Archive for the ‘Environmental Emergencies’ Category

New! From The Wilderness Medicine Newsletter

February 10, 2012

For decades the Wilderness Medicine Newsletter has provided up-to-date information to pre-hospital and definitive care providers. Since becoming an on-line journal, the readership of the WMN has become international. Now the WMN has it’s own web site: www.wildernessmedicinenewsletter.com

Subscribers pay the same $15 a year subscription rate but have access to more than 165 articles from back issues as well as current issues. You can search the site either by category, or by key words making the Wilderness Medicine Newsletter site a much more useful reference for everything from reviewing splinting to the prevention and treatment of tropical diseases.

Check it out!

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Haiti

February 5, 2010

the  Major disasters in the last 10 years, 2000 – 2010:

2001 – Gujarat Earthquake, India                                20,000 Deaths

2003 – Bam Earthquake, Iran                                      30,000 Deaths

2004 – Indian Ocean Earthquake and Tsunami    230,000 Deaths

2005 – Kashmir Earthquake, Pakistan                       85,000 Deaths

2005 – Hurricane Katrina, USA                                       1,300 Deaths

2008 – Sichuan China Earthquake, Chine                 70,000 Deaths

2008 – Cyclone Nargis, Burma (Myanmar)              150,000 Deaths

2010 – Haitian Earthquake, Haiti                               170,000+ Deaths

These natural disasters have cost hundreds of thousands of lives, displaced and made homeless millions of people, mostly the poorest of the poor, cost billions upon billions of dollars, and their global impact has lasted for years.

There is no reason for us to expect that these moanings and groanings of our living planet will ever stop. Therefore, it is essential that we are prepared for the worst. First, we have to be prepared in our own home, then in our community, our state, our country, and finally the world.

The point of this brief article is to provide you with a list of the principles of being prepared to go, to help, and to unselfishly SERVE others in their time of need.

The Principles that will help you to prepare to go and to SERVE:
SAFETY
SHELTER
SUSTENANCE
SANITATION
STAYING WELL
STRESS

SAFETY

Safety is first and foremost is having a well-thought-out plan and sticking to it.
There is safety in numbers; always travel in a group, and try to work together as a group. Keep the team together.
When moving around, remember that traveling during the day is much safer than traveling at night.
Know where you are going, how you are going to get there, and who is going to meet you.
Find out well in advance if there are any local concerns for safety or if there are dangerous areas that you should avoid.
Ask questions. Don’t guess. Most people are more than glad to answer questions and be helpful.
Have an evacuation plan. You need to know what to do if someone in your group does become sick or injured. The plan should include how to evacuate them to home.
It is a very good idea to have some form of evacuation insurance from a group such as Global Rescue, the American Alpine Club, or Divers Alert Network to name a few.
If you do have evacuation insurance, make sure that you carry the details of the policy on your person with appropriate contact information and phone numbers. You do not want to leave it at home or back at base camp. It needs to be with you at the time of the crisis, so the plan can be easily and accurately activated.

SHELTER

When you go into areas of destruction, you cannot count on there being any housing.
You have to carry your own shelter, i.e. a tent, and in the tropical climates you have to be able to sleep under mosquito netting at night to avoid bug bites.
Warmth. Check the weather conditions and carry appropriate sleeping bag or bed roll for the anticipated climate conditions. Remember, in the tropics 60F is considered cold.
Know how to and be prepared to bivouac, to be able to make an emergency shelter from a sheet of plastic or tarp.

SUSTENANCE

Food and water:
Like shelter, you cannot assume that there will be potable water or adequate foods supplies. You do not want to use up the resources of the people whom you’ve come to help.
Food:
You have to carry enough food for your team. Preferably, food that does not take a lot of cooking time or preparation time.
Carry food that can be eaten without cooking, such as protein bars or food that cooks quickly in boiling water, such as macaroni and cheese, instant potato, rice, or premade meals.

Water:
You have to be prepared to purify all you water.
Techniques of water purification: BOIL, CHEMICAL, FILTER, UVC LIGHT
All these techniques are very effective.
Boil: Bring to a rolling boil to sterilize. You have to have a source of heat.
Chemical: Chlorine or iodine.
Use chlorine for large supplies of water for a group.
Use iodine for individual water supply, one water bottle at a time. Although iodine is inexpensive, and safe to use, it does give the water an unpleasant taste.
Filtration: You can use for a group, but usually used by individuals.
Use a filter that also contains iodine to kill the viruses that are too small too filter.
UVC or ultraviolet C light.
Steripen is used by individuals for their own water bottles.

SANITATION
Sanitation is more than just good hand washing. It involves:
Wear gloves when examining and treating patients. It is essential that you bring lots of gloves.
Having a plan to properly dispose of human waist, urine and feces.
Choices: digging a pit and making an outhouse for the group to use or you can use commercially available potties or toilet bags with proper disposal. You want to avoid fecal contamination of the local water supply.
Staying clean. Keep the perineal area clean to avoid rashes and a painful butt. Applying a thin layer of Vasoline to the area around the rectum will help to stay clean and avoid chafing.
Bring lots of toilet paper and personal wipes.
Women need to bring sanitary napkins or pads.
You have to know how to bathe in a bucket of water, and do so daily.
Rinse out clothing every day with soap and water, i.e. the skill of hand washing.
Check your skin several days for ticks, bug bites, and rashes.

STAYING WELL

Immunizations/vaccinations:
Go to the CDC.gov website, travel advice, for information on travel vaccines and common diseases in the area you are going to.
Usual childhood vaccinations plus; Hepatitis A and B, IPV poliovaccine, Typhoid, make sure tetanus and diptheria are up-to-date, consider yellow fever and meningiococcal.
Antimalarials:
If you are going into an area where there is malaria, take an antimalarial daily such as doxycycline or Malarone. Remember that malaria is treatable, but not necessarily curable; therefore, malaria porphylaxis is common sense.
Know the modes of transmission of disease and practice good body substance isolation.
Insect repellants and insecticides. Do every thing that you can to avoid being bitten by insects – mosquitoes, black flies, ticks, sand flies, etc. Use insect repellants, wear appropriate clothing, and sleep under mosquito netting.

STRESS

Post Traumatic Stress Disorder:
One of the most difficult tasks is trying to determine who is emotionally prepared to face all the destruction and human suffering that you may be confronted with.
During the deployment, try to get your group together several times daily to share in their ongoing experiences, expectations, concerns, and to pray together if appropriate.
Have a follow-up plan for after everyone has returned home. PTSD can be prevented and is treated by talking about the tough work, the difficult things that you saw and did, and the sense of disappointment or even failure that can haunt you once you are back home, safe and secure.

We have to consider the whole human being; the body, the mind, and spirit. One cannot exist well without the others and they have powerful influences over one another. Being mature, having a wide variety of human experiences, a desire to serve as well as being well grounded in faith can be very helpful and important.

This post is an excerpt from the current special edition of the Wilderness Medicine Newsletter and is reprinted here with the permission of the editors.

Wilderness Medicine by Paul S. Auerbach, MD, MS

April 9, 2007

Once again, Paul Auerbach has managed to provide us with a tome that holds an absolute wealth of information. He has not only updated all the information contained in the previous edition, but he has also called upon more experts in the field who have added a wide variety of new topics. The list of contributing authors reads like a Who’s Who in Wilderness Medicine and Rescue. This text is a true accomplishment and a marvelous contribution to the wild side of medicine.

The Fifth Edition, 2007, consisting of 2316 pages is divided into 97 chapters, written by 157 contributing authors. A myriad of charts, tables, and spectacular photography complement the well-written text.

Needless to say, I have not had the time to read the entire book, but the several chapters I have read were packed with valuable information for all of us who are interested in or participate in wilderness medicine and rescue work.

Paul, a personal thanks. Great job! What a tremendous contribution this text will make to emergency medicine that is practiced in the extended care environment.

Wilderness Medicine, Fifth Edition, by Paul S. Auerbach, MD, MS is published by Mosby, ISBN 978-0-323-03228-5 and available through www.elsevier.com and probably amazon.com.

The Principles of Managing Musculoskeletal Trauma in the Backcountry

April 2, 2007

Assessment:  Look, Listen, and Feel

Look: 
Look at possible fracture sites.
Remove clothing, remove boots, and socks.  
Do you see any wounds, deformity, angulation, discoloration, or swelling?
Look around: 
What was the Mechanism of Injury (MOI)?
If the MOI indicates a possible fracture, treat as such. 
Listen: 
Talk to the victim. 
Did they feel anything break, snap, crack, or pop? 
Is there decrease in normal function? 
Is there guarding?
Feel: 
Check Circulation, Sensation, and Motion (CSM)?
Is there any point tenderness or crepitus?
WHEN IN DOUBT, SPLINT!

The Principles of Splinting:

Circulation, Circulation, Circulation
Is there good circulation distal to the site of the injury?
Can the injury be immobilized in the position found?
If not, pull traction-in-line to slowly and gently move the extremity into proper anatomical alignment. This is to establish and maintain good circulation distal to the site of the injury.
Create a rigid but very well padded splint.
Splints should be BUFF; Big, Ugly, Fat, and Fluffy.
It is more important for a splint to be well padded than rigid.
Immobilize the entire extremity, the joint above and below the site of the injury.
Monitor all splints, check C/S/M distal to the site of the injury every fifteen minutes for the duration of the evacuation.
In the cold winter environment beware of the risk of frostbite in immobilized extremities, may have to apply chemical heat packs to the hands and feet. 

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

Book Review:

March 22, 2007

Hypothermia, Frostbite, and other Cold Injuries
Prevention, Survival, Rescue, and Treatment

By Gordon Giesbrecth, Ph.D., and James A. Wilkerson, M.D.

The book is published by The Mountaineers Books
They describe themselves as “Outdoor books by the experts” and in this case it is certainly true. The authors of this text are recognized experts in the field of cold-related injuries.

The authors have done an excellent job of describing and reviewing the various cold-related injuries. The text is up-to-date, comprehensive, well written, and applicable. This is a very useful body of knowledge for both the outdoor enthusiast as well as mountain rescue personnel. The authors have taken the time to provide information on the fundamentals of thermoregulation and clothing design as well as the recognition and management of cold-related injuries. I had the opportunity and honor of writing the chapter on non-freezing cold injuries.

If you enjoy the outdoors, or if you are a provider wilderness emergency medicine and rescue, this is a must read book. I think you will enjoy it.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

LIGHTNING – THE BEAUTY AND THE BEAST

March 7, 2007

Lightning # 8 – Emergency Care – Hospital

Further Office Evaluation:  If seen in the ER or by FP after the event:

Continue O2 & IV
EKG & continuous monitoring
Labs:   
electrolytes & calcium, magnesium
CBC
CK & CKMB & myoglobin
BUN & Cr
Coagulation profile
ABG
U/A for urinary myoglobin
Consider CXR, CT head, C-spine series or CT of the cervical spine
Consider EEG (long-term)

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

LIGHTNING – THE BEAUTY AND THE BEAST

March 3, 2007

Lightning # 7 – Emergency Care – Prehospital

Emergency Care for a Lightning Strike Victim – At the scene:

Survey the scene:

For immediate danger to you, others, and the victim.

Primary Survey:

Are they CONSCIOUS?
Are they BREATHING?  —>  If not, give ARTIFICIAL RESPIRATION!
Do they have a PULSE?  —>  If not, begin CPR!

Secondary Survey:

Vital Signs:

Paying particular attention to level of consciousness.
Monitor every 5 minutes until conscious and coherent.

Physical Exam – needs to be detailed:

Skin – check for burns.
Check ears for blood in the canal, and look for Battle’s sign.
Evaluate for spinal injuries.
Evaluate for sprains/strains and fractures.
Monitor peripheral pulses.

Evacuate— force fluids to help prevent late complications.
   
Treat Injuries & Transport:

Protect Airway
Protect Spine
O2 – NC at 6lpm
IV – NS at 500 – 1000cc/hr

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

LIGHTNING – THE BEAUTY AND THE BEAST

February 28, 2007

Lightning #6 – Prevention

“30 – 30” rule:

When you see lightning, count the time from the flash until you hear the thunder.
Speed of light – 186,000 miles per second.
Speed of sound – 700mph = 1000’/sec, or it travels 1 mile in 5 seconds.
Each 5 seconds between flash and thunder is 1 mile away.
If the time is 30 seconds or less, seek safe shelter or do a lightning drill.
Wait 30 minutes until after the last thunder clap before leaving safety.

Imminent Danger – Hints that you are about to be struck by lightning:

Hair standing up or tingling skin.
Light metal objects vibrating or seeing a corona discharge.
Hearing a crackling or “kee-kee” sound.

On the water or in the water:

If possible, get off the water; the risk is lightning and the squall line.
Get at least 100 yards back from the water’s edge.
Do not seek shelter under trees or open-roofed shelters without walls.
Risk of a direct strike is greater in salt water than fresh water.
If you have to stay on the water, put on life jackets.
Prepare for the winds of the squall line and the potential to be capsized.
If in a boat, sit in the center and stay away from the mast and metal shroud lines.

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

LIGHTNING – THE BEAUTY AND THE BEAST

February 24, 2007

Lightning #5 – Prevention

Prevention of a lightning strike & resulting injury:

When a thunderstorm approaches – go inside.
If in the outdoors, avoid the areas most likely to be struck:
 Anything high: mountain tops, hilltops, tall trees, towers.
 Anything metal: ski poles, pack frames, bicycles, fences.
Do not sit under trees to protect you from the rain.
Do not get under shelters that only have roofs.
 Get small, get low, do a lightning drill.
If on water, Get Off.  When on water, you are the highest object around.
Get at least 100 yards away from lakes, ponds, rivers, streams, the ocean.

Lightning drill:

Put on your rain gear and prepare for foul weather.
Get below tree line; if not possible, get away from summits and ridges.
Get away from anything tall– the tallest tree in the woods, towers.
Get away from the water’s edge, at least 100 yards.
Spread the group out; do not hold hands or sit back-to-back.
Sit on something insulated, such as an ensolite pad, with your legs crossed.
 Try to have only one point of contact on the ground.
 Try to avoid being a conductor of the ground current.

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

LIGHTNING – THE BEAUTY AND THE BEAST

February 21, 2007

Lightning #4 – Lightning-Related Injuries

Permanent sequelae:

Sleep disorders – Irritability
Fine psychomotor function difficulty – Sympathetic nervous system dysfunction
Paresthesias – Atrophic spinal paralysis
Generalized weakness
Post-traumatic stress disorder

Psychological dysfunction:

Memory disturbance – short term
Concentration disturbance – loss of focus, easily distracted
Difficulty coding new information
Difficulty accessing stored or old information
Cognitive powers – decreased mental manipulation, decreased problem-solving
High executive functioning – decreased multitasking

Behavior issues:  

Emotional liability
Sleep disturbance
Phobic behavior
Personality change

The Goal of Prevention – Don’t be a Conductor!

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.