Ten Years of Search and Rescue in Yosemite National Park: Examining the Past for Future Prevention

Search and Rescue in California: The Need for a Centralized Reporting System

INTRODUCTION

There is no published information on the epidemiology of wilderness rescues in California outside of national parks. The objective of this study was to investigate the epidemiology of wilderness search and rescue (SAR) missions in California and identify risk factors for individuals requiring rescue due to accidental injury, illness, or navigation errors in the California wilderness.

METHODS

A retrospective review of SAR missions in California from 2018 to 2020 was conducted. This was done from a database of information collected by the California Office of Emergency Services and the Mountain Rescue Association from SAR teams, who submitted voluntarily. The subject demographics, activity, location, and outcomes of each mission were analyzed.

RESULTS

Eighty percent of the initial data were excluded because of incomplete or inaccurate data. Seven hundred forty-eight SAR missions involving 952 subjects were included in the study. The demographics, activities, and injuries of our population were consistent with those reported from other epidemiological SAR studies, and there were significant differences in outcomes based on the subject's activity. For example, water activities were highly correlated with a fatal outcome.

CONCLUSIONS

The final data show interesting trends, but it is difficult to draw firm conclusions because so much of the initial data had to be excluded. A uniform system for reporting SAR missions in California may be helpful for further research, which may aid both SAR teams and the recreational public in understanding risk factors. A proposed SAR form for easy entry is included in the discussion section.

Short hydration education video and hiker fluid selection and consumption at trails, a non-randomized quasi-experimental field study

Background: Education may improve hiker safety on trails. Aim: To investigate the impact of an educational video on hiker fluid selection and fluid consumption in a hot environment. Methods: Quasi-experimental field study at hiking trails in which the intervention group (INT) viewed a three-minute hydration education video, whereas the control group (CON) did not. Before the hike, all hikers were asked if they wanted to select extra fluid, which was provided by the research team. Results: A total of n = 97 hikers participated in the study, with n = 56 in INT (32 male) and n = 41 in CON (25 male). Despite absolute differences in environmental conditions, the differences fell within the same WBGT category. The total amount of fluid brought to the trails by participants was different between INT: 904 (503-1758) mL and CON: 1509 (880-2176) mL (P = 0.006), but participants in the INT group selected extra fluid (41%; n = 23) significantly more often when compared with participants in the CON group (7%; n = 3; P < 0.001). As a result, there was no difference in the amount of fluid brought on the trail between INT: 1047 (611-1936) mL and CON: 1509 (932-2176) mL (P = 0.069), nor for fluid consumption between INT: 433 (289-615) mL/h and CON: 489 (374-719) mL/h (P = 0.18). Conclusions and Implications: A 3-min educational video may encourage hikers to select additional fluid before the start of their hike but does not appear to increase fluid intake.

The Associations Between Visitation, Social Media Use, and Search and Rescue in United States National Parks

INTRODUCTION

Search and rescue (SAR) is vital for visitor safety in US national parks, which are popular destinations for tourists. Previous studies have described SAR and seasonal visitation patterns, but not in the context of overall visitation. In addition, studies on the association between SAR and developed park areas remain limited. Concurrently, social media can be valuable for sharing information about conservation awareness and the joy of being outdoors. However, social media can potentially be an avenue for users to share risky and dangerous behaviors performed during attempts to obtain photos and videos. The associations between SAR and social media have not been discussed in existing literature.

METHODS

Variables included recreational visits, developed site stay visits, backcountry visits, SAR incidents, and tweets. Data from 2017 were obtained from National Park Service visitor use statistics, the SAR incident dashboard, and the University of California, Irvine, Cloudberry application. Correlation analysis was performed using nonparametric Kendall rank correlation coefficients.

RESULTS

Recreational visits were correlated with SAR incidents (r_τ=0.415, P<0.001). Developed site stays were similarly correlated with SAR incidents (r_τ=0.447, P<0.001), as were backcountry visits (r_τ=0.428, P<0.001). Backcountry visits had a stronger correlation with fatalities (r_τ=0.380, P<0.001) compared to developed site stays (r_τ=0.304, P<0.001). Tweets were correlated with SAR incidents (r_τ=0.468, P<0.001), recreational visits (r_τ=0.403, P<0.001), and fatalities (r_τ=0.367, P<0.001).

CONCLUSIONS

Our findings demonstrate associations between national park visitation, SAR incidents, fatalities, and Twitter use and provides a concept framework for future prospective studies to further investigate the relationships between visitation, SAR, and social media.

Growth of Rescues in Natural Areas during the First Summer of COVID-19 Pandemic in Catalonia

This article analyzes the impact of the end of the COVID-19 lockdown on the number of rescues in natural areas in Catalonia (Spain) during July and August 2020. We compared the figures for 2020 with those corresponding to the same period in 2016–2019, including their temporal and spatial distributions. Our findings show that the number of rescues undertaken by the Catalan Fire Department in July and August 2020 increased significantly compared to the same summer period in the four previous years (+39.7%). The daily averages increased for both weekends and weekdays in 2020, with 7.5 and 3.9 rescues per day, respectively. The greatest increase corresponded to rescue operations conducted at low altitudes (up to 500 m ASL) and areas with no specific protection status near to populated places. Natural areas were perceived safer than, for example, coastal destinations in terms of the risk of COVID-19 contagion, and they experienced a growth in visitors during the first summer of the pandemic. One consequence of this was an increase in emergency service activity to rescue people in natural areas. This research adds new evidence of the multiple indirect effects of the reconfiguration of mobilities in the context of the COVID-19 pandemic. Our findings could be of interest to emergency service managers, managers of protected natural areas, and public authorities.

Hiking Time Trial Performance in the Heat with Real-Time Observation of Heat Strain, Hydration Status and Fluid Intake Behavior

This study investigated the real-time progression of heat strain in mountain hikers during time trials (TT). Participants (n = 12; 7M/5F; age 21.6 ± 2.47) attempted to climb Tempe Butte (~1.1 mi) four times in HOT and MOD trials (wet bulb globe temperature 31.6 °C vs. 19.0 °C). Performance, physiological outcomes, and fluid intake behavior were measured in real-time. Hot conditions significantly impaired hiking TT performance by 11%, reduced aerobic capacity by 7%, increased peak rate of perceived exertion (RPE) by 19%, and elevated core temperature (T_c) by 0.7 °C compared to MOD (all p < 0.03). Less-aerobically-fit participants were most negatively-affected by heat stress. Based on sweat lost, participants in HOT required 2.26 ± 0.91 L of fluids, brought 1.52 ± 0.83 L, and consumed 1.54 ± 0.49 L, losing an average of 1.1% ± 1.0%BM. Participants in MOD required 1.28 ± 0.39 L of fluids, brought 1.57 ± 1.09 L, and consumed 0.79 ± 0.57 L, losing an average of 1.0% ± 0.8%BM. Morning-after urine specific gravity (USG) values revealed 75% of hikers were hypohydrated (USG ≥ 1.020) after HOT; 67% after MOD. Heat stress impairs hiking TT performance while increasing RPE and T_c. Fitter participants showed less performance and physiological impairment from heat stress. Although hikers in both conditions lost similar body weight, hikers were limited in HOT by fluid availability, whereas in MOD, fluid was available and dehydration was voluntary.

Impact of a Half Dome Cable Permitting Process on Search and Rescue Activity, Hiker Mortality Rates, and Operational Costs Above Little Yosemite Valley

INTRODUCTION

The summit of Yosemite's Half Dome is reached using cable handrails for the final 146 m (480 ft). Access to these cables was restricted to users with permits in 2010. The authors aim to describe the impact of permitting on search and rescue (SAR) in the region of the park most affected by permitting.

METHODS

An observational study from 2005 to 2009 and 2011 to 2015 comparing the number of incidents, major incidents (exceeding $500), victims, and fatalities before and after permitting the use of cable handrails on Half Dome in the area above Little Yosemite Valley (LYV) and parkwide. Each year was analyzed separately with t tests and Mann-Whitney U tests. Data are presented as mean±SD.

RESULT

The number of hikers in the study area was reduced by up to 66% by permitting. Above LYV from 2005 to 2009, there were 85 SAR incidents, 134 victims, 8 fatalities, 38 major incidents, and annual SAR costs of $44,582±28,972. From 2011 to 2015, the same area saw 54 SAR incidents, 156 victims, 4 fatalities, 35 major incidents, and annual SAR costs of $27,027±19,586. No parameter showed statistical significance. Parkwide SAR incidents decreased from 232 to 198 annual incidents (P=0.013) during the same time period, with parkwide mortality increasing from 8 to 12 deaths annually (P=0.045).

CONCLUSIONS

SAR incidents, victims, fatalities, or costs above LYV did not decrease after cable handrail permitting. Parkwide SAR activity decreased during the same intervals. This strongly suggests that overcrowding is not the key factor influencing safety on Half Dome. This discordant trend warrants close observation over 5 to 10 y.

Epidemiology of Cardiac Events During Prehospital Care in Mountain Rescues Conducted in Aragón

INTRODUCTION

Cardiac events are one of the leading causes of death in the Spanish population. Given the increase in the nontraumatic medical conditions found in mountain rescues, the objective of this study was to report on the heart conditions of patients rescued in the mountains of Aragón in the Spanish Pyrenees.

METHODS

We conducted a retrospective observational study based on data collected from patients' medical histories for rescues undertaken in from 2010 to 2016 (at altitudes between 500 m [1640 ft] and 3404 m [11,168 ft]).

RESULTS

Of the 2079 individuals rescued from 2010 to 2016, 34 (2%) were diagnosed with heart conditions, accounting for 21% of all nontraumatic medical conditions. The data showed a statistically significant increase in the age of the rescued patients with heart conditions (55±15 y) and those with acute coronary syndrome/sudden death (60±8 y). Eighty-five percent of the rescued patients with heart conditions were men, 62% were rescued above 2000 m (6500 ft), 42% had acute coronary syndrome (of whom 56% had inferior infarction), and 35% died suddenly.

CONCLUSIONS

Aragón mountain rescues show an increase in patient age in recent years. The most common medical case among rescued individuals with heart conditions was a hiker over the age of 50 y with cardiovascular risk factors, inferior infarction, and occurrence at an altitude above 2000 m. Based on our observations, appropriate training should be undertaken, especially by older hikers, who may also benefit from cardiac screening, and rescue vehicles/personnel and mountain huts should be equipped with semiautomatic external defibrillators.

Research Gaps in Wilderness Medicine

INTRODUCTION

Wilderness medicine involves the treatment of individuals in remote, austere environments. Given the high potential for injuries as well as the unique treatment modalities required in wilderness medicine, evidence-based clinical practice guidelines are necessary to provide optimal care. In this study, we identify evidence gaps from low-quality recommendations in wilderness medicine clinical practice guidelines and identify new/ongoing research addressing them.

METHODS

We included relevant clinical practice guidelines from the Wilderness Medical Society and obtained all 1C or 2C level recommendations. Patient/Problem/Population, intervention, comparison, outcome (PICO) questions were created to address each recommendation. Using 24 search strings, we extracted titles, clinical trial registry number, and recruitment status for 8899 articles. We categorized the articles by trial design to infer the effect they may have on future recommendations.

RESULTS

Twelve clinical practice guidelines met inclusion criteria. From these we located 275 low-quality recommendations and used them to create 275 PICO questions. Thirty-three articles were relevant to the PICO questions. Heat-related illness had the highest number of relevant articles (n=9), but acute pain and altitude sickness had the most randomized clinical trials (n=6).

CONCLUSION

Overall, few studies were being conducted to address research gaps in wilderness medicine. Heat-related illness had the most new or ongoing research, whereas no studies were being conducted to address gaps in eye injuries, basic wound management, or spine immobilization. Animals, cadavers, and mannequin research are useful in cases in which human evidence is difficult to obtain. Establishing research priorities is recommended for addressing research gaps identified by guideline panels.

Job task characteristics of Australian emergency services volunteers during search and rescue operations

Search and rescue operations are necessary in locating, assisting and recovering individuals lost or in distress. In Australia, land-based search and rescue roles require a range of physically demanding tasks undertaken in dynamic and challenging environments. The aim of the current research was to identify and characterise the physically demanding tasks inherent to search and rescue operation personnel within Australia. These aims were met through a subjective job task analysis approach. In total, 11 criterion tasks were identified by personnel. These tasks were the most physically demanding, frequently occurring and operationally important tasks to these specialist roles. Muscular strength was the dominant fitness component for 7 of the 11 tasks. In addition to the discrete criterion tasks, an operational scenario was established. With the tasks and operational scenario identified, objective task analysis procedures can be undertaken so that practitioners can implement evidence-based strategies, such as physical selection procedures and task-based physical training programs, commensurate with the physical demands of search and rescue job roles. Practitioner Summary: The identification of physically demanding tasks amongst specialist emergency service roles predicates health and safety strategies which can be incorporated into organisations. Knowledge of physical task parameters allows employers to mitigate injury risk through the implementation of strategies modelled on the precise physical demands of the role.

Health Supply Utilization at a Boy Scout Summer Camp: An Evaluation for Improvement and Preparedness

OBJECTIVE

To describe the health conditions treated by a health services center at a Boy Scout summer camp and make recommendations for appropriate resources and supplies.

METHODS

We conducted a retrospective review of health center utilization at a Boy Scout camp in central Missouri during the summers of 2012 and 2013. Health logbook data were compiled and analyzed using descriptive and comparative statistics.

RESULTS

During the study period 19,771 camp participants made 1586 visits to the health care center. The overall incidence rate of health center visits was 6.20 visits per 1000 camp days. Two-thirds of visits were for illness and the remainder for injury. Over 90% of patients were returned to camp, 7.3% were transferred to another health facility, and 1.6% were advised to leave camp and return home. The most common treatments were rehydration (17.8 %) and administration of analgesics (13.4%) and topical creams (12.3%).

CONCLUSIONS

Summer camps need to be prepared for a wide range of conditions and injuries in youth campers, leaders, and staff members. Over 90% of presenting complaints were managed on site, and the majority of conditions were easily treatable minor injuries and illnesses. We provide recommendations for appropriate medical supplies and suggest opportunities for improvement to aid health centers in planning and treatment.

New Zealand land search and rescue operations: an analysis of medical and traumatic conditions

OBJECTIVE

The aim of this study was to describe the range and types of medical and traumatic conditions encountered in land search and rescue operations in New Zealand.

METHODS

Twenty months (May 2010 to December 2011) of land search and rescue operations were analyzed. Data on medical and traumatic conditions were extracted from the New Zealand Police search and rescue database.

RESULTS

During the period audited, New Zealand Police coordinated 1490 land-based search and rescue operations, from which 611 persons fulfilled the study inclusion criteria. Males accounted for 60.5% of the subjects, and a trauma-related injury was the most commonly encountered condition (37.3% of all). The lower limb was the most commonly injured body site, and most injuries occurred as the result of a slip or fall. Medical conditions were recorded in 11.6% of operations and included a wide spread of conditions, with cardiovascular events being seen most frequently. Hypothermia was diagnosed in 9.3% of all operations, and fatalities made up 5.6% of the sample. Thirty percent of all operations were for persons with cognitive impairment who had wandered away from their usual place of residence. These were almost entirely urban searches and concentrated in districts with large populations.

CONCLUSIONS

Search and rescue personnel are exposed to a broad range of medical and traumatic conditions. In New Zealand, they include preexisting cognitive impairment that results in persons lost in urban environments. Notwithstanding this, many subjects will also need to be managed in remote, resource-limited environments for extended periods. First aid training and field equipment should reflect these demands.

Where wilderness, medicine, technology, and religion collide

We report a case of a man injured in Yosemite National Park (YNP) whose use of technology and refusal of medical care, based on his Christian Science religious beliefs, created multiple challenges to the providers working to rescue and care for him. This case illustrates how our increasingly diverse and complex world requires flexibility and openness to provide the optimal care, both in the wilderness and in the front country.

Wilderness medicine

BACKGROUND

Human activity in wilderness areas has increased globally in recent decades, leading to increased risk of injury and illness. Wilderness medicine has developed in response to both need and interest.

METHODS

The field of wilderness medicine encompasses many areas of interest. Some focus on special circumstances (such as avalanches) while others have a broader scope (such as trauma care). Several core areas of key interest within wilderness medicine are discussed in this study.

RESULTS

Wilderness medicine is characterized by remote and improvised care of patients with routine or exotic illnesses or trauma, limited resources and manpower, and delayed evacuation to definitive care. Wilderness medicine is developing rapidly and draws from the breadth of medical and surgical subspecialties as well as the technical fields of mountaineering, climbing, and diving. Research, epidemiology, and evidence-based guidelines are evolving. A hallmark of this field is injury prevention and risk mitigation. The range of topics encompasses high-altitude cerebral edema, decompression sickness, snake envenomation, lightning injury, extremity trauma, and gastroenteritis. Several professional societies, academic fellowships, and training organizations offer education and resources for laypeople and health care professionals.

CONCLUSIONS

THE FUTURE OF WILDERNESS MEDICINE IS UNFOLDING ON MULTIPLE FRONTS: education, research, training, technology, communications, and environment. Although wilderness medicine research is technically difficult to perform, it is essential to deepening our understanding of the contribution of specific techniques in achieving improvements in clinical outcomes.