MEDICAL EVACUATION
&
CASUALTY EXTRACTION
AND SHORELINE
OPERATIONS
January 2012
CANADIAN
CANADIANCOAST
COASTGUARD
GUARDAUXILIARY
AUXILIARY- -PACIFIC
PACIFIC
Medical Evacuation
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Medical Evacuation
• Secure and stabilise patients to permit a safe
medical extraction.
• Complete patient documentation, and hand
over to next level of care.
• Coordinate medical evacuation and work
cooperatively with other rescue agencies.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Medical Evacuation
• If there is an opportunity to respond with a
higher level of first aid on board, it should be
taken.
• First aid treatment should be given, and
JRCC informed of the injuries and their
severity.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Medical Evacuation
• An assessment needs to be made as the
most appropriate mode of evacuation, given
the location, condition and state of the
casualty.
• Where it is agreed with JRCC that the
casualty is to be evacuated by water, again it
will be decided as to whether there is a
suitable point close where EHS or a
helicopter can access, and the patient
handed over to a higher level of care.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Medical Evacuation
• A intimate knowledge of the local area,
particularly boat landing sites, and possibly
for helicopters, is therefore important.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Casualty Preparation
• Whether the patient is on another ship, boat,
or ashore:
1. Firstly assessed by the first aid protocols of
the day.
2. If immediate treatment is required, that
treatment started.
This information to be passed to JRCC.
3. Where necessary packaged properly for
transportation.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Casualty Preparation
• Where the patient is ambulatory, they can be
moved around with care.
• If there is any doubt, a basket stretcher
should be used.
• The patient is to be fitted with a PFD or
lifejacket and the basket stretcher fitted with
flotation.
• Only if the patient requires CPR or has chest
injuries should a PFD not be fitted.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Casualty Preparation
• The patient should be keep warm and dry,
and as comfortable as possible in the
circumstances.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Evacuation By Water
• Where the transfer is to be made by water,
the casualty should be placed in the most
comfortable part of the rescue vessel (on a
RHIB or T Top this will be aft where the
acceleration forces are least).
• The position in the vessel will also be
governed by the treatment or monitoring
required on the trip to rendezvous with the
higher levels of care.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Evacuation By Water
• It may be necessary to secure the stretcher in
the rescue vessel, depending upon the
conditions, the design of the rescue vessel or
the position of the stretcher needed to
provide treatment.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Evacuation Speed
• The speed of the rescue vessel will be
governed by:
1. The injuries and/ or condition of the patient,
the urgency with which they need to access
higher care.
2. The level of treatment or monitoring required
from the crew.
3. The prevailing weather and sea conditions on
the planned route.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Evacuation Speed
4. The safety of the vessel and the crew and
other people on board.
5. The time the crew on board will be physically
capable to provide concentrated first aid
treatment, such as CPR, or exhaust medical
supplies such as oxygen.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Patient Information
• The crew should endeavour to gather as
much information on the patient as possible,
both from the patient where they are
conscious, or from accompanying family or
friends, where the patient is or becomes
unconscious.
• This should include details such as name,
age, address, as well as all items on the
SAMPLE checklist.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Patient Information
•
•
•
•
•
•
S
A
M
P
L
E
Signs and symptoms?
Allergies?
Medications - Yes/No? - What for?
Past Medical History?
Last meal?
Events leading to the emergency?
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Patient Information
• This should be recorded preferably on a
Patient Information Form, but additional
information either written down in the log, or
even on the back of the crews latex gloves.
• One idea is to put a latex glove on the patient
and write on that.
• This information (as well any personal effects
if there is time) must be passed over to EHS
when passing over the patient.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Patient Information
• Any personal effects or equipment connected
with the accident not handed over to EHS,
(such as dive equipment) must safeguarded
and secured.
• Contact should be made with police or
coroner to hand it over.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Casualty Extraction and
Shoreline Operations
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Casualty Extraction and
Shoreline Operations
• Supervise the packaging of the casualty
• Supervise the extraction of the casualty and
transfer into vessel.
• Understand protocols for requesting other
resources.
• Recognise risks of operations close to shore,
and when incident is beyond capabilities of
vessel and crew.
• Have intimate knowledge of area.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Casualty Extraction and
Shoreline Operations
• Maintain control of vessel and crew during
the rescue operation.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Extraction From Shore
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Extraction From Shore
• The prime strategy for casualty extraction is
to remove the persons safety.
• With a casualty extraction, minimise pain and
suffering of the casualty.
• If there is an opportunity to respond with a
higher level of first aid on board, it should be
taken.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Evaluation For Extraction From
Shore
• What communications are available?
• What requires the persons be evacuated from
shore (hypothermia, injury or immediate
danger)?
• Can the persons be evacuated safely (size of
crew, manoeuvrability of vessel, type of
shoreline, weather conditions)?
• Is there a more appropriate mode of
evacuation?
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Evaluation For Extraction From
Shore
• How is the rescue best effected by the rescue
vessel?
• What is the risk assessment for this rescue?
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Preparation
• Establish communication with those on shore.
• Stop, Assess, Plan
• Detail plan, including dangers and
contingency plans.
• Inform JRCC of situation and intentions.
• Brief those on shore.
• Prepare equipment.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Execution
• Choose an appropriate landing site, taking
into account being clear of obstacles, surf,
and if possible sheltered from wind and
waves.
• If an approach to a lee shore is necessary,
consider veering down to control the
approach of the rescue vessel.
• The rescue vessel may be beached in
sheltered conditions.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Execution
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Extracting Persons From Other
Vessels
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Extracting Persons From Other
Vessels
• In adverse weather or sea conditions this can
carry considerable risk, especially where
handing injured people, people not used to
being at sea, or the infirm.
• Consideration must be given as to whether
the extraction is necessary considering the
risks, and will be made by the coxswain,
JRCC and the master of the vessel being
assisted.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Preparation
• Stop, Assess, Plan.
• Agree extraction is necessary.
• Discuss operation with master of vessel being
assisted.
• Brief own crew on duties and risks.
• Ensure all personnel to be extracted are
wearing PFDs or lifejackets.
• Use safety harnesses where available (may
be line around someone’s waist).
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Preparation
• If necessary and available rig extra fenders.
• One crew member assigned to communicate
with vessel being assisted during approach.
• Make upwind approach from lee side of
vessel being assisted.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Transfer
• If conditions allow, the rescue vessel should
be secured alongside the vessel being
assisted, with slip rope, so that the rescue
vessel can let go quickly.
• If making fast is not possible, look for the best
place on the lee side to hold the rescue
vessel, which will facilitate the transfer.
• Crew to take change of transfer, instructing
when transfer to take place, and assist.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Liferaft Transfer
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Liferaft Transfer
• If conditions do not allow the rescue to get
close, if the assisted vessel has a liferaft, this
can be put in the water, inflated,everyone
climb in, and the liferaft floats down to the
rescue vessel.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Stretcher Patients
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Stretcher Patients
• The patient must be wearing a PFD or
lifejacket, and if in a basket stretcher, the
stretcher must be fitted with flotation for all
transfers over water.
• Guide lines should also be attached to the
head and foot of the stretcher to allow control
of the stretcher during the transfer.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Large Vessel Transfers
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Large Vessel Transfers
• Means of transfer may include:
1. Vertical rope ladder.
2. Accommodation ladder lowered, with rope
ladder for last 6 feet.
3. Ship side door about 8 foot above waterline.
4. Stretcher lowered using a ship’s cargo or
stores crane.
5. Lowering of a lifeboat to the water, with
stretcher inside.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Large Vessel Transfers
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Large Vessel Transfers
• The lee side is the best choice.
• If anchored, this will likely be the opposite
side to the anchor in use.
• If underway, all astern movements on the
vessel being assisted must have stopped and
the effects died away.
• Most large vessels will likely wish to maintain
steerage while going ahead, which will be
between 4 and 8 knots.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Large Vessel Transfers
• On large cargo ships stay on the flat side of
the vessel.
• Stay away for the stern, where the line of the
ship curve in toward the propeller and rudder.
This is a dangerous area, not least from the
rescue vessel superstructure, mast and
scanners contacting the ship side higher up.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Large Vessel Transfers
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Preparations
• If coming alongside a large vessel which is
underway, rig extra fenders.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Preparations
• If there is any intention of making fast using a
sea painter, the line from the vessel must be
come down to the inboard side of the rescue
vessel.
• Keep engines turning ahead, but with weight
on the line.
• Taking the line from the bow or outboard side
of the rescue vessel could put the rescue
vessel at risk of capsize.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Preparations
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Transfer
• If crew available, one crew to take charge of
communications, to allow coxswain to control
rescue vessel.
• Crew on deck to assist in transfer.
• On completion, if painter attached increase
speed, let go painter, shoulder check, then
steer stern into the large vessel, and the bow
will come clear.
CANADIAN COAST GUARD AUXILIARY - PACIFIC
Transfer
• It may be necessary to abort. Crew to be
briefed as to this possibility.
• Be ready for a man overboard situation.
CANADIAN COAST GUARD AUXILIARY - PACIFIC