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Extreme event medicine: considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions
  1. Linda Laskowski-Jones1,
  2. Michael J Caudell2,
  3. Seth C Hawkins3,
  4. Lawrence J Jones4,
  5. Chelsea A Dymond5,
  6. Tracy Cushing6,
  7. Sanjey Gupta7,
  8. David S Young8,
  9. Jennifer M Starling9,
  10. Richard Bounds1
  1. 1 Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware, USA
  2. 2 Augusta University Medical College of Georgia, Center of Operational Medicine, Augusta, Georgia, USA
  3. 3 Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  4. 4 Appalachian Center for Wilderness Medicine, Morganton, North Carolina, USA
  5. 5 University of Queensland Ochsner Clinical Foundation New Orleans, Los Angeles, California, USA
  6. 6 University of Colorado Denver School of Medicine, Aurora, Colorado, USA
  7. 7 Long Island Jewish Medical Center, Emergency Medicine, New Hyde Park, New York, USA
  8. 8 Rush University Medical Center, Chicago, Illinois, USA
  9. 9 Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
  1. Correspondence to Dr Richard Bounds, Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Emergency Medicine Residency, Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, DE 19718, USA; richbounds{at}


Obstacle, adventure and endurance competitions in challenging or remote settings are increasing in popularity. A literature search indicates a dearth of evidence-based research on the organisation of medical care for wilderness competitions. The organisation of medical care for each event is best tailored to specific race components, participant characteristics, geography, risk assessments, legal requirements, and the availability of both local and outside resources. Considering the health risks and logistical complexities inherent in these events, there is a compelling need for guiding principles that bridge the fields of wilderness medicine and sports medicine in providing a framework for the organisation of medical care delivery during wilderness and remote obstacle, adventure and endurance competitions. This narrative review, authored by experts in wilderness and operational medicine, provides such a framework. The primary goal is to assist organisers and medical providers in planning for sporting events in which participants are in situations or locations that exceed the capacity of local emergency medical services resources.

  • Prehospital Care
  • Major Incident / Planning
  • Trauma
  • Epidemiology
  • Remote And Rural Medicine
  • Environmental Medicine
  • Wilderness Medicine
  • Mass Gathering Medicine

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  • Contributors The author group includes leaders of the Appalachian Center for Wilderness Medicine and the Wilderness Medical Society, and all those listed have contributed substantially. LL-J spearheaded this effort by developing the concept, organising this group and coordinating in-person meetings, conference calls and electronic communications. Individual sections were authored as follows: Abstract, Methods and Conclusion: RB; Introduction, Defining WEM: TC and CAD; Medical problems: MJC; Certification, Scope of practice: SCH and JMS. Logistics: equipment, fuel/fluids, medical tents: DSY; communication, orientation, documentation, transportation, integration with EMS: LL-J and LJJ; removing unsafe participants: RB. Medicolegal considerations: SG. Postevent QA: LL-J. LL-J and RB brought the various sections together into a cohesive multidisciplinary work that represents the group’s collective recommendations.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.