Falls in mountain hikers – identification of risk factors

Mountain hiking is the most popular mountain-sport activity during the summer with some million hikers in Austria each year. The other side of the positive health effects of mountain-hiking activi- ties (e.g. an increased quality of life) is the risk of accidents and emergencies or even fatalities. Annually, about 1,500 persons have an accident and about 100 persons die during mountain hiking in the Austrian Alps and about 45 % of all non-fatal and fatal accidents during mountain hiking are caused by falls. Profound knowledge on the circumstances of these accidents and risk factors for falls in mountain hikers would be an important step to improve safety in this popular sport activity. However, scientific studies dealing with this topic are scarce. Therefore, the pre- sent project aims to analyze accidents caused by falls in mountain hikers and to identify risk fac- tors for falls during mountain hiking. The study will be divided into 2 parts. In part 1, non-fatal and fatal accidents caused by falls during mountain hiking, which are documented by the Austria Alpine Police during a 10-year period, will be analyzed in detail. The sample will comprise about 5,000 non-fatal accidents and about 500 fatalities caused by falls. The results will allow identifying situations and circumstanc- es in which falls frequently occur. Part 2 is designed as a case-control study and will focus on non-fatal accidents. During a 3-year period, mountain hikers, injured in an accident caused by a fall, will be asked for study participation and a questionnaire will be sent to the study participants (cases). The questionnaire will include personal data, pre-existing diseases (including medications) and previous injuries, regular physical activity and mountain hiking experience, risk taking behavior, details to the hik- ing tour, equipment, and a description of the accident from the viewpoint of the victim. Addition- ally, information on the circumstances of the accident will be collected by on-site evaluations. For the comparisons with controls, mountain hikers without falls will be interviewed on the same hiking routes where the accidents occurred using the same questionnaire. The comparison of about 400 cases with about 1,200 controls will provide substantial information on factors associ- ated with an increased risk for falls during mountain hiking. 1

English The superior goal of the present research project was to improve safety in mountain hiking by reducing fall-related accidents. Therefore, the project aimed to provide information on the circumstances of fatal and non-fatal mountain-hiking accidents caused by falls and to identify risk factors related to non-fatal falls in mountain hikers. The findings of this project can be transferred to evidence-based preventive measures in order to reduce the risk for falls during mountain hiking. The absolute number of fall-related fatalities during mountain hiking in Austria re-mained stable during the analyzed period of nine years whereas the number of non-fatal ac-cidents continuously increased during this time. Nevertheless, this increase was less pro-nounced compared to the estimated development in the number of active mountain hikers indicating that mountain hiking became safer with respect to fall-related accidents. About 75 % of the fall-related accidents happened during the descent indicating that the descend seems to be the most dangerous part for falls during a mountain hiking tour. Thus, mountain hikers should plan and include sufficient breaks or, in case of exhaustion, take cable cars etc. if available for their descent. The proportion of male victims was higher compared to females concerning fatalities and was accompanied by a continuous increase from 30 to 70 years of age. In contrast, fe-males were more represented among victims of non-fatalities with relatively stable percent-ages between 40 and 70 years of age. The results suggest that preventive measures should be addressed to female and male hikers with sex-specific priorities. About 70 % of the victims of non-fatal accidents in Tyrol were affected by an impaired vision suggesting this deficit and/or specific glasses might increase the risk for falls in specific situations during hiking in a mountainous environment. Therefore, visual acuity should be reg-ularly checked, and visual aids adapted accordingly if necessary. Contrary to popular opinion, about 90 % of the victims of non-fatal accidents wore mountain-hiking specific shoes defined as ankle-high shoes or flat shoes with a profiled sole comparable to mountaineering boots. Only less than 10 % were equipped with road running shoes, sneakers or similar type of shoes. This observation clearly refuses the opinion that most of the mountain hikers who suffer a fall wear inadequate shoes and suggests that the type of shoes per se plays a minor role in falls during mountain hiking.