6720
Page 1 of 23
FOREST SERVICE MANUAL
INTERMOUNTAIN REGION, R4
OGDEN, UT
FSM 6700 – SAFETY AND HEALTH PROGRAM
CHAPTER 6720 – OCCUPATIONAL HEALTH PROGRAM
Supplement No.: 6700-2014-1
Effective Date: 03/10/2014
Duration: This supplement is effective until superseded or removed.
Approved: NORA B. RASURE
Regional Forester
Date Approved: 2/28/2014
Posting Instructions: Supplements are numbered consecutively by Title and calendar year.
Post by document name. Remove entire document and replace with this supplement. Retain this
transmittal as the first page of this document. The last supplement to this title was 6700-2012-1
to FSM 6720.
New Document(s):
6720
23 Pages
Superseded Document(s) by
Issuance Number and
Effective Date
6720 (Supplement 6700-2012-1, 10/29/2012)
23 Pages
Digest:
6725 - Removes language that requires units adhere to individual state policies or rules with
regards to using employees that serve as Emergency Medical Providers. Assures employees that
state rules regarding requirements for employees to be licensed or certified in their particular
state do not apply to Forest Service employees in performance of Forest Service duties.
The term “Emergency Medical Provider” is used to define the full spectrum of national and state
recognized certifications beyond the Basic First Aid/CPR level. While generally similar, there
are differences in the titles and skills allowed to be practiced depending on the state or national
curriculum in question. Recognized certifications that fall under the term “Emergency Medical
Provider” include but are not limited to National Ski Patrol Outdoor Emergency Care Provider,
First Responder/Emergency Medical Responder (EMR), Emergency Medical Technician (EMT),
Intermediate EMT, Advanced EMT, and Paramedic. Other wilderness training programs that
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 2 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
may or may not be recognized are Wilderness First Responder (WFR), Wilderness EMT
(WEMT), and other Wilderness Advanced Life Support (WALS) programs.
The key component to all of these levels of “Emergency Medical Provider” is that the employee
is designated as an EMP in the Unit’s Emergency Medical Response Plan and that the employee
is current with regards to certification (or licensure) at the listed level of qualification. All
qualified Emergency Medical Providers will meet these two standards.
6725 - EMERGENCY MEDICAL SERVICES
Objectives:
1. To reduce the severity of accidents and injuries by establishing and maintaining
Emergency Medical Response preparedness and capability for all units in the
Intermountain Region.
2. To provide clear direction for the training and certification standard of Emergency
Medical Providers within the Intermountain Region.
3. To facilitate consistency within the Intermountain Region and among the cooperating
Agencies when such consistency is to the advantage of the Forest Service.
4. To assure Forest Service EMPs that they are they are acting within the scope of their
employment when they are providing emergency medical care consistent with this
direction.
Policy - Basic First Aid/Cardiopulmonary Resuscitation (CPR) training requirement for field
going crews and office groups are defined in FSH 6709.11 Health and Safety Code Handbook.
Emergency Medical Response (EMR) - Every unit in the Intermountain Region shall plan
and prepare to respond to a wide range of medical emergencies. To accomplish this, all
units shall take the following actions:
1. Prepare a Unit Emergency Medical Response Plan that defines
protocols and resources necessary to provide for emergency medical
response to reasonably foreseeable medical emergencies. All of the
unit’s emergency medical providers must be listed either by name or
by position within this plan. Exhibit 01 provides a template to assist
units in preparing the Unit Emergency Medical Response Plan. This
Plan shall be updated annually.
2. As appropriate, prepare Mutual Aid Agreements and/or Search and
Rescue plans that identify procedures for cooperating agencies (state
or county, municipal fire departments, or other federal agencies) to
request the assistance of our employees, including Emergency Medical
Providers.
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 3 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
3. Annually, each unit shall test or practice an emergency medical event,
exercising a sufficient portion of the Emergency Medical Response
Plan to test communications, notifications, and other essential
elements of the Plan. Afterword, the unit shall evaluate the test
through an after action review and make adjustments to the Plan as
necessary.
4. As appropriate, evaluate the need to establish Emergency Helicopter
Extraction protocols and prepare helitack crews to perform this
operation where no other reasonable or reliable alternative exists.
Resources operating in remote locations may benefit from cross
training in patient packaging and rigging for Emergency Helicopter
Evacuation.
5. Typically the county, city, or state is responsible for emergency
medical response, even on National Forest System lands. In instances
where a trained employee must render emergency medical care to
another employee or the public, the responsible agency (state and
county, or municipal fire department) should be notified. Upon arrival
at scene, the responsible agency should assume patient treatment and
care. The Forest Service may temporarily take the lead role where
quick response is needed; however, the lead role will be maintained
only until local responsible authorities are available to take over
leadership. In some cases, in coordination with local authorities, best
patient care may justify Forest Service Emergency Medical Providers
to remain in a lead role, especially when they are providing a higher
level of medical care.
Responsibility:
1. Regional Forester – The Regional Forester is responsible to ensure Intermountain Region
units are in compliance with this policy direction. Ensure units establish and maintain
Emergency Medical Response programs.
2. Forest Supervisors – The responsibility of the Forest Supervisor is to provide resources to
establish an Emergency Medical Response program and ensure the Forest Emergency
Medical Response Plan is in compliance with federal laws and receive adequate funding
for training and supplies. Forest Supervisors must approve the Forest Emergency
Medical Response Plan and appropriate agreements with cooperating agencies to support
emergency medical needs for their Forest.
a. At a minimum, the Unit’s Emergency Medical Response Plan shall specify the least
emergency medical response capability necessary to assure proper emergency
medical response to a reasonably foreseeable medical emergency on that Forest. This
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 4 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
capability shall become the Forest’s minimum required capability. The capability
determination shall be based on a risk assessment that considers the unique situations
of every Forest. Cooperating agencies should be considered in assessing the
minimum required capability.
b. Recommended staffing levels of Emergency Medical Providers will vary for each
unit and for each project. The current number of Unit Emergency Medical Providers
should be considered a factor in the development of the minimum Emergency
Medical Response Capability, but this number may need to be increased or decreased
based on the risk assessment.
c. The Forest Emergency Medical Response Plan will provide for monitoring of all
agency employees and volunteers and agency cooperators when working in remote
locations. For many units, the Forest Emergency Medical Response Plan may require
substantial changes to fire dispatch operations. The Forest Emergency Medical
Response Plan shall display procedures for cooperating, and periodic practicing, with
cooperating resources such as local fire departments and air ambulance services.
3. District Rangers – District Rangers shall promote the development, certification, and
continuing education of their Emergency Medical Providers. District Rangers shall
ensure their employees required to meet the Forest’s minimum capability are trained and
equipped as needed. District Rangers will ensure all documentation (training records,
certifications, and so forth) for their Emergency Medical Providers is properly recorded.
District Rangers will ensure that Emergency Medical Providers under their supervision
receive time and funding for certification training, their skills and education are
maintained, and necessary equipment for patient care is properly maintained and readily
available.
Guidelines:
1. Liability
a. Emergency Medical Provider duties typically account for less than 20 percent of an
employee’s duties. Those Emergency Medical Providers that are listed in the Unit’s
Emergency Medical Response Plan and are current in their licensure or certification
are acting within the scope of their employment when they provide emergency
medical care regardless of the jurisdiction of the medical emergency.
b. Employees providing Emergency Medical Provider services in connection with
Forest Service or cooperating agency operations may perform these duties at
locations outside of their certifying state (FSM 6725).
c. Forest Service employees certified or licensed to provide emergency medical care in
any state are authorized to provide this care in the performance of Forest Service
related duties anywhere in the United States. State laws or rules regarding
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 5 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
requirements for EMPs to be licensed or certified in their particular state do not apply
to Forest Service employees in performance of Forest Service duties.
2. Training
a. A unit may choose to follow the rules of the individual states in which the Forest
Service operate. Examples include use of the various titles and the scope of practice,
including initial and refresher training, for each level of Emergency Medical
Provider, such as Emergency Medical Responder, Emergency Medical Technician,
Outdoor Emergency Care Technician, Paramedic, and so forth.
b. Unit Emergency Medical Response Plans will identify what level of care is desired
for each unit.
c. The cost of training Forest Service personnel as Emergency Medical Providers as
identified by the Agency Administrator will be borne by the unit. This includes the
cost of State or National Registry of Emergency Medical Technicians certification
and recertification.
Units may deem it necessary to have employees with skills/certification above the
basic Emergency Medical Technician level. The unit will cover the cost of
certification for these identified individuals.
3. Project Specific Emergency Medical Response Planning and Emergency Medical
Provider Staffing Levels - Each project that requires an approved Job Hazard Analysis or
Risk Assessment (JHA/RA) shall include in the mitigations the minimum staffing level,
if any, of Emergency Medical Providers and the Emergency Medical Response protocols.
For example, a trail restoration project is being planned that involves a large number of
employees and volunteers clearing a section of trail from 10 to 30 miles from the
trailhead. The JHA/RA for this project must provide for mitigating the risks associated
with a difficult, and long, emergency medical rescue. This can be done by stating that the
crew composition shall include one Emergency Medical Provider for every 10 persons on
the crew (as an example). In addition, the JHA/RA should display the recommended
procedures to activate an emergency medical rescue for a time critical medical
emergency.
4. Individual Certification
a. Only certifications recognized by a state authority will be utilized in order to be
recognized by the unit. The state of certification need not be the same state in which
the unit is located (for example, an employee could be licensed as an EMT in Rhode
Island – a state that has no National Forests – this certification shall be recognized by
all units in the Intermountain Region.
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 6 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
b. The unit will pay individual certification fees as required by the regulations of the
state of certification, for employees identified as Emergency Medical Providers.
c. Locations with arrangements made with the National Park Service (NPS) can utilize
the NPS White Card system as their certifications with all the same requirements of
other state/federal systems.
5. Agency Licensure
a. Individual units are not required to obtain a state EMS license in order to provide
emergency medical services in conjunction with Forest Service authorized activities.
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 7 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
6725 - Exhibit 01
Region 4 Emergency Medical Response Plan Template
Region 4
Emergency Medical Response Plan
Template
_(fill in blank)_____National Forest
Updated May 21, 2012
Prepared by: _________________________________Date:____________
Reviewed by: _________________________________Date:____________
Approved by: _________________________________Date:____________
1
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 8 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
6725 - Exhibit 01--Continued
Table of Contents
Introduction
p. 3
1. Forest Wide Preplanning for Medical Emergency Response
a. Guidance for calling emergency services
b. Call protocols by Zone/District
c. List of contacts
d. Hospitals, Burn Centers, Air Ambulance Vendors by Zone/District
p. 4
2.
p. 5-8
Project Specific Pre-planning for Medical Emergency
a. Project Location, Driving Directions, Helispot Information
b. Patient Care Providers and Medical Aid Stations
c. Ambulance and Hospital Information
d. County Sheriff Departments
3. Emergency Medical Aid Response and Reporting Procedures
a. Project Leader Incident Commander
b. Patient Care Provider
c. Dispatch Center
d. Forest and District Notifications
e. Forest Supervisor/Agency Administrator
f. Other Considerations
p. 9-10
4. During a Medical Emergency
p. 11
5. Information needed by County Dispatch (911) for EMS Incident
p. 11
Appendix A:
Appendix B:
Appendix C:
Appendix D:
Appendix E:
Appendix F:
p. 12
p. 13
p. 14
p. 15
p. 16
p. 17
Example Trauma Kit Contents
Medical Incident Size-up Card
Trauma Triage Criteria to Consider a Request for an Air Ambulance
Example Patient Release Form
Emergency Helicopter Extraction (EHE) Protocol
Emergency Helicopter Extraction (EHE) Go/No Go Checklist
2
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 9 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
6725 - Exhibit 01—Continued
Introduction
What is our authority to implement this plan?
Refer to Intermountain Region, FSM 6700 Safety and Health Program, Chapter 6720
Occupational Health Program, 6725 Emergency Medical Response.
What is this Plan?
The purpose of this plan is to provide a standard template to all Forests for preplanning and
response to medical emergencies.
Each Forest should annually review and update the plan with their local information. Protocols
specific to the local unit (for example ordering procedures, checklists, and protocols for special
use patient transport or extraction) and locally developed job aides can be added to the plan as
appendices.
Each Forest employee must have an established, reliable point of contact who will know the
general location of the employee when they are working in the field. This point of contact shall
have authority, training and capability to implement this emergency medical response plan if
needed. This point of contact may be a dispatch office or the employee’s supervisor, District
Ranger, etc. The point of contact must be continuously available and aware of the status of the
employee when in work status.
Emergency Medical Response Plans should be kept at dispatch, in trauma kits, first aid kits,
front offices, vehicles, and with each group or individual that goes into the field.
Supervisors need to provide training and conduct training scenarios or exercises that will
educate employees on the use and value of the plan. Annual readiness reviews for fire
resources and other seasonal orientations are excellent times to review and practice plan
implementation and inventory medical supplies.
What can you do to preplan for a medical emergency? See page 4.
Who is responsible (roles and responsibilities)? See page 9.
What do we do when we have a medical emergency? See page 11.
How do we manage risk to medical responders? Examples of risk management tools include
tailgate safety sessions, Green Amber Red (GAR Model) Risk Matrix, ICS-215A, and safety
journey tools. Other risk management tools may be identified by the local unit.
How do we transport patients to a care facility? See page 11, section 4.
3
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 10 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
6725 - Exhibit 01--Continued
1. Forest Wide Preplanning for Medical Emergency Response
This section should give advice on responding to non-location or project specific
emergencies, such as a campground compliance officer collecting fees, an ATV patrol
helping dispersed campers in a district, a botanist checking trailheads across multiple
districts for noxious weeds or a helitack crew checking on multiple smoke reports forest
wide.
This might also be a place to provide an Emergency Medical Response Organization Chart
(organized by position, or name) of who is responsible to ensure what gets done.
An example can be found at:
http://www.wildfirelessons.net/documents/2010_Serious_Injury_or_Fatality_Guide_Templat
e_Grand_Junction_Air_Center.pdf . (See page 5.)
a. Guidance for calling emergency services
This section should talk about the preplanned actions to make sure everybody in the
woods is being tracked by someone. Including a check-in / check-out protocol and the
response required if an employee calls for help or doesn’t check-in as planned.
b. Call protocols by Zone/District
This section could be a map or other device showing what emergency services number
should be called based on where the response is needed. In some areas it is 911, in
other areas it is a county Sheriff’s office, etc.
c. Contact numbers for District Rangers, Safety Officers and Forest Supervisors,
etc.
d. Hospitals, Burn Centers, Air Ambulance Vendors--by Zone/District
This should be a listing of the area hospitals and their important information such as
phone numbers, location, Lat/Long, frequencies for helipad, etc.
e. Contact number for Unit Emergency Medical Providers.
4
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 11 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
6725 - Exhibit 01—Continued
2. Project Specific Pre-planning for Medical Emergencies
This section is for use on projects that involve multiple employees working for multiple days in a
specific area. The Project Leader should complete sections A and B with as much information
as available prior to implementation of each field project. Once completed, the Project Leader
should review this section with everyone on the project and ensure that all are aware of the
emergency procedures, roles and responsibilities. Sections C and D will be completed and
updated annually by dispatch prior to the field season. It is recommended that a copy of the
plan be kept with the Project Leader or in a vehicle at the project site.
Project Name: _________________________
Date/Time Prepared: ___________
Project Leader: _________________________
a. Project Location, Driving Directions, and Helispot Information* - To be completed
by the Project Leader for each project.
General Project Location: _______________________________________________
Driving Directions: (From the nearest paved road to the project area or access point.)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Legal Description: Township: _______
Or
Lat.___________________________
Range: _________ Section: ______ ¼:_____
x
Long: ___________________________
Potential Helispot: (see Incident Response Pocket Guide pg 57 – 59 for guidance on Helispot
selection)
Lat.___________________________
x
Long: ___________________________
The following information will be needed at the time a helicopter is ordered and landing:
Elevation: ________ Temperature: ________ Wind Speed: ________ Direction: ________
Ground Contact: ________________________________________________________
Known Aviation Hazards: (i.e. power lines, towers, other aircraft in the area)
______________________________________________________________________
* Do not assume aircraft is your best choice for transport. Consider location, geography,
weather and the nature of the emergency (see Appendix D).
5
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 12 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
6725 - Exhibit 01—Continued
b. Patient Care Providers and Medical Aid Stations – Identify the medical equipment,
supplies, and patient care providers available at the project location before you begin
work. Note: Consider the low probability high consequence events related the work
being performed and level of care and supplies needed to address the situation.
List Patient Care Providers
Name:
Equipment and Supplies
Trauma Kits:
Qualification: (EMR, EMT, Paramedic)
Location
Basic First Aid Kits:
AED’s:
Oxygen/Airway Kits:
Litter/Back Boards:
Fire Extinguishers:
Other:
6
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 13 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
6725 - Exhibit 01—Continued
c. Ambulance and Hospital Information - To be completed by Dispatch and updated
annually. Be sure to specify what format lat/longs are listed in.
Ambulance Services - List each ground ambulance service and air ambulance services within
the local area and identify their capabilities for medical care such as advanced life support, hoist
and emergency human extraction.
Department
Location
Phone Number
Capabilities
Hospital Information - List each hospital in your area.
Name of facility: ____________________________Address__________________________
Phone Number:
Trauma Level: □Level 1
Travel Time: Air:
□Level 2
Ground:
Burn Center: □Yes □No
□Level 3
Helipad:
□Yes Lat____________ x Long___________ Frequency: RX________TX_______ Tone
□No
Name of facility: ____________________________Address__________________________
Phone Number:
Trauma Level: □Level 1
Travel Time: Air:
□Level 2
Ground:
Burn Center: □Yes □No
□Level 3
Helipad:
□Yes Lat____________ x Long___________ Frequency: RX________TX_______ Tone
□No
7
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 14 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
6725 - Exhibit 01—Continued
Local Burn Center
Name of facility: ____________________________Address__________________________
Phone Number:
Trauma Level: □Level 1
Travel Time: Air:
□Level 2
Ground:
Burn Center: □Yes □No
□Level 3
Helipad:
□Yes Lat____________ x Long___________ Frequency: RX________TX_______ Tone
□No
d. County Sheriff Departments
Department
Location
Phone Number
8
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 15 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
6725 - Exhibit 01--Continued
3. Emergency Medical Aid Response and Reporting Procedures – Roles and
Responsibilities
a. Project Leader/Incident Commander:
 The Project Leader should complete A and B of Section 2 (pages 5-6) with as much
information as available prior to implementation of each field project.
 Contact _______________ Dispatch Center with patient injury/illness information
without releasing patient name. Specify the agency the patient works for, if
applicable.
 Request medical assistance, medical supplies and evacuation/transport equipment.
 Provide pick-up location or landing zone information for patient evacuation.
 Provide any known life hazards (downed power lines, Hazmat, traffic concerns etc.)
to __________ Dispatch to warn responders.
 When appropriate, transition command of the incident to the agency with primary
responsibility.
 In the event of fatalities, if possible, leave the bodies in place until law
enforcement/investigators arrive.
 Secure the scene and instruct all persons at the incident that their photos and notes
(weather observations, times, and so forth) may be needed.
b. Patient Care Provider:
 The highest level medical care provider on site should be in charge of patient care.
 Provide immediate care to patient within your scope of training and experience.
 Transition patient care to the higher level care provider when they arrive on scene
and provide assistance as requested.
 Keep the Project Leader/Incident Commander updated.
 Document your actions in writing.
c. Dispatch Center:
 Dispatch will complete C and D in Section 2 (pages 7-8) and updated annually prior
to the field season.
 Dispatch appropriate resources to medical incident if necessary and share life
hazard information.
 Make all necessary notifications to appropriate County Sheriff’s Office for patient
evacuation/transport and provide required information.
 Assign frequency as needed.
 Consider dispatching a landing zone coordinator for air ambulance requests.
 Consider clearing radio channel for emergency traffic only.
 Notify Forest Duty Officer and District Duty Officer of incident.
 Notify GACC if appropriate, and any other agencies that are involved.
 Obtain patient delivery location/hospital information.
9
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 16 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
6725 - Exhibit 01—Continued
d. Forest and District Notifications - Refer to the Agency Administrators Guide to Critical
Incident Management, PMS 926, Page 5 and Appendices C, D and E for additional
guidance in preparation of contacts.
 Make appropriate notifications based on local protocol:
a) Develop contact list for reporting process.
b) Include agency’s process for reporting and investigating serious injury or
deaths including procedures for reporting shelter deployments and
entrapments.
c) For wildland fire fatalities, entrapments and burnovers, notify the National
Interagency Coordination Center (208-387-5400) within 24 hours.
d) Ensure notification of Occupational Safety and Health Administration (OSHA)
area office within eight hours for:
i. Death of any employee from work-related incident.
ii. Inpatient hospitalization of three or more employees as a result of a
work related incident.
e. Forest Supervisor/Agency Administrator:
 Assign a person to act as liaison with the hospital. This person should perform this
important function full-time through the first critical days. Avoid assigning someone
with collateral duties that would interfere with the duties of hospital liaison.
 Assign a person to handle comp/claims paperwork with ASC.
 Assign a local agency person to act as liaison to the investigation team.
 Notify the victim’s next of kin. Protect the victim’s privacy. They have just suffered
mental and/or physical trauma, and they and their families should not be subjected to
intense outside scrutiny.
 Consider a Facilitated Learning analysis or similar process to promote learning to
provide for better safety outcomes.
f.
Other Considerations:
 Consult with the Forest or Regional Safety Advisor (801-625-5296) on accident
investigation responsibilities and options.
 Prepare a list of names, organizations, and telephone numbers of all persons
involved in the incident, and those who may offer witness statements (such as pilots,
dispatchers, line officers, and civilian observers).
 Assemble relevant paperwork, such as weather observations, forecasts, fire training
and qualification records, mobilization plans, time records of those involved, and so
forth.
10
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 17 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
6725 - Exhibit 01—Continued
4. During a Medical Emergency - Provide the following patient information and transportation
needs to _______________Dispatch Center.
Do not say patient names over the radio.
Number of Injured Parties: __________
Age: _______ Sex: (Male/Female) __________ Estimated Weight: _________
Extent and Mechanism of Injury (what happened):____________________________________
Level of Consciousness and Vital Signs:____________________________________________
Treatment Provided and Response to Treatment:_____________________________________
Method of Transportation: Considerations should include agency ground transport, ground
ambulance, regular helicopter transport, air ambulance, hoist helicopter, and emergency
helicopter extraction (EHE). Do not assume aircraft is your best choice for transport. Consider
location, geography, weather and the nature of the emergency.
____________________________________________________________________________
Pick-up Location: _____________________________________________________________
Special Equipment/Response Needs: Extraction, High or Low Angle Rope Rescue, Search and
Rescue, Law Enforcement, Tow Truck, Medical Equipment, etc.
See Appendix B of this plan or the Incident Response Pocket Guide, First Aid section, for more
detailed information on patient assessment, specific treatment etc.
See Appendix D of this plan for an example of a Release of Medical Assistance form.
5. Information needed by County Sheriff’s Dispatch (911) for EMS Incident - In the event
that you cannot reach your Agency Dispatch, the County Sheriff or 911 dispatcher will require
the following information:
 Incident Location
a. Cross Street, if available.
b. Lat/Long, If location is in a wilderness area
c. Any significant landmarks
 Patient Information
a. Chief Complaint
b. Mechanism of Injury
c. Approximate age and gender if available
 Who is responding from your agency
a. Capabilities, Advanced Life Support (ALS) vs. Basic Life Support (BLS)
b. How can the responders be contacted for updates
11
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 18 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM

6725 - Exhibit 01—Continued
Specialized responders if needed
a. Air ambulance
b. Extrication
c. Search and Rescue
Appendix A - Example Trauma Kit Contents
RECOMMENDED FOREST SERVICE MEDICAL SUPPLIES FOR TRAUMA KITS
EQUIPMENT
AIRWAY MANAGEMENT
PERSONAL PROTECTIVE QUIPMENT
1- Adult Blood Pressure Cuff
1- Oxygen Kit (“D” or “E” O2
1- Box of Disposable Blood Barrier
1- Stethoscope
Tank, Regulator with Liter
Gowns
1- Oral Glucose/Gel
Flow Valve)
Assorted- Disposable Gloves
1- Spring Loaded Center Punch
4- Nasal Canula, Adult
1- Box of Surgical Masks
1- Splinter Forceps
2- O2 NR Masks, Adult
1- N-95 or Better Respirator per
1- Scissors
1- Bag Valve Mask
Crew Member
1- Combat Application Tourniquet Resuscitator, Adult
4- Goggles or Face Shields
(CAT)
1- Bag Valve Mask
6- 4” Kling
Resuscitator, Pediatric
20- 4” x 4” Non-Sterile Gauze
2- Oxygen Tubing
50- 4” x 4” Sterile Gauze
1- Oral Pharyngeal Airway Kit
3- Multi-Trauma Dressing
(sizes 0-7)
5- Triangular Bandages
1- 2 oz. Bulb Syringe
2- 8” x 10” Surgical Pads
1- Rigid Suction Catheter
1- Disposable Emergency Blanket 1- #14 French Tip Suction
2- Blankets
Catheter
2- “D” Ring Straps, 12’ long
1- Suction Device (Manual,
2- Cold Packs
Mechanical or Pneumatic)
Assorted- Rigid Cervical Collars
1- Backboard with at least 3
straps (Spider straps, OK)
10- Triage Tags
2- 0.9% NaCl, Irrigation, 500ml
4- Cardboard Splints, Assorted
Sizes
16- 1” x 3” Adhesive Bandage
6- Sterile Eye Pads
4- Protective Eye Cup, 4 oz.
4- Petroleum Gauze
12- Safety Pins
2- 1” Adhesive Tape
2- 1” Hypoallergenic Adhesive
Tape
2- 1 Gallon (or larger) Zip Lock
Bags
1- OB Kit (optional)
1- Pen Light
12
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 19 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
6725 - Exhibit 01—Continued
Appendix B
MEDICAL INCIDENT SIZE UP CARD
Patient Location:
Location Description:
Patient Information:
Age:
Sex:
Weight:
Lat/Long:
Time of Injury:
Person making assessment:
Description of Injury/Illness (Mechanism of Injury/Chief Complaint):
1.
Airway:
Open
Closed
6. Lost Consciousness:
No
Yes
2.
Breathing:
Normal with a rate of:_______/min
Labored with a rate of:_______/min
Not breathing
Rescue breathing in progress
Pulse:
Present with a rate of:_______/min
Taken at: neck or wrist
Absent
CPR in progress
Bleeding:
Not bleeding
Oozing
Running
Squirting
Location of bleeding:_______
Control measures:
Direct pressure
Pressure bandage
Hemostatic Agent
Tourniquet
Control measures working:
Yes
Partially (slowing but not stopped)
No
7. Skin Color:
Normal
Pale
Flushed/Red
8. Skin Moisture:
Normal
Dry
Moist/Clammy
Sweating a lot
Level of Consciousness:
Alert and oriented to: Person, Place, Time, Event
Responsive to verbal stimulus
Responsive to pain stimulus
Unresponsive
13. Transport Request:
Walk out/crew transport
Carry out – non-critical
Air Transport – non-critical
Carry out – critical
Air transport - critical
14. Other Info:
3.
4.
5.
9. Skin Temperature:
Normal/Warm
Cool
Cold
Hot
10. Pupils:
Equal and reactive
Unequal
Dilated
Constricted
11. EMT with Patient
Yes
No
12. Gear with EMT
1st Aid Kit
BLS Kit
ALS Kit
13
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 20 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
6725 - Exhibit 01—Continued
Appendix C
TRAUMA TRIAGE CRITERIA TO CONSIDER A REQUEST FOR AN AIR AMBULANCE
If any one of the following criteria is met in sections 1, 2, or 3 listed below, order an air
ambulance. If any one of the criteria met in section 4, it is the judgment of the first responder on
scene to order an air ambulance. Note: When in doubt or not sure, order an air ambulance to
transport the patient.
1)Physiological Criteria
 Glasgow Coma Scale < 14 or
 Systolic Blood Pressure < 90 mmHg or
 Respirations <10 or >29 min (<20 if <1 y/o)








2) Anatomical Criteria
Penetrating trauma to head, neck, torso and extremities proximal to elbow and
knee
Flail chest (blunt chest trauma)
2 or more proximal long bone fractures
Crushed, degloved (skin is missing) or mangled extremity
Amputation proximal to the wrist or ankle
Pelvic fracture
Open/depressed skull fracture
Paralysis
3) Mechanics of Injury Criteria
 Falls: Adults > 20 ft.: Children > 10 ft or 2-3 times height of the child
 High Risk MVA: Intrusion >12 in. passenger space or >18 in. other site.;
Death in same vehicle; Ejection (partial or complete)
 Auto vs. Ped/Bike: Thrown/run over or impact of > 20 MPH
 Motorcycle crash: > 20 MPH






4) Special Considerations
>55 years old
Anticoagulation or bleeding disorder
Burns
Dialysis patient
Pregnancy >20 weeks
EMS Provider Judgment
14
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 21 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
6725 - Exhibit 01—Continued
Appendix D – Example Patient Release Form, to be completed by a licensed medical provider.
RELEASE OF MEDICAL ASSISTANCE
1. I (or my guardian) have been informed of the reason I should go to the hospital for further emergency care.
2. I (or my guardian) have been informed that only an initial evaluation has been rendered to me and have
been advised that I seek the advice of a physician as soon as possible.
3. I (or my guardian) have been informed of the potential consequences and/or complications that may result
in my (or my guardian’s) refusal to go to the hospital for further emergency care.
4.
I (or my guardian), the undersigned, have been advised that emergency medical care on my/the patient’s behalf is
necessary, and that refusal of recommended care and transport to a hospital facility may result in death, or imperil my/the
patient’s health by increasing the opportunity for consequences or complications. Nevertheless, and understanding all of
the above, I (or my guardian), refuse to:
accept emergency medical care
transport to a hospital facility
transport to ________________ Hospital as directed by EMS protocols, but request transport to
_________________ Hospital; and assume all risks and consequences resulting from my (or my guardian’s) decision,
and release all provider agencies, and all personnel directly or indirectly involved in my care from any and all liability
resulting from my (or my guardian’s) refusal. I have had the opportunity to ask all of the questions I feel necessary to
provide this informed refusal.
5. The reason for this refusal is as follows: (to be completed by patient/guardian)
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
________________________________________
Patient’s Name:
DOB:
Patient’s Address:
Patient’s Phone Number:
Signature (Patient/Guardian):
Witness:
Witness:
Date:
Time:
Incident #:
Refused to Sign (Patient/Guardian):
Telemetry Physician:
Hospital:
15
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 22 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
6725 - Exhibit 01—Continued
Appendix E
Emergency Helicopter Extraction (EHE) Protocol
Implementation


Only exclusive use helicopters and crews shall be used.
EHE mission must be approved by Line Officer or Incident Commander with delegation
of authority.
Equipment




Secondary Long Line Restraint System is required for this mission. System must be
manufactured and approved for human extraction by helicopter, this includes secondary
release mechanism.
Patient restraint system specifically designed and approved for human extraction by
helicopter is required for this mission.
Weight for insertion of long line (minimum 40 pounds), may be as simple as line gear.
Long line, 100 foot for type III helicopters, 150 foot for type II helicopters.
Training



When the helicopter(s) come on contract all pilots and spotters/managers need to
participate in live training exercises including; aircraft and patient rigging, and flying
configured equipment (no personnel long lined).
Helitack crew members and adjoining units as deemed necessary, should be trained in
patient packaging and patient rigging equipment (live exercises are encouraged).
Adjoining units may include smoke jumpers, IHC emergency medical providers.
Monthly proficiency mock-ups during the contract period to include rigging of helicopter
and patient.
Operations




Patient shall be moved to closest suitable landing zone.
Rescuers shall not fly on long line.
Emergency Medical Care Providers shall train in patient extraction taking into account
patient will be unattended in flight.
Spotter/manager will be on board aircraft to assist pilot with mission.
16
R4 SUPPLEMENT 6700-2014-1
EFFECTIVE DATE: 3/10/2014
DURATION: Effective until superseded or removed.
6720
Page 23 of 23
FSM 6700 - SAFETY AND HEALTH PROGRAM
CHAPTER 6720 - OCCUPATIONAL HEALTH PROGRAM
6725 - Exhibit 01—Continued
Appendix F
Emergency Helicopter Extraction (EHE) GO/No GO Checklist
Incident Name:___________________________
Location:_________________________
GO
NO GO
Patient is in critical need of advanced life support attention
Other evacuation options evaluated and rejected
Communications checked and made known to all involved
EHE Mission Planning and Recon Information form completed
Environmental hazards are manageable (fire, wind, sunset)
Load Calculation completed for the mission and current conditions
Complete inspection of required equipment
All items in the aircraft have been secured
Spotter harness and tether ready in accordance with IHRG requirements
Required length of longline is verified and 150’ or greater is attached
Belly Band installed with spotter release on the left side of the aircraft
Extension strap and 3 ring release properly configured to hook/longline (See Fig. 1&2)
Longline electrical connections are unplugged and secure
Weight bag is in place if no load is to be inserted
GAR Risk Assessment complete
ATGS briefed and ready to assume command (if applicable)
All involved personnel have been briefed on operation
Personnel at pick-up and drop off sites identified
Forest Supervisor has approved the mission
A “NO GO” response to any element on the checklist indicates a deficiency which must be
addressed prior to the start of the mission.
Pilot
Signature:
HMGB Signature:
Date:
Date:
17