Kyra’s left knee swelled up like a blowfish. She couldn’t put any weight on it; it was tender to the touch; the pain increased with any movement, and there was no way she could move around, let alone sit in a kayak.
We had landed on a surf-swept white sand beach at the end of day six, halfway through a trip on the west coast of Vancouver Island. Carrying the loaded kayaks up to the high tide line, Kyra slipped on slimy seaweed and wrenched her left knee.
We started all the basic first aid things we are trained to do—elevating the knee, icing it and pressure wrapping it in a crepe bandage. That part was easy.
The sun was starting to set and we were on a remote part of the coast: we had to decide whether or not to evacuate Kyra from the trip, and how we’d make it happen.
Evacuation is serious!
Evacuation is serious! There are many variables to consider with implications for all group members including frustration, financial costs, lost time and potential risks.
When deciding to evacuate, it is most important to clearly identify the level of urgency of the situation. There are three levels of urgency to consider.
Urgent evacuations are required in situations where there is an immediate and imminent threat to life or limb. Obvious examples include any ongoing problems with a person’s airway, breathing, circulation; or deadly bleeding. Also, ongoing deterioration in the person’s level of consciousness, high fever for more than 24 hours, recovery from a near drowning, or any traumatic event that involves large mechanism of injury, are situations you’d consider an urgent evacuation.
Situations where an injured person clearly needs medical or other services but whose situation is not deteriorating would be considered semi-urgent. Examples include: broken bones; dislocations; an episode of a chronic but stable medical condition such as epilepsy or angina; severe pain; worsening infections; and vomiting and diarrhea lasting more than 24 hours.
Finally, non-urgent evacuations are required in situations where there is no imminent threat to life or limb, but the participant cannot meet the objectives of the trip because of physical, emotional, or psychological limitations. Examples include acute and chronic tendonitis, debilitating blisters, anxiety or social behaviours that seriously undermine the safety and performance of the group.
How urgent is Kyra’s situation? Kyra is in a great deal of pain and experiencing stress and anxiety. She needs to get to a hospital for treatment, but her condition is stable. So we classified her evacuation as semi-urgent and set about planning the most suitable way to get her out.
Your options for evacuation will depend in large part on your methods of communication. All groups should have at least two types of external communication equipment including both one-way and two-way devices.
In many ways, urgent evacuations are the simplest in that they require immediate action, justifying the launch of a one-way distress signal such as flares, EPIRPs or PLBs or signaling mirrors. Or, using a two-way device, make a mayday call to the Coast Guard on a marine VHF radio, or a 911 call to the police or ambulance via a cell or satellite phone. In these cases, the authorities will decide for you what resources are available for the evacuation.
Our evacuation was not urgent; we felt we had the ethical responsibility and ability to resolve this situation ourselves. So we considered our non-emergency options.
For semi-urgent or non-urgent evacuations, water taxis and other boaters are a great resource. They can be contacted through a handheld marine VHF radio. VHF radios connect you to an entire network of boaters who can help you directly or pass on messages.
Planes are another option, weather and landing-site permitting. Most helicopters and planes use land-based VHF radio frequencies, which do not normally pick up marine radio VHF signals. In some coastal areas, planes and helicopters will also carry a marine VHF radio. Normally, however, you will have to contact the company office to arrange for a plane or helicopter.
Your final option is to paddle the person out. Typically this method is used in non-urgent evacuations, but may be your only option in urgent and semi-urgent evacuations if you are unable to make other arrangements. You are limited by weather, sea state and visibility, as well as the injured person’s ability to travel; if they are unable to wear a PFD or swim, be very judicious in your use of this method.
With Kyra, we managed to contact a fishing boat with our handheld VHF. The fisherman used his more powerful radio to reach the nearest marina. The marina staff arranged for a water taxi to come out in the morning. Kyra had an uncomfortable night and a bumpy ride out in the morning.
Our backup plan was to try to paddle Kyra out: if this was too painful, we would have arranged for two paddlers to head out and arrange for a water taxi. We had lots of food and water for several days.
It should be obvious from this example that preparation goes a long way toward planning a successful evacuation. Preparation includes getting first aid training to help you diagnose a situation and developing a multi-level evacuation plan that suits your destination. You will be much better off if you research before you leave. The more emergency information you gather before you face an evacuation decision, the better the odds of an appropriate decision and a positive outcome.
This article first appeared in the Fall 2004 issue of Adventure Kayak Magazine. For more great content, subscribe to Adventure Kayak’s print and digital editions here.