Wilderness & Environmental Medicine

Hypothermia increases mortality among trauma patients. It is difficult to identify hypothermia in conscious patients due to the limited availability of diagnostic equipment yielding accurate measurements. Shivering is a symptom associated with hypothermia, and it serves as a parameter for clinical staging of hypothermia. Because shivering is part of the body's response to counteract hypothermia, the resulting thermogenic effect and expected cooling rates in shivering individuals warrant further investigation. This study aimed to describe core temperature trajectories in a setting of cold air, mild wind, and wet clothing, simulating a clinically relevant prehospital scenario.

Fifteen healthy volunteers were dressed in wet clothing and placed in a windy climate chamber set at 5.0°C for 3 h. Core temperature was measured using an esophageal probe (T_eso) and an ingestible capsule (T_cap). Shivering was estimated based on oxygen consumption (VO₂) and by objective observations of the participants.

The temperature reductions from baseline were 0.25°C for T_eso (95% CI, 0.06–0.44°C, P=0.014) and 0.11°C for T_cap (95% CI, −0.13–0.34°C, P=0.36). Initially, participants exhibited a significant increase in temperature. The cooling rate in the climate chamber was 0.17°C·h^–1 (T_eso). VO₂ corresponded with objective observations of shivering and was inversely related to T_eso.

Healthy individuals exposed to the described windy, wet, and cold conditions with only light clothing retained a normal core temperature for 3 h. The heat-producing mechanism of shivering is considered to be a significant contributing factor; therefore, a lack of shivering in patients in cold environments should be considered a warning sign for hypothermia.

To evaluate the association between environmental conditions, specifically air temperature and cloud conditions (eg, sunny, partly cloudy, or cloudy/foggy), and types of injuries sustained by skiers and snowboarders.

We conducted a retrospective observational study of adult patients (≥18 y of age) who presented with skiing- or snowboarding-related musculoskeletal injuries at a Utah ski resort clinic during the 2022–24 ski seasons. Data were extracted from electronic medical records and included demographics, injury type, air temperature, and categorized cloud conditions. Statistical analyses included bivariate comparisons using χ² analysis and analysis of variance and adjusted analyses using multinomial logistic regression.

A total of 1813 patients were included; 62.2% were male, and 81.3% were skiers. Ligamentous knee injuries were the most common injury (31.3%). Unadjusted analysis showed a significant association between temperature and injury type (P<0.001), with higher temperatures linked to more upper extremity injuries and lacerations. Cloud condition showed no significant association with injury patterns (P=0.99). In the adjusted analysis, only head injuries remained significantly associated with temperature: For each 1°C increase, the odds of head injury increased by 6.4% (odds ratio = 1.06; 95% CI, 1.02–1.11; P = 0.01). Cloud conditions were not significantly associated with any injury type.

Higher temperatures are associated with a modest increase in head injuries among skiers/snowboarders, whereas general cloud conditions do not significantly impact injury type. These findings suggest that while temperature may influence injury risk, particularly for head injuries, other factors likely contribute to injury patterns.

Snake envenomation is relatively uncommon in New York State (NYS) but remains clinically relevant. The incidence and characteristics of snakebite and envenomation in NYS from 2000 to 2010 have been reported. This study sought to evaluate the incidence of snakebites in NYS from 2011 to 2022 and to describe recent patterns in terms of geography, time trends, and clinical characteristics.

This is a retrospective observational study of snakebites reported to NYS poison control centers from January 2011 to December 2022. Data from the National Poison Data System were analyzed for demographics, geographic location, treatment, and medical outcome. Density maps were constructed to illustrate frequency across NYS counties, and a time-series plot was generated to demonstrate trends over time of snakebite reports.

From 2011 to 2022, 564 snakebites were reported; 112 (19.9%) venomous snakes, 245 (43.4%) nonvenomous, and 207 (36.7%) unknown. Many cases were classified as minor outcomes (69.3%), and 6.6% of victims received antivenom. Both venomous and nonvenomous bites were common in more populous counties and correlated with known indigenous snake populations. Time-trend analysis showed a gradual nonlinear decrease in total number of snakebites reported over the study period.

snakebites reported to NYS poison control centers have decreased over the last 12 y but remain a risk to the NYS population. Public education surrounding prevention strategies and standardized approaches to seeking medical care and clinical management of snakebite injuries remain an important area for research and public health. These data help inform clinical management and guide antidote stocking at healthcare facilities.

Portable ultrasound enhances medical assessments in austere environments but is often limited by volume, weight, and availability of commercial gels. This study evaluates the stability and image quality of powder-based ultrasound gel substitutes.

Eight alternative gel formulations were compared with commercial gel across simulated environments: tundra, desert, altitude, and hospital control. Gels were assessed daily for color, viscosity, odor, homogeneity, and tensile strength. A stability score was calculated and analyzed using ANOVA with Tukey's HSD. Ultrasound images of the internal jugular vein, lung, hepatorenal recess, and quadriceps tendon were obtained using SonoSite and Butterfly devices. Blinded ultrasound-trained faculty graded the image quality (1–10), with t-tests comparing alternatives to control (p < 0.05 significant).

All alternatives degraded over 1 week. ANOVA confirmed significant effects of gel type (p < 0.0001) and time (p < 0.0001), with Tukey's HSD identifying dry commercial and xanthine as most stable.

Sonosite, cassava (p = 0.05), and dry commercial (p = 0.02) outperformed the control at the internal jugular, while tapioca (p < 0.00), cornstarch (p = 0.01), and water (p < 0.00) performed worse at the hepatorenal. At the quadriceps, cassava (p = 0.01), cold glucomannan (p < 0.00), guar gum (p = 0.01), cornstarch (p = 0.04), and water (p < 0.00) performed worse. Using Butterfly, cold glucomannan (p = 0.02), guar gum (p = 0.01), tapioca (p = 0.02), cornstarch (p = 0.01), and water (p < 0.01) performed worse at the hepatorenal, while at the quadriceps only water (p = 0.02) performed worse.

Traumatic injuries and medical emergencies are common in skiing and snowboarding, often occurring in remote alpine areas where ski patrols provide only basic trauma care. This pilot study, conducted at the Livigno Carosello 3000 Ski Area in Northern Italy, evaluated the impact of adding a healthcare-enhanced ski patrol team that included a critical care nurse and an on-call medical consultant.

A retrospective observational study compared rescue operations across 2 ski seasons: 2022–23 (basic team only) and 2023–24 (basic and enhanced team). Data were collected from all rescue operations conducted from Sundays to Thursdays, excluding logistical transports and refusals. Patient characteristics, injuries, treatments, evacuation methods, and dispositions were analyzed by season and by team composition.

Among 595 cases (281 in Season 1, 314 in Season 2), the enhanced team managed 61% of rescues in Season 2 and handled significantly more medical emergencies (P<0.01). The enhanced team administered pharmacologic therapy in 27% of cases and applied spinal motion restriction more often (12 vs 2%; P<0.01). Their involvement also was associated with increased snowmobile evacuations (62 vs 49%; P<0.01) and decreased referrals to trauma clinics (48 vs 60%; P<0.01), alongside more on-site discharges and private transports (11 vs 5%; P<0.01).

Adding healthcare professionals to ski patrol teams improved case management, enabled prompt treatment, and optimized evacuation strategies. These findings support integrating clinical expertise into ski patrol operations and warrant further study of long-term impacts on system efficiency and patient outcomes.

The municipality of Barcelos, located in the middle Rio Negro region, is home to various venomous snakes (ie, members of the Viperidae and Elapidae families). This study describes the epidemiology of incidents involving venomous animals in the remote municipality of Barcelos.

We conducted a retrospective epidemiological study to identify population groups vulnerable to envenomation by snakes, spiders, and/or scorpions in the middle Rio Negro (Barcelos) basin, Amazonas, Brazil. To determine the percentage of incidents, we calculated the occurrence and number of deaths. Data were collected from the Barcelos Reference Hospital from 2010 to 2024. The type and number of antivenom vials used in the treatment of patients were quantified according to the Strategic Inputs Information System (SIES).

A total of 511 people were envenomated by venomous animals, 402 of them by snakes. Yanomami individuals were the most affected by snakebites (62.4%). Envenomations by Bothrops spp. caused 7 deaths, while those caused by spiders and scorpions were mostly mild. Among the snakebite survivors, 38 had their occupations identified at the time of the incident: 25 worked in the extraction of piassaba fibers (Leopoldinia piassaba) and 13 were chestnut fruit collectors (Bertholletia excelsa).

Between 2010 and 2024, vulnerable groups to snakebites, such as Yanomami people, were the most affected in the middle Rio Negro region. Amerindians who sought medical care at the Barcelos referral hospital received antivenom treatment and intensive care when necessary. Emergency medical services and therapeutic serums are crucial to saving lives in the Rio Negro region.

Pelvic fractures pose a significant treatment challenge in the prehospital environment, often resulting from high-energy trauma and concurrently presenting with life-threatening hemorrhage necessitating immediate intervention. Commercial pelvic binders such as the Structural Aluminum Malleable (SAM) Pelvic Sling II have become commonplace in prehospital care, especially in military medicine. However, given limitations to carried equipment and the scarcity of pelvic fractures, medics in austere conditions may opt to carry just one or even no commercial pelvic binders.

This study explored an innovative approach using 2 Combat Application Tourniquet II (CAT II) devices tandemly connected to stabilize pelvic fractures. The primary aim was to assess whether this technique will generate comparable intrapelvic pressure to the SAM Pelvic Sling II.

This study employed a human cadaveric model for which pelvic fractures were surgically created to generate an open-book fracture. Intrapelvic pressure was measured via a Foley catheter. The SAM Pelvic Sling II was applied in standard fashion 3 times, each with intrapelvic pressure recorded. Similarly, 2 CAT IIs were applied in tandem to the pelvis 3 times to generate 3 pressure measurements.

There was a small yet statistically significant increase in intrapelvic pressure generated by the CAT II method than by the traditional method.

The use of 2 CAT II devices connected in the fashion described in this study appears to offer a potentially feasible and effective alternative for stabilizing pelvic fractures. Yet, further investigation is required before this concept is ever applied to real patients.

Frequent human–cattle interactions in high-density livestock regions expose farm workers to a significant risk of traumatic accidents, which range from minor to severe and life-threatening injuries. This study aimed to assess the incidence, mechanisms, and clinical impact of cattle-related injuries in a high-livestock-density area to inform preventive and healthcare strategies.

This monocentric retrospective observational study was conducted at Santa Croce e Carle Hospital, Cuneo, Italy, between January 1, 2018, and December 31, 2024. All patients aged ≥18 y presenting to the emergency department with cattle-related trauma were included. Injury severity was assessed using the Injury Severity Score (ISS), need for total-body computed tomography, intensive care unit admission, and 30-d mortality.

A total of 182 patients (male:female ratio 4.5) were included, with a median age of 55 y (interquartile range, 45–64). The primary injury mechanisms were kicks (43.4%), charges (29.1%), and trampling (9.9%). Most cases (67.6%) were low priority at triage; 5.5% required intensive care unit admission. The median ISS was 1 (interquartile range, 1–4), and 3.3% had an ISS of >15. No trauma-related mortality was observed within 30 d.

Cattle-related injuries pose a substantial burden on farm workers and healthcare services; injuries range from minor to severe trauma. Given the high-energy potential of cattle-related impacts, improved safety measures and specific clinical management protocols are warranted to mitigate risks and enhance occupational safety in agricultural settings.

Mount Fuji has four-distinct routes, each with unique characteristics. However, no studies have examined how different routes influence falls and related factors during descent.

We conducted a questionnaire survey of 463 participants who descended Mount Fuji via the Fujinomiya route and compared the results with data from our 2021 study on the Yoshida route (n = 551). The survey collected information on sex, age, height, body weight, luggage weight, experience on Mount Fuji and other mountains, use of a tour guide, single-day climb or overnight stay, awareness of downhill trail conditions (volcanic gravel, long distance, and fall risk), use of trekking poles, shoe type, shoe sole condition, and self-reported fatigue.

The fall rate was higher on the Fujinomiya route (271/463, 59%) than on the Yoshida route (232/551, 42%). Route-specific factors influencing fall risk included interactions between route and trekking pole use, shoe type, and fatigue level. On the Fujinomiya route, climbers not wearing hiking shoes or mountaineering boots had a higher fall risk. However, on the Yoshida route, fall risk was lower in climbers who used trekking poles and reported less fatigue. In contrast, on the Fujinomiya route, fall risk was unaffected by trekking pole use or fatigue level, while on the Yoshida route, shoe type had no impact.

These findings suggest that route-specific precautionary measures may be necessary for climbers on the Yoshida and Fujinomiya routes.

Cold exposure initially induces peripheral vasoconstriction. After 5–10 min, distal blood vessels will transiently and cyclically vasodilate and vasoconstrict in a phenomenon known as cold-induced vasodilation (CIVD). Increased CIVD response is thought to improve dexterity and confer a reduced risk of frostbite injuries. Current guidelines recommend the use of an intravenous synthetic prostacyclin (PGI2) analog for the treatment of some cases of severe frostbite. This double-blind crossover study investigates the effects of the inhaled PGI2 analog epoprostenol on CIVD response through continuous finger temperature measurement during cold water immersion.

Fourteen healthy volunteers completed both sessions of the study and were included in the analysis. Compared to placebo, inhaled epoprostenol sessions showed higher mean finger temperature (9.16 vs 8.34° C; p = .027), mean maxima temperature (10.86 vs 9.88° C; p = .045), and mean minima temperature (7.45 vs 6.80° C; p = .024). No significant difference was detected in the number of cycles (10.0 vs 7.93; p = .104). No hypotension, hypothermia, or hypoxia was observed, and no subject requested discontinuation due to side effects.

In this small study, inhaled epoprostenol induced a statistically significant increase in mean temperature, mean maxima temperature, and mean minima temperature in fingers immersed in a cold-water bath, consistent with an augmented CIVD response. The ability to deliver an inhaled PGI2 analog via nebulizer raises the possibility of early interventions to manage frostbite in austere environments, but further study is needed to draw any conclusions regarding the use of epoprostenol for frostbite care.

Submersion injuries are rare yet life-threatening events. The Trauma Quality Improvement Program (TQIP) registry is the largest national trauma registry in the United States. We describe the epidemiology and outcomes of submersion injuries in the TQIP registry.

We analyzed data from the TQIP registry for all encounters with a primary or secondary mechanism that included a submersion or drowning description. We used descriptive statistics to portray encounter data including disposition and survival. We used inferential and multivariable logistic regression analyses to identify associations with survival

From 2017 to 2023, there were a total of 8,014,737 trauma encounters, of which, 1677 met our inclusion criteria of a primary or secondary mechanism that included a submersion injury. Of the 1150 survivors, 656 (57%) were discharged home without additional services planned. In our multivariable logistic regression, we noted the following associations with survival: age in years (unit odds ratio, 0.98; 95% CI, 0.98–0.99), male sex odds ratio 1.25 (95% CI, 0.89–1.73), prehospital arrest odds ratio 0.15 (95% CI, 0.11–0.21), interfacility transfer odds ratio 0.52 (95% CI, 0.37–0.71), any signs of life on arrival odds ratio 11.33 (95% CI, 5.90–21.75), head/neck injury odds ratio 0.42 (95% CI, 0.31–0.58), thorax injury odds ratio 0.36 (95% CI, 0.24–0.55), abdomen injury odds ratio 0.36 (95% CI, 0.24–0.56), extremities injury odds ratio 2.70 (95% CI, 0.65–11.16), skin injury odds ratio 1.49 (95% CI, 0.69–3.21), any in-hospital arrest odds ratio 0.13 (95% CI, 0.08–0.20), emergency department intubation odds ratio 0.97 (95% CI, 0.65–1.43), and hypothermia <35°C odds ratio = 0.30 (95% CI, 0.21–0.44).

Submersion injuries were rare in the TQIP registry. In the setting of trauma, most survived to hospital discharge, of whom most were discharged home. Prehospital arrest, in-hospital arrest, lack of signs of life on arrival to the emergency department, and serious injuries to all body regions were associated with lower survival to discharge.