Evacuations

Check

  • How to contact the doctor on call or retrieval organiser
  • Usual method of evacuation
  • Who is available to assist in an emergency
  • Any equipment you need to take
  • How to access airstrip — keys or lock code
  • Who is responsible for airstrip maintenance
  • What vehicle is used for emergencies
  • Phone and/or satellite number in emergency vehicle
  • If you have a 2-way or UHF radio, ensure it is turned on and set to channel 13

Preparing the patient

  • Person or family or guardian agree to evacuation
  • Record next of kin contact details
  • Discuss with doctor on call or flight organiser if an escort is appropriate. Escort should be organised and briefed before departure to meet transport vehicle/flight. Will need escort weight and medical record number
  • Infants and children must have an adult escort over 18 years old
  • Luggage limited to one soft bag under 7kg including clothing, money, phone
  • Wrap pathology in absorbent material (eg ‘Bluey’) and seal in plastic pathology bag
  • Make sure patient and escort are in best condition possible — pain relief, antiemetic, sedation, other pre-flight medicine needed, fluids replaced, urinary catheter in, oxygen on, etc
  • Ensure person goes to toilet before starting journey
  • Ensure there is at least one well functioning cannula
  • Take medical items person might need for flight — another bag of IV fluid, infusions, bottle of ORS made-up for child/adult with diarrhoea
  • If person needs oxygen while waiting — they will need it during transfer
  • Take oxygen cylinder with you in vehicle running at the rate you need
  • Have portable oxygen cylinder for transfer between vehicle and aircraft
  • Get paperwork ready, photocopy or print 2 copies of file notes (1 for flight crew, 1 for person), include any faxed confirmation of orders given over the phone
  • Agree what monitoring should be undertaken whilst waiting transport and whilst en route in ambulance or clinic

Important

  • Have a recent weight of person , if patient weighs over 130kg — see Evacuating overweight patients
  • Check patient and/or escort is not carrying any dangerous items (eg cigarette lighters, matches) or weapons (eg knife, firearm, item for self-defence)
  • If condition of patient changes whilst awaiting transport or they become uncooperative and/or risk to crew or aircraft (eg person with psychosis, dementia, or affected by drugs or alcohol) —  medical consult with doctor responsible for transport
  • Babies and small children must be secured with a restraint for their age (eg infant car seat, or child restraint) — advise emergency responder/controller when first making contact

Evacuating by air

Preparing for aircraft landing and take-off

  • Discuss with retrieving team the timing of going to airport/meeting — often patient and any escort are taken to airstrip. Coordinate ETA
  • Pilot may call via satellite phone or UHF radio (channel 13) to ask if airstrip safe and ready or about weather conditions — rain, level of cloud cover in surrounding hills, etc

Airstrip inspection procedure (‘strip check’)

  • Only do this if requested by pilot or retrieval organiser
  • Identify wind direction — aircraft always land into the wind
  • Check the runway surface
    • Drive a stiffly sprung vehicle (eg 4WD) up and down airstrip at 75km/hr — should be smooth with no potholes
    • Drive heavy vehicle (eg 4WD) in zigzag pattern at less than 15km/hr along whole length of airstrip — If you slide, slip or tyre tracks are more than 2cm deep (10 cent coin) surface is not safe for landing
  • Check condition day or night — is it safe, surface hard and smooth, free of people, animals, vehicles, branches, large rocks, etc
  • Check twice for animals
    • Ensure no animals in airstrip area
    • If airstrip fenced, shut the gate
  • Check windsock — not tangled
  • No objects within 30m of airstrip — do not park at either end of runway
  • Ensure UHF radio on channel 13 — pilot may contact to confirm airstrip is safe and ready, or you may need to alert pilot to problem with airstrip. If no response from pilot, call emergency responder/controller to advise via phone or satellite phone

Rules for aircraft arrival and departure

  • Person opening gate to airfield for an evacuation is responsible for people entering airfield
  • All people and vehicles to remain behind gate until aircraft door is opened, propellers have stopped turning and rotating beacon light is off 
  • If no fences — people and vehicles must keep at least 30m from aircraft
  • No smoking
  • Vehicles
    • Have headlights on park — do not blind pilot
    • Do not reverse vehicle toward aircraft unless directed to by crew member
    • Park vehicle at least 5m from aircraft with engine off when loading/unloading person
    • Keep parallel with aircraft — do not drive across front or rear of aircraft
    • Do not walk under aircraft wings
  • Pilot will not start aircraft engine until all people and vehicles are behind fence and gate or 30m away
  • Remain at airstrip until aircraft has taken off safely — if there are problems with person or aircraft they may return

Figure 1.6  

Night time procedures

  • Review general airstrip inspection procedure (‘strip check’)
  • Never point lights at aircraft
  • Identify wind direction — aircraft always land into the wind

  • Lighting

    • Most airstrips have solar or electric lights already lit
    • If needed, place portable lights or flares at 90 metre intervals
    • Light flares at least 30 minutes before the aircraft’s arrival
    • Start lighting the flares at the end where the aircraft will land first

  • Windsock

    • If the windsock has its own lighting, turn it on
    • If not — do not attempt to light the windsock
  • Second check of the airstrip
    • 5 minutes before the aircraft is due to arrive check the strip again to ensure no animals have entered the area
  • Parking
    • Park your vehicle pointing INTO the wind
    • Turn your headlights on high beam and hazard lights on
    • No vehicle to be parked at either end of the runway
    • All vehicles to be kept at least 30 metres away from side of airstrip
    • If possible, park as close as reasonably possible to the windsock
    • If unable to park near windsock park in clear location at least 30 metres away from side of airstrip

  • After aircraft departure

    • Flares/lights must be left lit for 30 minutes in the event the aircraft must return to land due to an emergency

Figure 1.7  

Helicopters

  • Do not approach helicopter until rotors have stopped turning
    • Approach within the 9 to 3 o'clock position only — Figure 1.8
    • Stop and wait well clear of rotor arcs until pilot has seen you
    • Make sure pilot or crew member aware of your intention by giving a thumbs up signal, wait for thumbs up reply before going further
  • Never go toward rear of helicopter, even if it is shut down, unless directed to do so by a crew member — Figure 1.8

Figure 1.8  
  • On sloping ground, approach and depart on downhill side — Figure 1.9

Figure 1.9  
  • Under rotor arcs — duck (crouch down) — Figure 1.9. Do not wear hats, make sure you carry loose items securely — do not chase loose items
  • Be careful of long objects such as IV poles. Do not carry pointing upward
  • If blinded by dust from rotor downwash — stop and sit on ground until dust clears or help arrives

Evacuating by road or water

Attention

  • Principles are the same as for evacuating by air 
  • Medical consult especially if patient condition changes at any time
  • Doctor on call will advise service to be used, where pickup will occur and when
  • Ensure you have a communication plan or similar

What else you do
  • Check your vehicle/boat and that you have enough fuel, light working, etc
  • Ensure enough people to assist/drive — family member or extra staff
  • Monitor patient until hand over to ambulance/boat/hospital

If doing a ‘halfway meet’ (rendezvous)

  • Advise doctor on call and receiving party regarding
    • Your vehicle type and registration, satellite phone number and when you are leaving the clinic/community, handover is complete and have returned to clinic/community
  • When you see an ambulance coming towards you, stop vehicle in a safe place on side of road. Do not park on crests of hills or on corners
  • At night — ambulance and clinic staff can pass each other on the road
    • Slow down if a vehicle approaches and check for red and blue lights
    • If it is an ambulance — flash your headlights or turn on your own flashing lights then pull over safely
  • Medical consult if patient condition changes at any time
  • Do a set of observations before handing over
  • Take care driving back especially at night. Be aware of
    • Fatigue
    • Road conditions
    • Wild animals or stock on the road

Evacuating overweight patients

  • If patient weight over 130kg measure patient width (Figure 1.10) and advise on-call doctor/retrieval service to enable best mode of transport to evacuate patient
  • If patient weight over 180kg measure patient width (Figure 1.10) and advise on call doctor/retrieval service, best mode by road as special equipment and transport is required for safe patient handling

How to measure patient width

  • While on a bed/stretcher, lie the patient flat (or as flat as possible) with
    • Elbows at their sides
    • Hands resting on their chest
  • Measure the overall bed width (BW) in centimetres
  • Calculate the patient’s widest upper body width in centimetres
  • Upper Body Width = BW – (A1 + A2)
  • Calculate the patient’s widest point near the hips in centimetres
  • Lower Body Width = BW – (B1 + B2)
  • Document Upper and Lower Body Widths

Figure 1.10  

Supporting resources