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Hazardous Terrain. EMS Skills. Rescue awareness Types of specialized teams Effective coordination with specialists Hazardous terrain litter evacuations. Hazardous Terrain Types. High angle Low angle Flat terrain with obstructions. Surfaces inclined >40 o Gorges Cliffs Buildings

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EMS Skills

  • Rescue awareness

  • Types of specialized teams

  • Effective coordination with specialists

  • Hazardous terrain litter evacuations

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Hazardous Terrain Types

  • High angle

  • Low angle

  • Flat terrain with obstructions

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Surfaces inclined >40o




Very smooth surfaces <40o

Require use of hands in climbing

Ropes, aerial apparatus required for access, removal

Errors can cause life-threatening injury, death

High Angle

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Surfaces inclined <40o

Accessed by walking, scrambling

Difficulty can be affected by presence of:




Brush, down trees

Ropes used to counteract gravity, act as hand lines

Errors can result in falls, tumbles

Presence of obstructions can result in serious injury

Low Angle

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Creek beds

Difficulty may be increased by:

Downed trees


Slippery leaves

Scree (rock debris)

Patients can be moved by carrying

Least hazardous form of rugged terrain

Slips, falls can result in injury

Flat Terrain with Obstructions

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High Angle

  • Access/removal usually carried out by technical teams

  • Additional resources needed to balance technical/medical aspects of rescue

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High Angle

  • Rescuer skills

    • Knot tying

    • Ascending, descending skills

    • Rigging of hauling systems

    • Packaging of patients for evacuation

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High Angle

  • Specialized Terms

    • “Aided”—using means other than hands, feet, body

    • “Anchor”—technique for securing rescuers to vertical face

    • “Belay”—safeguarding climber by use of a rope secured to an anchor

    • “Rappel”—descend by sliding down a fixed double rope

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Low Angle

  • Access/removal conducted by EMS personnel in many systems

  • Still requires appropriate training/equipment

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Low Angle

  • Skills

    • Assembly/use of harnesses

    • Setting up hasty rope slides

    • Rappelling, ascending by rope

    • Patient packaging

    • Rigging simple hauling systems

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Stokes Basket Stretcher

  • Standard litter for rough terrain evacuations

  • Provides rigid frame for patient protection

  • Easy to carry

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Stokes Basket Stretcher

  • Come in plastic and wire/tubular (military) styles

  • Wire/tubular style will NOT accept long spine boards

  • Plastic styles weaker, but provide better shielding to patients

  • All require additional strapping, use of plastic litter shields

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Apply harness to patient

Apply leg stirrups to patient

Secure patient to litter

Tie tail of one litter line to harness

Use helmet, litter shield

Give fluids

Allow accessibility for assessment, management

Ensure adequate padding

Consider heating/cooling system use

Provide gravity “tip line” to clear airway if necessary

Stokes Basket Stretcher

During high/low angle evacuations:

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Flat Terrain

  • When possible, walk patient out!

  • Carrying over flat ground is strenuous under ideal conditions

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Flat Terrain

  • Two to three teams of 6 litter-bearers

  • All approximately same height

  • “Leapfrog” ahead to save time

  • Webbing straps tied to stretcher frame and pulled across rescuer shoulders to free hand can lessen load

  • Litter wheel may help on flat ground

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Low/High Angle

  • Anchors, personnel safety equipment, patient packaging, and hauling systems must be checked multiple times for safety

  • Hauling systems may require multiple personnel to move weight of patient, basket, and ropes

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Low/High Angle

  • Fire department snorkels can be used for patient evacuation

  • Stokes stretcher must be properly belayed to snorkel basket

  • Aerial apparatus is NEVER used as a crane to move a litter

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  • Capabilities, policies vary widely

  • Understand policies regarding:

    • Loading and unloading practices

    • Restrictions on carrying non-crew

    • Use of winches for rescues

    • Weight restrictions

    • Restrictions on hovering rescues

    • Use, practice of one-skids and toe-ins

    • Use of short hauls and rappel rescues

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Long-term hydration

Dislocation repositioning

Wound cleaning/care

Impaled object removal

Non-pharmacologic pain management

Pharmacologic pain management

Assessment/care of head/spinal injuries

Hypothermia/ hyperthermia management

CPR termination

Crush/compartment syndrome management


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Environmental Considerations

  • Weather/Temperature Extremes

    • Risk of hypo/hyperthermia

    • Difficulty in exposing patient for assessment

    • Use of specialized packaging

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Environmental Considerations

  • Limited Patient Access

    • Inaccessible parts of patient

    • Cramped space

    • Low lighting conditions

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Environmental Considerations

  • Difficulty Moving Equipment

    • Identify minimum essential equipment

    • Carry in backpack

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Environmental Considerations

  • Cumbersome PPE

    • Restricted rescuer mobility

    • Temporary removal of PPE to perform procedures

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Environmental Considerations

  • Patient Exposure

    • Covering for thermal protection

    • Hard protection from sharp objects, debris

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Environmental Considerations

  • ALS Skills

    • Wires, tubing complicate extrication

    • Limit to absolute necessities

    • Oxygen may have to be given at slower flow rates to prolong cylinder life

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Environmental Considerations

  • Patient Monitoring

    • Modification of procedures (palpated BP)

    • Modification of equipment (compact pulse oximeters)

    • Non-use of equipment (ECG monitors)

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Environmental Considerations

  • Improvisation

    • Splinting using patient’s uninjured body parts

    • Light-weight splints

    • Downsized or improvised medical gear