On a national level, the NPS experiences an equal number of medical and traumatic EMS events. This differs from past observed trends that reported a higher incidence of traumatic events than medical events in wilderness settings. Cardiac events and automated external defibrillator usage are relatively infrequent. Traumatic fatalities are more common than medical fatalities in the NPS. Regional variations in events likely reflect differences in terrain, common activities, proximity to urban areas, and access to definitive care between regions. These data can assist the NPS in targeting the regions with the greatest number of incidents and fatalities for prevention, ranger training, and visitor education.

Objective. Planning for time-sensitive injury may allow emergency medical services (EMS) systems to more accurately triage patients meeting accepted criteria to facilities most capable of providing life-saving treatment. In 2010, North Carolina (NC) implemented statewide Trauma Triage and Destination Plans (TTDPs) in all 100 of North Carolina's county-defined EMS systems. Each system was responsible for identifying the specific destination hospitals with appropriate resources to treat trauma patients. We sought to characterize the accuracy of their hospital designations. Methods. In this cross-sectional study, we collected TTDPs for each county-defined EMS system, including their assigned hospital capabilities (i.e., trauma center or community hospital). We conducted a survey with each EMS system to determine how their TTDP was constructed and maintained, as well as with each TTDP-designated hospital to verify their capabilities. We determined the accuracy of the EMS assigned hospital designations by comparing them to the hospital's reported capabilities. Results. The 100 NC EMS systems provided 380 designations for 112 hospitals. TTDPs were created by EMS administrators and medical directors, with only 55% of EMS systems engaging a hospital representative in the plan creation. Compared to the actual hospital capabilities, 97% of the EMS TTDP designations were correct. Twelve hospital designations were incorrect and the majority (10) overestimated hospital capabilities. Of the 100 EMS systems, 7 misclassified hospitals in their TTDP. EMS systems that did not verify their local hospitals' capabilities during TTDP development were more likely to incorrectly categorize a hospital's capabilities (p = 0.001). Conclusions. A small number of EMS systems misclassified hospitals in their TTDP, but most plans accurately reflected hospital capabilities. Misclassification occurred more often in systems that did not consult local hospitals prior to developing their TTDP. The potential of the TTDP to improve communication between EMS agencies and the facilities with which they work has not been fully realized. EMS agencies or systems should verify local hospital capabilities when engaging in destination planning efforts.

Objective.-Lift-accessed downhill mountain biking has grown exponentially in popularity over the past decade. The sport, while offering participants access to a vast amount of terrain, also requires navigating steep and technical terrain at high speeds, posing significant risk of injury to the rider. A limited understanding of these risks impedes both medical management as well as industry-appropriate protective equipment development. The objective of this study was to describe the frequency and type of injuries sustained by downhill mountain bikers utilizing such lift-accessed bike parks.Methods.-A retrospective chart review was performed at one resort's urgent care facility for all patients seeking medical treatment for injuries sustained while riding in the neighboring mountain bike park during the 2009 season.Results.-Of 898 identified cases, 86% (772) were male and the median age was 26 years (range 7-66). Of these patients, 19.4% (174) required transport off the mountain by the park's bike patrol while another 8.4% (75) arrived by emergency medical services. There were 1759 specific injury diagnoses identified, including 420 fractures in 382 patients (42.5%). Upper extremity fractures included 109 wrists, 122 shoulders, 37 elbows, and 49 hands/fingers. There were 31 lower extremity fractures and 19 spine fractures (one with paralysis). In addition, 27 patients were suspected to have internal abdominal trauma and 11.2% (101) had a concussion or more severe intracranial injury. Though 90.5% (813) of patients were discharged, 8.5% (76) required transfer to a higher level of care facility.Conclusions.-Mountain bikers riding at this resort incurred a considerable number of injuries with significant morbidity during the 2009 riding season. Though exposure information was unavailable, these findings demonstrate the serious risks associated with this sport and highlight the need for continued research into appropriate safety equipment and risk avoidance measures.