When Evacuation Becomes the Treatment
In wilderness and remote settings, there comes a point where the most important intervention you can make is getting your patient out. Evacuation to elevated care — whether that's an urgent care clinic, emergency department, or trauma center — is itself a critical medical decision that requires planning, communication, and execution under pressure.
Indications for Evacuation
Not every injury or illness requires an immediate evacuation, but certain conditions demand it. Evacuate urgently when your patient presents with:
- Altered mental status or decreasing level of consciousness
- Signs of shock (rapid/weak pulse, pale/cool/clammy skin, anxiety)
- Respiratory distress or airway compromise
- Chest pain or suspected cardiac event
- Spinal injury with neurological deficits
- Severe allergic reaction (anaphylaxis)
- Wounds requiring surgical intervention
- Conditions that are worsening despite field treatment
Evacuation Decision-Making
Use the STOP framework when assessing whether to evacuate:
- S – Severity: How serious is the condition right now?
- T – Trend: Is the patient improving, stable, or deteriorating?
- O – Options: What resources and routes are available?
- P – Plan: What is the safest and fastest path to definitive care?
Preparing the Patient for Evacuation
Before moving your patient, ensure the following:
- Stabilize first: Address life threats (airway, bleeding, shock) before movement.
- Immobilize injuries: Splint fractures, pad pressure points, and protect the spine if indicated.
- Document: Record a SOAP note or patient handoff report including mechanism of injury, vital signs, interventions, and trends.
- Communicate: Contact rescue services as early as possible. Provide GPS coordinates, patient count, condition severity, and any special equipment needs.
Modes of Evacuation
The method of evacuation depends on terrain, patient condition, available resources, and time:
- Self-evacuation: Appropriate for ambulatory patients with minor injuries who can walk out with assistance.
- Carry-out: Used for non-ambulatory patients. Improvised litters or commercial litters (e.g., SKED, Sked Lite) are used depending on terrain.
- Helicopter evacuation (MEDEVAC/HOIST): Reserved for life-threatening conditions or inaccessible terrain. Requires a landing zone (LZ) or hoist-capable aircraft.
- Vehicle evacuation: ATV, snowmobile, or boat transport when terrain allows.
Patient Handoff at Elevated Care
A clear, concise handoff is critical. Use the MIST or SBAR format:
- M – Mechanism: How was the patient injured or how did the illness begin?
- I – Injuries/Illness: What did you find?
- S – Signs & Symptoms: Vital signs, trends, and key findings.
- T – Treatment: What interventions were performed in the field?
Training Makes the Difference
Evacuation decisions are high-stakes and time-sensitive. The best time to learn these skills is before you need them. S&S Training Solutions offers Wilderness First Aid (WFA) and Nationwide Responder that include hands-on evacuation scenarios, litter carries, and patient handoff practice.
Browse our upcoming courses and get trained before your next expedition.