患者撤離指引和風險管理 Evacuation Guidelines & Risk Management

Jackwabbit

Evacuation/Transport (患者撤離/後送) 是 搜索和救援行動 (search & rescue operation) 的最後一個步驟 ( LAST= Locate, Access, Stabilize,  Transport; 搜索策略和搜索術 )。這是一個比較複雜的綜合課題。整體過程可以很快和簡單，但是又可以持續多日和十分複雜。

在最理想的情況下，決策者 (decision maker)/領導者 (leader) 通常需要有豐富的戶外和急救經驗，對整體情況有一個持續的意識 (situational awareness) 和正確的判斷力 (sound judgement)，能夠平衡風險和利益 (risk vs. benefit)；在需要時能夠堅持原則，但又可以靈活地改變計畫 (be flexible)；除了需要和各單位聯絡和精確地溝通 (a skilled communicator)，又需要考慮患者及其家人的需要...。

一個能幹的決策者不會盲目地跟從這些撤離/後送指引 (evaculation guidelines)，而會視乎情況去靈活地運用指引中的原則。通常一個比較保守(穩陣)的計策是安全過一個進取的計策。決策者最終的目的是把患者和所有的搜救人員，在合理的時間中，安全地撤離到適當的地方或設施。

參考(英文) References:
Advanced Wilderness Life Support PPT: http://awlsmedstudents.org/images/AWLS___Evacuation_Guidelines.ppt  or
   http://www.wildernessmed.org/images/WFR_-_Evacutation_Guidelines_v_2.0.ppt
WMS Practice Guidelines (5ed): http://www.falcon.com/pdf_files/9780762741021.pdf
WMTC Evacuation Guidelines: http://www.wildmedcenter.com/uploads/5/9/8/2/5982510/evacuation.pdf
   http://wildernessmedicine.wikispaces.com/evacuation
WMI-NOLS Wilderness Medical Practices & Protocols (2007, pg3, Evacuation Decisions):
   http://www.nols.edu/nolspro/pdf/WildMedProtocolsPracAug07.pdf
Evacuation Guidelines (R Ingebretsen, BWLS 2012 Ch 19): http://hedu5800.org/images/Chp_19-_Evac_Guidelines.pdf
more later...

== Fin ==

Jackwabbit

Evacuation Matrix:  Urgency (serious) vs. Risk ( usually faster, e.g. helicopter evac. )
If a patient's condition is serious (i.e. urgent), e.g. having problems with RABC (response, airway, breathing, circulation), then a high risk evcauation is justified.  In contrast, if a person is not injured or only lightly injured (i.e. no urgency), the incident leader should plan a low risk evacuation.  
Mismatched decisions: (a) non-serious situation + urgent (usually high risk) evacuation  OR  (b)  serious situation + non-urgent (usually low risk) evacuation

Jackwabbit

Risk Management for Adventure (Dom Hall, Oct 2013): http://www.theadventuremedic.com/features/risk-management-adventure/?utm_source=newsletter&utm_medium=email&utm_campaign=feb_2014

Risk -- the anatomy of chance and uncertainty: Grant Statham at TEDxC (Nov 2013):
  http://www.youtube.com/watch?v=WGZu5Lzgv1A#t=204
Every day, every one of us make choices and decisions in the face of uncertainty. Guided by a blend of intuition and logic, we spend a large part of our lives navigating the murky waters of chance. This is the space between 0 and 1; this is risk, and we confront it daily. But how many of us really understand the underlying constructs of risk? What is risk, and how do we break it down to better understand the decisions we face? How does probability, consequence, exposure and vulnerability play out in the choices we make and they impacts they have? In this captivating presentation, Grant Statham takes us on a journey into the heart of risk by weaving stories, ideas and concepts together with stunning images from a lifetime spent in high places.