2014, July/August Adirondac Adirondoc
One of my many pet peeves with much of the wilderness medicine crowd these days is their lack of attention to the actual risks in various outdoor pursuits. Auto accidents en route to the trailhead, for example, kill far more outdoor enthusiasts than do actual incidents in the backcountry. As I pointed out in an earlier column, skin cancer from sunburn claims thousands of summer sports participants. Yet, many wilderness first responder courses put their students through exercises like fashioning trekking poles into splints for femur fractures and debating the merits of wider availability of epinephrine auto-injectors, therapies for which the documented need in the backcountry is virtually nil.
Water safety is another example of our misplaced priorities in backcountry health and safety. Nearly four thousand Americans drown annually. Although annual backcountry data are not available, two major providers of outdoor adventure education, Outward Bound and the National Outdoor Leadership School, have lost participants to drowning. Indeed, the most recent analysis of Outward Bound fatalities (which are actually quite rare) cited drowning as the most common. Yet, while many organizations require some form of wilderness first aid training for their trek leaders, few have a requirement for water safety certification. (A notable exception is the New York State Department of Environmental Conservation, which has a water safety requirement for all of its guide license applicants.)
Drowning occurs in several clearly delineated situations, and the implications for prevention are consequently specific. Two large groups are children between ages one and four ( most often from wandering into pools) and adolescent and young adult males who are drunk Prevention strategies for these are largely self-evident, although difficult to achieve in the case of the latter.
Drowning in the context of outdoor sports is most commonly associated with boating. Nearly 90 percent of drownings among boaters occur in individuals not wearing a personal floatation device (PFD). This fact never ceases to astound me. Few folks leave their canoes or kayaks for a controlled entry into the water: they overturn, fall, lose consciousness for some other reason, or have other risks for being incapacitated upon entry. In such a circumstance, one’s swimming ability counts for naught, but a properly donned PFD will be life-saving. I’m a former competitive swimmer, but would not dream of setting out on even the calmest of Adirondack lakes without my PFD fully secured.
Another risk factor for water fatality in the backcountry is diving into waters whose depths or hidden obstacles are unknown. This means just about every natural swimming area one can imagine. Diving is for pools or marked natural waters, not for backcountry swims.
Although one associates danger from currents with ocean swimming, fast-flowing natural waters can be immensely powerful-far more so than they might appear. Readers may recall the tragic loss of four lives in a popular swimming spot on the Boquet River a decade ago. Since such incidents are usually isolated, they rarely get the kind of publicity that would make people more aware of this danger. As one who has spent countless hours in the (now off-limits) pool at the base of Hanging Spear Falls, I can never recommend taking friends (or, for guides, clients) into such an area.
Obviously, knowing how to swim reduces the risk of drowning. A recent article in the New York Times (http://well.blogs.nytimes.com/2014 / 04 / 28 /a-stroke-you-must-have/?_ php=true&_type=blogs&_r=0) highlighted the number of adults who are non-swimmers, while pointing out that it is never too late to learn.
Finally, a word about the treatment of near-drowning. This is the one situation in the backcountry in which CPR is possibly effective. Although the current teaching in layperson CPR courses is for “hands only,” drowning death is respiratory, and chest compressions should be accompanied by rescue breathing if the rescuer knows the technique. Drowning in very cold water can actually be “protective,” and recovery after up to an hour of CPR has been reported in such circumstances. Don’t give up.
Finally, if one is able to resuscitate someone after a near-drowning, he or she is not out of the woods. There are possible metabolic and infectious complications of having water in one’s lungs, so immediate transport for complete medical evaluation is indicated, even with apparent recovery.
~ Tom Welch, MD, is professor and chair of pediatrics at Upstate Medical University in Syracuse and an active member of the Wilderness Medical Society. He is a licensed professional guide and a certifying instructor for the Wilderness Education Association, and has guided groups in the Adirondacks, Montana, and Alaska. More information is available at his website and blog: www.adirondoc.comEnvironmental Injuries