SAR-EMT40
Well-known member
I have discussed this post with both Jason and Marty and they understand and everyone else should understand that this is in no way a reflection on what they did in the very sad situation they found themselves in. I said before and I’ll say again that they did the best they could and probably nothing that could have been done would have changed that outcome.
I know that I have written several times about trauma and how to do patient assessments for trauma but I don't think that I have written anything about what to watch out for with possible medical problems. This is an attempt to correct that shortcoming on my part. This doesn’t cover every possible event but it is a start.
These are things that could be a medical emergency and may require an immediate evacuation:
None of these are walk outs, they are carry outs except where noted. Some of these people will absolutely not be able to walk out. Others may want to and should actively be dissuaded from doing it. It should be noted that in the backcountry there is always going to be second guessing about carry outs because they put rescuers at risk and just as importantly they delay evacuation for the person with the condition. In these following cases I would consider a carry out to be a necessity until proven otherwise or clearance from a doctor. Contacting a doctor through the SAR team or relay by cell phone if possible to reinforce that belief should be attempted if possible. Try to get a doctor from the ER to talk to about the situation. Give as complete a medical history as you can including a SAMPLE and OPQRST work up and as full a patient assessment including vitals as you can to help them make an evaluation. If you need to know what the SAMPLE and OPQRST mnemonics mean I will tell you but what that actually means is you need to take a First responder or first aid class.
Here is the probably incomplete list:
Prolonged intense pain anywhere in the body, intermittent or constant.
Someone complaining of pain, constriction, pressure or heartburn in the chest area behind the sternum. Chest pain that radiates into the jaw or left arm. Those are symptoms in both men and women. Men also, but in particular women with any severe abdominal or back pain especially if the women are of child bearing age. Especially if either sex are diaphoretic (heavy perspiration). Especially if they also have dizziness, feel like passing out or have passed out. In particular with defecation and/or urination if they do pass out. Especially if the pain doesn't stop after resting for 10 minutes or if it restarts on exertion.
Any difficulty in breathing the patient considers abnormal.
Any altered mental status including passing out. Check if they are a known diabetic by looking for medic alert brackets or check their medical history if they are coherent. Are they conscious? If so try giving them some food or place some sugar between their cheek and gum if you suspect a diabetic issue. Don’t put anything in their mouth unless they are conscious enough to be able to protect their airway to prevent aspiration of the food. Also, don’t put your fingers in the mouth of any person with altered mentation. This type of an emergency may be a walk out if you can get them to a stable mental state. Always approach altered people with caution. Don’t get yourself in a situation where you cannot retreat if you need to. Altered people, even friends, can be dangerous. Always protect yourself.
A patient with drooping or weakness on one side of the body. Learn the Cincinnati stroke index and how to do it.
Cincinnati stroke index
With strokes time is of the utmost importance. Depending on if it is a wet stroke or dry stroke that will determine how the hospital is going to proceed with treatment. You need to document to the best of your ability the time of onset. This is critical as they only have a relatively small window to use the drugs for a stroke caused by a clot.
Evacuation by helicopter for strokes in particular should be mentioned and strongly considered if possible.
In my first aid kit I always carry eight baby aspirin or two 325mg adult aspirin (minimum) for use on myself.
What I am going to say next I need to qualify with several caveats. Offering, giving, suggesting, etc. to anyone that they take any medicine, any medicine, always opens oneself up to serious legal problems. I, like any EMT operates under protocols that are designed by committees and doctors and backed by national protocols, state protocols, regional EMS council protocols and our sponsor hospital. Doing what the tell us to do while in their jurisdiction protects us (EMT’s) legally. What I can tell you is that anyone in my jurisdiction gets 325mg of aspirin as part of our protocol for chest pain suspected as heart related. PROVIDING they have no known aspirin allergy, they are over 13 years of age and they have no known active GI bleed. We are talking about 4 baby aspirin (81 mg) or one adult aspirin (325 mg) chewed. Other areas have different protocols that include 162mg and others have no protocol for aspirin at all. Even me doing this in a wilderness setting technically/legally can be a problem for me. Just a warning.
I will try to answer any questions there might be and remember I am not the final medical authority. While this is as accurate as I feel I can make it if you have other questions in particular about yourself ask your doctor. I am not giving medical advice, just mentioning protocols used in my jurisdiction that are considered acceptable. Other areas may have different protocols.
Hopefully this will be of some use.
Regards,
Keith
EMS Instructor candidate
CT EMT-B
Wilderness EMT
NREMT-B
PHTLS
PEPPS
I know that I have written several times about trauma and how to do patient assessments for trauma but I don't think that I have written anything about what to watch out for with possible medical problems. This is an attempt to correct that shortcoming on my part. This doesn’t cover every possible event but it is a start.
These are things that could be a medical emergency and may require an immediate evacuation:
None of these are walk outs, they are carry outs except where noted. Some of these people will absolutely not be able to walk out. Others may want to and should actively be dissuaded from doing it. It should be noted that in the backcountry there is always going to be second guessing about carry outs because they put rescuers at risk and just as importantly they delay evacuation for the person with the condition. In these following cases I would consider a carry out to be a necessity until proven otherwise or clearance from a doctor. Contacting a doctor through the SAR team or relay by cell phone if possible to reinforce that belief should be attempted if possible. Try to get a doctor from the ER to talk to about the situation. Give as complete a medical history as you can including a SAMPLE and OPQRST work up and as full a patient assessment including vitals as you can to help them make an evaluation. If you need to know what the SAMPLE and OPQRST mnemonics mean I will tell you but what that actually means is you need to take a First responder or first aid class.
Here is the probably incomplete list:
Prolonged intense pain anywhere in the body, intermittent or constant.
Someone complaining of pain, constriction, pressure or heartburn in the chest area behind the sternum. Chest pain that radiates into the jaw or left arm. Those are symptoms in both men and women. Men also, but in particular women with any severe abdominal or back pain especially if the women are of child bearing age. Especially if either sex are diaphoretic (heavy perspiration). Especially if they also have dizziness, feel like passing out or have passed out. In particular with defecation and/or urination if they do pass out. Especially if the pain doesn't stop after resting for 10 minutes or if it restarts on exertion.
Any difficulty in breathing the patient considers abnormal.
Any altered mental status including passing out. Check if they are a known diabetic by looking for medic alert brackets or check their medical history if they are coherent. Are they conscious? If so try giving them some food or place some sugar between their cheek and gum if you suspect a diabetic issue. Don’t put anything in their mouth unless they are conscious enough to be able to protect their airway to prevent aspiration of the food. Also, don’t put your fingers in the mouth of any person with altered mentation. This type of an emergency may be a walk out if you can get them to a stable mental state. Always approach altered people with caution. Don’t get yourself in a situation where you cannot retreat if you need to. Altered people, even friends, can be dangerous. Always protect yourself.
A patient with drooping or weakness on one side of the body. Learn the Cincinnati stroke index and how to do it.
Cincinnati stroke index
With strokes time is of the utmost importance. Depending on if it is a wet stroke or dry stroke that will determine how the hospital is going to proceed with treatment. You need to document to the best of your ability the time of onset. This is critical as they only have a relatively small window to use the drugs for a stroke caused by a clot.
Evacuation by helicopter for strokes in particular should be mentioned and strongly considered if possible.
In my first aid kit I always carry eight baby aspirin or two 325mg adult aspirin (minimum) for use on myself.
What I am going to say next I need to qualify with several caveats. Offering, giving, suggesting, etc. to anyone that they take any medicine, any medicine, always opens oneself up to serious legal problems. I, like any EMT operates under protocols that are designed by committees and doctors and backed by national protocols, state protocols, regional EMS council protocols and our sponsor hospital. Doing what the tell us to do while in their jurisdiction protects us (EMT’s) legally. What I can tell you is that anyone in my jurisdiction gets 325mg of aspirin as part of our protocol for chest pain suspected as heart related. PROVIDING they have no known aspirin allergy, they are over 13 years of age and they have no known active GI bleed. We are talking about 4 baby aspirin (81 mg) or one adult aspirin (325 mg) chewed. Other areas have different protocols that include 162mg and others have no protocol for aspirin at all. Even me doing this in a wilderness setting technically/legally can be a problem for me. Just a warning.
I will try to answer any questions there might be and remember I am not the final medical authority. While this is as accurate as I feel I can make it if you have other questions in particular about yourself ask your doctor. I am not giving medical advice, just mentioning protocols used in my jurisdiction that are considered acceptable. Other areas may have different protocols.
Hopefully this will be of some use.
Regards,
Keith
EMS Instructor candidate
CT EMT-B
Wilderness EMT
NREMT-B
PHTLS
PEPPS
Last edited:
