TFTC #55 Tree climber Rescue & emergency preparedness: Patient Care
Arborculture Canada Training and Education LT by DJ Neustater Oct 24th 2025Duty of Care VS Scope of Practice
Understanding the distinction between duty of care and scope of practice is crucial in the context of patient care. Duty of care encompasses the legal and ethical obligations associated with providing care, while scope of practice defines the boundaries of tasks, activities, or knowledge that can be performed. It is essential to grasp these concepts and their specific relevance to your local area or jurisdiction. Once an individual has received the necessary training and qualifications, they are permitted to practice within those parameters. Now, let us examine the systematic steps involved in arborist emergency response.
Incident occurs
Action E.R.P
Complete Scene Survey H.E.M.P.A
Establish Patient Contact
Perform Primary Patient Assessment
Extricate The Patient Safely
Hand Off After Action
Once the arborist rescuer has activated the emergency response plan (E.R.P), conducted a scene assessment (H.E.M.P.A), and made contact with the patient, they may begin providing patient care. It is essential to deliver care only within the boundaries of your training and qualifications. Practicing beyond your level of training is not advised. When applicable, adhere to the guidance of a higher medical authority, always prioritizing the patient's best interests. Patient care may involve basic actions such as stabilization, comfort, and support until additional assistance arrives. The following acronyms are integral to the patient assessment model (P.A.M) utilized by professional emergency responders. The patient assessment model (P.A.M) is a validated systematic approach for the swift and effective evaluation of patient conditions, illnesses, and injuries in a pre-hospital setting. This article will concentrate on the primary patient survey component of P.A.M, which pertains to the care that can be provided within one's scope of practice. It is essential to recognize that an arborist rescuer may have limited time to conduct secondary patient assessments, focusing primarily on immediate threats to life or limb. The main objective will typically be to safely extricate or evacuate the patient while addressing any life-threatening conditions identified during the primary survey.
While secondary survey information can be beneficial, it should only be pursued if time allows and falls within the rescuer's scope of practice. Continuous training is advisable for those looking to expand their capabilities. This overview does not encompass all existing medical training models. Always seek formal training and adhere to local regulations, rules, and your employer's standard operating procedures concerning first aid, patient care, and tree climber rescue.
Primary Patient Assessment
L.O.C - A.V.P.U
S.M.R/M.A.R.C.H
R.B.S
S.O.A.R.I
Secondary Patient Assessment
S.A.M.P.L.E
Vitals
Head to Toe & Document
Hand Off - A.T.M.I.S.T
Level of Conscicusness
The initial evaluation of a patient involves assessing their level of consciousness or responsiveness (LOC/LOR). To perform this assessment, a rescuer will engage with the patient to establish communication. The A.V.P.U. method is employed to evaluate LOC/LOR during this interaction.
During the primary survey, it is essential to conduct critical interventions whenever a life-threatening condition is identified, such as the absence of breathing, pulse, or severe bleeding. These interventions may involve actions such as providing warmth with a blanket, stabilizing or immobilizing the patient, managing shock, performing CPR, or administering oxygen or medications. It is important to document all critical interventions undertaken and to act strictly within the scope of your qualifications and training.
Spinal Motion Restrict (S.M.R)
Following the evaluation of the level of consciousness (L.O.C), the rescuer must attend to any suspected spinal injuries by implementing appropriate spinal motion restriction (S.M.R). This procedure is essential for ensuring the patient is adequately stabilized and for minimizing the risk of additional harm. In cases of substantial blunt force trauma or falls, it is crucial to consider the likelihood of a spinal injury and to stabilize the patient as necessary and feasible.
Unresponsive Patient, Look - Listen - Feel
In the event that a patient is unresponsive, it is advisable to promptly employ the Look – Listen – Feel method. This approach is useful for quickly assessing the patient's pulse and respiration. It entails examining the carotidartery, listening for breath sounds, and observing the patient's chest for any rise and fall indicative of effectivebreathing. It is important to note that all medical evaluations necessitate formal training and practice.
M.A.R.C.H - A Systematic Survey Primary
The rescuer will subsequently conduct athorough assessment to identify any critical and immediate threats to the patient's health. Adhering to these methods is essential toensure that no vital information is overlooked. The M.A.R.C.H approach serves as an effective framework for prioritizing patient care and implementing critical interventions. Always ensure that you operate within the boundaries of your training and qualifications.
Rapid Body Survey
Following the evaluation of L.O.C - A.V.P.U, S.M.R, and M.A.R.C.H frameworks, the rescuer may conduct a rapid body survey (R.B.S). This assessment is crucial in the presence of distracting injuries, such as a compound fracture. Certain injuries may be more prominent and painful, potentially diverting attention from other critical issues. Additionally, there may be life-threatening conditions, such as severe bleeding, that require immediate identification. The R.B.S can help uncover other injuries that may be obscured by these distracting factors.
Obtain appropriate training and develop the necessary techniques prior to conducting an R.B.S. This procedure is performed effectively and with a clear objective to uncover vital information that may influence the patient's condition and the outcome of the rescue. Ongoing communication is crucial; keep all parties informed about the patient's status and any information collected. It is important to note that rescuers and first responders do not make diagnoses; their role is to collect information and manage life-threatening situations as evaluated during P.A.M, in line with their level of first aid or emergency response training. First responders primarily serve as information gatherers.
Skin, oxygen, airway, position interventions (S.O.A.P.I)
The initial responder may conclude the primary patient assessment during P.A.M by utilizing the S.O.A.P.I method. This approach serves to refine the primary survey and confirm that no essential evaluations have been overlooked.
This marks the completion of the last series of systematic evaluations within the primary survey of the Patient Assessment Model utilized by professional emergency responders. It is crucial to recognize the significance of the secondary survey within the patient assessment model (P.A.M). If the patient is deemed relatively stable and the primary survey has been finalized, a qualified rescuer may proceed with the secondary survey, starting with the S.A.M.P.L.E. framework for gathering information.
Secondary Survey Information
S.A.M.P.L.E
The secondary survey may encompass details such as signs and symptoms, allergies, current medications, medical history, recent bathroom visits or meals consumed, and the circumstances surrounding the incident. This process isreferred to as the S.A.M.P.L.E survey
O.P.Q.R.S.T
The secondary survey may incorporate a pain scale to evaluate the onset, provocation, quality, radiation, severity, and duration of pain. This assessment is referred to as the O.P.Q.R.S.T pain scale.
Secondary survey information should be collected only after the primary survey has been completed and the patient has received treatment and is stable. Continuous monitoring, assessment, documentation, and communication are crucial throughout the entire rescue operation. As an arborist rescuer, it is essential to understand and evaluate your patient's vital signs within your scope of practice.
Remember to pursue professional emergency response training and to operate strictly within your level of training and scope of practice. As an arborist rescuer, adhering to the Patient Assessment Model (P.A.M) and conducting thorough scene assessments, primary surveys, and secondary surveys will significantly enhance your chances of a successful rescue. Familiarity with these systematic evaluations, along with their methodologies and techniques, will improve your effectiveness as an arborist team member with the potential to save lives.
Thank you to the following contributors
All organizations, individuals, and publications mentioned herein are acknowledged for their valuable contributions and support of this article series. We extend our gratitude for the various photo credits, content, and reviews provided by those listed below. Your support, service, and commitment to safety are greatly appreciated.
References
Arboriculture Canada Training & Education, (Since 1999). Entire ArborCanada Team.Engström, A. Primary Care Paramedic (PCP) & Member of T.E.A.A.M.Fire Rescue, H.V.F.D. (2024). Highlands Volunteer Fire Department. Highlands, British Columbia, Canada.John Ball, PH.D., CTSP (2022). Tree Worker Safety Update By the Numbers: Another Us vs. Them. TCIA.T.E.A.A.M, (2025). Technical Evacuation Advanced Aero Medical. TEAAM. Canada.Tree Climber Rescue & Emergency Preparedness, (2024). ArborCanada Workbook. Tresselt, T. (2024). Director of Training & Education. Arboriculture Canada Training & Education. Canada.