<p> 2016 Emergency Medical Short-Haul Capability in the U.S. Forest Service Background and Frequently Asked Questions</p><p>About Emergency Medical Short-Haul </p><p>Wildland firefighters and other U.S. Forest Service personnel are often deployed in remote areas where there are no roads and where terrain and/or vegetation can preclude landing a helicopter to evacuate an injured employee. Helicopter short-haul provides a means to extract an injured employee from such a location for transportation to definitive medical care. </p><p>Emergency medical short-haul is used to remove a critically injured party by inserting (lowering) trained emergency response personnel attached to a fixed line beneath a helicopter into an area to attach the injured party to the line and then extracting (lifting) the emergency response personnel and injured party out of the area and transporting them to definitive medical care. </p><p>Two attendants, one of which is a qualified Emergency Medical Technician (EMT), wearing fireline Personal Protective Equipment (PPE), in harnesses will clip into a ring on the bottom of a line attached to a helicopter, along with their gear bags containing medical and fireline equipment and approved equipment to transport the injured party. The helicopter will transport the attendants to the area where the injured party is located and insert them. The attendants may provide any needed medical care before packaging/securing the injured party for flight. The helicopter will then extract the attendants and the injured party and transport them to the next level of medical care. The attendants will communicate with the helicopter pilot via radio and/or hand signals. </p><p>The safety of employees and the public is the U.S. Forest Service’s top priority in natural resource management. The agency’s primary goal is to manage risk so that emergency medical short-haul missions are not needed. Developing “in-house” emergency medical short-haul capability will ensure that injured employees working in remote areas can be transported to medical facilities as efficiently as possible.</p><p>Emergency Medical Short-Haul Implementation </p><p>The U.S. Forest Service is conducting a needs analysis to determine the numbers of helicopters and crews that are needed for the emergency medical short-haul capability. The agency does not plan on contracting additional helicopters or hiring new crews to conduct the emergency medical short-haul mission. Instead, existing U.S. Forest Service helitack crews that work with Type 3 (light) helicopters that are already on exclusive use contracts with private vendors will be equipped and trained to conduct emergency medical-short haul missions when needed. The helitack crews will continue to perform their regular duties, such as conducting reconnaissance missions, transporting fire crews, and dropping water and/or retardant from buckets on wildfires. </p><p>The U.S. Forest Service began implementing the emergency medical short-haul program in 2015 with two helitack crews, one based in Wenatchee, Washington and one based in Jackson, Wyoming. 2016 anticipated programs are; Krassel Helitack, Payette NF, Tucson Helitack, Coronado NF and Central Montana Helitack, Helena NF. A shared helicopter contract exists between the Coronado and Helena National Forests.</p><p>During fire season, the helicopters and helitack crews will likely be moved to central locations in areas experiencing a high amount of wildfire activity where they can be used to conduct regular wildfire suppression missions as well as emergency medical short-haul missions if needed. </p><p>The U.S. Forest Service is currently planning on holding an emergency medical short- haul consolidated training session in the spring. Training locations and dates will vary from year to year. While the agency anticipates increasing the number of emergency medical short-haul programs in the future, the U.S. Forest Service does not envision widespread proliferation of this capability across all helicopter platforms as the focus is on preventing injuries that would necessitate it.</p><p>Frequently Asked Questions: Why is emergency medical short-haul capability needed? Emergency medical short-haul capability is being developed primarily to assist in the effective treatment and evacuation of U.S. Forest Service employees and agency cooperators engaged in field operations. In some cases, emergency medical short-haul may be the only means available to remediate risk to employees and agency cooperators when other means are not feasible due to time constraints or environmental factors. What is “Short-haul”? Short-haul is a method of inserting or extracting personnel from a location, using a helicopter. It is used where other methods of insertion or extraction are not feasible or not available, such as in heavily timbered areas, steep slopes or roadless terrain where landing an aircraft is not possible. Personnel who are being inserted or extracted are attached to the helicopter by a rope, the length of which can vary but is typically greater than 100’. What is “Emergency Medical Short-haul”? The purpose of Emergency Medical Short-haul is to facilitate rapid and effective access to medical care in the field for critically injured or ill employees, as well as extraction of patients for transport to definitive medical care. </p><p>How is an Emergency Medical Short-haul mission performed? After a thorough recon is accomplished an Operational Risk Assessment is completed. If risk mitigations cannot be established, the mission is not performed. If risk mitigations can be established, at a minimum an Emergency Medical Technician (EMT) is inserted into the incident site and the patient is packaged for transport. The patient and the EMT are lifted from the site together. They are then transported an appropriate distance to a location where other medical transport (air ambulance or ground based ambulance) and higher-level medical care can intercept the patient and move them to definitive medical care for treatment</p><p>Is Short-haul the same as Hoist? No. Helicopters with hoist capability can raise and lower personnel and equipment at the end of a cable while hovering, using an onboard hoist system. This allows for the employee and patient to be brought into the cabin of the helicopter during transport, lessening exposure to both. The rope used in a Short-haul mission is an approved fixed length line that cannot be raised or lowered. When would emergency medical short-haul be used? The emergency medical short-haul mission is intended to extract the injured party from an otherwise inaccessible location and transport them the shortest possible distance to a location where another type of medical transportation is available (ground ambulance, Emergency Medical Response (EMS)/life flight, or internal in an agency helicopter). Based on an appropriate risk assessment, emergency medical short-haul for patient evacuation may be used under any of the following circumstances:  When an EMT or highest qualified medical provider on scene assesses an injury or illness to be serious enough (e.g., life threatening) to warrant prompt evacuation.  When a conventional rescue operation would expose rescue personnel and/or patient to a higher degree of risk. The following factors can contribute to this: duration and/or difficulty of a conventional evacuation; patient safety and potential medical complications; weather (past, present and predicted); available daylight; and resource availability.  When no other viable means of getting the patient to medical treatment in a timely manner exists (including air ambulance, National Guard Hoist, ground transport, etc.). </p><p>What are Forest Service Emergency Medical Short-haul helicopters? They are first and foremost firefighting resources to be used in support of fire suppression. They are exclusive use aircraft that are helitack configured and perform all the functions other Type 3 helicopters provide. In addition, they are trained and equipped to assist in emergency medical response when one of our employees, cooperators or contractors becomes critically injured or ill. Short-haul is considered as an option when other means of medical support and transportation are unavailable or cannot respond in a timely manner to extricate a critically injured or ill employee. Will helicopter pilots need special qualifications to perform emergency medical short- haul missions? Yes, helicopters and pilots will have to be inspected and carded for this mission by U.S. Forest Service Helicopter Inspection Pilots. How far can a helicopter transport an injured party in emergency medical short-haul? The helicopter will transport the injured party an appropriate distance, which will vary depending on location, terrain, helispot location, patient location, time of day, definitive medical care, etc. How high can helicopters flying emergency medical short-haul missions fly? Heights will vary depending on the situation. The terrain will likely change during the mission and the altitude at which the short-haul helicopter will fly will change accordingly. What kind of equipment will be used? The helicopters will be equipped with three special lines that will be used only for short- haul training and operations. The lines will be 100 feet, 150 feet, and 250 feet long and can be connected if needed to meet environmental conditions. What qualifications will the helitack crew have? The helitack crew will consist of seven to twelve members with three to five qualified as Emergency Medical Technicians (EMTs). The rest of the crew members will be trained in short-haul but may not possess medical qualifications. At least one of the attendants on all emergency medical short-haul missions will be qualified as an EMT. What level of Emergency Medical Services (EMS) will a Forest Service Short-haul helicopter be equipped to provide? Forest Service Short-haul crews will carry Emergency Medical Technicians, or EMTs. These personnel will be trained and equipped to provide Basic Life Support-level EMS, with the primary goal of patient stabilization and transport. Forest Service Short-haul helicopters will not be equipped to provide Advanced Life Support (ALS); the goal of the Forest Service Emergency Medical Short-haul mission is to facilitate the delivery of a patient to ALS as rapidly as possible. </p><p>What is the Forest Service’s history conducting Short-haul missions? The Forest Service has conducted numerous Short-haul missions associated with Law Enforcement and Investigations activities in the Pacific Southwest Region for a number of years. 2015 is the first year that the Forest Service was prepared to conduct Emergency Medical Short-haul missions. For additional information, contact John Heil, public affairs specialist, U.S. Forest Service Pacific Southwest Region, at 707-562- 9004.</p><p>Do other agencies perform Short-haul? Yes. A wide variety of agencies perform Short-haul missions in a variety of operational contexts. In terms of federal natural resource management agencies, the National Park Service (NPS) has conducted a Short-haul program for several decades. NPS performs Short-haul missions for the purposes of search and rescue, providing medical aid, and law enforcement. Many state and local government agencies also perform Short-haul missions for a variety of public safety and law enforcement functions. Why doesn’t the U.S. Forest Service continue to rely on cooperators and the military to provide emergency medical short-haul services? The limited number of cooperators and military units that can provide emergency medical short-haul services may not be available when needed and it may be difficult to for them to reach injured parties in a timely manner. Is the Forest Service developing an Emergency Medical Short-haul capability to replace air ambulances or cooperating agency capabilities such as the National Guard? No. It has long been recognized that cooperating agency resources are not always available or cannot always respond in a timely manner to a Forest Service medical emergency in a remote location. Development of a Forest Service Emergency Medical Short-haul capability will supplement existing extraction capabilities, not replace them; when used, the goal will always be to transfer patient care to Advanced Life Support (ALS) capable resources such as ambulances or Life Flight as soon as possible. Do other wildfire management agencies have emergency medical short-haul capability? Yes. The National Park Service (NPS) has years of experience conducting successful emergency medical short-haul missions at eight National Parks. CAL FIRE also has emergency medical short-haul capability. Does the Forest Service use the Short-haul capabilities of other agencies? Yes. Traditionally the Forest Service has used cooperating agencies’ Short-haul capabilities in the same way that it makes use of other cooperator capabilities. For example, seriously injured firefighters have been extracted from Forest Service fires using the Short-haul capabilities of other agencies such as the National Park Service. Will there be any differences between the U.S. Forest Service and National Park Service emergency medical short-haul programs? Yes. Although both agencies will have emergency medical short-haul programs, their mission profiles differ. The U.S. Forest Service intends to provide extraction capabilities for agency personnel working in the field while the National Park Service provides the capabilities for park visitors/recreationists as well as employees. What are the risks involved with Emergency Medical Short-Haul? There is risk associated with every aviation mission and Short-haul is no exception. For personnel being carried on the end of the line outside of the helicopter the consequences of a mechanical failure could be fatal. Helicopters have survivability built into the structure of the airframe for the aircrew; there is no similar protection for the employee or patient on the end of the line. Risk assessments are designed to evaluate if the risk to emergency responders is justified by the need of the patient. Short-haul missions are intended to be short duration flights for the purpose of getting a patient to better medical care. Should the availability of an Emergency Medical Short-haul helicopter justify the acceptance of a higher level of risk in a ground operation? No. An Emergency Medical Short-haul helicopter is not risk mitigation; it is a means for extracting a patient who has already become critically injured or ill. Hazards should be identified and risks assessed for all operations, prior to engagement. Accepting more risk because a Short-haul helicopter is available is akin to accepting more risk because you’re carrying a fire shelter. As with all aviation operations, there is no guarantee that a Short-haul mission will go as planned. There are times when an Emergency Medical Short-haul helicopter cannot respond due to reduced visibility caused by smoke, weather or darkness, or due to mechanical issues. This resource should not be considered a “safety blanket” that enables more risk to be accepted. Short-haul missions themselves involve some level of risk to aviators; risk should not be transferred from ground operations to aviation operations. </p><p>Will the Forest Service perform Emergency Medical Short-haul for members of the public? The primary purpose of emergency medical short-haul capability is to provide life-saving transportation to definitive medical care for employees, cooperators and contractors performing agency work. Participating in emergency medical short haul for a member of the public would be rare and should only be considered when a formal request has been made from the local agency with jurisdictional responsibility for search and rescue. Transporting injured members of the public is a local responsibility of county sheriffs, local search and rescue organizations, etc. Risk assessments and other protocols used for dealing with all such cooperator requests must be followed. </p>