Physicians are frequently asked to give medical permission or clearance for a patient who wishes to undertake a trip or pursue a new physical activity. The patient may be seeking pretrip advice or may need a medical evaluation/release form completed. Some physicians are consultants to organizations or travel as a trip doctor for wilderness outing groups and may play a role in screening participants. In any of these capacities, the physician should carefully consider potential health problems associated with the planned activities. Risks and reasonably anticipated problems must be communicated to achieve full disclosure and an informed patient. In short, the problem is to match the prospective participant with the proposed activity to minimize the risk of failure caused by medical problems. This article considers medical conditions that are exacerbated by or limit tolerance to specific environmental risks. The goal is to evaluate physiologic demands on the patient and the patient's ability to meet those demands. The focus is on wilderness ventures, but this could include a car or bus tour of national parks with optional day hikes or a remote mountain climbing expedition. Generally, wilderness activities imply some exposure to environmental stresses, a degree of physical exertion, and remote locationor at least delayed access to health care. In addition to providing health advice to a patient before foreign travel, the first step in a pretrip evaluation is to know the itinerary and the planned activities so that the specific environmental risks are known. Mountain trekkers in an underdeveloped country in Asia or South America may encounter conditions from tropical to alpine with exposure to heat, cold, strenuous exertion at altitude, and infectious illnesses like diarrhea and malaria. A diving trip to the tropics must consider barotrauma in addition to heat and infectious diseases. There are risks and contraindications for each of these exposures. Levels of restriction may be absolute, relative, or temporary. Restrictions for physical activities depend primarily on the general fitness of the participant and in only a few instances on specific health problems and musculoskeletal conditions. The health history of the participant, in addition to active medical problems, should include: Prior medical problems that could recur: e.g., ulcer disease, inflammatory bowel disease, spontaneous pneumothorax, high altitude pulmonary edema, frostbite, mental or emotional problems Prior habits like smoking or drug use Medications that can effect exercise tolerance, thermal regulation, acclimatization to altitude or judgment (beta blockers, anticholinergics, tranquilizers, sleeping pills) Degree of physical fitness (type, duration, and intensity of regular physical activity), any physical limitations, and history of undertaking similar activities in the past

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   |texte=   MEDICAL LIMITATIONS TO WILDERNESS TRAVEL
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