Advanced Life Support in the Mining Environment

"The mining environment presents challenging and complex situations for the application of medical care. The combination of remote locations, difficult access and longer response times may create an increase in morbidity and mortality in the event of serious accidents. The U.S Mine Safety and Health Administration (MSHA) has only minimal requirements of first aid training for mine workers. For mine rescue team members, MSHA requires medical training at the Emergency Medical Responder (EMR) level, as only prescribed by mine rescue contest rules. This paper examines, based on mine accident statistical information, whether a higher level of medical training, for example at the Emergency Medical Technician (EMT) or at the Advanced Life Support (ALS) level can better address injuries most commonly disabling or leading to the death of miners in the United States. BACKGROUND Prehospital emergency medical care for the sick and injured has evolved considerably from first inception. Ambulances used to be staffed by persons with little training and equipment and prehospital care was focused largely on the rapid transport of the injured person to a hospital and. The modern prehospital care model was initially developed in military applications, where medics were responsible for some treatment on the battlefield and rapid transport to the care of a physician. In 1965, the National Academy of Sciences and National Research Council Committees on Trauma and Shock published Accidental Death and Disability: The Neglected Disease of Modern Society (National Research Council Committees on Trauma and Shock, 1966). This white paper laid out the consequences of the insufficiency of the Emergency Medical System (EMS) in the United States at that time. According to this paper, in 1965, 107,000 people were killed from accidental injury, with another 400,000 injured with permanent disability. The authors estimated that approximately 50% of ambulance services were provided by local morticians that were not capable of rendering advanced life support. The paper states that, based on experiences in the Vietnam war, seriously wounded soldiers had a better chance of survival in the battle field compared to traffic accident victims with similar traumatic injuries because the military was capable of providing first aid and efficient transportation to emergency care facilities. The white paper states that death rates from battle injuries declined significantly from 8% in World War I to 2% in Vietnam. The publication of this white paper is credited for the broad evolution and rapid advance of the civilian EMS system after 1965. It eventually lead to the creation of the National Highway Transportation Safety Administration (NHTSA) National Standard Curricula (NSC) for emergency medical care in 1985. Training, and therefore required skill and knowledge for prehospital emergency care has continued to grow to reach the current standard."