Wilderness event medicine: planning for mass gatherings in remote areas

An increasing number of large recreational events are taking place in remote environments where medical care is far away. Such events include adventure races and large outdoor trips. Wilderness event medicine (WEM) has been previously defined as the healthcare response at any discrete event with more than 200 persons located more than 1h from hospital treatment. However, there is little literature describing the steps for providing medical care at such events.

This article provides a framework for planning and executing WEM. It reviews the published data on wilderness injury and illness rates and describes the nature of injuries as they relate to specific activities. The article then discusses the three stages of WEM: pre-event planning, medical treatment at the event, and post-event tasks.

Wilderness events include myriad activities, including orienteering, mountain biking, mountaineering, and whitewater paddling. The injury and illness rates are in the range of 1-10 per 1000 person-days of exposure, with rates one order of magnitude greater for events which last many days, include extremes of environment (heat, altitude), or are competitive in nature. Professional adventure racers may present for medical evaluation at rates as high as 1000 encounters per 1000 racer-days. Injuries depend largely on activity. Illnesses are mostly gastrointestinal, 'flu-like' malaise, or related to the event environment, such as humidity or altitude. Providing medical care requires the proper staff, equipment, and contingency plans. The remoteness of these events mandates different protocols than would be used at an urban mass gathering.

WEM will likely continue to grow and evolve as a specialty. Additional reports from wilderness events, perhaps facilitated through a web-based incident reporting system, will allow medical providers to improve the quality of care given at remote events. Research into wilderness activity physiology will also be useful in understanding the prevention and treatment of injuries and illnesses encountered.