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Wilderness Medical Society - snowmass 2005 (Page 177)

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Wilderness Medical Society - snowmass 2005
7
Chapter 1
WILDERNESS EVACUATION
Recommendations are considered Category 1B by the WMS Panel of Expert Reviewers

I. GENERAL INFORMATION:
The mode and urgency of the evacuation should be appropriate for the problem. Calling
for on-site evacuation, e.g., helicopter, versus evacuating a patient to care by foot or on a
litter is decided upon in view of multiple factors including:
1) severity of the illness or injury, including the psychological condition of the
victim,
2) rescue and medical skills of the rescuers,
3) physical/psychological condition of the rescuers,
4) availability of equipment and/or aid for the rescue,
5) danger/difficulty of extracting the victim(s) by the various means available,
6) time, a product of distance, terrain, weather (and the possible deterioration of
the weather), and multiple other variables, and
7) cost.
An evacuation deemed necessarily "urgent" considers the patient's life or significant
morbidity to be at immediate risk. These guidelines indicate "non-urgent" evacuation in
cases where the patient requires further evaluation and treatment, but is not at immediate
risk for significant morbidity or death.
Party leaders must know the capabilities of rescue organizations in the area the
group is using and how to contact those organizations. All wilderness leaders must leave
trip plans with a responsible person who can act on the group's behalf. If rescue by an
outside group (rather than self-rescue by the party) has been determined to be the best
course of action, the earlier it is initiated the better. Waiting may allow deterioration of
the patient, and may jeopardize the entire rescue operation.
When requesting outside assistance, delayed response time, the safety of in-
coming rescuers, number of personnel responding, time to assemble, their time
commitment, and the cost of the rescue must be considered. It is important to note that
the safety of the rescuers or the group takes precedence over ideal management of the
patient. Optimally, the entire group, including the patient, must make evacuation
decisions.
In general, it is appropriate to postpone further travel and/or initiate evacuation
from the wilderness for any person who has the following:

1. Sustained or progressive physiological deterioration, manifested by orthostatic
dizziness, syncope, tachycardia, bradycardia, dyspnea, altered mental status, progressive
or significant weakness, or intractable vomiting and/or diarrhea, inability to tolerate oral
fluids, or the return of loss of consciousness following head injury. In other words, if
patients are not improving, they must get out!
2. Debilitating pain.
3. Inability to sustain travel at a reasonable pace due to a medical problem.

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