Reduced Acetazolamide Dosing in Countering Altitude Illness: A Comparison of 62.5 vs 125 mg (the RADICAL Trial).

INTRODUCTION: North American guidelines propose 125 mg acetazolamide twice daily as the recommended prophylactic dose to prevent acute mountain sickness (AMS). To our knowledge, a dose lower than 125 mg twice daily has not been studied. METHODS: We conducted a prospective, double-blind, randomized, noninferiority trial of trekkers to Everest Base Camp in Nepal. Participants received the reduced dose of 62.5 mg twice daily or the standard dose of 125 mg twice daily. Primary outcome was incidence of AMS, and secondary outcomes were severity of AMS and side effects in each group. RESULTS: Seventy-three participants had sufficient data to be included in the analysis. Overall incidence of AMS was 21 of 38 (55.3%) in reduced-dose and 21 of 35 (60.0%) in standard-dose recipients. The daily incidence rate of AMS was 6.7% (95% CI 2.5-10.9) for each individual in the reduced-dose group and 8.9% (95% CI 4.5-13.3) in the standard-dose group. Overall severity of participants' Lake Louise Score was 1.014 in the reduced-dose group and 0.966 in the standard-dose group (95% CI 0.885-1.144). Side effects were similar between the groups. CONCLUSIONS: The reduced dose of acetazolamide at 62.5 mg twice daily was noninferior to the currently recommended dose of 125 mg twice daily for the prevention of AMS. Low incidence of AMS in the study population may have limited the ability to differentiate the treatment effects. Further research with more participants with greater rates of AMS would further elucidate this reduced dosage for preventing altitude illness.

Wilderness Medical Society practice guidelines for the treatment of acute pain in remote environments: 2014 update.

The Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded on the basis of the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for the Treatment of Acute Pain in Remote Environments published in Wilderness & Environmental Medicine 2014;25(1):41-49.

Wilderness search strategy and tactics.

Reports of overdue persons are common for search and rescue personnel. Search incidents for missing persons are conducted following established industry standard practices, which are continuously refined through experience and the analysis of previous search operations. Throughout this process, elements of uncertainty exist, and the knowledge and experience of the searchers and search managers may influence the outcome significantly. A sound knowledge of current search tactics will help search and rescue medical providers function more effectively during search operations. Initial actions during a search incident include 3 primary tasks that must be accomplished on any search: investigation, containment, and then hasty search efforts. Concurrent with these initial actions are the establishment of the search area and a formal US National Incident Management System incident command system. That is essential for an efficient operation and will lay the groundwork for expanding the operation past the initial operational period. The goal of applying these standard search management practices is to allow searchers to maximize their efforts, reduce some of the inherent uncertainty, and most importantly, place searchers in a position to detect the missing person.

Wilderness Medical Society practice guidelines for the treatment of acute pain in remote environments.

The Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded based on the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians.

Search and rescue in the Intermountain West states.

BACKGROUND: Minimal data exist regarding the activity, membership, training, and medical oversight of search and rescue (SAR) teams. OBJECTIVE: Our objective was to describe these characteristics in the Intermountain West SAR organizations. METHODS: A contact list was generated and electronic surveys were sent to SAR officials in each Intermountain West county. Results were descriptively analyzed. RESULTS: Of the contacted jurisdictions, 56% (156) responded to the survey. The annual average call volume was 29 missions (range, 5 to 152). Multiple levels of medical training were represented on SAR teams, ranging from first aid/cardiopulmonary resuscitation providers to the physician level, and 79% of teams provided some medical training to their membership. Of the SAR medical professionals, 23% had formal wilderness medical training. Local emergency medical services provided 60% of the medical care on SAR missions rather than SAR personnel. Formal physician medical oversight was present in 41% of the SAR teams. These physicians participated in a range of SAR activities including medical protocol drafting (including expanded scope of practice), medical trainings, mission participation, medical consultation, and prescribing medications for field use. The majority (69%) of those physicians were trained in emergency medicine, and 45% of the active medical directors had protocols allowing for an expanded scope of practice due to the remote nature of SAR medical care. CONCLUSIONS: Intermountain West SAR teams vary in their activity, composition, training, and level of medical oversight. This study confirms that opportunities exist for physician integration with SAR teams in the studied states and likely throughout the United States.