Evacuation Planning for Remote Expeditions

The mountains of Oman. December 2019. Photo by Grant Rayner.
Rough mountain roads in Oman. December 2019. Photo by Grant Rayner.

BACKGROUND AND CONTEXT

I’m a specialist in planning and executing small-scale, low-profile evacuations. I provide this support in very specific situations. Here’s an example that relates to the focus of this article: after the Nepal earthquake in 2015, I helped to evacuate dozens of trekkers by vehicle and helicopter from remote parts of the country. This evacuation included several locations that had been severely impacted by the earthquake and had been cut off from Kathmandu.

How Remote Is Remote?

For the purposes of this article, I’ll define remote as follows:

  • You are at least a day or two walk away from a road.
  • There may be roads, but the condition of the road network is poor; you are also a significant distance from good medical facilities.
  • You are in a location where there is no helicopter rescue service or are outside the reach of helicopter rescue services.
Remote helipad in the mountains of Oman. December 2019. Photo by Grant Rayner.

Death Is Out of Scope

This article will focus only on injuries to team members, not fatalities. If someone on your expedition team dies, you will still need to evacuate the body, but there are different factors and considerations involved. Obviously, you wouldn’t be dealing with the same time imperatives as with a casualty who requires urgent medical care. In this article, I’ll focus on scenarios where you need to evacuate a team member to save their life.

EVACUATION PLANNING

When first starting to plan an expedition, you should already be starting to think about how you will respond to different types of emergencies along the way. Specifically, you should be considering how you would evacuate one or more injured team members, including where you would evacuate them to.
While working through the planning processes, you should be thinking about a number of factors. I’ll break these down below.

Distance from the Trailhead

One key consideration is how far you’re willing to move from the trailhead or a trafficable road. This consideration effectively comes down to how far you want to have to carry a teammate (Murphy’s Law will ensure that the heaviest among you is the one who gets injured). The distance will ultimately depend on the number of people on your team and the type of terrain your team will be moving over. There’s a vast difference in how far someone can travel in an hour across a stony desert versus through a mangrove swamp.

Team Size

The size of your expedition team significantly affects your ability to conduct a successful evacuation. It takes a minimum of four people to carry a stretcher. Even with four, it would be extremely arduous because there is no opportunity to rest.

Airfields

The availability of helicopters was ruled out above, but that doesn’t mean you’ll be outside the range of light aircraft. Light aircraft are more widely available than helicopters and can operate at greater ranges and higher altitudes. In remote areas, light aircraft are often the only way to move people and supplies. There are therefore often airfields around, but they may be few and far between. Plus, they may not necessarily be marked on maps.

Medical Facilities

Once you’ve identified airfields, start looking for medical facilities. Identify every facility in your expedition area that has a medical capability. Such facilities could range from a small clinic operated by a local nurse in a village of 30 people to a world-class hospital. There may even be military bases or mining camps with their own medical clinics. If there are no medical facilities in your immediate area, you’ll need to look further afield to larger towns or cities.

Communications

Reliable communications are an essential component in executing an evacuation. An expedition team should carry at least two communications devices. If you’re operating in a very remote area without cellular coverage, then you should carry satellite phones and satellite communicators. Of course, you need to communicate with someone. That’s where your Field Support Team comes in.

Expedition Field Support Team

Aside from the team members actually participating in the expedition, it’s a good practice to establish an Expedition Field Support Team. The Support Team can have a number of different roles:

  • Monitoring your progress
  • Acting as a communications relay to other groups (including other expedition teams, family and friends, or sponsors)
  • Posting expedition updates
  • Coordinating resupply
  • Coordinating evacuations
Abandoned vehicle in a mountainous area of Oman. December 2019. Photo by Grant Rayner.

EXECUTING AN EVACUATION

Once out on an expedition, you’ll be singularly focused on achieving your objectives. While hopefully all goes as planned, there’s always the possibility of incidents occurring along the way. If someone on your team gets seriously injured and cannot continue, you’ll need to activate the evacuation plan. The details in this section focus on getting the casualty to the trailhead. I’ll provide additional details related to evacuation by vehicle and air in the next section.

Step 1: Send an Evacuation Request

Your first step is to send an evacuation request to your Support Team.

  • Team’s current location
  • Location of the preferred pickup point
  • Expected time of arrival at pickup point
  • Name of the casualty
  • Details of the injury
  • Whether other team members will be evacuating with the casualty
  • Any other relevant information

Step 2: Coordinate Vehicles

Should any parts of the evacuation require using vehicles, the Support Team should immediately contact their local transport provider, who will then prepare vehicles to go to the proposed pickup site.

Step 3: Inform Next of Kin

After receiving the evacuation request and dispatching vehicles, the Support Team should contact the casualty’s next of kin — from my experience, the sooner the better. If you delay, you’ll be asked ‘when did this happen?’ followed immediately by ‘why didn’t you call me sooner?’ On balance, it’s better to let the next of kin know as early as possible in the process and update them as the evacuation progresses. Be open and honest about the situation, but don’t engage in hypothetical ‘what-ifs’.

  • Who you are and why you’re calling
  • What the injury is
  • When and where it occurred (time and location)
  • What condition the casualty is in now
  • What the evacuation plan is (high-level overview)
  • What’s happening right now (where the casualty is currently)
  • What you need them to do, if anything
  • When you’ll contact them with the next update

Step 4: Get to the Trailhead

Getting the casualty to a trailhead or road is the most difficult part of an evacuation. Having carried stretchers through jungles, mangrove swamps, and up and down hills of all types, I can assure you that it can be absolutely epic.

  • Can they walk?
  • Can they see?
  • Is their injury worsening?
  • How heavy are they?
  • Do they need continual care?
  • Ease of movement across terrain
  • Foliage density (this will impact carrying a stretcher)
  • Steepness of terrain
  • Night or day
  • Hot or cold
  • Rain, snow or ice
  • Visibility
  • Number of people
  • Combined lifting capacity
  • Available equipment
  • Ability to get local support

The stretcher or litter

If your casualty is not mobile, you’ll need to make a stretcher. You can either use a properly designed roll-up stretcher or improvise one out of your equipment (using ground sheets or tarps, for example).

Make the trek slightly easier

Carrying stretchers in the field is hard, particularly when you only have a small team. There may be options available to make the move to the trailhead slightly easier. Here are a few such options:

  • Leveraging pack animals
  • Getting the assistance of nearby teams
  • Getting the assistance of locals

Step 5: Reach the Trailhead

When you get to the trailhead, if the evacuation vehicle isn’t there waiting, set up a shelter, keep the patient warm and dry, and maintain medical care. If you’re in a potentially hostile environment, stay a few hundred metres from the road in a concealed position until the evacuation vehicle arrives.

METHODS OF EVACUATATION

There are special considerations in each method of evacuation. Below is a quick breakdown of additional aspects to consider for vehicle and aircraft evacuations.

Evacuation by vehicle

Once the vehicle arrives, make sure it’s the right vehicle. In most remote areas, confirming this will be easy because the vehicle will probably be the only one around, but check nonetheless.

Mountain driving in Oman. December, 2019. Photo by Grant Rayner.

Evacuation by aircraft

If you’re lucky enough to be able to bring an aircraft into your expedition area, you have some major advantages. The biggest advantage of having access to an aircraft for evacuation is that you’ll be able to get your casualty to a major centre, and a major hospital, quickly — far quicker than by walking or driving.

CLOSING THOUGHTS/THE TAKEAWAY

Through the overview above, you’ve learned the basics on how to plan and conduct an evacuation if you’re on an expedition in a remote area. This article is obviously not exhaustive — there are a lot of other aspects to consider. But hopefully I’ve covered most of the main points.

--

--

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store