A Year in Review: Notable Events in Wilderness Medicine

Marc Cassone, DO, FAWM, DiMM
ACEP WM Section Secretary

Since we last met in Philadelphia, there have been some plenty of new stories and advancements in wilderness medicine - we’ve highlighted some of the major stories below!

• December 2023: A rare eruption on Sumatra’s Mt. Marapi killed 23 hikers and injured others including fractures and burns. Repeated eruptions, unstable terrain, noxious fumes, and risk of mudslides caused remarkable hazards for search and rescue teams.
• January 2024: The Wilderness Medical Society published updated Clinical Practice Guidelines on frostbite, acute pain management in austere settings, drowning, eye injuries, water disinfection, avalanche injuries, and spinal cord protection. Additionally, they also created new guidelines on medical direction of SAR teams.
• February 2024: A Colorado man dies from the venomous bite of an illegal pet Gila monster. This is the first fatality from this large North American lizard reported in over a century. To date, no antivenom exists.
• February 2024: US FDA approves iloprost, the first medication designated to treat severe frostbite via priority review and orphan drug designation. The approval was based on an open-label, controlled trail that showed decrease in risk of digit amputation in severe cases.
• Winter 2024: Palisades Tahoe ski resort in California sees one fatality from a rare inbounds avalanche, however, overall avalanche deaths in the 23-24 winter season are down compared to prior years (total: 13).
• April 2024: A total solar eclipse across North America causes leads to awe and an increase in reported cases of solar retinopathy.
• Summer 2024: Heat-related deaths in Canyonlands, Death Valley, and Grand Canyon National Parks highlight a disturbing yearly trend and the dangers of rising temperatures and increased visitor to national parks and other recreation areas.
• August 204: US FDA approves neffy, the first intranasal epinephrine spray used for treatment of anaphylaxis. While easier administration (compared to autoinjectors) is promising (especially in austere environments and for various levels of healthcare providers), important questions remain on side effects and storage and use in extreme temperatures.