Wilderness First Responder Medical Clearance – A Scoping Review with Recommendations

Due to environmental extremes, as well as the nature of the work itself, wilderness first responders are at risk of incurring medical events in the line of duty. There currently do not exist standardized and scientifically supported methods to screen for a wilderness first responder’s risk of incurring a medical event. We performed multiple scoping reviews using PubMed and CINAHL. The reviews covered six medical screening criteria based on previous recommendations from the National Fire Protection Association (NFPA) and the US Forest Service, and we grouped our reviews into two categories: articles that addressed objective screening criteria, and articles that addressed subjective findings with the first responder. Of the objective criteria, our reviews identified 21 articles addressing the ability to screen for risk of incurring a medical event by evaluation of a first responder’s heart rate, 12 by blood pressure assessment, and 56 by assessment of body temperature. Of the subjective criteria we identified 19 articles focused on self-assessment, 34 articles on the use of standardized tools to assess for fatigue and sleepiness, and two articles on assessment of a first responder’s urine to determine level of dehydration. We also identified seven additional articles through a hand search. Overall, there were 151 articles identified in our scoping reviews. These articles were largely of low quality, consisting mostly of case series without comparison groups. There is a dearth of high-quality research into the medical assessment of first responders. We recommend that this paper, and measures discussed within it, be used as a starting point in the development of an evidence-based assessment protocol for wilderness first responders. We also recommend the development of a national database of medical events incurred by wilderness first responders to facilitate higher-quality research of screening protocols in this community.

受极端环境因素与作业自身特性影响，野外急救人员（wilderness first responder）在履职过程中面临发生医疗事件的风险。目前尚无标准化且经科学验证的方法，用于筛查野外急救人员发生医疗事件的风险。
本研究利用PubMed与CINAHL数据库开展了多次范围综述（scoping review）。本次综述涵盖了基于美国国家消防协会（National Fire Protection Association, NFPA）与美国林务局（US Forest Service）既往建议制定的六项医疗筛查标准，并将纳入的文献分为两类：涉及客观筛查标准的文献，以及针对急救人员主观体征表现的文献。
在客观筛查标准相关文献中，本综述共检索到21篇通过评估急救人员心率以筛查医疗事件发生风险的文献、12篇通过血压评估开展相关筛查的文献，以及56篇通过体温检测开展筛查的文献。在主观筛查标准相关文献中，本综述共检索到19篇聚焦于自我评估的文献、34篇涉及使用标准化工具评估疲劳与嗜睡状态的文献，以及2篇通过检测急救人员尿液以判断脱水程度的文献。
本研究还通过手工检索额外纳入7篇文献。本次范围综述共纳入151篇文献。此类文献整体质量偏低，多数为无对照的病例系列研究。目前针对急救人员医疗评估的高质量研究仍较为匮乏。
本研究建议，以本文及文中提及的相关措施作为制定野外急救人员循证评估方案的起点。同时建议建立野外急救人员医疗事件全国数据库，以推动针对该群体筛查方案的高质量研究开展。