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Medicine for the Outdoors

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.

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Farewell to Outdoor Falls

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There is an increasing body of literature related to fall(s) prevention as a significant factor in reducing injuries in the home, particularly in the elder population. A recent article in the New England Journal of Medicine presented the conclusion that if older persons, their physicians, and others in the healthcare community were taught strategies for keeping old folks on their feet, that serious fall-related injuries were decreased. The techniques used included seminars, education of primary healthcare providers, recruitment of opinion leaders to influence colleagues, as well as posters, brochures, and advertising in various media.

Falls are a significant cause of serious injury and death among elders in the home in the U.S. Each year, an estimated one third of Americans aged 65 and older experience a fall, and nearly one third of those who fall sustain injuries that require medical attention. Based upon studies and intervention programs enacted in the urban environment, specialists believe that these numbers can be improved, perhaps by more than 10 percent. The focus is upon identifying persons at risk, and using a combination of education, surveillance, and in-home intervention to make improvements that might prevent a fall. The programs require participation by healthcare providers, to both identify potential beneficiaries and to reinforce the most important aspects of the programs.

But what about the outdoor environment? What about younger populations? What can be done to diminish the incidence of falls outside of the home? There is not the same attention focused on outside falls, and nothing approaching the programmatic support current directed at the senior population.

Consider the following tragic story:

"A 44-year-old Texas man plunged some 1,000 feet and instantly died while descending Crestone Needle, known for its steep and treacherous terrain. He was scrambling down a 14,197-foot peak in the Sangre de Cristo wilderness Friday afternoon when it is believed he took a wrong turn in the fog and fell. Authorities say he died immediately. Local authorities were alerted to the missing hiker after his hiking partner reported that he had not returned to base camp by nightfall. According to local reports, the hiking partner experienced altitude sickness while the two were ascending the trail, so the deceased decided to continue on his own. He later met up with two other hikers and the three reached the summit. The two hikers left him to descend on his own. His body was found on the edge of the mountain."

Such stories are all too common. Mountaineers fall from precarious ledges, youths fall from slippery rocks near the edges of waterfalls, rock climbers fall off boulders, and hikers get dangerously close to the edge of poorly maintained trails, from which they plunge into canyons.

We can accomplish it in the home. We ought to be able to accomplish it outdoors.

In The New Old Age blog, Jane Gross wrote that "four organizations -- the University of Southern California, the federal Veteran's Administration, the University of California, Los Angeles, and California State University, Fullerton -- have joined forces to create and evaluate model fall prevention programs that could be replicated at reasonable cost in community settings like senior centers." Experts say that "effective fall prevention requires three elements, which the Southern California research consortium is attempting to evaluate more closely: a physical examination and risk assessment conducted by a doctor or other medical professional, a progressive exercise regime implemented by a physical therapist, and an analysis and remediation of potential hazards in the home conducted by an occupational therapist."

The analogy from the home of an elder to the precarious setting on a mountainside or treetop is not one to one, but still, many of the principles are the same. So, pending some meaningful epidemiology and analysis of intervention programs, here are my recommendations for preventing falls in outdoor settings:

1. Heed all posted warning signs.
2. Stay on posted tracks and trails, and travel at a safe speed.
3. Wear properly fitted footwear appropriate for the situation.
4. Do not ingest alcohol or use mind-altering substances in situations of risk for falls. This includes prescription medications.
5. "Rope up" or otherwise connect yourself to a person or object intended to arrest a fall.
6. Avoid traveling in the dark if you will be in rocky or steep terrain. Always wear a headlamp or carry a lantern, torch, or flashlight.
7. Postpone travel during adverse weather conditions.
8. Rest when you are tired.
9. Condition yourself to improve balance. Keep your muscles strong, but maintain flexibility.
10. Wear appropriate vision correction.
11. Use a walking stick.
12. When handrails, or guide ropes or wires are available, hold onto them.
13. Do not ski recklessly.
14. Stay well hydrated.
15. Pay attention to what you are doing. When you take a picture, stop walking, take the photo, then begin to move again.
16. Do not overload your pack. This contributes to poor balance and fatigue.
17. Avoid walking on ice.

photo of narrow path at La Grotta dei Fichi

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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