MEDICAL DECISION-MAKING

MEDICAL DECISION-MAKING


The art of outdoor medicine absolutely depends on observation, anticipation, and resourcefulness. The cardinal rule is to act conservatively and not take unnecessary risks when making the decision to continue a journey or to postpone travel and seek formal medical attention. Similarly, you may need to decide whether to carry out a disabled victim, or to stay put and signal or send for help.


Although every situation is unique, all decisions begin with an accurate assessment of the victim’s condition. The situation should be categorized as trivial (small cuts, insect sting without allergic reaction, a single episode of diarrhea); minor (sprained ankle, small burn wound, sore throat); moderately disabling (broken wrist, kidney stone, bronchitis); potentially severe (chest pain, severe abdominal pain, high fever); totally disabling (seizure, broken hip, severe high-altitude illness); or life- and limb-threatening (uncontrolled bleeding, extensive frostbite, venomous snakebite with symptoms). In all cases that are other than trivial or minor, it is proper to insist on prompt evacuation or rescue for thorough evaluation. Never overestimate your abilities as a healer or count on good fortune. The assumption under which you must operate is that a victim’s clinical condition will deteriorate, particularly in a harsh environmental setting. No adventure is worth a lost life or permanent disablement.


If more than one victim is injured, you must set priorities and attend to the most critically injured. Continually evaluate each victim to detect improvement or deterioration over time. Don’t focus on situations that are beyond reasonable hope. For example, if a victim is near death from severe burns, decide if there is really anything you can do to save him, and if not, get busy with the people you can help. These are emotionally charged and extremely difficult decisions, even for those of us who have made them for many years.


You may have to decide whether to evacuate a victim or wait for a rescue party. In some instances, this is an easy decision—when a victim must be carried to a lower altitude to treat severe mountain sickness, for instance, or when the transport route is short and easily negotiated. The judgment call is based on weather conditions, the nature and severity of the injury or illness, and the distance that needs to be covered.


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Aug 11, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on MEDICAL DECISION-MAKING

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