Wilderness & Environmental Medicine最新文献

Fatality Following Gila Monster Envenomation. 吉拉怪物中毒后的死亡。

IF 1.1 4区医学

Wilderness & Environmental Medicine Pub Date : 2026-05-08 DOI: 10.1177/10806032261447178

Danae Massengill, Karen Muschler, Andrea Lielkoks, Cara F Smith, Anthony J Saviola, Samuel Kerwin, Farshad Shirazi, Stephen P Mackessy, Nicklaus Brandehoff

引用次数: 0

Sport-Specific Expertise Drives Provider Choice Among Injured Rock Climbers. 运动专业知识推动受伤攀岩者选择供应商。

IF 1.1 4区医学

Wilderness & Environmental Medicine Pub Date : 2026-05-08 DOI: 10.1177/10806032261447193

Daniel C Santana, Taylor Rakauskas, Jack Kornfeld, Zachary C Lum

{"title":"Sport-Specific Expertise Drives Provider Choice Among Injured Rock Climbers.","authors":"Daniel C Santana, Taylor Rakauskas, Jack Kornfeld, Zachary C Lum","doi":"10.1177/10806032261447193","DOIUrl":"https://doi.org/10.1177/10806032261447193","url":null,"abstract":"IntroductionMusculoskeletal injuries from rock climbing are increasing as participation rates rise. It is important to understand climbers' injury treatment decisions and trust in providers to improve communication, education, and care pathways. The purpose of this study was to examine healthcare-seeking behaviors and healthcare-provider trust among rock climbers following injury.MethodsA cross-sectional survey was distributed online via social media, email, and flyers. In total, 145 rock climbers who sustained a climbing-related musculoskeletal injury completed the survey. Outcomes included type of provider seen, reasons for provider choice or delay in care, and ratings of trust and satisfaction. Free-text comments were analyzed for themes.ResultsClimbers commonly sought care from physical or occupational therapists (PT/OTs; 31.7%), followed by specialists (24.1%) and primary care providers (PCPs; 16.6%, P<0.001). PT/OTs were more likely to be accessed virtually and through peer recommendation, whereas PCP visits often were assigned by the health system. Delays in care were common (68.3%) and attributed to cost, time constraints, and confidence in self-treatment. Pulley injuries were associated with delayed care and reliance on self-treatment. Trust/satisfaction ratings were highest for PT/OTs (median trust 9, satisfaction 9) and specialists (trust 9, satisfaction 8) compared with PCPs (trust 6, satisfaction 6; P=0.02 and P=0.002, respectively). Free-text responses emphasized the importance of climbing-specific expertise and individualized treatment plans.ConclusionsTrust and satisfaction with healthcare providers vary based on sport-specific knowledge and treatment recommendations. Delayed care and self-management are common, especially for finger injuries. PT/OTs often serve as both initial and final providers.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032261447193"},"PeriodicalIF":1.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Spaceflight and Fractures: 5-Year-Fracture Incidence Upon Return From Spaceflight. 太空飞行与骨折：5年内从太空飞行返回后的骨折发生率。

IF 1.1 4区医学

Wilderness & Environmental Medicine Pub Date : 2026-05-07 DOI: 10.1177/10806032261446640

Benjamin Fiedler, Nathaniel Grey Loyd, Joshua Morrow, Nick Cione, Abdullah Ghali, Brenden Ronna, Adil Shahzad Ahmed

{"title":"Spaceflight and Fractures: 5-Year-Fracture Incidence Upon Return From Spaceflight.","authors":"Benjamin Fiedler, Nathaniel Grey Loyd, Joshua Morrow, Nick Cione, Abdullah Ghali, Brenden Ronna, Adil Shahzad Ahmed","doi":"10.1177/10806032261446640","DOIUrl":"https://doi.org/10.1177/10806032261446640","url":null,"abstract":"IntroductionExposure to spaceflight and microgravity environments has been implicated in large reductions in astronaut bone mineral density (BMD). While low BMD is a known risk factor for fracture, there have been no reported cases of in-flight fracture, and very little documentation of post-flight fracture. The present study sought to review the incidence of fractures within 5 years of return to spaceflight.MethodsUsing NASA's Lifetime Surveillance of Astronaut Health epidemiology database, a retrospective cohort study was conducted to identify the incidence of fracture in the 5-year post-flight period. All astronauts who participated in spaceflight with 5-year post-flight medical data were included. Demographics were compared between the fracture and nonfracture cohorts.ResultsOf the 242 astronauts who met the inclusion criteria, 7 (2.9%) sustained fractures within 5 years post-flight. Three post-flight fractures occurred in the hip or spine. Six of the 7 fractures occurred within 2 years of return from spaceflight. Spaceflight length, age, and time from spaceflight were not statistically significantly associated with increased risk of fracture.ConclusionFracture upon return to the gravitational environment is a serious risk for astronauts that can significantly jeopardize astronaut health and mission success. Fractures of the hip and spine, specifically, are associated with decreased BMD. While the incidence of these fractures is roughly 1%, the negative implications, including high 1-year mortality rates and functional implications, emphasize the need to optimize bone health and fracture treatment protocols.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032261446640"},"PeriodicalIF":1.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Bite by a Beaded Lizard, Heloderma spp. (Helodermatidae), Resulting in Local Envenomation and Boutonnière Deformity. 被刺蜥科刺蜥咬伤，导致局部中毒和胸孔发育畸形。

IF 1.1 4区医学

Wilderness & Environmental Medicine Pub Date : 2026-05-07 DOI: 10.1177/10806032261446175

Ping Wu, Oi Fung Wong, Hiu Mei Wan, Hin Tat Fung

{"title":"A Bite by a Beaded Lizard, Heloderma spp. (Helodermatidae), Resulting in Local Envenomation and Boutonnière Deformity.","authors":"Ping Wu, Oi Fung Wong, Hiu Mei Wan, Hin Tat Fung","doi":"10.1177/10806032261446175","DOIUrl":"https://doi.org/10.1177/10806032261446175","url":null,"abstract":"Beaded lizards (Heloderma spp) are venomous lizards capable of inflicting local and systemic envenoming. An exotic pet collector presented with a reportedly prolonged bite by a presumed Guatemalan beaded lizard (Heloderma charlesbogerti). He reported immediate symptoms of envenoming, including severe pain, paresthesia, local swelling, dizziness, and nausea. Follow-up assessments conducted over a period of up to 4 y revealed a persistent boutonnière deformity of the right middle finger. This case report describes envenomation caused by the uncommonly documented bite of a beaded lizard (Heloderma spp) that was presumed by the patient to be the rare Guatemalan beaded lizard (H charlesbogerti). It illustrates the risks of long-term sequelae that may result from noncompliance with treatment after a helodermatid bite and also reemphasizes concerns about the underground sale of rare, endangered wildlife. Beaded lizard bites can inflict severe local envenomation and potentially cause permanent hand deformities. Proper referral and follow-up are essential to prevent long-term sequelae.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032261446175"},"PeriodicalIF":1.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Technical and Medical Challenges in the Mountain Rescue of a Fatally Injured BASE Jumper: A Case Report. 技术和医疗挑战在山区救援一个致命受伤的定点跳伞者：一个案例报告。

IF 1.1 4区医学

Wilderness & Environmental Medicine Pub Date : 2026-05-07 DOI: 10.1177/10806032261446176

Lars Flatø Nessa, Håvard Mattingsdal, Dordi Lea, Bjørn Malcolm Evensen Jacques, Steinar Kragset, Jon Kristian Narvestad

{"title":"Technical and Medical Challenges in the Mountain Rescue of a Fatally Injured BASE Jumper: A Case Report.","authors":"Lars Flatø Nessa, Håvard Mattingsdal, Dordi Lea, Bjørn Malcolm Evensen Jacques, Steinar Kragset, Jon Kristian Narvestad","doi":"10.1177/10806032261446176","DOIUrl":"https://doi.org/10.1177/10806032261446176","url":null,"abstract":"BASE jumping accidents at Kjerag, a 984-m vertical cliff in Norway, occur on an annual basis and can necessitate complex rescue operations involving coordinated efforts between helicopters and alpine rescue teams. Each operation poses distinct logistical, technical, and medical challenges. This case report aims to contribute to collective learning and continuous quality improvement in the management of such high-risk rescue missions. In the spring of 2025, a wingsuit BASE jumper sustained multiple impacts against the cliff face and was stranded two thirds of the way down the wall, suspended by the deployed parachute. A multiagency operation was initiated involving 2 helicopters and a volunteer alpine rescue team. Direct helicopter extraction was deemed unsafe due to the risk of rotor downwash causing unintentional reinflation of the parachute. The rescue operation was conducted through coordinated efforts between helicopter units and an alpine rescue team. Rescue climbers were inserted above the patient and were lowered 220 m to access the site. Twenty minutes after the rescuers arrived on scene, the patient went into cardiac arrest due to bleeding and hypovolemic shock, ∼3 h and 40 min after the accident occurred. This case represents the fastest documented alpine rescue at Kjerag to date and emphasizes that time remained the critical factor that could have altered the patient`s outcome. Potential areas for improvement include the implementation of longer and thinner ropes, optimized helicopter rescue methods such as an extended hoist with a rescuer, and on-scene blood transfusion with hemorrhage control in time-critical patients.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032261446176"},"PeriodicalIF":1.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Incidence and Epidemiologic Profile of Time-Sensitive Conditions Requiring Aeromedical Evacuation in the Isolated Areas of Chilean Patagonia. 智利巴塔哥尼亚偏远地区需要航空医疗后送的时效性疾病的发病率和流行病学概况。

IF 1.1 4区医学

Wilderness & Environmental Medicine Pub Date : 2026-05-06 DOI: 10.1177/10806032261448154

Pedro Arcos González, Marcos Saldivia González, José Antonio Cernuda Martínez

{"title":"Incidence and Epidemiologic Profile of Time-Sensitive Conditions Requiring Aeromedical Evacuation in the Isolated Areas of Chilean Patagonia.","authors":"Pedro Arcos González, Marcos Saldivia González, José Antonio Cernuda Martínez","doi":"10.1177/10806032261448154","DOIUrl":"https://doi.org/10.1177/10806032261448154","url":null,"abstract":"IntroductionChilean Patagonia faces major challenges due to geographic isolation and harsh climate, which limit access to emergency healthcare and result in a heavy reliance on air transport. We aimed to quantify the demand for healthcare and describe the epidemiologic profile of acute, time-sensitive conditions requiring aeromedical evacuation in the Los Lagos and Aysén regions.MethodsThis was a descriptive observational study analyzing aeromedical evacuations to higher levels of care during the 2022-24 period. We included trauma, myocardial infarction, stroke, respiratory failure, obstetric emergencies, psychiatric emergencies, and other clinical conditions. Data from the Emergency Medical Care System of Los Lagos and the Aysén Health Service were analyzed using descriptive statistics and χ2 tests to compare population-adjusted transfer incidences.ResultsWe analyzed 2415 evacuations (57% in Aysén, 43% in Los Lagos). The transfer incidence in Aysén was nearly 12 times higher than in Los Lagos. Severe trauma was the most common cause (15%), followed by acute abdomen (10%) and respiratory diseases (9%). Significant regional differences were found in Aysén, where trauma and respiratory conditions predominated, whereas in Los Lagos, trauma and acute abdomen were most frequent. Older adults in Aysén had the highest incidences per 100,000 inhabitants.ConclusionsRegional disparities in evacuation rates reveal profound territorial inequalities and logistical barriers. Addressing these systemic failures requires the decentralization of advanced diagnostic tools and the establishment of dedicated aeromedical crews stationed within isolated regions to ensure health equity in Chilean Patagonia.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032261448154"},"PeriodicalIF":1.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Addressing Obstacles to Wilderness Medicine Education for the Preclinical Medical Student. 探讨临床前医科学生野外医学教育的障碍。

IF 1.1 4区医学

Wilderness & Environmental Medicine Pub Date : 2026-05-05 DOI: 10.1177/10806032261445064

Adam D Hill, Kaitlyn Votta

引用次数: 0

3-10 OK. 3 - 10好。

IF 1.1 4区医学

Wilderness & Environmental Medicine Pub Date : 2026-04-29 DOI: 10.1177/10806032261444349

Kenneth V Iserson

引用次数: 0

Clinical Features and Antivenom Usage in Northern Cottonmouth (Agkistrodon piscivorus) Envenomations in Texas. 德克萨斯州北水腹蛇（Agkistrodon piscivorus）中毒的临床特征和抗蛇毒血清的使用。

IF 1.1 4区医学

Wilderness & Environmental Medicine Pub Date : 2026-04-29 DOI: 10.1177/10806032261445074

Spencer Greene, Chelsea R Caplan, George Warpinski, Rachel Culbreth, Sharan Campleman

{"title":"Clinical Features and Antivenom Usage in Northern Cottonmouth (Agkistrodon piscivorus) Envenomations in Texas.","authors":"Spencer Greene, Chelsea R Caplan, George Warpinski, Rachel Culbreth, Sharan Campleman","doi":"10.1177/10806032261445074","DOIUrl":"https://doi.org/10.1177/10806032261445074","url":null,"abstract":"IntroductionCottonmouths, also known as water moccasins, are responsible for <10% of the ∼5000 snakebites reported to America's Poison Centers annually. Envenomations are characterized primarily by local findings. Gastrointestinal signs and hematologic abnormalities have been reported. There are currently 2 antivenoms that are approved by the Food and Drug Administration for the treatment of cottonmouth envenomations. The purpose of this study was to describe the clinical features and antivenom use in the treatment of Northern Cottonmouth envenomations in Texas that were reported to the North American Snakebite Registry.MethodsWe reviewed cottonmouth bites reported between January 1, 2013, and December 31, 2024. Data regarding the circumstances, patient demographics, clinical features, treatment, and outcomes were reviewed.ResultsSixty patients, with a mean patient age of 26 y, were included. Females accounted for 20 cases (33.3%). Lower extremity bites accounted for 35 cases (58.3%). Swelling was observed in 56 cases (93.3%). Emesis was reported in 10 cases (16.7%). Two patients (3.3%) experienced diarrhea. Hematologic laboratory abnormalities were present in 10 patients (16.7%). Antivenom was administered in 47 cases (78.3%), including 22 pediatric patients (84.6%). Three patients (6.4%) who received antivenom experienced minor acute hypersensitivity reactions.ConclusionsCottonmouth envenomations are characterized primarily by local tissue injury. Gastrointestinal signs and hematologic toxicity are observed less commonly. Antivenom is often administered for cottonmouth bites and is associated with a low incidence of acute hypersensitivity reactions. There is a trend toward treating pediatric patients more aggressively.","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032261445074"},"PeriodicalIF":1.1,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Nursing on the Edge: Educating Independent and Resilient Post-Master of Science in Nursing Doctor of Nursing Practice Nurses for Extreme Environments. 边缘护理：培养独立和有弹性的护理学硕士后护理实践博士护士极端环境。

IF 1.1 4区医学

Wilderness & Environmental Medicine Pub Date : 2026-04-24 DOI: 10.1177/10806032261441253

Glenn A Barnes, Leann Horsley, Lisa Haddad

{"title":"Nursing on the Edge: Educating Independent and Resilient Post-Master of Science in Nursing Doctor of Nursing Practice Nurses for Extreme Environments.","authors":"Glenn A Barnes, Leann Horsley, Lisa Haddad","doi":"10.1177/10806032261441253","DOIUrl":"https://doi.org/10.1177/10806032261441253","url":null,"abstract":"BackgroundAs human activity expands into remote, extreme, and extraterrestrial environments, the role of nursing must evolve accordingly. Traditional nursing education rarely prepares nurses to function autonomously in settings where infrastructure, support, and resources are minimal or absent. PurposeThe aim of this study was to present a conceptual framework and methodologic approach for educating nurses to operate competently and confidently in Earth's most remote regions, space, and extreme environments.  MethodsA multistep curriculum development process is described that includes a needs assessment, recruitment of subject matter experts, faculty development, and train-the-trainer strategies. Deliberate faculty training, hands-on experiential learning, and competency validation are integrated into a Doctor of Nursing Practice program filled with immersive simulation and field exercises, competency checkoffs, and program-evaluation metrics. ResultsExpected outcomes include measurable gains in self-efficacy, simulation performance, skills mastery, and postgraduation deployment in remote/space operating settings. ConclusionThis model offers a path for graduate nursing education to prepare professionals for frontiers beyond hospital walls. Establishing outcome metrics and iteratively refining training will validate success and guide future expansion. .","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032261441253"},"PeriodicalIF":1.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0