Travel Reference
In-Depth Information
CHAPTER
3
LIFE-THREATENING PROBLEMS
Ernest E. Moore, M.D.
Ken Zafren, M.D.
James A. Wilkerson, M.D.
Principal Contributors
Some medical conditions are immediately life threatening. Prompt recognition and appro-
priateactionarerequiredforsafeevacuationoftheindividualtoamedicalfacilityfordefin-
itive care.
SAFETY AND LEADERSHIP
The safety of the rescuers is always the first priority, particularly when injuries have been
caused by hazards such as rockfall or avalanches. No uninjured person should attempt a res-
cue until scene safety has been ensured.
Rescuerswhomayhavecontactwithbloodorotherbodyfluidsshoulduseuniversalpre-
cautions, primarily gloves. Many people are now allergic to latex gloves, and vinyl gloves
are unreliable. The best current choice for glove material is nitrile. Latex-free dishwashing
gloves are more durable than medical gloves and serve as an effective barrier.
Most rescuers prefer to perform mouth-tomouth rescue breathing with a barrier device,
such as a mask, that separates them physically from the person while allowing mouth-to-
mouth ventilation.
Gloves and mouth-to-mouth barriers should be available in medical kits but can be im-
provised. A plastic bag of any type can be used as a glove when tied with string or taped at
or above the wrist.
A nitrile glove with a slit cut in the middle finger can be used as an improvised mask.
The middle finger is placed in the mouth of the individual being resuscitated so that blow-
ing into the glove inflates that finger and forces air through the slit into the person's mouth.
The person's nose must be held closed when blowing into the glove so that air is forced into
the lungs instead of out through the nose. Releasing or uncovering the nose between breaths
allows the individual to exhale. The slit acts as a one-way valve to prevent saliva from en-
tering the glove.
Ifmorethanonerescuerispresent,oneshouldbedesignatedtheleader.Ideally,theleader
should direct resuscitation and medical care, plan for evacuation, and coordinate calls for
help but should not lose sight of everything that is happening by performing resuscitation or
administering care.
THE ABC'S: AIRWAY, BREATHING, AND CIRCULATION
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