Epidemiology of Emergency Medical Search and Rescue in the North Shore Mountains of Vancouver, Canada, from 1995 to 2020.

INTRODUCTION: Little is known about the epidemiology of emergency medical search and rescue incidents globally. The purpose of this study was to describe the epidemiology of emergency medical search and rescue incidents in the North Shore Mountains of Vancouver, British Columbia, Canada. METHODS: This was a retrospective review and descriptive analysis of search and rescue incident reports created by North Shore Rescue over a 25 y period from 1995 to 2019, inclusive. Incident reports were screened for inclusion against a priori criteria defining a medical callout. The National Advisory Committee of Aeronautics (NACA) severity score was used as a method to grade medical acuity of included subjects. RESULTS: We included 906 subjects. Their median age was 35 y (interquartile range, 24-53), and 65% of subjects were men. Forty-one percent (n=371) of subjects were classified as non-trauma and 54% (n=489) as trauma. The top 3 activities were hiking (53%), biking (10%), and snow sports (10%). Forty-nine percent of incidents were classified as having a NACA score of ≥3. For subjects with trauma, the top 3 body regions were lower limb (52%), head (18%), and torso (12%). For subjects with non-traumatic conditions, the top 3 causes were mental health crises (25%), exposure (25%), and cardiovascular incidents (11%). CONCLUSIONS: Half of the incidents were serious enough to require medical assessment at a hospital (NACA score ≥3). Given this medical acuity, there is a need for evidence-based guidelines and core training competencies for mountain medical search and rescue. Standardized core data sets and outcomes are needed to monitor quality of care over time.

Dust content of lungs and its relationships to pathology, radiology and occupational exposure in Ontario hardrock miners.

BACKGROUND: Autopsied lungs from 29 hard rock miners were investigated to determine the relationship of the dust content to pathology, radiology, and occupational exposure. METHODS: Each lung was divided horizontally into three sections. Pathological and radiological studies and chemical analyses were carried out on samples from each section. The hilar lymph nodes were also studied chemically. The work history and smoking history were assessed. The occupational exposure to silica and total dust were estimated. The effect of smoking was examined, and the relationship between dust content of the lungs to that of the lymph nodes were also investigated. RESULTS: There was a good agreement between radiologic and pathologic findings. Positive correlations were seen between hydroxyproline (as an index of fibrosis), silica dust, non-silica inorganic dust, radiographic category of pneumoconiosis and pathologic grade of silicosis. Smokers lost on average 7 years of life compared to non-smokers, but numbers were small and no adjustment was made. Silica appeared to be concentrated in lungs and lymph nodes compared to the estimates of silica concentration in the mining environment. Silica in the lymph nodes on average is 2.4-fold higher than in the lungs. CONCLUSIONS: This study of autopsied hard rock miners lungs shows positive relationships between lung dust and hydroxyproline content, radiological and pathological findings.

Elevated liver enzymes as a predictor of liver injury in stable blunt abdominal trauma patients: case report and systematic review of the literature.

Liver injury secondary to blunt abdominal trauma is a well-defined entity in emergency medicine. A challenge exists in the diagnosis of liver trauma in the stable, wellappearing patient with a history of blunt abdominal trauma. In centres lacking advanced diagnostic modalities an elevation in hepatic transaminases may provide guidance for the rural emergency physician in seeking further imaging and/or surgical consultation. We present a case report and a discussion of the literature. The literature provided a broad spectrum of results. There appears to be a direct relationship between blunt liver trauma and elevation in liver transaminases. These results are especially evident in the pediatric population. Our findings may help guide the rural emergency physician in transfer and disposition decisions in patients in this situation.

Mountain biking injuries requiring trauma center admission: a 10-year regional trauma system experience.

BACKGROUND: Mountain biking has become an increasingly popular recreational and competitive sport with increasingly recognized risks. The purpose of this study was to review a population based approach to serious injuries requiring trauma center admission related to mountain biking, identify trends and develop directions for related injury prevention programs. METHODS: Three trauma centers in the Greater Vancouver area exclusively serve a major mountain bike park and the North Shore Mountains biking trails. The Trauma Registries and the patient charts were reviewed for mountain bike injuries from 1992 to 2002. The data were analyzed according to demographics, distribution, and severity of injuries, and need for operative intervention. Findings were reviewed with injury prevention experts and regional and national mountain-biking stakeholders to provide direction to injury prevention programs. RESULTS: A total of 1,037 patients were identified as having bicycling-related injuries. Of these, 399 patients sustained 1,092 injuries while mountain biking. There was a threefold increase in the incidence of mountain biking injuries over a 10-year period. Young males were most commonly affected. Orthopedic injuries were most common (46.5%) followed by head (12.2%), spine (12%), chest (10.3%), facial (10.2%), abdominal (5.4%), genitourinary (2.2%), and neck injuries (1%). High operative rate was observed: 38% of injuries and 66% of patients required surgery. One patient died from his injuries. Injury prevention programs were developed and successfully engaged the target population. CONCLUSION: Mountain biking is a growing cause of serious injuries. Young males are principally at risk and serious injuries result from intended activity and despite protective equipment. Injury prevention programs were developed to address these concerns.