Evacuation Guidelines Wilderness Medicine University 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.