Wilderness Rescue
What this domain covers
Wilderness rescue covers patients in remote or extended-care settings where definitive medical care is hours away. The exam tests search management, patient packaging and evacuation choice, prolonged field care, and the judgment to balance rescuer safety against a long operation.
Search and command
- Establish ICS early; the first-arriving person becomes incident commander until relieved.
- Gather the PLS (point last seen) and the LKP (last known position).
- Run a hasty search of trails, water features, and likely attractions first, then a grid, then specialized resources such as canine or air.
- Protect clues and trackways; a footprint is evidence, not a footpath.
Patient care and evacuation
The 'golden hour' is a trauma-system concept; in wilderness the realistic frame is the 'golden day'. Packaging options - soft litter, wheeled litter, Stokes basket, or helicopter - depend on terrain, patient condition, and available hands. A carry-out over rough ground is slow, so decide early and call for more people than you think you need. Prolonged field care means monitoring, warming, hydration, analgesia, and documentation over hours.
Worked example
A hiker 6 miles in with a closed ankle fracture, nightfall in two hours, and a four-person team. Correct reasoning: splint in place, package warmly, request additional litter bearers and a helicopter evaluation in parallel, and begin the carry on the gentlest route rather than the shortest one. Waiting for daylight costs the patient little and buys the team safety.
Traps
Load-and-go with an unstable patient. Assuming a helicopter is a plan. Committing a small team to a litter carry without calculating rotation and time.