Search and Rescue
Overview
The following are essential for a safe and efficient search and rescue (SAR) operation:
1. Provide for the safety of rescuers and patients. This must include injury prevention from environmental and rescuer causes; provision of water, shelter, and possibly food; and providing a mechanism for personal hygiene.
2. Communicate needs and changes during all phases of the operation. Call for backup at the earliest possible time. Ensure that rescuers are apprised of the activities and needs of others when there is a need to know. Keep command, base camp, medical control, and incoming rescuers informed. Communication seems to be the most frequently missed or most poorly managed item.
3. Locate and reach the patient with medical-rescue personnel and equipment. Implement organized and methodical procedures for finding the patient as soon as the safety of rescuers and patient has been ascertained.
4. Treat and monitor the patient during evacuation. Support basic personal hygiene and physiologic functions. Psychological support is also essential. This may be as basic as verbal encouragement from a familiar and constant voice. Help the patient to feel involved with the rescue by communicating as often as the situation permits.
Preplanning
1. Before engaging in any type of technical or advanced rescue, responsible individuals should perform a risk assessment to identify necessary skills and capabilities.
2. The preplan should consider the types of terrain in the response area, people exposed to that terrain, types of accidents likely to occur, and available resources.
3. Exposed personnel must be specifically trained for terrain and environmental considerations commonly encountered in the areas in which they may work. For example, a rescuer responding to a fallen ice climber incident in the wilderness must be trained in both high-angle ice rescue and in wilderness SAR.
4. Having wilderness skills also enables rescuers to work independently of external support and resources in nonwilderness incidents. For example, self-sufficiency and an ability to function with minimal external resources are beneficial when working in the aftermath of an earthquake, or in responding to a transmission tower incident far from a road.
Research the Location
1. Review all geographic and medical concerns specific to the rescue location, identifying in advance any hazards that pose a threat.
2. Determine the topography and potential evacuation routes before beginning any travel.
3. Make certain that the location of cached equipment and supplies and the phone numbers of available rescue resources and local hospitals are communicated to each member of the party.
Rescue Resources
1. The outdoor recreation and rescue communities emphasize personal responsibility. If the group has the skills and technical abilities to accomplish self-rescue, the participants must know their limitations. If necessary, members must be capable and willing to mobilize organized rescue resources. Organized rescue is often more expeditious and mitigates the risk of rescue.
2. Rescuers not familiar with a particular environment or type of response should operate only under the direct supervision and care of appropriately trained personnel. Placing an untrained person in a high-angle rope rescue situation to perform patient care, for example, endangers that person, the patient, and others involved in the operation.
3. Within the United States, law enforcement agencies are generally responsible for the command structure and direction of an operation. Mutual aid contracts or interagency agreements may give certain agencies responsibility for specific incidents. When adventuring outside the United States, always discuss rescue issues (e.g., forms of payment, available resources, notification systems) with the foreign U.S. embassy. In the United States, follow these guidelines:
a. County sheriffs have jurisdiction in unincorporated county areas and in most Bureau of Land Management and U.S. Forest Service lands, by congressional mandate.
b. The city police have jurisdiction on city lands and, in some cases, adjacent watersheds.
c. Fire districts and city fire departments may have jurisdiction over hazardous materials or urban SAR operations.
d. Emergency medical services (EMS) usually have jurisdiction over medical care of sick or injured persons.
e. The National Park Service has jurisdiction over its lands except where otherwise mandated.
Support Services
1. Volunteer SAR and sheriff’s SAR groups usually have both responsibility and authority to conduct an operation.
2. Technically specialized volunteer teams, in addition to regular SAR teams, may be available and may be certified by national organizations. Examples include local ski patrols and the National Ski Patrol System, National Cave Rescue Commission, Mountain Rescue Association, and National Association for Search and Rescue.
3. Do not overlook commercial enterprises or professional individuals or teams, even if they are not specifically certified. Such groups include mountain, river, and bicycle guides; commercial mine rescue teams; and military units.
Personal Preparation
Fitness
1. Participate in a regular physical fitness program.
2. Psychological fitness includes the following:
a. The patients are responsible for their own predicament.
b. Rescuers must ensure their own safety during both training and rescue operations.
c. Rescuers must be aware of their exposure to such risks as rockfalls, avalanches, dangerous plants and animals, faulty equipment, violent patients, untrained personnel, unrealistic personnel or patients, weather, exposure to falls, and water hazards.
d. Rescuers must be realistic about life-and-death situations in the backcountry. Patients may die if they are seriously injured and definitive care is far away. The death or significant injury of a friend, trip member, or child may cause profound psychological impact, such as post-traumatic stress syndrome. A critical stress debriefing team may be requested through the local EMS agency or sheriff’s office.
General Guidelines
1. Use appropriate safety equipment for the environment. Make sure that anchors are secure. Tie in anyone near an edge or precipice. Make sure that helmets are worn by persons at risk for falls or exposed to falling objects. Wear personal flotation devices when performing rescues near or in the water.
3. Practice using all technical-rigging systems before they are needed in an actual rescue operation. Have backup systems available whenever possible.
Training (Box 56-1)
1. As a rescuer, participate in wilderness medical and rescue conferences, and practice regularly under realistic conditions.
2. Basic survival, navigation, and first-aid skills are essential for all team members. Although complete information on these areas is beyond the scope of this field guide, two basic items essential for survival bear mention: procurement of drinking water and maintenance of body temperature.
a. Dehydration is a major problem for both rescuer and patient. Take the following steps to prevent problems:
• Drink before you are thirsty, and monitor rescuer and patient hydration status by observing urine output and color (minimum urine output should consist of a third of a liter every 6 hours, and urine should remain light or “straw” colored).
• Disinfect drinking water (see Chapter 45). In winter, insulate water bottles with commercial foam wrap, or cover them with old socks or Ensolite and duct tape. Use petrolatum (Vaseline) on bottle threads to keep the cap from freezing closed. Melt snow for water (average water-to-snow yield is 1 : 7). On mild days, spread snow on a dark plastic sheet to melt. Use a straw or piece of intravenous (IV) tubing to access trickles of water under the snow’s surface.
• Absorb electrolytes from food and maintain energy stores by eating before you become hungry.
b. Evaporation exacerbated by wind can cause significant heat loss. Use garbage bags to create a hasty personal shelter and vapor barrier (carry two for yourself and two for the patient). For an improvised bivouac, place one bag over the legs from the bottom and the other bag over the top, covering the head except for a small area cut out for the face. Use duct tape to join the bags for a complete seal. “Space blankets” (reflective lightweight Mylar tarps) flap in the wind and are not as useful as “space bags” into which the patient can be placed (see Chapter 59).
Personal Equipment
1. Your pack should be lightweight but rugged. An external frame snags trees and is generally less stable than an internal frame. Remember that the person with the largest pack usually carries the most.
2. Footwear may be anything from sneakers to double mountain boots, depending on the environment and situation.
3. Shell material (outermost layer of clothing) should protect from wind, evaporative heat loss, and external moisture. Because of the moisture and temperature difference (vapor pressure) between the inside and outside, breathable waterproof products work best in cold weather under conditions of little physical exertion. As temperature and physical activity increase, the practical differences between these products and simple coated nylon decrease. Sweating and condensation are uncomfortable but, if minimized, are not dangerous. They can be controlled by venting and modifying workload and pace. Excessive body moisture can cause increased evaporative heat loss, increased conductive heat loss (through wet clothes), and noticeable symptoms of dehydration and hypothermia.
4. Insulation guidelines are as follows:
a. Layer clothing for easy changing as weather and exertion change.
b. Avoid materials such as down or cotton that lose their insulating qualities when wet. “Water-compatible” materials (e.g., fleece, wool, polypropylene [Polypro]) absorb less water and maintain their loft.
5. Great amounts of heat can be lost from an uncovered head and neck. Put on or take off your hat, “neck gaiter,” or balaclava to compensate for underheating or overheating. Wear a helmet (International Mountaineering and Climbing Federation [UIAA] approved). Carry a wide-brimmed hat for sun protection. A baseball cap does not cover the ears or back of the neck.
6. For hand protection, use water-compatible material with a windproof, water-resistant shell as needed.
7. For eye protection, 100% ultraviolet filtering is suggested for exposure to snow or altitude. Side shields are essential in the snow at high altitude. Make sure that each person is carrying a spare pair of sunglasses.
8. Miscellaneous gear can include the following:
a. Bivouac (“bivi”) and survival gear (garbage bags/bivi sack, duct tape, whistle, candles and fire source, flares, smoke signal, signal mirror, etc.) (Box 56-2)
b. Personal care items (hygiene, personal first-aid kit that includes sunblock, blister care, etc.)
c. Self-evacuation and rescue equipment. Comprehensive information on these areas is beyond the scope of this field guide. Familiarity and competency with the use of the following items are recommended:
• Tubular webbing (2.5 cm [1 inch] in diameter) for improvised chest and seat harnesses, runners, anchors, etc.
• Kernmantle climbing rope for lowering or raising if the terrain is too steep or high for a simple climb up or down
• Carabiners to improvise lowering (rappelling) or climbing devices on the ropes
• Tubular webbing (2.5 cm) or 4-mm (0.2-inch ) rope for making improvised breaking devices (e.g., Prusik knot) for use with ropes and carabiners
Rescue Operations
Sequence of Events in Backcountry Rescue (Box 56-3)
Making the Decision to Get Help
Before anyone leaves to seek assistance, the patient’s companions should do the following:
1. Perform a physical examination.
3. Determine the level of consciousness.
4. Provide appropriate emergency care, which may entail moving the patient into a protective shelter.
5. Summarize patient information in a note that accompanies the individual(s) going for help.
6. Prepare a map depicting the patient’s exact location and a list of the other party members, noting their level of preparedness to endure the environmental conditions.
7. The individuals who are going for help should carry appropriate provisions.
8. Do not allow the leaving party to become a new set of patients. Plan and prepare for likely contingencies.
Organizing the Rescue Team
1. Assessment of time required and time of day. Will this be a night rescue? How long will the evacuation take? Will there be darkness and lighting considerations? How physically demanding will the operation be, and how often will rescuers need to be rotated for rest? The answers will influence resource requirements and may indicate that additional resources must be called in from farther away.
2. What are the current weather conditions at the rescue location, and what is the forecast?
3. When did the accident occur? Do we know the exact location, or is this a SAR?
4. Number of known and potential patients. How many patients are there? What are the supposed injuries? How many people are in the party? How well prepared are they? Does anyone in the party have medical expertise? When the potential of additional patients becomes a reality, the number of rescuers needed increases, and other stresses emerge. A new sense of urgency arises, and there is a need for triage, more equipment, more time, and more resources for evacuation. Additional potential patients must be anticipated.
5. Scope and magnitude of wilderness influence. Is the incident 100 yards from a vehicle access point or several miles into the backcountry? If the rescue will take place on high-angle terrain, is the best evacuation route from the top or bottom of the slope or cliff?
6. Scope and magnitude of technical rescue considerations. Is it high angle? How technical? What are the anchor points, rock types, etc.? The scope and magnitude of the incident will affect the type and number of resources requested.
7. Assessment of personnel needs. Given the time and work to be done, will changing shifts be a consideration? Is it necessary to keep responders available for a second incident in the area? Are there sufficient resources within the organization, or will external resources be required? If multiple agencies are involved, are radio frequencies coordinated?
8. Dedicating all resources in a given area to one incident requires consideration in advance. Prearranged agreements with nearby agencies (mutual aid agreements) can be useful in staffing a large incident or for backup in case of another call.
