My family calls me Safety Officer Ben. It started as a joke — the surgeon who narrates every hiking trail, every wet dock, every icy parking lot with a running commentary on what could go wrong and how to prevent it. But the nickname stuck because the instinct behind it is real. When you spend nearly three decades operating on injuries that were preventable, you stop seeing gear and environment choices as personal preferences. You start seeing them as clinical decisions made outside the hospital.
This column exists because I have a perspective most gear reviewers don't have — and I think it's one worth sharing.
What the OR teaches you
The injuries I treat most often are not freak accidents. They are predictable failures. The wrong footwear on an unstable surface. Inadequate thermal protection in cold water. Poor visibility in low light. Fatigue compounded by the wrong equipment for the conditions. The patterns repeat with remarkable consistency across patients who have nothing else in common.
A competitive athlete and a weekend fisherman and a grandfather on a glacier tour can arrive in my operating room via essentially the same chain of avoidable decisions. That repeatability is exactly the point. Predictable means preventable. And prevention happens before the outing — in the gear choices, the planning, and the framework you use to think about risk.
"The most important gear decision you make isn't what you buy. It's whether you thought clearly about what you were trying to prevent before you bought anything at all."
The OR/OR standard
I use a framework I call the OR/OR standard. Anything I take into the field has to meet the same baseline of scrutiny I'd apply to a tool in the Operating Room — will it perform reliably under the specific conditions I'm going to subject it to, or will it fail at exactly the wrong moment?
Operating Room reliability in the Outdoors.
In surgery, a tool that fails under load isn't inconvenient — it's catastrophic. In the field, gear that fails under conditions isn't an inconvenience either. It's how preventable injuries happen. The standard I apply: would I trust this under sustained load, in the worst conditions I'm likely to face, at the end of a long day?
How I think about risk in any environment
Identify the categories of risk in this environment
What are the ways this environment can hurt someone? Thermal, mechanical, hydrological, terrain, fatigue, wildlife. List them explicitly before you plan the gear.
Understand the physiological and biomechanical principles behind each risk
Cold water doesn't hurt you — hypothermia does. That distinction tells you exactly what properties matter in your thermal protection. Physics, not brand names.
Select gear that addresses the specific mechanism, not the general category
A "waterproof boot" doesn't tell you whether it's appropriate for a wet aluminum deck. A "warm jacket" doesn't tell you whether it retains thermal value when saturated. Ask the right question.
Test the system, not just the components
A great boot and a great sock and a great insole can fail together if the combination produces pressure points, moisture accumulation, or reduced proprioception. Test the full system before the trip, not during it.
What's coming in this column
This spring I'm taking my family — four people across four decades of age — into a demanding environment in Alaska. Cold water, variable coastal weather, physically challenging activities across multiple days. I'm planning that trip through exactly this clinical lens, and I'm going to show you the reasoning in real time: what risks exist, what principles govern them, what properties I need in each category of gear, and what I actually chose and why.
Ketchikan · Sitka · Hubbard Glacier · Resurrection Bay — Saltwater Fly Fishing
Four people across four decades of age. Cold coastal water, variable weather, physically demanding excursions. The full gear planning process — from footwear to thermal layering to safety equipment — documented here before departure. Every decision explained. No sponsored checklists.
Not brand recommendations. Not sponsored checklists. The underlying reasoning — and a framework you can apply wherever your next expedition takes you. Evidence over ego applies here the same way it does in the clinic.
The Alaska gear breakdown
is in The Brief.
Every issue of The Form & Function Brief includes the Safety Officer Ben column — one piece of gear or one risk framework, explained through a surgeon's lens.
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- McIntosh SE, Leemon D, Visitacion J, Schimelpfenig T, Fosnocht D. Medical incidents and evacuations on wilderness expeditions. Wilderness & Environmental Medicine. 2007;18(4):298–304. doi:10.1580/07-WEME-OR-093R1.1