A retrospective analysis of mission reports in the national Swedish Police Registry on mountain rescue 2018-2022: here be snowmobiles.

BACKGROUND: Increasing mountain activity and decreasing participant preparedness, as well as climate change, suggest needs to tailor mountain rescue. In Sweden, previous medical research of these services are lacking. The aim of the study is to describe Swedish mountain rescue missions as a basis for future studies, public education, resource allocation, and rescuer training. METHODS: Retrospective analysis of all mission reports in the national Swedish Police Registry on Mountain Rescue 2018-2022 (n = 1543). Outcome measures were frequencies and characteristics of missions, casualties, fatalities, traumatic injuries, medical conditions, and incident mechanisms. RESULTS: Jämtland county had the highest proportion of missions (38%), followed by Norrbotten county (36%). 2% of missions involved ≥ 4 casualties, and 44% involved ≥ 4 mountain rescuers. Helicopter use was recorded in 59% of missions. Non-Swedish citizens were rescued in 12% of missions. 37% of casualties were females. 14% of casualties were ≥ 66 or ≤ 12 years of age. Of a total 39 fatalities, cardiac event (n = 14) was the most frequent cause of death, followed by trauma (n = 10) and drowning (n = 8). There was one avalanche fatality. 8 fatalities were related to snowmobiling, and of the total 1543 missions, 309 (20%) were addressing snowmobiling incidents. Of non-fatal casualties, 431 involved a medical condition, of which 90 (21%) suffered hypothermia and 73 (17%) cardiovascular illness. CONCLUSIONS: These baseline data suggest snowmobiling, cardiac events, drownings, multi-casualty incidents, and backcountry internal medicine merit future study and intervention.

Olympic competition climbing: the beginning of a new era-a narrative review.

Climbing as a competition sport has become increasingly popular in recent years, particularly the sub-discipline of bouldering. The sport will debut in the Tokyo Summer Olympic Games. National and international competitions have three disciplines: lead (climbing with rope protection), bouldering (climbing at lower heights with mattress floor protection) and speed (maximum speed climbing on a standardised route in 1-on-1 mode). There is also a 'combined mode' of all three disciplines (combined) which forms the Olympic competition format; all competition formats are held on artificial walls. Existing literature describes a predominantly low injury frequency and severity in elite climbing. In comparison to climbing on real rock, artificial climbing walls have recently been associated with higher injury rates. Finger injuries such as tenosynovitis, pulley lesions and growth plate injuries are the most common injuries. As finger injuries are sport-specific, medical supervision of climbing athletes requires specific medical knowledge for diagnosis and treatment. There is so far little evidence on effective injury prevention measures in top athletes, and antidoping measures, in general, requiring further work in this field. An improved data situation regarding high-performance climbing athletes is crucial to ensure that the sport continues to be largely safe and injury-free and to prevent doping cases as extensively as possible.

Mountaineers on Mount Everest: Effects of age, sex, experience, and crowding on rates of success and death.

Mount Everest is an extreme environment for humans. Nevertheless, hundreds of mountaineers attempt to summit Everest each year. In a previous study we analyzed interview data for all climbers (2,211) making their first attempt on Everest during 1990-2005. Probabilities of summiting were similar for men and women, declined progressively for climbers about 40 and older, but were elevated for climbers with experience climbing in Nepal. Probabilities of dying were also similar for men and women, increased for climbers about 60 and older (especially for the few that had summited), and were independent of experience. Since 2005, many more climbers (3,620) have attempted Everest. Here our primary goal is to quantify recent patterns of success and death and to evaluate changes over time. Also, we investigate whether patterns relate to key socio-demographic covariates (age, sex, host country, prior experience). Recent climbers were more diverse both in gender (women = 14.6% vs. 9.1% for 1990-2005) and in age (climbers ≥ 40 = 54.1% vs. 38.7%). Strikingly, recent climbers of both sexes were almost twice as likely to summit-and slightly less likely to die-than were comparable climbers in the previous survey. Temporal shifts may reflect improved weather forecasting, installation of fixed ropes on much of the route, and accumulative logistic equipment and experience. We add two new analyses. The probability of dying from illness or non-traumas (e.g., high-altitude illness, hypothermia), relative to dying from falling or from 'objective hazards' (avalanche, rock or ice fall), increased marginally with age. Recent crowding during summit bids was four-fold greater than in the prior sample, but surprisingly crowding has no evident effect on success or death during summit bids. Our results inform prospective climbers as to their current odds of success and of death, as well as inform governments of Nepal and China of the safety consequences and economic impacts of periodically debated restrictions based on climber age and experience.

Equipment Became Better in Backcountry Skiing-Did Severity of Injuries Decrease? An Analysis from the Swiss Alps.

Background: Large technical developments in avalanche transceivers as well as in ski-shoe-binding units should make backcountry skiing a safer sport and as a consequence, yield to a decrease in the number and severity of mountain emergency events. Methods: From 2009-2018, a total of 3044 mountain emergencies (953 females and 2091 males) were identified from the SAC (Swiss Alpine Club) central registry while backcountry skiing. These were classified descriptively by cause, whereby the severity of the mountain emergency was quantified with a NACA-Score (National Advisory Committee for Aeronautics Score). Results: A total of 1357 falls (44.6%), 558 emergencies caused by avalanches (18.3%), 408 cases of blocking (13.4%), 214 cases of illnesses (7.0%), 202 cases of losing way (6.6%), 138 cases of a crevasse accident (4.5%), and material failure in 30 cases (1%) were registered. For the remaining 137 cases (4.5%), no classification or rare forms were detected. No substantial sex differences were found in severity of injury, however looking at the two endpoints of the observed time frame, a significant increase in NACA-Score from 2009 to 2018 (2.1 ± 1.8 up to 2.6 ± 2.1, p < 0.01) was detected. Conclusions: The increase in the severity of mountain emergencies while backcountry skiing in the last decade might be due to the fact that too many inexperienced absolve backcountry tours. The tendency might be promoted by the improved material in the way that it seems easier to absolve a tour while underestimating potential hazards.

Characteristics of Victims of Fall-Related Accidents during Mountain Hiking.

The study evaluated characteristics of non-fatal mountain hiking accidents caused by falls. Questionnaires were sent to mountain hikers who suffered a fall-related accident in Tyrol (Austria) during a 3-year period. The questionnaire included details of socio-demographic data, physical activity, medication intake, defective vision, breaks, fluid intake, level of fatigue, muscle soreness, use of backpacks, use of hiking sticks, and type of shoes. Data of 405 individuals (57% females and 43% males) were included in the analyses. Victims were 56 ± 15 years of age, had a body mass index of 24.8 ± 3.5, and indicated 4.2 ± 3.9 h/week regular physical activity. A defective vision was reported by 70% of the victims, breaks were frequent (in 80%), and alcohol intake was rare (4%) among the interviewed hikers. Subjective level of fatigue was low and only 5% reported muscle soreness. A backpack was carried by 83% of the victims and the average weight was higher in males compared to females. The majority (61%) of the victims wore ankle-height hiking shoes with a profiled sole. Victims of non-fatal falls in mountain hiking are older than the general population of mountain hikers and are often afflicted with defective vision.

Canyoning Accidents in Austria from 2005 to 2018.

Canyoning has become a popular recreational sport. Nevertheless, little is known about injuries or diseases associated with canyoning. The aim of this study was to examine accident causes, injury patterns, out-of-hospital and in-hospital treatment and outcomes. For this purpose, national out-of-hospital data from the Austrian Alpine Safety Board and regional in-hospital data from Innsbruck Medical University Hospital were analysed for the period from November 1, 2005 to October 31, 2018. Nationally, 471 persons were involved in such accidents; 162 (34.4%) were severely injured, nine of whom died. Jumping (n = 110, 23.4%), rappelling (n = 51, 10.8%), sliding (n = 41, 8.7%) and stumbling (n = 26, 5.5%) were the most common causes of canyoning accidents. A large proportion of injuries were documented for the lower extremities (n = 133, 47.5%), followed by the upper extremities (n = 65, 23.2%) and the spine (n = 44, 15.7%). Death was mainly caused by drowning. Overall mortality was 1.9% (n = 9), and the absolute risk was 0.02 deaths per 1000 hrs of canyoning. Many uninjured persons required evacuation (n = 116, 24.6%), which resulted in a substantial expense and workload for emergency medical services. Increased safety precautions are required to reduce accidents while jumping and rappelling and fatalities caused by drowning.

Mortality in Via Ferrata Emergencies in Austria from 2008 to 2018.

Although the European Alps now have more than 1000 via ferratas, limited data exist on the actual incidence of fatal events in via ferratas and their causes. This retrospective study analysed data from a registry maintained by the Austrian Alpine Safety Board (n = 161,855, per 11 September 2019). Over a 10-year period from 1 November 2008 to 31 October 2018, all persons involved in a via ferrata-related emergency were included (n = 1684), of which 64% were male. Most emergencies were caused by blockage due to exhaustion and/or misjudgement of the climber's own abilities. Consequently, more than half of all victims were evacuated uninjured. Only 62 (3.7%) via ferrata-related deaths occurred. Falling while climbing unsecured was the most common cause of death, and males had a 2.5-fold higher risk of dying in a via ferrata accident. The mortality rate was highest in technically easy-to-climb sections (Grade A, 13.2%/B, 4.9%), whereas the need to be rescued uninjured was highest in difficult routes (Grade D, 59.9%/E, 62.7%). Although accidents in via ferratas are common and require significant rescue resources, fatal accidents are rare. The correct use of appropriate equipment in technically easy-to-climb routes can prevent the majority of these fatalities.

Sudden Cardiac Arrest and Cardiopulmonary Resuscitation with Automated External Defibrillator in the Austrian Mountains: A Retrospective Study.

Background: Few data exist on the likelihood of surviving sudden cardiac arrest in the mountains. The aim of this study was to analyze the epidemiology and outcomes of patients suffering sudden cardiac arrest and undergoing cardiopulmonary resuscitation (CPR) with automated external defibrillator (AED) in the Austrian mountains. Materials and Methods: We analyzed all cardiac arrest cases in the Austrian mountains reported in the nationwide Austrian Alpine Police database from October 26, 2005, to December 31, 2015. To obtain information on outcomes, these patient data were manually merged with patient data from the main Austrian referral center for mountain emergencies, Innsbruck Medical University Hospital. Results: Overall, 781 cases of sudden cardiac arrest in the Austrian mountains were recorded. In 136 cases (17%), CPR with AED was attempted. The most frequent activities at the time of sudden cardiac arrest were hiking (n = 63, 46%) and skiing or snowboarding (n = 44, 32%). In the nationwide Austrian Alpine Police database, only 4 (3%) patients survived, whereas in the Innsbruck Medical University Hospital database, there were seven survivors who received CPR and AED. All survivors had received immediate CPR with an AED. Five patients had good neurological outcome (cerebral performance category 1-2). Conclusions: In the Austrian mountains, CPR was attempted in less than 20% of sudden cardiac arrest cases. The few that survived had received immediate CPR with an AED. To better understand the circumstances and outcome of sudden cardiac arrest in the mountains, out-of hospital and in-hospital data should be linked.

Factors influencing protective equipment use by mountain bikers: Implications for injury prevention.

AIM: To assess the attitudes of mountain bikers to the use of protective equipment and quantify the use of such equipment. METHOD: This was a prospective cohort study using an online questionnaire, offered to bikers participating in a series of Enduro races. The attitudes towards various factors that might contribute to a rider's choice to use protective equipment were quantified based on their responses to the questions. The actual reported use of various types of protective equipment was the outcome measure. The correlations between the factors and actual use were analysed for statistical significance, to assess their relative importance. RESULTS: Equipment use was similar in racing and non-racing settings and could be increased. 55% had experienced an injury requiring a week or more off work. Perceptions of the benefits, costs, cues, comfort and potential injury severity proved to be well correlated with the choice to use equipment, while harm, danger and exposure to media influences did not.

An Occupational Health Survey of British Mountain Guides Operating Internationally.

INTRODUCTION: Professional mountain guides face significant occupational health risks, including injuries, accidents, environmental exposures, chronic musculoskeletal strain, and psychological stressors. This study aims to investigate these risks and their impact on the quality of life of a group of international British mountain guides. METHODS: This self-reported online survey included demographics; acute and chronic occupational conditions; and questions on general health, lifestyle, symptoms of post-traumatic stress disorder (PTSD), and quality of life based on the World Health Organization quality of life [WHOQOL-BREF] questionnaire. RESULTS: Responses were received from 67 (32%) of the approached guides. Knee pain (75%), back and neck pain (62%), hand/upper extremity problems (51%), and lower limb injuries (49%) were the most commonly reported individual occupational health problems. Chronic eye problems were reported by 8%, and 5% reported skin cancer. Twenty-nine percent were on regular medications, which were mainly analgesics for chronic musculoskeletal complaints. Mountain guides have a healthy lifestyle, with lower rates of being overweight/obese, alcohol consumption, and smoking than the average UK population. Fourteen (61%) of the 23 guides responding to the PTSD questions reported experiencing life-threatening traumatic incidents, and 4 (25%) of this subgroup appear to have had some symptoms of PTSD. The quality of life assessment showed that the studied mountain guides have a high quality of life. CONCLUSIONS: Musculoskeletal problems are the main occupational health problems experienced by the study group. New findings include a low but important prevalence of ultraviolet radiation-associated conditions. One in 3 guides have experienced significant psychological trauma, and one quarter of these had symptoms of PTSD.

Epidemiología de la atención prehospitalaria de las luxaciones de hombro en montaña / Epidemiology of prehospital care of shoulder dislocation in the mountain / Epidemiologia do atendimento pré-hospitalar de luxação do ombro na montanha

Objetivo: Describir las características clínico-epidemiológicas de los pacientes rescatados que presentaban luxación de hombro, así como el abordaje terapéutico. Método: Estudio descriptivo retrospectivo de los pacientes atendidos durante el periodo julio 2010-diciembre 2016 que presentaban una luxación de hombro. Resultados: Se analizan 57 pacientes. Las luxaciones de hombro suponen un 42.5% de las lesiones en extremidades superiores y un 2.7% del total de rescates. La edad media es 40.7±11.9 años; 96.4% varones. El senderismo, barranquismo y esquí de montaña son las actividades con más luxaciones. El 98.2% eran tipo glenohumeral anterior. La reducción fue exitosa en 80.9%, siendo la maniobra de Kocher la más empleada. El tiempo medio hasta el primer intento de reducción cuando maniobra fue exitosa fue de 87 minutos y 142 minutos cuando fracasa. Conclusiones: Se observa un aumento en las luxaciones de hombro, siendo la mayoría reducidas en el lugar del accidente, sin existir una maniobra de elección, y mayor éxito cuanto menor tiempo hasta maniobra. Reducir sin radiografía es seguro y eficaz

Objective: To describe the clinical-epidemiological characteristics of the rescued patients with shoulder dislocation, as well as the therapeutic approach. Method: A retrospective descriptive study of the patients treated during the period July 2010-December 2016, who presented with a shoulder dislocation. Results: A total of 57 patients were analysed. Shoulder dislocations account for 42.5% of upper extremity injuries and 2.7% of total rescues. The mean age being 40.7±11.9 years; 96.4% were male. Hiking, canyoning and mountain skiing are the activities in which most of the dislocations occur. 98.2% of the dislocations were anterior glenohumeral type. The reduction was successful in 80.9%, with the Kocher manoeuvre being the most used. The mean time until the first reduction attempt was successful was 87 minutes and 142 minutes when the manoeuvre failed. Conclusions: An increase in the number of shoulder dislocation was observed, most of them reduced at the accident site, there is no evidence of a single most successful manoeuvre over another. The quicker the reduction is attempted the more success is achieved. A reduction without performing an X-ray is safe and efficient

Objetivo: Descrever as características clínico-epidemiológicas e abordagem terapêutica em pacientes resgatados com luxação do ombro. Método: Estudo descritivo retrospectivo dos pacientes que apresentaram luxação de ombro, atendidos no período de julho de 2010 a dezembro de 2016. Resultados: Um total de 57 pacientes foram analisados. Luxações do ombro representam 42.5% das lesões da extremidade superior e 2.7% do total de resgates. A médiade idade foi de 40.7 ± 11.9 anos; 96.4% eram do sexo masculino. Caminhadas, canyoning e esqui de montanha são as atividades nas quais a mayoría das luxações ocorre. 98.2% das luxações foram do tipo glenoumeral anterior. A redução foi bem sucedida em 80.9%, sendo a manobra de Kocher a mais utilizada. O tempo médio até a primeira tentativa de redução foi de 87 minutos e 142 minutos quando a manobra falhou. Conclusões: Um aumento no número de luxações do ombro foi observado e a maioria delas reduzidas no local do acidente. Não há evidência de uma única manobra de maior sucesso em detrimento de outra. Quanto mais rápidaa redução é realizada, maior é o sucesso alcançado. Uma redução sem a realização de um raio X é segura e eficiente

Amputation Risk Factors in Severely Frostbitten Patients.

In recent years, the incidence of frostbite has increased among healthy young adults who practice winter sports (skiing, mountaineering, ice climbing and technical climbing/alpinism) at both the professional and amateur levels. Moreover, given that the population most frequently affected is healthy and active, frostbite supposes a substantial interruption of their normal activity and in most cases is associated with long-term sequelae. It particularly has a higher impact when the affected person's daily activities require exposure to cold environments, as either sports practices or work activities in which low temperatures are a constant (ski patrols, mountain guides, avalanche forecasters, workers in the cold chain, etc.). Clinical experience with humans shows a limited reversibility of injuries via potential tissue regeneration, which can be fostered with optimal medical management. Data were collected from 92 frostbitten patients in order to evaluate factors that represent a risk of amputation after severe frostbite. Mountain range, years of expertise in winter mountaineering, time elapsed before rewarming and especially altitude were the most important factors for a poor prognosis.

Medicalizar los equipos de rescate en montaña: justificación socio-económica en base a la evolución de la mortalidad en el Pirineo Central / Medicalization of mountain rescue teams: social and economic approach based on mortality evolution in Central Pyrenees

Introducción: El montañismo mejora la salud física y mental de las personas que los practican contribuyendo a lograr un menor gasto socio-sanitario. Todos los deportes tienen efectos colaterales no deseados: accidentes y lesiones. Las operaciones de rescate en montaña implican dificultades logísticas y ambientales que exponen a numerosos e importantes riesgos, pero se han incorporado sanitarios en estas operaciones de rescate ya que acortar los tiempos de intervención médica y el tratamiento apropiado in situ disminuyen la morbi-mortalidad de los accidentados. En España hay muchas Comunidades Autónomas (CCAA) sin rescate en montaña medicalizado. La realidad de los accidentes de montaña: En España hay 5,4 muertos por cada 100 rescatados en montaña. En Aragón, se contabilizan 3,5 muertos/100 accidentados rescatados. El 11,3% de los rescatados en Aragón entre 1999 y 2008 presentaba un índice Glasgow entre 13 y 9 y el 12,9% tenían un Glasgow < 9 (grave). Un 6,3% de los pacientes rescatados sufrieron politraumatismos. Un 63,7% de los rescatados presentaban un índice de gravedad NACA≥III que hace referencia a pacientes que requieren asistencia médica en el lugar del accidente. En Aragón se medicaliza el rescate en montaña desde 1998. También están medicalizados estos rescates en Asturias, Cantabria y Castilla-León. Los efectos de la medicalización del rescate en montaña: Existen claras diferencias entre las prestaciones que establecen unas CCAA y otras. La "medicalización del rescate" supone un médico o enfermera específicamente formado en Medicina de Urgencias en Montaña integrado en los equipos de rescate. Esto mejora la eficacia del primer tratamiento en el lugar del accidente, por difícil que sea el acceso, mejorando la supervivencia y disminuyendo la morbilidad. En Aragón, la tasa de mortalidad media ha pasado del 9,32% antes de la medicalización del rescate al 3,45% en los 15 años de rescate medicalizado con médicos y enfermeras CUEMUM, lo que supone una disminución del 62%. Mientras que la tasa de mortalidad media en España en el mismo periodo ha pasado del 8,8% al 6,8%; lo que supone una disminución del 12,5%. La relación coste-beneficio: Calculamos a la baja que los accidentes de montaña en España cuestan más de 375 millones Euros al año. En Aragón estimamos que superan los 50 millones Euros al año. La disminución de la tasa de mortalidad en un 62% ha supuesto un ahorro de más de 175 millones Euros. Conclusiones: La medicalización del rescate es un derecho y un deber con claros beneficios socio-sanitarios. La asistencia médica in situ disminuye la morbi-mortalidad y el gasto público. España debe mejorar la prevención, además de garantizar la medicalización de los rescates en todo el territorio con sanitarios formados en Medicina de Urgencias en Montaña

Introduction: Mountaineering improve the physical and mental health of people who practices it. All sports have a collateral not wished effects: accidents and sport injuries. Although mountain rescue operations involve logistic and environmental difficulties that expose everybody to important risks, alpine countries have joined sanitary people in these rescue operations because they know shorten times of medical intervention and an appropriate treatment in place diminish mortality and sequels, and consequently, social and sanitary expenses. Many mountain regions in Spain have not medical services in mountain rescue teams. The facts of mountain casualties: There were 5,4 fatalities for every 100 rescued people in mountains in Spain. There were 3,5 fatalities for every 100 rescued people in Aragon. 6,3% of rescued patients suffered polytraumatisms. 63,7% of rescued people in mountains in Aragon presented a NACA index ≥ III (that means they need medical assistance in the place of the accident). 11,3% of people rescued in Aragon between 1999 and 2008 had a Glasgow Index among 13 and 9 and 12,9% had a Glasgow Index < 9. Mountain rescue operations are medicalized in Aragon since 1998. Also, mountain rescues are medicalized in Asturias, Cantabria y Castilla-León. Effects of medicalized mountain rescue operations: There are important differences between some regions in Spain about medical services in mountain rescues. Medicalization means to have a doctor or nurse specifically trained in Mountain Emergency Medicine integrated in rescue teams. This improves the efficiency of first treatments on the field, despite the difficulties of access, improving survival and diminishing morbidity. In Aragon, the rate of average mortality has changed from 9,32% before the medicalization of mountain rescue to 3,45% during medicalization with CUEMUM physicians and nurses, which supposes a decrease of 62% in 15 years. Whereas the rate of mortality in Spain was changed to 8,8% to 6,8% in the same period what supposes a decrease of 12,5%. Cost-benefit analysis: We calculate downwards that mountain casualties in Spain costs more than 375 million Eurosper year. They overcome 50 million Euros per year in Aragon. This region has save of more than 175 million Euros with this decrease of mortality of 62%. Conclusions: Medicalization of mountain casualties is a human right and a duty with clear social and sanitary benefits. The medical assistance on the field diminishes morbidity and mortality and the public expenditure. Spain must to improve the prevention and to guarantee the medicalization of mountain rescues in the whole Spanish regions with nurses and physicians trained in Mountain Emergency Medicine

Avalanche Safety Practices Among Backcountry Skiers and Snowboarders in Jackson Hole in 2016.

INTRODUCTION: Carrying standard safety gear (beacon, probe, and shovel), planning a route of descent, and recreating with companions can help to mitigate the risk of injury or death resulting from avalanches in the backcountry. The goal of this study was to identify factors associated with performance of these safety practices. METHODS: A convenience sample of backcountry skiers and snowboarders was surveyed in 2016 at the backcountry gates of Jackson Hole Mountain Resort. Each participant was surveyed on characteristics including skill level, sex, age, prior avalanche education, and residency in the Jackson Hole area. Safety practices were also measured against avalanche hazard forecasts. Correlations were assessed using Fisher's exact testing. RESULTS: A total of 334 participants were surveyed. Factors associated with carrying avalanche safety gear included higher expertise, being a resident of the Jackson Hole area, and prior avalanche education. Factors associated with having a planned route of descent included higher expertise and being a resident of the Jackson Hole area. Factors associated with recreating with companions included younger age and lower expertise. Sex had no association with any of the surveyed safety practices. Participants were less likely to carry avalanche safety gear on low avalanche hazard days. CONCLUSIONS: Certain individual characteristics of backcountry skiers and snowboarders are associated with increased frequency of adherence to recommended safety practices. These findings suggest that particular categories of backcountry recreationists may benefit from further avalanche safety education. The results of this study could help direct future educational efforts among backcountry recreationists.

Different outdoor professions have different risks - a cross-sectional study comparing non-melanoma skin cancer risk among farmers, gardeners and mountain guides.

BACKGROUND: One of the main risk factors for non-melanoma skin cancer (NMSC), the most common cancer worldwide, is solar ultraviolet radiation (UVR). This has led to the recognition of NMSC as occupational disease for outdoor workers in several countries. However, outdoor professions are a very heterogeneous group with diverse daily activities and associated UVR exposure. OBJECTIVE: To compare the prevalence of NMSC and associated risk behaviour in different outdoor professions. METHODS: Cross-sectional study among outdoor workers (farmers, gardeners, mountain guides) and indoor workers (office employees) as control group using a paper-based questionnaire on UVR exposure and protective behaviour followed by a skin examination by a dermatologist. RESULTS: A total of 563 participants (46.9% women, 46.9 ± 13.8 years) consisting of 348 outdoor workers (38.8% farmer, 35.3% gardener, 25.9% mountain guides) and 215 indoor workers were included in the study between March and September 2017. NMSC incl. actinic keratosis was diagnosed in 33.3% of mountain guides, 27.4% of farmers, 19.5% of gardeners and in 5.6% of indoor workers. Significant differences were seen between the outdoor professions with mountain guides at highest risk compared to farmers (OR = 2.6, 95% CI = 1.2-5.7). Substantial differences between the professions were also seen in skin cancer screening attendance rates (indoor worker 61.4%, mountain guides 57.8%, farmers 31.9%, gardeners 27.6%), daily UVR exposure during work and protective behaviour such as sunscreen use during work. CONCLUSION: Different outdoor professions have significant different risks for NMSC and show different risk behaviour. Tailoring prevention efforts to different professions based on their individual needs could be the key to lower the global burden of (occupational) NMSC.

Helicopter Mountain Rescue in Slovenia from 2011 to 2015.

INTRODUCTION: The popularity of adventure recreation in wilderness areas across the world continues to increase. Nevertheless, the risk of injury and illness remains significant. The purpose of this study is to analyze the mountain rescue operations performed in Slovenia between 2011 and 2015. METHODS: This retrospective study reports mountain rescue operations documented by the Slovenian National Mountain Rescue Association. The annual number of ground-based and helicopter-based rescues were identified and compared. For 2015, the indication for rescue and the severity of injury were also analyzed, specifically for interventions requiring the use of a helicopter. RESULTS: From 2011 through 2015, the number of rescues remained consistent with an annual average of 413 (SD ±15; range, 393-434) rescues. However, the percentage of ground-based rescues varied significantly year by year (P=0.016), with highest rate in 2014 (68%) and the lowest in 2015 (56%). In 2015, 434 mountain rescue operations were reported in Slovenia. Injury accounted for 44%, illness for 10%, and fatality for 9% of the rescues. In 37%, no illness or injury was reported. Helicopter rescue was used in 190 (44%) of all interventions. Among the 190 helicopter rescues, 49% of patients had nonfatal injuries, 29% required no medical treatment, 15% had illness, and 7% had fatal injuries. CONCLUSIONS: A significant number of mountain rescue operations were conducted in Slovenia from 2011 through 2015. Most of these were needed for injured, ill, or deceased persons. A notable number of rescues in 2015 required a helicopter.

Descriptive Epidemiology, Medical Evaluation, and Outcomes of Rock Climbing Injuries.

OBJECTIVE: To gather epidemiologic data on injury type, treatment, and recovery from rock climbing injuries. METHODS: Design: retrospective cross-sectional study. SETTING: web-based survey. PARTICIPANTS: rock climbers who sustained a climbing-related injury during the prior 24 months. Criteria for inclusion: aged ≥18 years; participation in rock climbing at least 4 times per year in the United States. INTERVENTIONS: none. MAIN OUTCOME MEASURES: percentage of injured climbers seeking medical care, providers seen, subspecialty referral, development of chronic problems, factors affecting return to climbing, injuries by climbing type, body region, and injury type. RESULTS: Data were collected over a 60-day period using the Research Electronic Data Capture (REDCap) survey system. Seven hundred and eight surveys were collected from 553 male and 155 female climbers. Thirteen hundred ninety seven injuries were reported, and 975 injuries were suitable for analysis. The most common provider initially seen was a primary care provider. Subspecialty referral was commonly obtained. Injury patterns differed by climbing type. The percentage of respondents that returned to climbing before their injury was fully healed was 51.1%, and 44.9% of respondents developed chronic problems related to their climbing injury. Twenty-eight percent of respondents were unable to return to their previous level of climbing performance. Several factors were associated with delayed recovery from climbing injury. CONCLUSIONS: A significant number of climbers sought healthcare after injury. A majority of climbers who sought treatment were referred to subspecialist providers. About one-half of climbers were symptomatic when they returned to climbing and developed chronic problems after injury. Factors associated with slower return to climbing included increasing age, smoking, fractures, and surgery.