HIGHLIGHTS

HIGHLIGHTS | RISK MANAGEMENT RISK MANAGEMENT 2019

Risk and consequence make our education relevant and practical. Risk is inherent in the remote locations through which we travel and our approach to risk is one of respect gained through knowledge, skill, experience, and expertise. We value critical thinking, reflection on experiences, resilience in difficult times, and commitment to our students; and we continually enhance our systems of risk management as societal expectations change, wilderness travel techniques evolve, and technology improves and develops. Risk management is a core element of our curriculum.

Our risk management performance in 2019 was successful on most levels, but also challenging in other areas. Following are the year’s highlights:

• There were 526 medical incidents (injuries and illnesses) reported—29 incidents more than average. The number of injuries (228) was two less than average, but the number of illnesses (298) was 32 more than average. • There were 181 medical evacuations—14 percent above average. The evacuation rate of 1.23 evacuations per 1,000 program days was the highest rate since 1995. • The majority of injuries and illnesses were not serious and the rise in our evacuation rate was largely due to illnesses. • Our most serious injury on a field course was when a student slipped and fell, then slid for 200 meters down a snow slope (see “Risk Management in Action” pg 19). • Our greatest challenge was in the realm of student behavior, in which incidents were up by 37 percent over average. In addition, mental health incidents were 15 more than average. • Our emergency and evacuation systems worked smoothly and effectively at all our locations worldwide due to having good plans and trained staff who responded well to situations as they arose. • Out of all field course students, 8 percent had a reportable injury or illness and 6 percent had a non-medical incident. Ninety-six percent of our students graduated.

Rate/1,000 Program Days 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

2.77 3.59

2.68 2.94

1.12 0.97 0.92

34 Year Avg. 1985-2018 10 Year Avg. 2009-2018 5 Year Avg. 2014-2018 1.23

2019 Medical Incidents Medical Evacuations

On a calm, clear, sunny day in the North Cascade mountains of Washington, a student slipped while descending a snow slope and slid for 200 meters on snow. She was unable to stop herself from sliding and went over some rocks protruding from the snow. She came to a stop where the snow met dry ground, but she was unconscious. The instructors got to her within minutes, performed a patient assessment, stabilized her for suspected head/spine injuries, and called NOLS to initiate an evacuation. The National Park Service responded with a helicopter and two rescue rangers, one of whom is a NOLS Wilderness Medicine instructor. The course instructors assisted the rangers in preparing the student for evacuation and she was extracted from the incident scene, transferred to another helicopter, and flown to a hospital in Seattle, where a NOLS staff person was waiting to provide whatever support they could. The student’s father arrived from out of state that night.

NOLS conducted an in-depth internal review of the incident in order to fully understand the contributing factors related to what happened. Reviews are standard procedure and reflect on our strong organizational risk management culture, where we can evaluate incidents in an open, objective, and analytical manner with all involved in order to learn from them.

The student recovered from her injuries and is making plans to return to NOLS in 2020 because she “wants to be a NOLS graduate.”