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Patient Access & ATVs

Considerations for ATV use during patient access & rescue

By Andy Speier
Published Friday, January 18, 2013 | From the March 2013 Issue of FireRescue

Consider this scenario: You’ve been dispatched to a report of an injured mountain biker at a popular state forest area, but the description of the patient’s location is rather sketchy. Units are dispatched from your agency, as well as a neighboring agency that’s equipped with all-terrain vehicles (ATVs). But are the ATVs appropriate for the given terrain? In this article, I’ll discuss responding to calls in these types of areas and the types of ATVs that can assist you with accessing and transporting the patient.  

Response Considerations & Questions
When we think of ATVs, we think of off-roading in difficult terrain, perhaps in a remote area, but even somewhat rugged or less developed parts of suburban metropolitan areas may not be accessible by traditional emergency response vehicles. So unless these areas are addressed and a plan is put into place about how to respond, access and movement of injured victims and personnel may be difficult. These incidents may also require a large number of personnel and take a significant amount of time, which could impact the patient’s condition and prevent personnel and equipment from responding to other calls.

Often in city, county or regional parks, the parks department employees have an ATV, but have your personnel been trained to operate these vehicles in off-road terrain? Does your department have a plan in place for ATV use? Is there sufficient PPE for all personnel on the vehicle? Are these vehicles set up to carry responders’ equipment and a litter if necessary?

Types of ATVs
One definition of an ATV: a small, open-motor vehicle with one seat and three or more large wheels that’s designed for recreational use in rugged terrain. (Note: Manufacturers stopped producing three-wheel ATVs in 1987 due to safety concerns regarding their stability.)

For the purposes of this article, I’ll break ATVs into two categories: quads and utility task vehicles (UTVs). The specs listed below are given as general examples; because several manufacturers produce these types of vehicles, the specs may vary depending on the brand. Although they’re street legal in some countries, they are not in the United States.

Quad Vehicles
Operators straddle this type of vehicle like a motorcycle and use a similar type of controls. They’re made for a single rider, but they also come in a two-seater version known as a tandem ATV where the passenger sits behind the operator. After-market accessories are available and are meant to carry cargo boxes and racks, as well as an additional rider.

Due to the short wheelbase of a quad and their width of about 45 inches, they can be driven on trails that wider vehicles can’t traverse. Depending on the size of the motor, they can reach speeds of more than 60 mph. Remember: Personal safety equipment should include a motorcycle helmet, goggles, gloves, boots and heavy-duty clothing.

These vehicles were designed for recreational and utility use, but they’ve also been found to be quite useful for rescue, EMS, law enforcement and military applications. With a total weight of less than 600 lbs. and a small footprint, they can be transported in the back of most full-bed pick-up trucks (using a ramp to drive the vehicle in and out of the truck).

As mentioned, a limited amount of EMS or rescue equipment can be carried in after-market racks and gear boxes. But due to the open-cab configuration and type of terrain that the vehicle will travel over, your equipment will need to be securely attached to it and protected in gear bags or boxes. A lost or crushed bag of EMS gear is useless. Since everyone has a story about a piece of equipment falling from an enclosed fire engine or EMS unit, it’s not difficult to imagine all the potential scenarios that could occur when carrying equipment on a quad.

UTVs
UTVs are available in four- and six-wheel models, and they’re generally available in an open-cab configuration with a roll bar. They’re more stable than a quad due to their wider width of 60 inches; however, due to their overall length of 118 inches, UTVs are usually transported on open or enclosed trailers.

Two people can sit side by side in a UTV, but models with two additional seats are also available. Because these units are designed for a utility function, they come with a small utility bed in the rear. Compartments and shelves can be installed, as well as a shelf to carry a litter with a patient. The top of the roll-bar cage can also be used to carry additional litters and/or a light bar.

The 60" width limits the UTV’s ability to travel on narrower trails, but where it excels is in its ability to carry personnel and equipment to the scene, as well as transport a back-boarded patient. An attendant seat can also be installed so that rescuers can monitor and treat a patient during transport.

UTVs have additional versatility in that they can come equipped a windshield, if needed, and can even have an enclosed cab. (Seatbelts are standard equipment.) Tip: Due to the terrain that rescue personnel may traverse in a UTV, I recommend wearing a rescue-type helmet with a chin strap along with goggles if there’s no windshield UTVs can reach a top speed of more than 45 mph.

All operators of emergency response vehicles undergo classroom training and a road test prior to driving response vehicles on an actual emergency call; prior to sending personnel out on ATVs, I advise using the same procedure. Unlike a fire apparatus or EMS vehicle, when an operator is responding on a quad, no one sits beside them to oversee the operation of the vehicle.

Uses for ATVs
Primarily, ATVs are used in places where there are no paved roads that can be negotiated by fire and EMS apparatus. During certain times of the year, rutted, muddy, gravel roads may be impassable in traditional apparatus. Other places of use include areas where units would need to traverse a beach, or locations where storms have left excessive debris along roads.

Considerations for ATV Use
First and foremost, when deploying quads, responders should travel in pairs to ensure that if a problem occurs, someone is there to assist and/or call for help.

In both quads and UTVs, communications may be difficult, which is why it’s best to use a headset/radio interface that will allow the user to hear the radio and transmit with a button. When traveling on a quad, both operators should, if possible, use a portable radio with an earpiece so they can hear over the noise of the vehicle. This allows the operators to communicate with each other in case they get separated, or if they need to convey important information, such as trail conditions. They can also communicate with incident command or dispatch regarding changes or updates in the mission status.

If responders on ATVs are responding to an initial call for help, they will need to communicate frequently back and forth with the dispatch center and the incident commander (IC) to determine the ATV’s best route of travel to the scene. But prior to deploying, responders will need to have a pretty good idea of where they’re attempting to go. A face-to-face with the IC is ideal because it allows responders to review their location and the patient’s location on a map. If this isn’t possible, either because the command post is far away or some other reason, the responders and the IC must communicate via radio about specific objectives and directions.

Note: Don’t assume you’ll always have cell phone service. I’ve found that when responding on these types of calls, there’s usually limited to no cell service. On long-duration incidents, portable radio batteries may need to be swapped out and charged as. As a company officer, I put a spare radio battery in my turnout pants’ pocket each morning to ensure that I could swap out the old battery for a new one if needed. When leaving response vehicles to ride or walk into an incident, consider carrying a spare, charged radio battery.

Tools & Equipment
In addition to carrying equipment to treat a patient, what else should you carry on an ATV? To answer that question, you must ask another question: What can go wrong mechanically and what can you fix? A basic tool kit may keep you on the road. Go through your vehicle with your agency’s mechanic and get their recommendations on what to carry. Always carry (or at least consider carrying) portable lights, a space blanket, water, and clothing that’s appropriate for being outdoors for an extended period of time or overnight.

Other tools to consider:

  • GPS: Remember the group that went out on a three-hour cruise (“a three-hour tour”)? They could’ve put a GPS unit to good use. With a GPS, you can relay your coordinates back to the IC once you locate the victim. Or if you’re attempting to get a helo to land somewhere near your location, GPS coordinates can help.
  • A map: Nothing beats a detailed area map that’s been updated with which roads your apparatus can drive on, bridges you can cross and boat access to bodies of water.
  • A winch: This could be used on either a 4 x 4 response vehicle or a quad, and it may make quick work of pulling out a vehicle that’s stuck in the mud.

Patient Transport
In a perfect rescue scenario, once you access and treat a patient, they can be flown by helo to a local emergency room—but many times, this is not the case. In a wooded forest area, there may not be a safe place to land a helo, and most medical transport helicopters don’t have hoist capabilities. Even if your local helicopter team does have hoist capabilities, weather may not be cooperative. The point: Don’t assume that you can always fly your patients out of a situation and to the nearest hospital.

As an alternative, UTVs may be outfitted with a mount that can accommodate a Stokes litter basket. Some may also have a seat for an attendant to monitor the patient. Due to the size of the UTV and the mounting configuration of the litter, the patient will be loaded feet-forward. This will give EMS personnel access to the patient’s head while walking with the vehicle or riding in the back.

Due to the size of a quad, it’s not possible to carry a back-boarded patient on the vehicle in a safe and secure manner (but it’s not entirely impossible either). A trailer may be used to tow the litter behind the quad, but due to the position of the exhaust at the rear of the quad, the patient will again need to be loaded in a feet-forward position.

Some small trailers can have a seat installed toward the rear and above the axle so that an attendant can monitor the patient as they’re being transported. In situations where the trailer doesn’t have a seat or the vehicle must travel along narrow terrain, personnel will have to walk alongside the trailer to monitor the patient.

Tip: Regardless of whether the patient is being transported on a UTV or in a litter trailer pulled by a quad, consider providing ear plugs or other forms of hearing protection to the patient. Since nearly all back-boarded patients will have C-spine precautions in place, patients may not be able to wear a helmet. A Lexan litter shield will provide protection to the patient’s face and eyes, and will reduce some of the exterior noise.

What Happened?
So what happened to the injured mountain biker? The first arriving BLS and ALS crews walked 2½ miles with their gear on a single-track trail. After several radio exchanges, and checking a map from the Department of Natural Resources, rescuers determined that closer road access was available. There was a slight delay due to a locked forestry gate, but after some creative rigging, it was opened and the vehicles were able to get within a few hundred yards of the patient.

The patient, complaining of neck and back pain, was back-boarded and transported with a litter wheel to a transport unit that took a long, slow drive out of the forest on a wet, bumpy, gravel road.

Author note: I would like to thank Lt. Chris Patti of the McLane-Black Lake (Wash.) Fire Department for his assistance in gathering information on ATVs.

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Here's an ATV with a rescue trailer attached to it. A trailer may be used to tow the litter behind the quad, but due to the position of the exhaust at the rear of the quad, the patient will need to be loaded in a feet-forward position. Photo Andy Speier

Patient Access & ATVs Gallery

Published Friday, January 18, 2013
Andy Speier shows the various kinds of ATVs and their configurations for accessing and rescuing patients in rugged terrain.