Scene Size-up



Volume 27 Number 5

We have asked several members of the SOLO staff who also work in remote settings to write up occasional first-hand experiences where some point or principle of wilderness medicine was underscored, relearned, or re-enforced.

We are calling these new segments “Reports From the Field,” and you will see them periodically as a new addition to the newsletter.

Our first Report comes from SOLO instructor Lee Lang who is a Protection Ranger at Yosemite National Park.


Scene Size-up Starts Sooner than Later:

By Lee Lang

Scene size-up should start as soon as you begin responding, and those first decisions may be just as critical as your later ones.HardenLake&DozerDome-028

The Grand Canyon of the Tuolomne for most people is generally a four-day hike. The typical hiker starts in Tuolomne Meadows, Yosemite National Park, and hikes down the canyon, exiting via the Pate Valley trail in White Wolf, a grueling 10-mile hike with more than 4000 feet of climbing. In mid-July the temperatures in Pate Valley can easily reach 104 F. The Pate Valley trail sees sun for most of the day, and the lower half to two-thirds of the trail is treeless and dark granite. The upper portion commonly meanders through high ground cover ensuring little air movement. Even though it is several thousand feet higher in elevation, on this July afternoon the temperature was in the mid-90s. I was several miles out from White Wolf on road patrol when I was dispatched:

Mike 52 – We have a report of 23-yr-old female near Hardin Lake. The RP reports that she is unresponsive, hot, dry, and pink. The RP states the hiker walked out of Pate Valley, and the patient drank very little fluid throughout the day.

A flurry of radio traffic ensues, and the decisions made are critical. I arrive at the trail head in several minutes and prepare for my 2.5 mile hasty approach. I know that a Park Medic is responding to the helitack base and is preparing to spool-up for a short-haul operation. A second ranger is en-route to the trail head but will be 20-30 minutes behind me. A ground SAR team, including a paramedic, is also being assembled but will be nearly an hour and a half behind.

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Critical Care and the Patient Assessment System Part II

This is the second of two articles on the Patient Assessment System (PAS). In the first article, we reviewed the entire PAS, paying particular attention to the areas of the PAS that can indicate an emergent problem requiring immediate care. In this edition of the WMN, we will review the PAS and Critical Care—taking a close look at the patient’s chief complaints which would indicate an underlying potentially life-threatening injury or illness that would necessitate immediate care and attention. In particular, we will review the differential diagnosis and management for changes in level of consciousness, chest pain, shortness of breath, and shock.

May/June 2007    ISSN-1059-6518    Volume 20 Number 3

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Critical Care and the Patient Assessment System

The way in which you handle the first five minutes

of an emergency can make the difference between life and Read more