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Prakash Chandran (Host): There's so much to do and enjoy outside in nature, especially as the weather gets warmer, but you want to make sure you don't put an end to the fun because of unnecessary injury. The most effective way to prevent mishaps is to adequately prepare and today we'll learn how to do this properly. Joining us today is Dr. Nathaniel Mann, an Emergency Physician at PRISMA Health. This is Flourish, a podcast brought to you by PRISMA Health. My name is Prakash Chandran. So Dr. Mann, really great to have you here today. You know, I just wanted to start by asking a general question. What type of activities, especially activities that are outdoors,require preparation?

Nathaniel Mann, MD (Guest): Yeah, Prakash, it's good to be with you. So you know, really any outdoor activity should require some preparation especially where we live. We have a lot of hiking ,and people like to get out on bicycles, both road and mountain biking. And all of those are activities where people should have some idea of where they're going, what they're going to do and what kind of danger they should get into. So even if it's a minor day hike through the woods of just a couple of miles, you should be pretty familiar with where you're at, so you can avoid any potential injuries or emergencies.

Host: Yeah, that makes a lot of sense. And you know, most oftentimes you're going out with a group of friends or family members. So, maybe let's talk a little bit about how group dynamics can change the way we prepare.

Dr. Mann: Absolutely. A lot of people like to experience outdoor activities in a group and certainly that brings a different dynamic, it could be more fun for people. But there are a few things to maybe keep in mind when you're traveling alone or participating in outdoor activities alone versus in a group. There is a little bit of a different safety dynamic that can come depending on the type of people that you're with.

So, you as an individual are likely to know your own medical conditions and the trouble that you can get into relatively well, compared to being with a group where you may have multiple individuals within for necessarily familiar. They might be people who have medical conditions or particular limitations that you aren't as cognizant of.

So, being able to know about those things ahead of time is pretty important. Now of course groups sometimes can be an increased safety factor. Certainly if you're going into situations where an injury is more of a likelihood than in places where maybe things are more safe, having additional people to be able to help in pursuing help or making phone calls or assisting someone who is injured, is important. But it can also increase the danger dynamic if you have somebody who is hesitant or worried about saying they have a particular illness, or maybe isn't comfortable in their group saying, you know, I'm really not that fit. And this maybe isn't a great activity, but feel a little bit of peer pressure to go along. So, it can be pretty important to speak to everybody in the group to know what are their limitations, what are they comfortable with.

And even beyond that a little bit, sometimes it's important to know when does the fun end for a particular individual. Once you get to the point where they're wet and upset and are no longer having fun in the activity, things can actually go downhill pretty quickly. So, really exploring all those topics and ideas can be important before you go out as a group into the wilderness.

Host: Yeah, absolutely. You know, it kind of reminds me of a trip that I took. I did a five day hike out to or a backpacking trip out with some friends at the Devils Postpile in New Mexico and, you know, two of our friends hadn't prepared at all. Like they didn't bring the right shoes. And so they just were really having a hard time with a lot of this stuff.

And I think, you know, especially, you know, when you're younger you don't think to talk about some of these dynamics or what can happen. So, I think what I'm hearing you say is that if you are a part of organizing this trip, it behooves you to try to do some upfront research and communication with the people that you're going with to ensure that number one, they're comfortable and they're at the right level of fitness to participate in the activity. And number two, that they have the equipment that they need to be safe. Is that correct?

Dr. Mann: Yeah, absolutely. You want to make sure that everybody knows exactly what they're getting into. You don't want to skimp on preparation at all.

Host: So, let's talk a little bit more about the elements of what people are getting into. I imagine that terrain is a big piece of this and the route that people are going to take. Does that play a factor in trip preparedness?

Dr. Mann: Oh, of course it does. Absolutely. You know, one of the other things I do outside of my current clinical obligations, is I work our search and rescue team. And the one of the most common things that we see people getting into trouble for is because they're unfamiliar with the terrain or unfamiliar with the route they want to take and rescue call-outs for lost hikers or lost boaters is one of the most common things that we'll deal with.

So, really having a good idea of where you're going to go, what your intended path and track is pretty darn important. A lot of people kind of think that, well, I saw it on a map. I realized there's a trail there. It'll be kind of like walking on a sidewalk through the woods and it's not going to be a problem. I should be able to get from point A to point B without an issue. But a lot of times when you get out into the woods or out into the mountains or into the wilderness, things don't always look the way you anticipated they would look. It's always helpful if you've been there before, but a minimum you really should have a map or a tracking device or a compass.

And actually you should know how to use it as well. A lot of people also think, you know, I'll bring my map and my compass, but they've never opened a map before. They've never used a compass before they get out in the woods and they get a little trouble and they don't, they can't even use the tools that they have with them.

So, being very familiar with the route that you have and knowing how to use tools that could potentially navigate your way out of a problem is really important. And then beyond that, having an idea of what kind of terrain you're going to deal with can help prevent illnesses or injuries out on the trail. One of the other very common things that we'll see on search and rescue, is people overly fatigued or are weak or dehydrated because they didn't anticipate the trail being very steep or much longer than they anticipated. Or sometimes they get into trouble because they didn't realize, hey, this is near water. It's very slippery. The rocks are not necessarily the most stable under foot. And so they'll fall and twist an ankle or break a knee. And so knowing what you're going to be dealing with will help you prevent any potential injuries, can help you prevent getting into any trouble situations like being lost or running into an environmental emergency of some sort.

Host: You know, that's really good advice. And one of the things that you mentioned is that you're a part of search and rescue, and I imagine that you have to do that because there's no communication with the person that's lost. So, maybe let's talk a little bit about like a communication strategy of preparedness when people go out there. I imagine also a very big piece of going into the outdoors because some places that you go, there's just no cell phone service. Right?

Dr. Mann: Yeah, absolutely. You know, the cell phone, the modern cell phone has really become a boon in many ways. And certainly cell phone coverage increases every year. And so we do see more and more people being able to rely on their cell phone in the back country because we have good cell service, but there are still a lot of places where you have no service at all.

So, if you're used to using your cell phone as your primary means of communication, navigation, and direction, you might be sorely disappointed when you get into some of these places and you have absolutely no access to your cell phone. And heaven forbid that you lose a battery or lose the phone and then you're completely out of luck with that.

So, there really should be some additional plan for how to communicate with the outside world. As a case in point, we had a group of people just a few weeks ago who went down the local river, the Chattooga River and didn't realize that they had no cell service in the Gorge and got into some trouble.

And one of the folks had to hike out miles just to try and get some cell service. And of course, injured themselves, trying to get into a position where they could call. So, this can be a real problem. So at the bare minimum for folks, I say, you know, there's usually some sort of trail registration for a lot of the major traffic trails and riverways, so you should add a bare minimum, fill out the registration card so that people know that somebody is out there.

You should always let somebody else know where you're going and when you plan to be back. And that way, if you don't make it at your required meeting time and location, they can at least have notify the authorities and that's something we get on search and rescue too. And that's, you know, shows it'll be some sort of advanced planning. For those who have the resources or the availability they may want to consider a, a special GPS unit or a satellite phone. Those of course can be pretty prohibitive due to cost. But if you have the capability to do that, that's a very reasonable option. Of course, those devices range from relatively cheap to quite expensive and have a whole range of potential utilities and capabilities. So, if you're going deep into the wilderness, it's worth looking into some of those things.

Host: Yeah. And that whole registration piece of it just makes so much sense, but it's something I never even think about, and I am assuming a lot of people don't think about, but it's really just a way for them to keep track of your movements and they make sure that you are coming in and leaving when you say you are. And if that doesn't happen, then they're calling search and rescue. Is that correct?

Dr. Mann: That's right. Yeah. And personally, when I go out on activities, that could be a little bit more risky, I usually tell a family member or friend where I'm going, what our planned route is and when we should be back. And even I'll just say, hey, we should be back to an area where I can call you and say that we're okay. And then, you know, we're fine from there. So, letting somebody know is really important.

Host: So, I want to move on to basically what we bring with us, or even what we wear when we kind of do one of these outdoor activities. You know, I mentioned the anecdote of my friend, not packing the right shoes. And then another case one of them had the right shoes, but had not broken them in. So, maybe let's talk a little bit about the clothing or accessories that people should be thinking about as they prepare for a trip to the outdoors.

Dr. Mann: Absolutely. You know, that the not breaking in my hiking boots is one of the biggest problems that people run into. I've spent time all over the world, taking care of people who have injured themselves in the outdoors. And that is one of the most common complaints that people have is foot and shoe related issues.

So, I think that's an important point there that your friend learned out on that hike or that camping trip. Really you should prepare your feet ahead of time. And a lot of people think that, you know, breaking in boots means that you have to wear them down and get them softened up. But some of it is also preparing your feet in that shoe so that they're not going to get injured and your feet get used to wearing that footwear.

But there are, of course, a host of other things that you want to consider when you go into the outdoor environments in terms of how to prepare your clothing. Most people who are not perhaps familiar with outdoor activities and don't do them on a regular basis will enter into an outdoor environment with relatively common street clothes. So, you might see them wearing cotton t-shirts or shorts, maybe just tennis shoes. And those are fine for short outings and for a lot of different things like getting around town and minor athletic activities. But when you really start getting more serious, you should start considering your layering system and your clothing items a little bit more closely.

People don't often realize the trouble that you can get into when you're sweaty and then you get cold and then you can develop hypothermia. They don't often realize how important it is to wear clothing that can allow you to offload heat in warm environments or underestimate the cold or think they're stronger than they are.

So, one of the things that we recommend is that you bring an additional layer of clothing. Now that could mean, maybe you just need an extra pair of dry socks, if your feet get wet. So, you can just change then out. That will keep you maybe happier than anything else. The same is true for an extra pair of underwear.

That's sort of just a good feeling and hygiene thing. But you may want to slip a backpack or yeah puffy jacket or a backup jacket of some sort in your backpack, or you may want a rain jacket depending on the type of weather where you're going outdoors. So, just considering that additional layer of clothing and thinking about what is my weather going to be like, and how can I go one step further to prepare for anything that I might encounter, weather wise.

Host: Yeah, that's really good advice regarding the clothing that you should be wearing and how you should be breaking in your shoes. But one of the other things that I wanted to move on to is, you know, sometimes when you are in the outdoors or you're hiking or camping, things happen. And you need to address, for example, a wound immediately before more professional help arrives.

So, that might come in the form of a medical kit or an emergency kit. What do you recommend that people bring with them to take care of themselves when something like that happens?

Dr. Mann: Yeah, absolutely. This is probably one of the more common questions that I receive as sort of an outdoors person and as a physician. This of course is going to be advice that varies depending on the activity, who you are, what your medical conditions are and the type of individuals in the group you're going out with.

Personally, as an example for most of my trips whether it's outdoors climbing for the day or just on a bike ride to the forest, or even just paddling out on the kayaks, I usually take a small first aid kit. And most of that personally, for me, will be some sort of mild painkiller, like an ibuprofen or Aleve or Naproxen, maybe some Tylenol. And then it includes things that I can't replicate well from the environment around me. So, things like tape can be very important that can help close wounds if you need it to, it can help repair things if they get damaged. And then sometimes I'll bring an anti-nausea pill. And then things like epi-pen can be very important, especially if you are in a group.

So, one of the few things that you might run into in the outdoor environment is someone who has a severe allergy. And there's nothing you can do for that patient if you don't have the right medication for it. So, I usually recommend that people carry with them an auto-injector epinephrine delivery device.

So, that's what I think about when I go out personally. Now, if you're going out in a larger group, maybe the example that you gave earlier, where it's a group of friends that are out for five days or so; you want to know what each individual's medical issues are, or potential medical problems that might arise. If you have a diabetic in your group, that's pretty darn important to know. So, you can plan accordingly, know how they need insulin or sugar, depending on what's going on. Planning, their meals can be important. So, making sure that they bring all the medications that are germane to their medical conditions.

And then you should probably bring things that will help in any potential trauma situation. Since trauma and injury is the most common medical problem that people get into in the outdoors. So, think about what can I bring that I can't replicate in the wilderness. There tends to be things synthetic things like tapes and bandages and a few drugs. What can I bring to make my life more comfortable if I get into a problem? So, that's the pain medications, fever reducers, nausea, medicine. And then think about the particular environment that you might going into. Am I likely going to run into some sort of bee, or am I going to run into snakes or am I gonna have a bear encounter? Is this a briar filled environment? I'm gonna have a lot of scrapes out there. So, planning accordingly for some of those anticipated medical issues can be important as well.

Host: Now, one of the things that you mentioned was the epi-pen, and I've obviously seen movies where, you know, they kind of stick it in the person's chest or even I think in some cases, the leg. There has to be training or something that can teach you how to use this properly, because I imagine you want to make sure to put it in the right place for it to be effective. Are those courses available to people?

Dr. Mann: Yeah, absolutely. So, there are a whole host of different courses available to folks who want to gain some information about how to provide medical care in the wilderness and epi-pens would be one of them. There are a variety of different groups and organizations that can provide you an epi pen instruction. Some will do it for free. Some will do it for a small fee. Personally I do teach epi-pen courses for those who would like to have them and we can give you a certification for it. There are a whole host of other options out there for people who want more information beyond that, or want to prepare themselves a little more aggressively.

There's something called Wilderness First Aid, something called Wilderness First Responder. Both of which are increasing levels of medical knowledge and how to apply it in the back country. And one of the things that we offer here at USC in the upstate at PRISMA Upstate is what's called Advanced Wilderness Life Support.

It's a program that's covered over three days for medical professionals of any kind. So, that could be EMTs or nurses or physicians or PAs, anybody. And it covers a whole range of outdoor medicine topics and some more advanced medical interventions that you might have to deal with in the wilderness environment. And in fact, we're putting one on here in just a couple of weeks, September 10th through 12th here in Greenville .

Host: Okay. That's really great to know. And, you know, just as we close here, we've talked about a lot of things today, but maybe you could give us like a top 10 essentials for outdoor activities that people can just have in mind as they go out and explore and start to have fun in the world.

Dr. Mann: Yeah, absolutely. So there, there is actually something called the 10 Essentials. It's sort of a known general list of items that people like to consider when they're going into the outdoors, because it covers most of your basic needs for survival. So, really you think about a lot of things we've already discussed. So, navigation is a big thing. That means, do I need a compass and a map? Do I have it in my GPS device? Do I have a personal locator beacon? Do I have a SAT phone? What do I have that can help me determine where I'm at, where I need to go. So, that would be one thing. Thinking about light. So, that's an important one.

If you get stuck in the outdoors or you're injured, and it starts to get dark. You want to be able to see, so bringing a headlamp or some sort of flashlight and extra batteries can be really important. We talked about having a first aid kit that's of course is important and preparing for what your activity is will be important and putting those items in your first aid kit.

Kind of overlapping with that would be some sun protection. Not everybody hikes in sunny weather. But if you do, you probably want to have some sunglasses or some sun some protectant cream. We like to say, think about bringing a knife, that's one of those things that we mentioned earlier, you can't replicate having a knife.

So, if you can have one with you that will save you a lot of grief in an emergency situation. You want to have the other things that become very important with just basic medicine, basic health needs. That includes how to make a fire, a shelter, and food that you might need if you get into trouble. And then think about extra water or maybe a purifier. So, if you're in an area where there's a lot of water available to you, you can just take a water purifier or some way to boil it. And then clothing, we talked about a little bit earlier, so being able to prepare for inclement weather. So, those 10 things. Just to recap, think about each one of these as you prepare for the outdoors, some sort of navigation, light, first aid kits, sun protection, fire, shelter, food, knife, extra water, or a purifier, and then clothing that's appropriate.

Host: Yeah. That's a perfect list. Just as we close, you know, obviously we're in this COVID-19 pandemic still. I would imagine that more and more people are going and spending time outdoors. Maybe just talk to us a little bit around how the pandemic has affected outdoor spaces and safety.

Dr. Mann: Oh, yeah, we, you know, that's sort of a two-edged sword there. So, a lot of people have realized that some of their typical activities being out being, you know, playing gym basketball or lift weights may not be as safe or meet their safety profile as they would like it to. So, more people have been going to the outdoors. Now I think that's great. It's good for mental health. It's good for physical health. And we like people to be able to get into nature, to experience that.

And that being said this has had a significant toll on our outdoor spaces. And for those of us who really care about the outdoors and the environment, we've seen a lot of trail erosion and a lot of increased litter and people who maybe aren't as familiar with how to behave and what kind of principles to follow in the outdoors. So, there's something called leave no trace. It's a whole protocol and program. You can take classes on this principle, but the idea is, when you go into the outdoors, when you go into the wilderness, you should leave it as pristine as it was before you got there. And if possible, even cleaner than when you got there.

So, I tell people or I encourage them, hey, take a trash bag with you. If you see a little bit of trash, pick it up. Know, where to use the restroom. Know, how to have proper sanitation in the back country. Stay on the trails. Don't bushwhack, if you don't have to. So, it's been an increasing toll on the outdoors from that perspective, but on the good side of things, people have been getting out more and getting that exercise, getting to be familiar with what it means to be part of the environment around you.

And that is a good thing. So, it's a great, safe, COVID safe area to recreate in the outdoors. But just remember, we need to treat it with respect and we want to maintain these spaces and areas for generations to come in more pristine condition.

Host: Well, Dr. Mann, thank you so much for that. And I think that is the perfect place to end and we'll end it with my sister's favorite quote, which is leave things better than you found them. So, thank you so again, and really appreciate your time today.

Dr. Mann: It's my pleasure.

Host: If you have any questions about what we talked about today, you can email Dr. Mann directly at nathaniel.mann. That's spelled M-A-N-N@prismahealth.org. Once again, that's nathaniel.mann @Prisma health.org. For more information, visit our website at prismahealth.org and listen to other podcasts, just like this one at prismahealth.org/flourish. This has been Flourish, a podcast brought to you by PRISMA Health.

My name is Prakash Chandran. Thank you so much. And we'll talk next time.