The first two editions were based on the Department of Transportation’s 1984 National Standard Curriculum for EMTs, which was revised in the mid-1990s resulting in the new EMT-B curriculum. The third edition of Outdoor Emergency Care reflects the national changes insofar as they are compatible with serving as a textbook for the National Ski Patrol’s Outdoor Emergency Care (OEC) course, while considering the need to maintain Ski Patrol’s credibility with the EMS system.
Major EMT-B curriculum changes that affect the OEC curriculum and Outdoor Emergency Care text include:
1) The previous sharp division of assessment into primary and secondary surveys is blurred and the terminology has been changed. The first part of the assessment is the “scene size-up” (similar to OEC’s First Impression), followed by the “initial assessment” and then the “focused history and physical” in which components depend on whether the patient has an injury or an illness. At this point, a decision to transport and/or to proceed with a detailed history and physical (the former “secondary survey”) is made. It is worth noting that, although the new EMS curriculum has changed from diagnosis-based to assessment-based, this text will continue to emphasize both similarities and differences between injuries and illnesses.
2) Patient monitoring (“ongoing assessment”) and early transport to a medical facility are emphasized. The ongoing assessment is performed while waiting and during transport.
3) Emergency care is now assessment- and intervention-based instead of diagnosis-based. This means that care depends on the patient’s signs and symptoms rather than what the EMT-B thinks the trouble is.
4) There is increased emphasis on the emergency treatment of younger patients with a separate chapter on Emergency Care of Infants and Children and a new section on resuscitation of the newborn has been added to the chapter on Emergency Childbirth.
5) All EMT-B’s are taught how to use the automated external defibrillator (AED) in a new section in the Appendix on Basic Life Support, although the decision of whether to actually obtain and use an AED is made by the area and its medical director in accordance with appropriate state laws or guidelines.
In the third edition of Outdoor Emergency Care, the most radical departure from previous editions is in the way assessment is presented. Because of the useful implication of the word “urgent,” the old primary survey has been renamed “urgent survey,” and the old secondary survey has been renamed “nonurgent survey.” As before, every patient is classified as early as possible as either “unresponsive” or “responsive.” This early separation is a departure from the EMT-B curriculum, but reflects the special need of the unresponsive patient for timely assessment, care and transport.
The assessment of all unresponsive patients starts with the ABC’s, followed by obtaining as much history as possible from companions, a rapid, onsite, hands-on/clothes-on body survey (the “urgent body survey”) and rapid transport to medical care. The responsive patient is classified early as either injured or ill, and both a trauma history and focused body survey or a medical history and focused body survey is performed with the object of assessing the site(s) of the patient’s chief concerns. However, if there is a significant mechanism of injury, an abnormal pulse and/or breathing, or if the patient appears critically injured or ill, a complete urgent body survey is performed and arrangements for rapid transport are initiated.
The third edition has continued to teach the urgent survey of the unresponsive patient as very similar to CPR assessment. This means that students do not need to learn a separate CPR assessment protocol, only standard assessment and triage assessment.
Members of the National Ski Patrol have always been in a special position because its members often serve in locations far from hospitals and frequently must provide care for an hour or more before patients can be turned over to the EMS system. However, although there is an element of prolonged transport in the OEC course and this textbook contains a “Wilderness Emergency Care” module, it is not a textbook of wilderness emergency care (also called prolonged or delayed transport care). Students are advised to consult specific wilderness emergency care textbooks and to take advantage of the many excellent courses available.
The nonurgent survey is a detailed history and clothes-off-body survey performed after reaching the aid room or other comfortable shelter, while awaiting transport. Patient monitoring is formalized as the “ongoing survey.”
The third edition of Outdoor Emergency Care and NSP’s prehospital care OEC course based on it, target environmental illnesses and injuries such as altitude sickness, deep frostbite and hypothermia; ski and other outdoor injuries; and the special equipment and techniques used by ski patrollers and other nonurban rescuers. They are intended to prepare the student, who may have no previous first aid or EMT training, to understand his or her body both in health and illness or injury, and to quickly detect serious alterations from the normal. They also are designed to interface with the EMS system in a timely and effective manner.
This textbook contains a carefully selected, minimal number of medical terms, which are defined when first used and are listed in the glossary. They are a form of shorthand: each one replaces several words or a sentence of nontechnical English, all are commonly used in medicine and in the EMS system and all are found commonly in EMT textbooks.
Another aim of this textbook is to prepare students in analyzing and devising rational emergency care for unusual situations not specifically covered in training. To this end, special emphasis is given to providing a solid foundation in anatomy and physiology (normal and abnormal), in-depth patient assessment for both injuries and medical illnesses, and improvisation of first aid equipment and techniques when necessary.
All chapters have been brought up to date and in some cases reorganized. In areas where controversy exists—such as the care of accidental poisoning, snakebite, spinal injuries and ski boot removal—a consensus has been presented based on recommendations from the more experienced and credible authorities in the field. Mention of the pneumatic anti-shock device has been deleted because it has been de-emphasized by the EMS system and is currently recommended only for pelvic fractures with shock. The classifications of frostbite and altitude illness have been updated to be consistent with changes in theory and practice in these fields. Information on snowboard, snowmobile and off-road biking injuries has been added to the chapter on Snowsport and Mountain Bike Injuries (entitled “Ski Injuries” in previous editions) in recognition of the increasing importance of these activities at ski areas. The only major new technique presented is the “bridge lift,” designed to lift a patient safely while protecting rescuers’ backs.
Mechanisms of injury continue to be emphasized so that students will develop the habit of always thinking of how laws of physics and peculiarities of human anatomy and physiology can be used to predict the locations and types of injuries—particularly internal injuries—and to decide about the urgency of transport to medical care.
The use of realistic, script-like scenarios has been continued, expanded and brought up to date.
Students will not become expert caregivers simply by studying this textbook or by successfully completing the National Ski Patrol’s OEC course or other similar courses. Nonetheless, these tasks will lay the groundwork for the continuing study, practice and review necessary to be worthy to serve the suffering.
