One of the most important skills taught in a wilderness medicine course is how to determine if an accident requires a high-risk or low-risk evacuation. I want to point out that this post does not replace the training you can get in a wilderness medicine course and I always recommend anyone take one before spending prolonged time outside.
Is an evacuation necessary?
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 wilderness?” For example, minor accidents can usually be resolved in the wilderness. This includes scrapes, cuts and minor burns that are easy to treat and temporary illness like a headache or a single episode of vomiting or diarrhea. You do the necessary treatment and the problem resolves itself.
This is also where your training plays a really important role. If someone on your trip cuts their leg but you know how to correctly wash and dress the wound, the person may be able to stay on the trip. If you don’t know how and there’s a risk for additional bleeding or infection, the people would need to be evacuated.
Other examples could include a twisted ankle, 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.
If you can fix something in the wilderness, an evacuation is not necessary. If you can’t fix something in the wilderness, an evacuation is necessary.
High-risk vs Low-risk Evacuations
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.
One misconception when you talk about high- and low-risk evacuations is that we are referring to the patient being in a high or low risk situation. This is not the case. The risk we are talking about pertains to the rescuers. What we’re really asking ourselves “is this emergency important enough that we should put the rescuers themselves at risk?”
In other words, “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 actually quite high, so we only want to put them in risk if the patient has severe, potentially fatal injuries. For example, if someone has deadly bleeding or has stopped breathing, we need help immediately. A high risk evacuation is 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. For example, a stable, fractured ankle, while painful and something you can’t fix in the wilderness, usually isn’t life threatening.
How to know if a high risk evacuation is required?
Here is the simple way to know if an emergency requires a high risk evacuation: 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 typically requires 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 Evngerous!
Additional Evacuation Examples
Can you fix it in the wilderness? 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.
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 is the fastest and more reliable way to get the patient to the hospital.
Large cut on the thigh from a fall on rock
Can you fix it in the wilderness? 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).
Wilderness Medicine is important!
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. I can’t stress enough how important wilderness medicine training is when you’re outside. If you have any questions or need help finding the best course for you, please reach out! You can also learn more by reading the following related posts.
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.