ALTITUDE ILLNESS  (Mountain Sickness)
It is rare to experience altitude sickness below 6,000 feet.  Moderate altitude is between 8,000 and 12,000 feet (2,400 and 3,600 meters), High altitude is between 12,000 and 18,000 feet (3,600 and 5,400 meters), and extreme altitude is over 18,000 feet (5,400 meters).  High altitude illness is a direct result of reduces barometric pressure and concentration of oxygen in the air at high elevations.  Lower pressure make the air less dense, so your body gets fewer oxygen
molecules with every breath.
Prevention
Graded ascent is the best and safest method of preventing altitude illness.  Avoid abrupt ascent to sleeping altitudes greater than 10,000 feet (3,000 meters), and average no more than 1,000 feet (300 meters) of elevation gain per day above 10,000 feet.  Day trips to a higher altitude, with a return to lower altitudes for sleep, will aid acclimatization.  Eat foods that are high in carbohydrates and low in fat, and stay well hydrated.

When to Worry

Descend Quickly When…

Progression of one’s symptoms despite rest at the same altitude, or the loss of coordination, mandate immediate descent to a lower altitude (2,000 to 3,000 feet lower).  Do not wait for morning to begin descent.  An individual who might have been able to walk down under his own power with aid of a headlamp can easily become a litter case in just 12 hours. The single most useful sign in recognizing the progression of altitude illness from mild to severe is loss of coordination.  The victim tends to stagger, has trouble with balance, and is unable to walk a straight line heel to tow, as if he were drunk.

Never allow a victim to descend alone.  Always have a healthy person accompany the individual.

Treatment
1.)    When mild symptoms develop, one should not go any higher in altitude until the symptoms have completely resolved.  Watch the victim closely for progression of illness to more severe forms.  Usually, within one or two days, the victim will feel better and can then travel to higher altitudes with caution.  Symptoms will improve more rapidly simply by going down a few thousand feet.
2.)    Administer acetaminophen (Tylenol®) 650 to 1000 mg or ibuprofen (Motrin®) 400-600 mg for headache.
3.)    Consider administering acetazolamide (Diamox®) at a treatment dose of 250 mg twice a day.
4.)    Minimize exertion.
5.)    Avoid sleeping pills.

SEVERE ALTITUDE ILLNESS
High Altitude Cerebral Edema (HACE)

Signs and Symptoms
A victim may have one or more of the following:

1.)    Severe headache unrelieved by Tylenol® or Motrin®;
2.)    Vomiting:
3.)    Loss of coordination;
4.)    Severe lassitude;
5.)    Confusion, inappropriate behavior, hallucinations, stupor or coma;
6.)    Transient blindness, partial paralysis or loss of sensation on one side of the body may occur;
7.)    Seizures.

Treatment
1.)    IMMEDIATE DESCENT of at least 3,000 feet (1,000 meters), or until the victim shows signs of considerable improvement, is the most important treatment.  Do not wait to see if the victim gets worse or improves.  Waiting could prove to be fatal.
2.)    Administer acetazolamide (Diamox®) 250 mg twice a day.
3.)    Administer dexamethasone (Decadron®) 8 mg followed by 4 mg every six hours if available.
4.)    Administer oxygen, if available.
5.)    When descent is not immediately possible, placing the victim in a portable hyperbaric chamber (Gamow Bag) may be helpful in mitigating the effects of HACE or HAPE.  When zippered shut with the victim inside, this nylon bag is pressurized with a foot pump, resulting in a decrease in altitude for the victim.  The bag takes approximately two minutes to inflate and is labor intensive; it requires 10 to 15 pumps per minute to maintain pressure and to flush out carbon dioxide.  The Gamow Bag should not be used as a substitute for descent;  it should be used when descent is not possible due to darkness, injury or lack of manpower to carry a victim to lower altitude.

The Golden Rules of Altitude Sickness
1.)    Above 8,000 feet, headache, nausea, shortness of breath, and vomiting should be considered to be altitude illness until proven otherwise.
2.)    No one with mild symptoms of altitude illness should ascend any higher until symptoms have resolved.
3.)    Anyone with worsening symptoms or severe symptoms of altitude illness should descend immediately to a lower altitude.

HIGH ALTITUDE PULMONARY EDEMA (HAPE)
HAPE usually begins within the first two to four days of ascent to higher altitudes, most commonly on the second night.

Signs and Symptoms
A victim may have one or more of the following:

1.)    Initially, the victim will notice marked breathlessness with minor exertion and develop a dry, hacking cough.
2.)    As fluid collects in the lungs, the victim develops increasing shortness of breath, even while resting, and a cough that may produce frothy sputum.
3.)    The victim looks anxious, is restless, and has a rapid bounding pulse.

4.)    Cyanosis (a bluish color of the lips and nails indicating poor oxygenation of the blood) may be present.

Treatment
1.)    IMMEDIATE DESCENT of at least 3,000 feet (1,000 meters), or until the victim shows signs of considerable improvement, is the most important treatment.  Do not wait.  Waiting could prove to be fatal.
2.)    Administer oxygen, four to six liters per minute, if available.
3.)    The prescription drug, nifedipine (Procardia®) may be helpful for HAPE.  The dose is 10 to 20 mg every eight hours.
4.)    The use of the Gamow Bag, as described above, may be beneficial when the victim cannot be immediately evacuated to a lower altitude.

The recent admission from SIGG that the aluminum bottles it had produced prior to August 2008 contained the chemical Bisphenol A (BPA) has once again put into sharp focus the safety of all water bottles. There is one way, however, you can be sure your next water bottle does not contain BPA or any other potentially harmful chemicals — that’s to select one made from stainless steel, like AMK’s new S.O.L. Survival Bottle.

Made of tough food-grade, 201 stainless steel, the BPA-free S.O.L. Survival Bottle will not dent nearly as easily as aluminum bottles, which contain inner linings which, if broken, can leach chemicals that can potentially contaminate water. AMK’s S.O.L. Survival Water bottle will hold up to 750 ml of water, but its much more than just a liquid container.

Unlike most water bottle manufacturers, which emblazon the exterior of their bottles with a logo or design, AMK used this otherwise ignored real estate to offer valuable information on everything related to water and hydration.

Printed on the outside of the bottle are a multitude of tips and facts — ranging from the useful (“How to find Water in the Desert”; “How to Purify Water”) to the novel (“Number of years it takes for a plastic bottle to decompose”; “Number of plastic bottles thrown away each hour”) — which lend the S.O.L. Survival Water bottle an added level of utility not found in competitor bottles. In reality, it truly is the only bottle that can save your life — even when it is empty!

The S.O.L. bottle is also safe to boil water in and comes with a sturdy screw top and carabiner, allowing you to attach it to your backpack for your next outdoor excursion.

Download our Tick Field Reference Guide to learn more about:

• How to protect yourself.
• How to identify a tick.
• How to properly remove a tick.
• What to do if you have been bitten.

Tick Reference Card

(Click image to download)

You can also read our blog about Lyme Disease to learn more.

Don’t forget to use Ben’s 30 Deet Insect Repellent or Natrapel 8 Hour Deet-Free Repellent to protect against ticks and other biting insects.

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.

VENOMOUS SNAKE BITES

There are two classes of poisonous snakes in the United States:

• Pit Vipers (rattlesnakes, cottonmouths [water moccasins], and copperheads) have a characteristic triangular head, a deep pit (heat receptor organ) between the eye and nostril, and a catlike, elliptical pupil.

• Elapids (coral snakes) are characterized by their color pattern with red, black, and yellow or white bands encircling the body. The fangs are short — these snakes bite by chewing rather than by striking.

All states except Maine, Hawaii, and Alaska have at least one species of venomous snake. The states with the highest incidence of snakebites are North Carolina, Arkansas, Texas, Mississippi, Louisiana, Arizona, and New Mexico. About 90 percent of snake bites occur between April and October, because snakes are more active in warm months of the year. Your chance of dying from a venomous snakebite in the wilderness is extremely remote — about one in 12 million.

Snakes can strike up to one-half their body length and may bite and not inject venom (dry bite). No poisoning occurs in about 20 to 30 percent of rattlesnake bites, and fewer than 40 percent of coral snake bites result in envenomation.

Pit Vipers

Signs and Symptoms of Envenomation

• One or more fang marks (rattlesnake bites may leave one, two, or even three fang marks).

• Local, burning pain immediately after the bite.

• Swelling at the site of the bite, usually beginning within five to 20 minutes and spreading slowly over a period of six to 12 hours. The faster the swelling progresses up the arm or leg, the worse the degree of envenomation.

• Bruising (black and blue discoloration) and blister formation at the bite site.

• Numbness and tingling of the lips and face, usually 10 to 60 minutes after the bite.

• Twitching of the muscles around the eyes and mouth.

• Rubbery or metallic taste in the mouth.

• After six to 12 hours, bleeding from the gums and nose may develop and denote a serious envenomation.

• Weakness, sweating, nausea, vomiting and faintness may occur.

Treatment

The definitive treatment for snake venom poisoning is the administration of antivenin. The most important aspect of therapy is to get the victim to a medical facility as quickly as possible.

First Aid

1) Rinse the area around the bite site with water to remove any venom that might remain on the skin.

2) Clean the wound and cover with a sterile dressing.

3) Remove any rings or jewelry.

4) Immobilize the injured part as you would for a fracture, but splint it just below the level of the heart.

5) Transport the victim to the nearest hospital as soon as possible. If you pass by a telephone, stop and notify the hospital that you are bringing in a snakebite victim so they can begin to locate and procure antivenin.

6) It is not necessary to kill the snake and transport it with the victim for identification. If the snake is killed, it should not be directly handled, but should be transported in a closed container. Decapitated snake heads can still produce envenomation

7) Extractor pumps designed to provide suction over a snakebite wound are sold in many camping stores and endorsed by some as a first aid treatment for snakebites. Based on recent scientific evidence, these devices are no longer recommended. A study published in the Annals of Emergency Medicine in 2004 showed that these devices remove an insignificant amount of venom, and may also be harmful to the victim. The best first aid for snakebite is a cell phone (call the hospital that you are going to so that they can procure antivenin) and a car or helicopter to get the victim there as quickly as possible.

Other First-Aid Treatments That May Be Beneficial

Immediately wrapping the entire bitten extremity with a broad elastic bandage (the “Australian Compression and Immobilization Technique”) has proven effective in the treatment of elapid and sea snake envenomations only. It is only recommended when the victim appears to have suffered a severe envenomation and is several hours from medical care.

The wrap is started over the bite site and continued upward toward the torso in an even fashion about as tight as one would wrap a sprained ankle (Fig. 60). Monitor the color, pulse and temperature of the hand or foot to make sure that there is adequate circulation. If circulation appears compromised, loosen the wrap. Otherwise the bandage should not be released until after the victim has been brought to a medical facility. The limb should then be immobilized with a well-padded splint.

Things Not To Do

1) Do not make any incisions in the skin or apply suction with your mouth.

2) Do not apply ice or a tourniquet.

3) Do not shock the victim with a stun gun or electrical current.

Coral Snake

Signs and Symptoms of Envenomation

• Burning pain at the site of the bite.

• Numbness and/or weakness of a bitten arm or leg develops within 90 minutes.

• Twitching, nervousness, drowsiness, increased salivation, and drooling develop within one to three hours.

• Within five to ten hours, the victim develops slurred speech, double vision, difficulty talking and swallowing, and difficulty breathing. The venom may cause total paralysis.

Symptoms may sometimes be delayed by up to 13 hours after the bite.

First Aid

Treatment is the same as for a pit viper bite. Early use of the pressure immobilization technique is highly recommended because it is both effective and safe (coral snake venom does not produce any local tissue destruction).

Download Printable PDF:

adventure-medical-kits-snake-bites

Handclens (the generic name for AMK’s Adventure Hand Sanitizer ), which contains BZK, kills all 3 types of germs: viruses, bacteria and fungi, including Influenza Type A, of which Swine Flu H1N1 is a subtype.

Handclens has been the subject of four peer-reviewed scientific investigations.

Two studies addressed the product’s efficacy against the Federal Guidelines for antiseptic hand washes and healthcare personnel hand washes.

Where the BZK-based hand sanitizers exceeded FDA regulations, the alcohol-containing sanitizers did not meet federal performance standards. (The results of these studies are represented by the image below.)

FDA testing protocol listed in Federal Register, Vol 59 (116), June 17, 1994, 21 CFR 333.470. “Effectiveness testing of an antiseptic Handwash or healthcare

personnel Handwash.”

The studies found that repeated use of alcohol-based sanitizers germ-killing effectiveness (the antimicrobial persistence of activity) is reduced by the drying effect of alcohol, which leaves microscopic cracks in the skin that can allow bacteria to become trapped or hidden.

Beyond being an inferior germ killer, alcohol-based hand sanitizers pose an obvious fire hazard and potential health risk, especially for young children. Last year poison control centers reported that 12,000 kids under the age of six ingested alcohol-based hand gels.

Remember that hand sanitizers are great for cleaning your hands when not in proximity to a washroom, but traditional hand cleaning using soap and water (about as long as you can sing “happy birthday to you”) are equally as effective  and even more effective when your hands are soiled with dirt and grime.

Check out these great tips found on REI.com

Together they form the first of the time-tested Ten Essentials—map and compass, the indispensible twin tools of navigation. Even in this high-tech GPS era, nothing replaces the value of a magnetized compass, a paper map and the understanding of how both can help you find your way in the wilderness.

Seek Instruction

This article and accompanying videos provide an overview of 2 primary navigational tools, map and compass. But even watching and reading every word will not turn any person into a skilled backcountry navigator.

REI strongly encourages outdoor adventurers to take a course in navigation with ample field practice to build up your skills and confidence. The REI Outdoor School offers such classes in selected U.S. cities. Local outdoor and mountaineering organizations also offer similar courses. Be sure to seek one out.

Basic Tools

Map

Simple trail maps, the line-drawing variety often found in guidebooks, are useful for trip planning but NOT for navigation in the field. To safely find your way in wilderness terrain, you need the detail provided by topographic maps.

So know your maps:

Basic (planimetric) maps:

• Examples: Traditional road maps; hand-sketched trail maps provided in visitor-center handouts.
• Appearance: Flat, 2-dimensional, horizontal view of land areas showing roads, rivers and trails.
• Attributes: They display points of interest (viewpoints, trail junctions) and routes that connect them, but offer no perspective on elevation variances. Thus they may make the distance to your destination appear to be modest, but they will not indicate if a deep valley or high ridge must be crossed in order to reach it.
• Usage: OK for following a simple nature trail or making a short trip on a well-defined trail system, but insufficient for navigation should you head deep into the wilderness or step off an established path.

Topographic (topo) maps:

• Examples: U.S. Geological Survey (USGS) quadrangles; customized commercial and downloadable map products.
• Appearance: Areas of varying colors (or shades of gray) are overlaid with “squiggly” contour lines. Together they combine to give trained eyes a mental picture of the elevation variances in a landscape. Tightly spaced contour lines, for example, indicate steeper terrain.
• Attributes: Their ability to convey the physical relief (the highs and lows) of a landscape enables you to orient yourself in the field by identifying prominent natural features—peaks, ridgelines or valleys. They also show the location of prominent man-made features such as roads and towns.
• Usage: Always the best choice for any type of wilderness travel, from day trips to extended expeditions. Even if you’re hiking on what you believe is an established, well-signed, can’t-get-lost trail system, a topo map remains a helpful tool when you reach a viewpoint and want to identify peaks and landmarks with certainty.

Compass

Every backcountry explorer needs at least a basic compass that includes a magnetized needle floating within a liquid-filled housing.

More sophisticated compasses offer useful features such as a sighting mirror or declination adjustment, but a basic compass includes all the essentials needed for navigation—magnetized needle, rotating bezel ring, orienting lines, index (degree) lines (north is 0°/360°, east is 90°, south is 180° and west is 270°) and line-of-direction (orienting) arrow.

Why not rely exclusively on a watch or GPS receiver that includes a compass? Because those are battery-reliant devices, and batteries may expire or electronic circuitry can malfunction. You need the dependability of a compass that relies only on earth’s magnetic fields.

Understanding Topo Maps

A topographic map helps you envision the appearance of terrain between 2 points. Such knowledge enables you to plan the best route of travel between them.

How Do Topo Maps Describe the Terrain?

Contour lines: They connect points on the map that share the same elevation, providing a 3-dimensional perspective of the landscape. Tightly packed contour lines indicate steep terrain; widely spaced lines indicate relatively level terrain. Contour lines never intersect.

Contour interval: Contour lines are separated at specific elevation intervals. Intervals may vary by individual map, appearing every 20, 40, 80, 100 or 200 feet. But the interval used on a single map (say, 80 feet) remains consistent throughout that map. A map’s chosen contour interval is identified in the margin of each map.

Index contour lines: Every fifth contour line is the index contour line. Usually the line is slightly bolder and intermittently includes the elevation (usually the number of feet above sea level) of all points on that line.

Scale: Beyond the ratio scale (described later in this article), a map includes a horizontal graphic scale. It displays how a measurement on the map (1 inch, for example) equates to miles/kilometers of terrain covered by the map.

Colors and shading: Darker colors (or shades of gray) represent dense vegetation. Lighter colors (particularly greens) or shades of gray indicate comparatively sparse vegetation. Lighter colors (such as beige) or no colors suggest open terrain. White spaces with blue edges indicate permanent snowfields or glaciers.

Magnetic declination diagram: Printed in the margin of the map, this diagram shows the difference (declination) between magnetic north (indicated by the MN symbol) and true north (or polar north, indicated by a star symbol).

Grid: Numbers displayed around the edge of a map represent two grid systems that can be used to determine your location.

• Latitude and longitude: Exact L&L numbers are displayed in the corners of maps and at equal intervals between the corners.
• Universal Transverse Mercator (UTM): This system, used primarily by the military, divides the earth’s surface into a number of zones.

Combined, all of the above can enable you to determine your elevation, the ruggedness of the terrain around you and the most desirable route to travel to reach a destination.

Choosing a Topo Map

Two factors play a role when you evaluate maps: Scale and content.

Scale

A map’s ratio scale conveys the relationship between a measurement on the map and the distance it represents on the terrain. The most popular USGS maps offer a scale of 1:24,000, which means 1 inch (or foot, or any unit of measure) on the map represents 24,000 inches on the ground.

Mapping software makes it possible to create customized maps that offer a larger scale (say, 1:12,000 or lower) to provide greater detail. Customized commercial maps are also sometimes created at these larger scales. This is especially useful for off-trail explorers who want to choose passageways through saddles or passes that offer the least resistance.

The downside: Such maps cover a small area. People who undertake 1-way, multiday trips along a linear route often choose small-scale maps (1:50,000 or 1:62,500, for example). These maps cover a lot of land area but offer less detail. When terrain becomes very steep, contour lines runs so closely together that they appear almost as blobs rather than lines.

So if you’re a long-distance traveler, a small-scale map will give you a good overview of the territory you’re exploring (much as a road map does). The good news: You don’t have to carry a dozen or so maps to cover your trip. But if you decide to go off-trail in a certain area, all a small-scale map may offer you is a clot of tiny, tightly packed lines—likely not enough detail to make wise navigational decisions.

Note: The terms “small-scale” and “large-scale” can be confusing to beginners since ratios get smaller as their denominators get larger. Remember this: 1:24,000 is a larger scale than 1:250,000, since the fraction 1/24,000 is larger than 1/250,000.

Content

Some commercial (non-USGS) maps include additional features that can be valuable to some users. They include:

• Highlighted trails
• Elevation call-outs
• Distances between trail junctions and landmarks
• Primitive trails
• Backcountry campsites
• Springs
• Highlighted boundary lines

These additions, even GPS coordinates and personal notations, can be inserted onto maps when created using mapping software.

Map Options

USGS Quadrangles

The USGS is the major supplier of topographic maps in the United States. USGS maps cover rectangular areas of land called quadrangles. The borders of these maps are determined by latitude lines, longitude lines and the smaller divisions between them (minutes). Every square mile of the U.S. is covered by USGS maps, and each map lines up flush with the others around it.

• Pros: USGS quads are easy to find, easy to use and easy to fit together when your trail crosses over onto an adjacent map (the borders match exactly, and the titles of adjacent maps are printed on the borders of each map).
• Cons: They typically provide limited trail information. Plus their information is sometimes dated. It’s not uncommon to find that the location, even the existence, of roads, bridges, trails and shorelines have changed since the map was printed.

Commercial Maps

Private map companies sometimes enhance existing topographic maps with highlighted features or, more commonly, create customized maps that focus on popular areas that attract lots of visitation (and therefore potential customers).

• Pros: Such maps not only have key features (primarily trails) highlighted, they are updated regularly. Release dates are usually found near the scale or the magnetic declination diagram.
• Cons: Higher cost; some remote yet scenically worthwhile areas are not covered by such maps.

Mapping Software

This is an exciting, ever-evolving category of products that allows computer-savvy adventurers to create customized maps. Choose a scale that best suits your needs, insert notes and reminders, toss in GPS coordinates, print it at home on waterproof paper. Nice.

• Pros: It’s hard to beat a map customized to the exact scope of your trip.
• Cons: Higher initial cost; some degree of computer sophistication is required.

Local Maps

Many government-owned public lands (national parks, national forests, state parks, recreational areas) produce their own maps to cover the land inside their boundaries. Some are free handouts (but usually planimetric). Some handouts focus on a specific trail.

• Pros: An entire park or area is encompassed on a single map, usually with information about roads, attractions and trails. Some get regular updates.
• Cons: If they are topographic, they usually are small-scale (meaning minimal detail), and they can be expensive.

Taking Compass Bearings

A compass makes wilderness navigation possible by enabling you to accurately gauge directions from your current position to identifiable landmarks throughout the terrain that surrounds you.

The most basic function a compass provides is pointing north (magnetic north, that is). An orienteering-style compass allows you to assign a numeric value (a “bearing”) to any direction in the 360° circle around you. This means you can head toward a specific spot rather than simply ambling “south-southwest” or “due east.”

The rotating bezel of a compass is used to convert general compass directions into specific bearings. A bezel’s outer edge includes index (degree) lines that breaks down the 360° circle into 2° or 5° increments.

A bezel measures the direction towards a given object in terms of an angle—specifically, the clockwise angle between a straight line pointing due north and a straight line pointing toward the object. This bezel allows you to express any specific direction as a number between 0° and 360°.

Why is it useful to know that your campsite lies on a bearing of 40° instead of “to the northeast”? Because precise navigation results in efficiency, safety and speed.

Following a bearing off by just 1° can translate into almost 100 feet of error after 1 mile. That means that after a 5-mile hike, you could miss your target by almost 500 feet. In the wilderness, a few dozen feet can mean the difference between spotting a campsite or other landmark and missing it completely.

Transferring Bearings

On most backcountry excursions, especially those planned by beginners, compass navigation is seldom necessary. Simply following the trail carefully and checking your map from time to time should get you from campsite to campsite safely.

But if you become disoriented, or are just feeling confidently adventurous, a compass becomes a splendidly useful tool.

For example, if you know your location on the map, you can take a bearing on an unseen target elsewhere on the map and head toward that destination simply by following the bearing—even though your objective is not yet visible. Check out our video for a visual demonstration of how to transfer a bearing from map to compass:

1. Identify your position and your objective on the map. Connecting those two points creates a line on the map (which you can either visualize or physically draw on the map).
2. Align the edge of your compass with that line.
3. Rotate the bezel so its orienting lines run parallel with the map’s orienting lines (which point to true north). This means the actual bearing have been captured at the front of the compass.
4. Take the compass and turn your body until the magnetic needle lines up with the orienting arrow on the compass. At point, you will be facing the direction that will lead to your chosen objective.

You can rearrange the process and use a compass to take a bearing off a real-world object (one that is known to be on your map) and transfer that information to the map to identify your location even if you are uncertain of your whereabouts in the field. Our companion video illustrates these steps:

1. Hold the compass level and aim the front of it at an object.
2. Rotate the bezel until the magnetic needle is aligned with the orienting arrow of the compass.
3. Locate the object on the map and place the edge of the compass on that object.
4. With the edge still tight against the object, and without touching the dial, turn the entire compass until the orienting lines within the bezel line up with the orienting lines on the map.
5. The edge of the compass forms a line on the map, and you now know you are somewhere along that line.

Triangulation

Triangulation is a technique that involves a map, a compass and 2 separate landmarks. It can pinpoint your position on your map even if you have no idea where you are. We demonstrate the following guidelines in our companion video:

1. Pick 2 distant landmarks that you can easily identify on your map. They should be at least 60° apart.
2. Take a bearing off of each object.
3. Transfer those bearing to your map.
4. Each bearing will form a line. Where the lines cross marks your location.

Magnetic Declination

As stated earlier in this article, the magnetized needle of a compass points toward magnetic north (abbreviated MN), but topo maps are oriented toward true north (or polar north, sometimes represented by a star symbol). Depending where you are located, the difference could be substantial—10°, 15°, 20° or more. Learn how to compensate for it by watching our video.

1. Find your map’s magnetic declination diagram, usually in the margin’s lower-right corner.
2. The original goal when taking a bearing is to align the magnetized needle with the orienting arrow.
3. The magnetized needle must then be adjusted to the degree indicated by your map’s magnetic declination diagram. Use the index (degree) lines on the edge of the bezel.
4. As you navigate, ensure that your needle is not pointed at magnetic north, but to the declination degree.

The Resort Sports Network (RSN), a national television network that specializes in creating and distributing outdoor content to America’s premier resorts, has announced it will begin airing AMK’s ‘Be Safe’ video segments starting in April. Hosted by high altitude mountaineer Ed Viesturs, the ‘Be Safe’ vignettes were designed to provide viewers with useful tips on first aid, safety and survival in the outdoors.   Based in Portland, Maine, RSN broadcasts content into 125 mountain and beach destinations across the country. Currently, RSN has affiliates in the following markets:

Aspen, CO
Bend, OR
Crested Butte, CO
Destin, FL
Key West, FL
Killington, VT
Lake Tahoe, CA
Loon, NH
Mammoth, CA
Mount Snow, VT
Myrtle Beach, SC
North Conway, NH
Panama City, FL
Park City, UT
Salida/Buena Vista, CO
Smugglers’ Notch, VT
Snowshoe, WV
Steamboat, CO
Stowe, VT
Stratton/Bromley/Okemo, VT
Sugarbush, VT
Sugarloaf, ME
Summit County, CO
Sun River, OR
Sun Valley, ID
Sunday River, ME
Telluride, CO
The Hamptons, NY
Vail, CO
Winterpark, CO

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.

BE SAFE Tip – Travel Tip – Always Carry Suture and Syringe Supplies

When traveling in Developing Countries carry sterile suture/syringe supplies to hand to a local professional medical care provider to insure the use of sterile needles. Over 10 million people per year contract a lethal disease such as HIV and Hepatitis through the re-use of needles.

You can get a Suture Syringe Medic Kit here.

Learn more travel medicine and first aid tips – click here for Dr. Weiss’s Comprehensive Guide to Wilderness and Travel Medicine.

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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BE SAFE Travel Tip – Plan Ahead and Visit the CDC Website Before Traveling

At least three months before your trip abroad visit the Center For Disease Control website www.cdc.gov./travel/travel.html and you will find health information for specific destination, recommended immunizations and much more.

Be prepared – bring a travel specific first aid kit on your trip!

Learn more travel medicine and first aid tips – click here for Dr. Weiss’s Comprehensive Guide to Wilderness and Travel Medicine.

BE SAFE Tip – Outdoor Tip – Snake Bite Prevention

• Stay away from infested areas.
• Do not hike at night when the snakes are out.
• Only place your foot or hand in areas you have visually searched for snakes.
• Shake out your shoes, clothing and bags in the morning.
• Don’t try to pick up a snake.
• Wear high leather boots in snake country.

Learn more wilderness medicine and first aid tips – click here for Dr. Weiss’s Comprehensive Guide to Wilderness and Travel Medicine.

BE SAFE Outdoor Tip – Preventing Lightning

• A lightning bolt can travel up to 15 miles
• Seek shelter indoors or inside a vehicle
• In a tent stay as far away from the poles an wet clothes as possible
• Do not stand under a tall tree in an open field or on a ridge top
• Get out an away from open water
• Get off bicycles and golf carts
• Stay away from wire fences, metal pipes or other metal objects that could carry the lightning bolt to you from a distance
• Avoid standing in small isolated sheds or other small buildings out in the open
• In a forest seek shelter in a low area under a thick growth of saplings or small trees. In an open area go to a low place such as a valley or ravine.
• If you are totally in the open, stay far away from single trees to avoid lightning splashes. Drop to your knees and bend forward, putting your hands on your knees. If available place insulating material between you and the ground. Do not lie flat on the ground.

BE SAFE Travel Tip – Avoiding Diarrheal Illness When Traveling

20-50% of all travelers experience stomach ailments or diarrhea on their trips with the number reaching 70% in some developing countries. Prepare before you go by scheduling an appointment with a travel medicine physician and getting prescription medications for diarrheal illness.

Be prepared by purchasing a travel specific first aid kit before your trip!

Learn more travel medicine and first aid tips – click here for Dr. Weiss’s Comprehensive Guide to Wilderness and Travel Medicine.

Dr. Weiss Advice – Malaria Prevention

There is no anti-malarial drug that is 100% effective. The best way to avoid the disease is to avoid the anopheles mosquito which carries it and feeds at night. Maximum precautions must be taken from dusk to dawn.

• Wear long, loose fitting clothes.

• Use Insect Repellents containing Deet or a 20% Picaridin formula.

• Sleep behind mosquito netting or effective screens.

• Spray your clothing with Permethrin before your trip. Permethin kills mosquitoes that land on your clothing.

• Consult a travel medicine physician on the appropriate anti-malarial medication for the area where you will be traveling.