clinical home > structured approach


There can be 3 phases of care "in the field":
Care in danger. This is the phase when you and the casualty are in danger - e.g. from falling rocks - so care is limited to those interventions needed immediately to preserve life. Moving the casualty (and rescuer(s) from danger shares top priority with life saving interventions and the two may have to be alternated.
Field care. Which is the phase most of the clinical content of this space addresses. This may be prolonged if evacuation is delayed.
Evacuation. The casualty will often require care during evacuation.

Evacuation needs to be planned.
The planning should start as soon as the initial treatment has been completed (sometimes calling for evacuation can be commenced sooner if there are enough personnel to do this without compromising casualty care). Issues to consider include:
Why? Evacuation is often difficult, expensive and/or time consuming. It is not a decision to be taken lightly. The casualty may well not be keen to be evacuated and the expedition leader will have to make the final decision.
Where? The destination to which the casualty is evacuated must be suitable for their needs. The best route to the destination should also be considered.
Who? Other group members (e.g. close family) may want/need to be evacuated with the casualty. The decision about who should accompany the casualty may be difficult but should be part of early considerations.
When? The urgency of the evacuation and the weather/facilities will determine when the casualty is evacuated. For example, HACE is an emergency that requires immediate evacuation to a lower altitude.
What? The means of evacuation needs to be considered. Some casualties may be able to self-evacuate; others will need helicopter evacuation.
How? The clinical aspects of evacuation need to be considered. A hypothermic casualty needs to be kept warm/rewarmed. Other casualties should be evacuated with specific equipment (e.g. airway equipment should be available if evacuating an unconscious casualty).
On expeditions / very remote trips evacuation planning MUST take place beforehand; it is often too late to wait until it happens.

Why evacuate?

Reasons for evacuation will include the following:
• Definitive care is needed that is not available in the field.
• Even if care can be provided the problems prevent the casualty continuing the activities they were undertaking.

The urgency of evacuation, and what is doen beforehand, will be influenced by the time that evacuation will take and the facilities to which evacuaction will occur.
For example, if helicopter transfer to a trauma centre is available and will take 30 minutes, then one would normally only do those procedures that are needed immediately to safe life. If evacuation will be longer, or to a less advanced facility, then further care is performed before evacuation.

Indications for evacuation

(taken from WMS guidelines 5th edition)
• Progressive deterioration in physiology / infection that fails to improve after 24 hours treatment
• Debilitating pain or sustained abdo pain
• Any illness or injur that prevents keeping up reasonable pace
• Serious wounds/injuries (see below)
• Chest pain that is not clearly minor musculoskeletal in nature
• Psychological problem that impairs safety of anyone
• HAPE, HACE (or AMS not settling)

Indications for evacuation after orthopaedic injury

• Open fracture or injury associated with blood loss (e.g. # pelvis)
• Injury with distal neurovascular compromise after reduction
• Spinal injury with neurology
• Dislocation of major joint that cannot be reduced

How to evacuate

Aeromedical transportsee safety section for safety considerations relating to helicpoter LZ

Aeromedical transport: external image msword.png Aeromedical transport.doc


If the casualty cannto walk out and people with him/her cannot support/carry them out then it will be necessary to ask for help to evacuate the casualty. In the UK this will be via a 999 call (assuming phone signal is available).


This mnemonic can be used to ensure that rescuers have enough information to effect the evacuation successfully.
Exact location
As a minimum a grid reference should be given.
This can be supplemented with additional information to help resecuers find the casualty.
Type of incident
What happened (if known) and what injuries/illness does the casualty have?
Rescuers who become further casualties will not be able to help. For instance near-by power lines are a hazard to helicopters & animals coul dpose a hazard to rescuers walking in.
Recommended way of reaching the casualty.
Number of casualties
There may be more than one casualty. If this is the case the number of casualties in each of the triage categories should be given (e.g. 0 immmediate, 1 urgent, 3 delayed).
Emergency services on scene & required
Who do you need?


This mnemonic is used to structure clinical handover to the rescuer:
Mechanism of injury
Injuries identified
Signs (vital signs)
Treatment (& timings and responses to treatment)

For example:
"This is Pete, who slipped about 3 metres while scrambling and sustained a closed fracture of the right tib and fib. His heart rate is 96 and his resp rate is 20. I have imporvised a splint and circulation and sensation in the foot remain intact. He slipped about 40 minutes ago."