Sudden Unexpected Death on Challenge Courses

Abstract

For decades, the ‘‘obstacle course’’ has been a staple of military physical training. The goal of these courses has been the development and assessment of physical fitness in a population of generally young and healthy subjects.1 More recently, a variation of the obstacle course has become popular in some civilian contexts. The ‘‘challenge’’ or ‘‘ropes’’ course uses some elements derived from military courses and a number of unique initiatives, along with equipment and procedures developed for rock climbing (Figure). Although these programs involve physical exertion, the emphasis is more on developing teamwork, self-confidence, and communication skills than on physical training or assessment. Such courses in the United States were initially popularized by Outward Bound. In the early 1970s, Project Adventure began to introduce them in the public schools of Massachusetts. They are now found in summer camps, rehabilitation settings, colleges, corporate headquarters, and a variety of other sites.2 The total number of programs operating in the United States today, based on data collected by Project Adventure, is estimated as 7750. Although there are reports of injuries and there have been anecdotal reports of fatalities, no real effort has been made to analyze data about deaths on challenge courses. Despite this, many providers of such programs have proposed medical screening procedures to assess risk to participants. None of these has been subject to careful scrutiny, and the industry has not developed a uniform standard. The purpose of this study was to perform the first systematic analysis of fatalities on challenge courses and to provide evidence-based recommendations on their prevention.