Julyaugust 2010

Also In This Issue:
Marine Bites
and Stings
Mites
Seasickness
Sun Blocks
Aqua Pure Traveller
Wilderness Medicine
Newsletter
July/August 2010 Volume. 23, No. 4
whats Inside
Anywhere in the WMN, if text is

underlined and in blue,
Feature

Departments
16 Tales of the Tapeworm: Mites
20 Common Expedition Problems: Seasickness
23 Medicine Chest: Sunburns and Sunblocks
T.B.R. Walsh 2008
3 Marine Bites and Stings:
26 Youre in Good Hands: Aqua Pure Traveller
WMN Notes
28
Subscriptions & Back issuesordering
29
Back issues (complete index: 1988 to present)
30
SOLO coursesthe current course calendar
All photographs and illustrations not otherwise attributed are T.B.R. Walsh 2010
Disclaimer: The content of the Wilderness Medicine Newsletter is not a substitute for formal training or the recommendation of an expert.
The Wilderness Medicine Newsletter is intended as an informational resource only. Neither
the WMN, nor its staff, can be held liable for the practical application of any of the ideas
found herein. The staff encourages all readers to acquire as much certified training as possible and to consult their physicians for medical advice on personal health matters.
2009 TMC Books, LLC and Stonehearth Open Learning Opportunities (SOLO)
ISSN 1059-6518. All rights reserved. The newsletter may not be reproduced or
distributed without prior consent. Published six times a year.
Wilderness Medicine Newsletter, C/O TMC Books, 731 Tasker Hill Rd., Conway, NH 03818
603-447-5589 tmcbooks.com info@tmcbooks.com
Medical Editor: Frank R. Hubbell, DO Editors: S. Peter Lewis, Lee Frizzell
Departments are written by Dr. Frank Hubbell, DO, or other WMN affiliates.
Design and principle photography by S. Peter Lewis; Artwork by T.B.R. Walsh.
July/August 2010 Vol. 23, No.4
But a certain Samaritan, who was on a journey, came upon him; and
when he saw him, he felt compassion, and came to him, and bandaged
up his wounds, pouring oil and wine on them; and he put him on his
own beast, and brought him to an inn, and took care of him.
Luke 10:43 (NAS)
The Wilderness Medicine Newsletter is dedicated to all the good
Samaritans who do not hesitate to help those in need.
Marine Bites and Stings:
One of the most inviting, relaxing, and beautiful places on earth is the ocean. The soft, warm,
luxurious sand, the gentle, soothing waves, and the spectacular bluegreen waters that reflect
the colors of the sky, draw us near. As we relax in the warm, tropical water, we cant help but
wonder why anyone would have ever wanted to crawl out of the sea, so that they could walk
on the hard earth, propelled by two small feet.
When adventure brings us to the ocean, there are several inherent risks of which we have to
be aware and prepared to manage. These concerns include: marine animal bites and stings,
environmental related problems, accidental poisoning by eating poisonous fish, and for the
SCUBA enthusiast barotrauma
Marine Bites and Stings:
Things that Bite fish, mammals, reptiles, octopi

Things that Stab sea urchins, stingrays, cone shells, lionfish, and stonefish
Things that Sting corals, jellyfish, sea anemones, hydra
Environmental Emergencies:
Heat-related injuries were discussed in detail in the March/April 2009 WMN:

Heat Stroke, Heat Exhaustion, Dehydration & Hyponatremia, and
Sunburn.
Cold-related injury were discussed in detail in the Jan/Feb 2009 WMN:
Hypothermia, Frostbite, and Non-Freezing cold injuries.
Seasickness is discussed in this issue of the WMN.
Poisons of the Sea: Fish Poisons:
These illnesses were discussed in the July/August 2006 WMN:

Ciguatera Poisonings ciguatoxin
Shellfish Poisoning saxitoxins
Scromboid Poisoning histamine overdose
Pufferfish (Fugu) Poisoning tetrodotoxin
Beyond the Golden Hour: Wilderness, Marine, Disaster & Travel Medicine
July/August 2006
ISSN-1059-6518
Volume 19, Number 4
Poisonous Pearls
(of Wisdom)
By Frank Hubbell, DO
*Real Messages Found in Bottles . . .
(Scromboid Poisoning)
(Paralytic Shellfish Poisoning)

(Manchineel Tree
Poisoning)
(Ciguatera Poisoning)
(Carbon Monoxide Poisoning)

*Well, okay, theyre not real messages
Disclaimer: The content of the Wilderness Medicine Newsletter is not a substitute for formal training or the recommendation of an expert. The authors and editors are not responsible for inaccuracies.
INSIDE
Poisoning ............. Cover
Wilderness Medicine Newsletter
Barotrauma: SCUBA-related injuries:
Subscriptions, Back Issues .................... 10,11
Barotrauma-related injuries were discussed in detail in the July/August 2007 WMN:

Squeeze injuries to the ears and sinuses
Decompression Sickness (DCS)
Pulmonary Over Pressurization Syndrome (POPS)
Arterial Gas Emboli (AGE)
Calendar ......... 1 2
January/February
July/August 2006
July/August 2007
issN-1059-6518
Volume 20, Number 4
by Frank Hubbell, DO
A little history:
The discovery and understanding of barotrauma-related injuries began over 100 years ago, long before the invention of
scuba diving. It was first described when laborers began to work inside caissons that were being used to build bridge supports. In order for a bridge to stand, the supporting pillars had to be set on bedrock and not the muddy bottom of a river.
The caisson was invented to remedy this problem.
A caisson is a large, thick, wooden container not unlike a boat. Once built, it was floated to the proposed building site
and then flipped over and sunk to the bottom. Air was then pumped into the caisson to force the water out which created
pressure inside the structure. Laborers could then descend into the caisson and dig out the muck on the bottom of the river.
As they removed the mud and muck, the caisson would slowly settle deeper and deeper into the river bed until it reached
bedrock. As it went deeper, the pressure inside the caisson had to be increased to hold the water back. Increasing the pressure inside the caisson created problems for the laborers who were experiencing terrible muscle and joint pains at the end
of the work day when they came out of the pressure-filled structures. Typically, they had to walk bent over, hence the name
the bends for this decompression illness. When they returned to the pressure-filled caisson, the symptoms would resolve.
Disclaimer: The content of the Wilderness Medicine Newsletter is not a substitute for formal training or the recommendation of an expert. The authors and editors are not responsible for inaccuracies.
iNside
Barotrauma..............Cover
Wilderness Medicine Newsletter
Subscriptions, Back Issues .............................................. 10,11
Calendar12, 13
January/February
July/August 2006
2007
As listed above, in previous issues of the WMN, we have written about barotrauma-related injuries, heat-related
injuries, cold-related injuries, and even fish toxins. In this issue, we will focus on marine bites and stings. These are
the injuries inflicted by various creatures in the ocean that can be a threat to those enjoying the water. These threats
consist of things that bite, things that stab, and things that sting along with their related signs and symptoms, lifethreats, and treatments.
THINGS THAT BITE

sharksmoray eelssea snakesbarracudassquidsealssharkscrocodilesoctopi
sharksmoray eelssea snakesbarracudassquidsealssharkscrocodilesoctopi
The vast majority of animals that live in the ocean are not a threat to us. However, there are large pelagic fish, reptiles, and mammals with formidable teeth
and a big appetite that can potentially cause physical harm and even death. The
obvious offenders that come to mind are the large predatory fish such as sharks,
barracuda, moray eels, the large reptiles like the salt-water crocodile, as well as
seals, walruses, and sea lions. However, there are also sea creatures that cannot
only cause soft tissue damage with a bite, but are also venomous, such as sea
snakes, octopi, cuttlefish, and squid.
The fact of the matter is that just about any fish, marine reptile or marine
mammal can and will bite if cornered, caught, or handled. The best way to
avoid being bitten is to avoid such encounters.
The following are a few simple, easily employed guidelines that you should
keep in mind when swimming, snorkeling, or SCUBA diving in the ocean.
These will help to prevent injury and may even save your life.
Avoid areas of known predatory animal and jellyfish concentrations.
Do a little research about the area you are going to be recreating in. Try to determine if there are any specific areas
or times of year when predatory fish, such as sharks, congregate. The same goes for specific times when jellyfish are
known to mass together or even times of increasing water temperatures when blooms of algae can occur, causing a
red tide.
Avoid power plant and waste plant outlets, organic waste areas, and river mouths.
In these areas the water tends to be warmer, which attracts the smaller bait fish that the larger fish like to feed on,
increasing the number of potentially dangerous predatory fish.
Avoid known breeding areas.
Understand some of the natural history of the area you are going to. During the proper season sharks, barracuda,
large squid, or other large predatory fish will congregate in specific areas to breed and feed.
Avoid wearing bright, sparkly items like jewelry, necklaces, or dog tags.
Bright, shiny objects flickering in the water may resemble a tasty morsel such as a small baitfish to the larger predatory fish, inviting the predator to take a bite, which may include you.
Be careful in the water at night, especially in the shallows around the coral reefs.
Many of the large pelagic, open ocean, predators, as well as the reef predators, come out at night to feed on the
smaller fish hiding, resting, and seeking refuge in the coral reefs.
Be careful in water with low visibility.
Debris, tangles, and predators may be difficult or impossible to see and avoid. With their specialized organs, they
can see you, but you cant see them.
Do not disturb:
Try not to disturb, chase, or act threateningly to any marine creature. The water is their home, and they are designed to be there. They can swim much faster than you can, and they may have defenses that you did not anticipate.
Dont Touch:
Do not try to touch, pick up, poke, prod, or handle any sea creatures or corals.
Dont Probe:
Do not blindly reach into holes, caves, or dark places, as you have no idea what is in there it might just take you
hand off.
Dont Kick:
Do not kick or step on the reef or the corals, and be careful where you put your feet when you stand on the sea
floor. You can damage the creatures and coral and, in return, they can hurt you.
Remember that usually the last thing the victim said was, Hey guys, watch this.
Symptoms of a non- venomous marine animal bite:
Bites may be the result of a defensive reaction or an attempt to make you part of the food chain.
The injuries caused by these animals are essentially the same as land-based bites.
There is the primary tissue damage and bleeding to deal with and then the long-term risk of infection.
These wounds may be severe or minor, depending upon the type and size of the creature.
The wound will be a combination of punctures, lacerations, avulsions, and amputations.
Bleeding may be profuse and arterial, requiring direct digital pressure.
The bite may result in a traumatic amputation where the missing part has been swallowed, and a tourniquet may be
required to control the bleeding.
Be prepared to treat for shock.
The Principles of Treatment of Non-Venomous Marine Bites:
A ASAP: Get the patient out of the water ASAP.

A AIRWAY: Airway, Airway, Airway monitor and manage.
B BREATHING: Be prepared to provide artificial respirations as needed.
B BLEEDING: Stop the BLEEDING with direct pressure.
Blood in the water can lead to feeding frenzy activity in many species.
In shark bite cases, it may be better to keep a wetsuit in place as this will help to apply direct pressure to the
wounds.
C CLEAN: Clean the wounds aggressively and rinse multiple times with a dilute solution of iodine in fresh water,
not salt water. Salt water may look pure and clean, but it is chock full of infectious bacteria that can cause serious
infections.
Consider tetanus prophylaxis. When was their last tetanus booster?
D DONT: Do not suture or tightly close the wounds, as this will increase the risk of deep, potentially life-threatening infection.
E ENVIRONMENT: Get the patient dry and protect them from the environment; treat for shock as appropriate.
E EVACUATE
SPECIFIC VENOMOUS SE A CRE ATURES

Cephalopods Octopi, cuttlefish, squids, and nautiluses:
These animals have to be mentioned under bites as they each possess a bird-like beak in the center of their multiple
limbs. The beak can cause a wound, that is usually minor, but along with the bite, they also have a toxin that can be
potentially life-threatening. They all have long flexible arms with suckers to capture and hold their prey. The prey
is then drawn into the center of their bodies where a beak is located. The beak is able to break open the hard shell
of a mollusk or crab: at the same time it injects into its prey a lethal toxin. It is interesting that they can then eat the
meat as they are immune to their own toxin.
The Blue-ringed Octopus:

This octopus has a complex venom consisting of tetrodotoxin, hyaluronidase, tyramine, histamine, tryptamine, octopamine, taurine, hydroxytryptamine, acetylcholine, and dopamine.
The major component that causes the most problems is the tetrodotoxin, a neurotoxin. The
toxins are created by bacteria that live in the salivary glands. Within minutes these toxins will
cause motor paralysis and respiratory arrest.
Symptoms of a Blue-ringed Octopus envenomation tetrodotoxin:

Pain at the bite site
Conscious motor paralysis
Respiratory arrest that will lead to cardiac arrest without artificial ventilations
istockphoto.com/Island Effects
All octopi, cuttlefish, and most squids possess this toxin that is delivered via its beak. However, one octopus in particular deserves special mention, as its toxin is lethal to humans: the small Blue-ringed Octopi that live in tidal pools
of the Pacific Ocean, from Australia to Japan.
Blue Ringed Octopus
Treatment of the Blue-ringed Octopus envenomation tetrodotoxin:
Airway and Breathing

Airway and artificial ventilation. Even though the victim is paralyzed, they are conscious and fully aware of what it
going on. If you are able to maintain an open airway and breathe for them, their liver will detoxify the toxin, and
they will survive. But, this can be a daunting task, as this process can take up to 24 hours, and during this time you
have to provide artificial ventilations.
(This is the same tetrodotoxin that is consumed when eating Fugu or Pufferfish, as it is commonly known.)
Please remember this is a conscious paralysis, and your patient is acutely aware of what it going on.
There is no available antitoxin/antivenom for the Blue-ringed Octopus.
Transport ASAP for advanced care and respiratory support.
istockphoto.com/Glenn Rose
Sea Snakes:
There are 17 genera of sea snakes, comprising 62 species, all of which are venomous elapid snakes in the same family as cobras, Elapidae, and the majority of
which are highly venomous.
The good news is that bites are rare. When they do occur, there is usually very
little venom injected.
They are found in the warm, tropical coastal waters from the Indian Ocean to
the Pacific Ocean.
Although they do not have gills and have to surface to breathe, they can remain submerged for several hours.
With flat, paddle-like tails, they are excellent swimmers, but move very poorly
on land.
They range in size from 1 10 feet long, and they can swim as deep as 300.
Symptoms of a Sea Snake bite and envenomation:
Post-bite onset of symptoms is 30 minutes to hours later.

Bites are usually painless.
There is very little or no swelling.
No lymphadenopathy.
There may be teeth left in the wound.
The primary symptom is rhabdomyolysis rapid breakdown of muscle
tissue.
There may be muscle pain (myalgia) especially with stretching, or
muscle weakness leading to paralysis.
Treatment of Sea Snake envenomation:
Try to identify the snake if possible, but do not waste valuable time and
do not risk being bitten.
Airway is a concern. Be prepared for airway control.
Breathing: Monitor for respiratory distress.
Apply a pressure immobilization splint to the bite site and involved extremity.
Transport/Evacuate ASAP as they may require antivenom administration.
There is a polyvalent available for the 31 species of sea snakes found
around Australia.
Pressure Dressing Treatment of Sea Snake Envenomations:
This is essentially the same technique that is used for venomous landbased snakebites.
Wrap the extremity with a wide bandage, preferably elastic, starting at the
bite site and progressing proximally up the limb.
This wrap stops lymphatic drainage and decreases the rate at which the
venom enters the blood stream.
Continue to wrap the entire limb distal to proximal and then again proximal to distal.
The limb should then be immobilized with a splint or arm sling and
swathe.
THINGS THAT STAB
Pressure Immobilization Splint

with Elastic Wrap
stingrays ...starfishsea urchins...lionfishrockfishstonefishstargazerscone shells
There are a wide variety of sea creatures that possess some sort of spines, barbs, or harpoons, all of which also have
associated venoms. These toxic weapons are used to either deter predators or capture and kill prey. Most of the
time you come into contact with their defense system by accidently stepping, kicking, or mishandling them.
There are two groups that use sharp, pointed bits and pieces covering their extremities and bodies for protection. The same defense strategy used by porcupines on land, it makes a very effective, passive, defensive shield.
Along with all the pointed bits, there are also biotoxins in their skin and spines that become implanted into the stab
wounds of those who would prey upon or step on these delicate creatures.
One set of sea creatures that takes advantage of the strategy of toxic spines are the Echinodermata. The spines are
strictly defensive to protect them from predators.
The Echinodermatas are in four families:

Brittle Stars Ophiuroidea
Starfish Asteroidea
Sea Urchins Echinoidea
Sea Cucumbers Holothuroidea
There are also many sea creatures that can also cause damage via a defense system consisting of sharp, pointed
barbs as well as spines imbedded in their dorsal fins. These barbs not only inflict pain and damage, but they also
deliver complex venoms. Like the Echinodermata these are weapons of defense not used to obtain food. These are
the venomous fish.
There are five families of venomous fish that take advantage of this defense system:
Stingrays Dasyatidae
Lionfish or Scorpion Fish Scorpaenidae
Rockfish and Redfish Sebastidae
Stonefish Synanceiidae
Stargazer Uranoscopidae

The last of the venomous sea creatures are the Cone shells with their venomous harpoons. This is a large group of
mollusks that have the ability to thrust or project a poisonous harpoon into unsuspecting prey, a lethal weapon
used to secure dinner.
Cone Shell Conidae
istockphoto.com/Island Effects
Specific Things That Stab

The Echinodermatas: Toxic Spines
Brittle Stars Ophiuroidea
Starfish with multiple arms covered by spines.

Slow-moving creature found on the bottom of the ocean on and
around the coral reefs.
Stepping on or mishandling one can result in multiple impaled spines.
Brittle Star
The Crown of Thorns (Acanthaster planci) is the only known venomous starfish.
The arms have large spines with venom-producing integument or
skin.
There is a complex biotoxin produced in the integument or skin.
When the thorns penetrate the skin, they cause direct soft tissue
damage and implant the biotoxin into the wound.
Symptoms of Brittle Star or Crown of Thorns spines

and envenomation:
istockphoto.com/IT.Light
Starfish Asteroidea
Crown of Thorns
Pain and soft tissue damage at the site from the impaled spines and
bards.
Envenomation causes rapid onset of swelling (edema), redness (erythema), and pain.
Treatment of Brittle star Crown of Thorns wounds:
Remove any thorns or foreign material with tweezers or forceps.

Cleanse the wound with soap and water or a dilute iodine solution and immerse in non-scalding hot water for 60
90 minutes.
(Non-scalding hot water is water as hot as you can stand it without getting burned.)
Monitor for and treat anaphylaxis.
Long-term: Monitor for signs of infection and treat with antibiotics if needed.
Consider tetanus prophylaxis.
Transport ASAP
There is not an antivenom for Crown of Thorns starfish envenomation.
Sea UrchinsEchinoidea:
Easily recognized creatures that live on the bottom and feed on corals.
These are slow-moving, lower order sea creatures that are covered with hollow, mobile spines
of various lengths, 1cm 20cm.
The spines become impaled in a persons body, particularly feet and hands, when they accidently kick or step on a sea urchin.
The spines contain complex biotoxins. Being very brittle, they tend to break off in the wound.
Resulting injuries are multiple puncture wounds with foreign materialspines imbedded in the woundand biotoxins and infectious bacteria implanted deep in the soft tissues.
Sea urchins also have mouthparts that consist of a seizing organ to capture prey as well as pedicellaria, that are
pincer-like jaws, to grasp and hold their prey while injecting a lethal venom.
Symptoms of sea urchin stab injuries:

Immediate onset of pain
Spines in the soft tissues and possibly joints
Joint pain
Swelling (edema)
Numbness
Treatment of stab injuries and envenomation:
Sea cucumbers Holothuroidea
Soft and easily handled, these are large, slow-moving sea creatures found on the sandy
bottoms.
They can be toxic to eat if not properly prepared.
There are biotoxins in their body wall as well as in the organs of Culvier, which are tubules
just inside the anus that can be extruded out when they feel threatened.
Their biotoxin is primarily a contact skin and eye irritant that can cause a contact dermatitis.
istockphoto.com/Gary Martin
Remove spines or thorns carefully by pulling straight out; do not twist, wiggle, or bend, as they will break off in the
tissue.
Control bleeding.
Immerse the wounds in non-scalding hot water for 60 - 90 minutes for pain relief.
(Non-scalding hot water is water as hot as you can stand without getting burned.)
Dark markings in the wound are dyes that are left behind when the spines are removed.
Clean aggressively by rinsing with copious amounts of fresh water containing a solution of dilute iodine.
Be prepared to treat for shock.
Evacuate for further assessment and treatment. They will most likely require x-rays to determine if spines have been
retained in their flesh.
Long-term care: Monitor for infection. Give antibiotics as needed.
Symptoms of sea cucumber toxins:
Local redness, itching, and pain.

If the eyes are involved, there may be intense pain and blindness.
Treatment of sea cucumber toxins:
Copious irrigation of the affected area with fresh water.

Transport ASAP if the eyes are involved.
The Venomous Fish Toxic Barbs

Stingrays Dasyatidae
Flat, diamond-shaped with a long tail housing a long, barbed spine.
These relatives of the shark are relatively timid.
Most stings are as a result of a wader stepping on a stingray in shallow,
generally calm water. Wounds may be very deep, usually into the foot,
ankle, or calf, and they are very dirty.
Lionfish or Scorpion Fish Scorpaenidae

Rockfish and Redfish Sebastidae
Stonefish Synanceiidae
Stargazer Uranoscopidae
Lionfish or Scorpion Fish, Rockfish, Redfish, Stonefish, and Stargazer:
istockphoto.com/David Pedre
These fish have venomous spines built into their fins, which may also
be projecting from their heads and around their eyes.
Like the Lionfish or Scorpion Fish , they can be very flamboyant and
easily seen freely swimming about, or like the Rockfish, Stonefish, and
Stargazer, they may be settled on the bottom, partially hidden in the
sand blending into their surroundings and very hard to notice.
Typically, envenomation occurs from stepping on or mishandling these
fish.
The Stonefish is found in the waters off the Australian coast. It is the
Lionfish
most venomous fish and requires antivenom treatment. It is estimated that one half of all the antivenoms used in
Australia are for Stonefish envenomations.
The Stargazer is not only venomous, but it can also deliver an electric shock.
Symptoms of these stab wounds and envenomations:

Rapid onset of pain, which can be severe
Spines or barbs imbedded in the soft tissues
Treatment of these stab wounds and envenomations:
Recognize the specific injury.

Remove the stinger and/or sheath.
Scrub the wound and clean it aggressively.
Immerse wounds in non-scalding hot water for 30+ minutes for pain relief.
Evacuate; the likelihood of impaled object and infection is high.
May require antivenom; there is Stonefish antivenom available in Australia.
10
The Venomous Mollusks - Cone Shells: Toxic Harpoons

Cone Shell Conidae:
These sting via a venomous tooth or harpoon that is thrust out from the shell.
Deaths have been attributed to envenomation.

Symptoms of Cone Shell envenomation:
Sharp burning or stinging sensation and numbness at the wound site.

Generalized muscle paralysis which may lead to respiratory failure and cardiac arrest.

Treatment of Cone Shell envenomation:
Monitor airway.
Treat like the Sea Snake envenomation by applying a light constricting elastic wrap over the extremity and splinting
to immobilize the extremity.
Evacuate to a medical facility if their condition deteriorates.
Immerse the limb in non-scalding, hot water (110-115oF) for 30 90 minutes.
Golden Rules in Ocean Envenomation IF STABBED, IMPALED, or HARPOONED:

C CONE SHELL: Consider whether they are going to require Cone Shell antivenom.
D DEBRIDE: Remove any spines, thorns, barbs, or harpoons and associated sheaths.
D DUNK: Soak the affected area in non-scalding hot water for 60 90 minutes.
E EVACUATE: Evacuate to definitive care ASAP.
Long-term care:
Retained impaled objects are very common.
Patients will require an x-ray to look for retained foreign body or spines.
Secondary infections are very common.
THINGS THAT STING

fire coralsjellyfishsea anemonesPortuguese man-of-warhydraIrukandji
fire coralsjellyfishsea anemonesPortuguese man-of-warhydraIrukandji
Corals, Jellyfish, Sea Anemones, Hydra: Nematocyst
What these sea creatures all have in common are small, stinging organs called nematocysts, which, when stimulated,
will deliver a potentially lethal toxin.
Nematocyst Envenomation Cnidocyte, Cnidoblast, Nematocyst
A nematocyst is a type of venomous cell, an organelle, that has the ability to deliver
a toxic or poisonous injection.
They are unique to the phylum Cnidaria corals, sea anemones, hydra, and jellyfish.
These cells are used to capture and kill prey as well as a deterrent or defense against
marauders.
These cells are bulb-shaped capsules containing a coiled hollow thread with a
harpoon-like tip. Oriented externally, they are designed to fire into the flesh of
11
anything that touches them. They have a trigger. When activated, the nematocyst capsule fires. Within nanoseconds
the harpoon has become implanted into the soft flesh and the toxin delivered.
The number of nematocysts on a fire coral, sea anemone, or jellyfish tentacle can vary from hundreds per centimeter into to millions. When they come in contact with the skin, they do not all fire; some will remain intact but can be
triggered later by inappropriate care and first aid.
The strength of the toxin varies with the different species. The most toxic to humans are the Box Jellyfish, such as
the Sea Wasp, Chironex fleckeri, which is considered to be one of the most venomous of all marine animals. Other
extremely dangerous jellyfish and potentially lethal jellyfish are the Lions Mane (Cyanea capillata), Portuguese Man o
War (Physalia physalis), and the Irukandji Jellyfish (Carukia burnesi)
Symptoms of nematocysts envenomation:
Vary with the specific toxin of the venom and severity of envenomation.
Initial burning or stinging pain and itching of the affected area.
In the following 5-30 minutes welts develop, marked by redness, warmth, and itching.
Pain generally resolves over 60-90 minutes, but the pain can also last days and be incapacitating.
If untreated and minor: welts will flatten over 14-24 hours, and totally resolve over 3-7 days.
Severe envenomation may result in skin necrosis, ulceration, secondary infection, and death.
Treatment of nematocysts envenomation:
Flood area with vinegar.

Rinse liberally with seawater. Do not use fresh water as this will cause more nematocysts to discharge.
Flood area with any liquid that contains a high alcohol content to inactivate nematocysts.
(e.g., drinking alcohol, rubbing alcohol, cologne, perfume)
Remove nematocysts by further rinsing the area with seawater.
Abrade neutralized nematocysts with sand or other mild abrasive and shave with a firm
plastic edge (credit card for example).
Prolonged wound care may be needed for treatment of secondary infection.
Evacuate ASAP. Artificial respiration may be required.
SPECIFIC CNIDARIA:
Corals:
Small marine organisms that live in colonies, they are well known as reef builders. Each individual coral polyp possesses tentacles that are covered with nematocysts allowing the coral to harvest small prey.
Fire Corals may appear to be corals, but they are not. They are more closely related to jellyfish. It can look like coral,
or it can coat other corals. Fire Coral is usually a yellow or mustard color. The name fire comes from the intense pain
that occurs on contact with the Fire Coral and its nematocysts. They are widely distributed in tropical and sub-tropical waters.

Sea Anemones:
Simple creatures with pliable, stalk-like arms that fix to a spot commonly found in and among corals, they inhabit the
same geographic range as corals. Like corals, they also possess stinging nematocysts, which they use to capture and
kill prey.
Hydra:
Even though hydra are fresh water, not salt water, they are mentioned here for the sake of completeness.
Hydra are small, a few millimeters long, fresh water, not salt water, animals that look like miniature anemones. They
are found in unpolluted fresh water ponds, lakes, and streams in temperate and tropical waters.
12
Specific Jellyfish:
Portuguese Man o War:
istockphoto.com/Jeanette Zehentmayerr
Also known as a Blue Bottle Jellyfish it has nematocysts covering the tentacles.
It floats and travels via a gas-filled bladder/sail.
Its tentacles hang below the floating gasbag, and a long tentacle will trail behind it.
These trailing tentacles, up to 20 feet long, recoil when they come in contact with another living organism, pulling
the Man o War to it and then stinging its prey on contact.
Death is extremely rare and most likely to occur in the young or old who sustain massive stings and/or drown.
Most commonly found 30o north and south of the equator globally.
Envenomation can occasionally cause muscular cramps and chest tightness.

Box Jellyfish and Irukandji:
Common to Australian and Indonesian waters, these are considered

to be some of the most venomous sea creatures in the world; they
can cause death in as little as several minutes.
Box Jellyfish come in a variety of sizes from very small (inches) to very
large (yards).
The Irukandji Jellyfish is very small, 1 - 3 inches in length, and almost
transparent, making it difficult to see. While the sting itself is mildly
irritating, the onset of severe pain occurs in 5 120 minutes. This is
referred to as Irukandji Syndrome.
Symptoms of Box Jellyfish or Irukandji envenomation:
Immediate intense pain.

Can be unconscious within 2 minutes.
Welts and small, clear fluid-filled blisters at site.
Skin blisters within 6-8 hours, and superficial necrosis develops within 12-18 hours.
Muscle cramps, back pain, abdominal pain.
Hypertension.
Occasionally pulmonary edema and cardiac complications.
Pain can last for days to weeks and can be incapacitating.
Death can occur in minutes.
Treatment of Box Jellyfish or Irukandji envenomation:
Inactivate nematocysts by flooding area with vinegar.

If vinegar is not available, use any isopropyl alcohol or ethyl alcohol.
Apply a light constricting band that should be placed proximally.
Keep the victim calm.
Evacuation should be immediate. Box Jellyfish antivenoms are available.
Golden Rules for Things that Sting:

B BATHE: Neutralize the venom of the nematocyst with vinegar, alcohol, or urine.
Do not rinse with fresh water.
Remove the nematocyst with sand, scraping the area with a piece of hard plastic or using tape.
Avoid getting the nematocyst on anyone else.
Evacuated ASAP, and consider the use of antivenoms if appropriate.
13
SUM M ARY TRE ATMENTS for M ARINE BITES AND STINGS

The Golden Rules of Marine Bites:

In shark bite cases, it may be better to keep a wetsuit in place as this will help to apply direct pressure to the
wounds.
C CLEAN: Clean the wounds aggressively
D DONT: Do not suture or tightly close the wounds.
E ENVIRONMENT: Get the patient dry and protect them from the environment; treat for shock as appropriate.
E EVACUATE
Special Considerations:
If it is a Blue-ringed Octopus envenomation:
Please remember this is a conscious paralysis.
There is no available antivenom for the Blue-ringed Octopus.
Transport ASAP for advanced care and respiratory support.
If it is a Sea Snake envenomation:
Try to identify the snake.
Apply a pressure immobilization splint to the bite site and involved extremity.
Transport/Evacuate ASAP as they may require antivenom administration.
Long-term care:


Monitor for infections.
Golden Rules If Stabbed, Impaled, or Harpooned:

C CONE SHELL: Consider whether they are going to require Cone Shell antivenoms.
D DEBRIDE: Remove any spines, thorns, barbs, or harpoons and associated sheaths.
D DUNK: Soak the affected area in non-scalding hot water for 60 90 minutes.
E EVACUATE: Evacuate to definitive care ASAP.
Monitor for anaphylaxis.
Long-term care:
Retained impaled objects are very common.
Will require an x-ray to look for retained foreign body or spines.
Secondary infections are very common.
Golden Rule for Things that Sting:

B BATHE: Neutralize the venom of the nematocyst with vinegar, alcohol, or urine.
Do not rinse with fresh water.
Remove the nematocyst with sand, scraping, or tape.
Avoid getting the nematocyst on anyone else.
Evacuate ASAP, and consider the use of antivenoms if appropriate.
14
Blue Water Sailors:

A special note to those who may find themselves on the high seas away from immediate care in the arena
of extended care, even if just for a day sail. There are several medications and pieces of equipment that
would prove to be very useful and even life-saving in the event of a marine bite or sting.
We would suggest that you carry these items as part of you first aid kit or medicine chest:
Vinegar at least 1 gallon.

Forceps for removing spines and barbs.
4 elastic bandages.
Mouth-to-mouth artificial ventilation mask.
Medications:
Antihistamines for allergic reactions. The drug of
choice is Benadryl Chewable Tablets, 25mg each.
For allergic reactions give 50mg every 4 hours for 24
hours.
Epinephrine in the form or an autoinjector, the EpiPen
or Twinject. To be used for an acute anaphylactic
reaction.
Antibiotics:
Most marines bites or stings will become infected over
24 hours.
Suggested antibiotics for the medicine chest would
include:
Bactrim DS (trimethoprim/sulfamethoxazole), 1 by
mouth every 12 hours for 7 days.
(cannot take if they are allergic to sulfa drugs)
Cipro (ciprofloxacin) 500mg, 1 by mouth every 12
hours for 7 days.
Keflex (cephalexin) 500mg, 1 by mouth every 6 hours
for 7 days.
15
By Frank Hubbell D.O.
illustrations by T.B.R. Walsh
Mites Chiggers
and Scabies:
Tales of the Tapewor m
For six issues of the WMNL, human ectoparasites are being discussed. Myiasis, caused by
the botfly, Tungiasis, an infestation caused by the Tungas penetrans flea, and lice have been
written about. In this issue we will focus on mites.
Fly maggots:
Myiasis: Dipterous fly larva, botfly, flystrike or fly-blown. (January/February 2010)

Tungiasis: Tungas penetrans, Chigger flea, jigger, or sand flea. (March/April 2010)
Lice: (May/June 2010 issue)
Pediculosis capitus: Head lice
Pediculosis corporis: Body lice or Vagabonds Disease
Pediculosis pubis or Phthriasis pubis: Crabs or pubic lice
Mites: (this issue, July/August)
Scabies: Sarcoptes scabiei : Itch mite, mange, crusted scabies, Norwegian scabies
Trombiculiasis: Trombicula: chiggers, harvest mites, red bugs, scrub-itch mites
Ticks: Ixodes, Dermacentor, Amblyomma, ticks that can spread disease, such as Lyme Disease. (will be discussed in the September/October 2010 issue)
Bedbugs: (will be discussed in the November/December 2010 issue)
Cimicidae
MITES:
There are over 48,200 species of mites, and it is estimated that this is only about 5% of their diversity.
Most mites are microscopic; therefore, they go unnoticed.
Many live freely in the soil and water.
A large number are parasitic of both plants and animals.
Fortunately, for us, very few of the thousands of species of mites are a bother or a concern. But, there
are several species that can be a nuisance to us and can also spread disease. The mites that we are
concerned about are scabies, chiggers, and ticks.
In this article we will take a close look at chiggers and scabies. Ticks will be discussed in the next
WMN. Scabies was discussed in the September/October issue of the WMN, but it will be included
here for the sake of completeness.
CHIGGERS:
Chiggers are of the family Trombicula, and they are typically referred to as berry bugs, harvest mites,
red bugs, or scrub-itch mites. Commonly found in forests and grasslands in the low damp areas, they
inhabit the grasses, bushes, and detritus on the forest floor.
16
Their life cycle begins as an egg that hatches into a larva. It

is the larva that feeds on a host and after several days drops
off onto the ground where it molts into a nymph. The nymph
will eventually molt into an adult that is ready to breed and
lay eggs. It is the larval stage that is looking for a meal, and if
we are the host, it is invasion of the larva that will cause the
infestation, skin rash, and possible disease.
The chiggers larva does not burrow into the skin. Instead
they secrete a digestive saliva onto the skin that dissolves
the cells making a small pit. They then use a feeding tube
to sip up the fluid and eat tiny bits of the cells in the pit. It is
a reaction to the sava that causes the rash.
li-
The rash consists of small erythematous (red) papules (raised

bumps) that are very pruritic (itchy) and hives. The rash tends
to be around the waist line, ankles, arm pits, and anywhere that
clothing fits tightly. Because of the itchiness, usually there is evidence of scratching.
In North America and other temperate climates chiggers such as
Trombicula alfredduges can be a cause of a skin rash, itchiness, and a
secondary bacterial infection, cellulitis, from scratching , but, they
do not spread any other diseases. However, in other parts of the
world, Trombicula autumnalis can carry and spread the bacterium, a
Rickettsia, Orienta tsutsugamushi, that causes scrub typhus.
Scrub Typhus
Scrub typhus is found primarily in the Tsutsugamushi Triangle that ranges from northern Japan and fareastern Russia in the north, to northern Australia in the south, to Pakistan and Afghanistan in the west.
Symptoms of scrub typhus:
The rash as described above plus:

Fever
Headache
Mayalgia (muscle pain)
Cough
Gastrointestinal upset
Treatment of scrub typhus:
Without treatment the disease is often fatal.

With treatment the fatality rate is <2%.
The drug of choice is doxycycline 100mg po bid x 14 days.

Or chloramphenicol 500mg po qid x 14 days.
In areas where there is resistance to doxycycline Rifampin or Azithromycin are alternatives.
Another complication of a chigger infestation, as was mentioned earlier, is the risk of a skin infection
17
from scratching. Roughing up the skin can allow staph and strep bacteria, that are normally found on
the skin, to invade into the deeper layers and multiply, causing a skin infection cellulitis.
When cellulitis occurs, as the bacteria multiply in the skin, the area will become warm to the touch, red,
and may develop a honey-colored exudate on the surface of the skin. Avoid touching the exudate as
this can spread the cellulitis to other parts of the body or other people.
This type of cellulitis is referred to as impetigo or erysipelas and is treated with appropriate antibiotics.
The prescription antibiotic cream Bactroban or Altabax and oral antibiotics are very effective against
staph and strep bacteria. You can use any of the penicillins (amoxicillin, penicillin, dicloxacillin), macrolides (erythromycin), or sulfa drugs (Bactrim or Septra) as well.
Prevention of chiggers and scrub typhus:
Avoid camping or picnicking in low-lying, dampish areas.

Wear proper clothing and tuck your pants into your socks.
Use an insecticide on your clothing such as permethrin or NEEM.
SCABIES:
(this was in the September/October 2009 issue of the WMN)
Sarcoptes scabiei, variety hominis
Scabies is Latin meaning to scratch. It was first described over 2500 years ago as a mite on the skin.
Scabies is a very small mite that spends its entire life-cycle
in and on human skin.
It is an obligate ectoparasite that infects the skin and causes
a red, itchy rash.
Scabies is very common worldwide with an estimated 300
million new cases annually.
Every traveler is at risk of contracting this bothersome rash.
Etiology:
Scabies rash is caused by the adult female mite burrowing

in the stratum corneum layer of the skin. As she burrows
her way through the skin, she excretes waste into the tunnel
she is building and lays eggs as well. She can survive in the
skin for up to 2 months. The excrement in the burrow causes an allergic reaction and the production of
histamines with the resulting redness of the burrow and itchiness. The itchiness (pruritis) seems to be
much worse at night.
The eggs hatch into larvae in 3 10 days. The larvae make their way onto the surface of the skin and
seek out hair follicles, where they feed, grow, molt, and turn into adults. The adults on the surface of the
skin survive for 3 4 weeks. The males remain on the surface to breed, and the females burrow into
the stratum corneum layer of the skin where the life-cycle starts again.
Scabies entire life-cycle is on humans, and it is spread from person to person by skin-to-skin contact.
Most typically it is spread by a simple handshake where one person passes the mite onto another per-
18
son. The newly infected person then scratches and plants the mite on their skin. It can also be passed
on in hostels and day care centers where there is close physical contact or the sharing of bedding.
The hallmark of scabies is the itchy rash. The rash consists of small erythematous (red), flat macules
that may have a thin red line attached to it, the burrow. Typically these spots are described as being
shaped like a hockey stick.
Since the rash is commonly spread by a handshake, the rash is usually on the hands in the web space
between the fingers. The rash can also be found on the hands, wrists, axilla (arm pits), areola of the
breasts, male genitals, buttocks, and around the waist at the belt line, but is very rarely seen on the
face, scalp, neck, soles of the feet, or palms of the hands.
From the excoriation and trauma to the skin from scratching,
it is very possible to get a secondary bacterial infection from
staph, impetigo, or a fungal infection tinea.
Signs and Symptoms of Scabies:
Rash that spares the face, scalp, palms, and soles of the
feet.
Itchiness (pruritis) that is worse at night.
Possible secondary bacterial infection from the trauma of scratching.
Diagnosis:
Clinical Based on the rash, location of the rash, and the nighttime itchiness.
Treatment:
Permethrin cream (Elimite). Applied from the tip of the toes to the chin, rubbed into the skin, it is left on
overnight and rinsed off in the morning. The itchiness and rash may remain for several more days while
the mites and waste products dissolve. The treatment should be repeated in two weeks, as the permethrin only kills the adults and does not kill the eggs. A second application of the permethrin will kill off
the mites that have subsequently hatched.
For the itch: An allergy medication or an antihistamine, such as Benadryl (diphenhydramine), can be
used to treat the itch.
Bedding and pajamas should be washed the day the permethrin is rinsed off to prevent reinfection. Normal washing will kill the scabies mites. Anything that cannot be washed should be treated with permethrin.
As with chiggers, scratching the rash can cause a skin infection, cellulitis, known as impetigo or erysipelas. The prescription antibiotic cream Bactroban or Altabax and certain oral antibiotics that are effective against staph and strep bacteria work well. You can use any of the penicillins (amoxicillin, penicillin,
dicloxacillin), macrolides (erythromycin), or sulfa drugs (Bactrim or Septra). Check for drug allergies.
Prevention of scabies can be very difficult as it is passed from person-to-person by a simple hand-
19
by Frank Hubbell,
COMMON
expedition
problems
Annoying ailments, afflictions, and mishaps. . . .
Seasickness or Mal de Mer

Seasickness, historically known as mal de mer, is a form of motion sickness caused by the pitching
and heaving motions of a boat on the high seas.
In Isaac Asimovs 1963 book, The Human Body, he relates a marvelous anecdote that describes the
effects of seasickness perfectly. A steward on a large sailing vessel was trying to cheerfully reassure
the passengers that no one ever dies of seasickness, that they would all make it through. One of the
passengers noted, Please its only the hope of dying that is keeping me alive.
Seasickness is the misinterpretation of neural information coming in from the parts of the body that are
responsible for balance and equilibrium.
What is balance and equilibrium?
It is obviously very important that we know where we are in space at all times; otherwise, we will have
a very difficult time walking, running, or even simply standing up. There are three different sets of sensors that our brain constantly monitors to maintain balance. These sensors are in the eyes, ears, and
the proprioceptors located in our extremities, back, and neck.
EYES:
Our eyes provide the visual reference. They tell us what is up, what is down, what is slanting, and how
steep the grade is. They tell us if we are standing on flat ground or sloped. Most of us can close our
eyes and not fall over because the information coming from the eyes is just part of the data flowing to
the brain to maintain equilibrium.
EARS:
The ears are actually two organs in one. Theyre
designed for hearing and for balance. The cochlea of
the ear receives sound waves and converts them to
neural signals for the brain to interpret as sound.
The ears also contain the vestibular system which
consists of a series of three fluid-filled semicircular canals, perpendicular to each other, and two fluid-filled
chambers, the utricle and saccule. The semicircular
canals interpret up and down and side-to-side motion,
as opposed to the utricle and saccule which interpret
linear motion or acceleration and deceleration.
20
PROPRIOCEPTORS:
Throughout the body, especially located along the back and at the major joints, are specialized nerves
called proprioceptors, or position sensors, that tell us where we are in space.
It is the combination of data streaming in from the eyes, ears, and proprioceptors that keep us oriented,
upright, and balanced. This combination is what allows us to walk across a balance beam or tightrope,
play sports, or even drive a car. Of the three the ears have the greatest input and control, and it is the
ears that can cause the most trouble.
Symptoms of Seasickness:
Jeff Fongemie 2007
Motion sickness and seasickness, in particular, occur when all these neural signals flooding into the
brain do not match up. When a mismatch has occurred, and the brain cannot properly interpret the
data, vertigo, dizziness, and nausea are the result.
Jeff Fongemie 2007
Early signs: yawning, sighing, and drowsiness that progress to:

Dizziness
Vertigo
Headache
Cold sweats
Nausea
Dry heaves
Belching
Vomiting (Usually, vomiting will relieve the nausea, at least temporarily. But, in the case of seasickness,
vomiting does not.)
Treatment of Seasickness:
Treatment focuses on stabilizing the vestibular apparatus in the ears and shutting down the vomit or
emetic center in the brain within the lateral reticular formation of the brainstem.
Eben Widlund 2004
Take the helm and steer if possible.

Focus on and watch the distant
horizon.
If not steering, position yourself by
getting to the midship or wheelhouse
and ride the waves. Actively use
your legs like pistons to keep your
head and upper body as still as possible. Absorb the motion with your
legs, as if you were skiing or skate
boarding.
Eben Widlund 2004
At the first warning signs of

seasickness:
Focus on the horizon
Go with the motion

and face forward
If symptoms worsen, try to lie down in a well-ventilated

area, flat on your back facing up, eyes closed, head still.
21
Drugs that can help seasickness:

Meclizine (Antivert, Bonine) 12.5 25mg by mouth every 6 hours as needed.
Dimenhydrinate (Dramamine) 50mg by mouth every 6 hours as needed.
Cinnarizine (Stugeron) 15mg by mouth every 6 hours as needed.
Scopolamine (Transderm-Scop) 1.5mg patch behind the ear which will last for 72 hours.
Scopolamine (Scopace) 0.4mg, 1 2 tabs by mouth every 8 hours as needed.
Promethazine (Phenergan) 12.5-25mg by mouth or by rectal suppository every 6 hours as needed.
The suppository is especially useful for someone who is nauseous or vomiting.
Phenergan plus ephedrine (The Coast Guard Cocktail) 25mg of each by mouth every 6 hours as
needed.
Prevention of Seasickness:
Keep the mind busy; find something to concentrate on that does not involve reading.
Take the helm if possible.
Move to the center of the ship where the pitch and yaw motion is minimized.
Anticipate the motion of the ship and use the legs to absorb and dampen the motion.
Fix your vision on a distant horizon, not on something close.
Lie down flat with the eyes closed in a well-ventilated area.
Take meclizine or Dramamine to prevent and help stabilize the ears.
Eat or consume ginger crystals, tea, or ginger ale.
Stay hydrated, taking frequent sips of liquid.
Snack on carbohydrates. Dont go hungry; an empty stomach is more susceptible.
Note:
Although this article is aimed at sailors, passengers in cars, buses, trains, planes, cruise ships, or on
ferry crossings, may also experience the same motion-induced symptoms. If you are susceptible to
seasickness or motion sickness, preventive measures like taking meclizine prior to getting on board
will help. There is anecdotal evidence that seabands worn on the wrist may help, but I wouldnt recommend solely relying on their effectiveness.
Jeff Fongemie 2007
Aye matey, if all else fails, stay off the high seas, you landlubber, you.
22
Medicine Chest
Sunburns and Sun Blocks:
The
by Frank Hubbell,
There are many variations on skin color ranging from albino to ebony. The color of the skin is
simply determined by the quantity of a pigment, melanin, in the skin. The more melanin that is
produced, the darker the skin.
The skin pigment melanin is produced by melanocytes,
which are found in the stratum basale of the epidermis. The number of melanocytes in the skin is very
similar from person-to-person, but how much melanin
is produced by the melanocytes varies greatly, giving
the wide range of skin colors that are seen around the
world.
Melanin is the protective pigment in the skin. The production of melanin by the melanocytes is stimulated by
damage caused to the skin by ultraviolet A and B (UVA
and UVB) light causing the skin to darken or tan. The
melanin in the skin blocks and absorbs the UVA and
UVB light protecting the layers of the dermis beneath it.
Exposure to UVA and UVB light not only causes tanning, but it also causes sunburns, wrinkles, rapid skin
aging, and skin cancers.
The ultraviolet section of the light spectrum consists of UVA,

UVB, and UVC. Most of the ultraviolet UVA and UVB light is
filtered out by the upper atmosphere, but all of the UVC light is
filtered out by the ozone (O3) in the upper atmosphere. This is
a good thing, as UVC light is 100% lethal to all life on earth. If
the ozone were to disappear, and the UVC light allowed to reach
the surface of the earth, all life exposed to that light would be
dead within days. (As mentioned in the previous WMN this is the
technology that Hydro-Photon, Inc. has harnessed to produce the
SteriPEN for treating water.)
Skin changes and skin cancers:

Over-exposure to the UVA and UVB light that does penetrate
the earths atmosphere, whether its a lot or a little at a time, can
override the protective qualities of the melanin pigment resulting
in sunburn, permanent damage to the skin such as wrinkles, or
age spots, and worst of all it increases the risk of the skin cancers: squamous cell carcinoma, basal cell carcinoma, and the potentially lethal malignant melanoma.
23
So, what do we do to protect ourselves from the harmful effects of UVA and UVB light?
#1. Cover up:
First and foremost, cover up by wearing clothing. It is most important to cover up and protect those
parts of the body that stick out and tend to get fried in the bright summer and even winter sun. Reflective surfaces such as snow, ice, and water will dramatically increase the quantity of UV rays and
the intensity of the skin damage. High altitude is also famous for causing severe sunburns in a very
short amount of time. Every 1000 feet of elevation gain increases the quantity of UV light by 4%.
Protect the most vulnerable areas, these include the top of the head, whether you are bald or not, ear
lobes, nose, face, back of the hands, back of the lower legs, and all of these at-risk areas also match
the parts of the body that statistically are most likely to develop skin cancer. Regardless of skin type
and the quantity of melanin in the skin, everyone is susceptible to skin cancer, so, please, cover up
any areas that might by subjected to long sun-exposure, such as the arms and legs.
Wear a hat with a wide brim to protect your head and your ears.
Wear SPF clothingclothing that comes with a sun protection factor (SPF) rating.
Use lip balm or lipstick with SPF protection.
Note: Dermatologists will tell you to wear SPF protection on your face year round.
#2. Lather up:
For the parts of the body that

dont get covered up, lather up.
In other words, cover those parts
with an SPFrated sunblock.
Sunblocks come in two forms:
chemical blocks and physical
blocks.
Chemical sunblocks are creams
and lotions that contain a chemical that is absorbed into the skin
where, by chemically absorbing
the UV rays, it decreases their
harmful effects. When using
chemical blocks, you have to
apply them at least 30 minutes
prior to the sun exposure in
order to give them time to be
absorbed; you may need to reapply throughout the day, and
you should use one with an SPF
rating of 30 or more.
Chemical blocks:
Active ingredient:
Type of UV light blocked:
Aminobenzoic acid
UVB
Avobenzone
UVA
Cinoxate
UVB
Dioxybenzone
UVA, UVB
Homosalate
UVB
Menthyl anthranilate
UVA
Otcocrylene
UVB
Octyl methoxycinnamate
UVB
Octisalate
UVB
Oxybenzone
UVA, UVB
Padimate O
UVB
Phenylbenzimidazole sulfonic acid UVB
Sulisobenzone
UVA, UVB
Trolamine salicylate
UVB
Physical blocks:
Titanium dioxide
Zinc oxide
UVA, UVB, broad spectrum

UVA, UVB, broad spectrum
Physical blocks are creams and lotions that sit on top of the skin - they are not absorbed into the skin.
They work by physically blocking and reflecting the UV rays preventing any skin damage. When applied correctly, they are 100% effective.
24
#3. Smarten up:

It is better to protect the skin then to suffer the temporary
pain of a sunburn and the permanent deleterious effects of
sun-induced damage and subsequent risk of skin cancer.
Wear protective clothing, stay out of the midday sun, take
advantage of the shade, and use sunblocks.
How do you treat a sunburn?
Anti-inflammatories, hydration, and moisturizers.
Non-steroidal anti-inflammatory drugs (NSAIDs): Any NSAID
will help - aspirin, ibuprofen (Motrin, Advil), or naprosyn
(Aleve) to reduce the pain and speed healing by removing
the toxic free radicals (inflammatory mediators) created by
the sun damage.
Hydrate, hydrate, hydrate: The sunburn damages, destroys, and dehydrates the skin. Part of proper
care of a sunburn is to rehydrate and stay well-hydrated.
Moisturizers: The skin has been damaged and dehydrated and is drying out, so moisture needs to be
added to the skin and kept in the skin.
Aloe is a very effective moisturizer and a potent antiinflammatory. Noxzema is another very effective postsunburn moisturizer. Any skin moisturizer should help,
but you need to check the label and make sure that it
does not contain isopropyl alcohol, as that will dry the
skin out even more.
Mad Dogs and Englishmen
Written by Noel Coward in 1931

The first verses of the song:
In tropical climes there are certain times of day

When all the citizens retire,
to tear their clothes off and perspire.
Its one of those rules that the biggest fools obey,
Because the sun is much too sultry and one must avoid
its ultry-violet ray
The natives grieve when the white men leave their huts,
Because theyre obviously, absolutely nuts
Only mad dogs and Englishmen go out in the midday sun.
25
Youre in Good Hands

practical treatments for
backcountry medical emergencies
Aqua Pure Traveller

The Agua Pure Traveller is an all-in-one water
purification system developed and marketed
by Pure Hydration in England. It combines
the process of filtration with the disinfection of
iodine in one refillable bottle. The filtration and
iodine are built into the lid.
The idea is quite simple but ingenious. When
you remove the cap from the water bottle, attached to the cap is a 3-stage filtration system
that contains a layer of iodine. You fill the
bottle, with as clear water as possible to preserve the life of the filters, shake it to release
the iodine resin into the water, wait 15 minutes,
and then drink. They describe the process as
Fill, Shake, Wait, Drink.
The iodine will kill the viruses and other pathogens that
might slip through the filter, and the filters remove the
larger bacteria and particles in the water, making it safe
to drink.
According to their advertising, the Agua Pure Traveller:
Kills viruses and bacteria such as E. coli, Polio, and
Hepatitis A virus.
Removes waterborne pathogens such as Giardia and
Cryptosporidium.
Removes toxic chemicals and heavy metals.
Removes bad tastes, odors, and sediment.
Will purify about 350 liters of water.
26
The water bottle holds a little more than 500ml or 1 pint of water.
Each unit will purify about 350 liters of water or 700 fills, liter each time.
Using myself as an example: I consume about 4 liters of water per day, more in a hot climate, so, if I
used this bottle all the time, it would last me about 3 months.
They do recommend that the cap filter assembly should be replaced every twelve months, even if
not in daily use, as the iodine will lose its potency.
Understand that it is intentionally designed for individual use.
Pros:
Very easy to use Fill, Shake, Wait 15 Minutes, and Drink.

Very effective and safe to use.
Each filtration/iodine system built into the lid will last for about 350 liters of fluid.
The filter removes the taste of the iodine.
The price is moderate at about $55 US.
It requires little or no maintenance other than replacing the filter assembly every twelve months.
Cons:
It is relatively small, holding and purifing about 500ml or 1 pint at a time.

There is no way to tell when the iodine resin has been spent other than keeping track of how many
times it has been used. But, you will know when the filter becomes plugged because you will not be
able to force water through it.
Overall, this is a very nice product, easy-to-use, safe, and effective. There is a lot to be said for easyto-use. The easier a water purification system is to use, the more likely it is going to be used, thus
preventing future illness.
Go to their website at: www.purehydration.co.uk. Check it out as they have a lot of good information.
27
Wilderness Medicine
Newsletter
July/August 2009 Volume. 23 No. 4
Subscription
Information
back issues
Each issue of the newsletter is uploaded to a protected area on our website, (www.tmcbooks.com),
as a PDF file. Each subscriber is issued a login name
and a password and can visit the website anytime
to download issues. Subscriptions can be ordered
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28
Complete WMN topical index: May 1988August 2010

1
May 1988
Head Injury, Headache
2
June 1988
Feet, Sprains & Strains, Blisters
3
July 1988
Heat Injury, Heat Cramps
4
August 1988 Lyme Disease, Insect Bites
5
September 1988 Wound Management, Wound Infection, Giardia
6
October 1988
Hypothermia, Immersion Foot
7
November 1988
Legal Aspects, Major Wound Care, Epistaxis
8
December 1988
Hx of Wild Med, Snakebite, Hyperventilation
9
January 1989 Frostbite, Cervical Spine
10
February 1989
Altitude Illness, Yeast Infections, Spinal Assessment
11
March 1989
Neck Pain, Altitude, Rashes, Poisoning
12
April 1989
Dental Emergencies, Poisoning Chart, Otitis Externa
13
May 1989
Backache, Poisoning, Heartburn
14
June 1989
Rabies, Cocaine, Anaphylaxis
15
July 1989
Dysbarism, Lyme, Sunburn
16
August 1989 Lightning, Common Cold, Altered LOC
17
September 1989 Malaria, Healing, Fractured Clavicle, Asthma, Peter Hackett, MD
18
October 1989
Feet, Fractures, Mushrooms
19
Nov/Dec 1989
Toxic Shock Syndrome, Spider Bites, Femur, Frostbite
20
Jan/Feb 1990 Optic Injuries, Pain, Rescue Tobaggan, Hand Injuries
21
Mar/Apr 1990
Naegleria, Panic, Hypothermia, Red Tide, Cold Sores
22
May/June 1990
Insects, Allergies, Water, Fishhooks, Water Disinfection
23
July/Aug 1990
Violent Behavior, SCIM, SOAPnote, Poison Ivy, Patellofemoral
24
Sept/Oct 1990
Immersion, Bears, Hearing, Carpal Tunnel, Femur
25
Nov/Dec 1990
Tendonitis. Tetanus, Asthma, Hobo Spider, Shin Splints
Vol. 2, 1 Jan/Feb 1991
Fever, Hypothermia, Leptospirosis
2
Mar/Apr 1991
Fractures, Hypothermia,
3
May/June 1991
Infectious Disease, Hypothermia, Amputation
4
July/Aug 1991
Dehydration, Dogs, Leeches, Facial fractures
5
Sept/Oct 1991
SAR Basics, Cervical Spine, Raynauds Syndrome
6
Nov/Dec 1991
BP, Hand Injuries, Arthritis
HBV, Socks, Snakebite
2
Mar/Apr 1992
Med Hx, Fibromyalgia, Appendicitis
3
May/June 1992
Drugs, Activated Charcoal, Vapor Barriers
4
July/Aug 1992
Ankle Injuries, Knee Injuries, Vapor Barriers
5
Sept/Oct 1992
Psych Assessment, NOLS
6
Nov/Dec 1992
Deep Wounds, Burn Care
Vol 4, 1 Jan/Feb 1993
Anaphylaxis, Puma Attacks
2
Mar/Apr 1993
Helicopter, Ailing Nails, Insects
3
May/June 1993
Diving Emergencies, Suicide, UTI
4
July/Aug 1993
Water Disinfection, Cryptosporidium, Hantavirus, Hygiene
5
Sept/Oct 1993
Book Review Issue
6
Nov/Dec 1993
Asthma, Seizures, Diabetes
Legal Issues
2
Mar/Apr 1994
Wild Pediatrics
3
May/June 1994
Zoonoses
4
July/Aug 1994
Ozone & UV light
5
Sept/Oct 1994
The 5 Commandments of First Aid Kits
6
Nov/Dec 1994
Principles of Wild EMS, Newsletter moves back to SOLO
Can I Do That, Legally?, Cellulitis, William Forgey, MD
2
Mar/Apr 1995
Outdoor LeadershipPast and Present, Diamox
3
May/June 1995
Parasitology, HAV, Warren Bowman, MD
4
July/Aug 1995
Wilderness Pediatrics, Allerigies
5
Sept/Oct 1995
Hypothermia, Keith Conover, MD
6
Nov/Dec 1995
Chest Injuries, Cardiac Risk, Anaphylaxis, Frank Hubbell, DO
Hello, 911? Murray Hamlet, DVM
2
Mar/Apr 1996
Eating disorders, Bill Herring, MD
3
May/June 1996
Immersion Foot, Robert Rose, MD
4
July/Aug 1996
Musculoskeletal system I
5
Sept/Oct 1996
Lightning
6
Nov/Dec 1996
Potpourri: Frostbite, chilblains, Avalanche, David Kuhns, PAC
Musculoskeletal system II
2
Mar/Apr 1997
Drowning, Ask the Experts
3
May/June 1997
Rabies, Ask the Experts
4
Jul/Aug 1997 Womens Health Issues, Ask the Experts
5
Sept/Oct 1997
Water, Water, EverywhereDeath in the Backcountry
6
Nov/Dec 1997
Medecine Sans Frontieres
Avalanche Awareness
2
Mar/Apr 1998
ALS in the Backcountry
3
May/June 1998
The Charcoal Vest hypothermia
4
July/Aug 1998
ISMM Case, Summer Review Heat Injuries
5
Sept/Oct 1998
Whats Your Position GPS, Trenchfoot
6
Nov/Dec 1998
Gender Specific Emergencies, Hypothermia
Vol. 10, 1 Jan/Feb 1999
Tendonitis, Musculoskeletal problems
2
Mar/Apr 1999
Anaphylaxis, Clearing the Cervical spine
3
May/June 1999
Wild Critical Incident, Kayaking injuries
4
July/Aug 1999
Children in the Mountains
5
Sept/Oct 1999
Oh, My Aching Feet, Joy of Socks,
6
Nov/Dec 1999
Breathing Hard in the Backcountry, Pre-Existing Conditions
Vol. 11, 1 Jan/Feb 2000
Lions & Tigers & Bears, Oh My,
2
Mar/Apr 2000
Unraveling Abdominal Pain, Oral fluids, cave rescue
3
May/June 2000
Sunscreen Controversy, Dehydration & Heat Injury
4
July/Aug 2000
Leadership in Prevention, Lost Proofing
5
Sept/Oct 2000
Stonefish, Sea snakes, & Jellyfish, Shark bites
6
Nov/Dec 2000
Got the Travel Bug, Bugs in Bed
Vol. 12, 1 Jan/Feb 2001
Have You Ever Wondered Why?
2
Mar/Apr 2001
Dont Blame Montezuma
3
July/Aug 2001
Contact Dermatitis
4
July/Aug 2001
Diabetes in the Wilderness, Answers to Common Wild ?
5
Sept/Oct 2001
Wilderness Rescue in the Winter Environment
6
Nov/Dec 2001
Survey of Backcountry Drugs
Vol. 13, 1 Jan/Feb 2002
Brief History of Wilderness Med Outside the Golden Hour
2
Mar/Apr 2002
Managing a Backcountry Fatality
3
May/June 2002
The World of Infectious Disease
4
July/Aug 2002
Preventing Infectious Disease, Schistosomiasis
5
Sept/Oct 2002
Cardiac Disease, Aspirin, West Nile Virus
6
Nov/Dec 2002
Risk Management Briefing, Psychotropics, smallpox
Vol. 14, 1 Jan/Feb 2003
Weather, Psychotropics, Giardia
2
Mar/Apr 2003
Musculoskeletal Trauma I, Psychotropics part 2
3
May/June 2003
Musculoskeletal Trauma II
4
July/Aug 2003
Lightning, Beauty & the Beast
5
Sept/Oct 2003
Musculoskeletal Trauma III, Pain Control
6
Nov/Dec 2003
The Performance Triad, H2O, Water purification
Vol. 15, 1 Jan/Feb 2004
When Jack Frost Bites, Mike Lynn
2
Mar/Apr 2004
Changes in Level of Consciousness, part 1
3
May/June 2004
Changes in Level of Consciousness, part 2
4
July/Aug 2004
The Heart of the Problem, Acute MI, Giant Hogweed
5
Sept/Oct 2004
Dental Emergencies, STARI, dislocated patella
6
Nov/Dec 2004
Frozen Mythbusters
Vol. 16, 1 Jan/Feb 2005 Non-Freezing Cold Injuries, Free Radicals
2
March/April 2005 Self-Preservation Disaster Response
3
May/June 2005
Heat-Related illness
4
July/Aug 2005
Malaria
5
Sept/Oct 2005
Eye Injuries
6
Nov/Dec 2005
Burns
Vol. 19, 1 Jan/Feb 2006
Soft Tissue Injuries: Part 1
2
March/April 2006 Soft Tissue Injuries: Part 2
3
May/June 2006
First Aid Kits, Crush Injuries
4
July/August 2006 Poisonous Pearls (of wisdom)
5
Sept/Oct 2006
SNAP! Crackle Pop: Orthopedic Emergencies
6
Nov/Dec 2006
High Altitude Illness
Vol. 20, 1 Jan/Feb 2007
20 Years of Wilderness Medicinea retrospective
2
Mar/April 2007
The First Five Minutesthe Patient Assessment System
3
May/June 2007
The First Five MinutesCritical Care
4
July August 2007 BarotraumaDeep Trouble
5
Sept/Oct 2007
AllergiesRunny Nose to Anaphylaxis
6
Nov/Dec 2007
The Rist of Caring
Vol. 21, 1 Jan/Feb 2008
Disaster, TB, Nausea, Tib-Fib splint, WMN Extreme Makeover
2
March/April 2008 Navigation, Dengue, Constipation, Laxatives, Traction Splint
3
May/June 2008
Diabetes, Yellow Fever, Fever, Pelvic Sling
4
July/August 2008 Facial Trauma, Water-Borne Disease, Spine, Water, Pain, Blisters
5
Sept/Oct 2008
Shortness of Breath, giardiasis, inhalers, eye abrasions/impalements
6
Nov/Dec 2008
Respiratory trauma, cholera, fishhooks, bugs in ear, antihistamines
Vol. 22, 1 Jan/ Feb 2009
A Winter Primer
2
March/April 2009 Summer Primer, influenza, rhinitis, dermatology, boot bash, Africa Prt I
3
May /June 2009
Summer Primer, influenza, rhinitis, dermatology, boot bash, Africa Prt II
4
July/August 2009 Principles of Long-Term Patient Care-Part I
5
Sept/Oct 2009
Principles of Long-Term Patent Care -Part II
6
Nov/Dec
Special Haiti edition: Disaster Management Revisited
Vol. 23, 1 Jan/Feb 2010
Celiac Disease
2
March/April
Abdominal Trauma
3
May/June
Abdominal Emergencies
4
July/August
Marine Bites and Stings
To order back issues, from

a single issue, to a great CD
deal, to a full set (140 issues),
please see the order form on
the previous page. CD special (02 09) $65
NOTE: Standard of care changes over time. Treatment deemed appropriate in years past may not be appropriate today.
Paper issues are available for May 1988 through December 2001 2002 and beyond are available on CD only see prices on the subscription page
29
SOLO Wilderness First Aid & Medical Training Options

START DATE END DATE
CLASS
LOCATION
CONTACT
09/18/10
09/18/10
09/18/10
09/20/10
09/22/10
09/24/10
09/25/10
09/25/10
09/25/10
09/27/10
09/27/10
10/01/10
10/02/10
10/02/10
10/02/10
10/04/10
10/09/10
10/12/10
10/12/10
10/15/10
10/16/10
10/16/10
10/16/10
10/16/10
10/18/10
10/23/10
10/23/10
10/23/10
10/25/10
10/25/10
10/30/10
11/06/10
11/06/10
11/06/10
11/06/10
11/06/10
11/06/10
11/06/10
11/06/10
11/07/10
11/08/10
11/08/10
11/12/10
11/13/10
11/13/10
11/13/10
11/13/10
11/15/10
11/15/10
11/20/10
11/20/10
11/20/10
11/20/10
11/20/10
11/20/10
11/20/10
11/22/10
11/29/10
CPR
WFA
WFR REVIEW
WEMT PART 2
WFR REVIEW
WEMT MODULE
WFA & CPR
WFA
WFA
WFR
WEMT
WFR
WFA
WFA
WFA
WFR
WFA & WFR REVIEW
WFR
WEMT
WFR INTENSIVE
WFA & CPR
WFA
WFA
WFA
WEMT MODULE
WFA
WFA
WFA
WFR
WEMT PART 2
WFA & CPR
WFA
AWFA (PT 2)
WFR REVIEW
WFR REVIEW & CPR
WFA
WFA
WFA
WFR INTENSIVE
WFR INTENSIVE
WFA & CPR
WEMT MODULE
WFR INTENSIVE
CPR
WFA
WFR REVIEW
WFA
WFR
WEMT
WFA
SEARCH & RESCUE
WFR REVIEW
WFA
WFA
WFA
AWFA
AWFA (PT 2)
WEMT PART 2
NANTAHALA OUTDOOR CENTER, NC

MOHICAN OUTDOOR CTR., NJ
SOLO, CONWAY, NH
OUTWARD BOUND DISCOVERY-JACKSONVILLE, FL
SOUTHERN BERKSHIRE AMBULANCE SQUAD, MA
CHATTAHOOCHE NATURE CENTER, GA
SOLO, CONWAY, NH
UNIVERSITY OF CT, CT
FOX KITS WILDERNESS SURVIVAL SCHOOL, TN
Central Wyoming College-JACKSON HOLE OUTDOOR, WY
GERRY BRACHE, ORLAND, ME
GREEN MOUNTAIN CLUB, HQ WATERBURY CTR., VT
INDIANA UNIVERSITY OUTDOOR ADVENTURE, IN
SAN JUAN ISLAND EMS - CAMP ORKILA, WA
NORTH AMERICA OUTDOOR INSTITUTE, AK
SOLO, CONWAY, NH
SOLO, CONWAY, NH
BLUE SKY GUIDES, CA
DARTMOUTH OUTING CLUB, NH
OBERLIN COLLEGE, OH
SHAVERS CREEK ENVIRONMENTAL CENTER, PA
SOLO, CONWAY, NH
BSA - ATLANTA AREA COUNCIL, GA
FLORIDA HEARTSAVER, LLC, FL
OUTDOOR ADVENTURE SOCIAL CLUB, LLC, VA
AMC - PINKHAM, HIGHLAND CTR., NH
SOLO, CONWAY, NH
MAHOOSUC GUIDE SERVICE, ME
AMC - PINKHAM, HIGHLAND CTR., NH
AMC - WORCESTER, MA
APEX MOUNTAIN SCHOOL/SOLO COLORADO, CO
HAMPSHIRE COLLEGE, MA
PAUL SMITHS COLLEGE, NY
SPNHF, NH
WATERVILLE VALLEY ATHLETIC & IMPROVEMENT, NH
SOLO, CONWAY, NH
APEX MOUNTAIN SCHOOL/SOLO COLORADO, CO
FOX KITS WILDERNESS SURVIVAL SCHOOL, TN
SOLO, CONWAY, NH
BLUE SKY GUIDES, CA
INDIANA UNIVERSITY OUTDOOR ADVENTURE, IN
ST. MICHAELS COLLEGE, VT
SOLO, CONWAY, NH
SOLO, CONWAY, NH
ALPINE ENDEAVORS, NY
HULBERT OUTDOOR CENTER, VT
SOLO, CONWAY, NH
UNH OUTING CLUB, NH
SOLO, CONWAY, NH
828-488-7213
908-362-5670
828-488-7213
603-447-6711
850-487-4365
413-717-0753
770-992-2055
603-447-6711
860-486-6697
731-610-8020
828-488-7213
802-598-0364
207-469-0059
802-244-7037
812-332-4102
360-378-5152
907-745-0075
603-447-6711
603-447-6711
805-320-7602
603-646-2428
617-374-3128
814-863-2000
603-447-6711
828-488-7213
706-342-1234
352-219-0054
434-760-4453
603-466-2727
603-447-6711
207-824-2073
603-466-2721
508-473-1923
970-949-9111
413-559-5536
518-327-6389
603-733-6089
603-236-4700
603-447-6711
970-949-9111
731-610-8020
603-447-6711
805-320-7602
828-488-7213
812-332-4102
828-488-7213
802-654-2614
603-447-6711
603-447-6711
845-658-3094
802-333-3405
802-333-3405
802-333-3405
603-447-6711
603-862-1577
802-333-3405
802-333-3405
603-447-6711
09/18/10
09/19/10
09/19/10
10/01/10
09/23/10
10/03/10
09/26/10
09/26/10
09/26/10
10/06/10
10/22/10
11/07/10
10/03/10
10/03/10
10/03/10
10/14/10
10/10/10
10/22/10
11/05/10
10/22/10
10/17/10
10/17/10
10/17/10
10/17/10
10/19/10
10/24/10
10/24/10
10/24/10
11/05/10
11/05/10
10/31/10
11/07/10
11/07/10
11/07/10
11/07/10
11/07/10
11/07/10
11/07/10
11/13/10
11/14/10
11/10/10
11/12/10
11/19/10
11/13/10
11/14/10
11/14/10
11/14/10
11/26/10
12/10/10
11/21/10
11/21/10
11/21/10
11/21/10
11/21/10
11/21/10
11/23/10
11/23/10
12/10/10
KEY: WFA: Wilderness First Aid AWFA: Advanced Wilderness First Aid WEMT: Wilderness Emergency Medical Technician EMT/RTP: WEMT Refresher Training
WEMT Module: certifies street EMTs to the WEMT level Advanced WEMT Module: 5 days, SAR & Technical Rescue emphasis WFR: Wilderness First Responder
WFR Intensive: fewer days, more hours/day WFR Review: two-day WFR review Mission Medicine: medicine for missionaries Wild Day: 1-day wilderness WEMT recert
International Medicine: International Travel Medicine at WFA, WFR, & WEMT levels
FOR A COMPLETE LISTING OF SOLO COURSES, PLEASE VISIT WWW.SOLOSCHOOLS.COM
30
SOLO Wilderness First Aid & Medical Training Options

START DATE END DATE
CLASS
LOCATION
CONTACT
12/04/10
12/04/10
CPR
828-488-7213
12/04/10
12/05/10
WFR REVIEW
828-488-7213
12/05/10
12/06/10
WFA
GREEN MOUNTAIN CLUB, HQ WATERBURY CTR., VT
802-244-7037
12/10/10
12/12/10
EMT/RTP
SOLO, CONWAY, NH
603-447-6711
12/10/10
12/18/10
WFR
828-488-7213
12/11/10
12/12/10
WFA
FLORIDA HEARTSAVER, LLC, FL
352-219-0055
12/11/10
12/15/10
WEMT MODULE
802-333-3405
12/11/10
12/18/10
WFR INTENSIVE
OLE MISS OUTDOORS, MS
662-915-6735
12/11/10
12/18/10
WFR INTENSIVE
SOLO, CONWAY, NH
603-447-6711
12/11/10
12/19/10
WFR
802-333-3405
12/12/10
12/19/10
WFR INTENSIVE
BLUE SKY GUIDES, CA
805-320-7602
12/13/10
12/13/10
WILD DAY
SOLO, CONWAY, NH
603-447-6711
12/14/10
12/18/10
AWEMT
SOLO, CONWAY, NH
603-447-6711
12/18/10
12/19/10
WFA
SOLO, CONWAY, NH
603-447-6711
12/28/10
01/07/11
WFR
SOLO, CONWAY, NH
603-447-6711
12/28/10
01/21/11
WEMT
SOLO, CONWAY, NH
603-447-6711
12/30/10
01/08/11
WFR
814-863-2000
01/03/11
01/11/11
WFR
WILLIAMS COLLEGE OUTING CLUB, MA
413-597-2317
01/06/11
01/14/11
WFR
WARREN WILSON COLLEGE, NC
828-280-6087
01/08/11
01/09/11
WFA
CONNECTICUT AUDUBON COASTAL CENTER, CT
203-878-7440
01/08/11
01/14/11
WFR INTENSIVE
SLIPPERY ROCK UNIVERSITY, PA
724-738-2883
01/09/11
01/16/11
WFR
UNIVERSITY OF VERMONT, VT
203-893-5762
01/10/11
01/21/11
WEMT PART 2
SOLO, CONWAY, NH
603-447-6711
01/15/11
01/16/11
WFR REVIEW
SLIPPERY ROCK UNIVERSITY, PA
724-738-2883
01/22/11
01/23/11
WFA
OUTDOOR ADVENTURE SOCIAL CLUB, LLC, VA
434-760-4453
01/22/11
01/23/11
WFA
SMITH COLLEGE, MA
413-585-3445
01/22/11
01/30/11
WFR
PLATTSBURGH STATE UNIVERSITY, NY
518-564-5292
02/11/11
02/20/11
WFA
Central Wyoming College-JACKSON HOLE OUTDOOR, WY 802-598-0364
02/12/11
02/13/11
WFA REVIEW
814-863-2000
03/01/11
03/24/11
WEMT
SOLO, CONWAY, NH
603-447-6711
03/05/11
03/06/11
WFA
UNIVERSITY OF NEW ENGLAND, ME
207-602-2768
03/16/11
03/24/11
WFR
CARLETON COLLEGE, MN
206-484-7089
03/19/11
03/20/11
WFA
PACK, PADDLE, SKI, NY
585-346-5597
03/29/11
04/21/11
WEMT
SOLO, CONWAY, NH
603-447-6711
04/02/11
04/03/11
WFR REVIEW & CPR
802-654-2614
04/16/11
04/17/11
WFA
802-654-2614
05/17/11
06/09/11
WEMT
SOLO, CONWAY, NH
603-447-6711
05/18/11
05/25/11
WFR INTENSIVE
802-654-2614
07/12/11
08/04/11
WEMT
SOLO, CONWAY, NH
603-447-6711
09/06/11
09/29/11
WEMT
SOLO, CONWAY, NH
603-447-6711
10/11/11
11/03/11
WEMT
SOLO, CONWAY, NH
603-447-6711
11/14/11
12/08/11
WEMT
SOLO, CONWAY, NH
603-447-6711
12/27/11
01/19/12
WEMT
SOLO, CONWAY, NH
603-447-6711

KEY: WFA: Wilderness First Aid AWFA: Advanced Wilderness First Aid WEMT: Wilderness Emergency Medical Technician EMT/RTP: WEMT Refresher Training
WEMT Module: certifies street EMTs to the WEMT level Advanced WEMT Module: 5 days, SAR & Technical Rescue emphasis WFR: Wilderness First Responder
WFR Intensive: fewer days, more hours/day WFR Review: two-day WFR review Mission Medicine: medicine for missionaries Wild Day: 1-day wilderness WEMT recert
International Medicine: International Travel Medicine at WFA, WFR, & WEMT levels
FOR A COMPLETE LISTING OF SOLO COURSES, PLEASE VISIT WWW.SOLOSCHOOLS.COM
31

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July/August 2010 Volume. 23, No. 4

Anywhere in the WMN, if text is

T.B.R. Walsh 2008

3 Marine Bites and Stings:

26 Youre in Good Hands: Aqua Pure Traveller

Subscriptions & Back issuesordering

Back issues (complete index: 1988 to present)

SOLO coursesthe current course calendar

July/August 2010 Vol. 23, No.4

Marine Bites and Stings:

Things that Bite fish, mammals, reptiles, octopi

Heat-related injuries were discussed in detail in the March/April 2009 WMN:

Poisons of the Sea: Fish Poisons:

These illnesses were discussed in the July/August 2006 WMN:

Volume 19, Number 4

*Real Messages Found in Bottles . . .

(Paralytic Shellfish Poisoning)

(Carbon Monoxide Poisoning)

Poisoning ............. Cover

Wilderness Medicine Newsletter

Barotrauma: SCUBA-related injuries:

Subscriptions, Back Issues .................... 10,11

Barotrauma-related injuries were discussed in detail in the July/August 2007 WMN:

Volume 20, Number 4

Wilderness Medicine Newsletter

Subscriptions, Back Issues .............................................. 10,11

THINGS THAT BITE

Avoid areas of known predatory animal and jellyfish concentrations.

Avoid known breeding areas.

Be careful in water with low visibility.

July/August 2010 Vol. 23, No.4

The Principles of Treatment of Non-Venomous Marine Bites:

A ASAP: Get the patient out of the water ASAP.

July/August 2010 Vol. 23, No.4

SPECIFIC VENOMOUS SE A CRE ATURES

The Blue-ringed Octopus:

Symptoms of a Blue-ringed Octopus envenomation tetrodotoxin:

Blue Ringed Octopus

Treatment of the Blue-ringed Octopus envenomation tetrodotoxin:

Airway and Breathing

July/August 2010 Vol. 23, No.4

Symptoms of a Sea Snake bite and envenomation:

Post-bite onset of symptoms is 30 minutes to hours later.

Treatment of Sea Snake envenomation:

Pressure Dressing Treatment of Sea Snake Envenomations:

THINGS THAT STAB

Pressure Immobilization Splint

stingrays ...starfishsea urchins...lionfishrockfishstonefishstargazerscone shells

The Echinodermatas are in four families:

Specific Things That Stab

Starfish with multiple arms covered by spines.

Symptoms of Brittle Star or Crown of Thorns spines

July/August 2010 Vol. 23, No.4

Treatment of Brittle star Crown of Thorns wounds:

Remove any thorns or foreign material with tweezers or forceps.

Symptoms of sea urchin stab injuries:

Treatment of stab injuries and envenomation:

Sea cucumbers Holothuroidea

Symptoms of sea cucumber toxins:

Local redness, itching, and pain.

Treatment of sea cucumber toxins: