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Pre-Participation Medical Evaluation for Adventure and Wilderness Watersports

Nathanson, Andrew T. MD*; Young, Justin Mark J. MD; Young, Craig MD

Clinical Journal of Sport Medicine: September 2015 - Volume 25 - Issue 5 - p 425–431
doi: 10.1097/JSM.0000000000000252
Care of the Wilderness Athlete

Abstract: A request for a preparticipation medical evaluation for wilderness watersports may be made by guiding agencies, instructional camps, or by patients presenting for an annual visit. Although guidelines have been published regarding preparticipation physical evaluation for traditional competitive high school and collegiate sports, little has been written about medical evaluations for those wishing to engage in wilderness and adventure watersports. In this article, we offer guidance based on literature review and expert opinion. Watersports are among the most common recreational activities in the United States and are generally safe. Drowning, however, is a significant risk, particularly in small, self-propelled craft, and among children. Medical counseling before participation in watersports should include screening for medical conditions which may impair swimming ability, including a history of seizures, heart disease, and lung disease. Physicians should also promote preventive health measures such as use of lifejackets and sun protection, as well as alcohol avoidance. Swim testing tailored to specific activities should be strongly considered for children and those with questionable swimming ability.

*Department of Emergency Medicine, Alpert Medical School of Brown University, and the Injury Prevention Center at Rhode Island Hospital, Providence, Rhode Island;

Department of Family Medicine and Community Health, Division of Sports Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii;

Departments of Orthopaedic Surgery and Community and Family, Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.

Corresponding Author: Andrew T. Nathanson, MD, Department of Emergency Medicine, Rhode Island Hospital, 593 Eddy St, Claverick 2, Providence, RI 02903 (

The authors report no conflicts of interest.

This article appears in a “Care of the Wilderness and Adventure Athlete” special issue, jointly published by Clinical Journal of Sport Medicine and Wilderness & Environmental Medicine.

Received February 27, 2015

Accepted July 02, 2015

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