Wilderness Medical Society snowmass 2005 Page 14
4). Age under 50 years.
One or more risk factors for coronary artery disease. Treadmill test
optional.
No risk factors for coronary disease. Treadmill test not indicated.
Definitions for the above guidelines:
Risk factors for coronary disease increase the possibility of coronary disease.
Family history (sudden death, infarct, angina before 55 years in family members);
History or presence of hypertension;
ST segment depression of any magnitude in the resting electrocardiogram; and
Prior episode of chest pain.
Treadmill test negative or minimally positive: patient can walk equal or greater than 9
minutes (through Stage 3 Bruce protocol) without chest pain and with equal or less than 1
mm ST segment depression.
Strongly positive treadmill test: patient walks less than or equal to 6 minutes (Bruce
protocol) and has either chest pain and/or equal to or greater than 2 mm ST segment
depression.
Risk categories:
LOW RISK: minimal risk for a coronary event (angina, infarct, sudden death)
over 5 years of 2-4%.
HIGH RISK: substantial risk for a coronary event in 5 years of 10-20%; requires
coronary arteriography.
Blair Erb, M.D., will be presenting a paper during this symposium that provides an
excellent discussion of the evaluation of the senior high adventure candidate. His work
should be referenced when planning your organizations pre-trip physical evaluation
procedures.
Continued monitoring during the trip
During the course of the expedition, various members of the group will tolerate
environmental and physical and mental stress differently. The trip leader and physician
must monitor the basic condition of all members. Establishing open lines of confidential
communication can best do this. Make certain that you encourage participants telling you
of problems with constipation, foot problems, headache, or other signs or symptoms of
medical problems during the earliest stages.
