Epidemiology of Mountain Search and Rescue Operations in Banff, Yoho, and Kootenay National Parks,

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1 Wilderness and Environmental Medicine, 19, (2008) ORIGINAL RESEARCH Epidemiology of Mountain Search and Rescue Operations in Banff, Yoho, and Kootenay National Parks, Finlay J. Wild, MBChB From the University of Aberdeen, Scotland. Objective. To describe the epidemiology of mountain incidents and mountain rescue operations occurring in Banff, Yoho, and Kootenay National Parks between 1 January 2003 and 31 December Methods. Retrospective review of Banff, Yoho, and Kootenay Public Safety Occurrence Reports detailing rescue operations within the study period. Demographics, activity, reason for rescue, mode of rescue, type of injury, and fatalities were analyzed. Results. A total of 317 emergency mountain rescue operations involving 406 persons was documented. The mean age of the rescued population was 35.2 years, and this population was predominantly male (63.1%). Hikers were involved in 43.5% of incidents, and slips and falls were responsible for 50.2%. Helicopter was the mode of rescue in 64% of cases. Almost half (40.7%) of all rescues involved people with no injuries. The limbs were the most common body part affected (68% of traumatic injuries). Forty fatalities occurred 45% due to avalanches and 27.5% due to slips and falls. Conclusions. This study offers a synopsis of the rescue service provided by Parks Canada Rescue in the study area. Further work is needed to separate primary and contributory causes of mountain incidents, and this can be achieved by use of better data collection methods. Hospital follow-up is required to accurately assess the morbidity and mortality associated with mountain incidents. Data presented are expected to be of value to a variety of tourism, health, and safety organizations. Key words: accident prevention, backcountry medicine, climbing injuries, orthopedic injuries, search and rescue, sports injuries, trauma Introduction Banff, Yoho, and Kootenay National Parks (Banff NPs) in the Canadian Rockies cover an area of over 9300 km 2 and receive in excess of 4 million visitors yearly. 1 Many people make use of the vast mountain ranges for outdoor activities. As in any such area, mountain incidents are inevitable as a result of the inherent risks of both the activities performed and the terrain. 2 In this area the Public Safety Program of Parks Canada has the responsibility for mountain search and rescue. The vast size of the parks and their extremely rugged terrain render much of the region poorly accessible by road, and a helicopter is often used for search and rescue. A pilot is on call at all times and on a typical helicopter rescue will be accompanied by 2 to 3 wardens. Corresponding author: Finlay J. Wild, MBChB, Tarradale, Heathercroft, Fort William, Scotland, PH33 6LD ( fin wild@ hotmail.co.uk). No winching is done during rescues. Casualties are either placed directly within the helicopter or a fixed line of typically 100 feet in length can be attached to the base of the helicopter to allow heli-sling manueuvers with a suspended stretcher or harnessed casualty. 3 The Public Safety Program is run by the Banff Field Unit (FU) and the Lake Louise, Yoho, and Kootenay FU. The 5 Public Safety Specialists are full-time wardens and qualified Mountain Guides (members of the Association of Canadian Mountain Guides, which is affiliated with the International Federation of Mountain Guides Associations). These wardens undergo continuing training as guides and receive Advanced Wilderness First- Aid training. Oxygen is used during rescue, but no controlled drugs are administered. General wardens sometimes become involved in nontechnical rescues, and Canadian Avalanche Rescue Dog Association volunteers assist with avalanche searches. Rescue operations are funded by park fees and do-

2 246 Wild nations, and rescue is free of charge. When casualties require further medical attention, they are flown to the hospital directly or rescuers rendezvous with ambulances. The main trauma hospital for Banff NPs is Banff Mineral Springs, which receives most of the casualties. No physicians are routinely involved in the search and rescue aspect of mountain rescue, although a paramedic will occasionally accompany the wardens for a nontechnical medical emergency or other such event. The objective of this study was to analyze the epidemiology of mountain rescues involving Parks Canada Rescue (PCR) in Banff NPs over a 4-year period between January 1, 2003, and December 31, The study examined age, gender, and nationality before considering the activities being performed when incidents occurred, the reason for rescue, the mode of rescue, injuries sustained, and fatalities. This is the first published study of mountain rescue data in the area described. The presented data describe the rescue service provided in Banff NPs. It is expected that this information will be useful to PCR and local health care agencies in service provision; Local tourism and media groups, who may wish to obtain objective data on the risks of mountain activities; and Those interested in improving safety and developing training schemes for mountain-based activities in the study area. Methods Table 1. Details of rescue operations undertaken by Parks Canada Rescue in Banff, Yoho, and Kootenay National Parks between January 1, 2003, and December 31, 2006 Details Year Total Rescue operations People recovered (alive or dead) Survivors rescued Survivors injured Fatalities This retrospective review examined information from all documented rescue operations carried out by PCR during the study period. The Public Safety Occurrence Reports (original paper copies, filed after every incident involving a warden) of Banff FU and Lake Louise, Yoho, and Kootenay FU were examined and the relevant data extracted. Data entries into reports were occasionally partially complete or ambiguous, and all calculations were performed using the available information. This error is not thought to be significant. Usually details of final hospital outcome were not available in the reports, and hospital follow up was not performed. A rescue operation was defined as any intervention by PCR in an incident involving injury or potential danger to persons while in the wilderness. The commercial ski areas within the study area have their own dedicated ski patrols and were excluded unless PCR became involved. Injury severity was assessed as Code Green (no injury or non life-threatening), Yellow (potentially lifethreatening), Red (serious and imminently life-threatening), or Black (fatality) by the rescuers upon arrival at the scene. Hiking is a broad term and was used to describe a spectrum of activities ranging from strolls around vehicle-accessible mountain lakes to multiday hikes through challenging and remote mountain terrain. The own power assist category includes persons who refused aid or those reported overdue or stranded who, after assessment or advice, did not require additional external help in evacuation. Excluded from the study were all non mountain rescue aspects of warden work. For example, attendance at traffic incidents and fire evacuation. Mountain rescue false alarms for which no assistance was required were excluded, as was any work involving missing or downed aircraft. Boat, canoe/kayak, and paraglider incidents were included when they took place in a mountain setting. Searches for missing persons that yielded no trace of a casualty were excluded. On occasion wardens assisted with rescue operations outside the Banff NPs area, and these rescues were included. Results Table 1 shows the details of rescue operations undertaken during the study period. DEMOGRAPHICS The population rescued had a mean age of 35.2 years (SD 17.0) and was 63.1% male. Figure 1 shows the age distribution and gender of rescued people. Three hundred of the 406 people recovered were Canadian (73.9%) and over half (208) were from Alberta. The United States accounted for 14.8% and Europe for 5.7% of people rescued. Figure 2 shows the monthly distribution of rescues.

3 Mountain Search and Rescue in Banff Park 247 Table 2. Activity pursued at time of incident, for persons rescued by Parks Canada Rescue in Banff, Yoho, and Kootenay National Parks between January 1, 2003, and December 31, 2006 Activity Count Figure 1. Age distribution and gender of people rescued by Parks Canada Rescue in Banff, Yoho, and Kootenay National Parks between January 1, 2003, and December 31, ACTIVITY Table 2 shows the activities engaged in at the time of the incident. REASON FOR RESCUE Table 3 shows the main reasons for which rescue was required. MODE OF RESCUE Helicopter was the mode of rescue in 64% of all rescues, with heli-sling rescue accounting for 29% and casualties placed within the helicopter 35% (Figure 3). INJURIES Figure 4 shows the severity of injuries sustained. Hike Mountaineering (including scrambling) Ski backcountry Mountain bike 19 6 Horse riding Ski/snowboard downhill Ice climb Rock climb Other (snowmobile, snowshoe, hangglide, run, cave) Watersports (canoe, kayak, boat) Total (rescue operations) Trauma There were 181 nonfatal traumatic injuries. Figure 5 shows the relative frequency of trauma to various body parts. Nontraumatic medical conditions Table 4 shows the wide range of medical reasons for rescue during the study period. FATALITIES Forty fatalities occurred (9.9% of the study population). The majority of fatalities (82.5%) were male and the mean age was 33.6 years (SD 18.4). Figure 6 shows Table 3. Reason for rescue by Parks Canada Rescue in Banff, Yoho, and Kootenay National Parks between January 1, 2003, and December 31, 2006 Reason for rescue Count Figure 2. Monthly distribution of rescue operations undertaken by Parks Canada Rescue in Banff, Yoho, and Kootenay National Parks between January 1, 2003, and December 31, Slips and falls Lost/stranded/overdue Nontraumatic medical reasons Objective danger Inexperience/inadequate equipment Other Total (actual rescue operations)

248 Wild Figure 3. Mode of evacuation of persons rescued by Parks Canada Rescue in Banff, Yoho, and Kootenay National Parks between January 1, 2003, and December 31, 2006.

4 248 Wild Figure 3. Mode of evacuation of persons rescued by Parks Canada Rescue in Banff, Yoho, and Kootenay National Parks between January 1, 2003, and December 31, the likely causes of fatalities. Table 5 shows the activity pursued at the time of fatality. Thirty-eight of the 40 individuals were dead when rescuers arrived. Recovery of the body was by helicopter in over 90% of cases. Discussion A search of the medical literature using Medline revealed no other published studies concerning mountain rescue in the Banff NPs area. Several similar studies concerning other mountainous areas were identified An unpublished report by Parks Canada details some rescue data for the study area. 12 Over 50% of people rescued were residents of Alberta. This is unsurprising given a substantial local outdoor community and the vast distances to be traveled by visitors to get to the Parks. It would be logical to assume that the local population spends more time overall in these mountains than do visitors, and so there is more opportunity for an incident in this population. Ela 8 suggests that local people who are familiar with the terrain and hazards may be more inclined to take greater risks or to evidence complacency when assessing danger. The study population had a similar mean age to that of several other studies worldwide. 8,11,13,14 Hiking is the most common mountain activity requiring rescue operations (43.5%). This is true in a number of varied mountain terrains globally, including Washington NPs (55%) and Scotland (72.6%). 9,13 While the precise definition of hiking varies among the areas, there is nevertheless a significant trend. Summer hiking is easily accessible, as it often requires less technical equipment, experience, physical fitness, or financial outlay compared to other mountain activities, such as ice climbing and mountaineering. These activities are generally considered to be more risky than hiking. 13,15 Slips and falls was the most common reason for rescue (50.2%), and this mirrors the findings of previous studies. 11,13,16 In this study slips and falls included a wide range of occurrences ranging from a simple trip and fall to the ground while hiking to a fatal fall down a mountain face while mountaineering. Further work to separate slips and trips from major falls would help to give a clearer view of the precise causes of injuries and fatalities. Inexperience and inadequate equipment (clothing, footwear, and technical gear) was stated as the primary cause in a small number of incidents (3.2%). These reasons are likely to be contributory factors in many incidents in which, for example, poor footwear and inexperience indirectly lead to falls. 2 Slips and falls is a Figure 4. Injury severity in survivors rescued by Parks Canada Rescue in Banff, Yoho, and Kootenay National Parks between January 1, 2003, and December 31, 2006.

5 Mountain Search and Rescue in Banff Park 249 Figure 5. Body part involved in nonfatal trauma dealt with by Parks Canada Rescue in Banff, Yoho, and Kootenay National Parks between January 1, 2003, and December 31, mechanism of injury and is unmodifiable. However, contributory causes of incidents which include inadequate training, knowledge, and equipment are often modifiable and thus represent an important area to be targeted in accident prevention. Almost two thirds of all rescues were accomplished Table 4. Nontraumatic medical reasons for rescue by Parks Canada Rescue in Banff, Yoho, and Kootenay National Parks between January 1, 2003, and December 31, 2006 Nontraumatic medical reasons for rescue Count by helicopter. This usage reflects the remote terrain and the technical ground in which many rescues occur. Comparison can be made with the Mont Blanc massif in the French Alps, where the highly technical ground necessitates the use of a helicopter in 95% of rescues. 11 Injury severity was documented using a system similar to that used for mass casualty triage by various organizations worldwide, including, for example, the Pan American Health Organisation. 17 The lack of hospital follow-up data means that the accuracy of the triage code cannot be evaluated. In the stressful and often dangerous environments in which rescue takes place it is of advantage to have a quick and concise triage code for initial Dizziness/faintness Exhaustion Hypothermia Chest pain Respiratory distress Abdominal pain/cramp Dehydration Parasuicide Seizure Frostbite 1 2 Anaphylactoid reaction 1 2 Weakness (suspected stroke) 1 2 Poisoning 1 2 Confusion 1 2 Total Figure 6. Likely cause of fatalities in incidents dealt with by Parks Canada Rescue in Banff, Yoho, and Kootenay National Parks between January 1, 2003, and December 31, 2006.

6 250 Wild Table 5. Activity pursued at time of fatality in incidents dealt with by Parks Canada Rescue in Banff, Yoho, and Kootenay National Parks between January 1, 2003, and December 31, 2006 Activity Fatalities Ski/snowboard Mountaineering Hike 8 20 Ice climb 4 10 Mountain bike Other Rock climb 2 5 Total (people) assessment of casualties prior to fast evacuation to more extensive medical management. Of the surviving population, 40.7% had sustained no injury. As a comparison, Sharp 13 found that around half of people rescued in the Scottish mountains suffered no injury, and Ela 8 found a similar figure in New Hampshire (45.2%). A large proportion of search and rescue is concerned with evacuation of noninjured people. Mountain safety education could reduce this number. Over two thirds of nonfatal traumatic injuries involved the limbs. Many of these injuries were fractures sustained in falls and other collisions. A large study by Montalvo et al 5 looked at morbidity and mortality occurring within 8 Californian NPs over a period of 3 years; the study included those injuries due to mountain activities. The most common site of musculoskeletal and soft tissue injuries was the lower limbs (38%), followed by the upper limbs (27%). Hearns 4 found that of 261 trauma casualties who survived, half had lower limb injuries. Other wilderness injury studies have found a similar predominance of lower limb injuries, 8,11,13 and this result could perhaps be attributed to the high rate of slips and falls. No injuries due to wild animal encounters were documented. As expected, most fatalities were male (82.5%). This has been shown elsewhere by Montalvo et al 5 in California (78% male) and Goodman et al 10 in Arizona (87% male). The mean age of fatalities (33.6 years) is younger than that found in similar studies Ela 8 found 46.4 years and Stephens et al 9 42 years. An explanation for this study s comparatively young mean age is that during the study period 2 fatal incidents occurred involving, in total, 9 school children. The objective dangers of avalanches, crevasses, and rock/tree fall together accounted for 55% of fatalities. This emphasizes the hazardous environment in which accidents and deaths occur, but it also leads to a consideration of human judgement in mountain situations. Lischke et al 2 highlight the important role of inexperience in incidents. McLennan and Ungersma 18 suggest that morbidity and mortality may be lessened by proper climbing preparation. Trayers 19 also highlights the role of bad judgement in mountain incidents. Financially, the revenue created by the tourism industry within the Parks greatly exceeds the cost of rescue provision an estimated 3% of park fees is spent on rescue operations (P. Woods, oral communication, 2007). Helicopter costs are significant, at $2000/h for an estimated use of around 200 hours per year (P. Woods, oral communication, 2007). Expensive and finite ambulance and hospital resources were often required. This study did not follow up casualties who received further medical management. Hospital follow up would allow definitive medical confirmation of provisional diagnoses made by rescuers in the outdoors and provide data on final hospital outcomes. Conclusions Parks Canada Rescue provides a necessary and professional rescue service for mountain users. While numbers are not as substantial as in busy and compact areas such as the European Alps, rescue operations are still frequent. A small but significant percentage of people rescued are seriously injured and require competent first aid prior to prompt evacuation to the hospital. This study provides a synopsis of mountain rescue and mountain incidents in Banff NPs. It is a unique study in this geographical area and highlights several limitations with the current methods of data capture used by PCR. In particular, primary and contributory causes of mountain incidents need to be carefully separated. Revision of the Occurrence Report is recommended to provide a standardized and consistent record of both primary and contributory causes of incidents. Analysis of these data is likely to allow evidence-based intervention in preventing mountain incidents. Hospital follow up of casualties is required to classify injuries definitively. This would allow more accurate study of the morbidity and mortality associated with mountain incidents. Objective data regarding the risks of mountain activities in Banff NPs are of value to tourism, media, health, mountain safety, and training organizations in terms of risk analysis, resource planning, and accident prevention.

7 Mountain Search and Rescue in Banff Park Acknowledgments The author wishes to thank the Public Safety Specialists and wardens at the Parks Canada Banff Warden Office for their help and support. References 1. Parks Canada. The mountain guide. Parks Canada, Available at: e.pdf. Accessed July Lischke V, Byhahn C, Westphal K, Kessler P. Mountaineering accidents in the European Alps: have the numbers increased in recent years? Wilderness Environ Med. 2001; 12: Klassen K. Helicopter rescue. In: Klassen K, ed. Canadian Parks Service Public Safety Manual. Canmore, Alberta, Canada: Canadian Parks Service; Hearns S. The Scottish Mountain Rescue Casualty Study. J Emerg Med. 2003;20: Montalvo R, Wingard DL, Bracker M, Davidson TM. Morbidity and mortality in the wilderness. West J Med. 1998;168: Durrer B. Rescue operations in the Swiss Alps in 1990 and J Wilderness Med. 1993;4: Lattimore C. Mountaineering emergencies on Denali. J Wilderness Med. 1993;4: Ela GK. Epidemiology of wilderness search and rescue in New Hampshire, Wilderness Environ Med. 2004;15: Stephens BD, Diekema DS, Klein EJ. Recreational injuries 251 in Washington State National Parks. Wilderness Environ Med. 2005;16: Goodman T, Iserson KV, Strich H. Wilderness mortalities: a 13-year experience. Ann Emerg Med. 2001;37: Marsigny B, Lecoq-Jammes F, Cauchy E. Medical mountain rescue in the Mont-Blanc massif. Wilderness Environ Med. 1999;10: White B, Gui T. Banff, Yoho and Kootenay National Parks Incident Response Analysis, Banff, Alberta, Canada: Banff Warden Office; Sharp RH. Scottish Mountaineering Incidents Research report no Edinburgh, Scotland: Sport Scotland; Available at: ChannelNavigation/Resource Library/Publications/ Scottish Mountaineering Incidents.htm. Accessed July Schussman LC, Lutz LJ, Shaw RR, Bohnn CR. The epidemiology of mountaineering and rock climbing accidents. J Wilderness Med. 1990;1: Malcolm M. Mountaineering fatalities in Mt. Cook National Park. N Z Med J. 2001;114: Addiss DG, Baker SP. Mountaineering and rock-climbing injuries in US National Parks. Ann Emerg Med. 1989;18: Pan American Health Organization. Establishing a Mass Casualty Management System. Washington, DC: US World Health Organization; McLennan JG, Ungersma J. Mountaineering accidents in the Sierra Nevada. Am J Sport Med. 1983;11: Trayers FJ. Wilderness preventive medicine. Wilderness Environ Med. 2004;15:1 3.

Epidemiology of Wilderness Search and Rescue in New Hampshire,

Wilderness and Environmental Medicine, 5, 7 (004) ORIGINAL RESEARCH Epidemiology of Wilderness Search and Rescue in New Hampshire, 999 00 Gretchen K. Ela, MD From the University of Pennsylvania School