evacuation

clinical home > structured approach =Evacuation = toc

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. **

<span style="font-family: Verdana,Geneva,sans-serif;">Why evacuate?
<span style="font-family: Georgia,serif;"> Reasons for evacuation will include the following: <span style="font-family: Georgia,serif;"> • Definitive care is needed that is not available in the field. <span style="font-family: Georgia,serif;"> • Even if care can be provided the problems prevent the casualty continuing the activities they were undertaking. <span style="font-family: Georgia,serif; line-height: 0px; overflow-x: hidden; overflow-y: hidden;">

<span style="font-family: Georgia,serif;">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. <span style="font-family: Georgia,serif;">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.

<span style="font-family: Verdana,Geneva,sans-serif;">Indications for evacuation
<span style="font-family: Georgia,serif;"> (taken from WMS guidelines 5th edition) <span style="font-family: Georgia,serif;"> • Progressive deterioration in physiology / infection that fails to improve after 24 hours treatment <span style="font-family: Georgia,serif;"> • Debilitating pain or sustained abdo pain <span style="font-family: Georgia,serif;"> • Any illness or injur that prevents keeping up reasonable pace <span style="font-family: Georgia,serif;"> • Serious wounds/injuries (see below) <span style="font-family: Georgia,serif;"> • Chest pain that is not clearly minor musculoskeletal in nature <span style="font-family: Georgia,serif;"> • Psychological problem that impairs safety of anyone <span style="font-family: Georgia,serif;"> • HAPE, HACE (or AMS not settling)

<span style="font-family: Verdana,Geneva,sans-serif;">Indications for evacuation after orthopaedic injury
<span style="font-family: Georgia,serif;"> • Open fracture or injury associated with blood loss (e.g. # pelvis) <span style="font-family: Georgia,serif;"> • Injury with distal neurovascular compromise after reduction <span style="font-family: Georgia,serif;"> • Spinal injury with neurology <span style="font-family: Georgia,serif;"> • Dislocation of major joint that cannot be reduced

<span style="font-family: Verdana,Geneva,sans-serif;">How to evacuate
<span style="font-family: Georgia,serif;"> Aeromedical transport//see safety section for safety considerations relating to helicpoter LZ//

<span style="font-family: Georgia,serif;"> Aeromedical transport: [| Aeromedical transport.doc]

<span style="font-family: Verdana,Geneva,sans-serif;">Communication
<span style="font-family: Georgia,serif;"> 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).

<span style="font-family: Verdana,Geneva,sans-serif;">ETHANE
<span style="font-family: Georgia,serif;"> This mnemonic can be used to ensure that rescuers have enough information to effect the evacuation successfully. <span style="font-family: Georgia,serif;"> This can be supplemented with additional information to help resecuers find the casualty. ||
 * <span style="font-family: Georgia,serif;">**Exact location** || <span style="font-family: Georgia,serif;">As a minimum a grid reference should be given.
 * <span style="font-family: Georgia,serif;">**Type of incident** || <span style="font-family: Georgia,serif;">What happened (if known) and what injuries/illness does the casualty have? ||
 * <span style="font-family: Georgia,serif;">**Hazards** || <span style="font-family: Georgia,serif;">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. ||
 * <span style="font-family: Georgia,serif;">**Access** || <span style="font-family: Georgia,serif;">Recommended way of reaching the casualty. ||
 * <span style="font-family: Georgia,serif;">**Number of casualties** || <span style="font-family: Georgia,serif;">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). ||
 * <span style="font-family: Georgia,serif;">**Emergency services on scene & required** || <span style="font-family: Georgia,serif;">Who do you need? ||

<span style="font-family: Verdana,Geneva,sans-serif;">MIST
<span style="font-family: Georgia,serif;"> This mnemonic is used to structure clinical handover to the rescuer: <span style="font-family: Georgia,serif;"> Mechanism of injury <span style="font-family: Georgia,serif;"> Injuries identified <span style="font-family: Georgia,serif;"> Signs (vital signs) <span style="font-family: Georgia,serif;"> Treatment (& timings and responses to treatment)

<span style="font-family: Georgia,serif;"> For example: <span style="font-family: Georgia,serif;"> "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."