1. Hazardous Terrain

2. EMS Skills Rescue awareness Types of specialized teams
Effective coordination with specialists
Hazardous terrain litter evacuations

3. Hazardous Terrain Types
High angle
Low angle
Flat terrain with obstructions

4. High Angle Surfaces inclined >40o Very smooth surfaces <40o
Gorges
Cliffs
Buildings
Very smooth surfaces <40o
Require use of hands in climbing
Ropes, aerial apparatus required for access, removal
Errors can cause life-threatening injury, death

5. Low Angle Surfaces inclined <40o Accessed by walking, scrambling
Difficulty can be affected by presence of:
Water
Ice
Boulders
Brush, down trees
Ropes used to counteract gravity, act as hand lines
Errors can result in falls, tumbles
Presence of obstructions can result in serious injury

6. Flat Terrain with Obstructions
Examples:
Trails
Paths
Creek beds
Difficulty may be increased by:
Downed trees
Rocks
Slippery leaves
Scree (rock debris)
Patients can be moved by carrying
Least hazardous form of rugged terrain
Slips, falls can result in injury

7. Patient Access

8. High Angle Access/removal usually carried out by technical teams
Additional resources needed to balance technical/medical aspects of rescue

9. High Angle Rescuer skills Knot tying Ascending, descending skills
Rigging of hauling systems
Packaging of patients for evacuation

10. High Angle Specialized Terms
“Aided”—using means other than hands, feet, body
“Anchor”—technique for securing rescuers to vertical face
“Belay”—safeguarding climber by use of a rope secured to an anchor
“Rappel”—descend by sliding down a fixed double rope

11. Low Angle Access/removal conducted by EMS personnel in many systems
Still requires appropriate training/equipment

12. Low Angle Skills Assembly/use of harnesses
Setting up hasty rope slides
Rappelling, ascending by rope
Patient packaging
Rigging simple hauling systems

13. Patient Packaging

14. Stokes Basket Stretcher
Standard litter for rough terrain evacuations
Provides rigid frame for patient protection
Easy to carry

15. Stokes Basket Stretcher
Come in plastic and wire/tubular (military) styles
Wire/tubular style will NOT accept long spine boards
Plastic styles weaker, but provide better shielding to patients
All require additional strapping, use of plastic litter shields

16. Stokes Basket Stretcher
During high/low angle evacuations:
Apply harness to patient
Apply leg stirrups to patient
Secure patient to litter
Tie tail of one litter line to harness
Use helmet, litter shield
Give fluids
Allow accessibility for assessment, management
Ensure adequate padding
Consider heating/cooling system use
Provide gravity “tip line” to clear airway if necessary

17. Patient Removal

18. Flat Terrain When possible, walk patient out!
Carrying over flat ground is strenuous under ideal conditions

19. Flat Terrain Two to three teams of 6 litter-bearers
All approximately same height
“Leapfrog” ahead to save time
Webbing straps tied to stretcher frame and pulled across rescuer shoulders to free hand can lessen load
Litter wheel may help on flat ground

20. Low/High Angle
Anchors, personnel safety equipment, patient packaging, and hauling systems must be checked multiple times for safety
Hauling systems may require multiple personnel to move weight of patient, basket, and ropes

21. Low/High Angle
Fire department snorkels can be used for patient evacuation
Stokes stretcher must be properly belayed to snorkel basket
Aerial apparatus is NEVER used as a crane to move a litter

22. Helicopters Capabilities, policies vary widely
Understand policies regarding:
Loading and unloading practices
Restrictions on carrying non-crew
Use of winches for rescues
Weight restrictions
Restrictions on hovering rescues
Use, practice of one-skids and toe-ins
Use of short hauls and rappel rescues

23. Extended Care Issues

24. Protocols Long-term hydration Dislocation repositioning
Wound cleaning/care
Impaled object removal
Non-pharmacologic pain management
Pharmacologic pain management
Assessment/care of head/spinal injuries
Hypothermia/ hyperthermia management
CPR termination
Crush/compartment syndrome management

25. Environmental Considerations
Weather/Temperature Extremes
Risk of hypo/hyperthermia
Difficulty in exposing patient for assessment
Use of specialized packaging

26. Environmental Considerations
Limited Patient Access
Inaccessible parts of patient
Cramped space
Low lighting conditions

27. Environmental Considerations
Difficulty Moving Equipment
Identify minimum essential equipment
Carry in backpack

28. Environmental Considerations
Cumbersome PPE
Restricted rescuer mobility
Temporary removal of PPE to perform procedures

29. Environmental Considerations
Patient Exposure
Covering for thermal protection
Hard protection from sharp objects, debris

30. Environmental Considerations
ALS Skills
Wires, tubing complicate extrication
Limit to absolute necessities
Oxygen may have to be given at slower flow rates to prolong cylinder life

31. Environmental Considerations
Patient Monitoring
Modification of procedures (palpated BP)
Modification of equipment (compact pulse oximeters)
Non-use of equipment (ECG monitors)

32. Environmental Considerations
Improvisation
Splinting using patient’s uninjured body parts
Light-weight splints
Downsized or improvised medical gear