Wilderness mortalities: a 13-year experience.

STUDY OBJECTIVE To analyze the epidemiology of wilderness mortalities in a localized area with diverse terrain. METHODS We conducted a retrospective review of the Pima County (Arizona) Sheriff's Office (PCSO) search and rescue logs and case reports, hospital records, and autopsy reports for all wilderness deaths from 1980 to 1992. The study group comprised all victims of injury or illness in Pima County wilderness who died during a 13-year period in a location remote enough so that standard ground-based emergency medical services units could not extract the body. RESULTS One hundred fatalities occurred during the 13-year study period. There were 59 unintentional traumas, 18 suicides, 9 homicides, 12 medically related deaths, and 2 deaths of unknown causes. Toxicology tests performed on body fluids yielded positive findings for alcohol in a total of 50 (50%) cases and positive findings for drugs of abuse in 12 (12%) cases. It was estimated that alcohol was "a very probable" or "a probable" causative factor in 23 (40%) of the 59 unintentional trauma deaths, and in 1 (8.3%) of the 12 medically related deaths. Fifty-five (55%) deaths were witnessed events, with 45 (80%) of these victims reported as dying immediately or before arrival of search and rescue personnel. Ten (10%) victims received resuscitation in the field, and according to a review of hospital charts and autopsy reports, only 2 victims had a potentially survivable injury or illness. CONCLUSION Many wilderness mortalities are related to incidents involving alcohol. Once the accident or injury has occurred, the majority of deaths are immediate, or at least before the arrival of medical personnel. Higher levels of medical care would not have improved the outcomes of those who did survive long enough to receive medical care. Therefore, primary efforts to reduce mortalities in the wilderness should be directed toward prevention, especially diminishing alcohol use in wilderness areas.