Publications by authors named "Scott E McIntosh"

73 Publications

Effect of Calcium-Channel Blockade on the Cold-Induced Vasodilation Response.

Wilderness Environ Med 2020 Sep 29;31(3):312-316. Epub 2020 May 29.

University of Utah, Division of Emergency Medicine, Salt Lake City, UT.

Introduction: Cold-induced vasodilation (CIVD) is seen in the extremities during exposure to cold. A strong vasodilation response has been associated with a decreased risk of cold injury. Increasing CIVD might further decrease this risk. The calcium-channel blocker nifedipine causes vasodilation and is used to treat Raynaud's syndrome and chilblains. Nifedipine is also used for high altitude pulmonary edema and could potentially serve a dual purpose in preventing frostbite. The effects of nifedipine on CIVD have not been studied.

Methods: A double-blind crossover study comparing nifedipine (30 mg SR (sustained release) orally twice daily) to placebo was designed using 2 sessions of 4 finger immersion in 5°C water, with 24 h of medication pretreatment before each session. Finger temperatures were measured via nailbed thermocouples. The primary outcome was mean finger temperature; secondary outcomes were mean apex and nadir temperatures, first apex and nadir temperatures, subjective pain ranking, and time of vasodilation onset (all presented as mean±SD).

Results: Twelve volunteers (age 29±3 [24-34] y) completed the study. No significant difference in finger temperature (9.2±1.1°C nifedipine vs 9.0±0.7°C placebo, P=0.38) or any secondary outcome was found. Pain levels were similar (2.8±1.6 nifedipine vs 3.0±1.5 placebo, P=0.32). The most common adverse event was headache (32% of nifedipine trials vs 8% placebo).

Conclusions: Pretreatment with 30 mg of oral nifedipine twice daily does not affect the CIVD response in healthy individuals under cold stress.
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http://dx.doi.org/10.1016/j.wem.2020.03.002DOI Listing
September 2020

COVID-19 Lung Injury is Not High Altitude Pulmonary Edema.

High Alt Med Biol 2020 06 13;21(2):192-193. Epub 2020 Apr 13.

Altitude Research Center, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

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http://dx.doi.org/10.1089/ham.2020.0055DOI Listing
June 2020

Reply to: Reconsidering the air pocket around mouth and nose as a positive outcome predictor in completely buried avalanche victims.

Resuscitation 2020 07 28;152:210-211. Epub 2020 Mar 28.

Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT 84107, United States.

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http://dx.doi.org/10.1016/j.resuscitation.2020.03.015DOI Listing
July 2020

Avalanche airbag post-burial active deflation - The ability to create an air pocket to delay asphyxiation and prolong survival.

Resuscitation 2020 01 5;146:155-160. Epub 2019 Dec 5.

Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT 84107, United States.

Aim: The primary purpose of an avalanche airbag is to prevent burial during an avalanche. Approximately twenty percent of avalanche victims deploying airbags become critically buried, however. One avalanche airbag actively deflates three minutes after deployment, potentially creating an air pocket. Our objective was to evaluate this air pocket and its potential to prevent asphyxiation.

Methods: Twelve participants were fitted with an airbag and placed prone on the snow. Participants deployed the airbag and were buried in 1.5 m of snow for 60 min with vital signs including oxygen saturation (SpO2) and end-tidal CO2 (ETCO2) measured every minute. Participants completed a post-burial survey to determine head movement within the air pocket.

Results: Eleven of the 12 participants (92%) completed 60 min of burial. Preburial baseline SpO2 measurements did not change significantly over burial time (P > 0.05). Preburial baseline ETCO2 measurements increased over the burial time (P < 0.02); only one ETCO2 value was outside of the normal ETCO2 range (35-45 mmHg). Participants reported they could move their head forward 11.2 cm (SD 4.8 cm) and backward 6.6 cm (SD 5.1 cm) with the majority of participants stated that they had enough head movement to separate the oral cavity from opposing snow if necessary. Visual examination during extrication revealed a well-defined air pocket in all burials.

Conclusion: The avalanche airbag under study creates an air pocket that appears to delay asphyxia, which could allow extra time for rescue and improve overall survival of avalanche victims.
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http://dx.doi.org/10.1016/j.resuscitation.2019.11.023DOI Listing
January 2020

Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update.

Wilderness Environ Med 2019 Dec 15;30(4S):S47-S69. Epub 2019 Nov 15.

Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City, UT.

To provide guidance to clinicians, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and a balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. This is the 2019 update of the Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2014 Update.
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http://dx.doi.org/10.1016/j.wem.2019.10.002DOI Listing
December 2019

Improvised vs Standard Cervical Collar to Restrict Spine Movement in the Backcountry Environment.

Wilderness Environ Med 2019 Dec 6;30(4):412-416. Epub 2019 Nov 6.

Division of Emergency Medicine, University of Utah, Salt Lake City, UT. Electronic address:

Introduction: To compare the effectiveness of a molded fleece jacket with that of a standard cervical collar at limiting movement of the cervical spine in 3 different directions.

Methods: This is a prospective study using 24 healthy volunteers to measure cervical flexion/extension, rotation, and lateral flexion with both the fleece collar and the standard cervical collar. A hand-held goniometer was used for measurements. The results were then analyzed for the 3 independent movements using a noninferiority test.

Results: The fleece collar was determined to be noninferior at limiting the designated motions. Comfort was greater while wearing the improvised fleece collar.

Conclusions: Our small study demonstrated that mountain travelers and rescuers may be able to use an improvised fleece jacket collar in place of a standard collar if spine trauma is suspected after a backcountry accident. Further research should examine different types of improvised collars, their ability to remain in place over extended evacuations, and when to apply collars to backcountry patients.
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http://dx.doi.org/10.1016/j.wem.2019.07.002DOI Listing
December 2019

In Reply to Dr Bennett.

Wilderness Environ Med 2019 09 8;30(3):334-335. Epub 2019 Aug 8.

Intermountain Medical Center, Murray, UT.

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http://dx.doi.org/10.1016/j.wem.2019.06.010DOI Listing
September 2019

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite: 2019 Update.

Wilderness Environ Med 2019 Dec 17;30(4S):S19-S32. Epub 2019 Jul 17.

Division of Emergency Medicine, Altitude Research Center, University of Colorado Denver School of Medicine, Denver, CO; Institute for Altitude Medicine, Telluride, CO.

The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the guidelines published in 2014.
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http://dx.doi.org/10.1016/j.wem.2019.05.002DOI Listing
December 2019

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update.

Wilderness Environ Med 2019 Dec 24;30(4S):S3-S18. Epub 2019 Jun 24.

Altitude Research Center, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.

To provide guidance to clinicians about best preventive and therapeutic practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. Recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to prevention and management of each form of acute altitude illness that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in 2010 and subsequently updated as the WMS Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness in 2014.
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http://dx.doi.org/10.1016/j.wem.2019.04.006DOI Listing
December 2019

Cause of Death in Utah Avalanche Fatalities, 2006-2007 through 2017-2018 Winter Seasons.

Wilderness Environ Med 2019 Jun 17;30(2):191-194. Epub 2019 Apr 17.

Utah Avalanche Center, Salt Lake City, UT.

Introduction: Understanding patterns of avalanche fatalities can aid prevention and rescue strategies. In 2007, we published a report reviewing avalanche deaths in Utah between the 1989-1990 and 2005-2006 winter seasons. In the current report, we discuss Utah avalanche fatalities from the 2006-2007 to 2017-2018 seasons.

Methods: Avalanche fatality data were obtained from the Utah Avalanche Center and Utah State Office of the Medical Examiner. Autopsy reports were reviewed to determine demographic information, type of autopsy (external vs internal), injuries, and cause of death.

Results: Thirty-two avalanche deaths occurred in Utah during the study period. The mean (±SD) age of victims was 32±13 (8-54) y. Thirty victims (94%) were male and 2 (6%) were female. Seventy-two percent of deaths were from asphyxiation, 19% from trauma alone, and 9% from a combination of asphyxiation and trauma. Snowmobilers accounted for the largest percentage of avalanche fatalities (15 victims; 47%) during the 2007-2018 period.

Conclusions: Asphyxia continues to be the most prevalent killer in avalanche burial. Patterns of ongoing avalanche deaths continue to suggest that rapid recovery and techniques that prolong survival while buried may decrease fatality rates. Trauma is a significant factor in many avalanche fatalities. Education and technologies focused on reducing traumatic injuries such as improved education in techniques for avalanche risk avoidance and/or use of avalanche airbags may further decrease fatality rates. Snowmobilers represent an increasing percentage of Utah avalanche deaths and now make up the majority of victims; increased education targeting this demographic in the basics of avalanche rescue gear and avalanche rescue may also reduce fatalities.
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http://dx.doi.org/10.1016/j.wem.2019.02.007DOI Listing
June 2019

Reduced Acetazolamide Dosing in Countering Altitude Illness: A Comparison of 62.5 vs 125 mg (the RADICAL Trial).

Wilderness Environ Med 2019 Mar 8;30(1):12-21. Epub 2019 Jan 8.

Intermountain Medical Center, Murray, UT.

Introduction: North American guidelines propose 125 mg acetazolamide twice daily as the recommended prophylactic dose to prevent acute mountain sickness (AMS). To our knowledge, a dose lower than 125 mg twice daily has not been studied.

Methods: We conducted a prospective, double-blind, randomized, noninferiority trial of trekkers to Everest Base Camp in Nepal. Participants received the reduced dose of 62.5 mg twice daily or the standard dose of 125 mg twice daily. Primary outcome was incidence of AMS, and secondary outcomes were severity of AMS and side effects in each group.

Results: Seventy-three participants had sufficient data to be included in the analysis. Overall incidence of AMS was 21 of 38 (55.3%) in reduced-dose and 21 of 35 (60.0%) in standard-dose recipients. The daily incidence rate of AMS was 6.7% (95% CI 2.5-10.9) for each individual in the reduced-dose group and 8.9% (95% CI 4.5-13.3) in the standard-dose group. Overall severity of participants' Lake Louise Score was 1.014 in the reduced-dose group and 0.966 in the standard-dose group (95% CI 0.885-1.144). Side effects were similar between the groups.

Conclusions: The reduced dose of acetazolamide at 62.5 mg twice daily was noninferior to the currently recommended dose of 125 mg twice daily for the prevention of AMS. Low incidence of AMS in the study population may have limited the ability to differentiate the treatment effects. Further research with more participants with greater rates of AMS would further elucidate this reduced dosage for preventing altitude illness.
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http://dx.doi.org/10.1016/j.wem.2018.09.002DOI Listing
March 2019

Avalanche Safety Practices Among Backcountry Skiers and Snowboarders in Jackson Hole in 2016.

Wilderness Environ Med 2018 Dec 10;29(4):493-498. Epub 2018 Sep 10.

Division of Emergency Medicine, University of Utah, Salt Lake City, UT (Drs Hawley, Wheeler, and McIntosh).

Introduction: Carrying standard safety gear (beacon, probe, and shovel), planning a route of descent, and recreating with companions can help to mitigate the risk of injury or death resulting from avalanches in the backcountry. The goal of this study was to identify factors associated with performance of these safety practices.

Methods: A convenience sample of backcountry skiers and snowboarders was surveyed in 2016 at the backcountry gates of Jackson Hole Mountain Resort. Each participant was surveyed on characteristics including skill level, sex, age, prior avalanche education, and residency in the Jackson Hole area. Safety practices were also measured against avalanche hazard forecasts. Correlations were assessed using Fisher's exact testing.

Results: A total of 334 participants were surveyed. Factors associated with carrying avalanche safety gear included higher expertise, being a resident of the Jackson Hole area, and prior avalanche education. Factors associated with having a planned route of descent included higher expertise and being a resident of the Jackson Hole area. Factors associated with recreating with companions included younger age and lower expertise. Sex had no association with any of the surveyed safety practices. Participants were less likely to carry avalanche safety gear on low avalanche hazard days.

Conclusions: Certain individual characteristics of backcountry skiers and snowboarders are associated with increased frequency of adherence to recommended safety practices. These findings suggest that particular categories of backcountry recreationists may benefit from further avalanche safety education. The results of this study could help direct future educational efforts among backcountry recreationists.
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http://dx.doi.org/10.1016/j.wem.2018.05.004DOI Listing
December 2018

Sildenafil and Exercise Capacity in the Elderly at Moderate Altitude.

Wilderness Environ Med 2016 Jun 23;27(2):307-15. Epub 2016 Apr 23.

Department of Pulmonary and Critical Care (Ms Lovelace, Drs Lanspa and Grissom, and Mr Briggs).

Objective: Hypobaric hypoxia decreases exercise capacity and causes hypoxic pulmonary vasoconstriction and pulmonary hypertension. The phosphodiesterase-5 inhibitor sildenafil is a pulmonary vasodilator that may improve exercise capacity at altitude. We aimed to determine whether sildenafil improves exercise capacity, measured as maximal oxygen consumption (peak V̇o2), at moderate altitude in adults 60 years or older.

Methods: The design was a randomized, double-blind, placebo-controlled, crossover study. After baseline cardiopulmonary exercise testing at 1400 m, 12 healthy participants (4 women) aged 60 years or older, who reside permanently at approximately 1400 m and are regularly active in self-propelled mountain recreation above 2000 m, performed maximal cardiopulmonary cycle exercise tests in a hypobaric chamber at a simulated altitude of 2750 m after ingesting sildenafil and after ingesting a placebo.

Results: After placebo, mean peak V̇o2 was significantly lower at 2750 m than 1400 m: 37.0 mL · kg(-1) · min(-1) (95% CI, 32.7 to 41.3) vs 39.1 mL · kg(-1) · min(-1) (95% CI, 33.5 to 44.7; P = .020). After placebo, there was no difference in heart rate (HR) or maximal workload at either altitude (z = 0.182; P = .668, respectively). There was no difference between sildenafil and placebo at 2750 m in peak V̇o2 (P = .668), O2 pulse (P = .476), cardiac index (P = .143), stroke volume index (z = 0.108), HR (z = 0.919), or maximal workload (P = .773). Transthoracic echocardiography immediately after peak exercise at 2750 m showed tricuspid annular plane systolic velocity was significantly higher after sildenafil than after placebo (P = .019), but showed no difference in tricuspid annular plane systolic excursion (P = .720).

Conclusions: Sildenafil (50 mg) did not improve exercise capacity in adults 60 years or older at moderate altitude in our study. This might be explained by a "dosing effect" or insufficiently high altitude.
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http://dx.doi.org/10.1016/j.wem.2016.01.006DOI Listing
June 2016

Preparticipation Evaluation for Climbing Sports.

Wilderness Environ Med 2015 Dec;26(4 Suppl):S40-6

Division of Emergency Medicine, University of Utah Health Care, Salt Lake City, Utah (Drs Ng and McIntosh).

Climbing is a popular wilderness sport among a wide variety of professional athletes and amateur enthusiasts, and many styles are performed across many environments. Potential risks confront climbers, including personal health or exacerbation of a chronic condition, in addition to climbing-specific risks or injuries. Although it is not common to perform a preparticipation evaluation (PPE) for climbing, a climber or a guide agency may request such an evaluation before participation. Formats from traditional sports PPEs can be drawn upon, but often do not directly apply. The purpose of this article was to incorporate findings from expert opinion from professional societies in wilderness medicine and in sports medicine, with findings from the literature of both climbing epidemiology and traditional sports PPEs, into a general PPE that would be sufficient for the broad sport of climbing. The emphasis is on low altitude climbing, and an overview of different climbing styles is included. Knowledge of climbing morbidity and mortality, and a standardized approach to the PPE that involves adequate history taking and counseling have the potential for achieving risk reduction and will facilitate further study on the evaluation of the efficacy of PPEs.
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http://dx.doi.org/10.1016/j.wem.2015.09.014DOI Listing
December 2015

Risk Stratification for Athletes and Adventurers in High-Altitude Environments: Recommendations for Preparticipation Evaluation.

Wilderness Environ Med 2015 Dec;26(4 Suppl):S30-9

Institute for Altitude Medicine, Telluride, Colorado (Dr Hackett).

High-altitude athletes and adventurers face a number of environmental and medical risks. Clinicians often advise participants or guiding agencies before or during these experiences. Preparticipation evaluation (PPE) has the potential to reduce risk of high-altitude illnesses in athletes and adventurers. Specific conditions susceptible to high-altitude exacerbation also important to evaluate include cardiovascular and lung diseases. Recommendations by which to counsel individuals before participation in altitude sports and adventures are few and of limited focus. We reviewed the literature, collected expert opinion, and augmented principles of a traditional sport PPE to accommodate the high-altitude wilderness athlete/adventurer. We present our findings with specific recommendations on risk stratification during a PPE for the high-altitude athlete/adventurer.
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http://dx.doi.org/10.1016/j.wem.2015.09.016DOI Listing
December 2015

Preparticipation Evaluation for Climbing Sports.

Clin J Sport Med 2015 Sep;25(5):412-7

*Family and Sports Medicine, University of Utah Health Care, Salt Lake City, Utah; †Department of Emergency Medicine, University of Colorado School of Medicine; ‡Kaiser Permanente, Department of Emergency Medicine, University of Colorado; §Division of Emergency Medicine, University of Utah Health Care, Salt Lake City, Utah; ¶Arizona Sports Medicine Center, Mesa, Arizona; and ‖Central Maine Sports Medicine (a Clinical Division of CMMC), Evergreen Sports Medicine Fellowship, Lewiston, Maine.

Climbing is a popular wilderness sport among a wide variety of professional athletes and amateur enthusiasts, and many styles are performed across many environments. Potential risks confront climbers, including personal health or exacerbation of a chronic condition, in addition to climbing-specific risks or injuries. Although it is not common to perform a preparticipation evaluation (PPE) for climbing, a climber or a guide agency may request such an evaluation before participation. Formats from traditional sports PPEs can be drawn upon, but often do not directly apply. The purpose of this article was to incorporate findings from expert opinion from professional societies in wilderness medicine and in sports medicine, with findings from the literature of both climbing epidemiology and traditional sports PPEs, into a general PPE that would be sufficient for the broad sport of climbing. The emphasis is on low altitude climbing, and an overview of different climbing styles is included. Knowledge of climbing morbidity and mortality, and a standardized approach to the PPE that involves adequate history taking and counseling have the potential for achieving risk reduction and will facilitate further study on the evaluation of the efficacy of PPEs.
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http://dx.doi.org/10.1097/JSM.0000000000000247DOI Listing
September 2015

Risk Stratification for Athletes and Adventurers in High-Altitude Environments: Recommendations for Preparticipation Evaluation.

Clin J Sport Med 2015 Sep;25(5):404-11

*Family and Sports Medicine, University of Utah Health Care, Salt Lake City, Utah; †Division of Emergency Medicine, University of Utah Health Care, Salt Lake City, Utah; ‡Department of Orthopedics, University of Utah, Salt Lake City, Utah; §Bay Area Pulmonary/Critical Care Medical Associates, Berkeley/Oakland, California; and ¶Institute for Altitude Medicine, Telluride, Colorado.

High-altitude athletes and adventurers face a number of environmental and medical risks. Clinicians often advise participants or guiding agencies before or during these experiences. Preparticipation evaluation (PPE) has the potential to reduce risk of high-altitude illnesses in athletes and adventurers. Specific conditions susceptible to high-altitude exacerbation also important to evaluate include cardiovascular and lung diseases. Recommendations by which to counsel individuals before participation in altitude sports and adventures are few and of limited focus. We reviewed the literature, collected expert opinion, and augmented principles of a traditional sport PPE to accommodate the high-altitude wilderness athlete/adventurer. We present our findings with specific recommendations on risk stratification during a PPE for the high-altitude athlete/adventurer.
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http://dx.doi.org/10.1097/JSM.0000000000000231DOI Listing
September 2015

Climbing On: Editorial Evolution.

Wilderness Environ Med 2015 Sep 31;26(3):287. Epub 2015 Jul 31.

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http://dx.doi.org/10.1016/j.wem.2015.06.019DOI Listing
September 2015

The Impact of Freeze-Thaw Cycles on Epinephrine.

Wilderness Environ Med 2015 Dec 19;26(4):514-9. Epub 2015 May 19.

Division of Emergency Medicine (Drs Ng and McIntosh), University of Utah Health Care, Salt Lake City, UT.

Objectives: Epinephrine is the first-line medical treatment for anaphylaxis, a life-threatening allergic syndrome. To treat anaphylaxis, backcountry recreationalists and guides commonly carry epinephrine autoinjectors. Epinephrine may be exposed to cold temperatures and freezing during expeditions. An epinephrine solution must contain 90% to 115% of the labeled epinephrine amount to meet United States Pharmacopeia standards. The purpose of this study was to determine whether freeze-thaw cycles alter epinephrine concentrations in autoinjectors labeled to contain 1.0 mg/mL epinephrine. A further objective was to determine whether samples continued to meet United States Pharmacopeia concentration standards after freeze-thaw cycles.

Methods: Epinephrine from 6 autoinjectors was extracted and divided into experimental and control samples. The experimental samples underwent 7 consecutive 12-hour freeze cycles followed by 7 12-hour thaw cycles. The control samples remained at an average temperature of 23.1°C for the duration of the study. After the seventh thaw cycle, epinephrine concentrations were measured using a high-performance liquid chromatography assay with mass spectrometry detection.

Results: The mean epinephrine concentration of the freeze-thaw samples demonstrated a statistically significant increase compared with the control samples: 1.07 mg/mL (SD ± 8.78; 95% CI, 1.04 to 1.11) versus 0.96 mg/mL (SD ± 6.81; 95% CI, 0.94 to 0.99), respectively. The maximal mean epinephrine concentration in the experimental freeze-thaw group was 1.12 mg/mL, which still fell within the range of United States Pharmacopeia standards for injectables (0.90 to 1.15 mg/mL).

Conclusions: Although every attempt should be made to prevent freezing of autoinjectors, this preliminary study demonstrates that epinephrine concentrations remain within 90% to 115% of 1.0 mg/mL after multiple freeze-thaw cycles.
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http://dx.doi.org/10.1016/j.wem.2015.04.001DOI Listing
December 2015

Advanced Avalanche Safety Equipment of Backcountry Users: Current Trends and Perceptions.

Wilderness Environ Med 2015 Sep 30;26(3):417-21. Epub 2015 Apr 30.

Division of Emergency Medicine, University of Utah, Salt Lake City, UT (Drs Ng and McIntosh).

Objective: Backcountry travelers should carry a standard set of safety gear (transceiver, shovel, and probe) to improve rescue chances and reduce mortality risk. Many backcountry enthusiasts are using other advanced equipment such as an artificial air pocket (eg, the AvaLung) or an avalanche air bag. Our goal was to determine the numbers of backcountry users carrying advanced equipment and their perceptions of mortality and morbidity benefit while carrying this gear.

Methods: A convenience sample of backcountry skiers, snowboarders, snowshoers, and snowmobilers was surveyed between February and April 2014. Participants of this study were backcountry mountain users recruited at trailheads in the Wasatch and Teton mountain ranges of Utah and Wyoming, respectively. Questions included prior avalanche education, equipment carried, and perceived safety benefit derived from advanced equipment.

Results: In all, 193 surveys were collected. Skiers and snowboarders were likely to have taken an avalanche safety course, whereas snowshoers and snowmobilers were less likely to have taken a course. Most backcountry users (149, 77.2%), predominantly skiers and snowboarders, carried standard safety equipment. The AvaLung was carried more often (47 users) than an avalanche air bag (10 users). The avalanche air bag had a more favorable perceived safety benefit. A majority of participants reported cost as the barrier to obtaining advanced equipment.

Conclusions: Standard avalanche safety practices, including taking an avalanche safety course and carrying standard equipment, remain the most common safety practices among backcountry users in the Wasatch and Tetons. Snowshoers remain an ideal target for outreach to increase avalanche awareness and safety.
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http://dx.doi.org/10.1016/j.wem.2015.03.029DOI Listing
September 2015

Bites, bugs, and blood.

Wilderness Environ Med 2015 Jun 18;26(2):113-4. Epub 2015 Apr 18.

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http://dx.doi.org/10.1016/j.wem.2015.03.026DOI Listing
June 2015

Hypothermia Evidence, Afterdrop, and Guidelines.

Wilderness Environ Med 2015 Sep 1;26(3):439-41. Epub 2015 Apr 1.

Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, University of Utah, Salt Lake City, UT, USA.

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http://dx.doi.org/10.1016/j.wem.2015.02.001DOI Listing
September 2015

Tribute to Jonna Barry.

Wilderness Environ Med 2014 Dec;25(4):375-7

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http://dx.doi.org/10.1016/j.wem.2014.09.034DOI Listing
December 2014

Wilderness Medical Society practice guidelines for the treatment of acute pain in remote environments: 2014 update.

Wilderness Environ Med 2014 Dec;25(4 Suppl):S96-104

Department of Anesthesia, Swedish Medical Center, Seattle, WA (Dr Lieberman). Electronic address:

The Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded on the basis of the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for the Treatment of Acute Pain in Remote Environments published in Wilderness & Environmental Medicine 2014;25(1):41-49.
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http://dx.doi.org/10.1016/j.wem.2014.07.016DOI Listing
December 2014

Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update.

Wilderness Environ Med 2014 Dec;25(4 Suppl):S86-95

Department of Emergency Medicine, Denver Health Medical Center/University of Colorado School of Medicine, Denver, Colorado (Dr Engeln).

To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the treatment and prevention of lightning injuries. These guidelines include a review of the epidemiology of lightning and recommendations for the prevention of lightning strikes, along with treatment recommendations organized by organ system. Recommendations are graded on the basis of the quality of supporting evidence according to criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for Prevention and Treatment of Lightning Injuries published in Wilderness & Environmental Medicine 2012;23(3):260-269.
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http://dx.doi.org/10.1016/j.wem.2014.08.011DOI Listing
December 2014

Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2014 update.

Wilderness Environ Med 2014 Dec;25(4 Suppl):S66-85

Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City, UT (Dr Grissom).

To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. This is an updated version of the original Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia published in Wilderness & Environmental Medicine 2014;25(4):425-445.
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http://dx.doi.org/10.1016/j.wem.2014.10.010DOI Listing
December 2014

Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite: 2014 update.

Wilderness Environ Med 2014 Dec;25(4 Suppl):S43-54

Division of Emergency Medicine, Altitude Research Center, University of Colorado Denver School of Medicine, Denver, CO, and the Institute for Altitude Medicine, Telluride, CO (Dr Hackett).

The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the original guidelines published in Wilderness & Environmental Medicine 2011;22(2):156-166.
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http://dx.doi.org/10.1016/j.wem.2014.09.001DOI Listing
December 2014

Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update.

Wilderness Environ Med 2014 Dec;25(4 Suppl):S4-14

Division of Emergency Medicine, Altitude Research Center, University of Colorado School of Medicine, Aurora and the Institute for Altitude Medicine, Telluride, CO (Dr Hackett).

To provide guidance to clinicians about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations about their role in disease management. Recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to prevention and management of each disorder that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in Wilderness & Environmental Medicine 2010;21(2):146-155.
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http://dx.doi.org/10.1016/j.wem.2014.06.017DOI Listing
December 2014
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