Evacuation Guidelines

Wilderness MedicineUniversity of Utah School of

Medicine

Evacuation Guidelines

• Evacuation statistics are not kept

Evacuation Guidelines

• Evacuation statistics are not kept

• Small injuries such as a blister on a foot can require “evacuation.”

Evacuation Highlights

• A lot of the guidelines are geared toward the patients ability to ambulate.– Foot injuries– Hand injuries– Frostbite on the feet– Cramps

Evacuation Highlights

• Some guidelines determine if the patient’s injury will worsen with time.– Lightening– Seizures disorders– Burns– Trauma

Evacuation Highlights

• Some guidelines are geared toward a patients ability to eat and drink.– Cramping– Nausea– Vomiting

Evacuation Highlights

• Some guidelines determine if the patient’s injury is life threatening.– Possible ectopic pregnancy– Sepsis– Skull fractures– Heart attack– Difficulty breathing

Evacuation Plan

• Patient is the first consideration:– Type of injury?– Is the patient stable?

(ABCDE’s)– Can they walk or

assist with evacuation?

– Are they likely to become worse or more difficult to evacuate if evacuation is delayed?

Evacuation Plan

• What equipment is necessary/available?

• Can EMS be contacted?

• How far to nearest help?

• Which route is fastest?• Are there environmental

limitations to immediate evacuation?

Symptom Evacuate?

• 18 year old male in camp 3 hours from help

• Cramping left sided pain for 6 hours, worsening

• No temperature• Minor guarding• Patient can eat

• Evacuate?• No shock, patient

can eat, pain on left side, pain has been less than 24 hour, no blood is seen in stool, no fever

• Probably can watch

Symptom Evacuate?

• 22 year old female with lower abdominal pain for 2 hours

• Sexually active• Sharp pain, guarding• Retains appendix• No fever• Day 3 of a Grand

Canyon river trip

• Risk of ectopic pregnancy.

• Need to evacuate

Symptom Evacuate?

• 35 year old male• Epigastric pain for

24 hours• Unable to eat or

drink well for 12 hours

• 12 hour backpack from help

• The patient can’t eat, this is an indication for evacuation.

• Pain for 24 hours in another indication.

• Can his eating get better?

Symptom Evacuate?

• 35 year old female epileptic has a seizure while on a rafting trip in Cataract Canyon. She is not injured. It has been 3 years since her last seizure.

• All that is probably necessary is to double her seizure medicine. She could be watched.

Symptom Evacuate?

• 18 year old female experiences “seizure like” activity. She did not injure herself. No previous experience. She is at day 5 on an 18 day trek still low in the Himalaya.

• New onset seizure activity warrants evacuation.

Symptom Evacuate?

• A 16 year old male climbing is bit in the hand by a rattle snake.

• Evacuate

Symptom Evacuate?

• 45 year old male climbing on Denali in Alaska develops sunned shortness of breath and other symptoms of HAPE.

• Evacuate to lower altitude immediately. It is conceivable that patient can continue with the trip. It depends upon how high he will need to hike.

Symptom Evacuate?

• A 54 year old female receives a superficial and partial thickness burn over the palms of both hands while on day 3 of a 6 day river trip on the Salmon River.

• The patient has burns which may make using her hands difficult. Evacuation from this area is problematic.

Symptom Evacuate?

• A 54 year old female receives a partial thickness burn over the palms of both hands, arms and face while on day 3 of a 6 day river trip on the Salmon River.

• The burns cover about 10% of the body, and now involve face. The patient needs to be evacuated.

Symptom Evacuate?

• A 65 year old man is in the Wind River on a back pack trip when he experiences symptoms of what you think is a TIA?

• According to the guidelines he should be evacuated, how emergently depends upon his ability to walk, etc.

Symptom Evacuate?

A young 14 year old boy is bit by a black widow spider while hiking King’s Peak. (1 day from help)

• Venomous spider bites should be evacuated.

Symptom Evacuate?

A 60 year old man with no cardiac history and no risk factors had chest pain while on a fishing trip – a 4 hour walk from help.

• The man must assumed to be having some cardiac problems and needs to be evacuated some way.

Symptom Evacuate?

A 21 year old male sustains a deep wound to the arm near the shoulder while camping on the John Muir trail in California. Bleeding is controlled.

• This man should be evacuated

Symptom Evacuate?

A 21 year old male while on a backpack, sustains a superficial wound to the ball of his right foot making it very painful for him to walk.

• This is a problematic wound. He probably needs to be evacuated simply because he can not walk.