Wilderness Medicine is a young specialty. Although research quantity and quality has stepped up dramatically, some of the core concepts have received little attention. Frostbite is one example. Our historical colleagues were warming their frozen extremities by an open fire and rubbing snow to “rewarm” the tissue. We believe that we have made considerable advances since then, but have we? The technique of rapid rewarming was not published until as recently as 1960 when William Mills, Jr. and Robert Whaley published “Frostbite: Experience with rapid rewarming and ultrasonic therapy” in Alaska Medicine. Since this description of rapid rewarming, few significant advances have been made. Prostaglandin analogues and thrombolytics show promise to improve outcomes, but this research is still in early stages.
In this issue, Auerbach et al advance frostbite research, and hopefully future care, by demonstrating the utility of a new mouse model. We hope that this model may help identify new and novel therapies to treat a common wilderness medical problem. In the meantime, Russell et al demonstrate with their report on “Kite Skier’s Toe” that outdoor enthusiasts will continue to come up with new variations on these old problems.
As a young specialty, we strive to broaden our evidence based body of literature, which includes publication of the several case reports in this issue, that cumulatively add to our growing knowledge of envenomations and wilderness toxidromes. The advancement of our specialty grows with each small case series and brief report, while we await the truly groundbreaking types of basic science research that propel us to a higher level of understanding of environmental exposures and their potential treatments.