Wilderness Evacuation
What to do when it all hits the fan
Jonathan Miller, MD
Maine Medical Center
Department of Emergency Medicine
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???
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
•Time
•Distance to care, or the
car…
•Terrain
•Weather
•the possibility of
deteriorating weather
•COST
If you decide to use
an outside rescue group
THEN DON’T 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
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 highaltitude illness
•Infections that continue to
progress for >24hrs 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 >15% of the body are
urgent evacuations
•Burns to the neck and face require
urgent evacuation
•Blistered burns require evacuation
but not urgently
Helicopter evacuation
Evacuate with a helicopter only if:
•
•
•
•
•
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A victim’s 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
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 aren’t always an option – high
altitudes, hot temperatures, poor visibility, bad weather, and terrain can
all prevent rescues.
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
Be nice…
•It’s 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.
Carries
•Assisted walk
•Four handed seat
•Back carries
•Rucksack method
•The ‘boy scout’ method
•Rope coil method
•Webbing carry
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?
•DON’T forget to PAD!
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.