Technical Rescue Interface: Off-Road Vehicle and Helicopter WEMS Response



Technical Rescue Interface: Off-Road Vehicle and Helicopter WEMS Response


Brian M. Scheele



INTRODUCTION

Wilderness emergency medical services (WEMS) providers do not have a choice where accidents and disasters occur. When their traditional fleet of ground vehicles can’t reach a patient, the needed supplies are too difficult to transport by pack, or the distance by foot is too far in a time-sensitive situation, they may be required to employ nontraditional transport options. In this case, “transport” can refer to transport of gear or providers to a patient or transport of a patient from a scene. All-terrain vehicles (ATVs), utility task vehicles (UTVs), all-terrain ambulances, WEMS response vehicles, and helicopters are among those nontraditional transport options. ATVs and UTVs are capable of traveling over terrain impassable by traditional ground emergency medical services (EMS) vehicles, carrying stretchers and additional gear, and can be modified to enable room to provide care with patient transport in the wilderness setting. All-terrain ambulances and WEMS response vehicles provide a rapid means of bringing lifesaving care and a provider to a patient that may outperform the response of traditional ambulance response in a time-sensitive environment. Helicopter use in WEMS is an unmatched means of covering large areas quickly, grossly increasing direct vision for a scene or search from the sky, and able to perform an active role in search and rescue (SAR) and EMS response. Helicopters in WEMS, when employed appropriately and safely, can enable initial patient stabilization, treatment, and transport to definitive care hours to days faster than any other methods of patient transport (Figure 28.1). The application of off-road vehicles and helicopters in WEMS response enables an added advantage to prompt lifesaving access to our patients, but it must never be forgotten that the emergency is the patient’s and deliberate attention to provider safety be practiced.






FIGURE 28.1. AS350-B3 A-Star helicopter landing at ˜4,300 m (˜14,000 ft) camp in Denali National Park to provide WEMS support for an ongoing SAR mission. Courtesy of Brian M. Scheele.


Scope of Discussion

In this chapter, we will discuss the following:



  • What defines ATVs versus UTVs and all-terrain trailers


  • Introduce all-terrain ambulances and WEMS response vehicles



  • Air medical and helicopter-based WEMS operations in comparison with traditional helicopter air ambulance (HAA) operations, regulations, and risk management


  • Where EMS agencies are utilizing ATVs, UTVs, and helicopters for rescue


  • How WEMS providers can operate and understand ATVs and UTVs and work as a team member on a helicopter during WEMS response


  • How using these vehicles may affect your particular practice and what to know before getting aboard



PREVALENCE


ATV/UTV Prevalence

Anecdotally, after the observed FDNY EMS use of UTVs and ATVs during their response to the attack of September 11, 2001 in combination with increased funding by the federal government, and the creation of the Department of Homeland Security, ATV and UTV use among EMS agencies has grown nationwide. Although data regarding the prevalence of ATV and UTV use across EMS agencies is not widely available, the number of their units sold in the United States is significant. ATV sales in the United States from 2012 to 2015 were steady at around 230,000 units per year. That contrasts to the 2015 UTV sales of around 400,000 units, of which 55% were intended for commercial use. The greatest number of UTVs is purchased in the southern United States followed by the midwest, west, and finally the northeast. Users in Texas, California, and Ohio purchased the greatest numbers by individual state.7


Helicopter WEMS Assets

Helicopter WEMS assets function within commercial organizations such as air ambulance services or local, tribal, state, and federal government in addition to the military. Private, for-profit, and not-for-profit organizations provide HAA operations in the wilderness setting with contractual relationships with hospitals and government agencies across the United States. Fire departments, local city, county, and state law enforcement agencies are also involved in WEMS as part of their HAA programs or SAR services. Federal agencies have developed a National Search and Rescue Plan (NRP) for the United States for coordinating SAR services to meet domestic needs and international commitments.8 Helicopter WEMS assets are often fundamental to the operation of SAR and make excellent SAR platforms for insertion or extraction of personnel, visual and electronic search, ground personnel direction, and equipment and personnel transfer.9

The U.S. National Search and Rescue Committee (NSARC) is responsible for the NRP and its member agencies include Department of Homeland Security (eg, U.S. Coast Guard, Federal Emergency Management Agency), Department of Transportation (eg, Federal Aviation Administration, Maritime Administration), Department of Defense (eg, U.S. Air Force, U.S. Pacific Command), Department of Commerce (eg, National Oceanic and Atmospheric Administration), Federal Communications Commission, National Aeronautics and Space Administration, and Department of the Interior (eg, National Park Service). The NSARC members all have unique responsibilities with a combined objective to
improve cooperation in providing expeditious and effective SAR services.8

Federal military arrangements with civil agencies provide their fullest practicable cooperation when military helicopter assets are requested provided these maintain noninterference with their military duties. The Air Force Rescue Coordination Center (AFRCC) serves as the agency responsible for coordinating on-land federal SAR activities in the continental United States carried out by the Civil Air Patrol primarily, and the Alaska Rescue Coordination Center (AKRCC) coordinates inland Alaskan SAR activities carried out by their Air National Guard Units primarily. Both the AFRCC and the AKRCC coordinate response, and the missions themselves are carried out by available deployable assets. The United States Coast Guard (USCG) is the SAR coordinator for other maritime areas governed by the federal government as well as the State of Hawaii. Upon civilian request for additional helicopter assets, the coordinating center will determine a mission go/no-go on the basis of whether there is a threat to life, limb, eyesight, or undue suffering and arrange assistance with available local, state, regional, and national assets.8


TECHNICAL DISCUSSION


ATV/UTV/ATT Technical Discussion

ATV and UTV use is technically similar. For that reason, we will discuss both simultaneously here while pointing out the differences when applicable. ATV and UTV use for wilderness, fire, EMS, law enforcement, and federal agencies require training and certification before official use, and that training is agency dependent. In this section, we will describe the basics of operating ATVs and UTVs, with emphasis on use in the wilderness setting.

Again, agency certification before use of ATV/UTV should be required by all personnel. Additional training and certification is recommended for any personnel towing an ATT behind their ATV/UTV before official use. ATT accidents can occur while loading or offloading patients and during towing over rough terrain. Both ATV/UTV and ATT certification should be checked before deployment on a rescue mission or EMS response. Annual recertification for personnel who respond to wilderness emergencies should demonstrate their off-road ATV/UTV operating skills on an approved course. This recertification should include loading and unloading from a trailer, assembly and coupling of the ATT to the tow vehicle, and safe towing of the trailer with rescuer and patient on board over rough terrain.

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Oct 16, 2018 | Posted by in EMERGENCY MEDICINE | Comments Off on Technical Rescue Interface: Off-Road Vehicle and Helicopter WEMS Response
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