Wilderness Medicine: Expert Consult Premium Edition, 6th Edition

Wilderness Medicine, 6th Edition......Page 4
Cover......Page 1
Copyright......Page 5
Contributors......Page 6
Foreword......Page 16
Preface......Page 20
Photo credits for cover images and part openers......Page 26
Acclimatization to High Altitude......Page 28
Ventilation......Page 29
Systemic Circulation......Page 30
Oxyhemoglobin Dissociation Curve......Page 31
Sleep at High Altitude......Page 32
Periodic Breathing......Page 33
Training at High Altitude......Page 34
Acute Cerebral Hypoxia......Page 35
High-Altitude Headache......Page 36
Epidemiology and Risk Factors......Page 37
Differential Diagnosis......Page 38
Brain Swelling in AMS.......Page 39
Treatment......Page 40
Prevention......Page 41
Acetazolamide Prophylaxis.......Page 42
Clinical Presentation......Page 43
Pathophysiology......Page 44
High-Altitude Pulmonary Edema......Page 45
Hemodynamics......Page 46
Laboratory Studies......Page 47
Role of Pulmonary Hypertension.......Page 48
HAPE Susceptibility......Page 49
Treatment......Page 50
Symptomatic High-Altitude Pulmonary Hypertension.......Page 51
Alcohol at High Altitude......Page 52
Immunosuppression......Page 53
Chronic Lung Disease......Page 54
Pulmonary Vascular Disorders......Page 55
Hypertension......Page 56
Arteriosclerotic Heart Disease......Page 57
Sickle Cell Disease......Page 58
References......Page 59
References......Page 0
Snow Climates......Page 60
Physical Properties......Page 61
Kinetic Metamorphism......Page 62
Avalanche Types......Page 63
Mechanical Properties: How Snow Deforms On a Slope......Page 64
Avalanche Dynamics......Page 65
Orientation......Page 67
New Snow Density and Crystal Type......Page 68
Weak Layers......Page 69
Crossing Avalanche Slopes......Page 70
Stability Evaluation Tests......Page 71
Avalanche Rescue Beacon......Page 73
Avalanche Airbag......Page 74
Swimming......Page 76
Going for Help......Page 77
Incident Command System......Page 78
Avalanche Rescue Dogs......Page 79
The Avalanche Victim......Page 80
Statistics of Avalanche Burials......Page 81
Rescue Statistics......Page 82
Respiratory Physiology of Avalanche Burial......Page 83
Medical Treatment and Resuscitation of Avalanche Burial Victims......Page 84
Summary......Page 86
References......Page 87
Historical Overview*......Page 88
Common Modern Myths, Superstitions, and Misconceptions*......Page 89
Other Myths*......Page 91
Lightning Across the United States......Page 92
U.S. Lightning Casualties......Page 93
Distribution of U.S. Lightning Deaths by State......Page 94
Trends in U.S. Lightning Fatalities......Page 95
Forensic Investigation......Page 96
Structural Signs of Direct Lightning Strike......Page 97
Physical and/or Autopsy Examination......Page 98
Special Procedures......Page 99
Early Scientific Studies and Invention of the Lightning Rod*......Page 100
Lightning Discharge......Page 101
Thunder......Page 102
Mechanisms of Injury......Page 103
Frequency, Voltage, Amperage, and Resistance......Page 106
Pathway, Duration of Current, Flashover Effect, and Time......Page 107
Estimates of Streamer Currents......Page 108
Magnetic Field Effects*......Page 109
Moderate Injury......Page 110
Cardiac Arrest......Page 111
Central Nervous System Injury†......Page 112
Burns*......Page 113
Eye Injuries*......Page 115
Behavioral Issues......Page 116
History and Physical Examination......Page 117
Cardiovascular Therapy†......Page 118
Long-Term Care¶......Page 119
Approaching Thunderstorm......Page 120
Vehicles*......Page 121
Large Group Safety......Page 122
Controversies in Lightning Injury*......Page 124
Remote and Psychological Symptoms......Page 125
Lightning Exposure......Page 126
Detection......Page 127
Lightning Explosive Barotrauma......Page 128
References......Page 129
Basics of Core Temperature......Page 132
Measuring Instruments......Page 133
Estimating Mean Body Temperature......Page 134
Radiative Heat Exchange......Page 135
Peripheral Thermal Sensors......Page 136
Regulator......Page 137
Vascular Adjustments......Page 138
Metabolic Responses......Page 139
Important Modifications of Thermoregulatory Responses......Page 140
Gender......Page 141
Alcohol, Anesthetics, and Toxins......Page 142
Competition with Other Homeostatic Systems......Page 143
References......Page 144
Classifications......Page 145
Nervous System......Page 146
Cardiovascular System......Page 147
Respiratory System......Page 148
Predisposing Factors......Page 149
Increased Heat Loss......Page 150
Trauma......Page 151
Acid–Base Balance......Page 152
Treatment......Page 154
Prehospital Life Support......Page 156
Initial Stabilization......Page 157
Passive External Rewarming......Page 158
Forced-Air Surface Rewarming......Page 159
Airway Rewarming......Page 160
Mediastinal Irrigation......Page 161
Peritoneal Lavage......Page 162
Cardiopulmonary Bypass......Page 164
Cardiopulmonary Resuscitation......Page 166
Blood Flow During Chest Compressions......Page 167
Resuscitation Pharmacology......Page 168
Ventricular Arrhythmias......Page 169
Forensic Pathology......Page 170
References......Page 171
History and Epidemiology......Page 172
Commercial Activities on Cold Water......Page 173
Physiologic Responses to Cold-Water Immersion With the Head Above Water......Page 175
Phase 1: the Cold Shock Response (0 to 2 Minutes)......Page 176
Phase 3: Onset of Hypothermia (Immersion of More Than 30 Minutes)......Page 177
Phase 4: Circum-Rescue Collapse......Page 178
Thermal Protection......Page 179
Body Morphology (Size and Composition)......Page 181
Head Immersion......Page 182
Behavior and Posture of the Body in Cold Water......Page 183
Shivering......Page 184
Ability to Control the Cold Shock Response......Page 185
Behavior of the Survivor in the Water......Page 186
Survival Modeling......Page 187
Physiologic Responses to Cold Water Submersion With the Head Under Water......Page 188
Mechanisms for Brain and Body Cooling......Page 189
Mechanisms for the Protective Effect of Brain Cooling......Page 190
Self-Rescue from Open Water or An Ice Hole......Page 191
Untrained Bystander Rescue......Page 192
Rescue from Open Water......Page 193
Examination, Triage, and Life Support......Page 194
Body-to-Body Rewarming......Page 197
Forced Air Warming......Page 198
References......Page 199
Prevalence......Page 200
Cold-Induced Vasodilation......Page 201
Pathophysiology......Page 202
Hyperemic Phase......Page 204
Posthyperemic Phase......Page 205
More Severe Injuries......Page 206
Prevention......Page 207
Pernio (Chilblains)......Page 208
References......Page 209
Anatomy and Physiology......Page 210
Indirect Cellular Damage/Progressive Dermal Ischemia......Page 211
Definitions and Classifications......Page 212
Temperature and Windchill......Page 213
Altitude......Page 214
Skin Wetness/Unwashed Skin......Page 215
Genetic Predisposition......Page 216
In the Prehospital Freezing Environment......Page 217
Overall Strategy......Page 219
Technetium-99m Scanning......Page 220
Topical: Aloe vera......Page 221
Antiprostaglandin Agents......Page 222
Buflomedil......Page 223
Choice of Imaging in the Patient Presenting Within 24 Hours of Injury......Page 224
Surgical Treatment......Page 225
Long-Term Sequelae of Frostbite......Page 226
Strategy to Prevent Frostbite......Page 227
Transcatheter Arterial Thrombolysis......Page 228
Ultrasound-Accelerated Thrombolysis......Page 229
References......Page 230
9 Polar Medicine......Page 231
Increases in Tourism and Expeditions......Page 232
Effects of Cultural and Demographic Transition......Page 233
Psychosocial Health Problems......Page 234
Medical Stations in Antarctica......Page 235
Somatic Health Problems......Page 236
Altitude Illnesses......Page 237
Environmental Health Issues......Page 238
Psychosocial Health Problems......Page 239
Winter-Over Syndrome......Page 240
Fourth World Medical Decision Making......Page 241
Arctic Racing Injuries Encountered to Date......Page 242
References......Page 245
Four Avenues of Heat Exchange......Page 246
Body Temperature Control......Page 247
Mechanisms of Heat Dissipation During Thermal Stress......Page 248
Heat Illnesses......Page 249
Heatstroke Epidemiology and Risk Factors......Page 250
Body Temperature Responses......Page 252
Immune Responses......Page 254
Tissue Injury......Page 255
Heat Shock Proteins......Page 257
Cooling......Page 259
Anticytokine Therapies......Page 260
Heat Acclimatization......Page 261
References......Page 262
On-Site Emergency Medical Treatment......Page 263
Hospital Emergency Medical Treatment......Page 264
Clinical Manifestations......Page 265
Sequelae And Aftercare......Page 266
Awareness of Host Risk Factors......Page 267
Activity......Page 268
References......Page 269
12 Wildland Fires:......Page 271
Wildland Fire Management and Technology......Page 272
Wildland Fire Management Policies......Page 273
Prescribed Fire And Wildland Fire Use......Page 274
Nature Of The Problem......Page 275
What Some Organizations Have To Offer......Page 281
Urban And Wildland Fire Threats......Page 282
Physical Principles of Heat Transfer......Page 283
Environmental Factors Influencing Wildland Fire Behavior......Page 285
Fuel.......Page 286
Weather.......Page 287
Topography.......Page 288
Extreme Fire Behavior......Page 289
Value of Fire Danger Ratings......Page 291
Fire-Related Injuries and Fatalities......Page 292
Common Denominators Of Fire Behavior On Fatality Fires......Page 293
Nature Of Injuries And Fatalities......Page 294
Wildland Fires, Air Toxins, And Human Health......Page 295
Wildland–Urban Interface Fire Survival Principles and Techniques......Page 296
Lces: The Key To Safe Procedures In Wildland Fire Environments......Page 297
Fifteen Structural “Watch Out!” Situations for the Wildland–Urban Interface......Page 298
Vehicles......Page 299
Buildings......Page 300
Protective Fire Shelters Used By Wildland Firefighters......Page 301
Emergency Procedures During A Wildland Fire Entrapment Or Burnover......Page 303
Survival Option 1: Retreat From the Fire and Reach a Safe Haven......Page 304
Survival Option 4: Pass Through the Fire Edge Into the Burned-Out Area......Page 305
Wildland Fires and Human Behavior......Page 306
How To Report A Wildland Fire To Local Fire Protection Authorities......Page 308
Basic Wildland Fire Materials, Training Courses, And Other Information Resources......Page 309
Concluding Remarks......Page 310
References......Page 311
Physiology......Page 312
Flash Burns......Page 313
Estimation Of Burn Size......Page 314
Depth Of Burn......Page 315
Fourth-Degree Burns......Page 316
Chemical Burns......Page 317
Technique of Burn Wound Debridement.......Page 318
Resuscitation......Page 319
Escharotomy......Page 320
Deep Partial-Thickness and Full-Thickness Burns......Page 321
Therapy......Page 322
Therapy......Page 323
Other Considerations......Page 324
References......Page 325
Environmental Influences On UVR Exposure......Page 326
Ozone Depletion and Ultraviolet Radiation Exposure......Page 327
Ultraviolet B Radiation......Page 328
Natural Defenses and Skin Type......Page 329
Ocular Effects......Page 330
Sun and Skin Cancer......Page 331
Melanoma......Page 332
Molecular Basis of Photocarcinogenesis......Page 334
Sunscreens......Page 335
Sunscreen Application......Page 336
Proposed New Sun Protection Factor and Ultraviolet A Radiation Labeling Requirements......Page 337
Sunscreen Prevention of Chronic Photodamage......Page 338
Sunscreens, Melanoma, and Vitamin D......Page 340
Clothing Protection......Page 341
Melanin and Thymine Dimers......Page 342
Endogenous Photosensitivity Disorders......Page 343
Photoallergy......Page 344
References......Page 345
15 Volcanic Eruptions, Hazards, and Mitigation......Page 346
Vesuvius, ad 79......Page 347
Theory Of Plate Tectonics......Page 349
Types of Volcanoes......Page 350
Calderas......Page 351
Subglacial Volcanoes......Page 352
Volcano Hazards......Page 353
Pyroclastic Flows and Surges......Page 354
Mitigation.......Page 355
Lahars (Volcanic Mudflows)......Page 356
Tsunamis......Page 357
Volcanic Ash.......Page 358
Mitigation.......Page 360
Volcanic Gases......Page 361
Posteruption Hazards......Page 362
Coordination Between Volcanologists And Health care Professionals......Page 363
References......Page 364
The Injury Field: Basic Principles......Page 366
Environmental, Educational, and Enforcement Approaches to Injury Prevention......Page 367
Social-Ecologic Model......Page 368
Planning......Page 369
Maps and Orienteering......Page 370
Communication Devices......Page 371
Foot and Hand Wear.......Page 372
Body Armor.......Page 373
Supervision and Buddy Systems.......Page 374
First-Aid Training.......Page 375
Injury Prevention for the Feet.......Page 376
Cold Injury......Page 377
Wind and Rain......Page 378
Water......Page 379
Hydration......Page 381
Bites and Stings......Page 382
Backpacking......Page 384
Horseback Riding......Page 385
References......Page 386
Anatomy and Physiology of Acute Nociceptive Pain......Page 387
Types of Pain......Page 388
Additional Supplies......Page 389
Nerve Blocks......Page 390
Femoral Block......Page 391
Ankle Block......Page 392
Ketamine......Page 393
Muscle Relaxants......Page 394
References......Page 395
Lower-Leg Taping......Page 396
Finger Taping......Page 398
Types of Bandages......Page 400
Thigh and Groin Bandaging......Page 401
Eye Bandaging......Page 402
References......Page 408
Indications for Spinal Immobilization......Page 409
Cervical Spine Immobilization......Page 410
Lower-Extremity Splinting......Page 411
Rigid Splints......Page 414
SAM Splints......Page 417
Pelvic Splinting......Page 420
Shoulder Dislocation......Page 422
Leg Fractures......Page 423
References......Page 426
Airway Anatomy......Page 427
Head Positioning......Page 429
Oropharyngeal Airway......Page 430
Nasopharyngeal Airway......Page 431
Suction......Page 432
Technique:......Page 434
Definitive Airway Management......Page 435
Induction agents.......Page 436
Neuromuscular blockade.......Page 437
Placement......Page 438
Postintubation Management......Page 439
Laryngeal Mask Airway......Page 440
Lighted-Stylet Intubation......Page 441
Technique:......Page 442
Airway Equipment for the Wilderness......Page 444
Suggested Readings......Page 445
Background......Page 446
Airway......Page 447
Exposure and Environmental Control......Page 448
Vascular Access......Page 449
Adjuncts......Page 450
Pathophysiology of Traumatic Brain Injury......Page 451
Physical Examination......Page 452
Further Management......Page 453
Blunt Neck Injuries......Page 454
Immobilization.......Page 455
Penetrating Neck Injuries......Page 456
Rib Fractures.......Page 457
Tension Pneumothorax.......Page 458
Traumatic Asphyxia.......Page 459
Physical Examination.......Page 460
Pelvic Trauma......Page 461
Crush Injuries and Rhabdomyolysis......Page 462
The Acute Abdomen......Page 463
Acute Cholecystitis and Biliary Colic......Page 464
Urologic Emergencies......Page 465
The Acute Scrotum......Page 466
Abscess Formation......Page 467
References......Page 468
Treatment......Page 469
Cleansing Techniques......Page 470
Vascular Injuries......Page 471
Anesthesia......Page 472
Wound Closure Techniques......Page 473
Dressings and Aftercare......Page 475
Complications......Page 476
References......Page 477
23 Improvised Medicine in the Wilderness......Page 478
Wrist and Calf Blood Pressure Measurements......Page 479
Volume Measurement......Page 480
Precordial Stethoscope......Page 481
Caps and Masks......Page 482
Dressing Material.......Page 483
Scalpels......Page 484
Boiling......Page 485
Positioning the Tongue......Page 486
Surgical Airway (Cricothyrotomy)......Page 487
Wound Irrigation......Page 488
Wound Glues......Page 489
Chicken Egg Membrane.......Page 490
Tension Pneumothorax......Page 491
Drainage System (Bottles/Bags)......Page 492
Padded Hip Belt.......Page 493
Internal-Frame Pack and Snow Shovel System.......Page 494
Kayak System.......Page 495
Fracture Versus Dislocation......Page 496
Sling (Arm)......Page 497
Rigid Splints......Page 498
Applying an Improvised Pelvic Sling......Page 499
Double Runner System.......Page 502
Tent Poles.......Page 503
Securing and Padding.......Page 504
Epistaxis......Page 505
Improvised Eyeglasses......Page 506
Prefabricated Crossbar......Page 507
Two-Rescuer Split-Coil Seat......Page 508
Nylon Webbing Carry......Page 509
Improvised Rescue Sled or Toboggan......Page 510
References......Page 511
Hunting in the United States......Page 512
Tree Stand Injuries......Page 513
Arrow Injuries......Page 514
Powder Firearms.......Page 515
Trap Injuries......Page 519
Emergency Department Care.......Page 520
Prevention of Hunting Injuries......Page 521
Fishhook Injuries......Page 522
Fishing Spear Injuries......Page 523
References......Page 524
25 Tactical Medicine*......Page 525
History of Tactical Medicine......Page 527
Shared Principles of Military Tactical Combat Casualty Care and Civilian Tactical Medicine......Page 528
Care Under Fire......Page 529
Tactical Field Care......Page 530
Principles of Tactical Medicine......Page 531
Tactical Medical Equipment......Page 534
Weapons Systems......Page 535
Medical Threat Assessment......Page 537
Personal Supply Module......Page 538
Intermediate Medical Module......Page 539
Support Vehicle Module......Page 540
The Tactical Mission......Page 541
Education and Training Programs......Page 542
References......Page 543
Introduction......Page 544
Scopes of Practice for Combat Lifesaver, Combat Medic......Page 545
Level III......Page 547
Joint Theater Trauma Registry......Page 548
Unique Aspects of Military Triage and Other Considerations......Page 549
Soldier Medical First Aid Kits (Figures 26-5 to 26-7) and Warrior Aid and Litter Kit......Page 550
Hemostatic Agents and Tourniquets......Page 551
Hypothermia......Page 552
Wound Vacuum-Assisted Closure (VAC)......Page 553
Casualty Evacuation (CASEVAC)......Page 554
Veterinary Issues......Page 555
Unexploded Ordnance*......Page 556
Acute Stress Disorder......Page 558
Signs and Symptoms......Page 559
References......Page 560
27 Wilderness Orthopedics......Page 561
Joint Function......Page 562
Cervical Spine......Page 563
Thoracolumbar Spine......Page 564
Pelvic Injuries......Page 565
Splinting Techniques......Page 566
Traction Pins......Page 568
Open Fractures......Page 569
Amputation......Page 571
Rice Principle......Page 572
Sternoclavicular Joint Dislocation......Page 573
Glenohumeral Joint Dislocation......Page 574
Proximal Humerus Fracture......Page 576
Fracture Around the Elbow (Distal Humerus, Olecranon, Radial Neck or Head)......Page 577
Elbow Dislocation......Page 579
Radius Fracture......Page 580
Wrist/Carpus Fracture......Page 581
Metacarpal Fracture......Page 582
Metacarpophalangeal Joint Dislocation......Page 583
Phalanges......Page 584
Hip Dislocation......Page 585
Knee Dislocation......Page 586
Tibia and Fibula Fractures......Page 587
Ankle Dislocation or Sprain......Page 588
Tarsal Fracture......Page 590
Phalanx Fracture......Page 591
Intra-Articular Knee Disruption......Page 592
Plantar Fasciitis......Page 593
Stress Fractures......Page 594
Returning to the Wilderness After Total Joint Replacement......Page 595
New Technologies......Page 597
References......Page 598
General Therapeutic Approach......Page 599
Acute Periocular Inflammation......Page 600
Chemical Injury of the Eye......Page 601
Acute Loss of Vision in a White, Quiet Eye......Page 602
Obvious Open Globe......Page 603
Corneal Abrasion......Page 604
Hyphema......Page 605
Corneal Abrasion and Corneal Ulcer With Contact Lens Wear......Page 606
Scleritis......Page 607
Ultraviolet Keratitis......Page 608
Solar Retinopathy......Page 609
High-Altitude Retinal Hemorrhage......Page 610
Intraocular Gas Bubbles at Altitude......Page 611
Refractive Changes at Altitude after Refractive Surgery......Page 612
Sunglasses Selection in Mountaineering......Page 613
Underwater Refractive Correction......Page 614
Decompression Sickness......Page 615
Hyperoxic Myopia......Page 616
References......Page 617
Reduction of Movement Within the Footwear System......Page 618
Blister Prevention Compounds......Page 619
Preventive Taping and Pads......Page 620
Lubricants......Page 622
Blister Treatment......Page 623
Basic Blister Treatment......Page 624
Toe Blisters......Page 625
Ball-Of-Foot Blisters......Page 626
Subungal Hematomas......Page 627
Blood-Filled Blisters......Page 628
Soft Tissue Injuries......Page 629
Orthotics......Page 630
Plantar Warts......Page 631
References......Page 632
History and Examination......Page 633
Pulpitis......Page 634
Severe Pulpitis (Intense, Continuous Pain)......Page 635
Myofascial Pain and Dysfunction......Page 636
Viral Infections......Page 637
Acute Apical Abscess/Cellulitis......Page 638
Periodontal Abscess......Page 639
Acute Necrotizing Ulcerative Gingivitis......Page 640
Exodontia......Page 641
Complicated Crown Fracture......Page 642
Exarticulation......Page 643
Injuries to Primary Teeth......Page 644
Local Anesthesia......Page 645
References......Page 646
Temporomandibular Joint Disorders......Page 647
Epistaxis......Page 650
Midface: Nose......Page 653
Midface: Maxilla......Page 655
Lower Face: Mandible......Page 656
Tongue......Page 658
Eyelid......Page 659
Nose......Page 660
Ear......Page 661
Cheek......Page 663
Foreign Bodies......Page 664
References......Page 666
Hyperbaria (Underwater Diving)......Page 667
Hypoxia (High-Altitude Activity)......Page 668
Established Coronary Artery Disease......Page 669
Cardiomyopathy/Congestive Heart Failure......Page 670
Implantable Cardioverter-Defibrillators and Pacemakers......Page 671
Syncope......Page 672
Cardiac Arrest......Page 673
References......Page 674
Preliminaries: History and Examination......Page 675
Headache with Scalp Tenderness......Page 676
Diagnosing a Seizure......Page 677
Simple Syncope, Cardiac Syncope, Postural Hypotension, and Drop Attacks......Page 678
Sleep......Page 679
Viral, Subacute, and Chronic Meningitis and Encephalitis......Page 680
Transient Ischemic Attack and Stroke in Special Circumstances......Page 681
Lumbar Back Pain: Lateral and Central Disc Protrusion......Page 682
Acute Vertigo......Page 683
Multiple Sclerosis, Parkinson’s Disease, and Other Degenerative Conditions......Page 684
References......Page 685
Increased Physical Activity......Page 686
Heat......Page 687
Asthma......Page 688
Chronic Obstructive Pulmonary Disease......Page 690
Diabetes......Page 692
Peripheral Arterial Disease......Page 695
Raynaud’s Phenomenon......Page 696
Osteoarthritis......Page 697
Glucose-6-Phosphate Dehydrogenase Deficiency.......Page 699
Hemophilia......Page 700
Travel Thrombosis......Page 701
Chemotherapy......Page 702
Solid Organ Transplant Recipients......Page 703
References......Page 704
Anxiety Disorders......Page 705
Mood Disorders......Page 706
Organic Mental Disorders......Page 707
Substance abuse Disorders......Page 708
Insomnia......Page 709
Disasters......Page 710
Triage......Page 711
References......Page 712
Sanitation......Page 715
Remote Medicine......Page 716
Occurrence of the Critical Event......Page 718
Providing Appropriate Extended Emergency Care......Page 719
Team Organization and Function......Page 720
Training of Wilderness Emergency Medical Technicians......Page 721
Airways, Oxygen, and Mechanical Aids to Breathing......Page 723
Bleeding and Shock......Page 724
Environmental Emergencies......Page 725
APPENDIX......Page 726
Suggested Readings......Page 727
Search and Rescue: An Overview......Page 728
Cospas-Sarsat......Page 729
U.S. National Search and Rescue Plan......Page 730
The National SAR Supplement......Page 731
Mercy.......Page 732
Federal Aviation Administration.......Page 733
The State’s Role in SAR: Coordination and Support......Page 734
Incident Command System......Page 735
Four Phases of a Search and Rescue Event: The Incident Cycle......Page 736
Search Resources......Page 737
Search Planning Considerations......Page 739
Lost Subject Behavior.......Page 740
Special Gear.......Page 743
Carabiners.......Page 744
Descending (Friction) Devices.......Page 745
Pulleys.......Page 746
Anatomy of a Search and Rescue Incident......Page 747
Search and Rescue Environments Within the Wilderness Setting......Page 748
Caves and Mines (See Chapter 46)......Page 749
Undertow.......Page 750
References......Page 751
Accident on Mt Kenya—1970......Page 752
Technical Terrain......Page 753
Risk Reduction......Page 754
Leadership......Page 755
Anchors......Page 756
Descent......Page 758
Haul Systems......Page 760
Knot Pass......Page 761
One-On-One Pickoff......Page 762
Establishing a Main Line......Page 763
The Rucksack Stretcher......Page 764
Commercial Litters......Page 765
Fixed-Wing Aircraft in Mountain Rescue......Page 766
Aeromedical Helicopters......Page 767
Landing Zones (Helispots)......Page 768
Loading and Unloading Safety Procedures......Page 769
Hoist Operations......Page 770
Hazards in Wilderness Travel and Rescue......Page 771
Lightning......Page 772
Glacier Hazards......Page 773
Human Factors of Victims......Page 774
Team Training......Page 775
Circulation and Control Of Bleeding......Page 776
Prolonged Care and Transport......Page 777
Use of Extrication Devices for Crevasse Rescue......Page 778
Main Compartment:......Page 779
References......Page 780
Drags and Carries......Page 781
Litter Improvisation......Page 783
Basket-Style Stretchers......Page 787
Mountain Rescue Stretchers......Page 789
Flexible, Wrap-Around Stretchers......Page 790
Transportation Hardware Accessories......Page 792
Patient Packaging......Page 793
References......Page 794
Aeromedical Evolution......Page 795
Primary Response......Page 797
Patients with Medical, Noncardiac Conditions......Page 798
Search and Rescue......Page 799
Flight Physician......Page 801
Appropriate Use of Aeromedical Services......Page 802
Dispatch and Communications......Page 803
Respiratory Distress......Page 804
Patient Combativeness......Page 805
Approaching the Aircraft......Page 806
Landing Zone Operations......Page 807
Aeromedical Aircraft......Page 808
Access for Patient Loading......Page 809
Range......Page 810
Service Ceiling......Page 811
Aircraft for Search and Rescue......Page 812
Suction......Page 813
Hypoxia and Altitude......Page 814
Motion and Acceleration......Page 816
Aeromedical Accidents......Page 817
Infectious Disease Patients......Page 819
References......Page 821
41 Essentials of Wilderness Survival......Page 822
Regulation of Body Temperature......Page 824
Decreasing Body Heat Loss......Page 825
Wind pants.......Page 826
Thermal Blankets......Page 827
Tarpaulins......Page 828
Natural Shelters......Page 829
Snow Caves......Page 830
Bivouac Sacks and Other Small and Portable Emergency Shelters......Page 832
Adding Heat From the Outside......Page 833
Strike-Anywhere Matches......Page 834
Orange Military-Style Match Cases......Page 835
Other Methods of Igniting Tinder......Page 836
Building Fires......Page 838
Linked-style survival saws.......Page 839
Commercial fire-starting aids.......Page 840
Food......Page 842
Stalled or Wrecked Automobiles......Page 843
Hurricanes......Page 844
Sanitation......Page 845
Psychological and Organizational Aspects of Survival......Page 846
B Suggested Additions for Winter Survival Kit (When Cold Weather or Snow Is Present or Expected)......Page 847
Suggested Readings......Page 849
Moisture......Page 850
Thunderstorms......Page 851
Weather Phenomena......Page 852
Human Comfort......Page 853
Skill......Page 854
International......Page 855
Clouds......Page 856
Boundary Layer Stability......Page 857
References......Page 860
Tropical Environment......Page 861
Conditioning......Page 862
Medical Kit......Page 863
Trail Shoes.......Page 864
Hammock......Page 865
Camera Case or Bag......Page 866
Machete......Page 867
Duration of Travel and Emotional Response......Page 868
Shelter......Page 869
Food......Page 870
Electric Eel.......Page 872
Chicha.......Page 873
Poison-Dart Frogs......Page 874
Rescue Strategies......Page 875
Caveats:......Page 877
Shelter......Page 878
Bamboo Fire Saw......Page 879
Psychology of Survival......Page 880
Categories of Hostage Takers......Page 881
Rescue......Page 882
References......Page 883
The Desert Environment......Page 884
Clothing......Page 886
Water......Page 887
Shelter......Page 889
Hazards......Page 890
Travel......Page 891
References......Page 892
Historical Perspective......Page 893
Morbidity and Mortality......Page 894
Paddling Equipment......Page 895
River Hazards......Page 896
Submersion Accidents......Page 898
Trauma......Page 899
head, facial, and dental trauma......Page 900
Applying an Improvised Pelvic Sling......Page 902
Infections......Page 903
Throw Ropes......Page 904
Wading and Strong Swimmer Rescues......Page 905
Rescuing Pinned Boats......Page 906
Rafting Kit......Page 907
References......Page 908
46 Caving and Cave Rescue......Page 909
Environment......Page 910
Personal Safety......Page 911
Basic Evacuation......Page 912
Cave Access......Page 914
Environmental Hazards......Page 915
Patient Care......Page 916
References......Page 917
Blackflies (Family Simuliidae)......Page 919
Tsetse Flies (Family Glossinidae)......Page 920
Ticks (Families Ixodidae and Argasidae)......Page 922
Repellents......Page 923
DEET.......Page 924
Botanical Repellents......Page 926
Citronella.......Page 927
Permethrin......Page 928
References......Page 929
Mechanism of Mosquito Bites......Page 930
Pathophysiology and Clinical Manifestations of Mosquito Bites......Page 931
Epidemiology and Transmission......Page 932
Clinical Presentation......Page 933
Treatment and Prevention......Page 935
Epidemiology and Transmission......Page 936
Treatment and Prevention......Page 937
Epidemiology and Transmission......Page 938
Treatment and Prevention......Page 939
Epidemiology and Transmission......Page 940
Clinical Presentation......Page 941
Treatment and Prevention......Page 942
Epidemiology and Transmission......Page 943
Diagnosis......Page 944
General Guidelines for Individual Protection......Page 945
Global Programs......Page 946
References......Page 947
Epidemiology......Page 948
Life Cycle......Page 949
Complications of P. Falciparum......Page 951
Complications of P. Vivax and P. Ovale......Page 952
Prevention......Page 953
Counseling......Page 954
Travelers to Areas with Chloroquine-Sensitive P. falciparum, P. vivax, P. ovale, and P. malariae......Page 956
Travelers to Areas with Predominant P. vivax......Page 959
Chemoprophylaxis While BreastFeeding......Page 962
Treatment of Chloroquine-Resistant P. Falciparum......Page 970
Resources......Page 972
References......Page 973
Hymenoptera (Bees, Wasps, and Ants)......Page 974
Bees......Page 975
Wasps......Page 976
Ants......Page 977
Hymenoptera Stinging Patterns......Page 978
Clinical Aspects......Page 979
Immunotherapy......Page 981
Venomous Species and Venoms......Page 982
Treatment and Prevention......Page 984
Centipedes and Millipedes......Page 986
Hemiptera (Sucking Bugs)......Page 987
Beetles and Other Insects......Page 988
Diptera (Two-Winged Flies)......Page 990
Other Biting Diptera......Page 991
Furuncular Myiasis.......Page 992
Hematophagous Myiasis.......Page 993
Wound Myiasis.......Page 994
Clinical Aspects......Page 996
Species, Life Cycle, and Distribution......Page 997
Clinical Aspects......Page 998
Clinical Aspects.......Page 999
Treatment and Prevention.......Page 1000
Trombiculid Mites......Page 1001
Protection and Prevention......Page 1002
References......Page 1003
51 Tick-Borne Diseases......Page 1004
Ixodid Ticks......Page 1005
Tick Paralysis......Page 1007
Lyme Disease......Page 1008
Epidemiology.......Page 1009
Early Localized Disease (Stage I).......Page 1010
Cardiac.......Page 1011
Diagnosis.......Page 1012
Treatment.......Page 1013
Epidemiology.......Page 1015
Tick-Borne Encephalitis......Page 1016
Pajaroello Tick Bites......Page 1017
Epidemiology.......Page 1018
Clinical Manifestations and Diagnosis.......Page 1019
Q Fever......Page 1020
Human Monocytic Ehrlichiosis......Page 1021
Epidemiology.......Page 1022
Clinical Manifestations.......Page 1023
Tick-Borne Disease Prevention and Awareness......Page 1024
References......Page 1025
Spiders and Their Venoms......Page 1026
General Assessment and Treatment of Spider Bites......Page 1027
Guide to Spider Diversity and Identification......Page 1031
Urticating Hairs......Page 1032
Family Hexathelidae: Funnel-Web Mygalomorphs......Page 1033
Venom.......Page 1034
Treatment.......Page 1035
Biology.......Page 1036
Clinical Presentation.......Page 1037
Venom.......Page 1039
Biology......Page 1040
Biology.......Page 1041
Clinical Presentation.......Page 1042
Venom.......Page 1043
Biology.......Page 1044
Clinical Presentation.......Page 1045
Clinical Presentation.......Page 1046
References......Page 1047
53 Scorpion Envenomation......Page 1048
Venom......Page 1049
Morocco......Page 1050
Southern Africa......Page 1051
Israel......Page 1052
India......Page 1053
Brazil......Page 1054
United States......Page 1055
Cardiovascular Effects......Page 1057
Neurologic Effects......Page 1058
Hematologic Effects......Page 1059
Treatment......Page 1060
Antivenom......Page 1061
Treatment in Austere Environments......Page 1062
References......Page 1063
Scope of the Problem......Page 1064
Pit Vipers......Page 1069
Coral Snakes......Page 1071
Pit Vipers......Page 1072
Pit Vipers......Page 1073
Pit Vipers.......Page 1075
Initial Management.......Page 1077
Analgesia and Wound Care.......Page 1079
Coral Snakes.......Page 1080
A Brief History of Antivenom Therapy......Page 1082
Antivenom Production......Page 1083
Adverse Reactions to Antivenoms......Page 1085
Injuries Caused by Giant Snakes......Page 1086
Anatomy......Page 1087
Hospital Care......Page 1091
References......Page 1092
Distinguishing Venomous from Nonvenomous Snakes......Page 1093
Mimics, Misidentification, and Mismanagement......Page 1096
Spitting Elapids.41......Page 1098
Viperoidea......Page 1099
Natriuretic Peptides......Page 1102
Variations in the Quantity and Composition of Venom Injected by a Snakebite......Page 1103
Distribution of Venomous Snakes......Page 1104
Snakebite Mortality and Morbidity......Page 1106
Senegal......Page 1107
Bites by Snakes Kept in Captivity......Page 1108
Local Signs at the Site of the Bite......Page 1109
Bleeding and Clotting Disturbances*......Page 1110
Pathophysiology.......Page 1112
Acute Kidney Injury......Page 1113
Species Capable of Causing Fatal Envenoming......Page 1115
Species Capable of Causing Systemic Envenoming......Page 1116
Neurotoxic Elapids......Page 1117
Envenoming by Mambas (Genus Dendroaspis)*......Page 1118
Envenoming by Asian Kraits (Genus Bungarus) (See Figures 55-20, B and C and Figure 55-21, B)†......Page 1119
Envenoming by Australian and New Guinean Elapids (Figure 55-74; See Figure 55-31)*......Page 1122
Envenoming by Sea Snakes (Hydrophiinae) and Sea Kraits (Laticaudinae) (Figures 55-77 and 55-78; see also Figures 55-45 to 55-47)*......Page 1123
Snake Venom Ophthalmia*......Page 1124
Viperidae (old World Vipers and Adders, Asian and Latin American Pit Vipers)*......Page 1125
Neurotoxicity......Page 1127
Clinical Features of the European Adder (Vipera berus) Bite.......Page 1128
Envenoming by Saw-Scaled or Carpet Vipers (Genus Echis) (Figure 55-87; See Figures 55-14, A and 55-18, C).*......Page 1130
Envenoming by the Berg Adder (B. atropos) (See Figure 55-84).......Page 1131
Envenoming by Desert Vipers (Genus Cerastes) (Figure 55-94).*......Page 1132
Sri Lanka.......Page 1133
Thailand.......Page 1134
Envenoming by Japanese and Chinese Mamushis (Gloydius [Agkistrodon] blomhoffii, G. brevicaudus, and others) (Figure 55-97)......Page 1135
Envenoming by Asian Arboreal Pit Vipers (Genera Trimeresurus, Cryptelytrops [Trimeresurus], Viridovipera, Protobothrops [Trimeresurus], and others) (See Figures 55-39 and 55-40)*......Page 1136
Agkistrodon, Bothrops (Bothriopsis), and Others (Figure 55-101; See Figures 55-7, 55-22, E, and 55-34, A).......Page 1138
Risk for Envenoming......Page 1141
Chronic Sequelae of Snakebite......Page 1142
Chest Radiography (See Figures 55-86, E and 55-96, F )......Page 1143
Treatment of Early Symptoms Before the Patient Reaches the Hospital......Page 1144
Clinical Assessment......Page 1145
Choice Of Antivenom In A Particular Case: Monovalent And Polyvalent Antivenoms......Page 1146
Conservation of Antivenom and Expiration Dates......Page 1147
Antivenom Reactions......Page 1148
Recurrent Envenoming......Page 1149
The “6-Hour Rule”......Page 1150
Debridement of Necrotic Tissue......Page 1151
Prevention of Snakebite......Page 1152
Komodo Dragon (Varanus Komodoensis)......Page 1153
References......Page 1154
General Epidemiology......Page 1155
Circumstances Surrounding and Prevention of Animal Bites: Animal Behavior......Page 1156
Basic Principles for Avoiding Animal Bites......Page 1157
Evaluation and Treatment of Injuries: Prehospital Care......Page 1159
Wound Management......Page 1160
Puncture Wounds......Page 1161
Rabies......Page 1162
Tetanus Prophylaxis......Page 1163
Psychiatric Consequences of Animal Attacks......Page 1164
Wolves......Page 1165
Tigers......Page 1166
Leopards......Page 1167
Primates......Page 1168
African Buffalo......Page 1169
Elephants......Page 1170
Deer......Page 1171
Raccoons......Page 1172
Skunks......Page 1173
Large Reptiles (See Chapters 54 and 55)......Page 1174
Elephant Seals......Page 1175
Cats......Page 1176
Ferrets......Page 1177
Cattle......Page 1178
Medicolegal Considerations......Page 1179
References......Page 1180
North American Bears......Page 1181
Grizzly Bears......Page 1183
Black Bears......Page 1184
Bears on Other Continents......Page 1185
Avoiding an Encounter......Page 1187
Reducing the Severity and Extent of Injuries......Page 1188
Preventing Predatory Behavior......Page 1189
Pepper Spray.......Page 1190
Bear-Induced Injuries......Page 1191
Antibiotic Therapy......Page 1192
References......Page 1193
Characteristics, Lifestyle, and Habits......Page 1194
First Aid......Page 1196
Microbiology and Antimicrobials......Page 1197
References......Page 1198
59 Wilderness-Acquired Zoonoses......Page 1199
Bacteriology......Page 1200
Treatment......Page 1201
Symptoms......Page 1202
Symptoms......Page 1203
Diagnosis......Page 1204
Symptoms in Humans......Page 1205
Leptospirosis......Page 1206
Transmission......Page 1207
Diagnosis......Page 1208
Symptoms......Page 1209
Epidemiology......Page 1210
Plague......Page 1211
Epidemiology......Page 1212
Symptoms......Page 1213
Treatment......Page 1214
Transmission......Page 1215
Diagnosis......Page 1216
Virology......Page 1217
Cowpox and Monkeypox Infections......Page 1218
Epidemiology......Page 1219
Prevention......Page 1220
Virology......Page 1221
Symptoms......Page 1222
Treatment......Page 1224
Parasitology and Transmission......Page 1225
Echinococcus multilocularis (Alveolar Hydatidosis)......Page 1226
Prevention and Control......Page 1227
Life Cycle......Page 1228
Diagnosis......Page 1229
Epidemiology......Page 1230
References......Page 1231
60 Rabies......Page 1232
Incidence in Humans......Page 1233
Rabies in Bats......Page 1234
Rabies in Domestic Animals......Page 1235
Sources of Human Infection......Page 1236
Epidemiology......Page 1237
Sources of Human Infection......Page 1240
Mortality......Page 1241
Pathogenesis of Central Nervous System Infection......Page 1242
Clinical Features......Page 1243
Laboratory Diagnosis of Rabies......Page 1244
Identifying Exposure......Page 1245
Rabies Immune Globulin......Page 1246
Rabies Vaccines......Page 1247
Human Vaccination......Page 1248
Immunocompromised Individuals......Page 1249
Rabies Therapy in Developing Countries......Page 1250
Immune Globulin......Page 1251
Other Lyssaviruses......Page 1252
Vaccine Developments......Page 1253
References......Page 1254
Support Animals......Page 1255
Horses, Mules, and Donkeys......Page 1256
Oxen, Yaks, and Water Buffalo......Page 1257
Feeding Dogs and Cats......Page 1258
Llamas......Page 1259
Dogs and Cats......Page 1260
Treatment.......Page 1261
Skunk Odor Removal......Page 1262
Plant Poisoning......Page 1263
Wound Dressing and Bandaging......Page 1264
West Nile Viral Encephalitis......Page 1265
Clinical Signs.......Page 1266
Clinical Signs.......Page 1267
Synchronous Diaphragmatic Flutter......Page 1268
Medical Problems in Elephants......Page 1269
Clinical Signs.......Page 1270
Hairballs......Page 1271
Euthanasia......Page 1272
Llamas, Camels, and Oxen......Page 1275
Field Evacuation of Injured Animals......Page 1276
A Sources of Veterinary Drugs for Expeditions......Page 1277
References......Page 1278
Allergens......Page 1281
Fungi.......Page 1282
Clinical Evaluation......Page 1283
Differential Diagnosis......Page 1284
Antihistamines and Decongestants.......Page 1285
Immunotherapy.......Page 1286
Pathophysiology......Page 1287
Treatment......Page 1288
References......Page 1289
Irritant Contact Dermatitis......Page 1290
Toxicodendron Family......Page 1296
Immunology of Poison Ivy and Poison Oak Dermatitis......Page 1300
Treatment......Page 1301
Prevention......Page 1302
Compositae Family......Page 1303
Contact Urticaria: Immunologic and Nonimmunologic Subtypes......Page 1305
Phytophotodermatitis......Page 1307
Phytophototoxic Contact Dermatitis......Page 1308
References......Page 1309
64 Toxic Plant Ingestions......Page 1310
Anticholinergic Syndrome.......Page 1311
Jimsonweed.......Page 1313
Treatment.......Page 1314
Nicotinic Plants (Pyridine and Piperidine Alkaloids)......Page 1315
Poison Hemlock.......Page 1316
Hallucinogenic Plants (Indoles, Phenylalkylamines)......Page 1317
Nutmeg.......Page 1318
Khat.......Page 1319
Wild Wisteria.......Page 1320
Cardiotoxins that Inhibit Na+/K+ Atpase (Cardiac Glycosides)......Page 1321
Sea Mango.......Page 1322
Clinical Presentation.......Page 1323
Aconite.......Page 1324
Taxine Alkaloids.......Page 1325
Chinaberry Trees.......Page 1326
Saponin Glycosides (Pokeweed).......Page 1327
Treatment.......Page 1328
Colchicine.......Page 1329
Cocklebur.......Page 1330
Reproductive Toxins......Page 1331
Wintergreen.......Page 1332
A Common Toxic Plants......Page 1333
B Nontoxic Plants......Page 1334
References......Page 1335
65 Toxic Mushroom Ingestions......Page 1336
Nontoxic Mushrooms......Page 1339
Causative Mushrooms......Page 1340
Toxins......Page 1346
Causative Mushrooms......Page 1348
Muscarine......Page 1349
Toxin......Page 1350
Treatment......Page 1351
Toxin......Page 1352
Causative Mushrooms......Page 1353
Clinical Presentation......Page 1354
Causative Mushrooms......Page 1355
Renal Toxicity......Page 1356
Causative Mushrooms......Page 1357
Toxins......Page 1358
Treatment......Page 1360
Approach to the Victim of Mushroom Poisoning......Page 1361
References......Page 1362
66 Ethnobotany: Plant-Derived Medical Therapy......Page 1363
Evolution of Phytopharmaceuticals......Page 1365
Topical Application......Page 1366
Spectrum of Applicability......Page 1367
Modern Clinical and Wilderness Applications.......Page 1368
Toxicity.......Page 1369
Native American and European Medicinal Uses and Folklore.......Page 1370
Modern Clinical and Wilderness Applications.......Page 1371
Toxicity.......Page 1372
Pharmacology.......Page 1373
Description and Habitat.......Page 1374
Description and Habitat.......Page 1375
Modern Clinical and Wilderness Applications.......Page 1376
Modern Clinical and Wilderness Applications.......Page 1377
Native American and European Medicinal Uses.......Page 1378
Arnica.......Page 1379
Vitamin C.......Page 1381
Nutritional Products......Page 1382
References......Page 1383
Risk and Etiology......Page 1385
Developing Countries......Page 1386
Recreational Contact......Page 1387
Parasitic Organisms......Page 1388
Persistence of Enteric Pathogens in the Environment......Page 1389
Filter Testing.......Page 1390
Heat......Page 1391
Boiling Time......Page 1392
Turbidity and Clarification......Page 1393
Granular Activated Carbon......Page 1394
Filtration......Page 1395
Improvised Filters......Page 1396
Contaminants.......Page 1397
Temperature.......Page 1398
Bacteria.......Page 1399
Chlorine......Page 1400
Products and Techniques for Chlorination......Page 1401
Chemistry......Page 1402
Recommendations.......Page 1403
Iodine Resin Filters.......Page 1404
Alteration of Chemical Species (Reduction).......Page 1405
Silver......Page 1406
Ultraviolet Light......Page 1407
Comparative Studies and Preferred Techniques......Page 1408
Preferred Technique......Page 1409
Kitchen and Food Sanitation......Page 1410
Aerobic Oxygen and Aquagen......Page 1420
A Water Disinfection Devices and Products for Field Use......Page 1411
Comments......Page 1417
Chlorination–Flocculation......Page 1418
Pristine (Advanced Chemicals Ltd, Port Coquitlam, BC, Canada)......Page 1419
Epidemiology......Page 1421
Traveler’s Diarrhea......Page 1422
Clinical Syndromes......Page 1423
Laboratory Tests and Procedures......Page 1424
Symptomatic Therapy......Page 1425
Antimicrobial Therapy......Page 1426
Immunoprophylaxis......Page 1427
Salmonella......Page 1428
Vibrios......Page 1429
Giardia Lamblia......Page 1430
Diagnosis......Page 1431
Diagnosis......Page 1432
Diagnosis......Page 1433
Microsporidia†......Page 1434
References......Page 1435
Importance of Nutrition in Stressful Environments......Page 1436
Nutritional Considerations in Planning for Wilderness Activities......Page 1437
Food and Adaptive Thermogenesis.......Page 1438
Other Potential Thermogenic Nutrients.......Page 1439
The “Right” Macronutrient Mix for Work at Altitude.......Page 1440
Carbohydrates: Critical for High Work Output Performance......Page 1441
Fat: A Special Place in Wilderness Exploration?......Page 1442
Protein and the Maintenance of Muscle Mass When Energy Intake Is Inadequate.......Page 1443
Vitamins and Their Relationship to Health and Physical Performance......Page 1444
Mineral Supplements—Electrolytes, Hematopoiesis, and Bone Health......Page 1445
Special Nutritional Requirements for Female Wilderness Travelers......Page 1446
Definitions......Page 1447
Acute Energy Restriction.......Page 1448
Long-Term Energy Restriction.......Page 1449
Hierarchy of Tissue Utilization During Starvation......Page 1450
Age and Gender Differences in Survival from Starvation......Page 1451
Feeding Victims of Starvation......Page 1452
Practical Considerations......Page 1453
Selecting Food Bars......Page 1454
References......Page 1455
Body Water, Fluid Turnover, and Fluid Requirements......Page 1456
Hydration Assessment......Page 1457
Thirst.......Page 1459
Sweat and Sweat Prediction......Page 1460
Environmental Heat Stress, Dehydration, and Performance......Page 1461
Dehydration and Cognitive Function......Page 1463
Hyponatremia......Page 1464
Fluid Replacement (Before, During, After)......Page 1465
During Exercise.......Page 1466
Gender.......Page 1467
References......Page 1468
Essence of Survival......Page 1469
Finding and Collecting Water......Page 1470
Seeps and Springs......Page 1471
Tanks......Page 1472
Snow......Page 1473
Using Body Heat to Melt Snow.......Page 1474
Solar Stills......Page 1475
Transpiration Bags......Page 1476
How Long a Person Can Live without Food......Page 1478
Success Stories......Page 1479
Rabbits and Hares......Page 1480
Birds......Page 1481
Insects......Page 1482
Reptiles......Page 1483
Simple Noose Snares......Page 1484
Noose Stick......Page 1486
Catapult (Slingshot or Flip) Hunting......Page 1487
Freshwater Fishing......Page 1489
Survival Firearms......Page 1492
Cooking Methods......Page 1494
Basic Food Preservation......Page 1504
References......Page 1505
Monitoring Phytotoxin-Producing Marine Algae and Seafood Poisonings......Page 1508
Ichthyohepatotoxication......Page 1509
Ichthyoallyeinotoxication......Page 1510
Prevention.......Page 1511
Pathophysiology.......Page 1513
Poisonings Associated With Algal Blooms......Page 1514
Pathophysiology.......Page 1515
Clinical Presentation.......Page 1516
Treatment.......Page 1517
Clinical Presentation.......Page 1518
Pathophysiology.......Page 1519
Neurotoxic Shellfish Poisoning......Page 1520
Pathophysiology.......Page 1521
Possible Estuary-Associated Syndrome......Page 1522
Diagnosis.......Page 1523
Sea Cucumber Poisoning......Page 1524
Bacteria Associated with Fecal Contamination......Page 1525
Treatment.......Page 1526
Viruses Associated with Fecal Contamination......Page 1527
Treatment.......Page 1528
Clinical Presentation.......Page 1529
Poisoning by Environmental Contamination......Page 1530
Liver Poisoning: Hypervitaminosis A......Page 1531
Acanthamoeba Keratitis (AK)......Page 1532
References......Page 1533
73 Seafood Allergies......Page 1534
Biologic Classification of Seafood......Page 1535
Immunologic Mechanisms......Page 1536
Clinical Manifestations......Page 1537
Differential Diagnosis......Page 1538
Diagnosis......Page 1539
Molecular Biology of Seafood Allergies......Page 1540
Fish Allergens......Page 1541
Crustacean Allergens......Page 1542
Fish Cross-Reactivity......Page 1543
Shellfish Cross-Reactivity with Insects and Arachnids......Page 1544
References......Page 1545
Water Characteristics......Page 1547
Ocean Structure......Page 1549
Ocean Circulation......Page 1550
Ocean Movement: Waves, Tides, and Tsunamis......Page 1552
Conditions for Oceanic Life......Page 1554
Marine Primary Productivity......Page 1555
Important Planktonic Autotrophs......Page 1557
Biogeochemical Cycles......Page 1558
Classification and Types of Submersion Injuries and Drowning......Page 1560
Incidence and Epidemiology......Page 1561
Location......Page 1562
Boating-Related Drowning......Page 1563
The Human Body and Water......Page 1564
Pulmonary system......Page 1565
Central Nervous System......Page 1566
Hypothermia......Page 1567
Clinical Presentation: A Case History......Page 1568
The Asymptomatic Patient: Grades 0 and 1......Page 1569
The Patient in Respiratory or Cardiopulmonary Arrest: Grades 5 and 6......Page 1570
Emergency Department Treatment of Submersion Injuries......Page 1571
Pulmonary Management......Page 1572
Central Nervous System......Page 1573
Infectious Diseases......Page 1574
Prognosis and Termination of Resuscitation......Page 1575
Pools......Page 1576
Swimming Techniques and Boating Instruction......Page 1577
Postimmersion Actions......Page 1578
References......Page 1579
Indications......Page 1580
Valves......Page 1581
Bag-Valve-Mask Device......Page 1582
FROPV/Positive-Pressure Demand Valve......Page 1583
Demand-Only, or Fropvs in Demand Mode......Page 1584
Nasal Cannula......Page 1585
Special Considerations in Nonbreathing or Inadequately Breathing Patients......Page 1586
References......Page 1587
77 Diving Medicine......Page 1588
Historical Perspective......Page 1589
Breath-Hold Diving......Page 1590
Scuba Diving......Page 1591
Enriched Air Nitrox......Page 1592
Saturation Diving......Page 1593
Diving Physics......Page 1594
Mask Barotrauma......Page 1595
External Auditory Canal Barotrauma.......Page 1596
Middle Ear Barotrauma (Barotitis Media).......Page 1597
Dental Barotrauma......Page 1598
Gastrointestinal Barotrauma......Page 1599
Local Injury.......Page 1600
Sudden Death......Page 1601
Treatment......Page 1602
Prevention of Pulmonary Barotrauma and ARTERIAL GAS EMBOLISM......Page 1603
Oxygen Toxicity......Page 1604
Hyperventilation and Shallow Water Blackout......Page 1605
Biochemical Effects of Bubbles......Page 1606
Fatigue......Page 1607
Long-Term Sequelae......Page 1608
Treatment......Page 1609
Decompression Sickness in Breath-Hold Divers......Page 1610
Internal Carotid Artery Dissection......Page 1611
Patent Foramen Ovale.......Page 1612
Spontaneous Pneumothorax.......Page 1613
Medications and Diving......Page 1614
Safe Scuba Diving......Page 1615
Dive Accident Investigation......Page 1616
References......Page 1617
Effects of Hbo on Oxygen Content......Page 1618
Antibacterial Effect......Page 1619
Altitude Illness......Page 1620
Diving Injuries......Page 1621
Visual Refractive Changes......Page 1622
Pediatric Considerations......Page 1623
Decompression Sickness......Page 1624
Necrotizing Fasciitis......Page 1625
Exceptional Anemia......Page 1626
Problem Wound Healing......Page 1627
Thermal Burns......Page 1628
Acute Cerebral Ischemia......Page 1629
Field Treatment of Combat Trauma......Page 1630
References......Page 1631
In Defense of the Fish......Page 1632
Bacteriology of the Aquatic Environment......Page 1633
Diversity of Organisms......Page 1634
Vibrio vulnificus.......Page 1635
Vibrio alginolyticus.......Page 1636
Antibiotic Therapy.......Page 1637
Wound Infections Caused by Aeromonas Species.......Page 1638
Sharks......Page 1639
Life and Habits......Page 1641
Shark Feeding and Attack......Page 1645
Clinical Aspects......Page 1648
Treatment......Page 1652
Prevention......Page 1653
Life and Habits......Page 1655
Treatment......Page 1656
Sea Lions......Page 1657
Large Leaping Fish......Page 1658
Killer Whales......Page 1659
Colossal Squid......Page 1660
Piranha......Page 1661
Snapping Turtle......Page 1662
Life and Habits......Page 1663
Treatment......Page 1664
Shocking Marine and Freshwater Animals......Page 1665
References......Page 1666
Anaphylaxis......Page 1667
Serum Sickness......Page 1668
Clinical Aspects......Page 1669
Morphology, Venom, and Venom Apparatus......Page 1670
Mild Envenomation......Page 1673
Moderate and Severe Envenomation......Page 1674
Treatment of Dermatitis......Page 1675
Prevention......Page 1676
Treatment.......Page 1677
Physalia (Man-of-War)......Page 1678
Seabather’s Eruption......Page 1680
Class Scyphozoa......Page 1681
Chironex (Box-Jellyfish)......Page 1682
Clinical Aspects.......Page 1683
Treatment.......Page 1684
Class Anthozoa......Page 1686
Clinical Aspects.......Page 1687
Treatment.......Page 1688
Venom and Venom Apparatus.......Page 1689
Clinical Aspects.......Page 1691
Treatment.......Page 1692
Venom and Venom Apparatus.......Page 1693
Treatment.......Page 1694
Venom and Venom Apparatus.......Page 1695
Treatment.......Page 1696
Venom and Venom Apparatus.......Page 1697
References......Page 1699
81 Envenomation by Aquatic Vertebrates......Page 1700
Venom and Venom Apparatus......Page 1701
Clinical Aspects......Page 1702
Treatment......Page 1704
Prevention......Page 1705
Venom and Venom Apparatus......Page 1706
Clinical Aspects......Page 1708
Treatment......Page 1709
Life and Habits......Page 1710
Clinical Aspects......Page 1711
Treatment......Page 1712
Treatment......Page 1713
Treatment......Page 1714
Venom and Venom Apparatus......Page 1715
Clinical Aspects......Page 1716
References......Page 1717
Algae......Page 1718
Pathophysiology.......Page 1719
Definition.......Page 1720
Clinical Presentation.......Page 1721
Definition.......Page 1722
Treatment.......Page 1723
Epidemiology.......Page 1724
Differential Diagnosis.......Page 1725
Clinical Presentation.......Page 1726
Differential Diagnosis.......Page 1727
Differential Diagnosis.......Page 1728
Localized form.......Page 1729
Clinical Presentation.......Page 1730
Diagnostic Tests.......Page 1731
Pathophysiology.......Page 1732
Treatment.......Page 1733
Definition.......Page 1734
Prevention.......Page 1735
Treatment.......Page 1736
Pathophysiology.......Page 1737
References......Page 1738
83 Safety and Survival at Sea......Page 1739
Seasickness......Page 1740
Life Jackets......Page 1742
Recovery of Crew Overboard......Page 1744
Crew Overboard Maneuvers......Page 1745
Flooding......Page 1746
Fire......Page 1748
Collisions with Other Vessels......Page 1749
Thunderstorms and Associated Weather Events......Page 1751
Lightning......Page 1752
Other Weather Phenomena......Page 1753
Cellular Telephones......Page 1754
SSB-HF Radios......Page 1755
Global Maritime Distress and Safety System (GMDSS)......Page 1756
Emergency Beacons......Page 1757
Visual and Sound Distress Signals......Page 1758
How to abandon ship......Page 1759
Preparation for Rescue: Life in the Raft......Page 1761
Water......Page 1762
Food......Page 1763
Helicopter Evacuation......Page 1764
References......Page 1765
Travel Health Risk Assessment......Page 1767
Hazards of Air Travel......Page 1768
Immunizations for Travel......Page 1769
Hepatitis A Vaccine.......Page 1772
Japanese Encephalitis Virus Vaccine.......Page 1773
Other Vaccines.......Page 1774
Malaria Risk Assessment......Page 1775
Malaria Chemoprophylaxis......Page 1776
Standby Self-Diagnosis and Drug Treatment......Page 1778
Symptomatic Treatment of Traveler’s Diarrhea......Page 1779
High-Altitude Illness (see Chapter 1)......Page 1780
APPENDIX Resources for Travel Medicine Information......Page 1781
References......Page 1782
Virology and Pathophysiology.......Page 1783
Ecology and Epidemiology.......Page 1784
Clinical Presentation.......Page 1785
Management.......Page 1786
Clinical Presentation.......Page 1787
Epidemiology.......Page 1788
Virology and Clinical Manifestations.......Page 1789
Diagnosis.......Page 1790
Management.......Page 1791
Epidemiology.......Page 1792
Management.......Page 1793
Clinical Manifestations.......Page 1794
Clinical Manifestations.......Page 1795
Ascariasis......Page 1796
References......Page 1797
86 Natural Disaster Management......Page 1798
Public Health Impact of Natural Disasters......Page 1799
Health Care Needs in Specific Natural Disasters......Page 1800
Information Management Systems for Disaster Response......Page 1802
January 12, 2010—the Dawn of A New Age in Human Adaptation......Page 1803
General Considerations......Page 1804
Critical Public Health Interventions......Page 1805
Psychosocial Aspects of Disasters......Page 1806
References......Page 1807
Historical Background......Page 1808
Preexisting Medical Conditions......Page 1809
Self-Awareness......Page 1810
Conflict Stemming From Expedition Purpose, Ethics, and Morals.......Page 1811
Expedition Medical Planning......Page 1812
Medical Screening......Page 1813
High Altitude......Page 1814
Medical Kit Packaging......Page 1815
Obtaining Medical Supplies......Page 1816
Legal and Ethical Considerations of Expedition Medicine......Page 1817
Consent......Page 1818
Professional Indemnity Insurance......Page 1819
Treating Local Staff......Page 1820
A Recommended Medical Kit......Page 1821
Resources......Page 1823
88 Global Humanitarian Medicine and Disaster Relief......Page 1824
Armed Conflict......Page 1825
Disease Epidemics......Page 1826
Emerging Contexts......Page 1827
Actors During Events: Their Capabilities, Limitations, and Usual Roles......Page 1828
Motivating Factors for Organizational Involvement......Page 1829
Sanitation......Page 1830
Control of Communicable Diseases and Epidemics......Page 1831
Principles for Health Assessment in Disasters and Crises......Page 1832
Team.......Page 1833
Data Analysis.......Page 1834
Program Development: The Logical Framework......Page 1835
Motivating Factors for Personal Involvement in Humanitarian Events and Disasters......Page 1836
Professional Characteristics of the Aid Worker......Page 1838
Typical Daily Field Responsibilities of Health Care Workers......Page 1839
How to Become Involved and Stay Involved......Page 1841
Working Outside One’s Skill Set......Page 1842
How to Pack......Page 1843
Professional.......Page 1844
Considerations When Returning Home......Page 1847
Activities After Returning From a Mission......Page 1850
Disaster by Design......Page 1851
Training and Certification......Page 1852
balancing the quality and quantity of medical care......Page 1853
Documents......Page 1854
References......Page 1855
Disaster Risk Reduction and Management......Page 1856
Assessing Vulnerability and Risk......Page 1857
Characteristics......Page 1858
Earthquake Scales......Page 1859
Location and Predictability......Page 1860
Typical Adverse Effects......Page 1861
Causal Phenomena and Characteristics......Page 1862
Vulnerability......Page 1863
Education.......Page 1864
Plinean.......Page 1865
Predictability......Page 1866
Despite Precautions, People Took High Risks in the Mt Merapi Eruption......Page 1867
Flows.......Page 1868
Risk Reduction Measures......Page 1869
Formation and Initial Development Stage.......Page 1870
Destructive Winds.......Page 1871
Predictability......Page 1872
Preparedness Measures Take Root after Cyclone Nargis in Burma......Page 1873
Examples of Tornado Outbreaks......Page 1874
River.......Page 1875
Predictability......Page 1876
Drought......Page 1877
Predictability......Page 1878
Snowstorms.......Page 1879
Freshwater Pollution.......Page 1880
Rise in Sea Level.......Page 1881
Climate Change and Global Warming.......Page 1882
Conversion to Agriculture.......Page 1883
Typical Adverse Effects......Page 1884
Deforestation.......Page 1885
Degradation of Vegetation.......Page 1886
Suggested Readings......Page 1887
Increasing Civilian Nongovernmental Organization Involvement in Unstable Regions......Page 1889
Weapons......Page 1890
Effects of Land Mines on Populations and Health......Page 1891
Risk-Reduction Strategies for Travel between Borders and Military Checkpoints......Page 1892
Kidnapping and Hostage Situations......Page 1893
Incarceration and Detention: A Global Perspective......Page 1894
Safety and Security Strategies for Travelers......Page 1895
References......Page 1896
Planning Strategies, Preventive Measures, and Risk Factors for Wilderness Travel......Page 1897
Before the Trip......Page 1898
People with Preexisting Medical Problems......Page 1899
Environmental Risks: Clothing, Fabrics, and Activities......Page 1900
Medical Kits for Expeditions and the Medically Trained......Page 1901
Specialized Equipment for Environmental and Recreational Hazards......Page 1904
Cold Exposure......Page 1905
Medications......Page 1906
Diarrhea and Abdominal Pain......Page 1914
Fractures and Dislocations......Page 1915
Wounds......Page 1916
Sunburn, Snowblindness, and Sunglasses......Page 1917
How Much to Bring?......Page 1918
Medical Data......Page 1919
References......Page 1921
C Suppliers Listed in the Text and Tables......Page 1920
Ultrasound......Page 1922
Cost.......Page 1923
Focused Assessment with Sonography for Trauma (fast)......Page 1924
Thoracic Ultrasound for Pneumothorax and Pulmonary Edema......Page 1927
Fracture Assessment......Page 1929
Optic Nerve Sheath Ultrasonography......Page 1930
Inferior Vena Cava Assay......Page 1931
Pregnancy......Page 1932
Right Upper Quadrant Ultrasonography......Page 1933
Right Lower Quadrant Ultrasonography......Page 1934
Peripheral Veins......Page 1935
Telemedicine......Page 1936
Power Supply Considerations......Page 1938
References......Page 1939
93 Outdoor Clothing for the Wilderness Professional......Page 1940
Down......Page 1941
Laminates.......Page 1942
Soft-Shell Fabrics.......Page 1943
Base Layer......Page 1944
Headgear......Page 1945
Footwear......Page 1946
Care and Storage of Clothing......Page 1948
Insect-Repellent Clothing......Page 1949
Hot......Page 1950
Selected Resources......Page 1951
Essential Emergency Equipment......Page 1952
Navigation......Page 1953
Sunglasses and Goggles......Page 1954
Headlamps......Page 1955
Multifunction Tools......Page 1956
Blade Shapes......Page 1957
Food......Page 1958
Water......Page 1959
Backpacks......Page 1960
Duffels, Stuff Sacks, and Dry Bags......Page 1962
Overnight Gear......Page 1963
Stoves......Page 1964
Down.......Page 1965
Temperature......Page 1966
Sleeping Pads......Page 1967
Tarps......Page 1968
Selected Resources......Page 1969
Impact Force......Page 1970
Materials......Page 1971
Rope Selection Considerations......Page 1972
Service Life......Page 1973
Stopper Knots......Page 1974
End-of-Line Knots......Page 1975
Midline Knots......Page 1976
Hitches......Page 1978
Lashing......Page 1980
Knots and Rope Strength......Page 1981
Learning More About Ropes and Knots......Page 1982
96 Wilderness Navigation Techniques and Communication Methods......Page 1983
Navigation With the Global Positioning System......Page 1984
The Geodetic Coordinate System......Page 1985
The Universal Transverse Mercator Coordinate System......Page 1986
Magnetic Dip, Deviation, and Declination......Page 1988
Compass Use......Page 1989
Celestial Navigation......Page 1990
Horizon Coordinate System......Page 1992
Celestial Lines of Position: Methods for Longitude......Page 1993
Shadow Methods......Page 1994
Direction by Observation of Circumpolar Stars......Page 1995
Direction by Observation of Other Stars......Page 1996
Navigation With a Pocket Radio......Page 1997
The Orienteering Meet......Page 1998
Orienteering for Children......Page 1999
Family Radio Service......Page 2000
2-Meter and 70-Centimeter Amateur Radio Service......Page 2001
Emergency Beacons......Page 2002
Thuraya......Page 2003
References......Page 2004
Maximum Oxygen Consumption......Page 2007
Sustainable Threshold......Page 2008
Training Effect on the Lactate Threshold......Page 2009
Efficiency of Movement......Page 2011
High Altitude and Exercise......Page 2012
Effect of High Altitude on Exercise......Page 2013
Hypoxic Training......Page 2014
References......Page 2015
Specificity......Page 2016
Flexibility......Page 2017
Pull-Ups.......Page 2018
Abdominal and Core Muscle Conditioning......Page 2019
Feet and Ankles......Page 2020
Anterior Shoulder and Chest......Page 2021
Balance Skills for the Trail......Page 2022
Conditioning for Special Environments......Page 2023
Performance and Injury......Page 2024
Safer Knee Positioning.......Page 2025
Buses and Flights......Page 2026
Fitness Myths......Page 2027
Performance-Enhancing Drugs and Nutrients for Exercise and Expeditions......Page 2028
Lobelia.......Page 2029
Anabolic Steroids......Page 2030
References......Page 2031
Cardiovascular and Respiratory Systems......Page 2032
Immunology and Infections......Page 2033
Food and Drink......Page 2034
Equipment......Page 2035
Safety......Page 2036
Hypothermia......Page 2037
Treatment......Page 2038
Prevention......Page 2039
Prevention......Page 2040
Snakes......Page 2041
Mosquitoes......Page 2042
Foreign Travel with Children......Page 2043
General Recommendations......Page 2044
Prophylaxis: Malaria......Page 2045
Prevention......Page 2048
Treatment......Page 2049
Respiratory Infections and Otitis Media......Page 2050
Conjunctivitis......Page 2051
Asthma......Page 2052
Infants and Neonates......Page 2053
Pediatric Wilderness Medical Kits......Page 2054
References......Page 2056
Pre–Wilderness Travel Women’s Health Assessment......Page 2057
Gender-Related Performance......Page 2058
Hot and Cold Environments......Page 2059
Gender-Related Issues Concerning Infectious Diseases......Page 2060
Menstrual Cycle Disturbance......Page 2061
Causes of Abnormal Uterine Bleeding......Page 2064
Contraceptive Options during Wilderness Travel......Page 2065
Drug Interactions That May Affect OC Efficacy.......Page 2066
Emergency Contraception......Page 2067
Urinary Tract Issues......Page 2068
Bacterial Vaginosis......Page 2069
Sexual Assault......Page 2070
Pre–Wilderness Travel Evaluation during Pregnancy......Page 2071
Physiologic Changes Accompanying Pregnancy......Page 2072
Changes in Immune Status: Response to Infection and Vaccines......Page 2073
Personal Protective Measures......Page 2074
Chemoprophylaxis......Page 2075
Exercise During Pregnancy......Page 2077
Water Sports......Page 2078
Miscarriage......Page 2079
Ectopic Pregnancy......Page 2080
Emergency Delivery......Page 2081
Shoulder Dystocia......Page 2083
Breech Delivery......Page 2084
Resources for Obstetrics in Remote Settings......Page 2085
Wilderness Health Issues for the Older Adventuress......Page 2086
References......Page 2087
The Aging Process......Page 2088
Demography of Elders and the Wilderness......Page 2090
Physiologic Workload of Wilderness Activities......Page 2091
Physical Conditioning to Prepare Elders for Wilderness Ventures......Page 2092
Heat......Page 2093
Cold......Page 2094
Coronary Artery Disease......Page 2095
Gastrointestinal Disorders......Page 2096
Musculoskeletal Disorders......Page 2097
Touch......Page 2098
Obesity......Page 2099
Medical Examination......Page 2100
Components of the Medical Examination......Page 2101
References......Page 2102
102 Persons With Special Needs and Disabilities......Page 2103
Disability Terminology......Page 2104
Prevalence of Disability in the United States......Page 2106
The Necessity of Wilderness......Page 2109
General Preparation Guidelines......Page 2110
Spinal Cord Injury......Page 2111
Signs and Symptoms.......Page 2112
Treatment.......Page 2113
Urinary Tract Infection.......Page 2114
Signs and Symptoms.......Page 2115
Prevention.......Page 2116
Special Considerations for a Wilderness Adventurer with Spinal Cord Injury......Page 2117
Cerebral Palsy......Page 2119
Other Causes of Muscle Imbalance......Page 2120
Amputation......Page 2121
Hypertension and Cardiac Disease......Page 2122
Asthma......Page 2123
Treatment......Page 2124
Cystic Fibrosis......Page 2125
Considerations for Wilderness Adventure for the Respiratory-Compromised Individual......Page 2126
Rheumatoid Arthritis......Page 2127
Systemic Lupus Erythematosus......Page 2128
Clinical Presentation......Page 2129
Prevention......Page 2130
Treatment......Page 2131
Glaucoma......Page 2132
Hearing Impairment......Page 2133
Useful Websites for Pet Travel and Animal Welfare......Page 2134
Handcycling and Off-Road Riding......Page 2135
Hunting......Page 2136
Anxiety.......Page 2138
Asthma and Scuba Diving......Page 2139
Visual Impairment and Scuba Diving......Page 2140
Acknowledgment and Resources.......Page 2141
References......Page 2142
Adventure Races......Page 2143
Medical Support for Wilderness and Endurance Events......Page 2144
Development of a Medical Support Plan......Page 2145
Logistics......Page 2147
Medical Disqualification......Page 2148
Adventure Races......Page 2149
Endemic Disease......Page 2150
Dehydration and Hyponatremia......Page 2151
References......Page 2152
Epidemiology of Agricultural Disease and Injury......Page 2153
Confined Spaces......Page 2154
Pulmonary Irritants (Manure Pits, Silos, Grain Bins)......Page 2155
Grain Storage Bin Entrapment......Page 2156
Grain Bin Rescue.......Page 2157
Farm Animals......Page 2158
Clinical Presentation.......Page 2159
Anhydrous Ammonia.......Page 2160
Clinical Presentation.......Page 2161
History and Perspective......Page 2162
Concussion......Page 2163
Diagnostic Tests.......Page 2164
Diagnostic Tests.......Page 2165
Sequelae and Aftercare.......Page 2167
Treatment.......Page 2168
References......Page 2169
105 Wilderness Medicine Education......Page 2170
Basic Principles......Page 2171
Learner-Centered Education......Page 2172
Problem-Based Learning......Page 2173
Discussion......Page 2174
Small-Group Learning......Page 2175
Description......Page 2176
Learning Objectives......Page 2177
Assessing Learning......Page 2178
Reliability and Validity......Page 2179
Good Teachers......Page 2180
Audiovisual......Page 2181
Simulations......Page 2182
Format of the Evaluation Instrument......Page 2184
Desired Outcomes......Page 2185
Planning for Continuing Medical Education......Page 2186
References......Page 2189
Professional Societies......Page 2187
Certification Programs......Page 2188
Case Study: Snakebite and Medical Malpractice......Page 2190
Case Study: Duty to Warn......Page 2191
Medical Screening......Page 2192
Professional Liability, Medical Malpractice, and Good Samaritan Laws......Page 2193
No Waiver for Gross Negligence......Page 2194
Harm to The Rescuer......Page 2195
Standing Orders and Medical Kits......Page 2196
References......Page 2197
Sources of Values......Page 2198
Utility......Page 2199
CHOOSING an Action in the Standard Setting......Page 2200
Using an Algorithm as a Guide for a Decision......Page 2201
Limited Resources......Page 2202
Giving Authority to Untrained Personnel......Page 2203
Issues of Direct Life-Threatening Situations for the Health Care Provider......Page 2204
No-Rescue Areas......Page 2205
References......Page 2206
Native American......Page 2207
Elder......Page 2208
Environmental......Page 2209
Spiritual......Page 2210
Treatment......Page 2211
Clinical Example: Back Pain......Page 2213
The Challenges of Research......Page 2215
References......Page 2217
109 The Changing Environment......Page 2220
Climate Change......Page 2221
Stratospheric Ozone Depletion......Page 2222
Population Growth......Page 2223
Pollution......Page 2224
Conversion of Wilderness......Page 2225
Indirect Impacts......Page 2226
Environmental Change and Medical Emergencies......Page 2227
Complexity and Uncertainty......Page 2228
International Actions......Page 2229
Local Actions......Page 2230
References......Page 2231
Understanding the Etiology of the Biodiversity Crisis......Page 2232
Threatened Ecosystems......Page 2233
Loss of Genetic Diversity......Page 2234
Altered Epidemiology Of Diseases......Page 2235
Threatened Food Production......Page 2236
Case Study......Page 2237
References......Page 2238
Extreme Heat Events.......Page 2239
Extreme Weather Events.......Page 2240
Dermatologic and Ocular Effects.......Page 2241
Water Pollution and Viruses......Page 2243
Other Parasitic Infections.......Page 2244
Air Pollution, Sulfur Dioxide, and Nitrogen Oxides......Page 2245
Chronic Pesticide Exposure.......Page 2246
Conclusions on Human Health and Environmental Change......Page 2247
References......Page 2248
Wilderness Legislation and Policy in the United States......Page 2249
Potential Threats to Wilderness......Page 2251
Distribution of Wilderness in the United States......Page 2252
Distribution of Wilderness Visitor Use......Page 2253
Wilderness Preservation as a National and International Movement......Page 2254
References......Page 2255
Energy......Page 2256
Solar Power......Page 2257
Sustainable Hospitals......Page 2258
Sustainability in the Wilderness......Page 2259
Water......Page 2260
References......Page 2261
114 Space Medicine:......Page 2262
Historical Perspective—X-15 To The Iss And Beyond......Page 2263
Effects on the Cardiovascular and Pulmonary Systems......Page 2264
Effects on the Neurovestibular and Sensory Systems......Page 2265
Effects on the Musculoskeletal System......Page 2266
Effects on the Endocrine System......Page 2267
Stressful Environment: Psychological and Behavioral Issues......Page 2268
Circadian Patterns and Sleep Disturbances.......Page 2269
Artificial Gravity......Page 2270
Protection Against Micrometeoroids and Space Debris During EVA......Page 2271
Radiation......Page 2272
Crew Selection—Medical Criteria......Page 2273
Psychological Factors in Crew Selection......Page 2274
Medical System Design......Page 2275
Deciding What To Bring (Benefit Vs. Burden)......Page 2277
Issues for Therapeutic Intervention......Page 2278
Keeping Them Healthy: Creating A Home......Page 2279
Temperature......Page 2280
Humidity......Page 2281
Medical Waste......Page 2282
Personal Hygiene......Page 2283
“Marching On Their Stomachs”......Page 2284
In-Flight Exercise Countermeasures Programs......Page 2285
Psychological Support......Page 2286
Crew Safety Equipment......Page 2287
Launch/Landing Stresses And Surface Concerns......Page 2288
Decompression Hazards......Page 2289
Fire Hazards......Page 2290
Case Study......Page 2291
Human Error......Page 2292
Exploration-Class Missions......Page 2293
References......Page 2294
Packaging......Page 2295
Storage......Page 2296
Acetazolamide Tablets, Extended-Release Capsules, Injection, and Solution (Rx)......Page 2297
Azithromycin Tablets, Solution, Injection, and Ophthalmic Solutions (Rx)......Page 2298
Dexamethasone Tablets; Oral, Implantation, Intravitreal, and Ophthalmic Solutions; and Injection (Rx)......Page 2299
Glucagon Injection (Rx)......Page 2300
Midazolam Oral Solution and Injection (S IV)......Page 2301
Penicillin GK and G Sodium Injection (Rx)......Page 2302
Tetanus Toxoid, Tetanus Toxoid/Diphtheria/Acellular Pertussis, and Hyperimmune Tetanus Globulin Vaccine Solutions (Rx)......Page 2303
References......Page 2304
A......Page 2305
B......Page 2310
C......Page 2312
D......Page 2318
E......Page 2321
F......Page 2325
G......Page 2328
H......Page 2329
I......Page 2333
J......Page 2335
L......Page 2336
M......Page 2338
N......Page 2341
O......Page 2343
P......Page 2344
R......Page 2349
S......Page 2352
T......Page 2358
U......Page 2362
V......Page 2363
W......Page 2364
Z......Page 2367