Altitude Sickness / Acute Mountain Sickness

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Sunburn: The depletion of the Earth’s ozone layer has made sunburn an increasingly common hazard of outdoor activities. The National Cancer Institute reports that 35 percent of adults and 57 percent of adolescents in the U.S. get at least one sunburn a year.52 The risk of melanoma, the most serious form of skin cancer, doubles after five or more blistering sunburns. Prevention is much more important than treatment.

The Skin Cancer Foundation provides the following tips for avoiding sunburn: • Stay in the shade or indoors, especially between 10 a.m. and 4 p.m. and particularly in tropical and polar latitudes and at high altitudes. • Use a sunscreen with a sun protection factor (SPF) of at least 15 for short intervals in the sun and 30 or higher for longer periods or when the sun is strongest. Apply it liberally to all exposed skin 30 minutes before going outdoors, and then reapply it every two hours. Use eco-conscious sunscreen without ecosystem-harming chemicals. • Wear sun-protective clothing, including a broad-brimmed hat and sunglasses that block ultraviolet (UV) radiation. • The sun reflects off water, sand or snow, increasing the intensity of the

UV rays. • You can get a sunburn on a cloudy day; some cloud formations can magnify the effect of the sun’s UV rays. • Do not use tanning booths. • Do the following if you get too much sun: • Take a cool shower or bath. • Apply moisturizing lotion. • Stay well hydrated. • Consider using a pain reliever such as ibuprofen (Advil) if the sunburn is painful. • Seek medical attention if a blistering sunburn covers more than 20 percent of your body.

It is a good idea to check your skin for unusual moles or other signs of potential skin cancer at least once a month.

Poison ivy, oak and sumac: Poison ivy, oak and sumac are the most common contact-poisonous plants in the United States, but there are others within the U.S. and elsewhere around the world. Learn to recognize the leaves of noxious plants to avoid the misery of the highly itchy rashes they can cause. For information about identifying poison ivy, oak and sumac, see CDC.gov/Niosh/Topics/Plants. Before you engage in wilderness activities in other parts of the world, research what plants to avoid there.

Exposure to urushiol, the natural chemical that causes the allergic rash, is possible by direct contact with the plant, indirect contact with a surface that has touched the plant or inhalation of particles from burning plants that contain the substance.

The CDC recommends the following steps for avoiding contact with such plants: • Cover up: Wear long sleeves, long pants and gloves. • Consider using a barrier lotion containing bentoquatam, but such lotions must be washed off and reapplied twice a day. • Use rubbing alcohol (isopropanol or isopropyl alcohol) or soap and water to clean any gear that may have come in contact with such plants.

Urushiol can remain potent on the surface of objects for up to five years. • Do not burn plants that may contain urushiol or similar substances.

If despite your best efforts you come in contact with poisonous plants, the CDC recommends the following steps: • Immediately wash the area well with rubbing alcohol, a specialized plant wash or a degreasing soap (such as dishwashing liquid) and lots of water, and then rinse well. • Scrub under your nails with a brush. • If you have a blistering rash, apply wet compresses, calamine lotion or hydrocortisone cream to mitigate the itching. An oatmeal bath or oral antihistamines such as Benadryl may also relieve itching. • Seek medical attention in cases of a severe allergic reaction or severe itching or blistering.

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WATER-RELATED INJURIES

Recreational activities in, on or near the water are extremely popular—from scuba diving to simply sitting on the beach. Some risks of such activities are obvious, but some are less so. Table 10 lists a few of the injuries that can occur during water sports—from the common swimmer’s ear to drowning or the greatly feared but very rare phenomenon of an unprovoked shark attack.

Drowning is defined as a process of respiratory impairment due to submersion in water. Worldwide, drowning is the third-leading cause of death due to unintentional injury; an estimated 236,000 people die by drowning each year, accounting for about 7 percent of all injury-related deaths.57 In the United States there are on average 3,960 unintentional drowning deaths.56

Take every nonfatal drowning victim to a medical facility for a thorough evaluation, no matter how trivial the episode may have seemed. Nonfatal drownings can cause serious complications. Anyone who plans to go out on a boat or to participate in activities near a body of water should be familiar with the factors involved in drowning and with accepted rescue and resuscitation techniques. (See also “What Drowning Really Looks Like,” Q1 2020 Alert Diver, DAN.org/alert-diver/article/what-drowning-really-looks-like).

If drowning victims remain submerged, they eventually die from anoxia—a lack of oxygen. Drowning occurs in the following stages: • Victims struggle to stay afloat while hyperventilating, which may result in negative buoyancy. • Victims drop below the surface of the water and begin reflexively

(involuntarily) holding their breath. The urge to breathe becomes stronger and stronger as victims consume all the oxygen remaining in their lungs. • After two to three minutes, the combination of lack of oxygen and accumulation of carbon dioxide results in an uncontrollable urge to breathe; victims eventually inhale water, though usually very little. • Victims, though now unconscious, begin to reflexively swallow water.

Consequently, some drowning victims have a stomach full of water. • More carbon dioxide accumulates, and the urge to breathe becomes even stronger. Reflexive swallowing gives way to a strong, deep breath. With the lungs then emptied of all air, victims become more negatively buoyant.

Treatment of drowning depends on restoring the victim’s breathing and heartbeat using CPR or basic life support (BLS) methods and promptly obtaining assistance from qualified medical personnel. Every second counts in recovery from drowning, and an onlooker’s knowledge of CPR is often crucial.

If you are the only person present with a drowning victim and you don’t know how to perform CPR, it is still beneficial to administer chest compressions. Using the heel of your hand on the center of the victim’s chest, press down about 2 inches at a rate of about 100 compressions per minute, letting the chest rise fully after each compression. After every 30 compressions, stop to give two rescue breaths. For more information about performing CPR, see Administering CPR in Section 6.

Even if a drowning victim appears to recover, they should receive a medical evaluation because delayed pulmonary edema (accumulation of excess fluid in the lungs) is a frequent complication.

Risk factors for drowning include alcohol use near or in the water, medical conditions such as epilepsy and lack of familiarity with local water hazards and features. Prevention requires several measures. Everyone who participates in water-related activities or travels on small boats should wear a life jacket, avoid alcohol, learn CPR and never swim unattended.

The following sections list popular water-related activities and the injuries most commonly associated with them.

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