Consider this scenario: You’re working at a remote wilderness guard station by yourself as a backcountry ranger (yes, people still do this in 2012), and you’re about to go off duty at 1700 hrs when a civilian comes riding up on horseback requesting medical assistance. He tells you that his girlfriend was thrown from her horse, slid down a steep embankment and is “broken up.” She’s at the upper lake, which is approximately 2½ miles up the canyon you’re currently located in. There’s no vehicle access to the accident location or your station. You call in the incident via a handheld portable radio to the dispatch center and are instructed to contact them when you have an exact location and know what resources you’ll need.
You grab your pack, toss in your first-aid kit and take a moment to think about what additional supplies you’ll need. How long will you be gone? How far will the temperature drop tonight? How long until it gets dark? Will you need food for yourself, the patient and/or the reporting party? How will you carry all of these items?
Are you and your agency prepared to respond to incidents like this—those that will be of a long duration and away from paved roads and other forms of “civilization”? Do you carry equipment and supplies to support your personnel in cold weather after dark? Is your rescue gear set up so that it can be carried for a distance from your rescue vehicle?
In this article, I’ll discuss the issue of responding to incidents in which rescue personnel must work away from their vehicles for extended periods of time (sometimes in inclement weather) and carry their team rescue gear to the scene.
What to Wear
Your team may not be located in the mountains, and you may not have off-road terrain to travel over, but when the temperature drops, are your team members prepared to be on scene for multiple hours? Our team learned early on that if they were going to be doing tech rescue training 12 months out of the year, then they would need to come prepared with appropriate foul-weather clothing and gear.
Note to Self: Avoid Cotton!
For most urban/suburban responses, it’s fine for teams to don coats or coveralls over their station uniforms. For calls that have the potential to become long-duration events, rescuers may want to consider taking a moment to exchange their station uniform for appropriate cold-weather clothing. Most agencies issue cotton T-shirts and sweatshirts as daily station uniforms, but mountain rescue teams learned long ago that there’s no value in cotton undergarments, because in cold, wet conditions, cotton becomes heavy and wet and will draw heat from your body, potentially putting you in the same hypothermic condition as the patient you’re attempting to rescue. Fleece and other synthetics make for good, inexpensive undergarments. (However, since they’re not fire resistant, these garments make poor station wear.)
Rescue operations often involve a lot of standing in one place and waiting—waiting for the patient to be packaged, waiting for rigging to be completed, waiting for another assignment, etc. But all this standing around and waiting doesn’t generate a lot of body heat. And once your core temperature drops, it may be difficult to bring it back up. To avoid this problem, don an additional garment before you get cold. If it’s raining or snowing, wear a water-resistant/proof shell garment on the outside. Our team purchased lightweight waterproof rain jackets and pants. They’re small and light enough that they can be carried in our rescue gear bags or fanny packs.
Feet & Hands
When it comes to your hands, you need to keep them warm, but you also need good dexterity when working with ropes. I’ve found that the small hand-warmer packets work really well for keeping my fingers warm (as well as the rest of my body). I can move them around inside my gloves so they reach each of my fingers and prevent them from going numb. They are light to pack, and many of them last for as long as six hours. I also try to keep two pair of warm gloves in my pack so that I have a dry pair to change into after the first pair gets soaked. It’s not always possible to keep your gloves dry, particularly when handling water rescue throw lines or ice rescue retrieval lines. To protect your feet and ankles, most departments use leather above-the-ankle boots with a steel toe and shank as their duty boot. Some departments can wear anything black since they’ll don their turnout boots on any response. But in wet, cold conditions, steel-toe boots may not be appropriate because, like many duty boots, they might not be waterproof. It’s also difficult to keep your feet warm while wearing steel toe and shank boots. In fact, when the steel shank gets cold, it’s like standing on ice. Winter hunting boots, mountaineering boots and/or shoe pack boots may be more appropriate footwear. The bottom line: The type of incidents you respond to will determine the most appropriate footwear. An ice rescue or rope rescue incident may indicate that the priority is warm boots that will give you good traction. For a structural collapse or trench shoring operation, steel-toe above-the-ankle boots would provide the best protection.
Don’t Forget Snowshoes
Keep in mind, too, that even if your response area isn’t in the mountains, as little as six inches of snow can cause problems. More than once I’ve brought snowshoes to work and placed them on the apparatus I was assigned to and used them because we were unable to access certain areas via our apparatus. Note: It’s easier to walk in snowshoes than to post-hole (i.e., make deep holes in the snow with every step) through 12 inches of snow.
Often, once a trail has been packed down from snowshoes worn by the lead person/rescuer, the others can follow more easily. For fresh, deep snow, it may be worth it to have several pairs of snowshoes on hand. Although this may not happen often, you may have to walk several blocks to access routine EMS and fire calls and will have difficulty transporting your equipment to the scene without the use of supplemental gear.
Case in point: A few winters ago, the Pacific Northwest was hit by a snowstorm that blanketed our community with 10 inches of snow. After the first day, the city and county crews were able to clear enough snow so that we could get around fairly easily. However, at one point, while my medic unit was responding to a call for a cardiac problem in a residence located on a dark, snow-filled road, we got stuck.
I left the driver to free himself, while my partner and I began our walk up the snow-filled driveway. We post-holed up the road, with snow covering the tops of our duty boots. (I was glad that I had put on long underwear at the start of the shift.) There were multiple houses along the driveway, but no lights and not much in the way of clues as to which house was the correct one (we went for the house at the very end and were correct). While walking up the driveway, we requested an engine company with a Stokes basket and rescue rope, and a medical services officer (MSO) to respond (the MSO had a four-wheel-drive vehicle).
In the end, we got the patient out of his house and down to our medic unit, but it was a time-consuming and labor-intensive operation. Snowshoes would have helped us access the house much quicker, and a four-wheel-drive vehicle with chains on all wheels would have easily made it up the driveway.
Remember: The time to look for appropriate clothing isn’t when the bell hits. Prior to the start of the winter weather, go through your tech bag and make sure you’re prepared for cold-weather conditions. At minimum, I suggest that you have the following packed and ready to go:
- Rain/wind jacket with hood
- Rain/wind pants
- Fleece, wool, holofill or down jacket or sweater
- Fleece, wool or synthetic pants
- Fleece or wool toque (hat)
- Fleece, wool or synthetic liner gloves
- Mitten/glove shell covers
- Wool socks
- Long underwear tops/bottoms
- Mountain, hunting or snowmobile boots (if temperature and terrain warrant)
- Goggles (if appropriate to your local conditions)
- Hand-warmer packets
What to Eat
In addition to warm clothing, consider specific food supplies as well. Having snack bars and a couple of bottles of water in your pack will make a difference after a few hours. Most of our senior rescue techs realized long ago the benefit of carrying a few snack bars and water in their bag. As our blood sugar drops, we tend to make poor decisions and we may get a bit cranky. One of our captains used to carry snack bars for Brad, one of our rescue techs who gets a little cranky if he doesn’t eat every two hours. Now Brad carries his own snack bars and is always offering me a bar or a piece of fruit (is he trying to tell me something?).
Rescue team equipment should be packaged so that it can be carried by four to six responders. A well-packed team should bring the following equipment:
- Patient access bag
- Mainline bag
- Belay line bag
- Patient package bag
- Anchor bag
- Stokes basket or SKED unit
Packaging the above kits in bags and packs that can be worn on the rescuers’ backs leaves rescuers’ hands free to help them travel over uneven terrain. Additional equipment can be stored at the station or on the apparatus, but the goal should be to keep the bags as light and small as possible to make them easier to transport. Remember: Smaller, well-labeled bags will be easier to pack and track than large, heavy ones.
If you’ll be traveling far from your vehicles and each of your responders has a gear bag as well, you may want to consider packing several large-capacity backpacks (5,000 cubic inches at minimum) so you can pack rescue rope, rigging gear and the rescue techs’ personal gear. However, it may not be practical to do a long approach wearing a Class III harness. If your team responds to both urban/suburban areas as well as backcountry areas, then it’s more practical to pack gear that’s specific to the backcountry, such as a lightweight Class II harness with a webbing chest harness, a light helmet, aluminum hardware and 11-mm ropes.
Choosing Essentials & Apparatus
When packing, be sure to stop and look at your rigging bags and review what you carry and how often you use the items. Decide what the essential items are and what’s just extra stuff. Ask yourself questions such as, how many carabiners must each bag carry in order for us to execute the function of each bag? Once the bags exceed 40 lbs. they become awkward to carry, and over time, the zippers blow out and the seams begin to pull apart. Remember: Extra gear can be stored in another bag that may be left on the rig.
Your team may not be stationed in the mountains, but often, with as little as six inches of snow on the ground, roads and other areas may not be accessible by your first-out apparatus. There should be at least one unit in your department that can respond to calls in difficult terrain under adverse conditions (e.g., partially washed-out roads and/or snow conditions that rear-wheel-drive-only units are unable to navigate). Chains should be available for all apparatus.
Patient Extrication & Transport
How will you move the patient from the scene to the waiting transport unit? Some Stokes litters may be dragged in the snow since they have a plastic bottom. For the military-style steel Stokes litter with mesh chicken wire on the bottom, a plastic skid plate can be made to cover the bottom or a SKED can be strapped to the bottom to facilitate dragging on the snow. Another option: A moving ladder can be made by lashing a Stokes litter to a roof ladder that can then be carried or dragged through the snow. A litter wheel can also be used to facilitate traveling over rough terrain or along railroad tracks. Removable handles can be mounted to plastic-bottom litters to allow them to be pushed and pulled over snow-covered terrain.
Remember: Most of the time when a team is dispatched to an incident, included in the response are other responders, such as engine, ladder and EMS units. Each of these units carries personnel that can help transport your Stokes basket and additional rigging gear to the scene.
So what happened to the woman who was thrown from her horse? After a 45-minute ride on the back of the reporting party’s horse, the ranger arrived on scene. He found a woman conscious on a steep, rocky slope with injuries to her head, face, rib and arm, with neck and back pain. He immobilized the patient using his wool jacket as a C-collar, splinted her injuries, took her vitals, and wrapped her in his sleeping bag to conserve heat.
The ranger instructed the woman’s boyfriend on how to maintain C-spine immobilization. He then made contact with the dispatch center by climbing a tree so he could hit a repeater with a handheld portable radio (the type with the four-section telescoping antenna) and request a helicopter. A nearby Boy Scout troop helped clear a landing zone (LZ), which was a half-mile from the rescue site. The helo arrived just after sunset, but the responding paramedic/deputy sheriff showed up wearing cowboy boots, so he stayed with the helo and gave the ranger a clam shell to transport the patient. The patient was carried with the assistance of the Boy Scout troop, fishermen and hikers to the LZ.
The helicopter departed with my sleeping bag and wool jacket (yes, I was the ranger). It was now dark, and the boyfriend and I were left to ride the two horses 6½ miles back to the trailhead in the dark—but that’s a whole different story.