RESCUE AND EVACUATION - Medicine for Mountaineering and Other Wilderness Activities - page 79

cold, long months of complete darkness, constant danger, safe return doubtful. Honour and
recognition in case of success.”
Decisions that an expedition must make prior to departure include whether to bring
equipment such as backup gear, specialized rescue equipment, and medical supplies, and
whethertoincludememberswithrescueormedicalskills,eitherasfullmembersoftheex-
pedition or as resource members who only have support roles such as staying in base camp
onamountaineeringexpeditionorstayingonthesurfaceinadivingexpedition.Somesup-
port personnel may not even go on the expedition but carry out such tasks as coordinating
resupply or launching a rescue. With satellite telephones and other modern communica-
tions links, support personnel may not need to wait until an expedition is overdue to send
help. Every backup plan should include measures to be taken if expedition members fail to
communicate as expected or miss a planned rendezvous.
Some of the most important decisions that expedition members must make are estab-
lishing safe operating procedures. Often these decisions are not made consciously. When
the consequences of failure are high, the consequences of an inadequate safety culture can
be grave. A routine activity that clearly exemplifies a safety culture is the operation of
commercial aircraft. Flying has become extremely safe in recent years because pilots and
airlines have embedded safety cultures. The rates of human error and equipment failure
have been minimized through checklists, standardized procedures, repetitive practice, and
redundancy. Vertical rescue is another example of an inherently dangerous activity that has
been made safer by implementation of these principles, although the level of safety hardly
approaches that of commercial flight.
When applied to expeditions, safety culture has the potential to decrease the incidence
of equipment failure, illness, and injury. Adequate training is essential. Even with training,
fail-safe measures are needed to decrease human error and prevent serious problems and
includesimplebasicmeasuressuchasensuringthatallmemberswashtheirhandsafterde-
fecating and before meals and requiring the use of sun protection in high-exposure areas.
Ensuring safe practices, including use of appropriate safety equipment in such hazardous
activities as boating, diving, mountaineering, canyoneering, and caving also can dramatic-
ally reduce the probability and consequences for accidents.
Problem Recognition
When a threat to the health or survival of one or more members of an expedition exists,
the leader or other members must recognize the problem and decide on a course of action.
This may seem obvious, but human nature tends to ignore problems until they are clearly
threatening. Workers have a natural tendency to ignore fire alarms in large buildings and
to carry on as usual. Many of those who died in the destruction of the World Trade Center
wereadvisednottoevacuatebyauthoritative-soundingbuttragicallymisguidedannounce-
ments on the public address system.