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.
9. Specific environmental factors involved. Are available personnel suitably trained and equipped for the terrain that will be encountered? Is there a river or lake in the area that will require additional personnel? What is the time of year? Is snow or ice a consideration? The steepness of terrain, as well as ground cover, must be considered when estimating whether personnel are adequately prepared to function.
10. Integrity and stability of the environment. Is a storm coming? Will night fall before the operation is done? Planning to accommodate for changes in weather, ground instability, and other environmental factors must be done several hours in advance.
11. Is a “hasty team” needed? Has it left for the scene yet?
12. Is each of the team members prepared? Does each have personal equipment, a bivouac kit, headlamp, food, and water? Is each member trained and skilled in this particular type of rescue?
13. Who is on the medical team? Who is on the evacuation team?
14. Is the team equipment organized and divided up?
15. How urgent is the situation? Is a helicopter required? Is one available? Are the weather conditions appropriate for an air rescue?
Beginning the Search
1. Once the team is assembled and all pertinent issues have been addressed satisfactorily, the team is transported to the trailhead (launch point) to begin the search.
2. Commonly a hasty team starts out ahead of the main team. Once the hasty team has enough information to locate the patient, team members travel as lightly as possible, with only enough gear to ensure their own safety and to equip them to manage the patient’s primary injuries. The goal is to reach the patient as quickly as is reasonably possible and deliver primary care, and then apprise the rest of the team of the patient’s condition, equipment needs, and environmental concerns.
Locating the Patient
How long it takes to locate the patient varies tremendously, depending on the following:
Patient Access
1. Be certain that all rescuers are aware of the fall line. This virtual line represents the path of travel for rocks, avalanches, or drifting boats and is the direction a rescuer may fall if footing is lost. Always avoid approaching the patient from directly above the fall line when working on loose ground or snow.
2. Accessing the patient requires skills essential for navigation, travel, and survival in the rescue environment.
3. The first person to the patient must have the medical skills required to stabilize the patient’s condition.
Patient Evaluation and Treatment at Scene (Box 56-4)
1. In most cases it takes at least 2 hours for an outside rescue or transport team to arrive. Use the time well. Carefully assess the situation, and arrange efficient packaging of the patient for transportation. It is difficult to redo systems once an evacuation has begun. If time and circumstances allow, test the system on an uninjured party member before using it on the patient.
2. Reduce the danger and minimize the risks to rescuers first, patients second. Make sure that safety officers (to watch for and halt high-risk activity) and equipment backups (e.g., belay or fixed safety lines) are in place when possible.
3. The rescue team should ensure its own safety. Wet clothes should be replaced with warm, dry clothing, and members should check for emerging problems within their group.
4. Companions of the patient may have been affected by the environment while waiting for the rescue team to arrive and may require assistance.
5. Perform the initial assessment and treatment essential to salvage or stabilize the patient’s condition. This includes the primary survey:
D:Disability determined (mental status checked and spine stabilized if any potential for injury)
E:All areas of the patient requiring further evaluation exposed (with consideration for environmental factors)
6. Perform a detailed head-to-toe assessment (secondary survey) of the patient before litter packaging. Continue to reevaluate the patient throughout the evacuation. Note the following:
a. Mechanism of injury or illness. Debilitating preexisting medical conditions, trauma, environmental stress, or any combination of the three raises your index of suspicion for a serious injury (e.g., a fall from three times the patient’s height would mean great potential for head, spine, and internal injuries; chest pain in a 45-year-old man before a snowmobile accident [vs. a tree accident] occurring 12 hours earlier would suggest the possibility of spine, head, and internal injuries; hypothermia; frostbite; and myocardial infarction).
b. Patient medical history (AMPLE):
L:Last oral intake to suggest fuel or fluid deficiency
E:Events leading up to the illness (i.e., history of present injury or illness)
c. Initial vital signs, with subsequent monitoring at regular intervals. Vital sign changes occurring over time, coupled with the patient’s mechanism of injury, help to direct treatment.
7. Take time to determine short-term and long-term plans, as well as contingencies for patient management and evacuation. Situations usually change, requiring a dynamic approach to problem solving.
8. Never assume that all injuries have been discovered or that all medical conditions have been managed properly (see Box 56-4).
Patient Evacuation Considerations
The evacuation team must explore different options:
1. If speed is a consideration, weather conditions are reviewed and the availability of a helicopter-assisted rescue is determined.
2. If a helicopter is not an option, the fastest evacuation route is established.
3. If time or speed is not critical, the safest means of evacuation that is easiest on the patient and rescuers is defined.
4. A general rule for the duration of an evacuation is that it will take 1 to 2 hours for every mile to be covered, requiring six well-rested litter bearers for every mile. Thus a 4-mile carryout will require a 24-member litter team and can take 4 to 8 hours to complete.
5. Eventually the team reaches a trailhead and the patient is transferred to an ambulance for transport to a hospital emergency facility.
Returning to Base
1. The team returns to base to debrief and reorganize equipment in preparation for the next extended rescue.
2. Because people are exhausted and hungry, the debriefing session is often abbreviated or cancelled. However, this is not wise. Establishing a mechanism to debrief after the rescue effort is imperative so that team members can learn from the shared experience, discuss patient care, and work through problems.
3. Whenever several different emergency organizations with disparate rescue and emergency personnel combine to perform a complex rescue, there may be tension, conflicting opinions, and concerns about the medical care provided or the evacuation plan used. When feasible, these problems should be discussed and managed in real time as expediently as possible so that teams will cooperate successfully, improve their performance, and provide the best possible patient care during the current and next rescue. This process may also help to lessen the burnout syndrome that can occur with volunteer teams.
Additional Patient Evacuation Considerations
1. No evacuation. Definitive care either is not necessary or is available at the scene.
2. Assisted evacuation. Definitive therapy is necessary, but the patient is ambulatory and needs moderate support. Consider walking assists, with either one or two persons.
3. Simple carries. The patient can sit, or the injuries allow positioning other than horizontal. Examples would include a patient with exhaustion and dehydration and an uncomplicated limb fracture.
4. Litter carries (see Chapter 57). The patient is unable to sit or injuries require a horizontal position. Examples would be a femoral fracture and spine immobilization. This type of transport usually requires a minimum of six rescuers. The longer the transport, the more necessary are additional party members. Depending on the terrain, this type of carry may also present significant risk to patient and rescuers. Two general types of litters are found on rescues: commercial and improvised.
a. The most common commercial litter is the Stokes litter (wire, plastic, or fiberglass), which may be found with or without leg dividers; the latter is preferable because of flexible packaging configuration based on injuries.
b. Another commercial litter is the SKED, which is popular among SAR teams and the military because it is easily carried rolled up in its own backpack, slides easily, and has flotation capability. It is narrower than the Stokes litter and somewhat flexible. A short spine immobilization device is necessary if spinal injury is possible.
c. Other specialized litters, such as cave-evacuation litters, may be found in particular environments. You can construct improvised litters from the external frames of packs, saplings, or ropes (see Chapter 57).
Additional Litter Evacuation Considerations
1. Litter packaging should provide for patient comfort and protection from trauma and environmental impact. Secure the patient in the litter by attaching harnesses to side rails, using pretied foot loops hitched to rails or torso immobilizing devices (e.g., Kendrick Extrication Device [KED], Oregon Spine Splint [OSS]), which may then be attached to the litter.
2. Monitor the patient. Protect the face from falling objects and passing branches. You can cover the head and face with a plexiglass (Lexan) shield or a helmet and goggles or fashion a piece of closed-cell foam (Ensolite) for this if necessary. Package and adequately pad the patient to prevent pressure sores during prolonged transport. Protect the patient from insects with netting, repellent, or a secure outer wrap.
3. Environmental concerns relate primarily to temperature regulation. The goal is warmth without overheating. Immobility reduces heat production. Extra insulation and an external heat source may be necessary. In a cold environment, a double–vapor barrier system may be necessary, with less insulation in a hot environment. A mixed system may be necessary in the high desert to allow venting of the package during the day and sealing at night. You can set up a double–vapor barrier system as follows (see Fig. 3-1):
a. Place the outside vapor barrier on the ground first (e.g., the patient’s tent fly or ground cloth).
b. Place the insulation layer(s), such as a sleeping bag or a number of blankets, on top.
c. Strip the patient down to a Polypro layer (or just skin), dry off, and place any instrumentation (e.g., blood pressure cuff, stethoscope, Foley catheter) properly.
d. Cover the patient, and seal him or her in an inner vapor barrier (two garbage bags).
e. Place the patient in the insulation layer.
f. Wrap the patient like a burrito with the outer vapor barrier.
4. Because the litter carry is strenuous and requires great focus, designate a route finder to find the most efficient trail. Choose a medical leader to direct patient monitoring and communication. Litter carries are best performed by at least six persons. Make sure the patient is level (or head up as indicated by injuries) and transported feet first. On level terrain with few obstructions, position any extra rescuers behind the litter. Rotate the carriers through the three litter-carrying positions on one side until they have finished their forward-most carry, and then have them rotate to the rear of the line on the opposite side. This allows for a change in sides to limit rescuer fatigue.
5. On terrain with short drops or obstructions, have extra rescuers place themselves in the direction of travel. This allows for a litter pass with rescuers in a stable, nonmoving position. When a rescuer has finished a pass, have the person move to the front of the line, in the direction of travel, on the opposite side.
6. On steeper terrain, set up a simple belay using a tree wrap as the lowering device or an anchored lowering device such as a Munter hitch attached to a rock. Leave an extra length of rope, or “tag” line, at the head of the litter to tie off the litter and rescuers during belay transfers. Remind rescuers to lean downhill so that their legs are perpendicular to the hillside. Trying to stand upright usually results in feet slipping out from under the rescuer and dropping the litter.
Patient Evaluation and Treatment During Transport
Patient Communication and Monitoring
1. Minimize the number of rescuers who are directly over the patient’s head. Limit the number of rescuers who communicate directly with the patient. This reduces perceived chaos and helps keep the patient oriented and calm.
2. Monitor pulses at the temporal or carotid artery with a packaged patient. Unless the pulse’s character changes significantly, blood pressure probably does not have to be measured.
3. Monitor blood pressure by placing a cuff over a flat-diaphragm stethoscope that is taped to the patient’s upper arm. Run the cuff bulb, gauge, and stethoscope ear pieces through a hole in the vapor barriers to the outside for easy access. Reseal access holes with duct tape after placement.
4. Monitor respirations using a small pocket mirror or noting condensation on the face mask or in the endotracheal (ET) tube.
5. Obtain rectal temperature using an indoor/outdoor remote thermometer. Insert the “outdoor” probe into the rectum after covering with a lubricated finger cot, latex glove finger, or condom. The “indoor” reading reflects the patient’s local environment. During the preplanning phase, test the thermometer’s accuracy against glass thermometers in water of varying temperatures. Thermometry is an essential component of a double–vapor barrier system because of the potential for raising the patient’s core temperature.
6. Skin color, temperature, and moisture are difficult to monitor in a litter-packaged patient. Other vital signs, especially pulse rate, are used more frequently.
7. Mental status is extremely sensitive to perfusion changes. If the rescuers continue to interact with a conscious patient, they will perceive subtle changes.
Respiratory Guidelines
2. The definitive airway is an ET tube. Neither oropharyngeal nor nasopharyngeal airways protect the trachea from upper airway bleeding or vomitus.
3. Improvise suction devices using a turkey baster or a 60-mL irrigating syringe with 1.5-cm (0.6-inch) surgical tubing or an inverted nasal airway. A commercial device (V-VAC hand-powered suction unit) is compact and works well. Remember that gravity is readily available. A well-packaged patient can be quickly rolled to the side or downward without compromise of spinal alignment.
4. Life Support Products makes a bag refill valve that is a demand valve for the bag-valve-mask, delivers 100% oxygen, and shuts off flow once the bag is filled. This prolongs a 30-minute E cylinder for up to 
hours at high flow.
5. Remote ventilation systems, mouth-to-mask ventilation, or even a bag-valve-mask may be difficult to manipulate when a patient is packaged in a litter, being carried over steep or rough terrain, or transported in a confined space. For a patient needing ventilation, consider the following system:
a. Mask or ET tube (preferable). A mask can be taped to the face (with quick-release capability), or an anesthesia mask and rubber spider strapping may be used (airway must be constantly monitored).
b. One-way valve. This is placed in-line near the face mask to limit dead space. In cold weather, this may freeze from condensation, so always carry a spare valve inside your coat or pack.
f. Commercial one-way valves, which can be purchased from most hospital respiratory therapy departments may be taped to the ventilator tubing. The White Pulmonary Resuscitator is a commercial version of the improvised system.
Circulatory Considerations
1. Because of weight and space restrictions, IV fluid therapy in the field is usually reserved for SAR teams or large expeditions.
2. IV fluids are typically infused by bolus during stops or when needed.
3. Do not leave any IV lines hanging during transport. They get in the way and are pulled out too easily.
4. Blood pressure cuff and body weight methods of pressure infusion are usually inadequate for high-volume fluid replacement.
5. Prewarm IV bags by carrying them inside your coat, and then protect lines from freezing by placing the fluids inside the litter package or your coat. To set up a non–gravity-feed field IV system, proceed through the following steps:
Musculoskeletal System Considerations
1. Skin and soft tissues may develop pressure sores. Use adequate padding.
2. Compartment syndrome from tissue edema is often overlooked because of the intensity of the evacuation. Perform ongoing assessment of injured extremities.
3. When packaging for a long evacuation, place the patient’s knees and elbows in slight flexion to achieve maximum comfort.
Gastrointestinal and Genitourinary Considerations
1. Although the fasting status of patients who may require surgery is a consideration, hydration of the patient during the extended evacuation is more important. Persuade patients whose injuries or illness do not preclude fluids by mouth to take small sips of water. Encourage them to eat and drink regularly.
2. With proper double–vapor barrier packaging and long transport delays unlikely, allow the patient to defecate or urinate freely inside the litter packaging. An improvised diaper helps to reduce discomfort.
3. For the unconscious patient, insert a Foley catheter and use a leg bag to allow for the assessment of urine output. In a conscious male, you may use a “condom catheter.”
4. For the conscious patient, the litter can be inverted or stood on end for urination if the packaging arrangement allows. A bedpan or urinal can also be used.
5. Female patients may benefit from an improvised funnel made from an inverted pocket mask held against the perineum. Attach this to 1.5-cm (0.6-inch) surgical tubing and drain it outside the litter. The Whiz Freedom or Lady J are manufactured devices that may also be used.
6. For defecation, you can cut a foam pad into the shape of a toilet seat (donut shaped), and place the pad over a hole dug into the ground or snow (this method assumes the patient can be moved out of the litter). Constipation and fecal impaction may become problematic in the immobile and dehydrated patient. Adequate hydration is the best prevention.
Additional Rescue Considerations
1. Fire is probably the most effective signaling method during darkness. The international distress signal is three fires in a triangle or in a straight line with about 25 m (82 feet) between fires. It is better to be able to maintain one signal fire if it is too difficult to keep three going. Using a small campfire for a signal conserves fuel and energy. Keep a good supply of rapid-burning materials to throw on the fire quickly if needed.
2. Make sure that smoke signals contrast to the surrounding area. Dark-colored smoke can be made with oil-soaked rags, rubber, plastic, or electrical insulation. Light-colored smoke can be made with green leaves, moss, ferns, or water sprinkled on the fire.
3. You can make a signal mirror from shiny metal or glass; this is probably the most effective method for signaling on a bright, sunny day. Extend your arm while sighting the reflection between your thumb and forefinger on the outstretched arm. Slowly move your arm direction until an aircraft or vehicle comes into sight between your thumb and forefinger, and then move the reflection to signal the vehicle.
Rescue Communications
1. Emergency radio communications usually occur on the following bands:
• Very high frequency (VHF), 32 to 50 MHz: good for two-way communication and paging; follows the terrain; susceptible to manmade and natural interference; uses more power and a longer (45-cm [17.7-inch]) antenna
• VHF high band, 140 to 170 MHz: less distance; more line of sight; short (15-cm [5.9-inch]) antenna
• Ultrahigh frequency (UHF), 460 to 470 MHz or higher: least distance; more penetration of buildings; almost always needs repeaters; shortest (5-cm [2-inch]) antenna
• Ham (amateur): many bands used; high power and good distance; phone patch and relay possible Military Affiliate Radio System (MARS); emergency nets already in place (Radio Amateur Civil Emergency Service [RACES]); worldwide
• CB (citizens band): crowded high-frequency (HF) band with poor distance; heavy interference; common and inexpensive
c. The basic parts for all mobile, handheld, and fixed (base) radios are as follows:
• PTT (push-to-talk). Push the key, and then talk.
• Volume/on-off. Adjust the volume so that the speaker does not distort an incoming broadcast.
• Squelch (signal sensitivity). Turn the squelch until the noise just stops for optimum, nonirritating sensitivity. You may need to turn sensitivity up to be able to hear a poor transmission.
d. The protocol for use is as follows:
• Turn off transmitter locator beacons because they may interfere with the radio broadcast.
• Use normal, “clear” speech. Code signal meanings vary from location to location.
• Identify the receiver (Rx) first and the transmitter (Tx) second.
• Battery life is limited. Keep batteries warm and as dry as possible. Keep transmissions limited to short periods on a regular basis rather than transmitting continuously. Energy consumption while transmitting is much greater than when receiving.
2. With cellular phones, it is important to know your location. The actual cell picking up your call may be many miles from your location, particularly if your location is at high altitude. Keep this in mind when placing a 9-1-1 call.
Distress Radio Beacons
Emergency Position-Indicating Radio Beacons (Marine EPIRBs)
There are several types of EPIRBs in use for maritime applications. The U.S. Coast Guard maintains an outstanding website with more information on EPIRBs: http://www.navcen.uscg.gov/?pageName=mtEpirb.
Personal Locator Beacons
1. PLBs are portable units that operate in much the same way as EPIRBs or ELTs.
2. These beacons are designed to be carried by an individual instead of on a boat or aircraft.
3. Unlike ELTs and some EPIRBs, they can only be activated manually and operate exclusively on 406 MHz in the United States.
4. Similar to EPIRBs and ELTs, all PLBs also have a built-in, low-power homing beacon that transmits on 121.5 MHz. This allows rescue teams to home in on a beacon once the 406-MHz satellite system has put them within 3.2 to 4.8 km (2 to 3 miles).
5. Some newer PLBs also allow Global Positioning System (GPS) units to be integrated into the distress signal. This GPS-encoded position dramatically improves the location accuracy down to the level of 100 m (328 feet).
6. PLB users should familiarize themselves with proper registration, testing, and operating procedures to prevent false activation and be careful to avoid their use in nonemergency situations.
SPOT (Satellite Personal Tracker) Satellite Messenger (http://www.findmespot.com)
1. An alternative to PLBs, satellite phones, and cell-based GPS trackers
2. Some advantages over PLBs, although reliability a concern for some
3. SPOT provides virtually full coverage in North America, Europe, and Australia
4. Covers portions of South America, northern Africa, and northeastern Asia
5. “SOS” function dispatches emergency responders to exact location (similar to PLBs but using proprietary satellites and dispatchers)
6. “Help” feature to request assistance from colleagues (or friends) via email or Short Message Service (SMS) (text) message
7. “Check-in/OK” allows transmission of location and “okay” message
8. Automatically track progress by sending and saving points along route to Google Maps
9. Integrated GPS determines location; commercial SPOT satellites transmit information
