In reply to Brillhart et al.

To the Editor:

We appreciate the interest of Drs. Brillhart, McIntosh, Dow, and Grissom 1 in the article “Epidemiology of search and rescue in Baxter State Park: dangers of descent and fatigue.” 2 We apologize for erroneously citing an absence of preceding research regarding fatigue, age, and ascent vs descent as they correlate with need for search and rescue (SAR) events, which are indeed directly and well addressed in the Denali 3 ^, 4 and Everest 5 articles.

Of note, we believe the Baxter data provide increased external validity regarding increased risk of age in outdoor recreation. While Denali and Everest represent high-altitude, highly technical environments drawing experienced mountaineers, Baxter is a low-altitude state park that draws a diverse demographic from experienced hikers to young families and weekend enthusiasts, many with no intention of summiting the 5270 foot peak. Moreover, Baxter represents a region with far less inclement weather than Everest or Denali, with a majority of SAR events occurring in seasons without any snow, glaciers, or major winds. It appears age as a general risk factor and descent as a risk factor for trauma transcend a variety of regions, terrains, and demographics.

Regarding fatigue as a major cause of SAR events, the Denali data did find fatigue to encompass 28.3% of all medical cases (13 of 261 total cases) “exclud[ing] altitude and cold-related injury.” 2 However, although these cases excluded the explicitly altitude-dependent primary complaints of frostbite, high altitude pulmonary edema, high altitude cerebral edema, acute mountain sickness, and hypothermia, it may be hard to delineate exclusive fatigue from the confounding factor of altitude hypoxia. As the authors state, “Denali is known for high altitude and extreme cold, and the majority of causes of medical cases reflected these features.” In contrast, the Baxter data are exclusively from below 5270 feet, confirming the role of fatigue in inciting SAR events regardless of altitude.

Once again, we appreciate your comments and collaboration, and acknowledge the preceding research in age, fatigue, and direction of travel. We are interested to see largely similar findings across a breadth of terrain and demographics, and hope these unified findings may serve accident prevention and SAR response preparation.