Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.See all posts »
Pediatric Wilderness Emergencies
These comments are based upon a presentation given at the Wilderness Medical Society Annual Meeting held in Snowmass, Colorado from July 24-29, 2009. The presentation was entitled “Pediatric Wilderness Emergencies.” It was delivered by Brian D. Clothier, MD, MS, who spoke as a Wilderness Medicine Fellow at the University of Utah.
Dr. Clothier began his session by commenting that there are plenty of places where one shouldn’t find children, but few places where they are not found. Outdoor enthusiasts are highly motivated about taking their children to the wild places of the world. For the definition of wilderness, he used “any place where resources are limited and transport times are long.”
Children are not just “little adults.” Their physiology and emotional makeup have them respond differently than do adults to environmental stressors, such as temperature, state of hydration, heat, cold, high altitude, and injuries. For example, in the heat, children (compared to adults) are less efficient at thermoregulation, because they have lower cardiac output (decreased ability to convey heat to the periphery for dissipation) and a larger relative surface area-to-volume ratio. For this reason, children might absorb more heat from sun exposure than adults.
Children are innately curious, yet inexperienced. This, combined with diminished judgment, puts them at higher risk of certain adverse events, particularly accidents. Male children are notoriously risk takers, particularly in their early teenage years. They will climb, jump, and dive into dangerous situations, and thus create tragic situations of catastrophic falls and drowning events. In part because of the frequency with which they pursue certain activities, and in part because of the opportunities of mishaps afforded by these activities, hiking, swimming, and river rafting can be risky situations. In accident analyses, it is distressing to see the association between death and lack of a personal flotation device or helmet.
Here are interesting observations:
- Being a male is more dangerous statistically than drinking alcohol (although drinking alcohol is not good).
- Infants do not die in the wilderness, but mobile independent four to five year olds do die.
- Adult supervision is important, but does not mitigate the need for protective devices. A moment’s lapse in observation leading to accident, or a quickly overturned boat in a swift water rapid, are two examples that highlight the need to assume that there will be situations in which a child may need to self rescue, or at least survive until help can arrive.
- Bodies of water pose a greater risk than do rock climbing, mountaineering, and other adventure activities.
- One cannot over-prepare for challenging situations and misfortune.
Dr. Clothier spoke of different concerns with different age groups. He made some excellent points about the risks associated with youth groups and camps, in which the predominant medical concerns are campfire burns, knife and hatchet injuries, drownings, infection control (e.g., diarrhea, respiratory, etc.—spread by communal living situations in which viruses and bacteria many spread, and in which good hygiene may not be practiced [an understatement…]), falls from heights, and lost persons (usually hikers).
Teenagers pose the additional complication of bravado—feeling a sense of immortality, they combine less experience with a desire to be unsupervised and flawed judgment. For instance, they may seek remote locations, such as in the wilderness, to engage in illicit substance use and to engage in unprotected sex. At all ages, kids will be kids, and we should constantly be on the lookout for ways to counsel and protect them.
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