Publications by authors named "Jay Lemery"

39 Publications

Associations Between Wildfire-Related PM and Intensive Care Unit Admissions in the United States, 2006-2015.

Geohealth 2021 May 1;5(5):e2021GH000385. Epub 2021 May 1.

Division of Biostatistics and Bioinformatics and Department of Immunology and Genomic Medicine National Jewish Health Denver CO USA.

Wildfire smoke is a growing public health concern in the United States. Numerous studies have documented associations between ambient smoke exposure and severe patient outcomes for single-fire seasons or limited geographic regions. However, there are few national-scale health studies of wildfire smoke in the United States, few studies investigating Intensive Care Unit (ICU) admissions as an outcome, and few specifically framed around hospital operations. This study retrospectively examined the associations between ambient wildfire-related PM at a hospital ZIP code with total hospital ICU admissions using a national-scale hospitalization data set. Wildfire smoke was characterized using a combination of kriged PM monitor observations and satellite-derived plume polygons from National Oceanic and Atmospheric Administration's Hazard Mapping System. ICU admissions data were acquired from Premier, Inc. and encompass 15%-20% of all U.S. ICU admissions during the study period. Associations were estimated using a distributed-lag conditional Poisson model under a time-stratified case-crossover design. We found that a 10 μg/m increase in daily wildfire PM was associated with a 2.7% (95% CI: 1.3, 4.1;  = 0.00018) increase in ICU admissions 5 days later. Under stratification, positive associations were found among patients aged 0-20 and 60+, patients living in the Midwest Census Region, patients admitted in the years 2013-2015, and non-Black patients, though other results were mixed. Following a simulated severe 7-day 120 μg/m smoke event, our results predict ICU bed utilization peaking at 131% (95% CI: 43, 239; < 10) over baseline. Our work suggests that hospitals may need to preposition vital critical care resources when severe smoke events are forecast.
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http://dx.doi.org/10.1029/2021GH000385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8095362PMC
May 2021

Evidence-Based Heatstroke Management in the Emergency Department.

West J Emerg Med 2021 Feb 26;22(2):186-195. Epub 2021 Feb 26.

University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado.

Introduction: Climate change is causing an increase in the frequency and intensity of extreme heat events, which disproportionately impact the health of vulnerable populations. Heatstroke, the most serious heat-related illness, is a medical emergency that causes multiorgan failure and death without intervention. Rapid recognition and aggressive early treatment are essential to reduce morbidity and mortality. The objective of this study was to evaluate current standards of care for the emergent management of heatstroke and propose an evidence-based algorithm to expedite care.

Methods: We systematically searched PubMed, Embase, and key journals, and reviewed bibliographies. Original research articles, including case studies, were selected if they specifically addressed the recognition and management of heatstroke in any prehospital, emergency department (ED), or intensive care unit population. Reviewers evaluated study quality and abstracted information regarding demographics, scenario, management, and outcome.

Results: In total, 63 articles met full inclusion criteria after full-text review and were included for analysis. Three key themes identified during the qualitative review process included recognition, rapid cooling, and supportive care. Rapid recognition and expedited external or internal cooling methods coupled with multidisciplinary management were associated with improved outcomes. Delays in care are associated with adverse outcomes. We found no current scalable ED alert process to expedite early goal-directed therapies.

Conclusion: Given the increased risk of exposure to heat waves and the time-sensitivity of the condition, EDs and healthcare systems should adopt processes for rapid recognition and management of heatstroke. This study proposes an evidence-based prehospital and ED heat alert pathway to improve early diagnosis and resource mobilization. We also provide an evidence-based treatment pathway to facilitate efficient patient cooling. It is hoped that this protocol will improve care and help healthcare systems adapt to changing environmental conditions.
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http://dx.doi.org/10.5811/westjem.2020.11.49007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7972371PMC
February 2021

Training Clinical And Public Health Leaders In Climate And Health.

Health Aff (Millwood) 2020 12;39(12):2189-2196

Emilie Calvello Hynes is an associate professor of emergency medicine in the Department of Emergency Medicine at the University of Colorado School of Medicine.

The effects of climate change are accelerating and undermining human health and well-being in many different ways. There is no doubt that the health care sector will need to adapt, and although it has begun to develop more targeted strategies to address climate-related challenges, a broad knowledge gap persists. There is a critical need to develop and cultivate new knowledge and skill sets among health professionals, including those in public health, environmental science, policy, and communication roles. This article describes specific initiatives to train future leaders to be proficient in understanding the linkages between climate change and health. We present an agenda for expanding education on climate and health through health professional schools and graduate and postgraduate curricula, as well as in professional and continuing education settings. Our agenda also identifies ways to promote sustainability in clinical practice and health care management and policy. Throughout, we cite metrics by which to measure progress and highlight potential barriers to achieving these educational objectives on a larger scale.
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December 2020

Clinical Implications of Climate Change on US Emergency Medicine: Challenges and Opportunities.

Ann Emerg Med 2020 08 2;76(2):168-178. Epub 2020 Jun 2.

Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Colorado Consortium on Climate Change and Human Health, University of Colorado, Aurora, CO.

The adverse influences of climate change are manifesting as health burdens relevant to clinical practice, affecting the very underpinnings of health and stressing the health care system. Emergency medicine is likely to bear a large burden, with its focus on urgent and emergency care, through its role as a safety-net provider for vulnerable populations and as a leader in disaster medicine. Clinically, climate change is affecting emergency medicine practice through the amplification of climate-related disease patterns and epidemiologic shifts for conditions diagnosed and treated in emergency departments (EDs), especially for vulnerable populations. In addition, climate-driven intensification of extreme weather is disrupting health care delivery in EDs and health care systems. Thus, there are significant opportunities for emergency medicine to lead the medical response to climate change through 7 key areas: clinical practice improvements, building resilient EDs and health care systems, adaptation and public health engagement, disaster preparedness, mitigation, research, and education. In the face of this growing health threat, systemwide preparation rooted in local leadership and responsiveness is necessary to efficiently and effectively care for our vulnerable communities.
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http://dx.doi.org/10.1016/j.annemergmed.2020.03.010DOI Listing
August 2020

The Climate-Smart Emergency Department: A Primer.

Ann Emerg Med 2020 08 23;76(2):155-167. Epub 2020 Jan 23.

Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA.

Climate change and environmental pollution from health care present urgent, complex challenges. The US health care sector produces 10% of total US greenhouse gas emissions, which have negative influences on human and environmental health. The emergency department (ED) is an important place in the hospital to become more environmentally responsible and "climate smart," a term referring to the combination of low-carbon and resilient health care strategies. Our intent is to educate and motivate emergency providers to action by providing a guide to sustainable health care and an approach to creating a climate-smart ED.
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http://dx.doi.org/10.1016/j.annemergmed.2019.11.003DOI Listing
August 2020

Science Policy Training for a New Physician Leader: Description and Framework of a Novel Climate and Health Science Policy Fellowship.

AEM Educ Train 2019 Jul 1;3(3):233-242. Epub 2019 Apr 1.

Department of Emergency Medicine University of Colorado School of Medicine Aurora CO.

The accelerating health impacts of climate change are undermining global health, and the roles of the health sector in addressing the many challenges of climate change are being articulated by governments, multilateral institutions, and professional societies. Given the paucity of physician engagement on this issue to date, there now exists a clear need for health professionals to meet this new challenge with the development and cultivation of new knowledge and skill sets in public health, environmental science, policy, and communication. We describe a novel GME fellowship in climate and health science policy, designed to train a new generation of clinicians to provide the necessary perspective and skills for effective leadership in this field. This fellowship identifies available university resources and leverages external collaborations (government, medical consortiums, affiliate institutions in public health, and environmental science), which we describe as being replicatable to similar training programs of any number of medical specialties and likewise bring meaningful opportunities to their respective training programs and academic departments. The creation of this novel fellowship in climate and health policy provides a roadmap and potential path for similar programs to join us in addressing the defining health issue of this generation and many to follow.
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http://dx.doi.org/10.1002/aet2.10323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637012PMC
July 2019

Climate Change and the Kidney.

Ann Nutr Metab 2019 14;74 Suppl 3:38-44. Epub 2019 Jun 14.

Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado, USA.

The worldwide increase in temperature has resulted in a marked increase in heat waves (heat extremes) that carries a markedly increased risk for morbidity and mortality. The kidney has a unique role not only in protecting the host from heat and dehydration but also is an important site of heat-associated disease. Here we review the potential impact of global warming and heat extremes on kidney diseases. High temperatures can result in increased core temperatures, dehydration, and blood hyperosmolality. Heatstroke (both clinical and subclinical whole-body hyperthermia) may have a major role in causing both acute kidney disease, leading to increased risk of acute kidney injury from rhabdomyolysis, or heat-induced inflammatory injury to the kidney. Recurrent heat and dehydration can result in chronic kidney disease (CKD) in animals and theoretically plays a role in epidemics of CKD developing in hot regions of the world where workers are exposed to extreme heat. Heat stress and dehydration also has a role in kidney stone formation, and poor hydration habits may increase the risk for recurrent urinary tract infections. The resultant social and economic consequences include disability and loss of productivity and employment. Given the rise in world temperatures, there is a major need to better understand how heat stress can induce kidney disease, how best to provide adequate hydration, and ways to reduce the negative effects of chronic heat exposure.
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http://dx.doi.org/10.1159/000500344DOI Listing
August 2020

Psychological Care Augmented by Telemedicine after a Polar Bear Encounter at an Arctic Research Station: A Case Report.

Telemed J E Health 2020 03 25;26(3):369-373. Epub 2019 Mar 25.

Department of Emergency Medicine and University of Colorado School of Medicine, Aurora, Colorado.

Psychologically stressful events can be particularly challenging in the wilderness or extreme environments due to a lack of immediate medical or psychological support. Telemedicine consultations may provide a means to supply medical providers in austere environments with expertise when confronted with these situations. In this study, we detail a case of psychological care imparted to residents at a remote, arctic research station after they encountered a polar bear. The health care provider at the camp was not a dedicated mental health professional but was able to deliver psychological care with assistance from a trained provider through use of telemedicine. We provide a brief overview of the evidence behind psychological first aid and incident support sessions for the treatment of stress injuries. We also review the evidence for telemedicine for psychological care in wilderness situations and describe its use in this scenario. All station residents were able to resume regular arctic activities. Resident feedback was that the sessions were advantageous. We anticipate the need for psychological care in austere situations to increase in the future, and further training in this field and the advancement of telemedicine consultation will be of benefit to wilderness providers.
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http://dx.doi.org/10.1089/tmj.2019.0008DOI Listing
March 2020

Fifteen years of emergency medicine literature in Africa: A scoping review.

Afr J Emerg Med 2019 Mar 18;9(1):45-52. Epub 2019 Jan 18.

University of Cape Town, Division of Emergency Medicine, Observatory, Cape Town, South Africa.

Introduction: Emergency medicine (EM) throughout Africa exists in various stages of development. The number and types of scientific EM literature can serve as a proxy indicator of EM regional development and activity. The goal of this scoping review is a preliminary assessment of potential size and scope of available African EM literature published over 15 years.

Methods: We searched five indexed international databases as well as non-indexed grey literature from 1999-2014 using key search terms including Africa", "emergency medicine", "emergency medical services", and "disaster." Two trained physician reviewers independently assessed whether each article met one or more of five inclusion criteria, and discordant results were adjudicated by a senior reviewer. Articles were categorised by subject and country of origin. Publication number per country was normalised by 1,000,000 population.

Results: Of 6091 identified articles, 633 (10.4%) were included. African publications increased 10-fold from 1999 to 2013 (9 to 94 articles, respectively). Western Africa had the highest number (212, 33.5%) per region. South Africa had the largest number of articles per country (171, 27.0%) followed by Nigeria, Kenya, and Ghana. 537 (84.8%) articles pertained to facility-based EM, 188 (29.7%) to out-of-hospital emergency medicine, and 109 (17.2%) to disaster medicine. Predominant content areas were epidemiology (374, 59.1%), EM systems (321, 50.7%) and clinical care (262, 41.4%). The most common study design was observational (479, 75.7%), with only 28 (4.4%) interventional studies. All-comers (382, 59.9%) and children (91, 14.1%) were the most commonly studied patient populations. Undifferentiated (313, 49.4%) and traumatic (180, 28.4%) complaints were most common.

Conclusion: Our review revealed a considerable increase in the growth of African EM literature from 1999 to 2014. Overwhelmingly, articles were observational, studied all-comers, and focused on undifferentiated complaints. The articles discovered in this scoping review are reflective of the relatively immature and growing state of African EM.
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http://dx.doi.org/10.1016/j.afjem.2019.01.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400014PMC
March 2019

Risk Factors and Mechanisms Underlying Cross-Shift Decline in Kidney Function in Guatemalan Sugarcane Workers.

J Occup Environ Med 2019 03;61(3):239-250

Center for Health, Work & Environment (Dr Sorensen, Dr Butler-Dawson, Ms Dally, Ms Krisher, Ms Tenney, Dr Newman); Department of Emergency Medicine, University of Colorado School of Medicine (Dr Sorensen, Dr Lemery); Colorado Consortium on Climate Change and Human Health (Dr Sorensen, Dr Butler-Dawson, Ms Dally, Ms Krisher, Dr Johnson, Dr Lemery, Ms Tenney, Dr Newman); Department of Environmental and Occupational Health (Dr Butler-Dawson, Ms Dally, Ms Krisher, Ms Tenney, Dr Newman), Colorado School of Public Health; Division of Renal Diseases and Hypertension (Dr Griffin, Dr Johnson); Pantaleon, Guatemala (Mr Asensio); Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine (Dr Newman), University of Colorado, Aurora, Colorado.

Objective: Identify early biomarkers and mechanisms of acute kidney injury in workers at risk of developing chronic kidney disease of unknown origin (CKDu).

Methods: We assessed cross-shift changes in kidney function and biomarkers of injury in 105 healthy sugarcane workers. We obtained pre-harvest clinical data as well as daily environmental, clinical, and productivity data for each worker.

Results: The average percent decline in cross-shift estimated glomerular filtration rate (eGFR) was 21.8% (standard deviation [SD] 13.6%). Increasing wet bulb globe temperature (WBGT), high uric acid, decreased urine pH, urinary leukocyte esterase, and serum hyperosmolality were risk factors for decline in kidney function.

Conclusions: Sugarcane workers with normal kidney function experience recurrent subclinical kidney injury, associated with elevations in biomarkers of injury that suggest exposure to high temperatures and extreme physical demands.
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http://dx.doi.org/10.1097/JOM.0000000000001529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416034PMC
March 2019

Climate Change and Health: An Urgent Call to Academic Emergency Medicine.

Acad Emerg Med 2019 07 14;26(7):837-840. Epub 2018 Dec 14.

Harborview Medical Center and University of Washington School of Medicine, Seattle, WA.

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http://dx.doi.org/10.1111/acem.13657DOI Listing
July 2019

Climate Change and Women's Health: Impacts and Opportunities in India.

Geohealth 2018 Oct 17;2(10):283-297. Epub 2018 Oct 17.

National Institute of Environmental Health Sciences Bethesda MD USA.

Climate change impacts on health, including increased exposures to heat, poor air quality, extreme weather events, and altered vector-borne disease transmission, reduced water quality, and decreased food security, affect men and women differently due to biologic, socioeconomic, and cultural factors. In India, where rapid environmental changes are taking place, climate change threatens to widen existing gender-based health disparities. Integration of a gendered perspective into existing climate, development, and disaster-risk reduction policy frameworks can decrease negative health outcomes. Modifying climate risks requires multisector coordination, improvement in data acquisition, monitoring of gender specific targets, and equitable stakeholder engagement. Empowering women as agents of social change can improve mitigation and adaptation policy interventions.
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http://dx.doi.org/10.1029/2018GH000163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007102PMC
October 2018

Climate change and women's health: Impacts and policy directions.

PLoS Med 2018 07 10;15(7):e1002603. Epub 2018 Jul 10.

National Institute of Environmental Health Sciences, Bethesda, Maryland, United States of America.

In a Policy Forum, Cecilia Sorensen and colleagues discuss the implications of climate change for women's health.
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http://dx.doi.org/10.1371/journal.pmed.1002603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6038986PMC
July 2018

Mortality in Puerto Rico after Hurricane Maria.

N Engl J Med 2018 Jul 29;379(2):162-170. Epub 2018 May 29.

From the Departments of Epidemiology (N.K., A.M., C.O.B.), Social and Behavioral Sciences (M.V.K.), and Biostatistics (R.A.I.) and the Center for Communicable Disease Dynamics (N.K., A.M., C.O.B.) and the François-Xavier Bagnoud Center for Health and Human Rights (A.F., J. Leaning, S.B.), Harvard T.H. Chan School of Public Health, Harvard University, the Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School (F.R., S.B.), and the Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute (R.A.I.) - all in Boston; the Department of Psychology, Carlos Albizu University (D.M., I.R.), and the Puerto Rico Science, Technology, and Research Trust (L.M.) - both in San Juan; Keck School of Medicine, University of Southern California, Los Angeles (P.E.); and the Section of Wilderness and Environmental Medicine at the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (C.S., J. Lemery).

Background: Quantifying the effect of natural disasters on society is critical for recovery of public health services and infrastructure. The death toll can be difficult to assess in the aftermath of a major disaster. In September 2017, Hurricane Maria caused massive infrastructural damage to Puerto Rico, but its effect on mortality remains contentious. The official death count is 64.

Methods: Using a representative, stratified sample, we surveyed 3299 randomly chosen households across Puerto Rico to produce an independent estimate of all-cause mortality after the hurricane. Respondents were asked about displacement, infrastructure loss, and causes of death. We calculated excess deaths by comparing our estimated post-hurricane mortality rate with official rates for the same period in 2016.

Results: From the survey data, we estimated a mortality rate of 14.3 deaths (95% confidence interval [CI], 9.8 to 18.9) per 1000 persons from September 20 through December 31, 2017. This rate yielded a total of 4645 excess deaths during this period (95% CI, 793 to 8498), equivalent to a 62% increase in the mortality rate as compared with the same period in 2016. However, this number is likely to be an underestimate because of survivor bias. The mortality rate remained high through the end of December 2017, and one third of the deaths were attributed to delayed or interrupted health care. Hurricane-related migration was substantial.

Conclusions: This household-based survey suggests that the number of excess deaths related to Hurricane Maria in Puerto Rico is more than 70 times the official estimate. (Funded by the Harvard T.H. Chan School of Public Health and others.).
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http://dx.doi.org/10.1056/NEJMsa1803972DOI Listing
July 2018

Climate Variability, Vulnerability, and Natural Disasters: A Case Study of Zika Virus in Manabi, Ecuador Following the 2016 Earthquake.

Geohealth 2017 Oct 14;1(8):298-304. Epub 2017 Oct 14.

Department of Medicine, Department of Public Health and Preventative Medicine SUNY Upstate Medical University Syracuse NY USA.

Climate change presents complex and wide-reaching threats to human health. A variable and changing climate can amplify and unmask ecological and socio-political weaknesses and increase the risk of adverse health outcomes in socially vulnerable regions. When natural disasters occur in such areas, underlying climatic conditions may amplify the public health crisis. We describe an emerging epidemic of Zika virus (ZIKV) in Ecuador following the 2016 earthquake, which coincided with an exceptionally strong El Niño event. We hypothesize that the trigger of a natural disaster during anomalous climate conditions and underlying social vulnerabilities were force multipliers contributing to a dramatic increase in ZIKV cases postearthquake.
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http://dx.doi.org/10.1002/2017GH000104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007105PMC
October 2017

Peering through the hourglass.

Authors:
Jay Lemery

Emerg Med J 2017 05 9;34(5):272-274. Epub 2017 Feb 9.

Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA

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http://dx.doi.org/10.1136/emermed-2016-206500DOI Listing
May 2017

Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy.

Clin J Am Soc Nephrol 2016 08 5;11(8):1472-83. Epub 2016 May 5.

Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.

Climate change has led to significant rise of 0.8°C-0.9°C in global mean temperature over the last century and has been linked with significant increases in the frequency and severity of heat waves (extreme heat events). Climate change has also been increasingly connected to detrimental human health. One of the consequences of climate-related extreme heat exposure is dehydration and volume loss, leading to acute mortality from exacerbations of pre-existing chronic disease, as well as from outright heat exhaustion and heat stroke. Recent studies have also shown that recurrent heat exposure with physical exertion and inadequate hydration can lead to CKD that is distinct from that caused by diabetes, hypertension, or GN. Epidemics of CKD consistent with heat stress nephropathy are now occurring across the world. Here, we describe this disease, discuss the locations where it appears to be manifesting, link it with increasing temperatures, and discuss ongoing attempts to prevent the disease. Heat stress nephropathy may represent one of the first epidemics due to global warming. Government, industry, and health policy makers in the impacted regions should place greater emphasis on occupational and community interventions.
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http://dx.doi.org/10.2215/CJN.13841215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974898PMC
August 2016

Wilderness Preparticipation Evaluation and Considerations for Special Populations.

Wilderness Environ Med 2015 Dec;26(4 Suppl):S76-91

Longs Peak Sports Medicine, Longmont, Colorado (Dr Madden).

Children, older adults, disabled and special needs athletes, and female athletes who participate in outdoor and wilderness sports and activities each face unique risks. For children and adolescents traveling to high altitude, the preparticipation physical evaluation should focus on risk assessment, prevention strategies, early recognition of altitude-related symptoms, management plans, and appropriate follow-up. As the risk and prevalence of chronic disease increases with age, both older patients and providers need to be aware of disease and medication-specific risks relative to wilderness sport and activity participation. Disabled and special needs athletes benefit from careful pre-event planning for the potential medical issues and equipment modifications that may affect their health in wilderness environments. Issues that demand special consideration for female adventurers include pregnancy, contraceptive use, menses, and ferritin levels at altitude. A careful preparticipation evaluation that factors in unique, population- specific risks will help special populations stay healthy and safe on wilderness adventures. The PubMed and SportDiscus databases were searched in 2014 using both MeSH terms and text words and include peer-reviewed English language articles from 1977 to 2014. Additional information was accessed from Web-based sources to produce this narrative review on preparticipation evaluation for special populations undertaking wilderness adventures. Key words include children, adolescent, pediatric, seniors, elderly, disabled, special needs, female, athlete, preparticipiation examination, wilderness medicine, and sports.
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http://dx.doi.org/10.1016/j.wem.2015.09.010DOI Listing
December 2015

Ethical, Legal, and Administrative Considerations for Preparticipation Evaluation for Wilderness Sports and Adventures.

Wilderness Environ Med 2015 Dec;26(4 Suppl):S10-4

Department of Emergency Medicine, University of Colorado, Denver, Colorado (Dr D. S. Young).

Preparticipation evaluations (PPEs) are common in team, organized, or traditional sports but not common in wilderness sports or adventures. Regarding ethical, legal, and administrative considerations, the same principles can be used as in traditional sports. Clinicians should be trained to perform such a PPE to avoid missing essential components and to maximize the quality of the PPE. In general, participants' privacy should be observed; office-based settings may be best for professional and billing purposes, and adequate documentation of a complete evaluation, including clearance issues, should be essential components. Additional environmental and personal health issues relative to the wilderness activity should be documented, and referral for further screening should be made as deemed necessary, if unable to be performed by the primary clinician. Travel medicine principles should be incorporated, and recommendations for travel or adventure insurance should be made.
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http://dx.doi.org/10.1016/j.wem.2015.09.013DOI Listing
December 2015

"Independence" Day.

Ann Glob Health 2015 May-Jun;81(3):416-7

Department of Environmental Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA.

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http://dx.doi.org/10.1016/j.aogh.2015.06.005DOI Listing
December 2016

Wilderness Preparticipation Evaluation and Considerations for Special Populations.

Clin J Sport Med 2015 Sep;25(5):443-55

*Clinical Outcomes Research, Intermountain Healthcare, Salt Lake City, Utah; †Department of Family Medicine, University of Colorado, Denver, Colorado; ‡CJW Sports Medicine, Richmond, Virginia; §Anne Arundel Medical Center, Orthopedic and Sports Medicine Center, Annapolis, Maryland; ¶Missouri State University, Springfield, Missouri; ‖Department of Emergency Medicine, University of Colorado, Aurora, Colorado; **Big Island Family Medicine Center, Lynchburg, Virginia; and ††Longs Peak Sports Medicine, Longmont, Colorado.

Children, older adults, disabled and special needs athletes, and female athletes who participate in outdoor and wilderness sports and activities each face unique risks. For children and adolescents traveling to high altitude, the preparticipation physical evaluation should focus on risk assessment, prevention strategies, early recognition of altitude-related symptoms, management plans, and appropriate follow-up. As the risk and prevalence of chronic disease increases with age, both older patients and providers need to be aware of disease and medication-specific risks relative to wilderness sport and activity participation. Disabled and special needs athletes benefit from careful pre-event planning for the potential medical issues and equipment modifications that may affect their health in wilderness environments. Issues that demand special consideration for female adventurers include pregnancy, contraceptive use, menses, and ferritin levels at altitude. A careful preparticipation evaluation that factors in unique, population-specific risks will help special populations stay healthy and safe on wilderness adventures. The PubMed and SportDiscus databases were searched in 2014 using both MeSH terms and text words and include peer-reviewed English language articles from 1977 to 2014. Additional information was accessed from Web-based sources to produce this narrative review on preparticipation evaluation for special populations undertaking wilderness adventures. Key words include children, adolescent, pediatric, seniors, elderly, disabled, special needs, female, athlete, preparticipiation examination, wilderness medicine, and sports.
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http://dx.doi.org/10.1097/JSM.0000000000000251DOI Listing
September 2015

Ethical, Legal, and Administrative Considerations for Preparticipation Evaluation for Wilderness Sports and Adventures.

Clin J Sport Med 2015 Sep;25(5):388-91

*Departments of Orthopaedic Surgery; and †Community and Family Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; ‡Family and Sports Medicine, University of Utah, Salt Lake City, Utah; §Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado; and ¶Department of Emergency Medicine, University of Colorado, Denver, Colorado.

Preparticipation evaluations (PPEs) are common in team, organized, or traditional sports but not common in wilderness sports or adventures. Regarding ethical, legal, and administrative considerations, the same principles can be used as in traditional sports. Clinicians should be trained to perform such a PPE to avoid missing essential components and to maximize the quality of the PPE. In general, participants' privacy should be observed; office-based settings may be best for professional and billing purposes, and adequate documentation of a complete evaluation, including clearance issues, should be essential components. Additional environmental and personal health issues relative to the wilderness activity should be documented, and referral for further screening should be made as deemed necessary, if unable to be performed by the primary clinician. Travel medicine principles should be incorporated, and recommendations for travel or adventure insurance should be made.
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http://dx.doi.org/10.1097/JSM.0000000000000246DOI Listing
September 2015

Wilderness Medical Society practice guidelines for the use of epinephrine in outdoor education and wilderness settings: 2014 update.

Wilderness Environ Med 2014 Dec;25(4 Suppl):S15-8

Wilderness Medical Associates International, Portland, ME (Dr Johnson).

The Epinephrine Roundtable took place on July 27, 2008, during the 25th Annual Meeting of the Wilderness Medical Society (WMS) in Snowmass, CO. The WMS convened this roundtable to explore areas of consensus and uncertainty in the field treatment of anaphylaxis. Panelists were selected on the basis of their relevant academic or professional experience. There is a paucity of data that address the treatment of anaphylaxis in the wilderness. Anaphylaxis is a rare disease, with a sudden onset and drastic course that does not lend itself to study in randomized, controlled trials. Therefore, the panel endorsed the following position based on the limited available evidence and review of published articles, as well as expert consensus. The position represents the consensus of the panelists and is endorsed by the WMS. In 2014, the authors reviewed relevant articles published since the Epinephrine Roundtable. The following is an updated version of the original guidelines published in Wilderness & Environmental Medicine 2010;21(4):185-187.
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http://dx.doi.org/10.1016/j.wem.2014.07.015DOI Listing
December 2014

Editorial: The Great Procrastination.

Health Hum Rights 2014 Jun 14;16(1):1-3. Epub 2014 Jun 14.

Editor-in-Chief, Health and Human Rights Journal, Kolokotrones Professor at Harvard University, and Chair of the Department of Global Health and Social Medicine at Harvard Medical School.

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June 2014

Core content for wilderness medicine fellowship training of emergency medicine graduates.

Acad Emerg Med 2014 Feb 17;21(2):204-7. Epub 2014 Jan 17.

The Department of Surgery, Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA.

Wilderness medicine is the practice of resource-limited medicine under austere conditions. In 2003, the first wilderness medicine fellowship was established, and as of March 2013, a total of 12 wilderness medicine fellowships exist. In 2009 the American College of Emergency Physicians Wilderness Medicine Section created a Fellowship Subcommittee and Taskforce to bring together fellowship directors, associate directors, and other interested stakeholders to research and develop a standardized curriculum and core content for emergency medicine (EM)-based wilderness medicine fellowships. This paper describes the process and results of what became a 4-year project to articulate a standardized curriculum for wilderness medicine fellowships. The final product specifies the minimum core content that should be covered during a 1-year wilderness medicine fellowship. It also describes the structure, length, site, and program requirements for a wilderness medicine fellowship.
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http://dx.doi.org/10.1111/acem.12304DOI Listing
February 2014

Perspective: Environment, biodiversity, and the education of the physician of the future.

Acad Med 2013 Feb;88(2):168-72

Wildlife Health Program, Wildlife Conservation Society, American Museum of Natural History, New York, New York, USA.

Ours is an age of unprecedented levels of environmental alteration and biodiversity loss. Beyond the exposure to environmental hazards, conditions such as environmental degradation, biotic impoverishment, climate change, and the loss of ecosystem services create important health threats by changing the ecology of many pathogens and increasing the incidence and/or severity of certain noncommunicable conditions. They also threaten health in the future by weakening the Earth's life support systems.Although physicians remain one of the most often accessed and most trusted sources of information about the environment, there is currently little emphasis on educating medical professionals about these environmental issues. This lack of training reduces the ability of most physicians to be efficient science-public interfaces and makes them ineffective at contributing to address the fundamental causes of environmental problems or participate in substantive environmental policy discussions. This is an important challenge facing medical education today.To turn medical students into effective physician-citizens, an already-overwhelmed medical school curriculum must make way for a thoughtful exploration of environmental stressors and their impacts on human health. The overarching question before medical educators is how to develop the competencies, standards, and curricula for this educational endeavor. To this end, the authors highlight some of the critical linkages between health and the environment and suggest a subset of key practical issues that need to be addressed in order to create environmental education standards for the physician of the future.
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http://dx.doi.org/10.1097/ACM.0b013e31827bfbebDOI Listing
February 2013

The global health curriculum of Weill Cornell Medical College: how one school developed a global health program.

Acad Med 2012 Sep;87(9):1296-302

Weill Cornell Medical College, New York, New York, USA.

Since 2009, a multidisciplinary team at Weill Cornell Medical College (WCMC) has collaborated to create a comprehensive, elective global health curriculum (GHC) for medical students. Increasing student interest sparked the development of this program, which has grown from ad hoc lectures and dispersed international electives into a comprehensive four-year elective pathway with over 100 hours of training, including three courses, two international experiences, a preceptorship with a clinician working with underserved populations in New York City, and regular lectures and seminars by visiting global health leaders. Student and administrative enthusiasm has been strong: In academic years 2009, 2010, and 2011, over half of the first-year students (173 of 311)participated in some aspect of the GHC, and 18% (55 of 311) completed all first-year program requirements.The authors cite the student-driven nature of GHC as a major factor in its success and rapid growth. Also important was the foundation previously established by WCMC global health faculty, the serendipitous timing of the GHC's development in the midst of curricular reform and review, as well as the presence of a full-time, nonclinical Global Health Fellow who served as a program coordinator. Given the enormous expansion of medical student interest in global health training throughout the United States and Canada over the past decade, the authors hope that medical schools developing similar programs will find the experience at Weill Cornell informative and helpful.
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http://dx.doi.org/10.1097/ACM.0b013e3182628edbDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052981PMC
September 2012

Wilderness medicine within global health: a strategy for less risk and more reward.

Wilderness Environ Med 2012 Mar;23(1):84-8

Emergency Medicine, Weill Cornell Medical College, 525 E 68th St, New York, NY 10065, USA.

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http://dx.doi.org/10.1016/j.wem.2011.11.011DOI Listing
March 2012

Lessons from Dr Strangelove.

Authors:
Jay Lemery

Wilderness Environ Med 2012 Mar;23(1):2-4

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http://dx.doi.org/10.1016/j.wem.2011.12.009DOI Listing
March 2012

Because it's there… The education of George Mallory.

Wilderness Environ Med 2011 Dec;22(4):352-4

Emergency Medicine, New York-Presbyterian Hospital, New York, NY 10065, USA.

Initiative, creativity, and resolve represent both the pillars of the Wilderness Medical Society (WMS) and the story of George Mallory. His journey from humble beginnings to his rise to become one of history's most legendary mountaineers is a testament to the impact of great mentors as well as the development of Mallory as a mentor himself. In this light, the path of George Mallory in mountaineering and the role of WMS in wilderness medicine share a common theme. This essay is not only a tribute to George Mallory but also a testament to the importance of mentorship and the role of WMS in inspiring mentorship and education to future pioneers.
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http://dx.doi.org/10.1016/j.wem.2011.04.005DOI Listing
December 2011
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