© 2005 Jeffrey Isaac, PA-C
Procedures
Cardiopulmonary resuscitation (CPR) serves as an interesting example of
an entrenched program that consumes training resources out of proportion to its
value as a treatment technique. Never-the-less, certification in CPR is required by
various government agencies for wilderness guide permits. While CPR is
appropriate in the urban setting, its requirement as an essential part of
wilderness medical care is questionable.
Numerous studies have confirmed that CPR will not extend survival
beyond 30 minutes, or resuscitate trauma patients in cardiac arrest. The success
rate of the technique in the backcountry setting is extremely low (zero?). When
one compares the value of CPR to the wide variety of other useful medical,
rescue, and survival skills, spending more than 30 minutes on CPR training
seems excessive.
Spine stabilization is another entrenched requirement that would benefit
from a more realistic wilderness perspective. The incidence of unstable spine
injury is very low compared with the incidence of rescuer injury and death
associated with technical or aero medical evacuation. The risk of exacerbating
cord injury rarely justifies the considerable risk inherent in the evacuation of a
patient in spinal stabilization.
Fortunately, new spinal assessment protocols offer a well-documented
procedure for determining which patients actually might benefit from spine
stabilization. The next step is to enable rescuers to weigh the benefit of
stabilization against the immediate risks to life presented by evacuation hazards,
aspiration, hypothermia and other problems created by the procedure. In
backcountry and technical rescue, the risks associated with spine stabilization
often outweigh the presumed benefit.
Authorization by a physician advisor for the use of wilderness-specific
protocols can free the team from the unrealistic and often dangerous obligation
to follow protocols written for street EMS. Offered by a number of sources, these
procedures represent a more practical approach to medical care for SAR units.
Wilderness medical training and protocols
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are already wildly accepted by federal
agencies and outdoor education institutions. Recognition and use by state and
local medical boards and state agencies is increasing.
Conclusions
Almost any piece of equipment or technique can look effective in the hands of a
skilled operator. "Effective at what?" is the essential question. Critical evaluators
need to look beyond the marketing to the science and practical application.
Generally, a product or procedure reinforced by a number of scientific
studies is going to be more valuable than something with little or no research
behind it. The limitations of CPR and the validity of "spine clearing" techniques
are examples well supported in the medical literature. By contrast, a number of
