To the Editor:
We appreciate the attention to wilderness search and rescue (SAR) in New England as provided in the recent Baxter State Park article. 1
In 2010 we published a review of 18 years of SAR activity on Denali. 2 We note that there were similarities between the SAR activity on Denali and the SAR activity on and around the rugged terrain of Mount Katahdin that deserve mention. Specifically, we noticed similarities regarding some of the central themes of the Baxter State Park article, including fatigue, age, and direction of travel. The risks of descent and older age are also comparable to published Mount Everest data.
Regarding fatigue, Welter et al 1 state that “the wilderness SAR literature has not described fatigue as it relates to the need for SAR response.” From 1990 to 2008 on Denali we reported that the leading general medical reason for SAR was “fatigue.” We commented that fatigue “is not usually ascribed as a top medical problem in the wilderness” but that it “commonly prompts SAR.” Thus we note similarities in fatigue as a common cause for SAR response on both Denali and in Baxter State Park. Although on Denali listing fatigue as the primary cause for SAR was less prevalent than in the study in Baxter State Park, medical reasons on Denali were attributed to more than half of all SAR events. One could speculate also that in many of the Denali altitude and hypothermia cases, fatigue could still play an important and adverse role.
Regarding age, Welter et al 1 indicate that “little is known about the influence of older age on wilderness SAR events.” Of Denali SAR activity we analyzed age and found that “the risk of a rescue increased by 3% per year as age increases (odds ratio, 1.03; 95% confidence interval, 1.01–1.04; P < .0001).” Although we did not compare age and fatigue directly in our study, our data would support the findings from Baxter State Park that an older demographic would be at higher risk of requiring rescue.
Regarding direction of travel, Welter et al 1 state that “the role of hiking phase (ascending or descending a mountain) is not discussed in currently available wilderness medicine literature.” In the Denali study we noted that of all SAR events, 44.8% “occurred while the subject was descending.” Perhaps more interestingly, we specified that of “falls recorded as the primary reason for SAR…77% occurred on descent.” (Further, in 2008 McIntosh et al 3 found that 61% of fatalities on Denali occurred on descent, a large percentage of which were falls.) In Baxter State Park, although only 30% of SAR cases documented a direction of travel, 86% of those indicated the subject was descending. Thus, published data from Denali would support the discussion point of Welter et al 1 that injuries leading to SAR, perhaps as a combination of exposure, descent ergonomics, or fatigue, may be more likely to occur on descent. Both the Denali and the Baxter State Park data appear to support the concept that safety on descent is important.
In addition to Denali data, a study of Mount Everest climbers further documents the risk of older age and descent direction. 4 In 2007, Huey et al 4 reviewed Mount Everest climber data from 1990 to 2005 and found that “those older than 60 years have increased odds of dying, especially when descending from the summit.” More specifically, Huey et al 4 state that there was an increase in “death rate for climbers older than 59 years” (P = .037), and that the “death rate of climbers descending from the summit was nearly twice that of those who did not summit” (P = .048). These Mount Everest results regarding older age and descent risks are comparable to the findings from both Baxter State Park and Denali.
The stated primary objective of the Baxter State Park study is to describe SAR epidemiology to facilitate training and preparation within their park. To that end, we put forth the consideration of studies from both Denali and Mount Everest, and how they relate to the Baxter State Park data. Although differences exist between the wilderness experience on these higher peaks when compared with the Mount Katahdin vicinity, there appear to be some comparable risks. These reported similarities may serve to enhance local educational objectives and preparation for rescue services in each region.