Backcountry Evacuation: Mastering Patient Transport Techniques in Remote Environments

Backcountry environments present unique challenges for medical emergencies. When evacuation is necessary, understanding and implementing effective patient transport techniques is crucial for ensuring the safety and well-being of the injured or ill individual. This guide provides a comprehensive overview of essential skills and considerations for successful patient transport in remote areas, applicable across diverse global landscapes.

I. Initial Assessment and Stabilization

Before initiating any transport, a thorough assessment of the patient's condition is paramount. This includes evaluating their level of consciousness, airway, breathing, and circulation (ABCs). Address any life-threatening conditions immediately. Consider the potential for spinal injuries, especially in cases of falls or trauma. Proper stabilization is key to preventing further injury during transport.

A. Primary Assessment: ABCs and Critical Interventions

The primary assessment focuses on identifying and addressing immediate threats to life:

• Airway: Ensure a clear and patent airway. Use manual maneuvers like the head-tilt/chin-lift (if spinal injury is not suspected) or jaw-thrust to open the airway. Consider using an oropharyngeal airway (OPA) or nasopharyngeal airway (NPA) if trained and available.
• Breathing: Assess respiratory rate, depth, and effort. Look for signs of respiratory distress. Provide supplemental oxygen if available and indicated. Be prepared to assist ventilation if necessary.
• Circulation: Check pulse rate, strength, and skin perfusion. Control any bleeding with direct pressure, elevation, and pressure points. Look for signs of shock.

Remember to adapt your approach based on the patient's condition and available resources. A rapid and efficient primary assessment is vital in time-sensitive situations.

B. Spinal Immobilization Considerations

Suspect spinal injury in any patient with trauma to the head, neck, or back; altered mental status; or neurological deficits. Immobilization is critical to prevent further damage to the spinal cord. However, complete immobilization in backcountry settings can be challenging and may have its own risks.

• Manual Stabilization: Maintain manual stabilization of the head and neck until a more secure method is available.
• Cervical Collar: Apply a cervical collar if available and you are trained to do so. Ensure proper sizing and application.
• Improvised Immobilization: In the absence of a commercially available backboard, improvise with available materials such as sleeping pads, backpacks, and clothing. The goal is to minimize movement of the spine during transport.

Carefully weigh the benefits of spinal immobilization against the potential risks, such as increased transport time and difficulty managing the airway. In some situations, prioritizing rapid evacuation may be more beneficial than attempting complete immobilization.

C. Managing Hypothermia and Environmental Hazards

Exposure to cold, wind, and rain can exacerbate a patient's condition. Hypothermia is a significant risk in backcountry environments and can quickly become life-threatening.

• Prevention: Protect the patient from the elements by providing insulation (sleeping bags, blankets, extra clothing), building a shelter, and minimizing exposure to wind and moisture.
• Treatment: Actively rewarm the patient by applying heat packs to the groin, axillae, and neck. Offer warm, sugary drinks if the patient is conscious and able to swallow. Avoid rubbing the patient's extremities, as this can cause cold blood to return to the core and worsen hypothermia.

Also, be aware of other environmental hazards such as heatstroke, altitude sickness, and lightning strikes. Take appropriate precautions to mitigate these risks.

II. Patient Packaging and Preparation for Transport

Proper patient packaging is crucial for ensuring comfort, stability, and safety during transport. The goal is to secure the patient to a carrying device in a way that minimizes movement and prevents further injury.

A. Stretcher Selection and Improvised Litters

The ideal stretcher depends on the terrain, distance, and available resources. In some situations, a commercially available stretcher may be feasible. However, in many backcountry scenarios, improvised litters are necessary.

• Commercial Stretchers: Lightweight, foldable stretchers are available for backcountry use. These offer good support and stability but can be bulky and difficult to maneuver in tight spaces.
• Improvised Litters: Create a litter using available materials such as rope, poles, tarps, and clothing. Common designs include the A-frame litter, poncho litter, and blanket drag. Ensure the litter is strong enough to support the patient's weight and evenly distribute the load.

When constructing an improvised litter, prioritize patient comfort and safety. Pad the litter with soft materials to prevent pressure sores and secure the patient with straps or rope to prevent them from falling off.

B. Securing the Patient to the Stretcher

Once the patient is on the stretcher, secure them with straps or rope to prevent movement during transport. Ensure the straps are snug but not so tight that they restrict breathing or circulation.

• Strapping Techniques: Use a combination of chest, hip, and leg straps to secure the patient. Crisscross the straps over the chest and hips to distribute the load evenly.
• Padding: Use padding to protect bony prominences and prevent pressure sores. Pay particular attention to the head, spine, and extremities.
• Monitoring: Continuously monitor the patient's condition during transport. Check their airway, breathing, and circulation regularly. Adjust the straps as needed to maintain comfort and stability.

C. Maintaining Body Temperature and Comfort

Maintaining the patient's body temperature is critical, especially in cold or wet conditions. Provide insulation with blankets, sleeping bags, or extra clothing. Shield the patient from wind and rain. Offer warm drinks if the patient is conscious and able to swallow.

Also, prioritize patient comfort. Provide reassurance and emotional support. Communicate clearly about the transport process and what to expect. Address any concerns or discomfort the patient may have.

III. Patient Transport Techniques

The choice of transport technique depends on the patient's condition, the terrain, the distance to safety, and the available manpower. Several techniques can be used, each with its own advantages and disadvantages.

A. Walking Assists

Walking assists are appropriate for patients who are able to bear some weight but require assistance with balance and stability.

• One-Person Assist: The rescuer provides support on one side of the patient.
• Two-Person Assist: Two rescuers support the patient on either side.
• Cradle Carry: One rescuer carries the patient in their arms. This is suitable for small children or lightweight adults.

Walking assists are relatively easy to implement and require minimal equipment. However, they are only suitable for short distances and relatively mild injuries.

B. Improvised Carries

Improvised carries are useful when the patient is unable to walk but the terrain is too challenging for a stretcher. These techniques require multiple rescuers and good coordination.

• Fireman's Carry: One rescuer carries the patient over their shoulder. This is a strenuous carry that requires significant strength and balance.
• Piggyback Carry: One rescuer carries the patient on their back. This is a less strenuous carry than the fireman's carry but still requires good strength and balance.
• Two-Person Seat Carry: Two rescuers interlock their arms to create a seat for the patient. This is a relatively comfortable carry but requires good coordination and communication.

Improvised carries can be effective for navigating difficult terrain but are tiring for the rescuers. Rotate rescuers frequently to prevent fatigue.

C. Stretcher Carries

Stretcher carries are the preferred method of transport for patients who are unable to walk and the terrain allows. They provide good support and stability for the patient but require multiple rescuers and a clear path.

• Two-Person Carry: Two rescuers carry the stretcher, one at each end. This is suitable for short distances and relatively flat terrain.
• Four-Person Carry: Four rescuers carry the stretcher, two at each end. This is more stable and less tiring than the two-person carry.
• Six-Person Carry: Six rescuers carry the stretcher, three at each end. This is ideal for long distances and uneven terrain.

When performing a stretcher carry, maintain good communication and coordination. Use a consistent pace and avoid sudden movements. Rotate rescuers frequently to prevent fatigue. Consider using a wheelbarrow or other wheeled device to assist with transport if available and appropriate for the terrain.

D. Rope Systems for Steep Terrain

In steep or technical terrain, rope systems may be necessary to safely transport the patient. These systems require specialized training and equipment.

• Lowering Systems: Use a rope system to lower the patient down a steep slope. This requires anchors, ropes, pulleys, and friction devices.
• Hauling Systems: Use a rope system to haul the patient up a steep slope. This requires anchors, ropes, pulleys, and mechanical advantage devices.

Rope systems are complex and require careful planning and execution. Ensure all rescuers are properly trained and experienced in their use. Always use appropriate safety measures, such as helmets, harnesses, and belay devices.

IV. Teamwork and Communication

Effective teamwork and communication are essential for successful backcountry evacuations. Clear roles and responsibilities, open communication channels, and a shared understanding of the goals are critical for ensuring patient safety and efficient transport.

A. Establishing Clear Roles and Responsibilities

Before initiating transport, assign specific roles to each rescuer. This includes:

• Team Leader: Responsible for overall coordination and decision-making.
• Medical Provider: Responsible for assessing and treating the patient.
• Stretcher Team: Responsible for carrying the stretcher and maintaining patient stability.
• Navigation: Responsible for determining the route and guiding the team.
• Communication: Responsible for communicating with outside resources.

Ensure each rescuer understands their role and responsibilities. This will help to prevent confusion and ensure that all tasks are completed efficiently.

B. Maintaining Open Communication Channels

Establish clear communication channels between rescuers. This can be done using radios, hand signals, or verbal communication. Ensure that all rescuers can hear and understand the instructions.

Regularly check in with the patient to assess their condition and address any concerns. Communicate any changes in the patient's condition to the team leader and medical provider.

C. Decision-Making in Dynamic Environments

Backcountry evacuations are dynamic events that require constant adaptation and decision-making. Be prepared to adjust your plans based on changing conditions, such as weather, terrain, and patient status.

Encourage open communication and feedback from all team members. Value different perspectives and consider all options before making a decision. Prioritize patient safety and well-being above all else.

V. Post-Evacuation Care and Documentation

Once the patient has been successfully evacuated, provide appropriate post-evacuation care and document the incident thoroughly. This information is valuable for improving future rescue efforts and ensuring accountability.

A. Transfer of Care to Higher Level Medical Providers

Upon arrival at a medical facility, provide a detailed report to the receiving medical providers. Include information about the patient's condition, the treatment provided, and the transport process.

Answer any questions the medical providers may have and provide any additional information that may be helpful.

B. Incident Documentation and Reporting

Document the incident thoroughly, including the patient's condition, the treatment provided, the transport process, and any challenges encountered. This documentation should be accurate, complete, and objective.

Report the incident to the appropriate authorities, such as search and rescue organizations or park services. This information is valuable for improving future rescue efforts and identifying potential hazards.

C. Debriefing and Lessons Learned

Conduct a debriefing session with all rescuers involved in the evacuation. Discuss what went well, what could have been done better, and any lessons learned. This is an opportunity to identify areas for improvement and enhance future rescue efforts.

Use the information gathered from the debriefing to update protocols and training programs. Share the lessons learned with other rescue organizations to improve overall backcountry safety.

VI. Equipment Considerations

Having the right equipment is crucial for a successful backcountry evacuation. This section outlines essential equipment categories and considerations for selection and maintenance.

A. Essential Medical Supplies

A well-stocked medical kit is indispensable. Customize the kit based on the anticipated risks and the skills of the team. Key items include:

• Wound Care: Bandages (various sizes), gauze pads, antiseptic wipes, tape, trauma dressings.
• Medications: Pain relievers, antihistamines, epinephrine auto-injector (if applicable), anti-diarrheal medication. Consult with a medical professional for appropriate medications based on the location and potential medical conditions.
• Airway Management: Oropharyngeal airway (OPA), nasopharyngeal airway (NPA), bag-valve-mask (BVM) (if trained).
• Splinting Materials: SAM splint, triangular bandages, elastic wraps.
• Other: Gloves, scissors, penlight, thermometer, blood pressure cuff (if trained).

Regularly check the kit for expired medications and damaged supplies. Ensure all team members know the location of the medical kit and how to use its contents.

B. Rescue and Transport Gear

Appropriate rescue and transport gear is essential for safely moving the patient. This includes:

• Stretcher: Commercial or improvised.
• Rope: For lowering and hauling systems in steep terrain.
• Harnesses: For rescuers working in steep terrain.
• Helmets: For rescuers and patients in steep terrain.
• Navigation Tools: Map, compass, GPS.
• Communication Devices: Radio, satellite phone.

Choose equipment that is lightweight, durable, and appropriate for the terrain. Regularly inspect and maintain all equipment to ensure it is in good working order.

C. Personal Protective Equipment (PPE)

Personal protective equipment is essential for protecting rescuers from injury and illness. This includes:

• Gloves: To protect against bloodborne pathogens.
• Eye Protection: To protect against splashes and debris.
• Masks: To protect against airborne pathogens.
• Appropriate Clothing: To protect against the elements.

Ensure all rescuers have access to appropriate PPE and know how to use it properly.

VII. Training and Education

Adequate training and education are paramount for anyone involved in backcountry evacuations. This section highlights essential training topics and resources.

A. Wilderness First Aid and CPR Certification

Obtain and maintain certification in wilderness first aid and CPR. These courses provide essential knowledge and skills for managing medical emergencies in remote environments.

B. Advanced Wilderness Life Support (AWLS) or Wilderness EMT (WEMT)

Consider pursuing advanced training such as AWLS or WEMT. These courses provide more in-depth knowledge and skills for managing complex medical situations in the backcountry.

C. Rope Rescue and Technical Rescue Training

If you anticipate working in steep or technical terrain, obtain specialized training in rope rescue and technical rescue techniques. This training will provide you with the skills and knowledge necessary to safely use rope systems for patient transport.

D. Ongoing Practice and Skill Maintenance

Regularly practice your skills and participate in refresher courses to maintain proficiency. Practice scenarios in realistic environments to prepare for real-world emergencies.

VIII. Conclusion

Backcountry evacuations are complex and challenging operations that require careful planning, effective teamwork, and specialized skills. By mastering patient transport techniques, understanding the unique challenges of remote environments, and prioritizing patient safety, you can significantly improve the outcome of backcountry medical emergencies. Remember that continuous learning, skill maintenance, and adherence to established protocols are crucial for ensuring the well-being of both the patient and the rescue team. This guide provides a foundational understanding; always seek formal training and guidance from qualified professionals before attempting any backcountry rescue operation.