Wilderness Helicopter Evacuations

August 16, 2010

This has not been a good summer for the medical helicopter industry, or its employees and patients. Crashes in July took the lives of three in Arizona and two in Oklahoma; these brought to four the number of fatal medical helicopter crashes in 2010 alone.
Fortunately, none of these crashes involved wilderness rescues. On the other hand, it is simply a matter of time before a catastrophic incident occurs in the backcountry.

There has been a proliferation in the use of helicopters to provide medical response to wilderness injuries and illnesses in the past few years. Indeed, in this month alone, two such responses occured in the New York Adirondacks. While there may certainly be circumstances in which such an undertaking could be lifesaving, there are others in which this response has been mobilized for a condition which turned out to be trivial. Folks have undergone helicopter evacuations for sprained ankles, broken arms, and similar mishaps which in an earlier time would have been handled with an uncomfortable, but safer, “walk-out”. The US Forest Service even dispatched a helicopter to “rescue” two workers who were freaked out by the sounds of wolves howling: Idaho Mountain Express – Wolf howls prompt wilderness evacuation

The Federal Aviation Administration has recently (June 8, 2010) recognized medical helicopters as an industry meriting closer regulation and scrutiny. Their fact sheet highlights (without explicitly addressing wilderness use) one of the vulnerabilities in the backcountry setting. The decision to mobilize a helicopter medical mission actually requires the decision of two professionals. First, a medical person (typically on the scene) makes the determination that air evacuation is necessary. Secondly, the pilot makes the determination that the mission is safe.

In urban settings, the first of these decisions is often (although not always) made by individuals with medical training and experience: EMTs, emergency physicians, etc. The system in the backcountry, however, is far less formal. The call for a helicopter rescue may well be initiated by an individual on the scene with minimal training and experience in the assessment of injuries. While one might argue that “when in doubt, err on the side of safety”, the above experiences suggest that it is hardly a given that “safety” is served by dispatching a helicopter into wilderness terrain.

This is obviously a very controversial subject, and it currently is informed by very little data and lots of anecdote. With a colleague, I am currently embarking on a study of medical helicopter evacuations in a wilderness area which will include actual disposition of the evacuees–some of the anecdote to which I allude suggests that it is not uncommon for individuals flown out of the woods to be evaluated in the hospital and sent home without admission. When complete, the data from this study may help us develop a more structured process for mobilizing this high-tech and potentially deadly resource in the wilderness.