Medical Incidents and Evacuations on Wilderness Expeditions for the Northwest Outward Bound School

Abstract

Introduction-Outdoor education (OE) expeditions travel far from definitive care and have unique epidemiology. Most OE expedition studies have examined a single organization and results may not generalize. This study examines the injuries, illnesses, medical evacuations, and nonmedical incidents of the Northwest Outward Bound School (NWOBS) to broaden our understanding and demonstrate commonalities within the field. Methods-This retrospective database review examined incidents and evacuations on NWOBS expeditions from June 1, 2014 through October 31, 2016. Incident rates, evacuation rates, and incident type frequencies were calculated. Frequencies of incidents during different expedition time periods were compared with a 1-sample x 2 test. The odds ratio that each type of incident would require evacuation was calculated and compared with other incident types using Fisher exact test. Results-The study period included 59,058 program days, 277 incidents, 143 medical incidents, 75 medical evacuations, and no fatalities. Injuries occurred at a rate of 1.64 per 1000 program days and illnesses at a rate of 0.78 per 1000 program days. The most common injuries were strains, sprains, and trauma or infection of the skin and soft tissue. Most injuries occurred while backpacking, hiking, or moving around camp. The most common illnesses were nausea, vomiting, diarrhea, abdominal pain, asthma, respiratory infections, and urinary tract infections. The medical incidents with the highest odds of evacuation were fractures, urinary tract infections, abdominal pain, and asthma. Conclusions-Results from the NWOBS database are consistent with those from other expeditionary OE programs. These findings should guide risk-management strategies and staff medical training.

Addressing ethical issues in outdoor health practice: a scoping review

“…Guided by the understanding that social research is by nature subjective, researchers should state their social positioning and standpoint (Walter, 2019). We acknowledge that we four authors are academics with a keen sense of the holistic benefits that nature connection can provide.…”

“…Three authors of this paper identify as white Anglo-Australians, and one as Worimi (Australian Aboriginal). Our social and cultural positionings have shaped the review process from conceptualisation and analysis through to findings and dissemination (Walter 2019).…”

Wilderness Medical Society Clinical Practice Guidelines for the Treatment of Acute Pain in Austere Environments: 2024 Update

“…Other circumstances that may require pain management include acute medical ailments and environmental injuries such as cold injuries, bites, stings, and burns. 3,4,5 In all cases, the management of pain is a secondary consideration to the management of immediate threats to life, including compromise of airway, breathing, or circulation, and secondary to scene safety for both the patient and the treating party. After scene safety and a primary survey have been addressed, a secondary survey should be undertaken to evaluate the cause and severity of pain.…”

“…Other circumstances that may require pain management include acute medical ailments and environmental injuries such as cold injuries, bites, stings, and burns. 3,4,5…”

“…19 These medications, in addition to training in nonpharmacologic pain management, are likely to suffice in many settings, as minor orthopedic injuries and soft tissue wounds comprise the majority of cases. 5 In the management of severe acute pain, however, these medications may be inadequate.…”