Bio

Clinical Focus


  • Emergency Medicine

Academic Appointments


Administrative Appointments


  • Chief, Division of Emergency Medicine, Department of Surgery (1991 - 1995)
  • Adjunct Professor of Military/Emergency Medicine, Uniformed Services University of the Health Sciences (2016 - Present)
  • Visiting Scholar, National Center for Disaster Medicine and Public Health (2018 - Present)

Honors & Awards


  • Illustrated Medical Textbook of the Year, for Wilderness Medicine 7th edition, British Medical Association (2017)
  • DAN/Rolex Diver of the Year, Divers Alert Network (2009)
  • Diver of the Year, Beneath the Sea (2008)
  • Hero of Emergency Medicine, American College of Emergency Physicians (2008)
  • New Orleans Grand Isle (NOGI) Award for Science, The Academy of Underwater Arts and Sciences (2006)
  • Founders Award, Wilderness Medical Society (2000)
  • Outstanding Contribution in Education Award, American College of Emergency Physicians (1999)
  • DAN America Award, Divers Alert Network (1998)

Boards, Advisory Committees, Professional Organizations


  • Member, Council on Foreign Relations (2010 - Present)
  • Board of Trustees, Emergency Medicine Foundation, American College of Emergency Physicians (2015 - Present)
  • Development Committee, Society for Academic Emergency Medicine Foundation (2016 - 2017)
  • High Threat Emergency Casualty Care Task Force, American College of Emergency Physicians (2016 - 2018)
  • Faculty Fellow, Center for Innovation in Global Health, Stanford University School of Medicine (2017 - Present)
  • Sports Head Injury Prevention Task Force, American College of Emergency Physicians (2017 - Present)

Professional Education


  • Residency:UCLA Emergency Medicine Residency (1980)
  • MS, Stanford Graduate School of Business, Management (1989)
  • Board Certification: Emergency Medicine, American Board of Emergency Medicine (1981)
  • Internship:Dartmouth Hitchcock Medical Center (1978) NH
  • Medical Education:Duke University School of Medicine (1977) NC

Community and International Work


  • Volunteer physician, Haiti

    Topic

    Emergency medical response

    Partnering Organization(s)

    International Medical Corps

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • Volunteer physician, Kathmandu, Nepal

    Topic

    Emergency medical care

    Partnering Organization(s)

    Health Care Foundation of Nepal

    Populations Served

    local residents

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • Hospitalito Atitlan, Santiago, Atitlan, Guatemala

    Topic

    Clinical practice

    Partnering Organization(s)

    Pueblo a Pueblo

    Populations Served

    local citizens

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

Patents


  • Paul Auerbach, Joshua Carter, Lauren Fuller, Daniel Haylett, Aaron Knoll, John Reitenberg, Andrew Smith, Eric Thorsell. "United States Patent 8,061,293 Avalanche rescue device", Nov 22, 2011
  • Paul Auerbach. "United States Patent 4,801,777 A device for microwave rewarming of blood products", Jan 31, 1989

Research & Scholarship

Current Research and Scholarly Interests


concussion in sports; wilderness medicine education

Clinical Trials


  • Effective Treatments for Jellyfish Stings Not Recruiting

    The purpose of the study is to attempt to determine which treatment from commonly used treatments is the best at reducing pain and redness of the skin after a sting from a Portuguese Man of War, Chrysaora chinensis, or Chrysaora fuscescens. Jellyfish stings are a common occurrence in many parts of the world causing significant morbidity to persons stung by jellyfish while participating in marine activities whether commercial or recreational. Much debate and confusion exist both in the medical literature and the common recommendations regarding how to treat persons stung by jellyfish. Specifically concerning what topical treatments are most efficacious at decreasing envenomation by nematocyst on skin, preventing the firing of un-discharged nematocyst, decreasing inflammation and pain resulting from envenomation by nematocyst. Antidotal recommendations and past studies have referenced numerous different topical treatments for jellyfish stings including but not limited to vinegar, urine, alcohol, distilled spirits, ammonia, bleach, acetone, bicarbonate slurry, lidocaine, meat tenderizer, Coca Cola, old wine, salt water, cold packs, hot water, and commercial products such as Stingose and Stingaid. Conflicting data exists regarding what works and what does not for nematocysts discharge, skin erythema, and pain reaction. The investigators would like to investigate which treatment is best out of some of the more commonly studied treatments for reducing pain and erythema. The investigators would like to complete a research study to try to bring some reasonable evidence to the field treatment of jellyfish stings, namely, the decontamination process (e.g., what can you put on a jellyfish sting that will be helpful, based on real data?). The questions asked are as follows: - What topical treatments for jellyfish stings actually decrease the amount of inflammation seen on a macroscopic level on the skin of humans? - What topical treatments for jellyfish stings actually decrease the sensation of pain in humans? - Do topical chemical treatments cause different outcomes when exposed to the above parameters? - Do different species of jellyfish nematocysts react differently based on the type of topical chemical treatment used? What is the variation of effects of topical treatments based on the species of jellyfish sting? Specifically, the investigators will be stinging human subject on both arms with a segment of tentacle for approximately 2 minutes. This will be followed by no treatment on one arm (control arm) and by treatment on the other arm with either: acetic acid (5%), sodium bicarbonate slurry (50%), papain slurry (70%), ammonia (10%), viscous lidocaine (4%), isopropyl alcohol (70%), or hot tap water (40 degrees Celsius). Outcomes measured will include pain and erythema.

    Stanford is currently not accepting patients for this trial.

    View full details

Teaching

2018-19 Courses


Publications

All Publications


  • Recommendations for the Emergency Department Prevention of Sport-Related Concussion. Annals of emergency medicine Bazarian, J. J., Raukar, N., Devera, G., Ellis, J., Feden, J., Gemme, S. R., Hafner, J., Mannix, R., Papa, L., Wright, D. W., Auerbach, P., American College of Emergency Physicians Sport-Related Head Injury Prevention Task Force 2019

    Abstract

    Sport-related concussion refers to the subset of concussive injuries occurring during sport activities. Similar to concussion from nonsport mechanisms, sport-related concussion is associated with significant morbidity, including migrainous headaches, disruption in normal daily activities, and long-term depression and cognitive deficits. Unlike nonsport concussions, sport-related concussion may be uniquely amenable to prevention efforts to mitigate these problems. The emergency department (ED) visit for sport-related concussion represents an opportunity to reduce morbidity by timely diagnosis and management using best practices, and through education and counseling to prevent a subsequent sport-related concussion. This article provides recommendations to reduce sport-related concussion disability through primary, secondary, and tertiary preventive strategies enacted during the ED visit. Although many recommendations have a solidevidence base, several research gaps remain. The overarching goal of improving sport-related concussion outcome through enactment of ED-based prevention strategies needs to be explicitly studied.

    View details for DOI 10.1016/j.annemergmed.2019.05.032

    View details for PubMedID 31326205

  • Dermatological Progression of a Probable Box Jellyfish Sting. Wilderness & environmental medicine Auerbach, P. S., Gupta, D., Van Hoesen, K., Zavala, A. 2019

    Abstract

    This case report describes the typical features of the dermatological progression of a patient stung by a (probable) box jellyfish. The purpose is to guide clinicians and patients to an understanding of what to expect after such a sting using the clinical narrative and unique sequential photographs of the injury. With knowledgeable consultation from experienced physicians and meticulous care, this envenomation healed without the need for skin grafting.

    View details for DOI 10.1016/j.wem.2019.05.004

    View details for PubMedID 31477508

  • The last gasp. Lancet Auerbach, P. S. 2016; 388 (10057): 2322-?

    View details for DOI 10.1016/S0140-6736(16)31722-6

    View details for PubMedID 27825510

  • It's Time to Change the Rules. JAMA Auerbach, P. S., Waggoner, W. H. 2016; 316 (12): 1260-1261

    View details for DOI 10.1001/jama.2016.8184

    View details for PubMedID 27673303

  • Detection of concussion using cranial accelerometry. Clinical journal of sport medicine Auerbach, P. S., Baine, J. G., Schott, M. L., Greenhaw, A., Acharya, M. G., Smith, W. S. 2015; 25 (2): 126-132

    Abstract

    To determine whether skull motion produced by pulsatile cerebral blood flow, as measured by cranial accelerometry, is altered during concussion.In phase 1, to identify a specific pattern indicative of concussion, cranial accelerometry of subjects who sustained a concussion underwent analysis of waveforms, which was compared with accelerometry from subjects without a concussion (baseline). In phase 2, this concussion pattern was tested against prospectively acquired, blinded data.High school tackle football practice and game play.Eighty-four football players.Subjects had accelerometry measurements and concurrent 2-lead electrocardiograms. In players with a concussion, multiple sequential measurements were obtained. Sport Concussion Assessment Tool 2 was used to assist clinical determination of concussion.Whether a characteristic waveform pattern of cranial accelerometry occurs in subjects with concussion.Phase 1 demonstrated a consistent pattern correlated to concussion. Phase 2 found this pattern in 10 of 13 subjects with concussion (76.9% sensitivity). Seventy-nine of 82 baseline plus nine postseason (total = 91) recordings from nonconcussed subjects did not show the concussion pattern (87% specificity).In subjects with concussion, we observed a unique pattern determined by cranial accelerometry. This may provide a method to noninvasively detect and longitudinally observe concussion.There is no objective, real-time, noninvasive, and easily accessible measure for concussion. If accelerometry is validated, it could provide a critical diagnostic tool for sports medicine physicians.

    View details for DOI 10.1097/JSM.0000000000000117

    View details for PubMedID 25010149

  • Poly-l-Arginine Topical Lotion Tested in a Mouse Model for Frostbite Injury. Wilderness & environmental medicine Auerbach, L. J., DeClerk, B. K., Garrison Fathman, C., Gurtner, G. C., Auerbach, P. S. 2014; 25 (2): 160-165

    Abstract

    Frostbite injury occurs when exposure to cold results in frozen tissue. We recently reported a novel mouse model for frostbite injury to be used in screening potentially therapeutic drugs and other modalities.We used the mouse skin frostbite model to evaluate the effect of poly-l-arginine contained in lotion (PAL) applied topically to involved skin.Sixty mice were studied in a randomized, double-blind method. Standardized 2.9-cm-diameter circles were tattooed on the mouse dorsum. Magnets snap frozen in dry ice (-78.5°C) were used to create a frostbite injury on skin within the circle as a continuous 5-minute freeze. Mice were treated with prefreeze placebo, postthaw placebo, combined prefreeze and postthaw placebo, prefreeze with PAL, postthaw with PAL, or combined prefreeze and postthaw with PAL. Appearance, healing rate, tissue loss, and histology were recorded until the wounds were healed.Application of PAL before inducing frostbite injury resulted in decreased tissue loss as compared with other treatment conditions.Applying PAL topically to frostbitten mouse skin caused decreased tissue loss. Poly-l-arginine should be studied further to determine whether it is a beneficial therapeutic modality for frostbite injury.

    View details for DOI 10.1016/j.wem.2014.01.006

    View details for PubMedID 24631228

  • A novel mouse model for frostbite injury. Wilderness & environmental medicine Auerbach, L. J., Galvez, M. G., De Clerck, B. K., Glotzbach, J., Wehner, M. R., Chang, E. I., Gurtner, G. C., Auerbach, P. S. 2013; 24 (2): 94-104

    Abstract

    Frostbite injury occurs when exposure to cold results in frozen tissue. To screen drugs and other field therapies that might improve the outcome for a frostbite victim, it would be helpful to have a reliable and cost-effective preclinical in vivo model.We sought to create a novel mouse skin model of induced frostbite injury. This model would allow quantification of the surface area of involved skin, histology of the wound, rate of wound healing, and skin loss in a standardized fashion after the frostbite injury.Thirty-six mice were studied. Standardized 2.9-cm diameter circles were tattooed on the mouse dorsum. Magnets frozen in dry ice (-78.5°C) were used to create a frostbite injury on skin within the circle, either as a continuous 5-minute freeze or as 3 repeated freeze (1-minute) and thaw (3-minute) cycles. Appearance, healing rate, skin surface area loss, and histology were recorded until the wounds were healed.The amount of skin surface area loss was approximately 50% for both freeze methods. Although the time to surface skin healing was similar for both freeze methods, the initial healing rate was significantly (P = .001) slower in mice exposed to the freeze-thaw cycles compared with the continuous freeze model. Histopathology reflected inflammatory changes, cell death, and necrosis.This novel in vivo mouse model for frostbite allows quantification of affected skin surface area, histology, healing rate, and skin loss and has the potential of being utilized to screen future treatment modalities.

    View details for DOI 10.1016/j.wem.2012.11.020

    View details for PubMedID 23481507

  • Civil-Military Collaboration in the Initial Medical Response to the Earthquake in Haiti NEW ENGLAND JOURNAL OF MEDICINE Auerbach, P. S., Norris, R. L., Menon, A. S., Brown, I. P., Kuah, S., Schwieger, J., Kinyon, J., Helderman, T. N., Lawry, L. 2010; 362 (10)

    View details for DOI 10.1056/NEJMp1001555

    View details for PubMedID 20181962

  • Physicians and the environment JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Auerbach, P. S. 2008; 299 (8): 956-958

    View details for PubMedID 18314440

  • Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite: 2019 Update. Wilderness & environmental medicine McIntosh, S. E., Freer, L., Grissom, C. K., Auerbach, P. S., Rodway, G. W., Cochran, A., Giesbrecht, G. G., McDevitt, M., Imray, C. H., Johnson, E. L., Pandey, P., Dow, J., Hackett, P. H. 2019

    Abstract

    The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the guidelines published in 2014.

    View details for DOI 10.1016/j.wem.2019.05.002

    View details for PubMedID 31326282

  • Change Is What You Make It. AEM education and training Auerbach, P. S. 2019; 3 (3): 299–300

    View details for DOI 10.1002/aet2.10322

    View details for PubMedID 31360825

  • Impact of a Half Dome Cable Permitting Process on Search and Rescue Activity, Hiker Mortality Rates, and Operational Costs Above Little Yosemite Valley Spano, S. J., Seymer, J. A., Crane, D. H., Auerbach, P. S. ELSEVIER SCIENCE INC. 2019: 113–20
  • Impact of a Half Dome Cable Permitting Process on Search and Rescue Activity, Hiker Mortality Rates, and Operational Costs Above Little Yosemite Valley. Wilderness & environmental medicine Spano, S. J., Seymer, J. A., Crane, D. H., Auerbach, P. S. 2019

    Abstract

    INTRODUCTION: The summit of Yosemite's Half Dome is reached using cable handrails for the final 146 m (480 ft). Access to these cables was restricted to users with permits in 2010. The authors aim to describe the impact of permitting on search and rescue (SAR) in the region of the park most affected by permitting.METHODS: An observational study from 2005 to 2009 and 2011 to 2015 comparing the number of incidents, major incidents (exceeding $500), victims, and fatalities before and after permitting the use of cable handrails on Half Dome in the area above Little Yosemite Valley (LYV) and parkwide. Each year was analyzed separately with t tests and Mann-Whitney U tests. Data are presented as mean±SD.RESULT: The number of hikers in the study area was reduced by up to 66% by permitting. Above LYV from 2005 to 2009, there were 85 SAR incidents, 134 victims, 8 fatalities, 38 major incidents, and annual SAR costs of $44,582±28,972. From 2011 to 2015, the same area saw 54 SAR incidents, 156 victims, 4 fatalities, 35 major incidents, and annual SAR costs of $27,027±19,586. No parameter showed statistical significance. Parkwide SAR incidents decreased from 232 to 198 annual incidents (P=0.013) during the same time period, with parkwide mortality increasing from 8 to 12 deaths annually (P=0.045).CONCLUSIONS: SAR incidents, victims, fatalities, or costs above LYV did not decrease after cable handrail permitting. Parkwide SAR activity decreased during the same intervals. This strongly suggests that overcrowding is not the key factor influencing safety on Half Dome. This discordant trend warrants close observation over 5 to 10 y.

    View details for PubMedID 30846401

  • Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update. Wilderness & environmental medicine Luks, A. M., Auerbach, P. S., Freer, L., Grissom, C. K., Keyes, L. E., McIntosh, S. E., Rodway, G. W., Schoene, R. B., Zafren, K., Hackett, P. H. 2019

    Abstract

    To provide guidance to clinicians about best preventive and therapeutic practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. Recommendations are graded based on the quality of supporting evidence and the 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 prevention and management of each form of acute altitude illness that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in 2010 and subsequently updated as the WMS Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness in 2014.

    View details for DOI 10.1016/j.wem.2019.04.006

    View details for PubMedID 31248818

  • Hydration Status as a Predictor of High-altitude Mountaineering Performance (vol 8, e918, 2016) CUREUS Ladd, E., Shea, K. M., Bagley, P., Auerbach, P. S., Pirrotta, E. A., Wang, E., Lipman, G. 2017; 9 (9): c10

    Abstract

    [This corrects the article DOI: 10.7759/cureus.918.].

    View details for PubMedID 28900588

  • Marine Envenomation EMERGENCY MEDICINE CLINICS OF NORTH AMERICA Hornbeak, K. B., Auerbach, P. S. 2017; 35 (2): 321-?

    Abstract

    Venomous aquatic animals are hazardous to swimmers, surfers, divers, and fishermen. Exposures include mild stings, bites, abrasions, and lacerations. Severe envenomations can be life threatening. This article reviews common marine envenomations, exploring causative species, clinical presentation, and current treatment recommendations. Recommendations are included for cnidaria, sponges, bristle worms, crown-of-thorns starfish, sea urchins, venomous fish, stingrays, cone snails, stonefish, blue-ringed octopus, and sea snakes. Immediate and long-term treatment options and management of common sequelae are reviewed. Antivenom administration, treatment of anaphylaxis, and surgical indications are discussed.

    View details for DOI 10.1016/j.emc.2016.12.004

    View details for PubMedID 28411930

  • Correction: Hydration Status as a Predictor of High-altitude Mountaineering Performance. Cureus Ladd, E., Shea, K. M., Bagley, P., Rundell, S., Auerbach, P. S., Pirrotta, E. A., Wang, E., Lipman, G. S. 2017; 9 (2): c7

    Abstract

    [This corrects the article DOI: 10.7759/cureus.918.].

    View details for PubMedID 28224062

  • Hydration Status as a Predictor of High-altitude Mountaineering Performance CUREUS Ladd, E., Shea, K. M., Bagley, P., Auerbach, P. S., Pirrotta, E. A., Wang, E., Lipman, G. S. 2016; 8 (12)

    View details for DOI 10.7759/cureus.918

    View details for Web of Science ID 000453617500014

  • Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Drowning WILDERNESS & ENVIRONMENTAL MEDICINE Schmidt, A. C., Sempsrott, J. R., Hawkins, S. C., Arastu, A. S., Cushing, T. A., Auerbach, P. S. 2016; 27 (2): 236-251

    Abstract

    The Wilderness Medical Society convened a panel to review available evidence supporting practices for the prevention and acute management of drowning in out-of-hospital and emergency medical care settings. Literature about definition and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded evidence supporting practices according to the American College of Chest Physicians criteria, then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking.

    View details for PubMedID 27061040

  • The 6-Minute Walk Test as a Predictor of Summit Success on Denali WILDERNESS & ENVIRONMENTAL MEDICINE Shea, K. M., Ladd, E. R., Lipman, G. S., Bagley, P., Pirrotta, E. A., Vongsachang, H., Wang, N. E., Auerbach, P. S. 2016; 27 (1): 19-24

    Abstract

    To test whether the 6-minute walk test (6MWT), including postexercise vital sign measurements and distance walked, predicts summit success on Denali, AK.This was a prospective observational study of healthy volunteers between the ages of 18 and 65 years who had been at 4267 m for less than 24 hours on Denali. Physiologic measurements were made after the 6MWT. Subjects then attempted to summit at their own pace and, at the time of descent, completed a Lake Louise Acute Mountain Sickness Questionnaire and reported maximum elevation reached.One hundred twenty-one participants enrolled in the study. Data were collected on 111 subjects (92% response rate), of whom 60% summited. On univariate analysis, there was no association between any postexercise vital sign and summit success. Specifically, there was no significant difference in the mean postexercise peripheral oxygen saturation (Spo2) between summiters (75%) and nonsummiters (74%; 95% CI, -3 to 1; P = .37). The distance a subject walked in 6 minutes (6MWTD) was longer in summiters (617 m) compared with nonsummiters (560 m; 95% CI, 7.6 to 106; P = .02). However, this significance was not maintained on a multivariate analysis performed to control for age, sex, and guide status (P = .08), leading to the conclusion that 6MWTD was not a robust predictor of summit success.This study did not show a correlation between postexercise oxygen saturation or 6MWTD and summit success on Denali.

    View details for Web of Science ID 000372379000005

  • Efficacy of Topical Treatments for Chrysaora chinensis Species: A Human Model in Comparison with an In Vitro Model WILDERNESS & ENVIRONMENTAL MEDICINE Declerck, M. P., Bailey, Y., Craig, D., Lin, M., Auerbach, L. J., Linney, O., Morrison, D. E., Patry, W., Auerbach, P. S. 2016; 27 (1): 25-38

    Abstract

    This study sought to create a model for testing topical treatment of jellyfish stings. It sought to determine which treatments 1) stimulate/inhibit nematocyst discharge; 2) decrease pain; and 3) decrease skin inflammation; it also sought to discover whether there is a clinical correlation between stimulated nematocyst discharge observed in vitro to the pain and erythema experienced by humans stung by a particular species of jellyfish, C chinensis.Chrysaora chinensis stung 96 human subjects, who were then treated with isopropyl alcohol, hot water, acetic acid, papain meat tenderizer, lidocaine, or sodium bicarbonate. Pain and erythema were measured. In a separate experiment, nematocysts were examined microscopically after exposure to the same topical treatments used in the human experiment.Forearms treated with papain showed decreased mean pain over the first 30 minutes after being stung, relative to placebo, although only by a small amount. The other topical treatments tested did not reach statistical significance. Sodium bicarbonate may reduce erythema after 30 minutes of treatment; sodium bicarbonate and papain may reduce erythema at 60 minutes. The other topical treatments tested did not reach statistical significance. Nematocyst discharge in vitro occurred when tentacles of C chinensis were exposed to acetic acid or isopropyl alcohol. Sodium bicarbonate, papain, heated water, and lidocaine did not induce nematocyst discharge.Papain-containing meat tenderizer used as a topical treatment for C chinensis stings may decrease pain. Although there is published experimental support for the concept that in vitro nematocyst discharge correlates with in vivo human pain perception, no definitive randomized controlled trial, including ours, has yet provided incontrovertible evidence of this assertion. Despite this study's limitations, it presents a viable basis for future human studies looking at the efficacy of topical treatments for jellyfish stings.

    View details for Web of Science ID 000372379000006

  • Hydration Status as a Predictor of High-altitude Mountaineering Performance. Cureus Ladd, E., Shea, K. M., Bagley, P., Rundell, S., Auerbach, P. S., Pirrotta, E. A., Wang, E., Lipman, G. S. 2016; 8 (12)

    Abstract

    Hydration status is a controversial determinant of athletic performance. This relationship has not been examined with mountaineering performance.This was a prospective observational study of mountaineers who attempted to climb Denali in Alaska. Participants' urine specific gravity (SG), and ultrasound measurements of the inferior vena cava size and collapsibility index (IVC-CI) were measured at rest prior to ascent. Upon descent, climbers reported maximum elevation gained for determination of summit success.One hundred twenty-one participants enrolled in the study. Data were collected on 111 participants (92% response rate); of those, 105 (87%) had complete hydration data. Fifty-seven percent of study participants were found to be dehydrated by IVC-CI on ultrasound, and 55% by urine SG. No significant association was found with summit success and quantitative measurements of hydration: IVC-CI (50.4% +/- 15.6 vs. 52.9% +/- 15.4, p = 0.91), IVC size (0.96 cm +/- 0.3 vs. 0.99 cm +/- 0.3, p = 0.81), and average SG (1.02 +/- 0.008 vs. 1.02 +/- 0.008, p = 0.87). Categorical measurements of urine SG found 24% more successful summiters were hydrated at 14 Camp, but this was not found to be statistically significant (p = 0.56). Summit success was associated with greater water-carrying capacity on univariate analysis only: 2.3 L, 95% confidence interval (2.1 - 2.5) vs. 2.1 L, 95% confidence interval (2 - 2.2); p < 0.01.Intravascular dehydration was found in approximately half of technical high-altitude mountaineers. Hydration status was not significantly associated with summit success, but increased water-carrying capacity may be an easy and inexpensive educational intervention to improve performance.

    View details for DOI 10.7759/cureus.918

    View details for PubMedID 28083462

  • Failure of Real-time Passive Notification about Radiation Exposure to Influence Physician Ordering Behavior. Cure¯us Polen, L. A., Rossi, J. K., Berg, C. K., Balise, R. R., Herfkens, R. J., Auerbach, P. S. 2016; 8 (7)

    Abstract

    Objectives  To determine whether real-time passive notification of patient radiation exposure via a computerized physician order entry system would alter the number of computed tomography scans ordered by physicians in the Emergency Department (ED) setting. Methods  When a practitioner ordered a computed tomography scan, a passive notification was immediately and prominently displayed via the computerized physician order entry system. The notification stated the following: the amount of estimated radiation in millisieverts (mSv), the equivalent number of single-view chest radiographs, and equivalent days of average environmental background radiation to which a patient during a specific computed tomography scan would be exposed. The primary outcome was changed in the number of computed tomography scans ordered when comparing data collected before and after the addition of the notification. Results  Before the dosimetry notification ("intervention") was instituted, 1,747 computed tomography scans were performed on patients during 11,709 Emergency Department visits (14.9% computed tomography scan rate). After the intervention had been instituted, 1,827 computed tomography scans were performed on patients during 11,582 Emergency Department patient visits (15.8% computed tomography scan rate). No statistically significant difference was found for all chief complaints combined (p = 0.17), or for any individual chief complaint, between the number of computed tomography scans performed on Emergency Department patients before versus after the intervention. Conclusions  Passive real-time notification of patient radiation exposure displayed in a computerized physician order entry system at the time of computed tomography scan ordering in the Emergency Department did not significantly change the number of ordered scans.

    View details for DOI 10.7759/cureus.695

    View details for PubMedID 27570716

  • Extreme, expedition, and wilderness medicine LANCET Imray, C. H., Grocott, M. P., Wilson, M. H., Hughes, A., Auerbach, P. S. 2015; 386 (10012): 2520-2525

    Abstract

    Extreme, expedition, and wilderness medicine are modern and rapidly evolving specialties that address the spirit of adventure and exploration. The relevance of and interest in these specialties are changing rapidly to match the underlying activities, which include global exploration, adventure travel, and military deployments. Extreme, expedition, and wilderness medicine share themes of providing best available medical care in the outdoors, especially in austere or remote settings. Early clinical and logistics decision making can often have important effects on subsequent outcomes. There are lessons to be learned from out-of-hospital care, military medicine, humanitarian medicine, and disaster medicine that can inform in-hospital medicine, and vice-versa. The future of extreme, expedition, and wilderness medicine will be defined by both recipients and practitioners, and empirical observations will be transformed by evidence-based practice.

    View details for Web of Science ID 000366866400026

  • Hypothermia Evidence, Afterdrop, and Guidelines WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K., Giesbrecht, G. G., Danzl, D. F., Bragger, H., Sagalyn, E. B., Walpoth, B., Weiss, E. A., Auerbach, P. S., McIntosh, S. E., Nemethy, M., McDevitt, M., Dow, J., Schoene, R. B., Rodway, G. W., Hackett, P. H., Bennett, B. L., Grissom, C. K. 2015; 26 (3): 439–41

    View details for PubMedID 25840910

  • Preparedness explains some differences between Haiti and Nepal's response to earthquake BMJ-BRITISH MEDICAL JOURNAL Auerbach, P. S. 2015; 350: h3059

    View details for DOI 10.1136/bmj.h3059

    View details for Web of Science ID 000355920200004

    View details for PubMedID 26047830

  • Extreme, expedition, and wilderness medicine. Lancet (London, England) Imray, C. H., Grocott, M. P., Wilson, M. H., Hughes, A., Auerbach, P. S. 2015; 386 (10012): 2520–25

    Abstract

    Extreme, expedition, and wilderness medicine are modern and rapidly evolving specialties that address the spirit of adventure and exploration. The relevance of and interest in these specialties are changing rapidly to match the underlying activities, which include global exploration, adventure travel, and military deployments. Extreme, expedition, and wilderness medicine share themes of providing best available medical care in the outdoors, especially in austere or remote settings. Early clinical and logistics decision making can often have important effects on subsequent outcomes. There are lessons to be learned from out-of-hospital care, military medicine, humanitarian medicine, and disaster medicine that can inform in-hospital medicine, and vice-versa. The future of extreme, expedition, and wilderness medicine will be defined by both recipients and practitioners, and empirical observations will be transformed by evidence-based practice.

    View details for PubMedID 26738718

  • The 6-Minute Walk Test as a Predictor of Summit Success on Denali. Wilderness & environmental medicine Shea, K. M., Ladd, E. R., Lipman, G. S., Bagley, P., Pirrotta, E. A., Vongsachang, H., Wang, N. E., Auerbach, P. S. 2015

    Abstract

    To test whether the 6-minute walk test (6MWT), including postexercise vital sign measurements and distance walked, predicts summit success on Denali, AK.This was a prospective observational study of healthy volunteers between the ages of 18 and 65 years who had been at 4267 m for less than 24 hours on Denali. Physiologic measurements were made after the 6MWT. Subjects then attempted to summit at their own pace and, at the time of descent, completed a Lake Louise Acute Mountain Sickness Questionnaire and reported maximum elevation reached.One hundred twenty-one participants enrolled in the study. Data were collected on 111 subjects (92% response rate), of whom 60% summited. On univariate analysis, there was no association between any postexercise vital sign and summit success. Specifically, there was no significant difference in the mean postexercise peripheral oxygen saturation (Spo2) between summiters (75%) and nonsummiters (74%; 95% CI, -3 to 1; P = .37). The distance a subject walked in 6 minutes (6MWTD) was longer in summiters (617 m) compared with nonsummiters (560 m; 95% CI, 7.6 to 106; P = .02). However, this significance was not maintained on a multivariate analysis performed to control for age, sex, and guide status (P = .08), leading to the conclusion that 6MWTD was not a robust predictor of summit success.This study did not show a correlation between postexercise oxygen saturation or 6MWTD and summit success on Denali.

    View details for PubMedID 26712335

  • Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2014 update. Wilderness & environmental medicine Zafren, K., Giesbrecht, G. G., Danzl, D. F., Brugger, H., Sagalyn, E. B., Walpoth, B., Weiss, E. A., Auerbach, P. S., McIntosh, S. E., Némethy, M., McDevitt, M., Dow, J., Schoene, R. B., Rodway, G. W., Hackett, P. H., Bennett, B. L., Grissom, C. K. 2014; 25 (4): S66-85

    Abstract

    To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. This is an updated version of the original Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia published in Wilderness & Environmental Medicine 2014;25(4):425-445.

    View details for DOI 10.1016/j.wem.2014.10.010

    View details for PubMedID 25498264

  • Wilderness medical society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. 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. 2014; 25 (4): S4-S14

    Abstract

    To provide guidance to clinicians about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations about their role 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 prevention and management of each disorder that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in Wilderness & Environmental Medicine 2010;21(2):146-155.

    View details for DOI 10.1016/j.wem.2014.06.017

    View details for PubMedID 25498261

  • Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2014 Update. Wilderness & environmental medicine Zafren, K., Giesbrecht, G. G., Danzl, D. F., Brugger, H., Sagalyn, E. B., Walpoth, B., Weiss, E. A., Auerbach, P. S., McIntosh, S. E., Némethy, M., McDevitt, M., Dow, J., Schoene, R. B., Rodway, G. W., Hackett, P. H., Bennett, B. L., Grissom, C. K. 2014; 25 (4): S66-85

    View details for DOI 10.1016/j.wem.2014.10.010

    View details for PubMedID 25498264

  • Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. 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. 2014; 25 (4): S4-14

    Abstract

    To provide guidance to clinicians about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations about their role 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 prevention and management of each disorder that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in Wilderness & Environmental Medicine 2010;21(2):146-155.

    View details for DOI 10.1016/j.wem.2014.06.017

    View details for PubMedID 25498261

  • Wilderness medical society practice guidelines for the prevention and treatment of frostbite: 2014 update. Wilderness & environmental medicine McIntosh, S. E., Opacic, M., Freer, L., Grissom, C. K., Auerbach, P. S., Rodway, G. W., Cochran, A., Giesbrecht, G. G., McDevitt, M., Imray, C. H., Johnson, E. L., Dow, J., Hackett, P. H. 2014; 25 (4): S43-54

    Abstract

    The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the original guidelines published in Wilderness & Environmental Medicine 2011;22(2):156-166.

    View details for DOI 10.1016/j.wem.2014.09.001

    View details for PubMedID 25498262

  • Implementing an emergency medical services system in kathmandu, Nepal: a model for "white coat diplomacy". Wilderness & environmental medicine Walker, R., Auerbach, P. S., Kelley, B. V., Gongal, R., Amsalem, D., Mahadevan, S. 2014; 25 (3): 311-318

    Abstract

    Wilderness medicine providers often visit foreign lands, where they come in contact with medical situations that are representative of the prevailing healthcare issues in the host countries. The standards of care for matters of acute and chronic care, public health, and crisis intervention are often below those we consider to be modern and essential. Emergency medical services (EMS) is an essential public medical service that is often found to be underdeveloped. We describe our efforts to support development of an EMS system in the Kathmandu Valley of Nepal, including training the first-ever class of emergency medical technicians in that country. The purpose of this description is to assist others who might attempt similar efforts in other countries and to support the notion that an effective approach to improving foreign relations is assistance such as this, which may be considered a form of "white coat diplomacy."

    View details for DOI 10.1016/j.wem.2014.04.006

    View details for PubMedID 24954196

  • Migraine headache confounding the diagnosis of acute mountain sickness. Wilderness & environmental medicine Karle, F. J., Auerbach, P. S. 2014; 25 (1): 60-68

    Abstract

    A 36-year-old man with a history of migraine headache attempted to hike from Lukla, Nepal, to Mount Everest Base Camp. On the sixth day of hiking, he had a migraine headache. After achieving resolution with typical therapies and rest, he ascended higher. Another headache developed that was interpreted to be a migraine. The headache was treated, and he ascended higher, after which severe symptoms of acute mountain sickness developed, necessitating his evacuation by helicopter. Persons with headaches in daily life may present challenges to diagnosis when traveling to high altitude. Careful evaluation and decision making are needed to achieve proper diagnosis and treatment of acute mountain sickness.

    View details for DOI 10.1016/j.wem.2013.10.006

    View details for PubMedID 24462763

  • Core Content for Wilderness Medicine Fellowship Training of Emergency Medicine Graduates ACADEMIC EMERGENCY MEDICINE Lipman, G. S., Weichenthal, L., Harris, N. S., McIntosh, S. E., Cushing, T., Caudell, M. J., Macias, D. J., Weiss, E. A., Lemery, J., Ellis, M. A., Spano, S., McDevitt, M., Tedeschi, C., Dow, J., Mazzorana, V., McGinnis, H., Gardner, A. F., Auerbach, P. S. 2014; 21 (2): 204-207

    Abstract

    Wilderness medicine is the practice of resource-limited medicine under austere conditions. In 2003, the first wilderness medicine fellowship was established, and as of March 2013, a total of 12 wilderness medicine fellowships exist. In 2009 the American College of Emergency Physicians Wilderness Medicine Section created a Fellowship Subcommittee and Taskforce to bring together fellowship directors, associate directors, and other interested stakeholders to research and develop a standardized curriculum and core content for emergency medicine (EM)-based wilderness medicine fellowships. This paper describes the process and results of what became a 4-year project to articulate a standardized curriculum for wilderness medicine fellowships. The final product specifies the minimum core content that should be covered during a 1-year wilderness medicine fellowship. It also describes the structure, length, site, and program requirements for a wilderness medicine fellowship.

    View details for DOI 10.1111/acem.12304

    View details for PubMedID 24438590

  • Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia WILDERNESS & ENVIRONMENTAL MEDICINE Zafren, K., Giesbrecht, G. G., Danzl, D. F., Brugger, H., Sagalyn, E. B., Walpoth, B., Weiss, E. A., Auerbach, P. S., McIntosh, S. E., Nemethy, M., McDevitt, M., Dow, J., Schoene, R. B., Rodway, G. W., Hackett, P. H., Bennett, B. L., Grissom, C. K. 2014; 25 (4): 425-445

    Abstract

    To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations.

    View details for PubMedID 25443771

  • Embracing the wild Conceptualizing wilderness medicine in Canada CANADIAN FAMILY PHYSICIAN Curran-Sills, G., McDonald, N., Auerbach, P. S., Crutcher, R. 2013; 59 (5): 581–84

    View details for Web of Science ID 000319801100018

    View details for PubMedID 23673594

    View details for PubMedCentralID PMC3653663

  • In Reply to Evidence-Based Treatment of Jellyfish Stings in North America and Hawaii ANNALS OF EMERGENCY MEDICINE Auerbach, P. S. 2013; 61 (2): 253-254
  • Getting the evidence. The challenge of implementing evidence-based medicine in tough global environments. Health management technology Auerbach, P. S. 2012; 33 (12): 18-20

    View details for PubMedID 23301420

  • In Tribute to James A. Wilkerson III, MD WILDERNESS & ENVIRONMENTAL MEDICINE McIntosh, S. E., Gravatt, A. R., Giesbrecht, G., Auerbach, P. S., Erb, B. D., Forgey, W. W., Schoene, R. B., Grissom, C. K. 2012; 23 (3): 199–202

    View details for Web of Science ID 000308284600001

    View details for PubMedID 22835798

  • Prehospital Medical Care and the National Ski Patrol: How Does Outdoor Emergency Care Compare to Traditional EMS Training? WILDERNESS & ENVIRONMENTAL MEDICINE Constance, B. B., Auerbach, P. S., Johe, D. H. 2012; 23 (2): 177-189

    Abstract

    The purpose of this study was to identify the differences between the educational curricula, skill sets, and funds of knowledge required for certification as an Outdoor Emergency Care Technician (OEC-T), Emergency Medical Technician (EMT), and Emergency Medical Responder (EMR).We directly and in detail compared topics and skills presented in the OEC-T curriculum with those presented in the EMT and EMR education and training curricula.The information and skills taught in the OEC-T curriculum are in general more extensive than those taught in EMR training but are not equivalent to EMT. The OEC-T program has more depth in environmental medical issues, such as altitude illness, hyperthermia and hypothermia. Completion of the EMR program is 112 hours shorter and constitutes 30% of the duration of the EMT program. Completion of the OEC-T program (for certification only and not including additional "on-hill" patroller training) is 80 hours shorter and is half the duration of the EMT program.The OEC-T curriculum includes a skill set and fund of knowledge that exceeds those of the EMR program, but does not include all the knowledge needed for an EMT program. The OEC-T program prepares out-of-hospital providers to care for patients in the wilderness, with special emphasis on snowsports pathology. The EMT program places a greater emphasis on medical disease and emergency medication administration. These differences should be considered when determining staffing requirements for agencies caring for patients with snowsports pathology.

    View details for Web of Science ID 000305098100017

    View details for PubMedID 22656667

  • The expanded scope of emergency medical practice necessary for initial disaster response: lessons from Haiti. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals Menon, A. S., Norris, R. L., Racciopi, J., Tilson, H., Gardner, J., McAdoo, G., Brown, I. P., Auerbach, P. S. 2012; 12 (1): 31-36

    Abstract

    A team of emergency physicians and nurses from Stanford University responded to the devastating January 2010 earthquake in Haiti. Because of the extreme nature of the situation, combined with limited resources, the team provided not only acute medical and surgical care to critically injured and ill victims, but was required to uniquely expand its scope of practice. Using a narrative format and discussion, it is the purpose of this paper to highlight our experience in Haiti and use these to estimate some of the skills and capabilities that will be useful for physicians who respond to similar future disasters.

    View details for PubMedID 22427047

  • Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite WILDERNESS & ENVIRONMENTAL MEDICINE McIntosh, S. E., Hamonko, M., Freer, L., Grissom, C. K., Auerbach, P. S., Rodway, G. W., Cochran, A., Giesbrecht, G., McDevitt, M., Imray, C. H., Johnson, E., Dow, J., Hackett, P. H. 2011; 22 (2): 156-166

    Abstract

    The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens for each modality according to methodology stipulated by the American College of Chest Physicians.

    View details for Web of Science ID 000292013700012

    View details for PubMedID 21664561

  • 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

  • In Tribute to Charlie Houston WILDERNESS & ENVIRONMENTAL MEDICINE Rennie, D., Powers, P., Schoene, R. B., Hackett, P., Auerbach, P. S., Hornbein, T., Roach, R. C. 2010; 21 (2): 89-97

    View details for Web of Science ID 000279235900001

    View details for PubMedID 20591367

  • Environmental Education for Providers and Patients-What's a Doctor to Do? WILDERNESS & ENVIRONMENTAL MEDICINE Auerbach, P. S. 2009; 20 (3): 197-198

    View details for Web of Science ID 000270288800001

    View details for PubMedID 19737045

  • Physicians and environmental change - Reply JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Auerbach, P. S. 2008; 299 (24): 2856
  • Marine catfish sting causing fatal heart perforation in a fisherman WILDERNESS & ENVIRONMENTAL MEDICINE Haddad, V., de Souza, R. A., Auerbach, P. S. 2008; 19 (2): 114-118

    Abstract

    Many marine catfish have serrated bony stings ("spines"), which are used in defense against predators, on the dorsal and pectoral fins. While catfish-induced injuries are generally characterized by the pain associated with envenomation, the stings in some species are sufficiently long and sharp to cause severe penetrating trauma. Most injuries are to the hands of victims, commonly fishermen. We report the death of a fisherman caused by myocardial perforation from a catfish sting. To our knowledge, this is the first such description in the medical literature.

    View details for Web of Science ID 000256509600007

    View details for PubMedID 18513109

  • A Case of Elevated Liver Function Tests After Crown-of-Thorns (Acanthaster planci) Envenomation WILDERNESS & ENVIRONMENTAL MEDICINE Lin, B., Norris, R. L., Auerbach, P. S. 2008; 19 (4): 275-279

    Abstract

    The crown-of-thorns starfish (Acanthaster planci) inhabits coral reefs, largely throughout the Indo-Pacific region. Its dorsal surface is covered with stout thorn-like spines. When handled or stepped on by humans, the spines can puncture the skin, causing an immediate painful reaction, followed by inflammation and possible infection. Initial pain and swelling may last for days. Effects of envenomation on the liver have been demonstrated previously in animal models, but hepatic toxicity has not previously been described in humans. We describe elevated liver enzymes in a 19-year-old female associated with A planci spine puncture wounds. To our knowledge, this is the first documented report of transaminitis in a human after A planci envenomation.

    View details for PubMedID 19099322

  • The relevance and future of wilderness medicine. Travel medicine and infectious disease Auerbach, P. S. 2005; 3 (4): 179-182

    View details for PubMedID 17292036

  • Efficacy of a jellyfish sting jellyfish stings inhibitor in preventing jellyfish stings in normal volunteers 61st Meeting of the American-Academy-of-Dermatology Kimball, A. B., Arambula, K. Z., Stauffer, A. R., Levy, V., Davis, V. W., Liu, M., Rehmus, W. E., Lotan, A., Auerbach, P. S. ALLIANCE COMMUNICATIONS GROUP DIVISION ALLEN PRESS. 2004: 102–8

    Abstract

    To evaluate the protective effects of a jellyfish sting inhibitor formulated in sunscreen lotion vs conventional sunscreen against Chrysaora fuscescens and Chiropsalmus quadrumanus jellyfish.Twenty-four healthy subjects at 2 research sites were randomly assigned to receive the jellyfish sting inhibitor (Nidaria Technology Ltd, Jordan Valley, Israel) to one forearm and conventional sunscreen to the other arm in a blinded fashion. Subjects were stung with jellyfish tentacles on each forearm for up to 60 seconds. Erythema and pain were assessed at 15-minute intervals over a 2-hour period.In the C. fuscescens group, all 12 arms pretreated with conventional sunscreen demonstrated erythema, and all subjects noted subjective discomfort. In contrast, no arm pretreated with the jellyfish sting inhibitor had objective skin changes (P < .01). Two subjects noted minimal discomfort in the arm treated with the sting inhibitor (P < .01). In the C. quadrumanus group, discomfort was reported in 3 of the 12 inhibitor-treated arms compared with 10 of the 12 placebo-treated arms (P < .05). Erythema was noted on 1 arm treated with the inhibitor and 9 arms treated with the placebo (P < .01).The jellyfish sting inhibitor prevented sting symptoms of C. fuscescens jellyfish in 10 of 12 subjects and diminished the pain of the jellyfish sting in the remaining 2 subjects. The jellyfish sting inhibitor also inhibited the more severe sting of the C. quadrumanus jellyfish in the majority of subjects. The jellyfish sting inhibitor does not eliminate the sting from C. fuscescens or C. quadrumanus jellyfish but significantly reduces the frequency and severity of stings.

    View details for Web of Science ID 000222041200005

  • Environmental injuries - Foreword DM DISEASE-A-MONTH Leikin, J. B., Aks, S. E., Andrews, S., Auerbach, P. S., Cooper, M. A., Jacobsen, T. D., Krenzelok, E. P., Shicker, L., Wiener, S. L. 1997; 43 (12): 813-916