Medical Standards for Mountain Rescue Operations Using Helicopters: Official Consensus Recommendations of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)

Abstract

The purpose of this article is to establish medical recommendations for safe and effective Helicopter Emergency Medical Systems (HEMS) in countries with a dedicated mountain rescue service. A nonsystematic search was undertaken and a consensus among members of International Commission for Mountain Emergency Medicine (ICAR Medcom) was reached. For the severely injured or ill patient, survival depends on approach time and quality of medical treatment by high-level providers. Helicopters can provide significant shortening of the times involved in mountain rescue. Safety is of utmost importance and everything possible should be done to minimize risk. Even in the mountainous environment, the patient should be reached as quickly as possible (optimally<20 min) and provided with on-site and en-route medical treatment according to international standards. The HEMS unit should be integrated into the Emergency Medical System of the region. All dispatchers should be aware of the specific problems encountered in mountainous areas. The nearest qualified HEMS team to the incident site, regardless of administrative boundaries, should be dispatched. The 'air rescue optimal crew' concept with its flexibility and adaptability of crewmembers ensures that all HEMS tasks can be performed. The helicopter and all equipment should be appropriate for the conditions and specific for mountain related emergencies. These recommendations, agreed by ICAR Medcom, establish recommendations for safe and effective HEMS in mountain rescue.

Epidemiological and medical aspects of canyoning rescue operations

“…Overall, GCS was high (i.e. mostly [14][15] and the NACA score was low and not indicative of potential or actual life-threatening injuries in almost 95% of the patients. However, long rescue time and exposure to environmental factors (e.g.…”

“…Emergency medical services operating in mountain areas use helicopters (HEMS) to reduce pre-hospital response time. 14 HEMS was part of most of the CRO, but the median CRO time was >60 min, ranging between 10 min and >12 h. It is presumed that long CRO time is primarily due to prolonged scene time rather than long response time because (i) helicopters were not equipped with winches, which would expedite evacuation and transport of patients and (ii) the topography of canyons generally do not permit landing. Helicopters that are equipped with a winch can transport the CRO team with all necessary rescue and medical equipment directly to the incident site or to the nearest possible access site.…”

“…be equipped with a winch of minimum length of 50 m and capable of carrying two persons. 14 Pasquier et al recently reported two successful winch operations in CRO. 15 The long rescue duration in our data justifies the presence of a physician/paramedic on-site and highlights that technical skills and ability in terrain with some grade of difficulty are required-ground access was used in a high percentage of CRO, particularly to incident sites with more difficult access.…”

Cardiopulmonary Resuscitation in Special Circumstances

“…In all cases, extricate the body gently and use spinal precautions. Extracorporeal life support (ECLS) is indicated if the duration of burial is >60 min, core temperature at extrication is <30°C and serum potassium at hospital admission is ≤8 mmol L −1 [4,35,37].…”

Wilderness medicine

“…[113,114] Helicopters facilitate rapid identification and extrication when they are deployed under appropriate circumstances. [115][116][117][118][119] …”