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)].
The following is an outline of the general guidelines from this publication (pages 7-9). It does not address specific cases of hypothermia, avalanche, cold-water immersion or lightning strikes. These may be addressed in a future Meridian. WMS Guidelines: General Information Guidelines for the general use of cardiopulmonary resuscitation (CPR) are well defined, regularly updated and widely distributed. Because the wilderness may impose circumstances that require special considerations in CPR, the following guidelines have been developed. A) Contraindications to CPR in the Wilderness There is no reason to initiate CPR if there is : 1) detection of vital signs; 2) danger to rescuers; 3) dependent lividity; 4) rigor mortis; 5) obvious lethal injury; 6) a well-defined Do Not Resuscitate (DNR) status; or 7) a patient with a rigid frozen chest. Criteria 3 and 4 may be difficult to evaluate in the non-frozen yet profoundly hypothermic person and without documentation criteria 6 is impossible to determine. B) Discontinuation of CPR in the Wilderness Once initiated, continue CPR until: 1) resuscitation is successful; 2) rescuers are exhausted; 3) rescuers are placed in danger; 4) patient is turned over to more definitive care; or 5) patient does not respond to prolonged (approximately thirty minutes ) of resuscitative efforts. The MRA MedCom welcomes comments and suggestions. Please feel free to comment in the listserv, or to contact me directly. All issues will be reviewed and commented on by the MedCom as a group. Skeet Glatterer, MD Alpine Rescue Team , Evergreen , Colorado Chairman , MRA Medical Committee glatterer@comcast.net
