Said Van Tilburg, “The stories that made the cut were selected partly for their fantastic nature, but also because they highlight important lessons that show what to do – or just as often, not do — in a life-threatening situation. In many cases, the people on this list made critical errors which led to the predicament they found themselves in, or at least prolonged it. Thankfully, all of the people on the list did enough things right to ensure their survival. That and a healthy dose of dumb luck didn’t hurt either!”

1. Woman survives four days in Oregon forest. After plummeting off a 50-foot cliff and fracturing her leg in two places, 28-year-old Pamela Salant of Portland, Oregon, survived for three frigid August nights in the rugged Columbia Gorge National Scenic Area, wearing only a tank top and shorts.  She had no cell phone and no water. How she did it: Salant ate wild berries and caterpillars, drank from creeks, used moss for warmth, bandaged a cut with her underwear and used her upper body strength to drag herself down a canyon to the shelter of thick trees. She was plucked from the wilds by an Oregon National Guard UH-60 Blackhawk. The lesson learned: even for a short hike, take the 10 essentials including a cell phone, proper clothing and a small survival kit. In this case, Salant got lucky: instead of staying put, she moved deeper into the wilderness, farther from rescuers, which likely prolonged her ordeal.
   

   Salant recovering in hospital following 3-day ordeal.

2. Man survives two days in Pacific Ocean. After the devastating 8.9 magnitude earthquake and subsequent tsunami that devastated Japan in March, many miraculous survival stories began to emerge. Top of the list concerned 60-year-old Hiromitsu Shinkawa from Minamisouma, who returned to his home to fetch items, only to be whisked away by the flooding. He grabbed the nearest potential flotation device at hand – the recently separated tin roof of his house –on which he floated in the Pacific Ocean for two days, drifting 10 miles off shore. A Maritime Self-Defense Force destroyer eventually rescued him. How he did it: He improvised. He looked for the closest object that offered the strongest flotation potential, grabbed it and clung for dear life. The lesson learned: Never go back to the scene of the disaster; instead, seek high ground. Also, for an urban crisis, pack a 72-hour emergency kit. that includes a communication device, clothing, food, water and depending on where you live, a life jacket.
3. Hiker survives 17 days in Brazil jungle. Denise Ciunek, a 38-year-old Brazilian woman set out to solo hike the 25-kilometer Caminho do Itupava, a steep 17th century track up the Serra do Mar Mountains in southern Brazil. When accosted by a gunman, she fended off attack—and imminent rape— by jumping into a river. She lost the trail, and was rescued 17 days later. How she did it: she holed up in a valley between waterfalls and waited for help. The lesson learned: unless you have the tools and skills to navigate, it’s best to stay put. Oh yeah, and don’t hike solo. There’s strength in numbers.
4. Mother, daughter and friend survive three days in Death Valley. After following a dashboard-mounted GPS named “Neil,” Donna Cooper of Pahrump, Nevada, took several wrong turns in her car, got lost, and ran out of fuel. She kept asking the GPS to take her home, but the electronic device led Cooper, 62, her 17-year-old daughter, Gina, and her friend, Jenny, down abandoned dirt roads. This was Death Valley in August. In 100+ degree heat. The problem was that her GPS (thanks for nothing, Neil!) relied on outdated maps and led the woman in circles 128 miles off route. How she did it: Cooper and the two teens stayed alive for three days by finding shade, and then located a private travel trailer with running water and a few cans of food. Gina Cooper’s boss alerted authorities that she was missing and the three were eventually spotted and rescued by a search and rescue helicopter.  The lesson learned: GPS is useful and convenient but not 100% reliable. Keep one foot in the analog world — take a map, a compass, a signaling device and follow road signs. Oh, and stop me if you heard this song before: tell someone where you are going and when you are expected to return.
5. Woman and son survive tornado in North Carolina. “I flew a football field length in a bath tub,” recalled Cindy Busick, who survived a tornado by climbing in a bathtub. Part of a record-setting tornado season with 25 touching down in North Carolina alone, this twister ripped through at 140 mph and leveled Busick’s 4,500 sq. ft Sanford, North Carolina home. How she did it: after the tornado had propelled her and the bathtub a distance of 75 yards from her home, Busick crawled under the tub, using it as a shield and rode out the remainder of the storm. The lesson learned: In tornados and earthquakes, dive in bath tubs, stand under door jambs, crawl under big desks, or back up against a brick wall.  Taking coverbehind such barriers will increase the odds you’ll make it through harsh weather in one piece.
   

   NC resident Cindy Busick (pictured right) post-tornado following her unbelievable bathtub ride.

6. Canadian woman survives seven weeks in forest. In March, Rita Chretien, a 56-year-old British Columbia resident, was lost with her husband Raymond in Nevada’s Humboldt National forest when their car got mired in mud. Her husband left the car to seek help after being stranded for three days and as of this post is still missing. The couple wasn’t reported missing for 10 days, when they didn’t return home to Canada. How she did it: Ms. Chretien stayed with the car, rationed her scant trail mix, and ate snow. Although losing nearly 30 pounds, she was found alive by a group of off-road-vehicle riders after 49 days.  The lesson learned: stay with the car and (here it comes) tell someone where you are going; for trips longer than a weekend, schedule check-in points by phone. Also, eating snow in subzero temps is not advisable: it lowers your core body temperature and can spur hypothermia. Rita Chretien had luck on her side. Don’t test yours. Pack a survival kit with an all-weather firestarter and stainless steel container for melting snow into water.
7. Couple trapped for five days in roadside ditch. John and Pat Norvell, both age 63, traveled from their home in Vancouver, Washington, to the snow-laden mountains in Cougar, the foothills of Mount St. Helens. On snowy roads, their car slid into a ditch and they got stuck, despite having four-wheel drive. What’s more: both the Norvells are diabetic. They were found five days later, after Mr. Norvell was able to flag down another motorist. How they did it: they rationed water and intermittently turned on the car to run the heat. And they stayed put. The lesson learned: use caution when traveling in foul weather on mountain roads. Four-wheel drive doesn’t make your car invincible. When stuck, stay with your car and break out your vehicle emergency kit. Always carry one.

Chris Van Tilburg, M.D., is the editor of WMS’s Wilderness Medicine Magazine and the author of eight books on the outdoors. His most recent book is Mountain Rescue Doctor. Van Tilburg is also a member of Hood River Crag Rats Search & Rescue Team. He lives in Bend, Oregon.

By Chris Van Tilburg, M.D.

The Wilderness Medical Society (WMS) recently published recommendations that guides carry epinephrine in outdoor education settings, according to a consensus statement in Wilderness and Environmental Medicine. The reason: allergic shock, called anaphylaxis, can be deadly in minutes. But, the practice of letting lay, non-medical guides use prescription medicine on clients is fraught with difficulties, and some potentially deadly effects.

A Word About Anaphylaxis

Anaphylaxis is a severe allergic reaction that occurs when a person eats an unfamiliar food, takes new medicine or gets stung by a bee. The body reacts with instant inflammation to shut out what it sees as a foreign toxin. No one can predict which people will react to which toxins—making this doubly deadly, especially in the backcountry. The throat swells shut and the lungs spasm; both can lead to death by hypoxia, or a lack of oxygen in the body’s tissues. Epinephrine is a powerful medicine that stops the swelling and restores breathing. It’s used in conjunction with over-the-counter antihistamines, like Benadryl, which block the hormone causing allergic reactions.

Doctors routinely prescribe epinephrine to kids in the form of easy-to-use auto-injectors like EpiPen or TwinJect and teach their parents on proper administration. But prescribing the same medicine to guides is problematic.

First, it’s illegal in most states for a guide to carry a prescription medicine and use it on a third party. A few states provide exceptions. North Carolina lets docs train lay people in epinephrine use. New York allows training for summer camp counselors.

Second, epinephrine is powerful medicine not to be used lightly. Anaphylaxis can be misdiagnosed, epinephrine can cause life-threatening heart arrhythmias, and the rescuer can accidentally inject their thumb if the auto injector is inadvertently used upside down, which can cause potentially limb-threatening decreased blood flow in the rescuer. That means two patients, instead of one.

Nonetheless, in the WMS’ view the risk is worth it, as epinephrine can save lives, especially in remote settings. Each year, anaphylaxis causes 1500 deaths in the U.S., but we really don’t know how big the problem is in the wilderness. The National Outdoor Leadership School database cites two cases of anaphylaxis in 2.5 million participant days, spanning 20 years. A separate study published in 1996 reported 8 cases in a 16-month span in Sequoia and Kings Canyon National Park, suggesting it’s more common.

For now, the WMS advocates lobbying state medical boards and state lawmakers to allow the drug to be carried by guides for use on clients. But even that can be problematic legally, because a guide trained in one state may be leading a trip in another. Perhaps the best option is to push to change laws at the federal level, as was the case with Canada’s Sabrina’s Law, which mandated anaphylaxis training in Canada’s school system. That 2006 law requires that teachers and school staff learn how to recognize symptoms of anaphylaxis and how to properly inject epinephrine.

Q. What do you think? Should there be a federal law allowing guides to carry and administer epinephrine?

Christopher Van Tilburg, MD, is the editor of Wilderness Medicine and the author of eight books on safety in the outdoors. His most recent book, Mountain Rescue Doctor: Wilderness Medicine in the Extremes of Nature, is now available in paperback.

By Christopher Van Tilburg, MD

With 2011 not quite two months old, we thought it high time to look at some big trends that are poised to impact wilderness medicine and safety this year. Here are five that may affect you:

1. WFR standardizations. For guides, rangers, and search and rescue teams, the de facto course for medical training beyond first aid has long been the Wilderness First Responder course. The week-long “woofer” course is offered by a number of schools, but they differ in content, instruction, and length. Right now, there is no formal standardization on content, schools, or teachers, but work is underway to homogenize WFR. The task, however, is fraught with the difficulty of trying to reconcile widely varying state laws, student needs, and teaching styles. WHY IT MATTERS: You may soon be able to get a WFR card recognized around the nation.
2. FEMA trickling down to Podunk. The post 9/11 changes with Homeland Security continue to improve disaster preparedness at the local level. Small-town volunteer search and rescue units have already seen regulations creeping into their protocols. What was once a rag-tag group of volunteers heading into the backcountry is slowly transforming into teams with medical and crime scene training, online incident response courses, and background checks. WHY IT MATTERS: New regulations can add a significant amount of time to what is traditionally a volunteer activity, which may deter participants. The upside: FEMA improves quality and resources for SAR missions.
3. Need help in the backcountry? Swipe your credit card. A once-subtle notion of sending a bill to someone needing rescue is now a rising trend. Diverting the cost of search and rescue to the rescued party is not new, but it’s increasing due to a slow economy and decreasing municipal budgets. The camp in favor of charging a fee per rescue argue that it’s long overdue that irresponsible backcountry users pony up and cover the cost of their reckless behavior. Those fighting against the pay-per-rescue trend counter that there are plenty of alternatives to charging rescued people directly, including: adding user fees in the form of permits, raising taxes, restricting access altogether, and mounting public safety campaigns in an effort to reduce accidents. WHY IT MATTERS: While we all recognize the budget pressures many states and municipalities are facing, charging people for rescues may lead them to delay calling for help, making rescues even more dangerous.
4. No go uphill or side-country. Winter resorts are changing their rules with regards to inbounds uphill traffic and side-country access, stemming from the burgeoning interest in skimo (aka ski mountaineering, alpine touring, and randonee). Of late, many mountain resorts have limited uphill travel or stopped it altogether for safety reasons. And many mountain resorts, which once had open or intermittently open boundaries, have restricted out-of-bounds travel. Rising costs to add ski patrollers and increase insurance coverage is one factor.  Another issue: some skiers and snowboarders are unprepared for or don’t follow rules and laws of side-country travel. In fact, many mountain resorts now don’t let ski patrol go after backcountry skiers or snowboarders in trouble; if they do, they may send a bill (see #3). WHY IT MATTERS:  We may be sending inexperienced skiers and snowboarders, who enjoy the added exercise of uphill travel, outside of the safe confines of the ski area to places they are unfamiliar with.
5. Tech’s Take-Over of the Outdoors. GPS-enabled smart phones, digital cameras, avalanche beacons, wrist- top computers, — we’ve got a lot of high tech gadgets for a walk in the woods. WHY IT MATTERS: The plethora of these gizmos—many of which demand our undivided attention to use—can detract from the very solace we seek in the backcountry. Of more serious concern, as a member of an SAR team, I fear that the proliferation of these technogadgets is leading to a false sense of security. “If the battery dies on your smart phone in the backcountry, do you have the basic survival skills necessary to make it back alive?” It’s a question I’m not so sure most people can answer in the affirmative.

Christopher Van Tilburg, MD, is the editor of Wilderness Medicine and the author of eight books on safety in the outdoors. His most recent book, Mountain Rescue Doctor: Wilderness Medicine in the Extremes of Nature, is now available in paperback.

By Christopher Van Tilburg, MD

The final week of 2010 was bittersweet for snow sports enthusiasts. Massive storms pummeled the Western mountains in North America with big fat flakes. Skiers and snowboarders flocked to the pow on holiday break.  Unfortunately, in a five-day span, five died in deep snow and tree wells. A sixth death occurred just after the New Year. The unlucky were found inbounds, out-of-bounds, and in the backcountry; they were skiers and snowboarders of various skill levels. The two commonalities that link all of their deaths: deep snow and stormy weather.

Although still being investigated, the six deaths in California, Montana and British Columbia were likely caused by snow-related suffocation. This condition, known as Snow Immersion Asphyxiation (SIA) or Non-Avalanche Related Snow Immersion Death, is a little known mountain hazard. Although that may soon change, as mountain resorts and snow sports professionals push to raise public awareness on this issue.

HOW SIA HAPPENS

SIA occurs when skiers and snowboarders fall upside down in deep snow or the cavernous holes around big conifers, can’t right themselves, and suffocate. Death can occur quickly — as fast as 15 minutes. The problem is that if you find yourself stuck in a tree well or snow bank upside down, there just aren’t a lot of great options. It is very difficult, if not impossible, to extricate oneself. Struggling can cause one to sink deeper. Removing skis doesn’t seem to help either.

KEYS TO PREVENTING SIA

The primary key to safety is preparation:

• Always ski and ride trails that are within your skill range.
• Use the proper tool — big powder means big sticks, so choose long wide skis and snowboards, which will provide better flotation and thus better control.
• Employ a buddy system—stay in voice and visual contact, which you should be doing anyway.

If you get sucked into a tree well or fall in deep snow try to tuck, roll, and land upright, grab the tree trunk or a branch, and yell to alert your partner. If buried upside down, stay calm and create an air pocket, which could buy you some precious minutes of oxygen.

Rapid partner rescue is really your only chance of survival. Avalanche safety gear may speed rescue if your location is unknown. The woman who died in British Columbia was found with a beacon, but unfortunately it was too late. Once you have removed the person from a tree well, immediately starting CPR — if they’re not breathing — is vital too. A life was saved in Washington State a few years back when a partner started CPR and rapidly brought a buried, non-breathing skier back from the brink of death. If you don’t have formal CPR training, do Hands-only CPR: push hard and fast on the center of the chest.

For more info on SIA, check out the comprehensive journal paper published recently in Wilderness and Environmental Medicine or the website www.treewelldeepsnowsafety.com.

Christopher Van Tilburg, MD, is the editor of Wilderness Medicine and the author of eight books on safety in the outdoors. His most recent book, Mountain Rescue Doctor: Wilderness Medicine in the Extremes of Nature, is now available in paperback.

I get a headache when I hunt elk from a camp at 11,000 feet, despite
living at 5,700 feet and cross-country skiing at 10,800 feet with no
symptoms. Is there a threshold when it comes to altitude illness?

Thanks in advance, Marilyn.

Hello Marilyn,

There is a threshold, but unfortunately it is different for everyone. While one person may experience a high altitude headache (the cardinal symptom of acute mountain sickness) at 11,000 feet, others may get a headache at 8,000 or none at any elevation in the lower 48.

If you know your personal threshold, you can help minimize the effects of a high altitude headache by staying fit and hydrated. As an additional measure, take ibuprofen; the latest research shows it works equally well as prescription acetazolamide at preventing a high altitude headache.

Hope you have a safe hunting trip.

Best,

Christopher Van Tilburg, MD

When I was a boy, I watched Mount St. Helens explode from the front yard of the family home. It was both thrilling and terrifying. The Toutle River overflowed Interstate 5, and school was canceled due to ash fallout. Hurricane Katrina, the Spring floods that devastated Northeastern states, and now Hurricane Earl — which at the time of this post was threatening to hammer much of the Eastern Seaboard — prove that natural disasters can hit close to home. So, everyone should prepare a 72-hour emergency kit for Mother Nature’s worst.

ESSENTIALS

Ideally you need two kits: a large plastic bin for home and a small portable kit for your car. A good disaster kit has 5 components: water, food, first aid kit, extra clothing and bedding, and survival gear.

WATER, HYDRATION & FOOD

You’ll need a gallon of water per person per day, and a method of purification, in case you refill from a tainted municipal source. The simplest, easiest water storage is gallon jugs of commercially bottled water. I keep a supply of chlorine dioxide purification tablets, which I find lighter and more compact than a filter or ultraviolet light pen. Non-perishable food should be no-cook, ready-to-eat canned or dry goods with a good source of protein and carbohydrates. Simple, heat-and-eat meals are great, but you’ll need to add a small camp stove and fuel to your kit.

FIRST AID

For first aid supplies, I like the Fundamentals for home because it has enough components for multiple people for many days, with room for extra medications and tools. A combo kit, like the SOL 3 which comes with essential first aid, survival and repair tools, is ideal for the car, when time and space are in short supply.

Select a kit with enough supplies to cover all the members in your household for a minimum of three days.

CLOTHING, BEDDING & SHELTER

Have a spare sleeping bag, or a lightweight bivvy which is always a mainstay in my SAR pack, car kit, and household bin. Toss in an old raincoat, fleece sweater, a hat, and gloves for everyone in your household.

SURVIVAL

Survival supplies are of paramount importance. Start with a personal survival kit that includes a whistle, fire starter, signal mirror, cord, wire, compass and other essentials. Include a headlamp with extra batteries, a pocket tool like a Leatherman Juice, hand sanitizer and body wipes for personal hygiene, insect repellent, sunscreen of SPF 25, and a battery operated AM/FM radio.

OTHER CONSIDERATIONS — PERSONAL NECESSITIES

Don’t forget personal items like spare prescription glasses; extra prescription medicine; baby formula and diapers, if required; hygiene sundries; family documents, like photo ID and passports stowed in a waterproof travel case; and access to cash and credit cards. Make a list of emergency contacts and emergency utility shutoff valves in your house.

LAST BUT NOT LEAST…

Toss in instructions! Even the most skilled benefit from reminders, such as Dr. Weiss’ excellent Comprehensive Guide to Wilderness & Travel Medicine 3rd Edition , which includes life-saving tips on how to improvise treatments when you don’t have ready access to professional medical care — a common occurrence following a major disaster.

Storing the whole shebang is pretty simple. For your home kit, get a large waterproof plastic bin like a Rubbermaid Action Packer. Make sure everyone in your household knows the location. Rotate the food and water out every 6 to 12 months as expiration dates recommend. Add an empty backpack to the bin so you can grab gear in a jiffy. For your car, stash the gear in a soft kit in the trunk or under a seat. In your car, you should always carry repair tools too, including: a jack, spare tire, jumper cables, extra oil, a flat repair kit, basic tools, a tow strap, duct tape, and a small folding saw.

Check expiration dates on your kit's food and water supplies every six to 12 months.

Let’s hope the natural world will calm down for a while. But when the seas heave, the winds blow, and the earth rattles, access to a complete disaster kit will make life easier and safer.

Chris Van Tilburg, M.D., is the editor of WMS’s Wilderness Medicine and the author of eight books on the outdoors. His most recent book is Mountain Rescue Doctor. Van Tilburg is also a member of Hood River Crag Rats Search & Rescue Team. He lives in Bend, Oregon.

Author and M.D. Chris Van Tilburg, a member of Oregon’s Hood River Crag Rats Search & Rescue Team, has been participating in the rescue attempt of the two hikers who were reported missing on Mt. Hood last Friday. Van Tilburg and his team were on the mountain all day Sunday before having to retreat due to bad weather. We spoke to him on Monday afternoon:
 

AMK. As of this writing, the two hikers have been missing for more than three days. What should they be focused on right now in order to improve their chances of survival?

CVT. Building a snow cave and hunkering down. It’s all about shelter from the elements at this point, trying to stay warm, and not trying to move about the mountain in foul weather.

AMK. It’s been reported that they have at least one bivvy sack or lightweight sleeping back between them. What should they do with it?

CVT. If they’ve got one, they can share it, use it for a ground pad. They can also stick their feet in their backpacks or use their packs for ground padding. Insulation from sitting on the cold snow is just as important as covering up.

AMK. According to reports, the hikers had planned to come down the south side of Mt. Hood. Have you hiked or climbed this part of the mountain? Is it particularly tricky this time of year?

CVT. I climbed to 10,500 feet on Sunday, and turned around just short of the summit due to dangerous conditions — avalanche risk, whiteout, cold temperatures and high winds. Any time of the year in any conditions, the south climb can be dangerous — even in clear, windless skies.

AMK. Temps are in the low 20s at night. According to media reports, there is the threat of avalanches, which is preventing full-on rescue efforts. What would you advise the two hikers do next – stay put, try to stay warm, or try their luck making it down the mountain?

CVT. Dig a snowcave, stay put, and try to signal rescuers by any means possible.

AMK. The hikers have been outdoors for more than three days; at this stage, what is the biggest threat to their survival?

CVT. Hypothermia and dehydration.

AMK. Bluntly, at this point, how would you rate their chances of being rescued alive?

CVT. It’s really hard to say. We had a group in the 1970s that lasted 14 days on Hood. There are a lot of variables at play. In this storm, lightly equipped, without injury, after 3 days I’d say chances for the hikers start plummeting. If they have a snow cave and a stove to melt snow for drinking water their chances improve.

AMK. What essential pieces of equipment do you advise hikers or climbers take with them before embarking on Mt. Hood or other hikes or climbs during the winter?

CVT. Extra clothing, a bivvy or blanket for warmth or shelter; food, water and a stove to melt snow in; communication and navigation equipment like a GPS, cell phone, mountain locator unit, a transceiver, signaling mirror and rescue whistle; avalanche safety equipment, including a shovel; gear for crevasse travel, including rope, harness, carabiners, russic cords, plastic boots, crampons, ice ax, helmet. It’s a long list and a heavy pack.

Chris Van Tilburg, M.D., is the editor of WMS’s Wilderness Medicine and the author of eight books on the  outdoors. His most recent book is Mountain Rescue Doctor. He lives in Bend, Oregon.

By Christopher Van Tilburg, MD

I’ve been chomped by a tick multiple times, as have most people who regularly tramp in the outdoors. It’s creepy — the tick drops onto your skin, burrows in painlessly, and sucks. Its anticoagulant can cause tick paralysis, and these arthropods carry all sorts of infections: Colorado Tick Fever (a virus), Rocky Mountain Spotted Fever (parasite), Tularemia (a bacteria), and the more commonly known Lyme Disease.

Lyme Disease can be scary. Lyme Disease is caused by an inoculation of the bacteria Borrelia burgdorferi. Ticks around the world carry it:  In North America it’s transmitted by deer ticks (Ixodes scapularis) and the Western black legged tick (Ixodes pacificus). It was first identified in Old Lyme, Connecticut, after a group of kids complained of having a strange pain in their joints and an odd rash. So one might think, No problem — bacteria can be killed by antibiotics. But, there is a problem: Lyme is hard to kill and it can turn chronic. A single bite from a Lyme-carrying tick can require years of treatment and recovery.

THE REAL SCOPE OF LYME DISEASE

Lyme Disease is a widespread, global disease that is poorly understood. According to the CDC, in 2007 there were 27,000 cases in the U.S. and, because of the sometimes-vague symptoms, it may be dramatically underreported. While West Nile Virus, Dengue Fever, and even Swine Flu have gotten press lately, they account for much less illness. For example, in 2007, there were only 3,600 imported cases of West Nile Virus.

HOW TO PROTECT YOURSELF

Outdoor adventurers should follow standard insect, tick and arthropod preventions when traveling in the backcountry or abroad. Ticks don’t jump or fly, they drop or fall onto humans from trees or grasses. So, long sleeve shirts and long pants tucked into socks is a great start.

Insect repellents, including ones containing DEET like Tender’s Ben’s 100® pump and Ben’s® 30 wipes, work well at warding off Ticks. For people looking for a DEET-free alternative, repellents like Natrapel® 8-hour, which contains 20% of the active ingredient Picaridin, provide protection that’s as effective as DEET. Insecticides with Permethrin also work, and can be sprayed on clothing or impregnated into the fibers of garments.

When in tick country, remember to check your entire body after the day’s hike. Often you have two or three hours before a tick burrows. If it does, your chance of getting Lyme is low if you remove the bugger right away.

HOW TO SAFELY REMOVE A TICK

Once burrowed, ticks are tricky to remove. Don’t try those old wives tales like fingernail polish or a match. The best technique is to use tick or splinter-removal forceps, grabbing as close as possible to the head, and pulling the tick out with slow, gentle pressure. Sometimes I’ve had to wiggle the head gently to unclasp the tick’s pinchers. Unfortunately, many people sever the body from the head. I’ve had to dig out many tick heads in the emergency room. Like all wounds, clean thoroughly with soap and water.

RECOGNIZING THE SIGNS OF LYME DISEASE – WHAT TO LOOK FOR

How do you know if you have Lyme Disease? First, you will see a circular rash that looks like a target or bull’s eye called erythema migrans, which slowly enlarges. Then, the Lyme bacteria can spread to your body causing fever, fatigue, malaise, muscle and joint aches, headaches and swollen glands. Some patients have these symptoms for several months or years. That’s the big problem with Lyme Disease: It affects multiple parts of the body and may be difficult to diagnose if the initial symptoms go unnoticed. The symptoms can take anywhere between three days to one month or longer to emerge. Twenty percent of people who do not receive treatment develop severe complications within weeks or months after the bite, ranging from heart and neurological problems to severe attacks of arthritis.

If you think you need treatment, see your doctor and let him or her know that you have been bitten by a tick. Antibiotics are the mainstay of treatment, but don’t try to treat yourself at home with an old prescription in your medicine cabinet – treatment requires a specific antibiotic, like Doxycycline, with a longer course than typical.

For more information on avoiding bug-borne diseases, visit www.tendercorp.com.
Christopher Van Tilburg, MD, is the editor of Wilderness Medicine and the author of eight books on safety in the outdoors. His most recent book, Mountain Rescue Doctor: Wilderness Medicine in the Extremes of Nature, is now available in paperback.

Oh Noooo! …Tips for Treating & Avoiding Travelers’ Diarrhea

By Christopher Van Tilburg, MD

After an all-night flight to Santiago, Chile, last year, I passed out a pack of AMK’s Fresh Bath Travel Wipes to everyone in our group right before hitting the tarmac. It was rejuvenating.And, the antibacterial properties actually do more than refresh, they function to prevent the most common travel related illness – travelers’ diarrhea.

The Risk of Travelers Diarrhea (TD) is higher than malaria: it is the most common affliction when heading overseas. According to the Centers for Disease Control, TD affects 30-50% of all travelers to high-risk areas. That’s 50,000 people per day and 10 million per year. TD is essentially food poisoning, which occurs when consuming food or water that is contaminated by bacteria, parasites, or viruses. It gets on your food or hands, and then down your gullet.`

The most common cause is E. coli, or one of several other bacteria like samonella, or shigella. Bacteria account for up to 80% of all cases; parasites like Giardia and Entomeboea are less common. Asia, Central and South America and Africa pose the greatest risks, primarily because the food and water supplies in these regions and in developing countries as a whole are more likely to be contaminated.

Fortunately, most cases of TD are self-limiting, lasting one to four days. Warning signs of more serious infection include blood in the stool, high fever, persistent diarrhea, or signs of dehydration like dry lips and eyes, dizziness, and headache. Get medical help if any of these occur.

Prevention is straightforward but not completely effortless, especially when you want to sample local fare from street vendors in Shanghi or Oaxaca or when you have limited choices on overland treks in the Chile’s Altiplano. In those instances, follow these time-tested tips:

• Drink bottled, carbonated, or purified water. My favorite water purification tablet for travel is chlorine dioxide packaged in single-use foil pouches.
• Make sure fruits and vegetables are washed in potable water or peeled.
• Meats should be thoroughly cooked and served steaming hot.
• Hand hygiene is critical, and extremely easy: wash your hands after you go to the bathroom and before meals with a hand sanitizer like Adventure^® Medical Kits’ Hand Sanitizer.
• Milk should be pasteurized.
• Bismuth subsalicylate, AKA Pepto-Bismol, prevents TD; the dose is two tablets or two ounces four times daily while abroad. Make sure you have an ample supply with you.

Treatment for TD includes electrolyte solutions, a bland diet, medicines that slow diarrhea called antimotility agents, and antibiotics.

Electrolyte solutions, called Oral Rehydration Solution (ORS), contain glucose or rice-based carbohydrate, the electrolytes sodium and potassium, and citrate; they replace lost electrolytes, help speed absorption of water, and correct the acid imbalance caused by TD. Sport drinks work okay too, but you should dilute them by half with water. For a homemade solution, take one liter of water and add eight teaspoons of sugar or one cup of rice cereal, one teaspoon of salt and a half-cup of orange juice or half banana.

I recommend the BRAT diet of bland foods: bananas, rice, applesauce, and toast (I add rice too). All are foods that aren’t likely to cause further gastrointestinal distress.

A doctor should prescribe the anti-motility medicines and antibiotics — either in country or before you go — with instructions on when and how to use them. They are not always indicated and sometimes can be dangerous if not used properly.

Before you go, check out the New World Travel and Smart Travel Kits, which include CeraLyte^® Oral Rehydration Salts, a premixed powder which provides the minerals and salts needed for replacing fluids lost from diarrhea. Carry a supply of Fresh Bath Travel Wipes and Adventure^® Hand Sanitizer. Both contain the active ingredient benzalchonium chloride, a chemical that kills the same percentage of germs and bacteria as alcohol-based wipes and hand sanitizers do, but will not dry out the skin. Get a supply of Pepto-Bismol and chlorine dioxide water purification tablets. Visit your local Travel Clinic to see if antibiotics or antimotility medicines should be carried. And check the State Department, www.state.gov, to get a list of in-country medical clinics and hospitals.

Christopher Van Tilburg, MD, is the editor of Wilderness Medicine and the author of eight books on safety in the outdoors. His most recent book, Mountain Rescue Doctor: Wilderness Medicine in the Extremes of Nature, is now available in paperback.

HYPOTHERMIA: THE COLD HARD FACTS ABOUT WINTER’S DEADLY KILLER
By Christopher Van Tilburg, M.D.

Rescue mission for a lost snowboarder: a bitter-cold, raging midnight storm high above timberline. That was the scene of my first search and rescue call to Oregon’s Mount Hood as a young doctor. After another team located the snowboarder, I scurried from the tempestuous black night to the ski patrol room, where I examined a shivering, huddling young man. He clutched a blanket draped over soaked ski clothes, and held a steaming cup of hot chocolate, too scalding to drink. Fortunately, the snowboarder had been found. But from across the room I could see he suffered from hypothermia and dehydration.

RECOGNIZING THE SYMPTOMS

Hypothermia is a cooling of the body’s core temperature. Every year 600 people in the U.S. die from hypothermia, according to the Centers for Disease Control and Prevention. Mild hypothermia begins with shivering and progresses to lethargy. Moderate hypothermia is dangerous: one has slurred speech, poor concentration, and a staggered gait. Severe hypothermia is a critical condition: the heart, lungs and other organs start to shut down, and extreme mental status changes occur such as the inability to talk coherently, walk properly, or even process thoughts. Bizarre behavior like paradoxical undressing — when a person discards articles of clothing, even though doing so hinders their chances for survival — can occur when the brain gets confused. A well-known example of this condition involved the CNET reporter James Kim. After being stranded for several days with his family in a remote forested area of southwestern Oregon, Kim set off on his own to find help. He was later found in the snow, having succumbed to hypothermia. Media reports said he had removed several pieces of clothing, including his pants. Paradoxical Undressing not only speeds death but it can also put an entire group at risk, because the person suffering from it will inevitably require more attention and resources – at a time when both may be in short supply. Death by hypothermia doesn’t occur instantly, but it does occur rapidly. And often it is the hypothermic person’s partner who notices a problem first.

IMPROVING YOUR CHANCES OF SURVIVAL

Exemplified by snow burial studies, we know that with today’s fleece and nylon-laminate clothing and a well-built emergency shelter, a person can spend an unexpected night in the winter mountain wilderness, even in below freezing temperatures. But beyond one night without proper clothing, food, water and shelter, your odds of survival plummet even if the thermometer doesn’t. And once you get hypothermic, the basic tasks of survival become difficult to complete.

Before you head into the wilds, always make sure you have enough food, water and clothing for an unexpected night out. And carry the tools to build an emergency shelter such as a shovel to dig a snow cave and a space blanket like the Heatsheets Emergency Survival Blanket to act as a covering.

TREATING HYPOTHERMIA

If you do notice even mild hypothermia—you are more likely to see it in your partner—treat it immediately. Change into dry clothing and put on all extra layers. Insulate yourself from the ground. Chemical heat packs do help, if you place them on your torso. Drink lukewarm fluids and eat a snack: calories and fluids are important to generate internal heat, no matter if they are hot or cold. Seek shelter right away and try to keep active. If you can, build a fire. Make sure you pack a survival kit, with a reliable fire starter and signaling mirror for alerting rescue craft. Above all, get help and evacuate from the backcountry as soon as you can.

Also, watch for coexisting frostbite — when your skin actually freezes — which usually occurs on the face, nose, fingers and toes. To prevent frostbite, make sure that all exposed skin is covered and you have proper boots, socks, gloves and a hat. Frostbite is treated by immediate evacuation then rapid re-warming, usually with 40-degree water or fluids. But be extra cautious if you re-warm an extremity in the backcountry to make doubly sure it doesn’t refreeze, which can cause worse damage than walking out with a frozen finger or toe.

To treat the snowboarder in the ski patrol room, I had his friends help him change in to dry clothes then covered him with dry blankets. And I gave him two large cups of lukewarm hot chocolate, which he guzzled down with gusto and perked up. I checked him for frostbite and we fed him whatever snacks we could find. He finally warmed up and we sent him down the mountain.

Chris Van Tilburg, MD, is the editor of Wilderness Medicine Magazine and is also a member of Crag Rats Mountain Rescue, in Hood River, Oregon. Started in 1927, Crag Rats is the oldest mountain rescue unit in the nation.

By Doug Abromeit – Director of the Forest Service National Avalanche Center

Avalanches typically kill more people in the mountains in the West than any other natural disaster, and the winter of 2007-2008 was particularly grim. Last year 36 people died – the worst on record. Two of those people were killed by avalanches off of house roofs, one was killed in a ski area and thirty-three were killed doing their thing in the backcountry — snowboarding, skiing, climbing or riding a snowmobile.

I am often asked why this past year was so bad and the short answer is that dangerous conditions existed virtually everywhere and they existed for extended periods of time. Typically one or two geographic areas will have bad avalanche conditions and the rest of the country will have relatively stable conditions, but that was not the case in 2007-2008.

Although there were many complex reasons for the spate of avalanche fatalities this past season, the weather – specifically, an unusual snowfall pattern — played a major role. In general terms, most mountainous areas started with relatively light snow fall and cold temperatures. These conditions produced a weak faceted snow layer that could not support the additional weight that was piled on top it by a subsequent series of large snow storms. The weak basal layer was analogous to the strength of potato chips; the big storm layers to the weight of a brick. Obviously potato chips have a hard time holding up a brick and so the basal layers collapsed and avalanches occurred.

The freakish weather wasn’t the only reason for the uptick in Avalanche deaths. Last winter, more people were out in the backcountry because the powder happened to be awesome just about everywhere. Technology exacerbated the situation. Because our skis, boards and snowmobiles are much better than they were just a few years ago it’s now easier and more tempting to get into steep avalanche-prone terrain.

WHAT YOU CAN DO TO AVOID AN AVALANCHE

There is only one absolutely certain way to avoid being caught in an avalanche and that is to avoid all avalanche terrain. Avalanches can only occur on slopes steeper than about 30 degrees, so if a person stays on slopes flatter than 30 degrees they are almost guaranteed to never get caught in an avalanche. But that’s easier said than done. Western mountain ranges all have an abundance of slopes steeper than 30 degrees and much of the best backcountry skiing, boarding and snowmobile riding occurs there. So if you choose to go into terrain steeper than 30 degrees – and most of us do – then you can only reduce your risk, you cannot eliminate it.

The most effective way to reduce your risk is to have the tools and skills necessary to identify avalanche terrain, assess snow stability, and carry out a fast and effective rescue if things go bad.

When you go out, along with bringing your dedication to following low-risk travel protocols, you must have a slope meter to determine slope steepness, an avalanche probe and know how to use it, a shovel, extra food, water and clothes, an emergency bivvy or blanket, and a good first aid kit. But the most important tool you can have is avalanche awareness skills. And the best way to develop those skills is to routinely read and/or listen to your local avalanche advisory provided your area has one, take an avalanche class (for information look on avalanche.org or go to your local outdoor shop), read books like the Avalanche Handbook and Staying Alive in Avalanche Terrain, watch videos like Think Like An Avalanche (available from Black Diamond mail order) and check out the Forest Service National Avalanche Center website at .fsavalanche.com.

There are no shortcuts; it takes time to learn how to assess avalanche danger and how to make reasonable decisions based on your assessment. I urge everyone who goes into the backcountry to take the time and make the commitment to develop your skills so you know when to say “go” and when to say “no”.

Doug Abromeit

Director of the Forest Service National Avalanche Center

(The NAC coordinates all the Forest Service Backcountry Avalanche Centers in the US, facilitates research, and manages the Forest Service Military Artillery for Avalanche Control Program, among its other duties)

BACKCOUNTRY GRUB: WHAT’S SAFE TO EAT AND DRINK?

Christopher Van Tilburg, M.D.

In October, a solo climber on Washington’s 12,276-foot Mount Adams fell on Suksdorf Ridge, and broke his ankle. It’s just what every climber fears: being alone on a high mountain with a disastrous injury. Unable to walk, he dragged himself down the snowfields. After five days and nights, he was found at 6,200 feet suffering from frostbite and dehydration. He survived on creek water and an eclectic mix of creepy crawlers: ants, centipedes, spiders, mushrooms, and berries.

Sooner or later, if you spend time outdoors, you may find yourself without food or water on a wilderness outing; hopefully it’s just a short distance to your car and you are uninjured. But in survival mode, if you are lost and injured, you may need to eat and drink from the wilds.

You can live several weeks without food. But you won’t last much past five to seven days without water, even fewer if you are in the desert or at high altitude. Finding water is a paramount priority.

Drinking from creeks, like the Mount Adams climber, is probably a risk worth taking in prolonged survival situations. Yes, you can get protozoa infections like Giardia and Cryptosporidium, as well as bacteria and viruses. However, it takes just one day for you to begin to become incapacitated from dehydration.

When you find a source, ideally you should have a means to purify water before drinking. That means boiling, filtering, or chemical treatment. I carry water purification tablets for emergencies: they are compact, light, and easy to use.

Remember, when in the mountains, eating snow can cause hypothermia, because you need to use vital calories to melt it in your mouth first. So you should carry a lightweight backpacking stove to melt water. When in the desert, locating water can be extremely difficult, so if you find a source, consider staying put until you are rescued. If you do get a gastrointestinal infection from drinking backcountry water, see your doctor A.S.A.P.

As for food, if you can’t identify it, don’t eat it. You can get seriously ill from toxins and infections. My friend Greg Davenport, a survival expert, said critters with eight or more legs like centipedes and millipedes are often toxic. He recommends sticking to insects, which have some nutrition, but not much. A typical 100 gm (3.5 ounce) serving of fish, for example, yields 22 g protein, 1g fat and 0g carbos. The same weight of crickets yields 13 g protein, 6 g fat, and 5 g carbos. But that’s a big pile of crickets to scrounge for.

Wild plants—leaves, roots, bark, nuts, seeds, and berries— can be energizing or deadly. Use caution: even a small bite can cause stomach pain, nausea, vomiting, diarrhea, and rashes. Mushrooms can kill you. Davenport said aggregate berries, like thimbleberries, raspberries, and blackberries, are generally safe to eat. Purple, blue and black berries, such as wild huckleberries and cranberries, are 90% edible. Red berries are about 50% edible, so it’s probably best to avoid those, as well as any berry white, green or yellow, which are not edible.

Remember: always take enough water and food (an extra bottle of water and a few extra energy bars) to spend at least one unexpected night in the wilderness. And stash some water purification tablets in your survival kit.

Christopher Van Tilburg, MD, is the editor of Wilderness Medicine and author of Mountain Rescue Doctor: Wilderness Medicine in the Extremes of Nature now available in paperback.

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