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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National Estimates of Outdoor Recreational Injuries

In Volume 19, Number 2 (2008) of the journal Wilderness & Environmental Medicine appears an original research article entitled "National Estimates of Outdoor Recreational Injuries Treated in Emergency Departments, United States, 2004-2005," authored by Adrian H. Flores and his associates from the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia. This article was the beneficiary of multiple press releases, and so there has already been a fair amount of discussion regarding its findings. Because I was briefly quoted regarding this article by the Associated Press, I have received a fair number of inquiries about its significance.

This article is the first to provide national estimates of nonfatal outdoor recreational injuries treated in 63 U.S. emergency departments (EDs). The data were gathered using the National Electronic Injury Surveillance Survey System - All Injury Program. In this way, national estimates of outdoor recreational injuries were calculated, and activities leading to injury, demographic characteristics, principal diagnoses, and primary body parts affected were described.

Averaged across the study years, an estimated 212,708 persons were treated each year in U.S. EDs for outdoor recreational injuries. Males accounted for 68.2% of the injuries, but the rates of injury did not take into consideration that males have higher rates of participation in outdoor recreation. The lower limb, upper limb, and head and neck region were the most commonly injured body regions. Fractures and sprains or strains were the most common diagnoses. For all injuries, the leading causes were falls, being struck by or against an object, and overexertion. In this study, the 10- to 19-year old and 20- to 29-year old ages groups accounted for the greatest percentage of injuries. Snowboarding, sledding, and hiking were the leading activities associated with outdoor recreational injuries.

What can be learned from this study? Much of what was documented is fairly well appreciated already, and confirms our suspicions about who suffers what type of injuries. As with any type of epidemiological research, the devil is in the details. For instance, to understand about how to make use of the information about injuries in snowboarders, it would be necessary to understand what happened during each event - did the accident occur at the beginning of the day (? icy terrain or deep powder) or at the end of the day (? participant tired, evolving icy conditions, impending darkness); was the snowboarder wearing protective equipment (? wrist guards, leash, helmet); was the snowboarder experienced (? beginner, intermediate, expert), etc. To understand how to make use of the information about injuries in hikers, it would be important to know the nature of the terrain, the skill-strength-experience of the hiker, the environmental conditions, type of footgear, use of a walking stick, etc. The premise is that with some reasonable degree of detail, we can draw conclusions about how better to prevent accidents and injuries. The name of the game is injury prevention.

One cannot remove all risks from outdoor recreational activities, but a reasonable goal would be to remove all unnecessary risks. If a deeper analysis of this study reveals that injured boaters were all driving above a certain speed, we can perhaps conclude something from that and perhaps make recommendations. If a greater percentage of the head-injured among the study persons were without helmets than the participating population at large, then we can perhaps make a recommendation. This is a nice study that will hopefully inspire others to look with greater depth at specific areas of outdoor recreation in order to identify patterns that can lead to more effective injury prevention.

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Preview the 25th Anniversary & Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 25-30, 2008.

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About the Author

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