Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Nutrition Needs for Rescuers and the Rescued

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This is the next post based upon a presentation given at the Wilderness Medical Society Annual Meeting held in Snowmass, Colorado from July 24-29, 2009. The presentation was entitled “Special Nutrition Needs for the Rescued (and the Rescuer!).” It was delivered by Eldon “Wayne” Askew, PhD from the University of Utah. The objectives of the presentation were to emphasize the medical and psychological importance of providing proper nourishment to rescued individuals, highlight some frequently encountered medical situations involving rescue for which clinical nutrition should be considered as part of treatment and stabilization of the rescued individual, and discuss expedition food planning for persons with medical conditions and for rescuers.

Here were some key points:

1. Plan ahead. Everyone is likely to be hungry. This may seem like a simple recommendation, but adequate planning in all aspects of an expedition is often not achieved.
2. Even if persons are not hungry, they will need nourishment of strength.
3. Food and drink can be emotionally reassuring
4. If victims have their energy stores “refueled,” they may be able to participate in their own rescues.
5. Do not count on a few food bars to maintain you. You may be out longer than you anticipate, food and water supply may not be feasible, you may need to share your supplies, and you have an obligation to be adequately fed and hydrated in order to maintain your performance.
6. If a victim is capable of eating and drinking, he or she should consume at least 30 grams of carbohydrate every 30 minutes to put off exhaustion. This is necessary to keep blood glucose sufficiently high to contribute to continued exertion.

By some estimates, 6% of the population suffers from some form of diabetes. If a person is on medication to lower blood sugar, that puts him or her at particular risk for a hypoglycemic (low blood sugar) reaction, so close observation is always necessary. Type I diabetics, who are insulin dependent, are most at risk, so heightened vigilance for this group is important. Trip leaders or other persons responsible for medical care should be informed about who suffers from diabetes, and should carry a glucose meter (“glucometer”). The medically trained person will carry insulin, injectable glucose, and perhaps glucagon for injection. Dr. Askew made the very important point that glucagon should not be expected to work with hypoglycemic persons who are also experiencing starvation, adrenal gland insufficiency or chronic hypoglycemia (low blood sugar), because these conditions are associated with an inability of the liver to produce glucose sufficiently in response to glucagon. These individuals need oral or injected glucose.

Blood sugar levels over 200 milligrams per deciliter (mg/dL) are too high, at 60 to 140 mg/dL are acceptable, and below 60 mg/dL are too low. These are general numbers. Some persons may exhibit signs and symptoms of hypoglycemia at levels above 60 mg/dL. Common symptoms of low blood sugar are shakiness, hunger, sweating, sudden moodiness or behavior changes, confusion, headache, pale skin color, dizziness and fatigue. Common symptoms of high blood sugar are thirst, vomiting, blurred vision , fainting, feeling ill, and fatigue. There is some overlap, but in general low blood sugar is rapid in onset, and high blood sugar develops more gradually.

If someone is suspected or proven to be hypoglycemic, then initially feed them 15 grams of sugar or carbohydrate, followed by small meals or snacks every 3 hours. Food sources that are roughly equivalent to 15 grams of carbohydrate are a slice of bread, a banana, 2 tablespoons of raisins, 1/3 cup of dry milk, 2 small cookies, a small granola bar, 8 ounces of sports beverage, a tablespoon of honey, or 4 restaurant packets of jelly.

Dr. Askew then discussed food allergies. The foods that most commonly cause serious allergic reactions are eggs, milk, fish, shellfish, nuts, soy, and wheat. Manifestations of a serious food allergy are hives, itching, swelling of the lips/face/tongue and throat/elsewhere, wheezing, difficulty breathing, nasal congestion, abdominal pain, diarrhea, nausea/vomiting, and/or dizziness/lightheadedness/fainting. When this occurs, treatment for a severe allergic reaction is necessary. To treat an allergic reaction from any cause, it is optimal to have injectable epinephrine and oral antihistamines.

Other topics covered included dehydration and rehydration, low serum sodium, and the importance of adequate food energy to performance. The last discussion merits more detailed mention, because it is so frequently underestimated.

If a person does not eat adequate food, with the extreme being no food at all, he or she should anticipate being uncomfortable from hunger, and having difficulty concentrating, anxiety, loss of body weight, decreased endurance, weakness, nutritional deficiencies leading to tissue and organ system deterioration, and perhaps collapse and death from starvation.

The situation may occur where a rescuer needs to feed a starving person who has been rescued. The general approach should be to:

1. Resolve any life threatening injuries or medical conditions.
2. Be certain that the person has functioning kidneys. This may be difficult for a layperson to determine, particularly in the field. If the person is still urinating, for the purposes of immediate care, you should proceed to offer food and drink. If the person is so “dry” that he has not urinated for 24 hours or more, then proceed with caution, observing for fluid retention. Approximately 10 milliliters of oral fluid per kilogram of body weight per hour consumed every 2 to 3 hours should initiate urination within 24 hours. An acceptable basic fluid for dehydration is to add the following to each liter: 3 grams potassium chloride, 1 gm sodium chloride, 4 gm calcium gluconate, and 50 gm glucose or sucrose. An alternative is to offer a dilute electrolyte solution (e.g., Gatorade diluted in half).
3. Slowly feed small portions of a food that is relatively high in fat (e.g., bacon, eggs, nuts, banana chips).
4. DO NOT permit the person to gorge on fluid or food. The sudden sensation of profound fullness may cause nausea and vomiting, which are detrimental.

Thanks so much, Dr. Askew, for making the outdoors a safer place!

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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