whitewater white knuckle issues ohsuwhitewater sports participation •2.6 million whitewater...
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Whitewater White Knuckle Issues
Olivia Linney, MDWhen Things Go Wrong in the Outdoors
Virtual Conference9/18/20
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Imagine…
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Lecture Objectives
• What are whitewater sports? How many people participate?
• How risky is it?
• What are the common injuries types?
• Inform practice patternsOHSU
Whitewater sports participation
• 2.6 million whitewater kayakers, 70% male
• 10 million whitewater rafters, 55% male
Source: 2019 Special Report on Paddle Sports and Safety – The Outdoor Foundation
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Whitewater Kayaking Participation
Whitewater Rafting ParticipationOHSU
Whitewater Jargon Crash Course
• 5 essentials
• Drysuits
• Eskimo Roll
• Whitewater rating systemOHSU
The 5 essentials
-Kayak-Paddle-Helmet-PFD (lifejacket)-Spray skirtOHSU
Drysuit
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The roll
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Whitewater Ratings
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What kind of literature is out there?
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• Wilderness and Env Medicine: Injuries in Commercial Whitewater Rafting on the New and Gauley Rivers of West Virginia (2013)
– 55% of injuries occurred in raft, 40% in the river
– 50% lacerations, 20% sprains, 20% dislocations
– Overall injury rate of 20/100,000 guests, 0.68 fatalities/100,000
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• Clinical J Sports med: Injuries in commercial whitewater rafting (1999)
– Similar injury rates
– Similar types of injuries, most commonly to the face/lower extremities
– 1/3 lacerations, 1/4 sprains, 15% fx, 8% dislocations
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• J Sports Med: Injuries in whitewater Kayaking (2001) – Number of days spent kayaking only independent
predictor of injuries
– Striking an object most common mechanism of injury (44%)
– 50% abrasion/contusion, 25% tendonitis, 17% dislocation
– Half sought medical care
– 96% reported good/complete recovery
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Limitations
• Limited studies
• Retrospective nature
• Sampling bias
• Hard to get data from kayakers
• Many injuries not mentionedOHSU
What is the risk?
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How does this compare to other “extreme” sports?
• Ski: 2.5/1000 skier days
• Base Jump: 3/1000 jumps require hospitalization
• Rock climbing and Mountaineering: 5/1000 days
• Mountain biking: 4/1000 days
• Commercial rafting: 0.25/1000 rafter days
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Injury Patterns
• Trauma
• Environmental concerns
• Infectious
• DrowningOHSU
Trauma
• Head
• Torso
• Back
• Extremities
• WoundsOHSU
Trauma - Head
• Concussion
• Cervical spine
• Dental trauma
• Broken nose
• Other facial traumaOHSU
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Trauma - Torso
• Broken Ribs
• PneumothoraxOHSU
Abiqua Falls
https://thatoregonlife.com/2016/09/abiqua-falls-tra ilhead/
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Trauma - Back
• Lumbar spine
• MSK injuriesOHSU
Abiqua Falls
https://thatoregonlife.com/2016/09/abiqua-falls-tra ilhead/
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MSK back
https://www.precisionpaincarerehab.com/blog/are-you-suffering-from-lower-back-pain-11650.html
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Trauma - Extremities
• Hand/Knuckle injuries
• Ankle sprain
• Anterior shoulder dislocation
• Tibia fracture
• Tendonitis/overuse injuriesOHSU
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Shoulder Dislocations
http://killerkayaks.com/basic-white-water-kayak-moves-learn-class/
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https://www.elsevier.es/es-revista-revista-colombiana-anestesiologia-341-articulo-ultrasound-nerve-stimulation-guided-axillary-block-S2256208715000851
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Environmental - Exposure
• Hypothermia
• Hyperthermia
• Sunburn
• Acute photokeratitisOHSU
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https://currently.att.yahoo.com/att/hot-grand-canyon-national-park-164013579.html
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Sunburns
“’Sunburn Tattoos’ are the uncool way to show skin this summer” – NY post
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Acute photokeratitis
https://www.shutterstock.com/video/clip-4565819-sun-glints-ref lection-sunlight-water
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Environmental - tox
• Venomous snakes
• Scorpions
• Poison oak/ivy/sumacOHSU
Death in the Grand Canyon
Worst day ever.
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Bark Scorpion
• Aka Centruroides exilicauda
• Venom is some of the worst in North America
• 15+ protein toxins, all neurotoxic
• Children most vulnerable
• Bites are common. No recorded deaths in Grand Canyon.
• Two fatalities in Arizona since 1968
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Poison oak, ivy, sumac
https://www.webmd.com/allergies/ss/slideshow-poison-plants
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Infectious
• Wound infections
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Infectious
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Infectious
• Otitis externa
https://www.youtube.com/watch?v=5hCS8JF-b-M
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Exostosis
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Infectious
• Tropical diseases
– Malaria
– Schistosomiasis
– LeishmaniasisOHSU
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Drowning
• Entrapment
• Flush DrowningOHSU
Foot entrapment
https://www.alpackaraft.com/rafting/foot-entrapment-rescue/
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Strainer
https://montanariverguides.com/2017/03/swiftwater-rescue-class/strainer-2bentrapment-2bw-253acanoe-jpg/
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Sieve
https://paddlingmag.com/stories/news-events/kayaker-trapped-in-sieve/
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https://paddling.com/learn/river-hazards/
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Flush Drowning
• Mechanisms poorly defined
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Wilderness EMS, Seth Hawkins
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Prevention
• Paddle with friends
• Don’t paddle rivers too high or too low
• Don’t kayak 100 foot waterfalls
• Always wear a lifejacket
• Don’t stand up in the river
• Dress for the swim
• Don’t pick up rattlesnakes
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Recovery
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Sources
• “2019 Special Report on Paddlesports and Safety.” Outdoor Industry Association, outdoorindustry.org/resource/2019-special-report-paddlesports-safety/.
• Attarian, Aram, and Christos Siderelis. “Injuries in Commercial Whitewater Rafting on the New and Gauley Rivers of West Virginia.” Wilderness & Environmental Medicine, vol. 24, no. 4, 2013, pp. 309–314., doi:10.1016/j.wem.2013.04.003.
• “Evan Garcia Runs 115ft Puma Falls and Breaks His Leg.” Kayak Session, www.kayaksession.com/evan-garcia-runs-115ft-puma-falls-and-breaks-his-leg/.
• Farstad, David J., and J. Matthew Luttrell. “Flush Drowning as a Cause of Whitewater Deaths.” Wilderness & Environmental Medicine, vol. 31, no. 1, 2020, pp. 11–15., doi:10.1016/j.wem.2019.09.006.
• Fiore, D C. “Injuries in Whitewater Kayaking.” British Journal of Sports Medicine, vol. 35, no. 4, 2001, pp. 235–241., doi:10.1136/bjsm.35.4.235.
• Fiore, David C. “Injuries Associated With Whitewater Rafting and Kayaking.” Wilderness & Environmental Medicine, vol. 14, no. 4, 2003, pp. 255–260., doi:10.1580/1080-6032(2003)14[255:iawwra]2.0.co;2.
• Kindelan, Katie. “Kayaker’s Record-Breaking, 96-Foot Plunge Caught on Video.” ABC News, ABC News Network, Sept. 2011, abcnews.go.com/blogs/lifestyle/2011/09/kayakers-record-breaking-96-foot-plunge-caught-on-video.
• Moag, Jeff. “Amazon Icons: The Historic Kayak Expedition to Colombia's Sacred Falls.” Men's Journal, 5 Dec. 2019, www.mensjournal.com/adventure/amazon-icons/.
• “Technical Rescue Interface: Swiftwater Rescue.” Wilderness EMS, by Seth Hawkins, Wolters Kluwer Health, 2018. • Weiss, E.a. “Whitewater Medicine.” Journal of Wilderness Medicine, vol. 2, no. 3, 1991, pp. 245–252.,
doi:10.1580/0953-9859-2.3.245.
• Whisman, Steven A., and Steven J. Hollenhorst. “Injuries in Commercial Whitewater Rafting.” Clinical Journal of Sport Medicine, vol. 9, no. 1, 1999, pp. 18–23., doi:10.1097/00042752-199901000-00004.
• Wilson, Iain, et al. “White-Water Paddlesport Medicine.” Extreme Sports Medicine, 2016, pp. 289–304., doi:10.1007/978-3-319-28265-7_23.
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