title: A review of emergency medical services events in US national parks from 2007 to 2011.
abstract: OBJECTIVE
  Outdoor recreation is growing in the United States, with more than 279 million annual visitors to areas controlled by the National Park Service (NPS). Emergency medical needs in these parks are overseen by the National Park's rangers within the NPS Emergency Medical Services (EMS) system. This study examines medical and traumatic emergencies throughout the NPS over a 5-year period to better understand the types of events and fatalities rangers encounter, both regionally and on a national scale.
  
  
  METHODS
  This is a retrospective review of the annual EMS reports published by the 7 NPS regions from 2007 to 2011. The following were compared and examined at a regional and national level: medical versus traumatic versus first aid events, cardiac events and outcomes, use of automated external defibrillators, and medical versus traumatic fatalities.
  
  
  RESULTS
  The national incidence of EMS events was 45.9 events per 1 million visitors. Medical, traumatic, and first aid events composed 29%, 28%, and 43% of reports, respectively. Of medical episodes, 1.8% were cardiac arrests, of which 64.2% received automated external defibrillator treatment; 29.1% of cardiac arrests survived to hospital discharge. Of fatalities, 61.4% were traumatic in nature and the remaining 38.5% were nontraumatic (medical). Regional differences were found for all variables.
  
  
  CONCLUSIONS
  On a national level, the NPS experiences an equal number of medical and traumatic EMS events. This differs from past observed trends that reported a higher incidence of traumatic events than medical events in wilderness settings. Cardiac events and automated external defibrillator usage are relatively infrequent. Traumatic fatalities are more common than medical fatalities in the NPS. Regional variations in events likely reflect differences in terrain, common activities, proximity to urban areas, and access to definitive care between regions. These data can assist the NPS in targeting the regions with the greatest number of incidents and fatalities for prevention, ranger training, and visitor education.
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO. Electronic address: mpdeclerck@gmail.com.
authors.forename: Matthieu P
authors.initials: MP
authors.lastname: Declerck
authors.forename: Laurie M
authors.initials: LM
authors.lastname: Atterton
authors.forename: Thomas
authors.initials: T
authors.lastname: Seibert
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Cushing
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D011998:Recreation; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology*
keywords: AED; Automated External Defibrillator; EMS; EMS events; Emergency Medical System; National Park Service; National Parks; rangers