Emergency medical services in mountain and remote recreational areas

Objective: To explore the current status of emergency medical services (EMS) in high mountain and remote recreational areas, and to help the government establish a well organized EMS in these areas, as well as the main goallowering the resuscitative rate of prehospital cardiac deaths. Materials and Methods: This study was conducted from November 1, 2000 through October 31, 2001. Five travel spots (Ho-Hwan mountain, Yu mountain, Tai-Ping mountain, Y-Li mountain and Keng-Ting National Park) were selected as study sites. The current EMS status, including EMS needs, function and equipment, was investigated. Results: During the one-year study, the current status of EMS at each study site was as follows: (1) Ho-Hwan mountain: One patient with syncopy and one patient with respiratory difficulties completely recovered after treatment. One patient with cerebral edema had a good prognosis after admission to hospital. No communication network existed. EMS response time averaged 40 minutes. Transportation time to the nearest community hospital averaged 80 minutes. Equipment consisted of only one oxygen tank, one bag-valvemask and several roller bandages. (2) Yu mountain: No communication network existed. Doctors and nurses from TaiChung Veterans General Hospital had previously served here as volunteers every weekend but were not doing so at the time of this study. The EMS response time averaged 90 minutes. Transportation time to the nearest community hospital averaged 120 minutes. Supplies included only some triangle bandages and roller bandages. (3) Tai-Ping mountain: There was a communication network which functioned well. A nurse's aid worked here during office hours. Doctors were supposed to serve here every weekend, but were often absent. EMS response time averaged 60 minutes. Transportation time to the nearest community hospital averaged 120 minutes. Equipment consisted of only one ambulance with oxygen, a blanket and a short back board, with one oxygen tank, one bag-valve-mask and several roller bandages in the office. (4) Keng-Ding: There was an EMS communication network but it functioned poorly. EMS response time was 10 to 20 minutes. Transportation time to the nearest community hospital averaged 110 minutes. Supplies included only one oxygen tank, splints, elastic bandages and triangle bandages. (5) Y-Li mountain: There was a well functioning communication network. EMS response time was 5 to 10 minutes. Transportation time to the nearest community hospital averaged 90 minutes. Emergency equipment was acceptable. Conclusions: EMS capabilities in mountain and remote recreational areas in this country are far inferior to that of standard. There is no communication network, and only a few places have emergency 119 phone service. Equipment for rescue and emergency use is not adequate for critically ill or injured patients. Response time is too slow. No well-organized helicopter rescue plan exsists. It is the norm for remote recreational areas to have no qualified health care provider. The "chain of survival" - early access, early cardiopulmonary resuscitation, early defibrillation, and early advanced cardiac life support is not being provided in remote recreational areas. Volunteer doctors and nurses serving in remote recreational areas often quit after a short period of time, so using this method to organize an EMS system in this areas is not satisfactory.