In Volume 19, Number 2 (2008) of the journal
Wilderness & Environmental Medicine
appears an original research article entitled "National Estimates of
Outdoor Recreational Injuries Treated in Emergency Departments, United
States, 2004-2005," authored by Adrian H. Flores and his associates
from the
Division of Unintentional Injury Prevention,
National Center for Injury Prevention and Control,
Centers for Disease Control and Prevention,
Atlanta, Georgia. This article was the beneficiary of multiple press
releases, and so there has already been a fair amount of discussion
regarding its findings. Because I was briefly quoted regarding this
article by the Associated Press, I have received a fair number of
inquiries about its significance.
This article is the first to
provide national estimates of nonfatal outdoor recreational injuries
treated in 63 U.S. emergency departments (EDs). The data were gathered
using the National Electronic Injury Surveillance Survey System - All
Injury Program. In this way, national estimates of outdoor recreational
injuries were calculated, and activities leading to injury, demographic
characteristics, principal diagnoses, and primary body parts affected
were described.
Averaged across the study years, an estimated
212,708 persons were treated each year in U.S. EDs for outdoor
recreational injuries. Males accounted for 68.2% of the injuries, but
the rates of injury did not take into consideration that males have
higher rates of participation in outdoor recreation. The lower limb,
upper limb, and head and neck region were the most commonly injured
body regions. Fractures and sprains or strains were the most common
diagnoses. For all injuries, the leading causes were falls, being
struck by or against an object, and overexertion. In this study, the
10- to 19-year old and 20- to 29-year old ages groups accounted for the
greatest percentage of injuries. Snowboarding, sledding, and hiking
were the leading activities associated with outdoor recreational
injuries.
What can be learned from this study? Much of what was
documented is fairly well appreciated already, and confirms our
suspicions about who suffers what type of injuries. As with any type of
epidemiological research, the devil is in the details. For instance, to
understand about how to make use of the information about injuries in
snowboarders, it would be necessary to understand what happened during
each event - did the accident occur at the beginning of the day (? icy
terrain or deep powder) or at the end of the day (? participant tired,
evolving icy conditions, impending darkness); was the snowboarder
wearing protective equipment (? wrist guards, leash, helmet); was the
snowboarder experienced (? beginner, intermediate, expert), etc. To
understand how to make use of the information about injuries in hikers,
it would be important to know the nature of the terrain, the
skill-strength-experience of the hiker, the environmental conditions,
type of footgear, use of a walking stick, etc. The premise is that with
some reasonable degree of detail, we can draw conclusions about how
better to prevent accidents and injuries. The name of the game is
injury prevention.
One cannot remove all risks from outdoor
recreational activities, but a reasonable goal would be to remove all
unnecessary risks. If a deeper analysis of this study reveals that
injured boaters were all driving above a certain speed, we can perhaps
conclude something from that and perhaps make recommendations. If a
greater percentage of the head-injured among the study persons were
without helmets than the participating population at large, then we can
perhaps make a recommendation. This is a nice study that will hopefully
inspire others to look with greater depth at specific areas of outdoor
recreation in order to identify patterns that can lead to more
effective injury prevention.
image courtesy of www.ABC-OF-SNOWBOARDING.com
Preview the 25th Anniversary & Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 25-30, 2008.