A prospective, multi-year analysis of illness and injury during summer travel to arid environments.

OBJECTIVE There exist no prospectively generated analyses of the type and frequency of medical incidents in desert settings. We created a database of every illness and injury during 6 field seasons in the Gobi Desert in order to optimize expedition medical and safety planning. METHODS Every incident presenting to the expeditions' physicians, regardless of type, magnitude, treatment, or outcome, was recorded. Incidents ranged from headache, insomnia, and diarrhea to lacerations, infection, fights, psychosis, and foreign body extraction and were thus categorized, segregating urban travel-related complaints from illness and injury occurring in the desert setting. The chronology of incidents and illnesses was observed. The incidence of categorized illness and injury was analyzed using descriptive statistics and was presented in terms of person-days in the field. RESULTS There were 412 incidents recorded during 2689 person-days from 6 field seasons in the Gobi Desert from 2003 through 2007. The expeditions' physicians saw an average of 2.2 incidents x d(-1) in the urban setting compared to 3.6 incidents x d(-1) in the desert. Circadian rhythm disturbances, gastrointestinal illnesses, and musculoskeletal complaints predominated in the urban setting, while minor trauma, heat-related exposures, and gastrointestinal and orthopedic problems predominated in the desert setting. Our data show an absolute risk of illness or injury of 153.2 incidents per 1000 person-days and a risk of "gastrointestinal" and "trauma" complaints of 21.2 and 23.1 per 1000 person-days, respectively. CONCLUSIONS Herein we describe results from the first ever prospective study of the hazards of travel in an arid environment. We observed that there are patterns of injury and illness that are consistent across expeditions to the Gobi Desert. For example, while heat- and wind-exposure-related illness and injury in the desert are quite common, other aspects of the desert environment are very forgiving. Perhaps the most interesting finding in our cohort was the degree to which different problems occurred at different stages of the expeditions. Our data sets suggest several future studies to evaluate patterns of illness and injury and could be an asset to recreational travelers and religious pilgrims, as well as to those sending employees to extreme environments.