Wilderness and Rescue Medicine 8th Edition

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Section V: Environmental Medicine

should be reassuring that DEET has been exten- sively studied and found to be remarkably safe and effective in concentrations to the low 30% range. Some formulations use vehicles that are more resilient to the environment and allow for release over time, thus less likely to be absorbed and requiring fewer applications. The minimal risk in its use is well outweighed by the benefit of avoiding devastating diseases like filariasis, malaria, Lyme, babesiosis, West Nile, and dozens of others.

General Principles

Toxins and Envenomations High-Risk Problem : • Persistent shock, respiratory distress, altered mental status

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• Known dangerous exposure • High-risk wounds or burns

• Cannot maintain body core temperature • Cannot maintain hydration and calories • The patient is getting worse

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The same endorsement is warranted for Picaridin, which has been used extensively and safely throughout the world for the past three decades and is as effective as DEET in similar concentrations. Lemon/eucalyptus is listed by the United States CDC as an alternative, but is much less effective against mosquitoes, not proven against malaria vectors, and not effective against ticks.