Showing posts with label hydration. Show all posts
Showing posts with label hydration. Show all posts

Tuesday, July 9, 2013

Summer Camping Trip Safety: Basic Prevention and First Aid

July 4th fireworks have come and gone and summer is in full swing.  Family vacations, trips to theme parks and other summer fun are in the works.  These family trips are what make great summer memories.  Camping trips are a common family adventure that often lead to great stories and fond memories that are relived for years to come.  Let’s just be sure those memories are happy ones of silly pranks and majestic views.  One of the most important ways to ensure a positive experience is to be prepared for potential emergency situations that can arise during your trip.  No one wants to have a trip impacted by someone spraining an ankle or getting bit by a snake, but it is important to be prepared with the knowledge and  supplies to handle these situations.  This blog will be a list of key situations you should be able to handle and the supplies necessary to address them. 

Most importantly, you or someone in your camping party should be trained in basic first aid and CPR before venturing out.  You can learn more about how and where to become trained in these techniques through the American Red Cross or the American Heart Association.  You can never be over prepared to handle an emergency.

CHOOSING A FIRST AID KIT
When camping it is always important to have a first aid kit with you at all times.  This kit should include a variety of items that can address blisters, cuts, abrasions and other minor injuries.  As appropriate (consider your camping location) it should also include insect repellent and a snake bite kit.  One of the most complete lists of items that should be included in your first aid kit is available from REI.  Some sources recommend purchasing an airtight container to keep your supplies in and purchase what you need instead of buying a pre-stocked first aid kit as a way to minimize cost.  Either is appropriate, just have a first aid kit available.  Check out this article if you have questions on how to choose a first aid kit.

SUN PROTECTION
Part of the joy of camping is being in the great outdoors.  It’s important to protect yourself while outside to minimize sunburn and cancer risk.  No one wants to be slowed by a severe sunburn that could have easily been prevented.  The American Academy of Dermatologists say that sunscreen should be broad spectrum, water resistant, and at least 30 SPF.  It should also be reapplied every 2 hours, more frequently if you’re going to be in the water.  For more specific details regarding sunscreen and how to protect yourself, check out this A4IA blog entry

WEATHER EMERGENCIES
Checking the weather before you leave for a camping trip is always the responsible thing to do.  Knowing the weather report for where you’re going can help you plan accordingly with appropriate supplies, tools and clothing.  Paying attention to the weather once you are immersed in your camping trip is also important.  Making appropriate decisions regarding your trip and impending weather can sometimes mean the difference between having a great time and getting caught in a storm.  It can be as simple as staying in during the middle of the day when the sun is hottest, especially in desert climates.  You should also be weary of thunderstorms and the associated lightning.  Lightning can be very dangerous and depending on the location can move quickly.  If you suspect a lightning storm, seek safe shelter.  Do not remain in the water or out on a hike.  Finding safety while camping can be particularly challenging, especially if you’re backpacking in the wilderness, be sure to have a plan.  Use the 30 minute rule to determine whether you can return to activities.  This means you must wait at least 30 minutes to return outside (or to activity) after the last audible thunder and/or visible lightning.    For more specific recommendations on how to protect yourself during a storm check out this recent A4IA blog post.

EXERTIONAL HEAT ILLNESS
Exertional heat illness (EHI) can range from heat cramps (relatively minor) to exertional heat stroke (life-threatening).  There are a variety of factors that can lead to someone suffering from heat illness, but one of the most common factors is dehydration.  Dehydration is preventable.  When camping and hiking be sure to take enough water (or have a water filter and utilize natural sources) for your hike based on the length and difficulty of your hike.  You can also monitor your hydration level based on urine color and level of thirst (although if you’re thirsty, it may be too late).  As a reference, when hiking a general rule of thumb is to drink 500mL per mile.  For more recommendations on how to manage your hydration demands when hiking check out this hiking blog.  Another resource on hydration and heat illness prevention is the NATA Position Statement on the topic.  If you need advice on how to select a hydration pack, one of the most common ways to carry water, check this out.

INSECT BITES & STINGS
A key item that should be included in your first aid kit is bug repellent.  It is important to protect yourself from insects of all kinds.  Mosquitos are notorious for carrying diseases (such as West Nile) as are ticks (most notably Lyme disease).  Another concern is being stung.  There are people who are very allergic to insect (bee/wasp) stings and if not treated immediately these situations can become emergencies.  When planning your trip, along with bug repellent you should be sure to have an antihistamine cream and tablets (oral medication) to treat the itching associated insect bites and stings.  You should also be aware of anyone in your party that has a sting allergy and how severe it is.  Many of those with severe allergies will be prescribed an Epi-pen.  Be sure you know how to administer the pen, in case the individual that has been stung is unable to administer it him/herself.  For more information on how to deal with stinging insects by properly removing their stingers and using an Epi-pen check out this A4IA blog post on anaphylaxis.

Ticks and tick bites are another concern.  While not common in all areas of the United States it is important that after a day in the wilderness in high risk areas that all campers check themselves  for ticks and tick bites.  Ticks are carriers of Lyme Disease.  According to the most recent research by the CDC in 2011 96% of all Lyme Disease cases were reported from 13 states:  Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Vermont, Virginia and Wisconsin.  It is notably concentrated in the Northeast, but it does not mean it cannot be contracted elsewhere. 

When protecting yourself against Lyme Disease it is important to recognize the signs and symptoms of a tick bite and Lyme Disease symptoms as well as how to remove a tick safely. If you are bitten by a tick and it is still attached use a pair of fine-tipped tweezers and pull upward with a steady even pressure, being sure not to twist.  Clean the area of the bite using rubbing alcohol, an iodine scrub or soap and water. The most obvious symptom is an expanding rash called erythema migrans, but you may also experience fatigue, chills headache, muscle and joint aches and swollen lymph nodes.  If you believe you may be suffering from Lyme Disease it is important to seek medical attention as soon as possible so antibiotics can be administered.  The discussion of Lyme Disease Syndrome is beyond the scope of this blog but check out the CDC for more information.

SNAKE BITES
Admittedly, until I moved to San Diego a year ago I wasn't as worried about being bitten by a snake.  Not that there are not snakes of all kinds around the United States, but there weren't many that I was especially concerned about like the rattlesnakes that are indigenous to San Diego.  The best protection against snakes is to avoid them and be respectful their territory.  The American Hiking Society (AHS) makes some great recommendations (check out the link) on how to hike safely and protect yourself.  One recommendation is that if a log has crossed your path, step on the log then down instead of over the log. Doing this, gives you a chance to see if there is a snake on the opposite side of the log and you can avoid stepping on it. 

If you should get bitten by a snake you should call 9-1-1 immediately or go to the nearest emergency department.  Minimize activity if possible and remove any restrictive clothing from your arm or leg to minimize complications from swelling.  Do not elevate the bite area above the heart.  The AHS also recommends that you do not try to suck the venom out, use a tourniquet or take aspirin.  If you’re alone you may need to find a way to hike out to the nearest phone or roadway for help.

WATER RELATED ILLNESS & INJURY
Aside from hiking one of the most common activities while camping is usually swimming.  You should always be aware of your surroundings and take care to enjoy the water safely.  The CDC has several resources that provide tips for healthy swimming, to avoid drowning and how to stay safe while boating.  Generally speaking, to avoid water-borne illnesses you should avoid swimming when you have diarrhea, shower before and after swimming and don’t drink the water.  When boating (ex.:  canoe, kayak or motorboat) be sure to wear a life jacket.  Most importantly, be sure you’re familiar with the water where you’ll be swimming or boating.  Finally, you should never swim alone.

OTHER EMERGENCIES
Other things you be familiar with include recognizing poison ivy, oak or sumac plants.  These plants can cause contact dermatitis when they touch your skin.  The rash is caused by an oil in the plants and can be extremely itchy and irritating.  Check out this photo. The rash can take up to several days to appear, but if you believe you have been exposed you should wash the area immediately after contact.  Most minor rashes can be treated with antihistamines (such as Benydryl) and calamines to relieve the symptoms.  A more severe rash may require treatment from a physician.  For more information checkout this link.

Finally, you should be prepared to handle basic first aid situations ranging from abrasions, blisters, to sprains and strains.  One of the most important acronyms you can remember when treating basic orthopedic injuries is RICE (Rest, Ice, Compression, Elevation).  This technique will allow to appropriately treat almost any acute orthopedic injury (see sprains and strains link for more information).  You should also be prepared to splint a potential fracture.  Taking a sanctioned first aid class can give you the skills you need to handle all these situations confidently.  If you suspect a fracture there are a few easy steps you can follow:  1) splint the body part in the position it is found; 2) check the pulse before and after applying a splint; 3) you can use anything rigid to splint (think tree branches, tent poles, cardboard, pillows) and 4) be sure you've had someone contact 9-1-1 immediately or hike to a phone or road to get help.  If you're in a large party it is best to send one person for help while others remain with the injured camper.  You should always avoid leaving the injured camper alone unless you have no other option.

OTHER RESOURCES

In the end, many of these sections are brief introductions.  It will be important for anyone who is taking a camping trip to be familiar with this information and much more.  My hope with this post was to introduce you to a variety of camping safety resources you may not already be familiar.  I also wanted to give you an idea of the types of things you need to be prepared for.  The best first aid for any emergency is to be prepared in advance and avoid troubling situations in the first place.  Of course, despite appropriate prevention efforts injuries and other stressful situations can still happen.  When they do, will you know what to do?  The best advice I can give is be prepared and know your plan for potential common emergency situations.  If an emergency arises execute your plan.  You should also know what you can handle and what needs more advanced medical attention.  This decision is often the most important one you'll make in any situation.  Happy camping!

Heather L. Clemons, MS, MBA, ATC











Wednesday, July 3, 2013

Soft Drinks to Enhance Performance?

The dietary supplement topics posted to the A4IA blog in the last month or so have really piqued an interest with those of you who have been reading.  Given this, I posted a request to the A4IA Facebook page to see what other related topics you wanted to learn more about.  One topic that was brought to my attention was the role of carbonated beverages (soft drinks/sodas) as a performance enhancer.  This post will attempt to summarize the information I was able to review. 

Before I jump into what I was able to find regarding soft drinks and athletic performance I think it is important to understand some of the basics regarding soft drinks and their typical consumption.  As of 2000 the average soft drink consumption was 600 (8 oz.) servings annually, up from 90 servings annually in 1942.  The significance of 1942 is that this is the first year the AMA (American Medical Association) first recommended against the consumption of soft drinks to help limit sugar intake.  Consumption of sugar sweetened beverages (juices, soft drinks, energy drinks and sports drinks) continues to increase in most age groups and soda is the most heavily consumed beverage.  Where there is a decrease in soda consumption for adolescents, sports drink and energy drink consumption are on the rise.


In most of the literature the overarching concern with soft drinks are their potential connection with the child obesity epidemic in this country. There are a variety of articles out there that discuss the nutritional and health implications of soft drink consumption.  A recent meta-analysis tried to sift through the current information available to answer some key questions regarding soft drinks.  The study shows:
  • Soft drink consumption does lead to increased energy intake as those who consume it typically do not reduce consumption of other foods to compensate
  • While difficult to make direct comparisons between various studies there seems to be a trend between soft drink consumption and an increase in body weight
  • Some studies have shown that drinking one less 16 oz. soda per day will result in the consumption of an additional 4 oz. of milk
  • The impact of soft drink consumption on changes in nutrient consumption are still unclear at this time
  • Research most strongly links soft drink consumption to the Type 2 Diabetes, but links between soft drinks and other diseases are still being investigated

Moving beyond the health and nutrition concerns soft drinks raise, soft drinks do contain two main ingredients that could potentially be beneficial to athletes looking to improve performance:  caffeine and sugar.  We discussed caffeine in detail previously when talking about energy drinks, while the use of sports drinks has increased because of their ability to replenish glucose (sugar) stores following long bouts of exercise.  On the surface it appears that it is plausible that soft drinks could in fact improve performance, but what does the available research say?

One recent study on male college athletes who performed 60 minute exercise bouts on an ergometer demonstrated that soft drinks are no more beneficial than non-carbonated beverages.  The study states that there were no statistical differences when comparing glucose serum levels, sodium (Na) and potassium (K) levels, insulin and free fatty acids. These biomarkers are the most common markers assessed when trying to understand improved exercise physiology.  Those in the soft drink group did state that they felt more refreshed when drinking soft drinks, but it was found that the carbonation limited the total volume of fluid drinkers were able to consume impacting the participant’s ability to maintain appropriate hydration.

Many of the other studies I reviewed focused specifically on the physiological utilization of carbohydrates (CHO) without a particular focus on soft drinks.  Most often, studies assessing the utilization of carbohydrates focus particularly on the percentage of carbohydrates in a solution and how quickly the stomach can utilize them.  Soft drinks most often are about 10% CHO, but research has most consistently shown that drinks that are 6% - 8% CHO (most sports drinks) are the most effective in providing CHO replenishment following intense exercise.  It is important to note that sports drinks or other CHO replenishment options should only be used following exercise bouts of 60 minutes or more, exercise for shorter periods often do not require CHO replenishment and drinking water to replace lost fluid is sufficient. 

I have previously discussed the positive and negative effects of caffeine and will not spend additional time discussing them here.  If you need a refresher you can check out this article or review my initial blogs regarding dietary supplements and energy drinks.  Caffeine is found primarily in colas, but in total is found in 70% of all soft drinks.  Remember, while it is proven that caffeine does improve alertness and focus when consumed in sufficient quantities it is also possible to suffer from caffeine toxicity.  Minimally this can result in nausea, but in a worst case scenario it can also lead to sudden cardiac arrest or death. 

From my perspective, while soft drinks do potentially offer the benefits of improved focus and carbohydrate replenishment after long, prolonged exercise I am hesitant to recommend soft drinks as a performance improvement option.  I believe the costs far outweigh the positives.  This is based primarily on my understanding of the significant negative outcomes associated with regular, significant consumption of soft drinks and the available alternatives.  Sports drinks are specifically formulated to help you replenish carbohydrates, water and electrolytes following long periods of intense exercise, a soft drink is simply meant as a basic form of refreshment and exercise physiology is not considered in their formulation.  Additionally, while caffeine in small doses is typically not of concern for minor improvements in alertness, when consumed in high doses (such as in energy drinks) it can be dangerous or even cause you to fail an NCAA drug test (see the banned substance list).  Children are also more sensitive to the effects of caffeine and I would recommend keeping consumption of caffeine based beverages to a minimum in young and adolescent children.


Finally, when attempting to maintain hydration during activity it is important to note the key for children is to get them to consume as much fluids as possible.  Children should consume 13mL/kg bodyweight during exercise and 4mL/kg bodyweight post exercise for each hour of exercise to avoid dehydration during future exercise bouts.  Children often do not consume enough fluids to appropriately stave off dehydration during and after activity and adults should assure appropriate consumption.  Providing beverages that taste good and stimulate thirst are key.  I realize saying this may seem like I’m advocating for soft drinks, bur remember the carbonation in these beverages can give a false sense of fullness actually inhibiting sufficient fluid consumption.  If your child doesn't like to drink just water, consider other beverages such as juices (watered down as necessary), milk and sports drinks to encourage regular consumption of fluids. Soft drinks are fine as an occasional treat at the family picnic, but I would recommend against using them as a regular part of your exercise nutrition regimen.

Heather L. Clemons, MS, MBA, ATC