Hiker silhouette with bandages and first aid kit against a mountain backdrop, symbolizing wilderness safety and injury prevention.

Wilderness Wounds: How to Stay Safe on Your Next Outdoor Adventure

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Elliot Brynn in Health & Wellness October 2026 • 4 min read.

"A 28-year study reveals the most common skin and soft tissue injuries in wilderness expeditions—and how to prevent them."


For many, the great outdoors is a source of rejuvenation, adventure, and peace. Whether it's a challenging hike, a peaceful camping trip, or an ambitious mountaineering expedition, outdoor activities offer unparalleled experiences. However, these adventures come with inherent risks, and understanding these risks is the first step in mitigating them.

A recent study published in Wilderness & Environmental Medicine delves into the trends of skin and soft tissue-related injuries sustained during wilderness expeditions from 1984 to 2012. The research focuses on data collected by the National Outdoor Leadership School (NOLS), a premier institution for outdoor experiential education. By analyzing nearly three decades of incidents, the study provides valuable insights into the types, causes, and prevention of common wilderness injuries.

Whether you're an experienced outdoor enthusiast or a novice planning your first adventure, understanding the risks and how to prevent them is crucial. This article breaks down the key findings of the NOLS study, offering practical tips and expert advice to help you stay safe and enjoy your time in the wilderness.

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The Scope and Severity of Outdoor Injuries

A study published June 1, 2008, described its national estimates of outdoor recreational injuries as a starting point for further research into the epidemiology of outdoor and wilderness injury. Its findings reinforced common perceptions about these injuries while highlighting their potential severity and long-term consequences. The study also emphasized proper planning, preparation, and anticipation of problems as ways to reduce both the number and severity of injuries.

From Field Care to Wilderness Medicine

Research on wilderness injuries has identified populations at risk, incident types and severity, occurrence rates, exposure history, participant skill levels, and comparative risks among wilderness activities as foundational information for prevention and management. The history of wilderness medicine is commonly traced to the emergence of the Wilderness Medical Society in 1983, although field care existed in early Greek and Roman societies. The National Outdoor Leadership School, which enrolls approximately 3,000 students annually across more than 150,000 field days of multi-week expeditions, was founded to train wilderness-program leaders in judgment, leadership, and wilderness skills.

What Are the Most Common Wilderness Injuries?

Hiker silhouette with bandages and first aid kit against a mountain backdrop, symbolizing wilderness safety and injury prevention.

The NOLS study examined a total of 9,734 reported incidents, with 2,151 (22%) classified as soft tissue-related injuries. Of these, 707 (33%) required evacuation, highlighting the severity of some wilderness incidents. The most frequent types of injuries included:

Infections and Rashes: These accounted for 33% of all soft tissue incidents. Common examples included fungal infections, polymorphic light eruption (sun bumps), cellulitis, and rashes from insects and plants.

  • Lacerations, Punctures, and Contusions: These made up 25% of injuries, often associated with hiking. Common causes were trips, falls, and accidental contact with branches and rocks.
  • Burns: Cooking-related incidents frequently involved burns, often from spills of boiling water.
  • Blisters: A common hiking-related issue that can significantly impede mobility and comfort.
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Modern Safety Research

A February 1, 2024 study examined trends in the top 10 U.S. national parks to help prevent injuries and improve visitor safety. Its findings underscored the importance of evaluating those trends and called for future research using broader information from the National Park Service and other park databases. The proposed expansion specifically included more visitor information, such as non-fatal injuries.

Preparedness Beyond Urban Emergency Care

A cross-sectional convenience survey examined the relationship between medical and wilderness training and backcountry hikers' preparedness for acute mountain sickness, illness, and injury. Unlike urban emergencies, outdoor injuries may require treatment for hours or even days before professional medical assistance becomes available. These findings and observations distinguish wilderness first aid from standard emergency care by emphasizing prolonged care before evacuation or definitive treatment.

Interestingly, the study found that 33% of incidents were not directly related to a specific activity but included general skin infections, insect bites, and other conditions that can arise during prolonged outdoor exposure.

Turning Insights into Action: How to Prevent Wilderness Injuries

The NOLS study offers actionable insights for improving wilderness safety. By understanding the most common types of injuries and their causes, outdoor enthusiasts and organizations can take proactive steps to minimize risks and ensure a safer, more enjoyable experience in the wilderness. Focused educational efforts, proper gear, and pre-trip preparation are vital components of any wilderness safety strategy. Prioritize safety, preparation, and awareness, you can confidently embrace the beauty and challenge of the natural world.

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Self-Sufficiency in the Backcountry

The National Park Service advises people entering the backcountry to be self-sufficient in case they encounter an unexpected hazard or emergency. Its Leave No Trace guidance recommends using toilet facilities whenever possible; otherwise, solid human waste should be deposited in catholes 6 to 8 inches deep and at least 200 feet from water, camp, and trails. Research among backcountry hikers has also examined how medical and wilderness training relates to preparedness for acute mountain sickness, illness, and injury.

Reading the wilderness evidence

The injury rate uses time spent in the wilderness as its denominator, so it describes injuries in relation to exposure rather than the share of people injured. The death rate uses the same exposure basis but a different scale, and does not by itself describe how deaths were distributed across activities.[1]

The illness findings connect hygiene with the incidence of viral illness and diarrhea, but they do not specify which hygiene practices accounted for that relationship. The mountain-biking review describes riders using their arms to protect themselves when thrown from bicycles, while the blister review identifies moisture, temperature, activity duration, and footwear as risk factors; these are distinct pathways rather than a single explanation for outdoor injuries.[1] [2]

How other outdoor injury records compare

A Texas state-park analysis reported injury and mortality rates per visit, a different denominator from the wilderness exposure rates above. Its records also describe park activities and injury categories, so those distributions provide context from a separate setting rather than a direct comparison of like populations.[3]

A systematic review of mountain-biking and hiking injuries, like a separate review of cross-country mountain biking, could not complete a meta-analysis because injury definitions varied widely. That limitation makes pooled comparisons across the reviewed studies difficult.[2]

What remains unclear about outdoor injuries

  • How strongly does hygiene relate to particular viral illnesses or diarrhea, and which hygiene factors account for the observed association?[1]
  • How much do injury patterns change when studies use consistent definitions, allowing findings from mountain biking and hiking research to be combined?[2]

Sources

  1. Wilderness injuries and illnesses. (pubmed.ncbi.nlm.nih.gov)
  2. Types and anatomical locations of injuries among mountain bikers and hikers: A systematic review (pmc.ncbi.nlm.nih.gov)
  3. Recreational Outdoor Injury and Mortality in Texas State Parks Between 2012 and 2021. (journals.sagepub.com)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

1

What are the most common types of wilderness injuries identified in the study?

The study highlights that the most frequent wilderness injuries are infections and rashes (33%), lacerations, punctures, and contusions (25%), burns, and blisters. Infections and rashes include conditions like fungal infections, polymorphic light eruption, and cellulitis. Lacerations, punctures, and contusions are often related to hiking incidents such as falls and contact with rocks. Burns typically occur during cooking, often from spills. Blisters are a common hiking problem. It's important to recognize these common injuries to better prepare for and prevent them during outdoor adventures.

2

What are some actionable steps to prevent wilderness injuries?

The study emphasizes several ways to prevent wilderness injuries. Focused educational efforts are crucial to inform people about common risks and how to avoid them. Having the proper gear can minimize exposure and injury, such as wearing appropriate footwear to prevent blisters and using cooking equipment carefully to avoid burns. Pre-trip preparation, including understanding the environment and potential hazards, is essential for a safer experience. Taking these proactive steps can significantly reduce the likelihood of encountering these common injuries.

3

Why is it important to consider injuries that are not directly related to specific activities during wilderness expeditions?

The study revealed that a significant portion of injuries, 33%, were not directly activity-related but included general skin infections and insect bites. This finding highlights the importance of maintaining good hygiene and protecting against insect bites during wilderness expeditions. Simple measures like washing hands regularly, using insect repellent, and wearing appropriate clothing can help prevent these types of incidents. These seemingly minor issues can become significant problems during prolonged outdoor exposure, underlining the need for comprehensive prevention strategies.

4

Why is the National Outdoor Leadership School (NOLS) mentioned, and what is its significance in the study?

The National Outdoor Leadership School (NOLS) is significant because the study analyzed data collected by them over nearly three decades (1984-2012). NOLS is a premier institution for outdoor experiential education, making its incident data particularly valuable for understanding the trends and causes of wilderness injuries. By focusing on the data from NOLS, the study provides reliable insights into the types of injuries that occur during wilderness expeditions and informs strategies to mitigate these risks. Their extensive records offer a comprehensive view of wilderness safety challenges.

5

What does the study say about the severity of wilderness injuries, and why is this important?

The study indicates that 33% of soft tissue injuries required evacuation. This is significant because it highlights the severity of some wilderness incidents and the potential impact on outdoor adventures. Evacuation can be a complex and costly undertaking, underscoring the importance of preventing injuries in the first place. Understanding that a significant portion of injuries may necessitate evacuation reinforces the need for thorough preparation, appropriate gear, and a strong focus on safety to minimize the risk of needing to be rescued from the wilderness. The remaining 67% could still require on site care and delay the expedition.

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