Wilderness Evacuation

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Wilderness Evacuation

• What to do when it all hits the fan
• Jonathan Miller, MD
• Maine Medical Center
• Department of Emergency Medicine

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Case 1 A missed jump in the backcountry results
in a broken leg

• What type of evacuation is needed?
• Helicopter
• Evacuation by foot
• Carry
• Litter
• What resources do we have available
• Where are we???

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The mode and urgency of the evacuation is decided
on several factors

• Severity of the illness or injury
• Psychological condition of the victim
• Rescue and medical skills of the rescuers
• Physical/Psychological condition of the rescuers
• Availability of equipment and/or aid for the
  rescue
• Danger/difficulty of extracting the victim(s) by
  the various means available

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• Time
• Distance to care, or the car
• Terrain
• Weather
• the possibility of deteriorating weather
• COST

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If you decide to use an outside rescue group
THEN DONT WAIT!!!
The longer you wait to make your decision, the
worse your patient is going to get
The entire group, including the patient (if
possible), should be in the decision making
process
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What deserves an evacuation?

• Orthostatic dizziness
• Syncope
• Altered mental status
• Progressive weakness
• Intractable vomiting/diarrhea
• Inability to tolerate fluids
• Head injuries
• Debilitating pain
• Sustained abdominal pain
• Signs and symptoms of high-altitude illness
• Infections that continue to progress for gt24hrs
  despite appropriate treatment

• Chest pain that is clearly not from a
  musculoskeletal injury
• Serious wounds
• Open fractures
• Impaled objects
• Suspected spinal cord injuries
• Partial and full thickness burns that cover gt15
  of the body are urgent evacuations
• Burns to the neck and face require urgent
  evacuation
• Blistered burns require evacuation but not
  urgently

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Helicopter evacuation

• Evacuate with a helicopter only if
• A victims life will be saved
• The victim has a better chance for full recovery
• Pilot believes the conditions are safe
• Ground evacuation may be unusually dangerous
• Not enough rescuers for ground evacuation
• Remember that a ground evacuation may still need
  to be made to a suitable landing zone

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Helicopter evacuations

• Assign someone to protect the landing zone
  remove debris and mark the LZ with a large green
  or red material
• Indicate wind direction using streamers or by
  standing with your backs to the wind and your
  arms forward
• Never approach a helicopter until a signal has
  been given by aircraft personnel, and never
  approach a helicopter from the rear
• Ground transportation may be safer if patients
  have suspected pneumothorax or decompression
  sickness
• Remember that helicopter rescues arent always an
  option high altitudes, hot temperatures, poor
  visibility, bad weather, and terrain can all
  prevent rescues.

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Ground evacuation

• Self Rescue
• Always send at least 2 people when walking out
  with a patient
• Litter carries require 6-8 or more depending on
  the terrain

• Outside rescue
• Write down the information assess the patient,
  the situation, and give a detailed location.
• Assess potential hazards to the rescuers and
  their vehicles.
• Taking the time to write out a detailed note
  ahead of time will decrease total evacuation time

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Be nice

• Its inappropriate to ask for help out of
  convenience, when you have the capabilities to
  carry out your own rescue
• Request assistance as a last resort, when life or
  limb is threatened
• Remember, that getting rescued is rarely free

• Improvising a litter will typically aggravate
  existing injuries, consider waiting for a real
  one.
• Remember that your patient can talk to you
  (sometimes) get their opinion as they are
  obviously part of the rescue.

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Carries

• Assisted walk
• Four handed seat
• Back carries
• Rucksack method
• The boy scout method
• Rope coil method
• Webbing carry

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Litters

• Daisy chain method
• Limb/paddle/shirt/blanket/what ever else I can
  find around me method
• A real litter!
• Snow rescue? Think about their sleeping bag?
• DONT forget to PAD!

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Sources

• Wilderness Medical Society Wilderness Medical
  Society practice guidelines for wilderness
  emergency care. William W. Forgey, MD. 5th ed.
• Mountaineering The freedom of the hills. Steven
  M. Cox and Kris Fulsaas, 7th ed.