Hunting Injuries and Safety: Tree Stand Falls, Cold, Heart and Getting Lost

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It’s still dark on opening morning. The ladder stand is cold and wet under your gloves, the pack pulls at your shoulders, and you’re thinking about the buck you saw on the trail camera, not about the next rung. That’s exactly the moment the numbers warn about. Hunting is a slow sport most of the time: long sits, quiet walks, a lot of waiting. But the risks come in short, sharp bursts: the climb into a stand, a shot taken too fast, a cold night nobody planned for, a heavy drag back to the truck. This page covers the hunting injuries and emergencies that show up in the published data, how hunter education teaches you to prevent them, and when to stop and get help.

General information, not medical advice. In an emergency call 911 or activate your PLB or satellite SOS. For the bigger picture, start at our hunting hub; the full safety and legal rules are on hunting rules and safety.

Tree stand falls: the number one cause

When people picture a hunting accident, they picture a gun. The data points somewhere else. Hunter education materials say plainly that the number one cause of injury or death when hunting from a tree stand is falls, and most of those happen while climbing up or down. In Pennsylvania, a study of the state trauma registry from 1990 to 2017 counted 1,229 hunters hurt in tree stand falls against 560 victims of hunting-related shooting incidents; falls overtook shootings in 1999, and the fall rate rose with age, peaking in hunters aged 50 to 59. Most victims (77%) had multiple injuries, and 26% left the hospital needing help with daily activities. In Arkansas, tree stand injuries now make up about two-thirds of hunting injuries reported to the state wildlife agency over 1993 to 2022, while projectile injuries fell.

The injuries are serious. At one Wisconsin trauma center, 65 of 117 tree stand fall patients had spine fractures, most often in the mid and low back, and 19 lost some nerve function; the authors linked stand heights of 10 feet or less with a lower chance of spinal cord injury. A Michigan trauma center found spinal injuries in a third of its tree stand patients. And the Tree Stand Safety Awareness foundation (TSSA), citing a multi-state study, reports that 99% of fall victims were not attached to the tree when they fell, and 86% weren’t wearing a harness at all.

Hunter education and the TSSA teach the same habits:

• Inspect first. Check the stand, straps and harness before every season and practice at ground level. Don’t leave a stand on a tree for more than two weeks, and never exceed its weight limit (you plus your gear).
• Harness on, connected before your feet leave the ground, and stay connected until you’re back down. A full-body harness with a shock-absorbing tether, no slack while seated.
• Three points of contact on every climb, and nothing in your hands or on your back. Use a haul line for gear; state agencies such as Virginia’s add: unload any firearm or bow before it goes up or down.
• Tell someone where your stand is and when you’ll be back.
• If you fall and the harness holds: don’t panic, signal for help and get back onto the platform as fast as you can. If you can’t, stand in the suspension relief strap or keep pushing with your legs to keep blood moving. Replace any harness that has caught a fall or passed the maker’s expiration date.

Tree stand harnesses and other safety gear we’d start with are below, and the full kit list is on our hunting gear page.

Firearm incidents: what hunter education teaches

Shooting incidents are rarer than they used to be, and hunter education is a big reason. Pennsylvania reports that hunting-related shooting incidents have dropped by nearly 80% since hunter education training began there in 1959, crediting the courses and fluorescent orange clothing. The two leading causes the state lists are failing to positively identify the target before shooting and failing to keep a safe zone of fire. Every hunter education course in North America is built around four primary rules, as taught in the national course:

1. Point the muzzle in a safe direction.
2. Treat every firearm with the respect due a loaded gun.
3. Be sure of the target and what is in front of it and beyond it.
4. Keep your finger outside the trigger guard until ready to shoot.

Two more lessons from the course matter for health: wear hunter orange where required (most states require it during firearm seasons, and nothing in nature matches its color, so other hunters see you), and take hunter education before your first license, which many states require before you can buy a license (often depending on your birth year). We don’t teach weapon handling on this site; take a certified course through your state wildlife agency, and see hunting rules and safety for licenses, orange rules and ethics.

Hypothermia and cold

Hunting has a built-in cold trap: you sweat on the walk in, then sit still for hours. The Compendium of Physical Activities rates hunting from a stand at about 2.5 METs, barely more than sitting, against 9.5 METs for hiking with hunting gear. Damp base layers plus a long, still sit in wind or rain is how mild chilling turns into hypothermia. The CDC lists the warning signs in adults as shivering, exhaustion, confusion, fumbling hands, memory loss, slurred speech and drowsiness; a body temperature below 95°F needs medical attention right away. Frostbite often starts with redness or pain, then white or grayish-yellow skin that feels firm or waxy, and numbness.

Prevention is mostly clothing and pacing: walk in slowly so you sweat less, add a dry layer once you’re in the stand, cover head, hands and face, and eat and drink through the day (see hunt day). If someone shows signs: get them out of the wind and wet, swap wet clothes for dry, warm the chest, neck, head and groin first, and give warm drinks only if they’re fully alert. The CDC is clear that alcohol is not a warm-up; it raises the risk. Hand warmers like HotHands help fingers and toes, and an emergency bivvy weighs a few ounces for the night you didn’t plan on.

Heart events: the drag, the climb and “buck fever”

Researchers describe deer hunting as an activity with a high rate of cardiovascular events, and small studies with heart monitors on real hunters show why. In 16 healthy men, dragging a deer over rolling ground pushed heart rate to an average of 89% of their treadmill maximum, with peaks around 95%. In 25 middle-aged men (17 with known coronary artery disease), 22 went above 85% of their maximum heart rate while hunting, 10 went higher than on a maximal treadmill test, and three showed signs of heart strain on the ECG in the field that the treadmill never revealed. The fitter the hunter, the lower the relative strain. A 2016 study added climbing into tree stands and the adrenaline rush of “buck fever” as moments when heart rate spiked, in men and women alike.

What helps: a check-up before the season if you’re over 40, have heart disease or risk factors, or have been inactive (the drag is often the hardest effort of a hunter’s year); building fitness months ahead (see hunting fitness); getting help with the drag, taking breaks, or using a game cart; and not hunting alone if you have heart disease. Know the CDC’s warning signs: chest pain or discomfort, shortness of breath, feeling weak, light-headed or faint, or pain in the jaw, neck, back, arms or shoulders. Stop and call 911 (or use your SOS device) right away; don’t try to walk it off.

Back strain: lifting and hauling game

Dragging a large animal is rated at about 9.8 METs, one of the hardest things hunters do, and lifting it into a truck bed or hauling meat out on a frame pack loads the low back. General lifting advice from orthopaedic surgeons applies: bend at the hips and knees rather than the waist, keep the load close to your body, tighten your core, and don’t twist while you lift. Share the load, split heavy loads into several trips, rest often on long hauls, and build back and leg strength before the season. Back pain that runs down a leg, comes with numbness or weakness, or doesn’t settle in a few days should be seen by a doctor or physical therapist. More in hunting recovery.

Getting lost

Hunter education teaches S.T.O.P.: Stop when you realize there’s a problem, Think, Observe (shelter, fuel, water) and Plan. If you can’t get back to camp or the car, spend the night where you are; you’re likely to be found, especially if you left a hunting plan with someone. The international distress signal is three of anything: three whistle blasts, three flashes with a mirror, three fires. A personal locator beacon sends an emergency signal to search and rescue by satellite with no subscription, and in the US it must be registered (free) with NOAA. Satellite messengers add two-way texting with a plan. Compare them on hunting wearables.

When to get help

• Call 911 or use your SOS now: any fall from a stand with back or neck pain, numbness or a head blow; chest pain or the other heart attack signs; confusion, slurred speech or drowsiness in the cold; any gunshot or arrow wound; someone who can’t walk out.
• Head out early: uncontrolled shivering, wet clothes and no dry layers, a twisted ankle on rough ground, a storm coming in.
• See a professional at home: back pain lasting more than a few days, pain down a leg, frostnip that blisters or stays numb, any heart symptom that came and went in the field. A sports medicine doctor, physical therapist or athletic trainer can help you plan a safe return.

Hunting injuries: FAQs

What is the most common hunting injury?

Falls from tree stands lead the serious injuries in the published data. In Pennsylvania they overtook hunting-related shooting incidents in 1999, and in Arkansas they now account for about two-thirds of hunting injuries reported to the state. Spine and leg fractures are common.

When should I put my tree stand harness on?

Before you leave the ground. Hunter education says to connect your fall-arrest system to the tree at ground level and stay connected the whole time until you’re back down. Most falls happen while climbing up or down, not while sitting.

Why do hunters have heart attacks?

Heart-monitor studies show dragging game, climbing and the excitement of seeing an animal push heart rate very high, sometimes higher than a maximal treadmill test, often in cold weather. Unfit hunters and those with heart disease are under the most strain. Get checked before the season and get help with the drag.

How do I know if someone is getting hypothermia?

The CDC lists shivering, exhaustion, confusion, fumbling hands, memory loss, slurred speech and drowsiness. Get them out of wind and wet, into dry clothes, warm the chest, neck, head and groin first, and get medical help. No alcohol.

What should I do if I get lost while hunting?

Stop, think, observe and plan. If you can’t get back safely, stay where you are, make shelter, keep warm and signal: three whistle blasts, three flashes or your PLB or satellite SOS. A hunting plan left with someone at home makes you much easier to find.