International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Institute of Forensic Medicine, University of Bern, Bern, Switzerland. Electronic address: firstname.lastname@example.org.
Determination of death requires specific knowledge, training, and experience in most cases. It can be particularly difficult when external conditions, such as objective hazards in mountains, prevent close physical examination of an apparently lifeless person, or when examination cannot be accomplished by an authorized person. Guidelines exist, but proper use can be difficult. In addition to the absence of vital signs, definitive signs of death must be present. Recognition of definitive signs of death can be problematic due to the variability in time course and the possibility of mimics. Only clear criteria such as decapitation or detruncation should be used to determine death from a distance or by laypersons who are not medically trained. To present criteria that allow for accurate determination of death in mountain rescue situations, the International Commission for Mountain Emergency Medicine convened a panel of mountain rescue doctors and a forensic pathologist. These recommendations are based on a nonsystematic review of the literature including articles on determination of death and related topics.
Major incident management relies on efficient patient transportation. In the absence of a standardized, field-friendly approach to multiple casualty management, the Norwegian Air Ambulance Foundation developed Optimal Patient Evacuation Norway (OPEN). OPEN aims to save time, improve patient handling, prevent hypothermia, and simplify scene management. We evaluated the feasibility of the OPEN concept in full-scale major incident field exercises.
Emergency service personnel participated in two standardized bus crash field exercises, without and with access to OPEN. The instructors timed completion of patient evacuation, and the students participated in a self-report before and after study. Each question was scored on a 7-point Likert scale, with points labeled "Did not work" (1) through "Worked excellently" (7).
Among the 93 study participants, 31% confirmed that stretchers could be available at the scene within 30 minutes in their catchment area. The students reported improved interdisciplinary cooperation for patient evacuation after the course (mean, 5.8, with 95% CI 5.7-6.0 after vs. 5.4 with 95% CI 5.2-5.6 before, P