9/10/2012. Chapter 54. Learning Objectives. Learning Objectives (Cont d) Wilderness EMS

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1 Chapter 54 Wilderness EMS 1 Learning Objectives Define and describe wilderness medicine and wilderness EMS Define and describe the wilderness EMS system Describe the differences in practice environments between traditional EMS and wilderness EMS 2 Learning Objectives Describe the differences in protocols between traditional EMS and wilderness EMS Describe the differences in certification and training between traditional EMS and wilderness EMS Demonstrate techniques used to clear the cervical spine clinically in a wilderness setting 3 1

2 Learning Objectives Describe differences in equipment between traditional EMS and wilderness EMS Describe differences in resources between traditional EMS and wilderness EMS Describe differences in team interfaces between traditional EMS and wilderness EMS 4 Learning Objectives Identify current wilderness EMS systems in the United States Identify challenges facing wilderness EMS systems 5 Wilderness Medicine Medical management where care and prevention are limited Environmental considerations Prolonged extrication Resource availability 6 2

3 Wilderness Medicine Categories Recreational Professional Expedition Disaster medicine 7 Wilderness EMS Certifications Wilderness first responder Wilderness EMT Other certifications Wilderness EMS Institute 8 Wilderness EMS Rural Affairs Committee of the National Association of EMS Physicians Guidelines describing wilderness EMS treatments Cardiopulmonary arrest Dislocations Spine injury Wounds Standardization Several states have certifications or protocols 9 3

4 Wilderness EMS NAEMT elements defining wilderness EMS Access to scene Weather Daylight Terrain Special transport, handling needs Access, transport times Available personnel Communications 10 Wilderness EMS Systems Regions with regular need for wilderness medical care have developed wilderness EMS systems Formerly structured Integrated into standard EMS system Many are volunteers 11 Differences in practice environment Alter expected duration of care Type of care Transport decisions Care for patient Care for self and team Special skill for each call 12 4

5 10 essentials for rescuer safety Attitude Food Water Clothing Shelter Warmth/fire Navigation Weather awareness Signaling First aid kit 13 Differences in protocols Should implement atypical and advanced skills by using offline protocols Build in certain degree of flexibility Provide online instruction 14 Differences in protocols Cervical spine clearance Dramatically simplifies extrication Criteria assessment 15 5

6 Differences in protocols Patient packaging and waste elimination Patient immobilized hours to days Stokes baskets common for wilderness Pain and pressure ulcers develop without padding Patient allowed to urinate and defecate Protection from elements Food and water needs of patient 16 Differences in protocols Scope of care Expanded, transfer to comprehensive care delayed Different medications Different intervention 17 Differences in protocols Medical direction Few wilderness trained Online direction cumbersome Offline direction ensures uniformity, may cause medicolegal and quality issues 18 6

7 Differences in certification, training Traditional providers need extensive additional training, equipment, logistical approach Formal wilderness EMS courses common Multiple sources of wilderness EMS training and certification New opportunities in wilderness EMS training and certification 19 Differences in equipment ATVs, snowmobiles Helicopters High-angle climbing and safety equipment Technical ropes Boats Swift water rescue equipment Hiking equipment Transport equipment 20 Differences in resources Rarely ambulance and ambulance-based equipment access Increased access to: Helicopter services Rescue gear Specialists in wilderness rescue Volunteer help Extended care equipment 21 7

8 Differences in team interfaces More adept at cooperating with multiple teams Air medical personnel Law enforcement personnel Military personnel Professional trip leaders and guides Search & rescue, mountain rescue, ski patrol Disaster teams Volunteers Civil air patrol 22 U.S. National Park Service Rangers became EMT trained Scope of practice Parkmedic Program U.S. Department of Defense Battlefield care meets definition of wilderness medicine USCG and USAF used in civilian rescues 23 National certifying and coordinating bodies National Ski Patrol Training and education programs Serve outdoor recreation community Winter safety and rescue courses Wilderness medical certification in Outdoor Emergency Care Outdoor First Care Wilderness EMS systems tasked with prevention and injury treatment 24 8

9 National certifying and coordinating bodies Mountain Rescue Association Training and certifications for mountain rescue teams Certifies only at team level National Cave Rescue Commission Training and development opportunities for persons and organizations involved in cave rescue Does not provide specific rescue medical training certifications or wilderness medical courses 25 National certifying and coordinating bodies Divers Alert Network Certification courses in medical management of diving conditions Rescue insurance for members Emergency medical hotline for divers National Association for Search and Rescue Courses for technical rescue and search skills Canine-assisted searches 26 Local wilderness EMS systems Search and rescue (SAR) teams Awareness Initial action Planning Operations Conclusion Certification courses provide more specialized training in SAR principles and practices 27 9

10 Local wilderness EMS systems Other wilderness medical entities Local EMS development Nonprofit rescue associations and teams Regional cooperative ventures Multiple agencies cooperating together 28 Disaster response providers Federal response teams NDMS Fields large numbers of temporarily self-sufficient teams into disaster areas Disaster medical assistance teams Disaster veterinary assistance teams Disaster mortuary response teams Disaster medical response teams specialized in chemical, biological, and radiological incidents 29 Disaster response providers Federal response teams FEMA Urban SAR task forces that locate, extricate, and provide medical care for people in collapsed buildings 30 10

11 Disaster response providers Nongovernmental and faith-based response teams Doctors without Borders Emergency aid 31 Challenges Facing Wilderness EMS Standardization of certifications and practice Regulated only at local level Challenges Quality assurance Medical control for expanded scope operations Research and reports that use standardized terminology and care 32 Challenges Facing Wilderness EMS Questions regarding wilderness rescue Costs for rescue: who pays What level of care should be provided 33 11

12 Challenges Facing Wilderness EMS Funding and participation Paramedic shortage Ranger shortage Volunteer dependence 34 Chapter Summary Wilderness medicine is a term that must be understood contextually Medical management in situations in which care and prevention are limited by environmental considerations, prolonged extrication, and resource availability 35 Chapter Summary Wilderness EMS systems plan and help implement provision of wilderness medical care, help integrate wilderness medical principles into the greater EMS system, and differ from traditional (street) systems 36 12

13 Chapter Summary Differences in environment Where providers deliver care Protocols, online/offline medical direction Certification and training Equipment Resources Organizations with which providers are expected to interact 37 Chapter Summary Wilderness EMS systems currently in place that provide standards and resources for medical care and rescue in certain environments Others provide wilderness medical care for certain regions and temporary care in regions with situational austerity 38 Chapter Summary Wilderness EMS systems may be federally funded, locally funded, or nonprofit Some wilderness EMS organizations operate as schools or commercial ventures providing wilderness medical training Numerous options are available to EMS providers interested in obtaining and providing additional training in wilderness EMS and in providing patient care in diverse practice environments 39 13

14 Chapter Summary Numerous challenges exist to the growth of wilderness EMS as a field: Federal funding Disparities in EMS funding relative to other public service entities Reliance nationally on volunteer service Ongoing debate regarding the appropriateness and source of funding for rescues and for wilderness medical care 40 Chapter Summary Given the rapid growth of wilderness activities and the corresponding demand for wilderness medical care, wilderness EMS will continue to grow as an important EMS subspecialty 41 Questions? 42 14