In the last year, the Australian outdoor industry has seen insurance prices increasing by 40 to 2000 percent. How does an organisation demonstrate that risks are manageable when the public perception of the outdoors is all high-risk thrills and spills? The Outdoor Medical Incident Database (OMID) can assist this process as a tool that identifies preventable incidents and measures the effect of actions taken to reduce incidents.
OMID has been successfully used by Outward Bound Australia (OBA) over the last three years to actively reduce the number of medical incidents. In 1999 OBA had 6.25 incidents reported per 1000 participant days. This was reduced to 5.82 in 2000 and 4.23 in 2001-an overall reduction of 32% in incident frequency. (Over the same period the total number of participant days increased by 4 percent.) This reduction was done by carefully analyzing incident patterns and implementing changes in policy and practices. OBA uses four main phases in the implementation and use of OMID.

Phase One: Collecting Data
To begin, a format needs to be established for the collection of data. A decision is made on what incidents are recorded-those beyond a certain degree of seriousness, or those involving lost program days, or some other suitable criteria. Procedures are established on when and how the incident is reported. Incident data is then entered over a period of time.

Phase Two: Identifying Patterns
Once data has been entered, OMID can generate reports which look at incident patterns. These patterns answer questions like: Which activities have a higher incident rate? What kinds of injuries are happening? Are locations a factor? Or time of day? What is the primary cause of the incident? What role do preexisting conditions play in the incidents?

When OBA first looked at the data in 1999, one of the strongest patterns was that 57 percent of incidents involved a preexisting health or fitness condition that contributed to the incident. It was then found that a large number (40 percent) of these preexisting conditions had not been reported to the instructor prior to the incidents. The majority of incidents in this category were strains, sprains, muscle tears, and other musculo-skeletal injuries.

Phase Three: Changing Policies or Practices that Cause Incidents
After patterns appear, an investigation into which incidents may be preventable occurs. A particular piece of equipment may need to be changed, or an activity altered. Perhaps a proactive approach can reduce the chance of incidents happening.With the information about preexisting conditions, OBA changed its medical forms to include a specific question on sports injuries. In addition, participants were asked about sports injuries in their medical form review with the instructor on the first night of the program. Then, if someone indicated that they had had previous trouble with their ankle, the instructor could proactively tape the ankle before a bushwalking expedition.

Phase Four: Monitoring Changes in Incident Levels and Evaluating Changes in Policies or Practices
After a practice/policy is changed, it is important to retest the new data to see if there is a measurable difference. If no change can be seen, then look for other factors. It is important to remember that preventable medical incidents are being targeted through this process. Not all accidents or incidents can be prevented through changes in policies, training and procedures, especially in the outdoors. Thus, we can only work to prevent and reduce injuries or near misses not eliminate them.

After changes to OBA's medical forms and approach to preexisting conditions, especially musculo-skeletal conditions, the number of incidents dropped dramatically. Unreported preexisting conditions dropped by 43 percent from 1999 to 2001. This compares to a decrease of 19 percent in reported preexisting conditions and a decrease of 25 percent in incidents involving no preexisting conditions over the same period. In 1999 the total number of preexisting musculo-skeletal incidents was sixty-seven. This dropped to forty-six incidents in 2001, a reduction of 31 percent. All these percentages mean that fewer people experience a medical incident on a program.

Summary
These four phases work continually to reduce incidents. An overall statistical decrease is one measure of success; another measure is a shift in staff attitude toward incidents. Ten years ago OBA staff were reluctant to report accidents and incidents, fearing that it would reflect on their abilities. By implementing OMID and using its information to target ways of reducing incidents, staff gain the opportunity to learn from a variety of incidents. This active learning culture is an important part of an effective risk management strategy.
Certainly using OMID requires expending additional time and effort to enter and analyse data, but if incidents can be reduced, that time is well spent. Not only are participants safer, but there are fewer incidents to manage and less time lost from programs.

Outward Bound International Offer
Outward Bound International received generous gifts from the board of directors, Outward Bound Canada, Outward Bound Singapore, and Outward Bound Hong Kong to initiate the distribution of OMID to member centers. Schools that are interested in receiving a copy of the database are encouraged to contact Ian Wade . OMID will be distributed on CD and will include a run-time version of Microsoft Access. The computers running the system will need to have a Windows 98 or higher operating system. If it is possible for your center to contribute toward the US$10,000 cost to OBI by purchasing a copy for US$500 (or whatever you can contribute), this will help fully cover OBI's costs.

OMID - What is it?

The Outdoor Medical Incident Database is a computer-based system, written using Microsoft Access and Windows.
Features include:
· Runtime version of MS Access
· Incident data entry and review
· Participant day data entry
· Built in reports-incident summary graphs, incident summary, date range, instructor incidents, program summary, and yearly summary
· Data backup and recovery
· Export function to central database for comprehensive reports
· Customisable lists
· Incident report form template, participant days collection sheet
· Upgrades for one year

New Version 1.5 released June 2002
Requires Windows 98 or later version
For more information about receiving OMID, contact Ian Wade at

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