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Wilderness Medical Society - snowmass 2005 (Page 180)

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Wilderness Medical Society - snowmass 2005
10
communication is available, the ground crew must keep the helicopter crew updated on
weather and other related conditions at the scene.
Landing and taking off are the two most dangerous activities for both the air and
ground crews. As altitude increases, the ability to make vertical hovers and land in small
areas is greatly reduced. The optimal landing zone (LZ) is large, well marked, and
relatively flat with a slope dropping slightly away from the LZ, and has no tall objects on
the perimeter, and no loose debris that could be thrown up by the rapidly spinning blades.
Marking at an LZ is best done with green reflective material and second best with red.
The LZ may have to be prepared by the on-site personnel. It must be far enough from the
patient so any maneuvering by the helicopter does not put the patient at risk. If there is no
suitable landing zone, helicopters equipped for short haul or winch operations may be
used.
The on-site personnel handling the patient must have some familiarity with
helicopter operations. Helicopter landing zones are dangerous places. It is imperative to
keep all non-essential personnel away from the area. If possible, assign personnel to keep
a safe perimeter around the landing zone and to prevent people from approaching the
craft. Wind generated by the helicopter is tremendous, and all ground personnel must
protect themselves when the aircraft lands and takes off. In winter the wind chill from
the rotor blades can cause rapid frostbite to areas of exposed skin. Never approach a
helicopter until a signal has been given by one of the aircraft personnel. Never approach a
helicopter from the rear where the spinning tail rotor is invisible and therefore dangerous,
unless it is a rear-entry aircraft and the safe-approach signal has been clearly understood.
Once on the ground, all directions from the aircraft crew must be followed explicitly.

B. Airmedical Considerations
The mechanics and physiology of flight must be understood if it is to be safely used for
patient transport. Noise and vibration levels are high, and it may be difficult to monitor,
or even communicate with the patient in flight without special equipment. Helicopter
cabins are not pressurized. Atmospheric and oxygen pressure go down as the aircraft goes
up. Supplemental oxygen must be available for all patients. Medical devices with air
bladders, e.g., MAST (military anti-shock trousers), air splints, endotracheal tubes, must
be monitored for over-inflation. Ground transport may be a safer alternative for patients
with a suspected pneumothorax, decompression sickness, or air embolism.

IV. CONTROVERSIES
Do wilderness travelers have a "right" to be rescued?
In the United States, it is often assumed that a cry for help will bring an immediate
response, free of charge. There is, however, no guarantee that a rescue will be initiated,
free or otherwise, despite the concerns of family and friends, the pressure of the media,
and the availability of eager and willing rescuers. Evacuations from the wilderness create
risk for the rescuers--who must walk in or fly in--and are typically very expensive.
Search and rescue managers have to make tough decisions based on numerous factors,
and the condition of the patient is only one of these factors. It is improper, therefore, to
ask for help out of convenience when a group could carry out a self-rescue. Request
assistance as a last resort, when life or limb is threatened, or when the group is unable to
carry out their own rescue.

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