ASRの対応

ばく

野外で傷病の評価をディスターブするASR(急性ストレス反応)。その対処を理解して、正確な傷病の処置を。

神経系は、随意神経（体性神経）と不随意神経（自律神経）に分類される。随意神経は、感覚神経と運動神経に分かれる。感覚神経は、脊髄、脳に信号を送るのに対し、運動神経は、それから信号を送る。これらの神経を通じて、随意神経は骨格筋を収縮させ、意図的な動きを作る。一方不随意神経は、平滑筋を収縮させ、ホルモンを調整し、ホメオスタシスを維持する。ほとんどの不随意神経は意識によって統制できない。不随意神経はさらに、交感神経と副交感神経に分類される。交感神経は、細胞や器官のエフェクターを刺激し、副交感神経はそれを妨げる。いずれの神経も、同じエフェクターに刺激を与え、相互に作用する。通常は、交感神経は体を覚醒させ、副交感神経は睡眠や消化を司る。

外傷によるストレスにより、不随意神経が不自然な信号を送ることがあり。これは急性ストレス反応（Acute Stress Reaction: ASR）という。交感神経が高まれば、体は「戦う」、「逃げる」の判断をし、虹彩が広がり、心拍、呼吸、血圧が上がり、強度の運動に備える。同時に、不安や緊張を高め、発汗し、血管収縮により、皮膚は青白く、冷たく、しっとりし、エンドルフィンの放出により、痛みがわからなくなる。過度の刺激により、筋収縮が統制できず震えが起こる。交感神経が過度に高ぶると、認知能力を下げ、複雑な情報を処理できなくなり、恐怖に対する感覚が麻痺する。そのため、交感神経系のASRでは、痛みに気づかずに、不自然なS/Sxを示す。バイタルサインは、ボリュームシックと類似しており、それをわからなくする可能性がある。

一方、副交感神経の刺激が優位になると、傷病者は、吐き気、めまい、時には気を失う。血流が消化器に集中し、心拍、呼吸、血圧が低下する。皮膚は青白く、冷たくなる。意識がある傷病者は、混乱する。副交感神経のASRは、脳震盪のS/Sxと類似しており、頭部への外傷の評価を難しくする。

重大な事故は、傷病者、救助者、看病者、バイスタンダーに急性、もしくは恒久的なストレスを与える。心的外傷後ストレス傷害（Post Traumatic Stress Disorders: PTSD）は、個人差があるが、一般的によく知られている。救助者、看病者としてのあなたの行動により、傷病者のストレスを短期的にも長期的にも軽減できる。（Psychological First Aid: PFA）とは、PTSDの予防、低減のために、近年注目されている技術である。用語自体は新しいが、傷病者の心的ストレスの低減は、PASの不可欠な部分として考えられてきた。

現場の脅威をできる限り緩和し、傷病者、救助者、看病者、バイスタンダーにとって、安全な環境を作る。救助者がやるべきこと、できることを集中するために、傷病者、看病者、バイスタンダーに真実を伝えることは不可欠である。時には、その場に不適切な人を、現場から離すことも必要である。

ストレスは、傷病者だけでなく、救助者にも発生する。救助者は、救助を開始する前に、自分のASRを低減する必要がある。現実に焦点を向け、できる限り冷静に対応する。PAS通りに進め、よく体系化されたSOAPノートに基づいてひちつずつ進めることは、ASRの低減に役立つ。

傷病者や救助者にとって、無力感や絶望感は容易に起こる。看病者は、傷病者を自分の処置や避難に目を向かせる。現場のリーダーは、救助者、看病者、バイスタンダーを励まし、現場でできることを、ひとつずつクリアしていく。

現場のリーダーは、看病者に傷病者と共に、評価、処置、避難に関与することで、現場の人間関係を構築する。看病者と傷病者の人間関係は、傷病者のライフラインにとって現実的に重要な要因である。また、傷病者やバイスタンダーが、家族や友達、恋人などの大切な人と連絡を支援することで、現場の枠を超えてライフラインを構築することができる。

Author: Paul Nicolazzo/ Translator: Taito Okamura

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