What is outdoor health?
Dr. Grant Lipman
Grant S. Lipman, MD, is a clinical assistant professor of surgery in the division of emergency medicine at Stanford University and associate director of the wilderness medicine fellowship at Stanford University School of Medicine.
Most people have had an experience with emergency medicine – where an accident occurs that requires immediate medical care. The emergency physicians determine what needs to be addressed at the moment, perform the needed tests and treatments to take care of you, then put you on the appropriate care plan.
The field of wilderness medicine developed out of emergency medicine to provide knowledge and care in resource-limited conditions where medical care may be limited or non-existent. The core content of this specialty is the foundation for outdoor health – the field of knowledge that exists at the intersection of the outdoor environment and its impact on the human condition.
Whether you identify as an “outdoors person” or prefer the creature comforts, everyone has their unique personal challenges and outdoor health to consider.
Outdoor health is the field of knowledge that exists at the intersection of the outdoor environment and its impact on the human condition.
The risks of choosing to go outdoors
People who choose an outdoor lifestyle are more obviously engaging with a landscape of environmental and situational factors that could impact their health. There are known objective hazards implicit in your favorite activity, like rafting whitewater or steep single track descents. However, even the most innocuous outdoor situation can quickly turn into trouble: a thunderstorm rolls in, an ankle is sprained, you sustain a head injury. Small decisions in these moments can be consequential.
Despite the acceptable risks, people head outside for a multitude of reasons, everyone with their own comfort zone and depth of understanding of their personal boundaries. Regardless of all the training, planning, and preparation one can do, the outdoors is unpredictable and every outing comes with potential threats to your health and well-being.
The risks of the outdoors coming to you
Maybe your outdoor trip is part of your regular day and you’re not out on an adventure, or you’re someone who avoids going outdoors at all. Regardless of your intentions, a suburban or urban environment doesn’t preclude you from outdoor health risks. In a world with increasingly extreme weather events, the outdoors will inevitably come to you, putting your health at risk.
Flooded downtowns turn into an urban wilderness, drought-fueled wildfires disrupt and destroy neighborhoods, and severe winter storms cause massive regional electrical grid failures. Being cut off from infrastructure, medical services, or internet reception, any space becomes a little more wild after a natural disaster.
A flooded residential area
The right information
We’re in a world saturated with information and resources. But one of the unique challenges of outdoor health is taking known medical information and applying the learnings to resource-limited conditions – meaning supplies, reception, and access to information is scarce. Extrapolation, improvisation, and innovation are required to solve these problems.
The science and research are there, the challenge is implementing it when you need it most. There have been numerous clinical trials based on tens of thousands of patients that evaluate health decisions around whether a particular test is needed, a trip to the hospital is indicated, or help define the likelihood of a particular disease or condition. These decision tools are peer-reviewed and published in the highest impact clinical journals. Having ready access to this expert information in real time, offline, in an easily digestible format to help ask the correct questions is not just ideal, it is often a requirement.
Medical handbooks have been the longtime standard for the outdoors – they don’t require cell reception to work. However, the downside is that they may have incomplete or outdated information, and you need to be able to diagnose the problem to know what to look up. They also lack evaluation tools for assessment of the problem, or may be unhelpful in explaining mysterious symptoms. Handbooks also take up room and weight in a pack.
An open book on grass with leaves on the page
Case in point: Incomplete information in a medical handbook
A husband and wife hiked down into the Grand Canyon on a June day with a high temperature of 106°F. They leisurely descended more than 4,000 ft in 6 hours, where she drank more than 5 L of water and ate some food. She started to feel tired, developed a headache, then later got nauseous and confused.
Her husband opened his wilderness medicine handbook, and read that her symptoms were likely from heat exhaustion. Based on the book’s recommendations, he attempted to cool her down and drink more fluids. She became more confused and sleepy, stopped urinating despite drinking more fluids, and then had 3 seizures.
After reading the handbook, he diagnosed her with heat stroke and immersed her in a nearby creek. After her third seizure, she remained unconscious and he made the difficult decision in the middle of the night to leave his wife to seek help.
When Grand Canyon Search and Rescue arrived 6 hours later, they quickly diagnosed her with very low salt levels (hyponatremia). They aggressively treated her with special concentrated intravenous fluids, then airlifted her to the nearest hospital. After a short hospital stay, she subsequently fully recovered.
This case highlights the challenge in differentiating overlapping symptoms. This emergency was caused by overhydration while exerting in a hot environment. The handbook did not discuss hyponatremia, a disease where drinking more water only worsens the dilutional process causing the problems.
The handbook couldn’t help the man evaluate his wife’s symptoms in the correct context. Making the right decisions from a book requires both availability of the correct medical information, and the interactivity to prompt asking the correct questions.
Weather apps will tell you the outside conditions, but it’s not enough to forecast your day. You need to understand and interpret how that forecast of weather conditions will impact your health. Everyone knows how an umbrella will help protect you from the rain, but where do you head to if out hiking and are threatened by a wildfire? How dangerous is it to cross that flash flood in your car? If you are standing on the sidelines on the hottest day of the summer, can you recognize the signs of heat stroke? Knowing how to intervene when it matters most can save a life.
GOES is for your outdoor health
This is the landscape of outdoor health for which GOES is designed. GOES takes the larger snapshot of your unique environmental context to distill what your potential risks are, how these conditions may impact your health, and what to do about it.
A simple, everyday example of your outdoor health is not only taking note of the UV index, but knowing when it poses a sunburn risk and how to protect yourself from that risk.
There is no reason not to have access to expert health information, even without internet access or medical infrastructure. Outdoor health doesn’t just apply to people who go outdoors anymore. It has evolved to support your relationship with and impact from the outdoors so you know what to do when things go wrong, regardless where or when that may happen.
