1
|
Van Tilburg C, Paal P, Strapazzon G, Grissom CK, Haegeli P, Hölzl N, McIntosh S, Radwin M, Smith WWR, Thomas S, Tremper B, Weber D, Wheeler AR, Zafren K, Brugger H. In Reply to Drs. Rousson, Hall, and Pasquier. Wilderness Environ Med 2024; 35:252-253. [PMID: 38629489 DOI: 10.1177/10806032241245617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Christopher Van Tilburg
- From Occupational Medicine, Mountain Clinic, and Emergency Medicine, Providence Hood River Memorial Hospital, Hood River, OR, USA
- Mountain Rescue Association, San Diego, CA, USA
- MedCom, International Commission for Alpine Rescue, Zurich, Switzerland
| | - Peter Paal
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Giacomo Strapazzon
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Colin K Grissom
- Department of Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT, USA
| | | | - Natalie Hölzl
- International Commission for Alpine Rescue
- German Association of Mountain and Expedition Medicine, Munich, Germany
| | - Scott McIntosh
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Martin Radwin
- From Occupational Medicine, Mountain Clinic, and Emergency Medicine, Providence Hood River Memorial Hospital, Hood River, OR, USA
- Department of Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT, USA
| | - William Will R Smith
- Mountain Rescue Association, San Diego, CA, USA
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT, USA
- Department of Emergency Medicine, St. Johns Health, Jackson, WY, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Stephanie Thomas
- Mountain Rescue Association, San Diego, CA, USA
- International Commission for Alpine Rescue
| | | | - David Weber
- Intermountain Life Flight, Salt Lake City, UT, USA
| | - Albert R Wheeler
- Mountain Rescue Association, San Diego, CA, USA
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT, USA
- Department of Emergency Medicine, St. Johns Health, Jackson, WY, USA
| | - Ken Zafren
- Emergency Department, Himalayan Rescue Association, Kathmandu Nepal
- Emergency Department, Stanford University Medical Center, Palo Alto, USA
| | - Hermann Brugger
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| |
Collapse
|
2
|
Fink PB, Wheeler AR, Smith WR, Brant-Zawadzki G, Lieberman JR, McIntosh SE, Van Tilburg C, Wedmore IS, Windsor JS, Hofmeyr R, Weber D. Wilderness Medical Society Clinical Practice Guidelines for the Treatment of Acute Pain in Austere Environments: 2024 Update. Wilderness Environ Med 2024; 35:198-218. [PMID: 38651342 DOI: 10.1177/10806032241248422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
The Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded based on the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. This is an update of the 2014 version of the "WMS Practice Guidelines for the Treatment of Acute Pain in Remote Environments" published in Wilderness & Environmental Medicine 2014; 25:41-49.
Collapse
Affiliation(s)
- Patrick B Fink
- Department of Emergency Medicine, University of Utah, Salt Lake City, UT
| | - Albert R Wheeler
- Department of Emergency Medicine, St. John's Health, Jackson, WY
| | - William R Smith
- Department of Emergency Medicine, St. John's Health, Jackson, WY
| | | | | | - Scott E McIntosh
- Department of Emergency Medicine, University of Utah, Salt Lake City, UT
| | | | - Ian S Wedmore
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | - Ross Hofmeyr
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - David Weber
- Mountain Rescue Collective, LLC, Park City, UT
| |
Collapse
|
3
|
Van Tilburg C, Paal P, Strapazzon G, Grissom CK, Haegeli P, Hölzl N, McIntosh S, Radwin M, Smith WWR, Thomas S, Tremper B, Weber D, Wheeler AR, Zafren K, Brugger H. Wilderness Medical Society Clinical Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents: 2024 Update. Wilderness Environ Med 2024; 35:20S-44S. [PMID: 37945433 DOI: 10.1016/j.wem.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/03/2023] [Accepted: 05/10/2023] [Indexed: 11/12/2023]
Abstract
To provide guidance to the general public, clinicians, and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to revise the evidence-based guidelines for the prevention, rescue, and resuscitation of avalanche and nonavalanche snow burial victims. The original panel authored the Wilderness Medical Society Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents in 2017. A second panel was convened to update these guidelines and make recommendations based on quality of supporting evidence.
Collapse
Affiliation(s)
- Christopher Van Tilburg
- Occupational Medicine, Mountain Clinic, and Emergency Medicine, Providence Hood River Memorial Hospital, Hood River, OR
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
| | - Peter Paal
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Giacomo Strapazzon
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Colin K Grissom
- Department of Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT
| | | | - Natalie Hölzl
- International Commission for Alpine Rescue
- German Association of Mountain and Expedition Medicine, Munich, Germany
| | - Scott McIntosh
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT
| | | | - William Will R Smith
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT
- Department of Emergency Medicine, St. Johns Health, Jackson, WY
- University of Washington School of Medicine, Seattle, WA
| | - Stephanie Thomas
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
| | | | - David Weber
- Intermountain Life Flight, Salt Lake City, UT
| | - Albert R Wheeler
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT
- Department of Emergency Medicine, St. Johns Health, Jackson, WY
| | - Ken Zafren
- International Commission for Alpine Rescue
- Himalayan Rescue Association, Kathmandu, Nepal
- Stanford University Medical Center, Palo Alto, CA
| | - Hermann Brugger
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| |
Collapse
|
4
|
Nichols TB, Hawley AC, Smith WR, Wheeler AR, McIntosh SE. Avalanche Safety Practices Among Backcountry Skiers and Snowboarders in Jackson Hole in 2016. Wilderness Environ Med 2018; 29:493-498. [PMID: 30213711 DOI: 10.1016/j.wem.2018.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 04/11/2018] [Accepted: 05/14/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Carrying standard safety gear (beacon, probe, and shovel), planning a route of descent, and recreating with companions can help to mitigate the risk of injury or death resulting from avalanches in the backcountry. The goal of this study was to identify factors associated with performance of these safety practices. METHODS A convenience sample of backcountry skiers and snowboarders was surveyed in 2016 at the backcountry gates of Jackson Hole Mountain Resort. Each participant was surveyed on characteristics including skill level, sex, age, prior avalanche education, and residency in the Jackson Hole area. Safety practices were also measured against avalanche hazard forecasts. Correlations were assessed using Fisher's exact testing. RESULTS A total of 334 participants were surveyed. Factors associated with carrying avalanche safety gear included higher expertise, being a resident of the Jackson Hole area, and prior avalanche education. Factors associated with having a planned route of descent included higher expertise and being a resident of the Jackson Hole area. Factors associated with recreating with companions included younger age and lower expertise. Sex had no association with any of the surveyed safety practices. Participants were less likely to carry avalanche safety gear on low avalanche hazard days. CONCLUSIONS Certain individual characteristics of backcountry skiers and snowboarders are associated with increased frequency of adherence to recommended safety practices. These findings suggest that particular categories of backcountry recreationists may benefit from further avalanche safety education. The results of this study could help direct future educational efforts among backcountry recreationists.
Collapse
Affiliation(s)
- Ty B Nichols
- Department of Emergency Medicine, George Washington University Medical Center, Washington, DC and; Division of Emergency Medicine, TeamHealth, West Region, Emergency Professionals of Colorado, Greeley, CO (Dr Nichols)
| | - Alana C Hawley
- Division of Emergency Medicine, McMaster University, Hamilton General Hospital, Hamilton, Ontario (Dr Hawley); Division of Emergency Medicine, University of Utah, Salt Lake City, UT (Drs Hawley, Wheeler, and McIntosh)
| | - William R Smith
- St. John's Medical Center, Jackson, WY (Drs Wheeler and Smith); Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA (Dr Smith)
| | - Albert R Wheeler
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT (Drs Hawley, Wheeler, and McIntosh); St. John's Medical Center, Jackson, WY (Drs Wheeler and Smith).
| | - Scott E McIntosh
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT (Drs Hawley, Wheeler, and McIntosh)
| |
Collapse
|
5
|
Blancher M, Albasini F, Elsensohn F, Zafren K, Hölzl N, McLaughlin K, Wheeler AR, Roy S, Brugger H, Greene M, Paal P. Management of Multi-Casualty Incidents in Mountain Rescue: Evidence-Based Guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol 2018; 19:131-140. [PMID: 29446647 PMCID: PMC6014052 DOI: 10.1089/ham.2017.0143] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Blancher, Marc, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R. Wheeler III, Steven Roy, Hermann Brugger, Mike Greene, and Peter Paal. Management of multi-casualty incidents in mountain rescue: Evidence-based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol. 19:131–140, 2018. Introduction: Multi-Casualty Incidents (MCI) occur in mountain areas. Little is known about the incidence and character of such events, and the kind of rescue response. Therefore, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) set out to provide recommendations for the management of MCI in mountain areas. Materials and Methods: Details of MCI occurring in mountain areas related to mountaineering activities and involving organized mountain rescue were collected. A literature search using (1) PubMed, (2) national mountain rescue registries, and (3) lay press articles on the internet was performed. The results were analyzed with respect to specific aspects of mountain rescue. Results: We identified 198 MCIs that have occurred in mountain areas since 1956: 137 avalanches, 38 ski lift accidents, and 23 other events, including lightning injuries, landslides, volcanic eruptions, lost groups of people, and water-related accidents. Discussion: General knowledge on MCI management is required. Due to specific aspects of triage and management, the approach to MCIs may differ between those in mountain areas and those in urban settings. Conclusions: Mountain rescue teams should be prepared to manage MCIs. Knowledge should be reviewed and training performed regularly. Cooperation between terrestrial rescue services, avalanche safety authorities, and helicopter crews is critical to successful management of MCIs in mountain areas.
Collapse
Affiliation(s)
- Marc Blancher
- 1 Department of Emergency Medicine, University Hospital of Grenoble-Alps , Grenoble, France .,2 The French Mountain Rescue Association (ANMSM) , Grenoble, France
| | - François Albasini
- 2 The French Mountain Rescue Association (ANMSM) , Grenoble, France .,3 Department of Emergency Medicine, St. Jean de Maurienne Hospital , St. Jean de Maurienne, France
| | | | - Ken Zafren
- 4 ICAR MedCom , Roethis, Austria .,5 Department of Emergency Medicine, Stanford University Medical Center , Stanford, California.,6 Alaska Mountain Rescue Group , Anchorage, Alaska
| | - Natalie Hölzl
- 7 Department of Anesthesiology and Intensive Care Medicine, Klinikum Kempten, Germany
| | - Kyle McLaughlin
- 8 Department of Emergency Medicine, Canmore, Canada .,9 Department of Emergency Medicine, University of Calgary , Calgary, Canada
| | - Albert R Wheeler
- 10 Department of Emergency Medicine, St John's Medical Center , Jackson, Wyoming.,11 Search and Rescue Medical Director, Grand Teton National Park , Jackson, Wyoming
| | - Steven Roy
- 12 Quebec Secours SAR, Resident Physician Elective in Wilderness Medicine, McGill University , Montreal, Canada
| | - Hermann Brugger
- 13 Institute of Mountain Emergency Medicine , EURAC Research, Bolzano, Italy
| | - Mike Greene
- 14 Emergency Medicine Physician, Medical Officer Mountain Rescue England and Wales , Whitehaven, England
| | - Peter Paal
- 15 Department of Anesthesiology and Intensive Care, Hospitallers Brothers Hospital, Paracelsus Medical University , Salzburg, Austria
| |
Collapse
|
6
|
Van Tilburg C, Grissom CK, Zafren K, McIntosh S, Radwin MI, Paal P, Haegeli P, Smith WWR, Wheeler AR, Weber D, Tremper B, Brugger H. Wilderness Medical Society Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents. Wilderness Environ Med 2017; 28:23-42. [PMID: 28257714 DOI: 10.1016/j.wem.2016.10.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/14/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
To provide guidance to clinicians and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the prevention, rescue, and medical management of avalanche and nonavalanche snow burial victims. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians.
Collapse
Affiliation(s)
- Christopher Van Tilburg
- Occupational, Travel, and Emergency Medicine Departments, Providence Hood River Memorial Hospital, Hood River, OR (Dr Van Tilburg); Mountain Rescue Association, San Diego, CA (Drs Van Tilburg, Zafren, Smith, and Wheeler).
| | - Colin K Grissom
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center and the University of Utah, Salt Lake City, UT (Dr Grissom)
| | - Ken Zafren
- Mountain Rescue Association, San Diego, CA (Drs Van Tilburg, Zafren, Smith, and Wheeler); Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA (Dr Zafren); International Commission for Mountain Emergency Medicine (Drs Brugger, Paal, and Zafren)
| | - Scott McIntosh
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT (Drs McIntosh and Wheeler)
| | - Martin I Radwin
- Iasis Healthcare Physician Group of Utah, Salt Lake City, UT (Dr Radwin)
| | - Peter Paal
- International Commission for Mountain Emergency Medicine (Drs Brugger, Paal, and Zafren); Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, United Kingdom (Dr Paal); Department of Anesthesiology and Critical Care Medicine, University Hospital, Innsbruck, Austria (Dr Paal)
| | - Pascal Haegeli
- School of Resource and Environmental Management, Simon Fraser University, Burnaby, BC (Dr Haegeli)
| | - William Will R Smith
- Mountain Rescue Association, San Diego, CA (Drs Van Tilburg, Zafren, Smith, and Wheeler); Department of Emergency Medicine, St. Johns Medical Center, Jackson, WY (Drs Smith and Wheeler); Clinical WWAMI Faculty, University of Washington School of Medicine, Seattle, WA (Dr Smith)
| | - Albert R Wheeler
- Mountain Rescue Association, San Diego, CA (Drs Van Tilburg, Zafren, Smith, and Wheeler); Division of Emergency Medicine, University of Utah, Salt Lake City, UT (Drs McIntosh and Wheeler); Department of Emergency Medicine, St. Johns Medical Center, Jackson, WY (Drs Smith and Wheeler)
| | - David Weber
- Denali National Park & Preserve, Talkeetna, AK (Mr Weber); Intermountain Life Flight, Salt Lake City, UT (Mr Weber)
| | - Bruce Tremper
- Utah Avalanche Center, Salt Lake City, UT (Mr Tremper)
| | - Hermann Brugger
- International Commission for Mountain Emergency Medicine (Drs Brugger, Paal, and Zafren); EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy (Dr Brugger)
| |
Collapse
|
7
|
Lane JP, Taylor B, Smith WR, Wheeler AR. Emergency Medical Service in the US National Park Service: A Characterization and Two-Year Review, 2012–2013. Wilderness Environ Med 2015; 26:531-5. [DOI: 10.1016/j.wem.2015.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 05/21/2015] [Accepted: 05/25/2015] [Indexed: 11/27/2022]
|
8
|
Russell KW, Scaife CL, Weber DC, Windsor JS, Wheeler AR, Smith WR, Wedmore I, McIntosh SE, Lieberman JR. Wilderness Medical Society practice guidelines for the treatment of acute pain in remote environments: 2014 update. Wilderness Environ Med 2015; 25:S96-104. [PMID: 25498266 DOI: 10.1016/j.wem.2014.07.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 06/21/2014] [Accepted: 07/10/2014] [Indexed: 01/21/2023]
Abstract
The Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded on the basis of the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for the Treatment of Acute Pain in Remote Environments published in Wilderness & Environmental Medicine 2014;25(1):41-49.
Collapse
Affiliation(s)
- Katie W Russell
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT (Drs Russell and Scaife)
| | - Courtney L Scaife
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT (Drs Russell and Scaife)
| | - David C Weber
- Denali National Park & Preserve Rescue, Talkeetna, AK (Mr Weber)
| | - Jeremy S Windsor
- Chesterfield Royal Hospital, Calow, Derbyshire, United Kingdom (Dr Windsor)
| | | | - William R Smith
- St. John's Medical Center, Jackson, WY (Drs Wheeler and Smith); Clinical Faculty, University of Washington School of Medicine, Seattle, WA (Dr Smith)
| | - Ian Wedmore
- University of Washington School of Medicine, Madigan Army Medical Center, Ft. Lewis, WA (Dr Wedmore)
| | - Scott E McIntosh
- Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT (Dr McIntosh)
| | - James R Lieberman
- Department of Anesthesia, Swedish Medical Center, Seattle, WA (Dr Lieberman).
| | | |
Collapse
|
9
|
Phillips K, Longden MJ, Vandergraff B, Weber DC, McIntosh SE, Smith WR, Wheeler AR. Reply to "in response to wilderness search strategy and tactics". In reply to Dr Cooper and Mr Frost. Wilderness Environ Med 2015; 26:271. [PMID: 25709070 DOI: 10.1016/j.wem.2014.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 12/09/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Ken Phillips
- Branch Chief, Search and Rescue National Park Service-WASO, Washington, DC
| | | | | | | | | | | | | |
Collapse
|
10
|
Phillips K, Longden MJ, Vandergraff B, Smith WR, Weber DC, McIntosh SE, Wheeler AR. Wilderness search strategy and tactics. Wilderness Environ Med 2014; 25:166-76. [PMID: 24792134 DOI: 10.1016/j.wem.2014.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 02/12/2014] [Accepted: 02/24/2014] [Indexed: 11/16/2022]
Abstract
Reports of overdue persons are common for search and rescue personnel. Search incidents for missing persons are conducted following established industry standard practices, which are continuously refined through experience and the analysis of previous search operations. Throughout this process, elements of uncertainty exist, and the knowledge and experience of the searchers and search managers may influence the outcome significantly. A sound knowledge of current search tactics will help search and rescue medical providers function more effectively during search operations. Initial actions during a search incident include 3 primary tasks that must be accomplished on any search: investigation, containment, and then hasty search efforts. Concurrent with these initial actions are the establishment of the search area and a formal US National Incident Management System incident command system. That is essential for an efficient operation and will lay the groundwork for expanding the operation past the initial operational period. The goal of applying these standard search management practices is to allow searchers to maximize their efforts, reduce some of the inherent uncertainty, and most importantly, place searchers in a position to detect the missing person.
Collapse
Affiliation(s)
- Ken Phillips
- Search and Rescue National Park Service-Washington Office, Washington, DC
| | - Maura J Longden
- National Park Service Climbing and Search and Rescue Ranger, Jackson, WY
| | | | | | | | | | | |
Collapse
|
11
|
Smith WR, Montopoli G, Byerly A, Montopoli M, Harlow H, Wheeler AR. Mercury Toxicity in Wildland Firefighters. Wilderness Environ Med 2013; 24:141-5. [DOI: 10.1016/j.wem.2013.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 12/20/2012] [Accepted: 01/09/2013] [Indexed: 11/25/2022]
|
12
|
Wheeler AR, Woody AY, Woody RW. Salt-dependent binding of Escherichia coli RNA polymerase to DNA and specific transcription by the core enzyme and holoenzyme. Biochemistry 1987; 26:3322-30. [PMID: 3307903 DOI: 10.1021/bi00386a012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The interaction of the Escherichia coli RNA polymerase with several forms of DNA has been studied by difference absorption spectroscopy, protection against endonucleases, and limited, specific initiation. The core enzyme is able to open duplex poly[d(A-T)] in 10 mM KCl. The core enzyme binds to promoters in linear DNA in a salt-dependent manner, but it does not bind to the same promoters in supercoiled DNA. The binding of the core enzyme is not as tight as that of the holoenzyme. The holoenzyme initiates specific transcription from promoters in a salt-dependent manner. The core enzyme also initiates specific transcription from the same promoters at approximately one-fifth the level of the holoenzyme with a different salt dependence. The profile of the salt dependence of specific transcription initiation varies with the promoter. The origin of differences between holoenzyme-DNA and core enzyme-DNA interactions and the mechanism whereby sigma improves transcriptional specificity are discussed in light of these data.
Collapse
Affiliation(s)
- A R Wheeler
- Department of Biochemistry, Colorado State University, Fort Collins 80523
| | | | | |
Collapse
|