Latest Wilderness Medical Society Journal Articles Jun-2016 (Volume 27, Issue 2)

New Practice Guidelines for the Prevention and Treatment of Drowning. If you have a pool, beach, swimming area as part of your program you need to know this!!!

You need to be a member to keep up to date with the latest medical and first aid issues.


VIEW: Is Drinking to Thirst Adequate to Appropriately Maintain Hydration Status During Prolonged Endurance Exercise? Yes

Martin D. Hoffman, James D. Cotter, Éric D. Goulet, Paul B. Laursen

COUNTERVIEW: Is Drinking to Thirst Adequate to Appropriately Maintain Hydration Status During Prolonged Endurance Exercise? No

Lawrence E. Armstrong, Evan C. Johnson, Michael F. Bergeron

REBUTTAL from “Yes”

Martin D. Hoffman, James D. Cotter, Éric D. Goulet, Paul B. Laursen

REBUTTAL from “No”

Lawrence E. Armstrong, Evan C. Johnson, Michael F. Bergeron

Original Research

Risk of Avalanche Involvement in Winter Backcountry Recreation: The Advantage of Small Groups

Benjamin Zweifel, Emily Procter, Frank Techel, Giacomo Strapazzon, Roman Boutellier

Pulley Ruptures in Rock Climbers: Outcome of Conservative Treatment With the Pulley-Protection Splint—A Series of 47 Cases

Micha Schneeberger, Andreas Schweizer

An Analysis of Media-Reported Venomous Snakebites in the United States, 2011–2013

Dennis K. Wasko, Stephan G. Bullard

Outdoor Activity and High Altitude Exposure During Pregnancy: A Survey of 459 Pregnancies

Linda E. Keyes, Peter H. Hackett, Andrew M. Luks

Practice Guidelines

Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Drowning

Andrew C. Schmidt, Justin R. Sempsrott, Seth C. Hawkins, Ali S. Arastu, Tracy A. Cushing, Paul S. Auerbach


Novel Technique for Epinephrine Removal in New Generation Autoinjectors

Patrick E. Robinson, Stephanie A. Lareau

Case Report

Subtle Cognitive Dysfunction in Resolving High Altitude Cerebral Edema Revealed by a Clock Drawing Test

Ian Quigley, Ken Zafren

Twostriped Walkingstick Targets Human Eye With Chemical Defense Spray

Ashley N. Ferrara, John B. Luck, Mark C. Chappell

First Reported Case of Fatal Stinging by the Large Carpenter Bee Xylocopa tranquebarica

Senanayake A.M. Kularatne, Sathasivam Raveendran, Jayanthi Edirisinghe, Inoka Karunaratne, Kosala Weerakoon

Snakebite by the Shore Pit Viper (Trimeresurus purpureomaculatus) Treated With Polyvalent Antivenom

Rupeng Mong, Hock Heng Tan

Fatal Honey Poisoning Caused by Tripterygium wilfordii Hook F in Southwest China: A Case Series

Qiang Zhang, Xinguang Chen, Shunan Chen, Zhitao Liu, Rong Wan, Juanjuan Li

Corneal Opacity in a Participant of a 161-km Mountain Bike Race at High Altitude

Morteza Khodaee, David R. Torres

Traumatic Amputation of Finger From an Alligator Snapping Turtle Bite

Robert D. Johnson, Cynthia L. Nielsen

Avalanche Survival After Rescue With the RECCO Rescue System: A Case Report

Katharina Grasegger, Giacomo Strapazzon, Emily Procter, Hermann Brugger, Inigo Soteras

Lightning Strike in Pregnancy With Fetal Injury

Kellen Galster, Ryan Hodnick, Ross P. Berkeley

Bitten by a Dragon

Stephen D. Ducey, Jeffrey S. Cooper, Michael C. Wadman

Case Series

The “Heel Hook”—A Climbing-Specific Technique to Injure the Leg

Volker Schöffl, Christoph Lutter, Dominik Popp

Brief Report

Acute Interstitial Nephritis Following Snake Envenomation: A Single-Center Experience

P.S. Priyamvada, Vijay Shankar, B.H. Srinivas, N.G. Rajesh, Sreejith Parameswaran

Sildenafil and Exercise Capacity in the Elderly at Moderate Altitude

George W. Rodway, Anne J. Lovelace, Michael J. Lanspa, Scott E. McIntosh, James Bell, Ben Briggs, Lindell K. Weaver, Frank Yanowitz, Colin K. Grissom

Cycling Injuries in Southwest Colorado: A Comparison of Road vs Trail Riding Injury Patterns

Simon Kotlyar

Body Positioning of Buried Avalanche Victims

Daniel K. Kornhall, Spencer Logan, Thomas Dolven

Clinical Images

A Wasp Sting and a Broken Heart

James H. Diaz

Mistaken Mushroom Poisonings

James H. Diaz

A Broken Leg in the Bugs

Alexander J. Martin-Bates

Letter to the Editor

Expanding Wilderness Medicine Fellowship Eligibility Beyond Emergency Medicine

Derek J. Meyer, Megann Young

In Response to ACE I/D Polymorphism and HAPE by Bhagi et al

Gaurav Sikri, Srinivasa A.B., Bikalp Thapa

In Reply to Dr Sikri et al

Swati Srivastava

Pitviper Envenomation Guidelines Should Address Choice Between FDA-approved Treatments for Cases at Risk of Late Coagulopathy

Leslie V. Boyer, Anne-Michelle Ruha

In Reply to Drs Boyer and Ruha

Nicholas C. Kanaan, Jeremiah Ray, Matthew Stewart, Matthew Fuller, E. Martin Caravati, Katie W. Russell, Sean P. Bush, Michael D. Cardwell, Robert L. Norris, Scott A. Weinstein

In response to Epidemiology of Search and Rescue in Baxter State Park: Dangers of Descent and Fatigue

Aaron Brillhart, Scott McIntosh, Jennifer Dow, Colin Grissom

In reply to Brillhart et al.

Chris R. Welter, J. Matthew Sholl, Tania D. Strout, Ben Woodard

Book Review

Book review

Aaron D. Campbell

Book review

Christopher Van Tilburg

Book review

Christopher Van Tilburg

Wilderness Image

Calotropis gigantea

Tanuj Kanchan, Alok Atreya



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Author: Outdoor Recreation Insurance, Risk Management and Law

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Latest Wilderness Medical Society Journal is out with great articles for First Aid Providers in the Wilderness

Here are the articles in the Wilderness Medical Society Journal that you should know if you provide First Aid outdoors.WMS
Editor’s Note

Can We Get There From Here?
Martin D. Hoffman

Original Research

Predictive Factors for Determining the Clinical Severity of Pediatric Scorpion Envenomation Cases in Southeastern Turkey
Aykut Çağlar, Halil Köse, Aslan Babayiğit, Taliha Öner, Murat Duman

Circadian and Sex Differences After Acute High-Altitude Exposure: Are Early Acclimation Responses Improved by Blue Light?
Juan A. Silva-Urra, Cristian A. Núñez-Espinosa, Oscar A. Niño-Mendez, Héctor Gaitán-Peñas, Cesare Altavilla, Andrés Toro-Salinas, Joan R. Torrella, Teresa Pagès, Casimiro F. Javierre, Claus Behn, Ginés Viscor

Practice Guidelines
Wilderness Medical Society Practice Guidelines for the Treatment of Pitviper Envenomations in the United States and Canada
Nicholas C. Kanaan, Jeremiah Ray, Matthew Stewart, Katie W. Russell, Matthew Fuller, Sean P. Bush, E. Martin Caravati, Michael D. Cardwell, Robert L. Norris, Scott A. Weinstein

Case Reports

Marked Hypofibrinogenemia and Gastrointestinal Bleeding After Copperhead (Agkistrodon contortrix) Envenomation
Kathryn T. Kopec, May Yen, Matthew Bitner, C. Scott Evans, Charles J. Gerardo

A Case Study: What Doses of Amanita phalloides and Amatoxins Are Lethal to Humans?
Ismail Yilmaz, Fatih Ermis, Ilgaz Akata, Ertugrul Kaya

Case Series

California Sea Lion (Zalophus californianus) and Harbor Seal (Phoca vitulina richardii) Bites and Contact Abrasions in Open-Water Swimmers: A Series of 11 Cases
Thomas J. Nuckton, Claire A. Simeone, Roger T. Phelps

Brief Reports

A Novel Method to Decontaminate Surgical Instruments for Operational and Austere Environments
Randy W. Knox, Samandra T. Demons, Cord W. Cunningham

The Impact of Freeze-Thaw Cycles on Epinephrine
Heather Beasley, Pearlly Ng, Albert Wheeler, William R. Smith, Scott E. McIntosh

The Effects of Sympathetic Inhibition on Metabolic and Cardiopulmonary Responses to Exercise in Hypoxic Conditions
Rebecca L. Scalzo, Garrett L. Peltonen, Scott E. Binns, Anna L. Klochak, Steve E. Szallar, Lacey M. Wood, Dennis G. Larson, Gary J. Luckasen, David Irwin, Thies Schroeder, Karyn L. Hamilton, Christopher Bell

Prolonged Exposure Dermatosis: Reporting High Incidence of an Undiagnosed Facial Dermatosis on a Winter Wilderness Expedition
Jodie E. Totten, Douglas M. Brock, Tod D. Schimelpfenig, Justin L. Hopkin, Roy M. Colven

Emergency Medical Service in the US National Park Service: A Characterization and Two-Year Review, 2012–2013
Jeffrey P. Lane, Bonnaleigh Taylor, William R. Smith, Albert R. Wheeler

Epidemiological Trends in Search and Rescue Incidents Documented by the Alpine Club of Canada From 1970 to 2005
Gwynn M. Curran-Sills, Amalia Karahalios

Civilian Helicopter Search and Rescue Accidents in the United States: 1980 Through 2013
Gordon H. Worley

Epidemiology of Search and Rescue in Baxter State Park: Dangers of Descent and Fatigue
Chris R. Welter, J. Matthew Sholl, Tania D. Strout, Ben Woodard

Review Article

Lyme Disease: What the Wilderness Provider Needs to Know
Joseph D. Forrester, J. Priyanka Vakkalanka, Christopher P. Holstege, Paul S. Mead

Clinical Images

An Elderly Man from Solukhumbu, Nepal, with a Rash
Nishant Raj Pandey, Abhijit Adhikary, Sanjaya Karki

Lessons from History

Coca: High Altitude Remedy of the Ancient Incas
Amy Sue Biondich, Jeremy D. Joslin

Letters to the Editor

In Response to How Not To Train Your Dragon: A Case of Komodo Dragon Bite, by Borek and Charlton
Scott A. Weinstein, Julian White

In Reply to Drs Weinstein and White
Heather A. Borek, Nathan P. Charlton

The UPLOADS Project: Development of an Australian National Incident Dataset for Led Outdoor Activities
Natassia Goode, Paul M. Salmon, Michael G. Lenné, Caroline F. Finch

Race Medicine: A Novel Educational Experience for GME Learners
Jeremy Joslin, Joshua Mularella, Susan Schreffler, William F Paolo

Wilderness Medicine Curricular Content in Emergency Medicine Residency Programs
Elizabeth J. Aronstam, Mark L. Christensen, Michael P. Williams, David T. Overton

A Rare Case of Vaginal Bleeding in a Child Due to a Leech Bite and Review of the Literature
Anuruddha H. Karunaratne, Buddhika T.B. Wijerathne, Ravihar S. Wickramasinghe, Anura K. Wijesinghe, Aloka S.D. Liyanage

First Record of an Unusual Incident Between a Finfish—the White Snake Mackerel Thyrsitops lepidopoides (Teleostei, Gempylidae)—and a Surfer
Acacio R.G. Tomas

In Response to Snakebite Rebound Coagulopathy by Witham et al.
Michael E. Mullins, Anah J. Ali

In Reply to Drs Mullins and Ali
William R. Witham

Brown Bear Attacks in a Nepalese Scenario: A Brief Review
Alok Atreya, Tanuj Kanchan, Samata Nepal, Jenash Acharya

In Response to Ultraendurance Athletes With Type 1 Diabetes: Leadville 100 Experience, by Khodaee et al
Harvey V. Lankford

In Reply to Dr Lankford
Morteza Khodaee, Mark Riederer, Karin VanBaak, John C. Hill

Wilderness Images

Thevetia peruviana
GN Pramod Kumar, Alok Atreya, Tanuj Kanchan


Reliance on Technology Among Climbers on Mount Rainier
David C. Hile, Jessica J. Walrath, Aaron S. Birch, Lisa M. Hile

Altitude Illness on Mt. Rainier—Incidence and Climbers’ Cognizance
Lisa M. Hile, Aaron S. Birch, Jessica J. Walrath, David C. Hile

Civilian Helicopter Search and Rescue Accidents in the United States: 1980 Through 2013
Gordon H. Worley

Impact of Previous Concussion on Helmet Use and Risk Compensation
Alison D. Taylor, Megan L. Fix, Jeremy L. Davis, Stuart E. Willick, Graham E. Wagner

Epidemiology of the Pennsic Wars 2007–2013: A Medieval Mass Gathering Event
Philip S. Nawrocki, Peter Roolf, Morgan Garvin, John O’Neill

Bridging the Gap: Introducing Undergraduate Students to Wilderness and Emergency Medicine
Katie E. Joy,, Elaine M. Reno, Bonnie Kaplan, Todd Miner, Jay M. Lemery

The Effect of Helmet Cameras on Risk-Taking Behavior Among Mountain Bikers
Lauren M. Cantwell, Meredith Ray, Timothy J. Fortuna

The Influence of Hydration on Thermoregulation During a 161-km Ultramarathon
Taylor R. Valentino, Kristin J. Stuempfle, Marialice Kern, Martin D. Hoffman

Weight Change and Hydration Status During a 161-km Ultramarathon
Karin D. Van, Jack Spittler, Bjorn Irion, Martin D. Hoffman, Morteza Khodaee

Hydration Guidelines During Exercise: What Message Is the Public Receiving?
R. Tyler Hamilton, Theodore L. Bross, Martin D. Hoffman

Food and Fluid Intake During Extreme Heat: Experiences From The Badwater Ultramarathon
Jacqueline S. Brown, Declan Connolly

Body Mass Changes and Fluid Consumption During an 80.5-km Treadmill Time Trial
Hannah J. Moir, Christopher C.F. Howe

Energy Cost of Running During a Bout of 80.5-km Treadmill Running
Christopher C.F. Howe, Hannah J. Moir

In-task Assessment of Psychological Changes During an Ultramarathon Race
Dolores A. Christensen, Britton W. Brewer, Jasmin C. Hutchinson

Would You Stop Running if You Knew It Was Bad for You? The Ultramarathon Runner Response
Martin D. Hoffman

The Development and Initial Assessment of a Novel Heart Rate Training Formula
Tracy B. Høeg, Phil Maffetone

Medical Care and Runner Characteristics at a 161-km High Altitude Ultraendurance Run in Colorado, 2014
G. Clover, Laura Pyle, Leo Lloyd

Utility of Urine Dipstick for Detecting Runners With Acute Kidney Injury Following a 161-km Ultramarathon
Morteza Khodaee, Bjørn Irion, Jack Spittler, Martin D. Hoffman

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New Wilderness Medical Society Practice Guidelines: If you are an outdoor provider, these are you first aid standards of care.

No matter what you think or what you have been told, these are how you will be judged based on your training

The Wilderness Medical Society has published updated and new Practice Guidelines for Wilderness Emergency Care. Those guidelines cover:

·         Use of epinephrine in Outdoor Education and Wilderness Settings: 2014 Update

·         Treatment of Eye Injuries and Illnesses in the Wilderness

·         Treatment of Exercise-Associated Hyponatremia

·         Prevention and Treatment of Frostbite

·         Prevention and Treatment of Heat-Related Illness

·         Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia

·         Prevention and Treatment of Lightning Injuries

·         Treatment of Acute Pain in Remote Environments

·         Spine Immobilization in the Austere Environment

·         Basic Wound Management in the Austere Environment

As well as understanding the new guidelines, make sure you understand the conditions under which the guidelines should be used.

You can access these guidelines by joining the Wilderness Medical Society here: Join Wilderness Medical Society.

If you work in the outdoors and want to provide first aid care to your fellow workers, clients, participants and friends you should understand these new guidelines.

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The Wilderness Medical Society has issued new practice guidelines for Treatment of Exercise-Associated Hyponatremia and Spine Immobilization in the Austere Environment


The Wilderness Medical Society has issued new practice guidelines for Treatment of Exercise-Associated Hyponatremia and Spine Immobilization in the Austere Environment

If you have medical protocols (and why would you?) they just WMS Poster 1changed. If you run wilderness programs, a new guideline that you will be judged against has been created.

The Wilderness Medicine Society is the organization for writing guidelines for outdoor recreation and SAR community, besides being a great organization for meeting the experts in the field of wilderness medicine. If you are involved in the outdoors you should be a member! Join today.

The Wilderness Medicine Society is the First Aid Organization

The new guidelines have been developed over years of research by experts in the field. These experts include both the SAR personnel who find people and the physicians who treat the injured victims once they arrive at a hospital.

Join today and find out what these new guidelines are and how to implement them in your program.

More Recreation Law Legal Articles:WMS Poster 2

10 First Aid Myths                                                                                          

Another Way to Teach CPR                                                                        

CPR is not fool proof                                                                                     

Everyone should write first aid protocols…. Or you could just buy a first aid book!

First Aid has its Limits. By law!                                                                    

Letter to the Editor: Wilderness and Environmental Medicine              

Not a final decision, but I believe an indication of where the law of AED’s is heading however the basis for WMS Poster 3the decision is nuts!                                                                                

Seriously, you have to send a memo about this, the issue is not what they are doing, it is who you are allowing to instruct.                                                                                       

Stopping a rescue when someone is willing to perform may create liability


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Environmental Change & Human Health



wms_logo.jpgOUR PATIENTS – OUR PLANETEnvironmental Change & Human Health

October 30 – November 3, 2013

Dauphin Island Sea Lab, Alabama

I don’t think it is a surprise to anyone that we are undergoing a period of intense discussions and even debate about environmental change. I think we all agree that something is happening whether it’s global warming…the migration of hazardous insect species northward…the release of environmental toxins, it’s important for physicians to know what these sorts of events are going to do to our planet and then the impact they’re going to have on human health….
-Paul S. Auerbach, MD, Co-Founder, Wilderness Medical Societyoilspillaerialvisit.JPGOne of the greatest challenges of our time is to address environmental changes that may harm human health. Some of these environmental changes like water and wastewater treatment have had a positive impact; however, others such as air pollution, toxic chemicals, loss of biodiversity and climate change have been detrimental to human health. Our health and the environment will forever be inseparable.This stand-alone conference presented by the Wilderness Medical Society is designed for health care providers to learn how changes in the environment affect the medical conditions of their patients and how to be more engaged at working on solutions.

water%20testing.jpgThe conference will be held at the Dauphin Island Sea Lab near Mobile, Alabama. Our expert faculty comes from many disciplines – medicine, science, law, green consulting and education – presenting on topical issues such as health impacts of climate change, air pollution, toxins, endocrine disrupters and the education of physicians in the future.

Please join us this fall for the Wilderness Medical Society’s first conference about the Environment & Human Health on the Alabama Gulf Shore. Details and registration are available at

We invite you to view a short video about this exciting event in wilderness medicine magazine or at!

Check out all the great articles at Wilderness Medicine Magazine!

Wilderness Medical Society | 2150 S 1300 E | Suite 500 | Salt Lake City | UT | 84106

Wilderness Medical Society 2013 CME Conferences


wms_logo.jpgContinuing Medical Education Conferences

Leading the Worldwide Community of Wilderness Medicine

Dear James,We hope to see you at one of our upcoming CME conferences!


30th Anniversary Conference and Annual Meeting

July 12-17, 2013
Breckenridge, Colorado


The ALL NEW Wilderness Medicine Magazine


Dear James,Launch2.png is the new repository of the best writing, graphics and audiovisual pieces available in wilderness medicine today. Embracing modern web technology, we will continuously bring you a dynamic, multimedia experience.

More content, more authors and more technologies, including abundant hyperlinks, videos, graphics and content-rich material make this site the go-to location for entertaining, interesting and cutting edge information.

As it is a constantly evolving web-based magazine, we suggest you check the site often for new articles and announcements.
Subscription tools are being developed that will allow you to be notified when new content of interest is posted. We are open to your suggestions for ways it can be even more functional and useful for you. Also please don’t hesitate to contact us if you’d like to contribute content. You can email the Executive Editor Seth Hawkins directly or refer to the “Submission Guidelines” link on the site.

Thanks for your support from the entire Magazine Committee of the Wilderness Medical Society.

Jonna Barry, Editorial Director

Seth C. Hawkins, MD, FAWM, Executive Editor
Debra Stoner, MD, FAWM, Senior Editor
Nancy Pietroski, PharmD, Associate Editor
Sam Schimelpfenig, MD, Associate Editor
Larry E. Johnson, MD, Assistant Editor

Jim Ingwersen, Web Developer

Visit Wilderness Medicine Magazine NOW!