McIntosh Scott E, Leemon Drew, Visitacion Joshua, Schimelpfenig Tod, Fosnocht David
Division of Emergency Medicine, University of Utah, Salt Lake City, UT 84132, USA.
Wilderness Environ Med. 2007 Winter;18(4):298-304. doi: 10.1580/07-WEME-OR-093R1.1.
Expedition activities such as mountaineering, rock climbing, river running, sea kayaking, and canoeing all involve an element of risk. Organizations that provide group wilderness and adventure experiences are responsible for managing the risk of their courses. The leaders and medical providers of these trips must therefore be prepared to anticipate and manage medical problems that may arise. The aim of this study is to provide the medical community with a better understanding of the specific injuries and illnesses that occur on wilderness expeditions.
A retrospective descriptive study was done examining the medical incidents that occurred on wilderness-based courses during the 3-year period from September 1, 2002, through August 31, 2005. Participants and staff of the National Outdoor Leadership School (NOLS) served as the study population.
Injuries occurred at a rate of 1.18 per 1000 program days, and illnesses at a rate of 1.08 per 1000 program days. There were no fatalities during the time period. Athletic injuries (sprains, strains) and gastrointestinal illnesses were the most common medical incidents. Hypothermia, seizures, appendicitis, heat stroke, and pregnancy occurred but with low frequency. Fractures, dental emergencies, tick fever, athletic injuries, and nonspecific body pains were the conditions most frequently requiring evacuation.
The rate of medical incidents on NOLS courses declined during the 1990s and has remained relatively steady apart from a slight increase in 2004 and 2005. Athletic injuries continue to be a difficulty, as they frequently result in evacuation even though their ultimate outcome is usually benign. Evacuation decisions should be made considering both the potential severity of the medical condition as well as patient comfort. Wilderness medical personnel must be familiar with a diverse range of medical conditions in order to provide optimal care.
登山、攀岩、激流泛舟、海上皮划艇和独木舟等探险活动都存在一定风险因素。提供团体野外探险体验的机构有责任管理其课程中的风险。因此，这些旅行的领队和医疗人员必须做好准备，以预见并处理可能出现的医疗问题。本研究旨在让医学界更好地了解野外探险中发生的特定损伤和疾病。
进行了一项回顾性描述性研究，调查2002年9月1日至2005年8月31日这3年期间在野外课程中发生的医疗事件。研究对象为国家户外领导力学校（NOLS）的参与者和工作人员。
损伤发生率为每1000个课程日1.18起，疾病发生率为每1000个课程日1.08起。在此期间无死亡病例。运动损伤（扭伤、拉伤）和胃肠道疾病是最常见的医疗事件。体温过低、癫痫发作、阑尾炎、中暑和妊娠也有发生，但频率较低。骨折、牙科急诊、蜱传回归热、运动损伤和非特异性身体疼痛是最常需要撤离的情况。
20世纪90年代NOLS课程中的医疗事件发生率有所下降，除2004年和2005年略有上升外，一直保持相对稳定。运动损伤仍然是一个难题，因为即使其最终结果通常是良性的，但它们经常导致撤离。撤离决策应综合考虑医疗状况的潜在严重程度以及患者的舒适度。野外医疗人员必须熟悉各种医疗状况，以便提供最佳护理。
