RESEARCH PARTICIPANT CONSENT FORM

Alpine Sports Health Study
You are invited to be in a research study of the health effects of engaging in mountain activities such as rock climbing, ice climbing, mountaineering, and back-country skiing. We ask that you read this form and ask any questions you may have before agreeing to be in the study. Your participation is entirely voluntary. This study is being conducted by Eric Haskell, PA-S, under the direction of Darcy Solanyk, MA, PA-C.

Purpose of Study
The purpose of this study is to determine the prevalence of accidents in alpine sports and their affects on participants health. You were selected as a prospective participant in this study because of your affiliation with various professional and recreational climbing, mountaineering and skiing groups and the assumption that participation in such groups guarantees your participation in said activities.

Procedures
If you agree to be in this study, we will ask you to do the following:
Complete an 17 question, multiple-choice, anonymous, online questionnaire.

Duration
Participation in the study involves the following time commitment: Approximately 5 minutes. The study team will not return clinically relevant information to you.

Risks and Benefits of Being in the Study

The study involves the following foreseeable risks and/or discomforts: Possible recollection and re-experience of previous traumatic events. Treatment for any adverse effects will not be provided. The benefits to participation are: Hopefully this study brings awareness to the amount of traumatic accidents that occur in climbing and mountaineering. This study aims assess the consequences of these incidents and inform further studies. Any risks to you associated with this study are not expected to be greater than anything you encounter in everyday life; however, if you find that you are emotionally triggered by taking this survey, please seek out counseling for your concerns.

Compensation and/or Costs
There will be no compensation for your participation in this study, but your help is appreciated by the researchers.

Confidentiality
Your responses to the survey will be anonymous. Your identity will not be revealed in any publications, presentations, or reports resulting from this research study. We will collect your information through an online survey on Survey Monkey. This information/data will be stored and safeguarded by an encrypted file on a password protected hard drive.
Identifiers may be removed from your identifiable private information and after such removal, the information could be used for future research studies or distributed to another investigator for future research without additional informed consent. This informed consent form will be kept for three years after the study is complete, and then it will be destroyed. The research team works to ensure confidentiality to the degree permitted by technology. It is possible, although unlikely, that unauthorized individuals could gain access to your responses because you are responding online. However, your participation in this online survey involves risks similar to a person’s everyday use of the internet.

It is unlikely, but possible, that others such as the Rocky Vista University Institutional Review Board (IRB), or state or federal officials may require us to share the information you give us from the study to ensure that the research was conducted safely and appropriately. We will only share your information if law or policy requires us to do so. Finally, you should understand that the investigator is not prevented from taking steps, including reporting to authorities, to prevent serious harm to yourself or others.

Question Title

* 1. Are you over 18 years of age, have read the above statement and agree to participate in this study?

Question Title

* 2. What is your age?

Question Title

* 3. What is your gender?

Question Title

* 4. Which outdoor activities do you participate or work in: (Select all that apply)

Question Title

* 5. Select the category that best applies to you and alpine sports

Question Title

* 6. How many years have you participated in climbing, mountaineering and/or backcountry skiing?

Question Title

* 7. Have you ever: been injured, witnessed an injury, or had a relative or close friend injured while participating in climbing, mountaineering or skiing activities? (Select all that apply)

Question Title

* 8. How many accidents resulting in hospitalization, permanent disability or fatality have you experienced, witnessed or happened to someone close to you?

Question Title

* 9. What was the severity of the injury in the most severe accident you have experienced, witnessed or happened to someone close to you?

Question Title

* 10. During which activity/activities did the accident(s) in the previous question occur? (Select all that apply)

Question Title

* 11. After this experience, did you avoid being reminded of it by staying away from certain places, people or activities?

Question Title

* 12. After this experience, did you lose interest in activities that were once important or enjoyable?

Question Title

* 13. After this experience, did you begin to feel more isolated or distant from other people?

Question Title

* 14. After this experience did you find it hard to have love or affection for other people?

Question Title

* 15. After this experience did you begin to feel that there was no point in planning for the future?

Question Title

* 16. After this experience were you having more trouble than usual falling asleep or staying asleep?

Question Title

* 17. After this experience, did you become jumpy or get easily startled by ordinary noises or movements?

0 of 17 answered
 

T