Medicine for the Outdoors: The Essential Guide to First Aid and Medical Emergency, 5th Edition

566 Pages·2009·8.34 MB·English

by  Paul S. Auerbach

“When a crisis occurs in the backcountry, punching in 911 may not even get you a
dial tone — you’re on your own. This book is your wilderness 911. Take the time
to read it and know the principles of care provided within it. Medicine for the Out-
doors just might save your life.” — Frank Hubbell, DO, Founder of Stonehearth
Open Learning Opportunities (SOLO), Wilderness Medicine and Rescue
Instructor, Conway, NH
“Students with a broad range of experience take wilderness medicine courses. It’s
not easy to fi nd a comprehensive text that accommodates all their needs. Medicine
for the Outdoors engages the non-professional while keeping the most seasoned
provider informed in the latest techniques for backcountry medical practice. Dr.
Auerbach has written another book that will become the gold standard for anyone
with an interest in health and safety outdoors.” — William Fred Baty, WEMT-P,
Assistant Fire Chief, City of Knoxville Fire Department; Lead Wilderness
Medicine Instructor, The Wilderness Medicine Program, Roane State
Community College, Knoxville, TN
“This manual contains a wealth of succinct, up-to-date, and practical advice. It is
an indispensable medical guide for wilderness enthusiasts and health professionals.”
— Kent R. Olson, MD, Medical Director, San Francisco Division, California
Poison Control System
“Most fi rst aid books describe a condition and sometimes advise simple fi rst aid
measures, but ultimately end up with the admonition to ‘seek medical attention.’
This is safe advice when a clinic or hospital or ambulance is right around the
corner. But what about when you’re on the adventure of a lifetime — in the wilds
of Mongolia or the mountains of Tibet or several days out to sea? ‘Seek medical
advice’ helps not a bit. In these situations, there is no better resource (including
having a direct line to your hospital ER) than Medicine for the Outdoors.
Dr. Paul Auerbach is to wilderness medicine what Bill Gates is to computers;
he is the source, and so this book is a treasure trove of information not only for
untrained laypeople but for most physicians. There is no more understandable or
complete collection of information on what to do for anything that might befall
an adventure traveler — from high altitude cerebral edema to soapfi sh dermatitis
to cougar attack to how to stitch a laceration. Even better, Medicine for the
Outdoors provides essential guidance in advance of an adventure to help with
planning and prevention — from immunizations to equipment and clothing to
dietary precautions. The handy appendices include a drug reference, conversion
tables, and defi nitions of common medical terms. Contemplating an adventure?
The old adage ‘Seek medical attention’ has been replaced with ‘Get Medicine for
the Outdoors.’” — Luanne Freer, MD, FACEP, FAWM, Founder/Director,
Everest Base Camp Medical Clinic; Medical Director, Yellowstone National
Park; Past President, Wilderness Medical Society
“You always hope for the best and plan for the worst. Being well prepared for the
unexpected in the wilderness is greatly enhanced by our ‘survival bible,’ namely,
Medicine for the Outdoors. Our guides, trip leaders, and clients never adventure
without this well-written and easy-to-understand book, and we invariably benefi t
from it. The common sense approach and complete coverage have helped us
mitigate situations and avoid greater emergencies. In all reaches of the globe, with
Medicine for the Outdoors, we’re much closer to defi nitive care.” — Laurence
Alvarez-Roos, Co-founder, Bio Bio Expeditions World Wide
“This new update of Medicine for the Outdoors is more impressive and indispens-
able than ever. The uncomplicated, clear writing and illustrations are delightfully
easy to understand, even though the book is remarkably thorough and superbly
detailed. I highly recommend it to anyone who is serious about working and playing
in the outdoors.” — Donald C. Cooper, PhD, Editor, Fundamentals of Search
and Rescue; Chair, National Fire Protection Association Technical Search and
Rescue Committee
“This book provides invaluable guidance for both the medical teams that travel
with us to remote areas around the world, and for the patients we treat there.
Medicine for the Outdoors is a must-have medical manual for serious travelers
who venture off the beaten path.” — Rachel Friday, MPH, MA, RD, Director,
Medical Expeditions International
“Auerbach’s much enhanced fi fth edition of Medicine for the Outdoors continues
to serve as an ideal portable reference. Whether you are in the front country,
exploring tropical reefs, or trekking at high altitude, Medicine for the Outdoors
rapidly guides to solutions for the most important medical problems. I strongly rec-
ommend this reference as a primary source for laypersons as well as a supplement
for individuals with advanced wilderness medicine training.” — Brad L. Bennett,
PhD, NREMT-P, FAWM, Captain, US Navy (Retired); Adjunct Faculty, Military
and Emergency Medicine Department, Uniformed Services University of the
Health Sciences
“Traveling in the wilderness or abroad can be punctuated by unexpected illness or
injury. If you plan to travel where medical care is not readily available, Medicine
for the Outdoors is the resource you want to have with you. Dr. Auerbach, one of
the foremost experts on wilderness medicine, covers topics from basic fi rst aid to
major medical illnesses, trauma, medications, and medical kits. Medicine for the
Outdoors provides knowledge that can help you survive until further assistance is
available.” — Albert R. Wheeler III, MD, Emergency Medicine of Jackson Hole,
WY; Medical Director, Grand Teton National Park EMS
MEDICINE FOR
THE OUTDOORS
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FIFTH EDITION
PAUL S. AUERBACH, MD, MS, FACEP, FAWM
Professor of Surgery
Division of Emergency Medicine
Department of Surgery
Stanford University School of Medicine
Stanford, California
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
MEDICINE FOR THE OUTDOORS ISBN: 978-0-323-06813-0
Copyright © 2009 by Mosby, Inc., an affi liate of Elsevier Inc.
Copyright © 2003 by Paul S. Auerbach
All rights reserved. No part of this publication may be reproduced or transmitted in any form
or by any means, electronic or mechanical, including photocopying, recording, or any information
storage and retrieval system, without permission in writing from the publisher. Permissions may
be sought directly from Elsevier’s Rights Department: phone: [phone] (US) or (+44)
1865 843830 (UK); fax: [phone]; e-mail: [email protected]. You may also
complete your request on-line via the Elsevier website at http://www.elsevier.com/permissions.
Notice
Knowledge and best practice in this fi eld are constantly changing. As new research and experi-
ence broaden our knowledge, changes in research methods, professional practices, or medical
treatment may become necessary or appropriate.
Readers are advised to, whenever possible, check the most current information provided
(i) on procedures featured or (ii) by the manufacturer of each product to be administered, to
verify the recommended dose or formula, the method and duration of administration, and con-
traindications. It is the responsibility of the reader, relying on their own experience, to determine
the best treatment for each individual and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the Author assumes any liability for
any injury and/or damage to persons or property as a matter of products liability, negligence or
otherwise, or from any use or operation of any methods, products, instructions or ideas con-
tained in the material herein.
The Publisher
Library of Congress Cataloging-in-Publication Data
Auerbach, Paul S.
Medicine for the outdoors : the essential guide to fi rst aid and
medical emergencies / Paul S. Auerbach. -- 5th ed.
p. cm.
Includes index.
ISBN 978-0-323-06813-0
1. Outdoor medical emergencies. 2. First aid in illness and injury.
I. Title.
RC88.9.O95A94 2009
616.02’52--dc22
2009007883
Acquisitions Editor: Dolores Meloni
Developmental Editor: Elena Pushaw
Design Direction: Steven Stave
Back cover photograph of Dr. Auerbach copyright Don Feria, with permission.
Printed in the United States of America
Last digit is the print number:
9 8 7 6 5 4 3 2 1
PREFACE
The outdoor environment is beautiful, but it is ever changing and can become
hostile in a moment. Good fortune favors the well prepared, and there are no
more important considerations for a successful outdoor experience than safety
and fi rst aid. Severe weather, wild animals, rugged terrain, and equipment failure
all conspire to create or complicate medical hardships that must be diagnosed
swiftly and remedied with certainty. The therapies can be integral to survival.
Medical education is thus as compelling as any other form of learning.
This revised fi fth edition of Medicine for the Outdoors has been updated and
rewritten based on advances in medical knowledge, suggestions from readers,
and reviews of the previous edition. I am indebted to my family and friends, who
continue to support me in my writing endeavors. Brian, Lauren, and Danny will
soon be writing their own books. This book is dedicated to all of the people who
have given generously of their time to the Wilderness Medical Society and
thereby advanced the specialty of wilderness medicine.
With as much effort as we seek to maintain good health, let each of us seek to
maintain the wilderness. It is my fervent hope that we can approach preservation
of the planet Earth with the same passion that we have poured into the develop-
ment of our vital medical missions; for without the wilderness, there can be no
wilderness medicine.
Paul Auerbach, MD
Summer, 2009
vii
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INTRODUCTION
The purpose of this book is to provide you with brief explanations of a wide variety
of medical problems and to offer practical solutions. The book is arranged to make
information easy to retrieve. Part One outlines basic principles of health care that
should be applied to all outdoor travel. Parts Two and Three describe medical situ-
ations, beginning with life threats and covering, in turn, major and minor medical
problems you might encounter. Part Four discusses disorders related to various
wilderness settings. Part Five covers additional practical information, such as
evacuation guidelines and techniques, water disinfection, useful knots and hitches,
drug injection techniques, and recommendations for immunization. Appendix One
lists medications and doses, with an emphasis on medications mentioned else-
where in the book. Conversion tables for common measurements are found in
Appendix Two. Appendix Three outlines guidelines for prevention of hepatitis,
acquired immunodefi ciency syndrome (AIDS), and other diseases transmitted by
human body fl uids. The glossary defi nes medical and technical terms. The index will
guide you swiftly to any topic.
To keep the book to a manageable size, I assume that you have a basic under-
standing of how your body and organs are supposed to work. Thus, explanations
are brief and to the point. This is neither a survival manual nor a sports medicine
encyclopedia. Rather, the book is meant to be carried on a journey as a ready
reference for a layperson who needs to medically rescue or aid an ill or injured
victim. I have included information that is necessary to make simple, accurate
diagnoses and to act on them.
This book does not transform a layperson into a physician, but unfortunately,
there are times when medical help is miles or even days away. No intervention is
completely without risk; however, some familiarity with diseases and injuries can
minimize that risk. Although some of the techniques and drugs described could
worsen a situation if misapplied or incorrectly administered, the treatments pre-
sented are current and well accepted. Still, the recommendations should not be
considered substitutes for prompt evaluation by a trained medical professional. If at
any time a diagnosis is uncertain, or a victim appears to be more than minimally
ill, all efforts should be directed at seeking a professional medical opinion.
The basic therapies recommended are not those that could be rendered by a
physician with sophisticated equipment and a large armamentarium of drugs. I
have not described every infectious or tropical disease that could possibly be
contracted during a journey abroad. However, the diagnosis and management of
illnesses such as schistosomiasis, malaria, Lyme disease, anaplasmosis, yellow
fever, dengue fever, West Nile viral disease, and Rocky Mountain spotted fever
are relevant to many people who travel domestically and overseas in wilderness
ix