Aaron D. Campbell

Mountaineering fatalities on Denali

Mount McKinley, or Denali, is the tallest mountain in North America and attracts over 1,000 climbers annually from around the world. Since Denali is located within a national park, the National Park Service (NPS) manages mountaineering activities and attempts to maintain a balance of an adventurous experience while promoting safety. We retrospectively reviewed the fatalities on Denali from 1903 to 2006 to assist the NPS, medical personnel, and mountaineers improve safety and reduce fatalities on the mountain. Historical records and the NPS climber database were reviewed. Demographics, mechanisms, and circumstances surrounding each fatality were examined. Fatality rates and odds ratios for country of origin were calculated. From 1903 through the end of the 2006 climbing season, 96 individuals died on Denali. The fatality rate is declining and is 3.08/1,000 summit attempts. Of the 96 deaths, 92% were male, 51% occurred on the West Buttress route, and 45% were due to injuries sustained from falls. Sixty-one percent occurred on the descent and the largest number of deaths in 1 year occurred in 1992. Climbers from Asia had the highest odds of dying on the mountain. Fatalities were decreased by 53% after a NPS registration system was established in 1995. Although mountaineering remains a high-risk activity, safety on Denali is improving. Certain groups have a significantly higher chance of dying. Registration systems and screening methods provide ways to target at-risk groups and improve safety on high altitude mountains such as Denali.

Mountaineering medical events and trauma on denali, 1992-2011

Denali (Mt. McKinley) is the tallest mountain in North America and a popular climbing destination for high altitude mountaineering expeditions. National Park Service (NPS) personnel care for and manage medical incidences and traumatic injuries for mountaineers each year. We retrospectively examined NPS medical reports from the climbing seasons of 1992-2011. Medical complaints, diagnoses, treatment, provider training, and overall numbers of injuries and illness were analyzed. Fatalities were included only if they were cared for by NPS medical personnel prior to death. Of the 24,079 climbers on Denali during this period, 831 (3.5%) required medical assistance from the NPS. There were 819 diagnoses; 502 were due to medical illness and 317 were traumatic injuries. Patient encounters occurred most frequently (71%) at the 4328 m camp. Frostbite was the most common individual diagnosis (18.1%), while altitude-related syndromes were the most common illness category (29%). Most patients (84%) were treated and released to descend without additional intervention, whereas 11% needed air evacuation, and 4% needed another type of NPS assistance to descend. The only fatality in this series was caused by traumatic brain injury due to a climbing fall. A broad variety of medical complaints were evaluated and treated by NPS personnel, most commonly altitude related problems and frostbite. The results of the study will enhance the awareness of potential illness and injuries encountered by medical providers participating in high altitude mountaineering expeditions. Additionally, providers responsible for evaluating mountaineers prior to their expeditions can educate them on the spectrum of physical and environmental conditions that increase the chances of illness or injury. This ideally will decrease the incidence of morbidity on both Denali and other high altitude mountaineering destinations.

Risk Stratification for Athletes and Adventurers in High-Altitude Environments: Recommendations for Preparticipation Evaluation

High-altitude athletes and adventurers face a number of environmental and medical risks. Clinicians often advise participants or guiding agencies before or during these experiences. Preparticipation evaluation (PPE) has the potential to reduce risk of high-altitude illnesses in athletes and adventurers. Specific conditions susceptible to high-altitude exacerbation also important to evaluate include cardiovascular and lung diseases. Recommendations by which to counsel individuals before participation in altitude sports and adventures are few and of limited focus. We reviewed the literature, collected expert opinion, and augmented principles of a traditional sport PPE to accommodate the high-altitude wilderness athlete/adventurer. We present our findings with specific recommendations on risk stratification during a PPE for the high-altitude athlete/adventurer.

Preparticipation Evaluation for Climbing Sports

Climbing is a popular wilderness sport among a wide variety of professional athletes and amateur enthusiasts, and many styles are performed across many environments. Potential risks confront climbers, including personal health or exacerbation of a chronic condition, in addition to climbing-specific risks or injuries. Although it is not common to perform a preparticipation evaluation (PPE) for climbing, a climber or a guide agency may request such an evaluation before participation. Formats from traditional sports PPEs can be drawn upon, but often do not directly apply. The purpose of this article was to incorporate findings from expert opinion from professional societies in wilderness medicine and in sports medicine, with findings from the literature of both climbing epidemiology and traditional sports PPEs, into a general PPE that would be sufficient for the broad sport of climbing. The emphasis is on low altitude climbing, and an overview of different climbing styles is included. Knowledge of climbing morbidity and mortality, and a standardized approach to the PPE that involves adequate history taking and counseling have the potential for achieving risk reduction and will facilitate further study on the evaluation of the efficacy of PPEs.

Preparticipation Evaluation for Climbing Sports.

Abstract:Climbing is a popular wilderness sport among a wide variety of professional athletes and amateur enthusiasts, and many styles are performed across many environments. Potential risks confront climbers, including personal health or exacerbation of a chronic condition, in addition to climbing-specific risks or injuries. Although it is not common to perform a preparticipation evaluation (PPE) for climbing, a climber or a guide agency may request such an evaluation before participation. Formats from traditional sports PPEs can be drawn upon, but often do not directly apply. The purpose of this article was to incorporate findings from expert opinion from professional societies in wilderness medicine and in sports medicine, with findings from the literature of both climbing epidemiology and traditional sports PPEs, into a general PPE that would be sufficient for the broad sport of climbing. The emphasis is on low altitude climbing, and an overview of different climbing styles is included. Knowledge of climbing morbidity and mortality, and a standardized approach to the PPE that involves adequate history taking and counseling have the potential for achieving risk reduction and will facilitate further study on the evaluation of the efficacy of PPEs.

Risk Stratification for Athletes and Adventurers in High-Altitude Environments: Recommendations for Preparticipation Evaluation.

High-altitude athletes and adventurers face a number of environmental and medical risks. Clinicians often advise participants or guiding agencies before or during these experiences. Preparticipation evaluation (PPE) has the potential to reduce risk of high-altitude illnesses in athletes and adventurers. Specific conditions susceptible to high-altitude exacerbation also important to evaluate include cardiovascular and lung diseases. Recommendations by which to counsel individuals before participation in altitude sports and adventures are few and of limited focus. We reviewed the literature, collected expert opinion, and augmented principles of a traditional sport PPE to accommodate the high-altitude wilderness athlete/adventurer. We present our findings with specific recommendations on risk stratification during a PPE for the high-altitude athlete/adventurer.

Counseling for the Wilderness Athlete and Adventurer During a Preparticipation Evaluation for Preparation, Safety, and Injury Prevention

Wilderness sports and adventures continue to increase in popularity. Counseling is an essential element of the preparticipation evaluation (PPE) for athletes in traditional sports. This approach can be applied to and augmented for the wilderness athlete and adventurer. The authors reviewed the literature on counseling during PPEs and gathered expert opinion from medical professionals who perform such PPEs for wilderness sports enthusiasts. The objective was to present findings of this review and make recommendations on the counseling component of a wilderness sports/adventure PPE. The counseling component of a PPE for wilderness sports/adventures should take place after a basic medical evaluation, and include a discussion on sport or activity-specific injury prevention, personal health, travel recommendations, and emergency event planning. Counseling should be individualized and thorough, and involve shared decision making. This should take place early enough to allow ample time for the athlete or adventurer to further prepare as needed based on the recommendations. Resources may be recommended for individuals desiring more information on selected topics.

Counseling for the wilderness athlete and adventurer during a preparticipation evaluation for preparation, safety, and injury prevention

Wilderness sports and adventures continue to increase in popularity. Counseling is an essential element of the preparticipation evaluation (PPE) for athletes in traditional sports. This approach can be applied to and augmented for the wilderness athlete and adventurer. The authors reviewed the literature on counseling during PPEs and gathered expert opinion from medical professionals who perform such PPEs for wilderness sports enthusiasts. The objective was to present findings of this review and make recommendations on the counseling component of a wilderness sports/adventure PPE. The counseling component of a PPE for wilderness sports/adventures should take place after a basic medical evaluation, and include a discussion on sport or activity-specific injury prevention, personal health, travel recommendations, and emergency event planning. Counseling should be individualized and thorough, and involve shared decision making. This should take place early enough to allow ample time for the athlete or adventurer to further prepare as needed based on the recommendations. Resources may be recommended for individuals desiring more information on selected topics.