Emergencies in the field: High-Risk vs. Low-Risk Evacuations

Disclaimer: I am not an instructor for wilderness medicine courses, I have just taken a great deal of them and find them incredibly valuable. This purpose of this post is not to be a substitute for training, but to show what you would learn and the value in getting training.

One of the most important skills taught in wilderness medicine courses is how to determine if a situation requires a high-risk or low-risk evacuation.

When an accident occurs, our first thought should be: Is an evacuation necessary? The question you’re really asking yourself is “Can I fix this in the field?” This is where your training plays a really important role. If you know how to treat minor injuries in the field, you can prevent an evacuation. Similarly, if you know how to treat a life-threatening injury, you drastically increase the chances of survival even with a high-risk evacuation.

Can I fix this in the field?

If the answer is yes, then an evacuation isn’t necessary. Examples of this could be a twisted ankle, a cut from a fall, mild hypothermia or heat exhaustion. Each of these have a treatment that, if applied correctly, can get the patient functioning and back to the trip. It may, however, require modifying your trip (such as taking an extra rest day to monitor the patient’s recovery). The key wording here is “treatment applied correctly” – this is why wilderness medicine training is so valuable; you need to know what treatment to apply and how to apply it correctly.


On one long rapid on the Missinaibi River, we had two boats tip get pinned on a rocks. Campers were in the water and trapped on the shore, sparking a 5 hour rescue by Dan (right) and myself. Everyone was okay, but shaken up, so we took an impromptu rest day (and this photo). Since the rescue was handled correctly, everyone stayed safe and no evacuations necessary!

If the answer is no, then an evacuation is necessary. When we think “evacuation” we typically imagine helicopters swooping in, but this often isn’t the case.  The method of evacuation depends on whether a high-risk or a low-risk evacuation is required.

“High-risk” means that those performing the rescue are at a high risk themselves. The number of rescuers who are injured or killed each year while performing rescues is higher than many think, so we only want to put them in risk if the patient has severe, potentially fatal injuries. A stable, fractured ankle, while painful and definitely something you can’t fix in the field, usually isn’t life threatening – helicopters wouldn’t be appropriate.

“Low-risk” evacuations are not as time sensitive so they can be performed over more time. For example, rather than having a helicopter or float plane meet you on the river, your group might paddle the patient to a portage trail that connects to an access road, where an ambulance could meet you.

If any of the ABC’s are in jeopardy, a fast evacuation is needed. The ABC’s stand for: A – Airways  | B – Breathing | C – Circulation | These three systems keep the body alive, so anything threatening them is an emergency and might require a high-risk evacuation. Chest wounds, heart attacks, anaphylactic shock, broken femur, drowning, severe hypothermia – these are just a few examples of situations that could be a high-risk evacuation. It’s also important to remember that the fastest evacuation isn’t necessarily the most complex or high-risk; you need to consider your surroundings and the specific context of the emergency you’re in.


I don’t exactly have photos of rescues I’ve been involved in (I don’t think anyone would appreciate me stopping a treatment to snap a pic), so here’s a menacing sign found on the Missinaibi. Even trips on well traveled routes can be extremely dangerous!

Example: Anaphylactic shock.

  1. Can you fix it in the field? While Epi-Pens, anti-histamines and prednisone are all drugs that contribute to the treatment anaphylactic shock, they did not fix the problem. The patient needs a hospital. Evacuation is necessary.
  2. Is it a high-risk or a low-risk evacuation? Both breathing and circulation are being severely impaired; a fast evacuation is imperative. Choose the method that get’s the patient to the hospital to the fastest and most reliably.

Example: Large cut on the thigh from a fall on rock.

  1. Can you fix it in the field? If applying direct pressure stopped the bleeding and you could effectively clean the wound, you could fix this in the field. It would require ongoing monitoring (maintaining a clean dressing, ensuring there are no signs of infection).

Hopefully this has highlighted the complex nature of medical emergencies in remote environments and has inspired you to look into getting some kind of training before setting off on your next adventure!

Next post: Rafting and Resuscitation – Taking my WFR course in Costa Rica



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