# Off-Road Patient Transport/Extrication



## NPO (Aug 14, 2019)

I am on a committee at my local agency and we are re-evaluating our resources and options for accessing, extricating and transporting patients in rough terrain and off road.

Currently we use modified Kubotas. I am interested to see what everyone else is using and if they find it useful or not.

We are evaluating all options from "big wheels" and a Stokes basket to large "ASAP" UTV vehicles.


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## DrParasite (Aug 14, 2019)

I love my former ASAP mini ambulance.  it has all the space and protection needed for the patient and crew, and can accommodate a full sized stretcher. and equipment.  

It really depends on what you mean by rough terrain and off road.  if I am crossing a soccer field, anything will do.  If I am going on a paved path or dirtroad, the ASAP mini ambulance is awesome.  Can I get away with a gator and a stokes?  sure, but if it's raining, it will suck for the patient.  But if i'm going through really rough and unsteady terrain (big rocks, tree roots, etc), I am going to look at something with a higher undercarriage than my mini ambulance, like my fire department's Ranger ATV . It all depends on what your individual areas needs are.  

Because these are pricey toys (often grant funded) that don't get a lot of use compared to other vehicles, they are typically better as regional resources vs single agency ones.


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## Chimpie (Aug 14, 2019)

This is made by Club Car, 4x4, gas powered. Not the fastest but we've used and abused it and it's still kicking.


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## KingCountyMedic (Aug 14, 2019)

A lot of the departments I work with use John Deere Gator ORV's. I've seen them navigate some unbelievable terrain. Super impressive units.


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## NPO (Aug 14, 2019)

DrParasite said:


> I love my former ASAP mini ambulance. it has all the space and protection needed for the patient and crew, and can accommodate a full sized stretcher. and equipment.
> 
> It really depends on what you mean by rough terrain and off road. if I am crossing a soccer field, anything will do. If I am going on a paved path or dirtroad, the ASAP mini ambulance is awesome. Can I get away with a gator and a stokes? sure, but if it's raining, it will suck for the patient. But if i'm going through really rough and unsteady terrain (big rocks, tree roots, etc), I am going to look at something with a higher undercarriage than my mini ambulance, like my fire department's Ranger ATV . It all depends on what your individual areas needs are.
> 
> Because these are pricey toys (often grant funded) that don't get a lot of use compared to other vehicles, they are typically better as regional resources vs single agency ones.



We need to cover everything from national forest to large resorts with national golf tournaments, and out door malls as large as 1 mile long.

We expect that one piece of equipment may not be perfect for all use cases, but we want to find the best one for the many uses we have. 

I have used an ASAP before and they are pretty limited to paved of dirt roads. Soccer field is a perfect example. We could definitely use that in most of our use cases, but it would not be applicable to our most rural rescues. (but combining it with a Stokes a big wheel would work well).

Price is obviously a factor, but my agency likes to spend it's money. We will buy it if it makes sense.


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## Summit (Aug 14, 2019)




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## Tigger (Aug 16, 2019)

Ranger 6x6 with a med-bed kind of thing is probably your best option. Put a big wheel on there for when it gets too rough to stay with the UTV. Litter carries, even with a wheel, should be a last resort. They are miserable and manpower intensive. 

We have a crew cab ranger where I'm at now, I like that we can get a good number of people on scene quickly. We also don't need a trailer for it (though we have one), the Ranger does 45+ on paved roads. That might not be practical for you guys, but it is appreciated here where the station is close to the primary target hazard. A litter can be lashed to the bed, though many patients will do just fine sitting in the back seat. 

UTV Conversions (there are many though having used one of these, it leaves little to be desired): https://www.kimtekresearch.com/medicalRescue_landing.php

The folding titanium litters we use (rad): https://www.cmcpro.com/equipment/titanium-split-apart-rescue-litter/

Litter wheel with fat tires are the way to go if you might be short handed or can't have any side tenders: https://cascade-rescue.com/cascade-rescue-advanced-series-terrain-master-litter-wheel/


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## NomadicMedic (Aug 17, 2019)

I was looking at these for my event medical business. QTAC skids in a gator.


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## cruiseforever (Aug 19, 2019)

NPO said:


> We need to cover everything from national forest to large resorts with national golf tournaments, and out door malls as large as 1 mile long.



Our experience when covering PGA events, is that they are very fussy on what type of vehicle is allowed.


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## Ensihoitaja (Aug 19, 2019)

NomadicMedic said:


> I was looking at these for my event medical business. QTAC skids in a gator.
> 
> 
> View attachment 4553



We have something similar that we use for large events, particularly NFL games.


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## DrParasite (Aug 19, 2019)

Since we are sharing photos, the NJ EMS task force had a little bit of extra grant money and bought a couple of these:






















In the back in a full sized stretcher, compartments for much of your needed equipment, at least enough to keep the patient stable until you get to a full sized ambulance or medical area.  While (likely) more expensive than a gator, you get the privacy, security, and protection levels that surpasses the other options.

My FD has a 2014 six wheel Ranger ATV (similar setup to this one).  we use it for brush fires (it has an onboard pump) and picking up injuries on the greenway trails.


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## NPO (Aug 19, 2019)

Those are ASAPs and we are considering one of those for our events, but they don't do backwoods very well. We are trying to find the best overall option, which is the hard part


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## Peak (Aug 19, 2019)

What is your rescue call volume, what type of rescue do you typically run? Do you mutual aid with any other services, can you buy complementing equipment and aid each other as needed? Is EMS in your area responsible for rescue or does that fall on fire/county/state?

I've carried patients out of the woods on a back board, used dirt bikes to get medical supplies in, ran ATVs, side by sides, and even driven a few patients to the hospital in our type 3s and 6s when the weather was too bad for the ambulances. There isn't probably going to be a perfect single solution. 

The bigger the vehicle the more it is going to get bogged down and have difficulty getting through tight spaces. The smaller they are the less protection they are going to offer you and the patient.

In my opinion you error on the side of the smallest unit you can that has as much off road capability and endure the suck until you get back to the ambulance. Any device is going to be about compromise, but in reality you are unlikely to be using this with any regularity so I don't see the point in dumping a bunch of money into something that is large and therefore difficulty to transport, maneuver, and store when not in use.

Honda makes great dirt bikes, atvs, and side by sides. I've never had one fail me on a trail, and hold up pretty well to general abuse. A certain very flashy competitor of theirs always seems to break down, plastics are of pretty poor quality, and are way too expensive to fix; I wouldn't buy one for myself let alone to be used for any kind of rescue.



cruiseforever said:


> Our experience when covering PGA events, is that they are very fussy on what type of vehicle is allowed.



Yeah, most of the above things are going to tear up the greens and are aweful on artificial turf if you are running anything on a sports arena.

On a side note, why do so many departments get their mini ambulances all whackered out with lights and sirens. The thing is only going to move so fast, you aren't going through traffic, and it sucks the battery down real quick. Do people really find a need beyond maybe a mini light bar?


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## Tigger (Aug 19, 2019)

The 6x6 with a litter bed is the best compromise. An ASAP is just not gonna make it down real trails as it is quite heavy and too wide. We’re bring the 6x6 with bed onto much rougher off highway trails than what exist outside of the Rockies.


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## DesertMedic66 (Aug 20, 2019)

I don't know if there is one good option. A lot of it is going to depend on your area and what kind of off-road environment you are going to be dealing with. While the ASAP vehicles look great, at least from the ones I have seen, I would not want to take them on any actual serious off road trails aside from grass, hard dirt with rolling hills, or a flat beach. 

For a couple of months I worked for an event company that used a modified Yamaha Rhino as a response vehicle. It worked great for them as it had a fast top speed, great suspension, 4x4, aggressive tires, and great ground clearance. It was a very bare bones set up with the only medical gear being the bags/monitor that would be secured inside it.

I for some reason am not able to upload photos but the link to some basic pictures is: http://www.symonsambulance.com/motorsports-events/
The blue bar that is folded up in the back of the rhino would be lowered to create a flat surface to strap either a backboard or a stokes type basket

Our local BLM rangers use actual dune buggies that have been modified to fit a backboard/stokes basket in the passenger front and rear seat. Due to the huge sand dunes that set up works the best for them.


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## DrParasite (Aug 20, 2019)

Peak said:


> On a side note, why do so many departments get their mini ambulances all whackered out with lights and sirens. The thing is only going to move so fast, you aren't going through traffic, and it sucks the battery down real quick. Do people really find a need beyond maybe a mini light bar?


For the same reason ambulances, fire trucks, and police cars do?  

1) it identifies them as emergency vehicles?
2) it alerts the general public when they are responding to an "emergency?"
3) it alerts the general public that said vehicle is requesting the right of way and requesting they move so they don't get run over?

While true, they aren't going through vehicular traffic, ever tried getting though a crowd of 100,000+ people to get to a stabbing victim at a festival in a super dense urban city?  the audio and visual warning devices 

And I don't think the ASAPs are battery powered, they are gas or diesel.

@NPO,  you aren't going to find the best overall solution for everything, because each vehicle type has it's advantages and disadvantages.  the ASAPs MedStat are awesome for sporting events, festivals, fireworks, etc, anything where you have relatively flat land or paths to drive on.  But you're right, when you are going into the woods where there aren't smooth paths, there are better options.

The Polaris, Gators, Ranger, and even the Club car are much better suited for off road use, simply because they have a higher clearance under the vehicle. You lose the branding (which is important to some companies, especially for-profit ones that rely on marketing), protection for the crew and patient), equipment storage and climate control that the ASAP provides, but if it's a simple get in and extricate the person in a horizontal position, you can't beat the ATV design (or the ASAP Trailrescue set up, since I am on their website).

Do you have to pick just one?  I still think the ASAP mini ambulance is the best choice for events, while an ATV customized for EMS or rescue use is best for going into the woods and off the beaten trail (and even then, the ATV is just the best to transport, 4 wheelers or bikes might be the best way to locate and get medical personnel to the victim).  Can you compromise in certain areas?  sure, but there is the old adage about using the right tool to get the job done correctly.

Also remember, there is a difference between a home built and in house designed vehicle and one that is specifically designed to transport sick and injured people.


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## Summit (Aug 20, 2019)

On backcountry trails which have many narrowpoints, it is nice to have flashers so other offroad vehicles can find pullouts for you way ahead of time.


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## EMDispatch (Aug 25, 2019)

Our response area is marshland and pine forest for backcountry, so we utilize a  variety of solutions based on the situation here. 

Our agency runs 2 crew cab gators  with medlite skids for events and when requested. One volunteer department has a 2 seater, same skid setup if our beasts can’t get there. 2 others run combo fire/ems skid mules. We also have 3 available Argos, one with an EMS skid in the county. USFWS Fire has a marshmaster that could also be used in a pinch.

If we can’t get subjects out by all-terrain, we can also get them to navigable water and boat them out. Aviation can also almost always hoist them out too.


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