Suggestions on a SAR Medical Training Manual?

Mountain Res-Q

Mountain Res-Q

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So, once again I come to ya seeking advice and input. Oh great and mighty EMSers of EMTLIFE, dirrect me in my quest towards meeting the most minimal levels of compitence...

My SAR Team has a Training Manual. We had them out to newbies so that they can get a feel for the team and have something to refernce as they become familiar with our operations. The manual is a joke! Most of it was writne from 88-95. Hell, most of the pages were hand writen or written with a type-writter (ya know, one of those things they keep in a museum). All that wouldn't be so bad, except the book does nothing to really teach: 40 pages on rope rescue, 5 pages on helo, 1 page on medical, 1 page on horses, 60 pages on how to use a 1995 IBM computer mapping system, and nothing on General Team Orientation, Navigation, Search, Tracking, Radios, Swiftwater, Dive, Nordic, ATV's, or Dogs. The pages that are there do nothing for us (medical is 2 sentances on the fact that you need, at minimum, FA/CPR).

After much pushing two of us convinced the team ot scrap it and start anew! Since it was my idea, I have taken on much of the manual (stupid me). Team Orientation, Radios, Technical, Swiftwater, Navigation, ATV, Dogs, and Search are pretty much done. MEDICAL is the one area that I have the most experiecne in, but am having a hard time with....

As I have said before, the medical certs on our team range from First Aiders to EMTs, to Paramedics, to Doctors. I am trying to refrain from writing too much on Medical, because this manual should not be viewed as "in lieu of certification". With the exception of the 3 OEC and WEMT people, everyone elses certs reflect an urban approach to EMS. I would like the manual to take whatever certification they currently hold and help them to mentally adapt their training to meet the challenges that are faced in a wilderness environment. SO MY QUESTION:

If you were joining a SAR Team and had no experience in it and were handed a manual to augment team training, what would you expect (want to) find contained with in it's MEDICAL pages? REMEMBER: I'm trying to keep it smal-ish (5-8 pages -ariel 10 with some diagrams).

Currently I have"
"Patient Assessment in the wilderness environment"
"Improvised splinting with diagrams"
"What Medical Gear you should have"
and a few paragraphs on hypothermia.
 
I'm assuming this manual serves as your SOGs for medical events. I would look up SOGs online and go over some of the outlines.

Pretty much what you are going to need is an outline of who does what by what standard. You generally start an SOG with a definition of terms or a flow chart of your command structure on a medical call. Do you have someone who serves as your medical officer or who is in charge of directing medical ops on a mission?

I would start with defining the chain of command. Who is the highest medical authority and what responsibility does he/she have on a scene. Go down the list from your docs to your FR. Who reports to whom under what circumstances.

You will need to define the medical credentials of each volunteer. Is it part of your mission statement or agency practice to have a doc on staff or is it just dumb luck that you have a local physician who likes to play in the woods. (That's what we have! :P)

Do you have a minimum staffing level for your EMS trained members? If so it should be outlined. Is their credential one sponsored by your agency or is it one they have obtained outside of your agency? How is their training maintained and who within your organization is responsible to make sure that the credentials and CME are maintained.

If the manual is more of a protocol and mission based, then you will need to outline the course of events during a SAR mission. Who keeps track of the responding members to make sure there is EMS personnel available. If, like most SAR units this is totally situation depending on who is available to respond, what to do if no EMS personnel are available needs to be addressed. Do you get mutual aid from a nearby agency?

When to call for another agency, the guidelines for backcountry CPR should be included. One rule we have is to assign one EMS trained member to each field team. With the highest credential going into the area with the highest likelihood of the subject being located. In other words, we won't send one of our two medics out to to a rule out type hasty search of an area on the fringes of the Search area.

I hope this is enough to get you started. I'd be more than willing to help further. If you have any specific questions. Just PM me.
 
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BossyCow said:
I'm assuming this manual serves as your SOGs for medical events. I would look up SOGs online and go over some of the outlines.

Pretty much what you are going to need is an outline of who does what by what standard. You generally start an SOG with a definition of terms or a flow chart of your command structure on a medical call. Do you have someone who serves as your medical officer or who is in charge of directing medical ops on a mission?

I would start with defining the chain of command. Who is the highest medical authority and what responsibility does he/she have on a scene. Go down the list from your docs to your FR. Who reports to whom under what circumstances.

You will need to define the medical credentials of each volunteer. Is it part of your mission statement or agency practice to have a doc on staff or is it just dumb luck that you have a local physician who likes to play in the woods. (That's what we have! :P)

Do you have a minimum staffing level for your EMS trained members? If so it should be outlined. Is their credential one sponsored by your agency or is it one they have obtained outside of your agency? How is their training maintained and who within your organization is responsible to make sure that the credentials and CME are maintained.

If the manual is more of a protocol and mission based, then you will need to outline the course of events during a SAR mission. Who keeps track of the responding members to make sure there is EMS personnel available. If, like most SAR units this is totally situation depending on who is available to respond, what to do if no EMS personnel are available needs to be addressed. Do you get mutual aid from a nearby agency?

When to call for another agency, the guidelines for backcountry CPR should be included. One rule we have is to assign one EMS trained member to each field team. With the highest credential going into the area with the highest likelihood of the subject being located. In other words, we won't send one of our two medics out to to a rule out type hasty search of an area on the fringes of the Search area.

I hope this is enough to get you started. I'd be more than willing to help further. If you have any specific questions. Just PM me.
Click to expand...

THANX FOR THE THOUGHTS. I was thinking along the same lines, but you had some thoughts I didn’t.

We don’t really have any written SOG’s and don’t know how far I can get into that before turning these few pages into a novel. Although I will put some flow charts / command structures in the manual. I am actually the Medical Team Leader (default – nobody wanted the responsibility or has the time – even me), but all that is needed to be active on the team and respond to any call is Basic First Aid/CPR. We just got lucky on the Doc. She is an ER Doctor with a history in Para-medicine and BLS instruction of firefighters. My first 2 years on the team the highest medical cert was EMT. Now we have several Paramedics and the Doc.

The stuff on minimum requirements and such is in there as is how to obtain and maintain the training. I am responsible to make sure that everyone is current on certs, but have no obligation or ability to organize CEU’s. In fact, several of our Medics and EMT’s have moved on from EMS over the years but still play in SAR. Their certs expired and they don’t understand that being a former Medic means nothing legally and that this guys and gals who worked Ambulance for 20 years need to take an 8 hour First Aid Course every now and then!

I’m trying to stay away from too much protocol and treatments, because I’m not looking to make this section in to just another First Aid / EMS Textbook. I want it to include enough so that it is a supplement to what they are certified in so that they understand the differences between Street EMS and Wilderness EMS.

Thanx for the thoughts, I have written a first draft for this section, and will continue to change it… but this section is giving more headaches than any of the highly technical rescue sections did, and iIam far more comfortable in /have more experience in EMS than on ropes or water rescue.
 
Mountain Res-Q said:
We just got lucky on the Doc. She is an ER Doctor with a history in Para-medicine and BLS instruction of firefighters. My first 2 years on the team the highest medical cert was EMT. Now we have several Paramedics and the Doc.
Click to expand...
Just curious - is she acting as the Medical Director for the team? Do you have a good Medical Director?

I think there should be some sort of page, or better yet a small pocket-reference sheet for new members with important contacts. For example, in my SAR uniform I have my little notebook. It has a printed list of phone numbers for our Medical Director, the local helicopters, Red Cross, Starvation Army, CAP, mine rescue, the biophones for area hospitals etc etc. Very useful. Know this isn't what you're exactly looking for as far a manual, but the thing is a manual can only answer so many questions, and your members should know where to get the answers that the manual can't provide.

I think it would be a good idea to make the inventory lists for any team medical equipment readily available to anyone. We have BLS bags. It is critical that every member, from the kid who just got his first CPR card, all the way up to the ER doc, knows the content of those bags like the back of their hand.

Anywho, here are some resources I've used in my instruction. At the bottom is a very brief outline on wilderness consideration, long carryout kinda stuff.

Reference+-+Treatment+of+Hypothermia.GIF


High Altitude Pulmonary Edema

High Altitude Sickness

Extended carryouts
-Stable vs. unstable
-Communication
--With medical control
--With patient
-Vitals, interventions
-Documentation
-Special equipment
--Extra 02 cylinders
--Bandage, splint materials
--Other interventions
--Wheel
-Patient needs
--Food / water
--Bathroom breaks
--Comfort
--Temperature, padding
--Communication
---Their condition
---With friends/ family
 
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I serve as an officer for both my SAR unit and my EMS agency so I tend to look at things from a bit of a different perspective. In order to be legally effective in limiting liability, your training programs and guidelines need to meet the expectations of the SOGs.

So instead of putting the cart before the horse, setting up your SOGs should be first. You have to outline what you are trying to accomplish, then create your training documents to meet that objective. Also having the clear definitions of who the players are will help with assigning responsibility, eliminating confusion on scene.

So in a nutshell...

  • Identify your goals and objectives
  • Identify the participants in the process
  • Identify the requirements credentials and skills needed for those participants to meet the objectives
  • Set a method for obtaining those requirements, and a system for maintaining them.
 
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