Objectives & Background Each year, about 120 casualties from Snowdonia attend our ED following assistance from Search & Rescue (SAR) services. We have noticed an increase in uninjured mountain users requiring evacuation due to “cold, cramp & cannot continue” (CCCC). We offered to investigate further, in order to help target injury prevention education.
Methods We interrogated our database of mountain casualties brought to our hospital following contact with Mountain Rescue Teams and/or RAF SAR helicopter 01/01/2004–16/11/2014. Age, sex & home postcode of CCCC casualties was noted. Surnames were used as a proxy estimate of ethnic origin.
www.surmanedb.com was used to ascertain origin of surnames (Anglo-Saxon, W/E European – “European”; SE Asian, Middle East/Indian Subcontinent & African – “Black & Ethnic Minority/BME”).
Results Of 1159 patients on the database, 56/1159 (4.8%) were CCCC. In 2004, the number of CCCC cases was one, remaining <5/yr until 2009, since when the number has been consistently >8/yr.
Of 1115 casualties with a European surname, 43 (4%) were CCCC cf. 13/43 (29%) with a BME surname (p<0.0000001, Fishers Exact test) with an OR of 10.12 (95% CI 4.96–20.64).
European surnames: 25/43 (58%) male, median age 32 (range 6–79, mean 36.7). BME surnames: 10/13 (77%) male, median age 26 (range 16–67, mean 29.7). 77% lived in the Birmingham or London conurbations.
Conclusion National Parks across the UK have been working since 2009 to increase the diversity of park users, so an increase in mountain casualties of BME origin is to be expected.
We acknowledge that surname analysis provides only a crude estimate of likely ethnicity, and our database is smaller than the populations for which this technique is generally used. Nevertheless, there is a stark difference in the proportion of mountain casualties requiring rescue for CCCC whose surnames are of BME vs. European origin. This confirms anecdotal reports by SAR personnel.
The most likely explanation is cultural. Few urban BME mountain users are taken hill-walking as children and may be unfamiliar with the misery of being wet, cold & weary with 2 hours walk to the car. There are also well-documented cultural differences in response to pain/discomfort.
Alongside encouraging people of BME origin to utilize the fantastic leisure opportunities of Britain's National Parks, we must step up efforts to alert them to the challenges of outdoor activities in what can be a lethal environment for the unprepared.
- emergency departments
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