January 3, 2021

There has been a lot of recent concern related to disturbances of salt and water among endurance athletes recently.  Some of this has spilled over into the wilderness medicine literature.  I have summarized some of the concerns related to this, along with some practical advice, in a new Adirondoc column just posted With a Grain of Salt

Ankles, redux
September 14, 2020

New York State produces a regular summary of Forest Ranger rescue activity (  The vast majority of such activity for medical incidents comes from ankle injuries.  This is consistent with virtually all data on wilderness evacuations. Although I have written on ankle sprains many times over the decades, the continued importance of the topic made me realize that it was time for a refresher. …

Covid-19 and the backcountry
July 13, 2020

Just about all of the nation’s health bandwidth is now consumed by issues related to covid-19.  One could understand the need to retreat into the backcountry to escape it all! While there has been a lot of discussion regarding the appropriate safety procedures for exercise and sports during the pandemic, there is actually very little written about the backcountry.  In particular, one of the…

Backcountry hygiene
May 5, 2020

A column on hand sanitation was just posted in my publications link [] I actually wrote this a few months before the epidemic in which we are finding ourselves, but the message is very timely. I will be discussing “social distancing” in the backcountry in a subsequent column. The situation in which we currently find ourselves actually is an example of the quandary when…

Wilderness Podcast
March 4, 2020

Adam Bronstein hosts a terrific wilderness podcast from his home base in the Pacific Northwest. We recently sat down to discuss Adirondack wilderness history. Early Adirondack History | Thomas Welch | Adirondoc | Ep. 028 Here is a link to the full podcast. [] Release Date: March 4th, 2020 In this episode, Adam Bronstein speaks with Thomas Welch, retired pediatrician, Adirondack guide and amateur…

Pain medication use in the backcountry
March 1, 2020

Today, we uploaded my latest column in Adirondac magazine.  It is a timely reminder of current recommendations on pain medication use in the backcountry.  This is a topic which has experienced a lot of recent interest, in parallel with the ongoing opioid overdose epidemic in this country. As usual, I welcome questions or comments.

Outbreak on Yosemite
January 19, 2020

Well, it has happened again.  Nearly two hundred people have come down with intestinal illness in a US wilderness area, Yosemite National Park ( The culprit?  It appears to be norovirus, spread by hand contact.  Which is not surprising, since this organism and this mode of spread are responsible for virtually all such outbreaks in the US.  Granted, the bulk of these folks were…

What’s the big deal with ticks?
January 11, 2020

In a new entry today, I have added the second of two columns I recently published in Adirondac regarding tick-borne diseases other than Lyme.  As much as I enjoy controversy (such as with water purification!), I always tread lightly when it comes to anything remotely related to Lyme disease.  No matter what I have to say, I can be sure that some Lyme “survivor” or “Lyme…

New Years Resolution
January 1, 2020

My most recent two columns in Adirondac magazine have been uploaded and are available. I am hoping to post more regularly to my blog in the coming year, a resolution I have made in the past and not kept. I will try to do better! I have also gotten more deeply into writing my new wilderness medicine book. This will not be a “text”…

Kids in the mountains
September 4, 2019

As someone who is both a practicing pediatrician and an outdoor educator, I occasionally confront the confluence of my two careers:  taking children into the wilderness.  There have been two very newsworthy Adirondack items this summer which bring one aspect of this issue into the fore. The first incident, which no doubt generated a host of guffaws, was a “rescue” from the summit of…

Diarrhea in the news
September 23, 2018

Even if you are not interested in the spread of intestinal infection, you probably haven’t missed all the discussion of major outbreaks in the US over the past several weeks.  We aren’t talking about the developing world here—diarrheal illnesses have been a scourge in those areas for centuries—the problem is becoming more and more common in our country. The culprits in these outbreaks vary,…

More on the dangers of water
August 18, 2018

This has been a topic of other blog posts, but recent developments have really highlighted it. Unfortunately, the message still hasn’t gotten through—witness the recent death of a high school football player from water intoxication. Thus, it bears repeating. A recent column by an exercise physiologist, Tamara Hew-Butler (, nicely summarizes the points I have been making in recent articles and posts. The notion that we…

February 6, 2018

After decades of practice and research in academic medicine, I have recently retired from the “administrative” aspects of my work. I am continuing to do direct patient care, and hope to have more time to pursue my wilderness and outdoor education pursuits. Here is a podcast in which I reflect on these changes. Listen Via Update’s Health Link On Air –

Bear Basics
December 19, 2016

Over the years, I have divided my guiding/outdoor education time between the Adirondacks of New York and Alaska.  Both are areas in which bear encounters are common, but with different species and potential outcomes. The concern in the Adirondacks is with black bear.  Poor human hygiene habits, both in camping areas and in rural communities, has led these animals to become human habituated and,…

More on the dangers of water
September 11, 2015

Just a day after posting the previous comment, a couple of very pertinent publications came out. First of all, Wilderness and Environmental Medicine, a wilderness medicine peer-reviewed journal, published a case report of a hiker in the Grand Canyon who appeared to have died from complications of hyponatremia. She was a 47 year old otherwise healthy woman, who hiked about 10 kg, and was…

Can water be bad for you?
September 2, 2015

I am not talking here about water borne illness–anyone reading my publications or blog posts knows my feelings about that! I am, instead, focusing on problems related to the over-consumption of water from any source. Believe it or not, this is actually a growing problem. It was nicely reviewed recently in an article in the New York Times: The physiology here is actually…

Ebola in the Wilderness
December 11, 2014

Yup. You read that right. It was bound to happen. With all the hullabaloo in the media about the risk of Ebola taking hold in the US “homeland”, it was only a matter of time before some started fretting about a participant in an organized camping program or wilderness trek developing the disease. Over the past few weeks, I have had emailed questions, participated…

Silly science and the drinking of urine
June 4, 2014

A friend sent me the following link, having remembered my outdoor education comments that urine was generally sterile, and did not require any particular precautions in the backcountry: There are two parts to this story, one which is simply a bad interpretation of mediocre science and the other of which is a genuinely stupid concept which seems to have some traction. First things…

What can they be thinking?
August 27, 2013

The following item caught my attention recently: Huffington Post: Sunburn Pain Relief – Could This New Discovery Soothe The Burn? The actual scientific study on which the above article was based is published in a very highly respected journal, Proceedings of the National Academy of Sciences: UVB radiation generates sunburn pain and affects skin by activating epidermal TRPV4 ion channels and triggering endothelin-1 signaling…

Updates and shameless promotion
June 19, 2013

Despite best of intentions for more regular posts, it’s been a pretty dry few months! Several recent Adirondoc columns are now available through the publications link. Some time ago, I mentioned Erik Schlimmer’s development of a route across the Adirondacks, from Blue Line to Blue Line, which he dubbed the “Trans Adirondack Route.” Erik has now produced a guidebook and video for the route,…

Happy New Year!
December 31, 2012

Looking back over my posts for this year, I realize that I haven’t been a very prolific blogger. Frankly, I can’t understand how some folks have the time to keep their blogs so current! I have, however, continued to keep up my regular column for Adirondac magazine, most of which reads like a blog anyway. Check out the publication link for some of these.…

“Sports Drinks” and the backcountry
August 7, 2012

The estimable British Medical Journal has just published a provocative expose on the “sports drink” industry. You know the stuff: Powerade, Gatorade, etc. As you’re watching the Olympics, no doubt you’ve caught some screen shots of competitors drinking them and have seen their ads. The theory behind these products is deceptively simple: Dehydration leads to decreased athletic performance. Salts are lost along with water…

Just when I thought I’d heard everything….
May 23, 2012

The things folks do in the backcountry never cease to amaze me. Check out this recent item from the Albany Times Union regarding some guys who became lost recently in the Adirondacks: Peeing on each other to stay warm? Yikees! Of course, equally important to keeping warm is keeping dry. This was obviously a counterproductive strategy. Since their names were used in the…

The “Trans Adirondack” Route
April 9, 2012

Erik Schlimmer is a good friend with whom I have guided in Alaska previously. He is one of the few people who approach me in the volume of untreated Adirondack water he has consumed without ill effects! Erik has a number of “firsts” under his wilderness belt, most of which I would have no desire to duplicate. (Canoeing the lower Hudson? Yuck!) His most…

Survival Lesson
March 17, 2012

For many of our frontcountry friends, outdoor education somehow equates with survival training. Such staples of television as “Man vs Wild” and “Survivorman” certainly add to this view. I had a personal taste of this a while ago when interviewed for a newspaper profile ( Not being a fan of the Discovery Channel (We only pay for basic cable.), I had a difficult time…

Northeast Wilderness Medicine Conference
February 20, 2012

Upstate New York will be hosting a major national conference on wilderness medicine from May 31, 2012 through June 2, 2012. A number of WM experts will be on hand, and the broad program offers something for everyone. Additional information and online registration are available at:

Wheezing in the Wilderness
December 1, 2011

Asthma is a big problem in the United States, and one which is growing annually. Somewhere between 3000 and 4000 people die from the disease in this country annually; this figure includes about 200 to 300 children. While I am unaware of confirmed asthma deaths in the setting of backcountry treks, the disease is so common it is inevitable that some folks with asthma…

What do ticks, heart attacks, and protozoa have in common?
October 5, 2011

I recently did a column in my wilderness health series in Adirondac magazine on the topic of ticks – Ticked Off). I warned the editor that as soon as the column came out, he would be receiving irate letters. He didn’t believe me. The ink on the magazine was hardly dry when the first complaint came across his desk. I was taken severely to task…

A “game changer” in grizzly territory?
July 30, 2011

You may have heard about the recent grizzly attack involving a group of NOLS students in Alaska’s Talkeetna Mountains. A good rendition of the story is in this article from the Alaska Dispatch: The story hit home, as this is a part of Alaska in which I have led scores of students during WEA courses over the past decade. The story is of…

Hand sanitizers work!
June 28, 2011

As is often the case, the best new wilderness medicine news is not in the outdoor or the wilderness medicine literature. Instead, it can be found in rigorous studies reported in major peer-reviewed journals. A recent study reported in the Pediatric Infectious Disease Journal is a case in point. With the recognition that poor personal hygiene, not drinking water, is the real culprit leading…

What happens in the wilderness, redux
March 29, 2011

One concern I have long had about the wilderness first responder “movement” has been the disconnect between their content and the actual data speaking to the types of medical events encountered in typical backcountry expeditions. When I discuss this with folks (as at a recent AORE conference), a frequent refrain is that there are not enough good data about such events. Bull %*#*. In…

Column Resumes
February 26, 2011

For several years, I wrote a regular column for the magazine of the Adirondack Mountain Club, Adirondac. They were having some financial challenges which caused their page allotment to shrink, so the column has been on hiatus. The editor has asked me to resume the column in the summer, and I am doing so. As in the past, it will provide advice on the…

Best Giardia Story Ever
January 6, 2011

A buddy of mine who works as a college outdoor education instructor recently shared an experience with me. For reasons I will mention later, today is an amazingly appropriate day to bring this up. My friend related a visit to one of the college’s treks by a student instructor from the west. The visitor was appalled to learn that this particular program did not…

Why mosquitos love us and hate DEET
December 2, 2010

It’s hard to be thinking about mosquitos during the first lake effect event of the season, but maybe it will get you into the mood for summer! For a long time, I have endorsed the usual understanding of the mechanism by which mosquitos target warm-blooded animals. For quite a while, it has been recognized that there is a complex neurochemical mechanism by which the…

How much “risk” can we tolerate in the wilderness?
October 13, 2010

This topic comes up a lot among wilderness educators, but I recently came across two seemingly unrelated pieces in the New York Times which provide a very nice context to the discussion. The first (NY Times – Struggling Cities Shut Firehouses in Budget Crisis) describes the angst which is developing in a number of urban areas as budget constraints are challenging city fire and…

Wilderness Helicopter Evacuations
August 16, 2010

This has not been a good summer for the medical helicopter industry, or its employees and patients. Crashes in July took the lives of three in Arizona and two in Oklahoma; these brought to four the number of fatal medical helicopter crashes in 2010 alone. Fortunately, none of these crashes involved wilderness rescues. On the other hand, it is simply a matter of time…

The dark side of Epi Pens
May 18, 2010

The Journal of Allergy and Clinical Immunology is probably not on the “must read” list for most of the wilderness medicine crowd, but an article in the current issue (2010; 125:419-423) merits careful study. This report queried two databases, the American Association of Poison Control Centers and the Food and Drug Administration’s Adverse Event Reporting System, to determine whether there has been a significant…

Packs and Strokes
May 7, 2010

The health problems which confront backpackers are rarely consequential, and certainly less important than the overall very positive impact on health which spending time in the wilderness conveys. Every now and then, however, something potentially serious comes up. Ignoring signs of trouble in the front country can be dangerous, but the rapid availablity of emergency medical services may compensate for earlier delays. The back…

Water, water everywhere….
April 27, 2010

I was thinking about this Coleridge quote the other day, after my friend Tod Schimelpfenig from NOLS let me know about a recent “near miss” involving a solo hiker in New Mexico. The whole story is reported in an article in the Silver City Sun News ( Basically, this is the tale of a chap who nearly lost his life because of bad information…

Wilderness First Responder Courses
March 27, 2010

This past Fall, I was invited to participate in a workshop at the annual AORE (Association of Outdoor Recreation Education) conference addressing the increasingly controversial matter of first aid training for wilderness leaders. The workshop was spurred by my recent publication on the topic in Wilderness and Environmental Medicine (available through the “publications” link on my website). To say that this topic is “controversial”…