Pediatric wilderness recreational deaths in western Washington State

To determine the causes and characteristics of pediatric recreational wilderness deaths.

All deaths of children between 12 months and 20 years of age involving a wilderness recreational activity in 5 western Washington counties between 1987 and 1996 were identified by medical examiners' logs. Univariate analysis was used to examine variables such as age, gender, activity, mechanism of injury, adult presence, blood alcohol level, safety equipment, and mode of evacuation.

Of 40 cases meeting inclusion criteria, 90% involved male subjects and 83% of victims were 13 to 19 years old. Hiking (33%), swimming (20%), and river rafting (10%) were the most common activities. Death was most often by drowning (55%) or closed head injury (26%). No victim was alone. All children younger than 10 years of age were accompanied by an adult, in contrast to only 26% of individuals 10 years or older. Only 4 victims had drugs or alcohol in their system. No victim wore a personal flotation device or helmet, and only 5% had foul weather gear. Although nearly one third of victims were transported by airlift, more than half of the victims were dead at the scene.

Males and teenagers were the 2 major risk groups for recreational wilderness deaths. Traditional activities such as hiking and swimming were the most common causes of death. Children younger than 10 years died despite the presence of an adult, whereas teenagers were usually with groups of peers. The majority of victims were not prepared for adverse events with basic safety equipment.