Patterns of Injuries and Illnesses in the Wilderness

As participants and health care providers, we are familiar with certain types of injuries and illnesses, such as animal bites, falls, drownings, frostbite, malaria, and so forth. Epidemiologists study the patterns of things, and so with a reasonable population size (in order to attain statistical significance, putting trust in the numbers), can offer us observations that might lead to methods of prevention and treatment. Since anecdotal opinions abound in medicine, and in particular, in wilderness medicine, it is very important to be fact-based when possible, so as to base recommendations upon real, verifiable, and reproducible data.

It is common to discuss incidence (of events) and risks associated with these events. For instance, how often do climbers fall? What happens when they fall? What injuries do they incur? What influences whether or not a climber will fall, and if a fall occurs, what influences the type and severity of injuries? Are certain climbing techniques or maneuvers more or less dangerous? What about the correlation with time of day, season, and weather conditions? Climber experience? You get the picture - determining what causes an event, and then determining what might prevent or mitigate the event are important factors in determing outcomes, and essential to the practice of medicine in the wilderness.

In the most recent issue (Volume 17, Number 3, 2006) of Wilderness & Environmental Medicine, the official journal of the Wilderness Medical Society, there are a few articles that approach some of these issues. In the article, "Pattern of Injury and Illness During Expedition-Length Adventure Races," Dr. Kyle McLaughlin and co-authors evaluated the 2003 Subaru Primal Quest Expedition Length Adventure Race held in Lake Tahoe, California. The event was held over 10 days, and generated 356 patient encounters and 406 illnesses and injuries. The most common problems were skin and soft tissue injuries, predominately blisters. I didn't find anything surprising or unexpected in this report, so the general recommendation to anticipate skin and soft tissue problems, minor orthopedic ailments (e.g., sprains and strains), and an assortment of other issues (bee sting, snake bite, diarrhea, upper respiratory infection, etc.) seems like common sense.

Another article in the same issue yielded a bit of a surprise for me. Entitled "Back Pain in Whitewater Rafting Guides," the article by David Jackson and co-authors was an attempt to quantify rates of back pain among whitewater guides and to look for correlations between the presence of back pain and specific activities associated with guiding. After evaluating 390 returned survey forms (of 2510 distributed), the authors concluded that the rates of back pain among whitewater rafting guides appeared to be similar to the general population. I would have expected a higher incidence of back pain, but perhaps the reason for this is that the guide population is younger (for sure) and in better shape (highly likely) than me! Events correlated with back pain in this analysis included stacking 5 or more inflated boats, as was loading and unloading rafts in general. No mention was made of prolonged periods in the sitting position, such as occurs during a long stretch of floating, but again, the respondents were presumably young and less commonly sufferers of chronic lumbar disk problems than older riders.

Although lifting techniques were not specifically studied, the authors offered suggestions for outfitters to decrease the incidence of back pain among their guides:

1. All guides be taught and reminded how to life heavy objects, including advice to utilize a deep knee bend, keep the weight close to the torso, minimize rotation or twisting while lifting, and conduct lifts with a controlled, measured pace.
2. Special attention should be paid to overhead lifts, with additional persons added to minimize the per-person load, and good communication emphasized.
3. When throwing rafts overhead, if the raft falls off the stack, all participants should get out of the way and let the raft fall to the ground, rather than trying to catch it.
4. Use a mechanical lift and hoist system if available.
5. Allow guides to take sufficient time off to rest during the rafting season, and in particular if they are suffering from back pain.

Two other articles of interest in the same issue are "Injuries at the 2005 World Championships in Rock Climbing" and "Spinal Injuries in Scottish Mountaineers."

Tags: injury prevention, illness prevention, whitewater, rafting, back pain, wilderness medicine, outdoor medicine, healthline

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