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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.
MEDICAL STANDARDS FOR MOUNTAIN RESCUE OPERATIONS USING HELICOPTERS:
2010 Official Consensus Recommendations of the ICAR MEDCOM
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IINTEGRATION
AND
COOPERATIONNTEGRATIONANDCOOPERATION
HEMSoperatinginthemountainsshouldbeintegratedwithin
theEMSandotheremergencysystemsoftheparticulararea
Strategies
for
cooperation
across
international
boundaries
areessential.
MEDICAL STANDARDS FOR MOUNTAIN RESCUE OPERATIONS USING HELICOPTERS:
2010 Official Consensus Recommendations of the ICAR MEDCOM
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FINANCEFINANCE shouldnotcompromisesafetyshouldnotcompromisesafetynorbasicprinciplesnorbasicprinciples::
serviceis
for
everyone
according
to
medical
andrescueneed
regardlessofnationality,insuranceorother
influences
MEDICAL STANDARDS FOR MOUNTAIN RESCUE OPERATIONS USING HELICOPTERS:
2010 Official Consensus Recommendations of the ICAR MEDCOM
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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
MEDICAL STANDARDS FOR MOUNTAIN RESCUE OPERATIONS USING HELICOPTERS:
2010 Official Consensus Recommendations of the ICAR MEDCOM
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TIMETIME
MEDICAL STANDARDS FOR MOUNTAIN RESCUE OPERATIONS USING HELICOPTERS:
2010 Official Consensus Recommendations of the ICAR MEDCOM
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
MEDICAL STANDARDS FOR MOUNTAIN RESCUE OPERATIONS USING HELICOPTERS:
2010 Official Consensus Recommendations of the ICAR MEDCOM
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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
MEDICAL STANDARDS FOR MOUNTAIN RESCUE OPERATIONS USING HELICOPTERS:
2010 Official Consensus Recommendations of the ICAR MEDCOM
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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
MEDICAL STANDARDS FOR MOUNTAIN RESCUE OPERATIONS USING HELICOPTERS:
2010 Official Consensus Recommendations of the ICAR MEDCOM
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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
MEDICAL STANDARDS FOR MOUNTAIN RESCUE OPERATIONS USING HELICOPTERS:
2010 Official Consensus Recommendations of the ICAR MEDCOM
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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
MEDICAL STANDARDS FOR MOUNTAIN RESCUE OPERATIONS USING HELICOPTERS:
2010 Official Consensus Recommendations of the ICAR MEDCOM
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HELICOPTER MEDICALPERSPECTIVE
TThehelicoptermustbeabletohehelicoptermustbeableto::
bringtheHEMSteamtotheincidentsitewithall
necessary
rescue
and
medical
equipment
pickupthecasualtyandHEMS
crewmember(s)
from
the
incident
site provide adequatespaceandequipmentfor
performingmedicaltreatmentandmonitoring
onboard
MEDICAL STANDARDS FOR MOUNTAIN RESCUE OPERATIONS USING HELICOPTERS:
2010 Official Consensus Recommendations of the ICAR MEDCOM
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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
MEDICAL STANDARDS FOR MOUNTAIN RESCUE OPERATIONS USING HELICOPTERS:
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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.
2010 Official Consensus Recommendations of the ICAR MEDCOM
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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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