An Observational Study of Patient Characteristics and Environmental Risk Factors of Stingray Envenomations in San Diego, California.

INTRODUCTION: Current literature on stingray envenomations focuses on the incidence, presentation, and complications of these injuries, with some studies providing such data for specific geographic locations. This is the first study to evaluate the influence of environmental factors and human characteristics on stingray envenomation patterns in San Diego, California. METHODS: Incident reports of injuries documented by the San Diego Fire-Rescue Department/Lifeguard Division (SDFR-LG) during 2017 were analyzed. Water temperature and tide height were populated based on date and time. Data was analyzed for associations between stingray injuries incidence and tide height, water temperature, time, month, age and sex of the injured person, and whether they were local. RESULTS: 1722 stingray injuries were reported to the SDFR-LG in 2017. Stingray injuries were associated with water temperature (p < 0.001), more frequently occurring between 18.8 °C and 19.5 °C. Most envenomations occurred at tide heights between 1.7 ft and 3.1 ft. Most victims were aged 20-29, and there were more males than females injured. Beaches separated from the greater ocean or with a reef bottom had a lower incidence. Stingray injuries were more frequent during summer months. More stingray envenomations were documented for out-of-town beachgoers. CONCLUSIONS: Beachgoers with certain characteristics had more reported stingray envenomations than others. Males, nonlocal beachgoers, and individuals in their twenties had more injuries than their counterparts. Stingray injuries were more common at water temperatures between 18.8 and 19.5 °C. These findings may lead to future research on the prevention of stingray injuries.

Wilderness Medical Society Clinical Practice Guidelines on Anaphylaxis.

The Wilderness Medical Society convened a panel to review the literature and develop evidence-based clinical practice guidelines on the treatment of anaphylaxis, with an emphasis on a field-based perspective. The review also included literature regarding the definition, epidemiology, clinical manifestations, and prevention of anaphylaxis. The increasing prevalence of food allergies in the United States raises concern for a corresponding rise in the incidence of anaphylaxis. Intramuscular epinephrine is the primary treatment for anaphylaxis and should be administered before adjunctive treatments such as antihistamines, corticosteroids, and inhaled ß agonists. For outdoor schools and organizations, selecting a method to administer epinephrine in the field is based on considerations of cost, safety, and first responder training, as well as federal guidelines and state-specific laws.