Evidence-Based Review of Wilderness First Aid Practices


  • Tod Schimelpfenig NOLS Wilderness Medicine Institute
  • David E. Johnson Department of Emergency Medicine, Central Maine Medical Center
  • Grant S. Lipman Department of Emergency Medicine, Stanford University School of Medicine
  • David H. McEvoy Aerie Backcountry Medicine
  • Brad L. Bennett F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences




wilderness first aid, lay person, assessment, treatment, evacuation


Wilderness First Aid is a common certification for outdoor recreationists, educators, and trip leaders. A panel of educators, researchers, and clinicians evaluated 15 core and eight elective WFA practices for strength of recommendations based on the quality of supporting evidence and balance between the benefits and risks/burdens according to the methodology stipulated by the American College of Chest Physicians. The strength of the evidence for these 23 WFA practices varies widely because of scant published research to date. When no evidence existed, the panel based recommendations on a consensus of the panelists for risk/benefit and best practices. This review clearly points out the need for conducting greater research to strengthen the level of evidence in numerous WFA topics and for educational strategies that improve retention of core knowledge, as well as skill application for the lay first aid provider.

Subscribe to JOREL

Author Biographies

Tod Schimelpfenig, NOLS Wilderness Medicine Institute

Fellow of the Academy of Wilderness Medicine

National Outdoor Leadership School Wilderness Medicine Institute

David E. Johnson, Department of Emergency Medicine, Central Maine Medical Center

Fellow of the American College of Emergency Physicians

Department of Emergency Medicine, Central Maine Medical Center

Grant S. Lipman, Department of Emergency Medicine, Stanford University School of Medicine

Fellow of the Academy of Wilderness Medicine

Fellow of the American College of Emergency Physicians

Department of Emergency Medicine, Stanford University School of Medicine

David H. McEvoy, Aerie Backcountry Medicine

Critical Care Emergency Medical Technician - Paramedic

Aerie Backcountry Medicine

Brad L. Bennett, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences

Fellow of the Academy of Wilderness Medicine

Military & Emergency Medicine Department

F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences


Akers, W.A., & Sulzberger, M.B. (1972). The friction blister. Mil Med. 137:1-7. http://dx.doi.org/10.1097/00006534-197207000-00049

Allen, P.B., Salyer, S.W., Dubick, M.A., Holcomb, J.B., & Blackbourne, L.H. (2010). Preventing hypothermia: comparison of current devices used by the US Army in an in vitro warmed fluid model. J Trauma. 69(Suppl 1):S154–S161. http://dx.doi.org/10.1097/ta.0b013e3181e45ba5

Anley, C., Noakes, T., & Collins, M (2010). A comparison of two treatment protocols in the management of exercise-associated postural hypotension: a randomised clinical trial. Br J Sports Med. http://dx.doi.org/10.1136/bjsm.2010.071951

Armstrong, L.E., Crago, A.E., Adams, R., Roberts, W.O, & Maresh, C.M. (1996). Whole-Body Cooling of Hyperthermic Runners: Comparision Of Two Field Strategies. Am J Emerg Med. 14:355-358. http://dx.doi.org/10.1016/s0735-6757(96)90048-0

Bandiera, G., Stiell, I.G., Wells, G.A., Clement, C., De Maio, V., Vandemheen, K., … Worthington, J. (2003). Canadian C-Spine and CT Head Study Group, The Canadian C-spine rule performs better than unstructured physician judgment. Ann Emerg Med. 42:395–402. http://dx.doi.org/10.1016/s0196-0644(03)00422-0

Barbash, IM., Freimark, D., Gottlieb, S., Hod, H., Hasin, Y., & Battler, A., … Leor, J. (2002). Outcome of myocardial infarction in patients treated with aspirin is enhanced by pre-hospital administration. Cardiology, 98:141–147. http://dx.doi.org/10.1159/000066324

Barennes, H. (2005). Sublingual Sugar Administration as an Alternative to Intravenous Dextrose Administration to Correct Hypoglycemia Among Children in the Tropics. Pediatrics, 116:e648-e653. http://dx.doi.org/10.1542/peds.2004-2218

Bärtsch, P., & Swenson, E.R. (2013). Clinical practice: Acute High Altitude Illnesses. N Engl J Med. 368:2294–2302. http://dx.doi.org/10.1056/nejmcp1214870

Beidleman, B.A., Fulco, C.S., Muza, S.R., Rock, P., Stabb, J., &Forte, V., … Cymerman, A. (2009). Effect of six days of staging on physiologic adjustments and acute mountain sickness during ascent to 4300 meters. High Alt Med Biol. 10:253–260. http://dx.doi.org/10.1089/ham.2009.1004

Berden H, Bierens J, Willems F, Hendrick J, Pijls N, & Knape J. (1994). Resuscitation skills of lay public after recent training. Ann Intern Med. 23(5):1003—8. http://dx.doi.org/10.1016/s0196-0644(94)70094-x

Blake, W.E., Stillman, B.C., Eizenberg, N., Briggs, C, & McMeeken, J.M. (2002). The position of the spine in the recovery position: an experimental comparison between the lateral recovery position and the modified HAINES position. Resuscitation, 53:289-294. http://dx.doi.org/10.1016/s0300-9572(02)00037-0

Bloch, K.E., Turk, A.J., Maggiorini, M., Hess,T., Merz, T., Bosch, M., Barthelemes, D., … Schoch O. (2009). Effect of ascent protocol on acute mountain sickness and success at Muztagh Ata, 7546 m. High Alt Med Biol. 10:25–32. http://dx.doi.org/10.1089/ham.2008.1043

Boissy, P., Shrier, I., Brière, S., Mellete, J., Fecteau, L., & Matheson, G.O., … Steele, R. (2011). Effectiveness of cervical spine stabilization techniques. Clin J Sport Med. 21:80–8. http://dx.doi.org/10.1097/jsm.0b013e31820f8ad5

Boulware, D.R. (2004). Influence of hygiene on gastrointestinal illness among wilderness backpackers. J Travel Med. 11:27–33. http://dx.doi.org/10.2310/7060.2004.13621

Bowra, J., Gillet, M., & Morgan, J. (2002). A trial comparing hot showers and icepack in the treatment of physalia envenomation. Emerg Med. 14:A22. http://dx.doi.org/10.2310/7060.2004.13621

Butler, F.K., Dubose, J.J., Otten, E.J., Bennett B., Gerhardt, R., Kheirabadi, B., … Bailey, J. (2013). Management of Open Pneumothorax in Tactical Combat Casualty Care: TCCC Guidelines Change 13-02. J Spec Oper Med 13(3):81-86. http://dx.doi.org/10.1007/978-3-642-29613-0_403

Canale, E., Isbister, G.K., & Currie, B.J. (2009). Investigating pressure bandaging for snakebite in a simulated setting: bandage type, training and the effect of transport. Emergency Medicine Australasia 21: 184–190. http://dx.doi.org/10.1111/j.1742-6723.2009.01180.x

Clayton, K., Monroe, K., Magruder, T., & King, W. (2012). Inappropriate home albuterol use during an acute asthma exacerbation. Annals of Allergy, Asthma and Immunology, 109:416-419. http://dx.doi.org/10.1016/j.anai.2012.09.013

Conrad, B.P., Horodyski, M., Wright, J., Ruetz, P., & Rechtine, G.R. (2007). Log-rolling technique producing unacceptable motion during body position changes in patients with traumatic spinal cord injury. J Neurosurg Spine. 6:540–3. http://dx.doi.org/10.3171/spi.2007.6.6.4

Cooper, M. (1980). Lightning injuries: prognostic signs for death. Annals of Emergency Medicine 9:134-13. http://dx.doi.org/10.1016/s0196-0644(80)80268-x

Cummins RO, Schubach JA, Litwin PE, & Hearne TR. (1989). Training lay persons to use automatic external defibrillators: success of initial training and one-year retention of skills. Am J Emerg Med. 7(2):143-9. http://dx.doi.org/10.1016/0735-6757(89)90126-5

Cuttle, L., Kempf, M., Liu, P., Kravchuk, O., & Kimble, R. (2008). The optimal temperature of first aid treatment for partial thickness burn injuries. Wound Repair Regen.16:626–634. http://dx.doi.org/10.1111/j.1524-475x.2008.00413.x

de Caen, A., Maconochie, I., Aickin, R., Atkins, D., Biarent, D., ; Guerguerian, AM. … Veliz Pintos, R. (2015). Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. (Circulation. 2015;132:S177–S203. http://dx.doi.org/10.1161/cir.0000000000000445

Del Rossi, G., Horodyski, M., Heffernan, T.P., Powers, M.E., Siders, R., Brunt, D., & Rechtine, G.R. (2004). Spine-board transfer techniques and the unstable cervical spine. Spine. 29(7):134-8. http://dx.doi.org/10.1097/01.brs.0000116986.48166.d0

Dire, D.J., & Welsh, A.P. (1990). A comparison of wound irrigation solutions used in the emergency department. Ann Emerg Med. 19:704-708. http://dx.doi.org/10.1016/s0196-0644(05)82484-9

Ditty, J., Chisholm, D., Davis, SM., & Estelle-Schmidt, M. (2010). Safety and efficacy of attempts to reduce shoulder dislocations by non-medical personnel in the wilderness setting. Wilderness Environ Med. 21:357-61. http://dx.doi.org/10.1016/j.wem.2010.06.010

Drew, B., Bennett, B., & Littlejohn, L. (2015). Review of Hemorrhage Control Principles in Austere Environments: Part 2. Wilderness Environ Med. 26(2):246-252. http://dx.doi.org/10.1016/j.wem.2014.08.018.

Duclos, P., & Sanderson, L. (1990). An epidemiological description of lightning-related injuries in the United States. International Journal of Epidemiology. 19: 673-79. http://dx.doi.org/10.1093/ije/19.3.673

Ellerton, J., Tomazin, I., Brugger, H., & Paal, P. (2009). Immobilization and Splinting in Mountain Rescue: Official Recommendations of the International Commission for Mountain Emergency Medicine, ICAR MEDCOM, Intended for Mountain Rescue First Responders, Physicians, and Rescue Organizations. High Alt. Med. Biol. 10:337–342. http://dx.doi.org/10.1089/ham.2009.1038

Fradin, M.S., & Day, J. (2002). Comparative efficacy of insect repellents. N Engl J Med. 347:13-18 . http://dx.doi.org/10.1056/nejmoa011699

Gaudio, F., Lemery, J., & Johnson, D. (2010). Recommendations on the Use of Epinephrine in Outdoor Education and Wilderness Settings: Round Table Report. Wilderness Environ Med. 21:185–187. http://dx.doi.org/10.1016/j.wem.2010.06.004

Gentile, D., Morris, J., Schimelpfenig, T., & Auerbach, P. (1992). Wilderness Injuries and Illness. Ann Emerg Med. 21:853-861. http://dx.doi.org/10.1016/s0196-0644(05)81034-0

German, B.T., Hack, J.B., Brewer, K., & Meggs, W.J. (2005). Pressure-immobilization bandages delay toxicity in a porcine model of eastern coral snake (Micrurus fulvius fulvius) envenomation. Ann Emerg Med. 45:603–608. http://dx.doi.org/10.1016/j.annemergmed.2004.11.025

Guerlain, S., Hugine, A., & Wang, L.A (2010). Comparison of 4 epinephrine autoinjector delivery systems: usability and patient preference. Ann Allergy Asthma Immunol. 104(2):172-7. http://dx.doi.org/10.1016/j.anai.2009.11.023

Gunning, R.R., & Garber, A.J. (1978.) Bioactivity of instant glucose. Failure of absorption through oral mucosa. JAMA, 240(15):1611-2. http://dx.doi.org/10.1001/jama.1978.03290150057025

Gupta, R.K., Sweeney, A.W., Rutledge, L.C., Cooper, R.D., Frances, S.P., & Westrom, D.R. (1987). Effectiveness of controlled-release personal-use arthropod repellents and permethrin-impregnated clothing in the field. J Am Mosq Control Assoc. 3:556-60. http://dx.doi.org/10.1603/0022-2585-37.1.182

Guyatt, G., Gutterman, D., Baumann, M., Addrizzo-Harris, D., Hylek, E., Phillips, B., … Schunemann, H . (2006). Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians task force. Chest, 129:174-181. http://dx.doi.org/10.1378/chest.129.1.174

Hadad E, Moran DS, & Epstein Y. (2004). Cooling heat stroke patients by available field measures. Intensive Care Med. 30:338. http://dx.doi.org/10.1007/s00134-003-2084-5.

Hendey, G., Chally, M., & Stewart, V. (2006). Selective radiography in 100 patients with suspected shoulder dislocation. Journal of Emergency Medicine 31:23-28 http://dx.doi.org/10.1016/j.jemermed.2005.09.006

Henriksson, O., Lundgren, P., Kuklane, K., Holmér, I., & Bjornstig, U. (2009). Protection against cold in prehospital care —thermal insulation properties of blankets and rescue bags in different wind conditions. Prehosp Disaster Med. 24:408–415. http://dx.doi.org/10.1017/s1049023x00007238

Henriksson, O., Lundgren, P., Kuklane, K., Holmér, I., Bjornstig, U., Giesbrecht G., & Naredi P. (2015). Protection Against Cold in Prehospital Care: Wet Clothing Removal or Addition of a Vapor Barrier. Wilderness Environ Med. 26:11–20. http://dx.doi.org/10.1016/j.wem.2014.07.001

Henriksson, O., Lundgren, P., Kuklane, K., Holmér, I., Naredi, P, & Bjornstig, U. (2012). Protection against cold in prehospital care: evaporative heat loss reduction by wet clothing removal or the addition of a vapor barrier—a thermal manikin study. Prehosp Disaster Med. 27:53–58. http://dx.doi.org/10.1017/s1049023x12000210

Hoffman, J.R., Mower, W.R., Wolfson, A.B., Todd, K.H., & Zucker, M.I. (2003). National Emergency X-Radiography Utilization Study Group: validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med. 343:94–99. http://dx.doi.org/10.1016/s0735-6757(01)80157-1

Holle, R.L., Lopez, R.E., & Zimmermann, C. (1999). Updated recommendations for lightning safety. Bull Am Meteorological Soc. 80:2035 1998-1999. http://dx.doi.org/10.1175/1520-0477(1999)080<2035:urfls>2.0.co;2

Howarth, D.M., Southee, A.E., & Whyte, I.M. (1994). Lymphatic flow rates and first-aid in simulated peripheral snake or spider envenomation. Med J Aust. 161:695–700. http://dx.doi.org/10.1016/s0965-2302(02)00189-3

Johnson, D., Schimelpfenig, T., Hubbell, F., Frizzel, L., Nicolozzo, P., McEvoy, D., …Weil, C. (2013). Minimum Guidelines and Scope of Practice for Wilderness First Aid. Wilderness and Environmental Medicine, 24;456–462. http://dx.doi.org/10.1016/j.wem.2013.05.003.

Kheirabadi, B.S., Scherer, M.R., Estep, J.S., Dubick, M.A., & Holcomb, J.B. (2009). Determination of efficacy of new hemostatic dressings in a model of extremity arterial hemorrhage in swine. J Trauma. 67(3):450-9. http://dx.doi.org/10.1097/ta.0b013e3181ac0c99

Kheirabadi, B.S., Terrazas, I.B., Koller, A., Allen, P.B., Klemcke, H.G., Convertino, V.A., & Blackbourne, L.H. (2013). Vented vs. unvented chest seals for treatment of pneumothorax (PTx) and prevention of tension PTx in a swine model. J Trauma Acute Care Surg. 75(1):150-6. http://dx.doi.org/10.1097/ta.0b013e3182988afe

Kleinman E. Brennan, E., Goldberger, Z., Swor, R., Terry, M., Bobrow, B. … Rea, T. (2015). Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality. 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. (Circulation. 2015;132:S414–S435. http://dx.doi.org/10.1161/cir.0000000000000259

Kotora, J.G. Jr., Henao, J., Littlejohn, L.F., & Kircher S. (2013). Vented chest seals for prevention of tension pneumothorax in a communicating pneumothorax. J Emerg Med. 45(5):686-94. http://dx.doi.org/10.1016/j.jemermed.2013.05.011

Knapik, J.J., Reynolds, K.L., Duplantis, K.L., & Jones, B.H. (1995). Friction blisters. Pathophysiology, prevention and treatment. Sports Med 20:136-47. http://dx.doi.org/10.2165/00007256-199520030-00002

Kragh, J.F. Jr., Walters, T.J., Baer, D.G., Fox, C.J., Wade, C.E., Salinas, J., & Holcomb, J.B. (2009). Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg. 249:1–7. http://dx.doi.org/10.1097/sla.0b013e31818842ba

Kyriacou, D.N., Arcinue, E.L., Peek, C, & Kraus, J.F. (1994). Effect of immediate resuscitation on children with submersion injury. Pediatrics, 94(pt 1):137–142. http://dx.doi.org/10.1016/0300-9572(95)99671-v

Lehmann, K., Heath-Lange, S.J., & Ferris, S.T. (1999). Randomized comparison of hemostasis techniques after invasive cardiovascular procedures. Am Heart J. 138(part 1):1118 –1125. http://dx.doi.org/10.1016/s0002-8703(99)70078-5

Littlejohn, L., Bennett, B., & Drew, B. (2015). Review of Hemorrhage Control Principles in Austere Environments: Part 1. Wilderness Environ Med. 26(2):236-245. http://dx.doi.org/10.1016/j.wem.2014.08.016

Loten, C., Stokes, B., Worsley, D., Seymour, J.E., Jiang, S., & Ibsbister, G.K. (2006). A randomised controlled trial of hot water (45C) immersion versus ice packs for pain relief in bluebottle stings. Med J Aust. 184(7): 329-333. http://dx.doi.org/10.3390/toxins8040097

Lundgren, J.P., Henriksson, O., Pretorius, T., Cahill, F., Bristow, G., Chochinov, A., … Giesbrecht, G. (2009). Field torso-warming modalities: a comparative study using a human model. Prehosp Emerg Care. 13:371–378. http://dx.doi.org/10.1080/10903120902935348

Markenson, D., Ferguson, J., Chameides, L., Cassan, P., Chung, K., Epstein, J., … Singer, A. (2010). Part 13: First Aid: 2010 American Heart Association and American Red Cross International Consensus on First Aid Science with Treatment Recommendations. Circulation, 122:S582-S605. http://dx.doi.org/10.1161/cir.0b013e3181fe3e4c

McGuire, R.A., Neville, S., Green, B.A., & Watts, C. (1987). Spinal instability and the log-rolling maneuver. J Trauma. 27:525–531. http://dx.doi.org/10.1097/00005373-198705000-00012

McIntosh, S., Opacic, M., Freer, L., Grissom, C., Auerbach, P., Rodway, G., Cochran, A., … Hackett, P. (2014). Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite: 2014 Update. Wilderness & Environmental Medicine. 25, S43–S54. http://dx.doi.org/10.1016/j.wem.2014.09.001

McLaughlin, J., Gessner, B., & Bailey, AM. (2005). Gastroenteritis Outbreak Among Mountaineers Climbing the West Buttress Route of Denali—Denali National Park, Alaska, June 2002. Wilderness Environ Med. 16:92-96. http://dx.doi.org/10.1580/1080-6032(2005)16[92:goamct]2.0.co;2

Mills, W.J .Jr. Frostbite. (1993). A discussion of the problem and a review of the Alaskan experience. 1973. Alaska Med. 35:29–40. http://dx.doi.org/10.1580/1080-6032(1998)009[0226:fewrra]2.3.co;2

Nomura, J.T., Sato, R.L., Ahern, R.M., Snow, J.L., Kuwaye, T.T., & Yamamoto, L.G. (2002). A Randomized Paired Comparison Trial of Cutaneous Treatments for Acute Jellyfish (Carybdea alata) Stings. Am J Emerg Med. 20:624–6. http://dx.doi.org/10.1053/ajem.2002.35710

Norris, R.L., Ngo, J., Nolan, K., & Hooker, G. (2005). Physicians and lay people are unable to apply pressure immobilization properly in a simulated snakebite scenario. Wilderness Environ Med. 16:16-21. http://dx.doi.org/10.1580/pr12-04.1

Oehmichen, M., Hennig, R., & Meissner, C. (2008). Near-drowning and clinical laboratory changes. Leg Med 10(1):1–5. http://dx.doi.org/10.1016/j.legalmed.2007.05.007

Ofeigsson, O.J., Mitchell, R., & Patrick R.S. (1972). Observations on the cold water treatment of cutaneous burns. J Pathol. 108:145–150. http://dx.doi.org/10.1002/path.1711080208.

Pincus, J., Lathrop, S., Briones, A., Andrews S., & Aurelius, M. (2015). Lightning deaths: A retrospective review of New Mexico’s cases, 1977-2009. Journal of Forensic Sciences. 60(1):66-71. http://dx.doi.org/10.1111/1556-4029.12546

Pumphrey, R. (2004). Anaphylaxis: can we tell who is at risk of a fatal reaction? Curr Opin Allergy Clin Immunol. 4:285–290. http://dx.doi.org/10.1097/01.all.0000136762.89313.0b.

Quinn, R., Wedmore, I., Johnson, E., Islas, A., Anglim, A., Zafren, K., … Mazzorana, V. (2014). Wilderness Medical Society Practice Guidelines for Basic Wound Management in the Austere Environment: 2014 Update. Wilderness and Environmental Medicine. 25: S118–S133. http://dx.doi.org/10.1016/j.wem.2014.08.015

Rall, J.M., Cox, J.M., Songer, A.G., Comeaux, J., Estep, J., Cestero, R., & Ross, J. (2013). Comparison of novel hemostatic gauzes to QuikClot Combat Gauze in a standardized swine model of uncontrolled hemorrhage. J Trauma Acute Care Surg. 75(2 Suppl 2):S150–S156. http://dx.doi.org/10.1097/ta.0b013e318299d909

Reid, S., Liu, M., & Ortega, H. (2013). Anterior shoulder dislocation in pediatric patients: are routine prereduction radiographs necessary? Pediatric Emergency Care 29:39-42. http://dx.doi.org/10.1097/pec.0b013e31827b52a7

Sack, RB., Cassells, J., Mitra, R., Merritt, C., Butler, T., Thomas, J., … Mondal, A. (1970). The use of oral replacement solutions in the treatment of cholera and other severe diarrhoeal disorders. Bull World Health Organ. 43(3):351-60. http://dx.doi.org/10.1056/nejm197711172972007

Schumann, SA., Schimelpfenig, T., Sibthorp, J., & Collins, RH. (2012). An examination of wilderness first aid knowledge, self-efficacy, and skill retention. Wilderness and Environmental Medicine; 23:281–287. http://dx.doi.org/10.1016/j.wem.2012.04.005

Singletary, E., Charlton, N., Epstein, J., Ferguson, J., Jensen, J., MacPherson, A., … Zideman, D. (2015). Part 15: First Aid: 2015 American Heart Association and American Red Cross Guidelines Update for First Aid. Circulation. 2015;132: S574–S589. http://dx.doi.org/10.1161/cir.0000000000000269

Simon, H. (1999). Caregiver Knowledge and Delivery of a Commonly Prescribed Medication (Albuterol) for Children. Arch Pediatr Adolesc Medicine, 153:615-618. http://dx.doi.org/10.1001/archpedi.153.6.615

Simpson, I.D., Tanwar, P.D., Andrade, C., Kochar, D.K., & Norris R.L. (2008). The Ebbinghaus retention curve: Training does not increase the ability to apply pressure immobilization in simulated snake bite–implications for snake bite first aid in the developing world. Trans R Soc Trop Med Hyg. 102:451– 459. http://dx.doi.org/10.1016/j.trstmh.2008.01.014

Singer, A. J., Berrutti, L., Thode H.C. Jr., & McClain, S.A. (1999). Octylcyanoacrylate for the treatment of partial-thickness burns in swine: a randomized, controlled experiment. Acad Emerg Med. 6(7): 688-92. http://dx.doi.org/10.1111/j.1553-2712.2000.tb01063.x

Soreide, K. (2014). Clinical and translational aspects of hypothermia in major trauma patients: From pathophysiology to prevention, prognosis and potential preservation. Injury. 45(4):647-54. http://dx.doi.org/10.1016/j.injury.2012.12.027

Spandorfer, PR., Alessandrini, EA., Joffe, MD., Localio, R., & Shaw, KN. (2005). Oral versus intravenous rehydration of moderately dehydrated children: a randomized, controlled trial. Pediatrics, 115(2):295–301. http://dx.doi.org/10.1542/peds.2004-0245

Squier, CA. (1991). The Permeability of Oral Mucosa. Crit Rev Oral Biol., 2(1): 13—32. http://dx.doi.org/10.3109/00016357109026540

Stiell, I., Clement, R., McKnight, R., Brison, R., Schull, M., Rowe, B., … Wells, G. (2003). The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma. N Engl J Med. 26:349-52. http://dx.doi.org/10.1056/nejmoa031375

Szpilman, D., Joost, J., Bierens, M., Handley, A., & Orlowski, J. (2012). Drowning: Current Concepts. N Engl J Med 366:2102-10. http://dx.doi.org/10.1016/s0031-3955(05)70331-x

Thomas, C.S., Scott, S.A., Gaanis, D.J., & Goto, R.S. (2001). The analgesic effect of Sting-Aid Adolph's meat tenderizer and fresh water on their stings: A double blinded, randomised, placebo controlled clinical trial. Hawaii Medical Journal. 60(8):205-10

Thomassen, Ø., Færevik, H., Østerås, Ø., Sunde, G., Zakariassen, E., Sandsund, M., … Bratteb, G. (2011). Comparison of three different prehospital wrapping methods for preventing hypothermia—a crossover study in humans. Scand J Trauma Resusc Emerg Med. 19:41. http://dx.doi.org/10.1186/1757-7241-19-41

Trestrail, J.H., & Al-Mahasneh, Q.M. (1989). Lionfish string experiences of an inland poison center: A retrospective study of 23 cases. Vet Hum Toxicol. 31:173–5. PMID: 2929130.

Tsang, K., Hertel, J., & Denegar, C. (2003). Volume decrease after elevation and intermittent compression of postacute ankle sprains are negated by gravity-dependent positioning. Journal of Athletic Training. 38:320-24 PMID:14737214

Valente, J.H., Forti, R.J., Freundlich, L.F., Zandieh, S.O., Crain E.F. (2003). Wound irrigation in children: Saline solution or tap water? Ann Emerg Med 41:609-16. http://dx.doi.org/10.1067/mem.2003.137

Vanden Hoek, T.L., Morrison, L.J., Shuster, M., Donnino M., Sinz E., Lavonas E., … Gabrieli, A. (2010). Part 12: Cardiac Arrest in special situations: drowning: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122:Suppl 3:S847-S848. http://dx.doi.org/10.1161/circulationaha.110.971069

Van de Velde, S., Broos, P., Van Bouwelen, M., De Win, R., Sermon, A., Verduyct, J., … Aertgeerts, B. (2007). European First Aid Guidelines. Resuscitation. 72:240—51. http://dx.doi.org/10.1016/j.resuscitation.2006.10.024

Venema, A.M., Groothoff, J.W., & Bierens, J.J. (2010). The role of bystanders during rescue and resuscitation of drowning victims. Resuscitation 81:434-9. http://dx.doi.org/10.1016/j.resuscitation.2010.01.005

Vicario, S.J., Okabajue, R., & Haltom, T. (1986). Rapid cooling in classic heatstroke: effect on mortality rates. Am J Emerg Med 4:394. http://dx.doi.org/10.1016/0735-6757(86)90185-3

Zafren, K., Giesbrecht, G., Danzl, D., Brugger, H., Sagalyn, E., Walpoth, B., … Grissom, C. (2014). Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2014 Update. Wilderness and Environmental Medicine. 25, S66–S85. http://dx.doi.org/10.1016/j.wem.2014.10.010

Zimmermann, C., Cooper, M., & Holle, R. (2002). Lightning safety guidelines. Annals of Emergency Medicine 39:660-64. http://dx.doi.org/10.1067/mem.2002.124439






Regular Papers