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

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Section III: Critical System Problems and Treatment

condition continues. However, spine management should not take precedence over patient protec- tion, adequate ventilation, or circulatory support. A major critical system problem carries a high risk of death and the benefit to the patient of almost any BLS/ALS treatment is obvious. What is less obvious, sometimes, is the risk to the rescu- ers performing the treatment. Risk Versus Benefit in BLS Any rescue effort, even the most desperate, must consider the overall probability and consequence of an adverse event. Performing CPR under a hang fire avalanche, for example, is a very low yield procedure in a very high-risk environment. Discontinuing resuscitation under such a circum- stance would certainly be appropriate but would be one of the most difficult decisions a medical officer would have to make.

Even in the urban context the global risks are often discounted in favor of low-yield procedures. Consider, for example, the AED-equipped police cruiser responding to a cardiac arrest call. The officer knows that a fast response is beneficial to the patient’s chance for survival. But, at the same time, his code 3 race through town substantially increases the risk to drivers on the road, children and dogs in crosswalks, and bicyclists turning to watch the excitement. Add an ambulance, engine company, and helicopter to the response and the risks really start to pile up. In the backcountry and offshore setting the risk associated with rescue and evacuation is often extreme. It is incumbent on the medical officer to balance the chance of successful medical treat- ment against these risks to the rescuers as well as the patient. There will be situations where remain- ing on scene and performing good basic medical care, while risks are mitigated, and a safe rescue is organized, will give everyone a better chance of survival. There will also be situations where rapid removal of the patient from the scene before initiating any medical care will be required. And, of course, there are situations where access to the patient is impossible without exposing rescuers to unreasonable hazards, and rescue efforts must be abandoned. Deciding which is which requires an objective, unemotional, concise valuation of probability and consequence and risk versus benefit.

External injury highlights the anticipated prob- lem of internal bleeding. However, significant blunt force trauma may leave no visible signs.

The risks are often extreme…