NASAR Conference Highlights:

I will try and provide an overview of the numerous workshops and newer vendor products I had the privilege of observing. A number of the presentations challenged many of the “assumptions”/conventional wisdom principals that have been advocated over the many years. These “challenges” were well thought out, the presenters provided their logic for formulating these approaches and in most cases were able to provide documented testing and/or anecdotal information for their points of view. I must say that a number of the approaches did challenge my current thoughts on a number of applications. These “challenges” included new ways of approaching wound care, wilderness/remote/delayed medical care, technical rescue and standards adoption. There were a few new (at least to me) products and some innovative/updated products of several manufactures.

Workshops:

Please note that I am only reporting the content of the workshop, I am neither endorsing nor rejecting the position of the presenters. In many cases, especially related to EMS and technical rescue techniques, you should evaluate and discuss the techniques with your medical control or present to your team for evaluation before implementation. Many of the EMS techniques are most likely already covered by state/local protocol; I am only providing the information. Many of the techniques require more formal instruction; in many cases the presenter is a representative of a company providing the instruction and technique development. I will say that all of the presenters did provide justification and/or testing for their position. While most of the workshops I attended were heavy on the EMS and/or technical rescue, there were dozens of other workshops dealing with search techniques, government policy development, dog use and techniques, Homeland Security and public education. Many of the positions/techniques were regional in nature, having to deal with local geography and access to SAR/EMS resources. Most of the workshop presenters agreed to provide NASAR with their PowerPoint presentations, I signed up to receive a CD of these presentations, when I do receive a copy, I may be able to elaborate with additional information.


ASTM (The American Society for Testing and Materials) Technical Rescue Training Standards: Be Part of the Solution – ASTM Committee F-32 Representatives:

NASAR really was pushing the ASTM International standards (there were a total of 5 workshops dealing with ASTM). It was clear NASAR wanted to have the membership well acquainted with ASTM training and equipment standards, since at the NASAR annual membership meeting, the board of directors formally voted to adopt the ASTM International standards as the standards adopted by NASAR and that NASAR would cease developing standards allowing/promoting the membership to assist the various ASTM subcommittees in the development of equipment and training standards, which NASAR would then develop the curricula and testing methodologies to meet and test for standard proficiencies. This workshop dealt with introducing ASTM to those who were unfamiliar with the organization, the relationship to NFPA standards and the desire to have individuals with specific interest in technical rescue to volunteer to assist with the development of technical rescue equipment and training standards. To view some of the ASTM rescue standards (note: you will not be able to actual view the documents, as you must pay a fee for the particular standard you are interested in, but this site will give you an idea of what standards have been developed): http://www.astm.org/cgi-bin/SoftCart.exe/COMMIT/SUBCOMMIT/F3202.htm?L+mystore+lqss1498


Situational Awareness in Search and Rescue Operations – Charley Shimanski, Educational Director, Mountain Rescue Association (MRA):

This workshop was an introduction to the concept and implementation of Situational Awareness, which has been used, in military, civil and commercial aviation for over 30 years. It is used to identify and reduce risks in rescue operations. The workshop looked at the stages, key factors and methods to prevent loss of situational awareness in rescue operations. I have attended one of Charley’s workshop once before and found it invaluable. This workshop was a newly revised version of the MRA program and used a combination of still/video images and case studies to drive home the points of situational awareness. This was one of the best workshops I attended. The information is available free from: http://www.mra.org/SituationalAwarenessinSAROperations.pdf


ASTM Water Standards: Be Part of the Solution - ASTM Committee F-32 Representatives: SEE ASTM (The American Society for Testing and Materials) Technical Rescue Training Standards: Be Part of the Solution – ASTM Committee F-32 Representatives:

The only thing I will add to this report is ASTM is trying to develop these standards before NFPA does. It is their experience that if they do so NFPA will defer to the ATM standards. Also, I somehow volunteered to help work on the standards for “signaling devices and lighting devices” for swiftwater rescue operations.


SAR Medical Kits: How to Select and Use Field Medical Supplies – Dr. Nick Williams, Medical Response International:

This was one of the more “controversial” workshops, not on the equipment side, but the treatment side, which I will go into in greater detail. Dr. Williams has been a NASAR Medical Advisory Committee Chairman, contributing editor to the Search and Rescue Medical Responder textbook, author of the book “The Wilderness Medical Kit” and has served as physician member on a number of National Disaster Medical System deployments. Again, I am only reporting on the workshop, not recommending the techniques explored in this workshop. Please keep in mind the techniques described in this workshop were for medical situations where delayed definitive care was significant. Dr. Williams, explored a number of “in the field” tests for detection of a myocardial infarction (MI), thought the use of urine dip sticks looking for hemoglobin in the urine with the absence of trauma and RBCs in the urine. He also showed a field assay for troponins (see this AHA for greater details: http://www.americanheart.org/presenter.jhtml?identifier=4477 ). He showed us a pocket sized 12 lead EKG machine that was about the size of a PDA (see here for more info: http://www.stopgettingsick.com/templates/news_template.cfm/4654 ). He recommended a number of items to include in a kit including a quality stethoscope (here is also a web site with additional recommendations: http://www.wemsi.org/pwm201.pdf ). Perhaps the potentially most controversially issue that was presented, was closing wounds in the field. I know that we have discussed this numerous times on the forums and have for the most part come to the conclusion that wound closure in the field is ill advised due to the possibility of severe infections. His approach and experience, that with appropriate wound cleaning and care, wound closure in the field was not only possible, but in many cases advisable. His recommendation was that all wounds be thoroughly cleaned with 10% Betadine and that closure could include steri-strips, sutures, derma-bond or even superglue. He said based upon over 1000+ closures in the field, in less than ideal conditions, there were 0% infections. He did limit the wounds primarily to skin only, where no ligaments or deep muscle was involved and the use of topical antibiotics to prevent infection. There was a considerable amount of other information, which would be difficult to include in this brief report.


Planning and Conducting a Helicopter Rescue Program for Water Rescue – How We Learned to Fly Again In NC (North Carolina) – Tim Rodgers, Battalion Chief, Charlotte Fire Department:

As a member of Maryland State Police and US Park Police’s Helicopter Emergency Aerial Tactical Team (HEAT Team) I was interested in learning how their program started, encountered problems and intended missions. Without going into detail, the NC-EMA should be applauded for finally being able to initiate a helicopter training program in cooperation with the NC-ANG for water rescue after 12 years of jumping through hoops to get the program off the ground.


The True Weapon of Mass Destruction: Lessons Learned (and Ignored) During Recent Major Flood Events in the United Sates and Europe – Jim Segerstrom, Rescue 3 International - Jim could not attend due to an unforeseeable event - the discussion resulted in a round table discussion including notable swiftwater rescue expert Slim Ray. One of the major discussions centered on the need to create a national database for swift- and floodwater disasters and rescues. Additional discussions on communications, equipment, training and public education ensued.


Higgins and Langley Memorial Awards for Outstanding Achievement in the Field of Swiftwater Rescue:

I will not mention the various award recipients and the actions that resulted in their becoming recipients of these awards, just that they all deserved the recognition. What I will mention are the two outstanding visual arts presentations, one by the Honor Guard of the Mountain Rescue Association (MRA) to the Honor Guard of NASAR and also a reflection of members who had passed on or had lost their lives during a rescue or SAR mission (domestic, internationally and military). I cannot believe there was a dry eye in the room. It was a very touching memorial to the motto: “So Others May Live”


Analyzing the Risk: Technical Myth Information - Loui McMurley, Pigeon Mountain Industries (PMI)

Here again was a potential controversial class, Loui especially challenged many of the “assumptions” in technical rescue that have established themselves as holy-than-thou techniques, never to be questioned. I must admit I had to look with an open mind and analyze many of the challenges to the traditional and generally excepted techniques I have been taught. Some of these challenges included: Is it always necessary to have a belay system that will pass the “whistle test”, the use tandem prusik belays pros and cons, the proper use of mechanical belay devices, as well a whole host of other topics. Loui is very knowledgeable and presented her point of view with logic and field-tested experiences.


Low Angle Technical Evacuations – Loui McMurley, Pigeon Mountain Industries (PMI) and Haul Systems Made Easy – Steve Hudson, Pigeon Mountain Industries (PMI) Classroom and Field Portions:

Anyone who has been involved with technical rescue is likely to have read “On Rope” by Steve, it is a classic for cave rescue and has been essential in the developments of all types of technical rescue. Most individuals in technical rescue are aware of the many contributions Steve and PMI have made to the field. Loui, is a veteran of technical rescue and co-founder of both Alpine Center for Rescue studies and Professional Rope Access Technicians, she has authored numerous papers and presentations on safety and rescue.

The workshop, both the classroom and field exercises were an introduction and/or review of the theory, practicality and implementation of haul systems, raising and lowering systems and litter operations.






Vendors:

Many of the vendors were well known and established manufactures or retail suppliers. There were a few new items (at least to me) on note. This is not an endorsement of any particular manufacturer or item unless noted. I will say all of the vendors I had the opportunity to discuss new ideas, were quite willing to listen to the front line users of the various products. Unfortunately, I do not have any photos. As I was not there in the journalistic sense, I did not feel it would be appropriate for me to photograph any of the new items and or prototypes. I have included web site links where appropriate. There were many other vendors, but chose these as having innovative or potentially useful items of general interest.


Cloudveil:

Cloudveil is an outstanding company, which produces a wide variety of high quality outdoor clothing. The prices are on the high end, but they do have a “backroom” for closeouts, which are an affordable way to purchase their fine clothing. They also offer “pro-qual” deals for those in SAR and having membership in MRA and/or NASAR. Currently, I do not have any of their products, but one of our team members does have a number of their products and swears by them.

www.cloudveil.com



CrossLine Solutions:

Dr. Michael Croslin, the founder of Crossline was a founding member of Rescue 3 the premier company for swiftwater instruction. He has designed a truly innovated product for swiftwater rescue. If you go to the web site (still under development) you can see a schematic of the product. It is like a grappling hook, but has wire gate to capture the line you are trying to retrieve. It is hard to describe how well this product works without seeing the video, but it has the potential for being a valuable swiftwater rescue tool. It is pricey (approx. $250-300), so for the average user it is not practical, but for a swiftwater rescue team, it could be a significant tool to have in the arsenal.

www.CrossLineSolutions.com


Greatland Laser LLC:

Doug already has a great review of these products: http://www.equipped.org/rescuelaser.htm

Let me just say, I own all three of the available products and carry EDC the Rescue Laser Light (RLL). The others are with my swiftwater rescue gear. As a testament to the great customer service from Greatland, I recently contacted (e-mail) them for some sporadic problems with my EDC RLL, while on it would intermittently turn off on it’s own and required jiggling the head to get it to work. Within a few hours of my e-mail, I received a reply back from Jim O’ Meara informing me he would take care of the problem immediately. Fortunately it turn out to be nothing more that some dirt in between the head and body which was easily corrected.

The green laser shown here, while very very expensive (approx. $3,500) has great potential for SAR groups, especially underwater search teams.
http://www.greatlandlaser.com/marine.htm


www.greatlandlaser.com/



Mountain Uniforms:
Custom designs of vests, jackets and jumpsuits for ski patrols, mountain rescue teams, SAR teams, law enforcement units, etc. Depending upon the item will make runs as small as 30 pieces. Can have many choices of fabrics, colors, pockets, and design layouts. Very well made items, willing to work with the customer to design outerwear products that will meet specific needs. Since they generally make extra of each design or have a basic design ready for the customer, the company has a number of items, which can be purchased directly for personal use. I plan on purchasing one or more of their items.

www.mountainuniforms.com




SAM Products:

Many of you are familiar with SAM Products, they make an extremely versatile splint, which is made of aluminum, and covered with a thin layer of foam. It comes in various sizes from finger splints to full leg splints. It is lightweight and highly malleable allowing one to be creative in making a wide variety of immobilization products (arm, leg, c-collar, etc.). Sam Products had two recently introduced items: one a terry cloth fabric covered splint (SOFT SHELL), the other, a pelvic sling (SAM Sling). The fabric covered splint which had a textured fabric over their traditional splint allowed for greater patient comfort. The splint retained all of the great features of their traditional foam covered splint. The pelvic sling, which has been extensively tested is used to stabilize pelvic fractures, which can be difficult to manage in a wilderness setting and are serious injuries. The sling was easy to use, is relatively lightweight and a real boon to those providing EMS in the wilderness setting.

www.samsplint.com



TRUENORTH:

This company produces some of the finest SAR, Wildland Firefighting and general packs and duffels I have ever seen. The designs are well thought out and the workmanship first class. The prices are not too bad and they have an excellent customer service. I really liked the Dragonfly and had I not purchased a SAR pack recently (L.A. Rescue – USAR pack - also a well made pack) I would have bought the Dragonfly without hesitation. I did buy some of the small organizers (Gear Boxes), which are soft-sided zippered “stuff” sacks in each size offered. I would have no problem in highly recommending this company.

www.TRUENORTHGEAR.COM




Youngstown equipment Co. (has joined with MountainSmith):

Youngstown produces quality gloves for a wide spectrum of activities. I had the chance to purchase three different products; the Pro XT for technical rescue, the mesh – high-visibility for water rescue and a pair of Gore-Tex lined cuffed gloves for winter use. All were well made and fit well. I had the chance to use the Pro XT gloves in the low angle evac. and haul system class, they performed great and look forward to use them next weekend on a drill. We were fortunate in that the gloves being sold at the conference were heavily discounted, but would have no problem recommending them at the normal retail price.

www.YOUNGSTOWNEQUIPMENT.COM

Pete

Pete,

Great NASAR review, thanks much for that.

One product intro that you didn't mention, but of which I am aware, is the new SEIMAC DR-500 Direction Finder ($1,500 for the entire kit - DF with training beacon, headphones, charger and waterproof case). This is an attempt to try to take some of the black art out of DFing a 121.5 homing signal. Now that PLBs are starting to become more widespread, there's a crying need for something that local law enforcement and SAR groups can use to DF without the need for extensive instruction, practice, etc. Anyone who has any experience doing ground DF will appreciate that it is, at best, a real PITA. By providing the user with direction indicators as well as signal strength, this may make it much easier. I have been promised a unit to test in the next few months and we'll see how well it delivers.

I have posted a PDF file with the specs at http://www.equipped.org/SEIMAC DR-500 - Direction Finder.pdf

Great stuff, Pete. Thanks for the report. I'd love to hear more about what Dr. Williams had to say, especially his comments on stethoscopes.

Pete,

I was trying to follow the link to that 12 lead PDA machine... Hmmm do you have any more info on that since the link seams to go to page with valve for CHF.

Matt

I just tried it and it took me directly to the 12 lead, not sure why you are getting linked to another item. Try it again:

http://www.stopgettingsick.com/templates/news_template.cfm/4654

Dr. Williams recommended staying away from the cheap ones even though the stethoscope might be damaged/abused in a wilderness or field hospital setting. He felt that the moderate to high quality stethoscopes were vital to be able to listen to lung sounds. He mentioned Littmann, as his brand of choice.

They did have a number of workshops/field exercises along that venue:

What Will They Put a GPS in Next?: Rick Hood, Hood Consulting and Services

The Evolution of Personal Locator Beacons: Sam Baker, Chief of SARSAT Mission Control Center, NOAA

Going the Last Mile- Hand-held Direction: Paul A. Steward, Seimac

(3) Personnel Locator Beacon Response Ground Rescue Exercises (PLBEX)

Due to the weather on the last day the vendors’ field display of products had to be canceled.

Unfortunately, with all of the great workshops, it was impossible to hit all of those that I had some interest in attending.

If I do get the CD of the PowerPoint presentations with information pertaining to the above, I will try and pass the information along. Pete

when I try that new link, I only get a blank page ????

Sorry you are having problems with the link. I just tried it and had no problem. Here is the text from the link:

FDA OKs Pocket-Sized EKG Machine
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By LAURAN NEERGAARD
AP Medical Writer
(AP) WASHINGTON

The government approved the first pocket-sized EKG machine Tuesday, so small that it promises easier, faster heart measurements in ambulances, the emergency room _ even a possible heart attack victim's bedroom.

It's also the first hand-held computer-based medical device, part of a growing trend to miniaturize some of medicine's most important equipment.

Electrocardiograms, also called EKGs or ECGs, are recordings of the heart's electrical signals, used to diagnose heart attacks, irregular heartbeats and other cardiac problems.

The new PocketView ECG works just as well as full-size electrocardiograph machines, the Food and Drug Administration determined _ but is the size of a handheld computer.

In fact, it's actually made from a Compaq hand-held personal digital assistant. Manufacturer MicroMedical Industries embedded that off-the-shelf PDA with miniaturized versions of the software and hardware that run full-size EKG machines.

Twelve leads, the electrodes that stick to the chest and record electric currents during each heartbeat, plug into a wire that in turn plugs into the top of the device.

The result is a machine that health workers can use to record EKGs anywhere the patient happens to be _ at home, in an ambulance _ without having to lug around heavy equipment, said FDA's Donna-Bea Tillman.

A doctor could view the readings right on the PDA screen. Or, if ambulance workers were recording the measurements, the PocketView ECG can transmit the results over wireless phones to a computer for a doctor to view. Or plug in a printer and the PocketView will spit out the electrocardiogram's traditional spike-covered paper printout.

Smaller means more portable, and "when it comes to heart patients, the ability to transmit an electrocardiogram quickly can be valuable," said Dr. Sidney Smith of the American Heart Association.

Emergency medical technicians already lug around briefcase-size EKG equipment, but stopping to set that up _ not to mention puffing up flights of stairs with it _ takes time that a smaller size unit should cut, he said.

Depending how easy the PocketView is to use, Smith suggests police officers or other first responders might one day be able to use them, just as they now frequently carry portable defibrillators to try to jump-start stopped hearts.

Australia-based MicroMedical couldn't be reached immediately to say how much the PocketView ECG will cost, although the company's Web site promised "a highly competitive price." U.S. heart experts say price will be one key in whether health workers try the miniature gadget or stick with their bigger machines.

But miniaturizing equipment "so you don't have to bring the patient to the machine" is a growing industry trend, said Dr. Susan Alpert, former FDA medical device chief now with equipment maker C.R. Bard. "If you really want to take care of people in an emergency, you want to bring everything they could possibly need to them."


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On the Net:

FDA: http://www.fda.gov

MicroMedical: http://www.micromed.com.au

Got it. My browser was doing stupid things. It is very interesting to have a device like that. Even after I become a medic I will still ride on the BLS buses and would love to have the ability to do a 12 lead on the patient in order to recognize cariac problems earlier.

Hopefully this will drive prices of medical devices down as well.

Matt