Wilderness & Remote Medicine Blog

Stop The Bleeding!

2011-03-02T10:43:00.000-05:00

Written by Lawrence Heiskell, M.D.

Expedient methods to clot the wound when only seconds count!

Each year, there are more than 70 million emergency department visits for bleeding. Bleeding, or acute hemorrhage in medical terms, is a leading cause of death in trauma cases. Under certain tactical situations, immediate evacuation of gunshot wound victims may be an option. Effective and immediate early hemorrhage control is paramount to saving lives.

The Clotting Mechanism
The coagulation of human blood is a complex biological process, and a full description is beyond the scope of this article. When a blood vessel is severed or damaged, the body reacts to try and stop the bleeding by spasm of the blood vessel, formation of a platelet plug and subsequent formation of a blood clot.

If the blood flow is under pressure, such as in a femoral artery wound, the normal clotting mechanism fails to stop the bleeding and the victim vcan bleed to death within a few minutes. Bleeding in the chest, pelvis and abdomen is impossible to detect in the field and can result in a large amount of blood loss. Once the blood loss exceeds about 40 percent of the total blood volume, which is about 5 liters, an irreversible shock state begins and the victim dies.

Hemostatic Bandages
There currently are several blood-clotting hemostatic bandages on the market. Each has a different mechanism to stop the bleeding. Readers are strongly urged to carefully conduct their own investigation to determine what is best for their agency, team and level of training.

The HemCon Bandage is composed of Chitosan, which is a biodegradable, nontoxic, complex carbohydrate of chitin, found in the exoskeletons of shellfish.

QuikClot is composed of granular zeolite and is derived from volcanic rocks. When this material is placed into a bleeding wound, it absorbs the water molecules in the blood and creates a high platelet concentration, to promote clotting.

The RDH or Rapid Deployment Hemostat Bandage is derived from single-cell algae and the mechanism of the material is to act as a catalytic surface that accelerates the normal clotting process. TraumaDEX is a wound-dressing agent material naturally synthesized from potato starch. The particles accelerate natural blood clotting by concentrating blood solids such as platelets and red blood cells.

The Emergency Bandage, Trauma Wound Dressing is an improved version of the time-honored battlefield dressing. This sterile, non-adherent bandage applies pressure to any site, is easily wrapped, secured and can act as a tourniquet in cases of severe bleeding. The beauty of this product is that the bandage can be applied to the head, armpit or groin for control of hemorrhage in these difficult areas.

The M.A.T. (Mechanical Advantage Tourniquet) is well designed and can be rapidly applied to any extremity with one hand. The M.A.T. is the only device that meets all of the DoD’s required and desired features in self-applied tourniquets. With its easy, fast and secure one-handed operation, blood flow can be stopped in less than 10 seconds.

Discussion
All of the hemostatic dressings are supposed to work in seconds, according to claims made by the manufacturers. The questions one must ask are, do they really work and what should be considered for purchase and distribution to tactical medics?

Unfortunately, there are conflicting reports in the medical literature regarding what bandage is the most effective. Unlike drugs that require years of testing and approval by the FDA, the manufacturers of hemostatic dressings are not required by law to conduct extensive research to support their claims. There are very few scientific, objective, controlled studies in the medical literature to support the claims made by some of the companies.

It stands to reason, that if the bleeding is under high pressure or very brisk, none of these products will work. You’ll need to apply direct pressure to the wound or to a pressure point between the heart and the wound. If you then get the bleeding slowed with a pressure point, you might be able to get the wound dry enough to apply the hemostatic dressing into the wound and hopefully it will work. After the dressing is complete, the tourniquet or pressure point may be released.

The one thing we do know is that the time-honored method of direct pressure and a tourniquet application for bleeding really works. It seems prudent that a medic will use the simplest and easiest technique in the field for hemorrhage control. At the International School of Tactical Medicine we recommend that agencies proceed with caution before spending valuable resources on the new blood-clotting agents until further studies are done, and stick with old-fashioned direct pressure and tourniquets.

Trenchfoot - A Common Ailment of Hikers

2011-02-15T09:49:00.014-05:00

An acquaintance of mine once lost all the feeling in his toes for three months from “trenchfoot.” He was lucky, in the end, that he suffered no permanent damage.

How did this happen? Well, you might guess that he froze his toes off in pursuit of an extreme adventure — high-altitude mountaineering or dogsledding across the North Pole — but no. He was backpacking, in June, near his home in Wyoming.

He started his five-day hike at a popular entry into the Wind River Range in sunny, warm, even hot conditions. In a matter of hours he gained enough elevation that he encountered winter snow that hadn't yet melted off, so he ended up hiking through freezing puddles of water on the trail. His boots became saturated with cold, icy water, and still hiked on. On the second day it started to snow and it grew much harder to take the time and effort to stay warm and dry.

His feet got cold when the icy water poured in over his boot tops; at some point they stayed cold and he didn’t do anything about it. And so his feet stayed cold for hours and hours, setting the stage for trenchfoot, more accurately known as “immersion foot” or a “nonfreezing cold injury.”

The physiology is simple. In response to the moisture and temperature, his body acted to narrow the tiny blood vessels that fed his toes. This is a standard reaction to cold exposure called “vasoconstriction.” Smaller tubes meant less blood got through, so the other tissues in his feet, the skin, bones, nerves, muscles, did not get the oxygen that they needed to stay healthy. Nor did they get cleaned of the normal cellular waste they generated, which is supposed to be flushed away by the blood, filtered by the kidneys and eliminated through urine. This waste built up.

The first tissue to be affected drastically was nerve tissue, which seemed to stop functioning. He perceived this as numbness that went away that evening when he warmed his feet, then came back the next day and persisted after the second cold day no matter how much he warmed his feet. In fact, the sensation of numbness in his toes persisted for about three months after he finished the trip!

His skin became red, itchy and painful when warmed, but that was about it. His feet did return back to 'normal' after three months; and he didn’t experience immersion foot at its worst: ulcers, infection of those ulcers, permanent nerve dysfunction, tissue death, amputation. All of these are possible.

You’d be better off not repeating his mistakes. The main rule is to never tolerate cold, wet feet. This starts with planning your activity and choosing appropriate footwear. Boots and shoes should fit well (and not squeeze the feet), insulate for the cold, and keep socks dry. Because any boot can become saturated if conditions are wet enough, consider using vapor barrier socks for your dampest slogs. Or, you can improvise these by using plastic bags to line your boots.

If your feet do get wet, take the time to dry them off, massage them warm again and change or at least wring out your wet socks. If you’re camping, sleep in a pair of dry socks that you keep at the bottom of your sleeping bag to guarantee that your feet get to stay warm and dry overnight at least.

Simple precautions and a little discipline will help you enjoy the wet conditions and not suffer from the cold.

A First Responder’s Top 4 Items Of Medical Equipment: Lessons From Haiti

2010-12-15T14:48:00.000-05:00

By Dr. Paul S. Auerbach

Prior to departing for my assignment in Haiti for International Medical Corps, I didn’t have much time to pack, so wasn’t able to bring everything I might need. However, I was able to carry a few items that proved quite useful. First and foremost was a new EMS-type trauma shears. Scott Forman, MD of Adroit Innovation, LLC has created a very functional titanium shears in which one finger loop has been replaced by a carabiner, so the shears can easily hang from a belt or other loop. I used them all the time to cut tape, change dressings, slice through wire, and other assorted tasks. I just purchased one for each member of the Stanford team.

I posted previously about elete electrolyte add-in solution. One dropper bottle holds enough electrolytes (sodium, potassium, chloride and magnesium) in concentrated solution to make ten 32 ounce (one liter) servings – which is 2 1/2 gallons. Everyone on our team made use of this product, because it was extremely hot and we were sweating a lot. We generally alternated bottles of unsupplemented water with bottles of water to which we added elete solution. The solution is absolutely tasteless, so we were able to add flavoring to the treated water as well. I will never travel anywhere that I expect to need to stay hydrated without bringing along elete.

We did a fair amount of cutting – both to treat patients, fashion splints, and perform mechanical repairs. I had my Kershaw carbiner cutting tool with me, and it was a terrific crossover instrument. I kept it attached to my fanny pack. Combined with a multi-tool, I had what I needed to be both a doctor and a handyman.

Finally, two of us each carried a SteriPEN with us for water disinfection. When we couldn’t obtain bottled water, it was necessary to use other sources, which sometimes was filtered and sometimes was not. Whether or not it had been through a filter, the water purity (disinfection) was pretty unreliable, so “touching it up” with the SteriPEN probably prevented more than a few cases of infectious diarrhea. It’s a convenient and very useful device and always travels with me when I have any question about the disinfection status of drinking water.

This post, A First Responder’s Top 4 Items Of Medical Equipment: Lessons From Haiti, was originally published on Healthine.com by Paul S Auerbach M.D., M.S..

California Hotels Continue to Analyze Defibrillators for Facilities

2010-11-08T16:55:00.005-05:00

The February 24th edition of the Wall Street Journal ran a story by Scott McCartney entitled "Why Hotels Resist Having Defibrillators." In a nutshell, the position reportedly taken by the hotel industry is that the risk of being sued as a result of having an automated external defibrillator (AED / defibrillator) on the premises outweighs the lifesaving benefits to the public of putting them there.

Without question the number of civil lawsuits over the past years has and continues to grow at an unprecedented, even explosive, rate. Businesses in general are reluctant to voluntarily take positive action, even for the public good, which could subject them to the substantial cost of defending their good deeds in court, and sometimes paying out money damages.

In the industry, it's been referred to as "No good deed goes unpunished". It's a pretty sad state of affairs when, according to the WSJ article, a hotel has to be worried that by spending as much as $1,800 for a lifesaving Automated External Defibrillator (AED), they risk being sued for having too few AEDs on the premises. None is OK, but one could land you in hot water.

But as the proven lifesaving advantages of having quick access to an AED have become more widely recognized, laws mandating their installation have become more common. AED's are presently required by federal law on commercial aircraft and cruise ships. A growing number of states require AEDs in health clubs and gyms, dental offices, schools, athletic events and public access facilities where large numbers of people gather such as airports and transit stations. The U.S. Congress and the California legislature have passed resolutions urging implementation of an AED program in all schools, grades K through university level. A growing number of California school districts, where AEDs are not yet mandated, have voluntarily installed them in schools and public buildings.

They are present in most major airports. San Diego, California's third largest city, passed an ordinance in December 2008 requiring AEDs in new construction of virtually every building with occupancy loads of 200 or more. This includes hotels, offices, stores, factories, warehouses and schools.

As the numbers of AEDs, and the lives saved due to their presence increases, so does the strength of the argument that the absence of an AED in a public gathering place (such as a hotel) falls below the reasonable standard of care in the community and exposes the owners and/or operators to negligence litigation.

On the other hand, there are positive public and community relations advantages to "doing the right thing" and it's reasonable to expect someone who places an AED in a public access accommodation such as a hotel to maintain it properly, just as you would a fire extinguisher or a smoke alarm.

Few would argue about whether a trained paramedic would be preferred over an untrained hotel employee or passerby in rendering CPR or activating an AED. But in the case of a sudden cardiac arrest, the difference between life and death has already been determined in the majority of cases before the ambulance with the paramedic aboard arrives. Given that the chances of survival are as high as 70% if a defibrillator is utilized within the first 5 minutes of an attack and around 5% by the time 10 minutes go by, the odds weigh heavily in favor of immediate defibrillation, whether given by an untrained responder or not.

Good Samaritan Laws were put on the books to deal with such situations These are laws generally giving a bystander protection from civil liability for voluntarily giving aid to someone who is injured or ill in an emergency situation. They were designed to reduce the reluctance of persons to render aid or assistance for fear of being held liable for their actions in a civil or criminal lawsuit.

Every state has some form of Good Samaritan Law and each has separately addressed the involvement of voluntary CPR and AED responders with proper CPR and First Aid training. Some offer more protections than others. California has addressed the specific subject of AEDs in what may be the most comprehensive set of statutes in the country. California's basic Good Samaritan statute has been held to protect those rendering emergency medical care at the scene of a medical emergency.

It therefore provides a liability shield for those rendering CPR, AED, First Aid or similar assistance in an emergency situation if certain requirements are met.

In addition to the general Good Samaritan Statute, California provides specific protection to those providing and utilizing AEDs.

Individuals who operate an AED in an emergency situation are protected from liability under Civil Code §1714.21(b).

An entity that purchases an AED also has immunity under Civil Code §1797.196 if it complies with for following conditions:

The AED be maintained and regularly tested.
The AED be checked for readiness after each use and at least once every 30 days if the AED has not been used in the preceding 30 days.
Any person who uses an AED contacts emergency personnel as soon as possible, and reports any use of the AED to a licensed physician and to the local emergency medical services agency.
For every AED unit acquired up to 5 units, no less than 1 employee per AED unit shall complete a training course in CPR and AED use.
There is a written plan that describes the procedures to be followed in the event of an emergency that may involve the use of an AED.

The maintenance and readiness checks can be accomplished by simply observing the AED and assuring a blinking green light is present, indicating it is "ready."

Training at least one employee per unit for the first 5 units and one for each 5 units thereafter seems reasonable and easily accomplished, as is having one on site during normal operating hours.

Obviously each entity must decide for itself if the benefits of purchasing an AED outweigh the risks. A simple internet search reveals news stories of "AED saves" appearing daily. There have been reports of litigation in which it was alleged that an AED should have been present and wasn't, but one would be hard pressed to find one in which it was alleged that an AED was used and didn't work properly.

Not only does placement of AEDs in public access buildings assure adherence to a reasonable standard of care for employees and the public, but more importantly it's sound public policy, a great public relations opportunity and evidences a commitment to the community at large, that says "We care about you and are willing to invest in the latest medical technology to give you a better chance of survival in case of an emergency."

For more information on AED training, sales and liability, please visit:
http://www.personalcpr.com/aed/index.html

At the Center for Wilderness Safety, Clifton Castleman teaches us how to stay safe in the great outdoors

2010-11-01T09:24:00.004-04:00

By Clifton Castleman, Co-Founder
Center for Wilderness Safety

The idea to create the Center for Wilderness Safety came to me in college. I was a student at Penn State University, taking an outdoor recreation class, and my professor gave us an assignment to create a company that offered goods and services needed in the outdoor recreation field. My group came up with a program called “Outdoor Ascent,” which provided three services: rock climbing instruction, team-building programs, and basic wilderness first aid. We got an A.

But I knew there was more to do with the idea. Having been a Boy Scout all my life, and an Eagle Scout since 2000, I realized that I could turn our project into a company. So in 2003, at the ripe age of 21, I began growing a new LLC organization dedicated to training people how to be safer in the wilderness.

In the last seven years, my organization has taught more than 4,000 people how to save lives. While most of our classes teach lifesaving skills to campers and hikers who may come into harm’s way while enjoying the outdoors, we recently began offering emergency medical services for special events and festivals in the metropolitan DC area. We also offer lifesaving courses to colleges and universities, corporations, non-profits, Scout troops, and government agencies. We also have an online store, www.wildsafestore.com, where fans of the outdoors can buy everything they might need in case of a problem — from tightly packed medical kits to a CPR mask that fits on your keychain. It’s all about being prepared!

Students practicing holding C-Spine

Welcome to Base Camp

Like the good Scouts we are, we run the program as efficiently as possible. We don’t have a fancy office or a big marketing budget, but our dozen dedicated instructors are passionate about teaching people to be safe in the outdoors. In fact, last March the Boy Scouts of America (BSA), which comprises at least 75 percent of our clientele, unveiled a new, wilderness, first-aid certification program.

The program was the result of collaboration between the Scouts, Wilderness Medical Society (the organization that sets the national standards of care for wilderness emergency medicine), and the American Red Cross. The new program is a requirement for any Scout or adult leader wishing to attend one of BSA’s high-adventure bases, and it will soon become a requirement for the rank of Star Scout, which is two ranks below the top rank of Eagle Scout.

Safety First

Patient packaging & evacuation

The Center for Wilderness Safety provides a customized curriculum for the outdoor enthusiast and professional, and fills a niche that few organizations offer — teaching wilderness medicine education.

About 80 percent of all community health and safety course participants attend our training courses to meet a certification requirement — for work, school, or a volunteer position. Those who have a personal interest in learning lifesaving skills, but have no job-related need or requirement, are often parents of young children or teen babysitters. Corporations often call us in to train their employees, since even though our core mission is teaching lifesaving skills, our program is also a great team-building exercise.

Building the Center for Wilderness Safety from the ground up and seeing how far we’ve come in a few short years is a dream come true. And it’s gratifying that wilderness medicine is seeing a steady increase in awareness. I never imagined that we would have come so far so fast — but we’ve done it, and I’m looking forward to helping more people enjoy the great outdoors safely in the years ahead.

About Clifton Castleman

Clifton Castleman has a degree in Recreation, Park & Tourism Management from Penn State University. A Wilderness EMT, he is a member of the Wilderness Medical Society, and since 2001 has been an American Red Cross instructor. He was recently awarded the Patricia M. & James M. Hudson Health & Safety Award from the American Red Cross for his outstanding leadership and instruction.

He currently serves as the volunteer medical team director for the Sierra Club’s One Day Hike, a 100/50 Kilometer hike from Georgetown, DC, to Harpers Ferry, WV, that attracts several hundred hikers each year. He is a former member of a local rescue squad and of the Shenandoah Mountain Rescue Group.

NEW Invisible Inflatable Airbag Helmet for Cyclists

2010-10-21T12:11:00.002-04:00

Behold the Hövding, a discreet airbag that, while not actually invisible, is understated and cool-looking, and which can be worn by cyclists around their necks instead of a helmet. Created by two Swedish university students, the airbag inflates around the cyclist's head in the instances of collision or a fall, protecting them from injuries. Watch it in action below.

Here is what it looks like while not inflated:

And now, inflated:

Watch the Video:

Finally, you can check out the high-fashion site promoting the thing here.

Haiti: Triage, Vodka & Wilderness Medicine

2010-10-11T10:40:00.004-04:00

The videos and pictures showed everything. Search and rescue teams digging through rubble. Haitians praying, then hushing, in hopes of the sound of a loved one.Rescue dogs sniffing for signs of life. Bodies decaying in the streets. Reporters weaving through crowds. Women singing towards the sky in the streets at night. A Haitian boy in the middle of a mob bleeding from the head after a brick to the head. Surgeons amputating limbs with hacksaws sterilized in vodka.

Doctors practiced medicine with primitive tools after the quake. They flew in from the best international medical centers to treat patients under makeshift tents.

Dr. Paul Auerbach arrived with an emergency medical team from Stanford. Auerbach, the founder and former president of the Wilderness Medical Society, knows how to treat medical conditions in the absence of resources and infrastructure. He wrote a footrest of a book on it, Wilderness Medicine. It's a textbook that addresses how to treat some of the worst medical conditions in extreme conditions.

Auerbach established the society to treat people in remote wilderness areas and poor rural areas in emergency situations. Doctors in the rubble of Port au Prince need those skills just as much. Some knew it before they left. One packed the booknext to a creole dictionary. Another expressed gratitude for a WMS workshop he attended.

For his part, Auerbach got right to work with limited resources. He updated hishealthline blog to provide a picture of emergency medicine in Haiti. Here are a few excerpts from those posts.

January 22
Today's story is about our 5 year old survivor of a week beneath the rubble. He was pulled from the ground and came to our team emaciated, dehydrated, frightened and confused. (For reference, we have heard that some victims under the rubble were forced to try to drink their own sweat and blood from faces dripping into open mouths. I apologize for being graphic, but this is reality.) Our doctors and nurses gently hydrated him, then began to nurse him back to health. He has made a remarkable recovery, as have others. With so many people affected, there will be many such stories, but for each tale with a happy ending, there are thousands with a tragic outcome.

Haiti, January 24
We continue to have new patients enter the compound, including nearly 100 emergency patients today, many with injuries related to the earthquake. This is done in two new triage tents provided by the army. We are receiving patients referred from the countryside and other hospitals. The operating rooms are busy with orthopedic and wound care, skull fractures, hand surgery, facial reconstruction and the like. Neurosurgery is still not ready to go at this facility.

The Swiss have a pediatric surgery service next to our pediatric area. This is a part of the compound that breaks your heart. The tented ward is full of children with multiple amputations and severe injuries. There is no candy coating this - their lives will never be the same. A half a block away, when the wind shifts, it smells of death from bodies buried in the rubble of the nursing building. We have learned to adapt, to walk past this place and wrinkle our noses. We no longer need to wear facemasks.

Haiti, January 28

Our two-tent E.R. continued to be busy. The doctor teams were swift, efficient and resourceful. We added service for HIV patients, and the number of patients with tuberculosis increased to the point that we created an isolation tent. These patients are coughing and cachectic. On the opposite side of the compound, the population in the pediatric tents in growing rapidly. Unless there is a concerted effort to create an off-site location to house patients that can be discharged from the hospital, there will once again be space problems.

I am so proud of my Stanford colleagues and all the other doctors present in the compound who have worked tirelessly for the past two weeks. The teams from California, Hanover, Boston, New York, Switzerland, Norway, Canada, Spain, and many other locations all pulled together in a model for collaborative behavior. There are always a few people more interested in citing their credentials than in getting the work done, and media people looking for the sensational angle, but they stood out in stark contrast to the dedicated and tireless people who rolled up their sleeves coming in and hugged going out. Take it from someone who was, as someone suggested to me, in the belly of the beast that when the memories finally register, they will be indelible and life-altering. I wish the people of Haiti every good fortune from this point forward and hope that you will find it in your hearts and schedule to assist these people, and others in need, in some fashion.

The extreme surgical triage has stopped, but the surgeries and treatment continue. The World Health Organization estimates that doctors still carry out 30-100 amputations every day. Left untreated in hot unsanitary conditions, minor wounds fester into life-threatening injuries. The rainy season is coming, and the WHO fears that epidemics may add to a body count feared to already be 200,000. Tetanus, cholera, and diarrhea may take more lives. That's to say nothing of the mental and emotional toll.

After a string of 18-hour days packed with surgeries and logistical headaches,Auerbach has returned home. His skills remain in Haiti in the hands of other doctors who practice wilderness medicine in a city's rubble. They are good skills to have, but the next wave of medical emergencies—diseases, PTSD, diarrhea—will require more.

So what is this New Hands-Only CPR thing, and does it work?

2010-09-07T17:24:00.000-04:00

Clif Castleman, WEMT

My thoughts as a medical professional (and by the way, these protocols have already become effective in Loudoun County, Virginia), are that overall, it makes sense, however you're only supposed to provide chest compressions for the first two minutes after arriving on the scene where somebody has collapsed and you witnessed them collapse then switch over to providing "traditional" CPR. The order of things is a bit of a lie; because first things first, you still have to check the scene for safety, then check the victim to see if they're responsive; if so, call 9-1-1 or your local emergency response number. Only then should you begin to do chest compressions.

After two minutes of chest-compressions-only have been done, both the American Heart Association and American Red Cross state that you then need to go into "traditional" CPR with 30 chest compressions and two breaths. This is because there is enough residual oxygen in your bloodstream and vital organs, however after roughly two minutes, that residual oxygen is used up, and must be replaced with new fresh oxygen. Remember, the air we breathe contains roughly 21% oxygen and when we breathe it in, our body uses only about 5% of that, exhaling 16% oxygen - which is way more than enough for another human being to utilize.

The real key to all of this is the Automated External Defibrillator, or AED. The AED is designed to shock the heart back into an effective rhythm. The sooner an AED is brought to the aide of a person who has collapsed and is completely unresponsive - even to painful stimuli such as a sternal "noogie" or a hard pinch on the back of their arm - the better chance that person has of being successfully revived. If you find yourself in a situation where you just saw the individual collapse, have checked for scene safety, checked them for responsiveness, and have called 9-1-1 - and there's an AED in the building but no one else to go get it, GO GET THE AED FIRST and don't worry about the two minutes of compressions, because literally speaking, the chest compressions are only pumping somewhat oxygenated blood to the vital organs long enough for an AED to restart the heart on its own.

Clifton Castleman

Executive Director,

Center for Wilderness Safety

www.wildsafe.org

1-888-945-3402

Dylan Gibbs tells us, "How Boy Scouts Saved My Life"

2010-09-03T16:03:00.002-04:00

By Dylan Zane Glenwood Gibbs, Age 11
(With a little help from his mom, Hope Katz Gibbs)

This summer I learned some big lessons about the perils of catching grapes in my mouth, the importance of knowing first aid, and what an amazing dad I have. It happened in August when my dad and I went on a biking and camping trip with two of my best friends and their fathers. Our mission was to bike at least 25 miles along the C&O Canal tow path, camp overnight, and bike back the next day as part of our Boy Scout cycling merit badge.

We left on a Saturday morning, and had a great time biking along and then stopping to look at the algae growing in the canal, eating lunch under the giant trees, spotting birds and turtles, and skipping rocks.
After a long day of cycling, we set up our campsite for the night. When the dads started cooking dinner, I decided to snack on some grapes. I ate them my favorite way, which is by throwing the grape as high in the air as I can and catching it in my mouth. When my dad saw what I was doing, throwing them about 30 feet high, he told me to cut it out. “You could choke, Dyl. You should stop.”

Not five minutes later I knew exactly what he was talking about. I tossed a grape so high that it nearly reached the branches on the highest tree, and when it came down it lodged right in my throat. Luckily, earlier that summer I had gotten my First Aid merit badge, so I knew what I had to do.

Although it was hard to breathe, I ran over to my dad with my hands up to my neck, which is the international sign for choking. He knew what had happened. (Of course, he told me later, the fact that my face was turning a terrible shade of purple was another clue.) He immediately threw me over his knee and began pounding on my back — just like he did when I choked on a Cheerio when I was a baby. It didn’t work though, and I was getting scared. That’s when I clasped my hands out in front of me, telling him to do the Heimlich maneuver.

He must have known what I was trying to say because he immediately stood behind me and clasped his hands under my diaphragm. It was a little too high up on my belly, though, so I moved them down to the spot that my Scout Master had showed me. My dad pushed in and up, but after two thrusts nothing came out. I felt him take a deep breath, because it wasn’t working. He clenched his fist and pushed on my stomach again, and finally, the grape flew out. As soon as it landed on the ground, I dropped to my knees and sat there, shaking.

My dad sat down and put his arm around me, and asked if I was OK. Other than that we didn’t talk or move for a really long time. It hurt to eat the Sloppy Joes he made us, especially the bun. I just wanted to get to bed and forget the whole thing. That didn’t work out, because my friends wanted to keep playing. It took my mind off things, which was good. We didn’t tell my mom until the morning after we got home. She’s still pretty freaked out about it, and to be honest so am I.

She’s a journalist, and that’s why she thought we should write this article together. She says that if you can talk about something that scares you, get it out of your head and put it into words, that it makes you feel better. She says that’s what writers do, and I guess it has helped. I don’t think I’ll ever eat a grape again, and I’m not so sure grape juice is a good idea, either.

ther tiny foods that can get lodged in my throat make me a little nervous now, too. So for the meantime, I’m taking a break from popcorn, baby carrots, and hard candy. I just can’t keep away from hotdogs, which are supposed to be another choking hazard. But I am chewing them very well. I most definitely won’t throw anything tiny up in the air and catch it in my mouth again. And if I ever see any of my friends doing it, I’m going to tell them this story. I don’t want this to ever happen to anyone else.

As for my dad
My dad is an illustrator and my best friend. He’s one of those guys who does not talk too much about what’s bothering him — but he is a man of action. The day we got back from the biking trip, he decided to sign up to learn how to be an EMT. (That’s an Emergency Medical Technician, which is one of those guys who comes to your house in an ambulance when there’s an emergency.)

His first class was last night, and I’m so proud of him. I know he wants to protect me and the other kids in my troop. I think that is incredibly cool. I hope he teaches me what he learns. I’m only 11, and I don’t like to think about what might have happened if my dad hadn’t been there, or if I hadn’t taken that First Aid course through the Scouts. I’m just glad that it all worked out. I hope every kid has the opportunity to learn First Aid, especially CPR and the Heimlich maneuver. It just may save your own life.

About Dylan Gibbs
Sixth grader Dylan Gibbs has been a Scout since 3rd grade. He loves to go on camping trips, earn merit badges, and attend meetings. He also loves to play basketball, chess, ride his bike, and beat his sister at card games. His favorite subjects in school are math, science and social studies. He enters middle school this month. His parents love him very much.

Sidecountry Rescue — Who Should Respond to Ski Resort Out-of-Bounds Rescues?

2010-08-18T19:03:00.000-04:00

Christopher van Tilburg, MD, FAWM
The latest buzzword in winter recreation, “sidecountry skiing and snowboarding,” is popping up in magazines, equipment marketing materials, and ski resort websites. The increasing popularity poses several questions.1, 2 First, what or where is the “sidecountry” aka “slackcountry?” Is it a geographic local, an activity, or both? Simply defined, the sidecountry is the area adjacent to but outside the boundary of winter resorts, which is accessed from the resort by a paying customer. In other words, a skier or snowboarder buys a lift ticket, rides a lift, and then heads out of bounds. This raises many questions and concerns. The biggest quandary: who should respond to sidecountry rescues?

This author presented this topic for discussion at conferences of 3 distinct groups: the National Ski Patrol Farwest Division Winter Conference, the Mountain Rescue Association 50th Anniversary Conference, and the 2009 Wilderness Medical Society Annual Meeting. Discussions centered on liability for rescuers, timely response, and the feasibility of joint trainings.

Why Head Into the Sidecountry?
Every year, thousands of accidents occur to skiers and snowboarders within the boundaries of the winter sports resorts or ski areas. Known as “in area” skiing and snowboarding, safety is monitored and enhanced by professional and volunteer ski patrollers, who operate as employees of the winter resort company. Accidents also occur in the backcountry, the area outside the boundaries or operating hours of developed resorts. Of 50 000 search and rescue missions per annum, 1300 occur in Colorado alone, with 6% of those relating to skiers/snowboarders.3 In most states and Canadian providences, law enforcement agencies are responsible for backcountry rescues and use volunteer mountain search and rescue teams. Adjunct participants may include personnel from private ambulance companies, city or county fire rescue teams, military units, the forest service, or ski patrols.

Leaving the ski resort into the sidecountry, which is technically part of the backcountry, can be legal. If allowed, resorts yield access through a specific break in the resort perimeter, called a “control gate,” which may or may not be opened by the ski patrol on any given day depending on safety conditions of weather, terrain, and snowpack. Boundary lines that are intermittently open are called “soft boundaries.” However, it is unlawful in most states for a skier or snowboarder to exit the ski resort when the boundary is closed. Some resorts keep their boundary closed permanently—referred to as “hard boundaries.”

Sidecountry skiing and snowboarding provides a backcountry experience with much less physical effort and time than hiking directly from a parking lot or trailhead. Compared to resort skiing, the sidecountry, like the backcountry, allows access to different terrain and snow conditions, often untracked powder, for example.

Unfortunately, the sidecountry can create a false sense of security with easy access, close proximity to the resort, and escalating popularity. The sidecountry often allows skiers and snowboarders with limited or no backcountry experience to venture beyond the relative safety of ski resort boundaries. Within ski areas, obstacles are marked, runs are groomed, ski patrollers come to the aid of customers, and certain terrain and snow features are made safe, such as avalanche zones and cliffs. The sidecountry, like the backcountry, is replete with a full cadre of mountain hazards, namely, avalanches, unmarked obstacles, cliffs, and routes of variable conditions like ice and deep snow.

In a related matter, “uphill traffic” within ski resorts has also increased in popularity. Alpine touring skiers, telemark skiers, and snowboarders ascend ski runs using climbing skins or snowshoes, without getting on a lift. Uphill traffic participants get exercise, learn to use backcountry equipment, and have a sidecountry ski experience within the safety of the resort, often without buying a ticket. Ski resorts lie on either public land leased from the forest service or private land. In either case, they can disallow uphill traffic. With similar issues to sidecountry use, uphill traffic sometimes occurs in the morning or evening, when the ski resort is closed.

Who Comes to the Rescue?
The biggest concern with sidecountry accidents is timely rescue. Search and rescue (SAR) teams are usually charged with rescues, dispatched under authority of county sheriffs or Royal Canadian Mounted Police. However, gearing up for a mission is time-consuming: volunteer rescuers leave work and family, rush home to assemble personal gear, and race up the mountain, often with little information. Although ski patrollers are in immediate proximity, they are not legally obligated to cover out of bounds and, due to liability issues, some ski areas have refused to let patrollers respond.

Don Schockey, Heavenly National Ski Patrol volunteer and coauthor of an International Snow Science Workshop paper Sidecountry Rescue: Who Is Responsible?,4 believes ski patrollers should head into the sidecountry.

“We are paid to be in area, but with life-threatening, time-critical injuries in the sidecountry, we can get there the quickest with the right equipment. That gives the injured person the best chance of survival. Not only can ski patrollers provide immediate response, they are highly skilled and equipped, and they may know the sidecountry terrain best” (written communicaton, April 2009).

Paul Baugher, Crystal Mountain, Washington, Ski Patrol Director, agrees that patrollers are “specifically trained and equipped” and can respond fastest. “Winter rescues have a narrow time window before they become deadly serious,” said Baugher (oral communication, April 12, 2009).

One problem with patrol response, said Schockey, is diminished resources in-area. “If the resort is short patrollers and equipment that could jeopardize the safety of paying customers.”

A second concern: ski patrollers may have no liability and workers compensation insurance coverage outside the resort boundaries. In many states, the Good Samaritan Law is not applicable. In Oregon, for example, the Good Samaritan Law applies to physicians only. State emergency management insurance may not apply to ski patrollers either.

A third issue is that not all ski patrollers possess backcountry skills, terrain knowledge, fitness, and equipment such as alpine touring or telemark skis with climbing skins and an overnight backpack.

Can We Solve the Problem?
Both time-tested and innovative solutions are focused on rapid response to sidecountry incidents, while eliminating modern-day problems of insurance and maintaining in-area staffing.

In Utah, full-time professional ski patrollers run the 22-year-old Wasatch Backcountry Rescue (WBR). Dean Cardinale, President of WBR, said patrollers know the terrain, weather, and snowpack because they are in it daily. “We can take one team per resort so we don't deplete resorts of manpower,” he explained. “We can have 9 teams from 9 resorts respond.” Since WBR is dispatched by the sheriff's office, rescuers' liability and workers compensation insurances are covered, said Cardinale (oral communication, April 2009).

On Oregon's Mount Hood, the Portland Mountain Rescue (PMR) Ready Teams patrol in and out of bounds on busy weekends above Timberline Lodge Ski Area. Steve Rollins, PMR Rescue Leader, said, “Ready Teams are coordinated with Timberline Lodge. This allows for a rapid and competent response while allowing the ski patrol to carry on with their normal resort operations” (written communication, April 2009).

This author's mountain rescue team, Crag Rats in Hood River, OR, has members who work on the ski patrol and at the medical clinic at Mount Hood Meadows Ski Resort. Thus, we can respond as either an employee of the resort or hospital-run clinic, or as a member of the mountain rescue team.

A multi-agency approach using helicopters has been successful in Colorado and British Columbia. According to Charlie Shimanski, president of Mountain Rescue Association and 22-year veteran of Alpine Rescue Team, Denver's Flight for Life helicopter responds to backcountry and sidecountry rescues in Summit County, the “epicenter of avalanche fatalities” (oral communication, May 2009). The hospital-based helicopter can be dispatched under the authority of the sheriff, off load the flight nurse and paramedic, and ferry a team of ski patrollers or SAR volunteers to the scene in minutes. Both ski patrollers and SAR volunteers get training and credentials specifically for this program.

Similarly, Ian Foss, a rescue leader from Golden and District Search and Rescue in British Columbia, said that last year they responded to in-area and sidecountry rescues in less than 30 minutes using helicopters (oral communication, May 2009).

A few recommendations seem obvious, but somewhat difficult to employ. First, winter resorts should have a clear protocol with regards to sidecountry rescues so there is no confusion. Second, backcountry training, terrain knowledge, fitness, and equipment are as important for sidecountry-capable ski patrollers, as they are for volunteer SAR personnel. Third, if appropriate, ski patrols should coordinate sidecountry rescues with law enforcement agencies responsible for rescues. Finally, search and rescue teams and ski patrollers would benefit from joint trainings. However, joint trainings tend to be difficult. Teams in small communities in Colorado and Alaska reported joint training with ski patrols, fire rescue units, search dog teams, and mountain rescue teams. But coordinating multi-agency trainings is time-consuming and difficult.

Even with improved response, complications like vague information, poor communication, and foul weather can delay rescues. Although obstacles of time, liability, and resource depletion can be minimized, that still does not guarantee rescue.

CPR with Chest Compression Alone or with Rescue Breathing

2010-07-30T23:14:00.001-04:00

Thomas D. Rea, M.D., Carol Fahrenbruch, M.S.P.H., Linda Culley, B.A., Rachael T. Donohoe, Ph.D., Cindy Hambly, E.M.T., Jennifer Innes, B.A., Megan Bloomingdale, E.M.T., Cleo Subido, Steven Romines, M.S.P.H. and Mickey S. Eisenberg, M.D., Ph.D.
N Engl J Med 2010; 363:423-433July 29, 2010

Background

The role of rescue breathing in cardiopulmonary resuscitation (CPR) performed by a layperson is uncertain. We hypothesized that the dispatcher instructions to bystanders to provide chest compression alone would result in improved survival as compared with instructions to provide chest compression plus rescue breathing.

Methods

We conducted a multi-center, randomized trial of dispatcher instructions to bystanders for performing CPR. The patients were persons 18 years of age or older with out-of-hospital cardiac arrest for whom dispatchers initiated CPR instruction to bystanders. Patients were randomly assigned to receive chest compression alone or chest compression plus rescue breathing. The primary outcome was survival to hospital discharge. Secondary outcomes included a favorable neurologic outcome at discharge.

Results

Of the 1941 patients who met the inclusion criteria, 981 were randomly assigned to receive chest compression alone and 960 to receive chest compression plus rescue breathing. We observed no significant difference between the two groups in the proportion of patients who survived to hospital discharge (12.5% with chest compression alone and 11.0% with chest compression plus rescue breathing, P=0.31) or in the proportion who survived with a favorable neurologic outcome in the two sites that assessed this secondary outcome (14.4% and 11.5%, respectively; P=0.13).

Pre-specified subgroup analyses showed a trend toward a higher proportion of patients surviving to hospital discharge with chest compression alone as compared with chest compression plus rescue breathing for patients with a cardiac cause of arrest (15.5% vs. 12.3%, P=0.09) and for those with shockable rhythms (31.9% vs. 25.7%, P=0.09).

Conclusions

Dispatcher instruction consisting of chest compression alone did not increase the survival rate overall, although there was a trend toward better outcomes in key clinical subgroups. The results support a strategy for CPR performed by laypersons that emphasizes chest compression and minimizes the role of rescue breathing. (Funded in part by the Laerdal Foundation for Acute Medicine and the Medic One Foundation; ClinicalTrials.gov number, NCT00219687.)

Source Information

From the Emergency Medical Services Division of Public Health for Seattle and King County (T.D.R., C.F., L.C., M.B., C.S., M.S.E.) and the University of Washington (T.D.R., M.S.E.) — both in Seattle; the London Ambulance Service, London (R.T.D., J.I.); and Thurston County Medic One, Olympia, Washington (C.H., S.R.).

Wilderness First Aid video

2010-07-15T10:24:00.000-04:00

CHOLERA and DIARRHEA

2010-07-13T11:07:00.007-04:00

At this very moment there is an outbreak of cholera in Zimbabwe– not a worldwide pandemic, but a localized epidemic. This is not a trivial point of interest, but a major news event that will not only have a dramatic impact on the population of Zimbabwe but also on the entire world as the aftermath of this epidemic will require international aid. Cholera will most likely kill thousands of people in Zimbabwe, impact tens of thousands of lives, and will continue to be a constant threat around the world and a very real concern for the adventurous and international travelers.

What is cholera?
Cholera, an acute infectious diarrheal illness that can cause death in less than 24 hours due to the profuse diarrhea, is caused by the bacteria, Vibrio cholera. Spread by oral-fecal contamination of food or water supplies, it is highly contagious, as has been demonstrated by at least seven worldwide pandemics over the past several hundred years.

How does cholera cause illness?
When consumed, the cholera bacteria passes through the stomach, where, fortunately, most of the bacteria are killed by the gastric juices and acid. Once the surviving bacteria have made it into the small intestine, they invade the lining of the small intestine and begin to multiply. In the process the bacteria produce an enterotoxin, and it is this enterotoxin that is responsible for causing the profuse, watery diarrhea that results in large quantities of fluid and electrolyte loss.

How does cholera cause death?
Death is a result of hypovolemic shock brought on by the profound dehydration from the enterotoxin-induced diarrhea. The very watery, grayish diarrhea is referred to as a rice water diarrhea. The victim of cholera can easily have massive diarrhea at a rate of 3 – 4 liters per hour or even more, literally dehydrating and shriveling up right before your eyes. Cholera is a very dehumanizing, debilitating disease.

What are the signs and symptoms of cholera?
Diarrhea – copious amounts of watery, rice water diarrhea. Dehydration leading to hypovolemic shock – rapid, weak pulse; hypotension; rapid, shallow breathing; pale, cool, clammy skin; anxiety; and a sense of impending doom (as with a heart attack). Severe headache. Exhaustion and lethargy. Malaise. Possible nausea and vomiting.

How is cholera treated?
Hydration, Hydration, Hydration. The initial goal, and that means IMMEDIATELY is to replace the lost fluids and electrolytes. Then continue to replace the fluids that are being lost as quickly as they are being lost. As long as these patients can drink, oral therapy works very well. However, you have to replace the electrolytes as well as the water that is being lost. Water alone will not improve their survivability.

Electrolytes are charged ions: sodium (Na+), chloride (Cl-), potassium (K+), and bicarbonate (HCO3-). Glucose is also required to supply the energy that is needed to live. These electrolytes with the addition of glucose maintain the basic and vital functions on a cellular level to sustain life as we know it.

How do you make an Oral Rehydration Solutions (ORS)?
   1. ORS can by made by mixing a commercially available ORS powder with water.
   2. Home remedy can by made by simple adding sugar and salt to water.
       1 liter of water + 1 teaspoon of salt + 8 teaspoons of sugar
   3. Rice water is also a very effective ORS. It is made by cooking rice as usual.
       1 liter of water + ½ cup of the cooked rice + 4 teaspoons of sugar + 1 teaspoon of salt. Stir to create a drinkable liquid.

The calories from sugar are very important. If sugar is not available you substitute molasses, brown sugar, fruit juice (contains glucose and fructose), or green coconut water. In fact molasses and brown sugar are better as they contain additional compounds that are also helpful.

Antibiotic Therapy:
Cholera is also caused by the bacteria, Vibrio cholera, and fortunately it is susceptible to several different antibiotic therapies.

Antibiotics that can be used to treat cholera:
Oral rehydration is the cornerstone of therapy. Antibiotics will shorten the course of the diarrhea and speed recovery. Following is a list of several antibiotics and their dosages that will help to eliminate the Vibrio cholera in the small intestine. There are several options, all are equally efficacious.

How can the spread of cholera be prevented?
Cholera is spread by oral-fecal contamination of the food and water supplies that are then consumed by others causing further spread of the illness. Therefore, drink only water that has been properly treated with iodine, chlorine, filtration, boiling, or UV light. Avoid ice as freezing does not sterilize water. Eat only properly prepared foods: Vegetables that can be peeled or cooked; well cooked meats and fish; avoid raw or undercooked meats. Beware of sanitation practices, hand washing, and dirty dishes.

In addition, health care providers must take Body Substance Isolation (BSI) precautions and practice extremely safe hygiene when working with cholera patients.

Quick summary of Cholera and its influence on recent history:

1816-1826: Cholera Pandemic
The outbreak began in Bengal and then spread across India. Approximately 10,000 British troops and countless Indians died during this pandemic.

1829-1851: Cholera Pandemic
This outbreak lasted 22 years and extended initially from Russia into Europe. In London, the disease claimed close to 7,000 victims, and in Paris alone another 20,000 perished with approximately 100,000 deaths in all of France.

The epidemic reached Quebec, Ontario, and New York in 1832 and the Pacific coast of North America by 1834. The number of deaths appears to not have been recorded. In 1848, a two-year outbreak occurred in England and Wales which claimed about 52,000 lives.

1849: A second major outbreak spread in Paris and London. In London it claimed 14,137 lives, twice as many as the 1832 outbreak.

1849: Cholera was responsible for 5,308 deaths in Liverpool, England, and 1,834 in Hull, England.

1849: Cholera spread into the Mississippi river system killing over 4,500 in St. Louis and over 3,000 in New Orleans, and thousands more in New York. Cholera also spread along the California and Oregon trails; hundreds died during the California Gold Rush.

1852-1860: Cholera Pandemic
The pandemic mainly affected Russia, with over a million deaths.
In 1853-1854, another London’s epidemic claimed 10,738 lives.

1854: An outbreak of cholera in Chicago killed about 3,500 people.

1863-1875: Cholera Pandemic
Occurring primarily in Europe and Africa, at least 30,000 of the 90,000 Mecca pilgrims died from cholera during their pilgrimage. Cholera also claimed 90,000 lives in Russia in 1866.

1866: A cholera outbreak took place in North America while at the same time in London where cholera killed 5,596. Also more than 21,000 people died in Amsterdam, The Netherlands.

1881-1896: Cholera Pandemic
The 1883-1887 epidemic took 250,000 lives in Europe and at least 50,000 in America. Cholera claimed 267,890 lives in Russia, 120,000 in Spain, 90,000 lives in Japan, 60,000 in Persia, 58,000 in Egypt, and 8,600 in Germany.

1899-1923: Cholera Pandemic
This pandemic killed more than 800,000 in India.

1961-1970s: Cholera pandemicBeginning in Indonesia, this pandemic reached Bangladesh in 1963, India in 1964, and the USSR in 1966. From North Africa it spread into Italy by 1973. In the late 1970s, there were small outbreaks in Japan and in the South Pacific.

January 1991 to September 1994:
An outbreak in South America, beginning in Peru where there were 1.04 million identified cases and almost 10,000 deaths.

November 2008 – Doctors Without Borders, (Medicines Sans Frontiers) reported an outbreak in a refugee camp in the Congo.

November – December 2008
Is has been estimated that more than 11,000 people in the African nation of Zimbabwe are infected, and there have been more than 600 deaths. Please note that these statistics come from a variety of resources. If you are interested, one of the most complete sources of the history of cholera pandemics can be found on Wikipedia by looking up cholera.

Preventing Tick Bites

2010-07-13T01:39:00.001-04:00

Doing your best to avoid tick bites is the best policy as there are currently no vaccines that prevent tick-borne diseases.

Avoid known or suspected tick infested areas - especially during tick season.
Wear proper clothing:

light-colored clothing makes tick spotting easier
closed-toe shoes and socks
long pants and long-sleeved shirts
tuck pant legs into socks and tuck shirts into pants

Stay on cleared paths and avoid brushing up against vegetation and tall grass.
Apply tick repellent to exposed skin and clothes according to product label description (which may be different for children).

DEET: may be applied to exposed skin and clothing
Permethrin: must be applied to clothing ONLY and allowed to dry completely before wearing

Perform frequent tick checks while you are outside and examine yourself thoroughly once you are indoors. Most common sites of attachments include but are not limited to the hairline, shoulders, armpits, waist, inner thighs and groin area. This means you should also examine areas you can't readily see without assistance.
Check your children thoroughly.
Check your pets thoroughly (your pets are more likely to come in contact with ticks and bring them indoors).

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Brought to you by: The new App for iPhone - Tick Doctor

Wound Cleaning 101

2010-07-08T22:41:00.010-04:00

By Paul Auerbach, M.D.

One of the hazards of cleaning wounds in the wilderness (or in the urban setting) is splashing the irrigation (cleaning) water, because the spray can transfer body fluids (containing infectious viruses, bacteria, etc.) onto the rescuer. In this day of hepatitis, human immunodeficiency virus infection, and other worrisome diseases, it is always prudent to shield oneself properly.

This includes wearing eyeglasses or goggles, latex (or non-latex) surgical gloves ("rubber" or "vinyl" gloves), and otherwise preventing your victim's body fluids from contacting your moist mucous membranes (e.g., lining of the mouth, the eyes, etc.) or entering into any significant opening in your skin (e.g., scrape, puncture wound, open cut).

A fellow emergency physician and friend, Dr. Keith Stamler, had the brilliant idea to invent an excellent device that we use in the E.R. for this purpose, and which is equally useful in the wilderness. The device is the ZEROWET SUPERSHIELD, available through the Center for Wilderness Safety of Northern Virginia (for the public only; not available for resale or to hospitals or clinics. Hospitals, please visit www.ZeroWet.com).

When you attach the SUPERSHIELD to a syringe, it allows you to squirt water or saline (salt) solution into a wound at a pressure of 8 to 12 pounds per square inch, which is optimal for removing dirt and debris without pushing them deeper into the delicate and vulnerable human tissues. The SUPERSHIELD, which is shaped like a cup, captures the splash, and therefore prevents the rescuer from becoming contaminated with errantly directed splashed fluid, blood, and other body fluids.

The new SUPERSHIELD product can be attached to virtually any syringe. Remember, "the solution to pollution is dilution." When I travel in the backcountry, I carry a couple of plastic syringes (size 20 to 35 milliliters) and a few SUPERSHIELDS, so that I can be prepared to adequately rinse a couple of wounds. I use the cleanest water available, which is usually filtered and/or disinfected drinking water.

This is far better than the technique of using a plastic drinking bottle with a narrow tip or with a hole pierced through the top, because the drinking bottle method does not generate sufficient pressure when compared to the syringe technique.

External Links:
+ Buy a SUPERSHIELD
+ Visit the ZEROWET website

It's Spider Season... Is that a Brown Recluse?

2010-07-07T09:11:00.006-04:00

Brown recluse spider

What does a brown recluse spider look like?

Named for its habit of hiding in dark corners, the brown recluse spider (Loxosceles reclusa) is also known as the violin spider or fiddleback spider because of a violin-shaped marking. The brown recluse spider is about a half-inch long (including legs) and is a solid light brown color. The violin marking is configured with the base of the violin beginning at the eyes and the neck of the violin pointing toward the "waist." The violin marking is difficult to see clearly.

Two other features can help identify the brown recluse: it has six eyes rather than the typical eight and the tail-end segment has no markings. If you see a brown spider with markings on the tail end, it cannot be a brown recluse spider. Any markings, patterns or spots on the tail end of a spider immediately eliminates the possibility that it is a brown recluse spider. It is, instead, one of dozens of brown spiders that live in houses and yards. They may bite, but they are not dangerous.

Where do brown recluse spiders live?

Spider experts across the US agree that the true brown recluse spider is native to Kansas, Texas, Oklahoma and Mississippi. There are many related species found in virtually all other states however, and have been spotted everywhere from the colder states like Maine and Vermont, to the Mojave and Sonoran deserts, but not in Northern California, Oregon and Washington states.

In any case, the brown recluse is called a "recluse" because it hides and is not commonly found out in the open. The brown recluse will hide in dark, moist, quiet, out-of-the-way areas where it will not easily be disturbed.

What are the symptoms of a brown recluse spider bite?

Due to the necrotic nature of the brown recluse spider's venom, a bite usually causes some pain or burning in the first 10 minutes, accompanied by itching. The wound takes on a bull's-eye appearance, with a center blister surrounded by an angry-looking red ring and then a blanched (white) ring. The blister breaks open, leaving an ulcer that scabs over. The ulcer can enlarge and involve underlying skin and muscle tissue which may grow for days - even with IV medications. Pain may be severe. A generalized red, itchy rash usually appears in the first 24-48 hours. Other symptoms include fever, chills, nausea, vomiting, muscle aches and hemolytic anemia (a condition where the red blood cells are destroyed).

People bitten by an unseen spider sometimes blame the brown recluse spider because their bite resembles a brown recluse spider bite. However, there are a number of other spiders and insects, as well as other medical conditions, that are capable of producing tissue wounds of similar appearance, but these are usually of a lesser severity.

What is the treatment for a brown recluse spider bite?

Treatment consists of washing the wound and applying an antibiotic ointment. The victim should seek medical attention if there are signs of an infection, an ulcer that does not heal, a bite accompanied by nausea, vomiting, fever or a rash. There is no special treatment or medication used to treat a brown recluse spider bite. If infection develops, antibiotics are used. If a wound becomes deep and infected, occasionally surgery is needed. Anytime there is a bite or a wound that is not healing and getting worse, see a physician for evaluation.

Chronic or Necrotic Arachnidism

While most spider bites are not dangerous, there is a group of spiders that can produce bite wounds that look similar to a brown recluse spider bite. Unless the spider was actually seen, captured and brought to the physician, the brown recluse spider is not likely to be the culprit. Some of the spiders in this group that can cause a nasty bite include the running spider, jumping spider, wolf spider, sac spider, orbweaver spider and the brown spider, also known as the hobo spider.

What are the symptoms of a bite from these kinds of spiders?

In most cases of bites from these spiders, there is pain or burning at the bite site in the first 10 minutes. The bite from this group is usually described as looking like a "target" or "bull's-eye." The center of the wound is usually a blister surrounded by a reddened area. A pale or blanched area may surround the discolored reddened area. The blister may rupture, leaving an open ulcer. In severe cases the ulcer can become deep and infected causing tissue breakdown or tissue death (necrosis).

Worsening pain, itching and a burning sensation develop. A patient may also have symptoms such as a red, itchy rash over the torso, arms and legs that is usually seen in the first 24-72 hours. Patients may have pain in the muscles and joints, fever, chills, swollen lymph nodes, headaches, and nausea and vomiting.

How are these bites treated?

Frequently, when people with spider bites call Poison Control (1-800-222-1222), they think there is some special treatment that is necessary for their bite. There is no specialized therapy other than treating the symptoms. Most importantly, keep the wound clean to prevent infection. If the wound does not heal or does develop an infection, see your physician. Do not wait days and weeks while the wound continues to get worse.

There are tales of people having limbs amputated after spider bites. These involve people who refused to see a physician even though they had massive wounds that did not heal and became grossly infected. A wound that may have been originally treated with simple oral antibiotics, but left untreated, may require surgical intervention in extreme cases.

What else can cause a nasty looking wound?

Kissing bugs, fleas, bed bugs, flies, mites, wasps, ants and blister beetles have produced lesions similar to a brown recluse spider bite. Many skin disorders and medical conditions can produce lesions that can also mimic a brown recluse spider bite. Some of these include infected herpes outbreaks, bedsores, diabetic ulcers, poison ivy/oak and Lyme disease. Again, use common sense: If there is a wound that is not healing as expected or getting worse, see a physician.

It's Spider Season... Is that a Black Widow?

2010-07-06T17:40:00.003-04:00

Black widow spiders

Black widow spiders generally live in trash, closets, attics, woodpiles, garages and other dark, somewhat moist places. They are found throughout the United States (there are various sub-species throughout the US however mostly look alike) and only the venom of the female spider is dangerous to humans.

What does a black widow spider look like?

The black widow spider is a shiny, inky black spider with a large round tail segment (abdomen). Including its legs, the black widow generally measures from one-half inch to one inch in length. Red to orange-colored markings, usually in the shape of an hourglass, are found on the underside of the belly.

What are the symptoms of a bite?

A black widow spider bite gives the appearance of a target, with a pale area surrounded by a red ring. Severe muscle pain and cramps may develop in the first two hours. Severe cramps are usually first felt in the back, shoulders, abdomen and thighs. Other symptoms include weakness, sweating, headache, anxiety, itching, nausea, vomiting, difficult breathing and increased blood pressure. Young children, the elderly and those with high blood pressure are at highest risk of developing symptoms from a black widow spider bite.

How dangerous are black widow spider bites?

If a black widow spider bites a person, do not panic! No one in the United States has died from a black widow spider bite in over 10 years. Very often the black widow will not inject any venom into the bite and no serious symptoms develop. Wash the wound well with soap and water to help prevent infection.

If muscle cramps develop, take the patient to the nearest hospital. Some victims, especially young children, may be admitted overnight for observation and treatment. There is treatment for a black widow spider bite that can take care of the symptoms. Various medications are used to treat the muscle cramps, spasms and pain of a bite. Black widow spider antivenin is seldom necessary.

Are You Ready for a Hurricane?

2010-07-01T15:46:00.000-04:00

Here’s what you can do to prepare for such an emergency:

Know what a hurricane WATCH and WARNING means:
✔ WATCH: Hurricane conditions are possible in the specified area of the WATCH, usually within 36 hours.
✔ WARNING: Hurricane conditions are expected in the specified area of the WARNING, usually within 24 hours.

Prepare a Personal Evacuation Plan
✔ Identify ahead of time where you could go if you are told to evacuate. Choose several places; a friend’s home in another town, a motel, or a shelter.

✔ Keep handy the telephone numbers of these places as well as a road map of your locality. You may need to take alternative or unfamiliar routes if major roads are closed or clogged.

✔ Listen to NOAA Weather Radio or local radio or TV stations for evacuation instructions. If advised to evacuate, do so immediately.

Assemble a Disaster Supplies Kit containing—
✔ First aid kit and essential medications.
✔ Canned food and can opener.
✔ At least three gallons of water per person.
✔ Protective clothing, rainwear, and bedding or sleeping bags.

✔ Battery-powered radio, flashlight, and extra batteries.
✔ Special items for infant, elderly, or disabled family members.

✔ Written instructions on how to turn off electricity, gas, and water if authorities advise you to do so. (Remember, you’ll need a professional to turn natural gas service back on.)

Identify what to do when a hurricane WARNING is issued
✔ Listen to the advice of local officials, and leave if they tell you to do so.
✔ Complete preparation activities.
✔ If you are not advised to evacuate, stay indoors, away from windows.
✔ Be aware that the calm “eye” is deceptive; the storm is not over. The worst part of the storm will happen once the eye passes over and the winds blow from the opposite direction. Trees, shrubs, buildings, and other objects damaged by the first winds can be broken or destroyed by the second winds.
✔ Be alert for tornadoes. Tornadoes can happen during a hurricane and after it passes over. Remain indoors, in the center of your home, in a closet or bathroom without windows.
✔ Stay away from flood waters. If you come upon a flooded road, turn around and go another way. If you are caught on a flooded road and waters are rising rapidly around you, get out of the car and climb to higher ground.

Know what to do after a hurricane is over
✔ Keep listening to NOAA Weather Radio or local radio or TV stations for instructions.
✔ If you are evacuated, return home when local officials tell you it is safe to do so.
✔ Inspect your home for damage.

✔ Use flashlights at all times; avoid using candles.

Prepare for high winds✔ Install hurricane shutters or purchase precut 1/2” outdoor plywood boards for each window of your home. Install anchors for the plywood and predrill holes in the plywood so that you can put it up quickly.
✔ Make trees more wind resistant by removing diseased and damaged limbs, then strategically removing branches so that wind can blow through.

Know what to do when a hurricane WATCH is issued✔ Listen to NOAA Weather Radio or local radio or TV stations for up to date storm information.
✔ Prepare to bring inside any lawn furniture, outdoor decorations or ornaments, trash cans, hanging plants, and anything else that can be picked up by the wind.
✔ Prepare to cover all windows of your home. If shutters have not been installed, use precut plywood as described above. Note: Tape does not prevent windows from breaking, so taping windows is not recommended.
✔ Fill your car’s gas tank.
✔ Recheck manufactured home tie-downs.
✔ Check batteries and stock up on canned food, first aid supplies, drinking water, and medications.

More information is available at the National Hurricane Center (http://www.nhc.noaa.gov)

National Lightning Safety Awareness Week, June 21-26, 2010

2010-06-25T10:36:00.003-04:00

SEATTLE, Wash. -- Observed the last full week of June, National Lightning Safety Awareness Week not only helps get safety messages out in time for the Fourth of July, but also signals summer as lightning season. Outside is the most dangerous place to be during a lightning or thunderstorm and more people are outside during the summer. According to Federal Emergency Management Agency (FEMA) Acting Regional Administrator Dennis Hunsinger, lightning strikes and high winds associated with thunderstorms also increase the risk of wildfires.

"Lightning can strike up to ten miles away from any rainfall, creating hotspots that smolder for days, to erupt when conditions are right," said Hunsinger. "Those of us who live in urban interface areas, wooded lots, or near heavily-grassed and dry rangeland should create fire-safe perimeters, and update family disaster plans."

Lightning accounts for more average deaths per year than tornados. "The safest place to be during lightning activity is a large enclosed building, not a picnic shelter or shed," said Hunsinger. "The second safest location is an enclosed metal vehicle, car, van, etc., but nota convertible, bike or other topless or soft top vehicle. If caught outdoors, and no shelter is nearby, stay away from tall trees. If there is no shelter—crouch in the open, keeping twice as far away from a tree as it is tall."

Lightning safety tips for inside the home include:

Avoid contact with corded phones

Avoid contact with electrical equipment or cords. If you plan to unplug any electronic equipment, do so well before the storm arrives.

Avoid contact with plumbing. Do not wash your hands, do not take a shower, do not wash dishes, and do not do laundry.

Stay away from windows and doors, and stay off porches.

Do not lie on concrete floors and do not lean against concrete walls.

For more information on lightning safety, visit: www.lightningsafety.noaa.gov. For wildfire preparedness tips, sample preparedness plans and emergency checklists, visit www.firewise.org/ or www.fema.gov.

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FEMA’s mission is to support our citizens and first responders to ensure that as a nation we work together to build, sustain, and improve our capability to prepare for, protect against, respond to, recover from, and mitigate all hazards.

Expert on bears? ... I did stay at a Red Roof Inn

2010-06-21T20:07:00.006-04:00

By 2007 AT Thru-Hiker, Max "Doggiebag" & Aldo (his dog)

Why shell out $37.00 for a canister of Bear Deterrent? Well being the rough outdoorsy type I would normally just pull out the old BFK (big friggin' knife) and just rumble. But the pacifist/sniveling worm in me says try spraying a little Tabasco his way. It may just ruin his appetite.

The enormity and sobering reality of the trip started sinking in when I was packing the ruck and reviewing the Great Smokey Mountain Range topographic maps; there it was in the lower right hand corner of the map ... a Government type warning entitled "Bear Guidelines For Your Safety"

I am voluntarily putting myself in a situation where I could be swatted around by a 600 pound animal. Being the strong silent type ... I immediately started to ponder ways out of my current dilemma. Should I fake a stroke that way I don't appear to be wussing out of the "Great Trip"?

Damn, I've already told everybody about it ... and besides faking brain damage is something I'm not good at (although that may be debatable). On the other hand I've already spent too much money on gear and I really don't feel like looking for a job just yet. Cheapest way out of this? No sniveling - Airborne all the way ... follow me troops ... but first let me get the bear spray.

The third paragraph of the "Bears Guidelines For Your Safety" document basically gave me flashbacks ... it's like listening to the Ex we'll call her Bunny from here on forward. According to the guideline/Bunny "If a bear persistently follows or approaches you without vocalization or paw swatting, try changing your direction." (or it may just follow you all the way home wherein you'll have to ask your mom on whether you can keep him). Bunny continues "If the bear continues to follow you stand your ground." (start telling it some knock knock jokes or politely tell it that you'd rather hike alone).

The guideline/Bunny continues with "If the bear gets closer, talk loudly or shout at it." (I'll do one better - tell it you don't have any money or they've got some slow fat guys just further down the trail). "Act aggressively and try to intimidate the bear." (At this point - try flashing it some Gang signs) "Act together as a group if you have companions." (time for the secret weapon ... Aldo?... Aldo?).

"Don't leave food for the bear this encourages further problems." (Further problems? for someone else maybe - he's getting the Ramen noodles if not the whole rucksack). The second to the last paragraph really sums up this very useful guideline. "If the bear shows no interest in your food and you're physically attacked,(as opposed to psychological abuse)fight back aggressively with any available object (Pillow fight!) - the bear may consider you as prey!" (No shit Sherlock).

-Doggiebag (Max and Aldo)

Blisters & Blister Care on the Trail

2010-06-13T18:52:00.002-04:00

Blisters are the number one foot ailment encountered by hikers - and they can turn the greatest hike into the most painful one. Blisters can be avoided by proper foot training; having the correct footwear and socks, and by early detection of possible problems. To help protect your feet, know the causes of blisters, how to prevent and treat them.

What Causes Foot Blisters?
HEAT
Heat is the number one reason for getting blisters. The heat responsible for causing blisters is mostly caused by the friction between your skin and the inner of your shoe or boot. Sand and gravel in your boot can increase friction which is why they also cause blisters.

MOISTURE:
Moist or wet feet from sweat or water are more susceptible to blisters as moisture softens your skin.

LOCALIZED AREA:
When there a small portion of your foot or ankle rubs against a part of your shoe, your foot first responds by getting red and hot. This is called a Hot Spot. While not a blister, these are the body's first sign of discomfort. If a hot spot is left untreated, the result is a painful blister which is either filled with clear mucus (the body's own coolant fluid) or blood (blood blisters).

How to Prevent Foot Blisters
Preventing blisters boils down to countering the factors that cause them. In general, keeping your feet cool, dry, and free of sand will do the trick. Here are some tips on how to prevent blisters:

1) First of all, select footwear with a good fit that does not chafe your feet or have painful pressure points. Choose watertight but breathable footwear that gives the proper ventilation which will get rid of excess moisture. Look for fully gusseted tongs that keep sand and gravel outside of your boots.

2) Give your feet ample rest. If you feel that your feet might be moist or overheated, it might be wise to make some alterations to your hiking rhythm and take a longer rest where you take off your boots and socks. If you do so, you might want to change socks and dry the ones you had on. Having two pairs of socks used alternately is always a good idea to prevent Blisters.

Take advantage of the many Support Stations found along the One Day Hike. Every 8 or so miles, you will find a fully stocked support station, stocked with volunteers eager to help you stay hydrated and fed, as well as medical team volunteers who are experts in blister management, heat illnesses, dehydration, hyponatremia and of course basic first aid & CPR.

3) If you decide to cool your feet in water or the canal (not recommended) then make sure to dry them off well before putting your socks and boots back on. When and if conditions allow, take off your boots and socks and walk with hiking sandals during breaks and at major support stations (White's Ferry, Point of Rocks, Brunswick & Bolivar).

Early Treatment of Friction Blisters
Blisters develop over a period of time and often you can already feel one coming up. Early detection and treatment is the key to preventing full grown blisters. If you feel a sore place on your foot or irritation, do the following:

+ Take off your boots and hiking socks immediately and remove any sand or gravel from your feet.
+ Let your feet dry and cool down.
+ Cover the sore area with the Silk Tape, band-aids, blister pads or moleskin; which are all provided at the support stations.
+ After the ODH, remove the moleskin, tape, etc. and let the skin recover during the night. The next morning, you can judge for yourself to apply a new cover or not for your regular walking shoes. In general, take precautions and apply a cover even if the area is only moderately irritated.

Treating Friction Blisters
You essentially have two options of treating your foot blister; and depending on whether you're planning on continuing the hike or dropping out, may affect your course of action. If you are continuing to hike, and the blisters are at the surface and filled with fluid, you may wish take a sterilized needle and pierce the blister in order to drain it. Be sure to pierce the blister at the lowest point of gravity (the base of the blister) and gently roll your thumb from the top, down, forcing out the liquid like a tube of toothpaste. If the affected skin is still intact then do not remove it or tear it off. Instead, cover the drained blister with moleskin or better yet, one of the 2nd Skin Blister Pads, provided at the first aid tents at each support station.

If the affected area is ruptured and the blister is torn, be sure to clean it with an antiseptic such as triple-antibiotic ointment or bacitracin (both provided at the first aid stations). Keep the area clean in order to prevent infection.

If the blisters are buried deep under the surface of your skin and does not hold a lot of liquid then do NOT try to puncture them. Instead, just cover them with one of the items listed above.

MYTH: Duct Tape Works Well

Duct tape sticks well to itself and has absolutely NO give or elasticity to it whatsoever. This being said, many ODH hikers tape their ankles and the balls of their feet with duct tape, only to have it come loose while hiking, creating a HUGE and painful blister due to the fact that duct tape does not stick to virtually anything when wet - especially to skin when there's a layer of sweat between the tape and skin.

Another common thing that we see unfortunately, are those folks who tape their feet and ankles circumferentially (meaning all the way around their feet). Again, the tape sticks well to itself but has NO give. These individuals know this and intend (as many have told us) to change the duct tape at every station. Here's the problem with that: As you hike, especially for long distances, you get what is called "peripheral edema", where your hands and feet start to swell. By wrapping your feet and/or ankles with tape, you create compartment syndrome or essentially an unintentional tourniquet around that part of the body, slowly killing the tissue inside. When these participants took off their duct tape, their feet literally swelled up within seconds (like balloons) and not only did it hurt so much that they couldn't put any weight on their feet and had to drop out of the race and explain to their friends and families why they were unable to continue, but also their feet became literally too big for their shoes!!

These are a few basic things you should know about blisters. It is not essential that you have adequate first aid knowledge, as we have an entire team of knowledgeable medical team volunteers in place to deal with any emergency; large or small - but we certainly recommend taking a wilderness first aid course if you are like me and love to spend time in the great out-of-doors.

If you have any questions or comments, please write them below and we'll do our best to answer them. Please also feel free to call me at (888) 945-3402!

Stay Safe!
Clif Castleman
Medical Director
Sierra Club's annual One Day Hike

Don’t Feed Honey to Infants

2010-05-20T15:06:00.002-04:00

Children under the age of 12 months are at risk of infant botulism if they are fed honey or anything with honey in it. Botulism spores can be found in honey; when swallowed, the spores release a toxin. Infants’ systems are too immature to prevent this toxin from developing. In fact, most cases of botulism in the U.S. are in infants.

When botulism toxin is absorbed from the intestines, it affects the nervous system. The most common symptoms in infants are muscle weakness – the infant feels “floppy” and the eyelids can droop; constipation, sometimes for several days; poor sucking and feeding; and an unusual cry. Poor feeding can quickly lead to dehydration. Muscle weakness can lead to breathing difficulties.

No one knows exactly how long it takes for symptoms to develop, but it’s thought to be about 3 to about 30 days. Over a period of a few days, a child can become acutely ill. Treatment in an ICU, including a respirator and feeding through an IV or a tube may be needed. If botulism is thought to be the cause of the child’s illness, there is a treatment available, but it takes a day or so for this unusual antitoxin to be delivered to hospitals. Children usually recover, even without the antitoxin, but receiving it can shorten the length of time that a child spends in the hospital.

There are other sources of botulism spores, especially soil, thus honey is not the only way that infants can be exposed. However, NOT giving honey in any form to infants is an easy, safe way for parents to limit the risk.

The Boy Scouts: Stewards of Nature?

2010-04-23T21:33:00.007-04:00

In honor of earth day, I thought that I would post something somewhat related to being mindful of this small planet we call "home"...

There I was, walking past small, scattered piles of half-burnt Spam cans and unraveled rope, burned-up matches and half-full water bottles. As I continued my wake-up calls for the 30-some Boy Scouts on my outpost, I decided to make the forest a classroom and show them exactly what Leave No Trace is really about.

It’s common sense, but not always commonly practiced (just ask those Boy Scouts): LNT is making a conscious effort to reduce your impact on the land and to leave it in the same condition, if not better, for the people who come to enjoy it afterward. One hiker venturing off the trail or one group creating a new campsite may seem of little significance, but the combined effects of millions of such instances leave a substantial and cumulative mark on the land.

This outdoor ethics code has seven principles:

1. Plan Ahead and Prepare
Know about all regulations and special concerns for the area you plan on visiting. Try to schedule your visit during a period of lower patron usage. Repackage food to minimize waste. Orient yourself using a map and compass to avoid using paint, rock cairns or flagging.

2. Travel and Camp on Durable Surfaces
Use established trails and campsites; camp on rock, gravel, dry grasses or snow surfaces, especially in popular areas. Camp at least 200 feet from any riverbank, lake shore or streams and remember that good camping sites are found, not made, and don't need to be large. Try finding areas where there isn't a lot of vegetation.

3. Dispose of Waste Properly
Pack it in, pack it out: leftovers, litter, trash and yes, even toilet paper and other hygiene products. Pick up spilled foods whenever possible. If you really gotta GO! walk a good 200 feet away from your camp, any water and trails. Dig a six-to eight-inch-deep cat-hole and bury it when you're done. Remain 200 feet away from water for washing dishes and use very minimal amounts of biodegradable soap (just because it biodegrades, doesn't mean it's natural). Scatter any water used.

4. Leave What You Find
Yeah, that rock would look awesome collecting dust in your house, but honestly it would be much better if it were left in nature for others to find and appreciate. That also goes for plants, fossils and any other natural objects you may find. Avoid messing with nature's balance by transporting non-native species and introducing them into new areas.

5. Minimize Campfire Impacts
The visual impact of your campfire will be felt long after it burns out. Use lightweight stoves for cooking and candle lanterns for light. Where fires are necessary, use established fire rings, pans or mound fires and keep them small. Use sticks found on the ground that can be broken by hand. Burn all wood and coals completely to ash; then extinguish the fire completely. Scatter the ashes once cooled.

6. Respect Wildlife
After all, you're their guest. Observe from a distance and do not approach or follow animals, especially during sensitive times (mating, nesting, with their young, in winter). Never feed animals; it damages their health, alters natural behaviors and exposes them to predators and other dangers. Hang or store your food rations and trash securely; control any pets that you bring along or leave them at home.

7. Be Considerate of Other Visitors
No, you’re not the only person in the forest so don’t act like you are. Camp and take breaks away from other visitors. Avoid loud voices and noises; let nature's sounds prevail. Respect others and protect the quality of their experience as you would like yours to be.

Let’s take it one step further, shall we?

8. Educate Others
LNT will only be effective if we inform others as well as practice it ourselves. Become an LNT advocate, take an awareness class, teach it to groups or clubs you’re involved in and tell your friends. Don’t shy away from intervening and stopping someone else if you’re out and see them breaking the code. Preserving nature is worth the minute or two it takes to explain to that other hiker that they shouldn’t be washing their dishes in that stream because it’s harmful to the environment. Odds are, they don’t even know they’re doing something wrong.

LNT is the best way to ensure that all that’s left of your trek is footprints.

The Skinny on Satellite Phones

2010-04-23T14:03:00.005-04:00

Should I get a satellite phone, a GPS locator or SPOT device? Well, the simple answer is that there is no "simple" answer. Satellite phones can be incredibly useful for people who travel to land or water areas that do not have access to other types of phones. Customers who need satellite phones have several major brands to choose from when selecting a phone and a service plan...

Significance

The cost of a satellite phone includes the initial expense of the phone itself. It also includes the cost for a monthly subscription, the minutes used for each call and any activation fees. Satellite phones range in price from about $700 to $1,300, depending on the brand, its features and the retailer that's selling it. Basic subscriptions generally cost about $50 per month, but these subscriptions--unlike cell phone plans--do not include any minutes or airtime. The cost of airtime varies widely depending on the type of call; it may range from $1 to $10 per minute. Activation fees for most satellite phones run about $40 to $50.

Types

The major brands of satellite phones include Inmarsat, Iridium and Thuraya. The Inmarsat IsatPhone is a handset style phone that costs about $700. The Iridium handset phone costs about $1,500, and Thuraya offers satellite phones for about $1,000 to $1,300. Minutes for the Inmarsat IsatPhone cost about $1 for voice calls to PSTN or cell phones, $2 for calls to most other Inmarsat phones, and $3 to Iridium or Thuraya satellite phones. Iridium charges about $1 per minute for calls to PSTN phones or voice mail, less than $1 per minute for calls to other Iridium phones and over $10 per minute for calls to other brands of satellite phones. Calls between Thuraya phones cost about $1 per minute, while calls to other brands of satellite phones cost about $6 per minute and calls to other types of phones cost about $1.50 per minute.

Features

Since satellite phones can only be outdoors--where there is a clear path between the phone and the satellite--all three major brands also offer terminals that allow the phones to be used indoors. These terminals generally cost about $2,000 to $7,000 for stationary terminals, and they cost $18,000 to $25,000 for terminals that can be attached to a vehicle. Most terminals also include data transmission services, although these services may require extra monthly and per minute costs.

Function

There are two major ways that satellite phones can function. Geosynchronous satellites are located over 20,000 miles above the Earth, and these satellites stay fixed relative to the planet's rotation, allowing greater coverage per satellite and therefore requiring fewer satellites. However, the distance can also cause a delay or echo when talking on the satellite phone. Inmarsat and Thuraya phones use these types of satellites, and Thuraya also offers dual mode phones that combine both satellite and GSM phone services. Iridium phones use 66 Low Earth Orbiting, or LEO, satellites. These types of satellites, being about 500 miles above the earth, typically do not have a delay. Unlike cell phone providers, satellite phone services generally do not charge roaming fees, since their phones either work or do not work within a given area, depending on the satellite coverage.

Geography

The primary benefit of satellite phones is their ability to provide coverage in areas that do not have land line or cell phone services. Not all satellite phones cover the same areas. Inmarsat's BGAN service covers most of the world except for the areas near the north and south poles. Iridium satellite phones also work throughout most of the world. In contrast, Thuraya phones only have satellite coverage in most of Europe and western Russian, the Middle East, northern and central Africa, India, China, Japan, and Australia.

You can also read this article on the eHow website (http://www.ehow.com/about_4693327_much-does-satellite-phone-cost.html)

MAWMC: Day One

2010-04-10T18:34:00.001-04:00

T'was a great day with several rivetting lectures on a plethera of topics. Our staff attended a number of workshops from great folks! See photos & our Facebook page (http://bit.ly/CWSonline) for more details!