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

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Wilderness and Rescue Medicine

dehydration. In multiple-casualty incidents, more seriously injured people are often overlooked in the rush to treat the noisiest and most uncomfort- able patients. Standard Precautions Included in this survey of dangers is the potential for exposure to body fluids. Several diseases can be transmitted via body fluids, including human immunodeficiency virus (HIV) and hepatitis B and C. The use of standard precautions is now standard in all areas of medicine where body fluid contact is possible. Standard precautions include the use of gloves, eye protection, face masks, hand washing, antiseptics, and proper disposal techniques.

General Principles

Scene Size-Up Stabilize the Scene

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Risk MOI

Personal Public Patient

Trauma Medical Environmental

SCENE SIZE-UP

Number Patients Rescuers Resources

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“The scene size-up will keep you alive and functioning.”

©2018WMA

but this is exactly what you must do. Stop, look around, and assess the risk to yourself and your team. The threats may be environmental, such as frigid water or a hang fire avalanche, or generated by the activities of other people. If it can harm you or your fellow rescuers it must be stabilized before you can do anything else. Once you are safe, or relatively so, look for any further threat to bystanders and the injured per- son. Stabilize the scene by moving danger from the patient or the patient from the danger. This has priority over everything else that fol- lows. Therefore, you must get the patient out of the water or out from under the cornice and clear the area of well-meaning (but potentially unsafe) bystanders. Determine Mechanism of Injury As you approach the scene, try to evaluate the mechanism of injury (MOI). How the problem developed is usually obvious, but occasionally more investigation will be necessary. For example, how far did the patient fall? Was it enough of a tumble to cause significant injury? Are there other factors, such as exposure to weather, that might contribute to the patient’s condition? You may be able to ask the patient or others on the scene for additional information about the MOI. Determine the Number of Patients Your scene size-up also determines how many people are injured or at risk. This is especially important in harsh environments where all field personnel may be at risk for hypothermia or

General Principles

Scene Size-Up

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Personal Safety

Body Substance Isolation: • Eye protection • Gloves • Protective clothing

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©2018WMA

The Primary Assessment The second part of PAS is the primary assess- ment, which is a quick check on the status of the patient’s three critical body systems: circulatory, respiratory, and nervous. The purpose is to iden- tify and correct immediate threats to the patient’s life. These three systems are equally important to survival, and major problems associated with these systems are equally dangerous. The order in which you check and stabilize them should be determined by the situation, not by the order in which they appear on any list. Stabilize the Patient Make sure that the airway is clear and that there is sufficient respiratory effort to oxygenate the lungs.