This is the second 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:

"2. Statewide QI: providing a Quality Improvement system for the care delivered to wilderness/backcountry patients."

So, how do we provide a statewide QI system?

First, data collection. Do we do this on the standard state trip sheet, or do we need to require a separate report for wilderness patients?

Certainly the standard PA "trip sheet" is inadequate for the lengthy clinical documentation often required for long backcountry rescues. We could develop a state wilderness trip sheet based on the WEMSI model. But I'll bet that standard trip sheets will be available a lot more often, at least for short wilderness rescues. Maybe a combination: the minimal data needed for any wilderness rescue on the state "street" trip sheet and more detail on a special state "wilderness" trip sheet, that also serves as a clinical record?

Let us know what you think. And which data items need to be gathered for proper wilderness EMS QI.

Second problem: who reviews these trip sheets? And what percentage of them? Do we set up a wilderness EMS QI board that reviews all these cases and makes recommendations for improvement? Or do we require local medical directors to learn enough about wilderness EMS that they can critically review wilderness EMS calls their service makes? This makes sense for search and rescue teams that are also EMS agencies, but maybe not for a service that does one wilderness call a year.

What do you think?

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WEMSI has developed a patient record form for backcountry care that is designed specifically for clinical use, but not specifically for QI purposes. Bernie Roche, WEMSI's Webmaster, is going to post GIF views (sorry if they're a little blurry) of the WEMSI Patient Record Form and continuation on the WEMSI WWW page sometime soon, so you can look at it. (There are three GIF pictures: the front of the form, the back of the form, and a one-page continuation sheet.)

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WEMSI WWW home page: http://www.pitt.edu/DOC/95/30/32686/Wemsi.html

PLEASE NOTE the FOUR capital letters in the address! They throw off a lot of folks first time around. We're hoping to get an easier address in the future.

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