Outdoor Ed Community

Oral Ondansetron to Assist Oral Rehydration Therapy

Outdoor Ed — Tue, 18 Nov 2008 04:14:00 GMT

by Paul Auerbach, M.D.

reposted with permission from the Medicine for the Outdoors Blog

Oral rehydration can be a lifesaving therapy for persons, particularly children, suffering from dehydration. The most common cause of dehydration in children is infectious diarrhea.

When dehydration occurs, it is important to act swiftly. If fluid losses are significant, begin to replace liquids as soon as you can.

Oral Rehydration Salts (ORS) that meet World Health Organization standards are available in a dry mix; use one packet per quart (liter) of water. One packet contains sodium chloride 3.5 grams, potassium chloride 1.5 g, glucose 20 g, and trisodium citrate 2.9 g (or sodium bicarbonate 2.5 g). Cera Lyte 70 oral rehydration salts are based on a rice solution. One packet is mixed with a quart (liter) of water. After the solution is prepared, it should be consumed or discarded within 12 hours if kept at room temperature or 24 hours if kept refrigerated. Other ORS products available over-the-counter include Pedialyte, Enfalyte, Naturalyte, and Rehydralyte.

1. Mild diarrhea/hydration: Drink soda water, clear juices, broth, and electrolyte-containing sports beverages. If diarrhea is the cause, try to replace each diarrheal stool with 10 milliliters of ORS per kilogram (2.2 pounds) of body weight. If the child is vomiting, try to replace each episode of vomiting with 2 mL of ORS per kg (2.2 lb) of body weight.

2. Moderate diarrhea/dehydration: Drink diluted (by half, with water) electrolyte-containing sports beverages, mineral water (bottled), or a homemade solution (1 quart or liter of disinfected water plus 1/2 to 1 teaspoon, or 1.3 to 2.5 mL, of sodium chloride [table salt], 1/2 tsp of sodium bicarbonate [baking soda], 1/4 tsp, or 0.6 mL, of potassium chloride [salt substitute], and glucose [6 to 8 tsp, or 30 to 40 mL, of table sugar; or 1 to 2 tbsp, or 15 to 30 mL, of honey]). Take care not to over-sweeten (exceed 2 to 2.5% glucose) the solution with sugar, because this may worsen the diarrhea; too high a sugar concentration inhibits water absorption through the gastrointestinal tract. Each quart of this “home brew” should be alternated with 1/2 to 1 quart of plain disinfected water. Try to replace fluid losses at least every 2 hours.

When using ORS, try to get the victim to ingest a quart per hour until the frequency of urination begins to increase and the urine color turns light or clear. To begin, start with small (e.g. 5 mL or one teaspoon) amounts every 1 to 2 minutes, to avoid collection of a large amount of fluid in the stomach that might cause vomiting. A child should be given 11/2 oz (44 mL) of ORS per pound (0.45 kg) of body weight over the first 4 hours, then 1 ounce (30 mL) of ORS per pound of body weight per 8-hour period until the diarrhea resolves. Another estimate of fluid replacement for children is 100 ml (approximately 3 oz) of fluid per significant loose bowel movement. For an infant with diarrhea, decrease the amount of milk in the diet, and add more water, diluted juices, half-strength sports beverages, and ORS. Sweetened carbonated beverages (soda pop) are not good replacement fluids, because they contain too much sugar and little or no sodium and potassium. If the child is ***-fed, keep nursing (offer the *** more often). If the child is formula-fed, use ORS for 12 to 24 hours, then try switching back to formula. If the diarrhea persists switch back to ORS for another cycle. It is important to continue to provide nourishment with food (and calories) to children with diarrhea, not fluid alone. Avoid foods high in simple sugars (including tea, juices, and soft drinks). Try complex carbohydrates (rice, wheat, potatoes, bread, cereals) and yogurt, lean meat, fruits, and vegetables.

If premeasured salts are not available with which to supplement water, you can alternate glasses of the following two fluids, as recommended by the U.S. Public Health Service:

GLASS ONE — 8 oz fruit juice with 1/4 tsp (a “pinch”) table salt and 1/2 tsp honey or corn syrup (237 mL juice, 1.3 mL table salt, 2.5 mL honey or corn syrup)

GLASS TWO — 8 oz disinfected water with 1/4 tsp baking soda (sodium bicarbonate) (237 mL water, 1.3 mL baking soda)

Another homemade fluid mixture is 1 tsp (5 mL) table salt and 1 cup (275 mL) rice cereal in a quart (liter) of water; this must be used within 12 hours or discarded. If only fruit juice (without supplementation) is available, remember to cut it to half strength with water. Otherwise, the sugar content will be too high and may contribute to continued diarrhea. Estimation techniques to measure powdered ingredients (such as a “pinch” of table salt) are notoriously inaccurate, and can even be dangerous if you add excessive amounts. Use a proper measuring implement whenever possible.

3. Severe diarrhea/dehydration: Same as moderate. After a certain point, as with cholera, intravenous hydration may be lifesaving. See a physician as soon as possible.

Sometimes, offering liquids to drink is not sufficient to diminish the nausea and vomiting that accompany an episode of gastroenteritis. If a person cannot ingest sufficient liquid, the diarrhea persists. In a recent article in the Annals of Emergency Medicine (Ann Emerg Med 2008:52:22-29) entitled "The role of oral ondansetron in children with vomiting as a result of acute gastritis/gastroenteritis who have failed oral rehydration therapy: a randomized controlled trial," the authors concluded that in subjects with acute gastritis/gastroenteritis and mild to moderated dehydration who failed initial oral rehydration therapy, the proportion of children who subsequently required intravenous hydration was lower in a group treated with ondansetron (Zofran) in a dose of 0.15 mg/kg body weight of the oral dissolving tablet, as compared to a group that did not receive the drug.

Having suffered nausea and vomiting from acute infectious gastroenteritis while traveling, I can attest to the benefit of ondansetron in providing sufficient relief to allow me to be able to begin to drink liquids and thereby rehydrate. Given that this observation is fairly common among clinicians in the field, and that this study strongly points to a benefit of the drug for children in whom oral rehydration is prevented by persistent nausea and vomiting, it makes perfect sense to carry a drug such as this, with limited side effects, that might allow initiation of essential replenishment of body fluid.

Betty van der Smissen, pioneer in outdoor education, passed away on November 6

Rick Curtis — Sat, 08 Nov 2008 06:04:00 GMT

Dr. Betty van der Smissen, pioneer in the field of outdoor education for more than 50 years, passed away on November 6, 2008 from cancer. Her contributions have influenced outdoor programming, legal liability, research and the accreditation fields. You can read more about her historic contributions at this article from Parks & Recreation Journal and from these video interviews (Interview #1, Interview #2). A list of her extensive publications are available at Amazon.com.

Here is a short list of some of her accomplishments

Her early experiences in outdoor programming were with church camps. She was an early member of Christian Camping International.
She was the first research chair on the American Camp Association (ACA) national board and served as president. She conducted research on the ACA camp standards that resulted in the first major revision.
She worked with the American Association for Health Physical Education & Dance (AAHPERD) outdoor programs beginning with the Council on Outdoor Education.
She attended the second meeting, in St. Louis, of what became the Association for Experiential Education (AEE), served on AEE's original bylaws committee, and assisted in the development of the AEE Accreditation Program.
Her university leadership with outdoor programs has helped shape the development of outdoor research and programming.
She was the first director of the outdoor field campus at the University of Iowa, where she conducted outdoor education programs.
Worked with the Stone Valley Outdoor Education Center at Penn State and conducted two national symposia on outdoor research and evaluation.
Directed more than 100 theses and dissertations related to outdoor topics.
Worked closely with a Japanese doctoral student who became the national leader for outdoor education in Japan.

The Association for Experiential Education had already created a Research Endowment Fund in Betty's name. The goal of the endowment is to provide grants for areas of research involving:

outdoor programming in adventure, challenge, and experiential programs
organized camping
environmental education
legal aspects related to outdoor programming

Research selected will focus on:

benefits and outcomes
attitudes
interests
good practic

Tax deductible contributions can be made to the van der Smissen endowment. You contribution will:

Honor the invaluable contributions Dr. van der Smissen made to the profession over a lifetime.
Emulate her belief in the importance of “giving back” professionally.
Demonstrate your belief in the importance of quality outdoor programming to human development.

For information on make a donation, go to the Betty van der Smissen Endowment Fund.

Together in 2012: Why we need an association merger in Outdoor/Experiential Education

Jay Roberts — Fri, 31 Oct 2008 13:13:00 GMT

I wrote last year about my hopes for a mega-conference that would combine AEE (Assoc. for Experiential Education), AORE (Association of Outdoors Recreation and Education), and WRM (Wilderness Risk Managers Conference). Each conference is held at approximately the same time (Fall) and, for many industry professionals, it becomes a very difficult issue to choose between competing conferences when there are elements to like about all three. See my post "Can't We All Just Get Along?" for more on this topic.

Well, this year I want to take it one step further, especially given the current economic context. We need a merger. Mergers often happen in tough economic times because the benefits of reducing redundancies, resource sharing, and creating stronger brand/market positioning are very appealing in resource and revenue constrained environments. As a field, we are simply much too small to justify three different organizations and conference models. Only one of the conferences/organizations listed above has significant office/administrative staff (AEE). The economic model is barely sustainable. Now, throw in a significant economic downturn and things look a lot worse. As colleges, universities, and other non-profits look to cut costs, maintaining multiple organizational memberships may be one of the things to cut. Individuals and organizations will likely reduce travel costs and membership expenses. This may significantly affect conference revenues-- something each of these organizations depends on to cover operating costs.

In times like this, we can either stick our heads in the sand or, conversely, keep our heads up and look for new opportunities and creative solutions. Mine? A merged organization that combines AEE, AORE, WRM, and WEA (perhaps even ACCT and other peripherals) into one, "big tent" style organization and conference model. By pooling resources, the advantges are many including better conference attendence, range of workshops/sessions, reduced administrative overhead costs, more effective lobbying and advocacy, clearer industry standards, etc. We would also be a stronger and more viable organization/industry that would be able to weather economic downturns. At the annual conference, we might have different tracks such as risk management, schools and colleges, adventure programming, challenge education, wilderness therapy, etc. Imagine a conference like that! It would draw greater diversity, more vendors, more international attendees, and more conference site bargaining power. In fact, it is the way most successful conferences are run.

How can we get there? I know what I am going to do. At AEE this year, I will work my colleagues, members of the board who I know, and anyone else who will listen. I am more convinced then ever that we must stop this madness of a splintered field. Are there differences? Sure! But we can keep those differences while still holding on to a larger whole... e pluribus unum. We tell our participants that "diversity equals strength," that "many hands make light work," that "cooperation is better than competition"... why can't we model it ourselves?

Economy hits outdoor print publications

Rick Curtis — Mon, 27 Oct 2008 04:22:00 GMT

Print publication is one of the most challenging businesses out there. You are in a constant push to write and edit content, find and keep subcribers, and find advertisers. Two small but well-respected niche print publications have stopped publishing, Alpinist and Backpacking Light. Their press releases tell some of the story of the challenges of a print publication in tough economic times. In the case of Backpacking Light, the company will continue to operate but cease to publish a printed magazine. In the case of Alpinist, the entire company is closing. According to Hoovers.com on average about 35% of a magazine's revenue comes from subscribers or single-copy sales and the remaining 65% comes from advertising. Mediaweek reports that advertising revenue has decreased.

Alpinist Magazine

Alpinist LLC, which publishes the climbing magazine Alpinist, runs the website www.alpinist.com and produces The Alpinist Film Festival, announced that the October 2008 financial crisis has forced them to suspend operations. The print publication Alpinist

Founded in 2002 by Marc Ewing and Christian Beckwith, Alpinist began in Jackson Hole, Wyoming, as an archival-quality publication dedicated to world alpinism and adventure climbing. The quarterly quickly gained a reputation for both superior writing and beautiful photography; by 2004, Italian climbing legend Reinhold Messner called it, "The best climbing magazine in the world today." Alpinist went on to win numerous awards; in March 2005 it was featured in a seven-page article in Outside Magazine ("The Purists") that explored its impact on American climbing. Alpinist's website, www.alpinist.com, attracted more than 50,000 unique visitors per month. Breaking news, weekly features, video, and desktop wallpaper images were complemented by reader's blogs and gear reviews, creating a site that thousands of climbers turned to daily for both information and entertainment.

In 2004, Beckwith founded The Barry Corbet Film Festival in honor of cinematographer and adventure legend Barry Corbet. In 2005, the event was folded into Alpinist LLC as The Alpinist Film Festival (AFF). By 2008, the AFF, held each winter in Jackson, had grown to a four-day annual event that attracted more than 3,000 people each year. In 2008, the AFF began touring; events in Bend, OR; Bozeman, MT; and Boulder, CO, exported signature elements of the master festival, such as cocktail hours and live DJs, to create a fun gathering for adventure communities across the West.

"We're extremely proud of what we've been able to accomplish in the six and a half years since we started," said Publisher Ewing from his home in Chicago. "There hasn't been a publication like Alpinist since Ascent"—the iconic climbing publication that emerged from the 1960s to inspire a generation of climbers—"and our readers have been our lifeblood. We owe them everything."

"It's incredibly sad to close after working so hard for so many years," said Editor-in-Chief Christian Beckwith. "That being said, I'm deeply proud of our team for putting out twenty-five great issues, the film festival has been a blast, and I'm honored to have shared all this work and creation with our community. I'll always look back on Alpinist with joy."

Exploration of the options for the various Alpinist businesses are underway. Details will be made available on www.alpinist.com when they are finalized.

Backpacking Light Magazine

Beartooth Media Group, Inc., announced today that it will suspend production of its print magazine (and the Zinio.com digital edition of that print magazine), Backpacking Light. Other operations, including its website, BackpackingLight.com, its book publishing division (“Beartooth Mountain Press”), and the Backpacking Light range of house-branded gear and apparel, will remain business as usual.

Issue 11 will be the final issue mailed to domestic (U.S.) subscribers and issue 10 will be the final issue mailed to international subscribers. All issues remain available for single copy purchase at BackpackingLight.com, and Issues 9-11 will remain available at existing newsstand locations throughout the U.S.

Reasons for discontinuing production of the print magazine include: rising costs, inability to meet production schedules, industry-wide declines in print media advertising and subscription revenues, increasing pressure from subscribers to have a “lightweight” footprint on the environment true to the company's vision, and the desire to refocus the company's energy back to its online media roots.

The company's President and CEO, Ryan Jordan, cites the current economic recession as a major factor in this decision. “Printing, transportation, and fulfillment cost increases over the past few years make publishing a print magazine of our size at an affordable price impossible without advertising,” Jordan said. “Now that advertisers are moving more of their ad dollars online, the ability to produce a high-quality, short run, niche publication requires substantial costs. It's not fair to our long-time customers, including our gear shop and online subscribers, to divert their dollars to unprofitable projects.”

In addition, the company has found it increasingly difficult to reconcile their print magazine footprint with their vision as an industry environmental leader. “We promote sustainability and responsible resource usage,” comments Jordan. “It's hard to do that when retailers and magazine distributors are destroying unsold copies of the magazine, and subscribers are throwing them away.” Jordan continues, “The printing industry is the fourth largest emitter of carbon dioxide to the atmosphere. Add to this the the monumental transportation costs required to deliver printed matter from the factory to distributors, retailers, and subscribers, and the combined tax upon energy levels is pretty dramatic. We can't in good conscience be a part of that simply to increase our sales base and to serve the decreasing number of subscribers that demand that their information be delivered in print. The outdoor industry's addiction to paper – magazines, catalogs, hang tags – is completely counterproductive to their long term sustainability. We've made the decision to break away from that herd.”

Jordan states that the complexity of producing a print magazine has also taken its toll on the resources of a company that already produces one of the outdoor industry's largest web sites, manages a book publishing division, and its own brand of outdoor gear and apparel. “The print magazine was an experiment that diverted resources away from our core activities. Now it's time to end the experiment and reinvest our resources into serving and building our core business, and serving those customers that have been such an instrumental part of growing our company. As hard as it is to end the print magazine, it's an exciting time because we have so much to look forward to in the future. Keeping the print magazine afloat has inhibited us from doing some of the other things that we really wanted to do for our customers.” One of those things, cites Jordan, is expanding the depth and diversity of the editorial content published online at BackpackingLight.com.

Subscribers holding unfulfilled subscriptions will not be left in the dark. “We are committed to making sure that every subscriber to the print magazine will be taken care of,” says Karen Wilson, Backpacking Light's Customer Service Manager. “We have a subscription conversion and refund program in place that has already been communicated to our print subscribers.”

Backpacking Light was founded in 2001 and rapidly established itself as a leading online publisher in the outdoor industry during a time when other outdoor magazines were struggling with their identity. Jordan claims that outdoor magazines still haven't quite figured out how to respond to economic and environmental pressures. “As for Backpacking Light, we have no identity crisis anymore,” says Jordan. “We know what has worked, what our subscribers want, and where to go from here. I'm really excited for the future.”

Worse Case Scenarios: The Economic Crisis and Outdoor Education

Jay Roberts — Fri, 17 Oct 2008 13:38:00 GMT

I was watching Jim Cramer of "Mad Money" on CNBC last night and his analysis of the economic crisis was striking. He said that we ought to be prepared for 2-4 years of severe recession with high unemployment and significant reductions in flexible income combined with increases in daily cost of living. He went on to say that any business or industry that relies on what would be considered "non-essential" services or "value added" products should expect a severe and extended income shortfall in the coming months. This is the same guy who, by the way, predicted the current credit crisis back in April of this year so his advice stands on a pretty solid track record. What does this mean for those of us working in the outdoor education industry? The future looks unsettled at best.

Cramer's advice to all? Have a "Plan B." It seems likely that as companies look to cut the fat from budgets, the first thing to go will be the training and development line item. This means adventure companies and challenge courses that rely on corporate clients may be in for a very rough ride in the next 2-4 years. In addition, outdoor programs (summer camps, colleges/universities) may also be affected as parents grow increasingly wary of "extra" out-of-pocket expenses. "Cocooning" is a new trend as people spend less time travelling and doing activities outside the home and more time on less expensive activities locally or within the home itself. Degree programs may be affected as well as students choose more "marketable" and financially safe career options that have a better chance at employment in an economic downturn. While it is true that during recessions more folks go back to school, it is less clear that those returning to school choose "lifestyle" degrees over more vocationally oriented ones.

All this is to say that we better be prepared. A long standing maxim of the outdoor field is to plan for worst case scenarios. Has your program or organization spent time planning worst case scenarios for the next five years? Are you over dependent on program revenue from more "flashy" offerings? Do you have a staffing reduction plan that is fair and equitable? Have you closely examined where you can "cut the fat" out of operating budgets? Are there creative programming solutions that can capitalize on the coming trends (cocooning, localism, etc.)?

I have no doubt about the value and worth of outdoor education long term. Through our courses and programs we teach many of the values that will become essential in the current economic climate: self sufficiency, simplicity, learning to live with less, compassion, interdependence, and dealing with hardship. But that does not mean we are not vulnerable to current market forces. Now is the time to think about our "Plan B's."

To Thaw or not to Thaw

Tod Schimelpfenig — Wed, 15 Oct 2008 19:56:00 GMT

I was recently asked what to do if you can't make it back to the trailhead in one day with frozen toes and have to spend the night in the field? How do you keep the toes from thawing while keeping the rest of your body warm?

This is a practical and real question. Thirty-four years ago I spent a night in a tent with my toes frozen, then walked 6 miles and traveled another 25 to a hospital. I know this situation first hand, or first foot as it were.

As so often happens in medicine, there is no easy answer. At every step of the way there are risks and benefits. What do we need to consider when making this decision?

If your feet are frozen, there are often accompanying issues of hypothermia, exhaustion, and dehydration that make walking unlikely. If you thaw a frozen foot in the field it’s hard to imagine walking. If you thaw a frozen toe or toes, you might be able to walk. Let’s talk about this scenario.

The benefit to frozen toes is the ability to walk. The risk is that the longer tissue is frozen, the worse the injury. Medicine can't give an exact timeline to help with this decision.

Practically speaking, keeping toes frozen is a challenge. It's likely your toes will slowly thaw overnight, especially if you can get inside shelter with clothing, sleeping bag, warm food and drink.

The benefit to rapid thawing in warm water, the treatment of choice, is that it gives the best chance for saving tissue. However, thawed toes often hurt and swell, and you put your toes at risk for a freeze-thaw-freeze injury, which is very likely to increase tissue loss.

Rapid thawing in warm water is easy to talk about in a classroom, but difficult to do in the backcountry. If you think your toes will thaw slowly, it’s better to “get er done” quickly. Hopefully, if warm water immersion isn't practical, your companion will donate their armpits or belly, which can work for thawing fingers and toes.

We weigh all these considerations-- some factors we’re sure of, others that are probable, but not certain-- and we make the decision.

In my case, it was desperately cold (minus 30F). I did sit up all night, and I kept my toes cold as I read Bradford's Washburn's classic frostbite pamphlet. It wasn’t fun, but it worked. My frozen toes, which still fit in my boots, began to thaw as I hiked out the next morning, but they were essentially still frozen at arrival in the hospital. I think I was lucky.

Tod

Oct 08

Poison Oak Allergic Contact Dermatitis

Rick Curtis — Tue, 14 Oct 2008 03:58:00 GMT

by Paul Auerbach, M.D.

reposted with permission from the Medicine for the Outdoors Blog

Case Reviews in Clinical Dermatology, Volume 1 Issue 3, had an interesting discussion about certain aspects of poison oak/ivy dermatitis. The following are some of the points made by the authors, with additional comments by me:

"Contact dermatitis" (CD) is a broad term used to describe inflammation of the skin caused by direct contact with an irritating substance or allergen (a substance that induces an allergic reaction/response). Allergic contact dermatitis is a hypersensitivity reaction to a substance exposed to the skin to which a person has become allergic.

Sensitization to a substance can develop at any time, including adulthood. It may develop for substances that have been used repeatedly without any difficulty by an individual in the past. Poison oak/ivy allergic contact dermatitis is quite common. It is most likely to occur in persons with significant outdoor exposure, such as forest firefighters and backpackers. Sometimes a person may unknowingly encounter the allergen. For instance, urushiol in poison oak can persist on items such as clothes and gardening tools for years, and may be transmitted to a person from the fur of a pet, in the smoke of a campfire, or from a casual brush with plant that intrudes on a hiking path.

In general, a contact dermatitis eruption due to poison oak appears as itchy blisters, both large and small, on a reddened base in a linear (patterned in lines) distribution. Despite common belief, the fluid contained in the blisters does not spread the rash; only the urushiol resin itself can spread the rash. The resin in the is composed of a mixture of catechols and causes the hypersensitivity reaction when it comes in direct contact with the skin.

Urushiol is a water-soluble substance that can only be removed in significant amounts if washed immediately. Only 50% can be removed after ten minutes of contact, 25% after 15 minutes, and no resin can be removed after one hour of contact with the skin. Prevention of exposure to these plants is the most sensible, but not always the most practical solution. Many attempts have been made to prevent contact with the resin by applying topical skin protectants.

To make some treatment recommendations, the authors of the article offered a clinical case:

A 28-year-old, otherwise healthy man presented with a one-week history of a rash that began as small, itchy blisters on his inner arms a few days after camping in the Sierra Nevada Mountains. A few days later, he started to develop new large, red areas on his back. He felt somewhat fatigued but denied having fever or other symptoms. On physical examination, small blisters and black streaks were apparent in a cluster on his inner arm. There were other large reddened areas on his back. Based on his presentation, the diagnosis was "black spot poison oak contact dermatitis with systematization (spread to other parts of the body)."

The patient was treated with oral prednisone, starting at 60 mg per day and tapered by 10 mg per oral dose every 3 days. His symptoms resolved completely within two weeks.

According to the authors, this case illustrated an unusual presentation of poison oak contact dermatitis and the importance of rapid diagnosis and treatment. "Rhus dermatitis," commonly known as "poison ivy, poison oak, or poison sumac," and currently referred to as "toxicodendron dermatitis," is one of the most common forms of contact dermatitis (CD) in the U.S. It is characterized by itchy blisters on a reddened base in the setting of a history of exposure to an offending plant or some other vehicle (such as a dog's fur) that is carrying the resin.

Poison ivy grows in all states in North America with the exception of Alaska. Poison oak is separated into two categories: Western Poison Oak, which only grows on the Pacific coast of North America, and Atlantic Poison Oak, which is found mostly in sandy soils in the eastern part of the U.S. Poison ivy and poison oak are grouped with other toxicodendron dermatitis agents, including Japanese lacquer tree, cashew nut tree, poison sumac, and other members of the Anacardiaceae family of plants. Marked pruritus is typically the first symptom of toxicodendron dermatitis, beginning between the fingers, and on the eyelids, wrists, and top (opposite the palm) aspects of the fingers within 48 hours of exposure.

Itching is generally followed by inflammation and the characteristic appearance of a linear bumpy (raised) rash with blisters. As long as the plant oil remains on the skin, it can be transferred from the hands to other body parts. However, once the offending agent has been washed off, there is generally no further expansion of the rash, except in areas that have come in contact with the resin. In some cases, CD can become severe, covering over 20% of the body in adults and 10% of the body in children or manifesting systemically with fevers, fatigue (tiredness), and other symptoms.

The offending urushiol is an oleoresin that is both an allergen (causes an allergic response) and a primary irritant. It is a very resilient substance, and can persist for weeks to months on clothes, furniture, and animal fur. Typically, the allergic reaction to urushiol occurs within 24 to 72 hours, but it can be seen as quickly as six hours after exposure, particularly in highly sensitive individuals.

Black spot contact dermatitis is usually caused by poison ivy and poison oak, but can also be caused by sap from the Japanese lacquer tree, because the chemical structures of the oils in both plants are quite similar. When the resin from the Japanese lacquer tree comes into contact with skin, it turns black and attains a shiny appearance that becomes especially noticeable within the first 72 hours after exposure.

Black spot poison oak as a diagnosis can be challenging when the presentation consists of only asymptomatic black spots. Patients become concerned when these black spots, appearing as marker or ink spots, do not wipe off, and they sometimes confuse the lesions with melanoma. The ability of the resin to persist on clothes, fur, and tools for years can also complicate the picture since patients may deny a history of exposure because they are unaware of their contact with the resin. This pigment develops not only on the skin but on clothing as well. The black lesions cannot be washed off the skin and are followed by itchy blisters. They eventually peel off, and the skin heals without scarring.

This presentation is not commonly observed, probably because for the black lesions to occur, the skin needs to come into contact with a much higher concentration of plant sap. In most cases, persons experience only brief contact with the offending plant and then further dilute the concentration of oleoresin via perspiration or bathing so the appearance of black spots does not occur.

Regardless of whether or not black coloration occurs, after suspected exposure to the resin, the first step should be to wash the skin with soap to remove the urushiol and prevent further spread of the agent. This is most effective if done within 15 minutes of exposure. All clothes and any other items that came into contact with the offending plant should also be washed. Many patients find cool tub baths helpful in relieving the itching and edema associated with the rash, and oral antihistamines provide nighttime relief from itching. During the acute blistering stage, cool, wet dressings applied for approximately 20 minutes several times a day may help with swelling, especially around the eyes and on the face.

The decision to use topical or oral steroid medication(s) depends on a number of factors, including but not limited to age of the patient, severity of symptoms, amount of body surface area involved, and presence or history of a medical condition in which administration of an oral steroid could cause an adverse reaction.

The American Academy of Dermatology recommends topical steroid treatment only for mild cases. Typically, medium potency topical steroids are used, except on (delicate) skin around the eyes, which requires a less potent steroid. In general, the steroid preparations are liberally applied to the affected areas twice daily for 7 days. Oral steroids are used in more severe cases and in sufferers who have systemic involvement.

In severe cases, oral steroid courses (typically prednisone) are given at 0.75 to 1 mg/kg/day every morning, and this dose is tapered over a three-week period. Generally, oral steroids are tapered by approximately 10 mg every 2 to 3 days. For these severe, generalized cases, short (e.g., a few days) courses of low-dose oral corticosteroids have proven inadequate.

image of black spot reaction courtesy of Professional Education Services Group

The 2008 Wilderness Risk Management Conference - WRMC Jackson, WY

Rick Curtis — Fri, 03 Oct 2008 03:12:00 GMT

For those of you who aren't able to be here, I'll try and give you a flavor of this year's Wilderness Risk Management Conference. OutdoorEd.com will be covering the conference and bringing you both highlights and key information from conference presenters.

Day 1

This is the first full day of the 15th Annual Wilderness Risk Management Conference (WRMC) sponsored by the National Outdoor Leadership School, Outward Bound, and the Student Conservation Association.The conference is being held in the Jackson Lake Lodge in Grand Teton National Park, a spectacular backdrop for the conference. It's the largest conference attendence ever with over 350 people from programs across North America and internationally.

As usual the conference was proceeded by several days of in-depth preconference sessions. Here's what was going on:

Wilderness Medicine Institute WFR Recertification
NOLS Risk Management Training
Outward Bound's Instructor Judgment Training
Risk Management for Service and Conservation Corps
Climbing Site Management
The Learning Brain
Managing Risk with Volunteer Leaders
Using Case Studies as a Teaching Methodology

That list gives you a really good sense of the topical focus of this conference. That's the reason why I find this conference one of the best professional development experiences for me each year. Unlike more general conferences, the core focus of the WRMC means that for three days I get to live and breathe the core issues of risk management from a broad range of perspectives. I have more than twenty-seven years in the field of outdoor education as a program director and I always gain new information and insights from the WRMC. It's also an opportunity for me to share my experience and bounce ideas off friends and colleagues.

The conference opened with a keynote address by Dr. Sarah Newman, who is the first Public Risk Management Specialist for the National Park Service. Dr. Newman is an epidemiologist by training and brings her expertise to the immense job of designing and implementing a Public Risk Management Program for the first time in the National Park Service's history. Her program will conduct risk assessments and analyze risk management to identify ways to prevent and reduce injuries to the millions of National Park visitors. Dr. Newman identified some of the complex issues of gathering and evaluating data from such a diverse set of parks across the country.

After the keynote the conference moved into workshop mode. There are four key conference workshop tracks:

General Program Management
Staff Training
Crisis Management & Emergency Response
Legal and Insurance

Within each of these four tracks there are numerous workshops by some of the top experts in the field. I started the first workshop session with a presentation by Kent Clement, professor at Colorado Mountain College. Kent, through his background in instructing in the outdoors for more than two decades and in statistics has identified a number of important components that make up the judgment and decision-making process.

In between workshops I've been at the OutdoorEd.com booth in the Exhibit Hall, talking to people about OutdoorEd.com and encouraging folks to continue contributing to the site. I'll be posting more about the conference over the next few days.

Wilderness Risk Management Conference - 15 years later

Tod Schimelpfenig — Tue, 30 Sep 2008 02:07:00 GMT

Fifteen years ago I opened the first WRMC in a large tent at the NOLS base in Conway Washington.   Today, amid the beautiful fall colors in Grand Teton National Park, I was looking at my notes from that presentation

Opening remarks WRMC 1994. Current Issues.
- Today the public demands more from wilderness educators, and we demand more of ourselves. This is still true. We wrestle to find the balance between risk management and adventure, worry whether we can make our programs too safe, and ask where we cross the line between risk management and program integrity. At some point, in order to sail, the ship needs to leave the harbor.
- We feel, either perceived or real, pressures from our litigious society and its seeming reluctance to accept responsibility for its actions. This is still true.
- We ask more of our staff in terms of their technical ability, experience and training. This is still true.
- We wrestle with the impact of technology in the traditional wilderness experience. In 1994 I didn’t imagine the communication, information, navigation technology available to us today. Nor did I anticipate how people have grown to expect these, to take them for granted as part of the wilderness experience. There are now field staff who have never worked in the pre-sat phone and GPS era.
- We try to explain our programs to people who seem more and more disconnected from wilderness. This was before we worried about children who did not even go outside.

Where have we gone in 15 years?
Industry-wide dialogue on risk management was, and is a goal in the formation of this committee and this conference.   We’re more knowledgeable. Our risk management practices are better.   We have better lines of communication. We have more resources; in people, information and experience.

Yet the issues are in many ways the same. I could say the same things today that I said in 1994. They remain relevant.

What I didn’t say then, but wish I had, is that we can develop risk management systems and programs, have sound training and support materials and good lines of communication, but ultimately, our ability to be present when a staff person and a participant are engaged in a real time decision is limited. Lets keep this focus on the person in the field making the decisions, the person at the sharp end of the rope, with their hands on the tiller and their eyes on the terrain and weather.   For this ultimately is the core of risk management in our programs and our most valuable tool.   It still comes down to the competence and judgment of our people in the field - and this is a good thing.

The Adventure & Recreation Law Center - Sample Legal Case

Outdoor Ed — Sun, 28 Sep 2008 18:46:00 GMT

Starting in January 2009
a new online community for outdoor education professionals
$95 annual subscription for full access to the online community with 12 legal cases written by Reb Gregg & Catherine Hansen-Stamp

Sample Legal Case:
Caution! Participant Agreements Containing a Release of Liability
by Reb Gregg and Catherine Hansen-Stamp

A recent Florida case emphasizes the need to carefully craft participant agreements or other documents that include language seeking a release of liability for your organization’s negligence, considering a court’s strict reading of that language.

In Murphy v. Young Men’s Christian Association of Lake Wales, 2008 Fla. App. LEXIS 2035, Elizabeth Murphy, an adult, suffered injuries while using exercise equipment at a YMCA and filed suit against them. Ms. Murphy (plaintiff) claimed that the YMCA had negligently failed to inspect, maintain and repair the equipment, and that that was the cause of her injuries. Plaintiff had signed a membership application before using the YMCA which contained the following language: “I understand that even when every reasonable precaution is taken, accidents can sometimes still happen. Therefore…..I release the (YMCA)….”. Further into the paragraph, the applicant states: “I understand that this release includes any claims based on negligence…”.

The YMCA claimed that the Membership Agreement release language barred plaintiff’s claim for negligence, and that therefore, her lawsuit should be dismissed before trial. Plaintiff argued that the release was not clear, because the “reasonable precaution” language could be interpreted as being inconsistent with the YMCA’s release of negligence – that is, the YMCA agreed it would NOT be negligent, and then asked to be released if it WAS negligent.

The Court agreed to dismiss the case before trial (granted “summary judgment”) in favor of the YMCA. The Plaintiff appealed to the Florida Court of Appeals.

The Appeals Court agreed with plaintiff and reversed the lower court ruling, refusing to dismiss the case on the strength of the release language. The Court noted that under Florida law, release provisions are not favored by the courts, must be “strictly construed against the party claiming to be relieved of liability” and must be “so clear…that an ordinary…party will know what he is contracting away”. The Court concluded that the YMCA clearly promised to “take every reasonable precaution” against accidents, and that a “reasonable reader” might conclude that the release covered only claims that were unavoidable even though every reasonable precaution had been taken.

The case was sent back to the trial court for “further proceedings”.

COMMENTARY:

Courts, as noted in this case, are reluctant to enforce agreements containing release (often referred to as exculpatory or liability “shifting”) language. To do so contradicts the notion, firmly embedded in this country’s tort laws, that folks who suffer a loss are entitled to be compensated for that loss. The other side of the argument is that folks are entitled to contract as they see fit, even if the the contract offends some notions of fair play. A few states, including Louisiana, Montana and Virginia will not enforce an individual’s agreement to release his or her right to recover for future negligence. However, the vast majority of states do allow such agreements.

Every jurisdiction has its own criteria for determining the enforceability of release language. Note that in Murphy, the release language was included in a ‘Membership Agreement.’ We commonly see release language in a larger agreement – what we have called a ‘participant agreement’ – containing additional language discussing the activities, risks and other pertinent information. It may be entitled ‘Acknowledgement and Assumption of Risks & Release and Indemnity Agreement’ or something similar. A participant agreement can inadvertently create contradictions similar to those present in the Murphy case: “we have chosen our contractors with care” for example, or “we guarantee you a safe and fun experience”.

Because release language attempts to shift liability already allocated under the law, courts in most jurisdictions will carefully scrutinize these agreements and enforce them only on a case by case basis. Courts will look to both the basic requirements of contract law, and law regarding releases, in judging enforceability. Generally, a release, must be clear in its intent, voluntarily and fairly entered into, involve parties who are competent to contract (age, mental acuity, etc.), and include terms that do not offend state public policy. Many states, for example, do not allow a parent or legal guardian to release a minor’s rights to recover for negligence, or allow an individual to release their right to recover for recklessness, or willful, wanton or intentionally wrongful conduct (to be discussed in future publications). As in all matters legal, consult with qualified counsel in your state regarding the laws that affect your program’s strategies for protection from claims.

Consistent with the prevailing ‘tough’ approach to releases, we have seen courts consider carefully whether the activity and risk which caused the loss were actually covered by the document – or, perhaps more succinctly, whether the loss was reasonably contemplated by the participant as within the scope of what he or she had agreed to release. As a result, programs should take care in describing the activities and potential risks, so the injured participant cannot claim: “Gee, that never occurred to me”. Keep in mind that a document cannot contain every possible contingency, and ‘catch-all’ language can be used in a thoughtful and appropriate way. Work with legal counsel familiar with your state’s law to address these issues.

Reflecting now on the Murphy case, discussed above: The activities and risks may appear to have been adequately covered, but the language of the release actually PROMISED, or strongly suggested, a level of care (“every reasonable precaution”) that contradicted the apparent intent of the release language – to be excused for NOT acting reasonably (that is, for acting negligently). The promise of reasonable care, the Court reasoned, eliminated the risk of unreasonable care (negligence). This internal contradiction (“how can you promise to do something and then ask to be forgiven if you don’t fulfill your promise?”) provides a perfect set-up for a court already disposed to disallow a release. If one were to try to reconcile the two provisions it might be appropriate, the Court notes, to interpret the release language as covering only losses that were unavoidable in spite of “reasonable precautions”. Obviously, this interpretation narrows considerably, the intent of the program to protect itself from claims of negligence.

TAKE-AWAYS:

Examine your participant agreement to determine if it contains language which might be interpreted as a promise to meet a certain standard of behavior that is inconsistent with your effort to be released from claims of negligence. If there is this type of inconsistency, your release language may be ineffective.
Work with experienced legal counsel who is familiar with the law in your jurisdiction, to assess this and other important aspects of your participant agreement.

This article is for educational purposes and general reference only and not intended as legal advice. Recreation and adventure providers should work with experienced legal counsel, including counsel licensed in their jurisdiction, to advise them on how developing case law or legal issues may impact matters specific to their operation.

Rabies Vaccine Shortage

Outdoor Ed — Thu, 25 Sep 2008 03:08:00 GMT

by Paul Auerbach, M.D.

reposted with permission from the Medicine for the Outdoors Blog

The American College of Emergency Physicians has just alerted emergency physicians that because of a shortage of rabies vaccine, they need to obtain a confirmation code from their state health department before ordering doses of the vaccine for post-exposure prophylaxis.

Here is some information about rabies:

Rabies virus infection occurs more frequently in wild than in domestic animals. In some foreign countries where immunization of animals is infrequently practiced, the risk is great even in domesticated animals. The virus is carried in saliva and is transmitted by bite or lick (if the skin is broken). It has been transmitted by bats in caves either by aerosolized saliva or undetected bites. Raccoons, dogs, cats, foxes, coyotes, skunks, wolves, bats, woodchucks, and groundhogs are the most common carriers. Rabies has not been reported in bears. Although rabbits, hares, mice, squirrels, chipmunks, rats, guinea pigs, and ferrets may be rabid, they are rarely involved in the transmission of rabies to humans. Domestic animals such as cattle, horses, and sheep become infected in regions where skunk or raccoon rabies is found. In developing countries in Asia, Africa, and South and Central America, dogs are the most common carriers.

Animals with rabies show abnormal behavior. In the “furious” phase, they are hyperactive, may have a fever, are overtly aggressive, and salivate excessively. With “dumb” rabies, they appear tired, lack coordination, and may become paralyzed.

Because of rabies risk, all wild animal bites or scratches, and bites or scratches of unregistered or strangely behaving cats and dogs, should be reported to the appropriate public health authority. If the animal is a pet with otherwise normal behavior, it should be observed for 10 days. If the animal is rabid, it will become very ill or die during that time, and its brain tissue can be analyzed for the presence of rabies. If the animal is a pet with unusual behavior, or a captured high-risk wild animal, it should be killed and examined. If it is a high-risk animal and cannot be captured, it must be presumed to be rabid.

Immediately scrub an animal bite wound or a wound that has been licked by a potentially rabid animal vigorously with soap and water. If benzalkonium chloride 1% (Zephiran); 10% povidone iodine (Betadine) solution (less effective); or, in a pinch, Bactine (benzalkonium 0.13%) antiseptic is available, one of these should be used to irrigate and deeply swab the wound, since they may kill rabies virus.

The standard instructions in times of plentiful rabies vaccine supply are:

If rabies is a consideration, the victim should seek the assistance of a physician, who will determine the need for postexposure rabies vaccination (a series of five injections) and injection of antirabies serum (human rabies immune globulin; as much as possible is injected around the bite wound, and the remainder intramuscularly). A person who has been previously immunized against rabies still needs two booster doses of rabies vaccine after high-risk contact with a rabid animal. In countries (Africa, Asia) where rabies in very prevalent in dogs and cats, the vaccination status of the biting animal should be ignored, because the vaccination may not have occurred or may have been ineffective. Begin vaccination and then discontinue after 10 days if the animal is observed to remain healthy during that time period.

Preexposure vaccination against rabies should be administered to people at high risk of exposure (animal handlers, cavers, hunters, and trappers in rabies-endemic areas, along with travelers to certain foreign countries). This is given as a series of three intramuscular injections over 28 days, although a newer 1 week schedule for the injections appears to be quite effective. An intradermal regimen can be used for immunization, but this technique may result in lower antibody level.

The incubation period of rabies ranges from 9 days to more than 1 year, but is usually between 2 and 16 weeks. The first symptoms are fatigue, weakness, anxiety, irritability, fever, headache, nausea and vomiting, sore throat, abdominal pain, and loss of appetite. Some victims complain of numbness and tingling where they were initially bitten. After a few days to 2 weeks, the virus shows its devastating effect upon the nervous system, with symptoms of increased agitation, hyperactivity, seizures, hallucinations, uncontrollable behavior, and inability to drink (hydrophobia) due to muscle spasms in the throat. This constellation is called “furious rabies.” With “dumb” rabies, a person becomes progressively weak, uncoordinated, and paralyzed. Unfortunately, rabies is virtually always fatal, with the terminal events being one or more of coma, respiratory failure, seizures, abnormal heart rhythms, paralysis, and pneumonia.

To avoid rabies, be certain that all pets and livestock are properly vaccinated, do not feed or handle wild animals, do not feed or touch stray animals, avoid sick or strange-acting animals, keep garbage and food (including feed for animals) covered and away from wild animals, do not keep wild animals as pets, do not touch or pick up dead animals, and do not handle bats.

With the current vaccine shortage, the protocol for post-exposure vaccination has been modified. Complete details are found at the CDC website dedicated to information about rabies. To emphasize some of the information:

As of August 29, 2008, Sanofi Pasteur in coordination with the Centers for Disease Control and Prevention (CDC) will resume shipping IMOVAX® Rabies, Rabies Vaccine for post-exposure prophylaxis only. Novartis Vaccines will no longer be shipping supplies of RabAvert®.

For a physician to obtain IMOVAX rabies vaccine, he or she must first contact the appropriate Rabies State Health Official so that a risk-assessment can be conducted for the suspected exposure. If the Official determines that post-exposure prophylaxis is required, the inquiring physician will be provided with a pass code to place on the Sanofi Pasteur Rabies Post-Exposure Form. The form must be filled out in its entirety, including the required physician’s signature and pass code provided by the Rabies State Health Official. Sanofi Pasteur may be contacted at 1-800-VACCINE to obtain the required form.

Vaccine availability for pre-exposure vaccination continues to be limited, and will be distributed on approval from state and federal public health authorities for those first responders with a critical need and in consideration of available supplies. These measures will allow responsible management of currently limited supplies of this vaccine for individuals at highest risk of exposure.

Why is there an interruption in supply?

Starting in June 2007, Sanofi Pasteur began renovating its IMOVAX Rabies vaccine production facility in France to maintain compliance with the most current requirements from FDA and the French regulatory body. Prior to these renovations, Sanofi Pasteur established an inventory based on historical levels of sales and projected market demand. The facility is scheduled to be approved and operational by mid-to-late 2009. Until the facility is operational, Sanofi Pasteur has a finite amount of IMOVAX Rabies vaccine.

After the renovations began, Novartis, the other supplier of rabies vaccine for the United States, was unable to meet projected rabies vaccine supplies. Since early 2008, Novartis has been supplying its rabies vaccine, RabAvert, for post-exposure use only. Consequently, Sanofi Pasteur has been supplying nearly all of the market for rabies vaccine. The increase in demand for IMOVAX is outpacing the company’s historical levels of supply.

Persons at increased risk for rabies exposure should take appropriate precautions to avoid rabies exposure. Vaccine is available for pre-exposure prophylaxis, and providers should consult with their local or state public health department to ensure appropriate use of such prophylaxis. General rabies awareness and prevention messages should be emphasized to avoid exposure (e.g., avoid wildlife contact, vaccinate pets/livestock, capture/observe/test exposing animal, etc.).

Building Sustainability into your Outdoor Program

Rick Curtis — Mon, 22 Sep 2008 03:16:00 GMT

Creating a more sustainable outdoor program is a goal for many of us. At Princeton University we began to look at our carbon footprint and overall environmental impact a year ago. Sustainability in outdoor programming is much larger than how we practice Leave No Trace in the outdoors. It strives to look at all of our practices as an organization, from what type of equipment we purchase: where it was made, how was it made - with what materials, who made it, how far did it have to travel to get to us, etc. Take this and expand it to the food you buy, methods of transportation and more and it becomes a huge project.

I want to share with you our experiences in building a sustainability curriculum into our wilderness orientation program for incoming freshmen. Since Princeton's Outdoor Action Frosh Trip Program is the largest single wilderness orientation program in the country (688 freshmen and 183 leaders on 83 different 6-day wilderness trips this fall) it offered us the unique opportunity to teach more than half of the incoming class about sustainability before they started schoo.

We were extremely lucky to be awarded a special grant from an office at Princeton that supports sustainabiltiy initiatives. With that grant we were able to hire two student sustainability interns for the summer to research our current practices to establish a baseline and to develop plans for reducing our overall footprint. What Collen Driscoll '11 and Emily Sung '11 discovered was that this research often leads to more questions than answers. We were given a great start on thinking about our program by Paul Van Horn at Northland College and his great research paper with his students - ASAP: As Sustainable As Possible. With the beginning research in place we were extremely lucky to be able to hire Jessica Kellett, an environmental educator from California as a consultant to develop a Sustainability Curriculum for our leaders to teach on the trail this year. Along with the curriculum, Jessica planned our first Sustainability Day of training for our leaders before the trips went out.

We are still working on assessing the results of this year's program and I'll be writing more about it in the coming weeks. We clearly had an impact on the attitudes of some students. Our trip leaders and their groups did a fantastic job of recycling and not just the traditional bottles and cans. During the trip they separated out all of their fruit and vegetable waste (onions, apple cores, orange peels, green peppers) which went into two 50 gallon drums and down to the community garden on campus. All other excess food waste (everything from leftover peanut butter in jars to uneaten cheese) went into nine 50 gallon drums which were sent off to a pig farmer (how Dining Services at Princeton currently disposes of its excess food waste). Bottles, jars and cans went into a recycling dumpster. Plastic bags for food packing were separated into clean and dirty with clean ones going to a local plastics recycling plant. Watching students unload all of this at the end of the trip as compared to just tossing everything in a dumpster demonstrated what a powerful effect sustainability curricula can have.

You can read the cover story "Training on trail may bring greener outlooks to campus" from the Princeton Weekly Bulletin and view the Online Video showing how students on trip G17 in the Delaware Water Gap commenting on what they learned about sustainable practices on their trip.

You can also download a PDF of the Outdoor Action Sustainability Guide for use in your program.

Lightning Precautions

Outdoor Ed — Tue, 09 Sep 2008 03:41:00 GMT

by Paul Auerbach, M.D.

reposted with permission from the Medicine for the Outdoors Blog

Spring, summer (peak season), and autumn are the seasons during which we witness most thunderstorms, and during which people and animals are struck by lightning. The National Oceanic and Atmospheric Administration indicates that approximately 50 Americans are struck and killed each year by lightning.

One of the world's experts on lightning injuries is Dr. Mary Ann Cooper, who is Professor of Emergency Medicine and Director of the Lightning Injury Research Program at the University of Illinois at Chicago. This year, Dr. Cooper was the recipient of the Research Award from the Wilderness Medical Society at its annual scientific meeting held in Snowmass, Colorado. She is also senior author of the chapter on lightning injuries in the textbook Wilderness Medicine.

As Dr. Cooper has noted, most people seriously underestimate the risk of being struck and do not know when or where to take shelter. NOAA data indicate that of persons struck and killed by lightning, 25 percent were standing under a tree and 25 percent occurred on or near the water. It is logical that nearly all persons killed by lightning are struck outdoors, so it is very important that everyone who might be caught in a thunderstorm be able to make a rapid assessment of the risk, and seek the best shelter or protective positioning possible. This is a personal responsibility for most, and a very important skill for group leaders.

Here is some information intended to help you understand the behavior of lightning in order to improve avoidance techniques:

1. Lightning strikes the earth at least 100 times per second during an estimated 3,000 thunderstorms per day. Fortunately, the odds of being struck by lightning are not very great. The wise traveler respects thunderstorms and seeks shelter at all times during a lightning storm.

2. Thunder, which is always present with lightning, is attributed to the nearly explosive expansion of air heated and ionized by the stroke of lightning. To estimate the approximate distance in miles from your location to the lightning strike, time the difference in seconds between the flash of light and the onset of the thunder, and divide by five.

3. Lightning can injure a person in five ways:

A. Direct hit, which most often occurs in the open.
B. Splash, which occurs when lightning hits another object (tree, building). The current seeks the path of least resistance, and may jump to a human. Splashes may occur from person to person, or from a metal fence.
C. Contact, when a person is holding on to a conductive material that is hit or splashed by lightning.
D. Step (stride) voltage (or ground current), when lightning hits the ground or an object nearby. The current spreads like waves in a pond.
E. Blunt injury, which occurs from the victim’s own muscle contractions and/or from the explosive force of the shock wave produced by the lightning strike. These can combine to cause the victim to be thrown, sometimes a considerable distance.

4. When lightning strikes a person directly, splashes at him from a tree or building, or is conducted along the ground, it usually largely flows around the outside of the body (flashover phenomenon), which causes a unique constellation of signs and symptoms. The victim is frequently thrown, clothes may be burned or torn (“exploded” off by the instantaneous conversion of sweat to steam), metallic objects (such as belt buckles) may be heated, and shoes removed. The victim often undergoes severe muscle contractions—sufficient to dislocate limbs. In most cases, the person struck is confused and rendered temporarily blind and/or deaf. In some cases, there are linear (11/2 to 2 in, or 1.3 to 5 cm, wide, following areas of heavy sweat concentration), “feathered” (fernlike; keraunographism; Lichtenberg’s flowers—cutaneous imprints from electron showers that track over the skin), or “sunburst” patterns of punctate burns over the skin, loss of consciousness, ruptured eardrums, and inability to breathe. Occasionally, the victim ceases breathing and suffers a cardiac arrest. Seizures or direct brain damage may occur. Eye injuries occur in half of victims.

5. A victim struck by lightning may not remember the flash or thunder, or even recognize that he has been hit. The confusion, muscle aches, body tingling, and amnesia can last for days. With a more severe case, the skin may be mottled, the legs and/or arms may be paralyzed, and it may be difficult to locate a pulse in the radial (wrist) artery, because the muscles in the wall of the artery are in spasm. First-, second-, or third-degree skin burns may be present. Broken bones are not uncommon.
If a person is found confused, burned, or collapsed in the vicinity of a thunderstorm, consider the possibility that he was struck by lightning. The victim is not “electrified” or “charged”—you will not be jolted or stunned if you touch him.

6. If you are in the vicinity of a thunderstorm, seek shelter for the victim and yourself. Lightning can strike twice in the same place!

Lightning Avoidance

1. Know the weather patterns for your area. Don’t travel in times of high thunderstorm risk. Avoid being outdoors during a thunderstorm. Carry a radio to monitor weather reports. Lightning can lash out from 10 miles in front of a storm cloud, in seemingly clear weather. If you calculate (see above) that a nearby lightning strike is within 3 miles (5 km) of your location, anticipate that the next strike will be in your immediate area. The “30-30 rule” specifies that if you see lightning and count less than 30 seconds prior to hearing thunder, seek shelter immediately. Since thunder is rarely heard from more than 10 miles away, if you hear thunder, it is best to curtail activities and seek shelter from lightning. Do not resume activities outdoors for at least 30 minutes after the lightning is seen and the last thunder heard.

2. If a storm enters your area, immediately seek shelter. Enter a hard-roofed auto or large building, if possible. Tents and convertible autos offer essentially no protection from lightning. Tent poles are lightning rods. Metal sheds are dangerous because of the risk of side splashes. Indoors, stay away from windows, open doors, fireplaces, and large metal fixtures. Inside a building, avoid plumbing fixtures, telephones, and other appliances attached by metal to the outside of the building.

3. Do not carry a lightning rod, such as a fishing pole or golf club. Avoid tall objects, such as ski lifts and power lines. Avoid being near boat masts or flagpoles. Do not seek refuge near power lines or tall metal structures. If you are in a boat, try to get out of the water. If you are swimming in the water, get out. Do not stand near a metal boat. Insulate yourself from ground current by crouching on a sleeping pad, backpack, or coiled rope.

4. Move off ridges and summits. Thunderstorms tend to occur in the afternoon, so attempt to summit early and be heading back down by noon. In the woods, avoid the tallest trees (stay at a distance from the tree that’s at least equal to the tree’s height) or hilltops. Shelter yourself in a stand of smaller trees. Avoid clearings—you become the tallest tree. Don’t stay at or near the top of a peak or ridge. Avoid cave entrances. In the open, crouch down or roll into a ball.

5. Stay in your car. If it is a convertible, huddle on the ground at least 50 yards (46 m) from the vehicle.

6. If you are part of a group of people, spread the group out so that everyone isn’t struck by a single discharge.

7. If your hair stands on end, you hear high-pitched or crackling noises, or see a blue halo (St. Elmo’s fire) around objects, there is electrical activity near you that precedes a lightning strike. If you can’t get away from the area immediately, crouch down on the balls of your feet and keep your head down. Don’t touch the ground with your hands.

8. The StrikeAlert Personal Lightning Detector (Outdoor Technologies, Inc.) is the size and configuration of a pager and uses an audible warning and LED display to show the wearer how far away lightning is striking and if a storm is approaching or leaving.

Experiential/Adventure Summit

Outdoor Ed — Mon, 08 Sep 2008 02:40:00 GMT

Four Points Sheraton Hotel, Schiller Park IL (next to O’Hare)

September 16 & 17, 2008

A forum for organizations and institutions to come together to discuss ways to collaborate on matters of common interest

Transform Conversation to Action

Expect to contribute ideas, find synergy with others, and come out with a collective plan for action.

Imagine the possibilities

Develop new alliances to benefit the experiential/adventure world in the areas of public policy and the research we need to show that our programs and methodologies are effective.

Join the Conversation

None of us is as strong as all of us—we know this and teach it on a daily basis. It’s time for us to live it.

Why are we doing this? To develop new alliances to benefit the experiential/adventure world

The experiential world’s issues are complex and difficult for a single organization to tackle. However, by working together, our achievements will be greater than our individual efforts. Imagine how many people we represent when you consider our collective staffs plus the numbers of participants whose lives we have touched. We all work on our own issues, in our own ways, but this is a time to imagine what we can accomplish together and how we can build our collective influence to sustain and expand our programs.

Summit participants will come up with strategies to transform conversation to action. Expect to contribute ideas, find synergy with others, and come out with a collective plan to move us forward. We can make a difference in our world in ways that will draw attention to the benefits of experiential and adventure programming and expand our influence. We will identify the unique assets of each organization and institution present and how they can best contribute to this whole, as well as places where those who cannot be present can join in afterwards.

Take a leadership role in building a better world. Participate in collaborative crafting of principles, guidelines, and actions to create an agenda to move forward.

Come to the Summit!

Schedule

Tuesday, September 16	Wednesday, September 17
1:00 p.m.–6:00 p.m. Meeting	7:00 a.m.–8:00 a.m. Breakfast
6:00 p.m.–7:00 p.m. Cash Bar	8:00 a.m.–12:00 p.m. Meeting
7:00 p.m. Dinner	12:00 p.m. Meeting adjourns

Site and Lodging Information

The site for the meeting is the Four Points Sheraton Hotel, adjacent to O’Hare Airport (847-671-6000). Hotel reservations must be made directly with the hotel. A room rate of $125 plus taxes is available to meeting attendees only until September 2, 2008. Rooms reserved after that date will be at a higher rate. Reservations may be made by calling 847-671-6000 and tell them you are attending the ACCT meeting or visiting

http://www.starwoodmeeting.com/StarGroupsWeb/res?id=0806169272&key=8DD5C.

Meals

Dinner on Tuesday night and breakfast on Wednesday morning will be provided to participants. Other meals are on your own.

Travel and Ground Transportation

• O’Hare airport is the closest airport to the site. There is free shuttle service to the hotel.

• For those flying into Midway Airport, a fee based shuttle goes from Midway to O’Hare, then you can get the free shuttle to the hotel.

• For those driving, the hotel is located at 10249 West Irving Park Road, Schiller Park, Illinois, at the corner of Irving Park and Mannheim Roads.

Download the registration form here

Don’t Let Regulations Become the Program by Jim Grout

Chris Ortiz — Fri, 05 Sep 2008 14:15:00 GMT

Below is an article by High 5's own Jim Grout. Jim brings a unique perspective, having been a member of the committee that drafted the ACCT Practitioner Certification Standards and his 28 years in the field. Jim offers up a much needed reminder of why we all do what we do. Thanks Jim ~Chris Ortiz

Over the last several years the challenge course industry has been in the midst of some of the most significant changes in its three decade plus history. Practitioner certification guidelines and governmental regulation are changing the way we do business more than ever before. Whether or not we agree with these changes matters little, for change is inevitable. We all must now decide how to best adapt to these changes. As we enter the second year of Practitioner Certification influencing the way we do business, it seems a bit of reflection may be in order.

It’s a given that we all must use our technical skills to deliver challenge course experiences within a safe environment. But in this era of growing requirements and regulations coming from many directions, administrators, insurance companies, government regulators and our industry itself, it is important not to let all of this become the program. Over my 28 years in the field of adventure I have always thought that experiential education can be defined simply; it is an educational tool for helping people develop as a person. When I’ve found myself challenged with what feels like too much information and regulation, too many details and demands, I go back to that simple definition for perspective.

Most skills based training workshops contain an enormous amount of information to absorb. It can feel overwhelming at times for participants to remember how to tie the right knot, choose an appropriate game or initiative, facilitate a debrief, set up a belay or put on a harness properly. Program managers are also taxed with the additional responsibilities of training and managing staff, developing local operating procedures and staying current with trends in the field.

It is because of all this that I end my training workshops by telling participants, “When in doubt, give them your heart.” Hopefully it reminds people that the essence of what we do as adventure educators is to provide people with a powerful learning experience that is engaging, challenging, thought provoking, fun and safe.

It is our job as skilled educators to try to achieve the magical balance between technical skills and thoughtful facilitation, to create the best and most powerful experience for our audience.

So by all means dot the I’s, cross the T’s, learn your skills and learn them well. But then make sure to connect and inspire those with whom you work.

~Jim Grout

Handwashing, Giardia and old Tales

Tod Schimelpfenig — Wed, 27 Aug 2008 16:18:00 GMT

Once there was a time, days of freedom and ignorance vaguely remembered as the 70’s, when we didn’t worry about wilderness water quality. We drank when and where we pleased. Yes, there was a tale of backpackers in Utah who became ill with “beaver fever” caused by Giardia, but we tried to ignore this challenge to our assumptions. The die was cast, however, and discussions began over whether we needed to disinfect the water.

Physician and outdoor educator Thomas Welch wrote an editorial on water disinfection in the Journal of Wilderness and Environmental Medicine 2004. He points out that this classic 1976 Utah incident of Giardia caused diarrhea, which brought this protozoa to our attention and probably sparked the water disinfection era, looks in hindsight like a hygiene, not a water disinfection problem. Other groups using the same area didn’t get sick, cysts could not be isolated from the water, and the patients all became ill at the same time, and with a short incubation period, suggesting this was not a waterborne protozoa illness.

Giardia’s reputation is enhanced by an association bias. People go camping, get diarrhea and assume the source was the water. This perception is encouraged when the diagnosis of Giardia is based on a history of a recent camping trip, but without testing. The patient leaves believing they may have Giardia, when in fact there is often no proof. They leave thinking it was the water they drank, when the cause of the illness may have been hand-to-mouth transmission. They might need a lecture about hand washing from their health care provider, along with the advice to be more diligent with water disinfection.

The editorial makes the point that water disinfection is not a substitute for hand washing or alcohol-based hand cleaners.

Someday we may have the science to give us a better sense of when we need to disinfect water. Until then, routine water disinfection has low health risks and is prudent. And hygiene, especially hand washing, is vital for avoiding illness on a wilderness trip.

Welch, TR. Evidence-based medicine in the wilderness: The Safety of Backcountry Water. 2004. Wilderness Environ Med. 15:235-237.

Maintenance in between your yearly inspections.

Chris Ortiz — Fri, 22 Aug 2008 04:57:00 GMT

I was going to include this in my last post but that one was getting sort of long and I felt like there was enough information about this that it deserved its own posting. Here are some tips for keeping up on the maintenance in between your annual challenge course inspection by a qualified challenge course professional.

In addition to the annual inspection, programs should conduct their own inspections on a regular basis. In this instance regular means two things, seasonal and daily.

Seasonal inspections or those done as conditions may dictate due to weather (on outdoor courses), high volume of use, etc. should be assigned to your course manager or some staff person who is familiar with the course construction. Many things can occur that can alter the condition of the course between annual inspection dates. Other daily inspections are the responsibility of all staff utilizing the course. It is recommended that you have a means for communicating any problems with the course to all staff whether they are in-house full-time people or adjunct staff who use the course occasionally. At High 5 we use emails and a white board posted in our equipment shed. Issues and concerns can be readily posted for the next facilitator to see before the next program begins.

Wood Chips - Without a covering of wood chips or some other type of organic mulch, a high volume of foot traffic on a challenge course will cause soil compaction which is a detriment to tree health. Six inches of organic material spread over all areas of consistent foot traffic is recommended. Because of ongoing decomposition, this should be done annually.
- Many sites, including my own, have a difficult time keeping up with wood chips. Here is one of the most simple and ingenious ways I have heard of keeping up with this tedious task. Keep a pile of wood chips at the entrance of your course along with a bunch of 5 gal. buckets. Each group that is going out on to the course takes a bucket of chips with them. They then dump the bucket at the element they are going to use. One bucket is not much but over the course of the year... Besides who really enjoys that sweaty buggy "staff day" of hauling and spreading wood chips. Thanks for the tip whatever site originally told me about this technique... I don't remember who you are.
Eye ka-bobs and widow makers - Make an effort to keep up with the removal of any loose, dead limbs that overhang an area where participants will be congregating or are passing. These hanging widow makers can come down in a strong wind and be a serious hazard, but don't forget the low level branches that stretch out into the path or activity area trying to poke an eye (my old friend Cathy is cringing somewhere if she is reading this, visualizing the eye-ka-bob.)
Vandalism - No matter how remote or protected your challenge course is... if people know about it... it is an attractive nuisance. Keep an eye out of dropped haul cords, moved or missing equipment as they could be clues to more significant damage you haven't yet found.
- While we are on the subject of attractive nuisances, simple measures can be taken to make your course unattractive. Challenge courses can easily be built with "put up/take down" cables or element access (which should be locked away when not in use). Has anyone thought of putting those fake security signs up... my father-in-law has them on his doors, little signs that say this house is protected by ABC security systems. No such company but I think would be a deterrent if I was just passing by and had nuisancy thoughts. That or just electrify your cables when you aren't there.... Just kidding... DON'T do that, I shouldn't have even joked!
Critters - Challenge courses provide numerous nooks and crannies for critters to find a home. Squirrel nests in tires are a common one. Give those tires a thump now and again to make sure there is no build up of nesting material inside. Another spot to be aware is in the shed. Our High 5 shed has had mice make a home in just a few short days and on one occasion ate partially through a belay rope. Such damage would only be detected by the watchful eye of the facilitator conducting the days’ program. Of course insect critters are also a concern. Keep an eye out for nest on towers or other elements and make sure you have wholes drilled in the bottom side of tires for water drainage so as not to create standing water for mosquito or other insects.
Weather - As I mentioned in the intro to this post... weather can reek havoc on the course. Be extra attentive after big electrical storms and high winds. Look for down branches and tree condition. If lightning strikes one tree on our course it can travel through cables or through the air to other trees... come check out our old zip line at High 5... 5 trees in one strike including the 2 primary trees on that element.
What is that Metallic grinding? - Be aware of points on your course were you have metal to metal contact... I know, that is everywhere, so keep your eyes open everywhere.
Cable ends - It is not uncommon for serving sleeves to slide out of places. Loose cable ends may seem like a cosmetic issue but they are sharp little buggers. Get skewered by one of those and you won't soon forget. If you can not replace the serving sleeve, a healthy dose of duct tape is a good band aid until it can be properly fixed.
Record Keeping and storage - Walking into a well organized, clean shed just makes you feel confident in the program on some level. It would follow suit that other aspects of the program are also thoughtfully cared for. Some form of rope log that could include such things as date rope is put in service, hours of use, days of use, number of participant, etc is also an example of conscientious management practices. Of course, such record keeping does not actually dictate the retirement date of a rope (though ropes do have a manufacturer suggested maximum shelf life). The most accurate measure of this is a regular visual and tactile inspection with every use and how your ropes have been used.

Wow, that is a lot of stuff to look at and pay attention to. There is even more but if you get nothing else from this post... be mindful of the equipment you handle on a daily basis. It is so easy to go into auto pilot and mindlessly hang ropes and attach carabiners. Notice the carabiners operation and wear points, inspect ropes every time you hang them and pay attention, period. (was that period redundant)

Chris Ortiz