Category 1 Continuing Medical Education credit for WMS member physicians is available for this article. Go to  http://wms.org/cme/cme.asp?whatarticle=1921 to access the test questions.

Objective.—To survey the incidence of blister formation in a group of military recruits and to determine the efficacy of a new commercially available blister prevention plaster (Blist-O-Ban).

Methods.—Questionnaires were completed by 100 male recruits, and the same 100 were entered into a field trial. Due to illness, 2 did not complete the study. Premarch foot condition was documented. Each participant acted as his own control. Foot side and plaster site were randomly selected, and plasters were applied according to a strict protocol. Participants were re-examined for blisters after a 16-km hike with pack, and the condition of the feet was documented. A χ² test was used to analyze the results.

Results.—Ninety-eight volunteers with 101 Blist-O-Ban application sites participated. Twenty-seven participants developed a total of 46 blisters. Heel and toe blisters accounted for more than half of all blisters. None of the bandage application sites developed blisters, and 99 out of 101 bandages remained well adhered to the application sites.

Conclusions.—When applied according to strict protocol, the new blister prevention bandage remained well-adhered to application sites and prevented the formation of foot blisters even in humid tropical conditions.

Category 1 Continuing Medical Education credit for WMS member physicians is available for this article. Go to  http://wms.org/cme/cme.asp?whatarticle=1922 to access the test questions.

Objective.—To provide a 5-year longitudinal assessment of risk of acquiring disease from Sierra Nevada Wilderness area lakes and streams. This study examines the relative risk factors for harmful water microorganisms, using coliforms as an indicator.

Methods.—Streams and lakes in the backcountry of Yosemite and Kings Canyon National Parks and neighboring wilderness areas were selected and water was analyzed each year over a 5-year period. A total of 364 samples from lakes or streams were chosen to statistically differentiate the risk categories based on land usage, as follows: 1) areas rarely visited by humans (Wild), 2) human day-use-only areas (Day Hike), 3) areas used by backpackers with overnight camping allowed (Backpack), 4) areas primarily impacted by horses or pack animals (Pack Animal), and 5) cattle and sheep grazing tracts (Cattle). Water was collected in sterile test tubes and Millipore coliform samplers. Water was analyzed at the university microbiology lab, where bacteria were harvested and then subjected to analysis using standardized techniques. Statistical analysis to compare site categories was performed utilizing Fisher exact test and analysis of variance.

Results.—A total of 364 sampling sites were analyzed. Coliforms were found in 9% (4/47) of Wild site samples, 12% (5/42) of Day Hike site samples, and 18% (20/111) of Backpacker site samples. In contrast, 63% (70/111) of Pack Animal site samples yielded coliforms, and 96% (51/53) of samples from the Cattle areas grew coliforms. Differences between Backpacker vs Cattle or Pack Animal areas were significant at P ≤ .05. All samples grew normal aquatic bacteria.

Conclusion.—Surface water from watersheds below cattle areas and those used by pack animals is at high risk for containing coliform organisms. Water from Wild, Day Hike, or Backpack sites poses far less risk for contamination by coliforms.

Objective.—To provide national estimates of nonfatal outdoor recreational injuries treated in US emergency departments (EDs).

Methods.—Outdoor recreational injuries from January 2004 through December 2005 were identified using the National Electronic Injury Surveillance System–All Injury Program, a nationally representative sample of ED visits. National estimates of outdoor recreational injuries were calculated, and activities leading to injury, demographic characteristics, principal diagnoses, and primary body parts affected were described.

Results.—From January 2004 through December 2005, an estimated 212 708 (95% CI = 113 808– 311 608) persons were treated each year in US EDs for outdoor recreational injuries. The annual rate of injuries was 72.1 per 100 000 population (95% CI = 38.6–105.6). Males accounted for 68.2% of the injuries. The lower limb (27%), upper limb (25%), and head and neck region (23.3%) were the most commonly injured body regions. Fractures (27.4%) and sprains or strains (23.9%) were the most common diagnoses. Traumatic brain injuries were diagnosed in 6.5% of injuries, and 5% of injuries resulted in hospitalization or transfer to another hospital.

Conclusions.—The results of this study provide a starting point for further research into the epidemiology of outdoor and wilderness injury. The results reinforce many common perceptions about the nature of these injuries while highlighting the potential severity and long-term consequences of the injuries. The general recommendations of proper planning, preparation, and problem anticipation for outdoor and wilderness injury prevention should be followed to reduce both the number and severity of injuries.

Category 1 Continuing Medical Education credit for WMS member physicians is available for this article. Go to  http://wms.org/cme/cme.asp?whatarticle=1923 to access the test questions.

A frequent tenet of snakebite literature is what has been described as the “worldwide shortage of antisnake venom” (ASV) and the demand for greater production. Antisnake venom is the mainstay of snakebite management, and thus this principle of “shortage” can impact the view of policy makers when it comes to framing solutions to the problem. This paper presents a model to enable policy makers to assess the amount and utilization of ASV in their areas. The model assesses ASV usage according to 2 criteria: risk and wastage. The actual usage of ASV is segmented in the model into the following main areas: (1) victims who receive too little ASV (high risk/low wastage); (2) victims who receive ASV either unnecessarily or in too great a quantity (low risk/high wastage); (3) victims who receive ASV that is not effective (high risk/high wastage); (4) victims who receive ASV according to effective local protocols (low risk/low wastage). The current proposition about the “shortage” of ASV and the proposal to simply produce more addresses only a small part of the high-risk/low-wastage group and does not address the 2 high-wastage groups. Until the high-wastage groups are recognized and resolved with training and local protocols and moved into the low-risk/low-wastage group, the true requirement for ASV worldwide cannot be assessed.

Injured patients in crevasses who are suspected of having sustained spinal injuries should ideally be extricated after being immobilized in a horizontal position on a stretcher and having a cervical collar applied. Sometimes, however, horizontal stabilization is not possible, because the crevasse is too narrow, and the patient needs to be stabilized in a vertical position. In such cases an extrication device can be a useful adjunct. The Kendrick Extrication Device™ stabilizes the position of the body and maintains firm support of the head, neck, and torso. Therefore, the International Commission for Mountain Emergency Medicine supports the use of this device in narrow crevasses, if horizontal evacuation is not possible.

Lizards of the Teiidae family are large reptiles measuring up to 2 meters long. If threatened, they can demonstrate aggressive behavior by whipping their tail and occasionally biting. Here, we report a severe injury following a Teiidae lizard bite on the right index finger of a human. There was significant soft tissue damage and an avulsion fracture of the distal phalanx. He was treated with conservative wound care and prophylactic antibiotics. He developed no evidence of secondary infection and underwent delayed skin grafting.

Many marine catfish have serrated bony stings (“spines”), which are used in defense against predators, on the dorsal and pectoral fins. While catfish-induced injuries are generally characterized by the pain associated with envenomation, the stings in some species are sufficiently long and sharp to cause severe penetrating trauma. Most injuries are to the hands of victims, commonly fishermen. We report the death of a fisherman caused by myocardial perforation from a catfish sting. To our knowledge, this is the first such description in the medical literature.

A hydatid cyst is a parasitic disease caused by the tapeworm Echinococcus granulosus. It is endemic in many areas, including New Zealand, Australia, and the Mediterranean region. Pulmonary hydatid disease can be diagnosed incidentally in asymptomatic patients or may cause symptoms such as cough, chest pain, dyspnea, fever, and hemoptysis both in patients with ruptured and nonruptured cysts. Anaphylactic reaction is a rare presentation of pulmonary hydatid cyst disease. In this case report, we report an unusual anaphylactic reaction following pulmonary hydatid cyst rupture secondary to blunt chest trauma.

Objective.—To test the hypothesis that acclimatization to high altitude results in an improvement of the ventilatory threshold (VT).

Methods.—Eight lowlanders underwent cardiopulmonary exercise testing with a cycle ergometer to determine VT and peak oxygen uptake (Vo₂peak) in Coventry, United Kingdom (altitude: 80 m), on arrival in Leh, India (altitude: 3500 m), and after 12 days of acclimatization that included a 5-day high altitude trek up to 4770 m.

Results.—Vo₂peak fell on arrival at 3500 m and remained depressed at 12 days. VT was depressed on arrival at high altitude and was further depressed at 12 days. VT as a proportion of the Vo₂peak was decreased on arrival at high altitude, and after acclimatization, this relationship was further decreased.

Conclusions.—Individuals who are sedentary or not participating in regular physical training appear to require a longer period of acclimatization than trained athletes. With the increasing numbers participating in high-altitude trekking and charity climbs of peaks, such as Mt. Kilimanjaro, this information has clinically significant practical implications for those leading or acting as medical advisors.

Objective.—To describe the relative frequency and types of injury and illness in the Newport-Bermuda off-shore yachting race.

Methods.—At the end of each race held in even numbered years from 1998–2006, the captain of each boat was asked to complete a survey detailing any injury or illness among his/her crew.

Results.—There was an overall 87% response rate to the survey. During the study period, 38 injuries and 57 illnesses were reported for an estimated 8105 sailors, yielding rate of injury or illness of 12 per 1000 races per sailor. Most common were injuries to the upper extremity (47%), and lacerations were the most common type of injury (45%). Sea sickness was the most common illness, and the rate of illness and injury increased in races that took place in heavy weather. Radio consultations were used 4 times, and 3 sailors required transport to a hospital.

Conclusions.—The rate of injury and illness was relatively low in the Newport-Bermuda race. Injuries to the upper extremities and lacerations were most common, and sea sickness was the most common illness. The majority of illness and injury can be initially managed onboard.