Wilderness & Environmental Medicine最新文献

{"title":"Medicine in the Final Frontier.","authors":"Erik Antonsen, Jennifer Fogarty, Anil Menon, N Stuart Harris","doi":"10.1177/10806032251338923","DOIUrl":"10.1177/10806032251338923","url":null,"abstract":"","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"1S-2S"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286974","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}

{"title":"Far from Home: Heat-Illness Prevention and Treatment in Austere Environments.","authors":"David W DeGroot, Brent Ruby, Alex Koo, Francis G O'Connor","doi":"10.1177/10806032251332283","DOIUrl":"10.1177/10806032251332283","url":null,"abstract":"<p><p>Austere environments present unique challenges concerning the prevention and treatment of exertional heat-illness patients that may greatly increase the risks of morbidity and mortality. For athletes, occupational groups, and others who may work, train, or compete in austere environments, proper preparation and planning may be lifesaving. The roles of acclimatization and hydration are often emphasized in the literature, but other important risk factors may be overlooked. Work capacity, especially aerobic work capacity, will always be reduced in hot environments, and individuals should understand that simply slowing down, to reduce metabolic heat production, can be considered the universal precaution to mitigate heat stress and strain. Conversely, appropriate rehydration alone does not mitigate other risk factors, such as metabolic heat production, high ambient temperature, or inadequate physical fitness. Risk factor-specific mitigation recommendations are provided, and areas where additional research is needed are identified. The ability to recognize the signs and symptoms of heat illness early in the progression of illness is especially important in austere environments due to the possibility of delayed access to higher levels of medical care. Treatment considerations in austere environments include knowledge of availability and effectiveness of cooling modalities such as natural bodies of water. Medications such as antipyretics, dantrolene, and nonsteroidal anti-inflammatory drugs are not recommended to treat a suspected heat casualty. Aggressive cooling, with the objective of reducing core temperature to <39°C within 30-min, is the treatment priority.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"397-404"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062941","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}

{"title":"Climber Mortality on Mount Aconcagua, 2013-2024.","authors":"Aaron Brillhart, Bernabé Abramor, Rodrigo Duplessis, Roxana Pronce, Javier Seufferheld, Scott McIntosh","doi":"10.1177/10806032251330534","DOIUrl":"10.1177/10806032251330534","url":null,"abstract":"<p><p>IntroductionMount Aconcagua (6961 m) is the highest peak in the Americas, and thousands of climbers attempt to climb it annually. This study aimed to characterize recent climber mortality on Aconcagua to aid in future safety efforts.MethodsClimber fatalities from Aconcagua for the 10 most recent climbing seasons (2013-2024) were retrospectively reviewed.ResultsOver the study period, 21 of 29,397 climbers died, yielding a fatality rate of 0.071% (0.71 per 1000). Most fatalities occurred at over 6000 m (90%) and were of unspecified medical cause (71%). Trauma represented 19% of deaths. Climbers older than 50 y were more than 5 times more likely to die on Aconcagua than those younger than 50 y (odds ratio = 5.11). Climbers from the United States were found to have a higher incidence of fatality (odds ratio = 2.56). Compared with 2001-2012, fatalities from 2013-2024 occurred with similar incidence overall but more frequently at elevations over 6000 m, and victims were older and more frequently from North America.ConclusionsDespite the fatality rate on Aconcagua remaining unchanged at 0.071% during 2013-2024, the percentages of deaths at over 6000 m and from medical causes increased from a prior study. Climbers older than 50 y and climbers from the United States were found to be at higher risk of death on Aconcagua. This information can provide a basis for education to reduce future mortality.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"335-341"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018356","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}

{"title":"Polar Life Pod Cooling Efficacy When Small Volumes of Water are Available to Treat Exercise-Induced Hyperthermia.","authors":"Kevin C Miller","doi":"10.1177/10806032251332282","DOIUrl":"10.1177/10806032251332282","url":null,"abstract":"<p><p>IntroductionCold-water immersion is the standard of care for treating exertional heatstroke (EHS). The Polar Life Pod (PLP; Polar Products Inc, Stow, OH), a body-bag-like device, is a novel, portable cold-water immersion device with excellent cooling rates (>0.18°C·min^-1) when 151 to 208 L of water are used to treat hyperthermia. Unfortunately, these water volumes are not always available to treat EHS (eg, wilderness firefighting). Little research has examined whether the PLP with small water volumes meets expert recommendations for acceptable (ie, 0.08-0.15°C·min^-1) or ideal cooling rates (ie, >0.16°C·min^-1).MethodsThirty-two subjects (20 males and 12 females aged 21±2 y with a mass of 72.2±11.0 kg and a height of 170.4±7.2 cm) were assigned to 1 of 4 groups in this matched-pairs laboratory study. Participants wore a uniform and 9.5-kg rucksack and marched in the heat (wet-bulb globe temperature=26.1±0.1°C) until their rectal temperature (<i>T</i>_REC) was 39.5°C. Then they removed the uniform and sat in the heat (0 L) or lay in a PLP filled with 19, 38, or 76 L of ∼8°C water until <i>T</i>_REC was 38°C.ResultsBy design, all groups had comparable physical characteristics: body fat percentage (<i>P</i>=0.39), lean body mass (<i>P</i>=0.86), fat mass (<i>P</i>=0.13), body surface area (<i>P</i>=0.36), body surface area-lean body mass ratio (<i>P</i>=0.98), and body mass index (<i>P</i>=0.63). Subjects exercised for similar durations (<i>P</i>=0.66), and pre-immersion water temperatures were consistent between groups (<i>P</i>>0.05). <i>T</i>_REC cooling rates differed (0 L=0.03±0.01°C·min^-1, 19 L=0.13±0.08°C·min^-1, 38 L=0.10±0.03°C·min^-1, and 76 L=0.17±0.09°C·min^-1; <i>P</i>=0.002). No cooling-rate differences occurred between 19, 38, and 76 L (<i>P</i><0.05).ConclusionPLP with 76 L met expert recommendations for ideal cooling rates; 19 and 38 L demonstrated acceptable cooling rates. PLP may help save lives from EHS when water access is limited.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"342-351"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048942","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}

{"title":"Smoke Exposure and Respirator Use Among Wildland Firefighters: A Narrative Review.","authors":"Arielle A Filiberti, Sarah C Davis, Susanne J Spano","doi":"10.1177/10806032251326825","DOIUrl":"10.1177/10806032251326825","url":null,"abstract":"<p><p>Climate change contributes to warm, dry conditions, which leads to longer and more active fire seasons. Wildland firefighters work long hours in smoky conditions without regulations requiring respiratory protection. Wildfire smoke has many toxic components, including high levels of fine particulate matter (PM_2.5). Regular monitoring for short- and long-term health outcomes in wildland firefighter populations is uncommon. However, extrapolating from knowledge about the individual components of smoke, it is likely that the firefighters' health is negatively affected. Firefighters are routinely exposed to dangerous levels of smoke, which may lead to both acute and chronic health consequences. Current guidelines from Occupational Safety and Health Administration (OSHA), the U.S. Forest Service (USFS), and the Interagency Standards for Fire and Fire Aviation Operations do not recommend respirator use for wildland firefighters. The methodologies used to quantify exposure and harm likely underestimate actual risks. Although there are no respirators that can filter all known harmful components of wildfire smoke, this review examines the potential benefit of respirator use by reducing some of the most harmful components of the smoke. Smoke exposure among wildland firefighters needs to be further characterized and quantified. Regulations should be reassessed to accurately reflect the exposure and potential harm that firefighters face. This narrative review gathers information from peer-reviewed scientific literature, government publications, news articles, and personal conversations with both public- and private-sector professionals. The objectives are to describe the likely health effects of wildland firefighting, evaluate the evidence behind current respiratory protection guidelines, and propose potential solutions.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"405-415"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055686","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}

{"title":"A Historical Review of Military Support for Space Capsule Rescue and Recovery Operations.","authors":"Prasanna Kumar, Kristin Silvia, Brent Maney, Mark F Brady","doi":"10.1177/10806032251322479","DOIUrl":"10.1177/10806032251322479","url":null,"abstract":"<p><p>The Department of Defense has a long history of supporting the National Aeronautics and Space Administration's (NASA) crewed missions to space. This includes the recently launched Artemis I, part of the mission that intends to send humans back to the Moon after more than 50 years. Rescue and recovery of astronauts upon splashing down at sea present logistical challenges and may exacerbate specific health concerns related to space travel and extended time spent in microgravity environments. In this article, we explore the evolution of the collaboration between the Department of Defense and NASA, and we describe the role of the US military in supporting NASA as it seeks to send humans to the Moon and beyond.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"172S-181S"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732761","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}

{"title":"Comparison of Camera-Acquired Vital Signs to Conventional Vital Signs in a Space-Analog Environment.","authors":"Carlo A Canepa, Dana R Levin, Amit S Padaki","doi":"10.1177/10806032241291994","DOIUrl":"10.1177/10806032241291994","url":null,"abstract":"<p><p>IntroductionVital sign acquisition is a key component of modern medical care. In wilderness and space medical settings, vital sign acquisition can be a difficult process because of limitations on available personnel or lack of access to the patient. Camera-acquired vital signs could address each of these difficulties.MethodsHealthy volunteers used software designed by Presage Technologies to acquire heart rate and respiratory rate at the HI-SEAS space-analog site in Mauna Loa, Hawai'i. Camera-acquired vital signs were compared to more conventionally acquired vital signs.ResultsCamera-acquired heart rate showed high correlation to conventionally acquired heart rate (R ∼ 0.95). Camera-acquired respiratory rate showed moderate correlation (R ∼ 0.65).ConclusionsThese results show that camera acquisition of vital signs is theoretically feasible in wilderness and space-analog environments. HR may be highly accurate even using current technology. Additional studies will be needed to further validate other types of camera sensors and other potential environments such as partial gravity and microgravity.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"77S-80S"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631351","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}

{"title":"Development of Progressively Earth-Independent Medical Operations to Enable NASA Exploration Missions.","authors":"Arian Anderson, Emily Stratton, Ariana Nelson, Jay Lemery, Kurt Berens, David Hilmers, Kris Lehnhardt","doi":"10.1177/10806032241310386","DOIUrl":"10.1177/10806032241310386","url":null,"abstract":"<p><p><b>Introduction</b> -The National Aeronautics and Space Administration's (NASA's) transition from operations in low-Earth orbit to long-duration missions to the Moon and Mars necessitates the development of progressively Earth-independent medical operations (EIMO) to support crews and reduce overall mission risk. Previous work has defined and laid the foundation for EIMO, but further development of the concept is required to prepare for future exploration missions. <b>Methods</b> -NASA's Exploration Medical Capability element organized a series of 5 technical interchange meetings from 2023 to 2024, which included internal (NASA) and external subject-matter experts in human spaceflight, health technology, and austere medicine to create a framework for developing the technologies and procedures necessary to maintain human health and performance in a progressively Earth-independent fashion. <b>Results</b> -The EIMO technical interchange meetings provided a forum for a field of experts and stakeholders to better understand gaps between current approaches to medical care in low-Earth orbit and the innovations needed to maintain the health and performance of astronauts on long-duration deep-space missions. These discussions were recorded, analyzed, and collated into reports that can inform the maturation of EIMO concepts. <b>Conclusions</b> -Multidisciplinary input from experts with experience in human spaceflight, health technology, and austere medicine is critical when planning for long-duration exploration missions. Innovations such as probabilistic risk assessment tools, extended reality devices, and advanced clinical artificial intelligence capabilities have been identified as high-value targets that can enhance inflight medical autonomy while maintaining appropriate workload balance and crew safety. By further developing the EIMO paradigm, NASA aims to identify areas of future work, research, and collaboration to reduce overall risk on future human spaceflight missions into deep space.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"95S-103S"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048110","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}

{"title":"Heroes in Red: Traumatic Event Exposure Linked to Reduced Wellbeing Among a Cohort of U.S. Ski Patrollers.","authors":"Elizabeth Keller, Wendie Robbins, Yijia Sun, Jian Li","doi":"10.1177/10806032251337468","DOIUrl":"10.1177/10806032251337468","url":null,"abstract":"<p><p>IntroductionSki patrollers face unique occupational risks and may be exposed to traumatic events. This study aimed to determine the relationship between traumatic event exposures and wellbeing among a cohort of U.S. ski patrollers.MethodsA non-experimental, descriptive, longitudinal design was followed to complete a pilot study. An online survey was employed with repeated measures (1, 2, & 3 months). Participants were conveniently sampled from one ski resort in the Western United States. This study was informed by the stress continuum model.ResultsA total of 29 participants completed at least one follow-up survey and were included as the analytic sample. Participants were primarily White (<i>n</i> = 27, 93.10%), non-Hispanic or Latino (<i>n</i> = 27, 93.10%), and male (<i>n</i> = 19, 65.52%), aged 39.07 on average. Three-quarters of participants reported exposure to traumatic events at Survey 1 (<i>n</i> = 22, 75.86%), and the frequency ranged from 1 to 20 events. Increased frequency of traumatic events by each one event was significantly related to decreased wellbeing levels over 3 months (β = -0.0253, <i>p</i> < .0001, 95% CI: [-0.0364, -0.0141]), after controlling for age, sex, race, ethnicity, marital status, and working hours. When included as an interaction term, resilience was found to buffer the negative effect of traumatic event exposure on wellbeing (β = -0.0068, <i>p</i> < .0001, 95% CI: [-0.0099, -0.0038]).ConclusionsFindings underscore the need for additional research to identify the most effective ways to support the wellbeing and resilience of ski patrollers.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"352-360"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081605","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}

{"title":"Simulated Avalanche vs Tree-Well Burial Effects on Human Physiology.","authors":"Nicholas C Kanaan, Jibreel Abdul Cader, Joseph Krakker, Heather Beasley, Colin K Grissom, Scott E McIntosh","doi":"10.1177/10806032251337476","DOIUrl":"10.1177/10806032251337476","url":null,"abstract":"<p><p>IntroductionAvalanches and tree-wells (TW) are causes of snow immersion death in skiers and snowboarders. TW burials may have different victim physiology profiles and rescue considerations than avalanche-related burials due to snow density, burial position, and compensatory physiologic responses. This study aimed to compare the physiological responses between avalanche and TW burials through a prospective controlled trial of simulated avalanche burial to simulated TW burial.MethodsEleven volunteers participated in two paired 60-min snow burials: Avalanche and TW simulations, controlling for position and snowpack densities. We monitored core temperature, respiratory rate, minute ventilation, end-tidal carbon dioxide, oxygen saturation, partial pressure of inspired carbon dioxide, and heart rate.ResultsThe average cooling rate for the avalanche simulation was -0.017(Δ°C/min) versus -0.012(Δ°C/min) for the TW simulation (<i>p</i> = 0.014*), 1.42 times faster cooling rate than TW burial. SpO2 decreased 10.9 times faster on average in TW burial than in avalanche conditions when normalized by burial time as a rate (avalanche -0.011 vs TW -0.12 (Δ%/min), <i>p</i> = 0.033*). More participants requested early study termination in the TW scenario.DiscussionSimulated TW burial resulted in a statistically significant slower rate of core temperature cooling and earlier hypoxemia. Inverted body position in TW burials may lead to increased physiologic distress and contribute to earlier hypoxia. These findings may have important implications for search and rescue as well as resuscitation efforts for snow burial victims.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"361-367"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081609","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}