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

Wilderness and Rescue Medicine 238

deployed, is usually delegated to an operations section chief, often stationed at or near the inci- dent site. The section chief directs branch, divi- sion, or group leaders responsible for specific tasks or geographic areas. NIMS and SAR management is beyond the scope of this text. However, if you choose to become involved in search and rescue it is cer- tainly wise to become familiar with the system, how it might be used by any team with which you will deploy, and where you fit in as a medical provider. If you are responding to an unfamiliar operation, look for the IC or the command post (CP). In the field, look for the operations section chief or medical leader. Recognize, however, that the typical top-down application of IMS may not be the best command and control structure for every situation. It tends to work best within a single agency dealing with a predictable problem, such as a fire department fighting a structure fire. It is less successful in man- aging unpredictable emergencies, situations that involve multiple agencies, or people who aren’t as familiar with their roles or the IMS structure.

Response Preparation Your preparation and response will be determined by the type of incident that is involved. A known medical problem at a known location allows you to be fairly specific in your choice of equipment and personnel. A search for a lost subject who may or may not have a medical problem, however, requires more generic medical preparation. This is basic information that the field medical officer should obtain in a briefing from the section chief or medical leader.

Operations Section

General Principles

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Operations Section Chief: • Reports to the Incident Commander • Establishes tactical objectives • Assigns deputies, e.g., medical leader • Manages all operational activities • Defines branches, divisions, groups, and resources “Field medical personnel will usually function under the Operations Section Chief.”

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General Principles

National Incident Management System

Personal Preparation

General Principles

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• Equipment and clothing • Technical training • Know the team • Medical kit – team and personal • Understand your role and limitations • What protocols are you working under?

Incident Commander (IC)

Finance Operations Logistics Planning • Budget • Implementation of plan

• Development of plan • Resources • Hospitals

• Support • Food • Sanitation • Supplies

• Donations • Who pays?

• Search • Rescue • Field medical care

• Personal • Team • Communications • Transportation

NIMS

©2018WMA

©2018WMA

Rigid adherence to the IMS can hamper response in rapidly changing situations where quick decisions and reallocation of resources are needed. Usually, the rescuer on the scene has a much better grasp of the situation than the offi- cer in the command post many miles away. In these cases, a more flexible bottom-up approach to emergency management is often more useful.

Risk Versus Benefit Most emergency response to medical problems, from the street to the open ocean, generates risk well in excess of any benefit from speed. The rea- sons include the inability of people on the scene to distinguish serious from not serious, the reluc- tance of dispatchers and responders to trust peo- ple’s judgment, and long-standing protocol that