Goodman T, Iserson K V, Strich H
Section of Emergency Medicine, Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA.
Ann Emerg Med. 2001 Mar;37(3):279-83. doi: 10.1067/mem.2001.112256.
To analyze the epidemiology of wilderness mortalities in a localized area with diverse terrain.
We conducted a retrospective review of the Pima County (Arizona) Sheriff's Office (PCSO) search and rescue logs and case reports, hospital records, and autopsy reports for all wilderness deaths from 1980 to 1992. The study group comprised all victims of injury or illness in Pima County wilderness who died during a 13-year period in a location remote enough so that standard ground-based emergency medical services units could not extract the body.
One hundred fatalities occurred during the 13-year study period. There were 59 unintentional traumas, 18 suicides, 9 homicides, 12 medically related deaths, and 2 deaths of unknown causes. Toxicology tests performed on body fluids yielded positive findings for alcohol in a total of 50 (50%) cases and positive findings for drugs of abuse in 12 (12%) cases. It was estimated that alcohol was "a very probable" or "a probable" causative factor in 23 (40%) of the 59 unintentional trauma deaths, and in 1 (8.3%) of the 12 medically related deaths. Fifty-five (55%) deaths were witnessed events, with 45 (80%) of these victims reported as dying immediately or before arrival of search and rescue personnel. Ten (10%) victims received resuscitation in the field, and according to a review of hospital charts and autopsy reports, only 2 victims had a potentially survivable injury or illness.
Many wilderness mortalities are related to incidents involving alcohol. Once the accident or injury has occurred, the majority of deaths are immediate, or at least before the arrival of medical personnel. Higher levels of medical care would not have improved the outcomes of those who did survive long enough to receive medical care. Therefore, primary efforts to reduce mortalities in the wilderness should be directed toward prevention, especially diminishing alcohol use in wilderness areas.
分析地形多样的局部地区野外死亡的流行病学特征。
我们对皮马县（亚利桑那州）警长办公室（PCSO）1980年至1992年期间所有野外死亡的搜索与救援日志、病例报告、医院记录及尸检报告进行了回顾性研究。研究组包括皮马县野外受伤或患病且在13年期间死于距离偏远以至于标准地面急救医疗服务单位无法搬运尸体地点的所有受害者。
在13年的研究期间共发生了100起死亡事件。其中有59起意外创伤、18起自杀、9起他杀、12起与医疗相关的死亡以及2起因不明的死亡。对体液进行的毒理学检测结果显示，共有50例（50%）酒精呈阳性，12例（12%）滥用药物呈阳性。据估计，在59起意外创伤死亡事件中有23例（40%）酒精是“极有可能”或“有可能”的致病因素，在12起与医疗相关的死亡事件中有1例（8.3%）酒精是致病因素。55例（55%）死亡事件有目击者，其中45例（80%）受害者据报告在搜救人员到达之前或到达时立即死亡。10例（10%）受害者在现场接受了复苏治疗，根据对医院病历和尸检报告的审查，只有2例受害者有潜在可存活的损伤或疾病。
许多野外死亡与涉及酒精的事件有关。一旦事故或伤害发生，大多数死亡是即时的，或者至少在医务人员到达之前。更高水平的医疗护理并不能改善那些存活足够长时间接受医疗护理者的结局。因此，减少野外死亡的主要努力应指向预防，特别是减少野外地区的酒精使用。
