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1. Evidence-Based Heatstroke Management in the Emergency Department

Author

Rublee, Caitlin, Dresser, Caleb, Giudice, Catharina, Lemery, Jay, and Sorensen, Cecilia

Subjects
climate change, heatstroke, adaptation, critical care
Abstract

Introduction: Climate change is causing an increase in the frequency and intensity of extreme heat events, which disproportionately impact the health of vulnerable populations. Heatstroke, the most serious heat-related illness, is a medical emergency that causes multiorgan failure and death without intervention. Rapid recognition and aggressive early treatment are essential to reduce morbidity and mortality. The objective of this study was to evaluate current standards of care for the emergent management of heatstroke and propose an evidence-based algorithm to expedite care.Methods: We systematically searched PubMed, Embase, and key journals, and reviewed bibliographies. Original research articles, including case studies, were selected if they specifically addressed the recognition and management of heatstroke in any prehospital, emergency department (ED), or intensive care unit population. Reviewers evaluated study quality and abstracted information regarding demographics, scenario, management, and outcome.Results: In total, 63 articles met full inclusion criteria after full-text review and were included for analysis. Three key themes identified during the qualitative review process included recognition, rapid cooling, and supportive care. Rapid recognition and expedited external or internal cooling methods coupled with multidisciplinary management were associated with improved outcomes. Delays in care are associated with adverse outcomes. We found no current scalable ED alert process to expedite early goal-directed therapies.Conclusion: Given the increased risk of exposure to heat waves and the time-sensitivity of the condition, EDs and healthcare systems should adopt processes for rapid recognition and management of heatstroke. This study proposes an evidence-based prehospital and ED heat alert pathway to improve early diagnosis and resource mobilization. We also provide an evidence-based treatment pathway to facilitate efficient patient cooling. It is hoped that this protocol will improve care and help healthcare systems adapt to changing environmental conditions.

Published
2021

9. A multinational Delphi consensus to end the COVID-19 public health threat

Author

Lazarus, Jeffrey V., Romero, Diana, Kopka, Christopher J., Karim, Salim Abdool, Abu-Raddad, Laith J., Almeida, Gisele, Baptista-Leite, Ricardo, Barocas, Joshua A., Barreto, Mauricio L., Bar-Yam, Yaneer, Bassat, Quique, Batista, Carolina, Bazilian, Morgan, Chiou, Shu-Ti, del Rio, Carlos, Dore, Gregory J., Gao, George F., Gostin, Lawrence O., Hellard, Margaret, Jimenez, Jose L., Kang, Gagandeep, Lee, Nancy, Matičič, Mojca, McKee, Martin, Nsanzimana, Sabin, Oliu-Barton, Miquel, Pradelski, Bary, Pyzik, Oksana, Rabin, Kenneth, Raina, Sunil, Rashid, Sabina Faiz, Rathe, Magdalena, Saenz, Rocio, Singh, Sudhvir, Trock-Hempler, Malene, Villapol, Sonia, Yap, Peiling, Binagwaho, Agnes, Kamarulzaman, Adeeba, El-Mohandes, Ayman, Barreto, Mauricio, Abdulla, Salim, Addleman, Sarah, Aghayeva, Gulnara, Agius, Raymond, Ahmed, Mohammed, Ramy, Mohamed Ahmed, Aide, Pedro, Aleman, Soo, Alfred, Jean-Patrick, Ali, Shamim, Aliaga, Jorge, Aloudat, Tammam, Alqahtani, Saleh A., Al-Salman, Jameela, Amuasi, John H., Agrawal, Anurag, Anwar, Wagida, Araujo-Jorge, Tania, Artaza, Osvaldo, Asadi, Leyla, Awuku, Yaw, Baker, Michael, Barberia, Lorena, Bascolo, Ernesto, Belcher, Paul, Bell, Lizett, Benzaken, Adele, Bergholtz, Emil, Bhadelia, Nahid, Bhan, Anant, Bilodeau, Stephane, Bitrán, Ricardo, Bluyssen, Philomena, Bosman, Arnold, Bozza, Fernando A., Brinkmann, Melanie M., Brown, Andrew, Mellado, Bruce, Bukusi, Elizabeth, Bullen, Chris, Buonanno, Giorgio, Burgess, Rochelle, Butler, Matthew, Byakika-Kibwika, Pauline, Cabieses, Baltica, Carlsson, Gunilla, Cascini, Fidelia, Chabala, Chishala, Chakroun, Mohamed, Cheng, null, Chetty, Agnes, Chumachenko, Dmytro, Consalves, Gregg, Conway Morris, Andrew, Cordie, Ahmed, Corrah, Tumani, Crabtree-Ramírez, Brenda, Dashdorj, Naranjargal, Davidovitch, Nadav, de Souza, Luis Eugenio, Dhariwal, Akshay Chand, Druică, Elena, Ergonul, Onder, Erondu, Ngozi A., Essar, Mohammad Yasir, Ewing, Andrew, Fanjul, Gonzalo, Feierstein, Daniel, Feigl-Ding, Eric, Figueroa, Ramon, Figueroa, John Peter, Fisher, Dale, Flores, Walter, Forero-Peña, David A., Frumkin, Howard, Gamkrelidze, Amiran, Gandhi, Monica, Garcia, Patricia, Garcia-Basteiro, Alberto L., García-Sastre, Adolfo, Garg, Suneela, Gbeasor-Komlanvi, null, Gershenson, Carlos, Gilada, Ishwar, Giovanella, Ligia, González, Marino, Green, Manfred S., Greenhalgh, Trisha, Griffin, Paul, Griffin, Stephen, Grinsztejn, Beatriz, Anand, Tanu, Guerra, Germán, Guinto, Renzo, Gujski, Mariusz, Guner, Rahmet, Hamdy, Adam, Hâncean, Marian-Gabriel, Haniffa, Abusayeed, Hartigan-Go, Kenneth Y., Hassan, Hoda K., Hay, Simon I., Heino, Matti T. J., Hel, Zdenek, Hotez, Peter, Hu, Jia, Hukić, Mirsada, IJsselmuiden, Carel, Iroko, Davidson, Iskarous, Maged, Izugbara, Chimaraoke, Jacobs, Choolwe, Jadad, Alejandro R., Jehan, Fyezah, Jordan, Ayana, Jroundi, Imane, Kain, Kevin, Kamberi, Fatjona, Karamov, Eduard, Karan, Abraar, Katz, Rebecca, Katzourakis, Aris, Kazembe, Abigail, Khamis, Faryal, Khamzayev, Komiljon, Khanyola, Judy, Khunti, Kamlesh, Kiguli-Malwadde, Elsie, Kim, Woo Joo, Kirenga, Bruce J., Klimovský, Daniel, Kmush, Brittany L., Knaul, Felicia, Kogevinas, Manolis, Kristensen, Frederik, Kumar, Dinesh, Kumar, Raman, Kvalsvig, Amanda, Lacerda, Marcus V., Lal, Arush, Lawton, Tom, Lemery, Jay, Leonardi, Anthony J., Li, Yuguo, Löttvall, Jan, Lounis, Mohamed, Maceira, Daniel, MacIntyre, C. Raina, Madani, Azzeddine, Magiorkinis, Gkikas, Malekzadeh, Reza, Choisy, Marc, Marcelin, Jasmine R., Marks, Guy B., Marr, Linsey, Marrazzo, Jeanne, Martina, Antonieta, Martín-Moreno, José M., Mateos, Carlos, Mayxay, Mayfong, Mazarati, Jean Bapiste, Mboup, Souleymane, McDonald, Jennifer, McMillan, Faye, Mechili, Enkeleint, Medici, Andre, Davis, Sarah L. M., Meier, Petra, Memish, Ziad A., Menon, Jaideep, Menon, Purnima, Mesiano-Crookston, Jonathan, Michie, Susan, Mikolasevic, Ivana, Milicevic, Ognjen, Mishra, Asit Kumar, Mohamed, Rahma, Mokdad, Ali H., Monroy-Valle, Michele, Morawska, Lidia, Moschos, Sterghios A., Motawea, Karam, Mousavi, Sayed Hamid, Mumtaz, Ghina, Munene, Peter K., Muñoz Almagro, Carmen, Muriuki, Janet, Muyingo, Sylvia, Naniche, Denise, Naylor, C. David, Ndembi, Nicaise, Nemec, Juraj, Nesteruk, Igor, Ngaruiya, Christine, Nguyen, Hung, Nikolova, Dafina, Nitzan, Dorit, Norheim, Ole, Noushad, Mohammed, Ntoumi, Francine, Nyborg, Gunhild Alvik, Ochodo, Eleanor, Odabasi, Zekaver, Okwen, Mbah Patrick, Olivia, Keiser, Ong, David S. Y., Opara, Ijeoma, Orozco, Miguel, Oshitani, Hitoshi, Pagel, Christina, Pai, Madhukar, Pálsdóttir, Björg, Papatheodoridis, Georgios, Paraskevis, Dimitrios, Leigh, Jeanna Parsons, Pécoul, Bernard, Peichl, Andreas, Perez-Then, Eddy, Duc, Phuc Pham, Philippe, Cécile, Pineda Rojas, Andrea, Pladsen, Courtney, Pozniak, Anton, Quiroga, Rodrigo, Qureshi, Huma, Rampal, Sanjay, Ranney, Megan, Rathe, Laura, Ratzan, Scott, Raventos, Henriette, Rees, Helen, Reis, Renata, Ricciardi, Walter, Rizk, Nesrine, Robalo, Magda, Robertson, Eleanor, Robinson, Leanne, Rokx, Casper, Ros, Tamsin, Røttingen, John-Arne, Rubin, Meir, Ruxrungtam, Kiat, Sadirova, Shakhlo, Saha, Senjuti, Salgado, Nelly, Sanchez, Lizet, Sangaramoorthy, Thurka, Santamaria-Ulloa, Carolina, Santos, Renata, Sawaf, Bisher, Schneider, Matthias F., Schooley, Robert T., Sener, Alper, Sepulveda, Jaime, Shah, Jaffer, Shibani, Mosa, Shoib, Sheikh, Sikazwe, Izukanji, Šimaitis, Aistis, Gill, Amandeep Singh, Skhvitaridze, Natia, Sokolović, Milka, Solomon, Roma, Solórzano, Xavier, Springer, Sandra A., Šrol, Jakub, Staines, Anthony, Stelfox, Henry T., Strathdee, Steffanie, Sulaiman, Lokman Hakim, Sutton, Brett, Svanæs, Dag, Swed, Sarya, Sypsa, Vana, Sørensen, Kristine, Tajudeen, Raji, Tan, Amy, Tang, Julian, Tanner, Marcel, Sethi, Tavpritesh, Temmerman, Marleen, Than, Kyu Kyu, Tinto, Halidou, Tomètissi, Sênoudé Pacôme, Torres, Irene, Tshering, null, Tsiodras, Sotirios, Tsofa, Benjamin, Vahlne, Anders, Vargas, Juan Rafael, Bernal, Ivan Dario Velez, Ventura, Deisy, Vilasanjuan, Rafael, Vipond, Joe, Wamala-Andersson, Sarah, Wargocki, Pawel, West, Robert, Weyand, Angela, White, Trenton M., Wolff, Guntram, Yao, Maosheng, Yates, Christian A., Yeboah, Georgina, Yee-Sin, Leo, Yi, Siyan, Teo, Yik-Ying, Yong, Poovorawan, Zamora-Mesía, Victor, Øvrehus, Anne, 0000-0001-9618-2299, 0000-0002-4832-9564, 0000-0002-4986-2133, 0000-0003-0790-0506, 0000-0003-0875-7596, 0000-0002-6994-1891, 0000-0002-3869-615X, 0000-0001-5286-4044, 0000-0001-6203-1847, 0000-0002-0121-9683, 0000-0003-1793-6350, 0000-0003-2418-0037, 0000-0002-5095-748X, 0000-0003-4492-3256, 0000-0002-5964-8210, 0000-0002-6779-3151, 0000-0002-8074-4450, Lazarus, Jeffrey V [0000-0001-9618-2299], Romero, Diana [0000-0002-4832-9564], Karim, Salim Abdool [0000-0002-4986-2133], Abu-Raddad, Laith J [0000-0003-0790-0506], Bassat, Quique [0000-0003-0875-7596], Chiou, Shu-Ti [0000-0002-6994-1891], Gao, George F [0000-0002-3869-615X], Gostin, Lawrence O [0000-0001-5286-4044], Jimenez, Jose L [0000-0001-6203-1847], McKee, Martin [0000-0002-0121-9683], Oliu-Barton, Miquel [0000-0003-1793-6350], Pradelski, Bary [0000-0003-2418-0037], Rathe, Magdalena [0000-0002-5095-748X], Trock-Hempler, Malene [0000-0003-4492-3256], Yap, Peiling [0000-0002-5964-8210], Binagwaho, Agnes [0000-0002-6779-3151], Kamarulzaman, Adeeba [0000-0002-8074-4450], Apollo - University of Cambridge Repository, Helsinki Collegium for Advanced Studies, Research Group of Nelli Hankonen, Doctoral Programme in Social Sciences, Academic Disciplines of the Faculty of Social Sciences, RS: CAPHRI - R2 - Creating Value-Based Health Care, International Health, Performance analysis and optimization of LARge Infrastructures and Systems (POLARIS), Inria Grenoble - Rhône-Alpes, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Laboratoire d'Informatique de Grenoble (LIG), Université Pierre Mendès France - Grenoble 2 (UPMF)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut National Polytechnique de Grenoble (INPG)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre Mendès France - Grenoble 2 (UPMF)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut National Polytechnique de Grenoble (INPG)-Centre National de la Recherche Scientifique (CNRS), Internal Medicine, Medical Microbiology & Infectious Diseases, Veritati - Repositório Institucional da Universidade Católica Portuguesa, and Lazarus J. V., Romero D., Kopka C. J., Karim S. A., Abu-Raddad L. J., Almeida G., Baptista-Leite R., Barocas J. A., Barreto M. L., Bar-Yam Y., et al.

Subjects
Pandemics/economics, BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences, COVID-19 Vaccines, Delphi Technique, General Science & Technology, International Cooperation, Temel Bilimler (SCI), ÇOK DİSİPLİNLİ BİLİMLER, Public Health/economics, [SHS]Humanities and Social Sciences, SDG 3 - Good Health and Well-being, RA0421 Public health. Hygiene. Preventive Medicine, Medicine and Health Sciences, Humans, prevention and control, human, Settore MED/42 - IGIENE GENERALE E APPLICATA, Health Education, Pandemics, Multidisipliner, Organizations, Multidisciplinary, MULTIDISCIPLINARY SCIENCES, COVID-19/economics, Temel Bilimler, pandemic, Communication, Health Policy, BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti, Doğa Bilimleri Genel, COVID-19, 3142 Public health care science, environmental and occupational health, Delphi study, NATURAL SCIENCES, GENERAL, N/A, Public Opinion, Government, Natural Sciences (SCI), Public Health, Natural Sciences
Abstract

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic . Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches , while maintaining proven prevention measures using a vaccines-plus approach that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

Published
2022

12. The Intersection of Telemedicine and Wilderness Care:Past, Present, and Future

Author

Davis, Christopher B., Lorentzen, Anne Katherine, Patel, Hemali, Cheung, Dickson, Wright, Angela, Lemery, Jay, Penninga, Luit, Davis, Christopher B., Lorentzen, Anne Katherine, Patel, Hemali, Cheung, Dickson, Wright, Angela, Lemery, Jay, and Penninga, Luit

Abstract

Wilderness medicine and telemedicine seemingly exist at opposite ends of the clinical continuum. However, these 2 specialties share a common history and the literature abounds with examples of successful deployment of telemedicine to resource limited settings. The recent widespread adoption of telemedicine has important ramifications for wilderness providers. Telemedicine is inherently reliant on some sort of technology. There is a wide spectrum of complexity involved, but in general these systems rely on a hardware component, a software component, and a network system to transmit information from place to place. Today, connectivity is nearly ubiquitous through access to cellular networks, Wi-Fi, or communication satellites. However, bandwidth, defined as the amount of data which can be transmitted through a given connection over time, remains a limiting factor for many austere settings. Telemedicine services are typically organized into 4 categories: 1) live/interactive; 2) store and forward; 3) remote patient monitoring; and 4) mHealth. Each of these categories has an applicable wilderness medicine use case which will be reviewed in this paper. Though the regulatory environment remains complex, there is enormous potential for telemedicine to enhance the practice of wilderness medicine. Drones are likely to transform wilderness medicine supply chains by facilitating delivery of food, shelter, and medicines and are able to enhance search and rescue efforts. Remote consultations can be paired with remote patient monitoring technology to deliver highly specialized care to austere environments. Early feasibility studies are promising, but further prospective data will be required to define future best practices for wilderness telemedicine.

Published
2022

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

Author

Sorensen, Cecilia, Murray, Virginia, Lemery, Jay, and Balbus, John

Subjects
Climate change -- Influence -- Research, Health policy -- Analysis, Women's health -- Research, Biological sciences
Abstract

Author(s): Cecilia Sorensen 1,*, Virginia Murray 2, Jay Lemery 1, John Balbus 3 Summary points Climate change impacts on health-including increased exposures to heat, poor air quality, extreme weather events, [...]

Published
2018
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18. Associations Between Wildfire‐Related PM2.5 and Intensive Care Unit Admissions in the United States, 2006–2015.

Author

Sorensen, Cecilia, House, John A., O'Dell, Katelyn, Brey, Steven J., Ford, Bonne, Pierce, Jeffrey R., Fischer, Emily V., Lemery, Jay, and Crooks, James L.

Subjects
INTENSIVE care units, WILDFIRE prevention, HOSPITAL admission & discharge, PUBLIC health, RATINGS of hospitals, ZIP codes
Abstract

Wildfire smoke is a growing public health concern in the United States. Numerous studies have documented associations between ambient smoke exposure and severe patient outcomes for single‐fire seasons or limited geographic regions. However, there are few national‐scale health studies of wildfire smoke in the United States, few studies investigating Intensive Care Unit (ICU) admissions as an outcome, and few specifically framed around hospital operations. This study retrospectively examined the associations between ambient wildfire‐related PM2.5 at a hospital ZIP code with total hospital ICU admissions using a national‐scale hospitalization data set. Wildfire smoke was characterized using a combination of kriged PM2.5 monitor observations and satellite‐derived plume polygons from National Oceanic and Atmospheric Administration's Hazard Mapping System. ICU admissions data were acquired from Premier, Inc. and encompass 15%–20% of all U.S. ICU admissions during the study period. Associations were estimated using a distributed‐lag conditional Poisson model under a time‐stratified case‐crossover design. We found that a 10 μg/m3 increase in daily wildfire PM2.5 was associated with a 2.7% (95% CI: 1.3, 4.1; p = 0.00018) increase in ICU admissions 5 days later. Under stratification, positive associations were found among patients aged 0–20 and 60+, patients living in the Midwest Census Region, patients admitted in the years 2013–2015, and non‐Black patients, though other results were mixed. Following a simulated severe 7‐day 120 μg/m3 smoke event, our results predict ICU bed utilization peaking at 131% (95% CI: 43, 239; p < 10−5) over baseline. Our work suggests that hospitals may need to preposition vital critical care resources when severe smoke events are forecast. Plain Language Summary: Wildfire smoke negatively affects people's health. Heavy smoke has been linked to higher rates of hospital admissions, emergency room, admissions, and death. However, we do not know the impact of smoke on Intensive Care Unit (ICU) admissions or on limited hospital resources like ICU beds. To fill this knowledge gap, we linked hospital ICU admissions to smoke levels near those hospitals. We also predicted how many ICU admissions would occur during a simulated severe week‐long smoke event and how many ICU beds would be needed to care for the patients. We found that the link between smoke and ICU admissions was relatively modest, but a severe smoke event could more than double the number of ICU beds needed. Key Points: Associations between smoke PM2.5 and ICU admissions were estimated using a national‐scale cohortSmoke PM2.5 was associated with modest changes in ICU admissionsA simulated smoke wave was found to impose severe strain on ICU resources [ABSTRACT FROM AUTHOR]

Published
2021
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23. Climate Change and Health: An Urgent Call to Academic Emergency Medicine.

Author

Salas, Renee N., Slutzman, Jonathan E., Sorensen, Cecilia, Lemery, Jay, Hess, Jeremy J., and Burton, John H.

Subjects
AIR pollution, CLIMATE change, EMERGENCY medicine, FOOD quality, GREENHOUSE effect, HEALTH status indicators, HEART diseases, LEADERSHIP, PATIENT advocacy
Abstract

The article reports that the Lancet Commission on pollution and health declared for occurring of anthropogenic climate change causes to risk in human health. Topics discussed include emergency medicine (EM) uses as while climate change affects patients, clinical practice, and emergency departments (ED); increased greenhouse gas emissions from activities like fossil fuel combustion for electricity generation; and epidemiologic analyses for climate change which impact on health system operations.

Published
2019
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24. Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy

Author

Glaser, Jason, primary, Lemery, Jay, additional, Rajagopalan, Balaji, additional, Diaz, Henry F., additional, García-Trabanino, Ramón, additional, Taduri, Gangadhar, additional, Madero, Magdalena, additional, Amarasinghe, Mala, additional, Abraham, Georgi, additional, Anutrakulchai, Sirirat, additional, Jha, Vivekanand, additional, Stenvinkel, Peter, additional, Roncal-Jimenez, Carlos, additional, Lanaspa, Miguel A., additional, Correa-Rotter, Ricardo, additional, Sheikh-Hamad, David, additional, Burdmann, Emmanuel A., additional, Andres-Hernando, Ana, additional, Milagres, Tamara, additional, Weiss, Ilana, additional, Kanbay, Mehmet, additional, Wesseling, Catharina, additional, Sánchez-Lozada, Laura Gabriela, additional, and Johnson, Richard J., additional

Published
2016
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34. Editorial: The Great Procrastination.

Author

LEMERY, JAY, WILLIAMS, CARMEL, and FARMER, PAUL

Subjects
CLIMATOLOGY, ENVIRONMENTAL health, GREENHOUSE effect, HUMAN rights, INVESTMENTS, PRACTICAL politics, RESPONSIBILITY, RISK assessment, SERIAL publications, PSYCHOLOGICAL vulnerability
Abstract

We wonder, given the evidence underlying the mounting climate crisis, if future generations will regard ours—amongst the epochs of history—as “The Great Procrastination.” Squandering time, dithering on action, and engaging in half-measures woefully incapable of addressing a threat that our best science warns will be more catastrophic and less reversible each year. The health effects of anthropogenic climate change are increasingly apparent and accelerating at an ominous pace. Global warming will now continue under all future scenarios, and immediate action can only slow, not reverse, the rate of warming. Our risk assessment has yet to translate into meaningful mitigation and, even with this knowledge, major industrial nations are continuing to invest significantly in new carbon-based energy technologies. This issue of the Health and Human Rights Journal explores a range of threats to human health from climate change, and examines these dangers as issues of human rights. Immediate morbidity and mortality impacts from extreme weather events and sea level rise are known and visible; less obvious and more insidious are health threats arising from the ongoing displacement, disenfranchisement, and deprivation brought about by the effects of climate change. [ABSTRACT FROM AUTHOR]

Published
2014

35. Protecting the Children of Haiti

Author

Balsari, Satchit Siddharth, Lemery, Jay, Williams, Timothy P., and Nelson, Brett Dee

Abstract

Haiti has long had difficulty in protecting its children from harm. The earthquake that struck the country on January 12 destroyed much of the capital, Port-au-Prince, as it killed many government officials and United Nations (UN) workers and left as many as 230,000 people dead and many thousands injured. In the wake of this sweeping disaster, the plight of Haiti's children has acquired new and terrible dimensions.

Published
2010
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36. Wilderness Medical Society Roundtable Report. Recommendations on the use of epinephrine in outdoor education and wilderness settings.

Author

Gaudio F, Lemery J, and Johnson D

Subjects
Bronchodilator Agents adverse effects, Clinical Competence, Congresses as Topic, Epinephrine adverse effects, Humans, Wilderness Medicine education, Wilderness Medicine standards, Anaphylaxis drug therapy, Bronchodilator Agents administration & dosage, Epinephrine administration & dosage, Wilderness, Wilderness Medicine methods
Published
2010
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