Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Sun, 2 Apr 2000 01:47:35 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 2 Apr 2000 01:47:02 -0500 (EST) Received: via switchmail; Sun, 2 Apr 2000 01:47:02 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 2 Apr 2000 01:45:53 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 2 Apr 2000 01:44:35 -0500 (EST) Received: from mail01.iprimus.com.au (mail01.iprimus.com.au [203.134.64.91]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 2 Apr 2000 01:44:30 -0500 (EST) Received: from mail pickup service by mail01.iprimus.com.au with Microsoft SMTPSVC; Sun, 2 Apr 2000 16:44:32 +1000 Received: from list.srv.cis.pitt.edu ([136.142.185.20]) by mail01.iprimus.com.au with Microsoft SMTPSVC(5.5.1877.387.38); Sat, 1 Apr 2000 09:09:16 +1000 Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 31 Mar 2000 17:12:50 -0500 (EST) Received: from mail.nucleus.com (mail.nucleus.com [207.34.93.23]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Fri, 31 Mar 2000 17:12:46 -0500 (EST) Received: from nis949529625 (unverified [209.115.165.75]) by mail.nucleus.com (Vircom SMTPRS 4.2.181) with SMTP id for ; Fri, 31 Mar 2000 15:12:47 -0700 Message-ID: <001801bf9b5e$2b309ae0$4ba573d1@nis949529625> From: "Lana Berrington" To: References: <003201bf9b28$d20e1a80$5f8ccfd8@oemcomputer> Subject: Re: W-EMED Glutose Paste vs. Glucose Tablets Date: Fri, 31 Mar 2000 15:12:13 -0700 MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="----=_NextPart_000_0015_01BF9B23.7E8E9F60" X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Disposition-Notification-To: "Lana Berrington" X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu This is a multi-part message in MIME format. ------=_NextPart_000_0015_01BF9B23.7E8E9F60 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable While I agree that cleaning glucose paste is a terrible thing to = scrape from everything in your pack. The tablets have their = disadvantages too.. =20 I've carried the tablets and found that they're just not terribly = durable in a pack that gets banged around a lot. =20 =20 What happened is.. over the course of a season in my kit, the tablets = became chunks and sugar particles that settled to the bottom of my pack = .. then my pack got wet.. the sugar kinda hardened in place. In personal use .. I've also found that giving tablets to somebody = with an altered level of consciousness due to hypoglycemia presents a = higher danger of having them choke on the tablets. I'm pretty sure they = were built for a person to keep with them and then to pop when they = started feeling themselves get a little low.=20 The only other thing that I don't like about the tablets is that = they're hard to chew and, sortta like a sugar cube versus a teaspoon of = sugar - the cube taking longer to disolve in your coffee - I suspect = that the tablets take a little longer to disolve and get to your = patient. The Gel: I've found gel that comes in two kinds of packets. the = little plastic tubes (that look like cake-mate icing) - these tend to be = more durable than the other kind - that comes in the foil packets.. = The foil packets I've found are often cheaper .. so for packing = purposes, I put some foil packets in a heavy duty ziplock and then duct = tape the ziplock shut and all the ziplock seams.. that way you can = still see the expiry date, and it's a pretty bomb-proof. just my two cents. (in Canadian funds.. which I think makes it more = like 1.2 cents USD) Lana ----- Original Message -----=20 From: Michelle Schonzeit=20 To: W-MED list=20 Sent: March 31, 2000 8:50 AM Subject: W-EMED Glutose Paste vs. Glucose Tablets After having the wonderful pleasure of cleaning glucose gel from = everything in my ski patrol pack, I started looking for a slightly more = rugged alternative to keep in my pack for treating ill diabetics. Our = local EMT supplies store only carries the glucose paste, however, I = found Wal-mart carried glucose tablets. Both have the main ingredient listed as dextrose, and other than = you'd have to give 4 tablets to equal the one dose of paste, they seem = comparable.=20 Does anyone know of any major disadvantage to using the tablets? I = can't find any problem, but it seems to me that if they were equal, the = tablets would be more popular in SAR and ski patrolling, since they = can't freeze, rupture, or create a sticky mess! However, I can't find = anyone using them, and all of the ski patrol and SAR supply catalogs = seem to exclusively sell the paste. Does anyone have any insight as to the pros and cons of either the = tablets or paste?=20 =20 Thanks, =20 Michelle Schonzeit schonzeit@slic.com SAR of the Northern Adirondacks - Whiteface Mt. Ski Patrol http://www.angelfire.com/mt/schonzeit =20 ------=_NextPart_000_0015_01BF9B23.7E8E9F60 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
  While I agree that cleaning glucose paste is = a terrible=20 thing to scrape from everything in your pack.  The tablets have = their=20 disadvantages too..  
 
   I've carried the tablets and found that = they're=20 just not terribly durable in a pack that gets banged around a lot.  =
 
   What happened is.. over the course of a = season in=20 my kit, the tablets became chunks and sugar particles that settled to = the bottom=20 of my pack .. then my pack got wet.. the sugar kinda hardened in=20 place.
 
   In personal use .. I've also found that = giving=20 tablets to somebody with an altered level of consciousness due to = hypoglycemia=20 presents a higher danger of having them choke on the tablets.  I'm = pretty=20 sure they were built for a person to keep with them and then to pop when = they=20 started feeling themselves get a little low.
 
   The only other thing that I don't like = about the=20 tablets is that they're hard to chew and, sortta like a sugar cube = versus a=20 teaspoon of sugar - the cube taking longer to disolve in your = coffee  =20 -   I suspect that the tablets take a little longer to disolve = and get=20 to your patient.
 
 
The Gel:   I've found gel that comes in = two kinds of=20 packets.  the little plastic tubes (that look like cake-mate icing) = - these=20 tend to be more durable than the other kind - that comes in the foil=20 packets..    The foil packets I've found are often = cheaper .. so=20 for packing purposes, I put some foil packets in a heavy duty ziplock = and then=20 duct tape the ziplock shut and all the ziplock seams..   that = way you=20 can still see the expiry date, and it's a pretty = bomb-proof.
 
just my two cents. (in Canadian funds..  = which I=20 think makes it more like 1.2 cents USD)
 
Lana
 
----- Original Message -----
From:=20 Michelle=20 Schonzeit
To: W-MED list =
Sent: March 31, 2000 8:50 = AM
Subject: W-EMED Glutose Paste = vs. Glucose=20 Tablets

    After having the wonderful = pleasure of=20 cleaning glucose gel from everything in my ski patrol pack, I started = looking=20 for a slightly more rugged alternative to keep in my pack for treating = ill=20 diabetics. Our local EMT supplies store only carries the glucose=20 paste, however, I found Wal-mart carried glucose = tablets.
    Both have the main = ingredient listed=20 as dextrose, and other than you'd have to give 4 tablets to equal the = one dose=20 of paste, they seem comparable.
    Does anyone know of any = major=20 disadvantage to using the tablets? I can't find any problem, but = it seems=20 to me that if they were equal, the tablets would be more popular=20 in SAR and ski patrolling, since they can't freeze, = rupture, or=20 create a sticky mess! However, I can't find anyone using them, = and all of=20 the ski patrol and SAR supply catalogs seem to exclusively sell = the=20 paste.
    Does anyone have any insight as = to the=20 pros and cons of either the tablets or paste?
 
Thanks,
 
Michelle Schonzeit schonzeit@slic.com
SAR of the Northern Adirondacks - Whiteface Mt. = Ski=20 Patrol
http://www.angelfire.com/m= t/schonzeit=20   
------=_NextPart_000_0015_01BF9B23.7E8E9F60-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Fri, 31 Mar 2000 17:15:45 -0500 (EST) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 31 Mar 2000 17:15:06 -0500 (EST) Received: via switchmail; Fri, 31 Mar 2000 17:15:05 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 31 Mar 2000 17:14:21 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 31 Mar 2000 17:12:50 -0500 (EST) Received: from mail.nucleus.com (mail.nucleus.com [207.34.93.23]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Fri, 31 Mar 2000 17:12:46 -0500 (EST) Received: from nis949529625 (unverified [209.115.165.75]) by mail.nucleus.com (Vircom SMTPRS 4.2.181) with SMTP id for ; Fri, 31 Mar 2000 15:12:47 -0700 Message-ID: <001801bf9b5e$2b309ae0$4ba573d1@nis949529625> From: "Lana Berrington" To: References: <003201bf9b28$d20e1a80$5f8ccfd8@oemcomputer> Subject: Re: W-EMED Glutose Paste vs. Glucose Tablets Date: Fri, 31 Mar 2000 15:12:13 -0700 MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="----=_NextPart_000_0015_01BF9B23.7E8E9F60" X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2919.6600 Disposition-Notification-To: "Lana Berrington" X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu This is a multi-part message in MIME format. ------=_NextPart_000_0015_01BF9B23.7E8E9F60 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable While I agree that cleaning glucose paste is a terrible thing to = scrape from everything in your pack. The tablets have their = disadvantages too.. =20 I've carried the tablets and found that they're just not terribly = durable in a pack that gets banged around a lot. =20 =20 What happened is.. over the course of a season in my kit, the tablets = became chunks and sugar particles that settled to the bottom of my pack = .. then my pack got wet.. the sugar kinda hardened in place. In personal use .. I've also found that giving tablets to somebody = with an altered level of consciousness due to hypoglycemia presents a = higher danger of having them choke on the tablets. I'm pretty sure they = were built for a person to keep with them and then to pop when they = started feeling themselves get a little low.=20 The only other thing that I don't like about the tablets is that = they're hard to chew and, sortta like a sugar cube versus a teaspoon of = sugar - the cube taking longer to disolve in your coffee - I suspect = that the tablets take a little longer to disolve and get to your = patient. The Gel: I've found gel that comes in two kinds of packets. the = little plastic tubes (that look like cake-mate icing) - these tend to be = more durable than the other kind - that comes in the foil packets.. = The foil packets I've found are often cheaper .. so for packing = purposes, I put some foil packets in a heavy duty ziplock and then duct = tape the ziplock shut and all the ziplock seams.. that way you can = still see the expiry date, and it's a pretty bomb-proof. just my two cents. (in Canadian funds.. which I think makes it more = like 1.2 cents USD) Lana ----- Original Message -----=20 From: Michelle Schonzeit=20 To: W-MED list=20 Sent: March 31, 2000 8:50 AM Subject: W-EMED Glutose Paste vs. Glucose Tablets After having the wonderful pleasure of cleaning glucose gel from = everything in my ski patrol pack, I started looking for a slightly more = rugged alternative to keep in my pack for treating ill diabetics. Our = local EMT supplies store only carries the glucose paste, however, I = found Wal-mart carried glucose tablets. Both have the main ingredient listed as dextrose, and other than = you'd have to give 4 tablets to equal the one dose of paste, they seem = comparable.=20 Does anyone know of any major disadvantage to using the tablets? I = can't find any problem, but it seems to me that if they were equal, the = tablets would be more popular in SAR and ski patrolling, since they = can't freeze, rupture, or create a sticky mess! However, I can't find = anyone using them, and all of the ski patrol and SAR supply catalogs = seem to exclusively sell the paste. Does anyone have any insight as to the pros and cons of either the = tablets or paste?=20 =20 Thanks, =20 Michelle Schonzeit schonzeit@slic.com SAR of the Northern Adirondacks - Whiteface Mt. Ski Patrol http://www.angelfire.com/mt/schonzeit =20 ------=_NextPart_000_0015_01BF9B23.7E8E9F60 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
  While I agree that cleaning glucose paste is = a terrible=20 thing to scrape from everything in your pack.  The tablets have = their=20 disadvantages too..  
 
   I've carried the tablets and found that = they're=20 just not terribly durable in a pack that gets banged around a lot.  =
 
   What happened is.. over the course of a = season in=20 my kit, the tablets became chunks and sugar particles that settled to = the bottom=20 of my pack .. then my pack got wet.. the sugar kinda hardened in=20 place.
 
   In personal use .. I've also found that = giving=20 tablets to somebody with an altered level of consciousness due to = hypoglycemia=20 presents a higher danger of having them choke on the tablets.  I'm = pretty=20 sure they were built for a person to keep with them and then to pop when = they=20 started feeling themselves get a little low.
 
   The only other thing that I don't like = about the=20 tablets is that they're hard to chew and, sortta like a sugar cube = versus a=20 teaspoon of sugar - the cube taking longer to disolve in your = coffee  =20 -   I suspect that the tablets take a little longer to disolve = and get=20 to your patient.
 
 
The Gel:   I've found gel that comes in = two kinds of=20 packets.  the little plastic tubes (that look like cake-mate icing) = - these=20 tend to be more durable than the other kind - that comes in the foil=20 packets..    The foil packets I've found are often = cheaper .. so=20 for packing purposes, I put some foil packets in a heavy duty ziplock = and then=20 duct tape the ziplock shut and all the ziplock seams..   that = way you=20 can still see the expiry date, and it's a pretty = bomb-proof.
 
just my two cents. (in Canadian funds..  = which I=20 think makes it more like 1.2 cents USD)
 
Lana
 
----- Original Message -----
From:=20 Michelle=20 Schonzeit
To: W-MED list =
Sent: March 31, 2000 8:50 = AM
Subject: W-EMED Glutose Paste = vs. Glucose=20 Tablets

    After having the wonderful = pleasure of=20 cleaning glucose gel from everything in my ski patrol pack, I started = looking=20 for a slightly more rugged alternative to keep in my pack for treating = ill=20 diabetics. Our local EMT supplies store only carries the glucose=20 paste, however, I found Wal-mart carried glucose = tablets.
    Both have the main = ingredient listed=20 as dextrose, and other than you'd have to give 4 tablets to equal the = one dose=20 of paste, they seem comparable.
    Does anyone know of any = major=20 disadvantage to using the tablets? I can't find any problem, but = it seems=20 to me that if they were equal, the tablets would be more popular=20 in SAR and ski patrolling, since they can't freeze, = rupture, or=20 create a sticky mess! However, I can't find anyone using them, = and all of=20 the ski patrol and SAR supply catalogs seem to exclusively sell = the=20 paste.
    Does anyone have any insight as = to the=20 pros and cons of either the tablets or paste?
 
Thanks,
 
Michelle Schonzeit schonzeit@slic.com
SAR of the Northern Adirondacks - Whiteface Mt. = Ski=20 Patrol
http://www.angelfire.com/m= t/schonzeit=20   
------=_NextPart_000_0015_01BF9B23.7E8E9F60-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Fri, 31 Mar 2000 10:45:37 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Fri, 31 Mar 2000 10:44:58 -0500 (EST) Received: via switchmail; Fri, 31 Mar 2000 10:44:57 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 31 Mar 2000 10:43:49 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Fri, 31 Mar 2000 10:41:22 -0500 (EST) Received: from buzz.slic.com (qmailr@eagle.slic.com [216.73.13.5]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Fri, 31 Mar 2000 10:41:12 -0500 (EST) Received: (qmail 13073 invoked from network); 31 Mar 2000 15:49:12 -0000 Received: from saratoga-async95.slic.com (HELO oemcomputer) (216.207.140.95) by eagle.slic.com with SMTP; 31 Mar 2000 15:49:12 -0000 Message-ID: <003201bf9b28$d20e1a80$5f8ccfd8@oemcomputer> From: "Michelle Schonzeit" To: "W-MED list" Subject: W-EMED Glutose Paste vs. Glucose Tablets Date: Fri, 31 Mar 2000 10:50:15 -0500 MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="----=_NextPart_000_002F_01BF9AFE.E5C7A3E0" X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2014.211 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2014.211 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu This is a multi-part message in MIME format. ------=_NextPart_000_002F_01BF9AFE.E5C7A3E0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable After having the wonderful pleasure of cleaning glucose gel from = everything in my ski patrol pack, I started looking for a slightly more = rugged alternative to keep in my pack for treating ill diabetics. Our = local EMT supplies store only carries the glucose paste, however, I = found Wal-mart carried glucose tablets. Both have the main ingredient listed as dextrose, and other than = you'd have to give 4 tablets to equal the one dose of paste, they seem = comparable.=20 Does anyone know of any major disadvantage to using the tablets? I = can't find any problem, but it seems to me that if they were equal, the = tablets would be more popular in SAR and ski patrolling, since they = can't freeze, rupture, or create a sticky mess! However, I can't find = anyone using them, and all of the ski patrol and SAR supply catalogs = seem to exclusively sell the paste. Does anyone have any insight as to the pros and cons of either the = tablets or paste?=20 Thanks, Michelle Schonzeit schonzeit@slic.com SAR of the Northern Adirondacks - Whiteface Mt. Ski Patrol http://www.angelfire.com/mt/schonzeit =20 ------=_NextPart_000_002F_01BF9AFE.E5C7A3E0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
    After having the wonderful = pleasure of=20 cleaning glucose gel from everything in my ski patrol pack, I started = looking=20 for a slightly more rugged alternative to keep in my pack for treating = ill=20 diabetics. Our local EMT supplies store only carries the glucose=20 paste, however, I found Wal-mart carried glucose = tablets.
    Both have the main = ingredient listed=20 as dextrose, and other than you'd have to give 4 tablets to equal the = one dose=20 of paste, they seem comparable.
    Does anyone know of any = major=20 disadvantage to using the tablets? I can't find any problem, but it = seems=20 to me that if they were equal, the tablets would be more popular=20 in SAR and ski patrolling, since they can't freeze, = rupture, or=20 create a sticky mess! However, I can't find anyone using them, and = all of=20 the ski patrol and SAR supply catalogs seem to exclusively sell the = paste.
    Does anyone have any insight as = to the pros=20 and cons of either the tablets or paste?
 
Thanks,
 
Michelle Schonzeit schonzeit@slic.com
SAR of the Northern Adirondacks - Whiteface Mt. Ski=20 Patrol
http://www.angelfire.com/m= t/schonzeit=20   
------=_NextPart_000_002F_01BF9AFE.E5C7A3E0-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 29 Mar 2000 16:58:05 -0500 (EST) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 29 Mar 2000 16:57:11 -0500 (EST) Received: via switchmail; Wed, 29 Mar 2000 16:57:10 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 29 Mar 2000 16:47:52 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 29 Mar 2000 16:47:39 -0500 (EST) Received: from imo23.mx.aol.com (imo23.mx.aol.com [152.163.225.67]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 29 Mar 2000 16:47:35 -0500 (EST) From: JadedMedic@aol.com Received: from JadedMedic@aol.com by imo23.mx.aol.com (mail_out_v25.3.) id h.5a.31e1d23 (9650) for ; Wed, 29 Mar 2000 16:46:58 -0500 (EST) Message-ID: <5a.31e1d23.2613d3d1@aol.com> Date: Wed, 29 Mar 2000 16:46:57 EST Subject: Re: W-EMED Current recommendations for oral fluids in hypovolemic shock? To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 100 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu > This is not to say that dehydrated patients can't be treated with oral > rehydration. This is done regularly with cholera victims, but oral > rehydration > should be reserved for mild to at most moderate dehydration, not patients in > shock. > > Roy Alson, PhD, MD Hi, First of all, thank you very much for your considered reply. It is genuinely appreciated. Please allow me to fine-tune my question by citing what is admittedly a somewhat contrived example. OK, consider the following: Let's say that you're in a situation where it is physically impossible to get a victim to any sort of more advanced care for at least 24 hours. (Maybe you're way out in the woods, maybe you're in a disaster situation, maybe you're out on a small boat at sea, whatever.) Anyway, IV fluid therapy is not an option, so oral fluid therapy is the only way you could get fluid into someone, should you choose to go that route. (We'll set aside, at least for now, the "retention enema" strategy so widely advocated back in the cold war/civil defense/fallout shelter days -- although maybe that deserves a closer look later on. If memory serves, I heard a report of British troops using that technique to apparently good effect on trauma victims during the Falklands war.) Let's further say that you have a patient whose problem is hypovolemic shock due to blood loss from, say, a bad wound on their arm that bled a _lot_ before the bleeding was finally controlled by direct pressure. OK, so you know for certain that you've got a patient who is in hypovolemic shock due to blood loss from an isolated wound on their arm. You know for certain that this patient has no head injury and/or abdominal injury, and is not nauseated, vomiting, having seizures, etc., and is currently "more or less" conscious. In such a situation, is there any plausible rationale for giving oral fluids? If so, what would be an acceptable maximum rate? (To keep it simple, let's assume that we're talking about giving saline.) I know that such patients certainly shouldn't be handed a liter of saline and told to chug it down. Even those who recommend oral fluid therapy advocate the "frequent small sip" approach. Red Cross is currently recommending, in at least one of their texts, oral fluid therapy at a rate of four ounces every twenty minutes. (Even assuming the fluid goes in without problems, is that rate enough to do a seriously hypovolemic patient any good?) So, given such a patient, what should we do...really? And on what basis do we know...really...that this is what we should do? These patients are hypoperfusing to a genuinely dangerous degree due to blood loss, and if that condition persists too severely for too long they will never recover -- and there is _no_ way to get them to advanced care in less than 24 hours. In such an admittedly dire and rare situation, do we really, honest-to-God, nonetheless never attempt any sort of oral fluid therapy? If so, what evidence supports this position? I gotta tell you, in the situation described, I suspect that I'd feel pretty strongly tempted to try to get some saline into that patient. Regards to all, Jay (who is wondering if any of the recommendations, pro or con, actually have any solid evidence to back them up) Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 29 Mar 2000 19:15:00 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 29 Mar 2000 19:11:40 -0500 (EST) Received: via switchmail; Wed, 29 Mar 2000 19:11:40 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 29 Mar 2000 16:44:05 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 29 Mar 2000 16:43:11 -0500 (EST) Received: from inago.swcp.com (inago.swcp.com [198.59.115.17]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 29 Mar 2000 16:43:07 -0500 (EST) Received: from localhost (tanman@localhost) by inago.swcp.com (8.8.7/8.8.7) with ESMTP id OAA15959 for ; Wed, 29 Mar 2000 14:43:01 -0700 (MST) X-Authentication-Warning: inago.swcp.com: tanman owned process doing -bs Date: Wed, 29 Mar 2000 14:43:01 -0700 (MST) From: TANMAN To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED Fluids in dehydration In-Reply-To: <38E227D4.10516.F792E42@localhost> Message-ID: MIME-Version: 1.0 Content-Type: TEXT/PLAIN; charset=US-ASCII Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu When working in Asia in the rural jungle in a typhoid epidemic and also working with dysenteries of numerous sorts, We found that giving fluids rectally worked very well in most cases. In the rural areas, IVs and other high tech equiptment may not be available. As I recall, one of our Presidents that was very sick was kept alive by rectal fluids for 90 days or something such as that. Thomas A. Naegele, DO Internet 9405 Lagrima de Oro NE 505-275-7267 Albuquerque, NM 87111 Board Certified Family Practice/Board Certified Quality Assurance MEDICAL WHITE PAPERS MAGAZINE FOR COMMUNITY PHYSICIANS http://www.swcp.com/~tanman/ FOR HUB Information Call MIKE at 303-220-1073 __________________________________________________________________ Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 29 Mar 2000 16:01:11 -0500 (EST) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 29 Mar 2000 16:00:37 -0500 (EST) Received: via switchmail; Wed, 29 Mar 2000 16:00:36 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 29 Mar 2000 15:58:43 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 29 Mar 2000 15:57:33 -0500 (EST) Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 29 Mar 2000 15:57:23 -0500 (EST) Received: from micron (ehdup-u-47.rmt.net.pitt.edu [136.142.23.157]) by post-ofc05.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 29 Mar 2000 15:57:13 -0500 (EST) From: "Keith Conover, M.D., FACEP" To: JadedMedic@aol.com, wilderness-emergency-medicine@list.pitt.edu Date: Wed, 29 Mar 2000 15:57:07 -0500 MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Subject: Re: W-EMED Current recommendations for oral fluids in hypovolemic shock? Message-ID: <38E227D3.28605.F792DCF@localhost> In-reply-to: <24.2eefdcb.26139173@aol.com> X-mailer: Pegasus Mail for Win32 (v3.12c) Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from Quoted-printable to 8bit by list.srv.cis.pitt.edu id PAA10704 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu On 29 Mar 2000, at 12:03, JadedMedic@aol.com wrote: > I'm wondering what the position is (this week, anyway [grin]), on > giving hypovolemic shock patients fluids by mouth. Dunno about this week, but here's something I published in 1991 (and will probably republish in the SAR/WEMT literature this year) that may be of use. Oral Fluids and Cave Rescue* by Keith Conover, M.D., FACEP† November 14, 1991 Disclaimer Recommendations for medical treatment in this article are presented for training purposes only. I have attempted to ensure that all recommendations are consistent with current medical practices, but all care provided by cave rescuers should be by the order of a physician. Your physician medical director must set protocols and standing orders, and you must follow them, even if they conflict with the recommendations in this article. Oral Fluids in Cave Rescue The Oral Route The standard rule for patients "on the street" is that you never give fluids. There are good reasons for this: you might make the patient more likely to vomit and aspirate (get vomit into the lungs). Even if the patient doesn't vomit in the ambulance, the patient may need surgery, and general anaesthesia with food or fluid in the stomach makes it likely for stomach fluid to regurgitate into the lungs, causing severe lung problems. However, wilderness patients can use the oral route for medication, food, and water, but only under certain conditions. First, the GI system must be working. If the patient has an ileus, nothing you give by mouth will be absorbed. What is worse, it will sit in the patient's stomach until the patient vomits it back up. At the best this is unpleasant for everyone, and at the worst, the patient aspirates into the lungs and dies. After any trauma, it is common for the intestines to go "on strike." In medical terms, this is an ileus. When a patient has an ileus (the most common grammatical way to use the term), the contents of the stomach and intestines stay where they are, rather than moving gradually from the beginning to the end, as is the usual case. The coordinated peristaltic movements of the GI tract stop, or are replaced by ineffective spasms. You cannot feed a patient with an ileus. If you give the patient something to eat or drink, it will sit in the patient's stomach until he or she vomits. Even if you don't let the patient eat, gas created by normal bacterial action on the contents of the GI tract tends to cause bloating and vomiting. The standard treatment for those with an ileus, therefore, is to place a nasogastric (NG) tube to allow gas and stomach secretions to drain out without making the patient vomit. Clues to a patient with an ileus include: (a) the patient is not hungry, and may be nauseated; (b) bowel sounds in the abdomen are absent or markedly decreased; and (c) the patient is not having bowel movements and is not passing gas per rectum.‡ Second, the patient must be alert enough able to eat or drink without aspirating. People often say, "The patient must have an intact gag reflex." But, about 30% of normals don't gag, ever, and these people don't spend their life aspirating everything they eat or drink. We just want someone alert enough to have an intact swallowing mechanism.* Third, don't give oral fluids to someone who is probably going to go to the operating room in the next 6-8 hours. This would include open or severe fractures, abdominal injuries, or severe abdominal pain. Why? Because of the possibility of aspiration as the patient is being put under anaesthesia. If you're more than 6-8 hours from the operating room, however, you may be able to give fluids up until about 6 hours before the patient is likely to reach the hospital. If you're going to start your patient on oral fluids, start with small sips of clear fluids. Don't let the patient take large amounts, no matter how thirsty. If the small sips stay down, then gradually give larger amounts. [continued next message) --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 29 Mar 2000 16:01:10 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 29 Mar 2000 16:00:31 -0500 (EST) Received: via switchmail; Wed, 29 Mar 2000 16:00:31 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 29 Mar 2000 15:58:46 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 29 Mar 2000 15:57:51 -0500 (EST) Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 29 Mar 2000 15:57:38 -0500 (EST) Received: from micron (ehdup-u-47.rmt.net.pitt.edu [136.142.23.157]) by post-ofc05.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 29 Mar 2000 15:57:22 -0500 (EST) From: "Keith Conover, M.D., FACEP" To: JadedMedic@aol.com, wilderness-emergency-medicine@list.pitt.edu Date: Wed, 29 Mar 2000 15:57:08 -0500 MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Subject: Re: W-EMED Current recommendations for oral fluids in hypovolemic shock? Part 4 Message-ID: <38E227D4.30324.F792EAB@localhost> X-mailer: Pegasus Mail for Win32 (v3.12c) Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from Quoted-printable to 8bit by list.srv.cis.pitt.edu id PAA10737 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu References 1.Keys, A., The biology of human starvation. 1950, Minneapolis: Univ. of Minn. Press. 2.Young, V.R. and N.S. Scrimshaw, The physiology of starvation. Sci Am. Vol. 225. 1971. 3.Scrimshaw, N.S., Undernutrition, starvation, and hunger edema, in Textbook of Medicine, P.B. Beeson and W. McDermott, Editors. 1975, Saunders: Philadelphia. p. 1367-1368. 4.Moore, F.D., Homeostasis: bodily changes in trauma and surgery, in Davis-Christopher textbook of surgery, D.C. Sabiston, Editor. 1981, W. B. Saunders: Philadelphia. p. 23-57. 5.Shires, G.T. and P.C. Canizaro, Fluid and electrolyte management of the surgical patient, in Davis-Christopher textbook of surgery, D.C. Sabiston, Editor. 1981, W. B. Saunders: Philadelphia. p. 91- 114. * This article is adapted from materials prepared by the ASRC-CEM Wilderness Emergency Medicine Curriculum Development Project, (r) 1991, with permission. The Appalachian Search and Rescue Conference and Center for Emergency Medicine of Western Pennsylvania are cooperating to develop a detailed, definitive curriculum for Wilderness EMT training. A textbook based on this material should appear in the future. The Task Group reviewing this material included Sherwood Chetlin, M.D.; Keith Conover, M.D.; Eric Davis, M.D.; William W. Forgey, M.D.; Lorick Fox, Jr.; Stephen A. Gates, M.D.; Murray Gordon, M.D.; Fred Harchelroad, Jr., M.D.; John R. Kihl, R.N.; Michael S. Kuga, EMT; Robert Lasek, M.D.; William Mackreth, EMT-P; Charles Stewart, M.D.; David Thomson, M.D.; Ray Townsend, M.D.; Ricardo Townsend, M.D.; and James A. Wilkerson, M.D. † Rescue certified member and past Chair, Appalachian Region, Mountain Rescue Association; Medical Advisor and Instructor, Eastern Region, National Cave Rescue Commission; Pennsylvania Medical Director, Appalachian Search and Rescue Conference; Clinical Assistant Professor, Department of Emergency Medicine, University of Pittsburgh.. ‡ Farting. * It's theoretically possible for someone to have a stroke that damages the swallowing mechanism and leaves a patient alert, but the chances of your rescuing such a patient in the wilderness is negligible. † Thus, for a 40 kilo child, this would be: 100cc/kg/day x 10 kilos = 1000cc/day, plus 50cc/kg/day x 10 kilos = 500cc/day, plus 20cc/kg/day x 20 kilos = 400cc/day, for a total of 1900cc/day. ‡ Except possibly some potassium imbalances by seeing certain changes on an EKG. * The calorie (with a small c) is the amount of energy needed to raise one gram of water one degree Centigrade. However, when capitalized, the word Calorie means kilocalorie. Whenever dietitians are talking about calories, they always talking about Calories with a capital "C." The Calorie, also known as the kilocalorie, is the amount of energy needed to raise a kilogram of water (1000 grams, or a liter) one degree Centigrade. Your basal metabolic rate is about 75 kilocalories an hour, about 3/4 of which comes from your internal organs, and 1/4 from your muscles. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 29 Mar 2000 16:00:39 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 29 Mar 2000 16:00:02 -0500 (EST) Received: via switchmail; Wed, 29 Mar 2000 16:00:00 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 29 Mar 2000 15:58:38 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 29 Mar 2000 15:57:29 -0500 (EST) Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 29 Mar 2000 15:57:21 -0500 (EST) Received: from micron (ehdup-u-47.rmt.net.pitt.edu [136.142.23.157]) by post-ofc05.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 29 Mar 2000 15:57:10 -0500 (EST) From: "Keith Conover, M.D., FACEP" To: JadedMedic@aol.com, wilderness-emergency-medicine@list.pitt.edu Date: Wed, 29 Mar 2000 15:57:07 -0500 MIME-Version: 1.0 Content-type: text/plain; charset=ISO-8859-1 Subject: Re: W-EMED Current recommendations for oral fluids in hypovolemic shock? Part 2 Message-ID: <38E227D3.24853.F792D61@localhost> X-mailer: Pegasus Mail for Win32 (v3.12c) Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from Quoted-printable to 8bit by list.srv.cis.pitt.edu id PAA10699 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Fluids The normal minimal need is about 2 liters/day for a standard-sized adult. Pediatric fluid requirements vary with weight. You can use the following formula to calculate minimal fluid needs based on weight. For the first 10 kilos, add 100cc per kilo per day; for each of the next 1- kilos, add 50cc per kilo per day; and for every kilo above 20, add 20 cc per kilo per day.† 0-l0 kg 100cc/kg/day 10-20 kg +50cc/kg/day 20+ kg +20cc/kg/day Fluid needs are significantly increased by: * fever (which increases insensible perspiration); * bleeding; * vomiting or diarrhea; * swelling in injured areas (including "third space" losses in abdomen that may not be visibly obvious); and * increased loss through damaged skin (large abrasions or burns). The best way to know that fluid replacement is adequate is to see a urine output of 50cc/hr or better. (Pediatric patients: l cc/kg/hr.) Even if a Foley catheter in the bladder, or Texas ("condom") catheter is not used, you can carefully measure the patient's urine output by having the patient urinate in a bottle and measuring the urine prior to discarding it. If you then average over a period of several hours, you should have an accurate assessment. Electrolytes We need a small amount of sodium and potassium each day. One liter of Ringer's Solution or Ringer's Lactate provides more than enough for basal needs, and just about any diet has enough to meet basal needs. As long as the amounts given aren't excessive, and the kidneys work properly, extra will be excreted. High or low values of sodium or potassium can cause heart and CNS problems, but cannot be diagnosed in the field.‡ Electrolyte losses are increased with: * sweating, which causes loss of both sodium and potassium (e.g., with varying fever, or a hot environment); * vomiting and diarrhea, which cause loss of significant amounts of both sodium and potassium; and * burns, bleeding, or third space losses, which decrease the available electrolytes. [continued in next message) --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 29 Mar 2000 16:00:54 -0500 (EST) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 29 Mar 2000 16:00:19 -0500 (EST) Received: via switchmail; Wed, 29 Mar 2000 16:00:19 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 29 Mar 2000 15:58:43 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 29 Mar 2000 15:57:36 -0500 (EST) Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 29 Mar 2000 15:57:25 -0500 (EST) Received: from micron (ehdup-u-47.rmt.net.pitt.edu [136.142.23.157]) by post-ofc05.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 29 Mar 2000 15:57:17 -0500 (EST) From: "Keith Conover, M.D., FACEP" To: JadedMedic@aol.com, wilderness-emergency-medicine@list.pitt.edu Date: Wed, 29 Mar 2000 15:57:08 -0500 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: Re: W-EMED Current recommendations for oral fluids in hypovolemic shock? Part 3 Message-ID: <38E227D4.10516.F792E42@localhost> X-mailer: Pegasus Mail for Win32 (v3.12c) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Caloric (energy) needs A normal adult on garrison duty needs 1700-2000 Kcal (Calories with a big C) each day.* This is increased markedly by strenuous exercise or injury up to about 4000 Calories a day. Also, fever increases basal metabolic rate about 10% per degree, and energy needs increase correspondingly. Most people have energy stores enough to last for days to weeks, even if injured. You cannot give enough through an IV in the field to make a significant difference -- a liter of D5W (5% dextrose solution) has 200 Calories, and adding two amps of D50 (50% dextrose solution) to the liter of D5W only brings it up to 400 Calories, only a tenth of the injured patient's needs). However, you should provide what little you can this way. Adding two amps of D50 to every other bag of IV fluid should be a standard treatment for long evacuations with an injured patient. If you are trying to feed a patient with severe injury or illness, and the patient can tolerate PO (oral) fluids (see above), start with clear fluids with salt and sugar (e.g., Gatorade(tm) diluted half-and-half with water) because this will be absorbed with minimal energy expenditure. Gradually move to liquids (e.g., soup) then to solid food. You can use commercial liquid feedings such as Ensure(r), which are available at drug stores, and often carried by cavers and alpine expeditions. Keep the amount of fat minimal to start, to avoid difficulty with digestion. Starvation is common among those who have been lost, and starvation causes certain biochemical abnormalities. A decrease in plasma proteins may lead to swelling of the ankles or other body parts. Starvation ketoacidosis may lead to a fruity odor on the breath similar to that in those with diabetic ketoacidosis. The ketoacidosis also leads to variable degrees of confusion and lethargy.[1, 2] "In all forms of severe under-nutrition, refeeding must be instituted slowly. Overeating was a cause of shock and death among concentration camp victims at the end of World War II."[3] Protein needs The body needs a half-gram of protein a day, and more with injury or healing. You can't give protein through I V in field, but by giving small amounts of glucose in I V (as described above), you can spare the use of some of the body's own protein. When starving, the body breaks down protein into sugar. The brain, unlike rest of body, can't use fat; so, when necessary, the body will always break protein down to make glucose for the brain.[4, 5] Conclusion Oral fluids may have a very important role in the wilderness or cave rescue patient. If the rescue and evacuation will take a long time, keeping the patient well-hydrated is essential to survival. And, if the patient is fluid depleted due to cold or heat exposure, injury, or simply being stranded, repleting the fluid losses is a vital part of emergency care. There are several situations in which you should not give oral fluids: surgery likely within the next 6 hours, internal injuries, or an ileus. However, there will likely be situations where the patient has none of these problems, you don't have an IV, or you don't have enough IV fluids to meet the patient's needs. In these cases, oral fluids may be lifesaving. [continued in next message] --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 29 Mar 2000 17:12:55 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 29 Mar 2000 17:12:16 -0500 (EST) Received: via switchmail; Wed, 29 Mar 2000 17:12:16 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 29 Mar 2000 14:24:52 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 29 Mar 2000 14:23:29 -0500 (EST) Received: from mail.wfubmc.edu (mail.wfubmc.edu [152.11.242.104]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 29 Mar 2000 14:23:26 -0500 (EST) Received: from wfubmc.edu ([152.11.185.86]) by mail.wfubmc.edu (Netscape Messaging Server 3.61) with ESMTP id AAA1044 for ; Wed, 29 Mar 2000 14:24:49 -0500 Message-ID: <38E2597D.3FBB9ED6@wfubmc.edu> Date: Wed, 29 Mar 2000 14:29:01 -0500 From: ralson@wfubmc.edu (Dr.Roy Alson) Organization: Wake Forest University School of Medicine X-Mailer: Mozilla 4.5 [en]C-CCK-MCD (WinNT; U) X-Accept-Language: en MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Current recommendations for oral fluids in hypovolemic shock? References: <24.2eefdcb.26139173@aol.com> Content-Type: multipart/mixed; boundary="------------4FF6F8AC6852787027212F7F" Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu This is a multi-part message in MIME format. --------------4FF6F8AC6852787027212F7F Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit While fluids can be given by mouth to a person who is able to swallow and protect their airway, the danger with giving large volumes of fluid by mouth to patients in "hypovolemic shock" is that as a result of their being in the shock state, flow to their intestinal tract will be diminished. This is to preserve flow to other more critical areas. Thus absorbtion of the oral fluids will be diminished and because of decreased gastric motility, there is an increased risk of aspiration. This is not to say that dehydrated patients can't be treated with oral rehydration. This is done regularly with cholera victims, but oral rehydration should be reserved for mild to at most moderate dehydration, not patients in shock. Roy Alson, PhD, MD JadedMedic@aol.com wrote: > Hi folks, > > I'm wondering what the position is (this week, anyway [grin]), on giving > hypovolemic shock patients fluids by mouth. > > I've looked over a number of the current books, and some of the main books on > wilderness emergency care (Weiss, Forgey, Wilderness Medical Society) do not > specifically recommend giving fluids by mouth to someone in hypovolemic > shock. Of course, none of them specifically recommend _against_ it either. > All three seem silent on the topic. (Candidly, this seems a bit strange to > me.) > > On the other hand, the Red Cross book on "When Help Is Delayed" recommends > giving a fully conscious, and otherwise uncomplicated (no abdominal injury, > etc.), hypovolemic shock patient oral fluids at a rate of four ounces every > twenty minutes in "frequent small sips." > > Furthermore, in the (IMO excellent) book "Advanced First Aid Afloat" (fourth > edition) by Peter Eastman, MD, the reader is advised to, among other things, > give a burn shock victim as much "salty lemonade" as they will tolerate. > (I'm simplifying what he recommends a great deal here.) > > Anyhow, assuming that an IV cannot be started, what is the current > recommendation, and what evidence is it based on, regarding giving fluids by > mouth (or possibly via other routes) to a hypovolemic shock patient? > > Regards, > > Jay > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu --------------4FF6F8AC6852787027212F7F Content-Type: text/x-vcard; charset=us-ascii; name="ralson.vcf" Content-Transfer-Encoding: 7bit Content-Description: Card for Roy Alson, PhD, MD, FACEP Content-Disposition: attachment; filename="ralson.vcf" begin:vcard n:Alson;Roy tel;fax:336-716-5438 tel;work:336-716-2193 x-mozilla-html:FALSE org:Wake Forest University School of Medicine;Department of Emergency Medicine adr:;;301 Medical Center Blvd;Winston-Salem;NC;27157-1089;US version:2.1 email;internet:ralson@wfubmc.edu title:Assistant Professor of Emergency Medicine fn:Roy L. Alson, PhD, MD, FACEP end:vcard --------------4FF6F8AC6852787027212F7F-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 29 Mar 2000 12:08:46 -0500 (EST) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 29 Mar 2000 12:08:01 -0500 (EST) Received: via switchmail; Wed, 29 Mar 2000 12:07:59 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 29 Mar 2000 12:06:13 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 29 Mar 2000 12:04:36 -0500 (EST) Received: from imo-d05.mx.aol.com (imo-d05.mx.aol.com [205.188.157.37]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 29 Mar 2000 12:04:29 -0500 (EST) From: JadedMedic@aol.com Received: from JadedMedic@aol.com by imo-d05.mx.aol.com (mail_out_v25.3.) id h.24.2eefdcb (1770) for ; Wed, 29 Mar 2000 12:03:47 -0500 (EST) Message-ID: <24.2eefdcb.26139173@aol.com> Date: Wed, 29 Mar 2000 12:03:47 EST Subject: W-EMED Current recommendations for oral fluids in hypovolemic shock? To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 100 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Hi folks, I'm wondering what the position is (this week, anyway [grin]), on giving hypovolemic shock patients fluids by mouth. I've looked over a number of the current books, and some of the main books on wilderness emergency care (Weiss, Forgey, Wilderness Medical Society) do not specifically recommend giving fluids by mouth to someone in hypovolemic shock. Of course, none of them specifically recommend _against_ it either. All three seem silent on the topic. (Candidly, this seems a bit strange to me.) On the other hand, the Red Cross book on "When Help Is Delayed" recommends giving a fully conscious, and otherwise uncomplicated (no abdominal injury, etc.), hypovolemic shock patient oral fluids at a rate of four ounces every twenty minutes in "frequent small sips." Furthermore, in the (IMO excellent) book "Advanced First Aid Afloat" (fourth edition) by Peter Eastman, MD, the reader is advised to, among other things, give a burn shock victim as much "salty lemonade" as they will tolerate. (I'm simplifying what he recommends a great deal here.) Anyhow, assuming that an IV cannot be started, what is the current recommendation, and what evidence is it based on, regarding giving fluids by mouth (or possibly via other routes) to a hypovolemic shock patient? Regards, Jay Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Tue, 28 Mar 2000 21:53:53 -0500 (EST) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 28 Mar 2000 21:53:19 -0500 (EST) Received: via switchmail; Tue, 28 Mar 2000 21:53:19 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 28 Mar 2000 21:52:50 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 28 Mar 2000 21:49:54 -0500 (EST) Received: from imo-d04.mx.aol.com (imo-d04.mx.aol.com [205.188.157.36]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 28 Mar 2000 21:49:51 -0500 (EST) From: Caverbru@aol.com Received: from Caverbru@aol.com by imo-d04.mx.aol.com (mail_out_v25.3.) id h.4b.23a8801 (4013) for ; Tue, 28 Mar 2000 21:49:12 -0500 (EST) Message-ID: <4b.23a8801.2612c928@aol.com> Date: Tue, 28 Mar 2000 21:49:12 EST Subject: Re: W-EMED cpr recert in wv To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 70 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Pendleton County rescue squad should be able to help you. Also check with the guy who runs CMI he is active in the local squads high angle rescue team and if you are living around there might sign you up. He helped us with a cave rescue a few years ago. Bru Randall Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Mon, 27 Mar 2000 21:56:24 -0500 (EST) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 27 Mar 2000 21:55:47 -0500 (EST) Received: via switchmail; Mon, 27 Mar 2000 21:55:46 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 27 Mar 2000 21:54:21 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Mon, 27 Mar 2000 21:54:12 -0500 (EST) Received: from imo27.mx.aol.com (imo27.mx.aol.com [152.163.225.71]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Mon, 27 Mar 2000 21:54:09 -0500 (EST) From: Trailblazer75@aol.com Received: from Trailblazer75@aol.com by imo27.mx.aol.com (mail_out_v25.3.) id h.61.25516a6 (4313) for ; Mon, 27 Mar 2000 21:53:35 -0500 (EST) Message-ID: <61.25516a6.261178af@aol.com> Date: Mon, 27 Mar 2000 21:53:35 EST Subject: Re: W-EMED cpr recert in wv To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 100 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Check with your local fire departments or paramedic groups. If that fails, ask at the local hospital emerg. facility. Most of the fire depts. around here have at least one CPR instructor certified to certify others. Trailblazer75 Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Mon, 27 Mar 2000 21:15:25 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Mon, 27 Mar 2000 21:14:53 -0500 (EST) Received: via switchmail; Mon, 27 Mar 2000 21:14:53 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 27 Mar 2000 21:14:32 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Mon, 27 Mar 2000 21:13:57 -0500 (EST) Received: from imo21.mx.aol.com (imo21.mx.aol.com [152.163.225.65]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Mon, 27 Mar 2000 21:13:53 -0500 (EST) From: Mkeowl@aol.com Received: from Mkeowl@aol.com by imo21.mx.aol.com (mail_out_v25.3.) id h.c6.31cc97b (4568) for ; Mon, 27 Mar 2000 21:13:18 -0500 (EST) Message-ID: Date: Mon, 27 Mar 2000 21:13:18 EST Subject: Re: W-EMED cpr recert in wv To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 66 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Just keep calling the local FDs or RSs and someone should have one soon... Linda with Rugby (WOW! Thanks for the yummy food -- HA HA! BOUS! I GET THE GOOD homemade food and YOU get the 'other' stuff... ), Chouette (Is this Sunday? "The day of REST?"...), and Uiltje (Can we go do the mountain hike again?... I've had my 3 minute rest... and my hip and shoulder will get better if I keep it moving -- sometimes...) Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 29 Mar 2000 00:37:58 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 28 Mar 2000 08:03:06 -0500 (EST) Received: via switchmail; Tue, 28 Mar 2000 08:03:05 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 27 Mar 2000 19:48:21 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Mon, 27 Mar 2000 19:45:47 -0500 (EST) Received: from hotmail.com (f259.law4.hotmail.com [216.33.148.137]) by list.srv.cis.pitt.edu with SMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Mon, 27 Mar 2000 19:45:44 -0500 (EST) Received: (qmail 50632 invoked by uid 0); 28 Mar 2000 00:45:09 -0000 Message-ID: <20000328004509.50631.qmail@hotmail.com> Received: from 198.77.38.154 by www.hotmail.com with HTTP; Mon, 27 Mar 2000 16:45:09 PST X-Originating-IP: [198.77.38.154] From: "Kristie Surmick" To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED cpr recert in wv Date: Mon, 27 Mar 2000 19:45:09 EST Mime-Version: 1.0 Content-Type: text/plain; format=flowed Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Howdy all, I just recertified my WFR, but still need to recert my CPR. Looking to travel not tooo far, does anyone know where I can get my cpr near Franklin WV, in Pendelton county? Or near Staunton or Harrisonburg Virginia. Thanks! kristie ______________________________________________________ Get Your Private, Free Email at http://www.hotmail.com Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Sun, 26 Mar 2000 20:23:25 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 26 Mar 2000 20:22:52 -0500 (EST) Received: via switchmail; Sun, 26 Mar 2000 20:22:52 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 26 Mar 2000 20:21:45 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 26 Mar 2000 20:19:08 -0500 (EST) Received: from mail.memlane.com (mail.memlane.com [199.185.225.3]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 26 Mar 2000 20:19:05 -0500 (EST) Received: from seasar ([199.185.225.231]) by mail.memlane.com (Post.Office MTA v3.5.3 release 223 ID# 0-55152U3000L300S0V35) with SMTP id com for ; Sun, 26 Mar 2000 18:07:50 -0700 Message-ID: <001401bf978a$6ab9b660$e7e1b9c7@seasar> From: "South East Alberta Search And Rescue" To: Subject: W-EMED Nursing Opportunities Date: Sun, 26 Mar 2000 18:18:52 -0700 MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="----=_NextPart_000_0011_01BF974F.BD4E5060" X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2314.1300 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2314.1300 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu This is a multi-part message in MIME format. ------=_NextPart_000_0011_01BF974F.BD4E5060 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Hi all, I am looking at a career change and was considering nursing. What = wilderness-type opportunities exist for a new, 30 year old nurse with a = BN or BScN? Any info would be great and feel free to respond directly to = seasar@memlane.com. Thanks Donovan Hoggan, R.S.W. ------=_NextPart_000_0011_01BF974F.BD4E5060 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable
Hi all,
 
I am looking at a career change and was = considering=20 nursing.  What wilderness-type opportunities exist for a new, 30 = year old=20 nurse with a BN or BScN?
 
Any info would be great and feel free = to respond=20 directly to seasar@memlane.com.
 
Thanks
 
Donovan Hoggan, = R.S.W.
------=_NextPart_000_0011_01BF974F.BD4E5060-- Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Sun, 26 Mar 2000 16:59:24 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 26 Mar 2000 16:58:35 -0500 (EST) Received: via switchmail; Sun, 26 Mar 2000 16:58:33 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 26 Mar 2000 16:55:52 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 26 Mar 2000 16:55:10 -0500 (EST) Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 26 Mar 2000 16:55:07 -0500 (EST) Received: from micron (ehdup-t-89.rmt.net.pitt.edu [136.142.23.99]) by post-ofc05.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 26 Mar 2000 16:54:58 -0500 (EST) From: "Keith Conover, M.D., FACEP" To: JadedMedic@aol.com, wilderness-emergency-medicine@list.pitt.edu Date: Sun, 26 Mar 2000 16:54:58 -0500 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: Re: W-EMED Re: whistle signals CC: Gene Harrison , Message-ID: <38DE40E2.13881.4B8CEC@localhost> In-reply-to: <8.2ce7fa9.260f9916@aol.com> X-mailer: Pegasus Mail for Win32 (v3.12c) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu On 26 Mar 2000, at 11:47, JadedMedic@aol.com wrote: > Of course, this raises the question of who "we" is. I don't know who > would be the standard-setting body in this regard. Is there such a > thing as "The International Society of Search and Rescue > Associations"? A group such as that would seem a logical choice. How about: ASTM Committee F-32 on SAR standards? http://members.aol.com/mgmsar/f32home.htm I'll also cc: the guy most involved in such communication standards, who as far as I know is also a suscriber to this list. Keith Conover, M.D., FACEP (NSS 12893, WD4PSY) http://www.pitt.edu/~kconover - Information Systems Coordinator, Dept. of EM, Mercy Hospital - Clinical Assistant Professor, Dept. of Emergency Medicine, Univ. of Pittsburgh (EM Residency and Center for Emergency Medicine) - Medical Director, Wilderness EMS Institute (http://www.wemsi.org; for a WEMSI-sponsored list, send "subscribe wilderness-emergency-medicine" to Majordomo@list.pitt.edu) - Eastern Region, Natl. Cave Rescue Comm./Appalachian SAR Conf. Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Sun, 26 Mar 2000 11:53:21 -0500 (EST) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Sun, 26 Mar 2000 11:52:42 -0500 (EST) Received: via switchmail; Sun, 26 Mar 2000 11:52:41 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sun, 26 Mar 2000 11:51:18 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Sun, 26 Mar 2000 11:47:58 -0500 (EST) Received: from imo20.mx.aol.com (imo20.mx.aol.com [152.163.225.10]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Sun, 26 Mar 2000 11:47:53 -0500 (EST) From: JadedMedic@aol.com Received: from JadedMedic@aol.com by imo20.mx.aol.com (mail_out_v25.3.) id h.8.2ce7fa9 (3946) for ; Sun, 26 Mar 2000 11:47:18 -0500 (EST) Message-ID: <8.2ce7fa9.260f9916@aol.com> Date: Sun, 26 Mar 2000 11:47:18 EST Subject: W-EMED Re: whistle signals To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 100 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Hi folks, I can certainly understand that formal search-and-rescue groups would investigate any unexpected whistle blasts, no matter what their pattern. OK, so far, so good. What concerns me about this is that it may take as long as a day or so for things to reach the point where such groups are out there (and the victim may be too weak to signal much of anything by then). Many "civilians" may have heard the blasts in the interim but, because the blasts fit no widely taught distress pattern, simply discount them and continue on their way. Thus, any number of opportunities for rescue may be lost. Thus, if there were a simple, uniform, widely taught, signal distress pattern (and three whistle blasts seems as good as any), it would increase the chances that more people would realize sooner that someone was in trouble, and act accordingly. Right now, there are at least four different whistle blast signal patterns being taught as an "I need help" signal. That obviously sets the stage for confusion. It would help if "we" could simplify and standardize this. Of course, this raises the question of who "we" is. I don't know who would be the standard-setting body in this regard. Is there such a thing as "The International Society of Search and Rescue Associations"? A group such as that would seem a logical choice. Regards to all, Jay Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Thu, 23 Mar 2000 22:18:22 -0500 (EST) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 23 Mar 2000 22:17:36 -0500 (EST) Received: via switchmail; Thu, 23 Mar 2000 22:17:36 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 23 Mar 2000 22:16:35 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 23 Mar 2000 22:15:40 -0500 (EST) Received: from smtp4.gateway.net (relay9.gateway.net [208.230.117.248]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 23 Mar 2000 22:15:36 -0500 (EST) Received: from default (1Cust199.tnt5.pittsburgh.pa.da.uu.net [63.10.65.199]) by smtp4.gateway.net (8.9.3/8.9.3) with SMTP id WAA24226 for ; Thu, 23 Mar 2000 22:15:30 -0500 (EST) From: "Matthew F. Russell, M.D." To: Subject: RE: W-EMED Information on MSO and PSO courses Date: Thu, 23 Mar 2000 22:15:02 -0500 Message-ID: MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Priority: 3 (Normal) X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook IMO, Build 9.0.2416 (9.0.2910.0) X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 In-Reply-To: <38DA7156.18858.6479D4@localhost> Importance: Normal Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu You can actually buy the Managing the Lost Person Incident Text locally at mountain Dreams International on Bower Hill orad if you want. MFR -----Original Message----- From: owner-wilderness-emergency-medicine@list.pitt.edu [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of Keith Conover, M.D., FACEP Sent: Thursday, March 23, 2000 7:33 PM To: Caverbru@aol.com; wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Information on MSO and PSO courses On 23 Mar 2000, at 8:27, Caverbru@aol.com wrote: > At its meeting in September 1999 the Eastern Region of the National > Cave Rescue Commission decided that there was a need for a weeklong > Level-3 course in Management of Cave Rescue (to include searches). A > brief discussion suggested that it might be prudent to take two > existing courses, combine them, and revise them, as needed, to apply > to caves. The two courses suggested are Managing the Search Operation, > MSO (formally Managing the Search Function, MSF) and Practicals of > Search Operations (PSO) developed, I believe, by Appalachian Search > and Rescue Conference (ASRC) and offered through the Virginia Ground > Search and Rescue School. Managing the Search Function (MSF) has, I believe, been updated and renamed as Managing the Lost Person Incident. The course is offered by NASAR and at one time, they refused to sell the text unless you took a course -- this may have changed. http://www.nasar.org/ An equivalent course, Managing Search Operations, is offered by Emergency Response Institute, and they definitely do sell the text. The web site is, I hear, out of date, but give it a try; and if not able to order it there, contact one of the principals, email address below: http://www.eri-intl.com/ "Skip Stoffel" "Rick LaValla" There is also a recent message from them about a new course, on the sar-l list, which I will forward to you and the list. The Practical Search Operations Course, an ideal follow-on course after MLPI or MSO, is offered by Search and Rescue Training Associates, which does the course on contract for the Commonwealth of Virginia as well as for the Appalachian Search and Rescue Conference and more recently the Pennsylvania SAR Council. Contact: David Carter or Commonwealth of Virginia SAR Coordinator: Winnie Pennington Bob Koester has a similar but shorter course, called Search Operations for Staff. http://www.people.Virginia.EDU/~rjk5a/sar.htm Hope this helps. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Thu, 23 Mar 2000 19:35:02 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 23 Mar 2000 19:34:27 -0500 (EST) Received: via switchmail; Thu, 23 Mar 2000 19:34:27 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 23 Mar 2000 19:33:44 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 23 Mar 2000 19:32:49 -0500 (EST) Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 23 Mar 2000 19:32:46 -0500 (EST) Received: from micron (ehdup-v-1.rmt.net.pitt.edu [136.142.24.11]) by post-ofc06.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 23 Mar 2000 19:32:39 -0500 (EST) From: "Keith Conover, M.D., FACEP" To: Caverbru@aol.com, wilderness-emergency-medicine@list.pitt.edu Date: Thu, 23 Mar 2000 19:32:38 -0500 MIME-Version: 1.0 Content-type: text/plain; charset=US-ASCII Content-transfer-encoding: 7BIT Subject: Re: W-EMED Information on MSO and PSO courses Message-ID: <38DA7156.18858.6479D4@localhost> In-reply-to: X-mailer: Pegasus Mail for Win32 (v3.12c) Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu On 23 Mar 2000, at 8:27, Caverbru@aol.com wrote: > At its meeting in September 1999 the Eastern Region of the National > Cave Rescue Commission decided that there was a need for a weeklong > Level-3 course in Management of Cave Rescue (to include searches). A > brief discussion suggested that it might be prudent to take two > existing courses, combine them, and revise them, as needed, to apply > to caves. The two courses suggested are Managing the Search Operation, > MSO (formally Managing the Search Function, MSF) and Practicals of > Search Operations (PSO) developed, I believe, by Appalachian Search > and Rescue Conference (ASRC) and offered through the Virginia Ground > Search and Rescue School. Managing the Search Function (MSF) has, I believe, been updated and renamed as Managing the Lost Person Incident. The course is offered by NASAR and at one time, they refused to sell the text unless you took a course -- this may have changed. http://www.nasar.org/ An equivalent course, Managing Search Operations, is offered by Emergency Response Institute, and they definitely do sell the text. The web site is, I hear, out of date, but give it a try; and if not able to order it there, contact one of the principals, email address below: http://www.eri-intl.com/ "Skip Stoffel" "Rick LaValla" There is also a recent message from them about a new course, on the sar-l list, which I will forward to you and the list. The Practical Search Operations Course, an ideal follow-on course after MLPI or MSO, is offered by Search and Rescue Training Associates, which does the course on contract for the Commonwealth of Virginia as well as for the Appalachian Search and Rescue Conference and more recently the Pennsylvania SAR Council. Contact: David Carter or Commonwealth of Virginia SAR Coordinator: Winnie Pennington Bob Koester has a similar but shorter course, called Search Operations for Staff. http://www.people.Virginia.EDU/~rjk5a/sar.htm Hope this helps. --Keith Conover, M.D., FACEP http://www.pitt.edu/~kconover Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc03.srv.cis.pitt.edu (root@post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Thu, 23 Mar 2000 08:31:51 -0500 (EST) Received: from localhost (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Thu, 23 Mar 2000 08:31:12 -0500 (EST) Received: via switchmail; Thu, 23 Mar 2000 08:31:11 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 23 Mar 2000 08:28:19 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 23 Mar 2000 08:27:42 -0500 (EST) Received: from imo23.mx.aol.com (imo23.mx.aol.com [152.163.225.67]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 23 Mar 2000 08:27:38 -0500 (EST) From: Caverbru@aol.com Received: from Caverbru@aol.com by imo23.mx.aol.com (mail_out_v25.3.) id h.b7.1a1539f (2617); Thu, 23 Mar 2000 08:27:03 -0500 (EST) Message-ID: Date: Thu, 23 Mar 2000 08:27:03 EST Subject: W-EMED Information on MSO and PSO courses To: amrg@list.pitt.edu, erncrc@svis.org, psc@sprucemt.com, wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 70 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Folks, I need some help. At its meeting in September 1999 the Eastern Region of the National Cave Rescue Commission decided that there was a need for a weeklong Level-3 course in Management of Cave Rescue (to include searches). A brief discussion suggested that it might be prudent to take two existing courses, combine them, and revise them, as needed, to apply to caves. The two courses suggested are Managing the Search Operation, MSO (formally Managing the Search Function, MSF) and Practicals of Search Operations (PSO) developed, I believe, by Appalachian Search and Rescue Conference (ASRC) and offered through the Virginia Ground Search and Rescue School. Over the past six months I have attempted to obtain syllabi for these courses without success. Obviously I asked the wrong people so now I am going out to the caving, SAR, and WEMS communities to ask for assistance. I need a current syllabus for each of these courses as well as information on who controls the teaching materials and requirements for using the materials such as instructor certification and royalty fees, etc. It would also be helpful to get the names of instructors and instructor trainers who would be willing and available to assist in this project. Please feel free to forward this to others that you think may be of assistance. Thanks for your assistance. Bru Randall NSS 12730 Supervisory Instructor Eastern Region, National Cave Rescue Commission Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Thu, 23 Mar 2000 02:55:27 -0500 (EST) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Thu, 23 Mar 2000 02:54:07 -0500 (EST) Received: via switchmail; Thu, 23 Mar 2000 02:54:07 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 23 Mar 2000 02:48:00 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 23 Mar 2000 02:47:42 -0500 (EST) Received: from snipe.prod.itd.earthlink.net (snipe.prod.itd.earthlink.net [207.217.120.62]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 23 Mar 2000 02:47:38 -0500 (EST) Received: from dell (dialup-63.212.139.117.LosAngeles1.Level3.net [63.212.139.117]) by snipe.prod.itd.earthlink.net (8.9.3/8.9.3) with ESMTP id XAA09175 for ; Wed, 22 Mar 2000 23:47:36 -0800 (PST) Message-Id: <4.2.2.20000322234227.00a1cb60@mail.earthlink.net> X-Sender: telemedic@mail.earthlink.net X-Mailer: QUALCOMM Windows Eudora Pro Version 4.2.2 Date: Wed, 22 Mar 2000 23:49:12 -0800 To: wilderness-emergency-medicine@list.pitt.edu From: Fred Wu Subject: Re: W-EMED subscription In-Reply-To: <49.2090757.260b14fe@aol.com> Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii"; format=flowed Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Robin, There are programs in Colorado and Wyoming offered by the Wilderness Medicine Institute of NOLS. The contact information is listed below. WMI of NOLS PO Box 9 Pitkin, CO 81241 (970)641-3572 wmi@nols.edu http://wmi.nols.edu/ Fred At 01:34 AM 3/23/00 -0500, you wrote: >Hey, i dont know if yaull are the ones that have the Colorado and Wyoming >wilderness training but if so Please send me some information. I plan on >taking one of the classes in Summer of 2001 when i finish EMT paramedics >course >Thank you >Robin Peck >PO BOX 546 >Port Allen, LA 70767 >Do not reproduce without author's express permission. >To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" >as the body of a message (no subject) To: Majordomo@list.pitt.edu >Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc07.srv.cis.pitt.edu (root@post-ofc07.srv.cis.pitt.edu [136.142.185.73]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Thu, 23 Mar 2000 01:53:36 -0500 (EST) Received: from localhost (root@localhost) by post-ofc07.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.3) ID ; Thu, 23 Mar 2000 01:53:03 -0500 (EST) Received: via switchmail; Thu, 23 Mar 2000 01:53:03 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 23 Mar 2000 01:36:43 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Thu, 23 Mar 2000 01:35:15 -0500 (EST) Received: from imo-d06.mx.aol.com (imo-d06.mx.aol.com [205.188.157.38]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Thu, 23 Mar 2000 01:35:12 -0500 (EST) From: NIBORS23@aol.com Received: from NIBORS23@aol.com by imo-d06.mx.aol.com (mail_out_v25.3.) id h.49.2090757 (7703) for ; Thu, 23 Mar 2000 01:34:38 -0500 (EST) Message-ID: <49.2090757.260b14fe@aol.com> Date: Thu, 23 Mar 2000 01:34:38 EST Subject: W-EMED subscription To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 68 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Hey, i dont know if yaull are the ones that have the Colorado and Wyoming wilderness training but if so Please send me some information. I plan on taking one of the classes in Summer of 2001 when i finish EMT paramedics course Thank you Robin Peck PO BOX 546 Port Allen, LA 70767 Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc05.srv.cis.pitt.edu (root@post-ofc05.srv.cis.pitt.edu [136.142.185.10]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Wed, 22 Mar 2000 01:11:54 -0500 (EST) Received: from localhost (root@localhost) by post-ofc05.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Wed, 22 Mar 2000 01:11:17 -0500 (EST) Received: via switchmail; Wed, 22 Mar 2000 01:11:17 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 22 Mar 2000 01:09:34 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Wed, 22 Mar 2000 01:07:36 -0500 (EST) Received: from mail.iwvisp.com (mail.iwvisp.com [198.77.196.4]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Wed, 22 Mar 2000 01:07:30 -0500 (EST) Received: from iwvisp.com ([198.77.198.123]) by mail.iwvisp.com with ESMTP (IPAD 2.52/64) id 8875300; Tue, 21 Mar 2000 22:02:54 -0800 Message-ID: <38D86323.659CC713@iwvisp.com> Date: Tue, 21 Mar 2000 22:07:41 -0800 From: chris antonsen Organization: none X-Mailer: Mozilla 4.72 (Macintosh; U; PPC) X-Accept-Language: en MIME-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: W-EMED Re: Much ado about whistle signals References: Content-Type: text/plain; charset=us-ascii; x-mac-type="54455854"; x-mac-creator="4D4F5353" Content-Transfer-Encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Raised in rural Montana (near Yellowstone National Park) I learned the 'local' custom of 3 as the recognized distress signal. Given the option, that's still the signal I would use (be it whistle blasts or gun shots or whatever). However, if I was lost, fatigued, suffering from exposue and/or dehydration, and perhaps injured as well I might very well end up giving a single long blast, beginning strong and trailing off as my energy and breath drained, and repeated as often as I had energy to do it. I now have a fair amount of 'formal' experience in SAR (through membership in an MRA group and elsewhere) and I can only ask, "When on a search and a signal is heard that cannot definitively be ascribed to another searcher, why wouldn't you investigate?" Be it 1, 3, 6 or whatever, especially if it repeats from a given direction, it warrents investigating. The incident commander (or whatever the local equivalent is) should have defined a signal system (if intra-search communications are in fact being done by whistles) and ANY signal that deviates from that and/or keeps coming from the same place should be checked out. My personal experience is that search teams are broken into small groups (2 to 3) and each group has at least one radio. Within the group members seldom get very far beyond voice range (unless everyone has a radio), and even then re-contact is frequent (necessary). So if you hear a whistle blast it can rather quickly be determined whether or not it can definitively be assigned to another searcher (a positive confirmation from that from the searcher). Even then, it would be prudent to at least pause, and wait for the signal to repeat from the same local. As I recall, in the Hug-A-Tree program (a _real_ life saver - many documented cases where the lives of children have been saved because of what they learned in a 1 hour assembly) the rule on whistles is always carry one and use it ONLY when you are lost or in trouble. There is no effort to drill in some arbitrary pattern. Lets face, most lost people haven't had formal training in the right or wrong way(s) to use a whistle. If they have one at all, it's because somewhere they gleaned the idea that it would be smart to take one along 'just in case', and that's all the more they know about it. Just my penny's worth of thought(?). kit Douglas Burchard wrote: > Just to through a little more controversy into this... > > My 1997 copy of Rescue 3 International's Swiftwater Rescue Technician 1 > textbook shows 3 blasts of a whistle as meaning "move or look down stream". > And yes, live in the USA. According to the same book however, 3 blasts > repeated means "Emergency". Which sounds like it's similar to the UK > standard of 6 blasts (See Russell Hore's post earlier today). > > -- > Douglas Burchard, OEC, WEMT-B email: burchard@nwlink.com > King County Search and Rescue (KCSARA) phone: 425/562-1968 > Training Coordinator fax: 208/293-8639 > > Do not reproduce without author's express permission. > To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" > as the body of a message (no subject) To: Majordomo@list.pitt.edu > Submissions To: wilderness-emergency-medicine@list.pitt.edu Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc02.srv.cis.pitt.edu (root@post-ofc02.srv.cis.pitt.edu [136.142.185.24]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Tue, 21 Mar 2000 18:18:22 -0500 (EST) Received: from localhost (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 21 Mar 2000 18:17:47 -0500 (EST) Received: via switchmail; Tue, 21 Mar 2000 18:17:47 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 21 Mar 2000 18:17:38 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 21 Mar 2000 18:16:40 -0500 (EST) Received: from smtp.nwlink.com (smtp.nwlink.com [209.20.130.57]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 21 Mar 2000 18:16:34 -0500 (EST) Received: from [207.202.175.2] (ip2.r12.d.bel.nwlink.com [207.202.175.2]) by smtp.nwlink.com (8.9.3/8.9.3) with ESMTP id PAA13116 for ; Tue, 21 Mar 2000 15:16:30 -0800 (PST) User-Agent: Microsoft Outlook Express Macintosh Edition - 5.01 (1630) Date: Tue, 21 Mar 2000 15:15:46 -0800 Subject: Re: W-EMED Question about survival whistle signals From: Douglas Burchard To: Message-ID: In-Reply-To: <200003212102.NAA08226@macs.mxim.com> Mime-version: 1.0 Content-type: text/plain; charset="US-ASCII" Content-transfer-encoding: 7bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Just to through a little more controversy into this... My 1997 copy of Rescue 3 International's Swiftwater Rescue Technician 1 textbook shows 3 blasts of a whistle as meaning "move or look down stream". And yes, live in the USA. According to the same book however, 3 blasts repeated means "Emergency". Which sounds like it's similar to the UK standard of 6 blasts (See Russell Hore's post earlier today). -- Douglas Burchard, OEC, WEMT-B email: burchard@nwlink.com King County Search and Rescue (KCSARA) phone: 425/562-1968 Training Coordinator fax: 208/293-8639 Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc06.srv.cis.pitt.edu (root@post-ofc06.srv.cis.pitt.edu [136.142.185.43]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Tue, 21 Mar 2000 16:47:23 -0500 (EST) Received: from localhost (root@localhost) by post-ofc06.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 21 Mar 2000 16:46:37 -0500 (EST) Received: via switchmail; Tue, 21 Mar 2000 16:46:35 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 21 Mar 2000 16:45:26 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 21 Mar 2000 16:43:47 -0500 (EST) Received: from macs.mxim.com (macs.mxim.com [204.17.143.130]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 21 Mar 2000 16:43:25 -0500 (EST) Received: from localhost (localhost [127.0.0.1]) by macs.mxim.com (8.7/8.6.9) with SMTP id NAA08226 for ; Tue, 21 Mar 2000 13:02:56 -0800 (PST) Message-Id: <200003212102.NAA08226@macs.mxim.com> X-Mailer: exmh version 2.0.1 12/23/97 To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: W-EMED Question about survival whistle signals In-reply-to: Your message of "Tue, 21 Mar 2000 12:43:35 EST." <3.0.1.32.20000321124335.008bf100@mail.vt.edu> Mime-Version: 1.0 Content-Type: text/plain; charset=us-ascii Date: Tue, 21 Mar 2000 13:02:55 PST From: Hal Lillywhite Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu I agree it would be nice to get an international standard on number of whistle blasts (or other signal)to call for help. I've heard that some places (I don't remember where) the standard is *9*! It is quite clear that the standard in one country won't necessarily be the standard somewhere else. Absent an international body with jurisdiction in this area maybe the various SAR groups could just try to agree on something. I don't know how many countries have organizations like NASAR in the US but if such bodies got together and agreed on a standard, then publicized it, I think it would be accepted. My own preference is a distress signal of three blasts or whatever. The reason is that by the time someone is in need of help, that person is often tired, thirsty, hungry and cold. The energy level is usually low. If the requirement is for 6 or 9 whistle blasts I'm afraid the last few may be rather weak. I would prefer to see the person in distress give three good, solid blasts rather than run out of gas on number 5 or number 7 etc. Three is *usually* enough to be distinct from non-distress whistling but doesn't require the effort of 6 or 9 blasts. I think three is about as good a compromise as we are likely to find. (As a lighter aside, a few years ago I was on a search around Mt. Hood, Oregon. Most of us were using police (or sports official) type whistles. That became a real problem since some birds in the area have a call similar to those whistles. We would blow our standard two blasts and the birds would answer. We eventually found the subjects but they must have had a hard time distinguishing between us and the birds by sound.) Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc04.srv.cis.pitt.edu (root@post-ofc04.srv.cis.pitt.edu [136.142.185.11]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Tue, 21 Mar 2000 14:46:07 -0500 (EST) Received: from localhost (root@localhost) by post-ofc04.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 21 Mar 2000 14:44:36 -0500 (EST) Received: via switchmail; Tue, 21 Mar 2000 14:44:36 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 21 Mar 2000 12:46:38 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 21 Mar 2000 12:43:20 -0500 (EST) Received: from mailman.naxs.com (mailman.naxs.com [216.98.64.6]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 21 Mar 2000 12:43:16 -0500 (EST) Received: from fairbanks ([151.199.74.193]) by mailman.naxs.com (Post.Office MTA v3.1.2 release (PO205-101c) ID# 0-42723U8000L3500S0) with SMTP id AAA211 for ; Tue, 21 Mar 2000 12:43:20 -0500 Message-Id: <3.0.1.32.20000321124335.008bf100@mail.vt.edu> X-Sender: crourke@mail.vt.edu X-Mailer: Windows Eudora Light Version 3.0.1 (32) Date: Tue, 21 Mar 2000 12:43:35 -0500 To: wilderness-emergency-medicine@list.pitt.edu From: Chris Rourke Subject: Re: W-EMED Question about survival whistle signals In-Reply-To: <4b.208255e.2608f8b9@aol.com> Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu Heck, we can't even agree what side of the road to drive on, or what units to use to measure the speed we're driving. What chance do we have with whistle codes? For what its worth, I think both 3 and 6 have certain disadvantages. Three whistle blasts or gunshots could easily happen by chance, or by someone ignorant playing with a whistle, six is a bit more reliable. On the other hand, firing off six rounds of ammo, or building six fires in a row could be a bit of a pain. I think if I was ever so lost that I wasn't sure if I was in england or north america, I'd probably just stick to whistling out SOS in morse code. A bit breath intensive, but its not likely to be confused for anything other than a distress call. Chris Rourke Do not reproduce without author's express permission. To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine" as the body of a message (no subject) To: Majordomo@list.pitt.edu Submissions To: wilderness-emergency-medicine@list.pitt.edu -- End -- Return-Path: Received: from post-ofc01.srv.cis.pitt.edu (root@post-ofc01.srv.cis.pitt.edu [136.142.185.25]) by imap.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisimap-7.2.2.3) ID ; Tue, 21 Mar 2000 11:12:44 -0500 (EST) Received: from localhost (root@localhost) by post-ofc01.srv.cis.pitt.edu (8.8.8/8.8.8/cispo-7.2.2.2) ID ; Tue, 21 Mar 2000 11:12:13 -0500 (EST) Received: via switchmail; Tue, 21 Mar 2000 11:12:13 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Tue, 21 Mar 2000 11:11:43 -0500 (EST) Received: from localhost (majordom@localhost) by list.srv.cis.pitt.edu (8.8.8/8.8.8/cisls-7.2.2.1) ID ; Tue, 21 Mar 2000 11:10:16 -0500 (EST) Received: from imo-d02.mx.aol.com (imo-d02.mx.aol.com [205.188.157.34]) by list.srv.cis.pitt.edu with ESMTP (8.8.8/8.8.8/cisls-7.2.2.1) ID for ; Tue, 21 Mar 2000 11:10:06 -0500 (EST) From: JadedMedic@aol.com Received: from JadedMedic@aol.com by imo-d02.mx.aol.com (mail_out_v25.3.) id h.4b.208255e (6694) for ; Tue, 21 Mar 2000 11:09:29 -0500 (EST) Message-ID: <4b.208255e.2608f8b9@aol.com> Date: Tue, 21 Mar 2000 11:09:29 EST Subject: Re: W-EMED Question about survival whistle signals To: wilderness-emergency-medicine@list.pitt.edu MIME-Version: 1.0 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit X-Mailer: AOL 5.0 for Windows sub 66 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk Reply-To: wilderness-emergency-medicine@list.pitt.edu In a message dated 3/21/00 1:20:54 AM Pacific Standard Time, Russell.Hore@capgemini.co.uk writes: > In the UK 'we' recommend 6 short blasts(noises) at one minute intervals. If > we hear this pattern, we as rescuers, respond with 3 short > blasts(noises)/minute. > The same pattern can be used with a torch etc. Hi there, [nod] Yeah, this is the sort of thing I was talking about. Over here on the left side of the pond, three short blasts is much more commonly taught as an "I need help" signal instead of an "I'm going to help you" signal. (Two short blasts is the most commonly taught "I'm going to help you" signal over here.) The potential for dangerous confusion and miscommunication is obvious. There seems to be a complete lack of standardization about this topic (and some others, but I'll stay away from them for now). It seems to me that it would be A Good Thing if this sort of thing could be internationally standardized so that all teachers of outdoor survival and/or search and rescue could be teaching the same thing to their students. However, I'm not at all sure that any sort of international