Blair Dillard Erb
Determining medical suitability for wilderness ventures© S U M M A RY Physicians may be called upon to assist in determining medical suitability of prospective participants in wilderness activities. To identify features of an examination, a survey was sent to 215 health professionals, wilderness leaders, organizations, and testing centers. Sixty-six were returned. Sixty were of adequate quality to be scored. Three objectives were targeted: 1) characteristics to be included in an examination, 2) the value of each characteristic as a predictor of success or failure, and 3) the single most important predictor of success or failure. From these a generic examination was developed. Classifications of the nature of the venture and of characteristics of individuals were established. Wilderness venture classifications include: 1) Extreme performance ventures, e.g., high altitude climbs, 2) High performance ventures, e.g., remote hunting activities, 3) Recreational activities, e.g. trail walking, and 4) Therapeutic activities, e.g., cardiac rehabilitation. Prospective participants were classified as: A) Demonstrated high performance individuals, e.g., Mount Everest climbers, B) Healthy, fit but noncompetitive individuals, C) Healthy “deconditioned” individuals, e.g., apparently healthy but with infrequent exercise, D) Individuals with risk factors, e.g., smokers, E) Individuals who are manifestly ill, e.g., coronary artery disease, diabetes mellitus. From these classifications an Exam Code was developed using letters for personal characteristics and numbers for the venture, e.g., C-1, D-3, etc. Armed with these classifications, a generic examination was designed appropriate for the individual and the venture. There were five categories of component features in the examination: 1) Personal data, 2) Historical Data, 3) Medical features, 4) Physiologic assessment, and 5) Psychological evaluation. Most candidates need only certain components as defined by the Exam Code. The survey of health characteristics revealed that the best predictor of a successful venture was a “history of successful similar ventures” (52%), and the best predictor of failure was “demonstrated psychological or interpersonal problems” (75%). Over half of the most valuable features could be derived from a
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