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Wilderness Medical Society - snowmass 2005 (Page 9)

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Wilderness Medical Society - snowmass 2005
afterwards should have been a disqualifying history or physical finding, you will also be
charged. If you take a person whose physical or mental ability does not seem reasonably
able to manage the potential events of the expedition, you must provide an adequate
safety net, or clearly describe to the client, in writing, your inability to do so. In this
manner, you transfer some of the risk to the client. Remember that it is normally not the
client who sues, but a relative. The client's enthusiasm for participating may not be
matched by a surviving family member. Their attorney will pick apart the management of
any accident, basing the case not so much on how the accident was managed in the field
(and you can believe this will be perused in detail also), but on that common medical
concept of informed consent.
The way to protect yourself from both legal and medical dilemmas is to develop a Risk
Assessment and Management Plan. In order to accomplish this you must be able to:
Anticipate possible adverse events.
Identify and eliminate causes of accidents.
Determine what should be done if leadership becomes ill or killed.
Develop an emergency response plan.
Familiarize yourself with the medical history, general health, and stamina of each
To accomplish this you will need several tools.
One of the most important is a medical history form, even on your personal friends.
Eighty percent of a medical diagnosis is usually attributed to the medical history.
Sometimes the history is obvious, such as a witnessed accident. But usually, someone is
suddenly ill, not feeling well, or having pain and the major clues of the diagnosis have to
be fished from the history. You might not be aware of critical details in even a close
friend's history. His use of a beta-blocker to treat high blood pressure, for example, could
result in a severe and unanticipated reaction to the use of epinephrine from your medical
kit when treating anaphylaxis, which would otherwise have been an appropriate first aid
The proper medical history will have qualifyer questions. An example is to request a list
of current medications as well as to identify chronic medical conditions. A person might
say that he dose not have any chronic condition, yet mention that he is taking an oral
diabetic medication. To the client's way of thinking he does not have a chronic "medical
condition". It is possible for an athlete to have knee surgery, be told that he is released,
and not to consider that three months later he needs to report this recent surgery. An
alerting qualifyer question could be: "When was the last time you saw a doctor and for
what purpose?" The answer "I have no medical problems" is thus clarified with the
answer "I saw a doctor three months ago for release from my knee surgery."
The degree of isolation, possible environmental stress, and distance from medical care
makes the selection and medical knowledge concerning participants a critical part of the
Risk Management Plan.

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