The Wilderness Medical Society (WMS) convened an expert panel to review evidence-supporting practices for the medical direction of search and rescue teams. Below is a summary of the clinical practice guidelines.
INTRODUCTION
Search and rescue (SAR) teams should be organized and have jurisdictional authority to operate in a given location and in a mandated capacity. A SAR team should aim to locate, access, stabilize, and evacuate subjects in need of assistance in austere environments. To optimize outcomes, the WMS recommends physician medical direction of SAR teams and elaborates on best practices in the guidelines.
SAR MEDICAL DIRECTION
Studies show that 84% of surveyed SAR teams provide some medical care to lost and injured subjects, but less than half have physician medical oversight. These guidelines are focused on the medical direction of volunteer SAR teams working with jurisdictional authority and those operating independently as nonprofit organizations. This document is intended to provide guidance to current and potential medical directors of SAR teams, leadership of SAR teams, as well as regional jurisdictions and regulatory agencies.
It is recommended that SAR medical directors have malpractice insurance that covers both the activity being performed and professional administrative liability. The medical director’s roles may include:
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Quality management
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Case review
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Protocol development
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Establishment of patient care standards
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Selections of appropriate medical equipment
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Credentialing of care providers
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Collection of patient follow-up and outcome information
SUMMARY OF RECOMMENDATIONS
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SAR teams should have medical direction. Because SAR teams providing any level of patient care deliver emergency medical services (EMS), they should have physician medical direction to guide their medical providers. This includes clinicians (all those licensed to provide medical care), practitioners (those licensed to provide independent medical care and who have prescription-writing authority), and first aid providers (all other medical care delivered legally).
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Medical directors of SAR teams should be trained in out-of-hospital medicine, licensed to practice medicine in the jurisdiction where the team operates and maintain knowledge of current best practices through relevant continuing education specific to operational medicine. Medical directors should be actively engaged in field operations and training.
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Medical directors should set the defined minimum level of training for their SAR team members based on local legal considerations and specific environmental and operational contexts.
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Medical directors of SAR teams should oversee ongoing in-house SAR-specific medical training. Active engagement and ongoing opportunities are fundamental to maintaining a strong level of medical proficiency in a wilderness setting.
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Medical directors should facilitate SAR team members to practice to the level of their education, certification, licensure, and credentialing. Education refers to what a patient care provider has been trained to do. Certification refers to that which a patient care provider has demonstrated competency in. Licensure refers to what the State will allow a patient care provider to do. Credentialing refers to what the medical director will allow a patient care provider to do. All four must be considered for a patient care provider on a SAR team to function legally and safely.
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Prehospital medical providers in the wilderness environment should function with defined scopes of practice as determined by their education, certification of the education, licensure, and credentialing by their local medical director. These scopes of practice should allow for operationally specific protocols that are approved by the local medical director and the appropriate EMS regulatory authority and allow them to give appropriate medical care to patients in austere operational environments.
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Medical directors should develop medical protocols for their SAR team. Use of the existing protocols of the local receiving and transporting EMS agencies, with SAR-specific exceptions, will facilitate good working relationships among involved agencies.
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Medical directors should develop SAR and environmentally specific exceptions and exclusions to broader medical protocols for their teams. The WMS has published a wide variety of clinical practice guidelines and their summaries to help guide clinicians through evidence and expert opinion in adapting their practice to this operational environment. The role of the SAR medical director is to use these and other resources to build protocols that are evidence-based and effective for the needs of their team.
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SAR teams should have an established mechanism and clear policies for obtaining real-time, two-way, online medical control.
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SAR teams should establish key clinical performance indicators and standards for documentation of patient care as well as mechanisms for routine and special review of that documentation by their medical director.