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Evacuation Guidelines
Wilderness MedicineUniversity of Utah School of
Medicine
Evacuation Guidelines
• Evacuation statistics are not kept
Evacuation Guidelines
• Evacuation statistics are not kept
• Small injuries such as a blister on a foot can require “evacuation.”
Evacuation Highlights
• A lot of the guidelines are geared toward the patients ability to ambulate.– Foot injuries– Hand injuries– Frostbite on the feet– Cramps
Evacuation Highlights
• Some guidelines determine if the patient’s injury will worsen with time.– Lightening– Seizures disorders– Burns– Trauma
Evacuation Highlights
• Some guidelines are geared toward a patients ability to eat and drink.– Cramping– Nausea– Vomiting
Evacuation Highlights
• Some guidelines determine if the patient’s injury is life threatening.– Possible ectopic pregnancy– Sepsis– Skull fractures– Heart attack– Difficulty breathing
Evacuation Plan
• Patient is the first consideration:– Type of injury?– Is the patient stable?
(ABCDE’s)– Can they walk or
assist with evacuation?
– Are they likely to become worse or more difficult to evacuate if evacuation is delayed?
Evacuation Plan
• What equipment is necessary/available?
• Can EMS be contacted?
• How far to nearest help?
• Which route is fastest?• Are there environmental
limitations to immediate evacuation?
Symptom Evacuate?
• 18 year old male in camp 3 hours from help
• Cramping left sided pain for 6 hours, worsening
• No temperature• Minor guarding• Patient can eat
• Evacuate?• No shock, patient
can eat, pain on left side, pain has been less than 24 hour, no blood is seen in stool, no fever
• Probably can watch
Symptom Evacuate?
• 22 year old female with lower abdominal pain for 2 hours
• Sexually active• Sharp pain, guarding• Retains appendix• No fever• Day 3 of a Grand
Canyon river trip
• Risk of ectopic pregnancy.
• Need to evacuate
Symptom Evacuate?
• 35 year old male• Epigastric pain for
24 hours• Unable to eat or
drink well for 12 hours
• 12 hour backpack from help
• The patient can’t eat, this is an indication for evacuation.
• Pain for 24 hours in another indication.
• Can his eating get better?
Symptom Evacuate?
• 35 year old female epileptic has a seizure while on a rafting trip in Cataract Canyon. She is not injured. It has been 3 years since her last seizure.
• All that is probably necessary is to double her seizure medicine. She could be watched.
Symptom Evacuate?
• 18 year old female experiences “seizure like” activity. She did not injure herself. No previous experience. She is at day 5 on an 18 day trek still low in the Himalaya.
• New onset seizure activity warrants evacuation.
Symptom Evacuate?
• A 16 year old male climbing is bit in the hand by a rattle snake.
• Evacuate
Symptom Evacuate?
• 45 year old male climbing on Denali in Alaska develops sunned shortness of breath and other symptoms of HAPE.
• Evacuate to lower altitude immediately. It is conceivable that patient can continue with the trip. It depends upon how high he will need to hike.
Symptom Evacuate?
• A 54 year old female receives a superficial and partial thickness burn over the palms of both hands while on day 3 of a 6 day river trip on the Salmon River.
• The patient has burns which may make using her hands difficult. Evacuation from this area is problematic.
Symptom Evacuate?
• A 54 year old female receives a partial thickness burn over the palms of both hands, arms and face while on day 3 of a 6 day river trip on the Salmon River.
• The burns cover about 10% of the body, and now involve face. The patient needs to be evacuated.
Symptom Evacuate?
• A 65 year old man is in the Wind River on a back pack trip when he experiences symptoms of what you think is a TIA?
• According to the guidelines he should be evacuated, how emergently depends upon his ability to walk, etc.
Symptom Evacuate?
A young 14 year old boy is bit by a black widow spider while hiking King’s Peak. (1 day from help)
• Venomous spider bites should be evacuated.
Symptom Evacuate?
A 60 year old man with no cardiac history and no risk factors had chest pain while on a fishing trip – a 4 hour walk from help.
• The man must assumed to be having some cardiac problems and needs to be evacuated some way.
Symptom Evacuate?
A 21 year old male sustains a deep wound to the arm near the shoulder while camping on the John Muir trail in California. Bleeding is controlled.
• This man should be evacuated
Symptom Evacuate?
A 21 year old male while on a backpack, sustains a superficial wound to the ball of his right foot making it very painful for him to walk.
• This is a problematic wound. He probably needs to be evacuated simply because he can not walk.
