MEDICAL EVACUATION & CASUALTY EXTRACTION AND SHORELINE OPERATIONS

1. MEDICAL EVACUATION&CASUALTY EXTRACTION AND SHORELINE OPERATIONS January 2012 CANADIAN COAST GUARD AUXILIARY - PACIFIC

2. Medical Evacuation

3. Medical Evacuation • Secure and stabilise patients to permit a safe medical extraction. • Complete patient documentation, and hand over to next level of care. • Coordinate medical evacuation and work cooperatively with other rescue agencies.

4. Medical Evacuation • If there is an opportunity to respond with a higher level of first aid on board, it should be taken. • First aid treatment should be given, and JRCC informed of the injuries and their severity.

5. Medical Evacuation • An assessment needs to be made as the most appropriate mode of evacuation, given the location, condition and state of the casualty. • Where it is agreed with JRCC that the casualty is to be evacuated by water, again it will be decided as to whether there is a suitable point close where EHS or a helicopter can access, and the patient handed over to a higher level of care.

6. Medical Evacuation • A intimate knowledge of the local area, particularly boat landing sites, and possibly for helicopters, is therefore important.

7. Casualty Preparation • Whether the patient is on another ship, boat, or ashore: 1. Firstly assessed by the first aid protocols of the day. 2. If immediate treatment is required, that treatment started. This information to be passed to JRCC. 3. Where necessary packaged properly for transportation.

8. Casualty Preparation • Where the patient is ambulatory, they can be moved around with care. • If there is any doubt, a basket stretcher should be used. • The patient is to be fitted with a PFD or lifejacket and the basket stretcher fitted with flotation. • Only if the patient requires CPR or has chest injuries should a PFD not be fitted.

9. Casualty Preparation • The patient should be keep warm and dry, and as comfortable as possible in the circumstances.

10. Evacuation By Water • Where the transfer is to be made by water, the casualty should be placed in the most comfortable part of the rescue vessel (on a RHIB or T Top this will be aft where the acceleration forces are least). • The position in the vessel will also be governed by the treatment or monitoring required on the trip to rendezvous with the higher levels of care.

11. Evacuation By Water • It may be necessary to secure the stretcher in the rescue vessel, depending upon the conditions, the design of the rescue vessel or the position of the stretcher needed to provide treatment.

12. Evacuation Speed • The speed of the rescue vessel will be governed by: 1. The injuries and/ or condition of the patient, the urgency with which they need to access higher care. 2. The level of treatment or monitoring required from the crew. 3. The prevailing weather and sea conditions on the planned route.

13. Evacuation Speed 4. The safety of the vessel and the crew and other people on board. 5. The time the crew on board will be physically capable to provide concentrated first aid treatment, such as CPR, or exhaust medical supplies such as oxygen.

14. Patient Information • The crew should endeavour to gather as much information on the patient as possible, both from the patient where they are conscious, or from accompanying family or friends, where the patient is or becomes unconscious. • This should include details such as name, age, address, as well as all items on the SAMPLE checklist.

15. Patient Information • S Signs and symptoms? • A Allergies? • M Medications - Yes/No? - What for? • P Past Medical History? • L Last meal? • E Events leading to the emergency?

16. Patient Information • This should be recorded preferably on a Patient Information Form, but additional information either written down in the log, or even on the back of the crews latex gloves. • One idea is to put a latex glove on the patient and write on that. • This information (as well any personal effects if there is time) must be passed over to EHS when passing over the patient.

17. Patient Information • Any personal effects or equipment connected with the accident not handed over to EHS, (such as dive equipment) must safeguarded and secured. • Contact should be made with police or coroner to hand it over.

18. Casualty Extraction and Shoreline Operations

19. Casualty Extraction and Shoreline Operations • Supervise the packaging of the casualty • Supervise the extraction of the casualty and transfer into vessel. • Understand protocols for requesting other resources. • Recognise risks of operations close to shore, and when incident is beyond capabilities of vessel and crew. • Have intimate knowledge of area.

20. Casualty Extraction and Shoreline Operations • Maintain control of vessel and crew during the rescue operation.

21. Extraction From Shore

22. Extraction From Shore • The prime strategy for casualty extraction is to remove the persons safety. • With a casualty extraction, minimise pain and suffering of the casualty. • If there is an opportunity to respond with a higher level of first aid on board, it should be taken.

23. Evaluation For Extraction From Shore • What communications are available? • What requires the persons be evacuated from shore (hypothermia, injury or immediate danger)? • Can the persons be evacuated safely (size of crew, manoeuvrability of vessel, type of shoreline, weather conditions)? • Is there a more appropriate mode of evacuation?

24. Evaluation For Extraction From Shore • How is the rescue best effected by the rescue vessel? • What is the risk assessment for this rescue?

25. Preparation • Establish communication with those on shore. • Stop, Assess, Plan • Detail plan, including dangers and contingency plans. • Inform JRCC of situation and intentions. • Brief those on shore. • Prepare equipment.

26. Execution • Choose an appropriate landing site, taking into account being clear of obstacles, surf, and if possible sheltered from wind and waves. • If an approach to a lee shore is necessary, consider veering down to control the approach of the rescue vessel. • The rescue vessel may be beached in sheltered conditions.

27. Execution

28. Extracting Persons From Other Vessels

29. Extracting Persons From Other Vessels • In adverse weather or sea conditions this can carry considerable risk, especially where handing injured people, people not used to being at sea, or the infirm. • Consideration must be given as to whether the extraction is necessary considering the risks, and will be made by the coxswain, JRCC and the master of the vessel being assisted.

30. Preparation • Stop, Assess, Plan. • Agree extraction is necessary. • Discuss operation with master of vessel being assisted. • Brief own crew on duties and risks. • Ensure all personnel to be extracted are wearing PFDs or lifejackets. • Use safety harnesses where available (may be line around someone’s waist).

31. Preparation • If necessary and available rig extra fenders. • One crew member assigned to communicate with vessel being assisted during approach. • Make upwind approach from lee side of vessel being assisted.

32. Transfer • If conditions allow, the rescue vessel should be secured alongside the vessel being assisted, with slip rope, so that the rescue vessel can let go quickly. • If making fast is not possible, look for the best place on the lee side to hold the rescue vessel, which will facilitate the transfer. • Crew to take change of transfer, instructing when transfer to take place, and assist.

33. Liferaft Transfer

34. Liferaft Transfer • If conditions do not allow the rescue to get close, if the assisted vessel has a liferaft, this can be put in the water, inflated,everyone climb in, and the liferaft floats down to the rescue vessel.

35. Stretcher Patients

36. Stretcher Patients • The patient must be wearing a PFD or lifejacket, and if in a basket stretcher, the stretcher must be fitted with flotation for all transfers over water. • Guide lines should also be attached to the head and foot of the stretcher to allow control of the stretcher during the transfer.

37. Large Vessel Transfers

38. Large Vessel Transfers • Means of transfer may include: 1. Vertical rope ladder. 2. Accommodation ladder lowered, with rope ladder for last 6 feet. 3. Ship side door about 8 foot above waterline. 4. Stretcher lowered using a ship’s cargo or stores crane. 5. Lowering of a lifeboat to the water, with stretcher inside.

39. Large Vessel Transfers

40. Large Vessel Transfers • The lee side is the best choice. • If anchored, this will likely be the opposite side to the anchor in use. • If underway, all astern movements on the vessel being assisted must have stopped and the effects died away. • Most large vessels will likely wish to maintain steerage while going ahead, which will be between 4 and 8 knots.

41. Large Vessel Transfers • On large cargo ships stay on the flat side of the vessel. • Stay away for the stern, where the line of the ship curve in toward the propeller and rudder. This is a dangerous area, not least from the rescue vessel superstructure, mast and scanners contacting the ship side higher up.

42. Large Vessel Transfers

43. Preparations • If coming alongside a large vessel which is underway, rig extra fenders.

44. Preparations • If there is any intention of making fast using a sea painter, the line from the vessel must be come down to the inboard side of the rescue vessel. • Keep engines turning ahead, but with weight on the line. • Taking the line from the bow or outboard side of the rescue vessel could put the rescue vessel at risk of capsize.

45. Preparations

46. Transfer • If crew available, one crew to take charge of communications, to allow coxswain to control rescue vessel. • Crew on deck to assist in transfer. • On completion, if painter attached increase speed, let go painter, shoulder check, then steer stern into the large vessel, and the bow will come clear.

47. Transfer • It may be necessary to abort. Crew to be briefed as to this possibility. • Be ready for a man overboard situation.