Obstacle, adventure and endurance competitions in challenging or remote settings are increasing in popularity. A literature search indicates a dearth of evidence-based research on the organisation of medical care for wilderness competitions. The organisation of medical care for each event is best tailored to specific race components, participant characteristics, geography, risk assessments, legal requirements, and the availability of both local and outside resources. Considering the health risks and logistical complexities inherent in these events, there is a compelling need for guiding principles that bridge the fields of wilderness medicine and sports medicine in providing a framework for the organisation of medical care delivery during wilderness and remote obstacle, adventure and endurance competitions. This narrative review, authored by experts in wilderness and operational medicine, provides such a framework. The primary goal is to assist organisers and medical providers in planning for sporting events in which participants are in situations or locations that exceed the capacity of local emergency medical services resources.
The modern-day history of trauma care system development encompasses a 45-year period. This report provides a timeline that highlights significant organizational and legislative initiatives that established the foundation of the current trauma system in the United States. The rationale for moving toward a public health approach in addressing trauma system development is explored and supported. Finally, the present-day issues confronting continued trauma system evolution and future opportunities are presented.
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