Introduction
Trip medical forms can reduce program liability and help administrators and field staff prevent injuries and illnesses. In most cases, prevention is accomplished through appropriate screening of participants and modifying the structure of a trip by adjusting the trip’s activities and routes to accommodate individual medical conditions or concerns. The type and format of a trip medical form affects the quality of information received and the ability of program administrators and field staff to prevent and treat injuries and illness in the field.

Why require medical forms for trips?

• Accident/illness prevention via screening
• Accident/illness prevention via course design/structure by program administration (preferred and requires time to prepare/adjust)
• Accident/illness prevention via individual & group management by field staff (may be necessary if discovered during the trip). If a physical disability or an ongoing medical problem are discovered during the trip, it may be necessary to assess both the group's and the individual's abilities in light of the newly discovered disability or problem as well as the proposed activity progression and environment before continuing with the trip as planned.​

How is client medical information collected?
Medical information may be collected orally from the client or via a written medical form. Collection is more effective if all involved—client, guide/instructor, healthcare provider, etc.—know why the information is important and how it will be used.
There are two basic types of written medical forms: Those completed by a health care professional (physician, PA, or nurse), and those completed by the client (self-reporting).
Medical forms completed by a health care professional—especially if they are the client's personal physician—tend to be the most accurate. Those completed by professionals with little or no previous knowledge of the client—college or university clinics, for example—can miss some conditions if the providers rely heavily on patient self-reporting.
Self-reporting may be oral or written. Oral self-reporting typically takes place the day of the trip, often as clients are ready to embark on the trip. The accuracy of oral self-reporting is questionable as it's easy for clients to forget something important or simply not mention it for fear they will not be permitted to go on the trip. Clearly written self-reporting forms are better than oral self-reports.
Written forms—regardless of whether completed by a healthcare professional or by the client—tend to be more effective when a combination of check boxes and open-ended questions are used. For example, here's a question with Yes/No checkbox followed by a series of open-ended questions asking for more information:

"Are you taking any prescription medications?" (Yes/No)

"If you answered "yes" to the above question please:

• List the medication, dose, the reason for taking it.
• Are you current with each medication?
• If you plan to carry this medication with you on the trip, are there any storage requirements we need to be aware of?

If client medical information is so important, why don't all outdoor programs collect it?

• Personal health information is protected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). While there are hundreds of ways that HIPAA rules can be violated, the most common with respect to outdoor programs is an organization's failure to control access to a client's personal health information (PHI) this includes the online transmission of PHI data. While a HIPAA violation is easy to avoid by simply not requesting clients to complete a written medical form, the lack of personal health information may have significant consequences in a remote setting if clients or guides are not prepared to address an emerging medical problem. The Family Educational Rights and Privacy Act of 1974 (FERPA) prohibits student trip leaders—but not professional trip leaders—from receiving medical information of other students. In some cases, a FERPA violation can be avoided if the student contractually waives their FERPA rights for the purpose of attending a student-led outdoor trip.
• Forms completed by a healthcare provider may cost the client additional money. As such, they are typically reserved for longer, more remote trips where the medical form is part of an overall admissions process. Once received, each form is reviewed by a trained person who may contact the individual or their provider for additional information. Outward Bound and NOLS are two organizations that require prospective students to meet with their personal physician and have them complete the organization's medical form as part of their admissions process. Some colleges and universities require trip participants to go to the college or university health system to have a medical form completed.
• Simple checklist forms with a few open-ended questions are easy to complete and, as such, are often used by outfitters on day or weekend trips that will have access to 911 systems. Clients are typically asked to complete them the day of the trip or bring the completed form with them.
• More detailed forms tend to yield more usable information. Usable meaning being able to guide a potential client to the trip that best suits them or adapting an existing trip to meet their medical and/or physical needs. The earlier a medical form is received by an outfitter, the more time they have to respond.

As mentioned earlier, it is extremely important for outdoor programs and outfitters to accurately describe the trip and its associated hazards and to share how a client's Personal Health Information (PHI) will be used. Consider integrating PHI information into the program's release form to obtain permission to treat the client should it become necessary during the trip, permission to allow the program/outfitter to share and transmit PHI information with guides etc. for the protection and safety of the client during the trip, as well as release the organization from any known and unknown hazards.

This is an excellent practical question! Since students remember the skills and information they use on a regular basis, skill retention is shared by the wilderness medicine provider, their employer(s), and the graduate.

1. Wilderness medicine providers are responsible for:

• delivering the course material in a practical hands-on manner with as many skill labs and simulations as possible so students are able to grasp the required concepts and skills.
• providing on-going case studies and updates via blogs, newsletters, and other media to aid a graduate's knowledge retention.
• providing a field handbook and/or app that gives graduates access to assessment and treatment data.
• providing training and training options to a graduate's employers so they can run effective simulations and training sessions for their staff on a regular basis.

   
2. Employers of wilderness medicine graduates are responsible for:

• taking advantage of the training opportunities and strategies offered by the wilderness medicine providers.
• providing on-going simulation training, case study review, and discussion of possible problems—including their assessment and treatment—that their trips may encounter to their employees.

   
3. Graduates are responsible for:

• taking advantage of the opportunities offered by the wilderness medicine providers and their employers.
• taking a recertification course when they think their skills are becoming inadequate even if the course is before their certification expires.

Follow-up questions include (and will be addressed in later blog articles):

1. What are the most effective delivery strategies for providers?
2. What are the most effective strategies for employers to use to maintain their employees' assessment and treatment skills?
3. What kind of medical training do outdoor program administrators and directors need so they can make preemptive program design changes and on-going training decisions for their programs? This is especially true when it comes to preparing staff to deal with environmental problems. For example, program directors need to understand heat acclimatization in order to design training sessions and protocols for trips where the heat challenge may suddenly increase. They need to understand the physics behind lightning to train staff how to manage a rapid descent from an exposed ridge when an unexpected lightning storm approaches. Etc.
   

Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.

​Outdoor kitchens are fraught with potential danger (really). Typically not life-threatening danger but definitely trip ending danger from cuts, burns, and diarrheal illnesses (gastroenteritis). Aside from sunburn, most burns on outdoor trips happen in or near the kitchen with the vast majority of those due to hot water; the rest tend to involve alcohol and camp fires. Deep cuts occur on a hand when someone holds a bagel or cheese in one hand and wields a knife with the other. Poor hygiene leads to diarrhea.

When you think about it, it's pretty silly to have to leave a trip because of a cut, burn, or an intestinal illness that requires advanced care, especially with a little forethought and planning these type of injuries can be easily avoided. What follows is a summary of good management techniques for outdoor and camp kitchens that focuses on avoidance.

Introduction
Spending time outside for work or play is part of human history, both past and present. Interest in the outdoors is constantly growing with new human-powered and motorized activities/sports emerging on a regular basis. The development of more sophisticated equipment allows access to more challenging terrain and environments...and greater risk. Use permits, once unheard of, are now the rule—and are increasingly difficult to procure for both individuals and organizations. Wilderness ethics are changing as use increases and "leave no trace" has become a mantra for many. In short, the outdoors has become a thriving industry.

Introduction
Since 1962 when Outward Bound first introduced wilderness adventure programing to United States and the world in the mountains of Colorado, the field has grown exponentially. It is now commonplace to find successful wilderness recreation programs in K-12 schools, summer camps, military bases, and city and state parks. The use of outdoor adventure programs for therapeutic reasons has become it's own industry. And, enrollment in undergraduate and graduate degrees programs in outdoor recreation, education, and therapy is on the upswing.

Within the college/university systems there are three types of outdoor programs:

1. Recreation programs typically housed under student life.
2. Academic degree programs ± immersion semester(s).
3. Cocurricular programs ± immersion semester(s).

Training outdoor leaders within a college/university setting requires a multidisciplinary approach that does not fit well into a standard quarter/semester format due to the type of terrain and time required teach outdoor skills. The purpose of this article is to briefly discuss the design of each program type, list their pros and cons, and provide a conceptual template for those training students to staff some of their programs.