Mounted search and rescue

[Karen Nesbitt <spanishequines@yahoo.com>]

IN RESPONSE TO:

 

 

Message: 2
Date: Sat, 09 Oct 2010 22:39:00 -0400
From: "IRVIN LICHTENSTEIN" <ilichten1@verizon.net>
To: "'Mounted search and rescue'" <msar-riders@lists.ibiblio.org>
Subject: Re: [MSAR] Have a heart-- EMS protocols
Message-ID: <692E8679E4C34F3E886AC23C4E08368C@irvsbigbox>
Content-Type: text/plain; charset="us-ascii"

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



  -------->>>>>

 

IRV, 

 

As a spontaneous volunteer, with certain limited skills vs someone trained, while taught mouth to mouth, with the compression method something that would concern me is if one was to be pushing in the wrong area or too hard the possibility of one fracturing a sternum bone thus causing more harm than good.

 

The link was commented on by many if you read the posts after the commentary for stupid and odd reasons alike however, as the article also stated, doing nothing is far worse.

 

Past experience with an unconscience person, had they not revived with a gentle nudge, they still would have been headed to the ER for a thorough check up.  Passing out is not to be taken lightly. Many hospitals routinely admit for 24 hours observation.  One subject of mine it was discovered had an intestinal rupture causing them to pass out, in another it was discovered they had internal bleeding caused by cancer.  I agree with you, most lay persons will probably never do CPR, but would encourage all to learn.    Most spontaneous volunteers myself included would be people also hollering out medic or for someone for back up anyway.

 

Thanks for the info Irv. 

        Karen Nesbitt

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