Mounted search and rescue

["IRVIN LICHTENSTEIN" <ilichten1@verizon.net>]

I have been teaching CPR and later AED since 1972 for the Red Cross and other agencies.  Approximately every 5 years the course material is reviewed after the periodic conference of the ARC, AHA, cardiologists, and later on the orthopedists who  got involved with neck and spine concerns.  Getting the new material produced and updating every volunteer instructor in the country takes a while so the courses being taught are often 12-24 months behind the conference highlights.

 

There are different causes for circulation to fail.  Fibrillation causes an ineffective compression of the heart but can often be “reset” by an AED, a manual defib, a pacer, or other device and drugs used in advanced life support.  Thrombosis, a blockage of a blood vessel, is treated by clot busters and or procedures involving catheters, or surgical reconstruction of the blood vessel. A complete stoppage with no electrical activity (flatline) is also possible.  Most AED’s cannot handle flatline.

 

In either case, survival without advanced care is doubtful.   CPR was designed to circulate oxygenated blood to the brain to keep the patient salvageable until ALS services arrived.  We teach cycles of 30 compressions, up from 15, for single rescuers today because they can increase blood flow.  However, we still emphasize a viable airway so that whether ventilation is used or the rescuer relies on the bellows effect (we used to call this arm lift) oxygen gets in and respiration products get out.  

 

Each revision of the course takes into account reality.  Most lay persons will never do CPR for real.  Most providers will do it often enough that more advanced techniques requiring 2 or more rescuers and equipment can be reviewed every 2 years without loss of skills.  Lay techniques are simplified so that the same practices are used on infants, children, and adults, which increases retention.

 

As to your responsibilities as a SAR person, they are set out in your state’s emergency medical protocols and based on your agency’s level of care (none, exempt, first responder, BLS, ALS, ILS, pre-hospital medical professional, etc.) usually defined by a state EMS agency/provider license.  In Pennsylvania the new EMS law has defined wilderness SAR as an EMS function and the proposed regulations require SAR units to become licensed EMS provider agencies, except for volunteer fire companies that do search spontaneously. The PA Director of EMS has stated his opinion that care begins as soon as the subject is located, even if all you do is observe the subject/patient.

 

Much can be made of the EMS part of wilderness SAR.  We deal with cold water drowning, trauma, medical problems.  For our own personnel we must maintain a medical response in the logistics section for the duration of the mission.  For the subject we must maintain a medical section in operations to support the first responders in the field who may encounter the search subject.  The problem we will face is that protocols designed for ambulance services which are required to respond a vehicle and crew to an emergency request in under 10 minutes may not be applicable where the patient is a two hour walk or a Gator ride, or even a travois behind a horse transport.

In the past because SAR did not use ambulances it was exempt from EMS regulations in PA. Search was a fire/rescue function. 

 

Our unit policy was, and probably will remain, that a subject found pulseless, cold and with the event not observed by the responders; DNR, call the medical examiner and cordon off the area for the investigators.  This may sound cruel but it stops people from trying to revive subjects who have killed themselves by various means and avoids someone else having to pull the plug later on.  The exception is cold water drowning where the local protocol is to transport to a trauma center for rewarming, regardless,

with declarations being made on warm subjects. Our volunteers’ job description (and even volunteers are employees in PA) includes finding search subjects and rendering first aid as possible pending arrival of more capable response.  This does give them a duty to act, but that action may be very limited and is based on how they evaluate the situation, their capabilities, and the subject who is about to become a patient.

 

Irv Lichtenstein, EMT-B

Chief of Operations

SE PA SAR

 

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From: msar-riders-bounces@lists.ibiblio.org [mailto:msar-riders-bounces@lists.ibiblio.org] On Behalf Of Jeff Hasse
Sent: Saturday, October 09, 2010 12:50 PM
To: Mounted search and rescue
Subject: Re: [MSAR] Have a heart!

 

MSAR Members,