What are you doing to Manage Participant Risk After your Program?

Outdoor programs spend a great deal of time and resources to reduce risk. Things ike staff training, equipment checks, participant screening. Much of this happens before a trip goes out and during the trip as instructors evaluate and manage risk for the group. But what about after the trip is over? What kind of safety follow-up do you do with participants after they've left your course? Diseases like West Nile Virus, Lyme Disease, and Rocky Mountain Spotted Fever may not show up until weeks or even months after exposure. Will the participant think to relate her current symptoms back to an exposure to a mosquito or tick bite from months earlier? Will they think to tell their doctor or health care provider that they were on a wilderness trip?

So what can you do to increase the likelihood that the participant (or staff member) will seek out proper medical care? This is where post-trip information is an important part of your risk management follow-up. We send out a post-trip safety briefing on possible infectious diseases to educate and remind both participants and staff about what to look for. Here is a sample of what could be distributed at the end or after a program. This information is based on common transmitted diseases in the eastern United States. Depending on the part of the world your program(s) are operating in, the particular diseases and symptoms you need to inform people about may be very different. 

Medical information changes rapidly so this may not be the most current. Do your own research to determine what your post-trip information should be.

After your Trip

We hope that you had an exciting and enjoyable time in the wilderness on your rip. After you've gotten a shower and washed your clothes, there are a few important pieces of information you need to be aware of. All outdoor travelers may come in contact with things during the trip that can lead to illnesses later on. Typically, the signs and symptoms of these illnesses don't become apparent until after your trip is over, so it is important that you be able to recognize them. Should you experience some of the symptoms noted below after your trip, go to the Health Center and describe your symptoms to a practitioner or see your own physician. Be sure to inform the health practitioner about your backcountry trip since they may not initially identify the proper cause of the illness without knowing about your wilderness trip. Most of these illnesses can be treated effectively using antibiotics, as long as you go for treatment promptly. For more information on any of these, see the Centers for Disease Control Web site (www.cdc.gov).

Water Borne Illnesses  

Giardia: Giardiasis refers to a syndrome of diarrhea, excess gas, and abdominal cramping. It is caused by Giardia lamblia, a water-borne parasite  that is worldwide in distribution. The symptoms usually occur one to two weeks after exposure to the parasite. Symptoms initially include diarrhea, bloating, nausea, abdominal cramping, and malaise. Weight loss is also a frequent finding. Backcountry travelers usually contract giardiasis by drinking water from untreated or improperly treated sources. Chemical treatment of the water and commercial water filtration systems, used properly, eradicate the parasite.  The diagnosis of giardiasis can be confirmed by inspecting a stool sample for  the presence of the parasite. Because this test may not always identify the organism even if it is present, a physician may elect to treat you empirically for the infection. The use of an appropriate antibiotic for seven days is  usually highly effective in relieving symptoms and curing the disease.

Cryptosporidium: Cryptosporidium is a protozoan that causes a diarrheal illness  similar to Giardia. Symptoms include watery diarrhea, headache, abdominal cramps, nausea, vomiting, and low-grade fever that may appear 2 to 10 days after infection. Some infected people will be asymptomatic. Currently, there is no effective treatment for Cryptosporidium. Symptoms usually last 1 to 2 weeks, at which time the body’s immune system is able to stop the infection. People with normal immune systems are generally not at risk and improve without taking antibiotics or antiparasitic medications. For people with compromised immune systems this can be a dangerous infection. Please see your physician.

Cyclospora: Cyclospora is a recently discovered cause of diarrhea. It can cause  a prolonged illness (average 6 weeks) with profound fatigue, loss of appetite,  and intermittent diarrhea. Cyclospora can be treated with antibiotics. If you  develop these symptoms, consult your physician.

Tick-borne Illnesses

Lyme Disease: Lyme disease is an infection caused by a spiral shaped bacterium called a spirochete. This bacterium is  carried in the gut of the deer tick Ixodes dammini. The tick becomes infected after feeding on the blood of an infected animal. Once infected, the tick can transmit the disease to its next host. Deer ticks are extremely small, with tick nymphs being about the size of the period at the end of this sentence. This means that you may have been bitten without realizing it. The tick needs to feed for an extended period of time (8-12 hours) before infection can occur. So just because you have found a tick does not mean that you have been infected. It is also possible that the tick was not carrying the disease.

Detecting Lyme Disease can be difficult to identify in the  early stages as the early symptoms—fever, headache, stiffness, lethargy, and a myriad of other mild complaints, are often dismissed as the flu. In some cases (25%), there is a red, ring-like rash that occurs at the site of the bite. The rash is often referred to as a “bull’s eye” rash because it has a white center  surrounded by a red ring. Most typically, the rash expands and then fades  within a few weeks after the bite. There is a blood test for Lyme Disease, but it is not perfect. The test generally produces positive results in the later stages of the disease but often turns up false negative results in the early stages of infection. Therefore, diagnosis in the early phase is frequently based on symptoms and the likelihood of a deer tick bite. Early detection means early treatment when the disease is most effectively controlled with antibiotics.  Lyme disease can result in more serious symptoms if left untreated. If you have had an attached tick, you may want to contact your doctor about antibiotics within 72 hours of the tick removal. Such treatments may be effective in preventing Lyme Disease.

Rocky Mountain Spotted Fever: This disease is carried by a bacterium and can be transmitted by the bites of dog or wood  ticks. Contrary to what the name of the disease suggests, it can be found throughout the U.S. Watch for mild chills, appetite loss, and a general run-down feeling. These symptoms may worsen to sever chills, fever, headaches,  muscle and bone pain, and sensitivity to light. Also, a spotty red rash may  appear (hence the name) usually starting at the wrists and ankles and spreading  over the rest of the body. Normal onset of these symptoms is anywhere between 3  and 14 days, so anyone bitten by a tick should be aware of the disease, as it may not present itself until the trip is over. Untreated, the mortality rate is  20 to 30%. Anyone who shows these signs should seek medical attention as soon as possible.

Ehrlichiosis: Ehrlichiosis is a recently  recognized tick-borne disease caused by a bacterium. The disease is similar to Rocky Mountain spotted fever and can be life threatening. The most  common symptoms are sudden high fever, tiredness, major muscle aches, severe headache, and, in some cases, a rash (similar to the symptoms of Lyme Disease).  Symptoms usually appear 3 to 16 days after a tick bite. The same ticks that  carry Lyme Disease can also transmit Ehrlichiosis at the same time. Without  treatment Ehrlichiosis can be fatal. Ehrlichiosis can be treated with the same antibiotic  used to treat Lyme Disease. Anyone who shows these signs should seek medical  attention as soon as possible.

Tick Paralysis: A number of species of ticks can  transmit tick paralysis. It is not an infection, but a by-product of venom in  the tick’s saliva that is secreted while the tick is attached. Symptoms are unsteady movement and gait (ataxia) and ascending paralysis starting in the  lower extremities and moving up. Paralysis can cause loss of respiratory drive, requiring CPR and immediate evacuation. Once the tick is removed, the source of  the venom is gone and the patient generally recovers completely. Children are more likely to be affected than adults. Any patient with an ascending paralysis  should be carefully checked for an attached tick.

Powassan Virus (POW): POW is a rate tick-borne disease that can cause encephalitis (inflammation of the brain) and meningitis (inflammation of the membranes that surround the brain and spinal cord). Symptoms can include fever, headache, vomiting, weakness, confusion, loss of coordination, speech difficulties, and seizures. The incubation period (time from tick bite to onset of illness) ranges from one week to one month. Many people who become infected with POW virus do not develop any symptoms. POW virus is not transmitted directly from person-to-person.

Tularemia: Tularemia, or rabbit fever, is a bacterial disease of which the most common carriers are rabbits, although it  can also be transmitted by ticks. The disease presents with flu-like symptoms  and can be treated with antibiotics.

Mosquito-borne Illnesses

West Nile Virus: West Nile virus (WNV) is a  potentially serious illness that is transmitted by the bite of some mosquitoes.  WNV affects the central nervous system. Symptoms vary.

  •  No Symptoms in Most People. Approximately 80 percent of people who are infected with WNV will not show any symptoms at all.
  •  Mild Symptoms in Some People. Up to 20 percent of the people who become infected will display mild symptoms, including fever, headache, and body aches,  nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the  chest, stomach and back. Symptoms typically last a few days.

Serious Symptoms in a Few People. About one in 150 people infected with WNV will develop severe illness. The severe symptoms can include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis. These symptoms may last  several weeks, and neurological effects may be permanent.