- Email: [email protected]
Wilderness and Environmental Medicine
Wilderness and Environmental Medicine
Preface Wilderness and Environmental Medicine
Eric A. Weiss, MD
Douglas G. Sward, MD Editors
Wilderness medicine is a rapidly growing discipline that is becoming increasingly more significant in today’s era of globalization, international travel, and wilderness exploration. The diverse field of wilderness medicine evolved from “mountain medicine,” the investigation of the physiology of maladies experienced during man’s quest to climb the highest peaks on the planet. Its roots, however, date back many centuries, as the manifestations of high-altitude illness were noted by the Chinese, who described headaches and vomiting in travelers along the high passes of the Silk Road between China and Afghanistan. Today, wilderness medicine is a dynamic multidisciplinary field. It comprises many of the qualities and characteristics that are inherent in emergency medicine (EM). There is a requisite need to know about other specialties of medicine and the frequent requirement for urgent intervention, stabilization procedures, and expertise with prehospital care and transportation. It also overlaps extensively with environmental, travel, military, disaster, and sports medicine. Although wilderness medicine generally focuses on medical problems and patient care in remote and austere environments, many of its lessons are essential to mainstream EM, and its application extends into urban communities. Natural and manmade disasters, like the Haiti earthquake, Hurricane Katrina, and the September 11, 2001 attacks may create an environment as limited as the wilderness in the midst of a city by destroying or damaging power, transportation, communication, and health care facilities. With escalating emergency department (ED) crowding and limited resources, improvised care has become a skill that many ED providers practice on a frequent basis. Wilderness medicine will continue to inform the real-life practice of EM as both fields grow and interact. EM has often been a springboard for pursuing wilderness medicine. In 2003, the first fellowship in wilderness medicine was established at Stanford University to provide EM residency graduates the opportunity to gain advanced knowledge, formal training, and Emerg Med Clin N Am 35 (2017) xvii–xviii http://dx.doi.org/10.1016/j.emc.2017.02.002 0733-8627/17/ª 2017 Published by Elsevier Inc.
emed.theclinics.com
xviii
Preface
proficiency in research and practice in wilderness and environmental medicine. Currently, there are fifteen wilderness medicine fellowships at academic EM programs throughout the country. These programs are helping develop new leaders in the field and are facilitating vital research to advance our knowledge and improve clinical care. This issue of Emergency Medicine Clinics of North America brings together updates on both the core content of wilderness medicine and additional topic areas that have not been previously addressed. Advances in the prevention and treatment of highaltitude illness, hypothermia, snake envenomation, frostbite, decompression illness, and marine envenomation are juxtaposed with more novel articles that include medical emergencies onboard commercial aircraft, medical-legal topics, the application of ultrasound to austere environments, and lessons learned from the battlefields of Iraq and Afghanistan. We are indebted to all of the contributing authors for their time and expertise and to Casey Potter and the editorial staff of Elsevier. We hope that the dedicated work of our colleagues will help guide health care providers to better care for patients in all environments, especially in the wildest and most austere places on earth. Eric A. Weiss, MD, FACEP Professor of Emergency Medicine Founder, Wilderness Medicine Fellowship Department of Emergency Medicine Stanford University School of Medicine Stanford, CA 94305, USA Douglas G. Sward, MD, FACEP Division of Hyperbaric Medicine Program in Trauma Department of Emergency Medicine University of Maryland School of Medicine Baltimore, MD 21201, USA E-mail addresses: [email protected] (E.A. Weiss) [email protected] (D.G. Sward)
Preface Wilderness and Environmental Medicine
Eric A. Weiss, MD
Douglas G. Sward, MD Editors
Wilderness medicine is a rapidly growing discipline that is becoming increasingly more significant in today’s era of globalization, international travel, and wilderness exploration. The diverse field of wilderness medicine evolved from “mountain medicine,” the investigation of the physiology of maladies experienced during man’s quest to climb the highest peaks on the planet. Its roots, however, date back many centuries, as the manifestations of high-altitude illness were noted by the Chinese, who described headaches and vomiting in travelers along the high passes of the Silk Road between China and Afghanistan. Today, wilderness medicine is a dynamic multidisciplinary field. It comprises many of the qualities and characteristics that are inherent in emergency medicine (EM). There is a requisite need to know about other specialties of medicine and the frequent requirement for urgent intervention, stabilization procedures, and expertise with prehospital care and transportation. It also overlaps extensively with environmental, travel, military, disaster, and sports medicine. Although wilderness medicine generally focuses on medical problems and patient care in remote and austere environments, many of its lessons are essential to mainstream EM, and its application extends into urban communities. Natural and manmade disasters, like the Haiti earthquake, Hurricane Katrina, and the September 11, 2001 attacks may create an environment as limited as the wilderness in the midst of a city by destroying or damaging power, transportation, communication, and health care facilities. With escalating emergency department (ED) crowding and limited resources, improvised care has become a skill that many ED providers practice on a frequent basis. Wilderness medicine will continue to inform the real-life practice of EM as both fields grow and interact. EM has often been a springboard for pursuing wilderness medicine. In 2003, the first fellowship in wilderness medicine was established at Stanford University to provide EM residency graduates the opportunity to gain advanced knowledge, formal training, and Emerg Med Clin N Am 35 (2017) xvii–xviii http://dx.doi.org/10.1016/j.emc.2017.02.002 0733-8627/17/ª 2017 Published by Elsevier Inc.
emed.theclinics.com
xviii
Preface
proficiency in research and practice in wilderness and environmental medicine. Currently, there are fifteen wilderness medicine fellowships at academic EM programs throughout the country. These programs are helping develop new leaders in the field and are facilitating vital research to advance our knowledge and improve clinical care. This issue of Emergency Medicine Clinics of North America brings together updates on both the core content of wilderness medicine and additional topic areas that have not been previously addressed. Advances in the prevention and treatment of highaltitude illness, hypothermia, snake envenomation, frostbite, decompression illness, and marine envenomation are juxtaposed with more novel articles that include medical emergencies onboard commercial aircraft, medical-legal topics, the application of ultrasound to austere environments, and lessons learned from the battlefields of Iraq and Afghanistan. We are indebted to all of the contributing authors for their time and expertise and to Casey Potter and the editorial staff of Elsevier. We hope that the dedicated work of our colleagues will help guide health care providers to better care for patients in all environments, especially in the wildest and most austere places on earth. Eric A. Weiss, MD, FACEP Professor of Emergency Medicine Founder, Wilderness Medicine Fellowship Department of Emergency Medicine Stanford University School of Medicine Stanford, CA 94305, USA Douglas G. Sward, MD, FACEP Division of Hyperbaric Medicine Program in Trauma Department of Emergency Medicine University of Maryland School of Medicine Baltimore, MD 21201, USA E-mail addresses: [email protected] (E.A. Weiss) [email protected] (D.G. Sward)