Wilderness & Environmental Medicine最新文献

{"title":"National Survey of Wilderness Medicine Scholarly Tracks in Emergency Medicine Residency Programs.","authors":"Kevin D Watkins, Justin M Gardner, Ross J Ferrise","doi":"10.1177/10806032251332280","DOIUrl":"https://doi.org/10.1177/10806032251332280","url":null,"abstract":"<p><p>IntroductionWilderness medicine (WM) tracks provide residents with a framework to foster their interests in wilderness medicine. However, there is little literature specific to WM tracks. We sent surveys to all 287 ACGME-recognized emergency medicine residencies in the United States to obtain data on the prevalence and characteristics of these tracks.MethodsA survey was distributed via the Society for Academic Emergency Medicine and American College of Emergency Physicians listservs with follow-up emails sent to nonrespondents. The survey included questions regarding program demographics, the presence of a WM track, and the characteristics of the track. Residencies lacking a track were asked about their interest, and challenges faced, in creating a track. We evaluated differences between 3-y and 4-y residency programs, smaller and larger programs, and scholarly activity production using the <b>χ</b>² test, where <i>P</i> < 0.05 was considered significant. We evaluated the differences between academic, community/county, and military centers using the ANOVA test, where <i>P</i> < 0.05 was considered significant.ResultsThe response rate was 28%; 24% of respondents had a WM track, and the majority of these were offered at academic centers, 4-year programs, or larger programs. Track participation, administration, and requirements varied significantly. Among programs without a WM track, a minority (35%) reported planning to develop one in the next few years.ConclusionsDespite the popularity of wilderness medicine, many residency programs do not have a WM scholarly track. Their engagement, administration, funding, scholarly productivity, and requirements are quite variable.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251332280"},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047192","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":"Evaluating Large Language Models on Aerospace Medicine Principles.","authors":"Kyle D Anderson, Cole A Davis, Shawn M Pickett, Michael S Pohlen","doi":"10.1177/10806032251330628","DOIUrl":"https://doi.org/10.1177/10806032251330628","url":null,"abstract":"<p><p>IntroductionLarge language models (LLMs) hold immense potential to serve as clinical decision-support tools for Earth-independent medical operations. However, the generation of incorrect information may be misleading or even harmful when applied to care in this setting.MethodTo better understand this risk, this work tested two publicly available LLMs, ChatGPT-4 and Google Gemini Advanced (1.0 Ultra), as well as a custom Retrieval-Augmented Generation (RAG) LLM on factual knowledge and clinical reasoning in accordance with published material in aerospace medicine. We also evaluated the consistency of the two public LLMs when answering self-generated board-style questions.ResultsWhen queried with 857 free-response questions from <i>Aerospace Medicine Boards Questions and Answers</i>, ChatGPT-4 had a mean reader score from 4.23 to 5.00 (Likert scale of 1-5) across chapters, whereas Gemini Advanced and the RAG LLM scored 3.30 to 4.91 and 4.69 to 5.00, respectively. When queried with 20 multiple-choice aerospace medicine board questions provided by the American College of Preventive Medicine, ChatGPT-4 and Gemini Advanced responded correctly 70% and 55% of the time, respectively, while the RAG LLM answered 85% correctly. Despite this quantitative measure of high performance, the LLMs tested still exhibited gaps in factual knowledge that potentially could be harmful, a degree of clinical reasoning that may not pass the aerospace medicine board exam, and some inconsistency when answering self-generated questions.ConclusionThere is considerable promise for LLM use in autonomous medical operations in spaceflight given the anticipated continued rapid pace of development, including advancements in model training, data quality, and fine-tuning methods.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251330628"},"PeriodicalIF":1.4,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043325","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":"Are Female-Specific Health Concerns a Barrier to Participation on Expeditions or Adventure Tourism?","authors":"Jasmine C Winyard, Laura McArthur","doi":"10.1177/10806032251332281","DOIUrl":"https://doi.org/10.1177/10806032251332281","url":null,"abstract":"<p><p>IntroductionFemales are underrepresented in the expedition environment. There are no published studies exploring females' concerns relating to their health in this environment. There is no guidance in key medical texts on preparing females during the pre-expedition phase. This study asked to what extent female-specific health concerns are a barrier and why.MethodsThis cross-sectional study used an electronic survey distributed to females aged 18 to 40 y. Individuals from both the expedition community and those with no related experience were invited to participate via WhatsApp and Posters in local workplaces. Questions explored attitudes around toilet facilities, period health (PH), and strategies females use to manage periods on expeditions.ResultsTwo hundred and eighty-one individuals completed the survey. Lack of toilets is a barrier to participation in adventure tourism and expeditions (AT&E) for 24% of respondents. PH concerns were a barrier for 26%, and only 12% had no concerns with managing PH. Concerns regarding toilets or PH have stopped 11.4% from taking part in expeditions. When looking for information regarding PH and AT&E, 14% of participants were unable to find useful information, and only 10% of respondents felt that school education was adequate.ConclusionsFemale health concerns are a barrier to participation in AT&E, and currently, the expedition community and education are not equipping individuals to overcome those barriers. For >10% of participants, these barriers have caused them to miss life-affirming opportunities. Better pre-expedition resources are needed for females, and further research is needed across a wider age range, including perimenopausal and teenage populations.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251332281"},"PeriodicalIF":1.4,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005473","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":"https://doi.org/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":"10806032251326825"},"PeriodicalIF":1.4,"publicationDate":"2025-04-23","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":"SPOCUS©: Spaceflight Point-of-Care Ultrasound Training Curricula for Crew Medical Officers.","authors":"Chanel Fischetti, Alaina Brinley Rajagopal, Emily H Frisch, Jon Steller, Adam Pissaris, Katharine Clark, Ariana Nelson, Michael Pohlen","doi":"10.1177/10806032251330504","DOIUrl":"https://doi.org/10.1177/10806032251330504","url":null,"abstract":"","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251330504"},"PeriodicalIF":1.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993673","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":"https://doi.org/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":"10806032251332283"},"PeriodicalIF":1.4,"publicationDate":"2025-04-22","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":"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":"https://doi.org/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":"10806032251332282"},"PeriodicalIF":1.4,"publicationDate":"2025-04-21","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":"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":"https://doi.org/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":"10806032251330534"},"PeriodicalIF":1.4,"publicationDate":"2025-04-18","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":"Hemostatic Properties of Climbing Chalk: A Comparative Analysis.","authors":"Mark Raymond, Brooke Solberg","doi":"10.1177/10806032251326025","DOIUrl":"https://doi.org/10.1177/10806032251326025","url":null,"abstract":"<p><p>IntroductionClimbing chalk is widely used by rock climbers and athletes to improve grip. It has been observed that climbers sometimes apply magnesium carbonate chalk to small wounds to stop bleeding, suggesting that climbing chalk may exhibit hemostatic properties useful for small cuts and scrapes. This study aimed to investigate and compare the effects of different types of climbing chalk on prothrombin time (PT) and activated partial thromboplastin time (aPTT).MethodsThree types of climbing chalk were randomly selected for comparative analysis of hemostatic properties, with talcum powder used as a negative control. PT and aPTT testing were conducted on normal plasma samples containing varying concentrations of climbing chalk (from 0.125 mg/mL to 4 mg/mL). Statistical analyses of the results were performed using two-tailed t-tests, Welch's analysis of variance (ANOVA), and Games-Howell post-hoc analysis.ResultsResults indicated that climbing chalk had no significant effect on PT but did significantly reduce aPTT compared to the negative control. Additional analyses revealed significant differences in aPTT results between different types of chalk and between higher and lower concentrations of chalk.ConclusionsMagnesium carbonate-based climbing chalks appear to have a procoagulant effect on hemostasis, likely by affecting the intrinsic pathway of the coagulation cascade. While further research is needed to better understand its coagulative properties, climbing chalk shows potential as a hemostatic agent for minor wounds in wilderness medicine.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251326025"},"PeriodicalIF":1.4,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041762","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":"Ambulatory Blood Pressure in Tourists at Low Versus High Altitude: Colorado High Altitude Monitoring Pressure Study.","authors":"Greta Kreider Carlson, Elan Small, Andrew C Burns, Ilaria Ferrari, Tiana Linkus, Linda E Keyes","doi":"10.1177/10806032251325563","DOIUrl":"https://doi.org/10.1177/10806032251325563","url":null,"abstract":"<p><p>IntroductionLimited evidence exists to guide travelers about blood pressure (BP) changes at high altitude (HA). Our primary objective compared 24-h ambulatory BP at low altitude (LA) vs HA in a cohort of tourists. Exploratory analyses compared results by sex and history of underlying hypertension.MethodsThis prospective observational cohort study measured ambulatory BP with Welch-Allyn ABPM 6100 monitors at LA (<1000 m) and HA (median 2751 m). Measurements included heart rate/BP every 30 min while awake and hourly overnight, BP≥180/100 mm Hg, sleep quality, and Lake Louise score (acute mountain sickness).ResultsAmong 33 participants (median age 61 y, 17 with hypertension, 12 on BP medication), 25 completed LA and HA measurements. Average 24-h mean arterial pressure (MAP) increased at HA by 6 mm Hg (95% CI, 2-10 mm Hg; <i>P</i>=0.04). When analyzed by the presence of preexisting hypertension, 24-h MAP was similar between LA and HA in those with underlying hypertension (mean difference, 4 mm Hg; 95% CI, -4 to 11 mm Hg; <i>P</i>=0.3) but rose at HA in those without (mean difference, 9 mm Hg; 95% CI, 5-14 mm Hg; <i>P</i>=0.001). At HA, 24-h MAP was similar in both groups (mean difference, 9 mm Hg; 95% CI, 0-19 mm Hg; <i>P</i>=0.05). Results did not differ by sex. Severe-range BP was common in all groups and asymptomatic.ConclusionsAmong this tourist cohort, we observed an increase in average 24-h MAP at HA. Altitude-related changes in BP varied greatly between individuals. This variation was related in part to underlying hypertension but not sex. Our data suggest that BP changes are not of clinical concern in HA travelers.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251325563"},"PeriodicalIF":1.4,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743914","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}