Hazardous Terrain

1
Hazardous Terrain
2
EMS Skills

• Rescue awareness
• Types of specialized teams
• Effective coordination with specialists
• Hazardous terrain litter evacuations

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Hazardous Terrain Types

• High angle
• Low angle
• Flat terrain with obstructions

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High Angle

• Surfaces inclined gt40o
• Gorges
• Cliffs
• Buildings
• Very smooth surfaces lt40o
• Require use of hands in climbing

• Ropes, aerial apparatus required for access,
  removal
• Errors can cause life-threatening injury, death

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Low Angle

• Surfaces inclined lt40o
• 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

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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

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Patient Access
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High Angle

• Access/removal usually carried out by technical
  teams
• Additional resources needed to balance
  technical/medical aspects of rescue

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High Angle

• Rescuer skills
• Knot tying
• Ascending, descending skills
• Rigging of hauling systems
• Packaging of patients for evacuation

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High Angle

• Specialized Terms
• Aidedusing means other than hands, feet, body
• Anchortechnique for securing rescuers to
  vertical face
• Belaysafeguarding climber by use of a rope
  secured to an anchor
• Rappeldescend by sliding down a fixed double
  rope

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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

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Patient Packaging
14
Stokes Basket Stretcher

• Standard litter for rough terrain evacuations
• Provides rigid frame for patient protection
• Easy to carry

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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

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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

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Patient Removal
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Flat Terrain

• When possible, walk patient out!
• Carrying over flat ground is strenuous under
  ideal conditions

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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

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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

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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

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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

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Extended Care Issues
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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

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Environmental Considerations

• Weather/Temperature Extremes
• Risk of hypo/hyperthermia
• Difficulty in exposing patient for assessment
• Use of specialized packaging

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Environmental Considerations

• Limited Patient Access
• Inaccessible parts of patient
• Cramped space
• Low lighting conditions

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Environmental Considerations

• Difficulty Moving Equipment
• Identify minimum essential equipment
• Carry in backpack

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Environmental Considerations

• Cumbersome PPE
• Restricted rescuer mobility
• Temporary removal of PPE to perform procedures

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Environmental Considerations

• Patient Exposure
• Covering for thermal protection
• Hard protection from sharp objects, debris

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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

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Environmental Considerations

• Patient Monitoring
• Modification of procedures (palpated BP)
• Modification of equipment (compact pulse
  oximeters)
• Non-use of equipment (ECG monitors)

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Environmental Considerations

• Improvisation
• Splinting using patients uninjured body parts
• Light-weight splints
• Downsized or improvised medical gear