From injury events to rescue burden: accident patterns, health outcomes, and prevention in mountain outdoor physical activities-a scoping review.

Background: Mountain outdoor physical activities generate accidents, traumatic injuries, acute illnesses, fatalities, navigation failures, environmental exposures, technical entrapments, and search-and-rescue or evacuation demands. This review mapped the international empirical evidence and examined how activity-specific incidents become rescue-system burdens. Methods: Following JBI guidance and PRISMA-ScR, we searched PubMed, Web of Science Core Collection, Scopus, and EBSCOhost for primary studies published between 1 January 2005 and 1 August 2026, without language restrictions. Eligible studies reported accidents, injuries, illnesses, fatalities, rescues, or evacuations in mountain, alpine, high-altitude, wilderness, snow, trail, or canyon settings. Data were charted on study characteristics, activities, exposures, outcomes, and rescue features. Methodological quality was assessed using appropriate JBI checklists or PROBAST, followed by descriptive and thematic synthesis. Results: Sixty-six studies were included. All 66 reported an explicit participant, casualty, mission, event, or case count, but most did not provide a comparable participation-exposure denominator. Walking and endurance activities were dominated by falls, exhaustion, navigation failure, and non-traumatic illness; vertical and technical activities by falls from height, protection or descent errors, and entrapment; high-speed and mechanically assisted activities by high-energy trauma; winter and avalanche activities by collision, burial, and time-critical rescue; and canyoning by combined trauma, drowning, hypothermia, and difficult evacuation. Uninjured rescue, inaccurate location, environmental amplification, and prolonged extraction recurred across activity groups. Conclusion: Mountain emergencies extend beyond injury to encompass illness, environmental exposure, navigation failure, technical entrapment, and uninjured rescue. They can be conceptualized as a descriptive rather than causal pathway from preparation and exposure to event onset, response, evacuation, and outcomes. Heterogeneous definitions and limited exposure denominators hinder cross-activity comparisons; priorities include standardized measures, linked rescue-clinical datasets, and prospective intervention evaluation.