ABSTRACT
To provide guidance to the general public, clinicians, and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to revise the evidence-based guidelines for the prevention, rescue, and resuscitation of avalanche and nonavalanche snow burial victims. The original panel authored the Wilderness Medical Society Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents in 2017. A second panel was convened to update these guidelines and make recommendations based on quality of supporting evidence.
Subject(s)
Avalanches , Snow , Accidents , Burial , Societies, Medical , HumansABSTRACT
The National Park Service (NPS) has domestic responsibility for emergency medical services (EMS) in remote and sometimes tactical situations in 417 units covering over 34 million hectares (84 million acres). The crossover between conflicting patient care priorities and complex medical decision making in the tactical, technical, and wilderness/remote environments often has many similarities. Patient care in these diverse locations, when compared with military settings, has slightly different variables but often similar corresponding risks to the patients and providers. The NPS developed a Tactical EMS (TEMS) program that closely integrated many principles from: 1) Tactical Combat Casualty Care (TCCC); 2) Tactical Emergency Casualty Care (TECC); 3) and other established federal and civilian TEMS programs. Combining these best practices into the NPS TEMS Program allowed for standardized training and implementation across not only the NPS, but also paralleled other military/federal/civilian TEMS programs. This synchronization is critical when an injury occurs in a joint tactical operation, either planned (drug interdiction) or unplanned (active shooter response), so that patient care can be uniform and efficient. The components identified for a sustainable TEMS program began with strong medical oversight, protocol development with defined phases of care, identifying specialized equipment, and organized implementation with trained TEMS instructors. Ongoing TEMS program management is continuously improving situationally appropriate training and integrating current best practices as new research, equipment, and tactics are developed. The NPS TEMS Program continues to provide ongoing training to ensure optimal patient care in tactical and other NPS settings.
Subject(s)
Emergency Medical Services/methods , Military Medicine/methods , Parks, Recreational , Wilderness Medicine/methods , Humans , United StatesABSTRACT
To provide guidance to clinicians and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the prevention, rescue, and medical management of avalanche and nonavalanche snow burial victims. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians.
Subject(s)
Accident Prevention , Avalanches , Wilderness Medicine , Humans , Accident Prevention/methods , Accidents/mortality , Asphyxia/epidemiology , Hypothermia/mortality , Hypothermia/physiopathology , Snow , Societies, Medical , Wilderness Medicine/standardsSubject(s)
Emergency Medical Services/standards , First Aid/standards , Anaphylaxis/drug therapy , Aspirin/therapeutic use , Burns/therapy , Chest Pain/diagnosis , Chest Pain/therapy , Dehydration/drug therapy , Dehydration/therapy , Emergency Medical Services/methods , Epinephrine/therapeutic use , First Aid/methods , Fluid Therapy , Glucose/therapeutic use , Hemorrhage/etiology , Hemorrhage/therapy , Humans , Hypoglycemia/drug therapy , Out-of-Hospital Cardiac Arrest/therapy , Wounds and Injuries/complications , Wounds and Injuries/therapyABSTRACT
To provide guidance to clinicians about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the treatment and prevention of lightning injuries. These guidelines include a review of the epidemiology of lightning strikes and recommendations for the prevention of lightning strikes, along with treatment recommendations organized by organ system. Recommendations are graded based on the quality of supporting evidence according to criteria put forth by the American College of Chest Physicians.
