Table Of ContentWILDERNESS
MEDICINE
WILDERNESS
MEDICINE
Sixth Edition
Paul S. Auerbach, MD, MS, FACEP, FAWM
Redlich Family Professor of Surgery
Division of Emergency Medicine
Department of Surgery
Stanford University School of Medicine
Stanford, California
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
WILDERNESS MEDICINE ISBN: 978-1-4377-1678-8
Copyright © 2012, 2007, 2001, 1995, 1989, 1983 by Mosby, an imprint of Elsevier Inc.
Chapter 83 © 2012 by Michael E. Jacobs and Charles G. Hawley
Chapter 3 all figures, tables, and photographs © Dr. Mary Ann Cooper
Chapter 29 photographs © Dr. Grant S. Lipman, Elsevier granted non-exclusive license to
publish
Chapter 20 © Swaminatha Mahadevan
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Notices
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Library of Congress Cataloging-in-Publication Data
Wilderness medicine / [edited by] Paul S. Auerbach.—6th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4377-1678-8 (hardcover : alk. paper)
I. Auerbach, Paul S.
[DNLM: 1. Wilderness Medicine. 2. Emergency Treatment—methods. 3. Environmental
Exposure. 4. Recreation. 5. Rescue Work. 6. Survival. WB 107]
LC classification not assigned
616.9′8—dc23
2011032078
Acquisitions Editors: Dolores Meloni and Stefanie Jewell-Thomas
Developmental Editor: Lucia Gunzel
Publishing Services Manager: Anne Altepeter
Associate Project Manager: Jessica Becher
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Contributors
Javier A. Adachi, MD, FIDSA, FACP Aaron L. Baggish
Associate Professor, Department of Infectious Diseases, Infection Associate Director, Cardiovascular Performance Program, Divi-
Control, and Employee Health, The University of Texas MD sion of Cardiology, Harvard Medical School, Massachusetts
Anderson Cancer Center; Adjunct Professor, The University of General Hospital, Boston, Massachusetts
Texas Health Science Center at Houston, Medical School and
School of Public Health; Adjunct Professor, Baylor College Jennifer G. Baine, MD
of Medicine, Houston, Texas; Visiting Professor, Universidad
Clinical Instructor, Division of Emergency Medicine, Stanford
Peruana Cayetano Heredia, Lima, Peru
University School of Medicine, Stanford, California
Martin E. Alexander, BScF, MSc, PhD, RPF
Buddha Basnyat, MD, MSc, FACP, FRCP(E)
Adjunct Professor, Wildland Fire Science and Management,
Medical Director, Nepal International Clinic, Himalayan Rescue
Department of Renewable Resources, Alberta School of Forest
Association; Principal Investigator, Oxford University Clinical
Science and Management, University of Alberta; Honorary
Research Unit, Patan Academy of Health Sciences, Kathmandu,
Research Associate, Faculty of Forestry and Environmental
Nepal
Management, University of New Brunswick, Fredericton, New
Brunswick, Canada; Senior Fire Behavior Research Officer
(Retired), Canadian Forest Service, Northern Forestry Centre, Ryan P. Bayley, MD
Edmonton, Alberta, Canada Resident Physician, Emergency Medicine, New York-Presbyterian
Weill Cornell Medical Center and Columbia University Medical
Robert C. Allen, DO, FACEP Center, New York, New York
Colonel, United States Air Force MC CFS (Retired), Contingency
Operations Division, United States Air Force School of Aero- Greta J. Binford, PhD
space Medicine, Brooks City, Texas Associate Professor of Biology, Lewis and Clark College, Port-
land, Oregon
Susan Anderson, MD, MS
Clinical Associate Professor, Division of Infectious Diseases and Nicholas H. Bird, BA, MD, DABFM, DABPM
Geographic Medicine, Stanford University, Stanford, California; CEO and Chief Medical Officer, Divers Alert Network, Durham,
Travel, Tropical, and Wilderness Medicine Consultant, Travel North Carolina
Medicine and Emergency/Urgent Care, Palo Alto Medical Foun-
dation, Palo Alto, California
Ryan Blumenthal, MBChB (Pret), MMed
(Med Forens) Pret, FC for Path (SA),
Christopher J. Andrews, BE, MBBS, MEngSc,
Dip For Med (SA)
PhD, JD, EDIC, DipCSc, GDLP
Forensic Pathologist, Department of Forensic Medicine, Univer-
Mt Ommaney Family Clinic, Australia
sity of Pretoria, Pretoria, Gauteng, South Africa
E. Wayne Askew, PhD
Jolie Bookspan, MEd, PhD, FAWM
Colonel, United States Army MSC (Retired), Professor and Chair,
Medical Director, Neck and Back Pain Sports Medicine, Academy
Division of Nutrition, University of Utah, Salt Lake City, Utah
of Functional Exercise Medicine, Temple University, Philadel-
phia, Pennsylvania
Dale Atkins, BA
President, American Avalanche Association; Vice President, Ava- Ralph S. Bovard, MD, MPH, FACSM
lanche Rescue Commission; International Commission for
Department of Occupational and Environmental Medicine,
Alpine Rescue, North America Training and Education Manager,
HealthPartners, St. Paul, Minnesota
RECCO, AB, Boulder, Colorado
Warren D. Bowman, MD, FACP
Paul S. Auerbach, MD, MS, FACEP, FAWM
Clinical Associate Professor Emeritus, Department of Internal
Redlich Family Professor of Surgery, Division of Emergency Medi-
Medicine, University of Washington School of Medicine,
cine, Department of Surgery, Stanford University School of
Seattle, Washington; Staff Physician (Retired), Department of
Medicine, Stanford, California
Internal Medicine, Division of Hematology-Oncology, The Bill-
ings Clinic, Billings, Montana
Kira Bacal, MD, PhD, MPH, FACEP
Phase 2 Director, Medical Programme Directorate, University of Leslie V. Boyer, MD
Auckland, Auckland, New Zealand
Director, Venom Immunochemistry, Pharmacology, and Emer-
gency Response Institute; Associate Professor of Pathology,
Howard D. Backer, MD, MPH University of Arizona, Tucson, Arizona
Director, California Emergency Medical Services Authority
v
John E. Bradford, RN, MPAS, PA-C Charles Clarke, MA, MBBCh, FRCP
S
R
O Peace Corps Medical Officer, United States Peace Corps, Malawi, Honorary Consultant Neurologist, National Hospital for Neurol-
T Lilongwe, Malawi, Africa; Clinical Adjunct Professor, University ogy and Neurosurgery, Queen Square, London, United
U
B of Utah Physician Assistant Program, Salt Lake City, Utah Kingdom
RI
T
N
O Mark A. Brandenburg, MD Kenneth S. Cohen, MA, MSTh
C
Medical Director, Emergency Department, Bristow Medical Independent Scholar, Traditional Healer, Nederland, Colorado
Center, Bristow, Oklahoma; Medical Director, Emergency
Medical Services, Tulsa Technology Center, Tulsa, Oklahoma Stephen D. Coleman, MD
Clinical Assistant Professor, Department of Anesthesia, Pain Man-
Beau Briese, MD agement Division, Stanford University School of Medicine,
Resident Physician, Division of Emergency Medicine, Stanford/ Stanford, California
Kaiser Emergency Medicine Residency Program, Stanford Uni-
versity, Stanford, California Bryan R. Collier, DO, FACS, CNSP
Assistant Professor of Surgery, Division of Trauma and Surgical
Colin M. Bucks, MD Critical Care, Vanderbilt University Medical Center, Nashville,
Clinical Instructor, Division of Emergency Medicine, Department Tennessee
of Surgery, Stanford University School of Medicine, Stanford,
California Shon Compton, MPAS, PA-C
Major, Specialty Corps (Retired), Chief Instructor, Center for
George H. Burgess Predeployment Medicine, United States Army Medical Depart-
Florida Program for Shark Research, Florida Museum of Natural ment Center and School, Fort Sam Houston, Texas
History, University of Florida, Gainesville, Florida
Benjamin B. Constance, MD
Sean P. Bush, MD, FACEP Chief Resident Physician, Division of Emergency Medicine,
Professor of Emergency Medicine, Loma Linda University School Stanford/Kaiser Emergency Medicine Residency Program, Stan-
of Medicine, Loma Linda, California ford University, Stanford, California
Frank K. Butler Jr., BS, MD Donald C. Cooper, PhD, MBA, EMT-P
Chairman, Committee on Tactical Combat Casualty Care, Defense State Fire Marshal, Department of Commerce, State of Ohio,
Health Board, Pensacola, Florida Columbus, Ohio
Dale J. Butterwick, ATC(C), BA, MSc Jimmy L. Cooper, MD, FACEP
Associate Professor, Faculty of Kinesiology, University of Calgary; Staff Physician, Department of Emergency Medicine, Director,
Former President, Canadian Pro Rodeo Sport Medicine Team, Center for Predeployment Medicine, San Antonio, Texas
Calgary, Alberta, Canada
Mary Ann Cooper, MD, FAMS, FAAEM
Steven C. Carleton, MD, PhD Emerita Professor, Department of Emergency Medicine, Univer-
Professor, Department of Emergency Medicine, University of sity of Illinois College of Medicine, Chicago, Illinois
Cincinnati College of Medicine, Cincinnati, Ohio
Kevin Coppock, BSc, MSc
Betty Carlisle, MD Head of Mission, Northern Sudan, Médecins Sans Frontières,
Adjunct Assistant Professor, Department of Public Health and Khartoum, Sudan
Preventive Medicine, State University of New York Upstate
Medical University; Staff Physician, Emergency Department, St. Larry I. Crawshaw, PhD
Joseph’s Hospital, Syracuse, New York
Professor Emeritus, Department of Biology, Portland State
University, Department of Behavioral Neuroscience, Oregon
Scott P. Carroll, PhD Health and Science University, Portland, Oregon
Department of Entomology, University of California, Davis,
California Joy E. Crook, MD, MPH
Instructor, Department of Emergency Medicine, Johns Hopkins
John W. Castellani, PhD School of Medicine, Baltimore, Maryland
Research Physiologist, Thermal and Mountain Medicine Division,
United States Army Research Institute of Environmental Medi- Gregory A. Cummins, DO, MS
cine, Natick, Massachusetts
Assistant Clinical Instructor, Department of Internal Medicine,
Kansas University of Medicine and Biosciences; Hospitalist,
Samuel N. Cheuvront, PhD Department of Medicine, North Kansas City Hospital, Kansas
Research Physiologist, Division of Thermal and Mountain Medi- City, Missouri
cine, United States Army Research Institute of Environmental
Medicine, Natick, Massachusetts Tracy A. Cushing, MD, MPH, FACEP, FAWM
Assistant Professor, Department of Emergency Medicine, Univer-
Richard F. Clark, MD sity of Colorado School of Medicine, Aurora, Colorado; Attend-
Professor of Clinical Medicine, Director, Division of Medical ing Physician, Fellowship Director, Denver Health Wilderness
Toxicology, University of California, San Diego, San Diego, Medicine Fellowship, Department of Emergency Medicine,
California Denver Health Medical Center, Denver, Colorado
vi
Jon Dallimore, MB, BS, MSc, MRCGP, MCEM, Herbert L. DuPont, MD
C
FFTM RCPS (Glasg), DCH, DRCOG Professor and Director, Center for Infectious Diseases, University ON
of Texas School of Public Health and Medical School; Chief of T
Specialty Doctor, Emergency Department, Bristol Royal Infirmary, R
Bristol, United Kingdom Internal Medicine, St. Luke’s Episcopal Hospital; Vice Chair- IB
man, Department of Medicine, Baylor College of Medicine, U
T
Houston, Texas O
Daniel F. Danzl, MD R
S
Professor and Chair, Department of Emergency Medicine, Uni- Blair Dillard Erb, BS, MD, FACP, FACC
versity of Louisville School of Medicine, Louisville, Kentucky
Past President, Wilderness Medical Society, The Study Center,
Townsend, Tennessee
Ian Davis, MBBCH, BSc (Hons)
Resident Medical Officer, Department of Accident and Emer- Timothy B. Erickson, MD
gency, Cirencester Hospital, Gloucestershire; Polar Medicine,
Professor, Department of Emergency Medicine, Division of
Medical Cell, Royal Geographical Society, London; Chief
Medical Toxicology; Director, Center for Global Health, Uni-
Medical Officer, Polar Challenge, Venture Group, Cirencester,
versity of Illinois College of Medicine, Chicago, Illinois
England, United Kingdom
Charles D. Ericsson, MD
Kathleen Mary Davis, BScF, MSc
Professor of Medicine, Head, Clinical Infectious Disease, Division
Superintendent, Montezuma Castle and Tuzigoot National Monu-
of Infectious Disease, Department of Internal Medicine, Uni-
ment, National Park Service, Camp Verde, Arizona
versity of Texas Medical School at Houston, Houston, Texas
Kevin Davison, ND, Lac
Peter J. Fagenholz, MD
Director, Maui Prolotherapy Clinic, Hamakuapoko, Peahi, Haiku,
Department of Surgery, Division of Trauma, Emergency Surgery,
Maui, Hawaii
and Critical Care, Massachusetts General Hospital; Instructor in
Surgery, Harvard Medical School, Boston, Massachusetts
Chad P. Dawson, BS, MPS, PhD
Professor, Forest and Natural Resources Management, State Uni- Joanne N. Feldman, MD, MS
versity of New York College of Environmental Science and
Clinical Faculty, Division of Emergency Medicine, University of
Forestry, Syracuse, New York
California, Los Angeles, Los Angeles, California
Janice A. Degan, RN, MS
D. Nelun Fernando, BA, MA, PhD
Senior Research Nurse, Venom Immunochemistry, Pharmacology,
Department of Geography, Rutgers University, New Brunswick,
and Emergency Response Institute, Arizona Health Sciences
New Jersey
Center, University of Arizona, Tucson, Arizona
Murray E. Fowler, BS, DVM
Thomas G. DeLoughery, MD, FACP
Professor Emeritus, Veterinary Medicine and Epidemiology,
Professor of Medicine, Pathology, and Pediatrics, Head, Benign
University of California, Davis, California
Hematology Section, Oregon Health and Science University,
Portland, Oregon
Mark S. Fradin, MD
Arlene E. Dent, MD, PhD Clinical Associate Professor, Department of Dermatology, Univer-
sity of North Carolina School of Medicine, Chapel Hill, North
Assistant Professor, Department of Pediatrics, Case Western
Carolina
Reserve University School of Medicine, Cleveland, Ohio
Michael E. Franco, Major, MSM, MPAS, PA-C
Thomas F. Ditzler, PhD, MA, FRSPH, FRAI
Chief, Plans and Operations, United States Army Environmental
Director of Research, Department of Psychiatry, Tripler Army
Management Systems Programs Office, United States Army
Medical Center, Honolulu, Hawaii
Medical Department Center and School, Fort Sam Houston,
Texas
Mark Donnelly, MD
Salem Emergency Department, Salem, Oregon Luanne Freer, MD, FACEP, FAWM
Medical Director, Medcor, Yellowstone National Park, Wyoming;
Howard J. Donner, MD Founder and Director, Everest Base Camp Medical Clinic,
Wilderness Medicine Instructor, Mountain Medical Seminars, Himalayan Rescue Association, Kathmandu, Nepal
Bozeman, Montana; Adventure Training Coordinator, The Finer
Points of Flying, San Francisco, California Steven P. French, MD, BS, MS, IUCN, ASNE,
SFW
Eric Douglas, BA, EMT, DMT
Co-founder and Research Director, Yellowstone Grizzly Founda-
Director, Education, Divers Alert Network, Durham, North
tion, Jackson Hole, Wyoming
Carolina
Nathan K. Friedline, MD
Jennifer Dow, MD, FACEP, FAWM
Resident, Division of Emergency Medicine, University of Utah,
Medical Director, Denali National Park and Preserve; Medical
Salt Lake City, Utah; Captain, United States Army, 32nd Medical
Director, National Park Service, Alaska Region, Department of
Brigade, Fort Sam Houston, Texas
Emergency Medicine, Alaska Regional Hospital, Anchorage,
Alaska
vii
Raymond R. Gaeta, MD Charles G. Hawley, BS
S
R
O Associate Professor, Department of Anesthesiology, Medical Vice President, West Marine, Safety at Sea Moderator, United
T Director, Pain Management Service, Stanford University School States Sailing Technical Board Member, American Boat and
U
B of Medicine, Stanford, California Yacht Council, Santa Cruz, California
RI
T
N
O Tom Garrison, BS, MA, PhD David M. Heimbach, MD
C
Professor, Department of Oceanography, Orange Coast College, Professor of Surgery, University of Washington School of Medi-
Costa Mesa, California; Adjunct Professor, Higher Education, cine, Seattle, Washington
University of Southern California, Los Angeles, California
Carlton E. Heine, MD, PhD, FACEP, FAWM
Daniel Garza, MD Clinical Instructor, University of Washington School of Medicine,
Assistant Professor, Department of Orthopaedic Surgery, Division Seattle, Washington; Attending Physician, Emergency Depart-
of Emergency Medicine, Stanford University School of Medi- ment, Bartlett Regional Hospital, Juneau, Alaska
cine, Stanford, California
Lawrence E. Heiskell, MD, FACEP, FAAFP
Alan Gianotti, MS, MD International School of Tactical Medicine, Palm Springs,
Clinical Assistant Professor, Division of Emergency Medicine, California
Stanford University School of Medicine, Stanford, California
John C. Hendee, PhD
Gordon G. Giesbrecht, BPE, BTh, MPE, PhD Emeritus Professor and Dean (Retired), University of Idaho,
Professor of Thermophysiology, Health Leisure and Human Per- College of Natural Resources, Moscow, Idaho
formance Research Institute, University of Manitoba; Professor,
Department of Anesthesia, University of Manitoba, Winnipeg, Henry J. Herrmann, DMD, FAGD
Manitoba, Canada
Dentist, Falls Church, Virginia
Kimberlie A. Graeme, BS, MD
Ronald L. Holle, BS, MS
Division of Emergency Medicine, Naval Medical Center San
Meteorologist, Holle Meteorology and Photography, Oro Valley,
Diego, San Diego, California
Arizona
Colin K. Grissom, MD
Renee Y. Hsia, MD, MSc
Associate Professor of Medicine, University of Utah School of
Assistant Professor, Department of Emergency Medicine, Univer-
Medicine; Associate Medical Director, Shock Trauma Intensive
sity of California, San Francisco; Attending Physician, Depart-
Care Unit, Intermountain Medical Center, Murray, Utah
ment of Emergency Services, San Francisco General Hospital,
San Francisco, California
Kirby R. Gross, MD, FACS
Trauma Services, United States Army Medical Department, Walter Franklin R. Hubbell, DO
Reed Army Medical Center, Washington, DC
Physician and Director, Urgent Care and Spine Center, Saco
River Medical Group; Physician, Director of Education,
Peter H. Hackett, MD Stonehearth Open Learning Opportunities Schools; Author,
Clinical Professor of Surgery, Department of Emergency Medi- Wilderness Medicine Newsletter, TMC Books, Conway, New
cine, Altitude Research Center, University of Colorado Denver Hampshire
School of Medicine, Denver, Colorado; Director, Institute for
Altitude Medicine, Telluride, Colorado Stephen E. Hudson, CEO, NTC
National Training Coordinator, National Cave Rescue Commis-
N. Stuart Harris, MD sion, National Speleological Society, Huntsville, Alabama; Pres-
Chief, Division of Wilderness Medicine, Director, Wilderness ident, Pigeon Mountain Industries, Lafayette, Georgia
Medicine Fellowship, Department of Emergency Medicine,
Massachusetts General Hospital; Assistant Professor of Surgery, Cynthia L. Idzik-Starr, DDS
Harvard Medical School, Boston, Massachusetts
Assistant Professor, Director of Urgent Care, Department of Oral
and Maxillofacial Surgery, University of Maryland Dental
Patricia R. Hastings, DO, MPH, FACEP, RN, School, Baltimore, Maryland
NREMT
Colonel, Medical Corps, United States Army; MEDCOM Liaison, Christopher H.E. Imray, PhD, MB, BS, DiMM,
Department of Homeland Security, Washington, DC, Depart- Clin Med Sci, FRCS, FRCP
ment of Emergency Medicine, Brooke Army Medical Center,
Professor of Surgery, Warwick Medical School, Department of
San Antonio, Texas
Vascular Surgery, University Hospitals Coventry and Warwick-
shire NHS Trust, Coventry, United Kingdom
Seth C. Hawkins, MD, FACEP, FAWM
Director, Mountain Emergency Physicians; Medical Director, Kenneth V. Iserson, MD, MBA, FACEP,
Burke Emergency Medical Services Special Operations Team;
Executive Director, Appalachian Center for Wilderness Medi- FAAEM, FIFEM
cine, Morganton, North Carolina; Assistant Professor, Emer- Professor Emeritus, Department of Emergency Medicine, The
gency Medical Care Program, Western Carolina University, University of Arizona, Tucson, Arizona
Cullowhee, North Carolina
viii
Michael Jacobs, MD, FAWM Brian J. Krabak, MD, MBA
C
United States Coast Guard Licensed Captain; Founder and Clinical Associate Professor, Department of Rehabilitation, O
N
Program Director, MedSail (Medicine for Mariners and Safety Orthopedics, and Sports Medicine; Team Physician, Seattle T
R
at Sea); Medical Director, Vineyard Medical Services, Martha’s Children’s Sports Medicine, Seattle University Athletics, Univer- IB
Vineyard, Massachusetts sity of Washington; Team Physician, USA Swimming; Medical U
T
Director, RacingThePlanet: 4 Deserts Ultra Marathon Series, O
R
Ramin Jamshidi, MD Seattle, Washington S
Fellow, Department of Pediatric Surgery, Children’s Hospital of
Wisconsin; Clinical Instructor, Department of Surgery, Medical Andrew C. Krakowski, MD
College of Wisconsin, Milwaukee, Wisconsin; Adjunct Profes- Pediatrician and Dermatologist, Rady Children’s Hospital of San
sor, Physics Department, University of California, San Fran- Diego, University of California, San Diego, San Diego, Califor-
cisco, San Francisco, California nia; Founder and Director, boonDOCS Wilderness and Travel
Medicine, La Jolla, California
James M. Jeffers, BA, LLB, LLM, MPhil
PhD Candidate, Department of Geography, Rutgers University, Peter Kummerfeldt, AD
New Brunswick, New Jersey President, OutdoorSafe, Former Survival Training Director, United
States Air Force Academy, Colorado Springs, Colorado
Jamie G. Jenkins, MD
Ultrasound Fellow, Department of Emergency Medicine, Wash- Ashley R. Laird, MD
ington Hospital Center, Georgetown University Hospital, Union Emergency Physician, Sonora Regional Medical Center, Sonora,
Memorial Hospital, Washington, DC California
Kirsten Johnson, MD, MPH, CCFP-EM Carolyn S. Langer, MD, JD, MPH
Assistant Professor, Department of Family Medicine; Director, Instructor, Harvard School of Public Health, Boston,
University Humanitarian Studies Initiative; Affiliated Faculty, Massachusetts
Institute for Health and Social Policy, McGill University, Mon-
treal, Canada; Affiliated Faculty, Harvard Humanitarian Initia- Patrick H. LaValla
tive, Harvard University, Cambridge, Massachusetts
CEO, ERI International; Operations Chief, All Hands Consulting;
Former President, National Association for Search and Rescue,
Hemal K. Kanzaria, MD Olympia, Washington
Resident Physician, Department of Emergency Medicine, Univer-
sity of California, San Francisco, San Francisco General Hospi- Jay Lemery, MD, FACEP, FAWM
tal, San Francisco, California
Assistant Professor, Weill Cornell Medical College; Attending
Physician, New York Presbyterian Hospital; President-Elect,
Lee A. Kaplan, MD Wilderness Medical Society; Visiting Scientist, François-Xavier
Clinical Professor, Department of Dermatology, University of Bagnoud Center for Health and Human Rights, Harvard School
California, San Diego Health System, La Jolla, California of Public Health, Boston, Massachusetts
Misha R. Kassel, MD Lisa R. Leon, PhD
Clinical Instructor, Departments of Emergency Medicine and Research Physiologist, Thermal and Mountain Medicine Division,
Orthopaedic Surgery, Stanford University School of Medicine, United States Army Research Institute of Environmental Medi-
Stanford, California cine, Natick, Massachusetts
Stephanie Kayden, MD, MPH Benjamin D. Levine, MD, FACC, FACSM
Director, Harvard International Emergency Medicine Fellowship; Director, Institute for Exercise and Environmental Medicine; S.
Attending Physician, Brigham and Women’s Hospital; Instruc- Finley Ewing Jr., Chair for Wellness, Texas Health Presbyterian
tor, Harvard Medical School; Faculty, Harvard Humanitarian Dallas; Harry S. Moss Heart Chair for Cardiovascular Research;
Initiative, Boston, Massachusetts Professor of Medicine and Cardiology, Distinguished Profes-
sorship in Exercise Science, University of Texas Southwestern
James W. Kazura, MD Medical Center at Dallas, Dallas, Texas
Professor of International Health and Medicine, Center for Global
Health and Diseases, Case Western Reserve University School Matthew R. Lewin, MD, PhD, FACEP
of Medicine, Cleveland, Ohio Director, Center for Exploration and Travel Heath, California
Academy of Sciences, San Francisco, California
Robert W. Kenefick, PhD
Research Physiologist, Thermal and Mountain Medicine Division, James R. Liffrig, MD, MPH, FAAFP
United States Army Research Institute of Environmental Medi- Chair, Department of Family Medicine, Womack Army Medical
cine, Natick, Massachusetts Center, Fort Bragg, North Carolina; Assistant Professor of Medi-
cine, Uniformed Services University of the Health Sciences,
Alexa B. Kimball, MD, MPH Bethesda, Maryland
Vice Chair, Department of Dermatology, Massachusetts General
Hospital; Associate Professor, Harvard Medical School, Boston, Grant S. Lipman, MD, FACEP
Massachusetts Clinical Assistant Professor, Division of Emergency Medicine,
Department of Surgery, Stanford University School of Medicine,
Judith R. Klein, MD, FACEP Stanford, California
Assistant Professor, Department of Emergency Medicine, Univer-
sity of California, San Francisco, San Francisco General Hospi-
tal, San Francisco, California
ix
