Medicine for the Outdoors
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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Injuries and illnesses in Wilderness Athletes

This is the fourteenth post based upon educational sessions and syllabus material presented at the Wilderness Medical Society Annual Meeting & 25th Anniversary held in Snowmass, Colorado from July 25-30, 2008. The information here is adapted from an excellent presentation given by Dr. Arthur “Tony” Islas (MD, MPH, FAWM) from the University of Texas Health Science Center at Houston School of Public Health. Dr. Islas introduces us to some considerations regarding estimating the potential for injuries and illnesses that apply to our favorite locations and activities, which are in the great outdoors.

Every fifth unintentional injury treated at healthcare facilities in industrialized nations is associated with sports or physical exercise. This statement emphasizes the popularity of leisure physical activity throughout the world and highlights the fact that these activities carry some risk of morbidity and mortality. Though the benefits of exercise for health status is well documented and, for most individuals, far outweighs the risk involved in participation, discussion of the risks involved in sports and exercise is common among healthcare providers and, especially after a sports related incident, by the public at large.

In an effort to decrease the risks associated with sports and exercise participation, most institutions in the industrialized world require a pre-participation physical examination for athletes competing in organized or scholastic sports and exercise programs. Though no hard data compares the risks involved in sports and exercise participation before and after the initiation of the pre-participation examination, it is widely accepted among health professionals that the pre-participation examination has decreased the risks associated with such participation.

Outdoor pursuits are the fastest growing segment of recreational life in the United States and perhaps the world. Traditional outdoor sports such as skiing and hiking are more popular than ever and sports that did not exist 10 to 15 years ago, such as snow boarding, adventure racing, and mountain biking, are now multimillion dollar enterprises that attract participants by the hundreds of thousands. In fact, according to the national survey on recreation and the environment conducted between July 1999 and March 2002, almost 210 million people age 16 years and older are involved in some form of outdoor recreation, with over 131 million of these individuals participating in outdoor adventure activities.

The National Park Service reports that for the year 2005 it had more than 273,000,000 recreation visitors with more than 13,800,000 staying overnight in the national parks and more than 1,600,000 individuals venturing into the backcountry. This genre of sports appeals to a broad spectrum of individuals and combines the traditional risks of physical activity and exertion with the remoteness and exposure associated with wilderness environments.

Wilderness sports are individual (as opposed to team) sports that take place in remote environments. As a result, gathering statistics for these sports poses a problem. Unlike team or organized sports that lend themselves to record and score keeping, wilderness sports are solitary and experiential in nature. However, through records from the National Park Service and through specific organizations that work with or provide services to wilderness athletes some information can be synthesized. This understanding should lead to a rationale for a pre-participation physical examination and specific advice germane to wilderness sports activities.

Risk Factors for Injuries (Lacerations, Contusions, Sprains, Strains and Fractures) in Wilderness Athletes


1. Poor conditioning for activity (physical and mental)
2. Lack of education on proper skills/ techniques to use in the field
3. Lack of appropriate equipment (boots, harnesses etc.)
4. Use of recreational drugs (alcohol, marijuana etc)
5. Equipment not properly maintained (boots, pack,harness, bicycle etc)
6. Poor trail/route/run planning (many curves, icy patches, unstable terrain, major rapids etc.)
7. Lack of awareness of risks and type of injuries by general public
8. Poor policies for developing/maintaining recreational sites


1. Poor acute physical status (tired, injured, etc.)
2. Refusal to wear/use appropriate/protective gear.
3. Lack of awareness of physical skills and limitations
4. Lack of knowledge of the field/terrain
5. Equipment failure (boot, pack, rope, raft etc.)
6. Lack of safety devices on equipment (ski and snow board bindings etc)
7. Poor trail/route/run maintenance
8 .Moving/traveling beyond abilities secondary to an unsafe “peak bagging or thrill seeking” mentality in the community


1. Lack of appropriate injury management
2. Lack of knowledge in how to contact and relay information to emergency services
3. Equipment not easily removed after injury
4. Poor trail/route/run conditions and directions for rescue personnel
5. Lack of training on how to handle injuries in general public.
6. Lack of training in how to contact and relay information to emergency services

Risk Factors for Gastrointestinal Illness in the Wilderness Athlete

1. Lack of knowledge on importance of prevention and transmission of GI illness
2. Lack of education on proper hygiene/first aid skills techniques to use in the field
3. Lack of water for hygiene
4. Lack of soap
5. Existence/exposure of virus/bacteria/parasite in environment naturally or secondary to poor planning, i.e. waste water management, animal contamination
6. Lack of policies to avoid contamination secondary to poor planning
7. Refusal to practice good hygiene
8. Inappropriate/no use of treatment modalities (medications –hydration)
9. Inappropriate/no recognition of transmission modes
10. Lack of medications and clean drinking water
11. Lack of appropriate sewage facility

Understanding the Risk Factor for Falls in the Wilderness Athlete

1. Athlete’s condition (physical and mental) – drowsy, carelessness, fatigued, stressed etc.)
2. Use of recreational drugs (alcohol, marijuana etc)
3. Not trained or refused to use protective equipment properly (if applicable to type of fall)
4. Failed to leave notification of itinerary with someone
5. Proper safety equipment not brought/used/ maintained
6. Poor trail/route/run planning (many curves, icy patches, unstable terrain)
7. Camps placed where fall risks exist
8. Emphasis on speed rather than safety in activity
9. Emphasis on pushing limits in selected sports
10. Lack of attention to surroundings
11. Low skill level in sport
12. Equipment failure/poor judgment
13. Height of fall
14. Hard or jagged objects at base of fall
15. Lack of safety equipment

Understanding the Risk Factors for Drowning in the Wilderness Athlete

1. Athlete’s condition (physical and mental) – drowsy, carelessness, fatigued, stressed etc.)
2. Lack of athletic skill/preparation (swimming/temperature of water)
3. Use of recreational drugs (alcohol, marijuana etc)
4. Not trained to use protective equipment properly (floatation devices)
5. Force of water
6. Temperature of water
7. Size of body of water
8. Proper safety equipment not brought/used/ maintained
9. Water recreation equipment not well understood/ maintained
10. Water crossings/recreation areas are areas which could have/be

A. Swift current
B. Rapids/rocks
C. Increased depth
D. Cold water
E. Submerged hazards

11. Lack of knowledge of the dangers of water
12. Socially “un-cool” to use floatation devices
13. No signs posted to alert of possible dangers
14. Non-realization of severity of submersion
15. Non-realization of the power of flowing water or size of body of water
16. Lack of knowledge on what to do in a dangerous near drowning situation
17. Water is deep enough or forceful enough to keep victim from surfacing
18. Body of water is too large to swim across.
19. Hazards that exacerbate event (swift current, deep water, rocks in water large expanses of water, submerged hazards, darkness)

In developing injury prevention strategies, passive strategies, or those that work automatically, are usually preferred over active strategies, or those that require a physical action or change in behavior to implement the strategy. For example, making vehicles and roadways safer has done more to prevent motor vehicle injuries than all of the drive safety campaigns combined.

Still, as with most athletic risks, the development of a safety culture among athletes is very important and can be accomplished through educational outreach programs. Whether it be a mere ankle sprain or something more serious, like immersion into water (drowning) or a sudden cardiac event, the more information we can gather that reliably demonstrates the nature and frequency of events, the better we can tailor our pre-participation examinations and advice given participants for the pre-event, event, and post-event phases of their activities.

painting of mountain man by Paul Calle

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About the Author

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