Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 27 Jul 2000 00:24:44 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JS8QDJLLWM003HBP@mb1i0.ns.pitt.edu>; Thu, 27 Jul 2000 00:24:44 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 27 Jul 2000 00:24:10 -0400 (EDT) Received: from mail1.hushmail.com (mail1.hushmail.com [216.18.8.67]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 27 Jul 2000 00:24:04 -0400 (EDT) Received: (from root@localhost) by mail1.hushmail.com (8.8.7/8.8.7) id VAA30463; Wed, 26 Jul 2000 21:23:33 -0700 Date: Wed, 26 Jul 2000 21:20:46 -0600 (PDT) From: melriser@hushmail.com Subject: Re: W-EMED Test message Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <200007270423.VAA30463@mail1.hushmail.com> MIME-version: 1.0 Content-type: multipart/mixed; boundary="Hushpart_boundary_lgAxnlgktOseoAqHIFKnGplvDqiXuWsG" Precedence: bulk --Hushpart_boundary_lgAxnlgktOseoAqHIFKnGplvDqiXuWsG Content-type: text/plain Well I just joined and could start some traffic... I used to be an EMT years ago with some SAR experience... However I have a technolgy job now and want to get back in as a volunteer or VFD type... We have a VFD close by and I have contacted them about training and such... i though a list would be good for refreshing skills and gaining contacts... Mel Riser Volente, Texas At Wed, 26 Jul 2000 19:15:23 -0700, "Liz Marr" wrote: > >There are slow days, and then there are SLOW months. > > >-- >^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^v^ >Visit the SAR-Dogs website: http://www.sar-dogs.com >Do not reproduce without author's express permission. >To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" >as the body of a message (no subject) To: Majordomo@list.pitt.edu >Submissions To: wilderness-emergency-medicine@list.pitt.edu > --Hushpart_boundary_lgAxnlgktOseoAqHIFKnGplvDqiXuWsG-- IMPORTANT NOTICE: If you are not using HushMail, this message could have been read easily by the many people who have access to your open personal email messages. Get your FREE, totally secure email address at http://www.hushmail.com. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Mon, 17 Jul 2000 16:50:11 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JRVPUWWADE00435O@mb2i0.ns.pitt.edu>; Mon, 17 Jul 2000 16:50:12 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 17 Jul 2000 16:49:58 -0400 (EDT) Received: from gate1.health.state.ny.us (gate.health.state.ny.us [192.135.176.62]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 17 Jul 2000 16:49:56 -0400 (EDT) Received: by gate1.health.state.ny.us id QAA18751 (InterLock SMTP Gateway 4.2 for wilderness-emergency-medicine@list.pitt.edu) ; Mon, 17 Jul 2000 16:49:24 -0400 Received: by gate1.health.state.ny.us (Internal Mail Agent-1); Mon, 17 Jul 2000 16:49:24 -0400 Date: Mon, 17 Jul 2000 16:49:09 -0400 From: rrt01@health.state.ny.us Subject: Re: W-EMED use of tourniquets! Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <200007172049.QAA18751@gate1.health.state.ny.us> MIME-version: 1.0 Content-type: text/plain; charset=us-ascii Content-disposition: inline Precedence: bulk X-Lotus-FromDomain: NYSDOH I agree with Jay's ( and earlier posters') comments. BTW, I've got >24 years EMS experience (including 9yrs in NYC) and have never needed a tourniquet. An additional point to consider is the amount of time that has elapsed between the injury and when you first encounter the patient. If it has been <10 minutes since the injury, I see where you could "conceiveably" (although highly unlikely) need a tourniquet. If it has been hours since the injury occurred (as in most wilderness rescue situations that I've experienced,) any wound requiring a tourniquet will be found on a patient who is already dead... Just my $.02... Raymond R. Thielke, EMT/P, MA(c) JadedMedic@aol.com on 07/17/2000 03:06:02 PM Please respond to wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu cc: (bcc: Raymond R. Thielke/Syracuse/DOH) Subject: Re: W-EMED use of tourniquets! Hi folks, In all my years of careening about the landscape on ambulances or on first responder units, I have never once been in a situation where I felt that I needed to apply a tourniquet. In my experience (and I'm sure that many of you have had similar experiences), most bleeding will stop by itself, and do so long before it become life-threatening, if simply left alone. In more serious cases, direct pressure alone will do just fine. (I have learned to hold pressure for ten minutes while resisting the temptation to occasionally peek at the wound.) Note: This means pressure applied with a _dry_ dressing. I have seen too many responders apply a saline-soaked dressing to a wound and then fail to understand why it kept bleeding. I tell my students that you can stop the bleeding (with a dry dressing) or you can try to clean out the wound (with a wet dressing) but you have to make up your mind regarding which of the two you're trying to do. You can't do both at the same time. Pursuant to the above, if I as a member of an ambulance crew or first responder unit arrived at a scene and saw "wet" blood on a victim, I knew that I had better get busy because two things were probably true: 1. This person had a "leak" somewhere that was big enough that it wasn't going to stop by itself. 2. If they were still "leaking" by the time I got there (typically anywhere from ten to twenty minutes after the injury occurred) they had likely already lost a significant amount of blood. Still, I found that direct pressure or maybe a dressing with mild pressure would almost always correct the problem. If that didn't work (which happened maybe once a year) the hitting a pressure point -- assuming the wound is on an extremity, of course -- for a few minutes while a pressure dressing was applied. Still, I carried a 2" Ace bandage and at least one 8"x10" dressing in my jump kit for those very rare occasions when I needed to apply a "heavy pressure" pressure dressing. What I have seen, time and time and time again, is "civilians" applying what amounted to a venous tourniquet above the wound. This, of course, tends to _increase_ the amount of blood that the victim uses. I've seen some really _scary_ cases of this. In other words, in all my years in EMS (eight years of street duty) I have never once been in a position where I felt that I needed to apply a tourniquet and I have never once seen a tourniquet applied by a civilian "for the right reasons and in the right way." In other words, I have seen an appropriate usage rate by civilians of zero. I tell my students that tourniquets may make the most sense as a means of applying pressure to a pressure point when for some reason the rescuer can't stay with the victim. Thus, I can see a role for them in a battlefield scenario or some other sort of mass casualty situation in which the number of victims is greater than the number of rescuers, but in everyday use when EMS can get there quickly and the rescuer can stay with the victim and apply direct pressure and hit the pressure point, I don't see any compelling reason for their use. One reference that I haven't seen cited so far is Eric Weiss's book "A Comprehensive Guide to Wilderness and Travel Medicine." Weiss recommends releasing the tourniquet after one hour to see if the bleeding has been brought under control by then and, if it has been controlled, to leave the tourniquet in place but untightened. Regards to all Jay Wiseman FA/CPR Instructor at large Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Mon, 17 Jul 2000 15:08:04 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JRVMB806GI00435F@mb2i0.ns.pitt.edu>; Mon, 17 Jul 2000 15:08:02 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 17 Jul 2000 15:06:45 -0400 (EDT) Received: from imo-r18.mx.aol.com (imo-r18.mx.aol.com [152.163.225.72]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 17 Jul 2000 15:06:42 -0400 (EDT) Received: from JadedMedic@aol.com by imo-r18.mx.aol.com (mail_out_v27.12.) id h.d0.8a074ea (9665) for ; Mon, 17 Jul 2000 15:06:03 -0400 (EDT) Date: Mon, 17 Jul 2000 15:06:02 -0400 (EDT) From: JadedMedic@aol.com Subject: Re: W-EMED use of tourniquets! Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-Mailer: AOL 5.0 for Windows sub 118 Content-type: text/plain; charset="US-ASCII" Content-transfer-encoding: 7bit Precedence: bulk Hi folks, In all my years of careening about the landscape on ambulances or on first responder units, I have never once been in a situation where I felt that I needed to apply a tourniquet. In my experience (and I'm sure that many of you have had similar experiences), most bleeding will stop by itself, and do so long before it become life-threatening, if simply left alone. In more serious cases, direct pressure alone will do just fine. (I have learned to hold pressure for ten minutes while resisting the temptation to occasionally peek at the wound.) Note: This means pressure applied with a _dry_ dressing. I have seen too many responders apply a saline-soaked dressing to a wound and then fail to understand why it kept bleeding. I tell my students that you can stop the bleeding (with a dry dressing) or you can try to clean out the wound (with a wet dressing) but you have to make up your mind regarding which of the two you're trying to do. You can't do both at the same time. Pursuant to the above, if I as a member of an ambulance crew or first responder unit arrived at a scene and saw "wet" blood on a victim, I knew that I had better get busy because two things were probably true: 1. This person had a "leak" somewhere that was big enough that it wasn't going to stop by itself. 2. If they were still "leaking" by the time I got there (typically anywhere from ten to twenty minutes after the injury occurred) they had likely already lost a significant amount of blood. Still, I found that direct pressure or maybe a dressing with mild pressure would almost always correct the problem. If that didn't work (which happened maybe once a year) the hitting a pressure point -- assuming the wound is on an extremity, of course -- for a few minutes while a pressure dressing was applied. Still, I carried a 2" Ace bandage and at least one 8"x10" dressing in my jump kit for those very rare occasions when I needed to apply a "heavy pressure" pressure dressing. What I have seen, time and time and time again, is "civilians" applying what amounted to a venous tourniquet above the wound. This, of course, tends to _increase_ the amount of blood that the victim uses. I've seen some really _scary_ cases of this. In other words, in all my years in EMS (eight years of street duty) I have never once been in a position where I felt that I needed to apply a tourniquet and I have never once seen a tourniquet applied by a civilian "for the right reasons and in the right way." In other words, I have seen an appropriate usage rate by civilians of zero. I tell my students that tourniquets may make the most sense as a means of applying pressure to a pressure point when for some reason the rescuer can't stay with the victim. Thus, I can see a role for them in a battlefield scenario or some other sort of mass casualty situation in which the number of victims is greater than the number of rescuers, but in everyday use when EMS can get there quickly and the rescuer can stay with the victim and apply direct pressure and hit the pressure point, I don't see any compelling reason for their use. One reference that I haven't seen cited so far is Eric Weiss's book "A Comprehensive Guide to Wilderness and Travel Medicine." Weiss recommends releasing the tourniquet after one hour to see if the bleeding has been brought under control by then and, if it has been controlled, to leave the tourniquet in place but untightened. Regards to all Jay Wiseman FA/CPR Instructor at large Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Sun, 16 Jul 2000 19:07:35 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JRUGDVJ5DI002KEE@mb1i0.ns.pitt.edu>; Sun, 16 Jul 2000 19:07:35 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 16 Jul 2000 19:07:15 -0400 (EDT) Received: from mail01.iprimus.com.au (mail01.iprimus.com.au [203.134.64.91]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 16 Jul 2000 19:07:11 -0400 (EDT) Received: (apparently) from gosta ([203.134.36.94]) by mail01.iprimus.com.au with Microsoft SMTPSVC(5.5.1877.467.46); Mon, 17 Jul 2000 09:07:15 +1000 Date: Mon, 17 Jul 2000 09:06:44 +1000 From: Gosta Subject: Re: W-EMED use of tourniquets! Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <000e01bfef7a$84c1b880$5e2486cb@gosta> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Content-type: multipart/alternative; boundary="----=_NextPart_000_000B_01BFEFCE.54563320" X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk This is a multi-part message in MIME format. ------=_NextPart_000_000B_01BFEFCE.54563320 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Gurkan, Generally, as you point out, tourniquets aren't needed in the = pre-hospital field. Most haemorrhages can be stopped by direct pressure = or even occasionally by clamping off an exposed torn artery. The times = when they are indicated tend to be serious trauma, often involving crush = injuries. There can also be occasions when you can't reach a seriously = haemorrhaging wound due to entrapment. When a tourniquet is released, it = is important to monitor EKG (as well as vitals) for hyperkalaemia and/or = rapid bleed out. Immediately reapply and treat hyperkalaemia and = hypovolaemia if protocols permit. G=F6sta Liljeqvist (Intensive Care Paramedic) Sydney/Australia.=20 B. Health Sc.(Pre-Hospital Care) Ad. Dip. Paramedical Sc. M.A.C.A.P. ------=_NextPart_000_000B_01BFEFCE.54563320 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
Gurkan,
Generally, as you point out, = tourniquets aren't=20 needed in the pre-hospital field. Most haemorrhages can be stopped by = direct=20 pressure or even occasionally by clamping off an exposed torn = artery. The=20 times when they are indicated tend to be serious trauma, often involving = crush=20 injuries. There can also be occasions when you can't reach a = seriously=20 haemorrhaging wound due to entrapment. When a tourniquet is released, it = is=20 important to monitor EKG (as well as vitals) for hyperkalaemia and/or = rapid=20 bleed out. Immediately reapply and treat hyperkalaemia and hypovolaemia = if=20 protocols permit.
 
G=F6sta Liljeqvist (Intensive Care = Paramedic)=20 Sydney/Australia.
B. Health Sc.(Pre-Hospital Care) Ad. = Dip.=20 Paramedical Sc. M.A.C.A.P.
 
 
------=_NextPart_000_000B_01BFEFCE.54563320-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Sun, 16 Jul 2000 14:04:30 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JRU5S4EMF0003XDW@mb2i0.ns.pitt.edu>; Sun, 16 Jul 2000 14:04:29 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 16 Jul 2000 14:02:50 -0400 (EDT) Received: from imo-d08.mx.aol.com (imo-d08.mx.aol.com [205.188.157.40]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 16 Jul 2000 14:02:47 -0400 (EDT) Received: from Yankeemedc@aol.com by imo-d08.mx.aol.com (mail_out_v27.12.) id h.c5.767e856 (3878) for ; Sun, 16 Jul 2000 14:02:14 -0400 (EDT) Date: Sun, 16 Jul 2000 14:02:13 -0400 (EDT) From: Yankeemedc@aol.com Subject: Re: W-EMED use of tourniquets! Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-Mailer: AOL 5.0 for Windows sub 108 Content-type: text/plain; charset="US-ASCII" Content-transfer-encoding: 7bit Precedence: bulk Gurkan, Orthopedic surgeons, and vascular surgeons routinely stop blood flow in extremities, in the case of orthopods, sometimes for long periods of time. The biggest hazards noted with tourniquets has to do with improper application - this is in two distinct areas, both dealing with tissue damage to viable tissue. The first has to do with placement. You are absolutely right in stating that the anatomy of the forearm (and of the lower leg, also) preclude effective application of a tourniquet. Oh, yes, you can get it to stop, if you apply enough pressure, but by that time you have caused significant tissue damage with the pressure of the tourniquet. So PLACE the tourniquet at a point where minimal pressure will occlude blood flow, basically the same place we would use a pressure point, mid humerus or upper femur compressing the arteries between the tourniquet and the bone, not trying to pinch it between bones. The second has to do with the tourniquet itself. When you tighten the tourniquet, you are pulling it down into the tissue, causing a shearing effect. If you spread this effect over a large area, you minimize the damage to underlying tissues. If you use something narrow, like a shoelace (heavens forbid), you actually can tear the underlying tissues with the tourniquet, causing more damage. One of the best touniquets is a BP cuff, just above arterial pressure. It is plenty wide enough not to cause damage, and the pressure is well regulated to prevent over tightening. Remember, you just have to go high enough to stop bleeding. The tissues of the extremities will last for a long time without significant damage in an ischemic state. Perhaps Keith Conover will comment further on this. But even though a tourniquet has long been chided as an extreme measure, it is a very useful tool which can be utilized with great effectiveness when used properly. Charles Dusha Asst Chief/ Paramedic Logan-Rogersville Fire District Springfield, MO Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Sun, 16 Jul 2000 12:47:03 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JRU333CV3Q0029PF@mb1i0.ns.pitt.edu>; Sun, 16 Jul 2000 12:47:03 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 16 Jul 2000 12:44:46 -0400 (EDT) Received: from hotmail.com (f256.law9.hotmail.com [64.4.8.131]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 16 Jul 2000 12:44:43 -0400 (EDT) Received: (qmail 82703 invoked by uid 0); Sun, 16 Jul 2000 16:44:12 +0000 Received: from 213.243.28.76 by www.hotmail.com with HTTP; Sun, 16 Jul 2000 09:44:12 -0700 (PDT) Date: Sun, 16 Jul 2000 10:44:12 -0600 (MDT) From: Gurkan Ozel Subject: W-EMED use of tourniquets! Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <20000716164412.82702.qmail@hotmail.com> MIME-version: 1.0 Content-type: text/plain; format=flowed Content-transfer-encoding: 8BIT Precedence: bulk X-Originating-IP: [213.243.28.76] Hi all, Was wondering what you guys think of use of tourniquets. Two main questions (maybe everything can be asked about TNTs), where to be applied and how long should be left in place once applied…Although this is a wilderness medicine list I want to find out about its use at urban situations as well. Almost all of my sources regarding urban patient care, suggest not to release the tourniquet until the patient arrives ER or a physician is consulted. This may be true when, the majority of time, the arrival time from the scene (scene to ER) is somewhere between 30-45 minutes or shorter. What if your ETA (to ER) is longer than 45 minutes? (this runs around 50 minutes in Turkey – excluding the major cities where there is a good response system had been set up-, and even more especially for the highway accidents where there is a limited aeromedical services available and you are, say, 60-70 miles away from the nearest medical facility) What would your suggestion be during a long urban transports and the patient needs a tourniquet to be applied since everything else failed? What is the safe time limit before the tissue necrosis occurs as a result of ischemia? As long as the wilderness recovery is indicated, the sources I have suggests several different applications. Regarding the time limits: No time limit is indicated (Isaac, J., Outward Bound WFA Handbook), totally discouraged (Wilkerson, J.A.; Medicine for Mountaineering), advised not to be released until a physician consulted (NSC and WMS – WFA Emergency Care for Remote Locations, Schimelphenig, T. and Lindsey, L..; NOLS WFA), advised to be released briefly every 10-15 mins (Auerbach, P.S.; Medicine for the Outdoors, Tilton, B. ; Medicine for the Backcountry) and released every 5 minutes according to the WMS Practice Guidelines (Forgey, W. – editor). Another point is where to be applied, and the options are: “Just above the wound (2-4 inches above)” or “as close to the wound as possible and above elbow or knee”. Imagine a casualty with a hand torn apart 4 inches above his wrist, and no other option left to try but a tourniquet to stop bleeding. If you consider losing a limb, ain’t that better to apply just above the wound and loose as little part of the limb as possible? Then the effectiveness is of question, the anatomy of the forearm will not allow a complete shut off of a blood supply... Would like to hear what the list members think! Many thanks for the invaluable input in advance. Gurkan Ozel, EMT-B Ankara, Turkey ________________________________________________________________________ Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc09.srv.cis.pitt.edu (root@post-ofc09.srv.cis.pitt.edu [136.142.185.57]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 30 Jun 2000 11:11:21 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc09.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 30 Jun 2000 11:10:49 -0400 (EDT) Received: via switchmail; Fri, 30 Jun 2000 11:10:49 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Fri, 30 Jun 2000 11:10:48 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 30 Jun 2000 11:10:45 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR7N26C4KO000CPW@mb2i0.ns.pitt.edu>; Fri, 30 Jun 2000 11:10:45 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 30 Jun 2000 11:08:13 -0400 (EDT) Received: from zonetail.med.unc.edu (zonetail.med.unc.edu [152.19.4.12]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 30 Jun 2000 11:08:10 -0400 (EDT) Received: from med.unc.edu (apex.med.unc.edu [152.19.4.80]) by zonetail.med.unc.edu (8.9.3/8.9.3) with ESMTP id LAA00385 for ; Fri, 30 Jun 2000 11:08:09 -0400 (EDT) Date: Fri, 30 Jun 2000 11:08:09 -0400 (EDT) From: Tom Bush Subject: Re: W-EMED Interesting article on rattlesnakes Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <19df61c92b.1c92b19df6@med.unc.edu> MIME-version: 1.0 X-Mailer: Netscape Webmail Content-type: multipart/mixed; boundary="--452629f57e35de2" Content-language: en Precedence: bulk X-Accept-Language: en This is a multi-part message in MIME format. ----452629f57e35de2 Content-Type: text/plain; charset=us-ascii Content-Disposition: inline Content-Transfer-Encoding: 7bit Interesting artcile and sound advice. We should also keep in mind the significant morbidity related to the treatment and over treatment of snake bite. While 20 or so people die each year from snake bite in the US over 200 suffer from effects of treatment. Only about 1/2 of all snake bites result in significant envenomation. Here in NC (and most of the southeast) 80% of snake bites are from the Copperhead. Their venom is less toxic and infrequently requires antivenin. The article makes many excellent points and we should keep in mind that the best first aid for snake bite is a set of car keys. We should also realize that not all bites require anitvenin and close observation with supportive care is frequently the best course of action. Tom Bush, NP Clinical Assistant Professor Department of Orthopaedics University of NC at Chapel Hill ----- Original Message ----- From: "Kevin Mar" Date: Friday, June 30, 2000 0:27 am Subject: W-EMED Interesting article on rattlesnakes > Hi all, > > A friend came across this article and I thought I'd pass it on. > Especiallyintriguing is the section that discusses the evolution > of rattlesnake venom. > > http://www.amnh.org/naturalhistory/features/0700_feature.html > > Hope you all find it useful. > > Kevin Mar > Durham Search & Rescue > North Carolina Search & Rescue, Central Unit > > > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency- > medicine"as the body of a message (no subject) To: > Majordomo@list.pitt.eduSubmissions To: wilderness-emergency- > medicine@list.pitt.edu ----452629f57e35de2 Content-Type: text/x-vcard; name="explore.vcf"; charset=us-ascii Content-Disposition: attachment; filename="explore.vcf Content-Description: Card for Tom Bush Content-Transfer-Encoding: 7bit begin:vcard n:Bush;Tom fn:Tom Bush NP tel;work:919.962.2600 org:University of North Carolina at Chapel Hill;Orthopaedics adr:;;CB #7055;Chapel Hill;NC;27599-7055; version:2.1 email;internet:Tom_Bush@med.unc.edu title:Clinical Assistant Professor end:vcard ----452629f57e35de2-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 30 Jun 2000 00:31:41 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 30 Jun 2000 00:31:07 -0400 (EDT) Received: via switchmail; Fri, 30 Jun 2000 00:31:07 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Fri, 30 Jun 2000 00:29:33 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 30 Jun 2000 00:29:31 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR70O39BGC001B50@mb1i0.ns.pitt.edu>; Fri, 30 Jun 2000 00:29:28 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 30 Jun 2000 00:27:00 -0400 (EDT) Received: from smtp10.atl.mindspring.net (smtp10.atl.mindspring.net [207.69.200.246]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 30 Jun 2000 00:26:52 -0400 (EDT) Received: from kdmar (user-2ivf51u.dialup.mindspring.com [165.247.148.62]) by smtp10.atl.mindspring.net (8.9.3/8.8.5) with SMTP id AAA23977 for ; Fri, 30 Jun 2000 00:26:51 -0400 (EDT) Date: Fri, 30 Jun 2000 00:27:41 -0400 From: Kevin Mar Subject: W-EMED Interesting article on rattlesnakes Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook IMO, Build 9.0.2416 (9.0.2911.0) Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit Importance: Normal X-Priority: 3 (Normal) X-MSMail-priority: Normal Precedence: bulk Hi all, A friend came across this article and I thought I'd pass it on. Especially intriguing is the section that discusses the evolution of rattlesnake venom. http://www.amnh.org/naturalhistory/features/0700_feature.html Hope you all find it useful. Kevin Mar Durham Search & Rescue North Carolina Search & Rescue, Central Unit Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 29 Jun 2000 09:56:41 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 29 Jun 2000 09:56:09 -0400 (EDT) Received: via switchmail; Thu, 29 Jun 2000 09:56:09 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Thu, 29 Jun 2000 09:54:40 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 29 Jun 2000 09:54:24 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR664535LW000B5S@mb2i0.ns.pitt.edu>; Thu, 29 Jun 2000 09:54:23 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 29 Jun 2000 09:51:50 -0400 (EDT) Received: from macs.mxim.com (macs.mxim.com [204.17.143.130]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 29 Jun 2000 09:51:47 -0400 (EDT) Received: from localhost (localhost [127.0.0.1]) by macs.mxim.com (8.7/8.6.9) with SMTP id GAA26934 for ; Thu, 29 Jun 2000 06:51:02 -0700 (PDT) Date: Thu, 29 Jun 2000 06:51:01 -0700 (PDT) From: Hal Lillywhite Subject: Re: W-EMED African Travel and Malaria In-reply-to: "Your message of Mon, 26 Jun 2000 17:03:30 CDT." Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <200006291351.GAA26934@macs.mxim.com> MIME-version: 1.0 X-Mailer: exmh version 2.0.1 12/23/97 Content-type: text/plain; charset=us-ascii Precedence: bulk OK, this one is just for fun. My grandfather told about having malaria or yellow fever (don't remember which) when he was a little boy. Quinine was new at the time but the nice capsules now availible hadn't been invented. They wrapped the stuff in tissue paper and he was expected to swallow the tissue paper pills. Sure enough, he recovered fairly rapidly and everybody was talking about what wonderful stuff this new drug was. Once he was recovered enough to leave the couch where he had been during his illness his mother set out to clean it. That's when she found the nest where he had hidden the pills so he wouldn't have to try to swallow them. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 29 Jun 2000 07:45:36 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 29 Jun 2000 07:45:04 -0400 (EDT) Received: via switchmail; Thu, 29 Jun 2000 07:45:04 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Thu, 29 Jun 2000 07:44:35 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 29 Jun 2000 07:44:32 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR61K4U30S000B5T@mb2i0.ns.pitt.edu>; Thu, 29 Jun 2000 07:44:30 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 29 Jun 2000 07:43:14 -0400 (EDT) Received: from imo-r18.mx.aol.com (imo-r18.mx.aol.com [152.163.225.72]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 29 Jun 2000 07:43:12 -0400 (EDT) Received: from Caverbru@aol.com by imo-r18.mx.aol.com (mail_out_v27.10.) id h.e8.66aed14 (4323) for ; Thu, 29 Jun 2000 07:42:34 -0400 (EDT) Date: Thu, 29 Jun 2000 07:42:33 -0400 (EDT) From: Caverbru@aol.com Subject: Re: W-EMED African Travel and Malaria Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-Mailer: AOL 5.0 for Windows sub 114 Content-type: text/plain; charset="US-ASCII" Content-transfer-encoding: 7bit Precedence: bulk To go with what Steve said, In 1990 Peace Corps Kenya was giving Volunteers a kit to do a self blood test as well as Fansidar to take if high fever symptoms appeared. At that time a PCV in our village was taking Chloroquine and Paludrin faithfully as well as following all other precautions. He still contracted the disease without the normal symptoms, was misdiagnosed by a Kenyan doctor with US training, perhaps because of a lab error, and subsequently died. We were also a full days travel to the nearest doctor. So self treatment and diagnoses is iffy, When you go to these places you take your chances. Be careful. Bru Randall RPCV Kenya 1989-1991 Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc09.srv.cis.pitt.edu (root@post-ofc09.srv.cis.pitt.edu [136.142.185.57]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 27 Jun 2000 12:15:59 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc09.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 27 Jun 2000 12:15:27 -0400 (EDT) Received: via switchmail; Tue, 27 Jun 2000 12:15:27 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Tue, 27 Jun 2000 12:13:27 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 27 Jun 2000 12:13:25 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR3IDTOB8Q001BB6@mb1i0.ns.pitt.edu>; Tue, 27 Jun 2000 12:13:25 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 27 Jun 2000 12:12:48 -0400 (EDT) Received: from cgi.icon.co.za (cgi.icon.co.za [196.35.95.41]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 27 Jun 2000 12:12:43 -0400 (EDT) Received: from mail450.icon.co.za (ismtp.icon.co.za [196.35.95.40]) by cgi.icon.co.za (Postfix) with ESMTP id B19D64C532 for ; Tue, 27 Jun 2000 18:19:03 +0200 (SAST) Received: from icon.co.za (c2-ndf-11.dial-up.net [196.34.156.139]) by mail450.icon.co.za (8.9.3/8.9.3) with ESMTP id SAA21911 for ; Tue, 27 Jun 2000 18:13:37 +0200 (GMT) Date: Tue, 27 Jun 2000 18:04:27 +0200 From: Arthur Morgan Subject: Re: W-EMED African Travel and Malaria Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <3958D08A.3C2F7041@icon.co.za> MIME-version: 1.0 X-Mailer: Mozilla 4.7 [en] (Win98; I) Content-type: text/plain; charset=us-ascii Content-transfer-encoding: 7bit Precedence: bulk X-Accept-Language: en-GB,en,af,pl References: Steven, I agree completely with what you said in your letter, as far as it goes. Most of Africa has malaria strains that have high grade resistance to chloroquine. Few people realize how FAST malaria can progress. I have had the disease a few times. The last time I went to bed healthy, woke up with mild symptoms and took the treatment. I walked over the road to the hospital where I worked and just had the strength to 'phone my wife to come by car to collect me - perhaps an hour or less from mild disease to incapacitation. If I had to wait a few hours for treatment I doubt if I would have survived. Arthur "Steven D. Pirie" wrote: > > > The current thought up here in Canada is that the non medical traveller > should not begin a self treatment for malaria unless they are unable to > seek medical care within 24 hours from the time of onset (fever). Due to > the fact that malaria symptoms are so non-specific there is a real risk of > treating another disease, and or running into problems with the toxicity of > malaria therapy. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 26 Jun 2000 17:04:31 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 26 Jun 2000 17:03:59 -0400 (EDT) Received: via switchmail; Mon, 26 Jun 2000 17:03:58 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Mon, 26 Jun 2000 17:03:02 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 26 Jun 2000 17:02:57 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR2E7DZ0HY0001LX@mb2i0.ns.pitt.edu>; Mon, 26 Jun 2000 17:02:54 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 26 Jun 2000 17:00:38 -0400 (EDT) Received: from mail1.toronto.istar.net (mail1.toronto.istar.net [209.89.75.17]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 26 Jun 2000 17:00:35 -0400 (EDT) Received: from ip37.ottawa8.dialup.canada.psi.net ([154.5.70.37]) by mail1.toronto.istar.net with smtp (Exim 2.02 #1) id 136g0M-0005wm-00 for wilderness-emergency-medicine@list.pitt.edu; Mon, 26 Jun 2000 17:01:20 -0400 Date: Mon, 26 Jun 2000 17:03:30 -0500 From: pirie@istar.ca (Steven D. Pirie) Subject: W-EMED African Travel and Malaria Sender: owner-wilderness-emergency-medicine@list.pitt.edu X-Sender: pirie@istar.ca (Unverified) To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 Content-type: text/plain; charset="us-ascii" Precedence: bulk Arthur and others, >Quinine must be carried with you for at least this time. Treatment must be >>started as soon as you become ill and a formal diagnosis can wait. A >delay of >just a few hours to get back to your supply of quinine can allow >the disease to >become really nasty, and a day to make a proper diagnosis >can be fatal. The current thought up here in Canada is that the non medical traveller should not begin a self treatment for malaria unless they are unable to seek medical care within 24 hours from the time of onset (fever). Due to the fact that malaria symptoms are so non-specific there is a real risk of treating another disease, and or running into problems with the toxicity of malaria therapy. I have heard that there is a rapid detection (of malaria) product sold outside of Canada that uses a simple dipstick test. The sensitivity and specificity of these tests in research laboratories is > 90%. There is however limited (if any) data about their accuracy in the hands of non-experienced operators and under non-refrigerated (read: real world) conditions. I am not sure if they are ready to be used yet by the wilderness traveller for the self diagnosis of malaria. Before recommending that a traveller undertakes self diagnosis and treatment I think it is important for us (the medical worker) to sit down and educate them on the signs and symptoms of malaria, other diseases that it can mimic and the risk / benefits of starting treatment on their own. It is also as important for the person to realize that they must get to a physician as soon as possible and that self treatment does not negate this obligation. I tell them that it is a "life saving measure like a AnaKit" and that self treatment is only temporary. Quinine alone to carry for self treatment is not good enough. For self treatment (prior to getting to a medical clinic): If in a chloroquine sensitive regions and not receiving chloroquine prophylaxis, self-treatment with chloroquine should be taken. Chloroquine is supplied in a 150 mg base (Aralen or in some parts of the world Nivaquine) and the self treatment is 1.5 gm (base) over 3 days. It is recommended that: Day 1 - 2 tabs BID Day 2 - 2 tabs BID Day 3 - 2 tabs for a total of 10 tabs. Chloroquine prophylaxis should then be started. If in a chloroquine sensitive regions and already receiving chloroquine prophylaxis, self treatment with atovaquone 250 mg / proguanil 100 mg (Marlarone) should be taken. Take 4 tabs once a day for 3 days. Once again chloroquine prophylaxis should be resumed. If in a chloroquine or chloroquine and mefloquine resistant P. falciparum regions, treatment recommendations for un-complicated P. falciparum involve taken oral Marlarone (as above) and resuming Mefloquine or other another appropriate prophylaxis. OR Oral Quinine 250 mg, two tabs TID for 3 to 7 days (7 in SE Asia) and doxycycline 100 mg, one tab BID for 7 days. You need both the Doxy and the Quinine to be effective. Once again Mefloquine or other appropriate prophylaxis should be resumed. OR If in Sub-Saharan Africa or the Indian Subcontinent you can begin oral Quinine (as above) plus three tabs of Pyrimethamine 25 mg with Sulfadoxine 500 mg (Fansidar). Once again Mefloquine or other appropriate prophylaxis should be resumed. It is worth noting that Fansidar is not the same drug as Fansimef (which is marketed in some areas. Fansimef is a combination of Mefloquine and Fansidar as is NOT recommended for the prevention or treatment of malaria. There is a risk of additive toxicity and reduced efficacy if used. Oral Quinine is not enough. Hope that helps, don't prescribe off this email (look it up incase I made a typo). Steven ---------------------------------------------------------- Lt. Steven D. Pirie, RN, BScN, UE General Duty Ward Officer - Military In-Patient Unit Canadian Forces Support Unit Ottawa - Civic Hospital Site 2 Health Support Operational Training Unit ---------------------------------------------------------- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sun, 25 Jun 2000 21:00:13 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 25 Jun 2000 20:59:40 -0400 (EDT) Received: via switchmail; Sun, 25 Jun 2000 20:59:40 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Sun, 25 Jun 2000 20:59:22 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 25 Jun 2000 20:59:14 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR185ZE3FW00153D@mb2i0.ns.pitt.edu>; Sun, 25 Jun 2000 20:59:10 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 25 Jun 2000 20:58:53 -0400 (EDT) Received: from picusnet.com (mail.picusnet.com [207.7.90.2]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 25 Jun 2000 20:58:50 -0400 (EDT) Received: from default [207.7.95.127] by picusnet.com (SMTPD32-5.05) id AAC336E000B8; Sun, 25 Jun 2000 20:58:43 -0400 Date: Sun, 25 Jun 2000 20:55:23 -0500 From: GATORDOC Subject: Re: W-EMED Water purification for adventure race Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <000d01bfdf11$9837e020$7f5f07cf@default> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <395622DC.18897.5A0B0F7@localhost> Geez Keith, are you going to put one of those things in the back of your truck also? By the way, The US Navy SEALs use the PUR Explorer. It is field cleanable, and high output. I think it would be ideal for the race. Rob ----- Original Message ----- From: "Keith Conover, M.D., FACEP" To: "Daryl" Cc: Sent: Sunday, June 25, 2000 2:18 PM Subject: Re: W-EMED Water purification for adventure race > On 24 Jun 2000, at 22:50, Daryl wrote: > > > My recommendation is for a combination of Iodine, either in liquid or > > tablet form, and the trusty "Milbank's Bag". For those who don't know, > > the Milbank's Bag has been in use by various sections of the British > > Forces for many years and, is still favoured by many including myself, > > as the ultimate crud remover. Manufacturers of modern devices will > > disagree, quite naturally as they want to sell their products! > > Hmmm. Sounds interesting, could you describe it in a bit more > detail? Haven't seen one avaialable in the U.S. > > BTW, for something like the EcoChallenge, something that works by > gravity may be a bit slow for the contestants. Most of the iodine- > resin filters have a prefilter that keeps out crud and is easily > cleaned. The advantage of the iodine-resin filters is that they can > be used rapidly to provide small amounts of drinkable water _now_ -- > just pump a liter into a one-liter Nalgene laboratory grade water > bottle (the standard kind used by outdoor people in the US > overwhelmingly -- and the filters have screwon caps so the output > can go directly into the bottle) and throw in your pack. In 15 > minutes the iodine has done its work and the water is ready to drink. > > Good if you're constantly on the go. > > Looking forward to hearing more about the Milbank bag. > > Thanks. > > --Keith Conover, M.D., FACEP > http://www.pitt.edu/~kconover > sent with Pegasus high-security email > download free from www.pmail.com > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID for ; Sun, 25 Jun 2000 21:27:55 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID for kconover@imap.pitt.edu; Sun, 25 Jun 2000 21:27:53 -0400 (EDT) Received: via switchmail for kconover+@pitt.edu; Sun, 25 Jun 2000 21:27:53 -0400 (EDT) Received: from mail.webpostal.com.ar (mail.webpostal.com.ar [200.16.190.25]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID for ; Sun, 25 Jun 2000 21:27:46 -0400 (EDT) Received: from marcelo ([200.51.54.86]) by mail.webpostal.com.ar (Netscape Messaging Server 4.15) with SMTP id FWQ61S00.X2Q for ; Sun, 25 Jun 2000 22:27:28 +0300 Message-ID: <023c01bfdef8$3cc71940$563633c8@marcelo> From: "jym@smandes.neuquen.com.ar" To: References: <39531D02.6896.29D280@localhost> Subject: Re: W-EMED Fw: Water purification for adventure race Date: Sun, 25 Jun 2000 19:40:42 -0300 MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 8bit X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2919.6600 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 Dear Keith So glad to hear from you again. It's been a long time since our last contact. Thanks for the info. By the way we are interested in getting training specifically in Search and I thought about you and mentioned your name over here. It would be great to have you teach us all you know and visit my place. I would like to know if you would be interested in this and what the costs would be. We still do not have any schedule because just started talking about it. Eric and me would do all the translation. We would also love to get some training in rope rescue. The ecochallenge was held just 100 miles from home and what you saw is what our region looks like. So we will take you on a nice climb or hike. Very kind regards to you and Betty and daughter? Say hi to Jorge Marcelo Parada MD Hospital Ramón Carrillo (8370) San Martín de los Andes Neuquén- ARGENTINA email jym@smandes.neuquen.com.ar ----- Original Message ----- From: "Keith Conover, M.D., FACEP" To: ; Sent: Friday, June 23, 2000 9:17 AM Subject: Re: W-EMED Fw: Water purification for adventure race I'm a fan of the iodine-resin filters. They serve as a filter to eliminate large parasites like giardia, as with all filters. Like the filters with smaler pore size, they filter out almost all bacteria. Th iodine resin, however, allows the filter to also kill off harmful bacteria (hepatitis, viral gastroenteritis). They also have an optional charcoal filter, that eliminates residual iodine in the output (the viruses are still coated with iodine and will diein about 15 minutes). The charcoal filter will also help get rid of pesticides and heavy metals. There are several manfufacturers in the U.S. I have had several of the devices made by PUR and have been quite happy. The larger models, e.g., the Scout, have an included cleaning mechanism which is not present in the lighter models, which may be appropriate. I've been able to clean off the lighter model's filter elements by opening and cleaning off with some paper or leaves or an old toothbrush, but the quicker cleaning of the Scout and similar models, without having to take them apart, may be worth the extra weight. On the other hand, the smaller and newer filters have filter elements that, instead of being like a round cylinder, have "pleats" much like the air or oil filters on a car, and will go much longer without cleaning. Don't know about jungle water, but when I was hiking in an area where most water was from pumps with iron pipes, the rust clogged the filter after only 3-4 days and I had to clean it off with some leaves (old cylinder type filter). Hope this helps some. Hope all is well with you and your family and the skiing's good in San Martin de Los Andes this season! It's 85 degrees F (30 degrees C) here in Pittsburgh today. P.S. we saw your picture on the film of the EcoChallenge last -- and Jorge Varcellotti says hi. Take care. On 22 Jun 2000, at 22:58, jym@smandes.neuquen.com.ar wrote: > I would appreciate the list members opinion on what would be the best > water purification system for Ecochallenge competitors (team of 4) in > the next race to be held in Borneo (Kinabalu). Ecochallenge is an > adventure race. Iodine in tablets or liquid is mandatory for the > organization, and this alone is quite a good option but I do not have > extensive experience with water filters with "jungle type water". If a > water filter was an option, how many would a 4 member team need for > 6-10 days? and what brand would be a good choice.These questions are > to address the clogging problem. Thanks > > Marcelo Parada MD > Hospital Ramón Carrillo > (8370) San Martín de los Andes > Neuquén- ARGENTINA > > email jym@smandes.neuquen.com.ar > --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com -- End -- Return-Path: Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sun, 25 Jun 2000 15:21:13 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 25 Jun 2000 15:20:41 -0400 (EDT) Received: via switchmail; Sun, 25 Jun 2000 15:20:41 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Sun, 25 Jun 2000 15:20:04 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 25 Jun 2000 15:19:59 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR0WBGEEUC00167E@mb1i0.ns.pitt.edu>; Sun, 25 Jun 2000 15:19:59 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sun, 25 Jun 2000 15:18:59 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sun, 25 Jun 2000 15:18:56 -0400 (EDT) Received: from micron ("port 1046"@[136.142.20.141]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR0WA372GK0014F7@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Sun, 25 Jun 2000 15:18:55 -0500 (EST) Date: Sun, 25 Jun 2000 15:18:52 -0400 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED Water purification for adventure race In-reply-to: <004d01bfde26$fa6352c0$e02a8cd4@default> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Daryl Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <395622DC.18897.5A0B0F7@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk On 24 Jun 2000, at 22:50, Daryl wrote: > My recommendation is for a combination of Iodine, either in liquid or > tablet form, and the trusty "Milbank's Bag". For those who don't know, > the Milbank's Bag has been in use by various sections of the British > Forces for many years and, is still favoured by many including myself, > as the ultimate crud remover. Manufacturers of modern devices will > disagree, quite naturally as they want to sell their products! Hmmm. Sounds interesting, could you describe it in a bit more detail? Haven't seen one avaialable in the U.S. BTW, for something like the EcoChallenge, something that works by gravity may be a bit slow for the contestants. Most of the iodine- resin filters have a prefilter that keeps out crud and is easily cleaned. The advantage of the iodine-resin filters is that they can be used rapidly to provide small amounts of drinkable water _now_ -- just pump a liter into a one-liter Nalgene laboratory grade water bottle (the standard kind used by outdoor people in the US overwhelmingly -- and the filters have screwon caps so the output can go directly into the bottle) and throw in your pack. In 15 minutes the iodine has done its work and the water is ready to drink. Good if you're constantly on the go. Looking forward to hearing more about the Milbank bag. Thanks. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Mon, 26 Jun 2000 13:44:43 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 26 Jun 2000 13:44:12 -0400 (EDT) Received: via switchmail; Mon, 26 Jun 2000 13:44:12 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Mon, 26 Jun 2000 13:43:17 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 26 Jun 2000 13:43:13 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JR277RZBRS001C5A@mb1i0.ns.pitt.edu>; Mon, 26 Jun 2000 13:43:10 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Mon, 26 Jun 2000 13:42:25 -0400 (EDT) Received: from cgi.icon.co.za (cgi.icon.co.za [196.35.95.41]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Mon, 26 Jun 2000 13:42:20 -0400 (EDT) Received: from mail450.icon.co.za (ismtp.icon.co.za [196.35.95.40]) by cgi.icon.co.za (Postfix) with ESMTP id AD2F24C5A5 for ; Mon, 26 Jun 2000 19:48:32 +0200 (SAST) Received: from icon.co.za (a5-jhb-59.dial-up.net [196.26.214.59]) by mail450.icon.co.za (8.9.3/8.9.3) with ESMTP id TAA06923 for ; Mon, 26 Jun 2000 19:43:11 +0200 (GMT) Date: Sun, 25 Jun 2000 15:19:04 +0200 From: Arthur Morgan Subject: Re: W-EMED African Travel Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <395606C8.BE719132@icon.co.za> MIME-version: 1.0 X-Mailer: Mozilla 4.7 [en] (Win98; I) Content-type: text/plain; charset=us-ascii Content-transfer-encoding: 7bit Precedence: bulk X-Accept-Language: en-GB,en,af,pl References: Hello all, Sorry about the delay in answering. There has been no mention of AIDS/HIV in the posts. This is the most common viral disease that anyone in Africa is likely to encounter unless good hygiene is practised. The incidence is **much** higher than any government will admit. The spread is by sex, blood products and dirty needles. Avoid each and every one of these. No matter how you try to avoid malaria there will be some infections. For at least 6 months after leaving the area ANY illness **IS** malaria unless it is otherwise diagnosed. Quinine must be carried with you for at least this time. Treatment must be started as soon as you become ill and a formal diagnosis can wait. A delay of just a few hours to get back to your supply of quinine can allow the disease to become really nasty, and a day to make a proper diagnosis can be fatal. Arthur Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sat, 24 Jun 2000 18:02:22 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 24 Jun 2000 18:01:50 -0400 (EDT) Received: via switchmail; Sat, 24 Jun 2000 18:01:50 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Sat, 24 Jun 2000 18:00:22 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 24 Jun 2000 18:00:18 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQZNLVC2BW0010T3@mb2i0.ns.pitt.edu>; Sat, 24 Jun 2000 18:00:17 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 24 Jun 2000 17:59:44 -0400 (EDT) Received: from scooby.lineone.net (doggy.lineone.net [194.75.152.224]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 24 Jun 2000 17:59:35 -0400 (EDT) Received: from default (host212-140-42-224.btinternet.com [212.140.42.224]) by scooby.lineone.net (8.9.3/8.9.3) with SMTP id WAA23221 for ; Sat, 24 Jun 2000 22:58:50 +0100 (BST) Date: Sat, 24 Jun 2000 22:50:20 +0100 From: Daryl Subject: Re: W-EMED Water purification for adventure race Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <004d01bfde26$fa6352c0$e02a8cd4@default> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Content-type: multipart/alternative; boundary="----=_NextPart_000_003B_01BFDE2E.92E1D9C0" X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <001001bfdcb6$213d7e60$593633c8@marcelo> This is a multi-part message in MIME format. ------=_NextPart_000_003B_01BFDE2E.92E1D9C0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Greetings from across the pond. My recommendation is for a combination of Iodine, either in liquid or = tablet form, and the trusty "Milbank's Bag". For those who don't know, the Milbank's Bag has been in use by various = sections of the British Forces for many years and, is still favoured by = many including myself, as the ultimate crud remover. Manufacturers of modern devices will disagree, quite naturally as they = want to sell their products! Basically the bag works by allowing water to filter through into a = container where the water may be finally treated with iodine or other = favoured treatment. 1. There is nothing to go wrong 2. There is no filter element to clean (other than to wash the bag out) 3. There is no fragile filter to crack or break (The only way you will = "break" a Milbank's Bag is by setting fire to it!) 4. It works on gravity - no pumping required 5. If it clogs with crud, simply wash it out and start again, time 20 - = 30 seconds. Not very likely with a pump device! 6. No parts to go astray 7. No expensive parts to replace after ox uses 8. A fraction of the cost of all singing - all dancing devices My business colleague, in a previous life, was a survival instructor at = the British Forces Jungle Survival School in Brunei. The Milbank's Bag = never failed to shine when it came down to the initial cleansing of = water with a high vegetation content. The mechanical devices failed = simply because they became crudded up with vegetation, silt etc, = necessitating regular, i.e. every 10 - 15 pumps, stripping and thorough = cleaning of the device and filter. Not to mention crud that got stuck in = the inlet pipe on some models! We still use the bag as our No.1 choice in all environments, from the UK = to Middle East to Belize and, after 30 years the only belly gripes I = have had is from drinking "safe" tap water and, during this time have = only used 2 bags (the first was "borrowed"). Contact me off list if you require any further info on use or supply of = the bag. Best of luck with your venture - Kinabalu is a great spot! Daryl J Wight ----- Original Message -----=20 From: jym@smandes.neuquen.com.ar=20 To: wilderness-emergency-medicine@list.pitt.edu=20 Sent: 23 June 2000 02:55 Subject: W-EMED Water purification for adventure race I would appreciate the list members opinion on what would be the best = water purification system for Ecochallenge competitors (team of 4) in = the next race to be held in Borneo (Kinabalu). Ecochallenge is an = adventure race. Iodine in tablets or liquid is mandatory for the organization, and = this alone is quite a good option but I do not have extensive experience = with water filters with "jungle type water". If a water filter was an = option, how many would a 4 member team need for 6-10 days? and what = brand would be a good choice.These questions are to address the clogging = problem. Thanks Marcelo Parada MD Hospital Ram=F3n Carrillo (8370) San Mart=EDn de los Andes Neuqu=E9n- ARGENTINA email jym@smandes.neuquen.com.ar =20 ------=_NextPart_000_003B_01BFDE2E.92E1D9C0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
Greetings from across the = pond.
 
My recommendation is for a = combination of=20 Iodine, either in liquid or tablet form, and the trusty "Milbank's=20 Bag".
For those who don't know, the = Milbank's Bag has=20 been in use by various sections of the British Forces for many years = and, is=20 still favoured by many including myself, as the ultimate crud=20 remover.
Manufacturers of modern devices will = disagree,=20 quite naturally as they want to sell their products!
 
Basically the bag works by allowing = water to=20 filter through into a container where the water may be finally treated = with=20 iodine or other favoured treatment.
1. There is nothing to go = wrong
2. There is no filter element to = clean (other=20 than to wash the bag out)
3. There is no fragile filter to = crack or break=20 (The only way you will "break" a Milbank's Bag is by setting fire to=20 it!)
4. It works on gravity - no pumping=20 required
5. If it clogs with crud, simply = wash it out and=20 start again, time 20 - 30 seconds. Not very likely with a pump=20 device!
6. No parts to go = astray
7. No expensive parts to replace = after ox=20 uses
8. A fraction of the cost of all = singing - all=20 dancing devices
 
My business colleague, in a previous = life, was a=20 survival instructor at the British Forces Jungle Survival School in = Brunei. The=20 Milbank's Bag never failed to shine when it came down to the initial = cleansing=20 of water with a high vegetation content. The mechanical devices failed = simply=20 because they became crudded up with vegetation, silt etc, necessitating = regular,=20 i.e. every 10 - 15 pumps, stripping and thorough cleaning of the device = and=20 filter. Not to mention crud that got stuck in the inlet pipe on some=20 models!
 
We still use the bag as our No.1 = choice in all=20 environments, from the UK to Middle East to Belize and, after 30 years = the only=20 belly gripes I have had is from drinking "safe" tap water and, during = this time=20 have only used 2 bags (the first was "borrowed").
 
Contact me off list if you require = any further=20 info on use or supply of the bag.
 
Best of luck with your venture - = Kinabalu is a=20 great spot!
 
Daryl J Wight
----- Original Message -----
From:=20 jym@smandes.neuquen.com.ar =
To: wilderness-emergency-= medicine@list.pitt.edu=20
Sent: 23 June 2000 02:55
Subject: W-EMED Water = purification for=20 adventure race

I would appreciate the list = members opinion=20 on what would be the best water purification system for Ecochallenge=20 competitors (team of 4) in the next race to be held in Borneo = (Kinabalu).=20 Ecochallenge is an adventure race.
Iodine in tablets or liquid is = mandatory for the=20 organization, and this alone is quite a good option but I do not have=20 extensive experience with water filters with "jungle type water". If a = water=20 filter was an option, how many would a 4 member team need for = 6-10 days?=20 and what brand would be a good choice.These questions are to address = the=20 clogging problem.
Thanks
 
Marcelo Parada MD
Hospital Ram=F3n = Carrillo
(8370) San Mart=EDn de los Andes
Neuqu=E9n- = ARGENTINA
 
email  jym@smandes.neuquen.com.ar= =20  
------=_NextPart_000_003B_01BFDE2E.92E1D9C0-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Sat, 24 Jun 2000 14:58:16 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 24 Jun 2000 14:57:42 -0400 (EDT) Received: via switchmail; Sat, 24 Jun 2000 14:57:42 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Sat, 24 Jun 2000 14:57:14 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sat, 24 Jun 2000 14:57:12 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQZH7TW8TC0013TE@mb1i0.ns.pitt.edu>; Sat, 24 Jun 2000 14:57:10 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Sat, 24 Jun 2000 14:55:10 -0400 (EDT) Received: from mail1.uts.ohio-state.edu (mail1.uts.ohio-state.edu [128.146.214.30]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Sat, 24 Jun 2000 14:55:08 -0400 (EDT) Received: from page (ts5-4.homenet.ohio-state.edu [140.254.112.91]) by mail1.uts.ohio-state.edu (8.9.3/8.9.3) with SMTP id OAA17166 for ; Sat, 24 Jun 2000 14:55:06 -0400 (EDT) Date: Sat, 24 Jun 2000 14:55:06 -0400 (EDT) From: John Page Subject: W-EMED Re: Water Purification option Sender: owner-wilderness-emergency-medicine@list.pitt.edu X-Sender: page.95@pop.service.ohio-state.edu To: Wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <200006241855.OAA17166@mail1.uts.ohio-state.edu> MIME-version: 1.0 X-Mailer: Windows Eudora Pro Version 2.1.2 Content-type: text/plain; charset="us-ascii" Precedence: bulk Marcelo - Regarding your water purification needs I suggest that you look into follwing - First off you must evaluate your likely hood of having a water source available and where each such source is to be found... Assuming you have access to water - Swimming pool treatment 50 grains @ quart of water oxidizer 2cc All of which can be carried in two water proof plastic containers no bigger than 1/2 cup containers. Details: Swimming pool treatment MUST include a min of: Dry contents Active ingredient = 65% Calcium Hypochlorite W/ 65% min cholorine Inert ingredients = 35% I use "Super Shock It" (HTM) A 1 pound container will last you all multiple life times 78% Calcium Hypochlorite W/75% min chlorine 22% inert Oxidizer Hydrogen peroxide 3% most any from a phrarmacy will suffice Directions: 1. Contact your local science dept. or lab to get ahold of a .050 grain heavy duty little scoop 2. Ask same for a small/modest sized sterile transfer pipette Add one scoop (50 grains) into each quart of water mix & shake WELL - loosen cap threads to ensure that some of the mix trickels out and along all thread areas. Then verify a good/strong chlorine smell exists If not ADD a second scoop of 50 grains This may well be neccessary should water source be poor quality or very cold. WAIT 30 minutes Add 2cc oxidizer & shake well Yes loosen threads a bit again - simply to rid chlorine taste and smell on mouth area. This is all you need to do - Suggest: You contact your local university medical center - or military base medical dept. to confirm details of disease likelyhood for the areas you will be going into. Then match up my above suggestions to them to verify which (IF any) diseases are not purified... WARNING: CHOLRINE is dangerous - DO NOT swallow by itself!!!! May be fatal if swallowed alone. IF SWALLOWED ALONE (by itself without being mixed as stated above per quart) - DO NOT INDUCE VOMITTING. Feed patient milk soaked bread followed by cooking oil. Call physician immediately!! ONLY mix cholorine with water! Contamination of chlorine with other substances MAY cause generation of heat, fire, or explosion. Caution is required - yet I find it very minor when treated with a bit of respect and mixed as above. We are useing the above mix within Ohio State University within the Outdoor Pursuits programs which include backpacking, hiking, rock climbing, sea kayaking, caving, etc. I might also hint that you set up two complete sets of purification packets and have two individuals carry them - so as not to loose one... Recomend: a high quality miniature water proof container for your calcium/chlorine - it sucks up moisture and can be a mucky mess if gotten the least bit wet. A complete packet of which can fit within a shirt pocket and weigh only a couple oz. Hope this helps - John Page Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 23 Jun 2000 15:28:15 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 23 Jun 2000 15:27:42 -0400 (EDT) Received: via switchmail; Fri, 23 Jun 2000 15:27:41 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Fri, 23 Jun 2000 14:53:08 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 23 Jun 2000 14:53:06 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQY2SFRKCI001759@mb1i0.ns.pitt.edu>; Fri, 23 Jun 2000 14:53:06 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 23 Jun 2000 14:52:10 -0400 (EDT) Received: from pol.net (sigma.po.com [204.178.220.39]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 23 Jun 2000 14:52:08 -0400 (EDT) Received: from web3.po.com (web3.po.com [204.178.220.30]) by pol.net (8.9.3/8.8.8) with ESMTP id OAA08497 for ; Fri, 23 Jun 2000 14:50:50 -0400 (EDT) Received: (from www@localhost) by web3.po.com (8.9.3+Sun/8.9.1) id OAA02472; Fri, 23 Jun 2000 14:50:48 -0400 (EDT) Date: Fri, 23 Jun 2000 14:50:48 -0400 (EDT) From: Charles Werntz Subject: Re: Re: W-EMED African Travel Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <200006231850.OAA02472@web3.po.com> MIME-version: 1.0 Content-type: TEXT/PLAIN Content-transfer-encoding: 7bit Precedence: bulk X-Authentication-warning: web3.po.com: www set sender to cwerntz@pol.net using -f Tobias, if you haven't had any luck yet, we have a rather nice travel medicine clinic out here in Morgantown, WV. They have all of vacinations, and they provide good handouts about the health and cultural concerns about where you'll be traveling. (304) 293-2311, then ask for the "traveller's clinic". Hope this helps > On 19 Jun 2000, at 14:59, Tobias Joy wrote: > > > Also, what should I get insofaras immunizations above the required > > ones (yellow fever, malaria, and cholera, although cholera isn't > > officially required). Any leads on a "one-stop" immunization place? > > I can get to Pittsburgh and down to DC and Baltimore with no problems > > (the closer to Cumberland, MD, the better). > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 23 Jun 2000 11:18:39 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 23 Jun 2000 11:18:07 -0400 (EDT) Received: via switchmail; Fri, 23 Jun 2000 11:18:06 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Fri, 23 Jun 2000 11:16:21 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 23 Jun 2000 11:16:19 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQXV7NRW8C0015DB@mb1i0.ns.pitt.edu>; Fri, 23 Jun 2000 11:16:19 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 23 Jun 2000 11:15:48 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 23 Jun 2000 11:15:41 -0400 (EDT) Received: from snickers ("port 1033"@[136.142.23.63]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with SMTP id <01JQXTE9982O0016JV@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Fri, 23 Jun 2000 10:24:23 -0500 (EST) Date: Fri, 23 Jun 2000 10:26:42 -0400 From: Suzanne Atkinson Subject: Re: W-EMED Fw: Water purification for adventure race Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <001401bfdd1f$0deb1ca0$0200a8c0@snickers> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2615.200 X-Mailer: Microsoft Outlook Express 5.00.2615.200 Content-type: text/plain; charset="iso-8859-1" Content-transfer-encoding: 7bit X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk References: <39531D02.6896.29D280@localhost> My two cents about cleaning filters, and charcoal filter add ons. The newer 'pleated' filters that Kieth mentions are usually cleaned on the inside of the cylinder...that is, the pumped water flows from the inside of the hollow cylynder to the outside. This means that cleaning must be done with a certain sized brush. I lost the brush on a rockies trip, and after that the filter was useless...it was next to impossible to reach inside and effectively clean it with a bandana, pine cone wrapped in a bandana, etc. However the design of the model I used, the SweetWater, was enormously easier to pump than some of the PURs I've tried. It has a levereaged handle that flips into place to aid pumping, a pressure relief valve so that you don't blow out the filter trying to force bad water through, and at one time, the filters were absolutely guaranteed not to clog before 200 gallons, or else you got a new filter. The best part of the SweetWater was that you could add or remove the iodine portion of the filter depending on whether or not you wanted to use it. I solved the lost brush problem on my next trip by tying it to the filter's storage sack! Secondly, PUR, Sweet Water and others all sell 'add-on' pre-and post filters that should fit onto any input or output hose on your existing filter. That means you can almost mix and match elements that you want. These include "silt-stoppers" (a prefilter) and iodine and charcoal filters (postfilter). Suzanne Atkinson Pgh, PA ----- Original Message ----- From: Keith Conover, M.D., FACEP To: ; Sent: Friday, June 23, 2000 8:17 AM Subject: Re: W-EMED Fw: Water purification for adventure race > There are several manfufacturers in the U.S. I have had several of > the devices made by PUR and have been quite happy. The larger > models, e.g., the Scout, have an included cleaning mechanism > which is not present in the lighter models, which may be > appropriate. I've been able to clean off the lighter model's filter > elements by opening and cleaning off with some paper or leaves or > an old toothbrush, but the quicker cleaning of the Scout and similar > models, without having to take them apart, may be worth the extra > weight. On the other hand, the smaller and newer filters have filter > elements that, instead of being like a round cylinder, have "pleats" > much like the air or oil filters on a car, and will go much longer > without cleaning. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 23 Jun 2000 08:19:35 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 23 Jun 2000 08:19:02 -0400 (EDT) Received: via switchmail; Fri, 23 Jun 2000 08:19:01 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Fri, 23 Jun 2000 08:18:01 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 23 Jun 2000 08:18:00 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQXOZI5W2M0016JV@mb1i0.ns.pitt.edu>; Fri, 23 Jun 2000 08:17:56 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 23 Jun 2000 08:17:11 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 23 Jun 2000 08:17:09 -0400 (EDT) Received: from micron ("port 1024"@[136.142.20.78]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQXOYHOTAK0015DB@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Fri, 23 Jun 2000 08:17:08 -0500 (EST) Date: Fri, 23 Jun 2000 08:17:06 -0400 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED Fw: Water purification for adventure race In-reply-to: <002401bfdcb6$781899e0$593633c8@marcelo> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: "jym@smandes.neuquen.com.ar" , wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <39531D02.6896.29D280@localhost> MIME-version: 1.0 X-MIME-Autoconverted: from Quoted-printable to 8bit by list.srv.cis.pitt.edu id IAA14003 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=ISO-8859-1 Content-transfer-encoding: 8BIT Precedence: bulk I'm a fan of the iodine-resin filters. They serve as a filter to eliminate large parasites like giardia, as with all filters. Like the filters with smaler pore size, they filter out almost all bacteria. Th iodine resin, however, allows the filter to also kill off harmful bacteria (hepatitis, viral gastroenteritis). They also have an optional charcoal filter, that eliminates residual iodine in the output (the viruses are still coated with iodine and will diein about 15 minutes). The charcoal filter will also help get rid of pesticides and heavy metals. There are several manfufacturers in the U.S. I have had several of the devices made by PUR and have been quite happy. The larger models, e.g., the Scout, have an included cleaning mechanism which is not present in the lighter models, which may be appropriate. I've been able to clean off the lighter model's filter elements by opening and cleaning off with some paper or leaves or an old toothbrush, but the quicker cleaning of the Scout and similar models, without having to take them apart, may be worth the extra weight. On the other hand, the smaller and newer filters have filter elements that, instead of being like a round cylinder, have "pleats" much like the air or oil filters on a car, and will go much longer without cleaning. Don't know about jungle water, but when I was hiking in an area where most water was from pumps with iron pipes, the rust clogged the filter after only 3-4 days and I had to clean it off with some leaves (old cylinder type filter). Hope this helps some. Hope all is well with you and your family and the skiing's good in San Martin de Los Andes this season! It's 85 degrees F (30 degrees C) here in Pittsburgh today. P.S. we saw your picture on the film of the EcoChallenge last -- and Jorge Varcellotti says hi. Take care. On 22 Jun 2000, at 22:58, jym@smandes.neuquen.com.ar wrote: > I would appreciate the list members opinion on what would be the best > water purification system for Ecochallenge competitors (team of 4) in > the next race to be held in Borneo (Kinabalu). Ecochallenge is an > adventure race. Iodine in tablets or liquid is mandatory for the > organization, and this alone is quite a good option but I do not have > extensive experience with water filters with "jungle type water". If a > water filter was an option, how many would a 4 member team need for > 6-10 days? and what brand would be a good choice.These questions are > to address the clogging problem. Thanks > > Marcelo Parada MD > Hospital Ramón Carrillo > (8370) San Martín de los Andes > Neuquén- ARGENTINA > > email jym@smandes.neuquen.com.ar > --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover sent with Pegasus high-security email download free from www.pmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Fri, 23 Jun 2000 01:13:33 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 23 Jun 2000 01:13:00 -0400 (EDT) Received: via switchmail; Fri, 23 Jun 2000 01:13:00 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Fri, 23 Jun 2000 01:12:10 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 23 Jun 2000 01:12:08 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQXA4K8IFO000R4M@mb2i0.ns.pitt.edu>; Fri, 23 Jun 2000 01:12:08 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Fri, 23 Jun 2000 01:11:41 -0400 (EDT) Received: from tenforward.com (tenforward.com [206.213.105.2]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Fri, 23 Jun 2000 01:11:35 -0400 (EDT) Received: from default [209.168.55.38] by tenforward.com (SMTPD32-6.00) id A18066D8029A; Thu, 22 Jun 2000 22:11:28 -0700 Date: Thu, 22 Jun 2000 22:08:36 -0700 From: "The Tate's" Subject: RE: W-EMED Fw: Water purification for adventure race In-reply-to: <002401bfdcb6$781899e0$593633c8@marcelo> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2615.200 X-Mailer: Microsoft Outlook IMO, Build 9.0.2416 (9.0.2910.0) Content-type: multipart/alternative; boundary="----=_NextPart_000_0038_01BFDC96.69C9C820" Importance: Normal X-Priority: 3 (Normal) X-MSMail-priority: Normal Precedence: bulk This is a multi-part message in MIME format. ------=_NextPart_000_0038_01BFDC96.69C9C820 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit I think that you should look at the Silver loaded ceramic ones they can be cleaned when they get muddy. You might also contact REI at http://www.rei.com they specialize in this kind of equipment. Most of the good ones include pre-filters that take care of the mud. Good luck on the Challenge! David Tate -----Original Message----- From: owner-wilderness-emergency-medicine@list.pitt.edu [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of jym@smandes.neuquen.com.ar Sent: Thursday, June 22, 2000 6:58 PM To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED Fw: Water purification for adventure race ------=_NextPart_000_0038_01BFDC96.69C9C820 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
I=20 think that you should look at the Silver loaded ceramic ones they can be = cleaned=20 when they get muddy. You might also contact REI at http://www.rei.com they specialize = in this=20 kind of equipment. Most of the good ones include pre-filters that take = care of=20 the mud.
 
Good=20 luck on the Challenge!
 
David=20 Tate
 
 
 
-----Original Message-----
From:=20 owner-wilderness-emergency-medicine@list.pitt.edu=20 [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf = Of=20 jym@smandes.neuquen.com.ar
Sent: Thursday, June 22, 2000 = 6:58=20 PM
To:=20 wilderness-emergency-medicine@list.pitt.edu
Subject: W-EMED = Fw:=20 Water purification for adventure=20 race

------=_NextPart_000_0038_01BFDC96.69C9C820-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 22 Jun 2000 23:20:55 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 22 Jun 2000 23:20:23 -0400 (EDT) Received: via switchmail; Thu, 22 Jun 2000 23:20:23 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Thu, 22 Jun 2000 23:20:01 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 22 Jun 2000 23:19:58 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQX67ILMD0000285@mb2i0.ns.pitt.edu>; Thu, 22 Jun 2000 23:19:58 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 22 Jun 2000 23:18:19 -0400 (EDT) Received: from mail.webpostal.com.ar (mail.webpostal.com.ar [200.16.190.25]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 22 Jun 2000 23:18:11 -0400 (EDT) Received: from marcelo ([200.51.54.89]) by mail.webpostal.com.ar (Netscape Messaging Server 4.15) with SMTP id FWKR5R00.08U for ; Fri, 23 Jun 2000 00:17:51 +0300 Date: Thu, 22 Jun 2000 22:58:01 -0300 From: "jym@smandes.neuquen.com.ar" Subject: W-EMED Fw: Water purification for adventure race Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <002401bfdcb6$781899e0$593633c8@marcelo> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Content-type: multipart/alternative; boundary="----=_NextPart_000_0021_01BFDC9D.50F56960" X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk This is a multi-part message in MIME format. ------=_NextPart_000_0021_01BFDC9D.50F56960 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable I would appreciate the list members opinion on what would be the best = water purification system for Ecochallenge competitors (team of 4) in = the next race to be held in Borneo (Kinabalu). Ecochallenge is an = adventure race. Iodine in tablets or liquid is mandatory for the organization, and this = alone is quite a good option but I do not have extensive experience with = water filters with "jungle type water". If a water filter was an option, = how many would a 4 member team need for 6-10 days? and what brand would = be a good choice.These questions are to address the clogging problem. Thanks Marcelo Parada MD Hospital Ram=F3n Carrillo (8370) San Mart=EDn de los Andes Neuqu=E9n- ARGENTINA email jym@smandes.neuquen.com.ar =20 ------=_NextPart_000_0021_01BFDC9D.50F56960 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
I would appreciate the list = members opinion on=20 what would be the best water purification system for Ecochallenge = competitors=20 (team of 4) in the next race to be held in Borneo (Kinabalu). = Ecochallenge is an=20 adventure race.
Iodine in tablets or liquid is = mandatory for the=20 organization, and this alone is quite a good option but I do not have = extensive=20 experience with water filters with "jungle type water". If a water = filter was an=20 option, how many would a 4 member team need for 6-10 days? and what = brand=20 would be a good choice.These questions are to address the clogging=20 problem.
Thanks
 
Marcelo Parada MD
Hospital Ram=F3n=20 Carrillo
(8370) San Mart=EDn de los Andes
Neuqu=E9n- = ARGENTINA
 
email  jym@smandes.neuquen.com.ar= =20  
------=_NextPart_000_0021_01BFDC9D.50F56960-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Thu, 22 Jun 2000 23:21:17 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Thu, 22 Jun 2000 23:20:46 -0400 (EDT) Received: via switchmail; Thu, 22 Jun 2000 23:20:45 -0400 (EDT) Received: from post-ofc09.srv.cis.pitt.edu via qmail ID ; Thu, 22 Jun 2000 23:18:46 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc09.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 22 Jun 2000 23:18:44 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQX65WTIOM0013S2@mb1i0.ns.pitt.edu>; Thu, 22 Jun 2000 23:18:41 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Thu, 22 Jun 2000 23:15:58 -0400 (EDT) Received: from mail.webpostal.com.ar (mail.webpostal.com.ar [200.16.190.25]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Thu, 22 Jun 2000 23:15:42 -0400 (EDT) Received: from marcelo ([200.51.54.89]) by mail.webpostal.com.ar (Netscape Messaging Server 4.15) with SMTP id FWKR1P00.W99 for ; Fri, 23 Jun 2000 00:15:25 +0300 Date: Thu, 22 Jun 2000 22:55:36 -0300 From: "jym@smandes.neuquen.com.ar" Subject: W-EMED Water purification for adventure race Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <001001bfdcb6$213d7e60$593633c8@marcelo> MIME-version: 1.0 X-MIMEOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Content-type: multipart/alternative; boundary="----=_NextPart_000_000D_01BFDC9C.FA450760" X-Priority: 3 X-MSMail-priority: Normal Precedence: bulk This is a multi-part message in MIME format. ------=_NextPart_000_000D_01BFDC9C.FA450760 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable I would appreciate the list members opinion on what would be the best = water purification system for Ecochallenge competitors (team of 4) in = the next race to be held in Borneo (Kinabalu). Ecochallenge is an = adventure race. Iodine in tablets or liquid is mandatory for the organization, and this = alone is quite a good option but I do not have extensive experience with = water filters with "jungle type water". If a water filter was an option, = how many would a 4 member team need for 6-10 days? and what brand would = be a good choice.These questions are to address the clogging problem. Thanks Marcelo Parada MD Hospital Ram=F3n Carrillo (8370) San Mart=EDn de los Andes Neuqu=E9n- ARGENTINA email jym@smandes.neuquen.com.ar =20 ------=_NextPart_000_000D_01BFDC9C.FA450760 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
I would appreciate the list = members opinion on=20 what would be the best water purification system for Ecochallenge = competitors=20 (team of 4) in the next race to be held in Borneo (Kinabalu). = Ecochallenge is an=20 adventure race.
Iodine in tablets or liquid is = mandatory for the=20 organization, and this alone is quite a good option but I do not have = extensive=20 experience with water filters with "jungle type water". If a water = filter was an=20 option, how many would a 4 member team need for 6-10 days? and what = brand=20 would be a good choice.These questions are to address the clogging=20 problem.
Thanks
 
Marcelo Parada MD
Hospital Ram=F3n=20 Carrillo
(8370) San Mart=EDn de los Andes
Neuqu=E9n- = ARGENTINA
 
email  jym@smandes.neuquen.com.ar= =20  
------=_NextPart_000_000D_01BFDC9C.FA450760-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 20 Jun 2000 22:43:12 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 20 Jun 2000 22:42:39 -0400 (EDT) Received: via switchmail; Tue, 20 Jun 2000 22:42:39 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Tue, 20 Jun 2000 22:41:16 -0400 (EDT) Received: from mb2i0.ns.pitt.edu (mb2i1.ns.pitt.edu [136.142.185.162]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 20 Jun 2000 22:41:06 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb2i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQUC9LDWP4000FKB@mb2i0.ns.pitt.edu>; Tue, 20 Jun 2000 22:41:04 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 20 Jun 2000 22:40:36 -0400 (EDT) Received: from jason04.u.washington.edu (root@jason04.u.washington.edu [140.142.78.5]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 20 Jun 2000 22:40:33 -0400 (EDT) Received: from aagaard04.u.washington.edu (mcmullen@aagaard04.u.washington.edu [140.142.13.103]) by jason04.u.washington.edu (8.9.3+UW00.05/8.9.3+UW00.01) with ESMTP id TAA43318 for ; Tue, 20 Jun 2000 19:40:32 -0700 Received: from localhost (mcmullen@localhost) by aagaard04.u.washington.edu (8.9.3+UW00.05/8.9.3+UW99.09) with ESMTP id TAA281146 for ; Tue, 20 Jun 2000 19:40:31 -0700 Date: Tue, 20 Jun 2000 19:40:31 -0700 (PDT) From: Russell McMullen Subject: Re: W-EMED African Travel In-reply-to: <394FE7A0.30215.A450CFB@localhost> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: MIME-version: 1.0 Content-type: TEXT/PLAIN; charset=US-ASCII Precedence: bulk If the primary physicians in Cumberland are not members of a certified yellow fever vaccination center they won't be able to provide this vaccine. Russell McMullen, M.D. University of Washington Medical Center On Tue, 20 Jun 2000, Keith Conover, M.D., FACEP wrote: > On 19 Jun 2000, at 14:59, Tobias Joy wrote: > > > Also, what should I get insofaras immunizations above the required > > ones (yellow fever, malaria, and cholera, although cholera isn't > > officially required). Any leads on a "one-stop" immunization place? > > I can get to Pittsburgh and down to DC and Baltimore with no problems > > (the closer to Cumberland, MD, the better). > > I'm sure that any of the family medicine or internal medicine > physicians in Cumberland would be happy to do this for you. Might > have to order some of the stuff for you but other than that, shouldn't > be a problem. > > --Keith Conover, M.D., FACEP > http://www.pitt.edu/~kconover > sent with Pegasus high-security email > download free from www.pmail.com > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu > Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc09.srv.cis.pitt.edu (root@post-ofc09.srv.cis.pitt.edu [136.142.185.57]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.4) ID ; Tue, 20 Jun 2000 21:54:29 -0400 (EDT) Received: from localhost (root@localhost) by post-ofc09.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 20 Jun 2000 21:53:58 -0400 (EDT) Received: via switchmail; Tue, 20 Jun 2000 21:53:58 -0400 (EDT) Received: from post-ofc01.srv.cis.pitt.edu via qmail ID ; Tue, 20 Jun 2000 21:53:11 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by post-ofc01.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 20 Jun 2000 21:53:09 -0400 (EDT) Received: from list.srv.cis.pitt.edu (majordom@[136.142.185.20]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQUAL3TD2O0012Q9@mb1i0.ns.pitt.edu>; Tue, 20 Jun 2000 21:53:05 EST Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.2) ID ; Tue, 20 Jun 2000 21:52:39 -0400 (EDT) Received: from mb1i0.ns.pitt.edu (mb1i1.ns.pitt.edu [136.142.185.161]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.2) ID for ; Tue, 20 Jun 2000 21:52:37 -0400 (EDT) Received: from micron ("port 1475"@[136.142.21.185]) by mb1i0.ns.pitt.edu (PMDF V5.2-32 #41462) with ESMTP id <01JQUAKGARO40012J6@mb1i0.ns.pitt.edu> for wilderness-emergency-medicine@list.pitt.edu; Tue, 20 Jun 2000 21:52:37 -0500 (EST) Date: Tue, 20 Jun 2000 21:52:32 -0400 From: "Keith Conover, M.D., FACEP" Subject: Re: W-EMED African Travel In-reply-to: <001601bfda20$75ccfc00$026fa8c0@allconet.org> Sender: owner-wilderness-emergency-medicine@list.pitt.edu To: Tobias Joy , wilderness-emergency-medicine@list.pitt.edu Reply-to: wilderness-emergency-medicine@list.pitt.edu Message-id: <394FE7A0.30215.A450CFB@localhost> MIME-version: 1.0 X-Mailer: Pegasus Mail for Win32 (v3.12c) Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Precedence: bulk References: On 19 Jun 2000, at 14:59, Tobias Joy wrote: > Also, what should I get insofaras immunizations above the required > ones (yellow fever, malaria, and cholera, although cholera isn't > officially required). Any leads on a "one-stop" immunization place? > I can get to Pitt