A group of long time friends, three couples and various children, were always coming up with new adventures to share. One of the couples loves to sail and suggested that they should all get together and rent a sailboat for a couple of days and go for an ocean voyage. Over the next several months that idea for a great vacation grew, as did their enthusiasm. They eventually were able to rent a sailboat along with its captain in the US Virgin Islands for their Great Adventure. The ship could accommodate all ten of them for a grand week of cruising on the great blue Caribbean sea.
Off they went to the Caribbean and for the first three days all went well. In the evening of the forth day, several of the younger kids began to feel sick with scratchy, burning throats, itchy eyes, runny noses, and upset stomachs. Because they were all in such close quarters the adults decided that the kids were either coming down with colds or allergies. Over the next several hours their conditions worsened and two of the kids began to complain of a sensation of shortness of breath accompanied by wheezing. At the same time several of the adults confessed that they were also beginning to fell sick, with similar symptoms. One of the adults complained of a burning, peppery taste in her mouth. Obviously, they were all getting progressively alarmed.
After sailing all day, the group was now anchored in a nice little hurricane hole on a remote uninhabited island. They would have to wait until morning to head for the nearest port, about four hours away once under sail.
A call was placed to the US Coast Guard who after listening to all the symptoms, thought it might be scombroid poisoning from eating fish that was not properly stored and refrigerated. They explained that it was a form of histamine overdose from eating the fish, in this case mahi mahi, and they needed to treat everyone onboard with antihistamines plus anyone who was wheezing would also need use a rescue inhaler, a bronchodilator such as albuterol.
There were no pharmacists, nurses, EMTs, or docs on board. The group needed to figure this out themselves. They decided to gather all the medications that each of them had brought and see what they had that might be of help. What would have helped the most was good old fashioned KNOW HOW. By the way, no internet service was available, just advice from the Coast Guard via their marine radio that the Captain was required to have on board the boat. (And no, the boat was not the USS Minnow on a 3-hour tour.)
This article highlights standard information that is taught to EMTs. The medications mentioned are ones they can and will commonly use in providing emergency medical care. Some of these medications are over-the-counter meds while others are prescription meds. The following section covers the basic pharmacological aspects of EMT training.
https://www.wildernessmedicinenewsletter.com/wp-content/uploads/2014/10/wmnlogo20151.png00WMN Editorshttps://www.wildernessmedicinenewsletter.com/wp-content/uploads/2014/10/wmnlogo20151.pngWMN Editors2014-12-11 21:23:142014-12-11 21:23:14Medications That an EMT Can Administer or Help Administer
We have asked several members of the SOLO staff who also work in remote settings to write up occasional first-hand experiences where some point or principle of wilderness medicine was underscored, relearned, or re-enforced.
We are calling these new segments “Reports From the Field,” and you will see them periodically as a new addition to the newsletter.
Our first Report comes from SOLO instructor Lee Lang who is a Protection Ranger at Yosemite National Park.
Scene Size-up Starts Sooner than Later:
By Lee Lang
Scene size-up should start as soon as you begin responding, and those first decisions may be just as critical as your later ones.
The Grand Canyon of the Tuolomne for most people is generally a four-day hike. The typical hiker starts in Tuolomne Meadows, Yosemite National Park, and hikes down the canyon, exiting via the Pate Valley trail in White Wolf, a grueling 10-mile hike with more than 4000 feet of climbing. In mid-July the temperatures in Pate Valley can easily reach 104 F. The Pate Valley trail sees sun for most of the day, and the lower half to two-thirds of the trail is treeless and dark granite. The upper portion commonly meanders through high ground cover ensuring little air movement. Even though it is several thousand feet higher in elevation, on this July afternoon the temperature was in the mid-90s. I was several miles out from White Wolf on road patrol when I was dispatched:
Mike 52 – We have a report of 23-yr-old female near Hardin Lake. The RP reports that she is unresponsive, hot, dry, and pink. The RP states the hiker walked out of Pate Valley, and the patient drank very little fluid throughout the day.
A flurry of radio traffic ensues, and the decisions made are critical. I arrive at the trail head in several minutes and prepare for my 2.5 mile hasty approach. I know that a Park Medic is responding to the helitack base and is preparing to spool-up for a short-haul operation. A second ranger is en-route to the trail head but will be 20-30 minutes behind me. A ground SAR team, including a paramedic, is also being assembled but will be nearly an hour and a half behind.
More and more seniors are hiking in the woods, which is simply a “walk in the woods.” You will find seniors walking along rugged trails, along riverbanks, through meadows, or on boardwalks over wetlands. You can find seniors recreating almost anywhere in the wilderness.
To look at the prevention side of things as a senior that plays out in the woods, there are a few things you should do before you go for your hike. I would like to review some of these simple steps to keep you safe and make your hike enjoyable.
If you are on medications, make sure you pack any medications that are needed for that day’ activity and extra medication in case something delays you from returning home at the appointed time. If you have special conditions that a first responder may need to know in order to provide you with the best possible care, wear a medical bracelet, necklace, or carry this vital information in your wallet. Program emergency contact information into your cell phone. Many first responders will check cell phones for the notation “ICE” (In Case of Emergency). Leave your family or friends an itinerary of when and where you are hiking, and when you plan to return.
When you head out, wear comfortable and appropriate footwear for your hike. Senior’s hiking shoes should have excellent ankle support, be lightweight, and, if possible, have non-skid soles. Have a well-supplied backpack to meet the needs of your hike. Make sure you pack it with the essentials: water, light snacks, a map and compass, a signaling device (whistle, or mirror), light source (headlamp, or flashlight), matches, cell phone, rain gear, extra pair of socks, a SOLO WFA map, and of course, your medications. If you have balance, knee, or back problems, I also recommended that you use a walking stick or trekking poles.
https://www.wildernessmedicinenewsletter.com/wp-content/uploads/2014/10/wmnlogo20151.png00WMN Editorshttps://www.wildernessmedicinenewsletter.com/wp-content/uploads/2014/10/wmnlogo20151.pngWMN Editors2014-12-01 19:45:452014-12-01 19:45:45Seniors Hiking In The Woods
I have been asked to write an article on triage and Mass Casualty Incidents (MCI). You might ask why are we writing an article on triage and MCI? Given the world we now live in, it is a good time to review these topics. With mass casualty incidents happening more frequently in schools, malls, political gatherings, and on mass transit systems it is important to know how to respond to save lives. Often when we teach these topics it is at the end of the course and we quickly cover them because of time constraints.
There is a wealth of data on these topics. You might recall one of the most famous studies. It focused on the Avianca, Flight 52, plane crash in Cove Neck, New York. It happened on a foggy and windy night on January 25, 1990. A number of volunteer fire and rescue units responded to this incident where 8 out of the 9 crew members of the aircraft were killed and 65 out of 149 passengers were killed. You may recall that during this event there was a huge problem with all the responders’ vehicles and equipment parked on either side of a narrow road which made it impossible for ambulances to get to the scene or turn around. This incident has changed how we now stage resources at MCIs.
Unfortunately, we have a wealth of data on triage and evacuation coming from the Iraqi and Afghanistan war. For example the battlefield injury survival rate for U.S. military personnel in Iraq reached 90%. This was 10 points higher than what was seen in the 1991 Persian Gulf War. Maj. Gen. George W. Weightman, commander of the Army Medical Department’s Center and School at Fort Sam Houston in San Antonio, Texas, cited a number of things that have changed in treating battlefield injuries which have improved survival. These include improved trauma care moments after the injury and a large number of soldiers trained as combat lifesavers.
In previous editions of the WMNL, articles have been written on the various tickborne diseases. Over the past few years several important changes have occurred, and there have been several more illnesses added to the list.
Tickborne Diseases:
– Leading insect vectorborne diseases in USA.
– 95% of all insect vectorborne illnesses in USA.
– Second only to mosquitoes worldwide in causing and spreading disease.
– Ticks are little cesspools.
– Lyme Disease is the #1 tickborne illness.
– Anaplasmosis (HGA) is the #2 tickborne illness.
Here is the current list of tickborne diseases seen in North America:
https://www.wildernessmedicinenewsletter.com/wp-content/uploads/2014/10/wmnlogo20151.png00WMN Editorshttps://www.wildernessmedicinenewsletter.com/wp-content/uploads/2014/10/wmnlogo20151.pngWMN Editors2014-11-10 12:39:062014-11-10 14:41:36Update and Summary of Tickborne Diseases in North America
There are currently a lot of concerns about infectious disease and the risk of another worldwide pandemic. This is being driven by the current Ebola scare. Over the course of human history, there have been many pandemics that did have a major impact on human populations and history itself.
In our most recent history, there was and still is, the Human Immunodeficiency Virus (HIV) pandemic. When HIV was first described in the mid 1980’s, there was a great outcry that it was the next great pandemic. Experts at the time estimated that it would kill upwards to 20% of the world population in 10 years and a much higher percentage in developing nations. HIV never became as serious as estimated because of dedication to good research, medical science, and excellent education. Today HIV remains a very serious illness, but it is very well understood, and excellent antiviral medications have been developed. As a result, it is under good control, at least in developed nations.
The last major, true worldwide pandemic was the Spanish Flu Pandemic in 1918.
From 1918-1919 the Spanish Flu raced around the globe, the worst influenza pandemic to date. Caused by an H1N1 flu virus, it was responsible for more than 500,000 U.S. deaths, as compared to 50,000 US servicemen who died in WWWI the previous two years. The worldwide death estimates range from 20 million to 100 million.
This Spanish Flu pandemic occurred before the invention of antibiotics. Antibiotics are essential in treating the secondary bacterial infections that often kill flu-weakened patients. So, that number would most likely be much lower today with the use of antibiotics to treat the potentially life-threatening secondary respiratory infections and pneumonias.
Major Worldwide Pandemics: (only the largest pandemics are noted.)
Date Number of Deaths and Location Cause
165-180 30% of Europe, Asia, and North Africa Smallpox
541-542 40% of the European population Bubonic plague
1346-1350 30%-70% of the European population Plague
1629-1631 280,000 deaths worldwide Plague
1665-1666 100,000 deaths in England,(Great Plague of London) Plague
1816-1826 >100,000 deaths in Europe and Asia Cholera #1 epidemic
1829-1851 >100,000 – Asia, Europe, and North America Cholera #2 epidemic
1852-1860 1,000,000 deaths in Russia Cholera #3 epidemic
1875 40,000 deaths in Fiji measles
1889-1890 1,000,000 deaths world from influenza influenza
1899-1923 >800,000 Europe, Asia, Africa Cholera #6 epidemic
1918-1920 75,000,000 deaths worldwide – the Spanish flu influenza
1957-1958 2,000,000 deaths worldwide – the Asian flu influenza
1968-1969 1,000,000 deaths worldwide – the Hong Kong flu influenza
1960 – now >30,000,000 deaths from HIV/AIDS pandemic HIV/AIDS
2009-2010 14,286 deaths from viral influenza influenza
2013-2014 6,000+ deaths from Ebola virus Ebola virus
In regard to pandemics, smallpox is no longer a threat, declared eliminated as of 1974 through the efforts of worldwide vaccination programs. A similar program is currently being undertaken by Rotary International in an attempt to eliminate the poliovirus as well.
Medications That an EMT Can Administer or Help Administer
/in Antihistamines, Asprin, First Aid Kits, Medical Response, Medications, NSAIDs, OTC, Oxygen, Pain control, Travel Medicine/by WMN EditorsISSN-1059-6518
The Backpack or Traveling Pharmacy
By Frank Hubbell, DO
A group of long time friends, three couples and various children, were always coming up with new adventures to share. One of the couples loves to sail and suggested that they should all get together and rent a sailboat for a couple of days and go for an ocean voyage. Over the next several months that idea for a great vacation grew, as did their enthusiasm. They eventually were able to rent a sailboat along with its captain in the US Virgin Islands for their Great Adventure. The ship could accommodate all ten of them for a grand week of cruising on the great blue Caribbean sea.
Off they went to the Caribbean and for the first three days all went well. In the evening of the forth day, several of the younger kids began to feel sick with scratchy, burning throats, itchy eyes, runny noses, and upset stomachs. Because they were all in such close quarters the adults decided that the kids were either coming down with colds or allergies. Over the next several hours their conditions worsened and two of the kids began to complain of a sensation of shortness of breath accompanied by wheezing. At the same time several of the adults confessed that they were also beginning to fell sick, with similar symptoms. One of the adults complained of a burning, peppery taste in her mouth. Obviously, they were all getting progressively alarmed.
After sailing all day, the group was now anchored in a nice little hurricane hole on a remote uninhabited island. They would have to wait until morning to head for the nearest port, about four hours away once under sail.
A call was placed to the US Coast Guard who after listening to all the symptoms, thought it might be scombroid poisoning from eating fish that was not properly stored and refrigerated. They explained that it was a form of histamine overdose from eating the fish, in this case mahi mahi, and they needed to treat everyone onboard with antihistamines plus anyone who was wheezing would also need use a rescue inhaler, a bronchodilator such as albuterol.
There were no pharmacists, nurses, EMTs, or docs on board. The group needed to figure this out themselves. They decided to gather all the medications that each of them had brought and see what they had that might be of help. What would have helped the most was good old fashioned KNOW HOW. By the way, no internet service was available, just advice from the Coast Guard via their marine radio that the Captain was required to have on board the boat. (And no, the boat was not the USS Minnow on a 3-hour tour.)
This article highlights standard information that is taught to EMTs. The medications mentioned are ones they can and will commonly use in providing emergency medical care. Some of these medications are over-the-counter meds while others are prescription meds. The following section covers the basic pharmacological aspects of EMT training.
Read more
Scene Size-up
/in Heat related Injuries, Medical Response, Mountain rescue, Patient Assessment/by WMN EditorsISSN-1059-6518
Volume 27 Number 5
We have asked several members of the SOLO staff who also work in remote settings to write up occasional first-hand experiences where some point or principle of wilderness medicine was underscored, relearned, or re-enforced.
We are calling these new segments “Reports From the Field,” and you will see them periodically as a new addition to the newsletter.
Our first Report comes from SOLO instructor Lee Lang who is a Protection Ranger at Yosemite National Park.
Scene Size-up Starts Sooner than Later:
By Lee Lang
Scene size-up should start as soon as you begin responding, and those first decisions may be just as critical as your later ones.
The Grand Canyon of the Tuolomne for most people is generally a four-day hike. The typical hiker starts in Tuolomne Meadows, Yosemite National Park, and hikes down the canyon, exiting via the Pate Valley trail in White Wolf, a grueling 10-mile hike with more than 4000 feet of climbing. In mid-July the temperatures in Pate Valley can easily reach 104 F. The Pate Valley trail sees sun for most of the day, and the lower half to two-thirds of the trail is treeless and dark granite. The upper portion commonly meanders through high ground cover ensuring little air movement. Even though it is several thousand feet higher in elevation, on this July afternoon the temperature was in the mid-90s. I was several miles out from White Wolf on road patrol when I was dispatched:
Mike 52 – We have a report of 23-yr-old female near Hardin Lake. The RP reports that she is unresponsive, hot, dry, and pink. The RP states the hiker walked out of Pate Valley, and the patient drank very little fluid throughout the day.
A flurry of radio traffic ensues, and the decisions made are critical. I arrive at the trail head in several minutes and prepare for my 2.5 mile hasty approach. I know that a Park Medic is responding to the helitack base and is preparing to spool-up for a short-haul operation. A second ranger is en-route to the trail head but will be 20-30 minutes behind me. A ground SAR team, including a paramedic, is also being assembled but will be nearly an hour and a half behind.
Read more
Seniors Hiking In The Woods
/in prevention/by WMN EditorsISSN-1059-65-18
Volume 27 Number 5
By Paul MacMillan, AEMT
More and more seniors are hiking in the woods, which is simply a “walk in the woods.” You will find seniors walking along rugged trails, along riverbanks, through meadows, or on boardwalks over wetlands. You can find seniors recreating almost anywhere in the wilderness.
To look at the prevention side of things as a senior that plays out in the woods, there are a few things you should do before you go for your hike. I would like to review some of these simple steps to keep you safe and make your hike enjoyable.
If you are on medications, make sure you pack any medications that are needed for that day’ activity and extra medication in case something delays you from returning home at the appointed time. If you have special conditions that a first responder may need to know in order to provide you with the best possible care, wear a medical bracelet, necklace, or carry this vital information in your wallet. Program emergency contact information into your cell phone. Many first responders will check cell phones for the notation “ICE” (In Case of Emergency). Leave your family or friends an itinerary of when and where you are hiking, and when you plan to return.
When you head out, wear comfortable and appropriate footwear for your hike. Senior’s hiking shoes should have excellent ankle support, be lightweight, and, if possible, have non-skid soles. Have a well-supplied backpack to meet the needs of your hike. Make sure you pack it with the essentials: water, light snacks, a map and compass, a signaling device (whistle, or mirror), light source (headlamp, or flashlight), matches, cell phone, rain gear, extra pair of socks, a SOLO WFA map, and of course, your medications. If you have balance, knee, or back problems, I also recommended that you use a walking stick or trekking poles.
Read more
MASS CASUALTY INCIDENT (MCI) and Triage
/in Disaster Response, Medical Response, Natural Disater, Teaching Wilderness Medicine, Trauma/by WMN EditorsISSN-1059-6518
MASS CASUALTY INCIDENT – 2014
Aka Triage – Are you hurt?
By Paul MacMillan, AEMT
Cover photo courtesy Dundar Sahin and AKUT
I have been asked to write an article on triage and Mass Casualty Incidents (MCI). You might ask why are we writing an article on triage and MCI? Given the world we now live in, it is a good time to review these topics. With mass casualty incidents happening more frequently in schools, malls, political gatherings, and on mass transit systems it is important to know how to respond to save lives. Often when we teach these topics it is at the end of the course and we quickly cover them because of time constraints.
There is a wealth of data on these topics. You might recall one of the most famous studies. It focused on the Avianca, Flight 52, plane crash in Cove Neck, New York. It happened on a foggy and windy night on January 25, 1990. A number of volunteer fire and rescue units responded to this incident where 8 out of the 9 crew members of the aircraft were killed and 65 out of 149 passengers were killed. You may recall that during this event there was a huge problem with all the responders’ vehicles and equipment parked on either side of a narrow road which made it impossible for ambulances to get to the scene or turn around. This incident has changed how we now stage resources at MCIs.
Unfortunately, we have a wealth of data on triage and evacuation coming from the Iraqi and Afghanistan war. For example the battlefield injury survival rate for U.S. military personnel in Iraq reached 90%. This was 10 points higher than what was seen in the 1991 Persian Gulf War. Maj. Gen. George W. Weightman, commander of the Army Medical Department’s Center and School at Fort Sam Houston in San Antonio, Texas, cited a number of things that have changed in treating battlefield injuries which have improved survival. These include improved trauma care moments after the injury and a large number of soldiers trained as combat lifesavers.
Read more
Update and Summary of Tickborne Diseases in North America
/in Bites and Stings, Disease/by WMN EditorsISSN-1059-6518
Volume 27 Number 5
In previous editions of the WMNL, articles have been written on the various tickborne diseases. Over the past few years several important changes have occurred, and there have been several more illnesses added to the list.
Tickborne Diseases:
– Leading insect vectorborne diseases in USA.
– 95% of all insect vectorborne illnesses in USA.
– Second only to mosquitoes worldwide in causing and spreading disease.
– Ticks are little cesspools.
– Lyme Disease is the #1 tickborne illness.
– Anaplasmosis (HGA) is the #2 tickborne illness.
Here is the current list of tickborne diseases seen in North America:
Read more
Viruses
/in Common Cold, Disease, Ebola, Infection/by WMN EditorsISSN-1059-6518
Volume 27 Number 4
What is a Virus?
What is a pandemic?
Why do we care?
By Frank Hubbell, DO
Illustrations by T.B.R. Walsh
There are currently a lot of concerns about infectious disease and the risk of another worldwide pandemic. This is being driven by the current Ebola scare. Over the course of human history, there have been many pandemics that did have a major impact on human populations and history itself.
In our most recent history, there was and still is, the Human Immunodeficiency Virus (HIV) pandemic. When HIV was first described in the mid 1980’s, there was a great outcry that it was the next great pandemic. Experts at the time estimated that it would kill upwards to 20% of the world population in 10 years and a much higher percentage in developing nations. HIV never became as serious as estimated because of dedication to good research, medical science, and excellent education. Today HIV remains a very serious illness, but it is very well understood, and excellent antiviral medications have been developed. As a result, it is under good control, at least in developed nations.
The last major, true worldwide pandemic was the Spanish Flu Pandemic in 1918.
From 1918-1919 the Spanish Flu raced around the globe, the worst influenza pandemic to date. Caused by an H1N1 flu virus, it was responsible for more than 500,000 U.S. deaths, as compared to 50,000 US servicemen who died in WWWI the previous two years. The worldwide death estimates range from 20 million to 100 million.
This Spanish Flu pandemic occurred before the invention of antibiotics. Antibiotics are essential in treating the secondary bacterial infections that often kill flu-weakened patients. So, that number would most likely be much lower today with the use of antibiotics to treat the potentially life-threatening secondary respiratory infections and pneumonias.
Major Worldwide Pandemics: (only the largest pandemics are noted.)
Date Number of Deaths and Location Cause
165-180 30% of Europe, Asia, and North Africa Smallpox
541-542 40% of the European population Bubonic plague
1346-1350 30%-70% of the European population Plague
1629-1631 280,000 deaths worldwide Plague
1665-1666 100,000 deaths in England,(Great Plague of London) Plague
1816-1826 >100,000 deaths in Europe and Asia Cholera #1 epidemic
1829-1851 >100,000 – Asia, Europe, and North America Cholera #2 epidemic
1852-1860 1,000,000 deaths in Russia Cholera #3 epidemic
1875 40,000 deaths in Fiji measles
1889-1890 1,000,000 deaths world from influenza influenza
1899-1923 >800,000 Europe, Asia, Africa Cholera #6 epidemic
1918-1920 75,000,000 deaths worldwide – the Spanish flu influenza
1957-1958 2,000,000 deaths worldwide – the Asian flu influenza
1968-1969 1,000,000 deaths worldwide – the Hong Kong flu influenza
1960 – now >30,000,000 deaths from HIV/AIDS pandemic HIV/AIDS
2009-2010 14,286 deaths from viral influenza influenza
2013-2014 6,000+ deaths from Ebola virus Ebola virus
In regard to pandemics, smallpox is no longer a threat, declared eliminated as of 1974 through the efforts of worldwide vaccination programs. A similar program is currently being undertaken by Rotary International in an attempt to eliminate the poliovirus as well.
Read more