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

Chapter 2: General Principles of Wilderness Rescue

There are countless examples of high-risk solutions to low-risk medical problems. This is nowhere more apparent than in backcountry and marine rescue. The reasons are not difficult to understand: Information about the scene is often unreliable, rescuers can become emotionally involved in the patient’s plight, and the operation itself can be an exciting, powerful, and distracting experience. Risk affinity often increases well out of proportion to the actual need. As a medical officer your primary responsibility is to reduce risk to your patient, the public, other rescuers, and yourself. This is not easy. Flexibility, innovation, and a certain amount of courage are required to cope with the varied and constantly evolving nature of medicine and rescue in the wild and remote setting. There are, however, a few guiding principles of wilderness rescue that can help to impose some degree of order on chaos. Serious or Not Serious There are only three things that will kill you or your patient; shock, respiratory failure, and brain failure. Anything causing these critical system problems is serious and an invitation to imme- diate action. Any concern for the development of critical system problems in the near future is serious and requires early treatment to prevent

General Principles

Serious or Not Serious? Low Risk or High Risk? No Emergency or Emergency? Stable or Unstable?

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Wilderness Perspective

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Low Risk High Risk

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the pattern from progressing. Based solely on the diagnosis of serious, you can begin basic sup- portive care and protection and summon help or initiate an evacuation. Conversely, no evidence of shock, respiratory failure, or brain failure, and no reason to antici- pate these problems, means not serious . You have time to treat and observe, and perhaps avoid evacuation altogether. Serious or not serious is the most generic and important diagnosis of all in field medicine. The Risk/Benefit Ratio Every treatment (or decision not to treat) and every emergency evacuation (or decision to stay in the field) involves the risk that the medical