Most sections of this book are of an excellent standard while others are inadequate and disappointing. I think this may reflect some uncertainty about the purpose of the book, which to my mind has not had enough thought put into who will use it, why and how.

The bulk of the book covers important topics in toxicology and toxinology. These sections are well prepared and will undoubtedly be very useful for practising clinicians like me, who rarely deal with such cases.

The book starts with an excellent section on resuscitation which underpins most of the other emergency medicine topics. However, given the book includes 'wilderness topics', it would have been helpful to include the role of cardiopulmonary resuscitation (CPR) and how it differs in hypothermia, near drowning and electrical injury compared to the standard cardiac arrest situations.

While the chapter on burns is excellent, anaphylaxis is probably too detailed and makes the book look unbalanced given the inadequate coverage of some of the other environmental topics.

The section on altitude illness is so short as to be almost useless. It does not correctly describe the diagnostic criteria for acute mountain sickness, and confusingly, and perhaps dangerously, lumps this common and benign condition together with two less common and deadly ones. The section on prevention is overly brief and contains recommendations for ascent rates that do not comply with internationally accepted standards.

The information on diving medicine and heat-related illness are so short they could only be interpreted by clinicians who understand the topic.

The chapter on hypothermia is again so short that it lacks clarity and accuracy. It misses out critical management issues such as clinical assessment, gentle handling of patients and the role of CPR. The treatment algorithm is too simplified.

This book should cover common wilderness topics such as motion sickness, carbon monoxide poisoning, evacuation and long-term patient care, non-freezing cold injury, frostbite and avalanche rescue medicine. The focus should be as much on prevention as it is on treatment in the emergency situation.

My recommendation for the prospective purchaser is to read the book for its excellent toxicology and toxinology sections. If you want something to cover 'wilderness' topics, I suggest Auerbach's Field Guide to Wilderness Medicine, or the new Oxford Handbook of Expedition Medicine.

Edi Albert

Senior Medical Educator and Co-ordinator, Expedition Medicine Program, General Practice Training Tasmania

Medical Officer, Polar Medicine Unit, Australian Antarctic Division

Medical Officer, Department of Emergency Medicine, Hobart Private Hospital, Hobart