Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Section VII: Roles, Responsibilities, and Technology 235

responsibilities, as well as your limitations, should be clearly understood by all concerned. Medical Screening Pre-trip screening discussions with clients and their medical advisors have also become a nor- mal and expected part of the job. Recent trends in adventure travel and experiential education now require a greater understanding of chronic disease states and the ability to make reasonable risk/benefit decisions with your clients. People with angina, asthma, and diabetes are as interested in trekking and sailing as anyone else and it is no longer routine practice to exclude them.

able to assess the risk involved in the trip being contemplated. A review of the medications people are taking is an important part of medical screening and your conversation with the treating physician. For you, it is more important to know what the consequences of overdose, withdrawal, and the drug’s effect on thermoregulation than to know about specific therapeutic mechanism of a drug. The patient can also be an excellent source of information about his or her condition and medi- cations and the proper response to emergencies. People with diabetes, for example, are usually very well informed about their disease and can help to further your understanding of the condition. Risk Versus Benefit As a guide or medical officer, the final decision to accept responsibility for the care of a client with a preexisting and potentially dangerous medi- cal condition should be yours. If the anticipated problem becomes real, you and your group will be the ones dealing with it. It is not practical or reasonable to defer this judgment solely to a phy- sician who will not be traveling with you and who may not fully understand the environmental and logistical challenges that you will face. “Cleared by the doctor” is just useful information, not a dictum that you must live by.

If an anticipated problem becomes an existing problem, you and your group will be the ones deal- ing with it. Be sure that you are able and willing to do so. If you will be serving as the expedition medic or instructor who will be responsible for a client with a chronic condition, it may be appropriate (with the patient’s permission) for you to have a direct discussion with their physician. Between your expertise in backcountry travel and wilder- ness medicine and the physician’s clinical experi- ence and knowledge of the patient, you should be