Bio

Clinical Focus


  • Emergency Medicine

Academic Appointments


Administrative Appointments


  • EMS Medical Director, State of Alaska (2001 - Present)
  • Associate Medical Director, Himalayan Rescue Association (1993 - Present)
  • Vice President, International Commission for Mountain Emergency Medicine (2001 - Present)
  • Medical Director, Denali National Park Mountaineering Rangers (1997 - 2001)
  • Medical Director, Alaska Mountain Rescue Group (1994 - Present)
  • Medical Director, Lake Clark National Park (1997 - 2010)
  • Board of Directors, Wilderness Medical Society (1999 - 2006)
  • Board of Directors, Wilderness Medical Society (1991 - 1996)

Honors & Awards


  • Hero of Emergency Medicine, American College of Emergency Physicians (2008)
  • Award for Outstanding Contribution to Mountain Rescue Medicine, Mountain Rescue Association (2012)
  • Governor's Council on Emergency Medical Services - George Longenbaugh Memorial Award, State of Alaska (2012)
  • Founder's Award, Wilderness Medical Society (2012)
  • Service Award of the Wilderness Medical Society, Wilderness Medical Society (2004)
  • Award for Excellence in Peer Reviews, Wilderness and Environmental Medicine (2010)
  • Education Award of the Wilderness Medical Society, Wilderness Medical Society (2003)

Professional Education


  • Internship:Presbyterian/St Luke'S Hosp (1986) CO
  • Board Certification: Emergency Medicine, American Board of Emergency Medicine (1995)
  • Residency:Kern Medical Center (1994) CA
  • Medical Education:University of Washington School of Medicine (1984) WA
  • BA, New College / USF, Mathematics (1975)
  • MD, University of Washington, Medicine (1984)

Community and International Work


  • Himalayan Rescue Association, Nepal

    Topic

    medical care and education in Nepal

    Populations Served

    trekkers, climbers and local residents

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • State of Alaska - EMS Medical Director, Alaska

    Topic

    State of Alaska

    Populations Served

    entire population of Alaska

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

Research & Scholarship

Current Research and Scholarly Interests


High altitude medicine, AMS, HACE, HAPE, cold injuries, including hypothermia and frostbite, emergency medical services, wilderness medicine, mountain rescue, thrombosis, international medicine, travel medicine, emergency medicine, resuscitation

Publications

Journal Articles


  • Resuscitation of avalanche victims: Evidence-based guidelines of the international commission for mountain emergency medicine (ICAR MEDCOM) Intended for physicians and other advanced life support personnel RESUSCITATION Brugger, H., Durrer, B., Elsensohn, F., Paal, P., Strapazzon, G., Winterberger, E., Zafren, K., Boyd, J. 2013; 84 (5): 539-546

    Abstract

    In North America and Europe ∼150 persons are killed by avalanches every year.The International Commission for Mountain Emergency Medicine (ICAR MEDCOM) systematically developed evidence-based guidelines and an algorithm for the management of avalanche victims using a worksheet of 27 Population Intervention Comparator Outcome questions. Classification of recommendations and level of evidence are ranked using the American Heart Association system.If lethal injuries are excluded and the body is not frozen, the rescue strategy is governed by the duration of snow burial and, if not available, by the victim's core-temperature. If burial time ≤35 min (or core-temperature ≥32 °C) rapid extrication and standard ALS is important. If burial time >35 min and core-temperature <32 °C, treatment of hypothermia including gentle extrication, full body insulation, ECG and core-temperature monitoring is recommended, and advanced airway management if appropriate. Unresponsive patients presenting with vital signs should be transported to a hospital capable of active external and minimally invasive rewarming such as forced air rewarming. Patients with cardiac instability or in cardiac arrest (with a patent airway) should be transported to a hospital for extracorporeal membrane oxygenation or cardiopulmonary bypass rewarming. Patients in cardiac arrest should receive uninterrupted CPR; with asystole, CPR may be terminated (or withheld) if a patient is lethally injured or completely frozen, the airway is blocked and duration of burial >35 min, serum potassium >12 mmol L(-1), risk to the rescuers is unacceptably high or a valid do-not-resuscitate order exists. Management should include spinal precautions and other trauma care as indicated.

    View details for DOI 10.1016/j.resuscitation.2012.10.020

    View details for Web of Science ID 000320996600008

    View details for PubMedID 23123559

  • Frostbite: Prevention and Initial Management HIGH ALTITUDE MEDICINE & BIOLOGY Zafren, K. 2013; 14 (1): 9-12

    Abstract

    Frostbite is a local freezing injury that can cause tissue loss. Historically, it has been a disease of wars, but it is a hazard for anyone who ventures outdoors in cold weather. Frozen tissue is damaged both during freezing and rewarming. Frozen tissue is numb. Rewarming causes hyperemia and is often painful. Blisters and edema develop after rewarming. Hard eschar may form with healthy tissue deep to the eschar. Frostbite can be classified as superficial, without permanent tissue loss, or deep, with varying degrees of permanent tissue loss, often less than appearances suggest. It can be difficult to predict the amount of tissue loss at the time of presentation and early in the subsequent course. Prevention is better than treatment. It may be advisable not to rewarm frozen extremities in the field, but spontaneous thawing is often unavoidable. Extremities that have thawed should be protected from refreezing at all costs. Once in a protected environment, extremities that are still frozen should be rapidly thawed in warm water. Therapy with aspirin or ibuprofen may be helpful, but evidence is limited. Thrombolytic treatment within the first 24 hours after rewarming seems to be beneficial in some cases of severe frostbite. Prostacyclin therapy is very promising.

    View details for DOI 10.1089/ham.2012.1114

    View details for Web of Science ID 000316859800002

    View details for PubMedID 23537254

  • Prophylaxis for Acute Mountain Sickness ANNALS OF EMERGENCY MEDICINE Zafen, K. 2012; 60 (5): 671-672
  • Does Ibuprofen Prevent Acute Mountain Sickness? WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K. 2012; 23 (4): 297-299

    View details for Web of Science ID 000311914700001

    View details for PubMedID 23158203

  • D-Dimer Is Not Elevated in Asymptomatic High Altitude Climbers after Descent to 5340 m: The Mount Everest Deep Venous Thrombosis Study (Ev-DVT) HIGH ALTITUDE MEDICINE & BIOLOGY Zafren, K., Feldman, J., Becker, R. J., Williams, S. R., Weiss, E. A., Deloughery, T. 2011; 12 (3): 223-227

    Abstract

    We performed this study to determine the prevalence of elevated D-dimer, a marker for deep venous thrombosis (DVT), in asymptomatic high altitude climbers. On-site personnel enrolled a convenience sample of climbers at Mt. Everest Base Camp (Nepal), elevation 5340?m (17,500?ft), during a single spring climbing season. Subjects were enrolled after descent to base camp from higher elevation. The subjects completed a questionnaire to evaluate their risk factors for DVT. We then performed a D-dimer test in asymptomatic individuals. If the D-dimer test was negative, DVT was considered ruled out. Ultrasound was available to perform lower-extremity compression ultrasounds to evaluate for DVT in case the D-dimer was positive. We enrolled 76 high altitude climbers. None had a positive D-dimer test. The absence of positive D-dimer tests suggests a low prevalence of DVT in asymptomatic high altitude climbers.

    View details for DOI 10.1089/ham.2010.1101

    View details for Web of Science ID 000295406200005

    View details for PubMedID 21962065

  • Wilderness Medical Society Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness WILDERNESS & ENVIRONMENTAL MEDICINE Luks, A. M., McIntosh, S. E., Grissom, C. K., Auerbach, P. S., Rodway, G. W., Schoene, R. B., Zafren, K., Hackett, P. H. 2010; 21 (2): 146-155

    Abstract

    To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the prevention and treatment of acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations for their roles in disease management. Recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to the prevention and management of each disorder that incorporate these recommendations.

    View details for Web of Science ID 000279235900013

    View details for PubMedID 20591379

  • Fluid management in traumatic shock: a practical approach for mountain rescue. Official recommendations of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High altitude medicine & biology Sumann, G., Paal, P., Mair, P., Ellerton, J., Dahlberg, T., Zen-Ruffinen, G., Zafren, K., Brugger, H. 2009; 10 (1): 71-75

    Abstract

    Sumann, Günther, Peter Paal, Peter Mair, John Ellerton, Tore Dahlberg, Gregoire Zen-Ruffinen, Ken Zafren, and Hermann Brugger. Fluid management in traumatic shock: a practical approach for mountain rescue. High Alt. Med. Biol. 10:71-75, 2009.-The management of severe injuries leading to traumatic shock in mountains and remote areas is a great challenge for emergency physicians and rescuers. Traumatic brain injury may further aggravate outcome. A mountain rescue mission may face severe limitations from the terrain and required rescue technique. The mission may be characterized by a prolonged prehospital care time, where urban traumatic shock protocols may not apply. Yet optimal treatment is of utmost importance. The aim of this study is to establish scientifically supported recommendations for fluid management that are feasible for the physician or paramedic attending such an emergency. A nonsystematic literature search was performed; the results and recommendations were discussed among the authors and accepted by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). Diagnostic and therapeutic strategies are discussed, as well as limitations on therapy in mountain rescue. An algorithm for fluid resuscitation, derived from the recommendations, is presented in Fig. 1. Focused on the key criterion of traumatic brain injury, different levels of blood pressure are presented as a goal of therapy, and the practical means for achieving these are given.

    View details for DOI 10.1089/ham.2008.1067

    View details for PubMedID 19278354

  • Acetazolamide fails to decrease pulmonary artery pressure at high altitude in partially acclimatized humans HIGH ALTITUDE MEDICINE & BIOLOGY Basnyat, B., Hargrove, J., Holck, P. S., Srivastav, S., Alekh, K., Ghimire, L. V., Pandey, K., Griffiths, A., Shankar, R., Kaul, K., Paudyal, A., Stasiuk, D., Basnyat, R., Davis, C., Southard, A., Robinson, C., Shandley, T., Johnson, D. W., Zafren, K., Williams, S., Weiss, E. A., Farrar, J. J., Swenson, E. R. 2008; 9 (3): 209-216

    Abstract

    In this randomized, double-blind placebo controlled trial our objectives were to determine if acetazolamide is capable of preventing high altitude pulmonary edema (HAPE) in trekkers traveling between 4250 m (Pheriche)\4350 m (Dingboche) and 5000 m (Lobuje) in Nepal; to determine if acetazolamide decreases pulmonary artery systolic pressures (PASP) at high altitude; and to determine if there is an association with PASP and signs and symptoms of HAPE. Participants received either acetazolamide 250 mg PO BID or placebo at Pheriche\Dingboche and were reassessed in Lobuje. The Lake Louise Consensus Criteria were used for the diagnosis of HAPE, and cardiac ultrasonography was used to measure the velocity of tricuspid regurgitation and estimate PASP. Complete measurements were performed on 339 of the 364 subjects (164 in the placebo group, 175 in the acetazolamide group). No cases of HAPE were observed in either study group nor were differences in the signs and symptoms of HAPE found between the two groups. Mean PASP values did not differ significantly between the acetazolamide and placebo groups (31.3 and 32.6 mmHg, respectively). An increasing number of signs and symptoms of HAPE was associated with elevated PASP (p < 0.01). The efficacy of acetazolamide against acute mountain sickness, however, was significant with a 21.9% incidence in the placebo group compared to 10.2 % in the acetazolamide group (p < 0.01). Given the lack of cases of HAPE in either group, we can draw no conclusions about the efficacy of acetazolamide in preventing HAPE, but the absence of effect on PASP suggests that any effect may be minor possibly owing to partial acclimatization during the trek up to 4200 m.

    View details for DOI 10.1089/ham.2007.1073

    View details for Web of Science ID 000259759600004

    View details for PubMedID 18800957

  • Lightning injuries: prevention and on-site treatment in mountains and remote areas - Official guidelines of the International Commission for Mountain Emergency Medicine and the Medical Commission of the International Mountaineering and Climbing Federation (ICAR and UIAA MEDCOM) RESUSCITATION Zafren, K., Durrer, B., Herry, J. P., Brugger, H. 2005; 65 (3): 369-372

    Abstract

    Lightning is a hazard during outdoor activities, especially for hikers and mountaineers. Specific preventive measures include staying off ridges and summits, and away from single trees. If possible, stay close to a wall but keeping a distance of at least 1m away from the wall. All metal objects (carabiners, crampons, ice-axe, ski poles, etc.) should be removed and stored away safely. Lightning currents can follow wet ropes. To prevent blunt trauma the helmet should not be removed. Move as quickly as possible away from wire ropes and iron ladders. The crouch position should be adopted immediately if there is a sensation of hair "standing on end". Crackling noises or a visible glow indicate an imminent lightning strike. Rescue of lightning victims may be hazardous. Airborne helicopters can be struck by lightning with disastrous effects. It is prudent to wait until the danger of further strikes has passed. Treatment of lightning victims is based upon the ABCs - (Assessment) airway, breathing and circulation. Victims who are not breathing can often be resuscitated and should be helped first. Respiratory arrest may be prolonged, but the prognosis can be excellent if breathing is supported. Standard Advanced Life Support (ALS), if necessary, should be given at the scene.

    View details for DOI 10.1016/j.resuscitation.2004.12.014

    View details for Web of Science ID 000229924200019

    View details for PubMedID 15919576

  • Thrombotic complications at altitude WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K. 2004; 15 (2): 155-155

    View details for Web of Science ID 000222041200015

    View details for PubMedID 15228070

  • Trends in the workload of the two high altitude aid posts in the Nepal Himalayas JOURNAL OF TRAVEL MEDICINE Basnyat, B., Savard, G. K., Zafren, K. 1999; 6 (4): 217-222

    Abstract

    Acute mountain sickness (AMS), High altitude pulmonary edema (HAPE) and High Altitude Cerebral Edema (HACE) are well known problems in the high altitude region of the Nepal Himalayas. To assess the proportion of AMS, HAPE, and HACE from 1983 to 1995 in the Himalaya Rescue Association (HRA) aid posts' patients at the Everest (Pheriche 4,243 m) and Annapurna (Manang 3,499 m) regions, the two most popular trekking areas in the Himalayas. A retrospective study was conducted at the HRA medical aid posts in Manang (3,499 m) and Pheriche (4,243 m) in the Himalayas, where 4,655 trekkers (tourists, mostly Caucasians) and 4,792 Nepalis (mostly porters and villagers) were seen at the two high-altitude clinics from 1983 to 1995, for a variety of medical problems, including AMS.The number of trekking permits issued for entering the two most popular regions in the Himalayas was calculated and referenced to the proportion of trekkers with medical conditions. Well established guidelines like the Lake Louise Diagnostic Criteria were used in the assessment of AMS, HAPE and HACE. Linear regression analyses were performed on data collected from the two aid posts to determine the effect of time on each variable. For comparison between the aid posts, angular transformation (arcsine) and analysis of variance (ANOVA) were performed on all proportional (incidence) data.Approximately 20% of all visitors (Nepali plus trekkers) who visited the higher Pheriche aid post were diagnosed with AMS compared to around 6% at the lower Manang aid post. There was a linear increase over time in the number of trekkers entering the Everest (r=0.904, p<.001) and the Annapurna (r=0.887, p<.001) regions. The proportion of trekker patients with any medical condition visiting the two HRA aid posts at Manang and Pheriche, expressed as a function of the total number of trekkers entering the Everest and Annapurna regions, was not significantly different between Pheriche (average 4%) and Manang (average 1%). However, the proportion of AMS, HAPE and HACE in patients (Nepali plus trekkers) to the aid posts was greater in those visiting the higher Pheriche aid post compared to the lower Manang aid post (f=56.74, n=13; p<. 001). Importantly, only the proportion of AMS (r=0.568; p<.05) and not HAPE or HACE increased over time in Pheriche, alongside an unchanged proportion of trekker patients, amongst all Pheriche aid post patients. There was no increase of AMS, HAPE or HACE in Manang.HAPE and HACE are the life-threatening forms of AMS and although there is a linear increase of trekkers entering the Himalayas in Nepal, the findings revealed that HAPE and HACE have not increased over time. One possible explanation may be that awareness drives by organizations like the Himalayan Rescue Association may be effective in preventing the severe forms of AMS.

    View details for Web of Science ID 000084359600001

    View details for PubMedID 10575168

  • Images - Chilblains (pernio) WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K. 1999; 10 (1): 25-26

    View details for Web of Science ID 000079896900007

    View details for PubMedID 10347676

  • Gamow bag for high-altitude cerebral oedema LANCET Zafren, K. 1998; 352 (9124): 325-326

    View details for Web of Science ID 000074974500065

    View details for PubMedID 9690443

  • Hyponatremia in a cold environment WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K. 1998; 9 (1): 54-55

    View details for Web of Science ID 000080104600010

    View details for PubMedID 11990182

  • High-altitude medicine. Emergency medicine clinics of North America Zafren, K., Honigman, B. 1997; 15 (1): 191-222

    Abstract

    This article discusses prevention, recognition, and treatment of altitude illnesses, especially acute mountain sickness, high-altitude pulmonary edema, and high-altitude cerebral edema. Physicians advising travelers and trekkers who will be visiting high-altitude areas will find an organized approach to giving pretravel advice. Physicians practicing in or visiting high-altitude areas will find guidelines for diagnosis and treatment. This article also addresses the issue of patients with underlying diseases who wish to travel to high-altitude destinations.

    View details for PubMedID 9056576

  • Treatment of high-altitude pulmonary edema by bed rest and supplemental oxygen WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K., Reeves, J. T., Schoene, R. 1996; 7 (2): 127-132

    Abstract

    We evaluated the safety and efficacy of treating high-altitude pulmonary edema (HAPE) by bed rest and supplemental oxygen at moderate altitudes. We also characterized clinical parameters in HAPE before and after treatment.Case series.Two primary care centers at about 9,200 feet (2,800 meters) above sea level.All patients aged 16-69 years who had been diagnosed with HAPE and were treated with bed rest and supplemental oxygen. Patients were seen on a follow-up visit. Interventions: Selected patients were treated with bed rest and supplemental oxygen rather than hospital admission or descent.Patients were considered improved on follow-up if room air arterial oxygen saturation was increased by 10 percentage points or if their symptoms had improved.Of 58 patients with confirmed HAPE, 25 (43%) were treated by bed rest and supplemental oxygen and were seen on return visits to the clinic. All of the treated patients improved at the return visit. Systolic blood pressure, heart rate, respiratory rate, and temperature decreased significantly between the first visit and the return visit. Oxygen saturation improved between visits.Some patients with HAPE at moderate altitudes where medical facilities are available can be safely treated with bed rest and oxygen without descent.

    View details for Web of Science ID A1996XU76000004

    View details for PubMedID 11990106

  • MORE ON TETRACYCLINE AND TICKS NEW ENGLAND JOURNAL OF MEDICINE Zafren, K. 1983; 308 (7): 403-404

    View details for Web of Science ID A1983QB71800029

    View details for PubMedID 6823249

  • "Performance enhancing" drugs at high altitude. Wilderness & environmental medicine Zafren, K., Berghold, F., Hillebrandt, D. 2013; 24 (2): 173-4

    View details for PubMedID 23434166

  • Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Lightning Injuries WILDERNESS & ENVIRONMENTAL MEDICINE Davis, C., Engeln, A., Johnson, E., McIntosh, S. E., Zafren, K., Islas, A. A., McStay, C., Smith, W. '., Cushing, T. 2012; 23 (3): 260-269

    Abstract

    To provide guidance to clinicians about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the treatment and prevention of lightning injuries. These guidelines include a review of the epidemiology of lightning strikes and recommendations for the prevention of lightning strikes, along with treatment recommendations organized by organ system. Recommendations are graded based on the quality of supporting evidence according to criteria put forth by the American College of Chest Physicians.

    View details for Web of Science ID 000308284600013

    View details for PubMedID 22854068

  • Prediction of Acute Mountain Sickness by Pulse Oximetry: What Are the Right Questions? WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K. 2012; 23 (4): 377-378

    View details for Web of Science ID 000311914700017

    View details for PubMedID 22981487

  • In Response to "Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite" WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K. 2011; 22 (4): 364-365

    View details for Web of Science ID 000297966300014

    View details for PubMedID 21982756

  • In Response to Bradford Washburn's 1962 NEJM Article "Frostbite: What It Is-How To Prevent It-Emergency Treatment"-Historical Background and Commentary WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K. 2011; 22 (4): 366-368

    View details for Web of Science ID 000297966300016

    View details for PubMedID 22000546

  • Prospective, Double-Blind, Randomized, Placebo-Controlled Comparison of Acetazolamide Versus Ibuprofen for Prophylaxis Against High Altitude Headache: The Headache Evaluation at Altitude Trial (HEAT) WILDERNESS & ENVIRONMENTAL MEDICINE Gertsch, J. H., Lipman, G. S., Holck, P. S., Merritt, A., Mulcahy, A., Fisher, R. S., Basnyat, B., Allison, E., Hanzelka, K., Hazan, A., Meyers, Z., Odegaard, J., Pook, B., Thompson, M., Slomovic, B., Wahlberg, H., Wilshaw, V., Weiss, E. A., Zafren, K. 2010; 21 (3): 236-243

    Abstract

    High altitude headache (HAH) is the most common neurological complaint at altitude and the defining component of acute mountain sickness (AMS). However, there is a paucity of literature concerning its prevention. Toward this end, we initiated a prospective, double-blind, randomized, placebo-controlled trial in the Nepal Himalaya designed to compare the effectiveness of ibuprofen and acetazolamide for the prevention of HAH.Three hundred forty-three healthy western trekkers were recruited at altitudes of 4280 m and 4358 m and assigned to receive ibuprofen 600 mg, acetazolamide 85 mg, or placebo 3 times daily before continued ascent to 4928 m. Outcome measures included headache incidence and severity, AMS incidence and severity on the Lake Louise AMS Questionnaire (LLQ), and visual analog scale (VAS).Two hundred sixty-five of 343 subjects completed the trial. HAH incidence was similar when treated with acetazolamide (27.1%) or ibuprofen (27.5%; P = .95), and both agents were significantly more effective than placebo (45.3%; P = .01). AMS incidence was similar when treated with acetazolamide (18.8%) or ibuprofen (13.7%; P = .34), and both agents were significantly more effective than placebo (28.6%; P = .03). In fully compliant participants, moderate or severe headache incidence was similar when treated with acetazolamide (3.8%) or ibuprofen (4.7%; P = .79), and both agents were significantly more effective than placebo (13.5%; P = .03).Ibuprofen and acetazolamide were similarly effective in preventing HAH. Ibuprofen was similar to acetazolamide in preventing symptoms of AMS, an interesting finding that implies a potentially new approach to prevention of cerebral forms of acute altitude illness.

    View details for Web of Science ID 000282163300007

    View details for PubMedID 20832701

  • Avalanche Triage: Are Two Birds in the Bush Better Than One in the Hand? WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K. 2010; 21 (3): 273-274

    View details for Web of Science ID 000282163300016

    View details for PubMedID 20832710

  • Clinical Images WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K., Basnyat, B., Basnyat, G. 2009; 20 (1): 81-82

    View details for Web of Science ID 000264280300015

    View details for PubMedID 19364167

  • The Most Dangerous Catch: Fisherman Caught by Halibut Hook WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K. 2009; 20 (4): 375-377

    View details for Web of Science ID 000273503700013

    View details for PubMedID 20030448

  • The use of extrication devices in crevasse accidents: official statement of the International Commission for Mountain Emergency Medicine and the Terrestrial Rescue Commission of the International Commission for Alpine Rescue intended for physicians, paramedics, and mountain rescuers WILDERNESS & ENVIRONMENTAL MEDICINE Winterberger, E., Jacomet, H., Zafren, K., Ruffinen, G. Z., Jelk, B. 2008; 19 (2): 108-110

    Abstract

    Injured patients in crevasses who are suspected of having sustained spinal injuries should ideally be extricated after being immobilized in a horizontal position on a stretcher and having a cervical collar applied. Sometimes, however, horizontal stabilization is not possible, because the crevasse is too narrow, and the patient needs to be stabilized in a vertical position. In such cases an extrication device can be a useful adjunct. The Kendrick Extrication Device stabilizes the position of the body and maintains firm support of the head, neck, and torso. Therefore, the International Commission for Mountain Emergency Medicine supports the use of this device in narrow crevasses, if horizontal evacuation is not possible.

    View details for Web of Science ID 000256509600005

    View details for PubMedID 18513106

  • When searches become futile WILDERNESS & ENVIRONMENTAL MEDICINE Fortini, A., Zafren, K., Sharp, F., Shimanski, C. 2008; 19 (1): 73-73

    View details for Web of Science ID 000254367000015

    View details for PubMedID 18333661

  • A reference correction. Wilderness & environmental medicine Zafren, K. 2007; 18 (4): 323-?

    View details for PubMedID 18076299

  • Management of blunt trauma victims with significant hemoperitoneum with normal examination AMERICAN JOURNAL OF EMERGENCY MEDICINE Zafren, K. 2003; 21 (6): 513-513
  • Clinical images. Wound care in the wilderness. Wilderness & environmental medicine Zafren, K. 2001; 12 (3): 201-203

    View details for PubMedID 11562020

  • Effect of insurance on admission for head injury AMERICAN JOURNAL OF EMERGENCY MEDICINE Zafren, K. 2001; 19 (5): 460-460

    View details for Web of Science ID 000170970400019

    View details for PubMedID 11555813

  • Warnings in the wilderness WILDERNESS & ENVIRONMENTAL MEDICINE Anonymous 2001; 12 (2): 129-133

    View details for Web of Science ID 000169377300010

    View details for PubMedID 11434489

  • Poison oak dermatitis. Wilderness & environmental medicine Zafren, K. 2001; 12 (1): 39-40

    View details for PubMedID 11294555

  • How useful is on-mountain sonography? WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K. 2001; 12 (4): 230-231

    View details for Web of Science ID 000172919300002

    View details for PubMedID 11769916

  • Unusual presentation of a fracture and possible early compartment syndrome. Wilderness & environmental medicine Zafren, K. 2000; 11 (3): 199-200

    View details for PubMedID 11055568

  • Clinical images WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K. 2000; 11 (4): 269-271

    View details for Web of Science ID 000166445800007

    View details for PubMedID 11199532

  • Images - Erythema nodosum WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, Z., Kercher, E. 1999; 10 (3): 171-173

    View details for Web of Science ID 000083483600008

    View details for PubMedID 10560312

  • Images - Answer WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K. 1999; 10 (2): 115-116

    View details for Web of Science ID 000081796100010

    View details for PubMedID 10442160

  • Presentation of the case. Lighting injuries. Wilderness & environmental medicine Zafren, K. 1999; 10 (4): 253-255

    View details for PubMedID 10628287

  • Tragedy on Ptarmigan Peak WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K. 1998; 9 (3): 188-190

    View details for Web of Science ID 000080104900008

    View details for PubMedID 11990189

  • Migratory pain in appendicitis AMERICAN JOURNAL OF EMERGENCY MEDICINE Zafren, K. 1998; 16 (4): 437-438

    View details for Web of Science ID 000074870100035

    View details for PubMedID 9672474

  • Telemedicine revisited ANNALS OF EMERGENCY MEDICINE Zafren, K. 1998; 31 (6): 790-790

    View details for Web of Science ID 000073986100022

    View details for PubMedID 9624327

  • Brown recluse spider bite (necrotic arachnidism) WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K. 1998; 9 (4): 211-212

    View details for Web of Science ID 000079405000003

    View details for PubMedID 11990193

  • Re: Prevention and Management of Cardiovascular Events during Travel. Journal of travel medicine Zafren, K. 1997; 4 (3): 152

    View details for PubMedID 9815504

  • Outcome assessments and air ambulance services LANCET Zafren, K. 1996; 347 (9018): 1843-1843

    View details for Web of Science ID A1996UU46900072

    View details for PubMedID 8667965

  • Warning! Long commute. Science Zafren, K. 1996; 272 (5269): 1726a-?

    View details for PubMedID 17831839

  • ALTERNATIVE TRAINING IN EMERGENCY-MEDICINE AMERICAN JOURNAL OF EMERGENCY MEDICINE Zafren, K. 1993; 11 (1): 97-98

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