Wilderness First Responder Medical Clearance - A Scoping Review with Recommendations.

BACKGROUND AND PURPOSE: Due to environmental extremes, as well as the nature of the work itself, wilderness first responders are at risk of incurring medical events in the line of duty. There currently do not exist standardized and scientifically supported methods to screen for a wilderness first responder's risk of incurring a medical event. METHODS: We performed multiple scoping reviews using PubMed and CINAHL. The reviews covered six medical screening criteria based on previous recommendations from the National Fire Protection Association (NFPA) and the US Forest Service, and we grouped our reviews into two categories: articles that addressed objective screening criteria, and articles that addressed subjective findings with the first responder. RESULTS: Of the objective criteria, our reviews identified 21 articles addressing the ability to screen for risk of incurring a medical event by evaluation of a first responder's heart rate, 12 by blood pressure assessment, and 56 by assessment of body temperature. Of the subjective criteria we identified 19 articles focused on self-assessment, 34 articles on the use of standardized tools to assess for fatigue and sleepiness, and two articles on assessment of a first responder's urine to determine level of dehydration. We also identified seven additional articles through a hand search. Overall, there were 151 articles identified in our scoping reviews. These articles were largely of low quality, consisting mostly of case series without comparison groups. CONCLUSION: There is a dearth of high-quality research into the medical assessment of first responders. We recommend that this paper, and measures discussed within it, be used as a starting point in the development of an evidence-based assessment protocol for wilderness first responders. We also recommend the development of a national database of medical events incurred by wilderness first responders to facilitate higher-quality research of screening protocols in this community.

Use of Unmanned Aerial Vehicles in Wilderness Search and Rescue Operations: A Scoping Review.

Wilderness Search and Rescue (WSAR) focuses on locating and extricating missing persons in remote settings. As unmanned aerial vehicle (UAV) or "drone" technology has evolved, so has the literature describing its application in WSAR operations. We conducted a scoping review of literature that describes the use of UAVs in WSAR contexts. The Joanna Briggs Institute Framework for scoping reviews was followed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews method. Additional individual databases, article reference lists, and relevant grey literature were also included in the search to provide an impartial scope. Seven hundred forty-seven articles were identified. Of these, 56 were found to be duplicates. The remaining 691 were further screened and checked for eligibility. Ultimately, 21 studies were found that met our inclusion criteria. This literature supports the use of UAVs to increase the safety and efficiency of a WSAR operation for locating victims, assessing risks, carrying equipment, and restoring communication systems. Unmanned aerial vehicles are a potentially useful adjunct in the management of WSAR operations. Their limitations include objects obscuring victims, weather changes, uneven terrain, battery-limited flight time, and susceptibility to environmental damage.

Wilderness areas under threat from global redistribution of agriculture.

Agriculture expansion is already the primary cause of terrestrial biodiversity loss globally1,2; yet, to meet the demands of growing human populations, production is expected to have to double by 2050.3 The challenge of achieving expansion without further detriment to the environment and biodiversity is huge and potentially compounded by climate change, which may necessitate shifting agriculture zones poleward to regions with more suitable climates,4 threatening species or areas of conservation priority.5,6,7 However, the possible future overlap between agricultural suitability and wilderness areas, increasingly recognized for significant biodiversity, cultural, and climate regulation values, has not yet been examined. Here, using high-resolution climate data, we model global present and future climate suitability for 1,708 crop varieties. We project, over the next 40 years, that 2.7 million km2 of land within wilderness will become newly suitable for agriculture, equivalent to 7% of the total wilderness area outside Antarctica. The increase in potentially cultivable land in wilderness areas is particularly acute at higher latitudes in the northern hemisphere, where 76.3% of newly suitable land is currently wilderness, equivalent to 10.2% of the total wilderness area. Our results highlight an important and previously unidentified possible consequence of the disproportionate warming known to be occurring in high northern latitudes. Because we find that, globally, 72.0% of currently cultivable land is predicted to experience a net loss in total crop diversity, agricultural expansion is a major emerging threat to wilderness. Without protection, the vital integrity of these valuable areas could be irreversibly lost.

Program evaluation of a wilderness experience for adolescents facing cancer: A time in nature to heal, connect and find strength.

OBJECTIVE: Despite advances in cancer treatment and increased survival, adolescents in treatment for cancer often suffer from psychosocial distress, negative mood, and chronic health problems. Wilderness therapy is considered a promising program to address psychosocial issues among adolescents with mental or behavioral health issues. There is little research on whether it may benefit adolescents in cancer treatment. METHODS: This program evaluation in the form of a pilot study uses qualitative and quantitative measures to describe the feasibility, acceptability, safety, and to explore the impact of a nine-day wilderness program among adolescents aged 13-17 in treatment or who recently finished treatment for a cancer. Quantitative tracking documented recruitment, retention, safety, and participant satisfaction. PROMIS measures assessed mental and social health, positive affect, fatigue, pain interference and intensity over three time-points: pre, post, and three-months after the nine-day wilderness experience. Mean differences were compared over time. Qualitative data collection involved participant observation and open-ended interviews. RESULTS: Study enrollment goals were met, enrolling eight adolescent participants with 100% participant retention. No serious adverse events were reported and participants described high satisfaction (9.25/10) with the wilderness experience on the final day and at three-months follow-up (9.5/10). Exploratory data analysis showed scores in a favorable direction indicating improved psychosocial outcomes in physical functioning, anxiety, depression, fatigue, and peer relations. From qualitative analysis it is suggested that program participation supported: increased self-confidence and peer connection. The program was evaluated as increasing personal accomplishment, supporting social interaction, having strong staff support, and capitalizing on the natural surroundings. CONCLUSION: Use of a wilderness program is feasible, acceptable, and safe among this highly vulnerable adolescent cancer population. Participants described greater self-confidence and peer connection which developed as participants experienced physical competency, group leadership, and personal strength. Larger randomized controlled studies are needed to learn whether these programs can improve psychosocial outcomes.

Using aircraft tracking data to estimate the geographic scope of noise impacts from low-level overflights above parks and protected areas.

Sightseeing air tours have proven to be a challenging management issue for many tourist destinations around the world, especially at locations meant to protect natural and cultural resources and wilderness character. Two of the primary challenges with managing air tours are a lack of information about their travel patterns and how such patterns result in a measurable noise impact to listeners. Recent studies have highlighted the usefulness of newer technology for tracking aircraft travel patterns, particularly over national parks. In this synthesis, we pair aircraft tracks with acoustic data using a quantitative observer-based audibility modelling software toolkit. The findings delimit the long-term geographic scope of audibility for specific aircraft noise sources above landscapes of Hawai'i Volcanoes and Denali National Parks, U.S. and identify practical, 3-dimensional offset distances that can be used to reduce the functional effects of air tour noise in terms of sound level.

A randomized controlled pilot study assessing feasibility and safety of a wilderness program for childhood, adolescent, and young adult cancer survivors: the WAYA study.

BACKGROUND: The majority of childhood, Adolescent and Young Adult (AYA) cancer survivors suffers from long-lasting health issues following cancer treatment. It is therefore critical to explore effective health promotion strategies to address their needs. Exposure to nature is a promising approach to support the needs of young cancer survivors. This study investigated whether it is feasible to conduct a randomized controlled trial (RCT) of a wilderness program for childhood and AYA cancer survivors. METHODS: Eligible participants were aged 16-39 years, had a cancer diagnosis, and met minimal criteria. Seventy-one individuals expressed interest and 59 were randomized to either a wilderness or a holiday program. The wilderness program involved an 8-day expedition including backpacking, sea kayaking, gorge climbing, camping, bush-craft skills, and mindfulness-practices. It was followed by a 4-day basecamp after 3 months. The comparison was an 8-day holiday program at a Spa-hotel followed by a 4-day holiday program at the same hotel after 3 months. Primary outcome was study feasibility and safety. RESULTS: Ultimately, 19 AYAs participated in the wilderness and 23 in the holiday program. All completed the study at one-year follow-up. Participants were mostly female (70%) and represented diverse cancers. Clinical characteristics were similar between study arms excepting greater age at cancer diagnosis in the wilderness program (age 19.1 vs. 12.5; p = 0.024). Program adherence and data completeness was high (> 90%) in both arms. Adverse Effects (AEs) in the wilderness vs. the holiday program were similar (Relative Risk: 1.0, 95% Confidence Interval 0.8-1.3). The most frequent AE was tiredness, all were mild to moderate in severity, and serious AEs were not reported. Nature connectedness significantly increased over time in the wilderness program participants, but not in the holiday program (p < 0.001). No differences were found between the two study arms regarding quality of life, self-esteem, or self-efficacy. CONCLUSION: It is feasible to conduct a RCT and a supervised wilderness adventure is equally safe for childhood and AYA cancer survivors as a holiday program. This pilot study lays the foundation for a larger RCT to investigate the effectiveness of wilderness programs on the health of young cancer survivors. TRIAL REGISTRATION DATE AND NUMBER: 18/02/2021, NCT04761042 (clinicaltrials.gov).

Wilderness Is the Prototype of Nature Regardless of the Individual's Connection to Nature. An Empirical Verification of the Solastalgia Effect.

(1) Background: Connectedness with Nature is a personality trait that influences our relationship with Nature. But Nature is not all the same. Wilderness is Nature in its original form, the form within which human beings have evolved as a species, while what we refer to as domesticated and urban Nature are relatively recent products of our interaction with the environment. (2) Aim: The main purpose of this study was to verify whether the individual trait "connection to Nature" influences the perception of restoration, preference for and familiarity with three types of Nature: wilderness, domesticated and urban. (3) Results: Regardless of the level of connection to Nature, wilderness is always perceived as more restorative than the domesticated or urban environment. Individuals with higher connectedness prefer wilderness more than others, and they are able to recognise the restorative value of domesticated environments more than those with medium or low levels of connectedness. Less connected individuals tend to prefer domesticated environments, although wilderness is more familiar to them. (4) Conclusions: This study shows that, despite our detachment from Nature, wilderness is the prototype of Nature, and this finding offers a plausible evolutionary explanation of solastalgia.

The global wildland-urban interface.

The wildland-urban interface (WUI) is where buildings and wildland vegetation meet or intermingle1,2. It is where human-environmental conflicts and risks can be concentrated, including the loss of houses and lives to wildfire, habitat loss and fragmentation and the spread of zoonotic diseases3. However, a global analysis of the WUI has been lacking. Here, we present a global map of the 2020 WUI at 10 m resolution using a globally consistent and validated approach based on remote sensing-derived datasets of building area4 and wildland vegetation5. We show that the WUI is a global phenomenon, identify many previously undocumented WUI hotspots and highlight the wide range of population density, land cover types and biomass levels in different parts of the global WUI. The WUI covers only 4.7% of the land surface but is home to nearly half its population (3.5 billion). The WUI is especially widespread in Europe (15% of the land area) and the temperate broadleaf and mixed forests biome (18%). Of all people living near 2003-2020 wildfires (0.4 billion), two thirds have their home in the WUI, most of them in Africa (150 million). Given that wildfire activity is predicted to increase because of climate change in many regions6, there is a need to understand housing growth and vegetation patterns as drivers of WUI change.

Sustainability, Collective Self-Regulation, and Human-Nature Interdependence.

Like any organism, humanity constructs its niche and adapts to the rest of nature by modifying available materials around them. In the era that some have dubbed the "Anthropocene," human niche construction has gone so far as to threaten the planetary climate system. The central question of sustainability is how humanity can collectively self-regulate niche construction, that is, humanity's relationship with the rest of nature. In this article, we argue that to resolve the collective self-regulation problem for sustainability, sufficiently accurate and relevant aspects of causal knowledge about the functioning of complex social-ecological systems need to be cognized, communicated, and collectively shared. More specifically, causal knowledge about human-nature interdependence-how humans interact with each other and the rest of nature-is critical for coordinating cognitive agents' thoughts, feelings, and actions for the greater good without falling into the trap of free riding. Here, we will develop a theoretical framework to consider the role of causal knowledge about human-nature interdependence in collective self-regulation for sustainability, review the relevant empirical research primarily focusing on climate change, and take stock of what is currently known and what we need to investigate in the future.

First-Trimester Pregnancy: Considerations for Wilderness and Remote Travel.

Women increasingly participate in outdoor activities in wilderness and remote environments. We performed a literature review to address diagnostic and therapeutic considerations during first-trimester pregnancy for remote multiday travel. Pretrip planning for pregnant patients traveling outside access to advanced medical care should include performing a transvaginal ultrasound to confirm pregnancy location and checking D rhesus status. We discuss the risk of potential travel-related infections and recommended vaccinations prior to departure based on destination. Immediate evacuation to definitive medical care is required for patients with a pregnancy of unknown location and vaginal bleeding. We propose algorithms for determining the need for evacuation and present therapeutic options for nausea and vomiting, urinary tract infections, and candidiasis in the field.

Trail running events contribute microplastic pollution to conservation and wilderness areas.

Clothing and footwear designed for trail running shed microplastics (MPs) during use. Trail running events may therefore present a significant source of MP pollution in conservation and wilderness areas. Microplastics may present long-term risks to biodiversity and endemic plant and animal species in such areas. In this study, we used a before-after-control-impact approach to quantify and characterise MP emissions from clothing and shoe outsoles during trail running events. Microplastic deposition on trail surfaces was assessed using both a controlled study and during two public trail running events in New South Wales, Australia (the Duval Dam Buster and the Washpool World Heritage Trail Race). Microplastics were present on trails after all events and included fibres and rubber fragments. Microplastic counts varied considerably depending on trail surface hardness and gradient, and clothing and footwear properties. The controlled study showed running tights (leggings) and shoes with soft rubber outsoles produced more MPs than shirts and hard rubbers. In the trail running events, abrasive wear to shoe outsoles produced an average of 0.3 ± 0.1 to 0.9 ± 0.2 MPs/linear metre/runner, and clothing produced 0.7 ± 0.3 to 2.0 ± 0.3 fibres/linear metre/runner, with fibres accounting for 63-69% of MPs. Microplastic deposition from both footwear and clothing was higher on sloped and rock trail surfaces than flat and soil surfaces. Laser Direct Infrared (LDIR) Imaging indicated the main types of MPs present on trails were polyurethane, polyethylene terephthalate and polyamide. Trail running is increasing in popularity and large-scale events may cause a rapid and significant input of MPs in protected areas. Land managers, event coordinators and outdoor apparel manufacturers could mitigate MP impacts however, by diverting foot traffic around ecologically sensitive areas, capping participant numbers, and developing abrasion resistant clothing and footwear.

Land-use and climate risk assessment for Earth's remaining wilderness.

Earth's wilderness areas are reservoirs of genetic information and carbon storage systems, and are vital to reducing extinction risks. Retaining the conservation value of these areas is fundamental to achieving global biodiversity conservation goals; however, climate and land-use risk can undermine their ability to provide these functions. The extent to which wilderness areas are likely to be impacted by these drivers has not previously been quantified. Using climate and land-use change during baseline (1971-2005) and future (2016-2050) periods, we estimate that these stressors within wilderness areas will increase by ca. 60% and 39%, respectively, under a scenario of high emission and land-use change (SSP5-RCP8.5). Nearly half (49%) of all wilderness areas could experience substantial climate change by 2050 under this scenario, potentially limiting their capacity to shelter biodiversity. Notable climate (>5 km year-1) and land-use (>0.25 km year-1) changes are expected to occur more rapidly in the unprotected wilderness, including the edges of the Amazonian wilderness, Northern Russia, and Central Africa, which support unique assemblages of species and are critical for the preservation of biodiversity. However, an alternative scenario of sustainable development (SSP1-RCP2.6) would attenuate the projected climate velocity and land-use instability by 54% and 6%, respectively. Mitigating greenhouse gas emissions and preserving the remaining intact natural ecosystems can help fortify these bastions of biodiversity.