Observational Study of Grand Canyon Rim-to-Rim Day Hikers: Determining Behavior Patterns to Aid in Preventive Search and Rescue Efforts.

INTRODUCTION: Grand Canyon National Park has seen an increase in visitors traversing the canyon from rim to rim (R2R) in a single day. R2R hikers travel over 33.8 km (21 mi) over 3300 m (11,000 ft) of elevation change and endure large temperature changes. Grand Canyon emergency medical service providers provide emergency medical services to over 1100 visitors annually. Direct guidance by Preventive Search and Rescue rangers has improved safety. The objective of this study was to examine visitors attempting an R2R traverse and to enhance PSAR rangers' anticipatory guidance. METHODS: We conducted an observational study of R2R hikers in the spring and fall of 2015. Hikers consented to study inclusion and were interviewed at the starting trailhead, canyon bottom, and exit trailhead. We performed a survey and collected biometric data. RESULTS: We enrolled 617 visitors with a median age of 43 y (interquartile range [IQR] 33-53); 65% were male and 46% had hiked the R2R a median number of 3 times previously (IQR 2-7). Hydration strategies included water bottle only (20%), hydration bladder only (31%), and both water bottle and hydration bladder (48%). R2R crossers had an average start time of 0530 (SD 1.3 h) and median crossing time of 11.9 h (IQR 10.7-13.3). Crossing time and self-reported fatigue were negatively correlated with prior R2R experience (P=0.02). CONCLUSIONS: Crossing R2R in a day is hazardous and associated with risk of injury and illness. The results of this study can be used by Preventive Search and Rescue to reduce these risks by educating hikers.

Electronic Cigarette Explosion Resulting in a C1 and C2 Fracture: A Case Report.

BACKGROUND: Electronic cigarettes have seen a drastic increase in use. A lithium-ion battery is often used as the rechargeable battery of the electronic cigarette device and has recently received much attention in terms of safety. There are several recent case reports in the scientific literature of injuries due to electronic cigarette explosions that involved soft-tissue injuries. CASE REPORT: We report a significant spinal fracture from an electronic-cigarette explosion in a 27-year-old male. The electronic cigarette exploded during use, sending the mouthpiece through the pharynx and into the first cervical vertebra and resulting in fractures of the first and second vertebrae. An x-ray study of the neck showed a foreign body in the neck at the level of C1. A computed tomography scan of the neck showed fractures of C1. The foreign body was removed in the operating room. The patient was discharged home without neurologic sequelae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Our case report is the first case of a cervical spine injury due to the explosion of an electronic cigarette. This case demonstrates that an electronic cigarette explosion can cause potentially serious penetrating neck injury. Emergency physicians should be aware of the potential danger of electronic cigarettes and have a low threshold to obtain radiographic tests and surgical consultation in the case of electronic cigarette explosion in the oral cavity. As the use of electronic cigarettes continue to increase, it is likely that injuries associated with them will also increase.