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Forum Post: Trying to figure out the next step to take and would love advice!

Swimchamp714 — Sat, 27 Apr 2013 09:46:00 GMT

My name is Corey and I am a 23 year old student studying Outdoor Adventure Leadership at Southern Oregon University. In a couple of terms I will be graduating and I honestly have no idea what I want to do with my degree. I know I enjoy being outside, adventures, and working with people, BUT besides that I don't know exactly what I want to do. I haven't found my overall passion of the outdoors.

I'm trying to figure out a direction to go in after I graduate in a couple of terms and I don't really know where to begin. I will admit I'm relatively new to all of the outdoor sports but I know, beyond a doubt, that this is the field for me. However, I do know I cannot graduate without some sort of plan of attack and I'm having difficulty trying to make a plan when I don't have something to set my sights on.

I figure I should ask the people who are in the field for advice and hope this will help me figure out where to go with everything.. and who knows maybe it will open some doors for the future!

Thank you for your time and advice!

-Corey

Forum Post: starting a semester school

coolnaturegirl — Tue, 23 Apr 2013 19:20:00 GMT

Hi. I work at a residential environmental education center in New York and there was talk once upon a time, years ago, of starting a semester school at our facility. I am trying to revive the idea, but don't have much to work with besides my desire to get the process started again. I was wondering if anyone in the community has experience in either starting or working in such a program and could give me an idea of where to start.

Our center has the space for students and plenty of things to teach and do with them, but I don't really know where to go from there. Do we need certified teachers and accreditation? Do we need to get permission from the state to start a school? I have many more questions and would greatly appreciate any help/ideas any of you may have.

Thanks so much! Sena R.

Wiki: Articles

Anonymous — Sun, 10 Feb 2013 11:21:00 GMT

Articles on outdoor & experiential education topics. These pieces are stand alone articles written by a specific author and cannot be edited.

Blog Post: WFA Scope of Practice Document Update

Tod Schimelpfenig — Wed, 26 Dec 2012 16:58:00 GMT

The Wilderness First Aid (WFA) course, widely taught by numerous providers, can be burdened with unrealistic expectations of the topics and skills that can be taught in a basic layperson first aid program.

In 2010, sensing a need to clarify what first aid skills and knowledge are realistic and practical for a WFA provider representatives from the major wilderness medicine educators created a WFA Scope of Practice (SOP) document. The SOP is in essence a job description of what a WFA provider should know and what skills they should and should not be able to perform.

The original writing group convened this fall to review and update the WFA SOP. Two years have passed since the original document and with the publication of the WFA Skills Retention Study a review was timely. The latest version articulates the minimum skills and knowledge base for a WFA provider.

Another ongoing project is a review of the medical evidence supporting WFA practices. Several representatives of wilderness medicine schools are on this Wilderness Medical Society working group. We hope to see publication of this work in 2013.

This SOP document is not binding on anyone. It is not crafted as a curriculum. It reflects the consensus of a group of providers who created and have taught this course to tens of thousands of students over three decades and who are actively engaged in the practice of wilderness first aid. It is our hope that it provides some guidance to those who teach WFA and guidance for the outdoor program manager deciding on the appropriate certification for their staff and for the consumer who is choosing between different certifications.

We invite observations and comments, which can be submitted to any member of the working/writing group, and for organizations/individuals to indicate their support for this work by adding their signatures.

Cordially

Tod Schimelpfenig

Curriculum Director

NOLS Wilderness Medicine

December 2012

Forum Post: Florida Everglades Weather educational materials

Andrew — Fri, 14 Dec 2012 22:25:00 GMT

I am putting together a course journal for a sea-kayaking trip to the Florida Everglades. Does anyone know of a good source online or in print for area specific weather signs and forecasting?

Thanks,

Andy

Forum Post: Re: Student Trip Leaders/requiring university employees on trips

Rick Curtis — Fri, 14 Dec 2012 05:39:00 GMT

Jared, I have a lot of questions in order to think about how best to respond. Are your student trip leaders paid? If so are they not acting as agents of the University within guidelines for performance, etc. That might get you out of the problem. Of course if your leaders are volunteers it doesn't help.

What is the reason given for having a staff member along? Is the University afraid of alcohol or drugs on the trip? Poor risk management? Again understanding their reasoning would help me respond.

Where is this coming from? The Dean of Students? The Risk Management Office? The Legal Office? Who often tells you a lot about why. Does the University have similar requirements say when the students in the Chess Club go to a big tournament in Chicago? If so then the institution is paranoid about students in general. If not then they are more paranoid about the outdoor program. If that's the case then it's worth thinking about history. Have there been incidents or close calls that would make the institution fearful? If not then my question is how much do the people concerned actually know about your program?

I know it's a lot of questions, but digging into the why is going to be the best way for you to figure out how to respond

Rick

File: Martyn Ashton: Road Bike Party

Outdoor Ed — Thu, 18 Oct 2012 05:10:00 GMT

Martyn Ashton takes the £10k carbon road bike used by Team Sky's Bradley Wiggins & Mark Cavendish for a ride with a difference. With a plan to push the limits of road biking as far as his lycra legs would dare, Martyn looked to get his ultimate ride out of the awesome Pinarello Dogma 2. This bike won the 2012 Tour de France - surely it deserves a Road Bike Party!

Shot in various locations around the UK and featuring music from 'Sound of Guns'. Road Bike Party captures some of the toughest stunts ever pulled on a carbon road bike.

A Film by Robin Kitchin

Produced by Ashton Bikes

Blog Post: Hantavirus in Yosemite National Park

Paul Auerbach — Sun, 30 Sep 2012 20:10:00 GMT

by Paul Auerbach

Our National Parks are a treasured heritage, and one of the ways in which we appreciate the outdoors. Millions of visitors flock to the parks in order to camp, hike, climb, swim and most of all, appreciate the wonder and natural beauty of America. As with any other outdoor setting, there are risks of injuries and illnesses. A recent cluster of cases of hantavirus pulmonary syndrome apparently originating from Curry Village in Yosemite National Park this summer points this out.

Hantaviruses (such as the sin nombre virus) cause a syndrome characterized by a combination of fever, lung failure, kidney failure, shock, and bleeding. The viruses are spread in the excreta of rodents; in the United States, hantavirus pulmonary syndrome (HPS) has been linked to the deer mouse (Peromyscus maniculatus) and white-footed mouse (P. leucopus), as well as to the cotton rat (Sigmodon hispidus) and rice rat (Oryzomys palustris). The animals shed the virus in saliva, urine, and feces. Aerosols are the most likely route of transmission from rodents to humans. Insect bites have not yet been implicated in transmission. The virus found in the U.S. is not known to cause human-to-human transmission.

The deer mouse is a creature that is adept at squeezing through very small openings. In the case of Curry Village at Yosemite, mouse nests have been found in the wall spaces of tent cabins, and mice have tested positive for the virus from around the park.

HPS has been reported in most states west of the Mississippi River, as well as in a few eastern states. In Louisiana and Florida, two hantavirus species, bayou virus and Black Creek virus, have been identified. A person infected by the virus has an incubation period of 1 to 6 weeks after exposure, and then suffers from fever, muscle aches, headache, cough, dizziness, abdominal pain, nausea and vomiting, and diarrhea for a few days; this is followed by difficulty breathing, mottled skin on the limbs, shock, and, sometimes, bleeding. In the U.S., approximately a third of victims die.

Most victims have had an interaction with rodents, such as when cleaning a barn or capturing the animals. Unfortunately, there is not yet any specific therapy beyond supportive care. Because a person with hantavirus infection may become seriously ill at a rapid rate, it is important to promptly bring any suspected victim to medical care.

To avoid unnecessary exposure to hantavirus, it is recommended that wilderness enthusiasts observe the following precautions:

keep food and water covered and stored in rodent-proof containers
dispose of food clutter
spray dead rodents, nests, and droppings with disinfectant before handling (wear gloves)
clean and disinfect cabins and other shelters thoroughly before using
don’t make camp near rodent sites
don’t sleep on bare ground
burn or bury garbage promptly
discard food that looks like it may have been chewed upon by rodents
use only bottled or disinfected water for campsite purposes.

Reprinted with permission from Healthline.com

File: British Mountaineering Council Helmet Campaign Video

Outdoor Ed — Sun, 30 Sep 2012 19:36:00 GMT

In 2012 the British Mountaineering Council (BMC) launched a Helmet Campaign. The aim of this campaign is to raise awareness amongst climbers and mountaineers about climbing helmets, and to help them decide when to wear one or not.

In this video we interview climbers at Stanage Edge, England's most popular crag, to find out about their attitudes to wearing helmets, and we discuss the different kinds of helmet on offer. We ask climber Neil Bentley about why he chose to wear a helmet on the first ascent of Equilibrium, the UK's first E10, and find out how a serious head injury affected his life, after an accident on the Marmolada in the Dolomites.

Blog Post: Wilderness First Aid Retention Study

Tod Schimelpfenig — Sun, 09 Sep 2012 18:26:00 GMT

Wilderness First Aid (WFA) courses are taught by multiple individuals and programs. They have become a standard for people working and recreating in the outdoors. Are they effective? Can the participants remember the information? Can they perform the skills?

To investigate these questions NOLS Wilderness Medicine Institute (WMI) conducted a research project to measure retention of WFA skills and knowledge. There is literature on skill and knowledge retention in CPR and first aid, but nothing we could find on WFA courses.

The research was conducted with our colleagues at the University of Utah; Scott Schumann PhD, Jim Sibthorp PhD and Rachel Collins MS. At the conclusion of an open enrollment WFA course the study participants were given a written exam and an assessment of their confidence in their ability to perform their WFA skills. At either 4, 8 or 12 months post course they returned to complete a scored skills-based scenario, familiar to anyone who has taken a WMI WFA course. They also repeated the WFA knowledge and self-efficacy measures they took at the original training. You can read the detailed study methodology, results and limitations at the Journal of Wilderness and Environmental Medicine http://wemjournal.org/.

Our findings are not surprising.

• We quickly forget what we do not practice. The longer the time from training, the more we forget.

• Written tests do not correlate with performance on practical tests.

• Our opinions on our competence may not correlate with our practical performance.

The study participants demonstrated poor skill proficiency when taking vital signs, obtaining a medical history, and conducting the focused spine assessment (a selective spine immobilization protocol). These results are consistent with studies that show first aid knowledge and skills, or any skills or knowledge for that matter, deteriorate in the absence of repeated practice.

The poor skill retention seen in this study brings an interesting perspective to the complaints we hear about the burden of biannual recertification of WFA/WFR. The American Heart Association suggests practicing medical professionals refresh their BLS skills more frequently than every 2 years. We cannot assume that laypeople will retain their skills any better than practicing professionals. Bravo to those organizations with ongoing training for their staff.

The study did not look at teaching competency, but it does beg these questions. The content may be basic first aid, but in our (albeit biased) opinion the volume of stuff in a WFA requires a skilled educator to have any chance for competent graduates. WFA courses are taught by skilled educators and outdoor medicine practitioners, and they are taught by people who obtain a WFA instructional credential online with no verification they can teach effectively, have ever touched a patient or spent a night outdoors. Buyer beware.

These results raise the question of the appropriate role for this certification. The WFA course was designed as an introductory layperson first aid course for those close to help or assisting a more highly trained provider and is described in this context in the Scope of Practice document. It has unfortunately evolved into a wilderness trip leader credential.

We must also pause and ponder all the content people want crammed into this course. Of everything we could teach, what needs to be learned by a layperson to practice wilderness first aid? We have grown to expect more from this course than we can deliver in 16 hours of instruction.

WMI doesn't find these results discouraging, nor did we choose, as can happen in product research, to bury the negative results. We empirically assessed and now report our outcomes. We have already revised our WFA curriculum. We cut unnecessary content detail, including the focused spine assessment. We found more practice time in a busy agenda. We are developing other educational tools to increase retention. We're excited to continue to evolve an important curriculum that is accurate, realistic and practical.

Cordially

Tod Schimelpfenig

Curriculum Director

NOLS Wilderness Medicine Institute

Reference: Schumann SA , Schimelpfenig T , Sibthorp J , Collins RH . An examination of wilderness first aid knowledge, self-efficacy, and skill retention . Wilderness Environ Med . 2012;23:281–287

September 2012

File: Dr. Tom Hornbein - Entries from the Top: An Everest Journal

Outdoor Ed — Tue, 07 Aug 2012 03:58:00 GMT

Featured in the American Mountaineering Museum, this video series asks Mt Everest climbers why they climb and holds stories from the top!

To learn more about the American Mountaineering Museum and Alpine Club Library please visit:
http://www.mountaineeringmuseum.org

File: Whitewater Kayaking - The Key To Catching Air

Outdoor Ed — Mon, 30 Jul 2012 01:47:00 GMT

In this episode, from 'Playboating with Ken Whiting', Ken talks about how to get airborne on waves.

Produced by The Heliconia Press http://www.helipress.com

Blog Post: Building a Wilderness First Aid Kit

Julie Anderson — Mon, 23 Jul 2012 13:57:00 GMT

Re-posted with permission from Wilderness Medical Associates International.

Walking through the first aid aisle at your local outfitter store can be overwhelming. While there are many excellent prepared kits on the market, often enthusiasts choose to create and specialize their own. Your kit will be different based on where you are camping and hiking. Trips at altitude, near marine environments or canyoning, and desert trekking each have unique needs that would require you augment your kit accordingly.

Below is a “basic kit list,” to which you can add on as your number of adventurers, length of trip, level of training, or destination dictate. An asterisk marks items that you might include for your week-long trip. For your overnight, you can feel comfortable paring down the quantities.

Personal Protection:

Gloves (Nitrile) – Vinyl is too porous, and latex is a common allergen. Bring a few more pair than you think you need. You use one pair of gloves each time you clean a wound, and gloves aren’t designed to be re-used. If your gloves have been in your kit for a long time, check them to make sure they didn’t degrade in heat or cold. Have these easily accessible so that you are inclined to use them when needed.
CPR mask and airway management- you can get a quality mask with a filter for around $12. “Keychain” masks are better than nothing, but have a short life span when put to use. If you have been trained to use airway adjuncts, include some—they are a little bit of weight for a lot of good.
Wound care (probably the most common supplies I use on trips):
1” athletic tape- one roll per person per week for hiking/skiing/climbing trips (really). It’s good for blister prevention, blister covering, ankle taping, and much more.
Gauze/ dressings (4-6) – different sizes and a few nonadherent (great for burns or abrasions).
Adhesive bandages (8)- various styles.
Roller gauze or vet wrap (2)- something to keep the gauze next to the wound that won’t cut off circulation. Vet wrap lasts longer than roller gauze.
Waterproof/ breathable (occlusive) wound dressings (2-3)*- an invaluable addition to wound care if you will be out for a few days. On a clean wound, this can create an environment conducive to healing that lasts a couple days. These are generally 2” x 3” or larger.
Tweezers- invest in a good pair (sharp and pointy), which will only cost a couple dollars more than a cheap pair.
Small magnifier- for wound cleaning. Be sure you have a reliably bright light source for wound exploration.
Wound cleaning*- a 60cc syringe (check the local feed store) with an irrigation tip is cheap and lightweight and gives better pressure than anything we could improvise.
Trauma shears (1)- there are some cool tiny ones (4”) on the market that only cost a few dollars and work great.
Blister care- Moleskin, foam, gel pads, or whatever your flavor. Duct tape should not be used on open blisters.

Musculoskeletal injuries:

Compression wrap(s)- 3” works great for supporting ankles or knees.
Aluminum foam splint (1)
Triangular bandages (2)- these are multi-functional.

Over the counter medications:

Pain management- ibuprofen and acetaminophen work in different ways. Bring what you prefer, and pack a few grains of rice if you have bottles of tablets. It keeps the tablets from becoming a paste in moist conditions.
Gastrointestinal meds*- antacids such as calcium carbonate, anti-diarrheal such as loperamide, or whatever works for you.
Antihistamines- diphenhydramine for allergic reactions. Epinephrine injectors are prescription only and should be carried by those who require them.
Topical antibiotic cream*- good for small, shallow wounds. No need to get a huge tube, and beware of antibiotic allergies among your group.

Random other things and debatable items:

Your Field Guide of Wilderness & Rescue Medicine
Timepiece
Extra waterproof zip bags- these can be packaged with your SOAP note, pencil, and local emergency numbers.
Stethoscope*- If you are comfortable listening to lung sounds, I would recommend this for aquatic or altitude trips.
Oral glucose gel*- If you have honey in your camp kitchen, it will suffice. Many coffee shops have honey packets available as condiments- perhaps pick up a few with your purchase.
Temporary dental filling*- maybe not for a week-long trip, but it’s small, cheap, easy to find in the store, and can turn a trip around to the good easily.
Antifungal cream*- miconazole or clotrimazole would be good for a longer trip.

Comfort care to be carried by individuals, depending on the environment:

Aloe*
Throat lozenges*
Lip balm
Sunscreen
Insect repellant
Contact care
Personal medications- asthma inhalers, etc.

Much of this can be bought at local pharmacies, “feed and seed” stores, grocery stores, or through online retailers.

Pick your vessel. You might be inclined to choose a zippered nylon clamshell with organizer pouches or see-through dividers. Or, if you are an ultralight hiker, you may choose waterproof zip-top bags. For paddling trips, dry bags or dry cases may be preferred if you can keep the inside dry (but I wouldn’t want to haul a dry box on a mountaineering trip!) Regardless of your outside package, it is worth the extra few minutes to compartmentalize your contents by thought- something that makes sense to you, like: big wounds; little wounds and blisters; common pills (like ibuprofen); uncommon pills (like GI meds); etc. I use a vacuum sealer when I am more worried about water seepage or risk management (this makes it inevitable to see if something’s been used, and then program managers know to seek out an incident report or replace stock).

Have a great trip!

*This assumes your survival gear (the rest of the ten essentials) is packaged elsewhere.

Forum Post: Re: Is there a 'Climbing Certification War' starting?

Nick Wilkes — Sun, 22 Jul 2012 21:06:00 GMT

Rick, et al.,

Different organizations may offer various forms of guiding certification, but the specific certification needed by a given guide depends on his/her context. I originally earned AMGA Single Pitch Certification when I was guiding in Utah, which was the only choice at the time (2007). Top-Rope certification would not have been sufficient in my guiding context at the time, as none of the crags there were accessible via top rope. Five years later, I now guide at Devils Lake in WI, where everything is top-rope accessible. Furthermore, I work for myself, and thus do not have a large company to insure me. At this point, PCGI certification Top Rope certification makes more sense because 1) I don't need more advanced training for my guiding context, and 2) PCGI offers an affordable insurance option that other certifying bodies do not. This last provision is extremely valuable; while the AMGA seemed to be trying to make certification expensive and difficult so as to make independent guiding more difficult, PCGI helps guides work for themselves by providing reasonable insurance options. So even though no certifying body is trying to dominate in its authority to certify, it's possible some organizations will offer guides more value in going through their particular organization. And that kind of competition, where organizations are trying to find more and more ways to bring value to certification, is very good for guides.

Best,

Nick Wilkes

Owner, Devils Lake Climbing Guides

Blog Post: When to Use Tourniquets

David Johnson — Thu, 19 Jul 2012 15:09:00 GMT

Re-posted with permission from Wilderness Medical Associates International.

I am not sure that there is a consensus about their use but here is my opinion about tourniquets in remote and hostile environments.

In brief:

1. Learn how to use one and practice with it.

2. Apply to stop bleeding not controlled by well-aimed direct pressure.

3. Use something wide and firm (but not hard) that can apply circumferential pressure. The pressure should be sufficient to stop bleeding. Make sure that it is in good shape and not a knock-off.

4. Place proximally (upstream) and as close to the wound as possible.

5. Don’t release in the field if the patient is in shock, has an an amputated limb, or has a wound site that cannot be monitored for re-bleeding.

6. For a long evacuation, wait an hour before trying to release it. If bleeding starts again, re-secure. Note the time and leave it in place until definitive care is reached or arrives.

7. Under dangerous circumstances, one may be applied before a thorough evaluation is possible. These should be applied to the proximal thigh or arm if there is any question about the location and/or number of wounds. Carefully check the wound when it is safe and feasible. As indicated, leave, reposition, or release it or add a second one proximally.

The following is an explanation of my above opinion. None of this should be misconstrued as a blanket endorsement to buy and carry one on all trips.

Tourniquets have a checkered history and hyperbolic claims continue to muddy the water. Past and current combat experience in the SW Asian theaters has drawn renewed attention to them because injuries to limbs have been a major source of life-threatening bleeding. There, they are being used successfully to control obvious and potentially serious bleeding. In the later case, they are applied before a proper assessment is possible e.g., multiple casualties, continued live fire. The tourniquets used are relatively cheap and can be lifesaving if used properly. As with anything in medicine, nothing works 100% of the time.

In civilian practice, it is relatively rare for death from limb bleeding to occur because properly applied, well-aimed direct pressure failed. Still, tourniquets have their use outside of theater (e.g., mass casualty), so knowing how to use one is important. The relevant questions include what, where and for how long.

What:
A good tourniquet ought to be soft (but not mushy) and wide. Within limits, wider is better. To be effective, the circumferential pressure needs to be sufficient to stop bleeding. A sphygmomanometer (BP cuff) might be ideal except that they usually will not maintain adequate pressure for a long enough period of time. They and similarly designed devices are also bulky and fragile. The gauges break easily and the fabric, bladder and tubes are vulnerable to sharp objects. Cordage, like a rope or 550 cord (parachute), is not a good choice either because of the potential for direct skin and neurovascular injury.

There are a variety of more serviceable versions. Two of them, the CAT (combat application tourniquet) and SOFTT (special operations forces tactical tourniquet), have worked reasonably well in combat. They are compact, inexpensive and easily applied, even by the patient. Their advantages are a tradeoff for effectiveness.

Where:
One needs to have enough remaining limb to hold the tourniquet. I have heard intelligent people argue that they should never be applied to forearms and legs (lower). Generally, I disagree and experience would seem to bear that opinion out. They should be applied as close to the wound as possible. When circumstances prevent a proper assessment for location and number of wounds, some recommend using only the proximal arm (upper) and/or thigh as default positions.

If limb bleeding will not stop, especially with a thigh, another applied in parallel, proximally, may help. Stay off joints. Controlling junctional (e.g., in the groin) bleeding remains problematic.

How long:
People fear tourniquets because prolonged use can lead to neurovascular damage and tissue death. We know that tissue death from impaired circulation can occur in as little as two hours. We also know that tourniquets have been left on for over 16 hours without any notable harm.

Releasing a tourniquet has its own risks and there are circumstances where removal never makes sense. These later would include limb amputation, shock, the inability to monitor the wound or continued bleeding. Intermittently releasing them to temporarily restore circulation has been reported to lead to unrecognized, ongoing blood loss and patient death. On a long evacuation, if the conditions seem otherwise safe, waiting 1 hour before attempting a removal seems like a reasonable time interval. If bleeding starts again, resecure, note the time and leave it in place.

Improper application is an important cause of failure. They can also fail when they breakdown from environmental exposure or from poor construction (e.g., older version knockoff). Always check your equipment before heading out and replace anything questionable. Practice with any tool before you need it for a real emergency.

There are plenty of good resources online that cover step-by-step application and the identification of knockoffs (e.g., date printed on webbing, red tip on the end of webbing).

File: Exertional Heat Illness during Training and Competition

Outdoor Ed — Mon, 16 Jul 2012 02:39:00 GMT

Medicine & Science in Sports & Exercise:

March 2007 - Volume 39 - Issue 3 - pp 556-572

doi: 10.1249/MSS.0b013e31802fa199

SPECIAL COMMUNICATIONS: Position Stand

SUMMARY

Exertional heat illness can affect athletes during high-intensity or long-duration exercise and result in withdrawal from activity or collapse during or soon after activity. These maladies include exercise associated muscle cramping, heat exhaustion, or exertional heatstroke. While certain individuals are more prone to collapse from exhaustion in the heat (i.e., not acclimatized, using certain medications, dehydrated, or recently ill), exertional heatstroke (EHS) can affect seemingly healthy athletes even when the environment is relatively cool. EHS is defined as a rectal temperature greater than 40°C accompanied by symptoms or signs of organ system failure, most frequently central nervous system dysfunction. Early recognition and rapid cooling can reduce both the morbidity and mortality associated with EHS. The clinical changes associated with EHS can be subtle and easy to miss if coaches, medical personnel, and athletes do not maintain a high level of awareness and monitor at-risk athletes closely. Fatigue and exhaustion during exercise occur more rapidly as heat stress increases and are the most common causes of withdrawal from activity in hot conditions. When athletes collapse from exhaustion in hot conditions, the term heat exhaustion is often applied. In some cases, rectal temperature is the only discernable difference between severe heat exhaustion and EHS in on-site evaluations. Heat exhaustion will generally resolve with symptomatic care and oral fluid support. Exercise associated muscle cramping can occur with exhaustive work in any temperature range, but appears to be more prevalent in hot and humid conditions. Muscle cramping usually responds to rest and replacement of fluid and salt (sodium). Prevention strategies are essential to reducing the incidence of EHS, heat exhaustion, and exercise associated muscle cramping.

Download PDF - http://pdfs.journals.lww.com/acsm-msse/2007/03000/Exertional_Heat_Illness_during_Training_and.20.pdf

Blog Post: Treating Severe Heatstroke with an External Cooling System

Paul Auerbach — Mon, 16 Jul 2012 02:19:00 GMT

by Paul Auerbach

Heatstroke is a life-threatening emergency. Therapeutic cooling measures need to be undertaken rapidly in order to prevent the catastrophic organ failure associated with markedly elevated body temperature.

The general dictum is to cool the victim to a normal body temperature, but to take care not to go further into the territory of hypothermia ("overshoot"), which theoretically might create another set of difficulties. But perhaps there is an opportunity now for new thinking regarding cooling a heatstroke victim in dire circumstances.

In an article entitled "Successful Treatment of Severe Heatstroke With Therapeutic Hypothermia by a Noninvasive External Cooling System" (Annals of Emergency Medicine 2012;59:491-493), Dr. Jen-Yee Hong and colleagues report treating a near-fatal case of exertional heatstroke using induced therapeutic hypothermia (33^oC [91.4^oF]) by a noninvasive external cooling system. After treatment, the patient recovered completely, without any neurological sequelae at one year. Prior to cooling, the victim had multi-organ dysfunction, including seizures, lung injury, and coagulopathy (diffuse bleeding).

This is a very important case report, because external cooling devices are much more commonly found these days in emergency departments because they are used to cool patients to protect their brains after they have been resuscitated from cardiac arrest, or in certain other situations where there has been a dangerous period of lack of oxygen to the brain.

The specific device used for this patient was the Medivance Arctic Sun System, which is a noninvasive (no direct access to the bloodstream is obtained) cooling system designed for external temperature management. It circulates chilled water through pads directly adhered to the patient's skin. While this is a single case report and it is impossible to know if merely cooling the patient from a hyperthermic (hot) condition to a normal body temperature would have been sufficient to achieve the same outcome, it is very important to note that going beyond a normothermic condition to a hypothermic (cold) condition did not appear to be harmful and may very well have been helpful, for theoretical reasons noted by the authors.

Outdoor Ed Note: Thanks Paul for this update. The heat waves happening across the U.S this summer are of particular concern for outdoor programs where physical activity is combined with high heat and humidity. Heat stroke can be an immediately life-threatening illness.

Here are a few other good sources about Exertional Heat Stroke (EHS). One critical observation from a number of these articles is advanced recognition of the problem. The person who is "'falling behind' his friends, or collapsing during or shortly after an exercise is suspected to suffer from heat stroke. Staff should be taught to look for these signs and take immediate vigorous steps.

Exertional Heat Illness and Competition - Position Paper by the American College of Sports Medicine (PDF Version)

"Cooling Techniques for Hyperthermia" at Medscape.

Exertional HeatStroke in Israeli Defence Forces (PDF)

File: Outdoor Recreation Participation Topline Report 2012

Outdoor Ed — Mon, 09 Jul 2012 00:20:00 GMT

How many people are involved in outdoor recreation activities and what activities are growing. The Outdoor Industry Association Recreation Participation Topline Report for 2012 shows the trends that my impact your organization.

In 2011, outdoor recreation among Americans reached the highest participation level in the last five years. Nearly 50 percent of all Americans ages six and older, or 141.1 million individuals, participated in at least one outdoor activity in 2011, making 11.6 billion outings. In fact, last year, Americans enjoyed 1.5 billion more outings than the previous year. Compared to 2010, participation in outdoor activities increased slightly among all age groups from 6 to 44, while participation among those ages 44 and up remained relatively flat.

File: The Outdoor Recreation Economy Report 2012

Outdoor Ed — Sun, 08 Jul 2012 23:51:00 GMT

The Outdoor Industry Economy Report by the Outdoor Industry Association presents the latest figures on the impact of outdoor recreation on the US economy.

"A balanced, healthy economy is not an either/or choice. Outdoor recreation is a larger and more critical sector of the American economy than most people realize. As a multi-dimensional sector, the outdoor industry pumps $646 billion in direct spending into the American economy and fuels traditional sectors like manufacturing, finance, retail trade, tourism and travel.

6.1 million American lives directly depend on outdoor recreation. As the globally recognized leader in outdoor recreation, America is poised to drive an industry that offers a diversity of rewarding and highly skilled career opportunities for people today and into the future."

- Conclusion section of the Outdoor Industry Economy Report

Blog Post: Treating Rattlesnake Bites in the Field

Paul Auerbach — Thu, 05 Jul 2012 01:30:00 GMT

by Paul Auerbach

There are two excellent photographs of a rattlesnake bite victim that appear in the June 10, 2010 issue of the New England Journal of Medicine (362;23:2212). Entitled “Rattlesnake Envenomation” in the IMAGES IN CLINICAL MEDICINE feature, they show the bitten finger and the effects on the torso of a man who presented for medical care within a half hour of having been bitten by a rattlesnake. He was treated with antivenom prior to being admitted to the hospital.

The finger image shows the local effect of the venom in this victim, which could have caused tissue destruction (but did not, which is most likely attributable to the timely administration of a sufficient amount of antivenom). The torso image shows the extensive bruising associated with the blood clotting disorder that developed because of the systemic effects of the venom, which combined to prolong bleeding time in this victim. Despite the initial administration of antivenom, the victim continued to develop his bleeding problem, so was administered additional antivenom, which is needed to counteract the venom effects. The patient had a full recovery, which is a credit both to the victim (for promptly seeking medical care) and to the treating physicians, who knew how to properly treat a venomous rattlesnake bite with antivenom.

For the benefit of anyone who might suffer a rattlesnake bite, here are instructions about what to do in the field:

If a person is bitten by a snake that could be poisonous, act swiftly. The definitive treatment for serious snake venom poisoning is the administration of antivenom. The most important aspect of therapy is to get the victim to an appropriate medical facility as quickly as possible.

Don’t panic. Most bites, even by venomous snakes, do not result in medically significant envenomations. Reassure the victim and keep him from acting in an energy-consuming, purposeless fashion.

Retreat out of the striking range of the snake, which for safety’s sake should be considered to be the snake’s body length (for pit vipers, it is actually approximately half the body length). A rattlesnake can strike at a speed of 8 ft (2.4 m) per second.

Locate the snake. If possible, identify the species. If you cannot do this with confidence (which is really only important for the Mojave rattlesnake and coral snake), you might be able photograph the snake using a digital camera, but be careful. Do not attempt to capture or kill the snake, for fear of wasting time and perhaps provoking another bite. Never delay transport of the victim to capture a snake. If the snake is dead, take care to handle it with a very long stick or shovel, and to carry the dead animal in a container that will not allow the head of the snake to bite another victim (the jaws can bite in a reflex action for up to 90 minutes after death). If you are not sure how to collect the snake, it is best just to get away from it.

Splint the bitten body part to avoid unnecessary motion. Allow room for swelling within the splint. Maintain the bitten arm or leg in a position of comfort. Remove any jewelry that could become an inadvertent tourniquet.

Transport the victim to the nearest hospital.

Do not apply ice directly to the wound or immerse the part in ice water. An ice pack placed over the wound (as one would do for a sprain) is of no proven value to retard absorption of venom, but may be useful for pain control. Application of extreme cold can cause an injury similar to frostbite, and possibly lead to enough tissue loss to require amputation.

Application of the Extractor Pump is at best controversial, and is no longer recommended by snakebite experts. The manufacturer claims that if the device is applied according to the instructions provided, it can remove venom without the need for a skin incision. Animal research appears to refute this notion, and even to suggest that by using the device for a rattlesnake bite, it might cause concentration of tissue-toxic venom under the suction cup, leading to a more severe reaction.

If the victim is more than 2 hours from medical attention, and the bite is on an arm or leg, one may use the pressure immobilization technique: place a 2 in by 2 in (5 cm by 5 cm) cloth pad over the bite and apply an elastic wrap firmly around the involved limb directly over the padded bite site with a margin of at least 4 to 6 in (10 to 15 cm) on either side of the wound, taking care to check for adequate circulation in the fingers and toes (normal pulses, feeling, and color). An alternative method is to simply wrap the entire limb at the described tightness with an elastic bandage. The wrap is meant to impede absorption of venom into the general circulation by containing it within the compressed tissue and microscopic blood and lymphatic vessels near the limb surface. You should then splint the limb to prevent motion. If the bite is on a hand or arm, also apply a sling. It should be noted that this recommendation is controversial, in that some experts believe that localizing venom in a single area might lead to an increased chance for tissue damage.

An alternative to the pressure immobilization technique is a constriction band (not a tourniquet) wrapped a few inches closer to the heart than the bite marks on the bitten limb. This should be applied tightly enough to only occlude the superficial veins and lymph passages. To gauge tightness, the rescuer should be able to slip one or two fingers under the band, and normal pulses should be present. The band may be advanced periodically to stay ahead of the swelling. It is of questionable usefulness if 30 minutes have intervened between the time of the bite and the application of the constriction band (or pressure immobilization technique). Again, this recommendation is controversial, for the reasons mentioned in the previous paragraph.

The impression of most snakebite experts is that incision and suction are of little value and probably should be abandoned. It appears that little venom can actually be removed from the bite site. Furthermore, the incision may set the stage for inoculation of bacteria, infection, and a poorly healing wound. Mouth contact with the incision may cause a nasty infection that leaves a noticeable scar; there is also the risk of transmission of blood-borne disease to the rescuer.

“Snakebite medicine” (whiskey) is of no value and may actually be harmful if it increases circulation to the skin.

There is no scientific evidence that electrical shocks applied to snakebites are of any value. On the contrary, there are experiments that refute this concept.

The bite wound should be washed vigorously with soap and water, and the victim treated with dicloxacillin, erythromycin, or cephalexin.

If the victim is many hours or days from a hospital, assist him to walk out or arrange for a litter rescue, allowing frequent rest periods and adequate oral hydration. Splinting and positioning (e.g., elevating or lowering) the bitten part are secondary to any effort to reach a facility where antivenom can be administered.

Watch for an allergic reaction caused by the snakebite. This might cause the victim to be short of breath with or without an airway obstruction from swelling of the mouth, tongue, and throat. Once the victim is in the hospital, the severity of envenomation will be ascertained, and the victim treated with antivenom if necessary. Such therapy must be carried out under the supervision of a physician, because serious allergic reactions to antivenom are possible.

Reprinted with permission from Healthline.com