This is one in a series of drafts of subsections of a formal state Wilderness EMS plan for Pennsylvania. This is a project of the Wilderness EMT Subcommittee, EMT and Paramedic Advisory Committee, Pennsylvania Emergency Health Services Council. Input is also coming from the Legislative and Medical Advisory Committees of PEHSC.

We are looking for commentary from outside PEHSC. Please review and reply with your comments to wilderness-emergency-medicine@list.pitt.edu. If you have questions that don't need to go to all list recipients you may contact Keith Conover, M.D. (kconover+@pitt.edu), Subcommittee Chair.

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The first part of the plan, as per a vote at a Subcommittee meeting in March 1995:

"1. Improving Care: working to provide Pennsylvania's wilderness/backcountry patients with care according to national wilderness/backcountry care clinical standards."

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This is a big order, and includes many of the different items that will be dicussed in following message threads. However, it does bring up two top-level questions: What is the "wilderness/backcountry" context? And what are the national wilderness/backcountry care clinical standards?

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I suggest we adopt the following definition, to be included in whatever regulations or legislation eventually result from our work. I do NOT think we should get specific about exactly how many miles from the road or how many hours from the road.

Wilderness/Backcountry Context:

The specialized prehospital situations of wilderness, backcountry, and other delayed and prolonged transport contexts such as catastrophic disasters, in which EMS delivery is complicated by one or more of the following four factors:

remoteness as far as logistics and access;

a significant delay in the delivery of care to the patient;

an environment that is stressful to both patients and rescuers;

or

lack of equipment and supplies.

Whether a given situation is in the wilderness/backcountry context shall be a medical command decision; if the on-scene EMS personnel cannot contact a command physician, the senior EMS person on-scene shall make the determination.

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Next is the question of which national standards to use. I'd actually suggest that we not limit ourselves to national standards, too, as in the charge; we must recognize the national standards, but in some situations we may be ahead of the curve, and able to improve on consensus national standards. I suggest that we include the following in whatever regulations or legislation eventually result from our work. I suspect that merely citing the WMS and the WMS Practice Guidelines in definitions as below will be adequate.

Wilderness Medical Society:

A national medical organization that sets standards for wilderness medical care and training.

Wilderness Medical Society Practice Guidelines:

A publication of the Wilderness Medical Society that sets consensus national standards for care of patients in the wilderness/backcountry context. [if you want to get a copy, it's available from Wilderness Medical Society, P.O. Box 2463, Indianapolis, IN 46206, 1-317-631-1745 --KC]

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Again, please reply with your comments to wilderness-emergency-medicine@list.pitt.edu. Thank you.