IJCI International Journal of Clinical Innovation IJCI International Journal of Clinical Innovation IJCI-2026-0022 Mountain Rescue Activity and Limitations of Accidental Hypothermia Surveillance in Spain: A Descriptive Analysis of Guardia Civil Data, 2018–2021 Mountain Rescue and Hypothermia Surveillance in Spain Guillermo Muñoz Guillem Serra Jesús Ceballos MD Instituto de Estudios Médicos, Universitat Ramon Llull, Spain Corresponding author: Guillermo Muñoz. Correspondence via editorial@ijcinnovation.org. 28 09 2026 1 1 27 09 2026 28 09 2026 © The Author(s). Authors retain copyright. This article is distributed under the Creative Commons Attribution 4.0 International (CC BY 4.0), which permits sharing and adaptation, including commercial reuse, provided appropriate credit is given, a link to the license is supplied, and changes are indicated. Third-party material is covered only when the article or credit line does not state otherwise.

BACKGROUND: Accidental hypothermia is a potentially life-threatening complication of cold exposure in mountain and wilderness environments. Reliable surveillance requires clinically specific field data, but administrative rescue datasets may group hypothermia with other medical problems.

OBJECTIVE: To describe mountain-rescue activity recorded by the Spanish Guardia Civil Mountain Service from 2018 through 2021 and assess whether publicly available administrative data can support estimation of accidental-hypothermia prevalence, severity, or clinical impact.

METHODS: We performed a retrospective descriptive secondary analysis of aggregate data from the Statistical Yearbooks of the Spanish Ministry of the Interior. Annual intervention totals were extracted for 2018–2021. Detailed 2021 data were summarized using separate denominators for rescue interventions and rescued persons, including activity, accident type, mountain massif, age, sex, and rescue status. Because the public data contain no hypothermia-specific count, core-temperature field, clinical stage, treatment data, or patient-level linkage, no hypothermia prevalence estimate or causal analysis was attempted.

RESULTS: Across 2018–2021, 3,780 mountain-rescue interventions were recorded: 974 in 2018, 981 in 2019, 790 in 2020, and 1,035 in 2021. Interventions decreased by 19.5% from 2019 to 2020 and increased by 31.0% from 2020 to 2021. In 2021, 1,489 rescued persons were reported across 1,035 interventions; 102 were recorded as deceased, 654 as injured, and 733 as uninjured at rescue reporting. Men represented 62.9% of rescued persons, and the largest age group was 19–30 years (22.4%). Hiking accounted for 552/1,035 interventions (53.3%), the Aragonese Pyrenees for 402/1,035 (38.8%), and same-level trips/falls for 302/1,035 (29.2%). A broad “physical problems” category accounted for 127/1,035 interventions (12.3%) and included severe hypothermia together with other medical conditions; hypothermia-specific frequency could not be isolated.

CONCLUSION: Guardia Civil data provide a useful description of mountain-rescue workload but do not support estimation of accidental-hypothermia prevalence, severity, or outcome. Future surveillance should separately record suspected or confirmed hypothermia, core temperature and measurement method, clinical severity, exposure context, treatment, and outcome using harmonized definitions across rescue services.

 accidental hypothermia mountain rescue wilderness medicine prehospital care surveillance Spain Funding No external funding. Conflicts of interest The authors declare no conflicts of interest. Author contributions Guillermo Muñoz, Guillem Serra, and Jesús Ceballos contributed equally to the conceptualization, methodology, investigation, data curation, formal analysis, visualization, writing of the original draft, and review and editing of the manuscript. All authors approved the final version of the manuscript. Data availability Available from the corresponding author upon reasonable request. Ethics approval Exempt Consent for publication Not Applicable References Paal P, Pasquier M, Darocha T, Lechner R, Kosinski S, Wallner B, et al. Accidental Hypothermia: 2021 Update. Int J Environ Res Public Health. 2022;19(1):501. doi:10.3390/ijerph19010501. Dow J, Giesbrecht GG, Danzl DF, Brugger H, Sagalyn EB, Walpoth B, et al. Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update. Wilderness Environ Med. 2019;30(4 Suppl):S47-S69. doi:10.1016/j.wem.2019.10.002. Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021;161:152-219. doi:10.1016/j.resuscitation.2021.02.011. Musi ME, Sheets A, Zafren K, Brugger H, Paal P, Hölzl N, Pasquier M. Clinical staging of accidental hypothermia: The Revised Swiss System. Resuscitation. 2021;162:182-187. doi:10.1016/j.resuscitation.2021.02.038. Walpoth BH, Brodmann Maeder M, Courvoisier DS, Meyer M, Cools E, Darocha T, et al. Hypothermic Cardiac Arrest - Retrospective cohort study from the International Hypothermia Registry. Resuscitation. 2021;167:58-65. doi:10.1016/j.resuscitation.2021.08.016. Saczkowski RS, Brown DJA, Abu-Laban RB, Fradet G, Schulze CJ, Kuzak ND. Prediction and risk stratification of survival in accidental hypothermia requiring extracorporeal life support: An individual patient data meta-analysis. Resuscitation. 2018;127:51-57. doi:10.1016/j.resuscitation.2018.03.028. Ministerio del Interior, Gobierno de España. Anuario Estadístico del Ministerio del Interior 2018. Madrid: Ministerio del Interior; 2019. Available from: https://www.interior.gob.es/opencms/pdf/archivos-y-documentacion/documentacion-y-publicaciones/anuarios-y-estadisticas/anuarios-estadisticos-anteriores/anuario-estadistico-de-2018/Anuario-Estadistico-del-Ministerio-del-Interior-2018.pdf. Accessed September 27, 2026. Ministerio del Interior, Gobierno de España. Anuario Estadístico del Ministerio del Interior 2019. Madrid: Ministerio del Interior; 2020. Available from: https://www.interior.gob.es/opencms/pdf/archivos-y-documentacion/documentacion-y-publicaciones/anuarios-y-estadisticas/anuarios-estadisticos-anteriores/anuario-estadistico-de-2019/Anuario-Estadistico-del-Ministerio-del-Interior-2019.pdf. Accessed September 27, 2026. Ministerio del Interior, Gobierno de España. Anuario Estadístico del Ministerio del Interior 2020. Madrid: Ministerio del Interior; 2021. Available from: https://www.interior.gob.es/opencms/es/archivos-y-documentacion/documentacion-y-publicaciones/anuarios-y-estadisticas/anuarios-estadisticos-anteriores/anuario-estadistico-de-2020_0001/. Accessed September 27, 2026. Ministerio del Interior, Gobierno de España. Anuario Estadístico del Ministerio del Interior 2021. Madrid: Ministerio del Interior; 2022. Available from: https://www.interior.gob.es/opencms/es/archivos-y-documentacion/documentacion-y-publicaciones/anuarios-y-estadisticas/anuarios-estadisticos-anteriores/anuario-estadistico-de-2021/. Accessed September 27, 2026. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-1457. doi:10.1016/S0140-6736(07)61602-X.