Clinical Focus

  • Emergency Medicine

Academic Appointments

Administrative Appointments

  • Executive Board Member, American College of Emergency Physicians Section of Wilderness Medicine (2006 - 2014)
  • Editorial Board / Reviewer, Wilderness and Environmental Medicine (2004 - Present)
  • Director, Wilderness Medicine Fellowship (2015 - Present)
  • Director, ED Fast Track, Division of Emegency Medicine, Stanford University School of Medicine (2012 - Present)
  • Medical Director, Stanford Outdoor Education, Stanford University (2009 - Present)
  • Medical Advisor, California Outward Bound (2012 - Present)

Honors & Awards

  • Research Award, Wilderness Medical Society (2013)
  • 2014 ACEP Service to Section Award, American College of Emergency Physicians (2014)
  • Top 25 Papers of 2012 in Annals of Emergency Medicine, ScienceDirect (2013)
  • Best Research Presentation (Chemical Cold Packs for Hyperthermia), Wilderness Medical Society (2013)

Boards, Advisory Committees, Professional Organizations

  • Research Director, RacingThePlanet (2011 - Present)
  • Medical Advisory Board, RacingThePlanet (2011 - Present)

Professional Education

  • Medical Education:St Georges University School of Medicine Grenada West Indies (2001) NYWest Indies
  • Residency:St Luke's-Roosevelt Hospital Center/Columbia University College of Physicians and Surgeons (2002) NY
  • Board Certification: Emergency Medicine, American Board of Emergency Medicine (2005)
  • BA, Connecticut College, Environmental Studies (1995)
  • MD, St. George's School of Medicine, Medicine (2001)
  • Residency, St. Luke's -Roosevelt Hospital, Emergency Medicine (2004)
  • Fellow, Stanford University Hospital, Wilderness Medicine (2005)

Current Research and Scholarly Interests

Examination of novel devices and medications for the prevention of acute mountain sickness. Examination of epidemiology of injuries in ultra-marathon runners including, exercise-associated hyponatremia, hypernatremia, acute kidney injury (AKI), and blisters. Randomized trials on potential blister prevention techniques and a double-blind placebo controlled RCT examining the relationship between non-steroidal anti-inflammatories and AKI. Translational studies of novel interventions for cooling hyperthermia and warming hypothermia. Wilderness Medicine education and training.


2016 RacingThePlanet© Research Grant
RacingThePlanet© – Hong Kong

2015 AAC Research Grant
American Alpine Club

2015 Igor Gamow High Altitude Research Grant
Institute for Altitude Medicine, Telluride, CO

2015 RacingThePlanet© Research Grant
RacingThePlanet© – Hong Kong

2014 RacingThePlanet© Research Grant
RacingThePlanet© – Hong Kong

2013 WMS Research-In-Training Grant (SLEEP-AID)
Wilderness Medical Society

2013 RacingThePlanet© Research Grant
RacingThePlanet© – Hong Kong

2010 Emergency Medicine Research Grant
Division of Emergency Medicine, Stanford University School of Medicine

2017-18 Courses

All Publications

  • Paper Tape Prevents Foot Blisters: A Randomized Prevention Trial Assessing Paper Tape in Endurance Distances II (Pre-TAPED II). Clinical journal of sport medicine Lipman, G. S., Sharp, L. J., Christensen, M., Phillips, C., DiTullio, A., Dalton, A., Ng, P., Shangkuan, J., Shea, K., Krabak, B. J. 2016; 26 (5): 362-368


    To determine whether paper tape prevents foot blisters in multistage ultramarathon runners.Multisite prospective randomized trial.The 2014 250-km (155-mile) 6-stage RacingThePlanet ultramarathons in Jordan, Gobi, Madagascar, and Atacama Deserts.One hundred twenty-eight participants were enrolled: 19 (15%) from the Jordan, 35 (27%) from Gobi, 21 (16%) from Madagascar, and 53 (41%) from the Atacama Desert. The mean age was 39.3 years (22-63) and body mass index was 24.2 kg/m (17.4-35.1), with 31 (22.5%) females.Paper tape was applied to a randomly selected foot before the race, either to participants' blister-prone areas or randomly selected location if there was no blister history, with untaped areas of the same foot used as the control.Development of a blister anywhere on the study foot.One hundred six (83%) participants developed 117 blisters, with treatment success in 98 (77%) runners. Paper tape reduced blisters by 40% (P < 0.01, 95% confidence interval, 28-52) with a number needed to treat of 1.31. Most of the study participants had 1 blister (78%), with most common locations on the toes (n = 58, 50%) and heel (n = 27, 23%), with 94 (80%) blisters occurring by the end of stage 2. Treatment success was associated with earlier stages [odds ratio (OR), 74.9, P < 0.01] and time spent running (OR, 0.66, P = 0.01).Paper tape was found to prevent both the incidence and frequency of foot blisters in runners.

    View details for DOI 10.1097/JSM.0000000000000319

    View details for PubMedID 27070112

  • Wilderness medical society practice guidelines for the prevention and treatment of heat-related illness. Wilderness & environmental medicine Lipman, G. S., Eifling, K. P., Ellis, M. A., Gaudio, F. G., Otten, E. M., Grissom, C. K. 2013; 24 (4): 351-361


    The Wilderness Medical Society (WMS) convened an expert panel to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat-related illness. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures as well as best-practice recommendations for both field- and hospital-based therapeutic management of heat-related illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality.

    View details for DOI 10.1016/j.wem.2013.07.004

    View details for PubMedID 24140191

  • Ibuprofen Prevents Altitude Illness: A Randomized Controlled Trial for Prevention of Altitude Illness With Nonsteroidal Anti-inflammatories ANNALS OF EMERGENCY MEDICINE Lipman, G. S., Kanaan, N. C., Holck, P. S., Constance, B. B., Gertsch, J. H. 2012; 59 (6): 484-490


    Acute mountain sickness occurs in more than 25% of the tens of millions of people who travel to high altitude each year. Previous studies on chemoprophylaxis with nonsteroidal anti-inflammatory drugs are limited in their ability to determine efficacy. We compare ibuprofen versus placebo in the prevention of acute mountain sickness incidence and severity on ascent from low to high altitude.Healthy adult volunteers living at low altitude were randomized to ibuprofen 600 mg or placebo 3 times daily, starting 6 hours before ascent from 1,240 m (4,100 ft) to 3,810 m (12,570 ft) during July and August 2010 in the White Mountains of California. The main outcome measures were acute mountain sickness incidence and severity, measured by the Lake Louise Questionnaire acute mountain sickness score with a diagnosis of ≥ 3 with headache and 1 other symptom.Eighty-six participants completed the study; 44 (51%) received ibuprofen and 42 (49%) placebo. There were no differences in demographic characteristics between the 2 groups. Fewer participants in the ibuprofen group (43%) developed acute mountain sickness compared with those receiving placebo (69%) (odds ratio 0.3, 95% confidence interval 0.1 to 0.8; number needed to treat 3.9, 95% confidence interval 2 to 33). The acute mountain sickness severity was higher in the placebo group (4.4 [SD 2.6]) than individuals receiving ibuprofen (3.2 [SD 2.4]) (mean difference 0.9%; 95% confidence interval 0.3% to 3.0%).Compared with placebo, ibuprofen was effective in reducing the incidence of acute mountain sickness.

    View details for DOI 10.1016/j.annemergmed.2012.01.019

    View details for Web of Science ID 000305302300008

    View details for PubMedID 22440488

  • A Novel Cooling Method and Comparison of Active Rewarming of Mildly Hypothermic Subjects. Wilderness & environmental medicine Christensen, M. L., Lipman, G. S., Grahn, D. A., Shea, K. M., Einhorn, J., Heller, H. C. 2017


    To compare the effectiveness of arteriovenous anastomosis (AVA) vs heated intravenous fluid (IVF) rewarming in hypothermic subjects. Additionally, we sought to develop a novel method of hypothermia induction.Eight subjects underwent 3 cooling trials each to a core temperature of 34.8±0.6 (32.7 to 36.3°C [mean±SD with range]) by 14°C water immersion for 30 minutes, followed by walking on a treadmill for 5 minutes. Core temperatures (Δtes) and rates of cooling (°C/h) were measured. Participants were then rewarmed by 1) control: shivering only in a sleeping bag; 2) IVF: shivering in sleeping bag and infusion of 2 L normal saline warmed to 42°C at 77 mL/min; and 3) AVA: shivering in sleeping bag and circulation of 45°C warmed fluid through neoprene pads affixed to the palms and soles of the feet.Cold water immersion resulted in a decrease of 0.5±0.5°C Δtes and 1±0.3°C with exercise (P < .01); with an immersion cooling rate of 0.9±0.8°C/h vs 12.6±3.2°C/h with exercise (P < .001). Temperature nadir reached 35.0±0.5°C. There were no significant differences in rewarming rates between the 3 conditions (shivering: 1.3±0.7°C/h, R(2) = 0.683; IVF 1.3±0.7°C/h, R(2) = 0.863; and AVA 1.4±0.6°C/h, R(2) = 0.853; P = .58). Shivering inhibition was greater with AVA but was not significantly different (P = .07).This study developed a novel and efficient model of hypothermia induction through exercise-induced convective afterdrop. Although there was not a clear benefit in either of the 2 active rewarming methods, AVA rewarming showed a nonsignificant trend toward greater shivering inhibition, which may be optimized by an improved interface.

    View details for DOI 10.1016/j.wem.2017.02.009

    View details for PubMedID 28506514

  • Biochemistry in Endeavor Adventure Racers Study (BEARS). Cureus Wetschler, M., Radler, D., Christensen, M., Lipman, G. 2017; 9 (2)


     Adventure sports events consist of a combination of two or more endurance disciplines, such as orienteering, running, and rock climbing, that range from a day's to a week's duration. No studies have examined acute kidney injury (AKI) in adventure sports athletes.To describe the prevalence of AKI in participants in the Endeavor Team Challenge, a 30-hour, 40-mile adventure race.In this prospective observational study, body weights were recorded at race registration. At the finish line, blood sample results by point-of-care testing and weights were recorded. Changes in serum creatinine (Cr) from an estimated baseline value and severity of AKI were calculated, with "risk of injury" defined as 1.5 x baseline Cr, and "injury" defined as 2 x baseline Cr. These two categories of AKI were combined to calculate the total prevalence.  Results: There were 88 enrolled study participants with complete data available on 46 (52%). The mean age of those enrolled in the study was 36.8 years (+/- 7.7), 90% were males, and body mass index (BMI) was 25.7 kg/m(2) (+/- 2.4). Of the competitors who completed the study, 34 (73%) had some degree of AKI, with 27 (58%) found to be at "risk" and seven (15%) with "injury". There was a significant correlation between weight loss and elevated Cr (r = -0.29, p = 0.047), with a trend towards nonsteroidal anti-inflammatory drug (NSAID) use being correlated with AKI (p = 0.058). Acute kidney injury was observed in the majority of the Endeavor Team Challenge adventure racers, similar to what has been observed in multistage ultramarathons, and greater than after standard marathons and single-stage ultramarathons.

    View details for DOI 10.7759/cureus.1024

    View details for PubMedID 28348942

  • Incidence and Prevalence of Acute Kidney Injury During Multistage Ultramarathons CLINICAL JOURNAL OF SPORT MEDICINE Lipman, G. S., Krabak, B. J., Rundell, S. D., Shea, K. M., Badowski, N., Little, C. 2016; 26 (4): 314-319


    Determine prevalence, incidence, and risk factors of acute kidney injury (AKI) during multistage ultramarathons.Prospective observational cohort study.Jordanian Desert 2012; Atacama Desert, Chile 2012 and 2013; and Gobi Desert 2013 RacingThePlanet 250 km, 6-stage, ultramarathons.One hundred twenty-eight participants (384 measurements) from the Jordan (25, 19.5%), Gobi (35, 27.3%), 2012 Atacama (24, 18.8%), and 2013 Atacama (44, 34.4%) races.Blood samples and weights were gathered and analyzed immediately after stage 1 (40 km), 3 (120 km), and 5 (225 km).Changes in serum creatinine (Cr), cumulative incidence, and prevalence of AKI were calculated for each stage with "risk of injury" defined as 1.5 × baseline Cr and "injury" defined as 2 × Cr.Cumulative incidence of AKI was 41.4%. Stage 1 had 56 (43.8%) with risk of AKI and 24 (18.8%) with injury; in stage 3, 61 (47.7%) were at risk, 41 (32%) had injury; in stage 5, 62 (48.4%) runners were at risk and 36 (28.1%) had injury. Acute kidney injury was significantly associated with females [odds ratio (OR), 4.64; 95% confidence interval (CI), 2.07-10.37; P < 0.001], lower pack weight (OR, 0.71; 95% CI, 0.56-0.91; P < 0.007), and percentage weight loss (OR, 0.87; 95% CI, 0.78-0.97; P < 0.015). Lowest quintile of finishers was less likely to develop AKI (OR, 0.18; 95% CI, 0.04-0.78; P < 0.022).Prevalence of AKI was 63%-78% during multistage ultramarathons. Female sex, lower pack weight, and greater weight loss were associated with renal impairment.

    View details for DOI 10.1097/JSM.0000000000000253

    View details for Web of Science ID 000379438300009

    View details for PubMedID 26513390

  • 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


    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

  • Reply. Journal of ultrasound in medicine Kanaan, N. C., Lipman, G. S., Constance, B. B., Holck, P. S., Preuss, J. F., Williams, S. R. 2016; 35 (2): 458-459

    View details for DOI 10.7863/ultra.15.11073

    View details for PubMedID 26795049

  • Reply. Journal of ultrasound in medicine Kanaan, N. C., Lipman, G. S., Constance, B. B., Holck, P. S., Preuss, J. F., Williams, S. R. 2016; 35 (2): 456-457

    View details for DOI 10.7863/ultra.15.10050

    View details for PubMedID 26795047

  • 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)


    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

    View details for PubMedCentralID PMC5218879

  • Optic Nerve Sheath Diameter Increase on Ascent to High Altitude Correlation With Acute Mountain Sickness JOURNAL OF ULTRASOUND IN MEDICINE Kanaan, N. C., Lipman, G. S., Constance, B. B., Hoick, P. S., Preuss, J. F., Williams, S. R. 2015; 34 (9): 1677-1682
  • A Chemical Heat Pack-Based Method For Consistent Heating of Intravenous Fluids WILDERNESS & ENVIRONMENTAL MEDICINE Declerck, M. P., Lipman, G. S., Grahn, D. A., Cao, V., Wieland, M., Troxel, T., Heller, H. C. 2015; 26 (3): 412-416
  • Novel Application of Chemical Cold Packs for Treatment of Exercise-Induced Hyperthermia: A Randomized Controlled Trial WILDERNESS & ENVIRONMENTAL MEDICINE Lissoway, J. B., Lipman, G. S., Grahn, D. A., Cao, V. H., Shaheen, M., Phan, S., Weiss, E. A., Heller, H. C. 2015; 26 (2): 173-179


    Heat-related illness is a common disease with significant morbidity and mortality. Despite no proven efficacy, application of chemical cold packs (CCP) to the skin overlying the large vessels of the neck, groin, and axillae is a traditional recommended cooling modality. The study objective was to compare the cooling rates of CCP applied to these traditional areas vs the glabrous skin surfaces of the cheeks, palms, and soles in exercise-induced hyperthermia.Ten healthy adult male volunteers walked on a treadmill in a heated room (40°±0.5°C) while wearing insulated military overgarments until their esophageal temperatures (Tes) reached 39.2°C. Each participant had three heat stress trials on separate days: no treatment followed by randomly ordered traditional (neck, groin, and axillae) cooling and glabrous skin cooling.With no treatment, Tes remained stable after the first 5 minutes of the heat trial (ΔTes=0.12°±0.07°C/10 min). Traditional cooling followed a linear decline (ΔTes=0.17°±0.04°C/10 min; P<.001). Glabrous cooling enhanced the treatment effect by a steeper decline (ΔTes=0.30°±0.06°C/10 min; P<.001), significantly different from traditional cooling by 2-way analysis of variance (P<.001).Application of CCP to glabrous skin surfaces was more effective for treating exercise-induced heat stress than the traditional CCP cooling intervention. This novel cooling technique may be beneficial as an adjunctive treatment for heat-related illness in the prehospital environment.

    View details for Web of Science ID 000355778900009

    View details for PubMedID 25771030

  • Blisters: the enemy of the feet. Wilderness & environmental medicine Lipman, G. S., Scheer, B. V. 2015; 26 (2): 275-276

    View details for DOI 10.1016/j.wem.2014.11.003

    View details for PubMedID 25747539

  • Study Looking at End Expiratory Pressure for Altitude Illness Decrease (SLEEP-AID) HIGH ALTITUDE MEDICINE & BIOLOGY Lipman, G. S., Kanaan, N. C., Phillips, C., Pomeranz, D., Cain, P., Fontes, K., Higbee, B., Meyer, C., Shaheen, M., Wentworth, S., Walsh, D. 2015; 16 (2): 154-161


    Lipman, Grant S., Nicholas C. Kanaan, Caleb Phillips, Dave Pomeranz, Patrick Cain, Kristin Fontes, Becky Higbee, Carolyn Meyer, Michael Shaheen, Sean Wentworth, and Diane Walsh. Study Looking at End Expiratory Pressure for Altitude Illness Decrease (SLEEP-AID). High Alt Med Biol 16:154-161, 2015.-Acute mountain sickness (AMS) affects 25%-70% of the tens of millions of high altitude travelers annually, with hypoxia and nocturnal desaturations as major contributing factors. This is the first double blind randomized placebo controlled trial to assess expiratory positive airway pressure (EPAP) for AMS prevention and nocturnal hypoxic events. Healthy adult participants trekking in the Khumbu region of the Himalayas were randomized to a single-use EPAP nasal strip, or a visually identical sham device (placebo) prior to first night sleeping between 4371-4530 m (14,340-14,800 ft). The primary outcome was AMS incidence, measured by Lake Louise Questionnaire (LLQ), with secondary outcomes of AMS severity (by LLQ) and physiologic sleep indices measured by continuous sleep monitor. Intent-to-treat analysis included 219 participants with comparable demographic characteristics, of which 115 received EPAP and 104 placebo. There was no decrease in AMS with EPAP intervention (14% EPAP vs. 17% placebo; p=0.65; risk difference (-)3.15%, 95% CI (-)12.85%-6.56%). While overall AMS severity was not different between groups, EPAP reported decreased incidence of headache (64% vs. 76%; p<0.05, OR 0.51, 95% CI 0.27-0.95) and dizziness (81% vs. 98%; p<0.03, OR 0.29, 95% CI 0.09-0.78). During sleep, EPAP resulted in significant improvements in average peripheral oxygenation (Spo2) (80% versus 78%; p<0.01, mean difference=2, 95% CI 0.58-3.63) and a reduced percentage of time below 80% Spo2 (31% vs. 46%; p<0.03, median difference=16, 95% CI 2.22-28.18). This lightweight and inexpensive EPAP device did not prevent acute mountain sickness, but did reduce the subgroup incidence of headache and dizziness while improving average nighttime peripheral oxygenation.

    View details for DOI 10.1089/ham.2014.1110

    View details for Web of Science ID 000363902400011

    View details for PubMedID 25950723

  • Correct wilderness medicine definitions and their impact on care. Sports medicine Lipman, G. S. 2015; 45 (4): 601-602

    View details for DOI 10.1007/s40279-014-0294-3

    View details for PubMedID 25520160

  • In response to: Canadian Academy of Sport and Exercise Medicine position statement: athletes at high altitude. Clinical journal of sport medicine Lipman, G. S., Kanaan, N. C. 2015; 25 (2): 173-?

    View details for DOI 10.1097/JSM.0000000000000156

    View details for PubMedID 25714259

  • Effect of an emergency department fast track on press-ganey patient satisfaction scores. The western journal of emergency medicine Hwang, C. E., Lipman, G. S., Kane, M. 2015; 16 (1): 34-38


    Mandated patient surveys have become an integral part of Medicare remuneration, putting hundreds of millions of dollars in funding at risk. The Centers for Medicare & Medicaid Services (CMS) recently announced a patient experience survey for the emergency department (ED). Development of an ED Fast Track, where lower acuity patients are rapidly seen, has been shown to improve many of the metrics that CMS examines. This is the first study examining if ED Fast Track implementation affects Press-Ganey scores of patient satisfaction.We analyzed returned Press-Ganey questionnaires from all ESI 4 and 5 patients seen 11AM - 1PM, August-December 2011 (pre-fast track), and during the identical hours of fast track, August-December 2012. Raw ordinal scores were converted to continuous scores for paired student t-test analysis. We calculated an odds ratio with 100% satisfaction considered a positive response.An academic ED with 52,000 annual visits had 140 pre-fast track and 85 fast track respondents. Implementation of a fast track significantly increased patient satisfaction with the following: wait times (68% satisfaction to 88%, OR 4.13, 95% CI [2.32-7.33]), doctor courtesy (90% to 95%, OR 1.97, 95% CI [1.04-3.73]), nurse courtesy (87% to 95%, OR 2.75, 95% CI [1.46-5.15]), pain control (79% to 87%, OR 2.13, 95% CI [1.16-3.92]), likelihood to recommend (81% to 90%, OR 2.62, 95% CI [1.42-4.83]), staff caring (82% to 91%, OR 2.82, 95% CI [1.54-5.19]), and staying informed about delays (66% to 83%, OR 3.00, 95% CI [1.65-5.44]).Implementation of an ED Fast Track more than doubled the odds of significant improvements in Press-Ganey patient satisfaction metrics and may play an important role in improving ED performance on CMS benchmarks.

    View details for DOI 10.5811/westjem.2014.11.21768

    View details for PubMedID 25671005

  • Wilderness medical society practice guidelines for the prevention and treatment of heat-related illness: 2014 update. Wilderness & environmental medicine Lipman, G. S., Eifling, K. P., Ellis, M. A., Gaudio, F. G., Otten, E. M., Grissom, C. K. 2014; 25 (4): S55-65


    The Wilderness Medical Society (WMS) convened an expert panel to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures as well as best practice recommendations for both field and hospital-based therapeutic management of heat illness. 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. This is an updated version of the original WMS Practice Guidelines for the Prevention and Treatment of Heat-Related Illness published in Wilderness & Environmental Medicine 2013;24(4):351-361.

    View details for DOI 10.1016/j.wem.2014.07.017

    View details for PubMedID 25498263

  • Evaluation and Treatment of Injury and Illness in the Ultramarathon Athlete PHYSICAL MEDICINE AND REHABILITATION CLINICS OF NORTH AMERICA Krabak, B. J., Waite, B., Lipman, G. 2014; 25 (4): 845-?
  • Evaluation and treatment of injury and illness in the ultramarathon athlete. Physical medicine and rehabilitation clinics of North America Krabak, B. J., Waite, B., Lipman, G. 2014; 25 (4): 845-863


    Participation in ultramarathon races and knowledge of these athletes continues to increase as the sport becomes more popular. Physicians and athletes need to better understand the impact of the unique aspects of ultramarathon races, such as race environment (temperature, humidity, and altitude), race distance, race stages, nutritional requirements and equipment, on athlete injuries and illness. Proper treatment of injuries and illnesses during an ultramarathon race is important for avoiding long-term medical issues. In this article, the evaluation and treatment of common musculoskeletal injuries and medical illnesses in ultramarathon runners are reviewed.

    View details for DOI 10.1016/j.pmr.2014.06.006

    View details for PubMedID 25442162

  • Medical Services at Ultra-Endurance Foot Races in Remote Environments: Medical Issues and Consensus Guidelines SPORTS MEDICINE Hoffman, M. D., Pasternak, A., Rogers, I. R., Khodaee, M., Hill, J. C., Townes, D. A., Scheer, B. V., Krabak, B. J., Basset, P., Lipman, G. S. 2014; 44 (8): 1055-1069


    An increasing participation in ultra-endurance foot races is cause for greater need to ensure the presence of appropriate medical care at these events. Unique medical challenges result from the extreme physical demands these events place on participants, the often remote settings spanning broad geographical areas, and the potential for extremes in weather conditions and various environmental hazards. Medical issues in these events can adversely affect race performance, and there is the potential for the presentation of life-threatening issues such as exercise-associated hyponatremia, severe altitude illnesses, and major trauma from falls or animal attacks. Organization of a medical support system for ultra-endurance foot races starts with a determination of the level of medical support that is appropriate and feasible for the event. Once that is defined, various legal considerations and organizational issues must be addressed, and medical guidelines and protocols should be developed. While there is no specific or universal standard of medical care for ultra-endurance foot races since a variety of factors determine the level and type of medical services that are appropriate and feasible, the minimum level of services that each event should have in place is a plan for emergency transport of injured or ill participants, pacers, spectators and event personnel to local medical facilities.

    View details for DOI 10.1007/s40279-014-0189-3

    View details for Web of Science ID 000344973900003

    View details for PubMedID 24748459

  • Keeping a broad perspective: Reply regarding the Wilderness Medical Society practice guidelines for the prevention and treatment of heat-related illness. Wilderness & environmental medicine Lipman, G. S., Eifling, K. P., Ellis, M. A., Gaudio, F. G., Otten, E. M., Grissom, C. K. 2014; 25 (2): 251-252

    View details for DOI 10.1016/j.wem.2014.02.004

    View details for PubMedID 24656907

  • The importance of keeping cool: Reply regarding the Wilderness Medical Society practice guidelines for the prevention and treatment of heat-related illness. Wilderness & environmental medicine Lipman, G. S., Eifling, K. P., Ellis, M. A., Gaudio, F. G., Otten, E. M., Grissom, C. K. 2014; 25 (2): 247-249

    View details for DOI 10.1016/j.wem.2014.01.019

    View details for PubMedID 24864070

  • 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


    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 Web of Science ID 000331297500013

    View details for PubMedID 24438590

  • A Prospective Cohort Study of Acute Kidney Injury in Multi-stage Ultramarathon Runners: The Biochemistry in Endurance Runner Study (BIERS). Research in sports medicine Lipman, G. S., Krabak, B. J., Waite, B. L., Logan, S. B., Menon, A., Chan, G. K. 2014; 22 (2): 185-192


    The purpose of the study was to evaluate the prevalence of acute kidney injury (AKI) during a multi-stage ultramarathon foot race. A prospective observational study was taken during the Gobi 2008; Sahara 2008; and Namibia 2009 RacingThePlanet 7-day, 6-stage, 150-mile foot ultramarathons. Blood was analyzed before, and immediately after stage 1 (25 miles), 3 (75 miles), and 5 (140 miles). Creatinine (Cr), glomerular filtration rate (GFR), and incidence of AKI were calculated and defined by RIFLE criteria. Thirty participants (76% male, mean age 40 + 11 years) were enrolled. There were significant declines in GFR after each stage compared with the pre-race baseline (p < 0.001), with the majority of participants (55-80%) incurring AKI. The majority of study participants encountered significant renal impairment; however, no apparent cumulative effect was observed, with resolution of renal function to near baseline levels between stages.

    View details for DOI 10.1080/15438627.2014.881824

    View details for PubMedID 24650338

  • A Prospective Randomized Blister Prevention Trial Assessing Paper Tape in Endurance Distances (Pre-TAPED) WILDERNESS & ENVIRONMENTAL MEDICINE Lipman, G. S., Ellis, M. A., Lewis, E. J., Waite, B. L., Lissoway, J., Chan, G. K., Krabak, B. J. 2014; 25 (4): 457-461


    Friction foot blisters are a common injury occurring in up to 39% of marathoners, the most common injury in adventure racing, and represent more than 70% of medical visits in multi-stage ultramarathons. The goal of the study was to determine whether paper tape could prevent foot blisters in ultramarathon runners.This prospective randomized trial was undertaken during RacingThePlanet 155-mile (250-km), 7-day self-supported ultramarathons in China, Australia, Egypt, Chile, and Nepal in 2010 and 2011. Paper tape was applied prerace to one randomly selected foot, with the untreated foot acting as the own control. The study end point was development of a hot spot or blister on any location of either foot.One hundred thirty-six participants were enrolled with 90 (66%) having completed data for analysis. There were 36% women, with a mean age of 40 ± 9.4 years (range, 25-40 years) and pack weight of 11 ± 1.8 kg (range, 8-16 kg). All participants developed blisters, with 89% occurring by day 2 and 59% located on the toes. No protective effect was observed by the intervention (47 versus 35; 52% versus 39%; P = .22), with fewer blisters occurring around the tape on the experimental foot than under the tape (23 vs 31; 25.6% versus 34.4%), yet 84% of study participants when queried would choose paper tape for blister prevention in the future.Although paper tape was not found to be significantly protective against blisters, the intervention was well tolerated with high user satisfaction.

    View details for Web of Science ID 000346895300013

    View details for PubMedID 25443754

  • Clinical practice guidelines for treatment of exercise-associated hyponatremia. Wilderness & environmental medicine Lipman, G. S. 2013; 24 (4): 466-468

    View details for DOI 10.1016/j.wem.2013.05.002

    View details for PubMedID 23954253

  • Ibuprofen for prevention of acute mountain sickness: is bigger really better? Wilderness & environmental medicine Lipman, G. S., Kanaan, N. C. 2013; 24 (2): 177-178

    View details for DOI 10.1016/j.wem.2012.11.007

    View details for PubMedID 23434167

  • Injury and illnesses prevention for ultramarathoners. Current sports medicine reports Krabak, B. J., Waite, B., Lipman, G. 2013; 12 (3): 183-189


    The popularity of ultramarathon races continue to grow with runners participating in races throughout the world. These events offer challenges unique to an ultramarathon compared to a marathon race. These challenges require the athlete to focus on factors including race distance, race stages, race environment (temperature, humidity, and altitude), appropriate training, nutritional preparation, and equipment. Athletes ill prepared for these challenges will be at risk from injury and illness. The goal of this article is to review preventive strategies for managing commonly encountered musculoskeletal injuries and medical illnesses in ultramarathon runners.

    View details for DOI 10.1249/JSR.0b013e3182913c98

    View details for PubMedID 23669089

  • Chemical Cold Packs May Provide Insufficient Enthalpy Change for Treatment of Hyperthermia WILDERNESS & ENVIRONMENTAL MEDICINE Phan, S., Lissoway, J., Lipman, G. S. 2013; 24 (1): 37-41


    Heat illness is a common ailment that, if left untreated, is associated with high morbidity and mortality. Chemical cold packs (CCPs) and ice packs are widely used in the pre-hospital setting and by those with limited resources, yet no controlled studies have compared the cooling of ice to that of CCPs. This study determined the theoretical cooling of CCPs on a benchtop model, comparing the results to similarly sized ice packs, and is the first known comparison of these hyperthermia treatments.The CCPs used in Stanford University's Emergency Department were activated in an insulated volume of water (2 L), and temperature was recorded at 1-second intervals in a controlled environment (41°C at 20% humidity). The procedure was repeated with 1-quart ice packs.The CCPs resulted in a 5.25°C degree temperature drop, with a time constant (time to 63% of initial temperature--a common engineering characterization metric) of 1.72 minutes for the test volume. Ice packs resulted on average in a 19.8°C temperature change, with a time constant of 26.8 minutes. The CCPs provide less overall temperature change and were shorter lived. Application of 6 CCPs on a 50th percentile male (weight 86.6 kg, height 1.7 m), assuming ideal heat transfer, would result in less than 0.5°C temperature change. Similarly configured ice packs would result in a 2.5°C change.Experiments demonstrate that CCPs are inferior to similarly sized ice packs for thermal regulation, and lose their effectiveness more quickly. These findings support the consideration of ice packs as an alternative to chemical cold packs when cooling hyperthermic patients.

    View details for Web of Science ID 000315473300010

    View details for PubMedID 23312558

  • Pharmacologic Prevention for Acute Mountain Sickness-Lack of Appropriate Inclusion of the Available Evidence ANNALS OF EMERGENCY MEDICINE Lipman, G. S., Gertsch, J. H. 2012; 60 (4): 538-539
  • Optic Nerve Sheath Diameter Changes on Ascent to High Altitude Annual Research Forum of the American-College-of-Emergency-Physicians LIPMAN, G. S., Kanaan, N., Constance, B., Holck, P., Grimm, E., Jeffrey, G., Williams, S. MOSBY-ELSEVIER. 2011: S185–S186
  • 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


    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

  • Possible Unilateral Ultraviolet Keratoconjunctivitis During an Expedition-Length Desert Race WILDERNESS & ENVIRONMENTAL MEDICINE Lipman, G. S., Constance, B. B., Ladbrook, M. 2010; 21 (2): 171-172

    View details for Web of Science ID 000279235900017

    View details for PubMedID 20591383

  • Carbon monoxide toxicity at high altitude WILDERNESS & ENVIRONMENTAL MEDICINE Lipman, G. S. 2006; 17 (2): 144-145

    View details for Web of Science ID 000238243900013

    View details for PubMedID 16805152

  • Survival rates and cardiopulmonary resuscitation CRITICAL CARE MEDICINE Borzotta, A., Lipman, G., Dunn, P. M. 1998; 26 (7): 1293-1294

    View details for Web of Science ID 000074755500036

    View details for PubMedID 9671386