Jennifer Dow

Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite

The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens for each modality according to methodology stipulated by the American College of Chest Physicians.

Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2014 Update

To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations.

Mountaineering fatalities on Denali

Mount McKinley, or Denali, is the tallest mountain in North America and attracts over 1,000 climbers annually from around the world. Since Denali is located within a national park, the National Park Service (NPS) manages mountaineering activities and attempts to maintain a balance of an adventurous experience while promoting safety. We retrospectively reviewed the fatalities on Denali from 1903 to 2006 to assist the NPS, medical personnel, and mountaineers improve safety and reduce fatalities on the mountain. Historical records and the NPS climber database were reviewed. Demographics, mechanisms, and circumstances surrounding each fatality were examined. Fatality rates and odds ratios for country of origin were calculated. From 1903 through the end of the 2006 climbing season, 96 individuals died on Denali. The fatality rate is declining and is 3.08/1,000 summit attempts. Of the 96 deaths, 92% were male, 51% occurred on the West Buttress route, and 45% were due to injuries sustained from falls. Sixty-one percent occurred on the descent and the largest number of deaths in 1 year occurred in 1992. Climbers from Asia had the highest odds of dying on the mountain. Fatalities were decreased by 53% after a NPS registration system was established in 1995. Although mountaineering remains a high-risk activity, safety on Denali is improving. Certain groups have a significantly higher chance of dying. Registration systems and screening methods provide ways to target at-risk groups and improve safety on high altitude mountains such as Denali.

Search and rescue activity on Denali, 1990 to 2008.

OBJECTIVE To describe search and rescue activity performed by the National Park Service (NPS) on Denali, the highest point in North America. METHODS A retrospective review was performed of all search and rescue (SAR) operations by the NPS from 1990 to 2008. Descriptive analysis was used to describe these cases as well as chi-square and logistic regression analysis to determine which mountaineers were more likely to require a rescue. RESULTS During the study period, 1.16% of all Denali climbers required NPS SAR response. The majority of medical cases (68.9%) were due to high altitude and cold injuries, and the majority of traumatic cases (76.2%) resulted from a fall. Mountaineers that attempt routes other than the standard West Buttress route are more likely to require rescue. Climbers are 3% more likely to require a rescue with each year of advancing age. Similarly, mountaineers from Asia are more likely to require a rescue (odds ratio = 4.1), although this trend has diminished in the past decade. CONCLUSIONS Mountaineers and rescuers should educate themselves on the environmental, logistical, and medical origins of Denali rescues. Certain demographic groups on certain routes are more likely to require a rescue on Denali. Rescuers should be aware of these groups and have the knowledge and capabilities to care for the medical issues that are common on SAR responses.

Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite: 2014 Update

The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the original guidelines published in Wilderness & Environmental Medicine 2011;22(2):156-166.

Mountaineering medical events and trauma on denali, 1992-2011

Denali (Mt. McKinley) is the tallest mountain in North America and a popular climbing destination for high altitude mountaineering expeditions. National Park Service (NPS) personnel care for and manage medical incidences and traumatic injuries for mountaineers each year. We retrospectively examined NPS medical reports from the climbing seasons of 1992-2011. Medical complaints, diagnoses, treatment, provider training, and overall numbers of injuries and illness were analyzed. Fatalities were included only if they were cared for by NPS medical personnel prior to death. Of the 24,079 climbers on Denali during this period, 831 (3.5%) required medical assistance from the NPS. There were 819 diagnoses; 502 were due to medical illness and 317 were traumatic injuries. Patient encounters occurred most frequently (71%) at the 4328 m camp. Frostbite was the most common individual diagnosis (18.1%), while altitude-related syndromes were the most common illness category (29%). Most patients (84%) were treated and released to descend without additional intervention, whereas 11% needed air evacuation, and 4% needed another type of NPS assistance to descend. The only fatality in this series was caused by traumatic brain injury due to a climbing fall. A broad variety of medical complaints were evaluated and treated by NPS personnel, most commonly altitude related problems and frostbite. The results of the study will enhance the awareness of potential illness and injuries encountered by medical providers participating in high altitude mountaineering expeditions. Additionally, providers responsible for evaluating mountaineers prior to their expeditions can educate them on the spectrum of physical and environmental conditions that increase the chances of illness or injury. This ideally will decrease the incidence of morbidity on both Denali and other high altitude mountaineering destinations.

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.

Investigating Carbon Monoxide Exposure on Denali

Abstract Objective.—This exploratory study assessed a potential relationship between elevated carboxyhemoglobin (COHb) levels and acute mountain sickness (AMS) at 4300 m on Denali. Additional analysis assessed the relationship among COHb levels, AMS, and climber characteristics and behaviors. Methods.—Participants were screened for AMS with the Lake Louise Self-Report questionnaire and answered questions focusing on AMS symptoms, prevention, and previous altitude illness. Levels of COHb were measured by serum cooximetry. Additional questions assessed stove practices, climbing practices, and climber behaviors. Nonparametric statistical analyses were performed to examine potential relationships among COHb levels, AMS symptoms, and climber behaviors. Results.—A total of 146 climbers participated in the study. Eighteen climbers (12.5%) were positive for carbon monoxide (CO) exposure and 20 (13.7%) met criteria for AMS. No significant relationship was observed between positive CO exposure and positive criteria for AMS. Climbers descending the mountain were 3.6 times more likely to meet the study criteria for positive CO exposure compared with those ascending the mountain (P = .42). In addition, COHb levels were significantly higher for those descending the mountain (P = .012) and for those taking prophylactic medications (P = .010). Climbers meeting positive criteria for AMS operated their stoves significantly longer (P = .047). Conclusions.—No significant relationship between AMS symptoms and CO exposure was observed. This may have been affected by the low percentage of climbers reporting AMS symptoms, as well as limited power. Descending climbers had a 3.6 times increased risk of CO exposure compared with ascending climbers and had significantly higher COHb scores. Increased hours of stove operation was significantly linked to climbers who also met criteria for AMS.

Demographic, Geographic, and Expedition Determinants of Reaching the Summit of Denali

Mount McKinley, or Denali as it is called by the native people of Alaska, is the highest mountain in North America and its summit is attempted by over 1000 climbers annually. Many factors affect the likelihood of achieving the summit of high peaks such as Denali: climber age, experience, weather, team characteristics, and many others. We analyzed the characteristics of mountaineers who gained the summit of Denali versus those who did not during the climbing seasons of 1990 to 2008. Of the 21,809 climbers who attempted to summit Denali during the study period, 11,297 (51.8%) achieved the summit. We found that male mountaineers were slightly more likely to attain the summit than females. Climbers older than 40 had a decreasing trend of summit success. Climbers from continents other than North America had better odds of achieving the summit. Our results help to better predict those who are more likely to achieve the summit of North Americas highest peak. The information can be used by mountaineers during expedition planning so that team selection, route choice, and expedition style may be considered when evaluating chances for summit success. National Park Service administrative personnel and rescue staff may be able to identify climbing teams with a lower likelihood of summit success for proactive discussion or intervention prior to an expeditions departure for this unique and often very inhospitable mountain.

Mountain research and rescue on denali: A short history from the 1980s to the present

Alaskas Denali (Mt. McKinley), 6194 m, is the highest and perhaps most celebrated peak on the North American continent. The cold and stormy nature of this mountain just 3° of latitude south of the Arctic Circle enhances its legend as a challenging peak. It has been the desired objective of over 1000 summit aspirants per climbing season for the last 20 years. As mountaineering traffic on the peak increased in the 1960s and 1970s, an increase in deaths and helicopter evacuations followed suit. These were largely owing to altitude illness, cold injuries, and trauma. By the late 1970s and early 1980s, the U.S. National Park Service (NPS) began exploring potential solutions regarding the problems with rescue scenarios in remote and hostile surroundings. The NPS eventually placed a team equipped with communications and medical supplies high on the mountain to remedy the problem. This seasonal high altitude camp, established in 1982, carried out clinical research, preventive education, and rescue work. Although this operation has undergone substantial changes since 1982, it continues to serve Denali climbers each season and has likely reduced the frequency of serious accidents, death, and helicopter rescues. In addition, a parallel increase in NPS infrastructure, medical research, and mountain rescue on this peak has contributed to an increased benefit for climbers and others, which has served (and continues to serve) a wide range of interests, from the safety concerns of mountaineers to high altitude-related scientific discoveries advantageous to the scientific community.