On the CPR Debate

By Skeet Glatterer, MD 

There have been recent postings on the MRA listserv regarding an increase in costs for CPR training, as well as comments on the use and efficacy of CPR in the field. As a group, our medical expertise is an integral part of the rescue portion of SAR. Some basic level of medical training is needed to achieve this goal. This is also becoming increasingly important as the government becomes more involved in resource typing and credentialing measures that will eventually define our group’s role in the community. It draws us back to a key concept in medical training and culture for our teams, and the valued use of that training: 1) care of myself; 2) care of my teammates; 3) care of our patients, in that order. It is unfortunate that costs are increasing for medical training, but it is clearly a necessity for us to fulfill our mission. There are options to defray the costs of medical training. Groups can work with local medical instruction agencies to pool groups together to help reduce costs “in bulk.” Also you can explore the option of having a team member become an instructor for your team, and others, to adjust charges or even waive instruction fees. Whether team certifications are CPR, WFA, WFR, OEC or an equivalent, most members will have only basic training and hence will apply BLS-CPR type measures. And most team’s field actions will be under the supervision of local medical services. Understandably, BLS-CPR in a wilderness setting has a dismal outcome after about 30 minutes. But this does not negate the value of being prepared to render this aid to our teammates and/or patients. Results may improve as the level of medical care increases (as with adding ALS level care). Perhaps it could be a consideration to have some team members with more advanced medical expertise. The “care of my teammates“ concept has shown to be valuable among pre-hospital providers with instances such as CPR being needed at a training where a member has become unresponsive due to a cardiac issue.

Remaining current on techniques such as CPR (at a minimum) helps us remain professionals and lends us credibility in the pre-hospital care arena, on par with our first aid and EMS counterparts. And it gives us depth where current knowledge and background in CPR helps us understand and be more competent practitioners for other medical issues and emergencies that we may see more often. The Wilderness Medical Society (WMS) has consensus guidelines for many areas of wilderness medical care that are published in the WMS Practice Guidelines Handbook [William W. Forgey, MD, Editor; Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care (Falcon Press , 5th Edition, 2006)].