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MEDICAL STANDARDS FOR

MOUNTAIN RESCUE OPERATIONSUSING HELICOPTERS

Official Consensus Recommendations of the

International Commission forMountain Emergency Medicine (ICAR MEDCOM)

Iztok Tomazin, John Ellerton, Oliver Reisten

ICAR Slovakia 2010

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To establish medical recommendationsfor safe and effective

Helicopter Emergency Medical System

(HEMS) in mountain rescue.

THE PURPOSE OF OUR WORK

ICAR Slovakia 2010

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For the severely injured or ill patient,For the severely injured or ill patient,

SURVIVAL IS TIME DEPENDENTSURVIVAL IS TIME DEPENDENT..HHelicopters can provideelicopters can providesignificant shortening of the timessignificant shortening of the times

involved in mountain rescue.involved in mountain rescue.

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SCOOP AND RUNSCOOP AND RUN

The north face ofRjavina in Julian Alps:

hanging climberwith fractured pelvis

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STAY AND TREAT

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STAY AND TREAT

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STAY AND TREAT

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THE FUNDAMENTAL PRINCIPLES OF (H)EMS

IN MOUNTAINS

Safetyis

most

important!

SpeedandqualityofHEMSarecriticalfactorsinpatients

ultimateoutcome

Cooperation amongstall

involved

services

Helicoptercharacteristicsforsafeandeffectivework

Appropriate,lightandportablemedicalandrescue

equipment

Appropriate continuoustrainingandeducationofallinvolved

personnelareofutmostimportance.

Goldenhour (time

from

the

accident

to

the

hospital)

MEDICAL STANDARDS FOR MOUNTAIN RESCUE OPERATIONS USING HELICOPTERS:

2010 Official Consensus Recommendations of the ICAR MEDCOM

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ORGANIZATION:ORGANIZATION:

Helicopterwithamountainrescuecompetentcrewshouldbe

dedicatedtoHEMSwithinaregion

Ideally,everymedicalemergencywithintheregionshouldbe

reachedin

less

than

20

minutes

RoleofMedicalDirector (qualitymanagement,clinical

governance,education etc.)

UIAAICAR

ISMM

Mountain

Emergency

Medicine

diploma

SafetyOfficerresponsibleforaSafetyManagementSystem

Facilitiesforrest, premissionplanningandtraining

Appropriaterescue

and

medical

equipment etc.



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IINTEGRATION

AND

COOPERATIONNTEGRATIONANDCOOPERATION

HEMSoperatinginthemountainsshouldbeintegratedwithin

theEMSandotheremergencysystemsoftheparticulararea

Strategies

for

cooperation

across

international

boundaries

areessential.



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FINANCEFINANCE shouldnotcompromisesafetyshouldnotcompromisesafetynorbasicprinciplesnorbasicprinciples::

serviceis

for

everyone

according

to

medical

andrescueneed

regardlessofnationality,insuranceorother

influences



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DISPATCHINGDISPATCHING

Dispatchcenters

should

be

contacted

by

awidely

publicized

Dispatch

centers

should

be

contacted

by

awidely

publicized

internationallyrecognizedcallingnumberinternationallyrecognizedcallingnumber (112,911(112,911))

IntegratedcentersIntegratedcentersforforallemergencymedicalandrescuecallsallemergencymedicalandrescuecallsarerecarerecommendommendeded

Dispatchershould

be

Dispatcher

should

be

aware

of

specific

mountain

rescue

aware

of

specific

mountain

rescue

problemsproblems

DDecisiontodispatchHEMSshouldbebetweenthedispatchecisiontodispatchHEMSshouldbebetweenthedispatchcenterandHEMSteam,andcenterandHEMSteam,andshouldexcludeunnecessaryshouldexcludeunnecessary

bureaucraticstepsbureaucratic

steps

TheThefinaldecisionfinaldecisiontoperformthemissionremainswiththetoperformthemissionremainswiththeHEMSteamHEMSteam

TheThenearestqualifiedHEMSnearestqualifiedHEMSteamtothesiteofthemountainteamtothesiteofthemountain

accident,regardless

of

administrative

boundaries,

should

be

accident,

regardless

of

administrative

boundaries,

should

be

dispatcheddispatched



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TIMETIME



Survival isSurvival is

time dependant!time dependant!Avalanchesurvivalcurve

TIME IS LIFE

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TIME

TIME medical

perspectivemedical

perspective

HEMSactivationtime(fromemergencycalltotakeoff)of

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COMMUNICATION

RobusttwowaycommunicationbetweenHEMScrewmembers,dispatchingcentres,other

EMS

and

the

incident

site

is

essential

for

safety,efficiencyandmedicaloutcome

personal

helmet

with

an

integrated

two

way

radioheadsetallowingcommunicationatalltimes.

internationalrecognized

hand

signals



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TEAM

QUALIFICATION

Allmembers,

including

medical

personnel,

should

be

trainedandregardedasmembersoftheaircrew

Leadershipqualitiesintheirareaofexpertise

Traininginallaspectsofmountainrescueandsafety,

andcooperationwithterrestrialteamsisessential

The

operator

should

ensure

medical

staff

are

trained

initssafetymanagementsystemandCRM

Localknowledgeisessential



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TEAM

LOCATION

Ideally all team membersare presentatthe

HEMSbase

ready

for

immediate

activation

Minimumstandard: itmaybeappropriate,

dependingontheservice,forrescueand

medicalmembers

to

be

on

call

with

an

appropriateactivationtime



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TEAM - TASKS

Airrescueoptimalcrew conceptallowsfordifferentpersonstoperformthetasksrequired,permittingflexibilityincrewingdependingonthenatureand

complexityof

the

mission,

and

the

carrying

capacity

of

theaircraft.

Specificcriteriaandqualificationsarerecommended

for

the

tasks Itisstronglyrecommendedthatmedicalpersonnel

assessacasualtyatthesiteoftheaccidentexceptwhentheterrainisextremelydangerousandbeyond

thecompetence

of

the

medical

crewmember



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Medical personnel (doctor) to the site of the accident !

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QUALIFICATIONFOREMERGENCYDOCTORSIQUALIFICATIONFOREMERGENCYDOCTORSINN

MOUNTAIN

MOUNTAIN

HELICOPTER

HELICOPTER

RESCUERESCUE

Physicalandmentalfitness

Trainedmountaineer

Comfortableinexposedsituations

Welltrainedinmountainhelicopterrescue

Ableto

work

under

extreme

conditions

Experiencedemergencydoctor

Familiarwithmountainmedicine



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HELICOPTER MEDICALPERSPECTIVE

TThehelicoptermustbeabletohehelicoptermustbeableto::

bringtheHEMSteamtotheincidentsitewithall

necessary

rescue

and

medical

equipment

pickupthecasualtyandHEMS

crewmember(s)

from

the

incident

site provide adequatespaceandequipmentfor

performingmedicaltreatmentandmonitoring

onboard



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From the medical point ofview, helicopter is only

flying ambulance vehicle

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EC 135

AB 214

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1. Bring HEMS team to the incident site withall necessary rescue and medical equipment

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2. P2. Pick up the casualty and HEMS crewmember(s)ick up the casualty and HEMS crewmember(s)

from the incident sitefrom the incident site

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2. P2. Pick up the casualty and HEMS crewmember(s)ick up the casualty and HEMS crewmember(s)

from the incident sitefrom the incident site

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3. Provide3. Provide adequate spaceadequate space and equipmentand equipment for performingfor performing

medical treatment and monitoringmedical treatment and monitoring on boardon board


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MEDICAL EQUIPMENT

Shouldmeetnationalandinternationalemergencymedicineandotherstandards

Mustbelight,portable(soastobebroughtto

thepatient)

and

robust

Mustbesafelysecuredduringthemission

Specialistmedicalequipmentanddrugsto

managespecific

mountain

related

emergencies

(hypothermia,altitudeillness,snakebite)

Ergonomicandcompartmentalizedmedical

rucksacksare

recommended.


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Portable medicalequipment

Medicalrucksack

M di l k kMedical cksack

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Medical rucksackMedical rucksack

A i tA i tfS f

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Injection setInjection set

Infusion setInfusion set IntubationIntubation setset

RSI drugsRSI drugs

ampullariumampullarium

O2 cylinderO2 cylinder

AdjustableAdjustable

cervicalcervicalcollarscollars

AspiratorAspiratorSet forSet for

coniotomyconiotomyECGECG

GlucometerGlucometerPulsePulse

oximeteroximeter

TympanoTympano

thermothermo

metermeter AmpullariumAmpullarium

Used needlesUsed needles

depotdepot

Various drugsVarious drugs PneumaticPneumatic

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O2 masksO2 masks

BandageBandage

material,material,

gloves,gloves,

disinfectiondisinfectionetc.etc.

StethoscopeStethoscope

SoftSoft

cervicalcervical

collarcollar

Various drugsVarious drugs

and other items:and other items:

intraosseus injectionintraosseus injection

surgical materialsurgical material

PneumaticPneumatic

and SAMand SAM

splintsplint

Bag maskBag mask

ventilationventilationdevicesdevices

Blood pressureBlood pressure

monitormonitor

LaryngealLaryngealtubetube

SuctionSuction

catheterscatheters

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FRIENDSHIPRESPECTRESPECT

CONFIDENCECONFIDENCE

MEDICAL STANDARDS FOR MOUNTAIN RESCUE OPERATIONS USING HELICOPTERS

2010 Offi i l C R d ti f th ICAR MEDCOM

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THA N K YOUTHA N K YOU

FOR YOUR K I N D FOR YOUR K I N D

ATTEN T I ONATTEN T I ON

2010 Offic ial Consensus Recommendations of the ICAR MEDCOM

Iztok Tomazin, John Ellerton, Oliver Reisten

Prim. Iztok Tomazin, MD, MSc, mountain guidePrim. Iztok Tomazin, MD, MSc, mountain guide

ICAR MEDCOMICAR MEDCOMMountain Rescue Association of SloveniaMountain Rescue Association of Slovenia

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