Well over 900 total pages ... 1. National Park Service EMERGENCY MEDICAL SERVICES PROTOCOLS AND PROCEDURES How To Use This Manual Manual Organization. Sections: the manual is organized into four sections. Subjects are organized alphabetically within the sections and numbered as follows (see Table of Contents): General Information Section 0000-0999. Procedures 1000-1999. Protocols 2000-2999. Drugs 3000-3999. Subject: each individual subject is identified in the subject page header and footer by: Subject Title: Header. Manual Title: Footer, lower left. Manual Revision Date: Footer, lower left. Manual Section: Footer, lower right. Subject Number: Footer, lower right. Table of Contents: Each Procedure, Protocol, and Drug is listed by section, in alphabetical and numerical order. Gaps in the number sequence allow future entries to be inserted in the correct order. 2. Homeland Security Austere Emergency Medical Support (AEMS) Field Guide The following protocols outline the emergency medical support that can be administered under austere conditions by emergency medical services (EMS) providers credentialed by the Department of Homeland Security (DHS) Offi ce of Health Affairs (OHA). These protocols are intended to supplement the DHS/OHA Basic Life Support (BLS) and Advanced Life Support (ALS) protocols when providers are operating in austere environments. The protocols guide the management of individual patients while considering the circumstances under which patient evaluation and treatment may occur. Any given patient may require the use of a single protocol, a portion of a protocol, or a combination of several protocols. OHA expects that providers will use the protocols to assess, and to establish a treatment plan for each patient. 3. United States Marine Corps WILDERNESS MEDICINE COURSE STUDENT HANDBOOK Table Of Contents CHAPTER 1 MOUNTAIN SAFETY 2 NUTRITION 3 WILDERNESS PATIENT ASSESSMENT 4 HIGH ALTITUDE ILLNESS 5 HEAT RELATED INJURIES 6 COMBAT CASUALTY CARE 7 BURN MANAGEMENT 8 HYPOTHERMIA / REWARMING 9 SUBMERSION INCIDENTS 10 WILDERNESS ORTHOPEDIC INJURIES 11 TREATMENT OF REPTILE AND ANTHROPOD ENVENOMATION 12 COLD INJURIES 13 LAND NAVIGATION 14 SEARCH AND RESCUE APPENDIX A SURVIVAL TECHNIQUES A1 REQUIREMENTS FOR SURVIVAL A2 SURVIVAL KIT A3 SURVIVAL SIGNALING A4 SURVIVAL SHELTERS AND FIRES A5 SURVIVAL NAVIGATION A6 WATER PROCUREMENT A7 FORAGING ON PLANTS AND INSECTS A8 TRAPS AND SNARES A9 MOUNTAIN WEATHER APPENDIX B SWIFT WATER RESCUE B1 RESCUE PHILOSOPHY FOR SWIFTWATER RESCUE TEAMS B2 PERSONAL AND TEAM EQUIPMENT B3 SWIFTWATER TERMINOLOGY AND DYNAMICS B4 COMMUNICATIONS B5 THROW BAGS AND FOOT ENTANGLEMENTS B6 DEFENSIVE SWIMMING AND FERRY ANGLE B7 F EET - W ET RESCUES AND C - S PINE ROLLS B8 BOATS AND BOAT HANDLING B9 ROPE SYSTEMS AND BOAT ANCHORS B10 VEHICLE RESCUES B11 STREAM CROSSING APPENDICES C C1 ROPE MANAGEMENT C2 NOMENCLATURE AND CARE OF MOUNTAINEERING EQUIPMENT C3 BALANCE CLIMBING C4 NATURAL AND ARTIFICIAL ANCHORS C5 SIT HARNESS C6 ESTABLISHMENT OF RAPPEL POINTS AND RAPPELLING C7 TOP ROPING C8 MOUNTAIN CASUALTY EVACUATIONS C9 ONE ROPE BRIDGE C10 SUMMER MOUNTAIN WARFIGHTING LOAD REQUIREMENTS 15 TRIAGE 16 PREVENTIVE MEDICINE / WATER PURIFICATION

The following protocols outline the emergency medical support that can be administered under austere conditions by emergency medical services (EMS) providers credentialed by the Department of Homeland Security (DHS) Office of Health Affairs (OHA). These protocols are intended to supplement the DHS/OHA Basic Life Support (BLS) and Advanced Life Support (ALS) protocols when providers are operating in austere environments. Much of the guidance in these protocols will be of greater use to other providers responsible for medical support to DHS operations under austere conditions. EMS providers operating under remote, austere, or hostile conditions are expected to provide pre-hospital care in these dangerous environments with little or no support when operational security is a consideration. In some situations, communications are not assured and evacuation may be delayed significantly. Care providers in an austere situation may be forced to improvise and adapt their medical procedures based on extant circumstances to provide care for and prepare the patient for evacuation to a safer environment. This guide, in conjunction with standard EMT/paramedic protocols, is intended to improve the DHS providers' capability to provide the best possible pre-hospital care until the patient can be transferred for definitive medical treatment.

Wilderness EMS is designed for EMS providers and leaders who deliver medical care in the wilderness, and those practicing wilderness medicine as part of a formal team. The textbook is a comprehensive, expertly-written reference ideal for this fast-changing and multidisciplinary specialty. This first-of-its-kind text provides specialized instruction and best practices for wilderness EMS practitioners and students – crucial information for the success of today’s rescue missions. A strong foundation in evidence-based medicine, clinical experience, and field applicability makes it especially useful for any EMS provider in a wilderness environment.

Remote Medic Field Guide: A Practical Approach is just that, a practical guide. This text has been written to provide trained Remote Medics with a reference guide to care for individuals in need of not only emergency care but also many of the non-emergent clinical medical issues that arise in isolated locations. It is assumed that the medics utilizing this material are trained to a level of at least emergency medical technician or higher, and are properly supplied and equipped. This is not a survival or 'do-it-yourself' manual. Rather it is a combination of several fields of medicine and treatment regimens that would apply to the Remote Medic's skill set in an isolated area. In many cases, the Remote Medic working in these areas of the world, isolated from definitive healthcare facilities or advanced emergency medical services, may be the only source of healthcare for those in his or her charge. As such, their mission may not be limited to providing emergency care to those critically ill or injured. It will also involve dealing with common medical issues that are experienced on a day-to-day basis. Evacuation or advanced assistance can be hours, if not days away. Not ideal conditions by any means. The information contained in this book is presented in a straight forward, "nuts-and-bolts" way. The clinical issues are formatted in a, 'what it is, what causes it, what are the signs and symptoms, and how do we treat it' manner for ease of use. It is sincerely hoped that this practical guide will find its way into every Remote Duty Medic's kit and make life a little easier along the way.

Disclaimer: These guidelines were developed as a reference for the Counter-Narcotics and Terrorism Operational Medical Support (CONTOMS) Program. The guidelines and protocols provided in this manual are based on the most current information available at the time of publication. Every effort has been made to ensure the accuracy of this information, but the CONTOMS Program cannot be responsible for discrepancies or typographical errors. Since medical practice is continually evolving, providers are reminded to remain cognizant of the most current practices that may revise or replace the approach adopted in this publication. Providers are also cautioned not to rely on this manual as a sole source of information about patient care, but rather to tailor their therapy to the clinical context and to consult medical control for any concerns. Foreword These protocols are issued by the Office of Health Affairs of the Department of Homeland Security (DHS). These protocols are for the use of licensed Emergency Medical Service (EMS) providers authorized to provide medical care in the Department. The protocols contained within this text are the “Standard of Care” within those areas regulated under DHS. These protocols outline and define the expected level of care that should be administered to patients treated by approved DHS EMS providers. These combined protocols create a dynamic document that must be applied relevant to individual patient presentations and situations. An individual patient may require the application of a single protocol, a portion of a protocol, or a combination of several protocols, in order to adequately treat the patient’s condition. It is the expectation of DHS OHA that providers utilize the protocols, patient assessment, and clinical findings cooperatively to establish a treatment plan for each patient. These protocols provide for patient care capabilities identified as acceptable protocols by the Office of Health Affairs and approved for adoption by DHS agency EMS programs. Program Medical Director approval and approved training and skills testing are required for these protocols to be adopted and available for use. Specific components of the protocols, therefore, may not be available to all DHS personnel. The scope of the medication and equipment is defined by operational capabilities and are approved by the Program Medical Director.

This field manual provides essential emergency information from assess ment to medications to protocols and procedures for EMTs, paramedics, and emergency room personnel.

This handbook incorporates requirements, information, and procedures formerly contained in AFSOC SG policy letters. This Handbook applies to all active duty AFSOC 4F0X1 and 4N0X1 personnel, certified at the Emergency Medical Technician- Intermediate and Paramedic level, as outlined in AFSOCI 48-101. Medical Control Care of injured personnel in combat or rescue situations requires medical command and control by licensed medical providers. Paramedical and Emergency Medical Technician-Intermediates providing care in these situations are acting under the principal of ‘delegated authority’, where the provider(usually a physician) allows appropriately trained personnel to perform specified diagnostic and therapeutic interventions. There are several types of medical control: - On Line Medical Control: A physician is either present on the scene and personally directs patient care, or is contacted by radio or other means and gives ‘live’ instructions. -Off Line Medical Control: Contact with a control physician is impossible or impractical, care is given based on specific physician approved protocols. The medical control chain for AFSOC medical technicians assigned to Operations Support Squadron Medical Flights(OSS/OSM) is in the following precedence: On Line Medical Control: - Senior AFSOC Flight Surgeon present at the scene. - Special Tactics Flight Surgeon present at the scene. - Senior US military physician present at the scene. - Qualified(training equivalent to US physician) Allied country senior military physician present at the scene - Qualified civilian physician(training equivalent to US MD or DO) present at the scene, provided he/she agrees to assume responsibility for care and accompany the patient to higher level of care. - Senior AFSOC Physician Assistant present at the scene - Any of the above in direct radio contact Off Line Medical Control: On line medical control is the preferred means of medical control for all casualty situations. In the event on line control is not possible the following will apply: - The Senior medic is responsible for directing medical care at all scenes where on line control is not possible. He/she will direct medical control in strict adherence to the established protocols contained herein. - AFSOC medical technicians assigned to OSS/OSM flights will attempt to contact on line medical control in all situations prior to reverting to protocol use, with the exception of an immediate life threat and then will attempt to establish on line control as soon as possible after the patient is stabilized.