© 2005 Jeffrey Isaac, PA-C
Your evaluation should emulate the characteristics of most really good
equipment; simple, inexpensive, with few moving parts. Ask yourself and your
team the following questions:
What does device really do?
Is the advertised benefit supported by real science?
Do we really need to do what the device does?
Can you carry it?
Based on your experience will it really work in the steep, dark, frozen, wet
wilderness?
What kind of trouble will you be in if it doesn't work?
If the device or technique survives for further consideration, try to avoid the
following pitfalls:
Assuming a device that is friendly and familiar in the ED will be safe and
effective in the backcountry.
Fielding a device that provides only part of a treatment regimen or
protocol, the rest of which is unavailable or impossible to accomplish.
Fielding equipment that creates training requirements out of proportion to
the frequency of use or medical benefit.
Consider, for example, the automatic external defibrillator (AED).
Citing the apparent success of the device in the urban context, AED's are being
aggressively marketed to SAR teams, backcountry guides, and offshore sailors.
As the size and cost of AED's come down it would seem to be an attractive
option in these environments as well.
It must be remembered, however, that the AED is just one link in a chain
of medical care including CPR, early defibrillation, advanced life support, and
transfer to a hospital coronary care unit. Successful defibrillation with an AED
depends on application within a few minutes, and the presence of an intact
cardiovascular system suffering specifically from ventricular fibrillation or
tachycardia
i
. In spite of its urban and EMS application, the chances of a
wilderness SAR team being in a position to effectively do what the device does
are remote at best.
The typical EMS-type extrication collar used for spine injury protection
provides another example for critical evaluation. These devices are light in
