | ||
| Calling for Professional Resources | 59 | ||
| Professional Rescue | 59 | ||
| Incident Command System | 59 | ||
| Organized Probing Search Techniques | 60 | ||
| Avalanche Rescue Dogs | 61 | ||
| RECCO | 61 | ||
| The Avalanche Victim | 61 | ||
| Statistics of Avalanche Burials | 62 | ||
| Rescue Statistics | 64 | ||
| Avalanche Victim Physiology and Medical Treatment after Rescue | 65 | ||
| Morbidity and Mortality | 65 | ||
| Respiratory Physiology of Avalanche Burial | 66 | ||
| Medical Treatment and Resuscitation of Avalanche Burial Victims | 67 | ||
| Hypothermia in the Avalanche Burial Victim | 69 | ||
| Summary | 70 | ||
| Acknowledgments | 71 | ||
| References | 71 | ||
| References | 71.e1 | ||
| 5 Lightning-Related Injuries and Safety | 71 | ||
| Historical Overview | 71 | ||
| Modern Lightning Myths and Misconceptions | 73 | ||
| Lightning Lore | 73 | ||
| Medical Myths and Misconceptions | 74 | ||
| Meteorologic Lore | 75 | ||
| Myths Regarding Electric Current Conduction | 75 | ||
| Miscellaneous Lore | 76 | ||
| Other Specific Myths and Misconceptions | 76 | ||
| Incidence of Injury | 77 | ||
| U.S. Lightning Casualties and Lightning | 77 | ||
| Global Lightning Casualties and Lightning | 78 | ||
| Trends in Lightning Fatalities | 79 | ||
| Conclusions | 81 | ||
| Early Scientific Studies and Invention of the Lightning Rod | 81 | ||
| Physics of Lightning Stroke | 83 | ||
| Lightning Discharge | 83 | ||
| Diameter and Temperature of Lightning | 84 | ||
| Forms of Lightning | 84 | ||
| Thunder | 84 | ||
| Mechanisms of Injury by Lightning* | 85 | ||
| Electrical Injury Physics Revisited | 85 | ||
| Concepts in Electricity | 85 | ||
| Technical Electricity Supply vs. Lightning Current | 85 | ||
| Mechanisms of Injury | 85 | ||
| General Conduction Effects | 85 | ||
| Specific Strike Mechanisms | 87 | ||
| Direct Strike. | 87 | ||
| Contact (Touch Potential) Injury. | 87 | ||
| Side Flash. | 87 | ||
| Earth Potential Rise. | 87 | ||
| Upward Streamers. | 87 | ||
| Barotrauma and Blunt Injury from Lightning | 88 | ||
| Pathophysiology of Lightning Injury | 89 | ||
| Electrical Injury Physics Revisited | 89 | ||
| Electric Field Effects | 89 | ||
| Characteristics of Lightning Current vs. Industrial Electricity | 90 | ||
| Estimation of Lightning Currents | 91 | ||
| Estimates of Streamer Currents | 92 | ||
| Behavior of Electric Current in Tissue | 92 | ||
| Magnetic Field Effects | 93 | ||
| X-Ray and Gamma Ray Effects | 93 | ||
| The Faraday Cage | 93 | ||
| Injuries From Lightning | 93 | ||
| Initial Presentation Model | 94 | ||
| Minor Injury | 94 | ||
| Moderate Injury | 94 | ||
| Severe Injury | 94 | ||
| Neurologic Outcome Model | 94 | ||
| Immediate and Transient Symptoms | 94 | ||
| Immediate and Prolonged or Permanent Symptoms | 94 | ||
| Possible Delayed Neurologic Syndromes | 94 | ||
| Lightning-Linked Secondary Trauma from Falls or Blast | 95 | ||
| Cardiopulmonary Arrest and Cardiac Injuries* | 95 | ||
| Cardiac Arrest | 95 | ||
| Other Cardiac Injuries | 95 | ||
| Pulmonary Injuries | 95 | ||
| Neurologic Injuries | 95 | ||
| Central Nervous System Injury | 96 | ||
| Peripheral Nerve Injury* | 96 | ||
| Autonomic Nervous System Injury | 96 | ||
| Posttraumatic Headache | 96 | ||
| Burns | 96 | ||
| Entry, Exit, and Types of Burns | 96 | ||
| Blunt, Concussive, and Explosive (Blast) Injuries | 99 | ||
| Eye Injuries* | 100 | ||
| Ear Injuries | 100 | ||
| Fetal Survival | 100 | ||
| Hematologic Abnormalities | 101 | ||
| Endocrine and Sexual Dysfunction | 101 | ||
| Psychological and Neurocognitive Dysfunction* | 101 | ||
| Functional Issues | 101 | ||
| Memory Disturbance. | 101 | ||
| Concentration Disturbance (Adult Attention Deficit Disorder). | 101 | ||
| Cognitive Function. | 101 | ||
| Higher Executive Functioning. | 101 | ||
| Behavioral Issues | 101 | ||
| Emotional Lability and Aggression. | 101 | ||
| Sleep Disturbance. | 101 | ||
| Phobic Behavior. | 101 | ||
| Depression. | 101 | ||
| Other Behavioral Issues. | 102 | ||
| Recognition and Acute Treatment of Lightning Injuries | 102 | ||
| Diagnosis | 102 | ||
| Initial First Aid and Triage of Victims | 102 | ||
| History and Physical Examination | 103 | ||
| Laboratory Tests and Radiographic Examination | 103 | ||
| Treatment | 103 | ||
| Fluid Therapy | 103 | ||
| Fasciotomy Not Needed | 103 | ||
| Antibiotics and Tetanus Prophylaxis | 103 | ||
| Cardiovascular Therapy | 103 | ||
| Central Nervous System Injury* | 104 | ||
| Burns | 104 | ||
| Eye Injuries* | 104 | ||
| Ear Injuries | 104 | ||
| Pregnant Victims | 104 | ||
| Other Considerations | 104 | ||
| Pronouncing the Victim Dead | 104 | ||
| Long-Term Care‡ | 104 | ||
| Pain Control | 105 | ||
| Psychological Problems and Cognitive Deficits | 105 | ||
| Referral to Support Groups and Other Information Sources | 105 | ||
| Forensic Investigation | 105 | ||
| Case History | 105 | ||
| Scene Investigation | 105 | ||
| Environmental Signs of Direct Lightning Strike | 106 | ||
| Structural Signs of Direct Lightning Strike | 106 | ||
| Trace Evidence Signs of Direct Lightning Strike | 106 | ||
| Physical and/or Autopsy Examination | 106 | ||
| Special Procedures | 107 | ||
| Diagrams and Photographs | 107 | ||
| Radiographs | 107 | ||
| Histologic Examination | 107 | ||
| Toxicologic Studies | 107 | ||
| Collection of Evidence | 107 | ||
| Collation | 107 | ||
| Precautions for Avoiding Lightning Injury | 107 | ||
| Lightning Safety Guidelines* | 107 | ||
| Lightning Safety Plan | 107 | ||
| An Approaching Thunderstorm | 108 | ||
| End of Thunderstorm | 109 | ||
| Safe Places Inside | 109 | ||
| Buildings | 109 | ||
| Vehicles | 109 | ||
| Always Unsafe Outside | 110 | ||
| The Difficulty of Wilderness Situations | 110 | ||
| Safety of Large Groups | 110 | ||
| Lightning Protection in Situ | 111 | ||
| Controversies and Ongoing Research in Lightning Injury | 111 | ||
| Problems with Expert Reporting | 113 | ||
| Totality of the Injury | 113 | ||
| Presumption of Site of Injury | 113 | ||
| Limits to Reporting | 113 | ||
| Research Methodology Problems | 113 | ||
| Bias in Research | 113 | ||
| Experimental Vehicles | 114 | ||
| Equipment Requirements | 114 | ||
| Survival Statistics | 114 | ||
| Remote and Psychological Symptoms | 114 | ||
| Technical Matters | 114 | ||
| Electroporation | 115 | ||
| Sites of Injury in the Body | 115 | ||
| Predictability of Lightning and Forecasting | 115 | ||
| Lightning Danger Warnings | 115 | ||
| Lightning Exposure and Safety Behavior | 115 | ||
| Lightning Safety Research | 115 | ||
| Building and Vehicle Safety | 115 | ||
| Safe Distance to Lightning | 116 | ||
| Demographics | 116 | ||
| Lightning Detection and Data Applications | 116 | ||
| Detection | 116 | ||
| Applications | 116 | ||
| Direct Threat from Lightning | 117 | ||
| Indicator Lightning | 117 | ||
| Substitute Lightning | 117 | ||
| Covariate Lightning | 117 | ||
| References | 117 | ||
| References | 117.e1 | ||
| 2 Cold and Heat | 119 | ||
| 6 Thermoregulation | 120 | ||
| Conceptualizing the Thermoregulatory System | 120 | ||
| Basics of Core Temperature | 120 | ||
| Consequences of Altered Core Temperature | 121 | ||
| Monitoring Temperature of the Core and Other Sites | 122 | ||
| Monitoring the Core Temperature | 122 | ||
| Types of Thermometers | 122 | ||
| Measurement Sites | 122 | ||
| Estimating Mean Body Temperature | 123 | ||
| Physical Factors That Govern Heat Exchange: the Heat Balance Equation | 123 | ||
| Conductive Heat Exchange | 123 | ||
| Convective Heat Exchange | 124 | ||
| Radiative Heat Exchange | 124 | ||
| Evaporative Heat Exchange | 124 | ||
| Thermoregulatory Network | 124 | ||
| Peripheral Thermal Sensors | 124 | ||
| Central Thermal Sensors | 126 | ||
| Central Neural Structures Responsible for Controlling the Level of Body Temperature | 127 | ||
| Effector Responses | 128 | ||
| Vascular Adjustments | 128 | ||
| Central Signal | 128 | ||
| 3 Burns, Fire, and Radiation | 275 | ||
| 14 Wildland Fires | 276 | ||
| Wildland Fire Management and Technology | 276 | ||
| Wildland Fire Management Policies | 278 | ||
| Prescribed Fire and Wildland Fire Use | 280 | ||
| Wildland-Urban Interface: New Look at a Historical Problem | 280 | ||
| Nature of the Problem | 281 | ||
| Wildland-Urban Interface Lessons Learned | 287 | ||
| What Some Organizations Have to Offer the General Public | 287 | ||
| Wildland Fire Behavior | 288 | ||
| Urban and Wildland Fire Threats | 288 | ||
| Fire Behavior Knowledge: a Wildland Fire Early-Warning System | 289 | ||
| Physical Principles of Heat Transfer | 290 | ||
| Fundamental Wildland Fire Behavior Characteristics | 292 | ||
| Environmental Factors Influencing Wildland Fire Behavior | 294 | ||
| Fuel. | 294 | ||
| Weather. | 294 | ||
| Topography. | 295 | ||
| Extreme Fire Behavior | 295 | ||
| Wind-Driven Crown Fire. | 298 | ||
| Plume-Dominated or Convection-Dominated Crown Fire. | 298 | ||
| Value of Fire Danger Ratings | 298 | ||
| Fire-Related Injuries and Fatalities | 299 | ||
| Common Denominators of Fire Behavior on Fatality Fires | 300 | ||
| Nature of Injuries and Fatalities | 301 | ||
| Wildland Fires, Air Toxins, and Human Health | 303 | ||
| Wildland-Urban Interface Fire Survival: Principles and Techniques | 304 | ||
| LCES: the Key to Safe Procedures in Wildland Fire Environments | 304 | ||
| Eighteen “Watch Out!” Situations in the Wildland Fire Environment | 305 | ||
| Fifteen Structural “Watch Out!” Situations for the Wildland-Urban Interface | 306 | ||
| Taking Refuge in Vehicles, Buildings, and Protective Fire Shelters Used by Wildland Firefighters | 306 | ||
| Vehicles | 306 | ||
| Buildings | 307 | ||
| Protective Fire Shelters Used by Wildland Firefighters | 309 | ||
| Emergency Procedures during a Wildland Fire Entrapment or Burnover | 310 | ||
| Survival Option 1: Retreat From the Fire and Reach a Safe Haven | 312 | ||
| Survival Option 2: Burn Out a Safety Area | 312 | ||
| Survival Option 3: Hunker in Place | 312 | ||
| Survival Option 4: Pass Through the Fire Edge Into the Burned-Out Area | 313 | ||
| Wildland Fires and Human Behavior | 313 | ||
| Proper Clothing | 315 | ||
| Water Intake | 316 | ||
| Personal Gear | 316 | ||
| How to Report a Wildland Fire to Local Fire Protection Authorities | 316 | ||
| Portable Fire Extinguishers | 316 | ||
| Basic Wildland Fire Materials, Training Courses, and Other Information Resources | 317 | ||
| Concluding Remarks | 317 | ||
| Acknowledgments | 318 | ||
| References | 318 | ||
| References | 318.e1 | ||
| 15 Emergency Care of the Burned Patient | 319 | ||
| Epidemiology | 319 | ||
| Physiology | 319 | ||
| Types of Burns | 320 | ||
| Scald Burns | 320 | ||
| Flame Burns | 320 | ||
| Flash Burns | 321 | ||
| Contact Burns | 321 | ||
| Electrical Burns | 321 | ||
| Chemical Burns | 321 | ||
| Clinical Presentation | 322 | ||
| Estimation of Burn Size | 322 | ||
| Depth of Burn | 323 | ||
| First-Degree Burns | 323 | ||
| Superficial Partial-Thickness Burns | 323 | ||
| Deep Partial-Thickness Burns | 324 | ||
| Full-Thickness Burns | 324 | ||
| Fourth-Degree Burns | 324 | ||
| Treatment | 324 | ||
| Care at the Scene | 324 | ||
| Flame Burns | 324 | ||
| Scalds and Grease Burns | 324 | ||
| Airway | 324 | ||
| Other Injuries and Transport | 325 | ||
| Cold Application | 325 | ||
| Swelling | 325 | ||
| Electrical Burns | 325 | ||
| Chemical Burns | 325 | ||
| First Aid at the Scene for Smaller Burns | 325 | ||
| Technique of Burn Wound Debridement. | 326 | ||
| Emergency Department Care | 327 | ||
| Resuscitation | 327 | ||
| Escharotomy | 328 | ||
| Burn Wound Management | 329 | ||
| Outpatient Burns | 329 | ||
| First-Degree Burns | 329 | ||
| Superficial Partial-Thickness Burns | 330 | ||
| Deep Partial-Thickness and Full-Thickness Burns | 330 | ||
| Rehabilitation | 330 | ||
| Inhalation Injury | 331 | ||
| Carbon Monoxide Poisoning | 331 | ||
| 4 Trauma | 377 | ||
| 18 Wilderness Trauma and Surgical Emergencies* | 378 | ||
| Wilderness Trauma Emergencies Overview | 378 | ||
| History of Wilderness Medicine | 378 | ||
| Establishing Priorities in the Wilderness | 378 | ||
| Universal (Body Fluids) Precautions in the Wilderness | 379 | ||
| Primary Survey | 379 | ||
| Airway | 379 | ||
| Breathing and Ventilation | 379 | ||
| Circulation | 380 | ||
| Disability and Neurologic Assessment | 380 | ||
| Exposure and Environmental Control | 380 | ||
| Secondary Survey | 380 | ||
| History | 380 | ||
| Adjuncts to Surveys | 380 | ||
| Advances in Wilderness Care Adapted From Combat Medicine | 381 | ||
| Vascular Access | 381 | ||
| Prehospital Hemorrhage Control | 381 | ||
| Tourniquets | 381 | ||
| Hemostatic Dressings | 382 | ||
| Junctional Tourniquet | 382 | ||
| Wound Closure Device | 382 | ||
| Damage Control Resuscitation: Directly Addressing the Lethal Triad | 382 | ||
| Fresh Whole Blood | 383 | ||
| Organization of Walking Blood Bank | 383 | ||
| Collection of Fresh Whole Blood | 384 | ||
| Injuries to the Head, Face, and Neck | 384 | ||
| Head Injuries | 384 | ||
| Anatomy of the Head | 384 | ||
| Pathophysiology of Traumatic Brain Injury | 384 | ||
| Diagnosis of Head Injury | 385 | ||
| Head Injury Classification | 386 | ||
| Physical Examination for Head Injury | 386 | ||
| Resuscitation with Head Injury | 386 | ||
| Further Management of Head Injury | 387 | ||
| Skull Fracture | 388 | ||
| Penetrating Head Injuries | 388 | ||
| Evacuation of Patients with Head Injury | 388 | ||
| Neck Injuries | 388 | ||
| Blunt Neck Injuries | 388 | ||
| Anatomy of the Neck. | 389 | ||
| Classification and Recognition. | 389 | ||
| Physical Examination. | 389 | ||
| Spinal Cord Syndromes. | 389 | ||
| Immobilization. | 390 | ||
| Treatment. | 390 | ||
| Penetrating Neck Injuries | 390 | ||
| Injuries to the Thorax | 390 | ||
| Specific Thoracic Injuries | 391 | ||
| Rib Fractures | 391 | ||
| Pneumothorax | 392 | ||
| Chest Tube Placement. | 392 | ||
| Hemothorax | 392 | ||
| Flail Chest | 392 | ||
| Blunt Cardiac Injuries | 393 | ||
| Traumatic Asphyxia | 393 | ||
| Penetrating Chest Wounds | 393 | ||
| Injuries to the Abdomen | 394 | ||
| Blunt Abdominal Trauma | 394 | ||
| Anatomy of the Abdomen | 394 | ||
| Diagnosis | 394 | ||
| Physical Examination | 394 | ||
| Penetrating Abdominal Trauma | 394 | ||
| Gunshot Wounds | 394 | ||
| Shotgun Injuries | 394 | ||
| Stab Wounds | 394 | ||
| Pelvic Trauma | 395 | ||
| Extremity Trauma | 395 | ||
| Vascular Injuries | 395 | ||
| History of the Injury | 396 | ||
| Physical Examination | 396 | ||
| Treatment of Vascular Injuries | 396 | ||
| Traumatic Amputation | 396 | ||
| Crush Injuries and Rhabdomyolysis | 396 | ||
| Wilderness Surgical Emergencies | 397 | ||
| Acute Appendicitis | 398 | ||
| Acute Cholecystitis and Biliary Colic | 398 | ||
| Peptic Ulcer Disease | 398 | ||
| Diverticulitis | 398 | ||
| Mechanical Small Bowel Obstruction | 398 | ||
| Incarcerated Abdominal Wall Defect | 399 | ||
| Anal Fissure and Hemorrhoids | 399 | ||
| Urologic Emergencies | 399 | ||
| Renal Colic | 399 | ||
| Urinary Retention | 400 | ||
| Acute Scrotum | 400 | ||
| Prostatitis | 400 | ||
| Urinary Tract Infection | 400 | ||
| Skin and Soft Tissue Infections | 401 | ||
| Cellulitis | 401 | ||
| Lymphangitis | 401 | ||
| Cutaneous Abscess | 401 | ||
| Community-Acquired Methicillin-Resistant Staphylococcus Aureus Infections | 401 | ||
| Wound Myiasis (Maggot Infestation) | 402 | ||
| Sterility in the Austere Environment | 402 | ||
| Anesthesia in the Wilderness | 403 | ||
| References | 403 | ||
| References | 403.e1 | ||
| 19 Emergency Airway Management | 403 | ||
| Airway Anatomy | 403 | ||
| The Decision to Intubate | 403 | ||
| Failure of Airway Protection | 403 | ||
| Failure of Ventilation or Oxygenation | 404 | ||
| Anticipated Clinical Course | 404 | ||
| Basic Airway Management | 405 | ||
| Head Positioning | 405 | ||
| Recovery Position | 405 | ||
| Manual Airway Techniques | 405 | ||
| Head Tilt and Chin Lift | 405 | ||
| Jaw Thrust | 405 | ||
| Mechanical Airway Adjuncts | 406 | ||
| Oropharyngeal Airway | 406 | ||
| Nasopharyngeal Airway | 406 | ||
| Improvised Nasopharyngeal Airway | 407 | ||
| Airway Obstruction From a Foreign Body | 407 | ||
| Suction | 407 | ||
| Supplemental Oxygen | 407 | ||
| Ventilation | 407 | ||
| Mouth-to-Mouth Ventilation | 408 | ||
| Mouth-to-Nose Ventilation | 408 | ||
| Mouth-to-Mask Ventilation | 408 | ||
| Bag-Valve-Mask Ventilation | 408 | ||
| Advanced Airway Management | 408 | ||
| Predictors of Airway Difficulty | 409 | ||
| Predicting Difficult Direct Laryngoscopy with the LEMON Mnemonic | 409 | ||
| Predicting Difficult Bag-Mask Ventilation with the MOANS Mnemonic | 410 | ||
| Predicting Difficult Extraglottic Device Placement with the RODS Mnemonic | 410 | ||
| Predicting Difficult Cricothyrotomy with the SMART Mnemonic | 410 | ||
| Immediate Oral Intubation (“Crash” Intubation) | 410 | ||
| Rapid Sequence Intubation | 410 | ||
| Preparation | 410 | ||
| Preoxygenation | 410 | ||
| Pretreatment | 411 | ||
| Paralysis with Induction | 411 | ||
| Induction Agents. | 411 | ||
| Neuromuscular Blockade. | 411 | ||
| Positioning | 411 | ||
| Placement | 412 | ||
| Proof (Confirmation of Endotracheal Tube Placement) | 412 | ||
| Clinical Assessment | 412 | ||
| Pulse Oximetry | 413 | ||
| End-Tidal Carbon Dioxide Detection | 413 | ||
| Aspiration Devices | 413 | ||
| Postintubation Management | 413 | ||
| Alternative Strategies for the Difficult Airway | 413 | ||
| Awake Oral Intubation | 413 | ||
| Nasotracheal Intubation | 413 | ||
| Alternative Airway Adjuncts and Techniques | 414 | ||
| Laryngeal Mask Airway | 414 | ||
| Combitube | 414 | ||
| King LT | 415 | ||
| Video Laryngoscopy | 415 | ||
| Fiberoptic Intubation | 416 | ||
| Digital Intubation | 416 | ||
| Surgical Airway Management | 416 | ||
| Cricothyrotomy | 416 | ||
| Standard Surgical Cricothyrotomy | 416 | ||
| Rapid Four-Step Cricothyrotomy | 418 | ||
| Improvised Cricothyrotomy | 418 | ||
| Needle Cricothyrotomy with Percutaneous Transtracheal (Translaryngeal) Jet Ventilation | 418 | ||
| Airway Equipment for the Wilderness | 419 | ||
| References | 419 | ||
| References | 419.e1 | ||
| 20 Management of Facial Injuries | 420 | ||
| History and Examination of Facial Injuries | 420 | ||
| Diagnosis and Treatment of Facial Injuries | 420 | ||
| Temporomandibular Joint Disorders | 420 | ||
| Temporomandibular Joint Dislocation | 420 | ||
| Diagnosis. | 421 | ||
| Treatment. | 421 | ||
| Internal Derangements of the Temporomandibular Joint | 423 | ||
| Diagnosis. | 423 | ||
| Treatment. | 423 | ||
| Epistaxis | 423 | ||
| Evaluation | 424 | ||
| Treatment | 424 | ||
| Facial Bone Fractures | 425 | ||
| Upper Face Fractures | 426 | ||
| Nasal Fractures. | 426 | ||
| Frontal Sinus Fractures. | 428 | ||
| Naso-Orbito-Ethmoid Fractures. | 429 | ||
| Midface Fractures | 429 | ||
| Orbital Fractures. | 429 | ||
| Zygomaticomaxillary Complex Fractures (Malar Fractures). | 429 | ||
| Zygomatic Arch Fractures. | 429 | ||
| Le Fort Fracture of the Maxilla. | 429 | ||
| Lower Face Fractures | 430 | ||
| Fractures of the Mandible. | 430 | ||
| Soft Tissue Injuries | 431 | ||
| Treatment | 431 | ||
| Injuries to the Lips | 432 | ||
| Tongue Lacerations | 432 | ||
| Injuries to the Eyelid | 432 | ||
| Injuries to the Nose | 433 | ||
| Injuries to the Ear | 433 | ||
| Injuries to the Cheek | 435 | ||
| Foreign Bodies in the Nose and Ear | 437 | ||
| Wilderness Medical Kit for Facial Trauma | 439 | ||
| Prevention of Facial Trauma | 439 | ||
| References | 440 | ||
| References | 440.e1 | ||
| 21 Wound Management | 440 | ||
| Types of Wounds and Definitions | 440 | ||
| Clinical Presentation | 441 | ||
| Treatment | 442 | ||
| Cleansing Techniques | 442 | ||
| Vascular Injuries | 443 | ||
| Anesthesia | 444 | ||
| Wound Closure Techniques | 445 | ||
| Dressings and Aftercare | 448 | ||
| Complications | 449 | ||
| Wound Care Kit | 450 | ||
| References | 450 | ||
| References | 450.e1 | ||
| 22 Wilderness Orthopedics | 450 | ||
| Scope of the Problem | 451 | ||
| Physical Examination | 451 | ||
| Vascular Function | 451 | ||
| Nerve Function | 451 | ||
| Skeletal Function | 451 | ||
| Joint Function | 452 | ||
| Potentially Life-Threatening Musculoskeletal Injuries | 453 | ||
| Spinal Injuries | 453 | ||
| Cervical Spine Injuries | 453 | ||
| Thoracolumbar Spine Injuries | 453 | ||
| Spinal Assessment (Clearing the Spine) | 454 | ||
| Spinal Immobilization | 454 | ||
| Pelvic Injuries | 455 | ||
| General Considerations in Extremity Injuries Techniques for Managing Extremity Injuries | 455 | ||
| Splinting Techniques | 455 | ||
| Reduction and Relocation Maneuvers | 458 | ||
| Traction Pins | 458 | ||
| External Fixators | 459 | ||
| Open Fractures of the Extremities | 461 | ||
| Classification of Open Fractures of the Extremities | 461 | ||
| Type I Fracture | 461 | ||
| Type II Fracture | 461 | ||
| Type III Fracture. | 461 | ||
| Subtype IIIA Fracture. | 461 | ||
| Subtype IIIB Fracture. | 461 | ||
| Subtype IIIC Fracture. | 461 | ||
| Management of Open Fractures of the Extremities | 462 | ||
| Significant Soft Tissue Injuries of the Extremities | 462 | ||
| Tourniquets for Extremity Injuries | 462 | ||
| Amputation of Injured Extremities | 462 | ||
| Compartment Syndrome | 462 | ||
| RICE Principle | 463 | ||
| Upper Extremity Injuries | 463 | ||
| Shoulder Girdle Injuries | 463 | ||
| Clavicular Fracture | 463 | ||
| Scapular Fracture | 464 | ||
| Sternoclavicular Joint Dislocation | 464 | ||
| Acromioclavicular Joint Dislocation | 464 | ||
| Glenohumeral Joint Dislocation | 465 | ||
| Arm and Elbow Fractures | 467 | ||
| Proximal Humeral Fracture | 467 | ||
| Humeral Fracture | 468 | ||
| Fracture Around the Elbow (Distal Humerus, Olecranon, Radial Neck or Head) | 468 | ||
| Elbow Dislocation | 470 | ||
| Forearm, Wrist, and Hand Fractures | 471 | ||
| Radial Fracture | 471 | ||
| Ulnar Fracture | 471 | ||
| Wrist and Carpal Fractures | 472 | ||
| Metacarpal Fracture | 472 | ||
| Metacarpophalangeal Joint Dislocation | 473 | ||
| Fractures of the Phalanges | 474 | ||
| Soft Tissue Injuries of the Wrist, Hand, and Digits | 475 | ||
| Hip and Leg Injuries | 475 | ||
| Femoral Fracture | 475 | ||
| Hip Dislocation | 476 | ||
| Knee and Lower Leg Injuries | 477 | ||
| Distal Femoral or Patellar Fracture | 477 | ||
| Knee Dislocation | 478 | ||
| Tibial and Fibular Fractures | 478 | ||
| Ankle and Foot Injuries | 479 | ||
| Ankle and Foot Fractures | 479 | ||
| Ankle Dislocation or Sprain | 479 | ||
| Hindfoot Dislocation | 481 | ||
| Midfoot Dislocation | 481 | ||
| Tarsal Fracture | 482 | ||
| Metatarsal Fracture | 482 | ||
| Fracture of the Phalanges of the Toes | 482 | ||
| Metatarsophalangeal and Interphalangeal Joint Dislocations | 482 | ||
| Other Soft Tissue and Musculoskeletal Injuries | 483 | ||
| Intraarticular Knee Disruption | 483 | ||
| Achilles Tendon Rupture | 484 | ||
| Hamstring Strain or Tear | 484 | ||
| Joint or Bursal Effusions | 484 | ||
| Overuse Syndromes and Special Considerations | 484 | ||
| Plantar Fasciitis | 484 | ||
| Carpal Tunnel Syndrome | 484 | ||
| Stress Fractures | 485 | ||
| Bursitis, Inflammation, and Irritation | 485 | ||
| Spinal Disorders | 485 | ||
| Corticosteroid Injections | 486 | ||
| Corticosteroid Medications | 487 | ||
| Risks and Side Effects of Corticosteroid Injections | 487 | ||
| Knee Joint Injection | 487 | ||
| Shoulder Injections | 487 | ||
| Subacromial Joint Injection | 487 | ||
| Glenohumeral Joint Injection | 487 | ||
| Acromioclavicular Joint Injection | 488 | ||
| Trochanteric Bursitis Injection | 488 | ||
| Olecranon Bursitis Injection | 488 | ||
| Medial and Lateral Epicondylitis Injection | 488 | ||
| Iliotibial Band Injection | 488 | ||
| Pes Anserine Bursitis Injection | 488 | ||
| Prepatellar Bursitis Injection | 489 | ||
| Plantar Fasciitis Injection | 489 | ||
| Field Block | 489 | ||
| Hematoma Block | 489 | ||
| Returning to the Wilderness after Total Joint Replacement | 489 | ||
| Prosthetics in the Wilderness | 490 | ||
| New Technologies for Casting and Bracing | 491 | ||
| Decisions About Evacuation | 492 | ||
| References | 492 | ||
| References | 492.e1 | ||
| 23 Splints and Slings | 492 | ||
| Spine Immobilization | 492 | ||
| Indications for Spine Immobilization | 492 | ||
| Benefits of Spine Immobilization | 493 | ||
| Risks of Spine Immobilization | 493 | ||
| Contraindications for Spine Immobilization | 494 | ||
| Guidelines for Spine Immobilization | 494 | ||
| Cervical Spine Immobilization Technique | 494 | ||
| C-Spine Immobilization Device | 495 | ||
| Special Considerations | 495 | ||
| Improvisational Techniques | 495 | ||
| Thoracolumbar Immobilization | 496 | ||
| Full Spine Immobilization | 496 | ||
| Splinting of the Extremities | 499 | ||
| Upper Extremity Splinting | 499 | ||
| Lower Extremity Splinting | 499 | ||
| Types of Extremity Splints | 500 | ||
| Rigid Splints | 500 | ||
| Soft Splints | 502 | ||
| SAM Splints | 503 | ||
| Improvised Extremity Splints | 503 | ||
| Techniques of Splinting | 503 | ||
| Pelvic Splinting | 503 | ||
| Hip and Femur Splinting | 504 | ||
| Ankle Splinting | 505 | ||
| Shoulder Dislocation | 505 | ||
| Humerus Shaft Injury | 505 | ||
| Elbow Dislocation | 505 | ||
| Elbow Fracture | 505 | ||
| Wrist Fracture | 505 | ||
| Metatarsal Fractures | 505 | ||
| Thumb Injuries | 505 | ||
| Finger Injuries | 505 | ||
| Femoral Fracture | 505 | ||
| Knee Injuries | 505 | ||
| Leg Fractures | 517 | ||
| Ankle and Foot Injuries | 517 | ||
| References | 517 | ||
| References | 517.e1 | ||
| 24 Taping and Bandaging | 517 | ||
| Taping | 518 | ||
| Types of Tape | 518 | ||
| Skin Preparation | 518 | ||
| Ankle Taping | 519 | ||
| Toe Taping | 519 | ||
| Lower-Leg Taping | 519 | ||
| Knee Taping | 519 | ||
| Patella Taping | 519 | ||
| Finger Taping | 519 | ||
| Thumb Taping | 521 | ||
| Wrist Taping | 521 | ||
| Elbow Taping | 521 | ||
| Shoulder Taping | 521 | ||
| Bandaging | 523 | ||
| Types of Bandages | 523 | ||
| Securing Bandages | 523 | ||
| Ankle and Foot Bandaging | 523 | ||
| Knee Bandaging | 523 | ||
| Thigh and Groin Bandaging | 523 | ||
| Wrist and Hand Bandaging | 528 | ||
| Finger Bandaging | 528 | ||
| Thumb Bandaging | 528 | ||
| Shoulder Bandaging | 528 | ||
| Scalp Bandaging | 528 | ||
| Ear or Side of Head Bandaging | 532 | ||
| Eye Bandaging | 532 | ||
| References | 532 | ||
| References | 532.e1 | ||
| 25 Foot Problems and Care | 533 | ||
| Blisters of the Foot | 533 | ||
| Pathophysiologic Findings | 533 | ||
| Blister Prevention | 533 | ||
| Reduction of Movement Within the Footwear System | 534 | ||
| Increasing Movement Within Footwear Systems | 535 | ||
| Minimizing Moisture | 535 | ||
| Foot Preparation | 535 | ||
| Blister Prevention Compounds | 535 | ||
| Preventive Taping and Pads | 536 | ||
| Antiperspirants and Powders | 537 | ||
| Lubricants | 538 | ||
| Blister Treatment | 538 | ||
| General Taping Rules | 538 | ||
| Basic Blister Treatment | 539 | ||
| Open Blister Treatment | 540 | ||
| Toe Blisters | 540 | ||
| Heel Blisters | 541 | ||
| Ball-of-Foot Blisters | 542 | ||
| Subungual Hematomas | 543 | ||
| Advanced Blister Care Treatments | 544 | ||
| Blood-Filled Blisters | 545 | ||
| Infected Blisters | 545 | ||
| Subcallus Blisters | 545 | ||
| Common Foot and Ankle Injuries | 546 | ||
| Ligament Injuries | 546 | ||
| Soft Tissue Injuries | 547 | ||
| Achilles Tendinopathy | 547 | ||
| Plantar Fasciitis | 547 | ||
| Bone Injuries | 547 | ||
| Stress Fractures | 547 | ||
| Sesamoiditis | 547 | ||
| Orthotics | 548 | ||
| Bunions | 548 | ||
| Tinea Pedis | 548 | ||
| Plantar Warts | 548 | ||
| Hyperhidrosis | 549 | ||
| References | 549 | ||
| References | 549.e1 | ||
| 26 Hunting and Fishing Injuries | 549 | ||
| Hunting Injuries | 549 | ||
| Hunting in the United States | 550 | ||
| Types of Injuries Encountered | 550 | ||
| Tree Stand Injuries | 551 | ||
| Arrow Injuries | 551 | ||
| Injuries From Firearms | 552 | ||
| Nonpowder Firearms. | 552 | ||
| Powder Firearms. | 553 | ||
| Trap Injuries | 556 | ||
| Treatment of Hunting Injuries | 556 | ||
| Arrow Injuries | 558 | ||
| Gunshot Wounds | 558 | ||
| Myths About Gunshot Wounds. | 558 | ||
| Emergency Department Care. | 558 | ||
| Prevention of Hunting Injuries | 559 | ||
| Fishing Injuries | 560 | ||
| Fishhook Injuries | 560 | ||
| Fishing Spear Injuries | 563 | ||
| Other Fishing Injuries | 563 | ||
| References | 563 | ||
| References | 563.e1 | ||
| 27 Tactical Medicine | 563 | ||
| History of Tactical Medicine | 565 | ||
| Shared Principles of Military Tactical Combat Casualty Care and Civilian Tactical Medicine | 567 | ||
| Care Under Fire | 567 | ||
| Tactical Field Care | 568 | ||
| Combat Casualty Evacuation Care | 569 | ||
| Principles of Civilian Tactical Medicine | 569 | ||
| Team Health Management | 572 | ||
| Operational Casualty Care | 572 | ||
| Tactical Medical Equipment | 572 | ||
| Communication | 573 | ||
| Entry and Breaching Tools | 573 | ||
| Weapons Systems | 573 | ||
| Vision | 575 | ||
| Medical Threat Assessment | 575 | ||
| Forms and Documentation | 576 | ||
| Medical Personal Protective Equipment | 577 | ||
| Personal Supply Module | 577 | ||
| Basic Medical Module | 577 | ||
| Intermediate Medical Module | 578 | ||
| Advanced Medical Module | 578 | ||
| Major Trauma Module | 578 | ||
| Support Vehicle Module | 579 | ||
| Chemical, Biologic, Radiologic, or Nuclear Specialty Modules | 580 | ||
| The Tactical Mission | 580 | ||
| Reserve Programs | 580 | ||
| Uniforms and Personal Protective Gear | 580 | ||
| Education and Training Programs | 580 | ||
| Future of Tactical Medicine | 581 | ||
| References | 581 | ||
| References | 581.e1 | ||
| 28 Combat and Casualty Care | 582 | ||
| Background | 582 | ||
| Battlefield Medicine Versus Standard Civilian Prehospital Care | 582 | ||
| The Basics of Military Medicine | 582 | ||
| Joint Theater Trauma System and Registry | 582 | ||
| Military Medical Echelons of Care | 583 | ||
| Scopes of Practice for Military Medical Personnel | 584 | ||
| Medical Equipment Unique to the Military | 584 | ||
| Blast Injuries | 584 | ||
| Primary Blast Injury | 584 | ||
| Secondary Blast Injury | 585 | ||
| Tertiary Blast Injury | 585 | ||
| Quaternary Blast Injury | 585 | ||
| Quinary Blast Injury | 586 | ||
| Tourniquets and Hemostatic Agents | 586 | ||
| Management of the Airway in Combat and Civilian Trauma | 587 | ||
| Chest Trauma | 588 | ||
| Fluid Resuscitation | 588 | ||
| General Principles | 588 | ||
| Vascular Access | 588 | ||
| Fluid Selection and Dosing | 588 | ||
| Medication | 589 | ||
| Burns | 589 | ||
| Mild Traumatic Brain Injury | 589 | ||
| Initial Approach to Wound Care | 590 | ||
| Pain Management | 590 | ||
| Unique Aspects of Military Triage and Mass Casualties | 591 | ||
| Traumatic Emotional Stress: the Continuum of Effects | 591 | ||
| Clinical Aspects of Psychological Trauma | 591 | ||
| Sources of Personal Trauma | 591 | ||
| How are Military Stress Reactions Characterized? | 591 | ||
| Combat and Operational Stress Reaction | 591 | ||
| Acute Stress Disorder | 591 | ||
| Posttraumatic Stress Disorder | 592 | ||
| Which Treatments Work? | 592 | ||
| Telemedicine | 592 | ||
| Unexploded Ordnance | 592 | ||
| Death | 593 | ||
| Acknowledgment | 593 | ||
| References | 593 | ||
| References | 593.e1 | ||
| 29 Injury Prevention | 593 | ||
| Principles of Wilderness Injury and Prevention | 594 | ||
| The Injury Field: Basic Principles | 594 | ||
| The Continuum of Injury Prevention | 595 | ||
| Epidemiologic Factors: Human or Host, Agent, and Environment | 595 | ||
| Conceptual Models | 595 | ||
| Haddon’s Ten Strategies for Reducing Injuries | 595 | ||
| Environmental, Educational, and Enforcement Approaches to Injury Prevention | 595 | ||
| Environmental Approach | 596 | ||
| Educational Approach | 596 | ||
| Enforcement Approach | 596 | ||
| Social-Ecologic Model | 596 | ||
| Risk and Effect Modification in Injury Prevention Epidemiology | 597 | ||
| Active Versus Passive Injury Prevention Strategies | 597 | ||
| Morbidity and Mortality Statistics for Wilderness Injury | 597 | ||
| Putting Injury Prevention Into Practice | 598 | ||
| Planning | 598 | ||
| Preparation | 598 | ||
| Physical Preparation. | 598 | ||
| Mental Preparation. | 598 | ||
| Equipment Preparation. | 598 | ||
| Problem Anticipation | 598 | ||
| Physical Disabilities | 598 | ||
| Individual Factors and Injury Prevention | 599 | ||
| Specific Tools for Planning and Preparation in the Wilderness | 599 | ||
| Maps and Orienteering | 599 | ||
| Global Positioning System Devices | 599 | ||
| Communication Devices | 599 | ||
| Protective Gear | 600 | ||
| Clothing. | 601 | ||
| Foot and Hand Wear. | 601 | ||
| Helmets. | 602 | ||
| Goggles. | 602 | ||
| Body Armor. | 602 | ||
| Mouth Guards. | 602 | ||
| Avalanche-Specific Protective Gear. | 602 | ||
| Training and Education | 603 | ||
| Supervision and Buddy Systems. | 604 | ||
| Problem Anticipation: Acute Illness and Injury | 605 | ||
| First-Aid Training. | 605 | ||
| Medical Clearance. | 605 | ||
| Vaccinations and Prophylaxis. | 605 | ||
| First-Aid or Emergency Medical Supplies. | 605 | ||
| Medications. | 605 | ||
| Improvisation in Treatment. | 605 | ||
| Injury Prevention for the Genitourinary Tract. | 605 | ||
| Injury Prevention for the Feet. | 606 | ||
| The Physical Environment and Injury Prevention | 606 | ||
| Ultraviolet Exposure | 606 | ||
| Temperature Extremes | 607 | ||
| Cold Injury | 607 | ||
| Heat Illness | 608 | ||
| Immersion (Trench) Foot and Pernio (Chilblains) | 608 | ||
| Wind and Rain | 608 | ||
| Water | 609 | ||
| Snow | 609 | ||
| Hydration | 610 | ||
| Altitude | 612 | ||
| Bites and Stings | 612 | ||
| Toxic Exposures | 614 | ||
| Water, Germs, and Hygiene | 615 | ||
| Unique Risks of Select Wilderness Activities | 615 | ||
| Backpacking | 615 | ||
| Backpacks with External Frames | 615 | ||
| Backpacks with Internal Frames | 615 | ||
| Backpack Lifting | 615 | ||
| Backpacks and Children | 615 | ||
| Hiking | 615 | ||
| Hammock Safety | 616 | ||
| Hunting | 616 | ||
| Horseback Riding | 616 | ||
| Climbing | 616 | ||
| References | 616 | ||
| References | 616.e1 | ||
| 5 Animals and Zoonoses | 617 | ||
| 30 Bites and Injuries Inflicted by Wild and Domestic Animals | 618 | ||
| General Epidemiology | 618 | ||
| Typical Victim | 619 | ||
| Circumstances Surrounding and Prevention of Animal Bites: Animal Behavior | 620 | ||
| Basic Principles for Avoiding Animal Bites | 620 | ||
| Evaluation and Treatment of Injuries | 622 | ||
| Out-of-Hospital Care | 622 | ||
| Hospital Care | 623 | ||
| Wound Management | 624 | ||
| Wound Closure and Infection Risk Factors | 624 | ||
| Bites of the Hand | 624 | ||
| Puncture Wounds | 625 | ||
| Facial and Scalp Wounds | 625 | ||
| Follow-Up Care | 625 | ||
| Infection: Zoonoses and Rabies | 625 | ||
| Rabies | 625 | ||
| Other Neurotropic Infections | 626 | ||
| Indications for Wound Culture | 626 | ||
| Prophylactic Antibiotics | 626 | ||
| Tetanus Prophylaxis | 626 | ||
| General Complications | 627 | ||
| Septic Complications | 627 | ||
| Allergic Reactions | 627 | ||
| Psychiatric Consequences of Animal Attacks | 627 | ||
| Wild Animal Attacks | 627 | ||
| Canines | 628 | ||
| Coyotes | 628 | ||
| Wolves | 628 | ||
| Foxes | 629 | ||
| Hyenas | 629 | ||
| Other Canines | 629 | ||
| Felines | 629 | ||
| Tigers | 630 | ||
| Lions | 630 | ||
| Leopards | 631 | ||
| Jaguars | 631 | ||
| Cougars | 631 | ||
| Bobcats | 632 | ||
| Primates | 632 | ||
| Herbivores and Ungulates | 633 | ||
| Wild Swine | 633 | ||
| African Buffalo | 633 | ||
| American Bison | 633 | ||
| Elephant | 634 | ||
| Hippopotamus | 635 | ||
| Rhinoceros | 635 | ||
| Tapir | 635 | ||
| Moose and Elk | 635 | ||
| Deer | 636 | ||
| Yak and Dzo | 636 | ||
| Guanaco and Llama | 636 | ||
| Other Wild Herbivores | 636 | ||
| Bears | 636 | ||
| Kangaroos | 636 | ||
| Large Birds | 636 | ||
| Raccoons | 637 | ||
| Porcupines | 637 | ||
| Coatis | 637 | ||
| Quokkas | 637 | ||
| Opossums | 637 | ||
| Skunks | 638 | ||
| Bats | 638 | ||
| Venomous Mammals | 638 | ||
| Large Reptiles (See Chapters 35 and 36) | 639 | ||
| Marine Mammals | 639 | ||
| Seals | 640 | ||
| Walruses | 640 | ||
| Sea Lions | 640 | ||
| Elephant Seals | 640 | ||
| River Otters | 640 | ||
| Domestic Animal Attacks | 641 | ||
| Dogs | 641 | ||
| Cats | 641 | ||
| Rodents | 642 | ||
| Rats, Mice, and Other Small Rodents | 642 | ||
| Rabbits | 642 | ||
| Ferrets | 642 | ||
| Domestic Herbivores and Ungulates | 643 | ||
| Horses and Donkeys | 643 | ||
| Cattle | 643 | ||
| Camels | 644 | ||
| Domestic Swine | 644 | ||
| Birds | 645 | ||
| Medicolegal Considerations | 645 | ||
| Documentation of the Injury | 645 | ||
| References | 645 | ||
| References | 645.e1 | ||
| 31 Rabies | 645 | ||
| Current Status | 645 | ||
| The Rabies Virus | 646 | ||
| Other Lyssaviruses | 646 | ||
| Rabies Burden of Disease | 646 | ||
| Rabies IN the United States | 647 | ||
| Incidence In Humans | 647 | ||
| Rabies In Wild Terrestrial Animals | 648 | ||
| Rabies In Bats | 649 | ||
| Rabies In Domestic Animals | 650 | ||
| Sources of Human Infection | 650 | ||
| Rabies In Other Countries | 653 | ||
| Epidemiology | 653 | ||
| Sources of Human Infection | 655 | ||
| Features of Human Rabies | 657 | ||
| Mortality | 657 | ||
| Incubation Period | 658 | ||
| Pathogenesis of Central Nervous System Infection | 658 | ||
| Clinical Features | 659 | ||
| Subclinical Rabies | 660 | ||
| Undiagnosed Rabies | 660 | ||
| Basic Transmission | 661 | ||
| Risk Factors Associated with Disease Transmission | 661 | ||
| Laboratory Diagnosis of Rabies | 661 | ||
| Rabies In Attacking Animals | 661 | ||
| Therapy | 662 | ||
| PreExposure Prophylaxis | 662 | ||
| Postexposure Prophylaxis | 663 | ||
| Identifying Exposure | 663 | ||
| Initial Wound Management | 664 | ||
| Further PEP Measures Following Wound Care | 665 | ||
| Rabies Immune Globulin | 665 | ||
| Rabies Vaccines | 666 | ||
| Human Vaccination | 667 | ||
| Immunocompromised Individuals | 668 | ||
| PreExposure Vaccination | 668 | ||
| Rabies Therapy In Developing Countries | 669 | ||
| Rabies Considerations for Travelers | 670 | ||
| Wound Cleansing | 670 | ||
| Immune Globulin | 670 | ||
| Vaccine | 670 | ||
| PreExposure Vaccination | 670 | ||
| Children | 670 | ||
| Obtaining Medical Care | 671 | ||
| Other Lyssaviruses | 671 | ||
| Current Rabies Developments | 672 | ||
| Rabies Eradication In Wild Animals | 672 | ||
| Vaccine Developments | 673 | ||
| Replacements for Rabies Immune Globulin | 673 | ||
| Simpler Laboratory Tests for Rabies | 673 | ||
| Rabies Remains a Neglected Global Public Health Crisis | 673 | ||
| Acknowledgment | 673 | ||
| References | 673 | ||
| References | 673.e1 | ||
| 32 Bear Behavior and Attacks | 674 | ||
| North American Bears | 674 | ||
| Grizzly Bears | 674 | ||
| Black Bears | 677 | ||
| Polar Bears | 678 | ||
| Bears on Other Continents | 678 | ||
| Prevention and Risk Reduction | 680 | ||
| Avoiding an Encounter | 680 | ||
| Avoid Provoking an Attack | 682 | ||
| Reducing the Severity and Extent of Injuries | 682 | ||
| Preventing Predatory Behavior | 683 | ||
| Special Considerations | 683 | ||
| Menstruation | 683 | ||
| Sexual Activity | 683 | ||
| Pepper Spray | 684 | ||
| Firearms | 684 | ||
| Dogs | 684 | ||
| Horses | 685 | ||
| Hunter Safety | 685 | ||
| Bear-Induced Injuries | 685 | ||
| Wound Management | 686 | ||
| Antibiotic Therapy | 686 | ||
| Rabies | 686 | ||
| Acknowledgment | 686 | ||
| References | 686 | ||
| References | 686.e1 | ||
| 33 Alligator and Crocodile Attacks | 687 | ||
| Characteristics, Lifestyle, and Habits | 687 | ||
| Feeding and Predation Habits | 687 | ||
| Overview of Attacks | 688 | ||
| Treatment of Crocodilian Bites | 690 | ||
| First Aid | 690 | ||
| Hospital Management | 691 | ||
| Microbiology and Antimicrobials | 691 | ||
| Prevention of Crocodilian Attacks | 691 | ||
| If an Attack Occurs | 692 | ||
| References | 692 | ||
| References | 692.e1 | ||
| 34 Wilderness-Acquired Zoonoses | 692 | ||
| Anthrax | 693 | ||
| Bacteriology | 693 | ||
| Epidemiology | 694 | ||
| Transmission | 694 | ||
| Presentation and Symptoms | 694 | ||
| Diagnosis | 694 | ||
| Treatment | 695 | ||
| Prevention | 695 | ||
| Bartonella Infections | 695 | ||
| Bacillary Angiomatosis | 695 | ||
| Epidemiology | 695 | ||
| Symptoms | 695 | ||
| Diagnosis | 696 | ||
| Treatment | 696 | ||
| Prevention | 696 | ||
| Cat-Scratch Disease | 696 | ||
| Epidemiology | 696 | ||
| Transmission | 696 | ||
| Symptoms | 696 | ||
| Diagnosis | 697 | ||
| Treatment | 697 | ||
| Brucellosis | 697 | ||
| Bacteriology | 697 | ||
| Epidemiology | 697 | ||
| Symptoms | 698 | ||
| Diagnosis | 698 | ||
| Treatment | 698 | ||
| Glanders | 698 | ||
| Bacteriology | 698 | ||
| Epidemiology | 699 | ||
| Transmission | 699 | ||
| Symptoms | 699 | ||
| Equids | 699 | ||
| Humans | 699 | ||
| Diagnosis | 699 | ||
| Treatment | 699 | ||
| Prevention and Control | 700 | ||
| Leptospirosis | 700 | ||
| Bacteriology | 700 | ||
| Epidemiology | 700 | ||
| Transmission | 701 | ||
| Symptoms | 701 | ||
| Diagnosis | 702 | ||
| Treatment | 703 | ||
| Prevention | 703 | ||
| Melioidosis | 703 | ||
| Bacteriology | 703 | ||
| Epidemiology | 703 | ||
| Transmission | 704 | ||
| Symptoms | 704 | ||
| Diagnosis | 704 | ||
| 6 Insects and Arachnids | 869 | ||
| 39 Mosquitoes and Mosquito-Borne Diseases | 870 | ||
| Mosquitoes | 870 | ||
| Mosquito Anatomy | 870 | ||
| Mosquito Life Cycle | 870 | ||
| Mechanism of Mosquito Bites | 870 | ||
| Pathophysiology and Clinical Manifestations of Mosquito Bites | 871 | ||
| Diseases Caused by Mosquitoes | 872 | ||
| Dengue | 872 | ||
| Epidemiology and Transmission | 872 | ||
| Clinical Presentation | 874 | ||
| Diagnosis | 875 | ||
| Treatment and Prevention | 876 | ||
| Yellow Fever | 876 | ||
| Epidemiology and Transmission | 876 | ||
| Clinical Presentation | 878 | ||
| Diagnosis. | 878 | ||
| Treatment and Prevention | 879 | ||
| Japanese Encephalitis | 880 | ||
| Epidemiology and Transmission | 880 | ||
| Clinical Presentation | 881 | ||
| Diagnosis | 881 | ||
| Treatment and Prevention | 881 | ||
| West Nile Virus | 882 | ||
| Epidemiology and Transmission | 882 | ||
| Clinical Presentation | 882 | ||
| Diagnosis | 883 | ||
| 7 Surgical and Medical Interventions | 1045 | ||
| 46 Improvised Medicine in the Wilderness | 1046 | ||
| General Assessment and Vital Signs | 1046 | ||
| Height | 1046 | ||
| Weight | 1046 | ||
| Pulses in Adults and Children | 1046 | ||
| Radial Pulse and Trauma Prognosis | 1046 | ||
| Blood Pressure | 1046 | ||
| Blood Pressure without a Cuff | 1046 | ||
| Blood Pressure without a Stethoscope | 1047 | ||
| Wrist and Calf Blood Pressure Measurements | 1047 | ||
| Improvised Diagnostic Equipment and Supplies | 1047 | ||
| Stethoscopes | 1047 | ||
| Ear to Patient | 1047 | ||
| Improvised Standard Stethoscopes | 1047 | ||
| Precordial Stethoscope | 1048 | ||
| Stethoscope Earpiece | 1048 | ||
| Improvised Treatment Equipment and Supplies | 1049 | ||
| Gowns, Gloves, Masks, Booties, and Goggles | 1049 | ||
| Standard Precautions | 1049 | ||
| Gowns | 1049 | ||
| Caps and Masks | 1049 | ||
| Eye Protection | 1049 | ||
| Booties, Shoes, and Vapor Barrier Liners | 1049 | ||
| Syringes, Needles, and Intravenous Equipment | 1049 | ||
| Saline Locks | 1049 | ||
| Intravenous Tubing | 1049 | ||
| Pressure for Intravenous Fluids and Blood Bags | 1049 | ||
| Improvised Airway Management (See Chapter 19) | 1049 | ||
| Positioning for Safe Airway | 1049 | ||
| Opening the Airway | 1049 | ||
| Chin Lift–Jaw Thrust | 1049 | ||
| Head Turn | 1049 | ||
| Positioning the Tongue | 1049 | ||
| Nasal Airways | 1050 | ||
| Mouth-to-Mouth Rescue Breathing Barrier | 1050 | ||
| Surgical Airway (Cricothyrotomy) | 1050 | ||
| Other Alternatives to Secure an Airway | 1052 | ||
| Improvised Wound Management | 1052 | ||
| Wound Hemostasis | 1052 | ||
| Wound Anesthesia | 1052 | ||
| Wound Irrigation | 1053 | ||
| Wound Closure | 1053 | ||
| Wound Glues | 1053 | ||
| Cyanoacrylate. | 1054 | ||
| Availability. | 1054 | ||
| Contamination of Other Areas. | 1054 | ||
| Staples | 1054 | ||
| Binding and Taping | 1054 | ||
| Suture Needles | 1054 | ||
| Natural and Alternative Suture Materials | 1055 | ||
| Fishing Line. | 1055 | ||
| Horsehair Sutures. | 1055 | ||
| Silk and Yucca or Agave Fibers. | 1055 | ||
| Cotton Thread. | 1055 | ||
| Dental Floss. | 1055 | ||
| Other Nontraditional Wound Closure Methods | 1055 | ||
| Hair Tying (with Glue) for Scalp Wound Closure. | 1055 | ||
| Chicken Egg Membrane. | 1056 | ||
| Disinfecting Rather Than Sterilizing Alternative Suture Materials | 1056 | ||
| Scalpels | 1056 | ||
| Tweezers | 1056 | ||
| Cleaning and Reusing Medical Supplies and Equipment | 1056 | ||
| Cleaning | 1056 | ||
| Disinfection | 1056 | ||
| Boiling | 1056 | ||
| Alcohols | 1057 | ||
| Povidone-Iodine | 1057 | ||
| Disinfecting Specific Items | 1057 | ||
| “Sterile” Dressings | 1057 | ||
| Syringes and Needles | 1057 | ||
| Single-Use Needle on Same Patient | 1057 | ||
| Surgical Instruments | 1057 | ||
| Endoscopes | 1057 | ||
| Dressings and Bandages | 1057 | ||
| Dressings | 1057 | ||
| Dressing Material. | 1057 | ||
| Bandages | 1057 | ||
| Blister Management | 1057 | ||
| Removal of Objects | 1057 | ||
| Rings | 1057 | ||
| Embedded Foreign Bodies | 1058 | ||
| Cactus Spines | 1058 | ||
| Stingray Spines | 1058 | ||
| Trauma | 1058 | ||
| Tension Pneumothorax | 1058 | ||
| Improvised Pleural Decompression Technique | 1058 | ||
| Open (“Sucking”) Chest Wound | 1059 | ||
| Drainage System (Bottles/Bags) | 1059 | ||
| Improvised Treatment for Orthopedic Injuries | 1060 | ||
| General Guidelines | 1060 | ||
| Spinal Trauma | 1060 | ||
| Improvised Cervical Collars | 1060 | ||
| Closed-Cell Foam System. | 1060 | ||
| Padded Hip Belt. | 1060 | ||
| Clothing. | 1060 | ||
| Malleable Aluminum Splint. | 1060 | ||
| Improvised Spinal Protection Systems | 1061 | ||
| Short-Board “Immobilization” | 1061 | ||
| Internal-Frame Pack and Snow Shovel System. | 1061 | ||
| Inverted-Pack System. | 1062 | ||
| Snowshoe/Snowboard System. | 1062 | ||
| Long Spinal Protection Devices | 1062 | ||
| Continuous Loop System. | 1062 | ||
| Backpack Frame Litters. | 1062 | ||
| Kayak/Canoe System. | 1063 | ||
| Extremity Fractures and Dislocations | 1063 | ||
| Physical Examination and Diagnosis | 1063 | ||
| Fracture vs. Dislocation. | 1063 | ||
| Tuning Fork/Percussion Diagnoses. | 1063 | ||
| Shoulder Dislocation Diagnosis without Radiographs. | 1063 | ||
| Treatment | 1064 | ||
| Reduction Treatment without Radiographs. | 1064 | ||
| Remeasure. | 1064 | ||
| Shoulder Dislocation Reduction (see Chapter 22). | 1064 | ||
| Splinting and Traction Methods | 1065 | ||
| Nonrigid Splints | 1065 | ||
| Sling (Arm) | 1065 | ||
| Shoulder Immobilizer (Shoulder Spica Wrap) | 1065 | ||
| “Buddy” Taping | 1065 | ||
| “Pillow” Splints | 1065 | ||
| Sandbag Splints | 1066 | ||
| Rigid Splints | 1066 | ||
| Pelvic Fractures | 1066 | ||
| Applying an Improvised Pelvic Binder | 1067 | ||
| Femoral Fractures | 1067 | ||
| General Principles of Femoral Traction | 1067 | ||
| Femoral Traction System | 1068 | ||
| Ankle Hitch. | 1069 | ||
| Single-Runner System. | 1069 | ||
| Double-Runner System. | 1070 | ||
| Patient’s Boot System. | 1070 | ||
| Buck’s Traction. | 1070 | ||
| Rigid Support. | 1071 | ||
| Double–Ski Pole or Canoe Paddle System. | 1071 | ||
| Single Ski Pole or Canoe/Kayak Paddle. | 1071 | ||
| Tent Poles. | 1071 | ||
| Miscellaneous Objects. | 1071 | ||
| Traction Mechanism. | 1071 | ||
| Cam Lock or Fastex-Like Slider. | 1072 | ||
| Trucker’s Hitch. | 1072 | ||
| Prusik Knot. | 1072 | ||
| Spanish Windlass. | 1072 | ||
| Litter Traction. | 1073 | ||
| Proximal Anchor. | 1073 | ||
| Securing and Padding. | 1073 | ||
| Patellar Dislocation | 1073 | ||
| Ankle Injuries | 1074 | ||
| Trauma and Hypothermia | 1074 | ||
| Eye, Ear, Nose, Mouth, and Throat Improvisation | 1074 | ||
| Epistaxis | 1074 | ||
| Dental Trauma | 1075 | ||
| Esophageal Foreign Bodies | 1076 | ||
| Improvised Eyeglasses | 1076 | ||
| Useful Tools and Equipment to Carry | 1076 | ||
| Multitool | 1076 | ||
| Tape and Glue | 1076 | ||
| Specific Equipment | 1077 | ||
| Plastic Cable Ties | 1077 | ||
| Parachute Cord | 1077 | ||
| Safety Pins | 1077 | ||
| Wire | 1077 | ||
| Bolts and Wing Nuts | 1077 | ||
| Prefabricated Crossbar | 1077 | ||
| Closed-Cell Foam Pads | 1077 | ||
| Fluorescent Surveyor’s Tape | 1077 | ||
| Space Blanket or Lightweight Tarp | 1077 | ||
| Improvised Transport | 1077 | ||
| Carries | 1077 | ||
| Three-Person Wheelbarrow Carry | 1077 | ||
| Two-Hand Seat | 1078 | ||
| Four-Hand Seat | 1078 | ||
| Ski Pole or Ice Ax Carry | 1078 | ||
| Split-Coil Seat | 1078 | ||
| Two-Rescuer Split-Coil Seat | 1078 | ||
| Backpack Carry | 1078 | ||
| Nylon Webbing Carry | 1078 | ||
| Nonrigid Litters | 1078 | ||
| Blanket Litter | 1078 | ||
| Tree Pole Litter | 1080 | ||
| Parka Litter | 1080 | ||
| Internal-Frame Pack Litter | 1080 | ||
| Personal Floatation Device (Life Jacket) Litter | 1081 | ||
| Rope Litter | 1081 | ||
| Improvised Rescue Sled or Toboggan | 1081 | ||
| References | 1081 | ||
| References | 1081.e1 | ||
| 47 Principles of Pain Management | 1081 | ||
| First Contact | 1082 | ||
| Scene Stabilization | 1082 | ||
| Comfort Measures | 1082 | ||
| Tactical Breathing | 1082 | ||
| Pain Assessment | 1082 | ||
| PRICE: Protection, Rest, Ice, Compression, and Elevation | 1083 | ||
| Pharmacologic Treatment of Acute Pain in the Wilderness | 1084 | ||
| Summary of Integrated Multimodal Analgesia for an Injured Patient in the Wilderness | 1084 | ||
| Acetaminophen | 1085 | ||
| Nonsteroidal Antiinflammatory Drugs | 1085 | ||
| Opioids | 1085 | ||
| Opioids Require Close Titration To Be Effective | 1086 | ||
| Morphine | 1087 | ||
| Fentanyl | 1087 | ||
| Transmucosal and Intranasal Fentanyl | 1087 | ||
| Ketamine | 1088 | ||
| Unique Considerations | 1088 | ||
| Pharmacology | 1088 | ||
| Muscle Relaxants | 1088 | ||
| Pharmacologic Treatment of Specific Patient Populations in the Wilderness | 1088 | ||
| Stable Patients with Mild to Moderate Pain Able to Take Medicines by Mouth | 1088 | ||
| Stable Patient with Severe Pain | 1088 | ||
| Potentially Unstable Patient with Severe Pain | 1089 | ||
| Introduction to Regional Anesthesia for Wilderness Pain Management | 1089 | ||
| Auricular Acupuncture in Austere Environments | 1089 | ||
| Mechanism | 1090 | ||
| Battlefield Auricular Acupuncture | 1090 | ||
| Topical Therapies | 1090 | ||
| Analgesia for Corneal Abrasions | 1091 | ||
| Pretravel Preparation | 1091 | ||
| Practical Guide to Regional Anesthesia for Emergency and Wilderness Pain Management | 1091 | ||
| Benefits of Regional Anesthesia | 1091 | ||
| Pharmacology of Local Anesthetics | 1092 | ||
| Local Anesthetic Toxicity | 1092 | ||
| Prevention and Management | 1092 | ||
| Treatment | 1093 | ||
| Fracture Infiltration (“Hematoma Blocks”) | 1093 | ||
| Intraarticular Injections | 1093 | ||
| Peripheral Nerve Blocks | 1093 | ||
| Anatomy for Regional Anesthesia: Matching the Peripheral Block to the Injury | 1094 | ||
| Ultrasound Guidance | 1094 | ||
| Peripheral Nerve Injury | 1094 | ||
| Prevention of Nerve Injury | 1095 | ||
| Patient Selection. | 1095 | ||
| Needle Selection. | 1095 | ||
| Painless, Ultrasound-Guided “Stay-Away” Technique | 1095 | ||
| Pressure Monitoring | 1095 | ||
| Local Anesthetic Neurotoxicity | 1095 | ||
| Wilderness Regional Anesthesia by Area of Injury (Box 47-5) | 1095 | ||
| Regional Anesthesia for the Neck and Clavicle | 1095 | ||
| Regional Anesthesia for the Shoulder | 1096 | ||
| Emergency Regional Anesthesia for the Arm | 1096 | ||
| Emergency Regional Anesthesia for the Hand | 1097 | ||
| Emergency Regional Anesthesia for the Thorax | 1097 | ||
| Emergency Regional Anesthesia for the Lower Extremity | 1097 | ||
| Specific Block Techniques | 1098 | ||
| Superficial Cervical Plexus Block | 1098 | ||
| Anatomy | 1098 | ||
| Indications | 1098 | ||
| Landmark-Based Procedure | 1098 | ||
| Ultrasound-Guided Procedure | 1099 | ||
| Positioning. | 1099 | ||
| Needle Approach. | 1099 | ||
| Local Anesthetic | 1099 | ||
| Potential Complications | 1099 | ||
| The Arm: Blocks of Terminal Branches of Brachial Plexus | 1099 | ||
| Axillary Block | 1100 | ||
| Indications. | 1100 | ||
| Landmark-Based Procedure. | 1100 | ||
| Ultrasound-Guided Procedure | 1101 | ||
| Anatomy. | 1101 | ||
| 8 Rescue and Survival | 1199 | ||
| 54 Wilderness Emergency Medical Services and Response Systems | 1200 | ||
| Defining Wilderness and Wilderness Medicine | 1200 | ||
| Relationship of Emergency Medical Services, Wilderness Medicine, Disaster Medicine, and Tactical Medicine | 1201 | ||
| History of Wilderness Emergency Medical Services | 1201 | ||
| Commercial WEMS Schools IN the United States | 1202 | ||
| In-House Training in the United States | 1202 | ||
| Growth of Wilderness Medicine | 1203 | ||
| Wilderness Emergency Medical Services Agencies | 1203 | ||
| Wilderness Emergency Medical Services Provider Types, Standardization, and Scope of Practice | 1203 | ||
| Levels of Wilderness Emergency Medical Services Providers | 1204 | ||
| Wilderness First Aid Provider | 1204 | ||
| Wilderness First Responder | 1204 | ||
| Wilderness Emergency Medical Technician | 1205 | ||
| Outdoor Emergency Care Provider | 1205 | ||
| Wilderness Paramedic | 1205 | ||
| Wilderness Physician and Advanced Practice Clinician | 1205 | ||
| Emergency Medical Dispatchers and Telemedicine Providers | 1206 | ||
| Medical Oversight | 1206 | ||
| Medical Advisors Versus Medical Directors | 1206 | ||
| Direct Medical Oversight | 1206 | ||
| Indirect Medical Oversight | 1206 | ||
| Operations | 1206 | ||
| Incident Command System | 1206 | ||
| Protocols | 1207 | ||
| Specific Protocols | 1208 | ||
| Anaphylaxis | 1208 | ||
| Termination of Resuscitation | 1208 | ||
| Wound Care | 1208 | ||
| Pain Management | 1208 | ||
| Joint Reduction | 1209 | ||
| Spinal Cord Protection | 1209 | ||
| Acute Coronary Syndrome | 1209 | ||
| Ectopic Pregnancy | 1209 | ||
| Hypoglycemia | 1209 | ||
| Common Ailments | 1210 | ||
| Medication Administration | 1210 | ||
| Equipment Specifically Needed IN Wilderness Emergency Medical Services | 1210 | ||
| The Future of Wilderness Emergency Medical Services | 1210 | ||
| Challenges to Wilderness Systems | 1210 | ||
| Provider Shortages | 1210 | ||
| Insufficient Funding | 1211 | ||
| Validity of and Reimbursement for Services | 1211 | ||
| Defining No-Rescue Areas | 1211 | ||
| Future Areas of Growth IN Wilderness Emergency Medical Services | 1212 | ||
| Intersection of Rural Emergency Medical Services and Wilderness Emergency Medical Services | 1212 | ||
| Technology | 1212 | ||
| EMS as a Physician Subspecialty | 1213 | ||
| Summary | 1213 | ||
| Suggested Internet Resources for Wilderness Services | 1213 | ||
| References | 1213 | ||
| References | 1213.e1 | ||
| 55 Search and Rescue | 1213 | ||
| Search and Rescue: An Overview | 1214 | ||
| International Agreements | 1214 | ||
| International Stages of SAR Operations | 1215 | ||
| Awareness Stage | 1215 | ||
| Initial Action Stage | 1215 | ||
| Planning Stage | 1215 | ||
| Operations Stage | 1215 | ||
| Conclusion Stage | 1215 | ||
| COSPAS-SARSAT | 1215 | ||
| Distress Radio Beacons | 1216 | ||
| Emergency Position–Indicating Radio Beacons. | 1216 | ||
| Emergency Locator Transmitters. | 1216 | ||
| Personal Locator Beacons. | 1216 | ||
| Other International Search and Rescue Organizations | 1217 | ||
| Search and Rescue in the United States | 1217 | ||
| U.S. National Search and Rescue Plan | 1217 | ||
| National Response Framework | 1218 | ||
| The National SAR Supplement | 1219 | ||
| Catastrophic Incident SAR Addendum to the National SAR Supplement. | 1219 | ||
| Land SAR Addendum to the National SAR Supplement. | 1219 | ||
| U.S. Rescue Coordination Centers | 1219 | ||
| U.S. Air Force Rescue Coordination Center. | 1219 | ||
| Search Missions. | 1220 | ||
| Rescue Missions. | 1220 | ||
| MEDEVAC Missions. | 1220 | ||
| Mercy Missions. | 1220 | ||
| U.S. Coast Guard Rescue Coordination Centers. | 1220 | ||
| Federal Aviation Administration. | 1221 | ||
| Unmanned Aircraft Systems. | 1221 | ||
| Civil Air Patrol. | 1221 | ||
| U.S. Coast Guard Auxiliary. | 1222 | ||
| Other Federal SAR Resources | 1222 | ||
| The State’s Role in SAR: Coordination and Support | 1223 | ||
| Local SAR Response | 1223 | ||
| Standards and Regulations | 1223 | ||
| Organization of a Search and Rescue Event | 1224 | ||
| National Incident Management System | 1224 | ||
| Incident Command System | 1224 | ||
| Incident Management Teams | 1225 | ||
| Search and Rescue Operations | 1226 | ||
| Locate Phase | 1226 | ||
| First Notice | 1226 | ||
| Planning Data and Their Uses | 1226 | ||
| Search Tactics | 1226 | ||
| Clues and Their Value | 1228 | ||
| Search Resources | 1228 | ||
| Dogs. | 1228 | ||
| Human Trackers. | 1228 | ||
| Ground Search Teams | 1229 | ||
| Hasty Teams. | 1229 | ||
| Grid Teams. | 1229 | ||
| Aircraft. | 1229 | ||
| Search Planning Considerations | 1229 | ||
| Search Theory. | 1230 | ||
| Lost Subject Behavior. | 1231 | ||
| Access Phase | 1232 | ||
| Stabilization Phase | 1233 | ||
| Transport Phase | 1234 | ||
| Rescue Equipment | 1234 | ||
| Personal Protective Equipment. | 1234 | ||
| Special Gear. | 1234 | ||
| Software | 1234 | ||
| Rope. | 1234 | ||
| Webbing. | 1235 | ||
| Harnesses. | 1235 | ||
| Hardware | 1236 | ||
| Carabiners. | 1236 | ||
| Descent and Belay (Friction) Devices. | 1236 | ||
| Ascenders. | 1237 | ||
| Pulleys. | 1238 | ||
| Litters. | 1239 | ||
| Anatomy of a Search and Rescue Incident | 1239 | ||
| Search and Rescue Environments within the Wilderness Setting | 1239 | ||
| Special Environments in Search and Rescue | 1240 | ||
| Technical Rock | 1240 | ||
| Caves and Mines | 1240 | ||
| Whitewater (Swiftwater) River | 1240 | ||
| Ocean Surf | 1241 | ||
| Runout. | 1241 | ||
| Rip. | 1241 | ||
| Undertow. | 1242 | ||
| Cold, Snow, and Ice | 1242 | ||
| References | 1242 | ||
| References | 1242.e1 | ||
| 56 Technical Rescue, Self-Rescue, and Evacuation | 1242 | ||
| Warning | 1243 | ||
| Terms Used in Technical Rescue | 1243 | ||
| Epidemiology | 1244 | ||
| Risks of Wilderness Travel | 1244 | ||
| Injuries and Illnesses in Mountain Rescue Subjects | 1244 | ||
| Preventive Decision Making | 1245 | ||
| Risk Reduction | 1245 | ||
| Planning | 1246 | ||
| Leadership | 1246 | ||
| Communications | 1246 | ||
| Hazards in Wilderness Travel and Rescue | 1247 | ||
| Natural Hazards | 1247 | ||
| High Altitude | 1247 | ||
| Extremes of Temperature and Humidity | 1247 | ||
| Weather | 1247 | ||
| Lightning | 1248 | ||
| Rockfall | 1248 | ||
| Frozen Waterfalls (Ice) | 1248 | ||
| Avalanches | 1248 | ||
| Cornice Failures | 1248 | ||
| Terrain Features | 1248 | ||
| Glacier Hazards | 1248 | ||
| Hazards Caused by Equipment Failure | 1249 | ||
| Hazards Resulting from Human Factors of Rescuers | 1250 | ||
| Training | 1250 | ||
| Physical Conditioning and Skills | 1250 | ||
| Food, Water, and Sleep | 1250 | ||
| Experience in the Environment | 1250 | ||
| Mission Planning and Risk Assessment | 1250 | ||
| Team Safety. | 1250 | ||
| Aircraft Safety. | 1250 | ||
| External Influences on Rescue Attempts | 1250 | ||
| Hazards Resulting from Human Factors of Subjects | 1251 | ||
| Planning for Rescue | 1251 | ||
| Team Training | 1251 | ||
| Role of the Medical Director | 1251 | ||
| Patient Care in Wilderness and Technical Environments | 1251 | ||
| Priorities | 1251 | ||
| Limitations | 1251 | ||
| Initial Patient Assessment and Treatment | 1252 | ||
| Resuscitation | 1252 | ||
| Airway and Breathing | 1252 | ||
| Circulation and Control of Bleeding | 1252 | ||
| Treatment of Pain | 1253 | ||
| Prolonged Care and Transport | 1253 | ||
| Altitude Considerations during Rescue | 1254 | ||
| Suspension Trauma | 1255 | ||
| Use of Extrication Devices for Crevasse Rescue | 1255 | ||
| Companion Rescue | 1255 | ||
| Decision Making in Companion Rescue | 1255 | ||
| Improvised Searches | 1255 | ||
| Planning for Wilderness Medicine Technical Rescue | 1256 | ||
| Basic Concepts of Technical Rescue | 1256 | ||
| Anchors | 1256 | ||
| Descent | 1258 | ||
| Ascent | 1259 | ||
| Haul Systems | 1260 | ||
| Knot Pass | 1261 | ||
| Backup Systems with Belay | 1261 | ||
| Personal Escape | 1262 | ||
| One-on-One Pickoff | 1262 | ||
| Belays | 1263 | ||
| Highlines | 1263 | ||
| Establishing a Main Line | 1263 | ||
| Tensioning a Main Line | 1264 | ||
| The Load | 1264 | ||
| Tag Lines and Haul Lines | 1264 | ||
| Safety Factors | 1264 | ||
| General Principles of Rope Rescue | 1265 | ||
| Improvised Methods for Carrying an Ill or Injured Patient | 1265 | ||
| The Rucksack Stretcher | 1265 | ||
| Improvised Transport Over Snow | 1265 | ||
| Litters and Vacuum Mattresses for Organized Rescue | 1265 | ||
| Vacuum Mattresses | 1265 | ||
| Commercial Litters | 1266 | ||
| Patient Packaging | 1267 | ||
| Use of Aircraft in Mountain Rescue | 1268 | ||
| Fixed-Wing Aircraft in Mountain Rescue | 1268 | ||
| Helicopter Rescue in the Wilderness | 1268 | ||
| Helicopter Capabilities | 1268 | ||
| Safe Use of Helicopters | 1268 | ||
| Types of Helicopters | 1269 | ||
| Aeromedical Helicopters | 1269 | ||
| Law-Enforcement Helicopters | 1269 | ||
| Commercial Helicopters | 1269 | ||
| Media Helicopters | 1269 | ||
| Military Helicopters | 1269 | ||
| Limitations of Helicopters | 1269 | ||
| Visibility Minimums | 1270 | ||
| Weather Conditions | 1270 | ||
| Fuel | 1270 | ||
| Safety Precautions on the Ground | 1270 | ||
| Landing Zones (Helispots) | 1270 | ||
| Landing Zones in Confined Spaces | 1270 | ||
| Landings and Takeoffs | 1270 | ||
| Loading and Unloading | 1271 | ||
| Approaching the Helicopter | 1271 | ||
| Loading and Unloading Safety Procedures | 1271 | ||
| One-Skid Landings | 1271 | ||
| Loading and Unloading Without Moving Toward or Away from the Helicopter | 1272 | ||
| Hover Load and Hover Jump Operations | 1272 | ||
| External Loads | 1272 | ||
| Hoist Operations | 1272 | ||
| Short-Haul (or Long-Line) Operations | 1272 | ||
| Helirappel | 1273 | ||
| Patient Care in Helicopter Operations | 1273 | ||
| Unmanned Aerial Vehicles | 1273 | ||
| Canyon Rescue | 1273 | ||
| Canyon Hazards | 1273 | ||
| Canyon Anchors | 1274 | ||
| Canyon Descent | 1274 | ||
| Canyon Ascent | 1275 | ||
| Canyon Self-Rescue and Companion Rescue | 1275 | ||
| Canyon Litters | 1276 | ||
| Organized Canyon Rescue and Evacuation | 1276 | ||
| Helicopter Canyon Rescue | 1277 | ||
| Technical Rescue Resources for Mountain Rescue | 1278 | ||
| Technical Rescue Medical Kit | 1278 | ||
| Afterword | 1278 | ||
| References | 1278 | ||
| APPENDIX Technical Rescue Medical Kit* | 1279 | ||
| Medication Bag | 1279 | ||
| Intravenous Bag | 1279 | ||
| Miscellaneous Bag | 1279 | ||
| Front and Top Pockets | 1279 | ||
| Bandaging Side Pocket | 1279 | ||
| Miscellaneous Side Pocket | 1279 | ||
| Main Compartment | 1279 | ||
| Airway Bag | 1280 | ||
| Oxygen Kit† | 1280 | ||
| References | 1280.e1 | ||
| Further Reading | 1280.e3 | ||
| 57 Litters and Carries | 1280 | ||
| Size-Up | 1280 | ||
| Drags and Carries | 1281 | ||
| Litter Improvisation | 1282 | ||
| Rescue Litters and Stretchers | 1286 | ||
| Desirable Characteristics of a Wilderness Stretcher | 1286 | ||
| Stretchers | 1286 | ||
| Basket-Style Stretchers | 1286 | ||
| Flat Stretchers | 1288 | ||
| Mountain Rescue Stretchers | 1289 | ||
| Flexible, Wrap-Around Stretchers | 1290 | ||
| Hybrid Devices | 1292 | ||
| Transportation Hardware Accessories | 1293 | ||
| Carrying a Loaded Litter | 1293 | ||
| Patient Packaging | 1293 | ||
| References | 1294 | ||
| References | 1294.e1 | ||
| 58 Helicopter Rescue and Air Medical Transport | 1294 | ||
| Evolution of Air Medical Transport | 1295 | ||
| Business and Organizational Models for Air Medical Transport Programs | 1295 | ||
| Hospital-Based Air Transport Services | 1296 | ||
| Community-Based Air Transport Services | 1296 | ||
| Government-Sponsored Air Transport Services | 1296 | ||
| Air Transport Organization: Lessons for Wilderness Medicine | 1296 | ||
| Crew Models in Air Medical Transport | 1297 | ||
| Air Transport Crew with a Physician | 1297 | ||
| Air Transport Crew Without a Physician | 1297 | ||
| Air Transport Crew Configuration: Lessons for Wilderness Medicine | 1298 | ||
| Physician Oversight in Air Medical Transport | 1298 | ||
| Direct and Indirect Medical Oversight | 1298 | ||
| Characteristics of the Medical Director | 1298 | ||
| The Medical Director: Lessons for Wilderness Medicine | 1298 | ||
| Types of Air Medical Transport Missions | 1299 | ||
| Scene Missions | 1299 | ||
| Interfacility Transports | 1299 | ||
| Types of Air Transport Missions: Lessons for Wilderness Medicine | 1299 | ||
| Air Transport Aircraft | 1299 | ||
| Airplanes for Long-Range Air Medical Transport | 1299 | ||
| Aircraft for Short- and Medium-Length Transports | 1301 | ||
| Helicopters for Wilderness Transport | 1301 | ||
| Categorizing and Comparing Helicopters Used in Air Medical Transport | 1303 | ||
| Single-Engine Helicopters | 1305 | ||
| Twin-Engine Helicopters | 1307 | ||
| Other Aircraft Factors | 1309 | ||
| Aviation Logistics and Selection of a Transport Vehicle | 1310 | ||
| Selection of an Airplane Versus a Helicopter for Transport | 1310 | ||
| Logistics and Triage in Helicopter Air Transport | 1310 | ||
| Aviation Safety | 1311 | ||
| Effects of Altitude on Air Medical Transport | 1312 | ||
| Boyle’s Law: Pressure, Volume, and Altitude | 1312 | ||
| Charles’s Law: Altitude and Temperature | 1313 | ||
| Henry’s Law: Altitude and Dissolved Gas Concentrations | 1313 | ||
| Medical Care in the in-Flight Setting | 1313 | ||
| Patient Loading and Cabin Considerations | 1313 | ||
| Motion and Vibrations | 1314 | ||
| Noise | 1314 | ||
| Cabin Layout and Space | 1314 | ||
| Communications and Coordination of Air and Ground Medical Resources | 1315 | ||
| Preflight Communications and Air-Ground Coordination | 1315 | ||
| Communications and Preparation AS the Aircraft Approaches the Patient’s Location | 1315 | ||
| Ground and Air Coordination during Patient Stabilization for Transport | 1315 | ||
| Preparation of the Landing Zone | 1315 | ||
| Helicopter Landing and on-Site Interactions between Air and Ground Personnel | 1317 | ||
| Communications after Transport to the Receiving Center | 1319 | ||
| Patient Populations That May be Suitable for Air Medical Transport | 1319 | ||
| Integration of Air Medical Transport Into Regional Systems Planning | 1319 | ||
| General Considerations for Triage in Air Medical Transport | 1319 | ||
| Air Medical Transport Outcomes Literature: State of the Evidence | 1319 | ||
| Patients with Traumatic Injury or Burns | 1320 | ||
| Patients with Cardiac Disease | 1320 | ||
| Stroke Patients | 1320 | ||
| Pediatric Patients and Neonates | 1320 | ||
| Obstetric Patients | 1320 | ||
| Other Disorders for Which Air Medical Transport May Be Useful | 1321 | ||
| Cost-Effectiveness of Air Medical Transport | 1321 | ||
| Air Medical Responses in Disaster and Mass Casualty Situations | 1321 | ||
| Air Medical Responses for Search and Rescue and Alpine Operations | 1321 | ||
| Airplanes in Search and Rescue Missions | 1321 | ||
| Helicopters in Search and Rescue Missions | 1321 | ||
| Helicopters and Avalanche Response | 1322 | ||
| Helicopters and Hoist Operations | 1322 | ||
| Helicopters and High-Altitude Search and Rescue in Lesser-Developed Countries | 1323 | ||
| Helicopter Flight at High Altitude | 1325 | ||
| Long-Line Operations at Extreme Altitude | 1325 | ||
| Medical Interventions during Helicopter Search and Rescue Missions | 1325 | ||
| Helicopter Program Safety and High-Altitude Operations | 1325 | ||
| Putting It All Together: Keys to Judicious Use of Air Medical Transport | 1326 | ||
| Air Medical Services Internet Resources | 1326 | ||
| Acknowledgments | 1326 | ||
| References | 1326 | ||
| References | 1326.e1 | ||
| 59 Essentials of Wilderness Survival | 1327 | ||
| General Considerations in Survival | 1328 | ||
| Oxygen | 1328 | ||
| Regulation of Body Temperature | 1329 | ||
| Cold Weather Survival | 1330 | ||
| Decreasing Body Heat Loss | 1330 | ||
| Dressing for Cold Weather | 1331 | ||
| First Layer | 1331 | ||
| Long Underwear. | 1331 | ||
| Socks. | 1331 | ||
| Thin Gloves (Glove Liners). | 1331 | ||
| Second Layer | 1331 | ||
| Shirt. | 1331 | ||
| Pants. | 1331 | ||
| Foot Gear. | 1331 | ||
| Hat. | 1331 | ||
| Third Layer | 1331 | ||
| Parka. | 1331 | ||
| Wind Pants. | 1331 | ||
| Hand Gear. | 1331 | ||
| Gaiters and Overboots. | 1332 | ||
| Fourth Layer | 1332 | ||
| Raingear. | 1332 | ||
| Vapor Barrier Systems. | 1332 | ||
| Shelter | 1332 | ||
| Summer Emergency Shelters | 1332 | ||
| Space Blankets and Bags | 1332 | ||
| Thermal Blankets | 1332 | ||
| Tube Tents | 1333 | ||
| Tarpaulins | 1333 | ||
| Plastic Bag Shelters | 1333 | ||
| Winter and Cold Weather Emergency Shelters | 1333 | ||
| Natural Shelters | 1334 | ||
| Constructed Shelters | 1335 | ||
| Snow Shelters | 1335 | ||
| Snow Trenches | 1335 | ||
| Snow Caves | 1336 | ||
| Snow Domes | 1336 | ||
| Igloos | 1337 | ||
| Tents | 1338 | ||
| Bivouac Sacks and Other Small and Portable Emergency Shelters | 1338 | ||
| Increasing Body Heat Production | 1338 | ||
| Adding Heat From the Outside | 1338 | ||
| Heat Sources | 1338 | ||
| Matches | 1339 | ||
| Safety Matches. | 1339 | ||
| Waterproof Matches. | 1339 | ||
| Windproof Matches. | 1339 | ||
| Strike-Anywhere Matches. | 1340 | ||
| Storm Matches. | 1340 | ||
| Match Containers | 1340 | ||
| Boy Scout–Style Match Containers. | 1341 | ||
| Olive Drab Military-Style Match Containers. | 1341 | ||
| Orange Military-Style Match Cases. | 1341 | ||
| Multipurpose Match Case. | 1342 | ||
| Other Methods of Igniting Tinder | 1342 | ||
| Building Fires | 1344 | ||
| Tools That Make Fire Building Easier | 1346 | ||
| Saws | 1346 | ||
| Wire Survival Saws. | 1346 | ||
| Linked-Style Survival Saws. | 1346 | ||
| Bow Saws. | 1347 | ||
| Pruning Saws. | 1347 | ||
| Fire-Starting Aids | 1347 | ||
| Commercial Fire-Starting Aids. | 1347 | ||
| Food | 1350 | ||
| Water | 1351 | ||
| Survival in Special Instances, Including Natural Catastrophes | 1351 | ||
| Stalled or Wrecked Automobiles | 1351 | ||
| Aircraft Accidents | 1351 | ||
| Floods | 1352 | ||
| Storms | 1352 | ||
| Thunderstorms | 1352 | ||
| Tornados | 1352 | ||
| Hurricanes | 1352 | ||
| Navigation in the Wilderness | 1352 | ||
| Backcountry Weather Forecasting | 1352 | ||
| Sanitation | 1352 | ||
| Psychological and Organizational Aspects of Survival | 1353 | ||
| Protection From Wild Animals | 1354 | ||
| Summary of Preparations for a Possible Survival Situation | 1354 | ||
| Appendix A Suggested Basic Contents of a Survival Kit for Temperate to Cold Weather | 1355 | ||
| Appendix B Suggested Additions for a Winter Survival Kit (When Cold Weather or Snow Is Present or Expected) | 1357 | ||
| Optional Items | 1357 | ||
| Mandatory for Avalanche Country | 1357 | ||
| Appendix C Vehicle Cold Weather Survival Kit | 1357 | ||
| Appendix D Minimal Equipment for a Survival First-Aid Kit | 1358 | ||
| Basic Items | 1358 | ||
| Small-Bag Items | 1358 | ||
| Other Items | 1358 | ||
| Additional Items for Consideration | 1358 | ||
| Suggested Readings | 1358 | ||
| Suggested Readings | 1358.e1 | ||
| 60 Jungle Travel and Survival | 1358 | ||
| Tropical Environment | 1358 | ||
| Trip Preparation | 1359 | ||
| Reading | 1359 | ||
| Attitude | 1359 | ||
| Relationship Considerations | 1359 | ||
| Conditioning | 1359 | ||
| Immunizations | 1359 | ||
| Medical Kit | 1360 | ||
| Gear | 1361 | ||
| Footwear | 1361 | ||
| Trail Shoes. | 1362 | ||
| Camp Boots. | 1362 | ||
| Other Options. | 1362 | ||
| Socks | 1362 | ||
| Clothing | 1362 | ||
| Hat | 1362 | ||
| Pullover | 1362 | ||
| Shirts | 1362 | ||
| Pants | 1362 | ||
| Undergarments | 1363 | ||
| Poncho | 1363 | ||
| Bedding | 1363 | ||
| Flannel Sheet | 1363 | ||
| Hammock | 1363 | ||
| Therm-a-Rest | 1363 | ||
| Mosquito Netting | 1363 | ||
| Backpacks | 1363 | ||
| Backpack for Porter | 1363 | ||
| Personal Pack | 1363 | ||
| Pack for River Trips | 1363 | ||
| Other Useful Items | 1363 | ||
| Antifogging Solution for Eyeglasses | 1363 | ||
| Batteries | 1363 | ||
| Binoculars | 1363 | ||
| Camera Equipment | 1363 | ||
| Camera Case or Bag | 1364 | ||
| Camp Soap | 1364 | ||
| Candles | 1364 | ||
| Cup and Plate | 1364 | ||
| Duct Tape | 1364 | ||
| Ear Plugs | 1364 | ||
| Fishing Supplies | 1364 | ||
| Garbage Bags | 1364 | ||
| Dry Bags | 1364 | ||
| Headlamp | 1364 | ||
| Inflatable Cushion or Pillow | 1364 | ||
| Insect Repellent | 1364 | ||
| Laminated Map | 1364 | ||
| Machete | 1364 | ||
| Matches or Cigarette Lighter | 1365 | ||
| Pen | 1365 | ||
| Pocket Tool | 1365 | ||
| Wide-Mouth Water Bottles | 1365 | ||
| Razor or Battery-Operated Shaver | 1365 | ||
| Spoon | 1365 | ||
| Sport Sponge | 1365 | ||
| Sunglasses | 1365 | ||
| Toilet Paper | 1365 | ||
| Umbrella | 1365 | ||
| Whistle | 1365 | ||
| Coping with the Jungle Environment | 1365 | ||
| Wetness | 1365 | ||
| Health Issues | 1366 | ||
| Health Risks | 1366 | ||
| Duration of Travel and Emotional Response | 1366 | ||
| Preventing Heat-Related Illness | 1366 | ||
| Unexpected Isolation | 1366 | ||
| Camp Life | 1366 | ||
| Shelter | 1366 | ||
| Food | 1367 | ||
| Potable Water | 1369 | ||
| Jungle Hazards | 1369 | ||
| Arthropods | 1369 | ||
| Ants. | 1369 | ||
| Chiggers. | 1369 | ||
| Jigger Flea. | 1369 | ||
| Myiasis. | 1369 | ||
| Scorpions and Spiders. | 1369 | ||
| Venomous Moths, Butterflies, and Caterpillars. | 1369 | ||
| Wasp and Bee Stings. | 1370 | ||
| Fish | 1370 | ||
| Stingray. | 1370 | ||
| Electric Eel. | 1370 | ||
| Candirú. | 1370 | ||
| Piranha. | 1370 | ||
| Mammals | 1370 | ||
| Bats. | 1370 | ||
| Dogs. | 1370 | ||
| Jaguars. | 1370 | ||
| Reptiles | 1370 | ||
| Snakes. | 1370 | ||
| Alligators and Crocodiles. | 1370 | ||
| Plants | 1370 | ||
| Armed or Spine-Bearing Plants. | 1370 | ||
| Chicha. | 1370 | ||
| Saw Grass. | 1371 | ||
| Hallucinogenic Plants | 1371 | ||
| Ayahuasca. | 1371 | ||
| Brugmansia. | 1371 | ||
| Virolas. | 1371 | ||
| Yopo. | 1371 | ||
| Miscellaneous Hazards | 1372 | ||
| Poison-Dart Frogs | 1372 | ||
| Falling Trees | 1372 | ||
| Fording Rivers | 1372 | ||
| Canoe Travel | 1372 | ||
| Log Bridges | 1372 | ||
| Mercury Contamination | 1372 | ||
| Riverain Hazards | 1372 | ||
| Rising Rivers. | 1372 | ||
| Safety of Swimming. | 1372 | ||
| Leptospirosis | 1372 | ||
| Schistosomiasis | 1372 | ||
| Quicksand | 1372 | ||
| Aquatic Plants | 1372 | ||
| Traveling with Children in the Tropics | 1372 | ||
| Survival | 1373 | ||
| Rescue Strategies | 1373 | ||
| Food | 1374 | ||
| Edibility Test | 1375 | ||
| Caveats | 1375 | ||
| Water | 1375 | ||
| Shelter | 1376 | ||
| Fire | 1376 | ||
| Tinder and Kindling | 1376 | ||
| Bamboo Fire Saw | 1377 | ||
| Bamboo Container | 1377 | ||
| Palm Spathe Container | 1377 | ||
| Psychology of Survival | 1378 | ||
| Cultural Factors | 1378 | ||
| Infanticide | 1378 | ||
| Intertribal and Intratribal Warfare, Revenge Killings, Homicide | 1378 | ||
| Enigmas | 1378 | ||
| Attribution of Causality | 1379 | ||
| Survival in Hostage Situations | 1379 | ||
| Prevention | 1379 | ||
| Categories of Hostage Takers | 1379 | ||
| Behavior at the Moment of Capture | 1379 | ||
| Hostage Rules of Behavior | 1379 | ||
| Stress Management in Captivity | 1379 | ||
| Adjusting to Captivity | 1380 | ||
| Stockholm Syndrome | 1380 | ||
| Escape | 1380 | ||
| Rescue | 1380 | ||
| Release | 1380 | ||
| References | 1380 | ||
| References | 1380.e1 | ||
| 61 Desert Travel and Survival | 1380 | ||
| The Desert Environment | 1380 | ||
| Preparation | 1382 | ||
| Clothing | 1382 | ||
| Survival Kit | 1383 | ||
| Priorities | 1383 | ||
| Water | 1384 | ||
| Shelter | 1385 | ||
| Food | 1386 | ||
| Hazards | 1387 | ||
| Travel | 1387 | ||
| Suggested Readings | 1389 | ||
| Suggested Readings | 1389.e1 | ||
| 62 Whitewater Medicine and Rescue | 1389 | ||
| Historical Perspective | 1390 | ||
| Injuries and Deaths From Whitewater Boating | 1390 | ||
| Whitewater Paddling Equipment | 1391 | ||
| River Hazards | 1392 | ||
| Hazards Created by the Flow of Water | 1393 | ||
| Eddies | 1393 | ||
| Hydraulics | 1393 | ||
| Undercuts | 1393 | ||
| Waterfalls | 1393 | ||
| Having to Swim in Whitewater | 1393 | ||
| Hazards Created by Obstacles in a River | 1394 | ||
| Drowning | 1395 | ||
| Trauma | 1395 | ||
| Proper Positioning for Prevention of Injuries | 1395 | ||
| Injuries Most Likely to Occur with Whitewater Sports | 1396 | ||
| Overuse Injuries | 1396 | ||
| Shoulder Dislocation | 1396 | ||
| Head, Facial, and Dental Injuries | 1396 | ||
| Spine Injuries | 1398 | ||
| Injuries Requiring Improvised Splinting | 1398 | ||
| Wounds and Infections | 1398 | ||
| Disorders Caused by Environmental Hazards | 1398 | ||
| Whitewater Rescue | 1399 | ||
| Rescue Equipment | 1399 | ||
| Throw Ropes | 1399 | ||
| Carabiners and Pulleys | 1399 | ||
| Prusik Loops | 1399 | ||
| Webbing | 1399 | ||
| Knives | 1399 | ||
| Whistles | 1399 | ||
| Rapidly Deployed Rescue Techniques | 1399 | ||
| Wading and Strong Swimmer Rescues | 1400 | ||
| Tagline Rescue | 1400 | ||
| Rescuing a Pinned Boat | 1401 | ||
| Appendix A Whitewater First-Aid Kit | 1402 | ||
| Appendix B Universal River Signals | 1402 | ||
| Appendix C Organizations | 1403 | ||
| References | 1403 | ||
| References | 1403.e1 | ||
| 63 Caving and Cave Rescue | 1403 | ||
| Environment | 1404 | ||
| Personal Safety | 1406 | ||
| Cave Navigation | 1407 | ||
| Cave Search | 1407 | ||
| Basic Evacuation | 1407 | ||
| Equipment for a Vertical Evacuation | 1408 | ||
| Logistics | 1409 | ||
| Cave Access | 1409 | ||
| Environmental Hazards | 1409 | ||
| Medical Hazards | 1410 | ||
| Patient Care | 1411 | ||
| The Caving Expedition | 1412 | ||
| Closing Comments | 1412 | ||
| References | 1412 | ||
| References | 1412.e1 | ||
| 9 Plants and Mushrooms | 1413 | ||
| 64 Plant-Induced Dermatitis | 1414 | ||
| Irritant Contact Dermatitis | 1414 | ||
| Treatment | 1419 | ||
| Allergic Contact Dermatitis | 1419 | ||
| Toxicodendron (Poison Ivy/Oak/Sumac) | 1420 | ||
| Immunology of Poison Ivy and Poison Oak Dermatitis | 1424 | ||
| Treatment | 1425 | ||
| Prevention | 1426 | ||
| Compositae Family | 1427 | ||
| Contact Urticaria: Immunologic and Nonimmunologic Subtypes | 1429 | ||
| Phytophotodermatitis | 1431 | ||
| Phytophototoxic Contact Dermatitis | 1432 | ||
| Phytophotoallergic Contact Dermatitis | 1433 | ||
| References | 1433 | ||
| References | 1433.e1 | ||
| 65 Toxic Plant Ingestions | 1434 | ||
| General Considerations | 1434 | ||
| Plant Toxins | 1434 | ||
| Alkaloids | 1434 | ||
| Glycosides | 1436 | ||
| Resins | 1436 | ||
| Oxalates | 1436 | ||
| Phytotoxins | 1436 | ||
| Central Nervous System Toxins | 1437 | ||
| Anticholinergic Plants (Tropane Alkaloids) | 1437 | ||
| Anticholinergic Syndrome | 1438 | ||
| Jimsonweed | 1438 | ||
| Deadly Nightshade | 1439 | ||
| Mandrake | 1439 | ||
| Additional (Rare) Signs and Symptoms Seen with Anticholinergic Plants | 1440 | ||
| Treatment | 1440 | ||
| Nicotinic Plants (Pyridine and Piperidine Alkaloids) | 1440 | ||
| Nicotinic Syndrome | 1440 | ||
| Tobacco Plants | 1440 | ||
| Poison Hemlock | 1441 | ||
| Betel Nut | 1441 | ||
| Golden Chain Tree | 1442 | ||
| Blue Cohosh | 1442 | ||
| Treatment | 1442 | ||
| Other Neuromuscular Blocking Plants | 1442 | ||
| Yellow Jasmine | 1442 | ||
| Stinging Nettle | 1442 | ||
| Hallucinogenic Plants (Indoles, Phenylalkylamines) | 1443 | ||
| Morning Glory | 1443 | ||
| Nutmeg | 1443 | ||
| Cannabis | 1443 | ||
| Peyote | 1444 | ||
| San Pedro Cactus (Echinopsis or Trichocereus spp.) | 1444 | ||
| Dona Ana Cactus | 1444 | ||
| Mescal Bean Bush | 1444 | ||
| Iboga | 1444 | ||
| Gifbol | 1444 | ||
| Khat | 1444 | ||
| Anticholinergic Plants | 1445 | ||
| Treatment | 1445 | ||
| Sedating Plants | 1445 | ||
| Poppy | 1445 | ||
| Plants Producing Spastic Paraparesis/Quadriparesis (Neurotoxic Amino Acids) | 1445 | ||
| Grass Pea | 1445 | ||
| Convulsant Plants (Indoles, Resins) | 1445 | ||
| Strychnine | 1445 | ||
| Wild Wisteria | 1446 | ||
| Water Hemlock | 1446 | ||
| Myrtle-Leaved Coriaria | 1446 | ||
| Tutu | 1447 | ||
| Kratom | 1447 | ||
| Star Fruit | 1447 | ||
| Other Convulsants | 1447 | ||
| Cardiovascular Toxins | 1447 | ||
| Cardiotoxins That Inhibit Sodium/Potassium Adenosine Triphosphatase (Cardiac Glycosides) | 1447 | ||
| Foxglove | 1448 | ||
| Oleander | 1448 | ||
| Squill | 1448 | ||
| Suicide Tree | 1449 | ||
| Sea Mango | 1449 | ||
| Clinical Presentation | 1449 | ||
| Treatment | 1450 | ||
| Cardiotoxins That Open Sodium Channels (Steroid Alkaloids, Resins) | 1450 | ||
| Aconite | 1450 | ||
| Veratrum Alkaloids | 1451 | ||
| Grayanotoxins | 1451 | ||
| Treatment | 1451 | ||
| Other Cardiotoxins | 1451 | ||
| Taxine Alkaloids | 1451 | ||
| Oral and Gastrointestinal Toxins | 1452 | ||
| Oral Irritants (Glycosides, Oxalates) | 1452 | ||
| Daphne | 1452 | ||
| Insoluble Oxalates | 1452 | ||
| Gastrointestinal Irritants (Resins, Alkaloids) | 1452 | ||
| Chinaberry Trees | 1452 | ||
| Solanum | 1453 | ||
| Plants Containing Saponin Glycosides | 1453 | ||
| Pokeweed. | 1453 | ||
| Toxins That Inhibit Protein Synthesis (Phytotoxins) | 1454 | ||
| Toxalbumins (Ricin, Abrin, Curcin, Robin, Phasin) | 1454 | ||
| Treatment | 1454 | ||
| Hepatotoxic Agents | 1455 | ||
| Pyrrolizidine Alkaloids | 1455 | ||
| Kava Kava | 1455 | ||
| Greater Celandine | 1455 | ||
| Black Cohosh | 1455 | ||
| Coffee Senna | 1455 | ||
| Renal Toxins | 1455 | ||
| Soluble Oxalates | 1455 | ||
| Other Nephrotoxins | 1456 | ||
| Hematopoietic Toxins | 1456 | ||
| Plants with Anticoagulant Properties (Lactone Glycosides) | 1456 | ||
| Toxins That Inhibit Cell Division and Bone Marrow | 1456 | ||
| Colchicine | 1456 | ||
| Podophyllum | 1456 | ||
| Plants That Induce Hemolysis | 1457 | ||
| Fava Beans | 1457 | ||
| Endocrine and Metabolic Toxins | 1457 | ||
| Plants That Interfere with Steroid Metabolism | 1457 | ||
| Licorice | 1457 | ||
| Plants with Mitochondrial Toxins | 1457 | ||
| Ackee Fruit | 1457 | ||
| Wild Yams | 1457 | ||
| Cocklebur | 1457 | ||
| Bird-Lime/Blue Thistle | 1458 | ||
| Ox-Eye Daisy | 1458 | ||
| Karaka | 1458 | ||
| Gifblaar | 1458 | ||
| Cyanogenic Plants | 1458 | ||
| Treatment | 1458 | ||
| Reproductive Toxins | 1459 | ||
| Other Toxins | 1459 | ||
| Oils | 1459 | ||
| Acknowledgment | 1459 | ||
| Appendix A Common Toxic Plants | 1460 | ||
| Appendix B Nontoxic Plants | 1463 | ||
| References | 1463 | ||
| References | 1463.e1 | ||
| 66 Toxic Mushroom Ingestions | 1464 | ||
| Nontoxic Mushrooms | 1467 | ||
| Types of Mushroom Toxicity | 1467 | ||
| Gastrointestinal Toxins | 1469 | ||
| Causative Mushrooms | 1469 | ||
| Toxins | 1474 | ||
| Clinical Presentation | 1476 | ||
| Treatment | 1476 | ||
| Disulfiram-Like Toxins | 1476 | ||
| Causative Mushrooms | 1476 | ||
| Toxin | 1477 | ||
| Clinical Presentation | 1477 | ||
| Treatment | 1477 | ||
| Neurologic Toxins | 1477 | ||
| Muscarine | 1477 | ||
| Causative Mushrooms | 1478 | ||
| Toxin | 1479 | ||
| Clinical Presentation | 1479 | ||
| Treatment | 1479 | ||
| Isoxazole Reactions | 1480 | ||
| Causative Mushrooms | 1480 | ||
| Toxin | 1480 | ||
| Clinical Presentation | 1480 | ||
| Treatment | 1481 | ||
| Hallucinogenic Mushrooms | 1481 | ||
| Causative Mushrooms | 1481 | ||
| Toxin | 1482 | ||
| Clinical Presentation | 1482 | ||
| Treatment | 1483 | ||
| Protoplasmic Poisons | 1483 | ||
| Gyromitra Toxin | 1483 | ||
| Causative Mushrooms | 1483 | ||
| Toxin | 1483 | ||
| Clinical Presentation | 1484 | ||
| Treatment | 1484 | ||
| Renal Toxicity | 1484 | ||
| Causative Mushrooms | 1484 | ||
| Toxin | 1484 | ||
| Clinical Presentation | 1485 | ||
| Treatment | 1485 | ||
| Amatoxins | 1485 | ||
| Causative Mushrooms | 1485 | ||
| Toxins | 1487 | ||
| Clinical Presentation | 1488 | ||
| Treatment | 1488 | ||
| Miscellaneous Reports of Toxicity From Mushrooms | 1489 | ||
| Approach to the Patient with Mushroom Poisoning | 1489 | ||
| Recommended Field Guides | 1490 | ||
| References | 1490 | ||
| References | 1490.e1 | ||
| 67 Seasonal and Acute Allergic Reactions | 1490 | ||
| Allergic Rhinitis | 1491 | ||
| Epidemiology and Risk Factors | 1491 | ||
| Pathophysiology | 1491 | ||
| Allergens | 1492 | ||
| Pollens | 1492 | ||
| Fungi | 1492 | ||
| Dust Mites | 1492 | ||
| Animals | 1492 | ||
| Functions of the Nose | 1493 | ||
| Clinical Evaluation | 1493 | ||
| Differential Diagnosis | 1494 | ||
| Allergy Testing | 1494 | ||
| Treatment | 1494 | ||
| Avoidance | 1494 | ||
| Antihistamines and Decongestants | 1494 | ||
| Intranasal Corticosteroids | 1495 | ||
| Leukotriene Receptor Antagonists | 1495 | ||
| Other Medications | 1496 | ||
| Immunotherapy | 1496 | ||
| Approach to Treatment | 1496 | ||
| Prevention | 1496 | ||
| Urticaria and Angioedema | 1496 | ||
| Urticaria | 1496 | ||
| Treatment | 1497 | ||
| Angioedema | 1497 | ||
| Treatment | 1498 | ||
| Wilderness Considerations | 1498 | ||
| Anaphylaxis | 1498 | ||
| Etiology | 1498 | ||
| Epidemiology and Risk Factors | 1499 | ||
| Pathophysiology | 1499 | ||
| Clinical Presentation | 1499 | ||
| Diagnostic Tests | 1500 | ||
| Treatment | 1500 | ||
| Epinephrine | 1500 | ||
| Treatment of Hypotension | 1501 | ||
| β2-Adrenergic Agonists | 1501 | ||
| Glucocorticoids | 1501 | ||
| Antihistamines | 1501 | ||
| Biphasic Reactions | 1501 | ||
| Medical Evacuation | 1501 | ||
| Sequelae and Aftercare | 1501 | ||
| Prevention | 1501 | ||
| Acknowledgment | 1501 | ||
| References | 1501 | ||
| References | 1501.e1 | ||
| 68 Ethnobotany | 1502 | ||
| Evolution of Phytopharmaceuticals | 1503 | ||
| Herbal Preparations for Clinical and Wilderness Use | 1504 | ||
| Homeopathic Use of Botanicals | 1504 | ||
| Topical Application | 1505 | ||
| Use of Herbal Medicine in the Wilderness | 1505 | ||
| Availability and Application | 1506 | ||
| Side Effects and Toxicity | 1506 | ||
| Spectrum of Applicability | 1506 | ||
| Affordability | 1506 | ||
| North American Plant Medicines | 1506 | ||
| Ephedra (Ephedra species) | 1506 | ||
| Description and Habitat | 1506 | ||
| 10 Marine Medicine | 1529 | ||
| 69 Drowning and Submersion Injuries | 1530 | ||
| Classification and Types of Submersion Injuries and Drowning Scenarios | 1530 | ||
| Incidence and Epidemiology | 1530 | ||
| Risk Factors | 1531 | ||
| Age | 1531 | ||
| Gender | 1532 | ||
| Race | 1532 | ||
| Location | 1532 | ||
| Familiar or Unfamiliar Places | 1532 | ||
| Submerged Vehicle Incidents | 1532 | ||
| Scuba Diving Accidents | 1532 | ||
| Water Birthing Incidents | 1533 | ||
| Ability to Swim | 1533 | ||
| Alcohol and Drugs Contributing to Drowning Incidents | 1533 | ||
| Preexisting Disease | 1533 | ||
| Child Abuse, Homicide, and Suicide | 1533 | ||
| Boating-Related Drowning | 1533 | ||
| Pathophysiology | 1534 | ||
| The Human Body and Water | 1534 | ||
| The Initial Event | 1534 | ||
| Pulmonary System | 1534 | ||
| Swimming-Induced Pulmonary Edema | 1535 | ||
| Central Nervous System | 1535 | ||
| Cardiovascular System | 1537 | ||
| Hematologic and Electrolyte Disturbances | 1537 | ||
| Hypothermia | 1537 | ||
| Management: the Element of Time | 1538 | ||
| Clinical Presentation: a Case History | 1538 | ||
| On-Scene Management | 1539 | ||
| The Asymptomatic Patient: Grades 0 and 1 | 1539 | ||
| The Symptomatic Patient: Grades 2, 3, and 4 | 1539 | ||
| The Patient in Respiratory or Cardiopulmonary Arrest: Grades 5 and 6 | 1539 | ||
| Cervical Spine Injury | 1541 | ||
| The Obviously Dead or Still-Submerged Patient | 1541 | ||
| Terminating Resuscitation Efforts | 1541 | ||
| En Route to Definitive Care | 1541 | ||
| Emergency Department Treatment of Drowning Patients | 1542 | ||
| In-Hospital Treatment of Drowning | 1542 | ||
| Pulmonary Management | 1543 | ||
| Cardiovascular System and Hemodynamics | 1543 | ||
| Central Nervous System | 1544 | ||
| Hypothermia | 1544 | ||
| Renal System | 1544 | ||
| Decompression Illness | 1544 | ||
| Infectious Diseases | 1544 | ||
| Prognosis and Termination of Resuscitation | 1545 | ||
| Drowning Prevention and Survival | 1546 | ||
| Preimmersion Interventions | 1546 | ||
| Preimmersion Interventions by Age | 1546 | ||
| Swimming Pool Safety | 1547 | ||
| Supervision and Lifeguards | 1547 | ||
| Training for Out-of-Hospital Personnel | 1547 | ||
| Swimming Lessons and Boating Instruction | 1547 | ||
| Personal Flotation Devices | 1548 | ||
| Preventive Equipment | 1548 | ||
| Education About Alcohol and Drugs | 1548 | ||
| Postimmersion Actions | 1548 | ||
| References | 1549 | ||
| References | 1549.e1 | ||
| 70 Safety and Survival at Sea | 1550 | ||
| How Do People Die in Recreational Boating Accidents? | 1550 | ||
| Personal Safety Gear | 1551 | ||
| Life Jackets | 1551 | ||
| The Inflatable Advantage | 1552 | ||
| Testing a Life Jacket | 1553 | ||
| Immersion (Survival) Suits | 1553 | ||
| Safety Harnesses | 1553 | ||
| Crew Overboard | 1554 | ||
| Remaining Aboard | 1554 | ||
| Recovery of Crew Overboard | 1554 | ||
| Crew Overboard Maneuvers | 1556 | ||
| Bringing the Victim Aboard | 1556 | ||
| Emergencies at Sea | 1557 | ||
| Fire at Sea | 1557 | ||
| Causes | 1557 | ||
| Fire from Fuels, Liquids, and Gases | 1557 | ||
| Fighting Fires | 1558 | ||
| Flooding | 1559 | ||
| Flood Mitigation | 1560 | ||
| Collisions with Other Vessels | 1562 | ||
| Automatic Identification System | 1563 | ||
| Using Radar to Avoid Collisions | 1563 | ||
| Visual Means of Avoiding Collisions | 1563 | ||
| Health Maintenance at Sea | 1564 | ||
| The Fearsome Five | 1564 | ||
| Food | 1564 | ||
| Fluid | 1564 | ||
| Fahrenheit | 1565 | ||
| Fatigue | 1565 | ||
| Fitness | 1565 | ||
| Seasickness | 1565 | ||
| Preventing and Treating Seasickness | 1566 | ||
| Marine Weather | 1567 | ||
| Thunderstorms and Squall Lines | 1567 | ||
| Sources of Marine Weather Information | 1567 | ||
| Traditional Weather Forecasting Methods | 1568 | ||
| Lightning | 1568 | ||
| Mitigating the Damage from Lightning | 1569 | ||
| Other Weather Phenomena at Sea | 1569 | ||
| Waterspouts | 1569 | ||
| Hurricanes and Cyclones | 1569 | ||
| Sea Conditions and Breaking Seas | 1570 | ||
| Emergency Communications and Distress Signals | 1571 | ||
| Visual and Sound Distress Signals | 1571 | ||
| Nonpyrotechnic Signals | 1573 | ||
| Cellular Telephones | 1573 | ||
| Satellite Phones | 1574 | ||
| Global Maritime Distress and Safety System and Digital Selective Calling | 1574 | ||
| VHF-FM Marine Radios | 1574 | ||
| SSB-HF Radios | 1576 | ||
| Emergency Beacons | 1576 | ||
| SEND Devices | 1577 | ||
| Abandon Ship and Life Rafts | 1577 | ||
| Decision to Abandon Ship | 1577 | ||
| Life Raft Classifications | 1578 | ||
| How to Abandon Ship | 1578 | ||
| Life Raft Storage | 1579 | ||
| Launching the Raft | 1579 | ||
| Life in the Raft: Extending Survival Time and Anticipating Rescue | 1579 | ||
| Signals and Watch Schedules | 1580 | ||
| Raft Maintenance | 1580 | ||
| Health Issues and Hypothermia | 1580 | ||
| Water | 1580 | ||
| Food | 1581 | ||
| Rescue and Evacuation of the Sick and Injured | 1581 | ||
| Automated Merchant Vessel Reporting Program | 1581 | ||
| Helicopter Evacuation | 1582 | ||
| References | 1583 | ||
| References | 1583.e1 | ||
| 71 Diving Medicine | 1583 | ||
| Historical Perspective | 1585 | ||
| Types of Diving and Diving Equipment | 1586 | ||
| Breath-Hold Diving | 1586 | ||
| Medical Problems of Breath-Hold Diving | 1586 | ||
| SCUBA Diving | 1586 | ||
| Rebreather Diving | 1587 | ||
| Rebreather Devices | 1587 | ||
| Oxygen Rebreather. | 1587 | ||
| Semiclosed-Circuit Rebreather. | 1588 | ||
| Manual Closed-Circuit Rebreather. | 1588 | ||
| Electronic Closed-Circuit Rebreather. | 1588 | ||
| Open-Circuit Scuba System versus Rebreather Approach | 1588 | ||
| Open-Circuit Air Approach. | 1588 | ||
| Rebreather Approach. | 1588 | ||
| Surface-Supplied (Tethered) Diving | 1589 | ||
| Mixed-Gas Diving | 1589 | ||
| Enriched Air Nitrox | 1589 | ||
| Heliox | 1589 | ||
| Trimix | 1590 | ||
| Technical Diving | 1590 | ||
| Saturation Diving | 1590 | ||
| Polar Diving | 1591 | ||
| Marine Life Hazards | 1591 | ||
| Polar Diving Emergencies | 1591 | ||
| Physiologic Considerations in Polar Diving | 1591 | ||
| Cold Water. | 1591 | ||
| Surface Cold Exposure. | 1592 | ||
| Hydration. | 1592 | ||
| Decompression. | 1592 | ||
| One-Atmosphere Diving | 1592 | ||
| Diving Physics | 1592 | ||
| Barotrauma | 1593 | ||
| Barotrauma of Descent | 1594 | ||
| Mask Barotrauma | 1594 | ||
| Sinus Barotrauma | 1595 | ||
| External Auditory Canal Barotrauma. | 1595 | ||
| Middle Ear Barotrauma. | 1595 | ||
| Inner Ear Barotrauma. | 1597 | ||
| Suit Barotrauma | 1597 | ||
| Dental Barotrauma | 1597 | ||
| Lung Barotrauma | 1597 | ||
| Underwater Blast Injury | 1598 | ||
| Barotrauma of Ascent | 1598 | ||
| Reverse Sinus or Ear Barotrauma (Reverse Squeeze) | 1598 | ||
| Alternobaric Vertigo | 1598 | ||
| Facial Baroparesis (Alternobaric Facial Palsy) | 1598 | ||
| Gastrointestinal Barotrauma | 1598 | ||
| Pulmonary Barotrauma | 1598 | ||
| Clinical Manifestations of Pulmonary Barotrauma. | 1599 | ||
| Local Pulmonary Injury. | 1599 | ||
| Arterial Gas Embolism | 1600 | ||
| Pathophysiology | 1600 | ||
| Arterial Gas Embolism and Sudden Death | 1600 | ||
| Clinical Manifestations | 1601 | ||
| Treatment | 1602 | ||
| Prehospital Care | 1602 | ||
| Hyperbaric Oxygen Therapy | 1603 | ||
| Adjunctive Treatment | 1603 | ||
| Prevention of Pulmonary Barotrauma and Arterial Gas Embolism | 1603 | ||
| Indirect Effects of Pressure | 1603 | ||
| Dalton’s Law of Partial Pressures | 1603 | ||
| Nitrogen Narcosis | 1604 | ||
| Oxygen Toxicity | 1604 | ||
| Pulmonary Oxygen Toxicity | 1605 | ||
| Central Nervous System Oxygen Toxicity | 1605 | ||
| Contaminated Breathing Gas (Carbon Monoxide Poisoning, Hypercarbia) | 1605 | ||
| Hyperventilation and Shallow Water Blackout | 1605 | ||
| Decompression Sickness | 1606 | ||
| Cause | 1606 | ||
| Pathophysiology | 1606 | ||
| Venous Gas Emboli | 1606 | ||
| Biochemical Effects of Bubbles | 1607 | ||
| Clinical Manifestations | 1607 | ||
| Musculoskeletal Decompression Sickness | 1607 | ||
| Fatigue | 1608 | ||
| Cutaneous Decompression Sickness (Skin Bends) | 1608 | ||
| Pulmonary Decompression Sickness (Chokes) | 1608 | ||
| Neurologic Decompression Sickness | 1608 | ||
| Inner Ear or Vestibular Decompression Sickness | 1609 | ||
| Vasomotor Decompression Sickness | 1609 | ||
| Long-Term Sequelae of Decompression Sickness | 1609 | ||
| Dysbaric Osteonecrosis | 1609 | ||
| Dysbaric Retinopathy | 1609 | ||
| Diagnosis | 1609 | ||
| Treatment | 1609 | ||
| Adjunctive Treatment | 1611 | ||
| Corticosteroids. | 1611 | ||
| Anticoagulants and Nonsteroidal Antiinflammatory Drugs. | 1611 | ||
| Prevention | 1611 | ||
| Decompression Sickness in Breath-Hold Divers | 1611 | ||
| Long-Term Health Effects of Diving | 1611 | ||
| Unusual Conditions of Uncertain Origin Following Dives | 1612 | ||
| Immersion Pulmonary Edema | 1612 | ||
| Internal Carotid Artery Dissection | 1612 | ||
| Medical Fitness for Diving | 1612 | ||
| General Considerations | 1612 | ||
| Medical Clearance for Diving | 1613 | ||
| Specific Conditions of Concern with Regard to Diving | 1613 | ||
| Neurologic Disorders | 1613 | ||
| Seizures. | 1613 | ||
| Head Injury. | 1613 | ||
| Unexplained Syncope. | 1613 | ||
| Migraine Headaches. | 1613 | ||
| Cardiovascular Disorders | 1613 | ||
| Atrial Septal Defect. | 1613 | ||
| Patent Foramen Ovale. | 1613 | ||
| Coronary Artery Disease. | 1614 | ||
| Dysrhythmias. | 1614 | ||
| Hypertension. | 1614 | ||
| Pulmonary Disorders | 1615 | ||
| Spontaneous Pneumothorax. | 1615 | ||
| Asthma. | 1615 | ||
| Bullous Lung Disease. | 1615 | ||
| Diabetes | 1616 | ||
| Pregnancy | 1616 | ||
| Ear, Nose, and Throat Disorders | 1616 | ||
| Sickle-Cell Disease or Trait | 1616 | ||
| Panic Disorders | 1616 | ||
| Abdominal Hernias | 1616 | ||
| Poor Physical Condition | 1616 | ||
| Medications and Diving | 1616 | ||
| Diving with Disabilities | 1617 | ||
| Flying after Diving | 1617 | ||
| Safe SCUBA Diving | 1617 | ||
| Dive Accident Investigation | 1618 | ||
| Investigation of Diving Fatalities | 1618 | ||
| References | 1618 | ||
| References | 1618.e1 | ||
| 72 Hyperbaric Medicine | 1619 | ||
| History of Hyperbaric Medicine | 1619 | ||
| Mechanisms of Hyperbaric Oxygen | 1619 | ||
| Effects of Hyperbaric Oxygen on Oxygen Content | 1619 | ||
| Effects of an Elevated Partial Pressure of Oxygen | 1619 | ||
| Vasoconstriction | 1619 | ||
| Bacteriostatic and Bactericidal Effects of Hyperbaric Oxygen | 1620 | ||
| Angiogenesis | 1620 | ||
| Wound Healing | 1620 | ||
| Ischemia-Reperfusion Injury | 1620 | ||
| Types of Hyperbaric Chambers | 1622 | ||
| Monoplace Hyperbaric Chambers | 1622 | ||
| Multiplace Hyperbaric Chambers | 1622 | ||
| Portable Recompression Chambers | 1622 | ||
| Hyperbaric Chambers for Altitude Illness | 1622 | ||
| Hyperbaric Chambers for Diving Injuries | 1624 | ||
| Contraindications to Hyperbaric Oxygen Therapy | 1624 | ||
| Absolute Contraindications | 1624 | ||
| Relative Contraindications | 1624 | ||
| Complications of Hyperbaric Oxygen Therapy | 1624 | ||
| Oxygen Toxicity | 1624 | ||
| Central Nervous System Oxygen Toxicity | 1625 | ||
| Pulmonary Oxygen Toxicity | 1625 | ||
| Barotrauma | 1625 | ||
| Claustrophobia | 1625 | ||
| Visual Refractive Changes | 1625 | ||
| Practical Aspects of Hyperbaric Treatment | 1625 | ||
| Evaluation of the Patient for Hyperbaric Oxygen Therapy | 1625 | ||
| Preparation for Hyperbaric Treatment | 1625 | ||
| Pediatric Considerations | 1626 | ||
| Approved Clinical Applications of Hyperbaric Oxygen Therapy | 1626 | ||
| Arterial Gas Embolism | 1626 | ||
| Decompression Sickness | 1628 | ||
| Arterial Insufficiencies | 1628 | ||
| Central Retinal Artery Occlusion | 1628 | ||
| Enhancement of Healing in Selected Problem Wounds | 1628 | ||
| Carbon Monoxide and Cyanide Poisoning | 1629 | ||
| Clostridial Myonecrosis (Gas Gangrene) | 1630 | ||
| Compromised Grafts and Flaps | 1630 | ||
| Crush Injuries and Skeletal Muscle Compartment Syndromes | 1630 | ||
| Delayed Radiation Injuries (Soft Tissue and Bony Necrosis) | 1631 | ||
| Idiopathic Sudden Sensorineural Hearing Loss | 1632 | ||
| Intracranial Abscess | 1632 | ||
| Necrotizing Soft Tissue Infections | 1632 | ||
| Refractory Osteomyelitis | 1632 | ||
| Severe Anemia | 1633 | ||
| Thermal Burns | 1633 | ||
| Trends in Hyperbaric Oxygen Therapy Research | 1633 | ||
| Acute Myocardial Ischemia | 1633 | ||
| Acute Cerebral Ischemia | 1634 | ||
| Traumatic Brain Injury | 1634 | ||
| Organ Transplantation | 1634 | ||
| Applications for Hyperbaric Oxygen Therapy in Wilderness Medicine | 1634 | ||
| Frostbite | 1634 | ||
| Brown Recluse Spider Bite | 1635 | ||
| Heatstroke | 1635 | ||
| Field Treatment of Combat Trauma | 1635 | ||
| References | 1635 | ||
| References | 1635.e1 | ||
| 73 Injuries From Nonvenomous Aquatic Animals | 1636 | ||
| Divisions and Definitions | 1636 | ||
| In Defense of the Fish | 1636 | ||
| General Principles of First Aid | 1636 | ||
| Wound Management | 1636 | ||
| Wound Irrigation | 1637 | ||
| Wound Debridement | 1637 | ||
| Wound Closure | 1637 | ||
| Prophylaxis Against Tetanus | 1637 | ||
| Bacteriology of the Aquatic Environment | 1637 | ||
| Marine Bacteriology | 1637 | ||
| Marine Environment | 1637 | ||
| Diversity of Organisms | 1638 | ||
| Wound Infections Caused by Vibrio Species | 1638 | ||
| Vibrio parahaemolyticus | 1639 | ||
| Vibrio vulnificus | 1639 | ||
| Vibrio mimicus | 1640 | ||
| Vibrio alginolyticus | 1640 | ||
| Photobacterium damsela | 1640 | ||
| Vibrio cholerae | 1640 | ||
| Growth in Culture | 1640 | ||
| Antibiotic Therapy | 1641 | ||
| Freshwater Bacteriology | 1642 | ||
| Diversity of Organisms | 1642 | ||
| Wound Infections Caused by Aeromonas Species | 1642 | ||
| Infections Caused by a Fish Pathogen, Streptococcus iniae | 1642 | ||
| Infection Caused by Desmodesmus armatus | 1643 | ||
| A General Approach to Antibiotic Therapy | 1643 | ||
| Sharks | 1643 | ||
| Life and Habits | 1647 | ||
| Shark Feeding and Attack | 1652 | ||
| Clinical Aspects | 1656 | ||
| Treatment | 1659 | ||
| Prevention | 1662 | ||
| Barracuda | 1665 | ||
| Life and Habits | 1665 | ||
| Clinical Aspects | 1666 | ||
| Treatment | 1666 | ||
| Prevention | 1666 | ||
| Moray Eels | 1666 | ||
| Life and Habits | 1666 | ||
| Clinical Aspects | 1667 | ||
| Treatment | 1667 | ||
| Prevention | 1668 | ||
| Giant Groupers | 1668 | ||
| Sea Lions and Seals | 1669 | ||
| Needlefish | 1669 | ||
| Large Leaping Fish | 1670 | ||
| Killer Whales | 1671 | ||
| Giant Clams | 1671 | ||
| Giant Squid | 1672 | ||
| Giant Octopus | 1673 | ||
| Giant Manta Ray | 1673 | ||
| Mantis Shrimp | 1673 | ||
| Piranha | 1674 | ||
| Snapping Turtle | 1675 | ||
| Triggerfish | 1675 | ||
| Sawfishes | 1676 | ||
| Stony Corals | 1676 | ||
| Life and Habits | 1676 | ||
| Clinical Aspects | 1676 | ||
| Treatment | 1677 | ||
| Prevention | 1677 | ||
| Electric Fish and Rays | 1677 | ||
| References | 1678 | ||
| References | 1678.e1 | ||
| 74 Envenomation by Aquatic Invertebrates | 1679 | ||
| Allergic Reactions | 1679 | ||
| Anaphylaxis | 1679 | ||
| Treatment | 1679 | ||
| Antivenom Administration | 1679 | ||
| Serum Sickness | 1680 | ||
| Phylum Porifera | 1680 | ||
| Sponges | 1680 | ||
| Life and Habits | 1680 | ||
| Clinical Aspects | 1680 | ||
| Treatment | 1682 | ||
| Prevention | 1682 | ||
| Phylum Cnidaria | 1682 | ||
| Morphology, Venom, and Venom Apparatus | 1682 | ||
| Cnidarian Syndrome | 1685 | ||
| Clinical Aspects | 1685 | ||
| Mild Envenomation. | 1685 | ||
| Moderate and Severe Envenomation. | 1686 | ||
| Treatment | 1688 | ||
| Systemic Envenomation. | 1688 | ||
| Pain Control. | 1689 | ||
| Treatment of Dermatitis. | 1689 | ||
| Delayed Reaction. | 1690 | ||
| Persistent Hyperpigmentation. | 1690 | ||
| Persistent Cutaneous Hypersensitivity. | 1690 | ||
| Prevention | 1690 | ||
| Class Hydrozoa | 1690 | ||
| Hydroids | 1690 | ||
| Clinical Aspects. | 1691 | ||
| Treatment. | 1691 | ||
| Fire Coral | 1691 | ||
| Clinical Aspects. | 1692 | ||
| Treatment. | 1693 | ||
| Physalia (Man-of-War) | 1693 | ||
| Clinical Aspects. | 1694 | ||
| Treatment. | 1695 | ||
| Seabather’s Eruption | 1695 | ||
| Clinical Aspects. | 1695 | ||
| Treatment. | 1696 | ||
| Gonionemus Species | 1696 | ||
| Classes Cubozoa and Scyphozoa | 1696 | ||
| Chironex (Box-Jellyfish) | 1697 | ||
| Clinical Aspects. | 1698 | ||
| Treatment. | 1700 | ||
| Irukandji Jellyfish | 1702 | ||
| 11 Travel Medicine and Expeditions | 1807 | ||
| 79 Travel Medicine | 1808 | ||
| Sources of Information | 1808 | ||
| Travel Health Risk Assessment | 1808 | ||
| Pretravel Preparations | 1808 | ||
| Hazards of Air Travel | 1809 | ||
| Jet Lag | 1810 | ||
| Before Travel | 1810 | ||
| In Flight | 1810 | ||
| On Arrival | 1810 | ||
| Deep Vein Thrombosis | 1810 | ||
| Immunizations for Travel | 1810 | ||
| Required Travel Vaccines | 1813 | ||
| Yellow Fever Vaccine | 1813 | ||
| Cholera Vaccine | 1813 | ||
| Smallpox Vaccine | 1814 | ||
| Recommended Travel Vaccines | 1814 | ||
| Hepatitis A Vaccine | 1814 | ||
| Hepatitis B Vaccine | 1815 | ||
| Typhoid Fever Vaccine | 1816 | ||
| Meningococcal Vaccine | 1816 | ||
| Japanese Encephalitis Virus Vaccine | 1817 | ||
| Rabies Vaccine | 1817 | ||
| Tick-Borne Encephalitis Vaccine | 1817 | ||
| Bacille Calmette-Guérin Vaccine | 1817 | ||
| Varicella-Zoster Virus (Chickenpox) Vaccine | 1817 | ||
| Influenza Vaccine | 1817 | ||
| Other Vaccines | 1818 | ||
| Routine Vaccines | 1818 | ||
| Diphtheria, Tetanus, and Pertussis Vaccine | 1818 | ||
| Poliomyelitis Vaccine | 1818 | ||
| Measles, Mumps, and Rubella Vaccine | 1818 | ||
| Haemophilus Influenzae Type B (Hib) Vaccine | 1818 | ||
| Pneumococcal Vaccine | 1818 | ||
| Malaria | 1818 | ||
| Malaria Risk Assessment | 1818 | ||
| Precautions Against Insects (see Chapter 45) | 1819 | ||
| Malaria Chemoprophylaxis (see Chapter 40) | 1819 | ||
| Standby Self-Diagnosis AND Drug Treatment | 1821 | ||
| Traveler’s Diarrhea (see Chapter 82) | 1821 | ||
| Chemoprophylaxis | 1822 | ||
| Symptomatic Treatment | 1823 | ||
| High-Altitude Illness (see Chapter 2) | 1823 | ||
| Radiation From the Sun (see Chapter 16) | 1825 | ||
| Motion Sickness | 1825 | ||
| Travel Medical Kit | 1825 | ||
| Post-Travel Medical Care AND Screening | 1825 | ||
| Resources for Travel Medicine Information | 1826 | ||
| Acknowledgment | 1826 | ||
| References | 1826 | ||
| References | 1826.e1 | ||
| 80 Expedition Medicine | 1826 | ||
| Historical Background | 1826 | ||
| Expedition Demographics | 1826 | ||
| Preexisting Medical Conditions | 1828 | ||
| The Expedition Medical Officer | 1828 | ||
| Clinical Skills | 1828 | ||
| Preexpedition Phase | 1828 | ||
| Expedition Phase | 1828 | ||
| Location. | 1828 | ||
| Environment. | 1828 | ||
| Goals. | 1828 | ||
| Preexisting Medical Conditions. | 1829 | ||
| Postexpedition Phase | 1829 | ||
| Expedition Skills | 1829 | ||
| Personal Skills | 1829 | ||
| Self-Awareness | 1829 | ||
| Communication Skills | 1829 | ||
| Empathy and Compassion | 1829 | ||
| Adaptability | 1829 | ||
| Sense of Humor | 1829 | ||
| Skills of Conflict Resolution | 1829 | ||
| Decision Making and Hierarchy. | 1829 | ||
| Expectations. | 1830 | ||
| Conflict Stemming From Expedition Purpose, Ethics, and Morals. | 1830 | ||
| Who is Qualified to be the Expedition Medical Officer? | 1830 | ||
| Expedition Medical Planning | 1832 | ||
| Medical Screening | 1832 | ||
| Generic PreExpedition Advice for Persons with Preexisting Medical Conditions | 1832 | ||
| Vaccinations, Malaria Chemoprophylaxis, and Personal Medication | 1833 | ||
| Vaccinations | 1833 | ||
| Malaria Chemoprophylaxis | 1833 | ||
| Personal Medication | 1833 | ||
| Risk Management | 1833 | ||
| Country-Specific Risks | 1834 | ||
| Expedition Medical Training | 1835 | ||
| Expedition Medical Kit Preparation | 1835 | ||
| Diagnostic Equipment | 1835 | ||
| Medical Kit Packaging | 1835 | ||
| Problems of Transporting Controlled Drugs | 1836 | ||
| Treating Infections | 1836 | ||
| Analgesia | 1836 | ||
| Other Essential Drugs | 1836 | ||
| Creams and Ointments | 1836 | ||
| Emergency Equipment | 1836 | ||
| Obtaining Medical Supplies | 1836 | ||
| Base Camp and Satellite Medical Kits | 1836 | ||
| Medical Kits for Special Environments | 1836 | ||
| Communications Technology | 1836 | ||
| Legal and Ethical Considerations of Expedition Medicine | 1837 | ||
| Duty of Care | 1837 | ||
| Level of Control and Age/Experience of the Ill or Injured Person | 1838 | ||
| Comparison with Peers | 1838 | ||
| Likelihood of an Incident Occurring | 1838 | ||
| Maintenance of Equipment and Cost of Precautions | 1838 | ||
| Emergency Situations | 1838 | ||
| Standard of Care | 1838 | ||
| Confidentiality | 1838 | ||
| Consent | 1838 | ||
| Competence and Capacity | 1839 | ||
| Negligence | 1839 | ||
| How Much Should Laypersons be Taught About Medicine? | 1839 | ||
| Legal Position of a Physician Advising Care to be Administered by a Layperson | 1839 | ||
| Liability on Commercial Expeditions | 1839 | ||
| Expeditions Departing Without an EMO | 1839 | ||
| Medical Records | 1839 | ||
| Professional Indemnity Insurance | 1839 | ||
| Ethical Considerations of Interacting with Local Populations | 1840 | ||
| Preexpedition Planning | 1840 | ||
| During the Expedition | 1840 | ||
| Treating Local Staff | 1841 | ||
| Biomedical Research | 1841 | ||
| Dealing with the Media | 1841 | ||
| Resources | 1842 | ||
| Appendix Recommended Medical Kit | 1842 | ||
| References | 1843 | ||
| References | 1843.e1 | ||
| 81 Non–North American Travel and Exotic Diseases | 1844 | ||
| Major Viral Infections | 1844 | ||
| Major Viral Hemorrhagic Fevers | 1844 | ||
| Yellow Fever | 1844 | ||
| Virology and Pathophysiology | 1844 | ||
| Ecology and Epidemiology | 1844 | ||
| Clinical Presentation and Diagnosis | 1844 | ||
| Management | 1845 | ||
| Prevention | 1845 | ||
| Dengue | 1845 | ||
| Virology and Pathophysiology | 1845 | ||
| Ecology and Epidemiology | 1845 | ||
| Clinical Presentation | 1845 | ||
| Prevention and Management | 1846 | ||
| Lassa Fever | 1846 | ||
| Epidemiology | 1846 | ||
| Virology and Pathophysiology | 1846 | ||
| Clinical Presentation | 1846 | ||
| Diagnosis | 1846 | ||
| Management | 1846 | ||
| Ebola and Marburg Viruses | 1847 | ||
| 12 Disaster Medicine and Global Humanitarian Relief | 1875 | ||
| 83 Natural Disaster Management | 1876 | ||
| Scope of the Problem | 1876 | ||
| Health Consequences of Disasters | 1876 | ||
| Health and the Medical Response to Natural Disasters | 1877 | ||
| Scene Safety | 1878 | ||
| Provision of Acute Care | 1878 | ||
| Provision of Mental Health Care | 1878 | ||
| Support for Primary Care and Long-Term Care | 1878 | ||
| Care of the Deceased | 1879 | ||
| Care for Vulnerable Populations | 1879 | ||
| Organizational Systems for Disaster Response | 1879 | ||
| The Incident Command System and the National Incident Management System | 1879 | ||
| The United Nations Cluster Approach for Global Humanitarian Response | 1880 | ||
| Core Activities of the Disaster Response and Recovery Phases | 1881 | ||
| Professionalization of the Disaster Response | 1883 | ||
| Social Media and Mobile Technology in Disasters | 1883 | ||
| Responder Self-Care | 1884 | ||
| References | 1884 | ||
| References | 1884.e1 | ||
| 84 Global Humanitarian Medicine and Disaster Relief | 1885 | ||
| Survey of Key Events and Medical Problems | 1885 | ||
| Armed Conflict | 1885 | ||
| Population Displacement | 1886 | ||
| Natural Disasters | 1887 | ||
| Disease Epidemics | 1887 | ||
| Sexual Violence and Mental Illness | 1888 | ||
| Famine and Malnutrition | 1888 | ||
| Neglected Diseases | 1888 | ||
| Emerging Urban Contexts | 1888 | ||
| Actors during Events: Their Capabilities, Limitations, and Usual Roles | 1889 | ||
| Motivating Factors for Organizational Involvement | 1891 | ||
| Needs in Humanitarian Crises | 1892 | ||
| Initial Assessment | 1892 | ||
| Water and Sanitation | 1892 | ||
| Water. | 1892 | ||
| Sanitation. | 1892 | ||
| Food and Nutrition | 1892 | ||
| Shelter, Security, and Site Planning | 1893 | ||
| Health Care in the Emergency Phase | 1893 | ||
| Control of Communicable Diseases and Epidemics | 1893 | ||
| Public Health Surveillance | 1894 | ||
| Human Resources and Training | 1894 | ||
| Coordination and Logistic Support | 1894 | ||
| Identifying Health Care Needs Following a Disaster and Setting Up a Humanitarian Intervention | 1894 | ||
| Background | 1894 | ||
| Principles for Health Assessment in Disasters and Crises | 1895 | ||
| The Assessment Process | 1895 | ||
| Planning. | 1895 | ||
| Team. | 1896 | ||
| Tools. | 1896 | ||
| Methods | 1896 | ||
| Initial Assessment. | 1896 | ||
| Surveys and Sampling Methods. | 1896 | ||
| Data Analysis. | 1896 | ||
| Reporting | 1897 | ||
| Program Development: the Logical Framework | 1897 | ||
| Surveillance, Monitoring, and Evaluation | 1898 | ||
| Putting Services in Place and Mobilizing Resources | 1898 | ||
| The Aid Worker in the Humanitarian Crisis | 1899 | ||
| Motivating Factors for Personal Involvement in Humanitarian Events and Disasters | 1899 | ||
| Professional Characteristics of the Aid Worker | 1900 | ||
| Typical Daily Field Responsibilities of Health Care Workers | 1902 | ||
| How to Become Involved and Stay Involved | 1904 | ||
| How to Prepare for a Mission | 1905 | ||
| Preparing to Deliver Medical Care in a Crisis | 1905 | ||
| Working Outside One’s Skill Set | 1906 | ||
| Dealing With Death | 1906 | ||
| Behavior and Expectations | 1907 | ||
| Practical Considerations | 1907 | ||
| Getting Oriented | 1907 | ||
| How to Pack | 1907 | ||
| Additional Training | 1907 | ||
| Practical Tips on How to Have a Good Mission | 1907 | ||
| Personal Matters. | 1907 | ||
| Professional Matters. | 1913 | ||
| Considerations When Returning Home | 1913 | ||
| Activities After Returning From a Mission | 1914 | ||
| Evolution of the Humanitarian System | 1914 | ||
| Efforts Toward Improving Responses to Needs in the Field | 1915 | ||
| The Sphere Project | 1915 | ||
| United Nations Reform: The Cluster Approach | 1915 | ||
| Humanitarian NGO Professionalization | 1915 | ||
| Training and Certification | 1915 | ||
| Current Challenges, Controversies and Key Future Issues | 1916 | ||
| Growth and Its Effects | 1916 | ||
| Local People and Local Capacity | 1916 | ||
| Medical Quality and Access to Care | 1917 | ||
| Security, Insecurity, and Power in the Field | 1918 | ||
| Humanitarianism and Environmentalism | 1918 | ||
| Humanitarian Ethics and Morals | 1918 | ||
| Appendix A Suggested Packing List | 1919 | ||
| Documents | 1919 | ||
| Gifts to Bring Your Team | 1919 | ||
| Address or Contact List* | 1919 | ||
| Gear | 1919 | ||
| Electronics | 1919 | ||
| First-Aid Kit | 1919 | ||
| Toiletries | 1920 | ||
| Extras | 1920 | ||
| References | 1920 | ||
| References | 1920.e1 | ||
| 85 Natural and Human-Made Hazards | 1920 | ||
| Disaster Risk Reduction and Management | 1920 | ||
| Slow-Onset Versus Rapid-Onset Hazards | 1921 | ||
| Assessing Vulnerability and Risk | 1922 | ||
| Disaster Mitigation Strategies | 1922 | ||
| Engineering and Construction | 1922 | ||
| Physical Planning Measures | 1922 | ||
| Economic Measures | 1922 | ||
| Legislation, Management, and Institutional Measures | 1922 | ||
| Societal Measures | 1923 | ||
| The Nature of Hazards | 1923 | ||
| Geologic Hazards | 1923 | ||
| Earthquakes | 1923 | ||
| Causal Phenomena | 1923 | ||
| Characteristics | 1923 | ||
| Earthquake Scales | 1923 | ||
| Location and Predictability | 1924 | ||
| Earthquake Hazards | 1926 | ||
| Fault Displacement and Ground Shaking. | 1926 | ||
| Ground Failure and Soil Liquefaction. | 1926 | ||
| Lateral Spreads and Flow Failure. | 1926 | ||
| Landslides and Avalanches. | 1926 | ||
| Tsunamis. | 1926 | ||
| Fires. | 1926 | ||
| Typical Adverse Effects | 1926 | ||
| Earthquake Risk Reduction Measures | 1927 | ||
| Risk Reduction in China. | 1927 | ||
| Tsunamis | 1928 | ||
| Causal Phenomena and Characteristics | 1928 | ||
| Predictability | 1928 | ||
| Vulnerability | 1929 | ||
| Typical Adverse Effects | 1929 | ||
| Casualties and Public Health. | 1929 | ||
| Crops and Food Supplies. | 1929 | ||
| Tsunami Risk Reduction Measures | 1930 | ||
| Warning Systems. | 1930 | ||
| Structural Design. | 1930 | ||
| Mapping and Land Use. | 1930 | ||
| Education. | 1930 | ||
| Volcanic Eruptions | 1930 | ||
| Causal Phenomena | 1930 | ||
| Pelean Eruptions. | 1931 | ||
| Plinian Eruptions. | 1931 | ||
| Vesuvian Eruptions. | 1931 | ||
| Vulcanian Eruptions. | 1931 | ||
| Strombolian Eruptions. | 1931 | ||
| Hawaiian Eruptions. | 1931 | ||
| Icelandic Eruptions. | 1931 | ||
| Characteristics | 1931 | ||
| Pyroclastic Flows. | 1931 | ||
| Air-Fall Tephra. | 1931 | ||
| Lava Flows. | 1932 | ||
| Volcanic Gases. | 1932 | ||
| Lahars and Landslides. | 1932 | ||
| Tsunamis. | 1932 | ||
| Location | 1932 | ||
| Predictability | 1932 | ||
| Problems in Eruption Forecast and Prediction. | 1932 | ||
| Vulnerability | 1932 | ||
| Typical Adverse Effects | 1932 | ||
| Casualties and Health. | 1932 | ||
| Settlements, Infrastructure, and Agriculture. | 1933 | ||
| Volcanic Eruption Risk Reduction Measures | 1933 | ||
| Despite Precautions, People Took High Risks in the Mt Merapi Eruption. | 1933 | ||
| Landslides | 1933 | ||
| Causal Phenomena | 1933 | ||
| Characteristics | 1933 | ||
| Falls. | 1933 | ||
| Slides. | 1933 | ||
| Topples. | 1933 | ||
| Lateral Spreads. | 1934 | ||
| Flows. | 1934 | ||
| Casualties. | 1934 | ||
| Predictability | 1934 | ||
| Vulnerability | 1935 | ||
| Typical Adverse Effects | 1935 | ||
| Landslide Risk Reduction Measures | 1935 | ||
| Climatic Hazards | 1935 | ||
| Tropical Cyclones | 1935 | ||
| Causal Phenomena | 1935 | ||
| Formation and Initial Development Stage. | 1935 | ||
| Maturity Stage. | 1936 | ||
| Decay Stage. | 1936 | ||
| Characteristics | 1936 | ||
| Destructive Winds. | 1936 | ||
| Storm Surges. | 1937 | ||
| Rainfall Events. | 1937 | ||
| Deadly Hurricanes | 1938 | ||
| Predictability | 1938 | ||
| Vulnerability | 1939 | ||
| Typical Adverse Effects | 1939 | ||
| Casualties and Public Health. | 1939 | ||
| Water Supplies. | 1939 | ||
| Crops and Food Supplies. | 1939 | ||
| Communications and Logistics. | 1939 | ||
| Preparedness Measures Take Root After Cyclone Nargis in Burma (Myanmar) | 1939 | ||
| Cyclone Risk Reduction Measures | 1940 | ||
| Tornadoes | 1940 | ||
| Causal Phenomena | 1940 | ||
| Predictability | 1941 | ||
| Vulnerability | 1941 | ||
| Examples of Tornado Outbreaks | 1941 | ||
| Tornado Risk Reduction Measures | 1941 | ||
| Floods | 1941 | ||
| Pakistan Flood Disaster of 2010 | 1942 | ||
| Causal Phenomena | 1942 | ||
| Types of Floods | 1942 | ||
| Flash Floods. | 1942 | ||
| River Floods. | 1942 | ||
| Coastal Floods. | 1942 | ||
| Contribution by Humans | 1943 | ||
| Predictability | 1943 | ||
| Vulnerability | 1943 | ||
| Typical Adverse Effects | 1943 | ||
| Casualties and Public Health. | 1943 | ||
| Water, Crops, and Food Supplies. | 1943 | ||
| Flood Risk Reduction Measures | 1944 | ||
| Drought | 1944 | ||
| Types of Droughts | 1944 | ||
| Meteorologic Drought. | 1944 | ||
| Hydrologic Drought. | 1944 | ||
| Agricultural Drought. | 1944 | ||
| Socioeconomic Drought. | 1944 | ||
| Causal Phenomena | 1944 | ||
| Predictability | 1945 | ||
| Vulnerability | 1945 | ||
| Typical Adverse Effects | 1945 | ||
| Drought Risk Reduction Measures | 1945 | ||
| Winter Storms | 1946 | ||
| Causal Phenomena | 1946 | ||
| Strong Winds. | 1946 | ||
| Extreme Cold. | 1946 | ||
| Ice Storms. | 1946 | ||
| Snowstorms. | 1946 | ||
| Predictability | 1946 | ||
| Vulnerability | 1946 | ||
| The 1998 Ice Storm | 1946 | ||
| Environmental Hazards | 1947 | ||
| Environmental Pollution | 1947 | ||
| Causal Phenomena | 1947 | ||
| Air Pollution. | 1947 | ||
| Marine Pollution. | 1947 | ||
| Freshwater Pollution. | 1947 | ||
| Ozone Depletion. | 1947 | ||
| Climate Change and Global Warming. | 1947 | ||
| Characteristics and Typical Adverse Effects | 1948 | ||
| Air Pollution. | 1948 | ||
| Marine Pollution. | 1948 | ||
| Freshwater Pollution. | 1948 | ||
| Global Warming. | 1948 | ||
| Rise in Sea Levels. | 1948 | ||
| Climate Change. | 1948 | ||
| Changes in Ecosystems. | 1949 | ||
| Public Health Impact. | 1949 | ||
| Measurement of Pollutants | 1949 | ||
| Air and Water Pollutants. | 1949 | ||
| 13 Food and Water | 1963 | ||
| 87 Nutrition, Malnutrition, and Starvation | 1964 | ||
| Importance of Nutrition in Stressful Environments | 1964 | ||
| Environmental Stress and Nutrient Requirements | 1964 | ||
| Nutritional Considerations in Planning for Wilderness Activities | 1965 | ||
| Food and Adaptive Thermogenesis. | 1966 | ||
| Potential Thermogenic Nutrients. | 1967 | ||
| Tailoring Fat, Carbohydrate, and Protein to Different Environments. | 1968 | ||
| The “Right” Macronutrient Mix for Work at Altitude. | 1968 | ||
| Energy: How Critical Is It? | 1969 | ||
| Carbohydrates: Critical for Performance of High Work Output | 1969 | ||
| Fat: A Special Place in Wilderness Exploration? | 1970 | ||
| Protein and Maintenance of Lean Body Mass and Performance | 1971 | ||
| Protein and Maintenance of Muscle Mass When Energy Intake Is Inadequate. | 1972 | ||
| Vitamins and Their Relationship to Health and Physical Performance | 1973 | ||
| Antioxidant Nutrients | 1974 | ||
| Mineral Supplements: Electrolytes, Hematopoiesis, and Bone Health | 1975 | ||
| Special Nutritional Requirements for Female Wilderness Travelers | 1975 | ||
| Nutritional Deprivation: Malnutrition and Starvation | 1977 | ||
| Definitions | 1977 | ||
| Malnutrition in a Wilderness Setting | 1977 | ||
| Starvation | 1977 | ||
| Acute Energy Restriction | 1977 | ||
| Long-Term Energy Restriction | 1978 | ||
| Hierarchy of Tissue Utilization during Starvation | 1979 | ||
| Sequence of Events During Starvation | 1980 | ||
| The Limits of Human Starvation and Factors Influencing Survival | 1980 | ||
| Loss of Fat and Lean Body Mass | 1980 | ||
| Age and Gender Differences in Survival From Starvation | 1981 | ||
| Feeding Victims of Starvation | 1981 | ||
| Nutrition Planning for Wilderness Activities | 1983 | ||
| Practical Considerations | 1983 | ||
| Food Bars | 1984 | ||
| Selecting Food Bars | 1984 | ||
| Emergency Food Supplies | 1985 | ||
| References | 1985 | ||
| References | 1985.e1 | ||
| 88 Field Water Disinfection | 1985 | ||
| Benefits of Water Treatment | 1985 | ||
| Risk of Waterborne Disease Transmission | 1986 | ||
| Developing Countries | 1987 | ||
| United States and Developed Countries | 1987 | ||
| Recreational Contact | 1988 | ||
| Specific Etiologic Agents | 1988 | ||
| Viruses | 1988 | ||
| Protozoa | 1988 | ||
| Giardia and Cryptosporidium. | 1988 | ||
| Parasitic Organisms | 1989 | ||
| Bacterial Spores | 1989 | ||
| Algae | 1989 | ||
| Chemical Hazards | 1989 | ||
| Persistence of Enteric Pathogens in the Environment | 1989 | ||
| Natural Purification Mechanisms | 1989 | ||
| Standards for Water Disinfection | 1990 | ||
| Standards for Portable Disinfection Products | 1991 | ||
| EPA Registration | 1991 | ||
| Mechanical Filters. | 1991 | ||
| Filter Testing. | 1991 | ||
| Chemical Methods | 1991 | ||
| Disinfection Methods: Definitions | 1991 | ||
| Heat | 1992 | ||
| Boiling Time | 1992 | ||
| Improvisation | 1993 | ||
| Hot Tap Water | 1993 | ||
| Solar Heat | 1993 | ||
| Physical Removal | 1994 | ||
| Turbidity and Clarification | 1994 | ||
| Sedimentation | 1994 | ||
| Coagulation-Flocculation | 1994 | ||
| Toxicity | 1995 | ||
| Alternative Agents | 1995 | ||
| Adsorption | 1995 | ||
| Granular Activated Carbon | 1995 | ||
| Filtration | 1995 | ||
| Reverse Osmosis | 1997 | ||
| Forward Osmosis | 1997 | ||
| Choice of Filter (See Preferred Technique and Appendix A) | 1997 | ||
| Improvised Filters | 1997 | ||
| Biosand Filters | 1998 | ||
| Chemical Disinfectants | 1998 | ||
| Halogens (Chlorine and Iodine) | 1998 | ||
| Variables With Chemical Agents | 1998 | ||
| Concentration and Contact Time. | 1998 | ||
| Contaminants. | 1999 | ||
| Halogen Demand and Residual Concentration. | 1999 | ||
| Temperature. | 2000 | ||
| pH. | 2000 | ||
| Susceptibility of Microorganisms. | 2000 | ||
| Bacteria. | 2000 | ||
| Viruses. | 2000 | ||
| Cysts and Parasites. | 2000 | ||
| Disinfection Constant. | 2002 | ||
| Chlorine | 2002 | ||
| Chemistry | 2002 | ||
| Toxicity | 2003 | ||
| Products and Techniques for Chlorination | 2003 | ||
| Superchlorination-Dechlorination. | 2003 | ||
| Iodine | 2003 | ||
| Chemistry | 2003 | ||
| Toxicity | 2004 | ||
| Thyroid Effects of Iodine Ingestion. | 2004 | ||
| Dose-Response or Threshold Level. | 2004 | ||
| Recommendations. | 2004 | ||
| Products and Techniques for Iodination | 2004 | ||
| Resins. | 2004 | ||
| Iodine Resin Filters. | 2005 | ||
| Chlorine Versus Iodine | 2005 | ||
| Taste | 2006 | ||
| Minimizing Dose. | 2006 | ||
| Dehalogenation. | 2006 | ||
| Alteration of Chemical Species (Reduction). | 2006 | ||
| Miscellaneous Disinfectants | 2006 | ||
| Peroxygens | 2006 | ||
| Ozone | 2007 | ||
| Chlorine Dioxide | 2007 | ||
| Mixed-Species Disinfection (Electrolysis) | 2007 | ||
| Hydrogen Peroxide | 2007 | ||
| Potassium Permanganate | 2007 | ||
| Citrus | 2008 | ||
| Metals | 2008 | ||
| Silver | 2008 | ||
| Copper and Zinc | 2008 | ||
| Nanoparticles: Solar Photocatalytic Disinfection | 2008 | ||
| Ultraviolet Light | 2009 | ||
| Solar Disinfection | 2009 | ||
| Comparative Studies and Preferred Techniques | 2009 | ||
| Preferred Technique | 2010 | ||
| Prevention and Sanitation | 2011 | ||
| Handwashing | 2012 | ||
| Kitchen and Food Sanitation | 2012 | ||
| Human Waste Disposal | 2012 | ||
| References | 2012 | ||
| Appendix A Water Disinfection Devices and Products for Field Use | 2013 | ||
| Appendix B Chemical Disinfection Products | 2026 | ||
| Iodination | 2026 | ||
| Iodine Solutions | 2026 | ||
| Iodophors (Povidone-Iodine) | 2026 | ||
| Crystals (Saturated Solution) | 2026 | ||
| Product | 2026 | ||
| 14 Unique Populations and Considerations | 2087 | ||
| 91 Children in the Wilderness | 2088 | ||
| What Makes Children Different? | 2088 | ||
| Size and Shape | 2088 | ||
| Musculoskeletal System | 2088 | ||
| Cardiovascular and Respiratory Systems | 2088 | ||
| Thermoregulation | 2089 | ||
| Immunologic System and Infections | 2090 | ||
| Types of Traumatic Injuries | 2090 | ||
| General Considerations and Expectations for Children in Wilderness Travel | 2090 | ||
| Children in the First 2 Years of Life | 2090 | ||
| Travel Expectations | 2090 | ||
| Safety | 2091 | ||
| Food and Drink | 2091 | ||
| Diapers | 2091 | ||
| Equipment | 2091 | ||
| Children 2 to 4 Years of Age | 2091 | ||
| Travel Expectations | 2091 | ||
| Safety | 2092 | ||
| Food | 2093 | ||
| Toileting | 2093 | ||
| Children of School Age (5 Years and Up) | 2093 | ||
| Travel Expectations | 2093 | ||
| Safety | 2094 | ||
| Equipment | 2094 | ||
| Environmental Illnesses | 2094 | ||
| Dehydration | 2094 | ||
| Symptoms | 2094 | ||
| 15 Wilderness Equipment and Special Knowledge | 2271 | ||
| 102 Wilderness Preparation, Equipment, and Medical Supplies | 2272 | ||
| Epidemiology Review | 2272 | ||
| General Preparation | 2272 | ||
| Pretrip Evaluation for Healthy Participants | 2274 | ||
| Evaluation of Participants With Preexisting Medical Conditions | 2274 | ||
| Training in First Aid and Wilderness Safety | 2275 | ||
| Trip Duration and Access to Medical Support | 2276 | ||
| Environmental Risks: Weather and Terrain | 2276 | ||
| Supplies, Kit Assembly Strategies, and Specialized Equipment | 2276 | ||
| Strategies for Packaging Medical Kits | 2277 | ||
| How Much to Bring | 2277 | ||
| Personal Medical Kit | 2278 | ||
| Comprehensive Community Medical Kit | 2287 | ||
| Medical Supplies for the Medically Trained Traveler | 2288 | ||
| Specialized Equipment for Environmental and Recreational Hazards | 2290 | ||
| High-Altitude Exposure | 2291 | ||
| Cold Exposure | 2291 | ||
| A Note on “Space Blankets” | 2292 | ||
| Water Disinfection | 2292 | ||
| Bicycling | 2292 | ||
| Mountain Climbing and Hiking | 2292 | ||
| Protection Against Mosquito-Borne Illness | 2292 | ||
| Items Stored in the Vehicle | 2293 | ||
| Medical Reference Material | 2293 | ||
| Mobile Health (mHealth) and Emerging Technologies | 2294 | ||
| Medications Useful in the Wilderness Setting | 2294 | ||
| Priority Prescription and Over-the-Counter Medications | 2294 | ||
| Passing Through Customs With Medications | 2295 | ||
| Preparing for Common Medical Problems in the Wilderness | 2296 | ||
| Gastrointestinal, Genitourinary, and Reproductive Care | 2296 | ||
| Diarrhea and Abdominal Pain | 2296 | ||
| Sexually Transmitted Infections | 2296 | ||
| Oral Hygiene and Health | 2296 | ||
| Fractures and Dislocations | 2297 | ||
| Sleeping and Staying Awake | 2297 | ||
| Blisters and Foot Care | 2297 | ||
| Wounds | 2298 | ||
| Bites and Stings | 2299 | ||
| Sunburn, Snowblindness, and Sunglasses | 2299 | ||
| Pain | 2300 | ||
| Special Considerations | 2300 | ||
| A Sample Journey | 2300 | ||
| Appendix A Information Sources on Wilderness Emergencies and Suggested Reading | 2301 | ||
| Appendix B Pretrip Medical Evaluation Form for Wilderness Travel | 2302 | ||
| Appendix C Suppliers Listed in Chapter | 2305 | ||
| References | 2305 | ||
| References | 2305.e1 | ||
| 103 Emergency Oxygen Administration | 2306 | ||
| Indications | 2306 | ||
| Contraindications | 2306 | ||
| Pulmonary Oxygen Toxicity | 2306 | ||
| Central Nervous System Oxygen Toxicity | 2306 | ||
| Equipment | 2306 | ||
| Cylinders | 2306 | ||
| Valves | 2307 | ||
| Regulators | 2307 | ||
| Devices for Assisted Ventilation | 2307 | ||
| Bag-Valve-Mask Device | 2307 | ||
| Resuscitation Mask | 2308 | ||
| FROPV/Positive-Pressure Demand Valve | 2309 | ||
| Demand-Only, or FROPVs in Demand Mode | 2310 | ||
| Constant Flow Devices for Adequately Breathing Patients | 2310 | ||
| Nonrebreather Mask | 2310 | ||
| Nasal Cannula | 2311 | ||
| Oxygen Rebreathers | 2311 | ||
| Emergency Oxygen Administration at High Altitude | 2311 | ||
| Oxygen Generator Systems | 2312 | ||
| How to Administer Oxygen From a Tank (Cylinder) | 2312 | ||
| Precautions | 2312 | ||
| Special Considerations in Nonbreathing or Inadequately Breathing Patients | 2312 | ||
| Hazards | 2312 | ||
| Legal Issues | 2313 | ||
| References | 2313 | ||
| References | 2313.e1 | ||
| 104 Telemedicine in the Wilderness | 2313 | ||
| Evolution of Telemedicine | 2313 | ||
| Telemedicine Systems Engineering | 2315 | ||
| Modern Telemedicine | 2320 | ||
| Telemedicine in the Wild | 2321 | ||
| References | 2322 | ||
| References | 2322.e1 | ||
| 105 Wilderness and Global Communications and Techniques | 2323 | ||
| Two-Way Local Communication | 2323 | ||
| Family Radio Service | 2323 | ||
| General Mobile Radio Service | 2323 | ||
| 900-MHz Band | 2324 | ||
| 2-Meter and 70-Centimeter Amateur Radio Service | 2324 | ||
| Two-Way Long-Distance Voice Communication | 2325 | ||
| Iridium | 2326 | ||
| Globalstar | 2326 | ||
| Inmarsat | 2326 | ||
| Thuraya | 2326 | ||
| Satellite Messaging Devices | 2327 | ||
| Satellite Internet | 2328 | ||
| Satellite Wi-Fi | 2328 | ||
| Emergency Beacons | 2329 | ||
| References | 2329 | ||
| References | 2329.e1 | ||
| 106 Wilderness Navigation Techniques | 2329 | ||
| Navigation With the Global Navigation Satellite Systems | 2330 | ||
| Geodetic Coordinate System | 2332 | ||
| Universal Transverse Mercator Coordinate System | 2333 | ||
| Compass Navigation | 2335 | ||
| Magnetic Dip, Deviation, and Declination | 2335 | ||
| Compass Types | 2336 | ||
| Compass Use | 2337 | ||
| Makeshift Compasses | 2338 | ||
| Celestial Navigation | 2338 | ||
| Celestial Coordinates | 2340 | ||
| Horizon Coordinate System | 2340 | ||
| Celestial Lines of Position | 2341 | ||
| Methods for Latitude | 2341 | ||
| Methods for Longitude | 2342 | ||
| Celestial Methods for Direction Finding | 2342 | ||
| Shadow Methods | 2342 | ||
| Direction by Amplitudes | 2344 | ||
| Direction by Observation of Circumpolar Stars | 2344 | ||
| Direction by Observation of Other Stars | 2345 | ||
| Practical Field-Expedient Celestial Navigation | 2346 | ||
| Navigation With a Pocket Radio | 2346 | ||
| Orienteering and Geocaching | 2347 | ||
| The Orienteering Meet | 2347 | ||
| Orienteering for Children | 2349 | ||
| Geocaching | 2349 | ||
| Conclusion | 2349 | ||
| References | 2349 | ||
| References | 2349.e1 | ||
| 107 Principles of Meteorology and Weather Prediction | 2350 | ||
| General Circulation and Atmospheric Profile | 2350 | ||
| Climate Controls and Radiation Balance | 2350 | ||
| Atmospheric Profile | 2350 | ||
| Lapse Rate | 2350 | ||
| Moisture | 2350 | ||
| Climatic Regions Controlled by Latitude: Tropics, Midlatitudes, and Poles | 2350 | ||
| Midlatitude and Polar Climates | 2350 | ||
| Subtropical and Tropical Climates | 2351 | ||
| Monsoons | 2351 | ||
| Tropical Cyclones | 2352 | ||
| Thunderstorms | 2352 | ||
| Types of Thunderstorms | 2353 | ||
| Arid Climates | 2353 | ||
| Mountain Climates | 2353 | ||
| Marine/Coastal Climates | 2353 | ||
| Human Comfort | 2354 | ||
| Weather Forecasting | 2355 | ||
| Obtaining Data and Forecasts and Predicting Weather in the Near Term | 2355 | ||
| Portable Weather Instruments of Use in the Wilderness | 2355 | ||
| Barometer | 2355 | ||
| Thermometer | 2355 | ||
| Lightning Detector | 2355 | ||
| Types of Forecasts | 2356 | ||
| Skill | 2356 | ||
| How to Interpret Forecasts | 2356 | ||
| Accessing Forecasts | 2356 | ||
| North America | 2356 | ||
| International Forecasts | 2356 | ||
| Forecast Variables | 2356 | ||
| Seasonal Precipitation Forecasts | 2356 | ||
| Temperature Forecasts | 2356 | ||
| Humidity | 2356 | ||
| Wind Direction and Speed | 2356 | ||
| Precipitation | 2356 | ||
| Forecast Products | 2356 | ||
| United States | 2356 | ||
| International | 2356 | ||
| How to Obtain Surface Observations | 2357 | ||
| United States | 2357 | ||
| Global Data | 2357 | ||
| How to Access and Interpret Weather Satellite and Radar Data | 2358 | ||
| Weather Prediction in the Wilderness | 2358 | ||
| Clouds | 2358 | ||
| Clouds and Weather | 2360 | ||
| Boundary Layer Stability | 2361 | ||
| Backing and Veering | 2361 | ||
| References | 2361 | ||
| References | 2361.e1 | ||
| 108 Ropes and Knot Tying | 2361 | ||
| Ropes, Webbing, and Cordage Terminology | 2361 | ||
| Rope Selection Considerations | 2362 | ||
| Fall Factors | 2362 | ||
| Rope Diameter | 2362 | ||
| Rope Strength | 2362 | ||
| Safety Factors | 2363 | ||
| Service Life | 2363 | ||
| Webbing | 2363 | ||
| Accessory Cord | 2363 | ||
| Rope for Life Safety | 2364 | ||
| Strength | 2364 | ||
| Impact Force | 2364 | ||
| Number of Falls Held | 2364 | ||
| Elongation | 2365 | ||
| Diameter | 2365 | ||
| Abrasion Resistance | 2365 | ||
| Compatibility With Other Equipment | 2365 | ||
| Hand | 2365 | ||
| Quality | 2365 | ||
| Weight | 2365 | ||
| Water Resistance/Flotation | 2365 | ||
| Life Safety Rope Construction | 2365 | ||
| Materials | 2365 | ||
| Nylon | 2365 | ||
| Polyester | 2366 | ||
| Ultra-High-Molecular-Weight Polyethylene | 2366 | ||
| Aramids | 2366 | ||
| Polyolefin | 2366 | ||
| Rope Type | 2366 | ||
| Dynamic Kernmantle Rope | 2366 | ||
| Static Kernmantle Rope | 2366 | ||
| Low-Stretch Kernmantle Rope | 2366 | ||
| Knots in Software | 2366 | ||
| Uses | 2367 | ||
| How Knots Work | 2367 | ||
| Knot Terminology | 2367 | ||
| Categories of Knots | 2368 | ||
| Stopper Knots | 2368 | ||
| End-of-Line Knots | 2368 | ||
| Midline Knots | 2369 | ||
| Knots That Join Two Ropes (Bends) | 2370 | ||
| Hitches | 2372 | ||
| Lashing | 2373 | ||
| Emergency Harnesses | 2373 | ||
| Knot Safety | 2373 | ||
| Knots and Software Strength | 2374 | ||
| Learning More About Software and Knots | 2375 | ||
| 109 Ultrasound in the Wilderness | 2376 | ||
| Introduction to Ultrasound | 2376 | ||
| Probe Construction and Frequency | 2376 | ||
| Overview of Clinical Imaging | 2376 | ||
| Common Clinical Imaging Applications | 2377 | ||
| Focused Assessment With Sonography for Trauma | 2377 | ||
| Right Upper Quadrant | 2377 | ||
| Left Upper Quadrant | 2377 | ||
| Pelvis | 2378 | ||
| Cardiac View | 2378 | ||
| Thoracic Ultrasound for Pneumothorax and Pulmonary Edema | 2381 | ||
| Pneumothorax | 2381 | ||
| Pulmonary Edema | 2381 | ||
| Musculoskeletal Assessment | 2382 | ||
| Fractures | 2382 | ||
| Dislocation | 2383 | ||
| Optic Nerve Sheath Ultrasonography | 2384 | ||
| Doppler and Blood Flow Studies | 2385 | ||
| Inferior Vena Cava and Volume Assessment | 2385 | ||
| Echocardiography for Patent Foramen Ovale | 2385 | ||
| Pregnancy | 2387 | ||
| First-Trimester Ultrasound | 2387 | ||
| Second- and Third-Trimester Ultrasound | 2388 | ||
| Fetal Positioning and Number of Pregnancies. | 2388 | ||
| Amniotic Fluid Volume Assessment. | 2389 | ||
| Placental Positioning. | 2389 | ||
| Gestational Age/Dating. | 2389 | ||
| Right Upper Quadrant Ultrasonography | 2390 | ||
| Right Lower Quadrant Ultrasonography | 2391 | ||
| Technique | 2391 | ||
| Peripheral Veins | 2391 | ||
| Special Considerations for Ultrasound in Remote Locations | 2391 | ||
| Tele-Ultrasound | 2391 | ||
| Power Supply Considerations | 2393 | ||
| Advantages of Ultrasound in the Wilderness | 2394 | ||
| Portability | 2394 | ||
| Safety and Noninvasiveness | 2394 | ||
| Versatility | 2395 | ||
| Cost | 2395 | ||
| Limitations of Wilderness Ultrasound | 2395 | ||
| References | 2395 | ||
| References | 2395.e1 | ||
| 110 Outdoor Clothing for the Wilderness Professional | 2396 | ||
| Fiber and Fabric | 2396 | ||
| Natural Fibers | 2396 | ||
| Wool and Merino Wool | 2396 | ||
| Down | 2396 | ||
| Fur, Leather, and Hides | 2397 | ||
| Synthetic Fibers | 2398 | ||
| Blends | 2398 | ||
| Waterproof/Breathable Fabrics | 2398 | ||
| Laminates. | 2398 | ||
| Coated Fabrics. | 2399 | ||
| Soft-Shell Fabrics. | 2399 | ||
| Durable Water-Repellent Finish. | 2399 | ||
| Layering | 2399 | ||
| Base Layer | 2400 | ||
| Middle Layer | 2400 | ||
| Outer Layer | 2401 | ||
| Multilayered Garments | 2401 | ||
| Accessories | 2401 | ||
| Headgear | 2401 | ||
| Neckwear | 2401 | ||
| Eyewear | 2402 | ||
| Handwear | 2402 | ||
| Footwear | 2403 | ||
| Care and Storage of Clothing | 2404 | ||
| Laundering | 2404 | ||
| Drying | 2405 | ||
| Durable Water-Repellent Finish | 2405 | ||
| Footwear | 2405 | ||
| Storage | 2406 | ||
| Repair | 2406 | ||
| Special-Use Clothing | 2406 | ||
| Sun Protection Clothing | 2406 | ||
| Insect-Repellent Clothing | 2406 | ||
| Fire-Resistant Clothing | 2406 | ||
| Vapor-Barrier Clothing | 2406 | ||
| Sport-Specific Clothing | 2406 | ||
| Climate-Specific Clothing | 2406 | ||
| Heat | 2407 | ||
| Temperate | 2407 | ||
| Cold | 2407 | ||
| Extreme Cold | 2408 | ||
| Water (Ocean and River) | 2408 | ||
| Selected Resources | 2408 | ||
| Selected Resources | 2408.e1 | ||
| 111 Nonmedical Backcountry Equipment for Wilderness Professionals | 2409 | ||
| General Concepts for Choosing Equipment | 2409 | ||
| Choosing Gear | 2409 | ||
| Essential Emergency Equipment | 2409 | ||
| Who? | 2409 | ||
| What and Where? | 2409 | ||
| When? | 2410 | ||
| How Far? How Long? | 2410 | ||
| Navigation | 2411 | ||
| Sun Protection | 2412 | ||
| Sunglasses and Goggles | 2412 | ||
| Lights | 2412 | ||
| Headlamps | 2412 | ||
| Flashlights | 2412 | ||
| Lanterns | 2412 | ||
| Lantern Safety | 2413 | ||
| Tools | 2413 | ||
| Multifunction Tools | 2413 | ||
| Knives | 2414 | ||
| Blade Shapes | 2414 | ||
| Construction | 2414 | ||
| Handles | 2415 | ||
| Care | 2415 | ||
| Shovels and Trowels | 2415 | ||
| Saws and Axes | 2415 | ||
| Gear Repair | 2415 | ||
| First-Aid Kit | 2415 | ||
| Fire-Starting Materials | 2415 | ||
| Food | 2415 | ||
| Water | 2415 | ||
| Heat Packs and Heaters | 2416 | ||
| Optics | 2417 | ||
| Packs | 2417 | ||
| Lumbar Packs | 2417 | ||
| Day Packs | 2417 | ||
| Backpacks | 2417 | ||
| Duffels, Stuff Sacks, and Dry Bags | 2418 | ||
| Electronics | 2419 | ||
| Power | 2420 | ||
| Overnight Gear | 2420 | ||
| Stoves | 2420 | ||
| Accessories | 2422 | ||
| Cook Sets | 2422 | ||
| Personal Toiletries | 2422 | ||
| Sleeping Bags | 2422 | ||
| Insulation | 2423 | ||
| Down. | 2423 | ||
| Synthetics. | 2423 | ||
| Temperature | 2423 | ||
| Sleeping Pads | 2424 | ||
| Shelters | 2425 | ||
| Construction and Design | 2425 | ||
| Shape and Size | 2426 | ||
| Bivouac Sack | 2426 | ||
| Tarps | 2426 | ||
| Tents | 2427 | ||
| Accessories | 2427 | ||
| Care of Outdoor Equipment | 2428 | ||
| Selected Resources | 2428 | ||
| Selected Resources | 2428.e1 | ||
| 112 Native American Healing | 2428 | ||
| Definitions | 2429 | ||
| Native American | 2429 | ||
| Health | 2429 | ||
| Traditional Healers | 2429 | ||
| Elder | 2430 | ||
| Etiology in a World of “All My Relations” | 2430 | ||
| Biomedical | 2430 | ||
| Environmental | 2431 | ||
| Psychological/Psychosocial | 2431 | ||
| Spiritual | 2432 | ||
| Assessment and Diagnosis | 2432 | ||
| Treatment | 2433 | ||
| Contraindications | 2433 | ||
| Aftercare | 2435 | ||
| Prevention | 2435 | ||
| Clinical Example: Back Pain | 2435 | ||
| The Challenges of Research | 2437 | ||
| References | 2438 | ||
| References | 2438.e1 | ||
| 16 Wilderness Medicine Education and Research | 2439 | ||
| 113 Wilderness Medicine Education | 2440 | ||
| Principles of Adult Learning | 2441 | ||
| Basic Principles | 2442 | ||
| Concepts, Theories, and Models | 2442 | ||
| The Education Cycle | 2442 | ||
| Experience-Based Learning | 2442 | ||
| Education and the Human Organism | 2442 | ||
| Learner Sophistication | 2443 | ||
| Principles of Andragogy | 2443 | ||
| Learner-Centered Education | 2443 | ||
| Learning-Oriented Teaching Model | 2443 | ||
| Decision Making and Error | 2443 | ||
| Putting It All Together | 2444 | ||
| Educational Techniques | 2444 | ||
| Learning Strategies | 2445 | ||
| Lecture | 2445 | ||
| Demonstration | 2446 | ||
| Skills Development Sessions | 2447 | ||
| Problem-Based Learning | 2447 | ||
| Case-Based Learning | 2447 | ||
| Scenarios and Role-Play | 2448 | ||
| Subject-Based Learning | 2449 | ||
| Discussion | 2449 | ||
| Small-Group Learning | 2450 | ||
| Distance Learning | 2450 | ||
| Field Experiences | 2451 | ||
| Outcomes and Competency-Based Education | 2451 | ||
| Assessing Learners’ Needs | 2452 | ||
| Learning Objectives | 2452 | ||
| Assessing Learning | 2453 | ||
| Timing of Evaluation | 2453 | ||
| Feedback | 2454 | ||
| The 360-Degree Evaluation | 2454 | ||
| Assessment Design | 2455 | ||
| Evaluating the Assessment Tool | 2455 | ||
| Limitations of Training | 2456 | ||
| Contrived Situations | 2456 | ||
| Teaching in Wilderness Medicine | 2457 | ||
| Good Teachers | 2457 | ||
| The Educational Environment | 2458 | ||
| The Classroom | 2458 | ||
| The Indoor Classroom | 2458 | ||
| The Outdoor Classroom | 2459 | ||
| Training Aids | 2459 | ||
| Equipment Considerations | 2459 | ||
| Audio and Visual Aids | 2459 | ||
| Textbooks | 2460 | ||
| Syllabus Material and Handouts | 2460 | ||
| Simulations | 2460 | ||
| Evaluation of Teaching | 2462 | ||
| Method of Evaluation | 2462 | ||
| Fairness and Confidentiality | 2463 | ||
| Usefulness of the Results | 2463 | ||
| What to Evaluate | 2463 | ||
| Format of the Evaluation Instrument | 2463 | ||
| Providing the Results | 2463 | ||
| Program and Curriculum Development | 2463 | ||
| Retention of Learning | 2464 | ||
| Wilderness Medicine Injury and Illness Data | 2464 | ||
| Concepts and Models | 2465 | ||
| Steps in Designing a Curriculum | 2465 | ||
| Desired Outcomes | 2466 | ||
| Determine the Content | 2466 | ||
| Select Teaching Methods | 2466 | ||
| Select Learning Assessment Instruments | 2466 | ||
| Developing the Course Evaluation | 2466 | ||
| Planning for Continuing Medical Education | 2466 | ||
| Professional Organizations and Training Programs in Wilderness Medicine | 2467 | ||
| Professional Societies | 2467 | ||
| Certification Programs for Outdoor Recreation and Education | 2467 | ||
| Training for Health Care Professionals | 2469 | ||
| Medical School, Residency, and Fellowship Offerings | 2469 | ||
| Continuing Medical Education Conferences and Travel | 2470 | ||
| References | 2471 | ||
| References | 2471.e1 | ||
| 114 MedWAR | 2471 | ||
| MedWAR Mission Statement | 2472 | ||
| The History of MedWAR | 2472 | ||
| The MedWAR Model: How It Works | 2473 | ||
| MedWAR Research | 2475 | ||
| Simulations, Scenarios, and Education in MedWAR | 2477 | ||
| Conclusion | 2478 | ||
| References | 2478 | ||
| References | 2478.e1 | ||
| 115 Evidence-Based Wilderness Medicine | 2478 | ||
| What EBM Is and Is Not | 2478 | ||
| The Evidence-Based Clinical Practitioner | 2479 | ||
| Evidence-Based Medicine: Experts Versus Practitioners | 2480 | ||
| Evidence-Based Medicine Resources for Wilderness Medicine Providers | 2481 | ||
| Moving Beyond Evidence- Based Medicine: What Is Implementation Science? | 2485 | ||
| The Future of Evidence-Based Medicine and Dissemination and Implementation in Wilderness Medicine | 2486 | ||
| Conclusion | 2487 | ||
| References | 2487 | ||
| References | 2487.e1 | ||
| 116 National Park Service Medicine | 2487 | ||
| Mission of the National Park Service | 2487 | ||
| History of the National Park Service | 2487 | ||
| Organization of the National Park Service | 2488 | ||
| Director’s Order | 2489 | ||
| Developing Advanced Medical Training for National Park Service Rangers | 2490 | ||
| Parkmedic Program | 2490 | ||
| Certification and Authorization of Providers | 2490 | ||
| Parkmedic (Level V) Scope of Practice | 2491 | ||
| Parkmedic Training | 2491 | ||
| Protocols for Parkmedics | 2491 | ||
| Local Control of Extended Scope of Practice | 2492 | ||
| Needs Assessment | 2493 | ||
| Level of EMS Training of National Park Service Providers | 2493 | ||
| Park EMS Medical Advisor Role | 2493 | ||
| Medical Oversight | 2493 | ||
| Medical Control | 2493 | ||
| Quality Assurance and Continuing Quality Improvement | 2493 | ||
| Continuing Education | 2494 | ||
| Refresher Courses for NREMT Recertification | 2494 | ||
| Continuing Education Sessions | 2494 | ||
| Multicasualty Incident Drills | 2494 | ||
| Specialized Support Assets | 2494 | ||
| Personnel and National Response | 2494 | ||
| Volunteers-in-Parks Program | 2495 | ||
| Technical Rescues | 2495 | ||
| Air Operations | 2495 | ||
| Search and Rescue Teams | 2496 | ||
| Future Directions | 2496 | ||
| References | 2497 | ||
| References | 2497.e1 | ||
| 117 Genomics in Wilderness Medicine | 2497 | ||
| Genetic and Environmental Influences on the Phenotype | 2497 | ||
| Establishing the Genetic Basis of A Trait | 2498 | ||
| The Era of Genomics | 2500 | ||
| Human Genetic Variation | 2501 | ||
| Genome-Wide Association Studies | 2501 | ||
| Omics Revolution | 2502 | ||
| Functional Genomic Elements | 2502 | ||
| Technologies for Identifying Genetic Variants and Their Associations With Disease | 2504 | ||
| Genetic Responses to Extreme Environments | 2504 | ||
| Genetics and Altitude | 2504 | ||
| Hypoxia and Acclimatization | 2504 | ||
| Altitude Illness | 2505 | ||
| Acute Altitude Illnesses | 2505 | ||
| Acute Mountain Sickness. | 2505 | ||
| Genetics of Acute Mountain Sickness. | 2505 | ||
| High-Altitude Cerebral Edema. | 2506 | ||
| Genetics of High-Altitude Cerebral Edema. | 2506 | ||
| High-Altitude Pulmonary Edema. | 2506 | ||
| Genetics of High-Altitude Pulmonary Edema. | 2506 | ||
| Chronic Altitude Illnesses | 2506 | ||
| Chronic Mountain Sickness. | 2506 | ||
| Genetics of Chronic Mountain Sickness. | 2508 | ||
| High-Altitude Pulmonary Hypertension. | 2508 | ||
| Genetics of High-Altitude Pulmonary Hypertension. | 2508 | ||
| High-Altitude Adaptation | 2509 | ||
| Genetics of Altitude Adaptation. | 2511 | ||
| Genetic Influences on Adaptation to Temperature and Ultraviolet Radiation | 2513 | ||
| Genetic Influences on Exertion in the Wilderness | 2513 | ||
| Physiology of Exercise | 2513 | ||
| Exercise Genomics | 2513 | ||
| Human Variation and Studies Relating Genes to Performance | 2513 | ||
| Baseline Fitness | 2513 | ||
| Family and Twin Studies. | 2513 | ||
| Genetics of Exercise Capacity. | 2514 | ||
| Training Responsiveness | 2514 | ||
| 17 The Wilderness | 2517 | ||
| 118 Wilderness Management and Preservation | 2518 | ||
| Historical Development of the Wilderness Concept | 2518 | ||
| Wilderness Legislation and Policy in the United States | 2518 | ||
| Wilderness Stewardship Philosophy | 2520 | ||
| Potential Threats to Wilderness | 2520 | ||
| Wilderness Management Agencies in the United States | 2521 | ||
| Distribution of Wilderness in the United States | 2521 | ||
| Wilderness Values and Public Perceptions | 2521 | ||
| Wilderness Visitors | 2522 | ||
| Distribution of Wilderness Visitor Use | 2522 | ||
| Wilderness Management Principles | 2523 | ||
| Wilderness Preservation as a National and International Movement | 2523 | ||
| References | 2523 | ||
| References | 2523.e1 | ||
| 119 The Changing Environment | 2524 | ||
| Issues of Environmental Change | 2524 | ||
| Climate Change | 2524 | ||
| Stratospheric Ozone Depletion | 2526 | ||
| Erosion of Biodiversity (See Chapter 120) | 2527 | ||
| Population Growth | 2528 | ||
| Pollution | 2529 | ||
| Impacts of Environmental Change on Wilderness Areas | 2529 | ||
| Conversion of Wilderness | 2530 | ||
| Human Penetration of Wilderness Areas | 2530 | ||
| Direct Impacts | 2531 | ||
| Indirect Impacts | 2531 | ||
| High-Risk Technologies | 2531 | ||
| Consequences of Environmental Change | 2531 | ||
| Environmental Change and Medical Emergencies | 2532 | ||
| Complexity and Uncertainty | 2533 | ||
| What Might Be Done About Limiting Environmental Change? | 2533 | ||
| Changes in Environmental Science and Policy Making | 2533 | ||
| References | 2535 | ||
| References | 2535.e1 | ||
| 120 Biodiversity and Human Health | 2535 | ||
| Understanding the Etiology of the Biodiversity Crisis | 2535 | ||
| Threatened Ecosystems | 2536 | ||
| Species Decline | 2538 | ||
| Loss of Genetic Diversity | 2538 | ||
| Invasive Species | 2539 | ||
| Public Health Concerns | 2539 | ||
| Altered Epidemiology of Diseases | 2540 | ||
| Loss of Biologic Raw Materials | 2540 | ||
| Loss of Models for Medical Research | 2540 | ||
| Threatened Food Production | 2541 | ||
| Threatened Water Resources | 2541 | ||
| Case Study | 2541 | ||
| Conclusion | 2543 | ||
| References | 2543 | ||
| References | 2543.e1 | ||
| 121 Health Implications of Environmental Change | 2543 | ||
| Climate Change | 2544 | ||
| Vulnerable Populations | 2544 | ||
| Direct Impacts of Climate Change on Human Health | 2544 | ||
| Heat-Related Health Impacts | 2544 | ||
| Floods and Storms | 2544 | ||
| Health Effects Mediated Through Natural Systems | 2545 | ||
| Vector-Borne Diseases | 2545 | ||
| Malaria (see Chapter 40) | 2545 | ||
| Other Viral Diseases (see Chapter 39) | 2545 | ||
| Other Vector-Borne Diseases | 2545 | ||
| Waterborne Disease | 2546 | ||
| Climate Change as A Threat Multiplier | 2546 | ||
| Mental Health | 2546 | ||
| Nutrition | 2546 | ||
| Violence and Conflict | 2546 | ||
| Biodiversity Loss | 2546 | ||
| Threats to Ecosystem Services | 2547 | ||
| Deforestation | 2547 | ||
| Nutrient Cycles | 2547 | ||
| Ocean Acidification | 2548 | ||
| Freshwater Use | 2548 | ||
| Atmospheric Aerosol Loading | 2548 | ||
| Chemical Pollution | 2549 | ||
| References | 2549 | ||
| References | 2549.e1 | ||
| 122 Sustainability | 2549 | ||
| Sustainability in the Wilderness | 2549 | ||
| Seven Principles of Stewardship | 2549 | ||
| Plan Ahead and Prepare | 2550 | ||
| Travel and Camp on Durable Surfaces | 2550 | ||
| Dispose of Waste Properly | 2550 | ||
| Leave What You Find | 2550 | ||
| Minimize Campfire Impacts | 2550 | ||
| Respect Wildlife | 2550 | ||
| Be Considerate of Other Visitors | 2550 | ||
| Sustainability in Special Environs | 2550 | ||
| The Mountains | 2550 | ||
| Snow | 2550 | ||
| Water | 2550 | ||
| Tundra | 2550 | ||
| The Desert | 2551 | ||
| Sustainability and the Human Footprint | 2551 | ||
| Energy | 2551 | ||
| Renewable Energy | 2552 | ||
| Biomass | 2552 | ||
| Wind Power | 2552 | ||
| Solar Power | 2552 | ||
| Geothermal Energy | 2552 | ||
| Nuclear Energy | 2553 | ||
| Sustainable Living | 2553 | ||
| Sustainable Hospitals | 2553 | ||
| Sustainable Travel | 2554 | ||
| Hydraulic Fracturing | 2554 | ||
| Water Pollution | 2554 | ||
| Air Quality | 2556 | ||
| Seismic Activity | 2556 | ||
| Sand Mining | 2556 | ||
| Global Warming | 2556 | ||
| National Parks in the United States | 2556 | ||
| Conclusion | 2556 | ||
| The Challenge | 2557 | ||
| References and Selected Resources | 2557 | ||
| Selected Resources | 2557.e1 | ||
| Carbon Offsets | 2557.e1 | ||
| Nuclear | 2557.e1 | ||
| Green Hospitals | 2557.e1 | ||
| References | 2557.e1 | ||
| 123 Brief Introduction to Oceanography | 2558 | ||
| Ocean Statistics | 2558 | ||
| Brief Appreciation of the Ocean’s History and Modern Ocean Tools | 2558 | ||
| Water Characteristics | 2559 | ||
| Ocean Structure | 2561 | ||
| Ocean Circulation | 2562 | ||
| Ocean Movement: Waves, Tides, and Tsunamis | 2563 | ||
| Conditions for Oceanic Life | 2566 | ||
| Marine Primary Productivity | 2567 | ||
| Important Planktonic Autotrophs | 2569 | ||
| Harmful Algal Blooms | 2570 | ||
| Biogeochemical Cycles | 2570 | ||
| Marine Environmental Issues | 2571 | ||
| Oil Pollution | 2571 | ||
| Plastic Waste | 2572 | ||
| 124 Brief Introduction to Forestry | 2572 | ||
| Definitions | 2573 | ||
| Forestry | 2573 | ||
| Forest | 2573 | ||
| Wilderness | 2574 | ||
| Trees and Rainfall | 2574 | ||
| Types of Forests | 2574 | ||
| Importance of Forests to People | 2576 | ||
| Human Interaction With Forests | 2577 | ||
| Hazards to People in Forests | 2578 | ||
| References | 2578 | ||
| References | 2578.e1 | ||
| 125 Brief Introduction to Earth Sciences | 2578 | ||
| Earth’s Origin | 2578 | ||
| Earth’s Interior Structure | 2579 | ||
| Earth’s Composition | 2580 | ||
| The Brittle, Restless Crust: Plate Tectonics | 2581 | ||
| Divergent Plate Margins | 2582 | ||
| Convergent Plate Margins | 2582 | ||
| Strike-Slip or Transform Plate Margins | 2583 | ||
| Tectonic Origin of Rocks | 2583 | ||
| Igneous Rocks | 2585 | ||
| Metamorphic Rocks | 2586 | ||
| Dynamics of Sedimentation and Sedimentary Rocks | 2586 | ||
| Present-Day Geology as a Key to Understanding the Past | 2588 | ||
| How Rocks Are Dated | 2588 | ||
| Geologic Time | 2588 | ||
| The Grand Canyon: an Example of Earth Science at Work | 2589 | ||
| Introduction and Physical Setting | 2589 | ||
| Creating the Rocks: 2 Billion Years of Earth History | 2589 | ||
| Basement Rocks | 2589 | ||
| Grand Canyon Supergroup | 2589 | ||
| Paleozoic Rocks | 2589 | ||
| Mesozoic Rocks | 2593 | ||
| Cenozoic Rocks | 2593 | ||
| Carving Grand Canyon | 2594 | ||
| Summary of Grand Canyon Geology | 2596 | ||
| Selected Resources | 2596 | ||
| Selected Resources | 2596.e1 | ||
| 126 Space Medicine | 2596 | ||
| The Spaceflight Environment | 2597 | ||
| Pressure | 2597 | ||
| Spaceflight Decompression Risks | 2597 | ||
| Decompression-Related Injuries | 2597 | ||
| In-Flight Decompression Events | 2598 | ||
| Oxygen | 2598 | ||
| Carbon Dioxide | 2599 | ||
| Temperature | 2599 | ||
| Carbon Monoxide | 2600 | ||
| Propellants and Coolants | 2600 | ||
| Fire | 2601 | ||
| Water | 2601 | ||
| Dust, Particulates, and Other Contaminants | 2601 | ||
| The Radiation Environment | 2602 | ||
| Radiation Health Effects | 2602 | ||
| Monitoring and Risk Reduction | 2603 | ||
| Mission Considerations | 2603 | ||
| Preflight | 2603 | ||
| Launch | 2603 | ||
| Effects of Microgravity | 2604 | ||
| Space Adaptation Syndrome | 2604 | ||
| Postflight | 2605 | ||
| Physiologic Concerns of Spaceflight | 2605 | ||
| Cardiovascular Issues | 2605 | ||
| Dysrhythmias | 2606 | ||
| Cardiovascular Fitness | 2607 | ||
| Monitoring and Treatment | 2607 | ||
| Future Research | 2607 | ||
| Visual Impairment/Intracranial Pressure Syndrome | 2607 | ||
| Musculoskeletal Issues | 2608 | ||
| Psychiatric and Behavioral Health | 2609 | ||
| Dermatology and Hygiene | 2611 | ||
| Trauma | 2611 | ||
| Immunology | 2612 | ||
| Urology | 2613 | ||
| Gynecology and Reproductive Issues | 2614 | ||
| Ophthalmology | 2614 | ||
| Otolaryngology | 2616 | ||
| Dental Concerns | 2616 | ||
| Gastrointestinal Issues | 2616 | ||
| Neurology | 2617 | ||
| Onboard Medical Capability | 2617 | ||
| Medical Kits | 2617 | ||
| Diagnostic Imaging | 2618 | ||
| Future Capabilities | 2619 | ||
| Summary and Future Considerations | 2619 | ||
| Acknowledgments | 2620 | ||
| References | 2620 | ||
| References | 2620.e1 | ||
| Appendix Drug Stability in the Wilderness | 2621 | ||
| Environmental Factors Influencing Drug Stability | 2621 | ||
| Expiration Dates and Shelf Life | 2622 | ||
| Packaging | 2622 | ||
| Sterility | 2623 | ||
| Storage | 2623 | ||
| Drugs for A Basic Field Kit | 2623 | ||
| How to Read the Drug List | 2623 | ||
| Drug List | 2624 | ||
| Acetaminophen Capsules, Tablets, Oral Solution, and Suppositories (OTC) | 2624 | ||
| Acetaminophen With Codeine Tablets and Oral Solution (S III) | 2624 | ||
| Acetaminophen With Hydrocodone Tablets and Oral Solution (S II) | 2624 | ||
| Acetazolamide Tablets, Extended-Release Capsules, Oral Solution, and Injection (RX) | 2624 | ||
| Acetic Acid Otic Solution (OTC) | 2624 | ||
| Albuterol Tablets, Syrup, and Inhaled Formulation (RX) | 2624 | ||
| Aloe Vera Gel, Ointment, and Laxatives (OTC) | 2624 | ||
| Amiodarone Tablets, Oral Solution, Inhalants, and Injections (RX) | 2624 | ||
| Antacids (OTC) | 2624 | ||
| Aspirin Tablets, Oral Solution, and Suppositories (OTC) | 2624 | ||
| Atenolol Tablets (RX) | 2625 | ||
| Atropine Injection and Ophthalmic Solution (RX) | 2625 | ||
| Azithromycin Tablets, Oral Solution, Injection, and Ophthalmic Solutions (RX) | 2625 | ||
| Bacitracin Topical Formulation (OTC) | 2625 | ||
| Bismuth Subsalicylate Tablets and Oral Solution (OTC) | 2625 | ||
| Bretylium Tosylate (RX) | 2625 | ||
| Bupivacaine Injection (RX) | 2625 | ||
| Butorphanol Tartrate Nasal Spray and IM and IV Injections (S IV) | 2625 | ||
| Calcium Chloride, Calcium Gluceptate, and Calcium Gluconate Injection (RX) | 2625 | ||
| Calendula Topical Formulation (OTC) | 2625 | ||
| Ceftriaxone Injection (RX) | 2625 | ||
| Cephalexin Capsules, Tablets, and Oral Solution (RX) | 2625 | ||
| Charcoal, Activated (OTC) | 2625 | ||
| Ciprofloxacin Tablets, Capsules, Oral Solution, Injection, Ophthalmic Solution, and Otic Solutions (RX) | 2625 | ||
| Crotalidae Antivenom (RX) | 2625 | ||
| Cyclopentolate Hydrochloride Ophthalmic Solution (RX) | 2625 | ||
| Dabigatran Tablets (RX) | 2625 | ||
| Deet (N,N-Diethyl-Meta-Toluamide, Diethyltoluamide)–Containing Insect Repellent (OTC) | 2625 | ||
| Dermabond (2-Octyl Cyanoacrylate) Topical Skin Adhesive (RX) | 2626 | ||
| Dexamethasone Tablets and Oral, Injection, Implantation, Intravitreal, and Ophthalmic Solutions (RX) | 2626 | ||
| Dextroamphetamine Tablets, Capsules, and Oral Solution (S II) | 2626 | ||
| Dextrose Oral Solution (OTC) and Injection (RX) | 2626 | ||
| Diazepam Tablets, Oral Solution, Suppositories, and Injection (S IV) | 2626 | ||
| Digoxin Tablets and Injection (RX) | 2626 | ||
| Diltiazem Tablets, Oral Solution, and Injection (RX) | 2626 | ||
| Diphenhydramine Tablets, Oral Solution (OTC), and Injection (RX) | 2626 | ||
| Domeboro (Acetic Acid and Aluminum Acetate) Otic Solutions (OTC) | 2626 | ||
| Dopamine Hydrochloride Injection (RX) | 2626 | ||
| Doxycycline Capsules, Tablets, Oral Solution, and Injection (RX) | 2626 | ||
| Edoxaban Tablets (RX) | 2626 | ||
| EMLA (Lidocaine/Prilocaine) Topical Formulation (RX) | 2626 | ||
| Epinephrine Injection and Topical, Inhaled, and Intranasal Formulations (RX) | 2626 | ||
| Erythromycin Tablets, Oral Solution, and Topical Ointment (RX) | 2626 | ||
| Famotidine Tablets (OTC) and Injection (RX) | 2627 | ||
| Fentanyl Oral Lozenges, Sublingual Tablets, Sublingual Spray, Buccal Film, Injection, and Intranasal Formulation (RX) | 2627 | ||
| Fluocinolone Acetonide Topical Ointment, Otic Solution, and Shampoo (RX) | 2627 | ||
| Furazolidone Tablets and Solution (NA) | 2627 | ||
| Furosemide Tablets, Solution, and Injection (RX) | 2627 | ||
| Glucagon Injection (RX) | 2627 | ||
| Haloperidol Tablets and Injection (RX) | 2627 | ||
| Hydrocortisone Tablets, Solution, Injection, and Topical Cream (RX) | 2627 | ||
| Hydromorphone Tablets, Solution, Suppositories, and Injection (S II) | 2627 | ||
| Ibuprofen Tablets and Solution (OTC) | 2627 | ||
| Insulin (Regular) Injection and Inhaled Formulation (RX) | 2627 | ||
| Intravenous Solutions (D5W, Ns, Lr, D5ns, and Other Admixtures) | 2627 | ||
| Isoproterenol Hydrochloride Inhalant and Injection (RX) | 2627 | ||
| Ivermectin Tablets (RX) | 2627 | ||
| Kaletra (Lopinavir/Ritonavir) Tablets (RX) | 2627 | ||
| Ketoconazole Tablets, Shampoo, Foam, and Gel (RX) | 2627 | ||
| Lacosamide Tablets, Oral Solution, and Injection (RX) | 2627 | ||
| Lacrisert (Hydroxypropyl Methylcellulose) Ophthalmic Solution (RX) | 2627 | ||
| Lemon Grass (Cymbogogon) Citronella Oil Topical Formulation (OTC) | 2627 | ||
| Levetiracetam Tablets, Oral Solution, and Injection (RX) | 2628 | ||
| Levofloxacin Tablets, Solution, Injection, and Ophthalmic Formulation (RX) | 2628 | ||
| Lidocaine Injection and Topical, Intradermal, and Ophthalmic Solutions (RX) | 2628 | ||
| Lidocaine/Epinephrine/Tetracaine (LET) Topical Solution (RX) | 2628 | ||
| Lindane (Gamma-Hexachlorocyclohexane) Lotion and Shampoo (RX) | 2628 | ||
| Loperamide Hydrochloride Capsules (OTC) | 2628 | ||
| Lorazepam Tablets, Oral Solution, and Injection (S IV) | 2628 | ||
| Malarone (Atovaquone/Proguanil) Tablets (RX) | 2628 | ||
| Mannitol Injection (RX) | 2628 | ||
| Mebendazole Tablets (RX) | 2628 | ||
| Meperidine Hydrochloride Tablets, Oral Solution, and Injection (S II) | 2628 | ||
| Metoprolol Tablets, Oral Solution, and Injection (RX) | 2628 | ||
| Metronidazole Capsules, Tablets, and Injection (RX) | 2628 | ||
| Midazolam Oral Solution and Injection (S IV) | 2628 | ||
| Modafinil Tablets (S IV) | 2628 | ||
| Morphine Sulfate Tablets, Epidural Suspension, and Injection (S II) | 2628 | ||
| Moxifloxacin Tablets, Oral Solution, Injection, and Ophthalmic Route (RX) | 2629 | ||
| Mupirocin Topical Formulation (RX) | 2629 | ||
| Nalbuphine Hydrochloride Injection (RX) | 2629 | ||
| Naloxone Hydrochloride Injection (RX) | 2629 | ||
| Neosporin Ointment (OTC) | 2629 | ||
| Nifedipine Capsules, Tablets, Oral Solution, and Injection (RX) | 2629 | ||
| Nitroglycerin Capsules, Sublingual Tablets and Sprays, Injection, Patches, and Topical Formulation (RX) | 2629 | ||
| Norfloxacin Tablets, Oral Solution, and Ophthalmic Solution (RX) | 2629 | ||
| Ofloxacin Tablets, Injection, Ophthalmic Solution, and Otic Solution (RX) | 2629 | ||
| Penicillin G Procaine Injection (RX) | 2629 | ||
| Penicillin GK and G Sodium Injection (RX) | 2629 | ||
| Phenobarbital Tablets, Solution, and IM and IV Injections (S IV) | 2629 | ||
| Phenylephrine Injection and Ophthalmic Solution (RX) and Nasal Spray (OTC) | 2629 | ||
| Phenytoin Capsules, Tablets, Oral Solution, and Injection (RX) | 2629 | ||
| Polysporin Ointment (RX) | 2630 | ||
| Potassium Permanganate Astringent Solution (OTC) | 2630 | ||
| Povidone-Iodine Solution (OTC) | 2630 | ||
| Prednisone Tablets and Oral Solution (RX) | 2630 | ||
| Prochlorperazine Capsules, Tablets, Oral Solution, and Injection (RX) | 2630 | ||
| Promethazine Capsules, Tablets, Solution, Injection, and Suppositories (RX) | 2630 | ||
| Pseudoephedrine and Pseudoephedrine/Triprolidine Capsules and Tablets (OTC) | 2630 | ||
| Rivaroxaban Tablet (RX) | 2630 | ||
| Rocuronium Injection (RX) | 2630 | ||
| Sildenafil Tablets (RX) | 2630 | ||
| Simethicone Capsules, Tablets, Drops, and Ultrasound Suspension (OTC) | 2630 | ||
| Sodium Bicarbonate Tablets, Injection, and Suppositories (RX) | 2630 | ||
| Sodium Sulfacetamide Tablets, Cream, Lotion, Ointment, and Ophthalmic Route (RX) | 2630 | ||
| Succinylcholine Injection (RX) | 2630 | ||
| Temazepam Capsules (S IV) | 2630 | ||
| Tetanus Toxoid, Tetanus Toxoid/Diphtheria/Acellular Pertussis, and Hyperimmune Tetanus Globulin Vaccine Solutions (RX) | 2630 | ||
| Tetracaine Hydrochloride Ophthalmic Solution (RX) | 2630 | ||
| Tetracycline Capsules, Tablets, Oral Solution, Injection, and Topical Ointment (RX) | 2630 | ||
| Tolnaftate Topical Antifungal Solution (OTC) | 2630 | ||
| Triazolam Tablets (S IV) | 2631 | ||
| Trimethoprim/Sulfamethoxazole (80 Mg/400 Mg) Tablets, Oral Solution, and Injection (RX) | 2631 | ||
| Truvada (Emtricitabine/Tenofovir) Tablets (RX) | 2631 | ||
| Verapamil Hydrochloride Capsules, Tablets, and Injection Solution (RX) | 2631 | ||
| Warfarin Tablets (RX) | 2631 | ||
| Zinc Salts (OTC) | 2631 | ||
| Zolpidem Tablets, Sublingual Tablets, and Spray (S IV) | 2631 | ||
| References | 2631 | ||
| References | 2631.e1 | ||
| Index | I-1 | ||
| A | I-1 | ||
| B | I-6 | ||
| C | I-10 | ||
| D | I-17 | ||
| E | I-20 | ||
| F | I-25 | ||
| G | I-28 | ||
| H | I-30 | ||
| I | I-34 | ||
| J | I-37 | ||
| K | I-38 | ||
| L | I-38 | ||
| M | I-41 | ||
| N | I-45 | ||
| O | I-47 | ||
| P | I-48 | ||
| Q | I-54 | ||
| R | I-55 | ||
| S | I-58 | ||
| T | I-65 | ||
| U | I-70 | ||
| V | I-71 | ||
| W | I-72 | ||
| X | I-75 | ||
| Y | I-75 | ||
| Z | I-76 | ||
| IBC_Clinical Key ad | IBC1 |