Wilderness Medical Society
Medicolegal Symposium
Medical Evaluation of the Wilderness Traveler and
The Risk Management Plan
William W. Forgey, M.D.
National Medical Advisor, Student Conservation Association
National Health & Safety Committee Member, Boy Scouts of America
July 2005
Objectives:
1.
Review the components of a Risk Management Plan
2.
Cite the importance of medical evaluation and screening prior to wilderness
adventure and exotic travel.
3.
Discuss the relationship between body signals and demands.
4.
Discuss specific considerations of specific chronic medical conditions.
5.
Review the basis and indications for individual physiologic testing prior to
wilderness travel.
Having to evacuate a trip member for any reason, be it physical or psychological,
disrupts, even cancels, an expedition and places other trip members and rescuers at
possible personal risk. The pre-trip physical evaluation is the first defense in preventing
the subsequent evacuation. Maintaining vigilance as to the trip members' medical and
mental status during the trip is the second step towards prevention of this expensive and
risky event.
A caveat that cannot be ignored, due to legal reasons, is if you are going to request
medical information of a participant, make certain that you do something appropriate
with the information. Protect the access of this information from persons who do not have
a need to know these personal medical details. Review the history and physical
information and make decisions concerning the applicant's appropriateness for the trip or
otherwise ensure that you will be able to manage any problems that are identified during
the course of the expedition. Legal actions taken against trip organizers always start with
the material provided with the client before the trip making sure that the risk was
appropriately described, understandable by the participant, and that health and other
protective services were as indicated in the pre-trip materials. One aspect that will be
scrutinized is the information obtained by the medical history and physical. If the trip
involves considerable physiological stressors, and the client was not informed of this and
was not advised to have appropriate medical screening, you will be charged in a tort
action. If this was accomplished and you failed to not a condition that seems obvious
