101
(Librium®), and alprazolam (Xanax®). Although other drugs, such as alcohol,
barbiturates, and narcotic analgesics, provide some relief of anxiety, the benzodiazepines
are much safer. The primary side effect is mild sedation and, apart from potential
interactions with other sedatives, very few contraindications exist. Therapeutic onset for
anxiety relief takes one to three hours with typical oral dosages. Diazepam is the fastest.
Haldol, 5 to 10 mg intramuscularly or orally, is also effective.
IV. CARE FOR RESCUERS
Rescuers must mask their emotions in order to perform well during the rescue.
Failure to relieve such pent-up emotions can lead to psychologic problems, particularly
post-traumatic stress disorder (PTSD). One proven way to reduce or eliminate such
problems is a group discussion, usually held after physical recovery, to discuss feelings
during the rescue. The session must be limited to that topic; the rescue must be critiqued
at another time. The discussion must be entirely nonjudgmental . . . a discussion of what
was actually felt. Obviously no feelings that actually were experienced can be right or
wrong. Professional guidance may be desirable after a particularly stressful event.
V. REFERRAL AND FOLLOW-UP
Victims of traumatic events, like their rescuers, are at increased risk of developing
PTSD and should be told about symptoms that signify the need for additional treatment.
Primary symptoms of PTSD include: distressing dreams or reliving the trauma; persistent
avoidance, psychogenic amnesia, or numbing in response to trauma-related stimuli; and
increased somatic nervous system arousal or hypervigilance. Any or all of these
symptoms are part of the normal human reaction to trauma, but their persistence beyond a
month is indicative of PTSD.
Clinical psychologists and psychiatrists who specialize in anxiety and stress
disorders have developed effective treatments for this disorder. Cognitive-behavioral
therapies and certain drugs have proven effective, alone and in combinations.
VI. OTHER CONSIDERATIONS
Emotional and behavioral disorders are common; incidence rates in the general
adult population are 10 percent for anxiety disorders, 6 percent for major depression, and
at least 5 percent for personality disorders. Although wilderness adventurers may be
robust and seem resistant to emotional distress, some outing members develop
psychological problems. Most people undergo emotional changes in harsh environments,
and personal conflicts add stress to group dynamics. The success of a wilderness
expedition depends significantly on the "people skills" of the leaders.
