title: Wilderness Preparticipation Evaluation and Considerations for Special Populations.
abstract: Children, older adults, disabled and special needs athletes, and female athletes who participate in outdoor and wilderness sports and activities each face unique risks. For children and adolescents traveling to high altitude, the preparticipation physical evaluation should focus on risk assessment, prevention strategies, early recognition of altitude-related symptoms, management plans, and appropriate follow-up. As the risk and prevalence of chronic disease increases with age, both older patients and providers need to be aware of disease and medication-specific risks relative to wilderness sport and activity participation. Disabled and special needs athletes benefit from careful pre-event planning for the potential medical issues and equipment modifications that may affect their health in wilderness environments. Issues that demand special consideration for female adventurers include pregnancy, contraceptive use, menses, and ferritin levels at altitude. A careful preparticipation evaluation that factors in unique, population- specific risks will help special populations stay healthy and safe on wilderness adventures. The PubMed and SportDiscus databases were searched in 2014 using both MeSH terms and text words and include peer-reviewed English language articles from 1977 to 2014. Additional information was accessed from Web-based sources to produce this narrative review on preparticipation evaluation for special populations undertaking wilderness adventures. Key words include children, adolescent, pediatric, seniors, elderly, disabled, special needs, female, athlete, preparticipiation examination, wilderness medicine, and sports.
authors.affiliation: Clinical Outcomes Research, Intermountain Healthcare, Salt Lake City, Utah (Dr Joy). Electronic address: liz.joy@imail.org.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Joy
authors.affiliation: Department of Family Medicine, University of Colorado, Denver, Colorado (Dr Van Baak).
authors.forename: Karin
authors.initials: K
authors.lastname: Van Baak
authors.affiliation: CJW Sports Medicine, Richmond, Virginia (Dr Dec).
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Dec
authors.affiliation: Anne Arundel Medical Center, Orthopedic and Sports Medicine Center, Annapolis, Maryland (Dr Semakula).
authors.forename: Barbara
authors.initials: B
authors.lastname: Semakula
authors.affiliation: Missouri State University, Springfield, Missouri (Dr Cardin).
authors.forename: Ashlea D
authors.initials: AD
authors.lastname: Cardin
authors.affiliation: Department of Emergency Medicine, University of Colorado, Aurora, Colorado (Drs Lemery and Yaron).
authors.forename: Jay
authors.initials: J
authors.lastname: Lemery
authors.affiliation: Big Island Family Medicine Center, Lynchburg, Virginia (Dr Wortley).
authors.forename: George C
authors.initials: GC
authors.lastname: Wortley
authors.affiliation: Department of Emergency Medicine, University of Colorado, Aurora, Colorado (Drs Lemery and Yaron).
authors.forename: Michael
authors.initials: M
authors.lastname: Yaron
authors.affiliation: Longs Peak Sports Medicine, Longmont, Colorado (Dr Madden).
authors.forename: Christopher
authors.initials: C
authors.lastname: Madden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology; D000532:Altitude Sickness / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D056352:Athletes; D002648:Child; D002908:Chronic Disease / Q000453:epidemiology; D006233:Persons with Disabilities; D004777:Environment; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods*; D011247:Pregnancy; D018570:Risk Assessment; D012307:Risk Factors; D013177:Sports; D055814:Wilderness; D014947:Wounds and Injuries / Q000453:epidemiology / Q000517:prevention & control*
keywords: altitude; disabled and special needs athlete; older adult; pediatrics; pregnancy; preparticipation evaluation