Wilderness Environments Research Articles

General Medical Considerations for the Wilderness Adventurer: Medical Conditions That May Worsen With or Present Challenges to Coping With Wilderness Exposure.

Participation in wilderness and adventure sports is on the rise, and as such, practitioners will see more athletes seeking clearance to participate in these events. The purpose of this article is to describe specific medical conditions that may worsen or present challenges to the athlete in a wilderness environment.

Wilderness Preparticipation Evaluation and Considerations for Special Populations.

Children, older adults, disabled and special needs athletes, and female athletes who participate in outdoor and wilderness sports and activities each face unique risks. For children and adolescents traveling to high altitude, the preparticipation physical evaluation should focus on risk assessment, prevention strategies, early recognition of altitude-related symptoms, management plans, and appropriate follow-up. As the risk and prevalence of chronic disease increases with age, both older patients and providers need to be aware of disease and medication-specific risks relative to wilderness sport and activity participation. Disabled and special needs athletes benefit from careful pre-event planning for the potential medical issues and equipment modifications that may affect their health in wilderness environments. Issues that demand special consideration for female adventurers include pregnancy, contraceptive use, menses, and ferritin levels at altitude. A careful preparticipation evaluation that factors in unique, population-specific risks will help special populations stay healthy and safe on wilderness adventures. The PubMed and SportDiscus databases were searched in 2014 using both MeSH terms and text words and include peer-reviewed English language articles from 1977 to 2014. Additional information was accessed from Web-based sources to produce this narrative review on preparticipation evaluation for special populations undertaking wilderness adventures. Key words include children, adolescent, pediatric, seniors, elderly, disabled, special needs, female, athlete, preparticipiation examination, wilderness medicine, and sports.

A Chemical Heat Pack–Based Method For Consistent Heating of Intravenous Fluids

Transfusion of cold intravenous fluids (IVF) can exacerbate hypothermia. Civilian and military guidelines recommend heated IVF for hypothermic patients; however, there is currently no ideal IVF heating system for use in resource-limited settings. Development of a system that uses flameless ration heaters (FRH) and an insulated sleeve for the consistent delivery of IVF at physiologically appropriate temperatures (40°-42°C) over the range of ambient conditions typical of the prehospital and wilderness environments. The temperatures of 0.9% normal saline (NS) 1-L bags were measured under 3 ambient conditions: 3°C, 10°C, and 20°C. The IVF was placed in an insulated pouch along with a predetermined number of activated FRH (5 FRH for 3°C, 4 FRH for 10°C, and 3 FRH for 20°C) for 10 minutes before removing the FRHs. The insulated IVF bag was drained through 280 cm of intravenous tubing at a flow rate of 77 mL/min. Raw temperature data for internal and delivery temperatures were collected and analyzed. The temperature of the IVF throughout the delivery of 1 L of NS under the 3 ambient conditions was as follows (mean ± SD): at 3°C ambient, 47° ± 2.1°C internal and 42.6°C ± 1.4°C at delivery; at 10°C ambient, 52.3° ± 2.7°C and 45.2° ± 1.6°C; and at 20°C ambient, 45.5° ± 1°C and 39.7° ± 0.7°C. The IVF heating system described here reliably delivered physiologically appropriate temperature intravenous fluids in 2 of the 3 ambient treatment conditions. With the appropriate number of FRH for the ambient conditions, this system enables the delivery of warmed IVF to provide active warming, which may be clinically beneficial in the prevention and treatment of hypothermia.

Challenges due to changing ideas of natural resources: tourism and power plant development in the Icelandic wilderness

ABSTRACTThe Arctic and nearby remote areas are attracting more attention than ever before, because of their abundance of physical natural resources as well their wilderness environments which have become a major attraction for tourists. But use of land for tourism practices can lead to conflicts with other industries that utilise natural resources. Tourism in Iceland has grown rapidly in recent decades and nature and the wilderness is the main attraction. As well as being an important resource for the tourism industry, wilderness and natural areas are also very valuable for hydro–electric and geothermal power production. During the latter half of the last century several glacier–fed rivers in the highlands were dammed and hydropower plants built. Now there are plans for further exploitation of the natural resources which creates challenges and conflicts as many of the proposed power plants are located in natural areas, some of which are defined as wilderness. The purpose of this paper is to analyse the development of tourism in the Icelandic highlands and power production development and the challenges created by the changing idea of natural resources. It discusses a governmental project which is intended to solve the challenging conflicts about the use of natural areas. The project exposed the fact that the energy resources in the country are a far more limited resource than has previously been assumed. The power production industry now has to share the limited natural resources with the tourism industry. Thereby the ideas about natural resources and their utilisation are being re–defined by Icelandic society, depending on technology, global influences and other social trends.

Enhancement of Convergent Creativity Following a Multiday Wilderness Experience

Contact with nature has been shown to improve a variety of psychological indices. The current study tested convergent creativity in undergraduate students following a 6-day wilderness trip to the Boundary Waters Canoe Area Wilderness (BWCAW). An indoor control group was also tested. The students taking the BWCAW trip had significantly more correct solutions on the Remote Associates Test (RAT) compared to the indoor condition. The results contribute to a growing interest in the cognitive benefits of the outdoors by demonstrating that nature immersion can improve correct solutions on a convergent creativity test. Limitations include self-selection issues and lack of rigorous control over extraneous variables while in the wilderness environment. Nonetheless, applications of this data may be important for providing natural experiences for students as a strategy for ensuring healthy cognition in ever-increasing urban environments. Key Words: Convergent creativity—Nature immersion—Remote Associates Test—Wilderness.

Addressing "Nature-Deficit Disorder": A Mixed Methods Pilot Study of Young Adults Attending a Wilderness Camp.

Background and Objectives. Rapid urbanization raises concern about chronic human health issues along with less frequent interaction with the natural world. “Nature-deficit disorder,” a nonclinical term, describes this potential impact on the well-being of youth. We conducted a mixed methods pilot study of young adults attending a four-week wilderness camp to investigate whether nature-based camp experiences would increase connection to nature and promote multiple dimensions of well-being. Methods. Participants completed precamp (n = 46) and postcamp (n = 36) online questionnaires including nature-related and holistic well-being measures. Differences were investigated using paired t-tests. Interviews (n = 16) explored camp experiences and social relations. Results. All nature-related measures—exposure, knowledge, skills, willingness to lead, perceived safety, sense of place, and nature connection—significantly increased. Well-being outcomes also significantly improved, including perceived stress, relaxation, positive and negative emotions, sense of wholeness, and transcendence. Physical activity and psychological measures showed no change. Interviews described how the wilderness environment facilitated social connections. Conclusion. Findings illustrate the change in nature relations and well-being that wilderness camp experiences can provide. Results can guide future research agendas and suggest that nature immersion experiences could address the risk of “nature-deficit disorder,” improve health, and prepare future environmental leaders.

Environmental Practices of Sea Kayak Guides in British Columbia, Canada

Seventeen commercial sea kayak guides were observed covertly on multiple trips in coastal British Columbia (BC), Canada. Behavioral observation criteria were developed from existing environmental best management practices (EBMPs). Guides demonstrated both common and less common low-impact practices that enabled interactive experiences desired by clients. However, not all observed behaviors demonstrated low-impact practices. Guide behavior was inconsistent relative to campfire management, wildlife interactions, and camp management. Although sea kayak guides appreciate the importance of reducing visitor impacts on wilderness environments, they have not yet consistently adopted EBMPs. Impact minimization programs can only be effective if applied in a consistent manner and therefore are essential for future viability of the industry.

Core Content for Wilderness Medicine Fellowship Training of Emergency Medicine Graduates

Wilderness medicine is the practice of resource-limited medicine under austere conditions. In 2003, the first wilderness medicine fellowship was established, and as of March 2013, a total of 12 wilderness medicine fellowships exist. In 2009 the American College of Emergency Physicians Wilderness Medicine Section created a Fellowship Subcommittee and Taskforce to bring together fellowship directors, associate directors, and other interested stakeholders to research and develop a standardized curriculum and core content for emergency medicine (EM)-based wilderness medicine fellowships. This paper describes the process and results of what became a 4-year project to articulate a standardized curriculum for wilderness medicine fellowships. The final product specifies the minimum core content that should be covered during a 1-year wilderness medicine fellowship. It also describes the structure, length, site, and program requirements for a wilderness medicine fellowship.

Blastomycosis in Quebec, Canada: Highlighting the Importance of Exposure to Decaying Wood in Patients

Blastomycosis is a systemic and cutaneous fungal infection of humans, dogs, cats and other animals that has been reported from parts of North America, Africa and India. In most areas the disease occurs predominantly in individuals exposed to rural agricultural, recreational or wilderness environments. The precise ecological niche for Blastomyces dermatitidis remains undefined. In the current work we report a series of cases of blastomycosis in Quebec associated with exposure to wood as a possible source of infection. This work is consistent with previous reports that demonstrate that wood and wood by-products are able to support the growth of B. dermatitidis and can play an important role in disease pathogenesis. Our findings suggest that it may be important to question blastomycosis patients about exposure to decaying wood as a possible source for acquiring the infection.

Retrieval of Additional Epinephrine From Auto-Injectors

Anaphylaxis is a challenging condition for any austere environment. It is unpredictable, has sudden onset and a high fatality rate, and is responsive only to epinephrine, a prescription medication. The Wilderness Medical Society has formally recommended that non-medical providers working in austere environments be trained to administer epinephrine. Medical providers frequently prescribe auto-injectors for this purpose due to their ease of use by nonmedical providers. However, auto-injectors have limitations in the wilderness environment, particularly due to their single-dose (or at most 2-dose) design. This paper describes an austere environment technique for obtaining multiple additional doses of epinephrine from auto-injectors that have already been used as designed.

Expert versus Machine: A Comparison of Two Suitability Models for Emergency Helicopter Landing Areas in Yosemite National Park*

Landing a rescue helicopter in a wilderness environment, such as Yosemite National Park, requires suitable areas that are flat, devoid of tree canopy, and not within close proximity to other hazards. The objective of this study was to identify helicopter landing areas that are most likely to exist based on available geographic data using two GIScience methods. The first approach produced an expert model that was derived from predefined feature constraints based on existing knowledge of helicopter landing area requirements (weighted overlay algorithm). The second model is derived using a machine learning technique (maximum entropy algorithm, Maxent) that derives feature constraints from existing presence-only points; that is, geographic one-class data. Both models yielded similar output and successfully classified test coordinates, but Maxent was more efficient and required no user-defined weighting that is typically subject to human bias or disagreement. The pros and cons of each approach are discussed and the comparison reveals important considerations for a variety of future land suitability studies, including ecological niche modeling. The conclusion is that the two approaches complement each other. Overall, we produced an effective geographic information system product to support the identification of suitable landing areas in emergent rescue situations. To our knowledge, this is the first GIScience study focused on estimating the location of landing zones for a search-and-rescue application.

Outdoor Orientation Program Trends at Colleges and Universities in the United States

n/a

Burning Man 2011: Mass Gathering Medical Care in a Hostile and Austere Environment

Burning Man is a weeklong outdoor arts festival held annually on a dry Pleistocene lakebed in the rugged and austere Black Rock Desert Wilderness Area in northern Nevada. The 2011 event presented numerous challenges in the provision of emergency medical services and medical care owing to attendance size, the hostile environment, and distance to definitive medical care. Our purpose was to describe the planning and implementation of medical care at a mass gathering event in a harsh and austere wilderness environment. This was a retrospective, observational review of the preparation, management, and implementation of medical care. Total attendance was 53 375, with a total of 2307 patients. Emergency medical services operations included 6 ambulances, 3 quick response vehicles, 2 first aid stations, and a physician staffed mobile hospital. The hospital had limited diagnostic capabilities and a limited formulary. Most conditions treated were minor, the most common being soft tissue injuries, dehydration, eye problems, and urinary tract infections. Most patients were treated and released. A total of 33 patients was transferred out. Several significant cases were seen, including a patient with a spontaneous subarachnoid hemorrhage who later died; there were several cases of trauma, a traumatic pneumothorax, and a thoracic aortic dissection. The latter patient sustained a cardiac arrest at the event, was resuscitated, flown to Reno, underwent emergency surgery, and survived to discharge. A unique phenomenon called “playa foot,” due to an alkali burn of the feet from constant exposure to the dry lake bed dust, was frequently encountered. Overall, Burning Man 2011 was successful. The goal of providing the highest level of care possible in an austere environment and allowing as many patients as possible to remain at the event was achieved. Our experience can help guide others planning for similar events under similar austere conditions in the future.

Lake Data Reveal Oil Sands Impacts

New measurements on the ecological impact of Canadian oil sands mining and processing operations have provided the first clear evidence that concentrations of toxic polycyclic aromatic hydrocarbons (PAHs) are on the rise in the wilderness environment of northern Alberta. The findings may lead to tighter oil sands emissions controls on PAHs, mercury, CO2, and other pollutants. Using a combination of radioisotope dating and mass spectrometry to analyze sediment layers in core samples from six small lakes, researchers say they have recorded levels of anthracenes, pyrenes, and dibenzothiophenes up to 23 times greater than natural background levels, and they are rising (Proc. Natl. Acad. Sci. USA, DOI: 10.1073/pnas.1217675110). Scant environmental monitoring data have been collected in northern Alberta since commercial extraction and processing operations began there in the 1960s. The study was carried out by Joshua Kurek and John P. Smol of Queens University, in Kingston, Ontario, along with colleagues from ...

Soft Tissue Foreign Body Removal Technique Using Portable Ultrasonography

Retained foreign objects account for as much as 2% of soft tissue injuries sustained in the wilderness. Subcutaneously embedded fragments are often missed during the initial medical evaluation and may result in morbidity secondary to delayed removal. Although the utility of ultrasonography in the emergency department for the detection of retained objects is established, the potential use of point-of-care ultrasound to aid with foreign body removal in the field has not been well described. We present 2 case reports that demonstrate the value of ultrasonography in detecting and successfully removing foreign bodies sustained in the wilderness, and outline a procedural technique that minimizes morbidity and uses equipment available in wilderness medical field kits. We propose that with the advent of portable and handheld ultrasound units, foreign body removal in the field has become feasible and may decrease the morbidity of soft tissue injuries, particularly in austere and wilderness environments with limited access to immediate medical care.

P05.17. Addressing nature deficit disorder: a mixed methods study of social well-being among young adults attending a wilderness science camp

Purpose An increasingly ‘screen-based’ culture raises concerns for the health and well-being of America’ sy outh. We investigated whether nature-based experiences affected the social well-being of young adults attending a threeweek wilderness camp. Methods Online surveys (pre, post) were administered. We used paired t-tests (N=35) to analyze differences in social well-being as measured by Ryff’s Positive Relations with Others subscale. In situ interviews (n=20) explored relationships between the camp experience, nature, and well-being. Interviewees were selected to produce a maximum variation sample along dimensions of gender, previous nature experiences, and nature connectedness. Analysis of interviews identified elements of social connection and the role played by nature. Results Quantitative assessment of social well-being showed no significant change (74.17+/-12.39 vs. 77.40+/-13.28, p=0.066). Interview results, however, strongly emphasized social relationships describing the process of making friends, the importance of being part of a group, and how the wilderness environment facilitated connection. Making friends was enhanced by spending time together, listening to each other, and developing intimacy. Being part of a group included subthemes of a sense of community, engaging in group play, working together as a team, and the bonding effect of shared experiences. The natural environment specifically enhanced these processes through loss of ego, breaking down barriers, and limited distractions. This facilitated deeper relationships than would occur in urban surroundings, and afforded social-relatedness (i.e., acceptance and help), positive feelings (i.e., enjoyment, reward, and love), and a sense of interdependence with others (i.e. learning/teaching, having an impact, and making long-term commitments). Conclusion

Medical and Commercial Ethics in Altitude Trekking

Medical and Commercial Ethics in Altitude Trekking

Managing Anaphylaxis in a Jungle Environment

Anaphylaxis is a medical emergency requiring prompt action to prevent death from cardio-respiratory collapse. It can be a biphasic, unpredictable, and challenging reaction to deal with even in a hospital environment. The wilderness environments afforded by expeditions, remote health posts, and military exercises pose additional challenges often involving casualty evacuation. This article identifies and addresses some of these points using a case report from the Costa Rican jungle.

Diamonds in Nature: A Guide to Rough Diamonds

Ralf Tappert, Michelle C. Tappert. Pp. 142. 2011. Springer. ISBN 978-3-642-12571-3. Price $69.95. In the past four decades or so, diamond research has proved to be an amazingly productive field of scientific investigation into the evolution of the Earth, as evidenced, for example, by the recent appearance of an article in the journal Science relating major diamond formation to the onset of the Wilson Cycle in the Archean (Shirey, 2011). Such findings depend on getting access to natural diamonds and developing an understanding of the significance of the properties of both diamond itself and mineral inclusions associated with its formation. This is not a straightforward issue for a number of practical reasons. Diamond holds the premium position as a gemstone on a global basis, fine quality diamonds form the backbone of the jewelry manufacturing industry; given this distinction, diamond can be extremely sought after and therefore have very high value as individual crystals. That leads to mining practices that are strongly focused on security at mines, which more often than not are situated in wilderness environments and not readily accessible to outsiders. This security extends into the distribution chain through the Kimberley process procedures that come with the transport of diamonds, across international borders, to the dealing and manufacturing sectors of the industry. Natural diamonds show a …

Centre‐based and expedition‐based (wilderness) adventure experiential learning regarding personal effectiveness: an explorative enquiry

The purpose of this study is to compare a centre‐based adventure programme (CBAP) with an expedition‐based wilderness programme (EBWP) with regard to personal effectiveness. In comparing these two programmes, this study made use of a crossover research design with data collection according to DE Vos. Participants were 28 third‐year students (14 men and 14 women), aged 20 to 23 ( x = 21.6 ± 0.7) from the Northwest University (Potchefstroom Campus) in South Africa. Both interviews and questionnaires (n = 28) were used to gather comprehensive data. Results indicated medium‐(d = 0.5) to‐practically significant (d ≥ 0.8) changes in most of the ROPELOC (Review of Personal Effectiveness and Locus of Control) variables. Each programme offered unique benefits. The EBWP resulted mainly in improvements in terms of the personal aspects of the ROPELOC, whereas the CBAP mainly delivered in terms of its social aspects. Even though both programmes seem to be beneficial for the facilitation of personal effectiveness, each programme should be selected according to the envisaged outcomes and intervention criteria. For the improvement of personal effectiveness, the EBWP seems to be of relatively more value – mainly on account of the impact of the wilderness environment. This translates into unique experiences of solitude, privacy and freedom of choice, spiritual upliftment, and restoration.