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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olivia.linney@gmail.com

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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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