Friday, August 21, 2009

Summer safety tips from an MGH wilderness medicine expert


Following a particularly rainy June and July, many are now taking the opportunity to enjoy the late summer season by spending more time outdoors. But according to N. Stuart Harris, MD, MFA, director of the Wilderness Medicine Fellowship at MGH, individuals should be aware of a number of seasonal hazards. While Harris assures these can be safely avoided or addressed, he offers the following information for general educational purposes:


Lightning and thunderstorms
"Ideally during a lightning and thunderstorm, you want to avoid being the highest point in the vicinity," says Harris. "Try to find shelter as soon as you can inside a house or car. If neither is available, crouch down into a ball, with your feet close together, preferably on top of a nonconducting surface, such as a foam pad or personal flotation device if you are on a boat."

A general guideline to remember during a lightning and thunderstorm is the "30-30 rule," which involves counting the seconds between seeing the lightning and hearing the thunder. If the time is under 30 seconds, the lightning storm is less than six miles away, which is close enough to be a threat. It is generally safe to leave the shelter 30 minutes after seeing the last lightning flash.

Heat stroke
Heat stroke is a medical emergency that requires immediate treatment. The condition occurs when the body's cooling strategies fail, leading to a rapid, potentially fatal increase in body temperature. A person with heat stroke often appears confused, is not speaking clearly and has dry, flushed skin. In contrast, those with more common, benign heat exhaustion are damp with perspiration and can still speak clearly. Although heat stroke can be fatal, it can be readily treated if recognized early.

"It's important to seek immediate medical attention if someone is very hot and not speaking coherently," says Harris. "In the meantime, move the individual out of the sun, remove any extra clothing, quickly get water onto their exterior and place them in front of a fan. This cools them from the exterior as best as possible."

Tick- and mosquito-borne diseases
"Unfortunately, tick- and mosquito-borne diseases are becoming increasingly more common," says Harris. "But these diseases are avoidable and treatable if recognized."

Harris recommends avoidance as the best protection against tick- and mosquito-borne diseases such as Lyme disease, West Nile virus and eastern equine encephalitis virus. Using an insect repellent helps repel most biting pests. He also advises wearing long sleeves and tucking pant cuffs into socks when outdoors in Lyme-endemic or mosquito-prone areas as well as during the evening and night, which are mosquito feeding times. After being in areas where there could be ticks, it is important to conduct "tick checks." If a tick is found, it should be promptly removed. Individuals should then discuss with their primary care physician the possible use of antibiotics. If a rash, muscle aches, headache and a fever higher than 101 degrees occur following a tick bite, the individual should see his or her physician for appropriate care.

Bee stings
Individuals with serious allergies to bee stings should be prepared to immediately administer adrenaline with an "EpiPen" and receive treatment at an emergency department if stung. For those without serious bee-sting allergies, home treatment will likely be sufficient. Harris advises removing the stinger as soon as possible by raking a flat-sided implement -- such as the edge of a credit card -- across the stinger to release it from the skin. Individuals should not try to pull out the stinger with their fingers, because this could cause more venom to be injected. After removing the stinger, an oral antihistamine, such as Benedryl, often is recommended at the discretion of the individual's physician.

In all bee-sting cases, it is important to watch for anaphylaxis symptoms such as facial swelling, wheezing, vomiting and fainting. If these occur, immediate adrenaline administration and a visit to the closest emergency department are in order.


Harris explains that the above advice and information is presented to raise general awareness and is not intended to be used in place of consultation with health care professionals.

"While the summer months are a time for fun, it is important to stay healthy and safe," says Harris. "Individuals should contact their physician or seek medical help if they have any questions or concerns."

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