Despite the best preparations, accidents and sudden illnesses sometimes happen. Typically, your role in an urban medical emergency is to summon help and perform urgent first aid. All other decisions and actions are handled by the 911 operator, emergency medical technicians (EMTs), the ambulance crew, and the hospital emergency team. When an accident or illness occurs in a remote place, you are much more involved.
You must assess the scene, approach, and perform urgent and secondary medical treatment. Next, you must decide if an evacuation is necessary, and whether you need or want professional assistance. Then, you must either summon help or evacuate the victim yourself.
🏥 Do this before requesting medical evacuations
Avoid a hasty decision — evacuation is difficult both for your party and the victim. Here are some things to keep in mind when considering medical evacuations.
A well-planned evacuation could begin only after you answer the following questions.
- Do the circumstances warrant an evacuation?
- How important is speed?
- Is a professional rescue service available?
- Can the professionals be contacted and on the scene within the necessary time frame?
- Is it possible and wise for your group to effect the evacuation without outside help?
- What route and evacuation system would be best?
Let’s discuss these points further
❔ Do the circumstances warrant an evacuation?
Not all accidents or illnesses require evacuation. If the group has time and supplies, perhaps the best solution for a minor problem would be a delay of a day or two. For example, time could heal the flu, a sprained ankle, a strained back, or mild hypothermia or exhaustion. With other injuries, like a simple fracture of the arm, the victim could walk with a companion.
Evacuation is necessary when an injury or illness requires medical attention beyond that the immediate group can provide. This can be true with a serious medical problem or with an unprepared group. Evacuation is also usually necessary where lengthy healing, as with a broken bone, must take place before the victim can resume normal activities.
💨 How important is speed?
Elapsed time from the incident to advanced help is important, where serious complications or rapid deterioration of the victim is likely. This includes massive trauma or blood loss, advanced hypothermia, and high altitude sickness.
Changing tides, rising floodwaters, increasing avalanche danger, and other environmental conditions also can make speed-critical. Waiting too long may endanger the group or decrease the chances of a successful evacuation.
In general, it’s best to call on a professional rescue service for medical evacuations where one is available. Trained professionals are usually better equipped and prepared than your own party. They will complete the evacuation faster with less additional stress for the victim, will provide better medical aid en route, and will have more efficient transportation available once they reach a road.
⛑️ Is a professional rescue service available?
In North America, rescue professionals include search and rescue teams, law enforcement officers, fire protection crews, and the Coast Guard. Ski patrol members, certified backcountry guides, and water safety staff also may be available to help. To reach the most appropriate group, contact a law enforcement agency. Before traveling to a remote area, find out what help is available.
If an evacuation is necessary and professional rescue is available, you must choose between professional and self-evacuation.
Are you able to contact the professionals, and can they reach and evacuate the victim in time?
Is your group capable of evacuating the victim without outside help?
Can the victim endure the kind of evacuation your party could provide?
In marginal cases, remember that professional evacuation is expensive and could occupy rescue personnel who might be needed for a more serious case. A working radio or mobile phone can make contact with outside help simple. If you carry a radio, have spare batteries, and be sure that everyone in your party can use it.
Without a radio or any other communication tool, it may be best to send someone for help. This person should be skilled and strong enough to reach help without incident. He should carry a written description of the problem and a map marked with the victim’s location. Where possible, send more than one person and discourage undue exertion or heroics, one victim is enough.
Avoid leaving the victim alone and never leave an unconscious or confused victim unless you are in danger. Another way to “contact” outside help is to stay where you are and wait. If you left a route description and an estimated return time with a responsible person, he might initiate a search.
This method, however, is by no means fool-proof. You must be considerably overdue before a search would start, and it might be further delayed by bad weather or nightfall. Rescuers would have to follow your proposed route and hope to find you along with way. Even if all else goes well, they may not find you if your shelter is hidden or if you are lost and off your route. Once they find you, they may be exhausted or may not have the supplies necessary to address the problem.
If you wish to wait for rescue, camp in a safe place visible from land and air. Brightly colored objects, such as tent flies or sleeping bags, can be spread out to make your camp more noticeable. When a hidden shelter such as a snow cave is necessary, leave highly visible signs around it.
Three of almost anything in a triangle is an international distress signal. This could be three fires: make them bright at night and smoky during the day. It could be three piles of brush on snow or three contrasting piles of rock in a field. If rescuers may be nearby, three gunshots or three whistle blasts will send the same message.
🚁 Can the professionals be on the scene and evacuate the victim in time?
If not, for all practical purposes, outside help does not exist. Remember to include time to contact the authorities, to mobilize the rescue, to approach and locate the victim, and to package and evacuate the victim. Before choosing between professional and self-evacuation, you also must determine if your group is capable of effecting the evacuation.
Is your party large enough and experienced enough?
Do you have the supplies, knowledge, and innovative skills necessary to build a suitable litter or other devices?
Can you move the victim without causing further damage?
Is a practical land route available?
Evacuating without outside help is serious business. It is recommended only if professional rescue is not available or not fast enough, or if the victim or group is endangered by staying in place. However, if your group is large and experienced, the terrain easy, and the distance short, you may wish to choose self-evacuation. The best choice may be to meet the rescue team halfway.
If you decide to evacuate without outside help, you must select a route and a method. Both are dictated by the terrain, the victim’s injuries, and the supplies and capabilities of your group. Several rules apply:
- never move the victim unless you know where you are going;
- always test the device with an uninjured person first;
- and never leave the victim alone.
Package the victim well: pad under him, cover him, and strap him comfortably, but securely in place. Immobilize injuries completely.
Normally the victim is carried on his back with his head uphill, especially over rough terrain. To treat for shock, carry the litter flat. For first-aid reasons, the victim may be placed on his stomach. If straightening the victim’s body from another position causes pain, package the victim as comfortable as possible in that position. The most important thing about carrying a litter in an evacuation is the smoothness of the ride, not the position of the victim.
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Mild terrain, where rescuers need not be belayed, allows many choices of route and device. Where trails are not available, choose the easiest route possible. Even the best route over mild terrain may include scree or snowfields, sloping rock, and dense timber or brush.
A traditional litter or stretcher is probably the easiest device to build and use. The best-improvised litter has light, stiff side poles, and a sturdy fabric bed. When the litter poles are attached to sturdy, almost empty backpacks, the carriers can more easily handle the weight. Other varieties of litters can be made from long looped and knotted ropes.
On a smooth trail, two litter bearers may be adequate if a second team of carriers can alternate with them. As the footing becomes more slippery or rough, a minimum of six carriers is recommended to prevent the litter from dropping if a carrier stumbles. Over even more difficult terrain, rescuers can stand in two lines and pass the litter along from hand to hand. A rope may be used to guide a stretcher over rough ground.
If the victim is small and does not require a litter, a strong rescuer could choose from a variety of solo carries. Similar to the piggyback carry, but much less fatiguing is the split coil carry. For this carry, split a coil of rope in half and place the victim’s legs through the loops. Then slip your arms through the coils and lift the victim like a backpack.
Another solo carry is the backpack carry. For this, cut leg holes in a large backpack, so the victim sits in it like a child sits in a child carrier. Other one- and two-rescuer carries are described in the recommended readings.
In the winter, a simple sled can be made from the victim’s skis and poles. In practice, we found the sled to be practical in a limited number of circumstances: downhill; on fast snow such as a solid crust; with a very light victim or a very strong puller; or with multiple pullers.
Uphill would be virtually impossible, as would steep downhill. To place the strain on padded shoulder straps and waist belt, tie the cords from the sled to the puller’s backpack. This is comfortable and leaves the arms free for poling.
If you are near water and have a boat, this can be a great way to move someone. Even a sailboard or small raft would work. Leave the victim in the litter, but remove the straps. Exercise extreme caution — an injured person could easily drown if your boat capsized.
Use your imagination! If you have horses, perhaps a travois is possible. A litter could be secured across the back of a four-wheeler. The wheels from a mountain bike could be used to create a cart. Remember, though, that these vehicles may be better used as a means for summoning professional help.
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On technical terrain where rescuers and victims must be belayed for safety, evacuation requires more equipment and more technical expertise. The best route may include lowering the victim down a rock face. With the right skills and supplies, this can be the quickest and least traumatic way to move a victim.
A direct lower can help you bypass more difficult terrain and can significantly shorten the distance to be traveled. A slightly injured victim can be lowered in a rope seat. Loaded litters can be lowered in either a horizontal or vertical position. Do not attempt these or other technical evacuation techniques unless you are qualified to do so.
🖊️ Final words
This article is not a substitute for instruction and practice with evacuation techniques. Considerable skill is needed to evacuate a victim safely and comfortably. Before attempting an evacuation on your own, be honest. Is an evacuation necessary? Is it wise to do it without help? Remember, medical evacuations are for the victims, not for your ego.
This article has been written by James H. Redford MD for Prepper’s Will.
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