Setting, Structure, and Timing of the Preparticipation Examination: The Wilderness Adventure Consultation.

Patients pursue wilderness experiences throughout the entire life cycle, and while outdoor pursuits are relatively safe, injuries do occur. Many of these adverse events can be anticipated, identified, and prevented through a wilderness preparticipation examination (PPE). To accomplish this, it is incumbent on the physician to assess the extrinsic and intrinsic factors faced by the patient and attempt to correct them to ensure an enjoyable experience in the outdoors. This article outlines the goals of the PPE along with identification of various risk factors that can influence a trip. Most injuries and rescues occur from underestimating the risks from extrinsic, environmental factors, and/or overestimating one's intrinsic skills. By matching the patient's fitness and skill level to the environment, the physician can help reduce the risk of serious injury.