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Injury and Illness in College Outdoor Education – Study Published

Author(s): Tod Schimelpfenig
Posted: January 10, 2011

The current issue of Wilderness and Environmental Medicine (Vol 21, Num4, 2010), the official publication for the Wilderness Medical Society, has an article titled “Injury and Illness in College Outdoor Education” by Flavio Gaudio MD and colleagues, that describes incident rates at Cornell Outdoor Education and makes comparisons to injury rates in traditional college sports.

This is the first data I’ve seen published in a medical journal from college programs and a welcome addition to the epidemiology literature for wilderness activities. For our participants who want to make informed decisions on program risk this transparency is essential.

The common injuries reported, not surprisingly, are sprains, strains and soft tissue wounds. The common illnesses are allergic reactions, asthma and gastroenteritis. This is different from expedition incident reports, and reminds us to pay attention to the context of a study before we extrapolate it’s results to our individual program.

There is a favorable comparison of college outdoor education activities to college sports, something we always thought was the case, but here there is evidence supporting the assumption.

The authors comment that “Knowing the nature and prevalence of injuries and illness in any athletic program is the first step towards allocating resources and educational efforts to decrease such incidents.” A discussion on the number of incidents, from spilled hot water burns to knife cuts and likely hygiene caused gastroenteritis points to food preparation as a focus for attention and speaks to how Cornell Outdoor Education is managing this, and other identified areas of risk.

I’ve been an advocate of publishing incident data for decades, both to inform ourselves and inform our participants and the public. This is another step in the right direction.



Wilderness and Environmental Medicine
Volume 21, Issue 4, Pages 363-370 (December 2010)
Injury and Illness in College Outdoor Education
Flavio G.Gaudio, MD, Peter W.Greenwald, MD, Mark Holton, PhD
(The full article is accessible only for people who are members of the Wilderness Medical Society or those organizations with a Science Direct or Journals Consult license).



Many colleges offer outdoor education courses such as rock climbing, kayaking, and mountain biking. Since these sports may be perceived as dangerous, we describe the prevalence of injuries and illnesses in a large, university-based outdoor education program. We also compare composite incident rates from this outdoor program to those of traditional college sports.


Cohort of college students participating in either Cornell Outdoor Education (COE) or National Collegiate Athletic Association (NCAA) sports and comparison of incident rates. COE data were prospectively collected in the field; and NCAA data were prospectively collected through the Association’s Injury Surveillance System. By definition, a COE injury or illness required follow-up care, prescription medication, or limited course participation. Similarly, a NCAA injury limited further practice or play. Incident rates were calculated as injuries and illnesses per 1000 participant-days (COE) or injuries per 1000 athlete-exposures (NCAA).


Included COE courses during 2002–2007 totaled 74 005 participant-days. There were 111 injuries and illnesses, rate = 1.50/1000 participant-days (95% CI 1.24–1.81). The NCAA reported 32 646 899 athlete-exposures during 1988-2004 and 181 476 injuries, rate = 5.56/1000 athlete-exposures (95% CI 5.53–5.58). Compared to COE, the relative risk of injury in NCAA sports was 3.7 (95% CI 3.1–4.5) overall and 3.3 (95% CI 2.8–4.0) after excluding the high-contact sports of football, ice hockey, and wrestling. For COE, mountain biking had the highest incident rate (7.5/1000), which was significantly lower than game injury rates in NCAA football and soccer. The most common injuries for both NCAA and COE were soft-tissue injuries such as sprains and strains.


Outdoor education at this university-sponsored program was at least as safe as traditional college sports. Overall, college students were less likely to be injured while participating in COE courses than while participating in NCAA sports, even after excluding high-contact sports from the comparison.

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