Independence Day

Happy July 4! As we celebrate Independence Day, we should be grateful for our freedoms, families, friends, and wonderful country. We are especially indebted to all who serve and have served America, be it military, education, environment, health care, or any other public service. Few of us would be able to enjoy much of our lives in the U.S. without the continual selfless devotion of others. When you watch the fireworks (from a safe distance) this year, think hard about what you might do in the coming year to make our nation healthier, safer, stronger, cleaner, and more wise.

The 4th of July holiday is usually a wonderful time to be outdoors. In the hope that you will all have a wonderful weekend and enjoy the scenery, here are a few tips for injury prevention that will help you have fun safely, and not need to visit me or any other emergency physician:

1. Be extremely careful with fireworks. Firecrackers, bottle rockets, sparklers, and the like are always the cause of unfortunate accidents on the 4th of July. Do not leave children unattended with fireworks - that would be a recipe for disaster. Wear eye protection around fireworks. Eye injuries from extremely hot-burning and explosive fireworks are common, particularly in children, and they can be devastating, including loss of vision. Obey the law. Whether or not it is legal to use fireworks in your location, do not make the mistake of igniting a wildland fire.

2. Supervise all young children when they are swimming, even in the backyard or hotel swimming pool. Never take it for granted that someone else will safeguard your child, particularly if a swimming pool is crowded. For teenagers and older, remember that alcohol and water sports do not mix. Finally, ignore the misguided folklore that informs people never to swim after eating. The truth is that swimming is exertion, and swimmers need fuel. A small amount of carbohydrate and a beverage are important to maintain energy, and are advised before strenuous or prolonged aquatic exercise.

3. Stay well hydrated, particularly in the heat. If you are hiking, climbing, running a road race, cycling, or doing anything else that causes you to sweat, breathe rapidly (particularly at altitude), or be outdoors in hot weather, take extra care to drink plenty of fluids. There are many recommendations floating around regarding how much of ingested fluid should be plain water, or supplemented (usually with electrolytes and carbohydrate) water, but the bottom line is that you should keep up with what you perspire, respire, excrete, and sweat.

4. Wear your bicycle, motorcycle, climbing, whitewater or other helmet. There are more people on the roads (so more collisions), people are on holiday, alcohol is consumed, and the river rocks and rockfall from cliffs are unforgiving. Many a head is bonked (hard) on the 4th of July. To put it simply, the people who wear helmets often live unimpaired, while those who are not wearing helmets suffer brain injuries and die or become disabled. If you should be wearing a helmet, forgo the freedom to suffer and be smart.

5. Leave no trace. Whether you are camping, boating, or hiking, pack out your garbage and dispose of it properly. Know how to build a proper latrine at a safe distance from your campsite or natural water sources, pick up paper, cans, and other refuse, and try to leave the wilderness the way you found it. Besides the obvious benefit to the environment and scenery, you are practicing good public health, by not contaminating the soil and groundwater, and thereby doing your part to control the spread of infectious diseases. Because everyone will not be as thoughtful as you, take care to wash your hands carefully, and consider using a disinfectant gel or lotion, before you eat or handle food.

sparkler image courtesy of www.ric.edu
drowning image courtesy of www.firstaidinaction.net
fly on flower image courtesy of www.freewallpaperdesktopwallpaper.com
campsite trash image courtesy of www.diglloyd.com

Preview the 25th Anniversary & Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 25-30, 2008.

Tags: drowning, fireworks, helmet, wilderness medicine, outdoor medicine, healthline

Labels: drowning, fireworks, hydration, July 4, safety

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Myths to Debunk

There are many myths related to outdoor medicine. These need to be “debunked,” so that people do not fall prey to outdated and useless techniques. Here are some of the most common myths (in italix):

1. Mechanical suction, electric shock, and immersion in ice water are effective first aid (“field”) therapies for snakebite. In truth, these are not only not helpful, they may be quite harmful. Antivenom therapy is the only therapy that has been proven effective, with the possible exception of pressure immobilization for certain elapid (e.g., coral) snake bites.
2. Urinating on a jellyfish sting is an effective method to reduce pain. This is of very limited value. Some persons will cite that it was helpful in their particular case, but at least as many persons will state that it did not diminish the pain. The most effective therapy is decontamination with a specific topical compound, such as vinegar or ammonia. The decontaminant chosen depends upon the species of stinging jellyfish.
3. Applying a cold pack to a jellyfish sting is the most effective method to reduce the pain. Current information indicates that application of warmth (e.g., immersion in non-scalding hot water) may be much more beneficial.
4. Rabies shots are injected into the abdomen and are horribly painful. Not true- post exposure rabies vaccination may include a painful component as rabies immune globulin is injected into the bite site, but the subsequent vaccine, which is administered as part of the post exposure treatment, is given as a series of very tolerable injections into the arm or thigh.
5. In any circumstance of frostbite, rapid rewarming is essential. Actually, this should only be done if the body part can be relatively guaranteed to remain thawed. Otherwise, re-freezing the tissue causes significantly more damage than does the initial episode of freezing.
6. The Heimlich maneuver should be used for any victim of submersion (near-drowning) to remove water from the lungs and improve the chance for survival. The Heimlich maneuver has never been proven to be of use in humans in this situation, and may in fact increase the risk for vomiting and harmful inhalation of gastric contents. There is no evidence that it removes water from the lungs.
7. Drinking large amounts of liquids is harmful during exercise because it promotes stomach cramps. Quite the opposite – so long as the ingested amounts are prudent and don’t promote nausea from a full stomach, it is essential to replace fluids and electrolytes constantly during periods of high exertion, particularly in the heat, to avoid dehydration.
8. A person struck by lightning is “electrically charged” and may not be safely touched. This is not true. It is perfectly safe to touch such a person, and in fact the sooner that breathing can be supported, the more likely that the victim will survive with maximal neurological recovery.
9. In cold water, it is better to remain in the water where one feels warm that to pull oneself onto a rescue vessel or platform and be exposed to wind chill. Absolutely not true – one may lose heat 25 times as fast in the water as in air, so no matter how uncomfortable you feel, if it is possible to get out of the water, do so.
10. Sharks and bears are attracted to menstrual blood, so it is important for women to avoid diving and hiking during menstruation. This is a false concept, and has never been proven to be true, either epidemiologically or scientifically.

photo by Jenny Hargrove

Tags: myths,wilderness medicine, outdoor medicine, healthline

Labels: :Heimlich maneuver, bear, drowning, hypothermia, jellyfish, lightning, myths, shark, snakebite, wilderness medicine

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