Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Section I: General Principles

those that are going to be urgent and important if you do not address them. Avoid addressing anything that is not important to the care and safety of your patient and crew. To an untrained or uninformed observer, you may appear detached or overly concerned with your own safety. Their perceptions are not your problem; the execution of a safe and competent rescue is. The Problem List Practitioners familiar with the SOAP format (Subjective, Objective, Assessment, and Plan) for medical documentation will recognize the prob- lem list as the A, or Assessment. Using this tool will allow you to render order from the chaos of an emergency scene.

environmental issues along with the medical. SOAP is discussed in more detail in the chapter on patient assessment. Medicine Is Dynamic Everything in medicine, from general principles of care to specific treatment, carries some degree of uncertainty. Fortunately, some of what we do is validated by extensive experience and good science. We must remember, however, that our practice setting bears little resemblance to the conditions under which most medical studies are performed.

General Principles

Medicine is Dynamic

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What we know: • Good science • Solid experience What we think: • Incomplete science

General Principles

The Problem List

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SOAP

Assessment: • Existing environmental problems and threats • Existing medical problems • Anticipated problems and threats Plan: • Risk vs Benefit analysis • A plan for each problem • Action to prevent anticipated problems

• Tangential experience Educated speculation: • What seems to make sense

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“We should be prepared to improvise, adapt, and to keep an open mind.”

©2018WMA

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Although laboratory science and medical cen- ter practice has plenty to teach us, those lessons must be measured against the irreducible reality of providing care in a remote and dangerous place. Some of our practice must be a based on anec- dotal experience and incomplete scientific evi- dence. Where even less experience is available, we are left to rely on educated speculation supported only by what seems to make sense. As more data becomes available, some widely accepted medical practices will be debunked and others validated. Medical practitioners at every level of training must be willing to reevaluate the standard of care whenever new information and field experience suggests a better way. We should be prepared to improvise, adapt, and keep an open mind.

“Constructing a succinct list of problems … begins a well-ordered process of treatment and evacuation.”

©2018WMA

Constructing a succinct list of problems identi- fied by the scene size-up and examination of the patient begins a well-ordered process of treatment and evacuation. For each problem identified, the practitioner establishes a priority and plans treat- ment. The problem list is also a primary tool for communicating the patient’s condition and treat- ment to other people. In the wilderness or disaster setting, the patient’s medical condition may be just a small part of a much larger problem list that includes adverse weather, difficult terrain, and hazardous working conditions. These factors can create new medical prob- lems as well as determine the plan for dealing with the existing ones. For the wilderness medi- cal practitioner, the problem list includes the