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

Section VII: Roles, Responsibilities, and Technology 239

considers everything an emergency until proven otherwise. Most 911 calls result in an ambulance, often accompanied by a police cruiser and a fire department engine company, disturbing traffic and distracting drivers over miles of busy highway. This emergent response strategy continues despite several good studies in urban areas that have demonstrated a substantial increase in risk with the routine use of lights and sirens on ambu- lances, but no overall improvement in medical outcome. Realistically, the default value should be non-emergent until proven otherwise . This simple baseline is far less likely to kill or injure somebody.

rescuers. A 20-minute flight with a crew of three may save 20 rescuers an overnight ground evacu- ation in avalanche terrain, or a rescue vessel many hours underway in rough seas. This is a perfectly legitimate use of a helicopter, and if the medical officer can determine that the scene and patient are stable, the air crew can pick the best weather and time of day. This is an extremely valuable and appropriate application of critical thinking and risk management.

General Principles

Type of Response

8

Known Location Known Medical

Known Location Unknown Medical

Unknown Location Unknown Medical

Known Medical Unknown Location

“Identifying the type of response can help you equip appropriately and set a reasonable level of urgency.

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A SAR response, even an emergent one, is usu- ally more careful, and deliberate, and less exciting. Early involvement of themedical officer inmission planning can help determine the sense of urgency. Sometimes this must be based on scant informa- tion, but any communication directly between the medical officer and the scene or reporting party can be useful. A few direct questions, much like a scene survey and primary assessment, can give you a sense for serious or not serious: Is the scene safe for the next few hours? Is the patient awake and talking? Is the patient having any trouble breathing? Is the patient getting worse or getting better? It is much more likely for the responses to be reassuring than alarming. The mission profile can involve lower speed and less risk. Although the data also suggest that aeromedi- cal helicopters may not be worth the risk and expense in urban EMS, this is not the case in the backcountry. The benefit is seldom in speed of access, but more commonly in reducing risk to