SAR and other WEMS operations can be summarized by the acronym LATE: Locate—Access—Treat—Extricate. All WEMS operations typically have some degree of each LATE principle in the technical rescue interface; some incidents will require a greater amount of focus and energy based on a specific component (see Box 24.1).
Locate: the first step in any event. The patient must be located before the next steps of a rescue can be taken.
Access: once a patient is located, the WEMS provider must be able to access the location in order to begin patient care.
Treat: this is the main function of the WEMS provider, but in some settings, Extricate may become a higher priority delaying care until the patient arrives at a safe location.
FIGURE 24.1. A-D, These images depict a small representation of some access problems, and packaging and movement solutions, that WEMS providers can experience: avalanche, swiftwater, cave/confined space, and cliff/high angle. Note that the backboard in image (B) is being used as a brief patient movement tool and not a longer-term medical immobilization tool. Courtesy of William R. Smith, with permission.
swiftwater, high angle). This decision is generally made by the lead patient care WEMS provider, and sometimes occurs even before airway, breathing, circulation life threats can be identified.
FIGURE 24.2. Helicopters provide a useful tool in WEMS, although their risk must be balanced to the benefit in the overall operation. Short haul is a rescue technique with the use of a helicopter and one or more persons suspended beneath the helicopter. This can be used for inserting rescuers as well as extricating injured patients from very technical terrain. Courtesy of William R. Smith, with permission.
Prevention and Treatment of Acute Altitude Illness13
Use of Epinephrine in Outdoor Education and Wilderness settings14
Treatment of Eye Injuries and Illness in the Wilderness15
Treatment of Exercise-Associated Hyponatremia16
Prevention and Treatment of Frostbite17
Prevention and Treatment of Heat-Related Illness18
Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia19
Prevention and Treatment of Lightning Injuries20
Treatment of Acute Pain in Remote Environments21
Basic Wound Management in the Austere Environment24
Prevention and Treatment of Drowning in the Austere Environment25
Prevention and Treatment of Envenomation from North American Venomous Snakes26
Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents27
Wilderness Fluid Resuscitation Guidelines (in development)
Prevention and Management of Cardiovascular Emergencies in Remote Environments (in development)
patient care improvement and capturing data which can help make future decisions for the WEMS program. Documentation is discussed in more detail in Chapters 30 and 31.
Changing patient status (improving or deteriorating)—very important to have one dedicated provider [if possible] to monitor and reassess the patient frequently. Also passing this information forward through the succession of care is important. SOAP (Subjective, Objective, Assessment, Plan) notes are often a good format to document and pass onto the next caregiver.
Anticipated medical problems (ie, hypothermia, continued blood loss)—a patient with a head injury and concern for increasing intracranial pressure will require a more rapid and higher risk acceptance for helicopter versus a prolonged ground rescue.
Technical realm accessed (ie, cave, high angle, avalanche, swiftwater).
Specific or specialized medical equipment, medication, and supplies available for WEMS operations.
Number of patients—a wilderness MCI adds multiple levels of complexity over a similar traditional EMS MCI.
Extrication time and anticipated time to definitive medical care.
Weather—precluding helicopter options or complicating care plans.
Time of day—nighttime operations generally increase risk, and can have additive effects with hypothermia and other mental/psychological challenges.
Elevation/altitude—Elevation of the scene and altitudes attained during the rescue can affect patient physiology, as well as rescuer health, as well as limit aircraft capabilities.
Acceptable risk/benefit ratio to the team and patient—a definitive discussion point that should be made by the incident commander with input from the safety officer and others, especially the rescuers who will be entering the technical terrain. Some algorithms exist to help flush this out as well as identify mitigation strategies that may be helpful.