ISSN-1059-6518
The last several issues of the Wilderness Medicine Newsletter have been devoted to musculoskeletal and joint issues and the common injuries and treatments associated with these two topics. By contrast we wanted to present something a little different that addresses, at least, some of the underlying causes of accidents in the backcountry. To that end we spoke with Jed Williamson. Jed is well known in the climbing community for his participation in signature expeditions and as a former President of the American Alpine Club. He may be more generally recognized as the managing editor of Accidents in North American Mountaineering, an annual publication that lists accidents and offers assessments of the root causes of those accidents.
We have always thought of Jed first and foremost as an educator. As can be seen below, his credentials speak volumes about his contributions to the world of education, contributions that are 
sometimes overlooked in the context of his broader resume. We feel that Accidents in North American Mountaineering represents a tremendous resource of case studies, making it a valuable teaching tool. Through the following interview, we hope to make sure that everyone in the world of Emergency Medicine is aware of this resource. We are delighted to have the opportunity to talk with Jed and give him an opportunity to share some of his insights.
The Editorial Staff
Wilderness Medicine Newsletter interview with Jed Williamson:
Snapshot Resume of John E. (Jed) Williamson
• Managing Editor of Accidents in North American Mountaineering (Annual Publication of the American Alpine Club) since 1974
• Former President of Sterling College, Craftsbury Common, VT, and faculty member in the Education Department at the University of New Hampshire.
• Former President of the American Alpine Club and current Chair of its Safety Advisory Council.
• First ascents in Canada, Alaska, and Mexico; expeditions to the Pamir, Minya Konka in western China, Bhutan, and Mount Everest.
• Former Board member: Association for Experiential Education, National Outdoor Leadership School, and Student Conservation Association.
• Current Boards: Upper Valley Educator’s Institute, Heartbeet Lifesharing, and Central Asia Institute.
• AMGA Certified Alpine Guide (Retired).
WMN: Jed, you are known for having a list of the top reasons that mountaineering accidents happen. Would you please review for the WMN what that list is?
JW: There are a lot of them, but when it comes to making decisions with a poor outcome, at the top of the list are: a desire to please other people and trying to stick to a schedule.
I mean clearly it varies from incident to incident. In addition, you have to look at other factors: for example, the big three—unsafe conditions, unsafe acts, and errors in judgment, but the top two are making decisions just to try to please other people or insisting on sticking with a schedule, particularly if conditions clearly dictate that it would be unwise to continue on.
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WEST NILE VIRUS
/in Disease, West Nile Virus/by WMN EditorsSeptember/October 2012
ISSN-1059-6518 Volume 25 Number 5
By Frank Hubbell, DO
This article on West Nile Virus was originally run in the WMN about 10 years ago. With the current rash of cases in the Northeastern and Midwestern states, we thought is would be a good idea to refresh this article to remind us of this potentially lethal virus.
The take-away message is that this virus is spread by mosquitoes; therefore, in order to become a victim of this disease, you have to become part of the food chain. Since this is a viral illness, it does not have an effective treatment. Your ability to survive is dependent upon your immune system.
Wear protective clothing, use insect repellents and insecticides, and stay out of their environment. We either have to eliminate the mosquitoes or not get bitten by them.
In the world of infectious disease, West Nile is not a statistically important. Its impact is actually quite minimal in that it does not cause harm to millions or even thousands. It is one of about 534 zoonotic viruses of which 120 are known to cause illness in humans. But it gains our attention because it is a new acute illness that is potentially lethal, highly preventable, and we do not know its full potential to spread and cause harm as yet.
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IMPROVISED LITTERS
/in Medical Response, Mountain rescue, Rescue Training/by WMN EditorsISSN-1059-6518
By Frank Hubbell, DO
Illustrations by T.B.R. Walsh
While hiking with a small group in a remote region of the Kamchatka Peninsula in Russia, one of the team members slipped on a wet rock crossing a stream and twisted their knee. The resulting injury was an anterior cruciate ligament tear, a medial collateral ligament tear, and a partially torn patella tendon. As a result they were unable to weight bear to walk and had to be carried out. They did have Russian guides with them, but they did not have the ability to call out for help and if they had, there wasn’t any help available. They were on their own.
The real questions are not how to build a litter, but why and when would you want to? Why would you want to take the time to build an improvised litter? Building a litter takes time, both in gathering the materials and the actual construction.
Most of the time you and your patient are much better off to spend the energy to build and create a really good bivouac and stay put, letting help come to you. However, you may find yourself in a part of the world where help is simply not available, and you are on your own.
You can also find yourself in a situation where time is of the essence. Your patient may have critical life-threatening injuries, and you have to evacuate ASAP. In this case you will have sent others to get help, but, in the meantime, you may want to start in the direction of rescue to save precious time.
Another problem is the number of litter carriers that you might need. Is your team big enough, or do you have access to enough people who are willing to help carry the litter to evacuate your patient.
Knowing the best ways to improvise a litter is a valuable skill, but rarely needed. Your priority should be in knowing the best way to stay put and stay safe while you wait for help to arrive. However, in the event that the skill is needed, the following information will be useful.
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Interview with Jed Williamson
/in Environemtal Injuries, Mountain rescue, prevention/by WMN EditorsISSN-1059-6518
The last several issues of the Wilderness Medicine Newsletter have been devoted to musculoskeletal and joint issues and the common injuries and treatments associated with these two topics. By contrast we wanted to present something a little different that addresses, at least, some of the underlying causes of accidents in the backcountry. To that end we spoke with Jed Williamson. Jed is well known in the climbing community for his participation in signature expeditions and as a former President of the American Alpine Club. He may be more generally recognized as the managing editor of Accidents in North American Mountaineering, an annual publication that lists accidents and offers assessments of the root causes of those accidents.
We have always thought of Jed first and foremost as an educator. As can be seen below, his credentials speak volumes about his contributions to the world of education, contributions that are
sometimes overlooked in the context of his broader resume. We feel that Accidents in North American Mountaineering represents a tremendous resource of case studies, making it a valuable teaching tool. Through the following interview, we hope to make sure that everyone in the world of Emergency Medicine is aware of this resource. We are delighted to have the opportunity to talk with Jed and give him an opportunity to share some of his insights.
The Editorial Staff
Wilderness Medicine Newsletter interview with Jed Williamson:
Snapshot Resume of John E. (Jed) Williamson
• Managing Editor of Accidents in North American Mountaineering (Annual Publication of the American Alpine Club) since 1974
• Former President of Sterling College, Craftsbury Common, VT, and faculty member in the Education Department at the University of New Hampshire.
• Former President of the American Alpine Club and current Chair of its Safety Advisory Council.
• First ascents in Canada, Alaska, and Mexico; expeditions to the Pamir, Minya Konka in western China, Bhutan, and Mount Everest.
• Former Board member: Association for Experiential Education, National Outdoor Leadership School, and Student Conservation Association.
• Current Boards: Upper Valley Educator’s Institute, Heartbeet Lifesharing, and Central Asia Institute.
• AMGA Certified Alpine Guide (Retired).
WMN: Jed, you are known for having a list of the top reasons that mountaineering accidents happen. Would you please review for the WMN what that list is?
JW: There are a lot of them, but when it comes to making decisions with a poor outcome, at the top of the list are: a desire to please other people and trying to stick to a schedule.
I mean clearly it varies from incident to incident. In addition, you have to look at other factors: for example, the big three—unsafe conditions, unsafe acts, and errors in judgment, but the top two are making decisions just to try to please other people or insisting on sticking with a schedule, particularly if conditions clearly dictate that it would be unwise to continue on.
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Vaccines – Typhoid and Paratyphoid Fever
/in Immunizations, Typhoid/by WMN EditorsMay/June 2012 ISSN-1059-6518 Volume 25 Number 3
By Frank Hubbell, DO
What is Typhoid and Paratyphoid?
Typhoid fever, also known as typhoid is a life-threatening illness caused by the bacterium Salmonella typhi. It is also known as gastric fever, abdominal typhus, infantile remittant fever, slow fever, nervous fever, and pythogenic fever.
Paratyphoid fever, also known as enteric fever, is a less serious illness that is also caused by Salmonella bacteria, but the symptoms are very similar to those of Typhoid Fever.
Warning: Typhoid fever is different from Typhus. Typhus is an illness caused by the bacterium Rickettsia while Typhoid is caused by Salmonella bacteria.
Pathophysiology of Typhoid:
Salmonella typhi lives only in humans – there is no other reservoir in nature besides humans.
The Salmonella typhi is spread from one person to another via the oral-fecal route where food or water has become contaminated by poor sanitation. Inadequate conditions have allowed the water source to become contaminated with human excrement – urine and feces, or by improper food handling and preparation.
Salmonella can also be spread by flying insects, such as flies, that feed on feces and then land and walk on food that you might then eat.
Flies: Their dirty little foot prints on your food is enough to spread Salmonella and other intestinal illnesses from one animal to another.
Once the Salomella bacterium has been consumed in food or water, it passes through the stomach into the intestinal tract where is multiplies and invades the mucosa wall. Within the mucosa wall the Salmonella bacteria are phagocystized (surrounded and consumed) by macrophages (white blood cells). If the bacteria manage to avoid the immune system in the gut wall, they will then invade and multiple in the blood stream.
It is the invasion and multiplication of the Salmonella in the bloodstream that causes the signs and symptoms of Typhoid.
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