Kootenai National Forest

Emergency Medical Field Evacuation Plan

INTRODUCTION

The purpose of the Kootenai National Forest Emergency Medical Field Evacuation Plan is to establish procedures and informative documentation for use during a field medical emergency evacuation. The Emergency Field Evacuation Plan is to be used for Forest Service personnel and Forest Service Volunteers under a signed agreement while working on the Kootenai National Forest. This plan is not intended to be used for private citizens injured on Kootenai National Forest Lands. Search and Rescue of injured private citizens injured on National Forest Lands is the responsibility of the Lincoln County Sheriff Office.

This plan will consist of the following three sections:

Section 1- Section one will include procedures and responsibilities of Kootenai Forest personnel when dealing with an Emergency Medical Field Evacuation.

Section 2- Section two will consist of a listing of Medical Facilities and EMS organizations, which may be used during a Medevac situation. This listing will include phone numbers, addresses, radio frequencies and other pertinent information. This section should be used as a stand-alone document and be posted in the following locations as a minimum: Supervisors Office, Dispatch, and the Ranger District Front Offices.

Section 3- Section three will consist of the Kootenai National Forest Medical Incident Patient Log /size up report. This form is to be used to assist with the evacuation of injured Forest Service personnel. Field going personnel should become familiar with this form and it is recommended that a copy be carried in vehicles.

SECTION 1 PROCEDURES

Kootenai Dispatch Office (KDC) will take the lead on all Medevac operations associated with Forest Service personnel on the Kootenai National Forest. Field going personnel must be made aware that the initial request for medical assistance should be made through KDC via the Forest radio net. If for any reason the requesting party does not get a response from KDC, the individual should immediately call the District Office associated with their current location.

On the initial broadcast the requesting unit should

1)	Declare a Medical Emergency and request that non-emergency radio traffic be suspended.

2)	Provide the name of the Medical Incident Commander/ Incident Within Incident (IWI-IC).

The requesting unit should be prepared to provide the information included on the 8 Line Medical Incident Report (ICS-206WF) or KNF Medical Incident Patient Log /size up report. KDC should immediately be prepared to copy the information on to their copy of Incident Size up form. If the requesting field unit does not have a copy of the form KDC or the responding office should be prepared to prompt the IC for the necessary information.

Once the initial request for assistance has been made all attempts should be made to maintain consistency throughout the process. Radio contacts on both ends should also remain the same. The office that initiates the medevac transport process with EMS should continue until the operation is completed.

Medical Incident Commander Responsibility

The responsibilities of the Medical IC (IWI-IC) are listed in order of priority:

Secure scene and determine if it is safe to begin first-aid.

Administer first aid; make assessment to determine if additional assistance is needed.

Call Kootenai Dispatch to report incident.

Determine if injury is life-threatening and whether Medevac via ground or air ambulance is needed. (If life-threatening, both may be appropriate in the event that one is delayed or unable to get to the scene). Medevac will be used for life-threatening injuries. If injury is not life-threatening, IWI-IC will request medical transport.

Begin 8 Line Medical Incident Report or KNF Incident Medical Size up report and provide information as determined on the report.

If needed determine helicopter landing zones.

Initiate documentation of incident.

Provide dispatch with patient updates and any change of status at the scene.

Assist EMS; be prepared to help with patient assessment and provide background information to	responding EMS personnel.

Ensure that KDC receives patient name and employing agency as soon as possible. *Names cannot be shared over the radio, so IWI-IC will need to relay information by cell phone, sat phone/inReach, landline, or send a runner.

Kootenai Dispatch Responsibility

Take report of medical incident from Medical incident commander, ensure radio frequency has been cleared for Emergency Medical traffic.

Open Incident in WildCAD.

Communicate with Medical IC to help determine the best method of transport for victim.

Prompt IC to provide information needed to complete the 8 Line Medical Report or Kootenai Medical incident size up report.

Order ground or air ambulance (both may be appropriate) using information on medical size up card.

Maintain communications log.

Start a 10- or 15-minute timer in the WildCAD incident and begin scheduled check-in with IC for patient updates and any change in status at the scene.

Provide overall coordination of the medical incident.

Coordinate with responding EMS personnel.

Notify Safety Officer for additional required safety program / OSHA notifications.

Ensure an agency representative will meet the individual at the hospital or emergency care center.

Make other notifications appropriate to the incident; Reference Northern Region Emergency and Disaster	Plan.

Kootenai Dispatch EMS Coordination: With either ground or air ambulance transport EMS providers will desire information pertinent to the patient, which will include:

1)	Age, gender and any known pertinent health history of patient (Note: Name is helpful for the purposes of the responding EMS but should not be broadcast via radio).

2)	Assessment of Patient

3)	Accident History

For air transport the following information is required

Latitude and Longitude (ALERT prefers decimal degrees – 49.43500° x 115.78342°)

Landing Zone Information, especially aerial hazards, such as power lines and trees

Wind Direction

Number of Patients and their weights

The Kootenai Exclusive-use helicopter can be configured to transport a patient in a litter. The most common use of the forest ship would be to transport ambulatory, non-critical patients. A medevac helicopter should be the primary responder for critical patients needing helicopter transport. During a medevac via helicopter, personnel assisting with the transport need to assess risks, implement hazard mitigation and work cooperatively to maintain the safety of the flight operations. As with all missions, a qualified Helicopter Manager will oversee helicopter operations during a medevac using an agency helicopter and will identify and implement mitigations that will enhance flight safety.

When working with medevac helicopters, personnel should follow the direction of the helicopter personnel, but should also be aware that Forest Service safety procedures for working around and near helicopters should be strictly followed. Field personnel should be aware that Life Flight/Alert helicopters may not have the same capabilities as agency helicopters and may not be able to land in areas that would be considered suitable for agency helicopters (slope, aerial hazards, size of touchdown pad, etc). Consider using short-haul or using an agency helicopter to transfer patient from backcountry medevac spot to established/improved LZ if situation warrants. Upon landing allow medical personnel to depart the helicopter and meet a safe distance from the helicopter to discuss the situation and process for loading the patient. If possible the patient should be positioned away from the landing zone for the helicopter to avoid debris and communication problems that occur when located near a helicopter.

For Ground Transport the following is required

1)	Location and Best Route of Travel

2)	Safety concerns pertinent to ground transport, i.e. Logging Traffic, Public Traffic, Road conditions, specific vehicle needs (chains or 4X4, high clearance) and turn-arounds.

Medevac EMS Providers

Provider	Location	Phone Number	To Order
Libby Volunteer Ambulance	Libby, MT	(406) 293-5582	911
Troy Volunteer Ambulance	Troy, MT	(406) 295-6505	911
Eureka Volunteer Ambulance	Eureka, MT	(406) 297-3318	911
Trout Creek /Noxon Volunteer Ambulance	Trout Creek/Noxon	(406) 827-3584	911
Alert Air Ambulance	Kalispell, MT	(406) 752-9797	911
Life Flight Air Ambulance	Missoula, MT	(800) 232-0911	911
MAST Air extraction helicopter	Fairchild AFB Spokane, WA Malmstrom AFB Great Falls, MT	(509) 247-2427 (406) 731-3250/ 800-851-3051	Call Direct

Medical Facilities

Medical Facility	Location	Phone Number
Cabinet Peak’s Medical Center	209 Health Park Dr. Libby, MT	(406) 283-7000
Kalispell Regional Medical Center	320 Sunnyview Lane Kalispell, MT	(406) 752-5111
North Valley Hospital	1600 Hospital Way Whitefish, MT	(406) 863-3500
Deaconess Medical Center	800 W Fifth Ave Spokane, WA	(509) 473-5800 ER (509) 473-7100
St. Patrick’s Hospital	500 West Broadway Missoula, MT	(406) 543-7271
Clark Fork Valley Hospital	10 Kruger Rd. Plains, MT	(406) 862-4800
North Country Medical Clinic	995 HWY 93 N Eureka, MT	(406) 297-2438
Bonner General Hospital	520 N 3rd Ave Sandpoint, ID	(208) 263-1441 ER (208) 265-4773
Prompt Care	304 Osloski Road Eureka, MT	(406) 297-3145
Libby Prompt Care	209 Health Park Dr Libby, MT	(406) 293-0186
Libby Clinic	211 E 2nd Libby, MT	(406) 293-8711
Harborview Burn Center	325 9th Ave, Seattle, WA 98104	(206) 520-5000
University of Utah Burn Center	50 N Medical Dr #4 Salt Lake City, UT 84132	(801) 581-2700

Helicopters

Organization	Location	Order information	Remarks
Alert Air Ambulance	Kalispell, MT	(406) 752-9797	Air to Ground use Tan Channel
Life Flight Network	Missoula, MT Spokane, WA Sandpoint, ID	(800) 232-0911	Air to Ground use Tan Channel
Forest Exclusive Use	Libby Airport	KDC	Type 2 Rappel Platform
Two Bear Air	Kalispell, MT	(406) 758-5610	S&R Helicopter dispatched by FCSO
MAST helicopter (Extraction)	Fairchild AFB Spokane, WA	(509) 247-2427	Bell 212 available with 240 feet of hoist cable and winch
MAST Helicopter (Extraction)	Malmstrom AFB Great Falls MT	800-851-3051 AFRCC (406) 731-3250 Ops (406)731-3801 Command Post	Bell 212 available with 250 feet of hoist cable and winch

* fill out EMS helicopter ambulance request form (appendix A)

**if agency helicopter is transporting patient to hospital, they will communicate with the hospital on White channel. Group 13 (Libby Emergency Group)- Channel 8

WHITE Frequency:	RX 155.2800 TX 155.2800 Tx Tone 156.7

TAN Frequency:	RX 155.3400 TX 155.3400 Tx Tone 156.7

Kootenai National Forest Offices

Office/Address	Phone Number 406 Area Code	Latitude	Longitude	Radio Contact
KNF Supervisors Office 31374 HWY 2 Libby, MT	293-6211	KDC
Libby Fire Cache 1263 HWY 37 Libby, MT	293-8768	KDC / East Zone
Canoe Gulch R.S. Office 12557 HWY 37 Libby, MT	293-7773	48° 22.180	115° 20.880	KDC / East Zone
Eureka (Ksanka) R.S. Office 949 US HWY 93 Eureka, MT	296-2536	48° 53.861	115° 03.453	KDC / East Zone
Three Rivers R.S. Office 12858 US HWY 2 Troy, MT	295-4693	48° 28.81	115° 54.21	KDC / West Zone
Trout Creek R.S. Office 2693 HWY 200 Trout Creek, MT	827-3533	47° 52.09	115° 37.52	KDC / West Zone
DNRC Libby Unit 177 State Lands Office Rd Libby, MT	293-2711	48° 21.878	115° 19.053	KDC / East Zone

Law Enforcement

Office/Address	Call Sign/Name	Phone Number	Cell Phone	Other
Montana Highway Patrol	(406) 444-3284
MT Fish Wildlife & Parks Libby Office	(406) 293-4161
Libby District LEO	FS 45 Lepo	(406) 283-7580	(406) 250-7597	KDC can assist with making contact
Eureka District LEO	FS 43 Oropeza	(406) 882-8332	(406) 250-7641	KDC can assist with making contact
Trout Creek District LEO	FS 48 Snead	(406) 827-0707	(406) 249-4508	KDC can assist with making contact

KNF Common Helispots

Murphy Lake Ranger Station

Description	Latitude	Longitude
Ant Flat	N 48° 43.32	W 114° 52.53
Barnaby Lake	N 48° 46.69	W 114° 58.11
Marston Lookout	N 48° 45.87	W 114° 47.33
Gravel pit jct Foothills/High One Rd	N 48° 52.53	W114° 49.05
Stahl Ck/Clarence Ck Trailhead	N 48° 55.47	W 114° 49.05
Rainbow Lake Trailhead	N 48° 59.20	W 114° 49.42
Birch Ck Campground	N 48° 51.23	W 114° 49.42
Clarence Ck Campgound	N 48° 53.26	W 114° 47.55
Sons of Rest Slide	N 48° 55.05	W 114° 45.44
Jct Ten Lakes /Weasel Lake Rd	N 48° 57.19	W 114° 45.21
Jaeger Rd Gravel Pit	N 48° 46.30	W 114° 51.30
Gravel Pit jct Sunday Ck/ Paul Mt Rd	N 48° 35.40	W 114° 47.40
Regen unit on Sunday Rd	N 48° 33.48	W 114° 50.35
Jct Sunday Ck Rd/East Fork Rd	N 48° 32.30	W 114° 51.20
Jct Twin Meadow/Sunday Ck Rd	N 48° 32.30	W 114° 51.59
Jct Sunday Ck /White Ck Rd	N 48° 32.18	W 114° 51.38
Gravel Pit at Portal Rd/Twin Meadow Rd	N 48° 31.43	W 114° 56.52

Eureka Ranger District

Lake Koocanusa Bridge	N 48° 49.40	W 115° 15.76
Eureka Ranger Station	N 48° 53.86	W 115° 03. 45
West Kootenai	N 48° 58.54	W 115° 12.90
Eureka Airport	N 48° 58.13	W 115° 04.23
Rocky Gorge	N 48° 39.33	W 115° 18.70
Dodge Creek Summit	N 48° 55.70	W 115° 21.35
Black Butte Lookout	N 48° 51.85	W 115° 07.45

Libby Ranger District

Happy’s Inn	N 48° 04.97	W 115° 08.51
Libby Dam	N 48° 24.83	W 115° 19.17
Libby Airport	N 48° 17.03	W 115° 29.41
Canoe Gulch Ranger Station	N 48° 22.29	W 115° 20.41
Pipe/17 mile	N 48° 35.62	W 115° 36.75
Barron Creek Flats	N 48° 31.05	W 115° 18.20
South Portal	N 48° 27.02	W 114° 56.86
Cripple Horse Pit	N 48° 28.5	W 115° 15.0
Blue Mountain Lookout	N 48° 29.9	W 115° 27.10
Swede Mountain	N 48° 22.25	W 115° 27.50
Ziegler Lookout	N 48° 34.60	W 115° 15.78

Troy Ranger District

Troy Airport	N 48° 28.81	W 115° 54.21
Sylvanite Work Center	N 48° 43.61	W 115° 52.52
Upper Yaak Work Center	N 48° 55.01	W 115° 39.56
Gravel Pit/Bull River	N 48° 12.00	W 115° 51.60
Mt. Henry Lookout	N 48° 53.03	W 115° 31.05
Keeler Mountain	N 48° 19.27	W 115° 53.69

Cabinet Ranger District

Cabinet Ranger Station	N 48° 52.12	W 115° 37.52
Detwiler’s Field (do not use weeds)	N 48° 04.65	W 115° 58.11
Napoleon Gulch	N 48° 08.27	W 115° 46.53
Star Peak Lookout	N 48° 05.62	W 115° 55.58

DNRC Libby Unit

DNRC Libby Unit	N 48° 21.5	W 115° 19.0
South Portal	N 48° 27.02	W 114° 56.86

Dispatcher clears the air:

***Attention all stations- there is a Medical Emergency in progress. Please clear the air for emergency traffic only.***

KNF Medical Incident Patient Log / Size Up Report

Incident Commander ____________	Radio Frequency _____________Total number of personnel to be transported _____

Assistance Required ____________	(none, ground or air ambulance)	EMT on Scene ___ (Y/N)

Location By: Latitude _____________	Longitude __________________

Legal T____ R____ Section______ 1/4 ______

Nearest Landmark __________________________________________	Road Numbers ____________________________

Directions Via Ground Route_____________________________________________________________________________

Patient Assessment	Don’t announce names over the radio!

*reassess patient every 10-15 minutes

Type, Extent, and Mechanism of Injury __________________________________________________________________

___________________________________________________________________________________________________

Age _______	Sex _________	Weight _____________

*Pulse _______________________	*Breathing _______________

Present rate (Beats per min)	Normal / Shallow / Labored / Deep

*Level of Consciousness ______________________

Alert/Unresponsive-if alert, are they able to recognize their surroundings, who they are, time of year…..

*Skin: (Color) __________ (Moisture) __________ (Temperature) ___________

Normal	/ Pale	Dry / moist	Hot / Warm / Cold / Cool

Red / blue / Grey

*Pupils __________________	Transporting Request____________

Equal and Reactive / Dilated / Unequal	Carry out / Backboard / ATV / Ground Ambulance / Aerial Lift

Known allergies/medications taken/ other information_____________________________________________

___________________________________________________________________________________________

****All dispatchers will have this form as well as the 8 Line Medical Incident Report (found on Page 117 of the IRPG), so either form can be used****

Emergency Medical Services (EMS) Helicopter Ambulance Request Information

*Highlighted info must be relayed to Helicopter Company or sheriff’s dept. when ordering air ambulance*

Date:___________

Time:___________

EMERGENCY MEDICAL SERVICES

HELICOPTER AMBULANCE REQUEST

CAUTION: EMS Helicopters do not usually carry extrication equipment or personnel trained in these procedures. If needed, order these resources following normal Dispatch protocols.

INJURY INFORMATION

A. Number of Patients to be transported: ___________________________

B. Is patient (s) able to walk? YES □ NO □

Explanation: _____________________________________________

_________________________________________________________

INCIDENT SITE INFORMATION

C. Forest / Agency: _____________________________________________________

D. Location of Helispot

Twn: __________ Rge: __________ Sec: __________ ¼ Sec: ________

Latitude: ____°_____’_____” x Longitude: ____°_____’_____”

VOR: _______________ Bearing: ___________°____ Distance _________nm

E. Is Helispot Complete? YES □ NO □

If not, estimate time of completion: _______________________________

F. Conditions at Helispot:

Windspeed: ___________ Direction: __________ Temperature : _________

Elevation: ___________msl Visibility: _________________________

G. Terrain Factors: ____________________________________________________

H. Helispot size and condition: ________________________________________

I. Other Aircraft operating in area:

Aircraft #:__________ AM Frequency:__________ FM Frequency:__________

Aircraft #:__________ AM Frequency:__________ FM Frequency:__________ Aircraft #:__________ AM Frequency:__________ FM Frequency:__________

RADIO FREQUENCIES

*Have responding aircraft use Tan Channel to communicate with ground personnel

J. Helispot Frequency: _________________________________ □ AM □ FM

K. Incident Frequencies:

Air-to-Air Frequency: _________________ □ AM □ FM

Air-to-Ground Frequency: ______________ □ AM □ FM Other Frequency: _________________ □ AM □ FM

Use/Contact: _________________________________

L. Administrative Unit Frequency: _______________________ □ AM □ FM

GROUND CONTACT INFORMATION

M. Contact person at Helispot: _____________________________________

N. Qualified Helitack personnel on site? YES □ NO □

O. Proximity of Helispot to injury site: ___________________________

P. Contact person with injured party(s): ___________________________

RAINY CREEK (OU3) MEDICAL EVACUATION PROCEDURES

If air evacuation is needed in the OU3 boundary consider the following:

Abate helispot with water if practical.

Prompt medical IC for helispot location prior to medevac ship arriving

See about getting Forest helicopter to provide buckets to wet down helispot or dispatch an engine to provide water abatement.

If air ambulance pilot has concerns with exposure to Libby Amphibole (LA) asbestos these best management practices are recommended but not required to help reduce cross-contamination. The USFS can provide an appropriate vacuum and assist with proper disposal of spent cleaning materials and air filters. Coordinate through Dispatch and the Forest Aviation Officer.

- Removal of visible dust from exterior surfaces utilizing a pressure washer or other means that will not damage the helicopter components

- Replacing air filters before demobilizing the helicopter from the area

-Vacuuming the interior of the helicopter using a vacuum equipped with a high-efficiency particulate air (HEPA) filter

- Wet-wiping hard surfaces of the helicopter interior to remove visible dust

- Bagging and properly disposing of spent cleaning materials and air filters

For ground ambulances accessing the Rainy Creek Rd consider the following:

If after hours and gate is closed, use bolt cutters to cut lock.

If injury is life threatening or serious DO NOT stop to decontaminate ambulance.

If injury is non-life threatening or serious and time allows ambulance should have under carriage washed off. During business hours EPA can and will assist with decontamination. If after hours an engine should be dispatched to wash ambulance.