On a national level, the NPS experiences an equal number of medical and traumatic EMS events. This differs from past observed trends that reported a higher incidence of traumatic events than medical events in wilderness settings. Cardiac events and automated external defibrillator usage are relatively infrequent. Traumatic fatalities are more common than medical fatalities in the NPS. Regional variations in events likely reflect differences in terrain, common activities, proximity to urban areas, and access to definitive care between regions. These data can assist the NPS in targeting the regions with the greatest number of incidents and fatalities for prevention, ranger training, and visitor education.

IntroductionThis study examines the emergency department (ED) waiting room (WR) population’s knowledge about the ED process and hospital function and explores the types of educational materials that might appeal to patients and their companions in an ED waiting room. Our goal was to identify potential high-impact opportunities for patient education.MethodsA 32-question survey about demographics, usage of primary care physicians (PCP), understanding of the ED and triage process, desire to know about delays, health education and understanding of teaching hospitals was offered to all qualified individuals.ResultsFive hundred and forty-four surveys were returned. Fifty-five percent reported having a PCP, of which 53% (29% of all WR patients) called a PCP prior to coming to the ED. It was found that 51.2% can define triage; 51% as an acuity assessment and 17% as a vital signs check. Sixty-nine percent knew why patients were seen according to triage priority. Seventy-two percent wanted to know about delays, yet only 25% wanted to know others’ wait times. People wanted updates every 41 minutes and only three percent wanted a physician to do this. Forty-one percent wanted information on how the ED functions, 60% via handouts and 43% via video. Information on updates and common medical emergencies is significantly more important than material on common illnesses, finding a PCP, or ED function (p<0.05). Median estimated time for medical workup ranged from 35 minutes for radiographs, to one hour for lab results, computed tomography, specialist consult, and admission. Sixty-nine percent knew the definition of a teaching hospital and of those, 87% knew they were at a teaching hospital. Subgroup analysis between racial groups showed significantly reduced knowledge of the definitions of triage and teaching hospitals and significantly increased desire for information on ED function in minority groups (p<0.05).ConclusionThe major findings in this study were that many visitors would like handouts about ED function and medical emergencies over other topics. Additionally, the knowledge of functions such as triage and teaching hospitals were 70% and 69%, respectively. This was reduced in non-Caucasian ethnicities, while there was an increased desire for information on ED function relative to Caucasians. This research suggests increasing updates and educational materials in the waiting room could impact the waiting room and overall hospital experience.

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Objective.-Lift-accessed downhill mountain biking has grown exponentially in popularity over the past decade. The sport, while offering participants access to a vast amount of terrain, also requires navigating steep and technical terrain at high speeds, posing significant risk of injury to the rider. A limited understanding of these risks impedes both medical management as well as industry-appropriate protective equipment development. The objective of this study was to describe the frequency and type of injuries sustained by downhill mountain bikers utilizing such lift-accessed bike parks.Methods.-A retrospective chart review was performed at one resort's urgent care facility for all patients seeking medical treatment for injuries sustained while riding in the neighboring mountain bike park during the 2009 season.Results.-Of 898 identified cases, 86% (772) were male and the median age was 26 years (range 7-66). Of these patients, 19.4% (174) required transport off the mountain by the park's bike patrol while another 8.4% (75) arrived by emergency medical services. There were 1759 specific injury diagnoses identified, including 420 fractures in 382 patients (42.5%). Upper extremity fractures included 109 wrists, 122 shoulders, 37 elbows, and 49 hands/fingers. There were 31 lower extremity fractures and 19 spine fractures (one with paralysis). In addition, 27 patients were suspected to have internal abdominal trauma and 11.2% (101) had a concussion or more severe intracranial injury. Though 90.5% (813) of patients were discharged, 8.5% (76) required transfer to a higher level of care facility.Conclusions.-Mountain bikers riding at this resort incurred a considerable number of injuries with significant morbidity during the 2009 riding season. Though exposure information was unavailable, these findings demonstrate the serious risks associated with this sport and highlight the need for continued research into appropriate safety equipment and risk avoidance measures.

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