The Epidemiology and Medical Morbidity of
Long-Distance Backpackers in the Sierra Nevada

Just out in December Wilderness and Environmental Medicine by authors Philip Stalcup, Susanne Spano

Introduction
The John Muir Trail (JMT) is a 355-km
(220-mile) trail in the Sierra Nevada Mountains. There are few reports on long-distance backpackers, and none in the Sierra Nevada.

Objectives
To survey medical issues and demographics of JMT hikers.

Methods
Using online and onsite recruitment, hikers completing the JMT in 2014 were directed to an online 83- question survey.

Results
Of 771 respondents, 92.8% completed all medical and demographic questions. The majority (59.3%) of respondents were men. The average age was 43 years (SD 14), and ranged between 13 and 76 years. Hikers completed their trips in an average of 15.2 days (SD 7.6) . Hikers lost an average of 3.5 kg (7.7 lbs). Weight gain (3.6 kg [8 lbs]) was reported in 12% of respondents. Blisters (67%), sleep problems (57%), and packstrap pain (46%) were the most prevalent symptoms. More than 10% of respondents rated experiences as significant to severe for blisters (n 103), knee and ankle issues (n 89), and sleep problems (n 75). The most common environmental illness reported was altitude sickness (37%). Hypothermia (7%) and heat stroke (5%) were uncommon. Constitutional complaints including headache (33%), excessive fatigue (41%), and excessive shortness of breath (37%) were frequent. Falls were reported in 16% of hikers; 1.3% reported some form of fracture. Of respondents, 8.1% required medical attention, and 18.8% reported a medical problem that persisted for at least 2 weeks after the conclusion of their trips. Thirty hikers were forced to leave the trail for medical issues; 4 of these required emergency medical services assistance, including 3 helicopter evacuations.

Conclusions
JMT hikers experienced medical issues similar to those reported on other national trails. Weight loss and altitude sickness were prevalent. A majority of hikers had medical complaints with a small percentage requiring medical attention.