Mental health response to acute stress following wilderness disaster.

Expedition physicians should be prepared to respond to traumatic stress disorders following wilderness disasters. Stress disorder symptoms include re-experiencing the traumatic event, avoiding stimuli associated with the traumatic event, and increased physical arousal. These symptoms can also be seen in healthy individuals, and should only lead to disorder diagnosis when they cause distress or impairment. Treatment options for stress disorders include observation, psychological interventions, and medication. Approximately half of those with diagnosable stress disorders will return to nondiagnosable status over time without therapeutic intervention. Psychological interventions with empirical support concentrate on providing either noninvasive support in the short term, such as psychological first aid (PFA), or more long-term controlled re-experiencing of the precipitating trauma, such as many exposure-based therapies. Exposure-based treatments can result in temporary increases in symptoms before long-term gains are realized, so they are not recommended for wilderness settings. Medications to treat stress disorders include benzodiazepines, propranolol, and antidepressant medications. Benzodiazepines are often carried in wilderness first aid kits, but they provide very limited stress disorder symptom relief. Propranolol is being explored as a method of preventing traumatic stress disorders, but the data are not currently conclusive. Antidepressant medications are a good long-term strategy for stress disorder treatment, but they are of limited utility in wilderness settings as they are unlikely to be included in expedition medical kits and require approximately 4 weeks of administration for symptom reduction. Recommendations for wilderness treatment of stress disorders focus on increasing knowledge of stress disorder diagnosis and PFA.