© 2005 Jeffrey Isaac, PA-C
weight, relatively inexpensive and, even if properly applied, excruciatingly
uncomfortable. While discomfort is not much of an issue on a short ambulance
ride to the hospital, it is a major factor in long-term transport in the backcountry.
An uncomfortable patient actually moves around more, complains more, and
requires more pain medication. Skin ischemia and aspiration of vomit, blood, and
secretions also become anticipated problems.
As any ski patroller can tell you, a stiff cervical collar is difficult to apply
around bulky winter clothing. As any ski area practitioner can tell you, they rarely
arrive at the clinic adjusted as shown in the training manual. The device was
designed for short-term EMS use during extrication, not for wilderness rescue.
Yet, they considered by most rescuers to be a standard of care, even in the
backcountry.
By contrast, the old ski patroller's "horse collar" used with a vacuum
mattress or litter offers effective stabilization for everything from the cervical
spine through the pelvis and femur. It is also warm and comfortable
ii
. The
vacuum mattress is moderately expensive and bulky, but it is lightweight and
infinitely versatile in the stabilization and positioning of injured patients. It also
makes a fine bivy pad if you get stuck overnight some place. Since the mattress
is a vacuum device, it is easily repaired in the field with duct tape. A blanket and
a vacuum mattress are easier to use and effectively replace cervical collars,
backboards, thermal padding, and traction splints. For your money, here's a
simple, multi-purpose tool for packaging and stabilization.
Communication and Telemetry
Advances in communication technology such as sat phones and telemetry
units enable medical control physicians to provide advice and give orders real-
time almost anywhere. A hospital-based provider can now receive information by
voice, telemetry, and digital image. Orders for treatment can be given and the
progress observed from hundreds or thousands of miles away.
In considering these obvious benefits, we must also acknowledge the risks
associated with remote decision-making. The medical officer on scene may
actually be in a better position to develop a treatment and evacuation plan but
obligated to defer to the higher authority on the radio. The need to establish
communication with remote medical control may unnecessarily delay transport.
While adopting these new communication technologies, we must be sure that
our virtual presence will enhance rather than inhibit on-scene medical capability.
Medications and Delivery Systems
New drug delivery systems offer some good solutions to SAR medicine,
particularly in the form of pain relief. Sub-lingual morphine, liquid Vicodin, and
Fentanyl pops offer rapid onset and easy administration, and completely avoid
