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Saving Lives: Prioritize, Plan, Protect, and Monitor

Once you've stabilized a backcountry injury or illness, the next step is to prevent the patient from worsening. Here's some key steps to take.

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Prioritize, Plan, and Protect

Take notes and prepare for the long haul.

During this step you transition to long-term care, which means caring for the patient’s ongoing treatment and safety (if, for instance, you’re waiting for evacuation and will be in the backcountry for an extended period) or handing the patient off to medical professionals (comprehensive information will help them do their job). Use a written SOAP note—an acronym for an incident’s subjective and objective elements, your assessment, and your treatment plan.*

Subjective Include the patient’s age, sex, and a description of the incident as the victim describes it. Include the chief complaint, spinal injury assessment, and responsiveness.

Objective Detail your evaluation. How did you find the patient? Include vital signs, SAMPLE history, and pertinent negatives (e.g. “Patient denies allergies to any medications.”)

Assessment Prioritize a list of injuries and conditions that may complicate rescue and evacuation or need monitoring.

Plan Outline a strategy for managing patient needs over time. Consider potential problems and environmental
factors, like keeping an immobile patient warm and dry.


Continue care to prevent complications.

Prevent relapses and problems like infection and dehydration by checking your patient’s vitals for signs of shock:

Measure Key Vital Signs

Trends are key, so record vitals every five minutes. After three rounds of stable results, double the time between monitoring. Here’s how to gauge two tricky vitals that can indicate worsening conditions.

Level of responsiveness (LOR) This changes quickly and indicates possible brain injuries and the severity of other conditions.
If the patient is alert, ask him four questions: What’s your name? Where are you? What day is it? What happened? Fewer than three correct answers is abnormal. A verbally responsive patient reacts to loud noises. A pain-responsive one winces or groans when you pinch him. If a victim is not alert, maintain the airway, check for breathing and circulation, and manage life-threats while monitoring LOR improvements.

Blood pressure (BP) No radial pulse—or one that’s weakening? That could indicate a dropping BP and a seriously worsening patient.
Check In the backcountry, alertness, a strong radial pulse, and normal skin color/temperature/moisture together indicate adequate BP. If you suspect BP is dropping, look for and treat the possible cause.

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