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

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Section I: General Principles

of probability and consequence. Both elements are important to overall risk assessment. You may choose, for example, the faster evacua- tion route down a ridgeline because the probabil- ity of a lightning storm is low and there are good escape routes available if one does develop. We like low probability and low consequence choices like this one. This is good risk management. A more complex example is the ubiquitous use of helicopters in rescue work. Although air medical helicopters experience the highest rate of accidents in civilian aviation, the probability of one crashing is still quite low. However, the conse- quences of a helicopter crash are usually extreme which elevates the overall risk considerably. Good weather, a safe landing zone, and a conservative pilot will all contribute to keeping the probability of an accident low. But, a significant change in any one of these can quickly change the risk profile. Whenever possible, avoid the combination of high probability and high consequence.

problems will become worse because of what we have done. We also run the risk of causing injury to the rescuers themselves or to other people who may be involved. Against this risk, we balance the potential benefits of our actions. Good decisions increase benefit and decrease risk. Risk/benefit decisions in medicine are usually reserved for licensed practitioners. In the wilder- ness setting, this kind of critical thinking becomes a required skill at any level of medical training. It is often up to the person in charge of medical care on scene to convey the appropriate sense of urgency, determine the type of care needed next, and figure out how to access it safely and efficiently.

General Principles

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The Risk/Benefit Ratio

General Principles

Probability and Consequence

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“Avoid high risk solutions to low risk problems.”

©2018WMA

A good risk/benefit judgement may be the result of a gut feeling, or the product of a more formal group process. Whatever form it takes should replace emotion, obligation, panic, and if necessary, established protocol. The beneficiaries include the rescuers and bystanders as well as the patient. Probability & Consequence We tend to look at the risk associated with any decision or activity as a function of chance. We may know or guess that there is a 10%, 5%, or 0.005% probability of a bad outcome, but we seldom give much thought to the bad outcome itself. Treatment failures, falls, and crashes dur- ing rescue are considered tragedies, mistakes, or serendipitous events. But risk is really a function

“…the probability of injury in a remote setting may be no greater…but the consequence can be far worse.”

©2018WMA

In medical care, an example of a good risk/ben- efit profile is the use of epinephrine in the field treatment of anaphylaxis. The risks associated with injectable epinephrine are very low while the risks associated with untreated anaphylaxis are very high. This is a low risk treatment for a high-risk problem. All our wilderness medical protocols are examples of this principle. Generic to Specific In a hospital the process of diagnosis and treat- ment moves from generic to specific. The generic complaint of abdominal pain, for example, can