Search and Rescue Basics for Wilderness Medicine

According to some emergency medical professionals, including one of my early mentors, every emergency medical service (EMS) call involves a search. Even in urban settings where we’re given a home address for a patient, we need to confirm the location, find it, and gain access to the patient. And even after arriving at the right address, finding and gaining access to the patient within the home or building can be a challenge.

As a current or future Wilderness Medicine Care Provider, you may be called upon to provide care in diverse environments under a variety of circumstances — and you need to be prepared to do so. One of the environments we train for here at The National Center for Outdoor & Adventure Education (NCOAE) is the backcountry, more commonly referred to as the wilderness.

Wilderness medicine encompasses a broad range of scenarios, ranging from the simple treatment of basic cuts, scrapes, blisters, and bruises, to conducting complex search and rescue operations in remote areas, in dangerous weather conditions and across challenging terrain. 

Patients are often those within an activity group or in a group nearby, but sometimes the incoming call notifies us of a problem in a remote, unclear location. In such cases, we need to find the patient before we can treat the patient, and in many cases, we need to move distressed individuals or parties to safety. 

In this post, I bring you up to speed on the fundamentals of conducting search and rescue in diverse environments and unpredictable circumstances.

Defining Search and Rescue (SAR)

Wilderness medicine includes some complex and challenging diagnostic and treatment procedures. SAR adds another layer of complexity to make it even more challenging. To gain a better understanding of the challenges, consider what each of these tasks involves:

• Search: Search is the series of tasks related to locating a person in need of help. The person may be lost, injured, ill, trapped, immobile, or even deceased. In some cases, when you receive the initial call, you may have very little information as to the individual’s location or condition.
• Rescue: Rescue is the series of tasks required to move a person in need of help from an area of danger to that of safety. Rescue is what happens after a successful search. It involves safely reaching, stabilizing, and removing a person or group from a dangerous situation, and then moving them to safety.

SAR teams often specialize based on location and conditions. Each type of SAR demands specialized training and coordination. Many large-scale incidents require a multi-type, multi-agency response. SAR operations are often broken down into the following areas of specialization:

• Ground Search and Rescue (GSAR) for lost or injured hikers or people missing in forests, urban areas, or deserts.
• Maritime Search and Rescue (MSAR) for people distressed at sea or in other large bodies of water — for example, shipwrecks or capsized boats or swimmers who’ve been swept out to sea.
• Air Search and Rescue (ASR) for downed aircraft or people lost in wilderness areas.
• Urban Search and Rescue (USAR) for victims trapped in collapsed buildings (for example, in the aftermath of an explosion or earthquake).
• Combat Search and Rescue (CSAR) for military personnel behind enemy lines.
• Mountain or Alpine Search and Rescue for climbers, skiers, or hikers in alpine or glacial terrain.
• Cave or Mine Search and Rescue for spelunkers or miners trapped underground.

Sizing Up the Scene

Every medical event, regardless of complexity, should start with a scene size up. The three components of a scene size up most applicable to SAR are as follows:

• Safety: The first step in any crisis should be to stop, take a deep breath, and consider the immediate surroundings. Any immediate danger should be managed before taking further action. For example, suppose a hiking party is moving quickly toward a trail head as a storm is brewing and notices that a member of their party is no longer with them. They should stop and take shelter or add other layers of safety to protect themselves before embarking on a search and rescue of the lost member.
• Mechanism of Injury (MOI) / Nature of Injury (NOI): Prior to responding to a medical event, conduct a quick but thoughtful analysis of the problem to guide the plan design. Analysis may include the condition of the sick or injured party, the location, the terrain, weather conditions, and so on. In terms of MOI/NOI, you need to know whether you’re dealing with a physical injury from a fall, someone who’s exhausted, someone who’s ill, an allergic reaction, or something else.
• Resources: Take inventory of your resources. If necessary, lay out everything you have to work with, including communication tools, on a tarp. Knowing what you have at your disposal can help you make critical decisions, such as whether to begin SAR, provide medical care, or contact others in the area to request emergency services.

Locate, Access, Stabilize, and Transport (LAST)

To commit the four steps of any SAR operation into your memory, use the mnemonic LAST — Locate, Access, Stabilize, Transport.

• LOCATE: Before you can rescue someone who’s injured or ill, you need to locate the individual or party. After deciding to conduct a search, take the following steps:
  1. Gather information. Information about the person/party and the location can help you narrow your search, such as the following:
     
     Person/party: Who is the person/members of the party and what are their challenges and strengths? What kind of equipment and experience do they have? What was their intention before becoming lost/distressed?
     
     Location: Try to determine the general location of the person/party. Keep in mind that wilderness areas often have alternate names. You may need to clarify the location before conducting your search.
  2. Practice containment. Containment involves identifying and managing possible exits the person/party may make from the wilderness area. Sending a small search party to the trailhead to check whether the person/party has made it there by another route may be wise in certain situations.
     
     A common practice is to send a hasty team to find a person/party along a route or at a likely location. This team is often small, self-sufficient, and capable of moving quickly.
  3. Follow a systematic search protocol. Two common search protocols are circle search and area search:
     
     Circle search: An example of a circle search is beginning at a known camp and searching from that point out in an increasingly larger spiral. This may be conducted after determining that a party member was not located at a bear hang site by the hasty team.
     
     Area Search: An area search designates a specific vicinity that the lost person may be in. Search areas are typically bordered by obvious features such as trails or streams. They grow in size and scope as the search time increases.
• ACCESS: After locating the lost or distressed individual or party, the focus shifts to access — getting to them. At this point, the search turns to rescue. Challenging terrain such as cliffs, rivers, and caves require special skills to navigate. If the rescue party is properly equipped and trained, they may be able to access the patient. If not, a specialized team needs to be called in if it hasn’t been already.
• STABILIZE: The stabilize component of SAR is the traditional wilderness medicine component — providing appropriate patient assessment and medical care. See our previous post “The Role of Assessment in Wilderness Medicine” for details about assessing patients in wilderness settings.
• TRANSPORT: This step involves moving the person/party out of the area of concern. It may be as simple as leading them out or as complex as airlifting them via helicopter in an improvised litter. 

While most wilderness medicine incidents involve simple actions such as padding a blister along the trail, others provide significant challenges that might include finding the person/party, accessing them, caring for them in exceptionally challenging terrain, and evacuating them from the wilderness over the course of hours with a large team. 

As a wilderness medicine provider, you need to be prepared for any scenario. Here at NCOAE, we provide the EMT Training and specialized training in Wilderness Medicine you need to respond effectively in any emergency medical situation. 

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About the Author: Todd Mullenix is the Director of Wilderness Medicine Education at The National Center for Outdoor & Adventure Education (NCOAE) in Wilmington, North Carolina.

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