Subterranean medicine: an inquiry into underground medical treatment protocols in cave rescue situations in national parks in the United States.
Caving and spelunking have become increasingly popular over the years, with hundreds of thousands of amateur spelunkers across the country visiting caves. National parks in the United States offer hundreds of caves for all levels of spelunkers and, in fact, many national parks boast caves as either their main or major attraction. In an effort to increase visitor safety and establish subterranean medical treatment protocols, we began an investigation into cave rescue, medical protocols, previously published recommendations concerning cave safety, and visitor and rescue statistics in the national parks. Our inquiry provided little guidance from either the literature or the present US National Parks database for treating underground injuries. However, 2 predominant trends did appear. First, despite the nearly 2 million visitors to the caves in the 14 parks surveyed, there were only about 200 total calls for medical care. The vast number of those calls were for minor injuries. Second, no strict evidence-based treatment protocols for underground injuries exist, probably because they are not feasible. A caving incident database for the national parks would facilitate suggestions for preventative measures for the minor injuries and would help catalog the creative solutions for the rare serious subterranean medical incident.