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front of the litter as the litter "driver's" position. It is best to support a litter skeletally by
utilizing straps, webbing, or pack frames rather than depending on hand grips.
The patient must be carefully "packaged" in the litter for maximum safety and
comfort. Protect the patient's head and eyes. Pad stress points, e.g., where the straps press
against the body, and the voids, e.g., in the small of the back and behind the knees.
Protect from wind, cold, and precipitation. To prevent decubitus ulcers, have the patient
move occasionally or alter the patient's position at least every two hours if he or she is
unconscious. Expect to handle urine and fecal elimination by allowing the functional
patient to leave the stretcher with assistance (if serious spine injuries can be cleared), or
provide appropriate tilting and/or cleansing toweling to catch excrement. To prevent
deep vein thrombosis it is necessary to allow leg movement or to move or massage legs
hourly, as long as this does not increase the severity of the original injury. If the litter is
improvised, test the system and padding first on an uninjured person.
III. GUIDELINES FOR HELICOPTER EVACUATION
Helicopters can significantly reduce the time to definitive care when used for emergency
transportation of the sick or injured. The decision to use a helicopter for an evacuation
must take into account clinical, logistical, and environmental factors. Using a helicopter
always adds an element of risk both to rescuers and victim, and a note requesting an air
evacuation should include all known specific hazards relative to the rescue. This risk
must be balanced against the risk to the patient, other members of the party, or the rescue
team if the patient is evacuated by ground. Evacuate by helicopter only if: 1) a victim's
life will be saved, 2) the victim has a significantly better chance for full recovery via a
helicopter evacuation, 3) the pilot believes that conditions are safe enough to do the
evacuation, 4) a ground evacuation may be unusually dangerous to the ground crew, 5)
ground evacuation would be excessively prolonged, or 6) there are not enough rescuers
available for a ground evacuation.
Four important points must be kept in mind: 1) evacuating a patient by ground
may be faster than waiting for a helicopter (especially in high risk flight conditions); 2)
begin evacuation by ground if the helicopter may not be able to respond, or removal from
the accident site would benefit the patient, e.g., descent for altitude sickness; 3) patient
may need to be moved to an appropriate landing site; and 4) do not use a helicopter to
recover a corpse under emergency conditions.
A. Aircraft Limitations
Helicopters have various configurations, with different capabilities, and different crew
skill levels. All helicopters are adversely affected by increased altitude, high
environmental temperature, high wind, and heavy payload. The aircraft pilot makes the
ultimate decisions concerning flight operations. A helicopter must not fly into known
icing conditions or into even moderate storm conditions. Winds over 45 mph, night
flights into mountains, and landing in high winds are extremely hazardous. Not all
helicopters or pilots are capable of flying by instruments into cloudy or foggy conditions.
Moreover, instrument flight rules (IFR) are generally used only for airport-to-airport
transport, not in flights to to wilderness destinations; and most EMS helicopters are not
equipped for IFR. Party leaders must be familiar with ground-to-air signals, and if radio
