ADVANCED LIFE-SUPPORT IN THE WILDERNESS - 5-YEAR EXPERIENCE OF THE REACH AND TREAT TEAM

Increasing recreation in the wilderness-raises questions about the val ue of providing advanced life support (ALS) care in the backcountry. S ince 1989 the Reach and Treat (RAT) team has provided ALS care in the wilderness area that surrounds Mount Hood, Oregon. The purpose of our study was to describe patient demographics, terrain, injuries, and ALS treatment in the wilderness environment. We utilized a retrospective observational analysis of RAT missions from 1989 to 1994 based on data sheets maintained by the RAT team prehospital run sheets and hospital charts. Of the 114 missions analyzed the median time of missions was 3 h, 9 min (range, 44 min-76 h) and 209 required technical climbing sk ills. Of the 74 patients treated, 55 (90%) received ALS care; 8 were i ntubated, 52 had intravenous titles established, and 24 received morph ine for pain. Twenty patients were entered into the local trauma syste m. The most common injuries were extremity injuries (58), head injurie s (18), and hypothermia (15). Mean time from arrival to return to stag ing area was 95 min. No injury to RAT team members occurred during the se missions, although two minor injuries occurred during training and testing, We found that wilderness-trained paramedics safely provided A LS care in a backcountry environment. This care may improve patient co mfort during long extrication and speeds the arrival of potentially Li fe-saving interventions such as advanced airway management.