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The Wilderness Medical Society convened a panel to review the literature and develop evidence-based clinical practice guidelines on the treatment of anaphylaxis, with an emphasis on a field-based perspective. The review also included literature regarding the definition, epidemiology, clinical manifestations, and prevention of anaphylaxis. The increasing prevalence of food allergies in the United States raises concern for a corresponding rise in the incidence of anaphylaxis. Intramuscular epinephrine is the primary treatment for anaphylaxis and should be administered before adjunctive treatments such as antihistamines, corticosteroids, and inhaled β agonists. For outdoor schools and organizations, selecting a method to administer epinephrine in the field is based on considerations of cost, safety, and first responder training, as well as federal guidelines and state-specific laws., (Copyright © 2021 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Introduction: The National Outdoor Leadership School (NOLS) conducts backcountry research in an effort to provide the most up-to-date support to its students. Past research efforts have used a variety of body composition measurement tools, including bioelectrical impedance (BIA), skinfold calipers, and air displacement plethysmography (Bod Pod), but these tools are not interchangeable. The purpose of this study was to determine the feasibility and accuracy of the Tanita scale and the Harpenden skinfold calipers for assessing body composition in backcountry hikers., Methods: Twenty-two NOLS participants completed a 23-d backpacking trip into the Wind River Range in Wyoming. Pre- and postexpedition anthropometric measures were collected using 3 different body composition measurement tools: Tanita segmental body composition monitor, Harpenden skinfold calipers, and the Bod Pod. For the purposes of this study, the Bod Pod was used as the standard against which other methods were compared., Results: Participants lost a significant amount of weight and fat during the expedition. Fat-free mass increased by 0.4±1.9 kg, but this did not reach significance. A high degree of reliability was found between skinfold calipers and the Bod Pod and between BIA and the Bod Pod. The BIA measurements significantly underreported body fat percentage when compared to the Bod Pod, whereas the skinfold measurements were not significantly different from the Bod Pod, but measurements were more variable., Conclusions: This study shows that the skinfold caliper and the Tanita scale give measurements comparable to the less readily available and more costly Bod Pod measurement in backcountry expedition participants., (Copyright © 2019 Marketing EDGE.org. Published by Elsevier Inc. All rights reserved.)

Objective: Previously unclassified inflammatory skin lesions referred to as sun bumps have been observed throughout the year on participants of wilderness trips; however, the underlying cause and diagnosis remain unclear. The purpose of this prospective observational study was to document the incidence, characteristics, and risk factors associated with these skin lesions as they occurred on a winter wilderness expedition., Methods: For this study, the lesions were defined as pruritic or erythematous skin lesions occurring while in the wilderness. Seventy-four participants in a wilderness ski touring course in Wyoming fully completed a 44-question written survey concerning occurrence and risk factors for these lesions. Weather information and photographs were collected., Results: Twenty-six percent of participants had similar lesions. The lesions were described as edematous pale papules and plaques with erosions and crusts on an erythematous background. The face was involved in 90% of affected persons. Lesions occurred after an average of 8.7 days in the wilderness and resolved 10.6 days later. Skin that was less prone to sunburn was associated with a decreased incidence (odds ratio 0.44). No association could be found between lesion incidence and history of polymorphous light eruption, sun exposure, ambient temperature, affected contacts, sex, or body mass index., Conclusions: Overall, the lesions were common among study participants but occurred only after prolonged exposure to wilderness conditions. It was not possible to classify the skin condition as an example of any known diagnosis. We propose the name "prolonged exposure dermatosis" for this condition until further studies better define its etiology, prevention, and treatment., (Copyright © 2015 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Objective: This paper describes field injury, illness, near miss, and evacuation profiles of the National Outdoor Leadership School (NOLS)., Methods: The NOLS incident database is used to record injuries, illnesses, near-miss incidents (close calls), evacuations, and nonmedical incidents. The database has been used continually since 1984., Results: During the period September 1, 1998, through August 31, 2002, there were 630,937 program days on which 1940 incidents were reported involving 1679 students and 233 staff. Athletic injuries account for 50% of all injuries, and soft-tissue injuries account for 30%. Athletic injuries are most often sprains and strains of knees (35%), ankles (30%), and backs (13%). Falls and slips around camp or while hiking are the leading contributing factors. The most common illnesses are gastrointestinal symptoms such as nausea, vomiting, and diarrhea (26.4%) and all flu-like illness, including flu symptoms and respiratory symptoms (16.6%). Rock fall was the leading near-miss incident. Two hundred fifty-seven (53%) medical evacuees received treatment and were able to rejoin and finish their course. There was one fatality from 1999 to 2002. The fatality rate for this period is 0.002 per 1000 program days., Conclusions: The number of injuries and, specifically, the number of athletic injuries have declined. The number and rate of near-miss incidents increased as a result of better reporting; the rate of nonmedical incidents held steady. Motivation continues to be our leading category of nonmedical incident. Efforts at collecting incident data provide a useful measurement from which we can gauge our risk-management performance.

A statistical analysis of the medical characteristics of students on field courses at the National Outdoor Leadership School (NOLS) was performed. This analysis determined that the group of students with the highest overall student scores (> or = 4 on a 1 through 5 scale) tended to score lower in the psychological counseling and current psychological treatment questions and scored significantly higher in the athletic ability question on the NOLS medical review form. This indicates that these individuals tended to have little or no history of counseling and psychological treatment and were more likely to be engaged in competitive sports. Discriminant analysis demonstrated that these variables also contributed the most to discerning mathematically among the four possible student outcome score groups, which ranged from the inability to complete a course (evacuation) through highly successful. Many of the questions on the current NOLS medical form could not be analyzed statistically because they demonstrated no variance among the groups. Although these questions may still be valuable for screening purposes, some of them could be reworded for increased sensitivity. Discriminant analysis of six responses on the medical form was 43.7% effective at classifying individuals to outcome groups, and it is likely that this could be more effective with some modifications to the evaluation process. Admissions personnel in outdoor programs are encouraged to include questions such as those mentioned above in their overall admission procedures and to examine them thoroughly in their admissions decisions. Although additional studies should be conducted to examine these issues more thoroughly, it is possible that programmatic changes would assist students without the above-mentioned characteristics in becoming more successful in field courses.