This is a tool that was piloted in the Washington MRA region last winter; a gear and resource decision tree to support our operations both at command and in the field. The concept is a loose algorithm to guide gear and resources in prep and during the mission, so it’s a dynamic scheme to apply to conditions as they develop.
This decision tree avoids an all-inclusive algorithm that incorporates clinical assessment and treatment since that already exists in a nice concise format, such as the Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update and the Hypothermia “Cold Card.” Some of our existing hypothermia tools are limited in that they apply to generalized field applications or EMS and not the rescue environment. This one is designed for mountain rescue.
This decision tree is thereby a supplement to address rescue specific needs to support both operations and field teams to conduct a mission for a cold subject. The emphasis here is on the management consistent with the 2019-2020 updates for accidental hypothermia in the wilderness, relying on generalizable concepts, gear, and resources.
There are 2 versions:
Slim tree: which is the simplified version without annotations.
Detail tree: includes annotations and more detailed examples and explanations.
This tool is in concept phase and hasn’t been largely validated. That being said, you’re welcome to adopt it for your team to use at any time as a reference. Please send feedback on what your team thinks and how it works out for you.
PDF LINK: Hypothermia rescue decision tree (detail) Jan 2022 for MRA Meridian
References
MRA MedCom 2022 Bios
The MRA Medical Committee, or MedCom, is a group of medical experts that are active field responders and medical advisors of MRA teams. The original chair was Dr. Bill Clem, followed by Dr. Ken Zafren, and Dr. Skeet Glatterer. Dr. Christopher Van Tilburg is the current chair.
Among other activities, MRA MedCom attends and speaks at conferences such as those organized by MRA, Wilderness Medical Society, and International Commission for Alpine Rescue. We wrote COVID-19 guidelines for MRA teams. We contribute a quarterly story to Meridian. We do have the ability to help MRA teams answer questions related to medicine, medical advising, and medical direction. Queries to MRA MedCom can be sent to Dr. Van Tilburg at vantilburg@gorge.net.
MRA MedCom 2022 Bios
J. “Pearce” Beissinger, MS, PA-C, FAWM, DiMM, AMGA-SPI (Portland Mountain Rescue) is a physician assistant in critical care and cardiothoracic surgery in Portland, OR.
Bill M Campbell MD FAWM DiMM (Appalachian Mountain Rescue Team) is a physician from Tennessee.
Anna Condino, MD, MPH, (Seattle Mountain Rescue), is an emergency physician in the Puget Sound region, with EMS fellowship training and board certification.
Chris Davis MD (Appalachian Mountain Rescue Team) is an emergency doctor and paramedic currently based in North Carolina.
Benjamin Lantow, RN, EMT-P (Alpine Rescue Team) is a nurse and paramedic based currently in Denver.
Cassie Lowry Edmark, DO, W-EMT (Everett Mountain Rescue) is a resident physician from Washington State currently training in Montana.
Skeet Glatterer, MD, FAWM (Alpine Rescue Team) is a cardiothoracic surgeon.
Seth Hawkins, MD, MFAWM, FAEMS, FACEP (Appalachian Mountain Rescue Team) holds dual board certification in emergency medicine and EMS.
Timothy R. Hurtado, DO, FACEP (El Paso County Search and Rescue) practices Emergency Medicine in Colorado Springs, Colorado.
Jeff Isaac, PA, (Crested Butte SAR) is an emergency medicine PA and the director of the GVH Mountain Clinic in Crested Butte, Colorado.
Roger Matthews, DO, ABFM (Park County Search and Rescue) is a family physician and co-owner of Conifer Medical Center.
Will Petitt PA-C (Douglas County Search and Rescue) is a physician assistant for at a level one trauma center in orthopedics in Denver.
Todd Shechter, (Corvallis Mountain Rescue Unit) is a Wilderness First Responder.
Alison Sheets MD, FAWM, DIMM (Rocky Mountain Rescue Group) is an Emergency Physician in Boulder, Colorado, and vice president of MRA.
Dan Sherman, RN, BSN, CCRN (Corvallis Mountain Rescue Unit), is a RN, working in ICU for the past 5 years.
Will Smith MD, Paramedic, FAWM (Teton County SAR and Grand Teton National Park SAR) practices Emergency Medicine in Jackson Hole, Wyoming
Don Slack, MD, (Skagit Mountain Rescue and Bellingham Mountain Rescue) practices Emergency Medicine in Mt Vernon, Washington
Christopher Van Tilburg MD FAWM (Crag Rats and Portland Mountain Rescue) works in the Emergency Dept., Occupational and Travel Medicine Clinic, and at Mountain Clinic for Providence Hood River Memorial Hospital.
Janalee Whalen, RN (Rocky Mountain House), is an emergency nurse, instructor for TNCC and ACLS in Rocky Mountain House, Alberta.
AJ Wheeler, MD. (Teton County SAR and Grand Teton National Park SAR) is an Emergency Physician in Jackson Hole Wyoming.
Ken Zafren, MD, FAAEM, FACEP, FAWM (Alaska Mountain Rescue Group) is an emergency physician in Anchorage, Alaska and a Clinical Professor of Emergency Medicine at Stanford University in California.