Abstract
On September 1, I will have completed my first year as editor-in-chief (EIC) of Wilderness & Environmental Medicine (WEM). Concurrently, the Wilderness Medical Society (WMS) will have celebrated its 40th anniversary. In what is anticipated to become an annual tradition, I presented the top submissions to WEM over the past year at the WMS’s summer conference. In preparation, I sorted papers into larger themes. Categories included gender, COVID fallout, the Big Picture, education, clinical medicine, and inspiration. While this disparate group of topics were seemingly unrelated, I recognized a pattern. Submissions to the journal simultaneously revealed both introspection and the spirit of innovation, and were unified by an exhortation for change and improvement.
In September 2022 Keyes and Schlein looked inward and examined gender equity and opportunity within both the WMS and WEM.1,2 Similar to others3,4 who have studied patterns of authorship and opportunity, these authors and their colleagues provided additional evidence of an imbalance in contributions to journals and membership and advancement in a medical society. While a new equilibrium is inevitable—more women than men matriculate to medical school—WEM has embraced the call to action and has taken steps to add more balance and perspectives to the editorial board.
Other papers, either directly or indirectly, examined the pervasive impact of the COVID-19 pandemic on outdoor recreation. Outdoor activity among US citizens increased markedly in 2020-2021. Sales of outdoor equipment increased by over 50% during the first year of the pandemic, and injuries increased concordantly.5,6 While there are numerous reasons for the increase in outdoor activity, several studies have examined an association between emotional well-being and outdoor activity leading to a pandemic resilience strategy. 7 Given this background, Valle et al examined perceptions of backcountry skiers toward avalanche safety during the early portion of the pandemic, and differentiated between newly minted and established skiers. 8 Almost 25% of newcomers had no avalanche safety formal education yet the percentage of skiers leaving resorts behind for backcountry skiing increased dramatically. Lane and McIntosh queried backcountry skiers regarding risk behavior and the use of avalanche airbags in a study that has a corollary relationship to Valle’s study. 9 These two studies will likely influence policy decisions and have ramifications regarding resources devoted to search and rescue, and education and equipment, and may have an impact on avalanche fatalities.
The COVID-19 pandemic led to a transformation in education, as well. In a brief letter to the editor, LaFleur and others described a new hybrid wilderness/telemedicine fellowship at George Washington University, which combined a wide ranging wilderness curriculum with advances in telehealth and asynchronous communication. 10 Technological advancements in communication and the success of the GW program suggest there is enormous potential for providing guidance and care in remote and austere settings such as marine environments and in space, where a resurgence in manned travel will undoubtedly require active interventions.
In the spirit of innovation, both Weinstein and Thoolen delivered manuscripts that were forward thinking.11,12 Weinstein’s commentary introduced a thematic international issue on toxinology and explored both the immediate clinical significance of envenomation, as well as innovations in treatment for snake bites in Sri Lanka and wasp stings in China. Thoolen and others provided an inspiring review article on the burgeoning space industry, considered by some as the fourth Industrial Revolution, and the use of external hemorrhage control techniques.
Otten and Nima Ongchuk Sherpa brought me full circle as I considered the impact of wilderness medicine upon my own career.13,14 Upon completing an internship in internal medicine in Baltimore, I decided to re-evaluate my trajectory. I connected with Dr. David Shlim, the former director of the Himalayan Rescue Association and signed on for a stint with the HRA in Pheriche in the spring of 1992. I traveled from the depths of Baltimore in the midst of an HIV epidemic to the top of the world. I lectured world travelers on altitude illness in John West’s old reconfigured lab (we called it the Pheriche Beach club), drained peritonsillar abscesses by flashlight, ran several miles to another village and delivered a baby with a triple nuchal cord, carried a Nepali porter with pulmonary edema on my back from 4000 m down to 2700 m, and ran out of supplemental oxygen while treating a 74-y-old Japanese hiker with high altitude pulmonary edema. In short, I had found my raison d’etre. Nima Ongchuk Sherpa’s essay “How I Started my Medical Career at the Top of the World” reminded me of the beauty, elegance, wonder, and connection I found in medicine. Otten’s recounting of the origins of the WMS and the fledgling Journal of Wilderness Medicine (precursor to Wilderness & Environmental Medicine) reminded us that wilderness medicine has roots in innovation, improvisation, creativity, and the joy of medicine.
A number of other papers published during the past year were reviewed during the summer meeting. Coffey and others examined the clinical aspects of first-trimester pregnancy in wilderness and remote travel, and Zafren and others presented guidelines on the prevention and treatment of nonfreezing cold injuries and warm water immersion tissue injuries.15,16 Each of these papers provided clinical insights and posed important research questions, and contributed to the relevance of the work promulgated by WEM and the WMS. Given the vast province of wilderness and environmental medicine, I look forward to additional contributions from our diverse and enthusiastic authors and readers.
William D. Binder, MD
Editor-in-Chief