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Wall Street Journal

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THE INFORMED PATIENT



By LAURA LANDRO

On a trek to the base camp at Mount Everest last year, Brenda Tiernan woke up in her tent at 1 a.m. feeling "like someone had put a hatchet through my head." Barely recovered from a bout of infectious diarrhea earlier in the trip, she was now suffering from acute mountain sickness, requiring emergency therapy with intravenous steroids before doctors at the camp's medical clinic evacuated her to a lower altitude to prevent a potentially fatal complication such as cerebral edema, a build-up of fluid in the brain.

Ms. Tiernan, a 51-year-old nurse, was fortunate to be close to medical help -- and to be traveling with a group that included experts in wilderness medicine. This fast-emerging medical specialty covers conditions ranging from altitude-induced mountain sickness and deep-sea decompression illness to venomous snake bites, bear attacks and animal-borne parasites. As interest in adventure travel, eco-tours, backcountry trekking and survival courses grows, the risk of injuries, even to the most experienced participants, is increasing as well.

Now medical schools and emergency-responder programs are adding wilderness-medicine education, conducting research into the special dangers of environmental exposure, and teaching travelers how to better prepare for the hazards of the great outdoors.

"People of all walks of life and all skills levels are going out into increasingly harsh and remote environments in ever-increasing numbers, and encountering situations both common and unique for which they are not adequately prepared," says Paul Auerbach, a professor of surgery in the emergency department at Stanford University School of Medicine and a co-founder of the Wilderness Medicine Society.

The society met at Snowmass, near Aspen, Colo., this week for an annual conference that included an advanced wilderness life-support course and other related training for physicians. The medical society, which has grown to 2,700 members since its 1983 inception, last year began offering a 100-hour certification program in wilderness medicine. Its first 38 fellows are graduating at this year's meeting.

Wilderness-medicine experts are the swashbucklers of health care, often emergency physicians who take time from hospital practices to accompany expeditions, run clinics at Everest base camp and work with ski-patrol rescue teams, often without pay. Their meetings tend to combine work and outdoor pursuits in places like Aspen and Big Sky, Mont.; the Wilderness Medical Society and the International Society for Mountain Medicine will hold their world congress this October in the scenic Cairngorms National Park in Aviemore, Scotland.

But wilderness-medicine experts also treat Sherpas and other local workers on climbs and treks, and provide care to inhabitants of less-developed countries where they conduct research into animal- and insect-transmitted diseases, snake bites and toxic plants.

Such experts are also working with disaster-preparedness groups and the military on helping victims of natural disasters or combat casualties. They can convey an arsenal of improvisational techniques for use in locations far from modern facilities -- such as tying scalp lacerations with a victim's hair and dental floss, using a kayak paddle to make a splint, or immobilizing a neck injury with a fanny pack and duct tape.


Medical-clinic staffers treat a climber with severe frostbite at the Mount Everest base camp.
Dr. Auerbach, an avid trekker and deep-sea diver, recently started a blog, Medicine for the Outdoors (www.healthline.com/blogs/outdoor_health2), where he discusses new developments in the field and chronicles occasional misadventures -- such as a recent run-in with a giant Portuguese man-of-war on a diving trip to Mexico after he forgot to apply a combination sunscreen-jellyfish repellent product.

He corralled more than 150 experts to contribute chapters to a new edition of "Wilderness Medicine," a textbook released in May, which weighs in at 2,316 pages, and he also wrote a portable field guide for doctors and a consumer handbook, "Medicine for the Outdoors."

Wilderness experts help develop wilderness-medicine survival equipment: Colin Grissom, an emergency specialist at Salt Lake City's LDS Hospital and an avalanche rescue-and-survival expert, conducted studies on the Avalung. The device helps skiers trapped in avalanches breathe until rescuers can come. Howard Backer, an authority on heat illness and dehydration in California, conducted the studies that led to the use of portable devices in National Parks to help emergency medical technicians diagnose the severity of hyponatremia, a loss of sodium that can be life-threatening for hikers in high heat.

For travelers, experts advise getting a complete physical before an adventure trip, as well as visiting a travel-medicine clinic for vaccinations and a prescription for medications such as the antibiotic ciproflaxin, which can treat infectious diarrhea. Many adventure outfitters now require travelers to take out special insurance for medical catastrophes.

And be aware that even people in relatively good health can be at risk for injury if they are sedentary. "If you are going to go trekking in Nepal you should be in reasonable physical condition and you shouldn't do it at all if you haven't gotten off the couch for the last two years," says Ken Kizer, the former undersecretary of health for the Department of Veteran's Affairs and a co-founder of the Wilderness Medical Society.

While there are no comprehensive national statistics on injuries sustained during wilderness recreation, the Centers for Disease Control and Prevention says as many as 68% to 82% of long-distance hikers have reported illness or injury during tours through backcountry areas of the U.S.


The CDC is planning a study in Yellowstone National Park next summer about the risk factors for illness and injury, including determining the level of risk from drinking untreated water from lakes and streams. With about 272 million visitors in each of the past two years to national parks, there were 15,846 incidents requiring emergency medical response in 2006, up from 13,898 in 2005.

Luanne Freer, the medical director for Yellowstone -- and the founder and director of the Mount Everest base camp medical clinic -- notes that physicians not trained in wilderness medicine may not know how to treat certain injuries. For instance, a bite from a deer or moose requires an antibiotic used specifically to treat pasteurella, bacteria found in the mouth of bears and other wild animals, and many of the rashes from plants in the wilderness may not be recognizable to urban dermatologists.

Travelers can sign up for basic wilderness first-aid courses sponsored by Lander, Wyo.-based National Outdoor Leadership School (www.nols.edu3), which trains people in the outdoor industry and provides wilderness medical courses for professionals.

Eric Johnson, the director of emergency services at Teton Valley Hospital in Driggs, Idaho, says there is a "constant battle" against myths of wilderness care, such as the common belief that snakebites should be treated by slashing the skin and sucking out the venom; the technique can make things worse, increasing bleeding and adding oral bacteria to the snake venom. The most important measure is to keep victims stable and breathing until they can reach a clinic or hospital where an anti-venom agent can be administered.

"We don't want people to be afraid of the wilderness, but we need to educate them about common misconceptions and prevention," says Dr. Johnson, who is also president of the Wilderness Medical Society and volunteers every other year for four months in clinics in Nepal and elsewhere.

• Email informedpatient@wsj.com4.

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