OANRPPCSU

SOPNo.15

14March2011

StandingOperatingProcedure(SOP)for
EmergencyResponse

1.PURPOSE.Tooutlinestepstofollowinthecaseofafieldemergency.

2.SCOPE.Includesproceduresforfieldoperations.

3.RESPONSIBLITIES.

a.NaturalResourceManagementSupervisor:ReviewprocedureswithNaturalResource
ManagementStaffduringsafetybriefingstoensureunderstandingandcompliance.Ensure
staffhasreceivedorientationfromMedevacandWildernessFirstAid.

b. NaturalResourceManagementStaff:Executeemergencyresponseproceduresin
accordancewithSOP.

c. FailuretocomplywiththisSOPmayresultindisciplinaryaction.

HelicopterwreckagefromcrashDecember2003.

4.PROCEDURES.NewstaffshallreadthisSOPandallattacheddocumentsbeforebeginning
fieldwork.
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a.GeneralConsiderations.

(1)Intheeventofanemergency,staffshouldseektoremaincalm,respondwithalacrity
andcompassion,andcommunicateclearlyandfrequentlywithBase,supervisors,and
otherfirstresponders.

(2)Firstrespondersmayinclude:NRS,EmergencyMedicalTechnicians,Medevac,Range
Control,andHonoluluFireDepartmentStaff.

b.EmergencyProcedures

(1) FollowattachedWilderness1stResponsedocumentsWMAsWildernessFirstAid
Guideisanewresource,(scannedandattached)

c.TrainingandGear

RequiredGear
FirstAidKit,includingrubber
gloves, CPR faceshield, and
flaresormirror,asdetailedin
theFieldworkSOP.
Communcation: radio or cell
phone
Emergency Response Forms
(seebelow)

SuggestedGear/Training
Fieldpackwithall
standardgear
Vehicle/largefirstaid
kit
MedevacOrientation

RequiredTraining
CPR
WildernessFirstAid

ChecklistofFieldSafetySheets

Makesureyouhavethelatestversionofeveryform!
Item

1 FieldPhoneList
V:\NewHireOrientationandTraining\SafetyandFirstAid\
fieldphonelist.exl
2 EmergencyContactList
V:\NewHireOrientationandTraining\SafetyandFirstAid\
EmergencyContactSheet.doc
3 FieldWildernessFirstResponse
V:\NewHireOrientationandTraining\SafetyandFirstAid\
FieldWILDERNESS1stRESPONSE2009.doc
4 PatientInformationFormSOAPA
V:\NewHireOrientationandTraining\SafetyandFirstAid\
PatientInformationFormSOAPA.doc

SOP15EmergencyResponse

Latest
Version
3/11/10

12/16/09

3/17/10

2/10/10

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5 LZlist
V:\Forms\NR_LZ_List_MASTER.pdf
6 FieldSafetyMaps
V:\MapGraphics\FieldSafetyMaps\Koolau\PDFs\_KoolauFieldSafetyMaps.pdf
V:\MapGraphics\FieldSafetyMaps\Waianae\_WaianaeFieldSafetyMaps.pdf
7 RamikLabel
V:\NewHireOrientationandTraining\SafetyandFirstAid\
RamikMiniBarsLabelExp2013.pdf
8 NARSPermit09
V:\NewHireOrientationandTraining\SafetyandFirstAid\
NARSPermit09.pdf

9/30/09
4/09

7/1/09

4/6/09

LastModified6/6/2011
V:/NewHireOrientationandTraining/SafetyandFirstAid/CurrentForms

d.Practice/FireDrills

(1)SupervisorsshallconductFireDrillswithstaffthreetimesperquarter(minimum),
unlessotherwisespecifiedbytheSeniorNaturalResourceManagementCoordinators.
Otherstaffhavespecificgoalssetforfiredrillcompletionrates.Baseshallconduct
impromptufiredrillswithfieldstaffattheirdiscretion.

(2)FireDrillswillbetrackedviatheFireDrillRecordForm.Theseformswillbefiledand
keptbytheSeniorNaturalResourceManagementCoordinator.Theywillbereviewed
byparticipatingstaffandthePCSUSafetyofficer.Theywillalsobediscussedat
CoordinatorMeetings.

(3)PotentiallyproblematicfindingsofFireDrillswillbeaddressedbysupervisorystaff.If
needed,changestoSOPSandotherdocumentswillbemade.

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WILDERNESS1stRESPONSE

PatientAssessment
ProvidePatientCare
CompleteSOAPAPatientInformationForm
MakeanEvacuationDecision
ContinuallyMonitorPatient
EvacuatePatient

PatientAssessment
STOP.SizeuptheScene
Identifyhazardstopatients,rescuers,bystanders:isanyoneinimmediatedanger?
DetermineMechanismofInjury(MOI).Whathappenedandhow?
Establishbodysubstanceisolation.Noteanybodyfluids,useuniversalprecautionstokeepoutofthem
untilhavegloves.
Determinenumberofpatients
InitialAssessment:STOPANDFIX!
Identifyselfandtraininglevel,obtainconsent,checkformedicalalerttags
Assessresponsiveness(verbalorpain)
StabilizespineifMOIforspuinal(handonforehead)
Airway:lookinmouth,clearofobstructions
Breathing:look,listen,feel.Ifunresponsiveandnobreathor<12breath/min,ADMINISTERRESCUE
BREATHING(1breath/5sec).
Circulation:checkpulseinwrist/neck,ifnone,ADMINISTERCPR.Checkforbleeding;control/treat
shock
Disability:maintainstabilizationofspineunlesspatienthasnosignificantMOI
Environment/Expose:assess/treatenvironmentalhazards,identifypotentiallifethreateningwounds
FocusedExamandHistory
1. HeadtoToeBodyCheck:Ifmajorspinalinjurysuspected,dontroll.Incaseofunsuspectedspinal
injury,rollpatientonsidetocheckvertebrae,usingpropertechniquetokeepheadandneck
stabilized.
2. VitalSigns
Notetimevitalsignstaken.Takeatregularintervals,dependentonpatientscondition.
LevelofResponsiveness(LOR):
a. AVPUA=awake,gotoA&Oscalebelow;V=verbal,responsetoverbalstimulous;P=
pain,respondestopain(suchasapinchtotheunderarm);U=unresponsive.
b. A&OscaleforallAwakeonAUPU;4questions:identity,location,time,event(A&Ox14).
Retainmemorystartingfromidentitygoingtoevent.ResponsivenessBesttoWorst:
A&Ox4,3,2,1,Alert,Verbal,Pain,Unresponsive
Heart:Rate,Rhythm,Quality:normalraterangebetween50100beats/min
Respiratory:Rate,Rhythm,Quality:normalraterangebetween1220breaths/min
Skin:Color,Temperature,Moisture(SCTM):normalispink,warm,anddry
Pupils:PupilsEqualRoundandResponsivetoLight(PERRL)
Temp:Touchtest
3. PatientHistory(SAMPLE)
Symptoms
Allergies:whatarethey,haspatientbeenexposed,whatwerepastexposureslike
Medications:whatarethey,whytaking;legal,recreational,herbal,vitamins

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PertinentHistory:experiencedanythinglikethisbefore?Anyrelatedillnesses?
LastIntake/Output:what,when,howmuch,isitnormalforpatient?
Eventsprecedingindicationsofillness:redundancy
ProvidePatientCare
CompleteSOAPAPatientInformationForm

MakeanEvacuationDecision
1.EvacuationNecessary?
Assessseverityofthesituation:BECONSERVATIVE.

Howurgentisthevictimscondition,andhowvitalisresponsetimetoincreasinginjuryseverity?
Whattypeoftransportisneededaccountingforinjuredpersonsconditionandtheweather?

Isthevictimmobile?Howlongisthehike?Ishelicoptersupportneeded?Whattype?

Medevac(EvergreenHelicopters) 911(AirOne)
Commercial
Bell412
McDonnellDouglasMD520N
Hughes500
Ship
30x30ft,ifneedtoland,butMedevac 15x15ftifneedtoland,butrescue 15x15ft,andtighter!
LZsize
personnelcanrappelfromhelicopter Squadmemberscanrappelfrom
intoaremotearea.
Air1intoaremotearea.
250
300

Line
SpecialEquipment litter(basketlikestretcherdevice)and
harnessedhoist
HoursofOperation 247
Unknown
Pilot

Communication

Dialin(phoneorpacmere)

MedicalResponse Medic,Hospital,Ambulance

100

infraredcamera,rescuenetandlitter
(basketlikestretcherdevice)

N/A

247

Daylight

Unknown (perhapsLincoln)

Wellknown

Dialin(phoneorpacmere)

Direct(helicopter
radio)
Hospital,Ambulance
NOMEDIC.

Hospital,Ambulance.
NOMEDIC.

2.Ifhelicopterevacuationisnecessary,complete9LineMedevacQuickFax(usedforallhelicopterrescues).
Lat/Long
LocationofPickupSite
PacmereA6:DPWEnv;Heli:141.100
PickupSiteFrequency&CallSign
NumberofPatientsbyPrecedence #Urgent,#Priority,#Routine
Litter,rescuenet(only911),infraredcamera(only911)
SpecialEquipment
#RequireLitter,#Ambulatory(abletowalk)
NumberofPatientsbyType
Number&TypeofWound,Injuryor
Illness
Colorflagging,flare,strobe,glowstick,smoke,mirror.
PickupSiteMarking
TELLMEDEVACWEARECIVILIANS.
PatientStatus

TerrainDescription:
Howclosetopatient?
SizeofLZ&SlopeofTerrain
Wires,antennas,ditches,vehicles,etc.
Obstacles
WindDirection&Speed,Weather

ConverttoLat/LongforMedevacand911onRinoLegendGPSasfollows:
1.
2.
3.

Takeawaypoint,ormakesureyouhaveawaypointforthepointforwhichyouwantcoordinates.Fig.1
NavigatetotheMainMenuScreenusingthepagebutton(ontherightsideabovethepowerbutton).Fig.2
GotoSetup(thehammer)byusingthejoystick.Fig.2

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4.
5.

UndertheSetupMenu,gototheUnitsoption(tapemeasure)byusingthejoystick.Fig.3
ThefirstheadingisPositionFormat.BelowitshouldreadUTMUPS.UsethejoysticktohighlightUTMUPSandselectitby
depressingthejoystick.
ScrollDownwiththejoystickandselecthddd mmss.s
NavigatebacktotheMainMenu(Fig.2)byusingthepagebuttonand
selecttheFindOption.
ChooseWaypointsthennearest.Pickyourwaypointfromthelist.
IntheLocationbox,youshouldhavethecoordinatesintheLat/Longformat.

6.
7.
8.
9.

3.Contacthelp
CALLBASEYARD.EastRange:6567641,6567741,6568341.WestRange:6559175PacmereCh.A6
ProvideresponderwithinfoonSOAPAForm/9LineMedevacQuickFax(usedforallhelicopterrescues).
Coordinaterescuecallswithbaseyard:
Medevac(EvergreenHelicopters)
911(AirOne)
Commercial
OfficecallsSchofieldFiringDesk
Officecalls911andprovides Officecallscommercialhelicopter
Phone6551434;Fax6551433
themwithsameinfoason
companiesprovidesthemwith
SchofieldFiringDeskneedstocall
HelicopterQuickFax.
sameinfoasonHelicopterQuick
Medevacbeforetheycanfly
Fax.
OfficesendsHelicopterQuickFaxand

PacificHelicopters
callsMedevac
18009535552,8088719771
Fax6561855andPhone6561849
Howard4791492
AlfredPena,BaseManager/LeadPilot,
LincolnIshii5420506
cell3759192
JoeAllen:TBD

K&S/ParadiseTropicalHelicopters
2843288
Josh7414354;Cal8088959612

WindwardAviation8088773368

AirborneAviation;Jim(808)281
4198,(808)8781088,Susie(808)
4422122

ContinuallyMonitorPatient

EvacuatethePatient
Ifhelicoptersupportisneeded,prepareLandingZoneorDropZone
IfLZsiteisnearbyandlargeenoughforBell412landing(30x30ft),orMcDonnellDouglasMD520N&Hughes
500landing(15x15ft):
cleartreesandshrubs
markLZininvertedYformation(pointintowind).
markLZwithflagging,brightlycoloredclothing,etc.buttiesecurely
IfLZisnotavailable,clearDZlargeenoughforlitterorrescuenet,butnotvital
markDZwithflagging,brightlycoloredclothing,etc.,tieintreeifneed
GuideHelicoptertoSite
Communicatetopilotoclockorcompassrelationtositefrompilotsviewpointandemploylightsource
asconstantsiteindicator.Atnight,useonlyglowssticksforNVGoperations
Ifhelicoptersupportisnotneeded,assistthevictimtothenearestmedicalfacility
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Page99hasbeenremovedasitcontainspersonalinformationregardingemployees

SecondaryFocusedSpinalAssessment(FSA)
AppropriatewhenMOIindicatespossiblespineimpact

REQUIREMENTSforspinalassessment:
Inwilderness(>1hourfrommedicalassistance)
Fullassessmentalreadycompleted

PatientmustpassALL5ofthefollowing:
1. A&Ox3or4.

4questions:identity,location,time,event
2. Sober,nonarcoticsoralcohol
3. Nodistractinginjuries(whentouchedwith
pressure,patientcanfeel)
4. NormalCirculation,Sensation,Motion(CSM)in
allextremities;canmovefigureandtoesagainst
resistance,candifferentiatebetweensharp(poking
withsharpestick)anddull(touchwithcloth)onall
4extremitieswitheyesclosed
5. Nopain/tendernessonspine

Signs/SymptomsofSpinalInjury
Pain,tenderness,obviousinjuryordeformityalong
vertebralcolumn
Altereddistalsensations:numbness,tingling,unusual
hot/coldsensations
Diminishedcirculation,sensation,motion
Weaknessorparalysis
Respiratorydifficulty
Incontinenceoruncontrollederection
Shock
Nausea
Skincolorflushedfromaccidentsitedown

IffailFSAorhaveanyaboveSigns/Symptoms,
ASSUMESPINALINJURY

Treatment
Stabilizespineandheadmanually
CheckCSMsinextremities
Establishneutralalignmentofspine(naturalprone
position,bodypartsinline)
Applycervicalcollar,ifavailable
Securebody,andheadontoabackboard,ifavailable
Ifcollarorbackboardnotavailable,keepneckalignment
stablewithgear,clothes,etc.
RecheckCSMsinextremities
Anticipateshock
EVACUATE

CPR
REQUIREMENTSforCPR
Unresponsivepatientwithnopulse.
DONTbeginCPRifpatientisalive,hasinjuries
incompatiblewithlife,hasanobviouslylethal
injury,hasrigormortisorlividity,orhasawell
definedDNR(DoNotResuscitate)

2componentsofCPR:
RescueBreathing(pulse,nobreath)
ChestCompressions(nopulse,nobreath)

InitialSTOP&FIXAssessment,conductABCs.
Airway:lookinmouth,clearofobstructions.
HeadTilt/ChinLift:standardmethod
JawThrust:goodiffearspinalinjury,butneedto
usepressuretomaintain.
Breathing:look,listen,feel.Ifnobreathing,
administer2breaths,andcheckpulse
Circulation:checkpulse,
Ifhavepulse,continuerescuebreathing.
1breathevery5seconds
Ifnopulse,addchestcompressions.
30compressions,1breathx2,checkforpulse.
Continueuntilachievesuccess,becomeexhausted,
dangerousconditionsdevelop,turnovertohigher
levelofcare,ordeclareddeadbydoctor.In
wilderness,greaterthan30minwithoutsignsoflife,
assumedead.

______________________________________

WoundManagement
Evacuate:

Animalbites
Deeporhighlycontaminatedwounds,highriskofinfection
Woundsopeningtofracturesorjointspaces
Infectedwounds
Woundswithseverebloodloss

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HeatIllness
HeatStroke=EVACUATION
Signs/Symptoms
Dizziness, fainting
Heat Exhaustion Weakness
Shock caused by
Headache
dehydration
Mild confusion
Nausea
Loss of appetite
Difficulty breathing
Rapid onset of confusion, irrational behavior
Loss of coordination
Heat Stroke
Causes irreversible Loss of conciousness
liver, kidney,
Increased HR, RR
nervous system
Skin hot, red, dry (no sweating)
damage

Treatment
Move patient out of direct sun, away from heat
Oral rehydration: electrolytes, lightly salted water
Spray with water; fan

Move patient out of direct sun, away from heat

Oral rehydration if concious enough to drink
Spray with water; fan aggressively
Ice packs to neck, groin, armpits
Massage extremities to increase circulation
Monitor vital signs
EVACUATE

_____________________________________________________________________________________________

Hypothermia
Alcoholintoxicationcanreduceshiveringandcomplicatediagnosisandtreatmentofhypothermia
Severehypothermia=EVACUATION
Signs/Symptoms
Treatment
Alert
Prevent further heat loss
Vital
signs
normal
Mild
Employ rewarming techniques
Vigorous shivering
No alcohol, tobacco consumption
Vital signs depressed
In addition to above:
LOC altered
Monitor vital signs
Moderate to Lack of response to painful EVACUATE
Severe
or verbal stimuli
Lack of shivering

Rewarming Techniques
Shivering
Dry clothes
Insulate patient from ground
Cover with vapor barrier
Move to warm envionment
Mild exercise
Warm, sweet drinks if patient can hold own cup
Heat application to underarms, neck, groin,
sides of chest wall

_____________________________________________________________________________________________

Shock
Inadequateperfusionofbodycellswithoxygenatedblood
Shockisalwaysasecondaryconditioncausedbyanunderlying
problemwith:
pipes,pump,fluid,orobstruction

Signs/Symptoms
Weak,rapidpulse(over120bpm)
RRincreasing,shallow
Skinpale,cold,clammy,bluish
Capillaryrefillslow(nailbeds)
Nausea,vomiting
Restlessbehavior
Drymouth,severethirst
Visiblebloodloss,pooling

SOP15EmergencyResponse

Internalbloodloss,swelling

Treatment
Treatunderlyingproblem
Placeheaddownhillorelevatefeet12offground
Insulatefromcoldground
Keeppatientwarm
Monitorvitalsigns
Reassure,calmpatient
Sipsofwater

Evacuateif
Noimprovementwithtreatment
Significantvitalsignchangeswhenstand
Conditionuntreatableinfield(internalbleeding)

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HeadInjury
DurationofSigns/Symptomsdeterminesseverityofinjury:mild=quickrecovery,severe=quickdecline.
Lossofconsciousness=EVACUATION

Signs/Symptoms
A&Ox3 or 4
Nausea
Mild
Vomiting
Dizziness
Headache
Repetitive questions
Moderate A&Ox2 or 3 (short term memory loss)
Prolonged headache and dizziness
Altered mental state (combative)
Low HR
Irregular RR
A&Ox1 or 2, decreasing
Loss of conciousness
Increasing headache
Severe
Uncontrollable or protracted vomiting
Amnesia
Unequal pupil size
Seizure
Bruises below eyes or behind ears
Fluid (pink/clear) in ears, eyes, nose, scalp
Fracture, depression, or soft skull

Time
Treatment
Quick recovery, Monitor LOC for decrease
within .5 to 2 hrs Monitor vital signs
Monitor for signs of severe injury
Withhold pain medication
Sleep allowed, wake up every 2 hrs for 8hrs
Monitor LOC for decrease
Monitor vital signs
Sleep allowed, wake up hourly
If no improvement after 4 hrs, EVACUATE
Quick loss of
Monitor vital signs
function
No sleep
EVACUATE

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PatientInformationFormSOAPA

Name________________________________________Date______________Age________SexM/F

Subjective(accordingtopatient)
ChiefComplaint_____________________________________________________________________
____________________________________________________________________________________

MechanismofInjury(MOI)/HistoryofPresentIllness(HPI)_______________________________
____________________________________________________________________________________

Objective
PatientExam(descriptionofhowpatientfound,resultsofheadtotoeexam)
____________________________________________________________________________________
____________________________________________________________________________________

VitalSigns
Time

LevelofResponsiveness:
A&Ox41,Alert,Verbal,

HeartRate

RespiratoryRate

Skin:Color,
Temperature,Moisture
Pupils:Equal,Round,
ResponsivetoLight
Temperature

History(SAMPLE)
Symptoms___________________________________________________________________________
____________________________________________________________________________________
Allergies____________________________________________________________________________
Medications__________________________________________________________________________
Pertinentmedicalhistory_______________________________________________________________
Lastintake/output_____________________________________________________________________
Eventsleadingtoaccident/illness_________________________________________________________
____________________________________________________________________________________
Assessment(problemlist)
____________________________________________________________________________________
____________________________________________________________________________________

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Plan(planforeachproblemonassessmentlist)
____________________________________________________________________________________
____________________________________________________________________________________

AnticipatedProblems
____________________________________________________________________________________
____________________________________________________________________________________
Base,thisIS/ISNOTafiredrill.IhaveaMILD/MODERATE/SEVEREsituationinvolving
_____________________________(name/callsign)at__________________________(management
unit).Evacuationwillberequiredvia_______________________________(ambulance/heli/hike).

Herearetheincidentdetails:Ihavea______(age)yearold______(sex),whosechiefcomplaintis
_________________________________________________________(injury/illness)asaresultof
_______________________________________________________(MOI/HPI).Patientwasfound
_______________________________________________________(position/location/time)andis
currently____________________________________________(status)and___________(LOC).
Examreveals______________________________________(assessment).Patientvitalsignsat
_________(time)are_____________________________________(HR/RR/SCTM/PERRL/Temp)with
ahistoryof__________________________________________________________(SAMPLE).
Evacuationwillrequire_____________________________________________________(gear)at
____________________________________________________(location).Anticipatedproblems
include____________________________________________________________________________.

9LineMedevacQuickFaxInfo:
1 LocationofPickupSite(Lat/Long,
UTM):

SpecialEquipment(litter,hoist):

2 RadioSiteFrequency:141.100
CallSignofResponder:
3 NumberofPatientsbyPrecedence:
#Urgent:____#Priority:____

PickupSiteMarking(flagging,flare,etc):

9
a

SizeofLZandSlopeofTerrain:

SOP15EmergencyResponse........................................................................................................................................Page104

#Routine:____
5 NumberofPatientsbyType:
#Litter:_____#
Ambulatory:_____
8 NumberofPatientsbyStatus
#Civilian:_____#Military:_____
6 Patient&Typeof
Wound/Injury/Illness:
Patient1:

Patient2:

Patient3:

9
b

Obstacles(wire,antennae,ditch,
vehicle,etc):

9
c

Weather,WindDirection&Speed:

OANRPBasePOC:
Phone:6567641/6567741
Fax:6567471
OtherDirections/Instructions:

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