# First "Wilderness" Call



## SafetyPro2 (May 2, 2004)

As I've mentioned, our town sits in the foothills of the San Gabriel Mountains, so our entire northern border is wilderness area (part of the Angeles National Forest). This includes the Santa Anita Canyon/Chantry Flats recreation area.

Yesterday, about 2:00, we got toned out for a "minor trauma", a male patient with an ankle injury, up in the Canyon. This is the first wilderness call I've had a chance to respond to.

Standard response for Canyon EMS calls is to respond to the last city street below the gate and wait for a responding unit (to limit personal vehicles, as the road can get tight and there's not many places to pull over). Since I live about a 1/4 mile from there, I went and jumped on the BC Suburban as the Chief was heading up ahead of the ambulance and the utility.

About halfway up the road, we could see the LA County Sheriff Department's Air Rescue 5 coming in for a search. Air-5's a former military Sikorsky H-3 Sea King with a crew of 5 (2 pilots, a crew chief and 2 paramedics) that handles most of the wilderness air rescue for the area. Made me wonder just how "minor" this trauma was.

We get up to the trailhead the dispatch indicated and tie-in with the USFS Ranger there, who tells us the patient's about 3/4 of a mile down the trail. We can see Air 5 hovering around down that way, so we grab our over-the-side trauma bag and the O2 bag and 4 of us head down the trail.

When we get down towards the bottom, we're having trouble locating the patient (and can hear, but not see Air-5 due to the trees), so we radio back to the BC who informs us that the patient's down by the river and that the two LASD medics have dropped down and are with him.

We work our way a bit further down and see the patient, the two medics and one of our Engineers, who just happened to be getting out of his truck for a hike in the area when the call came in. Get down to the scene and find a 23 year old male who had fallen approximately 25 feet down the side from the trail above. He has at least 6 beers on board, multiple contusions and, to top it all off, an open fracture to his right ankle. Plus, he doesn't speak English. And, he's laying on a very narrow, rocky and steep stream bank...he was out of the water, but the rest of us were in it.

We tie in with the LASD medics. I start O2 on the patient, then put a C-collar on him and hold C-spine while two of our other guys splint his ankle. The medics had already started a line on him and done the assessment. Then about 6 Sierra Madre Search and Rescue Team members get there to assist. We get him strapped to the Miller board in the Stokes, then move him across the stream to an opening in the canopy. Air-5 comes back over and drops their line. We hook him and one of the medics up, and up they go. Line comes back down for the second medic, and up he goes as well and they're off to the trauma center.

Then the 5 of us and the 6 SAR folks get to hike back about a mile to the nearest fire road where the SAR truck and our BC are waiting for us.

Heck of an interesting call, and a good reminder not to always take dispatch info at face value.


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## MMiz (May 5, 2004)

wow, that's quite a call.

Did you have special training for the wilderness portion?


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## SafetyPro2 (May 6, 2004)

We've done a couple drills with the SAR guys, but not much beyond that. Since we're not talking about delayed transport like you get way out in the boonies, its not that much different than any other EMS call...just rougher terrain to work in, and we do practice that for wildland firefighting. We run these calls probably a dozen times a year at least (more in the spring/summer). This was my first one though.

There are Wilderness EMT and Wilderness First Responder courses offered through UCLA (same place I did PHTLS), but they're pretty long courses (72 hours for FR and 54 hours for EMT). The reason the FR's longer is because it's a full DOT FR class in a wilderness setting, while the EMT course is an add-on to an existing EMT cert.


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## lastcode (May 10, 2004)

Hunting is big in my area so without fail we get at least one hunting accident a year.  Thats when we get to play on our ATVs haha...  That is a great example of not taking dispatch at face value.   In my area all calls are grouped into categories such as dif. breating, chest pain, traumatic injury, etc... And then the disp. gives them a rating or either Alpha, Bravo, Charlie, or Delta.  Delta being the most serious call.   Yesterday I got a Charlie chest pain call that ended up being a cardiac arrest, and last week I got a Delta chest pain call that ended up being indigestion.  I guess it boils down to the inability to assess a patient over the phone.   Are the dispatchers in your area EMT-Dispatchers?  or are they not certified?  Ours are not always certified, and I think that there lack of medical training leads to improper dispatching of call seriousness.


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## SafetyPro2 (May 10, 2004)

Some, but I don't believe all, are. In fact, one of the dispatchers just finished the EMT class our department hosted for our new members and some other area agencies. He'd been previously certified, but let it lapse.

ATVs would be nice, but most of the area we go into are narrow hiking trails, so it's hoofing it from the trailhead.


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## MMiz (May 10, 2004)

> _Originally posted by SafetyPro_@May 10 2004, 01:32 AM
> * Some, but I don't believe all, are. In fact, one of the dispatchers just finished the EMT class our department hosted for our new members and some other area agencies. He'd been previously certified, but let it lapse.
> 
> ATVs would be nice, but most of the area we go into are narrow hiking trails, so it's hoofing it from the trailhead. *


 I know in general one doesn't need any training beyond passing an EMT-B *class* to be a dispatcher.

The private company I work for is dispatched by a huge dispatch center.  The handle the dispatch for several areas, and are highly trained.  That means little to us though.  The company that dispatches us has a tiered training system.  Only after a few years are they allowed to dispatch 911 calls for the main company.  Unfortunately we, a smaller private company with less than 40 rigs, are one of the first steps on their training path to becoming a trained dispatcher.  This often leads to bad post assignments, and just confusion.

The community college I took my EMT-B course at requires all EMT-Paramedic students to have a course in Emergency Medical Communications, which I think is good.

Our dispatch system is:
Priority 1: RLS (This is the *only* priority for lights / sirens use.  This is used for "Loss of limb/life" calls.
Priority 2: Similar type calls with less urgency
Priority 3: This is for all 911 calls that are of not of an emergent nature.  Simple MVCs with no suspected injuries, welfare checks, and the similar.
Priority 4 / 5:  These are scheduled transports from Hospital > Nursing home or reverse.  

We use a different system when we actually are transporting a patient:
Green 3: Patient in stable condition, normal transport. - This is what we almost always do as BLS.
Yellow 2: BLS transporting requiring an ALS intercept, or standard ALS transfer.
Yellow 1: ALS Urgent transport. RLS
Red 1: Cardiac arrest / CPR / Etc. RLS

Then the county has their own system.  Similar to our dispatch system, but with Priority 5 = Death.

That's what happens when your dispatchers are in a different county and use their own system.  It's confusing.


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