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

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

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

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

Supporting resources

• Airstrip safety video