Abstract
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The editors have not explicitly identified the target audience, other than to say that it is made up of students in DiMM courses. There is little discussion about why students are motivated to take the courses and about their educational needs. The students are healthcare providers with varied roles and specialties. Some of them are physicians in specialties such as emergency medicine, for whom most of the medical content is too basic. Other students will lack the training and skills to provide effective medical care in many specialty areas even after studying from the book.
The book is handicapped by the lack of insight into specific educational goals. The depth of coverage is uneven. Some chapters give specific advice. Others are more general. Several chapters assume that readers already have specialized knowledge that most are unlikely to have. Some of the authors are clearly experienced in providing medical care in field settings, while others seem to have only a theoretical knowledge of mountain medicine. In trying to be complete, the focus of many of the medical chapters strays far from the mountains. These chapters would have been more useful had they concentrated on conditions likely to be found in mountain environments. For students who have had no familiarity with mountaineering or technical rescue before enrolling in a DiMM course, the technical rescue chapters are likely to be hard going.
The book could have been improved by careful, consistent editing. There are many grammatical and typographical errors and many instances of poor writing that should have been corrected by the copy editor. One major lapse is that two chapters in the table of contents, Chapter 21 (Organized Rescue Techniques) and Chapter 22 (Companion Rescue Techniques), have very different titles in the text, in which they are called Large Team Rescue Techniques and Small Team Rescue Techniques, respectively. The first three chapters also have different titles in the table of contents than in the text. Some chapters have citations in the text whereas others lack them. Some are completely unreferenced. Photo credits are given inconsistently. Many basic concepts in the text are not found in the index.
For potential readers who are not enrolled in a DiMM course, I would recommend picking and choosing chapters. Here are some highlights of the medical chapters. Chapter 6 (Medical Problems in the Mountain Environment) contains an excellent introduction by David Hillebrandt, who is not listed as an author of the book. The introductory remarks of the chapter proper are also outstanding. The rest of the chapter is too basic for emergency physicians, internists, and general practitioners. Chapter 8 (Avalanche Medical Physiology and Victim Management) is an excellent practical guide to management of avalanche victims that is perfectly pitched for students in DiMM courses and others who might be interested in an introduction. Chapter 12 (Medical Professional Roles in Search and Rescue) is a good general introduction for healthcare providers who want to get involved in organized Search and Rescue in North America. Chapter 13 (Legal Aspects of Mountain Medicine) is an excellent introduction for expedition physicians. Chapter 14 (Finding Balance: Patient Care Challenges in Technical Rescue) introduces an important concept: “Experienced wilderness providers often report that the more they operate in remote settings, the less medicine they perform, unless absolutely necessary.” This chapter could have been improved with more specific examples.
Some of the rescue chapters are exemplary and others are likely to be overwhelming to the reader who is not already familiar with technical climbing. Fortunately, Mountain Medicine and Technical Rescue offers the usual disclaimer that no book can teach mountain rescue without proper hands-on training. Chapter 15 (Rescuer Safety Systems) has an excellent introduction and first section on safety prioritization. The rest of the chapter depends on technical rescue concepts that are not introduced until Chapter 18. Chapter 17 (Fitness Training for Mountain Rescue Professionals) might have been a great asset to the book had it not concentrated on a proprietary training scheme employed by the author rather than explaining important basic concepts. There is obvious bias and conflict of interest. Chapters 18–21 have their good points, such as the discussion of rescuer safety in Chapter 18 (Rescue System Fundamentals) and the introductory sections of Chapter 23 (Mountain Rescue Environments). However, large sections of the rescue chapters become bogged down with details and slip into jargon that is likely to be unfamiliar to most of the DiMM students. Two notable exceptions are Chapter 25 (Helicopter Operations) and Chapter 27 (Human Factors in Mountain Rescue). These two chapters should be required reading for anyone involved with helicopters or mountain rescue, not just for DiMM students.
Overall, Mountain Medicine and Technical Rescue is a reasonable introductory text for students enrolled in DiMM courses, but there are many areas that could have been better covered and many inaccuracies that should be pointed out and corrected by knowledgeable instructors. Readers who are interested in a more in-depth treatment of individual topics would do better to read about them in Auerbach's Wilderness Medicine (Auerbach, 2017).