By the time your team has reached the evacuation stage of a remote medical response, chances are there has been time to brainstorm a variety of strategies.
It is clear that your patient needs to be evacuated, but how quickly? Using what kind of resources? Who is going to have to get involved? Will you self-evacuate, or call in external resources?
It may also be clear that there is an ideal solution to your evacuation needs, but that ideal remains grounded to the reality of what you can actually achieve.
Every single backcountry evacuation is unique, and it is likely that numerous options would be equally suitable.
Faced with that kind of variability, what can you use to guide your final decisions?
Strategy #1: Risk/Benefit Assessment
Performing a risk/benefit assessment is the first step you can take to help balance the “ideal” and the “real” in your evacuation plan.
Your ability to balance the risk of your evacuation plan with the overall benefit to the patient is critical.
Draw on your scenario-based training to help you evaluate your current situation. Backcountry first aid education is geared towards understanding medical conditions within the context of evacuations – do you need to evacuate, or not? If you do need to evacuate, how urgent is the need? The higher the urgency, the more risk your evacuation plan could theoretically take on.
These are some of the highest-risk strategies to incorporate into an evacuation, and should ideally only be considered if your patient’s need is urgent.
- Sending out someone alone for help
- Night operations
- Working through inclement weather
- Helicopter (risk varies depending on landing zones, weather and type of aircraft)
Strategy #2: Resource Inventory
Next, consider the resources you have at your disposal.
Personnel: How many rescuers do you have available? What are their energy levels, and psychological condition? What kind of first aid training do they have?
Supplies: What kind of first aid supplies do you have? Do you have enough to last you through the duration of the evacuation? What kind of communication devices do you have?
Environment: Where are you located? What is the terrain like around you? How is the weather trending? How long will it take to get to a vehicle-accessible road, or a helicopter landing zone?
Use these details to help you establish a backcountry evacuation plan that gets the patient out as quickly as possible, while minimizing danger for both the patient and the rescuers.
Strategy #3: Compare Modes of Backcountry Evacuation
After you’ve completed a risk/benefit assessment for your patient and your rescuers and you’ve taken an inventory of your available resources, you’re ready to select a mode of evacuation.
There are three broad categories of evacuation to consider: ground-based, boat-based, or helicopter-based.
You may combine these approaches in your final evacuation strategy.
Ranging from personnel-heavy litter carries, to patients that can walk out under their own power, there’s a lot of variety in ground-based rescue options.
In general, the lowest-risk ground-based rescue is a patient walking out under their own power. Consider the length of the walk, and the physical and mental implications to the patient, before assuming that this option is the best fit for your situation.
While the risk to the rescuer does increase, a carry-out evacuations is worth considering, particularly if your rescuers are physical capable adults, and the patient is a small child. Backpack-style carries can be effective to manage in a large variety of terrain.
Prolonged litter carries have the highest probability of injuring a rescuer. While the injuries aren’t typically life-threatening, even minor injuries can have a big impact on the rescuer, and the success of the evacuation. Prolonged litter carries are also not without risk to the patient, both mentally and physically.
Keep in mind that rescuers regularly underestimate the difficulty and resources required to perform a litter carry, and regularly overestimate how quickly they can transport someone. Professional SAR teams rely on strict personnel requirements for litter carries:
- 8 litter bearers per 100 metres of travel over rough terrain
- 6 litter bearers per 100 metres over relatively smooth terrain
But in spite of all of this cautionary information, a littler carry may still be the best option in some cases.
Floating a patient out may be easier on the team than a gound-based carry. There are still many variables to consider, such as:
- Type of craft: How stable is it, and how much room do you have? Is it motorized, or non-motorized? This might be simple on a rafting trip, but impractical on a whitewater kayaking trip.
- Nature of the river: How probable is a capsize or a pin?
- Skill level of the group: Do they have the ability to safely manage the craft?
- Weather: Keep in mind that being on the water can be more exposed than traveling on the land in inclement weather.
If you have made a decision to float a patient out, make sure you consider their capsize survivability. If a capsize is possible, the patient should be wearing a PFD and possibly thermal protection. Generally speaking, it is ill-advised to strap or tie a patient in if there is a chance they could end up in the drink – strapping a patient down limits any potential for self-rescue and the team’s ability to recover the patient.
Expensive and risky, helicopter rescues can also be very fast. Think seriously about your need for this strategy.
When planning on a helicopter evacuation, always have a back-up plan. Pilots will generally not fly in the following conditions:
- High winds
- Low visibility (fog, smoke)
- Unknown landing conditions
- Slopes more than 10 degrees
Your Best Backcountry Evacuation
Hindsight is 20/20, and nothing proves that sentiment more than organizing and executing a backcountry evacuation.
You’ll learn something new every time you’re faced with an evacuation challenge in the backcountry, and your judgement and decision-making will evolve and improve.
Having a solid communications pre-plan can be a game changer. InReach and Spot devices allow for basic communication with emergency services. This capability can drastically increase response times, assist in getting the right resources on scene, and decrease the risk to rescuers, responders, and the patient.
But rest assured – if you prioritize the safety and well-being of your patient and your rescuers, your evacuation strategies will be respectable, regardless of the room for growth that remains.