title: Managing moderate and severe pain in mountain rescue.
abstract: OBJECTIVE
  We aimed to describe evidence-based options for prehospital analgesia, and to offer practical advice to physicians and nonphysicians working in mountain rescue.
  
  
  METHODS
  A literature search was performed; the results and recommendations were discussed among the authors. Four authors considered a scenario. The final article was discussed and approved by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) in October 2013.
  
  
  CONCLUSIONS
  Many health care providers fail to recognize, assess, and treat pain adequately. Assessment scales and treatment protocols should be implemented in mountain rescue services to encourage better management of pain. Specific training in assessing and managing pain is essential for all mountain rescuers. Persons administrating analgesics should receive appropriate detailed training. There is no ideal analgesic that will accomplish all that is expected in every situation. A range of drugs and delivery methods will be needed. Thus, an 'analgesic module' reflecting its users and the environment should be developed. The number of drugs carried should be reduced to a minimum by careful selection and, where possible, utilizing drugs with multiple delivery options. A strong opioid is recommended as the core drug for managing moderate or severe pain; a multimodal approach may provide additional benefits.
authors.affiliation: 1 General Practitioner and Medical Officer, Mountain Rescue (England and Wales), Birbeck Medical Group , Penrith, United Kingdom .
authors.forename: John
authors.initials: J
authors.lastname: Ellerton
authors.forename: Mario
authors.initials: M
authors.lastname: Milani
authors.forename: Marc
authors.initials: M
authors.lastname: Blancher
authors.forename: Grégoire
authors.initials: G
authors.lastname: Zen-Ruffinen
authors.forename: Sven Christjar
authors.initials: SC
authors.lastname: Skaiaa
authors.forename: Bruce
authors.initials: B
authors.lastname: Brink
authors.forename: Ashish
authors.initials: A
authors.lastname: Lohani
authors.forename: Peter
authors.initials: P
authors.lastname: Paal
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D004632:Emergency Medical Services / Q000379:methods; D006801:Humans; D009051:Mountaineering; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D018635:Rescue Work
chemical_list: D000700:Analgesics