The epidemiology of extreme hiking injuries in volcanic environments.

The objective of this review was to summarize the epidemiological literature for extreme hikers in volcanic environments and describe the incidence, nature and severity of injuries, the factors contributing to the injuries, and strategies for preventing injuries. Due to the relative newness of extreme hiking in volcanic environments, there are only a small handful of studies addressing the topic. Moreover, these studies are primarily focused on extreme hikers in Hawaii Volcanoes National Park. These studies found that the majority of extreme hikers in volcanic environments are inexperienced and unfamiliar with the potential hazards present in volcanic environments. The studies found that upper respiratory irritation resulting from exposure to volcanic gases and dehydration and scrapes, abrasions, lacerations, and thermal burns to the extremities were common injuries. The severity of the injuries ranged from simple on-site treat-and-release incidents to more severe incidents and even death. This review reveals a need for well-designed epidemiologic research from volcanic destinations outside of Hawaii that identify the nature and severity of injuries along with the factors contributing to injury incidents. There is also a demonstrated need for studies identifying preventive measures that reduce both the occurrence and severity of extreme hiking incidents in volcanic environments.

Search and rescue trends associated with recreational travel in US national parks.

BACKGROUND: National parks are popular travel destinations worldwide. Unfortunately, negative health experiences can and do occur during travel in national parks. This study investigated search and rescue (SAR) trends associated with recreational travel in US National Park Service (NPS) units. METHODS: A retrospective study was conducted of the Annual US National Park Service Search and Rescue Report for the years 2003 to 2006. RESULTS: From 2003 to 2006, there were 12,337 SAR operations involving 15,537 visitors. The total operational costs were US$16,552,053. The operations ended with 522 fatalities, 4,860 ill or injured visitors, and 2,855 saves. Almost half (40%) of the operations occurred on Saturday and Sunday, and visitors aged 20 to 29 years were involved in 23% of the incidents. Males accounted for 66.3% of the visitors requiring SAR assistance. Day hiking, motorized boating, swimming, overnight hiking, and nonmotorized boating were the participant activities resulting in the most SAR operations. The vast majority of visitors requiring SAR assistance were located within a 24-hour period, and the most common rescue environments were mountain areas between 1,524 and 4,572 m, lakes, rivers, oceans, and coastal areas. An error in judgment, fatigue and physical conditions, and insufficient equipment, clothing, and experience were the most common contributing factors. CONCLUSIONS: SAR incidents can be expensive and end with severe health consequences. NPS management should develop education and preventive efforts focused on hikers, boaters, and swimmers who are males and aged 20 to 29 years, addressing issues of adequate judgment, preparation, and experience.

Saving tourists: the status of emergency medical services in California's National Parks.

BACKGROUND: Providing emergency medical services (EMS) in popular tourist destinations such as National Parks requires an understanding of the availability and demand for EMS. This study examines the EMS workload, EMS transportation methods, EMS funding, and EMS provider status in California's National Park Service units. METHODS: A retrospective review of data from the 2005 Annual Emergency Medical Services Report for National Park Service (NPS) units in California. RESULTS: Sixteen NPS units in California reported EMS activity. EMS program funding and training costs totaled USD $1,071,022. During 2005 there were 84 reported fatalities, 910 trauma incidents, 663 non-cardiac medicals, 129 cardiac incidents, and 447 first aid incidents. Sequoia and Kings Canyon National Parks, Yosemite National Park, Golden Gate National Recreation Area, and Death Valley National Park accounted for 83% of the total EMS case workload. Ground transports accounted for 85% of all EMS transports and Emergency Medical Technicians with EMT-basic (EMT-B) training made up 76% of the total 373 EMS providers. CONCLUSIONS: Providing EMS for tourists can be a challenging task. As tourist endeavors increase globally and move into more remote environments, the level of EMS operations in California's NPS units can serve as a model for developing EMS operations serving tourist populations.

Recreational travel fatalities in US national parks.

BACKGROUND: Injuries are a public health problem affecting traveling populations such as tourists visiting National Parks. This study investigates the distribution of visitor fatalities in US National Park Service (NPS) units and identifies the predeath activities and contributing factors associated with them. METHODS: A retrospective study was conducted of visitor fatalities from all NPS units during 2003 and 2004. RESULTS: There were 356 reported fatalities during 2003 and 2004. Fatalities were most common during the summer months and on weekends. Males accounted for 75% of the reported fatalities, and visitors aged 20 to 29 and 50 to 59 years accounted for 51% of all deaths. Only 99 of 388 (26%) NPS units reported at least 1 fatality, and only 10 units reported 10 or more fatalities. However, these 10 units were responsible for 36% of all fatalities. Lake Mead National Recreation Area, Blue Ridge Parkway, Grand Canyon National Park, Great Smoky Mountains National Park, and Yosemite National Park reported the highest number of fatalities. Domestic visitors accounted for 73% of the fatalities, and European visitors accounted for 13%. Transportation and water-based activities recorded the highest number of fatalities. Motor vehicle crashes accounted for 20% of fatalities and was followed by suicide (17%), swimming (11%), hiking (10%), plane crashes (9%), climbing (6%), and boating (5%) incidents. CONCLUSIONS: Fatalities in NPS units are not widespread and are related to more common events such as motor vehicle crashes, suicide, swimming, and hiking rather than exotic causes such as bears or other wildlife. It is recommended that preventive techniques first be developed in the 10 NPS units responsible for 36% of the total NPS-wide fatalities.

Search and rescue trends and the emergency medical service workload in Utah's National Parks.

OBJECTIVE: To identify the emergency medical service (EMS) workload and trends associated with search and rescue (SAR) operations in Utah's National Park Service (NPS) units. METHODS: Data for this study were collected from the Annual Emergency Medical Services Report and the Annual Search and Rescue Report for National Park Service units in Utah from 2001-2005. RESULTS: There were 4762 EMS incidents reported between 2001 and 2005, including 79 fatalities (50 traumatic; 29 nontraumatic). The most common EMS transportation method was ground (1505) and helicopter (553) transport. The heaviest trauma, medical, and cardiac workload was at Glen Canyon National Recreation Area (GLCA) and the heaviest first aid workload was at Zion National Park (ZION). There were 1190 SAR operations between 2001 and 2005 involving 67 fatalities, 623 ill or injured visitors, 1813 non-ill or non-injured visitors, and 92 saves. GLCA and ZION accounted for 47% and 21% of all SAR operations. The total cost of SAR operations was $1 363 920. SAR operations most commonly occurred on weekends, involved male visitors (59%), visitors aged 20-29 years (23%), and 40-49 years (20%), and visitors participating in day hiking (221), motorized boating (196), and canyoneering (98) activities. Most SAR operations were in lake (226), desert (147), and canyon (140) environments and were resolved within 24 hours. CONCLUSIONS: GLCA and ZION experienced heavy use of EMS resources that should be noted by EMS administrators and planners. GLCA and ZION also reported the most SAR operations. The development of techniques to prevent the need for SAR at GLCA and ZION would likely have the most potential to reduce the financial impact of SAR incidents and morbidity and mortality to visitors.

Viewing lava safely: an epidemiology of hiker injury and illness in Hawaii Volcanoes National Park.

OBJECTIVE: To report the injuries and illnesses encountered by wilderness hikers in Hawaii Volcanoes National Park attempting to hike to active lava flows and to investigate the roles that demographics, prior hiking experience, hiking behavior, and preparedness play in hiker vulnerability to injury and illness. METHODS: During an 8-week period, daily on-site exit interviews of lava hikers were conducted by a uniformed park ranger and park volunteer. Information about the hiker's home residence, wilderness hiking experience, preparedness, health status, and health problems encountered during the hike was collected from a total of 804 hikers. RESULTS: A high rate of injury and illness was found among the study population. Scrapes and abrasions (59%), blisters (51%), and muscle strains and sprains (47%) were the most common injuries. Dehydration (77%) and respiratory irritation (46%) were the most common illnesses. Lower extremities were the most common site of injuries, and beginning hikers were the most vulnerable to injury and illness. Many hikers were inexperienced tourists willing to disregard warning signs and enter high-risk areas. CONCLUSIONS: Hawaii Volcanoes National Park is one of 22 US national park units with volcanic resources. The injuries and illnesses reported by the study group identify the impact that this type of environment can have on the safety of wilderness users in areas with similar resources. Recreating in remote and severe areas has inherent risks, but the high rate of injuries and illnesses sustained by the hikers of this study can potentially be reduced through the development of more direct risk management methods.