OA Guide to General Emergency Procedures

by Rick Curtis, Director, Outdoor Action Program


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This material is taken from Chapter 8 - Safety & Emergency Procedures from The Backpackers Field Manual by Rick Curtis. For more details on this exciting book check out The Backpacker's Field Manual Page.

This material is provided by the author for educational use only and is not a substitute for specific training or experience. Princeton University and the author assume no liability for any individual's use of or reliance upon any material contained or referenced herein. When going into outdoors it is your responsibility to have the proper knowledge, experience, and equipment to travel safely. This material may not be reproduced in any form for commercial or Internet publication without express written permission of the author. Copyright 1999, all rights reserved, Random House Publishing & Rick Curtis, Outdoor Action Program, Princeton University.


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Emergency situations in the backcountry will tax all of your knowledge, experience, and judgment. Paul Petzoldt, the founder of the National Outdoor Leadership School (NOLS) and the Wilderness Education Association (WEA) once said, "Rules are for fools." He meant that you can’t categorize situations into a simple rule to handle each scenario. Each situation is unique so backcountry travelers need to assess the situation and make your best determination on the best response. This chapter will identify the issues to help you in your assessment, but should not be taken as "rules" or the only responses. You good judgment is what keeps you safe in the backcountry.

Dealing with Emergencies - Who’s in charge?

On some wilderness trips there may be organized trip leaders and participants. In this case part of the definition of the trip leader role is to take charge in the event of an emergency. Other trips may be a group of friends out for a trip. In this case there may be no assigned trip leaders and everyone shares the load and the responsibility for making group decisions. While this distributed leadership model works well when deciding where to camp or how long to hike on a particular day, it is not the best approach when there is a serious problem or emergency. At this point, the best thing is for a few people (one or two) with the proper experience and training to take charge. This is something that should be determined before the trip departs. The group should decide who has the skill and experience to take over in an emergency and/or who the group is willing to delegate this responsibility to. From this point forward we will consider that, in an emergency, every group has a trip leader or leaders. Note that depending on the type of emergency, there might be different people who would take charge. In the event of a lost person, it might be the person with the most backpacking or search and rescue experience. In a first aid situation it might be the person with the highest level of formal first aid or medical training.

Trip leaders must intimately understand certain realities about injuries and illness in the backcountry (serious or minor) if they are to deal with them effectively. Most trips are 2-24 hours from having professional medical help arrive at their accident site. The group is dependent upon the trip leaders to take full charge of the situation—the trip leaders must care for the physiological and psychological needs of both the victim and the group. A trip leader who puts him/herself in danger physically or emotionally for the "good of the victim" is a liability to the victim and to the group.

These realities suggest certain leadership strategies. First and foremost, the trip leaders must stay calm and inspire confidence in the group and in each other that the situation is being handled in the best way. Talk through every step confidently and out loud. This way trip leaders can fill in each other’s omission and nothing will be rushed into. Depending on the nature of the emergency, it may be productive to ask the group for suggestions, they may have good ideas. However, there are also times when opening up the discussion too much only bogs down the issue and prevents people from taking the necessary immediate actions.

Since each situation is unique, trip leaders must remain flexible in their response. The key to properly responding to an emergency is to remain calm, assess things carefully before acting, and continue to reassess your strategy throughout. There are two basic things to be done, care for the victim and care for the rest of the group. The more severe the situation, the more both populations will need your care and support. A basic approach to handling emergency situations is shown in flowchart form in Figure 8.1 below.

  1. Assess the Situation: determine the nature of the emergency and what type of response is required (first aid, search for a lost person, etc.).
  2. Develop a Response Plan: based on the nature of the emergency, develop an appropriate response plan (first aid treatment, initiate search, etc.)
  3. Reassess Situation and Re-plan: Continue to reassess the situation and alter the response plan if necessary.
  4. Assume leadership of the group and delegate responsibility: group members should assist in patient care if needed, locate position on map, prepare a camp with shelter and food, etc.
  5. The group with the victim(s) should:

Emergency Flow Chart (14052 bytes)

Figure 8.1

Evacuation Procedures

When to Evacuate:

Evacuation is used as a general term for transporting someone from a trip. In most cases we think of this as caused by a medical problem. It can also be the result of psychological problems, a family emergency, or the assessment of the trip leaders that the person’s behavior poses a threat to themselves or others in the group. Specific evacuation protocols for first aid situations are covered in Chapter 9 - First Aid & Emergency Care.

If someone needs to be evacuated due to injury or illness, the primary concern is for the safety and health of the patient. When assessing the need for an evacuation, think both about the patient’s condition and how rapidly medical attention is needed. For example, it may take 2 hours for the patient to walk out on their own. Whereas to send two people out for help (2 hours), get a rescue squad to the trailhead (1 hour), hike back in (2 hours - unless driving in is possible), and hike back out (2 hours+) will mean over 7 hours before the patient is evacuated. Their injury may need treatment sooner than that. You also consider your resources, do you have the necessary equipment, manpower, and experience to safely evacuate the person given the current trail and weather conditions. If you do evacuate the person, take the time to plan out the best route keeping in mind patient condition, distance, terrain, etc. Depending on the situation, you might chose the shortest route, the quickest route, or a longer route that poses less threat to the patient’s condition. Use the evacuation flow chart (see Figure 8.3) to determine how to deal with an evacuation situation.

Possible Evacuation Scenarios:

  1. Person can walk out on his/her own power: The person’s medical condition would not be compromised by walking out. This may necessitate taking all the person’s equipment. Ex. Stomach ailment, mild allergic reaction, minor laceration.
  2. Person can walk out with assistance: If the distance is not too great, the person may be able to hike out if carrying no weight and with assistance. This is to be attempted only as long as it does not aggravate the individual’s condition. The person must be constantly monitored.
  3. Person cannot walk out: The injury/illness would be aggravated by walking out or movement is contraindicated. Do not attempt a litter evacuation unless you have the necessary equipment, experience, and manpower, otherwise you risk additional injury to your patient as well as placing other members of the group at risk (see Dynamics of Accidents Model page 00). In this case a litter evacuation by skilled rescue personnel (rangers, first aid squad, etc.) is required. Send for help (see Sending for Help page 00).

Evacuation Flow Chart (15200 bytes)

Figure 8.3

Choosing to Evacuate:

If you have determined that it is medically appropriate to evacuate your patient, you need to determine whether or not you have the skills, the time and the manpower to perform the evacuation safely. Ask yourself these questions.

_____ How much daylight do you have?

_____ What is the weather? Is it changing? For the worse?

_____ Can you continue to provide the necessary first aid treatment and monitoring during the evacuation?

_____ What if your patient’s condition deteriorates? Would it be more difficult to treat him/her once you start hiking our?

_____ How many people do you have to do the evacuation? For a litter evacuation you should plan to have a minimum of 3 teams of 6-8 people rotating through the litter carry.


This section is from the Outdoor Action Program's Guidelines for Handling Emergency Situations and is not contained in The Backpacker's Field Manual.

Emergency Call-ins:

In the event of an emergency one of the most important components is how you handle the incoming call. You need to gather sufficient information to determine the nature of the problem and to select the most appropriate responses.

In order to categorize the nature of the response we use an adaptation of the International Scale of River Difficulty which is used to rate whitewater rivers on a scale from Class I to Class V. As you will see below, we use this scale to establish responses levels for Evacuation, Medical Response, and Notification.

  1. Identify caller
  2. Identify exact location and phone number. Can you call back? If not determine a time or plan for the caller to contact you again.
  3. Interview caller to determine problem
  4. Triage problem
  5. Determine appropriate evacuation response
  6. Determine appropriate professional medical response
  7. Notifications (each higher level is cumulative of the levels beneath)
  8. Follow-up

Triage:

The purpose of Triage is to determine the nature and extent of injury or illness. In the case of multiple victims, it is used to prioritize treatment. As you take an emergency phone call, you need to gather information to do your own triage of the situation.

  1. Get full SOAP Note from Leader
  2. Determine exact location of the group.
  3. Contact outside experts as needed to develop emergency response plan

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