Wilderness and Rescue Medicine 8th Edition

Chapter 7: Basic and Advanced Life Support

Basic life support (BLS) is the immediate treat- ment of life-threatening critical system prob- lems discovered during the primary assessment. Although BLS is outlined in a specific sequence, field treatment requires flexibility. The circulato- ry, respiratory, and nervous systems are equally important. It is often necessary to change the order in which things are done, or to manage sev- eral components at the same time. The primary goal is to support oxygenation and perfusion of the brain and other vital organs.

However, the goals of BLS and ALS are the same: to preserve and enhance oxygenation and perfusion. Some techniques that were previously reserved for advanced level practitioners have been added to the basic scope of practice. The time-critical treatments for anaphylaxis and asthma offered in the protocols for wilderness medicine are examples. The use of automated external defi- brillators (AEDs) in the urban context is another. At any level of medical expertise, it is important to understand what the next step along the chain of medical care should be. This allows for better referral and evacuation decisions. The BLS rescuer should know when ALS care may be beneficial, and, conversely, when it isn’t. If you know what type of care the patient needs, you may refine evacuation decisions and routes based on services Respiratory failure is presumed to exist whenever inadequate or difficult breathing is associated with an altered level of consciousness or severe changes in mental status. Your immediate response is to ensure an open and clear airway, begin positive pressure ventilation (PPV), and add supplemen- tal oxygen if you have it. Your initial goal is to maintain oxygenation while you determine what available at one hospital or another. Respiratory Failure

Basic Life Support Stabilize the Patient Circulatory Respiratory

Pulse Bleeding

Airway Breathing

PRIMARY ASSESSMENT

Nervous AVPU Spine

“The initial assessment is your quick check on the status of the patient's three critical body systems.”

Where available, advanced life support (ALS) is also part of the immediate response to life-threat- ening critical system problems. ALS techniques are more invasive, using a range of medications, advanced airways, and some surgical techniques.