An Insight into Mountain Rescue Teams (MRTs)

You may have seen Mountain Rescue teams (MRTs) if you’ve been out in the hills or mountains, seen them on the television (a few series have recently been on air), or perhaps you’ve seen them at Emergency Services open days. What is it all about, from the viewpoint of a doctor? I offer my viewpoint as a doctor having been involved in MRTs for over 11 years.

What are Mountain Rescue Teams?

As background, MRTs are groups of volunteers who come together from any walk of life to answer the call when it comes to aid in searching for and/or rescuing a lost or injured person. As a result of the breadth of members’ backgrounds (the one similarity between us all being love and proficiency in the outdoors), not all teams have healthcare professionals in them, relying on higher national mountain rescue qualifications to enhance their care of casualties beyond outdoor first aid level.

MRTs vary in membership, size and frequency of callout (some may be almost every day, others a handful a year) – the only common factor is each has a geographic area they respond within. Team equipment, procedures, training schedules/frequency, and skill mix vary between teams greatly. Scottish Mountain Rescue (SMR) is an umbrella organisation, with teams the final decider of how they operate. This is slightly different in England and Wales where the Mountain Rescue England and Wales (MREW) organisation has more input over team processes – hence the variability between teams. You may work with the police, fire service, helicopters, coastguard, and ambulance services, so interagency relationships are important.

Working as a doctor in an MRT

Most members are on-call 24 hours a day, 7 days a week, 365 days a year, and depending on your team, you may be called to all ‘shouts’, or only some. As a medic, however, you have a responsibility to your patients during your working hours, so unlike some team members whose professions may allow some flexibility, your patients come first so you may not be able to attend every shout. Depending on your team’s area, rescues can last hours to days, whilst searches can last longer.

The commitment is significant – on top of callouts is training, and depending upon what stage of life you’re at and your priorities at the time, including family, career hurdles, dependents, or perhaps you still have the itch to travel, you need to be able to give the team the appropriate time to be a useful member. Membership also involves helping organise training, getting to know your teammates so you’re familiar with them at the darkest times (in many potential ways) to support each other, and keeping your rescue skills current. If you’re thinking of joining a team, consider the commitment in time to the area you’re in (teams may have up to a year as a probationer to complete training before you can be added to the active callout list).

So MRTs are so much more than an emergency rescue service. So many skills are required other than clinical ones. Teamwork, communication, resilience, outdoor proficiency (even before being in the team), Leadership (and followership), problem-solving, general fitness, and a will to make the team work are all needed (members also need to clean equipment, the base, order supplies, apply for funding, respond to enquiries – all the general tasks of running a charity as well as a team). Medics have much to offer teams in various aspects of the above, but the ability to help with the day-to-day tasks is important.

From a medical perspective, perhaps the bit you’re more interested in here, how does a doctor fit in? Clinically, your enthusiasm for providing maximal quality care needs balanced against rescue practicalities and a hostile environment (very different to your warm, dry resuscitation bay) – the cold makes all veins disappear…and you may be the only clinician responder at the scene. Early on you need to learn what is both practical and appropriate – at that time and place. Your skills as a doctor need to be different to your hospital role or abilities.

What illnesses or injuries do we see?

Official statistics from 2023 from SMR tell us the majority of our callouts are trauma, with lower leg and ankle injuries accounting for 57% of callouts. A more detailed but voluntary reporting of medical care indicated (note only a quarter of rescues had this information gathered) that 32% were suspected lower limb fractures (the casualty can no longer mobilise hence the callout), and soft tissue injuries making up the rest of lower limb issues. On the severest end of the spectrum, polytrauma was encountered in 7%, and concerns over a spinal injury in 7%. Of the medical conditions reported, hypothermia was the largest group – the vast majority mild. Seizures, chest pain, intoxication, and deliberate self-harm were also reported. Each year a team usually reports CPR being delivered.

What medical care can teams provide?

Most teams will carry equipment for managing bleeding, splinting, immobilisation, and managing environmental illness – which all sounds more like first aid. All team members should be able to provide this irrespective of background. The next level of care of the casualty, which some (or all – dependent on the team) may have is a qualification designed for MRT, recently re-termed to ‘Remote Rescue Medical Technician (RRMT)’ – which sits at a similar level to an Ambulance Technician but has some variations and added skills. RRMT providers can provide resuscitation including bag valve masks and simple airways, complete an A-to-E assessment in medical and trauma scenarios, and provide some life-saving interventions (like chest seals and tourniquets). MRTs are a unique emergency service in that they have the ability, along with the RNLI, to hold controlled drugs to treat casualties. Therefore RRMT treatment options are a limited range of prescription-only medicines, including morphine intramuscularly and more recently, fentanyl lozenges, with Penthrox inhalation analgesia to come. Other treatments are available for nausea, respiratory depression, cardiac pain, seizures, hypoglycaemia, and asthma. I’ve done the course and now instruct and examine on it – well worth doing if you join to help determine what’s appropriate and sensible, and what you can expect of RRMTs who attend a scene with you.

So there’s help at hand at the scene – hopefully, you agree a good breadth of skills for the range of acute issues we encounter. Where, might you say, is the role of the doctor? The team can’t be reliant upon your consistent attendance – and you may well not be first to find a casualty even if you are on the hill – some redundancy in skills within the team is important. My personal experience on the hill has been to provide advanced decision-making in diagnosis (treatments may be limited but clinical urgency of evacuation and consideration of options can be invaluable), decisions on the balance of priorities (for example multiple casualties or complex extrications), familiarity with clinical assessment and patient-engagement skills and therefore supporting other team members in their own clinical skills. In addition to hands-on when available! Perhaps the less pleasant part of the medic’s role is decision-making in managing casualties who have died – casualty recovery is an essential but less well-publicised part of an MRT’s role – but helps bring resolution to the family and friends involved.

Have I given you a flavour of life as an MRT doctor? It’s varied, challenging, rewarding, and a great opportunity to get to know an enthusiastic, committed group of people volunteering for their local area. I value it greatly and enjoy being part of the Moffat MRT – I’m grateful for them having me. Would I recommend it? If you have the mindset, family support, and can commit for the medium and long term- absolutely.

If you have queries, I suggest getting in touch with your local team to learn how they work and see if you might like to join.

Useful links

Moffat MRT website:

https://www.moffatmrt.org.uk

Scottish Mountain Rescue website:

https://www.scottishmountainrescue.org

MREW Website:

https://www.mountain.rescue.org.uk

Author: Dr Alexander McDonald, Consultant in Acute Medicine and Critical Care at Dumfries and Galloway Royal Infirmary

Reviewer: Dr Joshua Grubb, MTB Pre-Hospital Medicine Lead

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