In the early 1970s, Rita Cloutier, Ray Cole, Gene Harrison and I, at the instigation of the Potomac Appalachian Trail Club’s Council, organized the Appalachian Search and Rescue Conference. Ray, Gene and I put as much of the ASRC’s history as we could remember in a document on the ASRC Archive called The Early History of the ASRC. Part of that bears repeating here, the two incidents that resulted in the ASRC’s creation. I refer to this as the ASRC’s founding myth.
The first incident: one late fall, a boy scout troop was out for a hike along the Virginia/West Virginia border, on the west side of the Shenandoah Valley. The place is called Wolf Gap, and it’s pretty wild compared to, say, Shenandoah National Park. As the crow flies, it’s about twenty miles due west of Front Royal, Virginia, which is at the northern tip of Shenandoah National Park. The PATC maintains a cabin up the trail from the gap, and makes maps of the trails in the vicinity.
Wolf Gap is in the George Washington National Forest. I don’t know if you know this, but the management and culture of National Forests and National Parks are as different as night and day. (Having been a summer-seasonal National Park Service Ranger for several years drilled this into me.) There are many differences, such as hunting being allowed in forests but not in parks. But for our purposes, the main difference is jurisdiction. National Park Rangers generally have “exclusive jurisdiction”—they are in charge of all search and rescue and other emergency services and law enforcement within a park. However, National Forest Rangers generally have “concurrent jurisdiction”—most emergency services within a national forest are handled by the local counties and other municipalities.
Anyway, the boy scout troop was on the trail from Wolf Gap to Big Schloss (“big fortress” in German, a reference to the big blocky cliffs). Actually, they were on the way back, and they were behind schedule. It got dark. And it started snowing; hard, and fast. When they straggled back to the cars in misery and disorder, a couple of the scouts were missing. So two of the adults set out back up the trail, in the dark, and in heavy snow.
Well, the two kids showed up at the cars, but they hadn’t seen the adults. As it got later and later, there was no sign of the two adults. After waiting, and waiting, someone finally went to a pay phone (remember, this was long before cellphones) and called PATC headquarters in DC and asked for help. They said they needed people with headlamps and snowshoes to go out and look for the two adults. Now, in those days the PATC had no callout roster, nor any sort of emergency response plan. This was even before the days of the Trail Patrol, not that even to this day the Trail Patrol is any sort of response team, or patrols in this area. The people at PATC HQ suggested they call the local County Sheriff and the Forest Service District Office, which they did. Finally, the next morning the local county and forest service people managed to get some people out on the trail, and of course they just found two frozen bodies.
The second incident: It happened at Harper’s Ferry. Harper’s Ferry is where the Shenandoah River joins the Potomac River, and the greatly-enlarged Potomac pours through the Blue Ridge. It’s an impressive gap, with some nice cliffs on either side. The cliffs on the northern side are about 300 feet high, and known as Maryland Heights. I’ve climbed there, and it’s a real challenge. There are some overhangs, but the real interesting challenge is that there’s a train tunnel through the bottom of the cliff. And this is for the B&O mainline, so quite frequently a big freight train barrels through the tunnel and the whole cliff shakes. The area is a popular National Historical Park, but unlike most NHPs, it has plenty of backcountry and trails and cliffs (and even John Brown’s Cave).
Here’s the story as we heard it. Now this was back before the National Park Service Rangers at Harper’s Ferry had their own vertical rescue capability. They do now and have had for the past several decades. Well, there was this climber who was hurt and stuck halfway up the cliff (or halfway down, I don’t know if he was climbing or rappelling or what). The Park Rangers had a mutual aid agreement with a local fire department (Bolivar?) to handle cliff rescues, so they called the fire department. And the way we heard it, this fire department lowered a wire-basket Stokes litter down to the guy, with a rope on the head of it, and a tag line on the bottom. And I guess someone rappelled down and strapped him in the litter. But then, instead of lowering with someone tending the litter, they just lowered on the top line while pulling on the bottom line from below. And as they guy got lowered down, the litter kept spinning around, crashing against the cliff face, smashing his face pretty bad, enough to keep him in the hospital for quite a while. The Park Service was not happy.
Based on this narrative, true in all respects or not, the ASRC was founded with a primary charge of improving SAR training in the mid-Appalachian region, so that when things like this happened, there would be more trained individuals to respond. At first, the ASRC was not involved in response at all: it was all about training people in SAR skills, and only later did we organize local Groups to provide response organizations. 
From the beginning, the ASRC was all about training and credentialing, and this Guide continues this emphasis, more than 40 years later.
— Keith Conover, July 2019
ASRC Training and Credentialing 
The ASRC training and credentialing system’s documents fall into four parts. 
First: we publish training curricula later in this ASRC Training Guide. These are what members are supposed to learn and be taught, including both knowledge and psychomotor skills. The curricula list teachable subject areas and topics, divided by subject and training level. Group Training Officers and instructors may use them to construct classes and training programs to get members to the levels established in the Training Standards
Second: we publish performance standards in the ASRC Training Standards, a separate document. These are what members are supposed to be able to do once they have completed the curricula. 
Third: we publish a set of Position Task Books (PTBs), one for each of the credentialing levels, which provide verifiable checklists of the performance standards and other requirements for each of the levels. Also known as “skills checkoffs,” the PTBs include checkoffs for when a member demonstrates mastery of one of the skills of the Training Standards, to the satisfaction of the Group Training Officer (GTO) or someone designated by the GTO. They also provide a checklist for outside credentialing or other requirements, such as completing National Incident Management System (NIMS), Incident Command System (ICS) and aircraft safety online training.
Fourth: the semi-independent ASRC Credentialing Board establishes test methods based on the performance standards in the form of written and practical tests. Written and practical tests challenge members to demonstrate mastery of a representative sample of the knowledge and skills of the curricula, in accordance with the performance standards in the ASRC Training Standards. 
The first three are filed in the ASRC Archive () and linked on the ASRC website (); instructions on applying to take written and practical tests are available at asrc.net as well.
The This is not the ASRC Training Standards; those are in a separate document. The ASRC Training Standards are performance standards to which ASRC members of various levels are held. 
This ASRC Training Guide explains the why and the what for training members (or from a members’ perspective, what they need to learn), and has two parts. 
This first part is an overview of the ASRC’s system for training and credentialing individual members. This lays out the discussions that led to the current training levels, why they contain what they do, and why the levels are as they are. 
The second part lays out detailed curricula for the different credentialing levels. It is an authoritative reference for content we think should be taught to members, and learned by members. It’s what we want members to know, and what psychomotor and interpersonal leadership skills to practice, to do what we expect of them safely and effectively.
Most important is what the training curricula are not. The curricula are not required sequences in which topics must be taught. They are not lesson plans, though they certainly make it easier to create your own lesson plans. They are not required classroom material, as members can get this information in many different ways, or may know some of it already. It is not a list of what’s going to be on the written and practical test, though we suspect the ASRC Credentialing Board will look carefully at the Training Guide and Training Standards in crafting their written and practical tests. It is not a list of requirements imposed by outside agencies; it does not say anything about required clearances, or required ICS online classes, except where they relate directly to what we want them to know. For example, some of the IS-100 (ICS-100) online FEMA course is relevant to what we expect of members, but some of it is not; we note in the curriculum which parts we think are useful at a particular level and which we think or not. This is a guide to the Credentialing Board in creating tests. And, while FEMA expects field members at a particular level to have completed the online IS-700 class, there is nothing in IS-700 we think is necessary for our members to be able to do their jobs in the field, so nothing from IS-700 appears in the Field curricula. It is not a list of what equipment members need to show they possess when they undergo their required pack checks.
Where there is an “ASRC way” to do something, as with the ASRC Seat Harness, or nontechnical evac litter bearer rotation, the details are included or referenced. This does not mean that “The ASRC Way” is the only right way, and this does not mean that an instructor cannot teach other reasonable alternatives. This does mean that the way described is an acceptable technique, and that ASRC members are expected to be familiar with it.
The ASRC training system originated circa 1972, even before the ASRC was incorporated in 1974. Since then we have revised our training system many times. Each time, we said that we needed a training curriculum. Finally, 45+ years later, it appears in this Training Guide, at the same time we were working on a major revision of the Training Standards (version 8.0). The question then arises: if there are conflicts between the Training Standards and the Training Guide, which should be authoritative? Or perhaps a better question is where should we start as we work on revising our training system? 
A reasonable answer is that there are four parts to consider when we revise our training system; this is similar to the four parts of our documentation, with one difference.
First is a job description, a brief statement of what we expect someone at that credentialing level to be able to do. This includes both common tasks, such as leading a search team of local volunteers, as well as rare but important tasks such as dealing with a seriously ill or injured team member. These appear in the ASRC Training Standards, and are summarized in the grid on page 18 of this Training Guide.
Part two is a curriculum, a list of educational topics, which forms the bulk of this Training Guide. 
Part three is the performance standards, which form the bulk of the ASRC Training Standards. 
And part four consists of the test methods, which are the online written tests, PTBs (position task books) and practical tests created and administered by the ASRC Credentialing Board, following the policies in the ASRC Credentialing Policy Manual, and based on the performance standards in the ASRC Training Standards.
Changes to any of these four interrelated chunks of information should prompt an inspection of, and maybe changes in, the other three chunks. From a cognitive, how-easy-is-it-to-wrap-your-brain-around-it viewpoint, the easiest to review, critique and change is the job descriptions, but they’re not very detailed. 
The next-easiest chunk to critique and revise is a curriculum. It’s detailed enough that people can get a mental handle on it. And it’s easier to create performance standards from a curriculum than to create a curriculum from performance standards. 
Performance standards drive the ASRC Credentialing Board’s test methods. But they need the details of a curriculum, and its references to the literature, to create test questions and criteria for passing practical tests. 
This is illustrated in the diagram on the next page.

When the ASRC’s training started, in the early 1970s, there were no GPS units, no cellphones, no laptop computers, and topographic maps were only on paper. As the world changed, our training has had to change to keep up. Reviewing and updating our training, performance and credentialing is continuous. But certain issues tend to occur over and over, and this and the following sections lay out some of the reasoned discussions about them and the resulting decisions about our training and credentialing system.
Those who cannot remember the past are condemned to repeat it. ­­—George Santayana

Originally, we just offered certifications in certain skill areas, basically class-completion certificates. In the late 1970s when the ASRC started setting up local Groups with a response capability, one of the first things we did was to establish a set of training standards for individuals. In the decades since then, they have been tweaked many times, but the basic concept has stayed the same: a list of what someone needs to know and be able to do to be effective at doing wilderness search and rescue in the mid-Appalachian area.
At the time, there were no such standards anywhere in our mid-Appalachian area. We looked at the existing Mountain Rescue Association (MRA) standards, and modeled ours, in many ways, after the MRA’s; that’s where the Rescue level and name came from. In fact, we intended, and eventually succeeded at, getting the ASRC to be the MRA’s eastern/Appalachian region, though the two are now separate entities. 
The name of the standards has changed; at first it was the ASRC Training Guide, later renamed to ASRC Training Standards, and now we have this document taking up once again the title of Training Guide. 
The names of the credentialing levels have also changed over the years. At first (1970s), we had Trainee, Basic and Rescue levels; Trainee was initially limited to 6 months. In 1988-89, we changed Basic and Rescue to Field Team Member (FTM) and Field Team Leader (FTL); we also added Base Radio Operator (BRO) which has been in the Training Standards ever since, but nobody has ever been credentialed as a BRO. We planned to add Rescue Specialist and Tracker but to this day have never developed these credentialing standards though we certainly have many experts in technical rescue and mantracking. 
In 1988, we added Incident Staff (IS) and Incident Commander (IC) as credentials. There was much discussion of whether IS and IC credentials required prior or ongoing field certification, a discussion that continues to this day. The persistent consensus, though by no means a unanimous one, was that these “Base” credentials require prior field experience to be able to appreciate what you’re sending members out to do, but that ongoing field credentialing is not necessary. 
In 1993 we added Alert Officer (AO) as a credential (that was when the ASRC responded to missions as the ASRC as opposed to Groups responding), and in 1994, we added Callout Qualified (COQ or CQ) that replaced the Trainee level that we had long ago dropped. 
In 2008, we added standards for Conference Dispatch Officer (CDO) for managing resource coordination during large operations.
In 2011-12, we renamed the Incident Staff (IS) level to Search Manager IV, and the three levels of IC we had developed to Search Manager III, II and I. This was a response to the idea that seldom would we be running an entire operation; generally a representative of the Agency Having Jurisdiction (AHJ)/Responsible Agency (RA) is in overall charge as the Incident Commander, and handles the ICS logistics and finance functions, whereas one of our Search Managers may manage much of the Operations and perhaps Plans functions.
Old versions of the ASRC Training Guide and ASRC Training Standards are available at .

For decades, there was sentiment in the ASRC for standardized written testing at the Conference (ASRC) level. Traditionally, written and practical tests were developed and administered by each individual Group Training Officer (GTO), based on the ASRC Training Standards. Conference-wide testing finally occurred in 2017, when we started moving the responsibility for credentialing from GTOs to a semi-independent ASRC Credentialing Board. 
Why, after decades of discussion, did we finally move testing to the Conference level, and do it via a semi-independent Credentialing Board? The momentum to centralize testing had been there for decades, but another factor that finally made the change happen: “self-credentialing.” 
Some Agencies Having Jurisdiction/Responsible Agencies (AHJ/RAs) were becoming concerned about the validity of teams credentialing their own members by testing by other members of the same team. They were concerned about the “old boy” network, where members would pass other members based on friendships rather than competence.
The AHJs/RAs started expecting teams to use external credentialing for their teams. We wanted to make it clear that ASRC’s credentialing was not done internally by ASRC Groups, and that it was at least as rigorous as the testing and credentialing done by other organizations.
The ASRC Credentialing Board consists of a single member appointed by each ASRC Group. The Credentialing Board reports to the ASRC Chair/President, but is independent in terms of the creation, administration and scoring of tests. 
 Written tests are online, and practical tests are scheduled by the Credentialing Board, ensuring that the evaluators for any practical test include evaluators from ASRC Groups other than the Group of the member being tested. Details are provided in the ASRC Credentialing Policy Manual, available in the  and linked at .
Reasons for the 
It is worth examining why we have standards for credentialing levels, and why we have credentialing levels at all. 
Originally the ASRC just offered course completion certificates, but soon moved to having named levels of credentialing, each including a wide range of topics including survival, land navigation, communications, search skills, first aid/medical skills and rescue. There were plenty of arguments about the specific knowledge and skills for each the levels, but almost no introspection about why we needed levels at all.
So, why do we need such levels? Why not just let everyone to train as they desire and use them based on whatever abilities and training they have? That actually might be a semi-reasonable approach, but there are some solid reasons to have a set of training levels.

The Federal Emergency Management Agency (FEMA) sometime around 2005, started typing emergency response resources, so that those requesting resources and those sending them know they are talking about the same thing. A resource can be an aircraft, an ambulance, or a team of people. In each case, the FEMA typing depends on the capabilities of the resource.
The current draft/revised FEMA typing describes a “Land Search and Rescue Team” thus: A Land Search and Rescue (SAR) Team conducts search, rescue, and recovery in one or more of the environments of land or wilderness, in response to natural and human-caused events. In the FEMA typing, Land SAR Team has two Types, Type 1 and Type 2. A Type 1 team consists of at least 9 people, one Type 1 Land Strike Team/Task Force Leader, two Type 1 Land SAR Team Leaders, and six Type 1 Land SAR Technicians, all of whom are further defined as far as their individual capabilities. The Type 1 team’s environment is specified as “wilderness.” A Type 2 team’s environment is specified as “land.” A Type 2 team has six members.
FEMA further defines the roles and capabilities of Type 1 and 2 Land Search and Rescue Technicians, including such arbitrary stipulations as: 
Performs search, rescue, and recovery in: 
a. Land environments: Areas located within, or immediately next to, urban boundaries, no further than 0.5 miles (0.8 kilometers) from a road readily accessible by emergency personnel, and which may include parks, wild areas, private, state, and municipal lands 
b. Weather conditions not including snow or slippery ice conditions 
c. Yosemite Decimal System ( YDS ) classes 1 -2 terrain
There are corresponding requirements for a Type 1 Land Search and Rescue Technician.
While FEMA insists this is just “typing” and not setting standards for training and credentialing, pretty much everyone else sees this as FEMA setting standards for training of individuals. This seems to be more prevalent in urban search and rescue, where the FEMA typing is taken very seriously. However, we are aware of no requests of an ASRC Group, ever, specifically for a FEMA Type 1 or Type 2 Land Search and Rescue Team, and few within the ASRC argue that there is a need to prepare for such an eventuality. 
However, the idea that we should take the FEMA typing of individuals into account is real, and a consideration whenever a search and rescue organization is creating standards for credentialing individuals. The FEMA typing for wilderness search and rescue individuals are short and vague, except that they specifically require that certain FEMA online National Incident Management System/Incident Command System classes be completed.
Too, some states such as Virginia and Pennsylvania set their own standards for training and credentialing of SAR team members, though some states have accepted ASRC credentialing as the equivalent of the state credentialing. 
In Pennsylvania, the standards are pretty much voluntary; Virginia is much more emphatic about the need for SAR team members to be credentialed by the state, and offers state-sponsored training called the GSAR College. The ASRC was instrumental in setting up the GSAR College in the first place; the ASRC’s Keith Conover wrote the first GSAR textbook back in 1972 for Virginia Wing, Civil Air Patrol, but later this program was taken over by the state government.
The international standards-setting organization that started in 1898 as the as the American Society for Testing Materials, later the American Section of the International Association for Testing Materials, and now just known as ASTM, has a Committee F-32 on Search and Rescue. The fact that ASTM standards are based on a rigorous consensus process make them very credible. Many ASRC members have contributed to the work of ASTM F-32 over the years and continue to do so today. ASTM standards are entirely voluntary, as ASTM has no enforcement mechanism. 
While ASTM standards for things, such as climbing helmets, are widely adopted by industry, ASTM standards for services, such as SAR, have had less penetration in the SAR community. Still, agencies and organizations looking to set their own SAR standards tend to look closely at the ASTM standards in crafting their own. If you hew to ASTM standards, it may offer you some protection if your agency or organizations ends up in court. ASTM standards have to be purchased; ASRC has purchased the relevant standards for use in crafting our own standards. 
So, there is pressure from governments wanting us to credential our members to certain levels, and an international standards-setting organization that we should take seriously. 
 and Pride
Most any company or organization wants its employees or members do a good job of what they’re supposed to do, and do it safely. Credentialing to certain training levels, and whenever possible assigning people jobs consistent with their credentialing level, certainly makes sense from this perspective. 
But credentialing is also a matter of pride. Once you are credentialed in a profession, once you get your credentialing for EMT or paramedic or firefighter or law enforcement or welding or nuclear power plant operation or a college degree, you feel some pride in that accomplishment. 
If on one side of the professionalism coin is pride, the other side is a desire to protect the profession. You don’t want incompetent people giving the profession a bad name. You don’t want them doing a bad job, or hurting themselves or others publicly. So once you’ve got your credentialing, you’ve got motivation to make sure that others doing the job are also credentialed. 
This desire for professionalism isn’t something new in the 21st century or even the 20th or the 19th. Guilds have restricted trade since at least mediæval times, and the profession of medicine since ancient Periclean Greece. 
This is true not only of the trades but also the “learned professions,” such as law and medicine, which usually have set a high bar to credentialing, for reasons such as: 
to improve the view of the trade or profession in the public’s eye,
to restrict membership to keep the income high for guild members,
to protect the public from unscrupulous or incompetent practitioners, and
to keep the government from stepping in and regulating the trade or profession.
Even if the “income” that our volunteers get is just recognition and pride, all these apply to the ASRC.
Pride sometimes gets a bad name, as with the “sin of pride” or, in ancient Greece, the overweening pride known as hubris (ὕβρις) that invited the wrath of the gods. And since ancient Greece, the literature is full of those with an overweening pride who met a bad end.
But it’s hard to see unselfish pride in the profession as a whole as a bad thing. And pride in a job well done is, by most accounts, morally superior, to be encouraged, and when that job is helping others, doubly to be encouraged.

Training topics and performance standards for a particular level serve as guides, but not only to what you need to learn or be able to do. It also encapsulates the expert advice of many people, quite a few of whom are smarter and more experienced than you, at least in terms of certain aspects of search and rescue, about what you need to know to be an all-around competent member of a SAR team. 
New members don’t only want to learn some SAR stuff, they want to learn what they should learn, and be confident that they have learned the right stuff. 
And, once you have achieved the credential for a certain level, you feel a sense of accomplishment. Maintaining impetus in new member’s training by moving from a three-level system to a four-level system was one of the motivations for the 2014-2019 restructuring of the field training standards. Slipping another merit badge into the middle of the system, if you will. And since recognition is one of the ways we “pay” our members, going from three levels of recognition to four means one more formal recognition of members’ work. It’s a pay raise.

Assume you’re in Base. Assume you’re trying to put together a 2-person team for a fairly long hasty task along a stream, and the weather’s threatening. There are two ASRC members from another Group, people you don’t know, and you’re thinking about sending them out as a Field Team on this task.
You’d feel a lot better about doing this if both of them were credentialed to ASRC Field I rather than if they’re both just ASRC Field III. Everyone is different, with different outdoor experience, different aerobic condition, and different judgment and mental toughness. Still, the ASRC field credentialing levels give you a good estimate of someone’s SAR competence.
If you’re out in the field with people from other ASRC Groups, knowing the others’ credentialing level gives you some idea of what minimum competence to expect from each of them. Yes, they may and probably do have expertise and credentialing in other specialties, such as medical or tracking or vertical rescue. But if you know their ASRC Field level, you know they meet certain minimum base competence in things like land navigation when you’re going out on a backcountry task.
2014-2019 
Starting in 2014, and extending for several years, we embarked on an ambitious restructuring of the ASRC training and credentialing. 

One impetus for this was that states were (to some degree, justly) suspicious of self-credentialing of SAR teams and other emergency responders. They looked for external credentials which they viewed as more trustworthy. Thus was born a semi-independent ASRC Credentialing Board that was responsible for developing and conducting Conference-wide testing to the various credentialing levels. This started in 2018 with the existing Training Standards 7.2 FTM level. It started with PTBs (Position Task Books, the Federal acronym for what most call “skills checkoffs”). Then we established standardized online written testing. And then in-person practical testing, done in a way that involved at least some testers from outside the member’s Group, to avoid any impression of Group self-credentialing. 

Another impetus was driven by FEMA and aided and abetted by the standards-setting organization ASTM; it was the PTB: Position Task Book. While most ASRC Groups always used something similar called skills checkoff sheets, FEMA and ASTM were demanding a standardized format for these skills checkoffs, a process that specified who could sign off on a particular required accomplishment, and that we call it by the TLA (Three Letter Acronym) PTB. 
Steve Weiss, the ASRC’s first Credentialing Board Chair, was deeply involved in NIMS (the National Incident Management System) and the FEMA credentialing system; but he disclaims any responsibility for the FEMA PTB format and promised the ASRC PTBs would be much better. He went to the length of borrowing an out-of-print book on the scientific basis for effective forms design.

Likely a more important impetus to the ASRC’s credentialing restructuring, at least to us internally, was that our FTMs were leading teams of firefighters and spontaneous volunteers all the time. So, we really needed to change the name “Field Team Member” to something else. 
And there was some dissatisfaction with what was required in the existing FTM and FTL standards. 
And some Groups added lots of stuff to the base ASRC CQ level, and then people ended up sticking at CQ for a long time, at a level that was initially viewed as just the equivalent of the old time-limited Trainee membership. 
And the fact that we wanted the credentialing levels to be a bit more granular, so that it was easier, and therefore more attractive, for members to move up the credentialing ladder. 
 
Starting in the 1970s, the ASRC required members to complete a 16-hour Red Cross Standard First Aid course and a separate CPR course. There had been debates about the validity of CPR training, which is essentially useless in the backcountry. But, we often operate at a Base, where CPR might be of use, so the CPR requirement persisted. There was always some discussion of replacing the Red Cross course with a wilderness first aid (WFA) course requirement, but the lack of a national standard for WFA training and credentialing precluded this until more recently.
Back in the 1990s, ASRC members helped the Red Cross develop an add-on wilderness first aid module called When Help is Delayed (1996), and the cover of the text even featured two ASRC members from Shenandoah Mountain Rescue Group. 
Despite having been one of the most popular American Red Cross training courses since the 1950s, though, the Standard First Aid and Personal Safety class died an ignominious death in the 1990s, being watered down to just a few hours of online training and covering no more than a tiny fraction of what it used to cover. The Red Cross also scrapped the When Help is Delayed module, and instead partnered with the Boy Scouts to offer a wilderness first aid course specifically slanted to the needs of the Scouts.
Back about 2010, the ASRC started talking about integrating wilderness first aid into our training standards. After much prodding and pushing by the Medical Committee, in 2016, version 7.2 of the Training Standards changed the Red Cross first aid and CPR requirement in the FTM standard to 
5. Hold a current First Aid certification, as outlined in
the ASRC medical guidelines.
6. Hold a current CPR certification, as outlined in the
ASRC medical guidelines.
The medical guidelines in question were presumably the recommendations of the Medical Committee, which were to incorporate the wilderness first aid (WFA)educational objectives recommended by the Wilderness Medical Society (WMS) into our training standards; and indeed this was also done in Version 7.2 of the Training Standards, but it all went into the FTM standard (actually a fair bit of it was there before, as we long required FTMs to, for example, have a good understanding of hypothermia). The Medical Committee noted that Groups could (and should, when possible) integrate wilderness first aid training into Group training, but that also it would be possible for a Group to outsource this training by having members complete an external wilderness first aid course. 
In 2013, the Wilderness Medical Society (WMS) published a pair of articles that arguably are the closest we have to a national wilderness first aid (WFA) standard.
There was some feeling that the ASRC’s wilderness first aid material should be spread throughout the various training levels. The Medical Committee also recommended that when the ASRC credentials a member at a level that includes all of the Wilderness Medical Society wilderness first aid (WMS WFA) objectives, the ASRC also include on this member’s credential that the member has completed WFA training and is credentialed by the ASRC in WFA. Note that the WMS WFA standards also include basic CPR. The first draft of this document had a bit of WFA in Field IV, a bit in Field III, and the bulk in Field II, meaning that anyone newly-credentialed as Field II under the new system would also get an ASRC WFA credential, noting that it meets the guidelines published in the WMS’s journal, Wilderness and Environment Medicine. 
Those who are using this curriculum to organize training for ASRC members may, if they wish, “contract out” some of the training by having members attend an outside wilderness first aid class and perhaps a CPR class, and presume that the wilderness first aid and CPR portions of the Field curricula were thus accomplished. Or, it is a relatively simple matter to work the wilderness first aid topics into relevant search and rescue training, for instance, covering splinting when covering packaging in the litter. The Medical Committee unanimously recommended this type of integrated training as being optimal. 
Regardless of whether this wilderness first aid and CPR material is covered internally or externally, members are expected to know the material covered in this ASRC Training Guide and to be able to perform the skills listed here and in the ASRC Training Standards. 
As with the Field training in general, there was strong sentiment that the wilderness first aid component should be right-sized for our environment. Thus, no need to cover altitude illness. Our training should also be optimized for search and rescue team members working in a system where first aiders will often be working with advanced medical providers of various levels, and often have physician medical direction. This is a much different context than Boy Scouts doing outdoor recreation. 
If a subject or team member has a condition that could benefit from an advanced technique, such as needling a chest for a tension pneumothorax, or having a fasciotomy for compartment syndrome, recognizing this need may be important even at the first aid level. During an ASRC operation, a paramedic, nurse or physician who knows how to decompress a slowly-developing tension pneumothorax may already be in the field and able to respond to the scene quickly enough to save a life. Realistically, this will most likely be an ASRC or other field team member who has fallen and cracked a rib causing a pneumothorax.
In the case of compartment syndrome, simply recognizing this early, and changing the method and urgency of evacuation, might save a limb. Those identifying the problem could contact Base and arrange for an urgent improvised evacuation to a LZ for a medical helicopter evacuation to a trauma center. 
While these conditions are beyond the capacity of a wilderness first aider to treat, in the ASRC setting, they are important enough to be able to tentatively identify and take appropriate actions.

As we worked on Version 8 of the Training Standards, we considered all the topics discussed above and other different and sometimes conflicting goals for this revision.
One was state standards. In the beginning, the ASRC was very Virginia-centric, and thus having the ASRC standards meet or exceed the Virginia SAR standards (which the ASRC was instrumental in developing) was very important. Now the ASRC has spread over many states, some with very different SAR standards, so direct correspondence with the Virginia standards is less important. 
Being consistent with national SAR standards was also a pressure on the Version 8 development process. However, there really aren’t national SAR standards. 
FEMA has types for teams, which are not really standards. NASAR has its own credentialing program, but it’s not a national standard in the ordinary sense of the word, it’s a proprietary credentialing system of a non-governmental organization. True, the Mountain Rescue Association has standards on what individual members must know, but those are only applicable to member teams, and the MRA has no credentialing process for individual team members. 
The closest to national SAR standards are the individual, very-granular, standards developed by the voluntary international standards-setting body ASTM. But few organizations or states adopt ASTM standards as-is, they tend to use them as models, which is also the approach the ASRC adopted in creating the Version 8 Training Standards. 
; Frequency and Severity
Perhaps the most pressure on the Version 8 standards came from the idea that we need to make them meet our actual needs. 
That “right-sizing” argument, however, is not as simple as it might seem. You can’t just look at how often our members do something and use that to decide what to put in the curriculum. Particularly as far as safety, you not only need to consider how often we encounter the problem, but also:
how serious the problem can be,
whether there is something effective we can do to prevent the problem, 
whether there is something effective we can do to deal with or treat the problem once it occurs, and
how much of a hassle it is to prevent or treat the problem, for example, how heavy, bulky or expensive something to prevent or treat the problem would be to carry around in your pack all day, or how hard it is to learn to deal with the problem.
A trivial example is ice-axe self-arrest. Many ASRC members are mountaineers who are quite proficient at ice-axe self-arrest on glaciers and snowfields. Ice-axe self-arrest is prominently covered in the NASAR Fundamentals of Search and Rescue textbook. But the opportunity to exercise this skill in the heavily forested mid-Appalachians are pretty much constrained to artificially-maintained ski areas, where being able to dodge out-of-control skiers is more important than ice-axe self-arrest.
The ASRC’s Allegheny Mountain Rescue Group is a certified team of the Mountain Rescue Association, and for their team re-credentialing, they need to have members capable of ice-axe self-arrest and placing snow and ice anchors. This is in case they get called to assist another MRA team with a winter rescue, such as an above-timberline rescue in the Adirondacks. But for the rest of the ASRC, these skills are much less likely to be needed than the low likelihood that AMRG will need them. 
Diagnosis and treatment of altitude illness in the mid-Appalachians – even the highest peaks are not high enough to make altitude illness other than an exceptionally-rare problem –  is likewise not worth including in our curricula, however important they might be for recreational mountaineering.
Another example: in land navigation, “boxing” around obstacles. This may make sense on a wide-open desert, but in the up-and-down, heavily-wooded central Appalachians, this, although taught in the NASAR SAR Tech program, has essentially no application here. 
For yet another example, consider rattlesnake bites. Some people (probably those with a pathological fear of snakes) have suggested that our wilderness first aid kits should contain antivenin to give in case of a rattlesnake or copperhead bite. While these bites can be sometimes limb-threatening, they are very rarely life-threatening, and poisonous snakebite is exceedingly rare, especially for search and rescue personnel. So from that analysis alone, it’s probably not appropriate to stock this in our wilderness first aid kits. And, antivenin is appropriate only for envenomated bites, which is just a fraction of defensive bites against humans. True, the antivenin is fairly light and small. But the clincher: it’s about $500 or more a vial, you need 5 or more vials to treat someone with a snakebite, and it spoils if it’s not kept at a controlled temperature.
For a perhaps even more subtle example, there always have been arguments over the decades that we need to get rid of the CPR requirement, because (a) with rare exceptions, if you’re in the backcountry and you think someone needs CPR then that person is dead and CPR is not going to fix it, and (b) in the 45+ years the ASRC has been around, with hundreds of members on hundreds of operations, nobody has ever used their CPR training. Nonetheless, in the right (rare) setting in Base or at a training, CPR can be lifesaving, and there is nothing that really can replace it when it is needed.
Same thing with helmets. The ASRC has never had a significant head injury, but we still expect people operating in a vertical environment or exposed to rockfall to wear helmets. If helmets cost $500 each, and people had to buy one to join, the decision might be different.
Another good example of “rare but important” might be the requirement to be able to bivouac overnight, which has never happened on an ASRC operation. Yes, we’ve sent some people out to do a camp-in with a tent, sleeping bag and pad, and stove, but never a forced overnight bivouac. At an ASRC Officers’ Call meeting in September 2019, we had a long discussion of the traditional requirement for an overnight bivouac with just daypack gear. Some were in favor of it and said their Groups would continue it even if it was no longer an ASRC requirement, some were against it. Eventually there was a consensus that an actual overnight bivvy should not be required, but learning to prepare for a bivvy should still required. Here are some of the salient points of the discussion:
For members, doing an overnight bivvy is a rite of passage, an initiation ritual, a bonding experience, but perhaps some would say more like a fraternity hazing
When we force members to do an overnight bivvy, we don’t do an unannounced test that requires them to do it with only usual search task gear in their packs, they get to pick what is in their packs
Some highly-effective things you might do in a real survival situation, such as stripping a white pine of all of its lower branches to build a pine-bough bed, would be highly frowned on by land managers
For those without much hard-core outdoor experience, surviving an overnight bivvy is a big confidence-builder
Learning to bivouac by yourself is a survival skill that will rarely if ever be used; learning to bivouac a team with an injured patient, for instance to wait until a flooded stream recedes, seems less rare and might be a better situation for which to prepare
Finally, we realized that camping overnight at a remote Base with backpacking gear is something that we end up doing on a regular basis, for example at the Dolly Sods search. Therefore, we recommended that camping overnight using backpacking-type gear (sleeping bag and pad, tent or sleeping-bag-cover-type bivouac sac) should be required of all members.
These type of calculations figured in selecting topics for Field IV, which is all about hazards and mitigating them. For some topics, it’s obvious why they are in Field IV. Falling asleep while driving is a really big hazard, and caused the ASRC’s only line-of-duty death. Ticks and Lyme disease and poison ivy are very common if non-lethal hazards. But why is litter handling, at least the book-learning part of it, in Field IV and Essentials for Search and Rescue? Picking up and carrying a litter improperly, or getting confused and doing the wrong thing during laddering or rotating litter bearers is a great way to do your back a big mischief. And what about the section on conduct? Making a big faux-pas because you didn’t know what was expected of you is a great way to get yourself kicked out of a SAR team, which is certainly a hazard to your reputation and mental state. 
Whatever we put in the curriculum and the Training Standards and equipment requirements needs to consider a mix of how commonly someone needs the knowledge or skill, how important that knowledge or skill might be, and the cost of dealing with it in terms of weight, bulk, training and money.

For Version 8 of the ASRC Training Standards, we’ve moved from a three-level field credentialing system (Callout Qualified, Field Team Member, and Field Team Leader) to a four-level system (Field IV, Field III, Field II, and Field I). The table on page 18 lays out the new levels, compares with other ASRC and regional standards levels, and outlines the expected tasks and training for each level.
The ASRC Credentialing Board established a “grandfathering” process where those credentialed as an Field Team Leader are converted to a Field I, and those credentialed as a Field Team Member are converted to a Field II, unless the Group Training Officer has reservations about someone’s skills and recommends converting to a Field III (ASRC Board of Directors meeting, 3/19).
Some of the principal goals of this restructuring were:
Identify key skills based on 45+ years of ASRC experience, mostly search, some nontechnical evacuations, and rare semi-technical evacuations. High-angle rescues that are so rare that they should be left to specialized training beyond Field I. 
Remove non-essential skills.
“Even out” the skills/time across the levels.
Maintain a common approach to training and skills
Use a linear approach easily understood by agencies having jurisdiction for SAR in our states.
Avoid operational titles such as Field Team Member and Field Team Leader, which may not correspond with actual field duties. 
Ensure that the standards can be tested in a written or practical test, based on Mager’s Preparing Instructional Objectives and similar texts. 
Include Wilderness Medical Society compliant wilderness first aid training into the various field levels, so that those who complete Field II receive, in addition to their ASRC Field II credential, an ASRC wilderness first aid credential.
This gets away from levels that are named after positions that are assigned during an operation, such as “Field Team Leader” or “Field Team Member,” or that are tied to particular levels in other fields, such as the HazMat “Awareness” and “Operations,” which carry regulatory baggage, such as what someone at that level is permitted to do, which may not apply well to search and rescue training or operations. 
Once we arrive at numbers rather than names for the levels, there is always the question of whether to number up or down. There is an excellent argument that when creating something, whether in industrial design or training standards, that you should look at existing standards. And for levels applied to people, there is an excellent argument that the number one should be at the top. “Second-class citizen.” “Second-class” and “first class” on trains and airplanes, even if in the USA there is a move to change this to a more politically-correct but less-informative “coach” and “business” class. 
And, the ASRC has used levels IV, III, II and I already, in Search Manager standards. When we set up the Search Manager levels, we used Roman numerals and nobody even suggested we use Arabic numerals instead, so Roman numerals it is.
Adopting this “first-class” approach means that it’s hard to add on any levels above Level I. But for our purposes of having generalist levels of field competence and credentialing, including a bit of search, a bit of rescue, a bit of first aid, and a bit of management, a four-level system seems right. Anything above Level I can be specialist credentials, if we wish to add them. We already recognize medical credentials by having the external medical credential patch on the right shoulder of the ASRC uniform. (This means that if we offer wilderness first aid credentialing as part of the credentialing, we need to also offer ASRC wilderness first aid patches.) If we wish to add additional credentials as far as rescue, tracking, or the like, it still won’t affect the field generalist levels IV, III, II and I. 
The ASRC Credentialing Board has delegated the credentialing for Field IV (Trainee) to the Group Training Officers, but with the Credentialing Board providing a standard written online test. In 2018, the ASRC Board of Directors decided to produce a short, free online textbook that provides all of the knowledge required for Field IV (Trainee) credentialing, called Essentials for Search and Rescue. It is  in the ASRC Archive.
Credentialing for Field III, Field II, and Field I is entirely under the purview of the ASRC Credentialing Board. Written testing is online, and practical testing is conducted by the Credentialing Board on a regular basis, ensuring that evaluators from outside the member’s Group are involved in the evaluation. See the ASRC Credentialing Policy Manual for more details. 
To be credentialed, members need to meet the minimum standards in the ASRC Training Standards. Classes that use the curricula in this ASRC Training Guide should do a good job of preparing members to meet those standards, as tested by the ASRC Credentialing Board.
The ASRC Training Standards, and the curricula in this document, are minimums. Groups may require more of their members at the various levels. For instance, a Group that is also a member of the Mountain Rescue Association can require members to meet the extra technical rescue requirements for MRA Operational Member when testing for Field II, and MRA Rescue Member for Field I. A Group that specializes in canine search can require an external search dog credential for members who are qualifying at Field III level. Groups may also layer additional specialty qualifications on top of the four standard ASRC Field levels. For example, Groups that do cave rescue might either require NCRC Orientation to Cave Rescue, or NCRC Level I, in addition to ASRC Field II, to participate underground during cave rescues. (Having non-cave-rescue-trained ASRC members provide the above-ground portion of a cave rescue is a 45+ year old tradition embedded in a cooperative agreement between the ASRC and Eastern Region, National Cave Rescue Commission.)
While there are many different SAR credentials available, our hope is that the ASRC credentials represent an attractive, respectable and fairly easily-achievable ladder of progressive credentialing, tied to high-quality training and testing suited specifically for search and rescue in the mid-Appalachian area. It is also free.

After a considerable amount of discussion, we agreed to organize the field curricula topics as follows:
Safety, Health and First Aid
Communications
Land Navigation
Operations, Management and Leadership
Search
Rescue
We chose this order based on importance. What is more important than safety and first aid? And communications is next, so that you can call for help when needed. And land navigation is next so you don’t get lost. The operations, management and leadership section is next, so you don’t make some terrible mistake that hurts you, your team, or the organization or operation as a whole. Next comes search and finally rescue. Search comes before rescue both in our list and in real life.
Some topics, such as individual knots, pretty much stand alone, and it works well to divide them among the field levels fairly evenly, corresponding with the performance requirements for each level.  But at least for some topics, it is better to “chunk” material into teachable and learnable blocks, rather than spread them out evenly among the four field levels. A good example of this is the radio section of the Field II curriculum. 

If you are a Group Training Officer or an instructor, there are a few features of the Training Guide that you may find helpful. 
If you are putting together a training schedule or a field training session, scan through the Table of Contents, which in the PDF version consists of clickable links, for topics that have the  annotation. These are all psychomotor skills that lend themselves to small-group indoor sessions or field training.
A few of the topics don’t have a good printed or online reference. For the most part, though, print or online reference materials are given in footnotes, many with clickable links. These serve as resources for those working towards a particular credential, and for Group Training Officers and instructors preparing educational programs, classes and field training sessions.
Everything a trainee needs for Field IV credentialing is in  But footnotes to the Field IV topics show where some of the topics and the recommendations in Essentials for SAR come from. Those crafting a class for trainees may find this helpful, in case a trainee’s questions go beyond the material in Essentials for SAR.
Regarding student questions, a quote from the Journal of the American Medical Association (JAMA) back in 1989 might be appropriate; the article is The Art of Pimping, and you can find it online. It explains that Socratic questioning of medical students has been known as “pimping” at least since 1628. It is an art well worth knowing for teaching anything to others. This particular paragraph from the article encapsulates Dr. Brancati’s sage advice to those facing questions from their students:
On the surface, the aim of pimping appears to be Socratic instruction. The deeper motivation, however, is political. Proper pimping inculcates the intern with a profound and abiding respect for his attending physician while ridding the intern of needless self-esteem. Furthermore, after being pimped, he is drained of the desire to ask new questions— questions that his attending may be unable to answer. In the heat of the pimp, the young intern is hammered and wrought into the framework of the ward team. Pimping welds the hierarchy of academics in place, so the edifice of medicine may be erected securely, generation upon generation. Of course, being hammered, wrought, and welded may, at times, be somewhat unpleasant for the intern. Still, he enjoys the attention and comes to equate his initial anguish with the aches and pains an athlete suffers during a period of intense conditioning.
Work to Do
The end goal of the curricula is to have nothing but terse bullet points, with a footnote for each major section that references an authoritative and comprehensive free online text. Footnotes also may provide references as to why a topic is included, why a specific procedure was chosen, or how to perform a skill, perhaps a video or diagram. These help those studying the material and are reference materials for instructors preparing to teach a class. 
For several sections, a single comprehensive reference is not yet available. An example is the section on GPS navigation. So, this section has many footnotes, each linking to a separate reference for an individual point.
For the first version, some bullet points provide detailed information because a free and high-quality online reference is simply not available. As more and better online information becomes available, we expect those bullet points to become shorter as well.
You will note that after the Educational Goals and Curriculum sections for Field IV is a section titled Educational Objectives. Some would call these Terminal Educational Objectives: basically what you could be tested on, and should be able to answer, once you’ve completed the Field IV curriculum. These are in the instructional objective style popularized in the books of Robert F. Mager, starting with his 1962 book Preparing Instructional Objectives, currently in its third edition from 1997.   
Future projects include
Preparing Mager-ish instructional objectives for the rest of the Field training levels.
Possibly adding Group- and Corps-specific material as a support to our members who are using the Training Guide to inform their progress towards credentialing; these might be in a different color for each Group
Completing the Search Manager goals, curricula and objectives
Je n’ai fait celle-ci plus longue que parce que je n’ai pas eu le loisir de la faire plus courte. (I have made this letter longer than usual because I lack the time to make it shorter).
—Blaise Pascal, in Lettres Provinciales, 1657
 Overview
Search management is a task that can be done poorly, and, based on past experience, often is. People may die even during a very well-managed search, but a lot more people die from poorly managed searches. And in this day of ubiquitous cellphones and an ever-expanding network of cellphone towers, large backcountry lost-person searches occur less and less frequently. As a result, real-life opportunities to learn how to manage a large search are decreasing. Unless we do something,that means a smaller pool of expert search managers, which in turn means people who are lost in the backcountry have less of a chance of surviving. 
of a Search Manager
Managing a large backcountry search well requires expertise, not just in incident management, but in a vast array of arcane and esoteric subjects. Incident management skills and intimate familiarity with the ins and outs of the Incident Command System (ICS) are an absolute requirement, but they only provide a foundation on which to build.
Search managers must have a detailed and deep-seated emotional understanding of what field teams and other search resources can and cannot do, and the stresses and risks they face in the field. 
Search managers must be scientists and mathematicians, at least enough to be able to understand the equations that drive search planning, including the roles of sweep width calculations, and probability heat maps combining different models of lost-person behavior. 
Search manager must be cartophiles—map-lovers—for whom a glance at a topographic map immediately conjures up a detailed mental image of the terrain of the search area.
Search managers must be tech-savvy, able to use—and help others use—the latest electronic gadgets and software to aid search operations and planning.
Search managers must be patient and expert teachers, as Base is full of opportunities—and demands—for on-the-job, just-in-time teaching. 
Search managers must have, or quickly gain, a keen grasp of local politics, even to the point of knowing which officials are up for election and when, and the turf battles between local and regional emergency response agencies. 
Search managers must have well-developed people skills, and the ability to get along with people of widely-differing personalities, though “leadership” in the macho-ish “win one for the Gipper” sense has little place in search management.
Becoming a search manager might sound like an impossible task. But many of those who join the ASRC have many of these talents. And their motivation is to leverage their existing skills to help others, and then learn new skills that then uniquely qualify them to help others. Search manager credentialing may not be for every ASRC member, but it’s a logical extension of why people join the ASRC.
 and Requirements
Originally, we had four levels of related to search management: Incident Staff (IS) and three levels of Incident Commander (IC). While Incident Staff was not a bad name for someone who has expertise in serving in Base if not running the whole operation, the term IC was flawed. We never really had a member who truly served as IC in the ICS sense. Since we were all-volunteer, we never had to deal with the Finance section, and mostly depended on local expertise and resources for the Logistics section. 
Some representative of the local Agency Having Jurisdiction (AHJ), which more commonly we used to call the Responsible Agency or Responsible Agent (RA), was usually really the IC. What we did is manage the search for the RA/AHJ. We provided services that comprised most of the Operations Section and parts of the Plans Section related to tactics and strategy, though not logistics or finance. That’s why we changed the name to Search Manager (SM), which better fit our roles.
In the big update of the Training Standards to version 8, unlike the Field Levels, there was sentiment to consolidate the Search Manager levels from four to three, and this was unopposed. Why? Perhaps because advancement seemed to be less important to the Search Managers themselves, and simplifying the system might make it easier and more attractive for people to keep their Search Manager credentialing current.
Given the decrease over the years in the number of large searches, we decided to allow simulations that involve the ASRC and at least two other non-ASRC agencies to count the same as a real search; else, it might be impossible for Search Managers to keep up their credentials. 
Related to this, we also moved to more continuing education and fewer required actual search management shifts at the higher levels. Managing a search is sort of like riding a bicycle; once you master it, it doesn’t take that much practice to keep it up, and keeping up with the current thinking in search management is arguably more important.
We also decided to emphasize the role of mentoring for SM candidates.
Topic outlines for Search Manager training will be added after the Field portion of the Training Guide is completed and approved.

 (Trainee) This curriculum is to ensure that those credentialed to Field Level IV achieve the following educational goals.
Learn the major life-safety and health hazards and risks for wilderness travel and wilderness search and rescue activities in the mid-Appalachian area, including subjective hazards and those from climate/weather, terrain, and flora and fauna, and how to compensate for them from planning, personal equipment, and basic wilderness first aid. These include
Subjective hazards, including lapses in judgment such as in risk assessment and not compensating from the mental effects of sleep deprivation and physical stress,
Hazards from the area’s continental climate and changeable weather, including cold and heat exposure and lightning strikes,
Hazards from the area’s terrain, including slips and falls, rockfall, and streams and lakes, 
Hazards from pedestrian-vs-vehicle accidents, and from falling asleep at the wheel, and
Hazards from bees and wasps, ticks and poison ivy.
Learn how to use the basic controls and functions of a team handheld radio, basic ASRC radio protocols, to communicate standard field team status reports, including USNG/UTM location. Field IV credentialing requires being able to properly use a radio to communicate. 
Learn enough about a personal GPS device or smartphone GPS app to be able to make sure the datum is set properly and determine WGS84 USNG/UTM location, and communicate this properly over a radio. Learn the concept of safety direction and when to use it.

Learn the basics of the Incident Command System (ICS), as applicable to wilderness search and rescue as practiced by the ASRC. This may be learned via the FEMA free online course Introduction to the Incident Command System, ICS-100.B:  Field Level IV members should have a working knowledge of critical ICS concepts, terms and principles, and how they may be modified slightly for wilderness search and rescue. While the ICS-100.B course incorporates additional material that may be helpful during a disaster response, it is not required for Field Level IV credentialing, and ICS-100.B or ICS-100.c material beyond what is covered in this curriculum will not be part of the test.Learn the essentials of SAR operation procedures and good behavior. 
Learn how to serve as a member of a litter team, carrying a litter on non-technical terrain (non-technical evacs), following standard ASRC procedures for litter team positions including litter team positions including Litter Captain, Medic, and speaker, and standard calls, lifting and setting down a litter, dealing with vomiting, load straps, laddering, toenailing, litter bearer rotation, paving, turtling and lap pass. Field IV credentialing requires only knowledge about how to safely carry a litter, no actual litter-carrying experience required.
 (Trainee) Curriculum
A free, online text for Field IV, called Essentials for Search and Rescue, is  by the ASRC and updated as needed. Essentials covers everything a new member needs to know to pass the short online test for Field IV.
As with any level of ASRC credentialing, Groups may add training material, requirements or more knowledge or skills. However, this is the minimum Field IV (Trainee) candidates are expected to be taught and which they are expected learn, and on which the online written test is based.
These curriculum topics are all knowledge-based; there is no expectation that Field IV qualification requires any demonstration or practice for any of these topics. We expect that as members progress through their Field III training, they will have opportunities to watch demonstrations and practice skills, including those listed as knowledge topics in the Field IV curriculum.
Those topics appear as knowledge topics here in the Field IV curriculum, and are repeated in the Field III curriculum with the annotation . We don’t expect any field or classroom practical training to achieve Field IV credentialing, as Field IV is the minimum credential to safely participate in field training. This is not to say that a new member cannot participate in classroom practical training en route to Field IV credentialing, but we strongly recommend that all new members read Essentials for Search and Rescue and take and pass the short, online test before participating in field training.  
, Health and First Aid
Mid-Appalachian SAR  and Risks
Subjective vs Objective Hazards
Objective hazards: things in the environment such as cliffs or cold weather
Subjective hazards: dangers from our own thinking, such as getting to a particular destination no matter the risk
Search and rescue best practices help with both objective and subjective hazards by creating good habits that we still follow in bad situations
Best practice to have knots and rigging, and other important decisions, double-checked by another member
Best practice to routinely practice these checks during training to develop good habits 
Need to assess risk vs. benefits for a difficult task, including preplanning for injured field team member
Climate and Weather Hazards
Continental climate – sudden changes in weather and extremes of weather
Lightning strikes
High-danger and lower-danger areas
Step potential
30/30 rule, and 20/30 rule for athletics
How fast thunderstorms may move
Smartphone apps that track lightning strikes
Environmental clues to an approaching thunderstorm
Safe to touch lightning strike victims
“Triage the dead”: after lightning strike, if moving, will probably be OK; if appears dead, even with fixed and dilated pupils, may respond to short course of CPR
Terrain Hazards
Falls down slopes or cliffs and “safety zone” near drops
Falls from equipment failure and role of formal double-checks as a best practice
Rockfall, helmets and “ROCK!”
Drowning and PFDs for certain tasks near water
Hazards from Vehicles
Walking along roads often most dangerous part of task
Humans tend to discount danger
Canines: poor awareness of traffic dangers
Walk on left facing traffic if possible, safer
Increase visibility with reflective gear or clothing
Trains:
Up to 80 mph (130 kph) in mid-Appalachians
High-visibility clothing of limited value: trains can’t veer away or stop in time
One SAR team member killed by train
Look both ways before crossing tracks
Do not walk on or near tracks
Base may arranged for trains to be slowed or stopped in area
Situational awareness
Whether walking along roads or in the woods, need to be aware of environment around you
Must be alert to weather changes
Must be alert to terrain hazards, such as dead trees when windy (“widowmakers”) or slippery slopes, or the sound of many bees or wasps, especially in the early fall when they are most aggressive 
Must be alert to slowly-changing situations
Interaction of fatigue, exhaustion of energy, and dehydration or mild hypothermia may dull thinking
Need to keep eye on self and others
Fatigue
Falling asleep while driving is the biggest life-safety hazard for SAR personnel
Sleep is essential, both core sleep and non-core sleep
Larks vs owls (morning vs night people)
Circadian alertness rhythms and danger of driving at 0800 hours
Caffeine may help temporarily but just postpones things
Sleep deprivation makes people make mistakes, sometimes deadly mistakes
Most common mistake not doing something wrong but forgetting to do something; why keeping a pocket notebook and writing things down essential when sleep-deprived
Only cure for fatigue is: 
Sleep
Robert Koester recommends at least a half-hour nap to restore alertness
Mean Sleep Latency Test: lay down in dark quiet place and keep eyes closed for 5 minutes
If able to stay awake during this, likely OK to drive, at least right now
If fall asleep, get a nap, and then should be OK to drive right now
Recognize microsleep (“nodding off for a second”) as danger sign, especially if driving
If very sleepy driving, pull over and take nap
May nap at official highway rest areas in ASRC area as follows:
Ohio: up to 3 hours
Pennsylvania: up to 2 hours
Maryland: up to 3 hours
Delaware: up to 4 hours
West Virginia: unlimited but no overnight parking
Virginia: unlimited but no overnight parking
Many WalMarts allow overnight parking; napping should not be a problem
Even just pulling off side of road and napping for 15 minute preferable to maybe dying and killing others
Sleep inertia (grogginess on waking up) happens, but not reason to not nap; just wait for it to go away
Sleeping and napping best practices
No caffeine for 6 hours prior to bedtime
No nicotine: mild withdrawal during sleep interferes with sleep middle of night 
No alcohol: rebound interferes with sleep last half of night
Find comfortable, dark, quiet place; consider sleep mask and earplugs
Consider white noise, can use fan, can use app on cellphone or handheld radio tuned to unused frequency with squelch turned off
No eating or reading in bed, especially on device with illuminated screen, even with blue filter on
Easiest to nap at alertness minimum at 0800 and afternoon “sleep gate” 1400-1600.
Hazards from Flora and Fauna
Problems not found in the mid-Appalachian region not covered 
Black bear, snake, mountain lion and wild boar attacks so rare that not covered
Bee and wasp and other insect stings
Bees and wasps generally more aggressive in late summer and fall
Removing stingers safely by scraping
Immediate pain from stings: over-the-counter anti-itch or anaesthetic cream or liquid (e.g., pramoxine-menthol cream, Sting-Eeze) for pain, over-the-counter oral medications for pain 
Delayed local reaction, day or so later: red, swollen, itchy, use over-the-counter anti-itch cream, not associated with life-threatening immediate reactions 
Mild generalized immediate reaction: hives alone
Severe generalized reaction: anaphylaxis: usually hives first, then swelling of lips, tongue, airway (hoarseness), maybe wheezing causing shortness of breath, maybe low blood pressure
Impending anaphylaxis (especially if visible lip or tongue swelling or hoarseness) means risk of death
Immediate treatment of anaphylaxis: epinephrine intramuscular injection in lateral thigh, from autoinjector or drawn up from vial or ampule); lasts for ~ 15 minutes, may need second injection
Ongoing treatment of anaphylaxis: over-the-counter H1-blocker antihistamine such as diphenhydramine (e.g., Benadryl) vs H2-blocker antihistamine such as famotidine (e.g., Pepcid; less sedating and equally if not more effective) for ongoing treatment of anaphylaxis; for wilderness first aid kit as important as epinephrine injection; also useful without epinephrine for hives
Ticks
Blacklegged ticks as vector for Lyme disease, and how common Lyme disease is in area
Insect repellents: DEET vs picaridin vs others
Permethrin for treating clothing
Checking for and removing ticks
Signs and symptoms of Lyme disease
Poison Ivy
Poison ivy as a four-season hazard
Urushiol
Poison ivy as a delayed-hypersensitivity allergic reaction and differences with immediate hypersensitivity like beestings
Human and great apes’ unusual sensitivity to poison ivy allergy
Recognizing poison ivy
Poison ivy decontamination, including crushed jewelweed as a field expedient
Treatment of mild cases with over-the-counter medications
Treatment of more severe cases with prescription steroid cream or oral steroids
Personal Equipment, Clothing and
Pack as wilderness life support system and “Don’t get separated from your pack!” 
Cheap sources for outdoor gear
REI co-op
Sierra Trading Post
Pro deals
The Ten Essentials
Background of The Ten Essentials 
The Ten Essentials, Current Version
Navigation
Sun Protection
Insulation
Illumination
First-aid
Fire
Repair kit and tools
Nutrition
Hydration
Emergency Shelter
Water purification
Ice axe
Signaling devices 
Personal Equipment and Supplies
Selecting equipment in general and for the specific task at hand
Usefulness-to-weight and usefulness-to-bulk ratios
How likely you will need it
Even if unlikely you’ll need it, how important it might be
Why we say don’t get separated from your pack
Why always two leaf bags in your pocket
Learn from the experience of others to avoid mistakesFor extra clothing consider warmth to weight and warmth to bulk ratio
British hill-walking and climbing tradition of the “duvet in the pack” 
Balaclava-style hood/hat 
Winter facemask as a rebreathe flap: high warmth-to-weight and warmth-to-bulk ratio, protects against frostbite 
Thin breathable nylon windshirt with hood for very cold conditions, as breathes better than even “waterproof-breathable” parkas and prevents getting wet from sweat; waterproof garments not as important in deep winter 
Selecting a pack
Suspension: hip belt and a sternum strap
Recommended capacity
Compression strap
Separate rain cover or rain liner
Food and water
Extra food
Standard survival times:
Food: 			3 weeks
Water: 			3 days
Shelter in the cold: 	3 hours
Air: 			3 minutes
Will to survive:		?
Needs for performance:
Quick-energy food
Sustained energy
Essential amounts of fat and protein
2000-4000 calories of food per day
Weight of food: fats most calories per unit weight, water has no calories: canned tuna in olive oil much more energy than canned tuna in water
Freeze-dried food advantages and disadvantages
MREs
Water bottles, Gatorade mix, and duct tape around water bottle
Water bladders, e.g., Camelbak
Water purification tablets and filters
Gloves and mittens 
Medical protective gloves
Leather, leather-palm or similar ropework gloves 
Insulated gloves for spring and fall (touch-screen versions recommended)
Mittens for winter (touch-screen version or liner gloves that are touch-screen versions recommended)
Importance of all gloves and mittens able to handle rope
Climbing helmet 
Visibility enhancements
Bright-color/reflective vests 
Bright colors/reflective materials on packs and clothing 
Bright reflective armbands
Eye protection for day and night
Bivouac shelter most survival gear 
Leaf bags and why five of them on ASRC pack list
Bothy bags
Sleeping-bag cover bivouac sacs
Smartphone Support
Given importance of GPS and other smartphone apps, may want to have spare cellphone AC charger as tend to get lost during long searches
May want DC charger in vehicle
May want external cellphone charger in pack
Personal First Aid Kit
Personal medications 
If history of anaphylactic reactions
Epinephrine autoinjector
Primatene Mist; available over-the-counter again 2019 at $30, likely not as good as epinephrine autoinjector but cheap alternative treatment for anaphylaxis
Chewable H2 antagonist antihistamine such as famotidine (e.g., Pepcid Complete) and/or a chewable H1 antagonist antihistamine such as diphenhydramine (e.g., Benadryl)
Common over-the-counter medications, such as
Acetaminophen (generic Tylenol) for pain
Diphenhydramine (generic Benadryl) for itching at nighttime 
Fexofenadine (generic Allegra) for itching during the day
Famotidine (generic Pepcid) for acid indigestion
Loperamide (generic Imodium-AD) for diarrhea. 
Naproxen (generic Aleve) for pain
Pramoxine-menthol cream for itching
Sting-Eeze for beesting pain
Minor injury supplies
Bandaids
Moleskin and/or 3M micropore tape for blisters
Ampules of tincture of benzoin to make bandages stick better 
Tick remover
Swiss Army knife or multitool
Compass suitable for orienteering-type navigation 
GPS unit or smartphone with GPS app
Headlamp with LED bulb and lithium batteries
Clothing
Selecting clothing suitable to the weather not just now but for tonight and tomorrow
Layer principle
Traps air for insulation
Flexible for changing conditions
Baselayer
Insulation layers
Shell garments and “pit zips” (underarm zippers for ventilation)
Duvets 
Clothing materials
Polyester baselayer and fleece
Wool
Down
“Artificial down”
“Cotton kills!”
Nylon 
Softshell materials
Waterproof-breathable shells
Dri-Release
Blisters 
“Hamlet Socks” 
Terry-knit wool on outside of socks 
Merino wool
Boots 
“A pound on your foot is like ten pounds on your back”
Well-fitting, broken-in boots
Features for SAR boots: ankle support, protection against rock bruises, waterproof
After-market insoles
Sun Protection 
Sunburn and second-degree sunburn
Clothing and hats with brims
Sunscreen
Sunglasses

Hypothermia = low (hypo-) temperature (‑therm-) condition (-ia)
Getting chilled deep inside: not just the periphery (arms and legs), but the core, vital organs such as brain and heart
“Killer of the Unprepared”
Heat Balance
Body producing heat continuously
Heat production must equal heat loss to keep body tempe­rature from going up or down
Narrow range of body temperature needed for normal body processes to work
Use clothing and knowl­edge to keep body core near 99°F=37°C
Lose heat from:
Cold temperature
Radiation 
Conduction
Windchill: convection
Wetchill
Conduction into and through cold water in clothes
Evaporation
Hypothermia Weather
Temperatures around freezing (32°F=0°C) with wind and rain: cold temperature, windchill, and wetchill 
Danger in summer thunderstorms
Windchill
Wetchill
Cold upper-atmosphere air comes down in center of thunderstorm and drops temperature markedly, may have sleet or hail even is summer
Clothing as life-support system
Waterproof raingear to prevent wetchill
Condensation even in “waterproof-breathable” parkas and pit zips and other ventilation
Wet clothing conducts heat like water
Need warm when wet clothing
Down flat and cold when wet
Cotton useless as insulation when wet
Only wool and some synthetics retain some warmth when wet
The Three W’s
Waterproof Clothing
Warm-when-Wet Clothing
Windproof Clothing
Two large plastic leaf bags as survival shelter standard survival teaching for anyone in the outdoors; ASRC says keep five in your pack so you have extras for others
Hypothermia recognition
People may be cold on outside but still warm on the inside: “chilled”
If in cold environment, chilled, and showing signs of poor mental and physical coordination, assume hypothermic
Hypothermia treatment (team member, not patient)
Treatment depends on context
In the field with hypothermic team member
Interrupt task, inform Base if possible
Seek sheltered area, get out bivouac gear
If have bothy bag for team, get it out and use it
Share and force food and water, share clothing and shelter, huddle for warmth
Food essential to keeping warm; body burns it, creating warmth
Building fire generally not worthwhile use of energy and time
Plan for getting back to civilization; once warmer and fed, forced march may be best plan

Wind-chill temperature 
Not good index of hypothermia danger
Good index of frostbite danger for exposed skin
Frostnip = superficial frostbite = first-degree frostbite: freezing of the superficial tissues
Usually fingers, toes, ear lobes, and noses
Sudden blanching of nose, ear, or fingertip
Part pale or yellowish, but still soft to the touch
Numbness not a useful for diagnosing
Cold skin gets numb before frostnip
Treatment of frostnip 
Warm hand over nose or ear, or placing frostnipped finger in mouth, armpit, or warm pocket
On rewarming affected part red, painful, possibly slightly swollen, but no permanent damage
Face masks and goggles or sunglasses for protecting face from frostbite
Team members should check each other’s faces regularly for blanching
Deep Frostbite
Deep tissues frozen
Affected part feels hard, like wood or frozen meat
Freezing causes great tissue damage; effects postponed until re~warmed
Once rewarmed, excruciating pain and blistering
Trauma to frozen tissue may push sharp ice crystals into cells, rupturing them
“You can walk on frostbitten feet, but you can’t walk on rewarmed feet” but walk on frostbitten feet only to save your life as much more damage
Human body highly resistant to freezing but
Too-tight boots, dehydration or hypothermia or exhaustion impair circulation, make frostbite more likely
Two pair of socks with pair of boots fitted for one pair of socks may cause (“two-sock frostbite”) 
When very cold and wind very strong can get frostbite of exposed skin even if healthy
Even if healthy can get frostbite by touching bare hand to supercooled metal, or by spilling sub-freezing stove fuel on a hand
Secondary phase of damage after rewarming
Thawed tissues inflamed, damage to blood vessels, small clots
Blood vessels leak, causing swelling
Blood vessels go into spasm, cutting off blood supply
Definitive treatment of deep frostbite
Rapid rewarming in hot water, 99-102° F (37-39°C)
If don’t have thermometer, dip elbow in water; if feels hot but can keep elbow in, about right
Don’t rewarm until no danger of re-freezing, refreezing causes severe damage
Frostbitten limbs numb: don’t cook in too-hot water, or burn rewarming by fire
Non-steroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Motrin, Nuprin, Advil), naproxen (Aleve) and aspirin, if given early, prevent some tissue loss
Ibuprofen preferred
Rapid rewarming best, but slow rewarming is better than keeping frozen
May place frostbitten part in warm armpit or groin if that is all that’s available
Protect rewarmed flesh from pressure, very easy to damage, no walking on rewarmed feet or toes
-Related Illness
Heat Acclimatization
In winter, lose heat acclimatization
Takes about 1-2 hours of exertion a day for 10-14 days to regain heat acclimatization
Heat acclimatization lasts for about a month
Heat acclimatization: many changes to better tolerate heat exposure and lose heat better
One change of heat acclimatization is to decrease amount of salt in sweat; when first exposed to heat in spring and not acclimatized, lost lots of salt, need to increase salt in diet for ~ 2 weeks 
Dehydration
Common even in winter
Lose water by airways humidifying dry air
In winter “rebreathe flap” across mouth and nose decreases water loss, decreases the heat loss from evaporation
Signs and symptoms
Thirst may occur; but not necessarily 
Lightheadedness, weakness, tunnel vision, or headache
No urine, or small amounts dark urine
May get so weak cannot continue with task
Extreme cases: may not be able to stand without losing consciousness
Mild dehydration decreases aerobic, muscular and mental performance
Prevention: must bring enough water, especially in hot weather; single liter/quart water bottle not enough on hot day
Water bladders (e.g., CamelBak) hold multiple liters of water and encourage frequent drinking and likely improve performance 
Monitor yourself and teammates for dehydration; team leaders may schedule pee stops, asking about amount and color of members’ urine 
Treatment
Drink more water
Dehydration from sweating: loss of water and salt 
If not enough salt to hold water in body, water will pass right through 
Salt depletion common at beginning of hot weather: people not acclimatized to heat
Heat acclimatization includes producing less-salty sweat
About two weeks’ moderate exercise for 1-2 hours/day in heat to acclimatize
Especially if not acclimatized, need to increase salt intake
Salty foods have much more salt than electrolyte drinks
Avoid salt tablets, cause stomach problems
Heat Exhaustion 
Very bad dehydration, feel faint
No real dividing line between dehydration and heat exhaustion
Dehydration raises body temperature mildly
Skin should be slightly damp
Treatment is rest in shady area and salt and water repletion
Heatstroke
Qualitatively different from dehydration and heat exhaustion
Certain medications make heatstroke more likely; those on them may get heatstroke in hot environment without major exertion
Aerobically-fit people in a hot environment can create heat faster than they can get rid of it (“exertional heatstroke”)
Core body temperature rises high enough to damage vital organs
May cause lifelong medical problems or death
If right setting for heatstroke, skin hot and maybe dry and confused or comatose, assume heatstroke and treat for it
Skin may be dry or wet, flushed (red) or pale
Treatment: reduce the person’s temperature to near-normal
Immerse in cold water if available
Cold or even cool water on clothing. fan to increase evaporation
Do not over-cool, hypothermia is risk
Don not give acetaminophen (Tylenol) or ibuprofen (Motrin, Advil, Nuprin) or naproxen (Aleve) as likely to make patient worse

Goal: accurate, clear, and effective reports over radio
Before speaking:
Take time to organize thoughts
Rehearse under breath
Use ASRC radio standard operating procedures
 has standard ASRC prowords and phonetic alphabet
Keep copy of crib sheet in SAR pack.
Field Level IV: may use Crib Sheet rather than having entire phonetic alphabet memorized
Essential prowords, their meanings and their appropriate use: 
This Is
Over
Go Ahead
Roger
Affirmative
Negative
Clear
Clear the Net
Secure the Net
Status One
Status Two
Status Three 
Standard radio communications procedures:
Push push-to-talk button
Pause for a second
Speak in normal tone
Speak slowly and distinctly
Use basic prowords
Use “you, this is me,” not “me to you”
Break long transmission with “break… continuing” to allow priority radio traffic to break in; or say, “How copy so far?” then release push-to-talk
How to operate standard handheld radio controls and perform simple field maintenance tasks:
Operate off/on switch
Operate volume adjustment
Operate push to talk
Operate channel selector
Attach and detach antenna (note that transmitting without an antenna properly attached may kill a radio)
Replace battery
Toggle keyboard/channel select lock if available
Other buttons might accidentally hit and how to recover from it

 System
Universal Transverse Mercator (UTM) system commonly used for wilderness SAR
At scale of wilderness SAR, UTM same as newer United States National Grid (USNG)
Searches in mid-Appalachian area in USNG Zone 17S, 17T, 18S, or 18T
Entire lost-person search in one zone, so do not report or record zone
Numeric USNG/UTM grid coordinates may be to arbitrary precision, but standard to report your position to a 10 meter precision, four digits east-west and four digits north-south

“Easting” comes before “northing”
Standard mnemonic for this is “read right, up” 
UTM/USNG Example
If standing at Newcomb Hall Post Office at University of Virginia, ASRC’s official mailing address:
Look at GPS, GPS app, or USNG app (preferred) and see “17S QC 1880 1269”; USNG app always gives coordinates to 10 meter precision
Ignore “17S QC” as same for everyone in vicinity
Report position over the radio: “Base, this is team Bravo. Our location is, figures, WUN, AIT, AIT, ZE RO, [pause] WUN, TOO, SIX, NIN er.” 
Maps printed from SARTopo or similar usually have gridlines labeled with UTM coordinates
On these maps may see gridlines labeled:
0718800 on one of the gridlines at bottom,
4212700 on one of the gridlines at the right
These UTM coordinates to the meter, so to give coordinates to 10 meters, give two big numbers and then next two numbers: 
“Base, this is team Bravo. Our location is, figures, WUN, AIT, AIT, ZE RO, [pause] WUN, TOO, SEV en, ZE RO” 
May see this format for GPS position on many GPS units and GPS apps, so may need to parse the numbers as for printed map
Safety Direction
Base or Field Team Leader may give compass safety direction such as northeast
If get separated from team and go this direction, should come to linear feature that leads back to civilization
Can look at the map and pick safety direction before starting out
, Management and Leadership
 as Adapted for SAR
ICS
National, mandated Incident Command System for all US inter-agency incidents
Most emergency services workers learn some ICS
ASRC members use ICS regularly
ICS Functions and Positions
Command
Incident Commander (IC)
On larger incident may also include additional Command Staff:
Public Information Officer: handles interactions with press and public
Safety Officer: in overall charge of safety
Liaison Officer: handles relations with supporting agencies (such as ASRC)
General Staff
Broken into four functional parts who report to IC:
Operations: Operations Section Chief (“Ops”): sometimes an Agency Having Jurisdiction/Responsible Agent will ask an ASRC Search Manager to take on this task
Planning: Planning Section Chief (“Plans”) (also sometimes combined with Ops: “Plops”)
Logistics: Logistics Section Chief (“Logs”)
Finance/Administration: Finance/Administration Section Chief
Standardization
Common terminology for: 
Functions 
Facilities
Resources 
Positions
Standard for communications: no codes, use English and use functional position or last name
Chain of Command
Starts with Incident Commander 
Down through levels to individual searcher 
Unity of Command
You report to only one supervisor
You get instructions only from that supervisor
Unified Command
When multiple Agencies Having Jurisdiction (AHJ)/Responsible Agents (RAs)
Each AHJ/RA has own IC
ICs work together to command operation using single Command Staff and single General Staff
Co-located shared facilities
A single shared set of objectives, planning process, and IAP: 
Incident Action Plan
 “IAP”
The overall plan for the search or rescue
Modular Organization
Jobs are chunked
Use standard terms for the chunks, such as Plans or Ops
Flexible
One person can assume more than one function, or all functions, for small incident
Others can be assigned positions as incident and incident staff expands
Manageable Span Of Control
Per ICS, 3–7 subordinates per position
More than 7 just doesn’t work
Five is ideal maximum, except maybe in line search, but usually have assistant team leader on other end of line
Sign-in and Sign-out
Important in ICS
Critical for SAR 
Accountability
See separate section later on accountability
Includes more details than in ICS-100
Resource Tracking
Keeping track of “resources” (people, teams, vehicles)
Whether need more resources 
Standard Location Terms
Standard ICS terms:
Incident Command Post (ICP)
Base
Camp
Helibase
Helispot
Staging Area 
For smaller SAR operations combined and called “Base” 
Standard map symbols for these places, Field Level IV not expected to memorize
Communications
ICS says should only use plain English and position titles or last names
Per ICS, don’t use non-ICS abbreviations or 10-codes 
For ASRC, use standard radio prowords per  including Status 1, Status 2, and Status 3 but everything else in plain English
Task Assignment Form (TAF)
TAF: form similar to the ICS Assignment Form (ICS 204)
ASRC originated TAF in 1970s 
Used in different variants nationwide for assigning tasks to search Field Teams
TAF covered in detail for Field Level III
Field Level IV: need to know that:
TAF is wilderness search and rescue add-on to ICS
Commonly used
Field Team Leader (FTL) responsible for carrying out task specified on TAF 
Other ICS Positions
Field Level IV doesn’t need to memorize: 
Names for ICS supervisory positions (Officer, Chief, Director, Supervisor, Leader)
Differences between Branches, Groups, or Divisions
Units that may be parts of a Section, Branch, Group or Division
Definitions or standard sizes of Strike Teams or Task Forces
For wilderness search and rescue best practice to hand-craft variable-size Field Teams (term not used in standard ICS) for specific tasks
Operational 
Group Alerting Process 
How process works
How expected to respond when alerted
Best Practices for Safety
Double-checking knots and rigging by a separate person 
Wearing a helmet and gloves when appropriate
Carrying some semblance of
Ten Essentials 
ASRC required gear list
As adapted to task and weather and terrain
Best Practices For Conduct 
How to sign in and out 
Why signing in and out so important
Don’t want people out searching for you when on way home
Has happened, many times
Staging area
Where you rest, eat, drink, and wait patiently for assignment
Why important not to bother incident staff
Chain Of Command 
Why important to observe chain of command
Option to refuse unsafe task at any point
Accountability 
Personnel Accountability Report or PAR
Phrase “we have PAR”: everyone on our team is here or otherwise accounted for
Personal Conduct
When approached by the press
Give general information on what it’s like be involved in SAR
Refer specific questions about operations up chain of command or to Public Information Officer (PIO)
Observe communications security
Turn down radio when near people other than team
Turn volume way down if hear Secure the Net. 
Interpersonal/interagency conflicts 
As dangerous to the mission as incompetence
Importance of trying to defuse them
Avoid even appearance of publicly criticizing other persons or organizations involved in the mission
If need to, do it privately one-on-one with superior in command chain or in secure debriefing
As mother used to say, “if you can’t say anything nice about someone, don’t say anything at all”
Avoid even appearance of freelancing/self-deploying:
Responding to a situation without approval of Agency Having Jurisdiction/Responsible Agent, or
Responding to field or deviating from assigned task without coordinating with Base
Freelancing/self-deploying can be by individuals, field teams, or SAR organizations
Freelancing/self-deploying may disrupt search operations (e.g., not knowing another team is in segment being searched by an air-scenting dog) 
Reputation for freelancing/self-deploying bad for people and for teams: don’t get called
Freelancing/self-deploying can be deadly: in 2010s, non-ASRC SAR team self-deployed to a search area after search officially concluded, without letting AHJ/RA) know; AHJ/RA told the railroad company to let trains start running through area again, and a train hit and killed SAR team member

Don’t get hurt: avoid back injury
Person in driver’s seat (front left, in current direction of litter movement) is  says “  ” (ASRC standard)
“” or “” or “”: acceptable but deprecated alternatives
:  quickly scans all the litter bearers to assure they are ready
Litter bearers may respond to “” with “” or “” or “”
“Lift with your legs, not your back”
Face litter
Squat down on one knee, keep other knee up
Put both hands on litter rail
Lean away from litter, keeps your back straight and upright
Don’t lift, pull out; pull directly away from litter bearer across from you
Only  communicates with rope team if the litter being belayed 

Reverse of picking up
Standard call is “”
Lean out and keep head up and buttocks down as lower litter, to protect back
Might put the litter down on a rock or sharp object, so before putting litter down, visually check or sweep with feet to check for objects during 
Also may need to secure litter from sliding
Two litter bearers may hold onto litter
If have a short rope may clip onto a tree or rock

Medic may tell team to 
Keep litter in slightly head-down position (perhaps blood loss, dehydration, or hypothermia), or
Slightly head-up position (perhaps head injury, or breathing problem)
May need to carry litter higher, strain on the arms
Vomiting
Litters designed to carry people on backs, traditional to package patients on back
If vomit when on back, vomit may get into lungs
If see litter patient on back vomiting, yell “” and rotate litter sideways away from  
Rotate litter 90° or more

Stops
May need stop for medical reason
May need stop to change litter rigging
Patient may need to pee
Otherwise, litter should never stop moving
Litter Bearing
Standard for non-technical evacs (without rope belay): six litter bearers
Load straps make carrying easier
2” or 1.5” flat nylon webbing, 10’ long
Girth-hitch middle of load strap to litter rail behind your hand on the rail
Lift litter
With hand not used for litter rail, reach across in front and grab load strap next to litter rail, slide hand out along it until 2-3’ stretched out from litter rail
Lift hand up over head, flip strap backwards over head 
Load strap now diagonally across upper back and forwards across shoulder
Bring hand down in front of chest
Wrap load strap few times around hand,  pull down hard
Some litter load now on left shoulder
2”/1.5” webbing superior to 1” webbing, less pain in shoulder

ASRC protocol for rotating litter bearers from early 1970s to meet these principles:
Litter should not stop
Litter bearers alternate using right and left arms
Litter bearers in pairs roughly matched by height
Litter bearers ready to rotate in to carry litter whenever  calls “”
Relief bearers do not have to pass litter
Based on this:
Relief bearers in front of the litter
When calls “”:
 Relief bearers step off trail on either side
 Relief bearers set feet
As litter passes, relief bearers grab tail end of litter, move out into trail
Once both relief bearers have hand on litter, back left relief bearer calls “” and both new back litter bearers use free hand to tap hand of litter bearer in front of them
Litter bearers in front of relief bearers shift forward one position, use free hand to tap hand of litter bearer next towards head
Those litter bearers move forwards, tap hand of front litter bearers in front
Front litter bearers let go of litter, cross sides, walk ahead of litter, go to head of line of relief bearers on trail ahead
: Laddering, Toenailing
Laddering
Laddering used to move litter past obstacles that prevent normal carrying
Importance of not moving feet during laddering: decreases falls
Starts as litter team slides head of litter onto or over obstacle in trail
 calls “”
Back two litter bearers: 
Let go of litter
Scramble forwards around obstacle to just in front of head of litter
Find secure footing
Grab top of litter with one hand
New front left litter bearer is now new 
If other new front litter bearer looks ready, new calls “”
Without moving feet, litter bearers shift litter forwards
Sequence repeats, from (3) to (6), as long as needed to get over obstacle
Toenailing
Can ladder up short, steep slope: “toenailing”
Litter bearers not moving feet when laddering even more important on slopes, to decrease danger of slips and falls
Starts as litter team pushes head of litter onto ground to secure it (“toenailing”)
 calls “”
Back two litter bearers: 
Let go of litter
Scramble forwards around litter and uphill to just above head of litter
Find secure footing
Grab top of litter with one hand
New front left litter bearer is now new 
If other new front litter bearer looks ready, new calls “”
Without moving feet, team lifts litter a foot and moves it forwards and toenails into slope
Sequence repeats, from (3) to (6), as long as needed to get up steep slope
Can toenail down as well, but much easier to use a rope belay as simple semi-tech evac (covered in more advanced training)

, Health and First Aid
Mid-Appalachian SAR  and Risks

Given a list, pick the best example of an objective hazard
Given a list, pick the best example of a subjective hazard
Given a list, pick the best example of a best practice to protect against error when fatigued, exhausted, chilled or distracted

Given a list, pick the best description of the continental climate characteristics of the mid-Appalachian region
Given a list, pick the best definition of step potential as related to lightning strikes and how to mitigate the risk it entails
Given a list, pick the item that best outlines best practices for triaging and providing first aid to a group struck by lightning

Given a list, pick the item that best outlines best practices to follow when you hear the call “ROCK!”
Given a list, pick the item that best outlines best practices for walking on roads or near railroad tracks
 Situational Awareness
Given a list of items that might be part of one’s situational awareness when in a mid-Appalachian woodland, identify those that should trigger increased alertness
Given a list of scenarios, identify the one that best typifies a situation where situational awareness might be compromised and lead to a bad outcome
 Fatigue
Given a list, pick the best definition of
Circadian alertness rhythms 
Mean Sleep Latency Test
Microsleep
Sleep inertia
Hazards from Flora and Fauna
Given a list of first-aid measures for simple bee and wasp stings, pick the one or more items that are recommended
Given a list, pick the best description of a delayed hypersensitivity reaction (local allergic reaction) to a bee or wasp sting
Given a list, pick the items that represent warning signs of a generalized immediate hypersensitivity reaction (allergic reaction) to a bee or wasp sting
Given a list, pick recommended best practices for treating a generalized immediate hypersensitivity reaction to a bee or wasp sting
Given a list of potential measures to prevent tick bites, pick those that are recommended
Given a list of potential symptoms, identify those that are consistent with Lyme disease
Given a list of potential treatments for Lyme disease, pick the one that is recommended
Given a series of pictures of somewhat-similar common mid-Appalachian plants, correctly pick out poison ivy
Given a list of possible poison ivy decontamination methods, pick the one or more items that are recommended
Personal Equipment, Clothing and
For each of the following items, given a list of reasons to carry it, pick the best reason
Helmet
Medical protective gloves
Leather gloves
Visibility enhancements (bright and reflective on clothing or gear)
Clear protective safety glasses or goggles
Leaf bags
Ziplock bags
Headlamp instead of handheld flashlight
Orienteering-type compass
Plastic surveyor’s flagging tape
Given a list of explanations for each of the following outdoor clothing concepts, pick the best one
Cotton kills
Warm-when-wet
Layer principle
Baselayer
Midlayer
Shell layer
Waterproof-breathable
Condensation
Pit zips
Wicking

Given a list of definitions for the following terms, pick the best:
Core temperature 
Hypothermia 
Heat balance
Radiation 
Conduction
Convection
Evaporation 
Wetchill
Windchill
Hypothermia weather
The “three Ws”
Given a list of possible signs and symptoms suggestive of hypothermia in a fellow team member, pick those for which the ASRC recommends monitoring
Given a list of best practices for dealing with a hypothermic team member in the field, pick those that are recommended

Given a list of possible explanations of the wind-chill temperature as a risk for hypothermia and frostbite, pick the best one
Given a list of possible signs and symptoms for the following terms, pick the best:
Frostnip
Deep frostbite
Given a list of possible treatments for frostnip and deep frostbite, pick those that are appropriate
Given a list of risk factors for frostbite, pick all those that are correct
-Related Illness
Given a list of explanations of heat acclimatization and its implications, pick the best one
Given a list of prevention, possible signs and symptoms, and treatment for each of the following, pick the best one
Dehydration
Heat exhaustion
Heatstroke
Given a list of possible uses of monitoring urine output and color, pick the best one

Given a list of best practices for using a radio to communicate by voice, pick those that are recommended
Given a list of potential meanings of the following standard ASRC prowords, pick the correct one
This Is
Over
Go Ahead
Roger
Affirmative
Negative
Clear
Clear the Net
Secure the Net
Status One
Status Two
Status Three
Given a list of possible radio communications best practices, select those that are recommended 

Given a list of possible ways to report one’s grid position over a radio, pick the one that is recommended for ASRC use
Given a list of explanations of the land navigation term safety direction, pick the best one
, Management and Leadership
Given a list of definitions, match them with the following Incident Command System (ICS) positions
Incident Commander (IC)
Public Information Officer
Safety Officer
Liaison Officer
Operations Section Chief (“Ops”)
Planning Section Chief (“Plans”)
Logistics Section Chief (“Logs”)
Finance/Administration Section Chief
Given a list of communications practices, identify those that are specified as part of the ICS
Given a list of definitions, match them with the following ICS and ASRC terms
Chain of Command
Unity of Command
Incident Action Plan
Task Assignment Form (TAF)
Staging area
“We have PAR”
From a list, identify safety and conduct best practices recommended in Essentials for Search and Rescue 
Dealing with a vomiting litter patient
Using load straps
Rotating litter bearers
Laddering a litter up or down a slope This curriculum is to ensure that those credentialed to Field Level III meet the following educational goals. 
Safety, Health and First Aid 
Learn principles of personal hygiene during search and rescue operations, and their role in disease prevention.
Learn the confidentiality restrictions on ASRC members, both from ASRC best practices about protecting the personal information of search and rescue subjects, and from legal constraints on medical information related to HIPAA (the Health Insurance Portability and Accountability Act). 
Learn standard principles and use of Personal Protective Equipment (PPE) and best practices related to bloodborne pathogens (BBP) as adapted for wilderness search and rescue.
Learn the principles for a forced bivouac: siting and microclimate, improvising emergency shelter and insulation, and possible roles for fire-building during an emergency bivouac.
Learn about the reasons for backcountry water purification, current technology for backcountry water purification, and strategies for selecting water purification methods for a search and rescue pack.
Communications
Learn how to use the entire phonetic alphabet and numerals, ASRC prowords, and ASRC radio protocols as outlined in the .
Learn how to confidently and reliably use the major controls of handheld radios and to perform basic field maintenance tasks such as changing antennas or batteries.
Learn how to confidently and reliably use standard radio protocols and a radio to communicate. 

Learn the uses, advantages and disadvantages of signal mirrors and improvised mirrors, whistles, smoke, flares and chemical light sticks.

Land Navigation
Learn to use the UTM/USNG and ASRC grid systems to plot a location on a map, and to read and communicate the grid coordinates of a point on the map.
Learn about true north, grid north, magnetic north, and magnetic declination, and be able to convert bearings from magnetic to grid and back. 
Learn about the three map/GPS datums and how setting the datum wrong can affect GPS location accuracy.
Learn the basics of how the GPS system works, and basic GPS terms, including GPS, GPS receiver, GPS unit, APRS, vector and raster maps, the two types of digital USGS topographic maps, GPS fix, dilution of precision, multipath interference, GPS track, and GPS waypoint.
Learn that one can transfer .gpx files between a smartphone GPS app, a dedicated GPS unit to a laptop computer in Base and the advantages of this.
Learn common GPS problems and how to work around them.
Learn how to navigate using map, compass and GPS or GPS smartphone app, well enough to reliably complete basic-level orienteering courses during daylight. 
Operations, Management and Leadership
System Operations
Learn how the ICS operates for a small incident through the free online course IS-200.B: ICS for Single Resources and Initial Action Incidents: and how the ICS is adapted for search and rescue operations by the ASRC. 
Learn the phases of a search and rescue operation and the major events in each phase. 
Field Team Management
Learn the functions usually required of a field team, how those functions can be efficiently delegated by assigning a named position to a team member, and the field team position names traditionally used by the ASRC.
Learn why imbuing patience is an important team leader skill for leading teams of emergency services workers, but difficult.
Learn the advantages and limitations of the GAR (green-amber-red) model for assessing risk for search and rescue operations and methods for estimating search or rescue urgency.
Learn standard outdoor recreation trip leader skills, including assessing the extent and difficulty of the task, assessing the team members’ capabilities and limitations, and measuring against the assigned task, promoting situational awareness, modeling good behavior, bringing extra gear for emergencies and for unprepared team members, and monitoring team members’ condition.
Search 
Learn basic search terms and their definitions, including:
Common search management terms,
Common search resources,
Common search strategies, 
Search tactics, 
Search Types I, II and III,
The LAST mnemonic, and
Common search tasks.
Learn best practices for finding clues, evaluating potential clues, and dealing with clues.
Learn the functions and procedures usually used to accompany a search dog and dog handler as a “flanker,” also known as a “walker.”
Learn best practices when dealing with a potential or actual crime scene in the backcountry. 
Learn legal aspects relevant to search, including various types of trespass.
Rescue
Field IV credentialing requires only knowledge about how to safely carry a litter, but those credentialed Field III are expected to practice this until competent.
Learn how to serve safely and effectively as a member of a litter team, including the following. 
Learn how to carry a litter on non-technical terrain or semi-technical terrain (non-technical and semi-tech evacs), including clipping into the litter.
Learn how to follow standard ASRC procedures for litter team positions including: Litter Captain, Medic, Speaker, and standard litter team calls.
Learn best practices for lifting and setting down a litter, dealing with vomiting, using load straps, laddering and toenailing, and litter bearer rotation.
 Curriculum
The majority of the topics in this curriculum are knowledge-based, and for these, attend Group or ASRC training, and read the recommended references.
Some of the topics are psychomotor skills, for example, tying a knot. For psychomotor skill topics, we recommend that students observe a skill being performed and then practice it. Such psychomotor skills are indicated by the annotation . 
If you are a Group Training Officer planning your training schedule, or an instructor preparing to run a class,  is your key to cover these topics in practical sessions, either small groups in a classroom or during field training. 
If you are using this curriculum to plan your personal learning and progress towards Field III credentialing,  indicates that you should either:
Seek out someone more experienced to demonstrate a skill to you, such as how to tie a particular knot, and then have someone experienced observe one-on-one while you practice it. 
For a group skill like rotating litter bearers, get several experienced someones to demonstrate it to you, then practice it with them. 
If you need to learn and practice a group skill, work with your Group Training Officer and training session instructors and request that they incorporate the skills you need into training sessions.
, Health and First Aid

Role of handwashing/alcohol based hand cleaners in preventing diarrhea, colds, influenza
Clean hands after pooping or peeing (skin in genital area covered with fecal bacteria)
Clean hands before eating
Alcohol-based hand cleaner effective against most germs, but not those that cause norovirus infections (“24-hour stomach flu”) or Clostridium difficile (“C diff”) infections; more on handwashing under Bloodborne Pathogens
Using trowel or heel-dig cat-hole to bury your poop, and how far to dig in mid-Appalachian fields and forests
Be very suspicious of food served by local people to help feed searchers at Base: common cause of food poisoning as not being refrigerated or hot enough for several hours promotes bacterial growth, flies may contaminate food with fecal material
Toothbrush and toothpaste and flossers appropriate, especially on multi-day searches; think of teammates
Fatigue
Mental fatigue covered in Field IV curriculum
Physical fatigue comes from buildup of waste products, such as lactic acid, in muscles and throughout the body; takes rest to clear waste products from muscles and rest of body
Physical fatigue may be in specific muscle groups, such as arms and upper body after carrying litter; weight training will improve muscle endurance and allow longer use of those muscle groups
Physical fatigue may be generalized; aerobic = ”cardio” exercise will improve endurance in this respect
Exhaustion
Physical exhaustion is when energy reserves, such as glycogen = “animal starch” in muscles and in liver is used up
Good nutrition before heading into field will help prevent exhaustion, as will eating well in field, even if just snacking frequently
Experienced outdoorspeople and SAR people stock belt pouches, pack hipbelt pockets and other pocket with snacks that may be eaten without stopping
Nutrition
Quick-energy foods contain sugars, usually sucrose (table sugar) but often the more-rapidly-absorbed glucose
Starches are long chains of sugars that provide a bit more sustained energy than sugars, but are a bit harder to digest
Both sugars and starches are carbohydrates = “carbos”
Carbohydrates are considered high-glycemic = high glycemic index: 
Carbos cause blood sugar to rapidly rise (good when need energy for strenuous exercise)
This high blood sugar causes body to increase level of hormone insulin, which pushes blood sugar into cells
Increased level of insulin tends to stay up and cause blood sugar to “crash” (become low = hypoglycemia) unless continue intake of carbos
Hypoglycemia may cause weakness or fainting
Adding some fat to the carbohydrates slows digestion and release as blood sugar, so preventing blood sugar “crashes” 
“Fiber” (long-chain carbohydrates that we cannot digest but the bacteria in our guts can digest) will also slow digestion and prevent hypoglycemia “crashes”
Fats provide the most energy per unit weight, as well as some essential nutrients 
Damage to muscles and other parts of body from exertion or just normal wear and tear requires protein
GORP is old traditional trail food
GORP is one part raisins, one part Virginia peanuts, and one part M&Ms chocolate candy (by number according to an article in the Intercollegiate Outing Club Association newsletter)
Mixture of quick energy (glucose in raisins, sucrose in M&Ms), fat to slow digestion and provide ongoing energy (cocoa butter in M&Ms), protein (in peanuts) and fiber (in raisins)
Should consider this old traditional mix, at least it mix of food ingredients when picking snacks for SAR tasks
Trail snacks should be supplemented with meals rich in fat and protein
In warm weather, need salt in trail snacks and meals, especially in spring when not heat-acclimatized; salted peanuts in GORP provide some salt

Bloodborne Pathogens Overview 
Microorganism (viruses, bacteria, protozoa) in many body fluids
Some can cause serious disease in humans
Those infected may transmit disease to those exposed to their body fluids
Examples include Hepatitis A, B and C, and Human Immunodeficiency Virus (HIV)
Hepatitis
Hepatitis A
Most commonly transmitted by contaminated water or food
Also transmitted by body fluids
Not as serious as Hepatitis B or C but may make some people very sick
Hepatitis B and C 
Transmitted through sex or “blood to blood” contact.
Hepatitis B and C very contagious from blood to blood exposure; virus particles (virions) may survive in dried blood up to a week
Hepatitis, particularly Hepatitis B and C, may cause cirrhosis, liver cancer and death, 
Vaccines available for Hepatitis A and B, but not C
Hepatitis A and B vaccines strongly recommended for all ASRC members even though bloodborne pathogen exposure rare in wilderness search and rescue
Human Immunodeficiency Virus (HIV)
HIV attacks immune system, so cannot fight other infections
Acquired Immune Deficiency Syndrome (AIDS) caused by untreated HIV
HIV infection requires lifelong drug treatment with toxic drugs to prevent death from AIDS
Although HIV infection can be managed, no cure for HIV infection yet
Means of Transmission
Sexual contact 
Sharing contaminated needles 
From pregnant woman to fetus during or before birth 
Accidental puncture from contaminated needle, broken glass, or other “sharps”; if advanced medical providers using intramuscular needles or intravenous needles, need to ensure dirty needles get into protective case, either designed for indoor medical facilities or an austere alternative such as a small water bottle appropriately labeled, or a commercial container designed for prehospital use (e.g., Sharps Shuttle, Sharps Shaft, Porta Sharps)
Intact skin impervious to bloodborne pathogens, but they may be transmitted by contact between body fluids and broken or damaged skin 
Open blisters or other open sores 
Cuts 
Abrasions
Some pathogens may be transmitted when body fluids contact mucous membranes in eyes, nose or throat
Universal Precautions and PPE
Treat all blood, body fluids and potentially contaminated materials as infectious
Personal Protective Equipment (PPE): gloves 
Impermeable medical exam gloves when dealing with contaminated materials or examining patients who might have body fluids on them
Should have at least two pair of medical exam gloves in SAR pack, packaged to prevent damage in pack
No latex (natural rubber) gloves: some people have anaphylactic allergic reactions to latex
Nitrile stretchy plastic most common material for gloves
Different brand gloves fit differently and some more sturdy than others; recommend textured thicker (4, 6 or 8 mil) nitrile gloves as more sturdy for search and rescue use
Can wear nitrile exam gloves under outer cold-weather or rope-handling gloves or mittens, but should have spare pair of gloves or mittens in pack, as well as plastic bag (required leaf bag may be used) to isolate contaminated outer gloves or mittens; spare gloves or mittens and spare hat in pack should be standard in cold weather, as may need to use or lend to less-well-equipped team member
Cover cuts or open areas on hands with a bandage before putting on gloves
Inspect gloves for tears or punctures before putting on
Use proper procedure when taking gloves off; don’t touch outside of gloves with ungloved skin
PPE: eyes and face
If risk of contaminated fluids splashing, such as with high-pressure irrigation of contaminated wounds, protect eyes
Corrective-lens glasses provide some protection
Sunglasses provide some protection
Goggles used for helicopter operations, deep winter operations or night search provide better protection
Swim goggles provide good protection as well as eye protection for night operations, and are smaller to pack than larger goggles
Face shields protect nose and throat as well as eyes; disposable lightweight medical procedure nose-mouth masks with attached clear upper-face plastic shield available cheaply, but require careful packaging to survive in a SAR pack; may be put in large zipper plastic bag and put in pack water-bladder pouch or back-padding pouch to protect from breakage
Hand-Washing
Hand-washing critical part of preventing transmission of bloodborne and other pathogens, particularly diarrhea and respiratory viruses
Hand-washing recommended after taking off medical protective gloves, especially if visibly contaminated; gloves may have tiny holes that let invisible but potentially-infectious amounts of blood through. 
Handwashing critical if ungloved hands visibly contaminated with body fluids
Washing with water and soap: may want liquid soap that works in cold water, Dr. Bronner’s has been standard for backpackers for many decades; can put in Nalgene dropper bottle as less likely to leak
In winter, alcohol-based hand cleaner may be better choice as has much lower freezing point than water, and small amounts unlikely to cause frostbite; may also put in Nalgene dropper-top bottle
May wish to carry small, light microfiber towel for drying hands after soap and water or alcohol-based hand cleaner
Nalgene or similar 15 mL (0.5 oz), 30 mL (1 oz) and 60 mL (2 oz) bottles more durable and less likely to leak than store-bought bottles, and can get with dropper tops or transfer dropper tops from other size bottles with similar sized tops 
Contaminated Gear
Contaminated hardware, rope and webbing may be washed in hot water or may be decontaminated with a 1:10 dilution of household chlorine bleach
Clothing that might have been contaminated with body fluids should be isolated in a plastic leaf bag and washed with hot water and dried in a drier once home, unless needed for survival in the field
Dealing with Exposure
Some exposures to body fluid have significant risk of catching a disease, some do not
OSHA (US Occupational Safety and Health Administration) says: “If you are stuck by a needle or other sharp or get blood or other potentially infectious materials in your eyes, nose, mouth, or on broken skin, immediately flood the exposed area with water and clean any wound with soap and water or a skin disinfectant if available. Report this immediately to your employer and seek immediate medical attention.”
US CDC (Centers for Disease Control and Prevention), NIOSH (National Institute for Occupational Safety and Health) says: “If you experienced a needlestick or sharps injury or were exposed to the blood or other body fluid of a patient during the course of your work, immediately follow these steps:
Wash needlesticks and cuts with soap and water
Flush splashes to the nose, mouth, or skin with water
Irrigate eyes with clean water, saline, or sterile irrigant
Report the incident to your supervisor
Immediately seek medical treatment”
Body fluids on intact skin should be cleaned off immediately but do not constitute a significant exposure that requires evaluation or treatment by a medical practitioner, nor does it need to be reported
Should report significant exposures up the chain of command for the operation or training session
If member has not had Hepatitis B vaccine, a dose is generally given in the ED, with follow-up to obtain two more doses of the vaccine
If significant risk of HIV transmission, member will be generally started on HIV post-exposure prophylaxis (PEP), medications to help prevent contracting HIV
If significant exposure, member must go urgently to the nearest hospital Emergency Department for evaluation and treatment (Urgent Cares and clinics generally do not provide Hepatitis B vaccine or PEP for HIV)
If “donor” (the subject/patient/other team member whose body fluid responsible for exposure) has significant risks for having a bloodborne pathogen, or known bloodborne pathogens; if can obtain, confidentially record this information and should go with exposed member to Emergency Department
Most states mandate “donors” submit to testing for bloodborne pathogens such as Hepatitis B and HIV, so if possible, information that “donor’s” body fluids were responsible for exposure go with donor to Emergency Department where donor is taken

ASRC best practices:
Requests from press or public for information:
May give public or press information about what job is like, weather and terrain, kind of training you have, things that are or should be public record 
If request for specifics of this operation, refer up chain of command or to ICS Public Information Officer (PIO), don’t give details
HIPAA:
Search subject’s medical condition is confidential information under Federal law, Health Insurance Portability and Accountability Act (HIPAA), and fines or legal action may result from violations
Exception to HIPAA confidentiality for anything that might interfere with urgent patient care 
Emergency 
Picking location
Microclimate
Sheltered from prevailing wind direction (usually from west)
Heat islands (urban, wilderness: rocky areas that have been exposed to heat)
Effect of bodies of water on temperature and mosquitoes
Effect of tree transpiration on cooling, and of winter evergreens on protecting from wind and rain 
Hills, valleys and warm and cold air at night
Effect of tree leaves on infrared radiation at night and implications for bivvy sites
Danger of flooding
Danger of rockfall, dead trees or limbs falling
Natural shelters: caves, large downed trees, under coniferous trees (pines, spruces, firs, eastern hemlocks)
Full team bivouac maybe with patient:
Do check of all packs for items that might be of use during bivouac, such as removable foam pads from packs for insulation
Huddle together for warmth
Building shelters, improving natural shelters such as caves or under large evergreen trees or beside large downed trees
Full debris hut: too much work for a single night
Debris shelter: more suited to single overnight bivvy
Improvised insulation
Dry leaves
Bark sleeping pads
Pine bough beds: only in true emergency bivvy, not for practice
Advantages and disadvantages of building a fire
Jack London: “To Build a Fire”
Energy costs of building a fire
Dangers of building a fire
Heat reflectors
Camping exercise
Camp overnight
Austere setting with nothing more than a flat place large enough for a small backpacking tent
May have to hike a short distance to site
Use standard backpacking-type gear
Sleeping bag
Sleeping pad
Tent or sleeping-bag-cover type bivouac sac
May use borrowed or rented gear

Hazards in water
Protozoa: Giardia, amebic dysentery: about 5 microns in size, removed by most filters, 
Bacteria: 0.1-1 micron in size, cause diarrhea, removed by most but not all filters
Viruses: 0.01 microns, cause diarrhea, Hepatitis A: not removed by filters
Pesticides: removed by carbon filters
Heavy metals from mine drainage: hard to remove
Methods of purifying water
Bringing water to a boil 
Pumps, straws and gravity feed devices: 
Filters vs purifiers
Role of pore size
Role of iodine resins
Role of prefilters
Role of activated carbon elements
Danger of freezing
Need to clean and store properly, and to have spare filter element 
Water purification tablets: 
Chlorine: not used much any more
Iodine: available, causes interaction with thyroid gland in those with thyroid problems (actually pretty common); may use thiosulfate tablets to remove iodine taste, but problems with thyroid remains
Chlorine dioxide: compared to chlorine or iodine tablets, does better job of killing bacteria and viruses at 30 minutes, and if leave for 4 hours, even kills cyptosporidium (but probably better to use a filter first to get rid of Giardia and Cryptosporidium); ~5 year shelf life, but need to protect tablets from being crushed in pack; contains chemicals such as sodium chlorite and sodium dichlorcyanurate that release chlorine dioxide when put in water
Chlorine and iodine don’t kill Giardia and particularly Cryptosporidium even after 4 hours
UV light treatments (e.g., SteriPen)
Need prefilter to remove turbidity
Effective with one-liter/quart water bottles
Not effective with bladders, e.g., Camelbak
Mixed oxidants (e.g., Potable Aqua PURE Electrolytic Water Purifier): effective with water bottles or bladders, roughly equivalent to chlorine dioxide tablets, heavier and tend to be used for long-term trips with lots of people as can purify lots of water with just some salt and water and a little power
Heaviest, most expensive, but best: filter combined with mixed oxidants (bladder or bottle) or chlorine dioxide tables (bladder or bottle) or UV light treatment (1-liter/quart water bottle only)
For short cool-weather tasks, usually can carry enough water, so having some backup chlorine dioxide tablets reasonable
For longer or hot-weather tasks, may use a lightweight filter like a MSR Hyperflow filter and then treat with mixed oxidants or chlorine dioxide tablets.

 and Prowords 
Learn to use entire phonetic alphabet  and official ASRC prowords and radio protocols without reference to the ASRC Radio SOP Crib Sheet
Learn how to use standard ASRC whistle and hand signals with reference to the ASRC Radio SOP Crib Sheet
and Maintenance 
Learn to confidently and reliably operate standard handheld radio controls and perform simple field maintenance tasks
Operate off/on switch
Operate volume adjustment
Operate push to talk
Operate channel selector
Attach and detach antenna
Replace battery
Toggle keyboard/channel select lock if available
Know other buttons might accidentally hit and how to recover from them
Radio  Learn to confidently and reliably:
Push push-to-talk button
Pause for a second
Speak in normal tone
Speak slowly and distinctly
Use basic prowords
Use “you, this is me,” not “me to you”
If speaking long occasionally say, “How copy so far?” then release push-to-talk
s.
Alternative/Backup 
Learn uses, advantages and disadvantages of
Signal mirrors and improvised mirrors (knifeblade, mirror on compass)
Whistles 
Smoke
Flares
Chemical luminescent light sticks

Land 

Identifying common USGS topographic map symbols: 
How to measure distance on topographic maps
Using scale bars
Knowing that UTM/USNG grids are 1 km 
Using transparent grid overlays (i.e., grid readers)
Determining UTM/USNG position on topographic maps
Plotting a set of UTM/USNG coordinates on a map
Reading off UTM/USNG coordinates from a point on the map 

Three common map “datums”
Datum is zero,zero origin for grid 
1927 NAD27 datum on older US Geological Survey (USGS) topographic maps
Newer maps use 1983 NAD83 or 1984 WGS84 datum, basically same
Most GPS units GPS apps set for WGS84, though can change to NAD27 
If give grid coordinate and GPS set to NAD27 and Base uses WGS84, 200 meters ( > 0.1 mile) off

Latitude and longitude
UTM/MGRS
USNG
ASRC Grid System 
Magnetic north, true north, and grid north; where the magnetic north pole is and how it is moving
Declination
What declination is
How declination varies over time and across globe
Direction of declination throughout the mid-Appalachian region (5° west in western Ohio, and 12° west in eastern Maryland) 
How nearby ferromagnetic metal objects and bodies of iron ore may change declination
How to set declination (for adjustable compasses)
How to adjust for declination (nonadjustable compasses)
How to use a protractor, and given points A and B on a map, to determine the true and magnetic bearing from A to B
How to use a compass, and given points A and B on a map, determine the true and magnetic bearing from A to B
Given a true bearing, set the corresponding magnetic bearing on the compass

GPS System Overview
GPS can tell you where you are, either a set of numeric grid coordinates (e.g., USNG app) or with a dot on a map
GPS will not plot the best backcountry route from A to B for you 
GPS satellite network with highly-accurate clocks sending signals all the time; both US NavStar satellites and Russian GLONASS satellites
GPS multi-satellite receivers in GPS units and smartphones
Use tiny differences in timing from different satellites to determine position
Precision of position determined by number of satellite “fixes”; fix on three satellites will give rough location, fix on four satellites will give more precise location including elevation
If GPS has not been on for a while, or hasn’t been on in area recently, will need to  take several minutes to download data to start getting fixes: “cold start”
If GPS has been on in area and only stopped for hour or two, only takes 1-2 minutes to get fixes: “warm start”
Smartphone GPS apps also improve accuracy, particularly in urban areas with obstruction of GPS signals by tall buildings, by noting names of nearby WiFi routers
Things that interfere with radio receiver view of satellites and thus GPS satellite signal 
Large buildings
Being inside a building or vehicle
Sides of deep ravines or canyons
Land over caves
Water between GPS satellites and GPS unit/app, including in leaves on trees in deep forest, in clouds or rain
May interfere not only by blocking signals, but also sometimes by reflecting signals and making timing off “multipath reception” or “multipath interference” resulting in wrong location
Military may simply flip switch and make GPS much less accurate for national security reasons
Possible to “jam” GPS receiver, either deliberately to cause harm, or accidentally by transmitting with radio or cellphone right next to GPS unit 
GPS terminology
GPS: Global Positioning System a system for determining position using radio broadcasts from a network of 24 satellites, each with a computer, a clock, and a radio transmitter
GPS Receiver: electronic circuitry that receives GPS satellite broadcasts, compares them, and uses this information to determine locations; GPS receivers are found in dedicated GPS devices, smartphones, cars, planes, ships, and in general anything that needs to track its location
GPS Device: a device dedicated to providing GPS location; some devices may just record a track of GPS locations, or transmit GPS locations for APRS, but the most common GPS units for search and rescue display one’s GPS position on a map
APRS: Automatic Position Report Systems remotely track the movements of a GPS device; this may be used to surreptitiously track a police suspect’s vehicle, or to track a field team during a search
Vector Map
A vector map is a type of vector graphic
Vector graphics display curves (“paths”) based on mathematical equations, which means smaller file sizes than bitmapped graphics 
Examples of paths in a vector map include contour lines, trails, the outlines of buildings and the boundaries of areas of green woodland overprint
Raster graphics stay sharp no matter how much you enlarge or shrink them
Topographic maps are quite suitable for vector formats, provided the vector data is available
Raster Map
Raster map is  type of raster graphic, also known as  bitmapped graphic
Raster graphic is made of a raster (rectangular grid) of dots of different color
Common raster graphic formats on computers are .jgp and .gif
Even with file compression, raster graphics (and maps) have much larger file sizes than vector graphics that show same area
USGS Digital Topographic Maps
USGS is United States Geological Survey
USGS 7.5 minute topographic map quadrangles were hand-drawn based on both aerial photographs and on-site inspection (“field checking”) by cartographers; USGS quit updating the 7.5 minute topographic map quadrangles in 1992, so will not show changes since 1992
USGS 7.5 minute topographic map quadrangles are available only in bitmapped raster graphics format, scanned from printed maps
Starting in 2009, but only fully realized in 2012, free, online “US Topo” series maps are in vector format, but have only a fraction of information on raster bitmapped version of older USGS 7.5 minute topographic maps
Some vector topographic maps have more information than US Topo vector map series, but usually not free
GPX (.gpx) Format: designed to be universal interchange formats; allows information including GPS tracks, GPS waypoints and search areas (“polygons”) to be sent between GPS device or app and search-management computer program such as SARTopo
GPS Fix 
When a GPS unit or app has determined its position
May take some time for a GPS unit or app to obtain a GPS fix
Time to obtain a GPS fix depends on many factors
Dilution of Precision (DOP)
Engineering term for the accuracy of the GPS fix
GPS units or apps may use DOP, or more specifically horizontal DOP (HDOP) or vertical DOP (HDOP) to describe how accurate of a fix the unit currently has
Ranges from 1 (ideal) to >20 (may be off by 300 meters)
With low DOP may get location fix but without elevation 
Multipath Interference
Precise timing of GPS signals needed for accurate fix
Distortions from atmospheric conditions (e.g., ionization in the troposphere) may slow signals
Reflections from cliffs, bodies of water, or buildings may be stronger than direct signal and make timing off
Explains why GPS fix may be wrong in canyons or urban areas between tall buildings
GPS Track
GPS units or apps generally may keep record of minute-by-minute GPS position
When plotted on a map, is a line, thus called GPS track
Usual to turn on GPS tracking when heading out for a search task
GPS units with map usually show tracks on a map; very helpful to see where you’ve been in case you need to retrace your tracks, or to download to computer at Base as a precise record of your search task
GPS track may be included in a .gpx file for transfer between computers and GPS units/apps
Common to use software on Base laptop to create “track” that is really polygon that describes search area and transfer to searcher’s GPS unit or GPS smartphone app; allows searchers to view their search area on GPS map with precision and track their location relative to the search area boundaries
At end of task, common to transfer track of where field team actually went to Base laptop to integrate into software such as SARTopo as a record of what was actually searched
GPS Waypoint
GPS location saved in GPS unit/app’s memory
May be included in .gpx file and transferred to Base on return
Commonly used in SAR tasks to mark clue locations, trail junctions or decision points (places one is likely to go off the trail) not on map, 
Usually can be manually named to help recall reason for saving waypoint
GPS Problems
Datum set wrong on GPS unit/app
Multipath interference may not just block signal but make GPS unit/app misjudge position
More satellites visible means better position fix; if only three satellites visible (minimum to get fix) then precision less
GPS Navigation 
Details differ widely between GPS units/apps, but should learn to do the following with Group GPS units and personal GPS unit/app
System Operations
Turn unit on and off or open and close app (and make app stop using cellphone battery)
Check battery charge
If applicable, change battery; if cellphone, how to attach external battery charger
Setup
Set datum to correct datum (usually WGS84 or NAD83 but not NAD27)
Set units for distance (usually miles or meters/kilometers)
Set the grid location format to USNG (US National Grid), or, on older units, UTM 
Determine the UTM and USNG coordinates for your current location
Track Logging
Clear the track log (if available on the unit or app being used)
Turn track logging on and off
Rename a track
Find an existing track on the GPS unit or GPS app
Waypoints
Mark your current location as a waypoint
Select a point on the map and mark as a waypoint
Locate a previously stored waypoint
Input USNG coordinates to create a new waypoint (e.g., a find to which you must navigate)
Rename a waypoint
Locate a particular waypoint stored in the GPS unit or GPS app
 
By inspection (terrain association)
By compass
Land Navigation/Handrail
Catching feature
Map simplification 
Comparing routes as far as difficulty of travel/hazards, elevation change, and difficulty of navigation/”safety” in terms of getting lost
Attack point
Aiming off
Rough vs precision navigation
Thumbing a map 
 
Attempt basic-level orienteering courses until able to apply the above concepts to complete them safely and confidently during the day
, Management and Leadership
 
ICS national, mandated Incident Command System for all US inter-agency incidents
Used all the time by ASRC
:
Command: Incident Commander (IC), which on big incident may include additional Command Staff:
Public Information Officer: handles interactions with press and public
Safety Officer: in overall charge of safety
Liaison Officer: handles relations with supporting agencies (such as ASRC Groups)
General Staff 
Broken into four functional parts and they report to the IC:
Operations Section Chief (“Ops”): sometimes an Agency Having Jurisdiction/Responsible Agent will ask an ASRC Search Manager to take on this task
Planning Section Chief (“Plans”) (also sometimes combined with Ops resulting in a single person handling “Plops”)
Logistics Section Chief (“Logs”)
Finance/Administration Section Chief (“Admin”)

Standardization: common terminology for functions, facilities, resources and positions
Chain of command: from the Incident Commander to the General Staff, and down to individual searcher
Unity of command: you report to only one supervisor, and get instructions only from that supervisor
Unified Command: when there are multiple Agencies Having Jurisdiction (AHJ)/Responsible Agents (RAs), each with their own IC, who work together to command the operation using a single Command Staff and a single General Staff with a single integrated incident organization, co-located shared facilities, and a single shared set of objectives, planning process, and IAP
Incident Action Plan (IAP): the overall plan for the search or rescue
Modular organization: jobs are chunked and standard terms for chunks, such as Plans or Ops
Flexible: one person can assume more than one function, or all functions, for a small incident, others may be assigned positions as incident expands
Manageable span of control 
per ICS, 3–7 subordinates per position: any more than 7 just doesn’t work
Five ideal maximum
Except in a line search, and then usually have assistant team leader on other end of line
Sign-in and Sign-out: important in the ICS but critical for search and rescue
Accountability: see e and Field IV (Trainee) curriculum
Resource tracking: which “resources” (people, teams, vehicles) are where, and whether need more
ICS Geographic Terms
Incident Command Post (ICP)
Base
Camp
Helibase
Helispot
Staging Area 
For most smaller SAR operations these are usually combined and just called “Base”
Standard map symbols for these places exist
Field Level III members not expected to memorize these symbols

SAR phase/stage names and groupings arbitrary, depend on whether lumper or splitter and which words you like best: this is splitter’s list with fairly-common names for educational value but not for testing
Readiness/standby/preplanning
Alerting/notification
Response to scene
Initial on-scene actions (done simultaneously if possible)
Coordinate with Agency Having Jurisdiction/Responsible Agent
Information gathering and start filling out Missing Person Questionnaire 
Send out reflex tasks (brief mention of bike spoke model) such as
Cutting for sign around the Initial Planning Point (IPP), which is either the Point Last Seen (PLS) or the Last Known Position (LKP), with either clue-conscious searchers or man-trackers
Hasty tasks along travel routes, such as trails and streams, leading away from the IPP
Hasty tasks to hazards or high-probability locations
Canvass campgrounds
Containment
Start Base staff organization
Set up Base radio
Full-scale search operations
Establish strategy: 
On map, plot planning areas
Estimate POA (Probability of Area; estimated probability subject is in planning area) for each planning area
Segment area into searchable segments
Create TAFs for available resources and get them into the field to search high-priority segments
Evaluate results and create more TAFs
Request additional resources if needed
Find management or suspension
After-action review (now, later or both)
Demobilization
Ensuring everyone is home safe
Readiness/standby/preplanning/cleaning and repacking stuff 

Leadership
FTLs must be ready to lead teams with members not only from their own Group but from other SAR teams or firefighters, medics and others with no SAR experience.
More people skills included in Field II and I curricula
Two main leadership styles: authoritative and relationship-oriented; some leaders use one more than another but usually a mix appropriate to the situation at hand
Authoritative style concentrates on getting the job done: delegating tasks, and instructing members how to accomplish those tasks
Authoritative style needed when seconds count
Relationship-oriented style means showing that you are interested in your team members, learning about them, consulting them on decisions, and building team cohesion and morale
Relationship-oriented style requires crafting different interaction styles with team members with different personalities
Relationship-oriented leadership style should usually be default for most field team operations 
Delegation 
Delegation of positions only as needed
One member may fill multiple positions
Not all functions needed on a particular task
Field Team Positions and Functions
Leading: Field Team Leader 
Place in chain of command
Decision-making authority, limited by team members’ right to refuse to do something they regard as unsafe
Receive briefing from Base and brief team
Review entire Task Assignment Form before leaving Base 
Debrief team after task and provide debrief information to Base on return
Responsibility for safety and well-being of team members, including those from other agencies and spontaneous volunteers, similar to that of an outdoor-recreation trip leader
Complete task provided can be done safely
Assess capacity of team, and individual members, for further tasks
Backup: Assistant Team Leader
Sometimes predesignated in case something happens to FTL
No other duties
Navigating: Navigator
Carry task map
Save track on GPS or GPS app
Provide GPS position when requested by Base
Save waypoints for clues, trail decision points (places one is likely to go off the trail) not on map, and other important locations
Advise FTL as far as task completion on map
Communications: Radio Operator
Obtain radio, spare battery from Base
Obtain communications briefing from Base, including getting Base cellphone numbers and giving Base cellphone numbers of team members
Check radio equipment to make sure it’s functional and do radio check with Base prior to leaving Base
Advise FTL of potential or known communication issues
Check in with Base as per TAF schedule
First Aid and/or Medical Care: Medic
“Medic” just means person assigned to deal with first aid/medical issues
may not be highest medical qualification on team as that person may have other duties
may just have first aid training, but still is “The Medic”
Decides what kind of first aid/medical kit/gear to bring on task
Rescue: Rescue Specialist
Decides what rescue gear the team carries
Manages rescue operations by the team until relieved by someone higher in the command chain specifically related to rescue
Safety: Safety Officer
FTL’s job unless otherwise assigned
Specifically assigned in high-risk situations
Safety officer usually freed from other duties to concentrate solely on safety

Patience
SAR team members and other emergency services workers generally go-getters, eager to get job done
Field team leadership challenge is usually not to develop enthusiasm for task, but to encourage members to take the time to do the job right, such as adequately scanning for clues
FTL must model patience with team members, especially given “hurry up and wait” nature of big SAR operations, perhaps with stories of “hurry up and wait” during past operations
There is a saying in technical rescue, “Slow is smooth. Smooth is fast.”
Trip Leader Skills
Leading Field Team is like leading outdoor recreation trip: same skills needed by FTL
Best-known mountaineering text identifies following roles for trip leaders, also discussed in SAR textbook chapter:
Guardian of safety
Anticipator
Planner
Expert
Teacher
Coach
Initiator
Arbiter
Guardian of the environment
Delegator
Preparing for emergencies: FTLs bring extra gear such as: 
A bit of oversized spare clothing
First aid kit suitable for larger group
Extra leaf bags 
Spare map and compass
Extra water and/or water purification system suitable for larger groups
In winter, a bothy bag survival shelter 
Assess task for aerobic and muscular difficulty, hazards, time to accomplish and available light, and compare with assessment of Field Team members
Quick rules of thumb: fat = poor aerobic condition, slow uphill; skinny = poor resistance to hypothermia
Assess Field Team members’
Outdoor experience
Aerobic condition
Muscular strength
Mental strength
Nutrition, hydration, fatigue
Any medical conditions that might affect team’s function 
Situational Awareness
Good definition: Situational awareness or situation awareness is the perception of environmental elements and events with respect to time or space, the comprehension of their meaning, and the projection of their future status.
FTLs need to assess for progress with task compared with expectations, note good bivouac sites or water sources along way, changes in weather
FTLs challenge members to be alert to clues but also changes in temperature, vegetation, terrain, weather, and hazards such as poison ivy, brambles, dead trees that might fall, trip hazards
FTLs need situational awareness of team members: hydration, nutrition, fatigue, aerobic condition, mental state
Modeling: Team leaders consciously exhibit behavior they expect of team members: courtesy, concern for others’ welfare, and not complaining
Point, Sweep, Stops, Pacing
Point selects route and navigates, good if familiar with area
Sweep makes sure nobody gets left behind; sweep may also have to deal with injury or illness so wilderness first aid/medical skills helpful; sweep may have to speed up to catch up with the group after a stop so should be in fairly good aerobic condition
For large team, point, sweep and leader may use radios smartphones and Bluetooth or WiFi “walkie-talkie” app to keep in touch
Goals: keep group together, not lose anyone, keep moving
Young fit people tend to run ahead, but can only go as fast as slowest member, but slow people may go slow for a long time without stopping
Members must know to stay behind point and in front of sweep 
May put fittest people at front and slowest at end, start off at medium speed, group spreads out; few minutes before next stop, start slowing down, so that group bunches together; may load down young, aerobically-fit members of the group from those in worse aerobic shape, or team equipment, or some of leader’s extra emergency gear	
Dividing group dangerous, may take separate trails at decision point (places one is likely to go off the trail) and become separated

With larger groups may schedule stops, remind people to check bootlaces and adjust packs 
At stop with large group, may have men head forwards and women stay behind to take toilet break; ready to go when all women catch up with the men
Best solution: nobody passes the point member, and point, even if very fit, moves slowly
May need to stop to tighten boots before heading down long hill, to take off a layer of clothing before heading up  long hill, or for a toilet break, to eat, or because Base says to stop
If cold or chilly, and stopping for more than few minutes, remind team members to put on warm clothes before get chilled
Task Assignment
What a Task Assignment Form (TAF) is, and what each section means; on TAF, Base staff write down 
Where you are supposed to search
How you’re supposed to search
Who is on team, and positions
With what you are supposed to communicate with base, on what channel or by what cellphone number, and how often, and when
What gear you need 
Should have zip lock plastic bags for TAF and task map, with backup spare plastic bags
Mission briefings: Base staff brief everyone who is at Base with what relevant information they have; should take notes in personal pocket-sized waterproof notebook
Base briefing for Field Team Leader (varies based on information available and urgency of task; reflex task at beginning of search may get very little information); ideal briefing includes:
Expected duration of task
Specific clues to seek
Expected POD (Probability of Detection) for subject and clues
Subject information
Teams nearby
Hazards and safety information
Terrain and weather to expect
Plans for dealing with press and family
Plans for a find and a rescue
Previous efforts in the area
Field Team Leader briefing for team members: everything FTL got from briefer in Base; good time for introductions, if needed, and to assess team members’ capabilities and limitations  
End-of-operation “briefings”
Critical Incident Stress Management type large debriefing not thought to be appropriate at end of psychologically-stressful operation, but leaders may give guidance for avenues for one-on-one assessment or counseling
Leaders may gather personnel at Base to announce command staff decision to suspend mission, or outcome of mission with reasons for this decision
Leaders may lead discussion with those present at Base to discuss what went right and what went wrong: “hot-wash” or “mission debriefing
Leaders may be responsible for formal written After-Action Report (AAR) and may solicit information from personnel to put into AAR
First at Scene
If Field III and first from the ASRC to arrive, best to (1) let Group dispatch know you’ve arrived, (2) sign in (start sign-in sheet if none yet)
If organized search effort by people from non-ASRC teams that you know and respect, might be appropriate to let them assign you to field team unless instructed otherwise by your Group leadership
If you are first SAR member to arrive, gather information and try to contact a more senior ASRC member for advice on what to do.

Search  and Theory
Term definitions
Search
Rescue
Recovery 
Point Last Seen (PLS)
Last Known Position (LKP)
Initial Planning Point (IPP)
Active vs passive search
Planning area
Search segment
Probability of Detection (POD)
Probability of Area (POA), also known as Probability of Containment (POC)
Decision points (places one is likely to go off the trail)
Search resources
Human field teams
Dogs
Tracking/Trailing
Air Scent
Human Remains Detection (HRD)
Horses
ATVs
Mountain bikes
Planes
Helicopters
Drones
Others…
Search strategies
Investigation
Containment
Attraction/Passive
Hasty search
Area search
Search tactics
Looking
Listening (sometimes with shouting as attraction)
Smelling (dogs and horses especially)
Tracking/trailing (human man-trackers looking or trailing dogs smelling)
(teaching tool, not tested)
Type I (emphasizes speed more than thoroughness), such as hasty search of linear features; 45 years ago ASRC called this scratch search tasks
Type II (a balance of speed and thoroughness): sweep search tasks
Type III (emphasizes thoroughness more than speed): line or saturation search tasks
(teaching tool, not tested)
Locate
Access
Stabilize
Transport

Containment patrol task (foot, vehicle)
Try to assure that subject doesn’t leave the search area without being contacted
Generally go slow and look for clues as on patrol
When meet people along trail, ask if they have seen subject, give information about search 
Reflex tasks
“Reflex” means get into field as soon as possible even if minimal information available for team briefing
Example: field team hasty search along linear feature
Example: field team hasty search of Point Last Seen (PLS), Last Known Position (LKP), Initial Planning Point (IPP), attractive hazards or other small high-probability locations 
Hasty (Type I) task: small fast-moving team along linear feature such as trail or stream, or search of a point with high probability of find or clues; may be used as reflex task but also at later times in search
Area tasks
Sweep (Type II) task: larger and slower-moving team, widely spaced (maybe voice but not visual contact); generally do not lay out flagging
Saturation/Line (Type III) task: even larger and much slower-moving close-spaced “grid” search; generally lays out flagging to ensure complete coverage 
Man-tracking and signcutting tasks: needs tracker with specialized training
Air-scenting dog task: air-scenting dog and handler sweep back and forth through area, smelling for any human in area
Trailing dog task: trailing dog and handler try to follow the specific scent trail of the lost subject
Flankers: Man-tracking and dog tasks require accompanying human search team members, usually called flankers or walkers
Flankers stay back behind mantracker or dog and handler
Though dog handler or mantracker usually team leader, may ask flankers to handle communications and navigation to free handler to concentrate on communicating with dog
Flankers try to avoid interrupting mantracker’s or dog handler’s concentration
Other kinds of tasks but these are most common
 
Kinds of sign: being clue-conscious
Obvious clues, such as piece of clothing with subject’s name on it
Less-obvious clues, such as piece of clothing that might or might not belong to subject
More subtle clues, such as a bootprint that seems like the subject’s in an area that has not been traveled by humans in a long time
Even more subtle clues, such as man-tracking type “sign” 
Step-by-Step Mantracking
Tracking of humans and game done for thousands of years
Step-by-step method of mantracking brought to wilderness search and rescue teams by former US Border Patrol Ab Taylor 1n 1980s
Technique uses a tracking stick (usually a trekking pole with some “pony-tail” type rubber bands on it) to mark length of footprint and length of stride (usual length between subject’s footprints)
Technique emphasizes looking for the imprint of a single step, and then and only then using the stride marked on the tracking stick to look for the next “sign” that indicates the subject’s next step
“Sign” may be actual footprint, but usually more subtle, such as bent grass, mud scuffmarks on rocks, “shine” (flattened vegetation or dirt that reflects the sunlight), dead leaves turned over, a rock that has been pushed slightly out of place or vegetation bruised where stepped on
“Sign-cutting”: moving across an area perpendicular to the subject’s expected line of travel, hoping to intersect and then follow the track
May also use sign-cutting in a circle or spiral around a point of interest
Tracking easiest in morning and evening when slanting light and its shadows bring out footprints
Can track at night with a flashlight
Protecting a track
Most important for clue-conscious searcher: if in rarely-traveled area and find sign, protect it from your and other’s feet
To further protect track, mark for others:
Marking a track 
There are different ways for a mantracking field team to mark the tracks they have found and their progress
In desert areas, it’s traditional to drag one’s tracking stick so as to leave a line in the dirt
One tradition is to, when unable to continue tracking, to mark the location of the last definite sign with a Popsicle stick in the dirt and/or a bit of plastic flagging tape with date, time and team designator on it with a laundry marker (e.g., Mini Sharpie)
Used to be traditional to make a sketch of a good footprint; now more common to put a dressmaker’s measuring tape or a disposable paper medical measuring tape next to the track and take a good-quality smartphone picture of it; may even be able to text it to Base
A fairly common but not universal way to mark individual footprints is to use the tip of the tracking stick to inscribe a semicircle behind the heel of the footprint, with a short line from the semicircle leading away from the semicircle to the outside of the track: to the right for a right heel, to the left from the left heel

Military joke about “secure a building”
Priorities: 
Assess scene safety (including firearms, weapons on military aircraft, fuel, sharp debris, booby traps)
Consider any find site a possible crime scene
Medic alone goes in to assess if alive or dead, and if alive to start first aid/medical assessment and treatment
FTL notes path medic takes and marks it if needed, team follows this path only
Establish safe area for team, away from find
Mark off scene with flagging tape if possible; ask personnel to stay out of area
Coordinate with local law enforcement, coroner or medical examiner via radio/cellphone
Start documenting (cellphone pictures, notes, sketches)
Post guards around crime scene or route into crime scene to warn incoming people away; cannot use force but can warn and do cellphone video of people entering crime scene
Prepare list of team members and contact information to give to coroner/medical examiner/law enforcement
If prolonged stay at site needed, think about maintaining Chain of Custody and ensure that anyone taking over security at site signs note to accept responsibility with date and time of transfer of Chain of Custody
When SAR team members may, should and may not enter private property: trespassing and curtilage
Criminal trespass: defined by state law, different in different states, but generally, intentionally entering or remaining on someone else’s property without authorization
Innocent trespass: common in SAR, when enter land marked “No Trespassing” but from uncommon direction where no signs posted; not a crime as long as leave as soon as landowner says to leave
Trespass to save a life: may lawfully enter land posted No Trespassing in two conditions:
Express consent: the landowner, either verbally or writing, says can enter
Implied consent: if landowner not present, but see situation where reasonable person would think entering land posted No Trespassing would save a life or prevent a serious injury, may assume that the landowner would give you consent if he or she were present, and enter onto the land
If refused entry or No Trespassing signs posted, contact Base, refer to local law enforcement for guidance
Curtilage: in US common law, curtilage is house and nearby surroundings (with some complex legal definitions of what is included) reasonably considered to be protected from warrantless law enforcement searches under Fourth Amendment to Constitution; limits law enforcement’s ability to search lands marked No Trespassing without warrant; does not apply to SAR team members who are not law enforcement

Experience leading field teams, with a Field III, II or I assigned as mentor, either on simulations or actual searches, on simple linear hasty tasks, both day and night
Self-evaluate performance of each phase of task
Briefing by Base
Assembling field team
Assessing team members’ capabilities and limitations and comparing with assigned task
Briefing field team
Delegating duties/positions as appropriate
Acquiring the necessary equipment for task
Completing Task Assignment Form (TAF)
Performing task
Assessing for completion of task
Assessing team members’ condition at end of task and arranging for rest and rehab or return to duty as appropriate
Debriefing field team members
Debriefing task with Base
Followership
Best practices for raising safety or other concerns with a leader
International Association of Fire Chiefs (Crew Resource Management)
Opening or attention getter
State your concern
 State the problem as you see it
 State a solution
 Obtain agreement
Graded assertiveness: PACE mnemonic
Probe
Alert
Challenge
Emergency

Don’t get hurt: avoid back injury
Person in driver’s seat (front left, in current direction of litter movement) is  says “  ” (ASRC standard)
“” or “” or “”: acceptable but deprecated alternatives
:  quickly scans all the litter bearers to assure they are ready
Litter bearers may respond to “” with “” or “” or “”
“Lift with your legs, not your back”
Face litter
Squat down on one knee, keep other knee up
Put both hands on litter rail
Lean away from litter, keeps your back straight and upright
Don’t lift, pull out; pull directly away from litter bearer across from you
Only  communicates with rope team if the litter being belayed 

Reverse of picking up
Standard call is “”
Lean out and keep head up and buttocks down as lower litter, to protect back
Might put the litter down on a rock or sharp object, so before putting litter down, visually check or sweep with feet to check for objects during 
Also may need to secure litter from sliding
Two litter bearers may hold onto litter
If have a short rope may clip onto a tree or rock

Medic may tell team to 
Keep litter in slightly head-down position (perhaps blood loss, dehydration, or hypothermia), or
Slightly head-up position (perhaps head injury, or breathing problem)
May need to carry litter higher, strain on the arms

Litters designed to carry people on backs, traditional to package patients on back
If vomit when on back, vomit may get into lungs
If see litter patient on back vomiting, yell “” and rotate litter sideways away from  
Rotate litter 90° or more
 
Stops
May need stop for medical reason
May need stop to change litter rigging
Patient may need to pee
Otherwise, litter should never stop moving
Litter Bearing
Standard for non-technical evacs (without rope belay): six litter bearers
Load straps make carrying easier
2” or 1.5” flat nylon webbing, 10’ long
Girth-hitch middle of load strap to litter rail behind your hand on the rail
Lift litter
With hand not used for litter rail, reach across in front and grab load strap next to litter rail, slide hand out along it until 2-3’ stretched out from litter rail
Lift hand up over head, flip strap backwards over head 
Load strap now diagonally across upper back and forwards across shoulder
Bring hand down in front of chest
Wrap load strap few times around hand,  pull down hard
Some litter load now on left shoulder
2”/1.5” webbing superior to 1” webbing, less pain in shoulder
Semi-Tech Litter Bearing
Semi-tech evac when steep enough that rope needed for security of litter on slope
As rope takes much of load, standard to have just 4 litter bearers
When litter being hauled up with rope, litter bearers mostly keep litter up off ground more than move it up
When litter being lowered by rope (more common), litter bearers also mostly keep litter up off ground, leaning back and letting rope take much of the load 
If steep enough that not just litter but litter bearers endangered by possible fall, litter bearers wear seat harnesses and clip seat harness into rail with Prusik or webbing loop and carabiner
Semi-Tech Hauling
Setting up hauling systems discussed for higher level training; serving as rope team member expected of Field III
Provides smooth, continuous movement for the patient 
Engages large muscles 
Allows good visibility in direction of travel for footing 
Does not provide visibility of the haul system to the haul team 
Requires room to walk

Calls used during hauling
Set! Gradually release tension on haul line until ratchet Prusik is engaged; call from member best able to see that the team can make no more progress
Reset! Drop the haul line and move the haul Prusik back toward the load; call from member who checked that ratchet Prusik has gripped rope to haul team
Slack! Let out some rope; may be quantified as: Slack One Foot! The Belayer echoes (sometimes used instead of Reset! in cave rescue)
Haul! Pull on haul line; call from member who just reset the haul Prusik to haul team; whistle equivalent: 2 short whistles (NCRC standard, ASTM rope rescue standard: “Up”)
Up Slow! Haul the rope/load up slowly; usually from The Litter Captain to haul team; leader of  haul team echoes 
Up Fast! Haul the rope/load up faster; usually from The Litter Captain to haul team; leader of haul team echoes
Stop! Meaning 1: in the context of a technical rescue or semi-tech evac, from anyone to everyone: major safety issue, everyone stop, including stopping hauling; everyone echoes; whistle equivalent: 1 short whistle (NCRC standard, ASTM rope rescue standard); meaning 2: in the context of nontechnical litter carry, from The Litter Captain to litter team: stop walking  
Call Sequences Used in Semi-Tech Evacs
The Litter Captain (semi-tech lowering)
Ready! [pause] Lift!
On Belay!
Down Slow!
Down Fast!
Stop!
Off Belay!
Ready! [pause] Down!
The Belayer (semi-tech lowering)
Belay On!
Down Slow!
Down Fast!
Stop!
Belay Off! 
Clear!
The Litter Captain (semi-tech uphill with belay)
Ready! [pause] Lift! 
On Belay!
Up Rope!
Falling!
On Belay!
Stop!
Ready! [pause] Down! 
Off Belay!
The Belayer (semi-tech uphill with belay)
Belay On!
Up Rope!
Falling!
Belay On!
Up Rope!
Belay Off!
Clear!
The Litter Captain (semi-tech uphill with haul system)
Ready! [pause] Lift!
On Belay!
Up Slow! 
Up Fast!
Stop!
Ready! [pause] Down! 
Off Belay!
The Belayer (semi-tech uphill with haul system)
Belay On!
Up Rope!
Falling!
Belay On!
Up Rope!
Belay Off!
 
ASRC protocol for rotating litter bearers from early 1970s to meet these principles:
Litter should not stop
Litter bearers alternate using right and left arms
Litter bearers in pairs roughly matched by height
Litter bearers ready to rotate in to carry litter whenever  calls “”
Relief bearers do not have to pass litter
Based on this:
Relief bearers in front of the litter
When calls “”:
 Relief bearers step off trail on either side
 Relief bearers set feet
As litter passes, relief bearers grab tail end of litter, move out into trail
Once both relief bearers have hand on litter, back left relief bearer calls “” and both new back litter bearers use free hand to tap hand of litter bearer in front of them
Litter bearers in front of relief bearers shift forward one position, use free hand to tap hand of litter bearer next towards head
Those litter bearers move forwards, tap hand of front litter bearers in front
Front litter bearers let go of litter, cross sides, walk ahead of litter, go to head of line of relief bearers on trail ahead

Classification of ropes
Kernmantel vs laid construction
Static rope
Dynamic rope
Tubular webbing
Weld-abrasion of nylon rope
 
Uncoiling, stacking, and inspecting rope
Characteristics of knots
Strength
Security
Proneness to jamming
Anchoring: tensionless hitch to a tree or similar object
Specific knots
Backup knots: 
Overhand
Barrel knot (double overhand)
Joining lines
Overhand bend (water knot)
Barrel knot (grapevine, double overhand bend)
Climb or secure rope with another rope: 3-wrap Prusik knot
Secure oneself to rope or rappel device: ASRC seat harness
   
This curriculum is to ensure that those credentialed to Field Level II meet the following educational goals. 
Safety, Health and First Aid 
Learn legal issues pertinent to wilderness first aid, including informed consent, implied consent, express consent, competence, restraint, duty to act, abandonment, negligence, medical licensure and practice of medicine vs first aid.
Learn standard wilderness first aid patient assessment, including scene safety survey; primary survey including recognition and management of cardiac arrest, airway management, respiratory arrest, tension pneumothorax, flail chest, bleeding, shock, determining Status 1, Status 2 or Status 3, including determining death; and secondary survey, including basic history-taking, assessing level of consciousness, pulse and respiration, inspection, palpation, percussion and auscultation.
Learn principles of human thermoregulation, including heat balance, physical modes of heat loss, and human compensatory mechanisms such as sweating,vasodilation and vasoconstriction, and shivering.
Learn more than covered in Field IV about heat illness, including dehydration, heat syncope, heat cramps, and particularly heatstroke, including pathophysiology, recognition, cooling methods, and coaling goals.
Learn more than covered in Field IV about field management of hypothermic team members and find subjects, including incipient hypothermia, signs and symptoms of bad hypothermia, diagnosing hypothermia without a thermometer, treating bad hypothermia in the field, including insulating and adding heat as much as possible, not being concerned about rewarming shock in the field except for evacuating the patient flat, avoiding bumps that might cause ventricular fibrillation, and dealing with severe hypothermia that might mimic death, including questions of whether to start external cardiac compressions or not and about the efficacy of extended CPR even if interrupted.
Learn standard wilderness first aid treatment of minor and major wounds, including blisters, burns including grading of burns  and nosebleeds.
Learn management and splinting of musculoskeletal injuries, including bruises/contusions, sprains and strains, twisting injuries of the ankle including the Ottawa criteria, closed and open fractures, joint dislocations including how to reduct digit and patella but not other dislocations, improvised splinting, understanding the pathophysiology of compartment syndrome and recognizing compartment syndrome.
Learn basic multisystem trauma recognition and management, including the concepts of the Golden hour in the golden day, and general principles for managing multisystem trauma in the backcountry.
Review lightning safety from Field IV, and learn common injury patterns from lightning strikes, and learn triage and immediate treatment for a group struck by lightning.
Know search-and-rescue-focused, standard wilderness first aid level assessment and management of trauma, including head (brain) trauma, pelvic fractures, possible spinal injury including the NEXUS criteria and the need to prevent decubiti, chest trauma including pneumothorax, hemothorax, broken ribs, flail chest, sucking chest wounds, and submersion injury.
Learn recognition and treatment of “dry” and envenomated bites from local pit vipers.  
Learn standard wilderness first aid level recognition and treatment of common or severe medical problems, including “red flags,” specifically, hypoglycemia, chest pain, decreased level of consciousness, and seizures.
Learn “red flags” for the following medical problems: abdominal pain; vomiting and diarrhea; urine problems including urinary tract infection and hematuria (blood in urine); cough; and fever.
Learn the seriousness of the following: 
Persistent blurred vision
Uncontrolled nasal or other bleeding
Head injury with decreasing level of consciousness
Airway compromise
Learn to recognize immediate stress reactions, and to provide psychological first aid.
Learn the factors that go into evacuation urgency decisions.
Learn basic improvised evacuation methods, including split-coil and sling piggyback carries, packstraps and pole carry, and poles-and-blanket and poles-and-parkas stretchers.
Communications
Learn basic radio principles relevant to the ASRC, including the following.
Learn about electromagnetic waves, wavelength and frequency, and effect of frequency on radio signal propagation.
Learn the difference between AM and FM and how speaking loudly on FM decreases signal strength.
Learn about radio bands and modes, simplex vs duplex, retransmitters (remote bases), repeaters, trunked systems, and ASRC and national interoperability channels.
Learn antenna principles, including antenna radiation patterns and effective radiated power (ERP), the effect of ground planes and reflectors and how to improvise them in the field, and how to use other teams to relay to Base.
Learn about carrier squelch, monitor buttons, and PL tone squelch.
Learn the cost range of commercial radios.
Learn basic principles of network discipline.
Learn techniques for improving cellphone communications in the backcountry, including use of texting instead of voice, and ways to improve antenna effective radiated power (ERP). 
Land Navigation
Learn more detailed interpretation than Field III about topographic maps, including more symbols and edge information.
Learn more about coordinates and grids than in Field III, including both degree variants and UTM/USNG variants. 
Learn how to transfer .gpx files between a smartphone GPS app, a dedicated GPS unit and a laptop computer in Base.
Learn how to apply orienteering concepts covered in Field III to plot orienteering routes on a map, and practice so as to complete basic-level orienteering courses safely and confidently during the night, using map, compass and GPS.
Operations, Management and Leadership
Learn basic terminology and concepts related to team and group morale, including esprit de corps, employee/member engagement, human capital, recognition, trust, concern welfare and opinions of others, and organizational prestige.
Learn physical and emotional influences on individual morale and simple ways to improve individual morale.
Learn best practices for dealing with a search subject‘s or rescue patient’s friends and family including the role of the family liaison, how to tell of death, and how to deal with friends and family at Base and in the field. 
Search 
Practice leading teams in common search tasks.
Formally self-evaluate all steps in leading search tasks.
Practice using a tracking stick to do step-by-step mantracking.
Rescue
Learn to do paving, turtling and lap pass.
Learn basic care for nylon kernmantel rope.
Learn uncoiling, stacking, and casting a rope, and coiling and inspecting a rope.
Learn wrap-3, pull-2 and modified basket hitch anchors.
Learn knots: figure 8, figure 8 on a bight, figure 8 follow-through loop, figure 8 bend, and clove hitch. 
Learn best practices to belay and lower a litter with tree wraps, lower a litter with a mechanical device, belay a litter with Prusik loops and with a mechanical device, both uphill and downhill rope team rotations for semi-tech evacs (low-angle rope rescue), and manage (but not rig) a 3:1 haul system.
Learn standard best practices for litter packaging, tie-in and semi-tech (low-angle rope rescue) litter rigging.
 Curriculum
This curriculum is to ensure that those credentialed to Field Level II learn the following educational topics.
, Health and First Aid
 Issues
Consent Overview
Treating person without informed consent unlawful
Not treating person, regardless of consent, when patient has impaired decision-making capacity and needs medical or first aid help, is unlawful
Ordinarily-competent person may have impaired decision-making from alcohol or other intoxication, medication side effects, illness or injury
Unconscious patient: implied consent
Confused or intoxicated or psychotic patient: implied consent
When in doubt, do what’s best for person
“Treat the patient the same way you would treat your mother – with concern for her Constitutional right to make her own decisions, even if it kills her, but when her decision-making is impaired, you make decisions for her.”
Consent Terms
Informed consent:
Express consent:
Implied consent:	
Principles for Consent Decisions
Legal: What do applicable laws and common-law principles say? Sometimes don’t know, so you move to another level:
Ethical: What will most reasonable people say is right thing to do, according to commonly-accepted ethical principles? May sometimes need to move to another level:
Moral: What do you think is right thing to do?
Competence and Capacity
Unless court declares person incompetent (legal term, must be determined by court) and assigns power-of-attorney (legal term, must be determined by court) to another person for making medical decisions, person is assumed to be competent  (legal term) to make medical decisions 
Medical personnel (including ASRC members) may not determine competence, but may and if indicated must determine capacity for informed decision-making
Four tests for capacity are:
Does person understand relevant information?
Can person process the information?
Can person make a choice?
Can person put all these together to appreciate the situation and possible consequences of refusing car?
Needed level of capacity varies with seriousness of decision
Restraint
Courts give physicians (and, by extension, medical personnel, especially if supervised by a physician; includes ASRC members) very wide latitude in restraining people
If think restraints needed to protect against harm to person or others, and have doubts about capacity of person to make informed decision to refuse treatment, restrain patient in least-restrictive manner possible
Extremely unlikely to face criminal charges or be sued for damages for restraining impaired person; much more likely to face charges of criminal negligence or be sued if do not restrain someone who should have been restrained
Duty to Act
Different states have different laws about duty to help person in distress: duty to act (legal term)
If you start going towards someone with intent to help, have duty to act
If acting as public safety personnel, such as SAR team member on training or operation, especially if in uniform, have duty to act
If have duty to act and do not help, may face criminal charges or be sued for damages
Abandonment
If start to help person, have duty to continue help person
If stop helping person, may be abandonment (legal term)
If abandon person in need, may face criminal charges or be sued for damages
Not abandonment if turn person over to person with similar or better capacity to help
Negligence
Good Samaritan laws
Different in every state
Generally say cannot be sued for damages if provide emergency care without compensation, in good faith, and without gross negligence
Not a defense against criminal charges, just against being sued for damages
Many lawyers say Good Samaritan laws are just a road bump to get past when suing someone for negligence 
In good faith (legal term): you really are trying to help, not to hurt
Gross negligence (legal term): harder for plaintiff lawyer to support than simple negligence, means average person would say that was incredibly stupid
Civil suit
Civil suit is when one person sues another for damages
Civil suit different from criminal prosecution, which is the government accusing person of crime
Suit may be for different reasons, but we are concerned with negligence
Negligence claims require plaintiff (person suing) proving that chain of five elements occurred (“chain of negligence”) 
You had duty to act on behalf of plaintiff
You committed unreasonable act or omission in context of this duty 
An injury occurred to plaintiff, 
Proximate cause (your act or omission caused injury)
Foreseeability: you must have been able to foresee possibility of injury
Prevent negligence suits by
Documenting well
Being poor (lawyers prefer cases where they can sue people or organizations with lots of money)
Doing the right thing: meeting the standard of care (legal term)
Standard of care is what a court decides it is in a particular instance; to establish standard of care courts look to
Prior appellate (appeals court) decisions that set precedent (legal term): case law ≈ common law (legal terms)
Textbooks
Journal articles
Common practice for similar situations in the particular time the incident occurred
The level of training/credentialing of the defendant
Medical Licensure
Practicing medicine, including giving medications to people or telling people which medications to take, is practice of medicine
Practice of medicine regulated by each state’s medical practice act
All states’ medical practice act requires those practicing medicine to be licensed by state
Practicing medicine without a license is a crime under state law in every state
First aid is not considered medicine and mostly unregulated by states
Giving medicine to someone and telling person to take it is not first aid, is practice of medicine
Putting medicine on a stump or a rock where a person could pick it up and take it, for example two aspirin, and telling person that someone having a heart attack is less likely to die if take a couple of aspirin, is not the practice of medicine and is not a violation of state medical practice acts (“stump method”)
This material covers standard wilderness first aid and cardiopulmonary resuscitation for adults but not infants or children
Safety, Patient Surveys
In EMS and emergency medicine, standard three-stage approach to an ill or injured person:
Scene Safety
Primary Survey
Secondary Survey
Applies to teammates as well as search and rescue patients 
Scene Safety: (“A dead rescuer never did anyone any good”) start first aid only after ensuring safety of patient and team from hazards such as
Falling
Rockfall
Flooding
Cold, Hungry and Thirsty: 
All backcountry patients are hypothermic, starving and dehydrated until proven otherwise; may need to address this during or right after primary survey
Must consider hypothermia during the primary survey, covering and if needed moving patient to prevent heat loss may be high priority; need to insulate under as well as over patient
Oral fluids and food important defenses against hypothermia, and should give to all backcountry patients unless some good reason not to, such as comatose; even patients with vomiting may be able to keep down some fluids 
Patient’s blood and body fluids are hazards: may carry infectious diseases such as Hepatitis A, B and C, and HIV; covered in bloodborne pathogens section above
Primary Survey
Primary survey looks for immediately life-threatening problems and to tries to correct as found, not moving on until problem fixed
If patient talking to you without major respiratory distress and no major bleeding, ABC primary survey is done
Primary survey often called “ABCs”
A for airway: assess; if needed, open airway
B for breathing: assess; if needed, support ventilation with mouth-to-mouth or bag-valve-mask ventilation
C for circulation: assess; if no pulse, begin cardiac compressions; in first aid/EMS, also includes bleeding control and shock treatment
Some like to add D and E but not standardized
ABCs most traditional and useful as general framework
American Heart Association now teaching CAB instead of ABC: starting external cardiac compression right away important for survival from sudden cardiac arrest in urban, safe environment
American Heart Association changed ABC to CAB because:
For cardiac arrest (but not necessarily other medical emergencies) circulation (external cardiac compression) more important than breathing (artificial respiration)
External cardiac compression until can rapidly defibrillate heart may be lifesaving 
External cardiac compression moves some air in and out of lungs, and passive diffusion of oxygen provides some oxygen to lungs
People think mouth-to-mouth artificial respiration yucky, and may prevent them from doing external cardiac compression
US military now teaching MARCH
M for massive hemorrhage: assess; if needed, apply tourniquet, then direct pressure with QuickClot Combat Gauze or similar hemostatic dressing
In combat, massive bleeding major preventable source of death and should be addressed first
Pressure points and elevation used to be recommended; military, based on research and experience, says not to use
A for airway: same as A in ABCs
R for respiratory: same as B in ABCs, including quality of respiration and check for chest trauma such as sucking chest wound or tension pneumothorax
C for circulation: if pale, sweaty, rapid weak pulse, maybe altered level of consciousness, keep from chilling, elevate legs)
H for head trauma: prevent additional brain damage by monitoring airway and respirations, avoid any straps across neck; no need to elevate head
H also for hypothermia: assess and if needed place patient in HPMK (military Hypothermia Prevention and Management Kit) consisting of fiber-reinforced “space” blanket mummy-type sleeping bag with four iron heat packs on chest, or improvised equivalent
Primary survey: context-dependent
If shooting or explosion, military MARCH sequence probably best
If in building at Base and someone collapses, American Heart Association CAB sequence probably best
If in field on task and first aid emergency, have to use judgment as to which mnemonic/algorithm to use, ABC is usual default
Alive or dead?
May assume dead if:
Decapitation
Transection of torso
Patient is frozen so hard that chest can’t be compressed
Patient’s rectal temperature very cold, and same as environment
Well-progressed decomposition that is not frostbite
Probably dead if:
Rigor Mortis: postmortem rigidity, but similar rigidity seen in hypothermic semiconscious patients
Dependent Lividity: redness of lower portions of body common in corpses, but find pressure necrosis (bedsores) and frostbite in some live patients
Decomposition: odors of decomposition common in corpses, but live search subject may be very smelly; even maggots may be found growing in live patients
Lack of Presumptive Signs of Life: if dead, pulses not palpable, respirations undetectable, dilated and unreactive pupils and no signs of consciousness, but may also see in deep hypothermia
Some medical conditions mimic death, extended resuscitation attempts may be appropriate:
Hypothermia
Near-drowning
Lightning strike
Electrocution
Drug overdose
Avalanche burial
Half an hour of resuscitation maximum in wilderness unless signs of successful resuscitation
No attempts at resuscitation of probably-dead if will put team at risk
Status I vs Status II
Status I can walk out with assistance
Status II needs litter evacuation
Main determination of ability to walk made by subject/patient 
May not be able to walk initially, but with food, water, pain medication, or splinting or taping of ankle, may be able to walk out with assistance
Should not try to bear weight on obvious lower extremity fracture, may cause damage, converting closed fracture to open fracture; much worse outcome for open fractures)
Medical Resource Assessment
Based on assessment by person with highest medical training at site, may request specific medical equipment or medications be brought to patient
May be for treatment or to make evacuation easier, for example
Aircast type ankle brace 
“Fiberglass” splinting material
Pain medication 
FTL determines evac route, method and urgency, based on medical condition and available resources with input from medic
 Management 
Problem: blood, vomit or acid reflux in airway/lungs 
Blood in airway may interfere with breathing
Vomit in airway may interfere with breathing
Vomiting or passive acid reflux in unconscious patient  (may be no outward sign of this) may get stomach acid into lungs; may cause severe lung damage
Managing airway blood, vomit or acid reflux 
Turn litter patient when vomiting
Position in coma position = recovery position, and package patient on side in litter using coma position 
Using portable suction device to clear airway
Problem: when on back and deeply unconscious tongue may fall back and obstruct airway; ways to manage:
Coma position
Head-tilt (but concern if possible cervical spine injury)
Jaw thrust
Chin lift
Oral and nasal airways
Foreign body
If making noise, allow to try to clear airway by self
Abdominal thrusts may help; may use chest thrusts if abdomen thrusts not effective, less than 1 year old, or pregnant
Remove foreign body with fingers if can see 
 Assessment and Management 
Assess rate of breathing
Too slow, too fast, or just right; normal depends on activity level, resting rate normally about 12-20
While watching chest, traditional to measure for 30 seconds and multiply by 2
Traditional to not tell patient when counting respirations to avoid conscious changes in breathing rate
Assess quality of breathing
Shallow breaths? Deep breaths?
Work of breathing: easy or hard?
Signs of respiratory distress:
Nasal flaring
Supraclavicular retractions (soft tissues above collarbone sucking in with deep breath in)
Subcostal retractions (soft tissues below ribs sucking in with deep breath in)
Using accessory muscles (neck muscles) to breathe
Assess for normal vs abnormal sounds
Stridor: upper airway obstruction
Gurgling: secretions in upper airway
Listening to lungs directly: wheezing (listening directly to lungs with ear against chest or stethoscope): asthma, chronic obstructive pulmonary disease or similar
Listening to lungs directly: Crackles (râles): sounds like rubbing hair together near your ear, sign of pneumonia, blood clot in lung, or bruised lung
Listening to lungs directly: decreased breath sounds: maybe from air around lung (pneumothorax) or blood around lung (hemothorax)
If breathing absent or not adequate:
Open airway
Artificial respiration by mouth-to-mouth resuscitation
Artificial respiration may be lifesaving by itself after lightning strike
May wish to carry keychain-sized pocket mask to protect against communicable diseases when giving artificial respiration
Assess for rare but deadly chest injuries
Pneumothorax and Tension Pneumothorax
May come from blunt or penetrating trauma
Leak in lung leads to air around lung, causes lung, which works by suction from the rib cage, to collapse: simple pneumothorax, lung doesn’t work as well as normal
One-way valve leak in lung may lead to lots of air around lung with high pressure, leads to complete long collapse and pushes heart into good lung, may cause death: tension pneumothorax 
Signs and symptoms of tension pneumothorax: decreased breath sounds on bad side, increased percussion tone on bad side, trouble breathing, shock, death
Percussion, one of four classic modes of physical examination: inspection, palpation (feeling), percussion, auscultation (listening); done by pressing firmly on chest or distended abdomen with hand, then tapping middle finger knuckle with tip of other hand’s middle finger straight-on, hard, and listening to the drum-like sound that results
Treatment: stick large-bore long needle through chest wall to let excess air out
Not a first aid skill but should be aware, as needling a tension pneumothorax may be lifesaving and nothing else works
Sucking chest wound
Hole in chest wall that causes lung, which works by suction from the rib cage, to collapse 
Have patient breathe out to expel air from around the lung, then make airtight seal with whatever is handy; take off seal briefly if seems to be getting worse
Flail Chest
Multiple ribs broken in multiple places
Paradoxical movement of chest: part moves in and part moves out with each breath, preventing normal lung expansion
Splint with soft bulky mass (e.g., fleece sweater) duct-taped to chest to stabilize; better to stabilize in than have moving in and out
Circulation:  
External cardiac compression wilderness-specific background
External cardiac compression may provide about 1/3 of normal cardiac output, if done perfectly
In ventricular fibrillation or similar cardiac arrest external cardiac compression may sustain life until can defibrillate with AED or defibrillator
External cardiac compression may sustain life for hours if patient severely hypothermic; much less effective if patient warm
If patient warm and no AED or defibrillator available, no point in continuing external cardiac compression for more than 30 minutes, especially in backcountry
External cardiac compression not effective in traumatic arrest
In cardiac arrest, external cardiac compression without ventilation may be adequate as it forces some air in and out of lungs, may be enough
External cardiac compression technique
“Push hard and fast in center of chest” (American Heart Association = AHA)
AHA recommendations 2015:
Minimize interruptions in chest compressions
Provide compressions of adequate rate and depth
Avoid leaning on the victim between compressions
Ensure proper hand placement
Avoid excessive ventilation
“The rescuer should place the heel of one hand on the center (middle) of the victim’s chest (which is the lower half of the sternum) and the heel of the other hand on top of the first so that the hands are overlapped and parallel.” (AHA 2015)
Practice CPR on manikins until able to do it effectively and efficiently 
AEDs
AED usually not available in field but may be available at Base
Steps to use AED (American Red Cross; video available)
These AED steps should be used when caring for a non-breathing child aged 8 or older who weighs more than 55 pounds, or an adult.
After checking the scene and ensuring that the person needs help, you should ask a bystander to call 911 for help, then:
Turn on the AED and follow the visual and/or audio prompts.
Open the person’s shirt and wipe his or her bare chest dry. If the person is wearing any medication patches, you should use a gloved (if possible) hand to remove the patches before wiping the person’s chest.
Attach the AED pads, and plug in the connector (if necessary).
Make sure no one is, including you, is touching the person. Tell everyone to “stand clear.”
Push the “analyze” button (if necessary) and allow the AED to analyze the person’s heart rhythm.
If the AED recommends that you deliver a shock to the person, make sure that no one, including you, is touching the person – and tell everyone to “stand clear.” Once clear, press the “shock” button.
Begin CPR after delivering the shock. Or, if no shock is advised, begin CPR. Perform 2 minutes (about 5 cycles) of CPR and continue to follow the AED’s prompts. If you notice obvious signs of life, discontinue CPR and monitor breathing for any changes in condition.
Should practice with trainer AED or watch video referenced above until confident how to use AED
Circulation:  
If massive bleeding, apply tourniquet immediately
Direct pressure
Direct pressure on bleeding area with fingers stops most bleeding
Gloves and eye protection to prevent bloodborne pathogen exposure
Gauze pad or scrap of clean cloth on fingers will help prevent fingers from slipping
Have to hold continuous pressure for usually at least 10 minutes to get significant bleeding to stop, sometimes longer; if starts bleeding again, need to hold pressure again for 10 or more minutes
May have to quickly switch fingers to relieve pressure on fingertips
If unable to control with direct pressure, apply tourniquet
Elevation (of arm or leg) may help slightly by decreasing blood pressure in the limb
Pressure points now thought to be essentially useless
Improvised tourniquet principles
Place 2-3” (5-8 cm) proximal (higher on limb) than bleeding site
Should be wide, at least an inch (2.5 cm) to avoid damage to underlying skin and muscle
Tourniquet must be flexible to tighten with twisting with a strong stick, carabiner or similar object (“windlass”)
Non-stretchy webbing belt or pack or climbing webbing or strip of shirttail cut off and folded over multiple times may work
Must be tight enough to cut off arterial flow; less-tight tourniquet may increase bleeding
If possible, place flat relatively stiff object, such as cover of pocket notebook, under where windlass will be to prevent twisting and crushing of skin and muscle
Tighten windlass until bleeding stops, then tighten another half-turn and secure windlass stick so does not loosen
Monitor frequently for loosening and re-bleeding
May use tourniquet along with elevation and direct pressure
Hemostatic gauze, such as Quick-Clot Combat Gauze, may help stop bleeding; some other brands effective, some not
Circulation: 
Shock is generalized state of poor perfusion of entire body
Perfusion is an adequate supply of blood to bring O2 and glucose to the cells, and to take away CO2 and other waste products
Hypovolemic shock (= low blood volume, most common type) may come from:
Blood loss
Dehydration from heat exposure 
Dehydration from vomiting and diarrhea
Dehydration from lack of food and water
 Other types of shock from heart (cardiogenic), from spinal damage (neurogenic) and from infection (septic) less common
Psychogenic shock (sometime grouped with spinal neurogenic shock): fainting from stress or bad news, causes blood vessels to dilate (get bigger) and blood rushes away from the head and towards the feet
Signs and symptoms of shock
Increased pulse rate, weak and thready pulses; lose arm and leg pulses, then femoral pulse, finally carotid pulse 
Cool, clammy and maybe mottled skin
Restlessness from adrenaline response early; later may become lethargic or unconscious
May pass out if tries to stand, or with worse shock, sit up
Treatment for all kinds of shock:
Keep from chilling (very predisposed to hypothermia)
Lay flat with legs elevated slightly
In backcountry context, if possible, give food, fluids, and adding salt to food as will help rehydrate patient 
If appropriate, consider asking for IV fluids and someone who can give them to come to patient 
Try to correct cause of shock (bleeding, diarrhea… )
Standard saying is that “in the backcountry, all patients are hypothermic, dehydrated and starving” (cold, thirsty and hungry)
At same time as primary or secondary survey should be insulating under and over patient and protecting from wind, rain and snow
First aid and Emergency Medical Services (EMS)in civilized places has rule to not give food or fluids to patient
In backcountry, rule is to always give food and fluid to patient unless unconscious
If patient has decreased level of consciousness or other concerns about eating or drinking, try small sips of water; if doesn’t choke, give food and drink
 
Vital Signs
People argue about whether vital signs are part of secondary survey, or separate; and about what really are the vital signs (temperature? pulse oximetry? pain?); not worth wasting time on this
Pulse
Pulse points: artery close to skin, compressible against bone or trachea and can feel relatively easily
Locations and technique of carotid, femoral, radial, dorsalis pedis and posterior tibial pulses, including for arm and leg pulses two fingers on pulse point and thumb on other side to allow better control of pressure level 
Quality: normal, full and bounding, weak and thready
Pulse rate: normal resting pulse 50-90, may be higher with exertion, shock, dehydration, fever; may be lower if hypothermic
Count pulse for 15 seconds then multiply by 4 
Hard to feel pulse when your fingers are cold; if cold, warm them up first
Cold, damage to arteries, or compression of arteries by too-tight splints or dressings or tie-ins may decrease or stop pulses in arms or legs
With progressively worse dehydration, shock or hypothermia, will lose pulses in arms and legs, then femoral pulse, then carotid pulse (then death)
May be helpful to know, for example, that at first could feel carotid and femoral pulses but now unable to feel femoral pulse.
Modes of Examination
Inspection = looking for abnormalities such as deformities, bruises, cuts or scrapes, burns, swelling: (generally expose area of concern, if only briefly, considering danger of cold exposure)
Palpation = pressing: firmly but gently with fingers or whole hand, checking for tenderness (pain with pressure), deformities, crepitance (crunching) 
Palpating head and face, spine, chest and extremities: start with firm pressure with entire hand
Best to do both sides at same time, one with each hand: helps compare bad side with good side for deformity and swelling
If causes pain (pressure > pain = tenderness), use finger or couple of fingers to try to localize tenderness better
Bony point tenderness (tender one place, but not an inch to either side) suggests fracture
Palpating abdomen: warm hands first (cold > patient tightens muscles); come in from side (less scary = patient less likely to tighten muscles); one hand on top of other and press gently; when moving hand, slide across abdomen, don’t pull away and then come back (scary)
Percussion = tapping and listening for drum-like sound, but specifically holding fingers firmly against something like chest with suspected pneumothorax, then using other hand’s straight finger, with a flipping of the wrist, as a hammer to tap on one of the knuckles; takes practice (check for hyperresonance of lung = more echo-y than normal may indicate pneumothorax)
Auscultation = listening, made easier by stethoscope but can be done with ear firmly against, for instance, bare chest
Secondary Survey vs Directed Physical Exam
Directed physical exam is physical exam focusing on area of interest, such as ankle; may be appropriate if no concern about other injuries
Secondary survey is head to toe survey for injuries for trauma patient
For significant trauma best practice to do at least a brief head-to-toe secondary survey for injuries patient didn’t notice
To make it easier to tell normal from abnormal, humans mostly bilaterally symmetric, so can compare with other side
Can also use exam of normal team member as comparison
AVPU assessment of level of consciousness mnemonic:
Alert
Verbal: opens eyes to your voice 
Pain: opens eyes to a painful stimulus (rubbing knuckles on chest, twisting skin on back of hand or pressing on nerve in groove towards middle of eyebrow traditional)
Unresponsive: no response to pain
SAMPLE history mnemonic 
Symptoms (Symptoms are complaints related by patient; signs are what first-aider observes)
Allergies
Medications
Pertinent Past medical history
Last oral intake (sometimes also Last menstrual cycle.)
Events Leading Up to present illness/injury
DCAP-BTLS mnemonic: traumatic findings to look and feel for (memorization not required)
Deformities
Contusions
Abrasion
Penetrations
Burn
Tenderness
Lacerations
Swelling

Heat Balance
Body always producing and losing heat
Heat production from muscular activity and digestion, and in an emergency, shivering
Physiological methods to decrease heat loss
Piloerection (goose bumps) essentially useless in humans, not enough fur to fluff out to make a difference
Vasoconstriction of superficial veins and shunting to deep veins with countercurrent heat exchange from deep arteries to deep veins (demonstrate by looking at superficial veins on arms and hands)
Physiological methods to increase heat loss
Vasodilitation (vasodilation) of superficial veins (getting larger, bringing more blood to surface to cool)
Sweating, including sweat salt concentration changes with adaptation, and how much exercise in the heat is needed for adaptation
Effect of certain relatively-common drugs and diseases on heat regulation
Physical modes of heat loss from the body, with real-life examples of each, and methods for countering each
Conduction 
Convection 
Evaporation 
Radiation
Respiration
Weather factors affecting heat loss, real-life examples of each, and methods to counteract each
Windchill
Wetchill
“Hypothermia weather” (sudden onset of wind and rain at temperatures just above freezing, combining windchill and wetchill) and how to manage a team that just got hit by it
Even on hot midsummer day, center of thunderstorm, with high wind, drenching rain, and cold air coming down from upper atmosphere, maybe with hail or sleet, may cause near-instant hypothermia
In cold, peripheral veins constrict to prevent heat loss from skin; this and direct effects of cold on kidneys leads chilled or hypothermic people to generate more urine (“cold diuresis”) and thus cold exposure causes some dehydration directly
People in winter don’t drink much water because it’s inconvenient, even though losing fluid from cold diuresis and lots of evaporation from breathing cold, dry air (“seeing your breath steam” in the cold)

Dehydration
Prevention of dehydration and heat acclimatization discussed in Field IV curriculum 
Suspect dehydration in appropriate setting (exertion in hot weather, especially if not heat-acclimatized; exertion in cold weather without adequate fluid intake) when person has some or all of:
Thirst 
Lightheadedness, weakness, tunnel vision, or headache
No urine, or small amounts dark urine
Weakness, sometimes so weak cannot continue with task
Extreme cases: may not be able to stand without losing consciousness
Similar symptoms may occur with hypoglycemia and other conditions
Treatment of dehydration is replacement of water and salt; Gatorade or similar drinks, salty bouillon in winter, or water and salty snacks recommended 
Since sometimes hard to tell if dehydration or hypoglycemia, best to treat for both with water, salt and sugar
Heat Syncope
People exposed to heat may faint
Heat causes vasodilation (expanding blood vessels)
May not have enough blood to fill expanded blood vessels
If not enough blood and standing, not enough blood gets to brain
Not enough blood to brain causes fainting
As with other kinds of fainting (e.g., psychological shock), treatment is to lay person flat with legs elevated to return some blood from legs
If patient still unconscious when laid flat, should turn on side into coma/recovery position
Heat Cramps
Dehydration and salt loss may lead to cramps
Treatment is rehydration, salt replacement and stretching
Heat Exhaustion
Heat exhaustion just bad case of dehydration, maybe with mildly elevated core temperature which may occur with dehydration even without heat exposure
Treatment same as for dehydration
Heatstroke
Review of material from Field IV with more on treatment
Qualitatively different from dehydration and heat exhaustion
Certain medications make heatstroke more likely; those on them may get heatstroke in hot environment without major exertion; certain psychiatric medications in particular
Aerobically-fit people in a hot environment can create heat faster than they can get rid of it (“exertional heatstroke”)
Core body temperature rises high enough to damage vital organs such as kidney, liver and brain
May cause lifelong medical problems or death
If right setting for heatstroke, skin hot and maybe dry and confused or comatose, assume heatstroke and treat for it.
Skin may be dry or wet, flushed (red) or pale
Treatment
Wilderness Medical Society (WMS) recommends immersing heatstroke patients in cold water
WMS says not true that cold water immersion is bad due to causing shivering and vasoconstriction that limits heat loss; conduction of cold water overwhelms these effects even if they’re real
If immersion in cold water not possible, drench with water and fan
If applying ice packs or water”
If enough, apply to whole body
If don’t have enough, don’t apply to traditional neck, axilla (armpit) and groin; instead, apply to palms, soles and cheeks which have direct access to the central circulation via high-capacity blood flow subcutaneous arteriovenous anastomoses
Don’t give Tylenol (acetaminophen, paracetamol), ibuprofen (Motrin, Advil, Nuprin) or naproxen (Aleve); even though we tend to give them for fever they don’t help with heatstroke and likely will cause worse organ damage
If have thermometer, cool to 39°C (102.2° F) but no lower; heatstroke may damage brain thermal regulation circuitry, danger of cooling too far and causing hypothermia
Arrange for urgent transportation to an Emergency Department; heatstroke may warrant medical air transport
 
Hypothermia recognition and prevention, and treatment for mild hypothermia in team members, covered in Field IV
Additional background on hypothermia
Incipient hypothermia, also known as pre-hypothermia
Hypothermia is specifically a low core temperature
But, periphery (non-core: arms and legs and body fat on torso) may become chilled well before core temperature drops
Rewarming the periphery when very chilled requires energy equivalent to a very large dinner
Signs and symptoms suggesting bad hypothermia:
Uncontrollable shivering (but some don’t do this even if very cold, or may stop shivering below a certain core temperature)
Arms held close against body
Clumsiness (but may be sign of many other conditions)
Slow thinking; poor memory; as core temperature drops more, confusion then finally unconsciousness
Diagnosing hypothermia without a thermometer:
If have reason to suspect hypothermia, place your warm hand in armpit
If armpit feels cold, treat for hypothermia 
Might be just incipient hypothermia = pre-hypothermia, but treatment is same 
Treatment of patient with bad hypothermia in field
Insulate from cold as much as possible
Add as much heat as possible
“Rewarming Shock”
If put in tub of hot water to rewarm, may cause reflex dilation (expansion) of surface veins; combined with dehydration from cold exposure, may result in low blood pressure and fainting; hot water immersion of bad hypothermia appropriate only if giving IV or oral fluids with salt to prevent shock
Tubs of hot water not available in field, can’t add enough heat to cause rewarming shock in field, so add as much heat as possible
Dehydration from bad hypothermia may cause fainting; if person tilted head-up, prolonged fainting may cause seizures and death; carry litter flat; when carrying, do not elevate the head as there are case reports of this causing death
Hypothermia makes patient’s heart more irritable, handle gently to avoid causing cardiac arrest
Exertion also reportedly causes sudden death in bad hypothermia; have patient rest while lying flat
CPR and very bad hypothermia:
Severe hypothermia may mimic death; check for a full minute for a carotid pulse if suspect severe hypothermia 
If having hard time telling if patient dead or very hypothermic, check for any signs of life (such as movement of chest, fogging of cold object held near mouth and nose)
If has signs of life, best not to do cardiac compressions, may cause ventricular fibrillation cardiac arrest as cold heart is irritable
If patient with bad hypothermia goes into cardiac arrest, may perform CPR at normal rates
If bad hypothermia and CPR in progress, some have survived lengthy pauses in CPR for evacuation, as requirements for perfusion decreased when bad hypothermia; if external cardiac compression needed, unlike warm patient, may survive hours of external cardiac compression
If severely hypothermic patient with signs of life or with external cardiac compression in progress, may contact Base to discuss possible helicopter evacuation to facility with 24-hour core rewarming which might be lifesaving 

Preventing infection
Treating minor wounds (abrasions, scratches that don’t require sutures)
Cleanse with clean (doesn’t need to be sterile) water
Dry
Apply antibiotic ointment and bandage, possibly with tincture of benzoin so adheres better
Cleanse with water, perhaps with soap, twice a day and reapply antibiotic ointment until healed
Treating larger non-contaminated wounds (example: forehead laceration from someone’s elbow)
Rinse with clean (doesn’t need to be sterile) water
Dry
Apply antibiotic ointment and bandage, possibly with tincture of benzoin so adheres better
Irrigation for larger contaminated wounds
Need for member to protect eyes
High-pressure irrigation for contaminated wounds only: reduces infection in contaminated but not clean wounds
Clean but not sterile water needed
May use plastic bag with small hole (and zipper folder over to prevent unexpected opening) to generate high pressure stream
Dangers from antiseptics (alcohol, peroxide) in wounds: damage tissue and increase risk of infection
Dressings and bandages, including role of benzoin tincture to make bandages stick better
Antibiotic ointment:
Prevent about 1 in 10 traumatic wound infections
Bacitracin ointment recommended: high risk of blistering allergic reaction like poison ivy with neomycin-containing ointments such as Neosporin
Re-cleansing and reapplying antibiotic ointment a few times a day will also help prevent infection
Deciding which wounds need to be treated in a medical facility: high-risk wounds needing exit or evacuation from field for immediate treatment to help avoid later problems:
“Golden 8 hours” in which to primarily close laceration vs recent study contradicting this
Diabetes mellitus as a major risk for infection and may want to delay closure for wounds in diabetic patient 
Role of delayed primary closure 4 days after initial wounding: if not visibly infected then, can close just like brand-new with same results
High-risk wounds 
Large wounds that require suturing
Wounds with exposed bone or tendon (white in wound)
Wounds with extensive crushing of tissue
Deep puncture wounds if no tetanus shot within 10 years 
Splinters and fishhooks 
May remove in field if comfortable doing so, not deep and not near vital structures such as tendons, bones or major blood vessels
Techniques for removing
String and pressure method
18 ga needle method
Advance and cut method
Larger impaled objects
Standard “street” first aid management is to stabilize in place and transport
In backcountry setting, remove impaled objects if unable to stabilize, will easily fall out, prevents transport, or unable to control bleeding because of the object
Blisters
Wool socks with terry-knit on outside (e.g., Rohner, or SmartWool or Darn Tough worn inside out: as good as using separate liner socks
Moleskin adhesive felt patches: traditional, but 3M paper tape may be better
Vaseline or similar lubricants:
Works for about an hour
3-4 hours later makes blisters more likely
Benzoin tincture on skin: no evidence it works
3M Micropore paper tape on hot spots
Shown to be most effective in one marathon runner study
Tends not to stick that long
Can put benzoin tincture on skin first to help it stick
After-market insoles not only help sore feet but help prevent blisters
Closed blisters:
Drain with clean needle or knife point
Do not put hydrocolloid dressings on intact blisters
Apply benzoin tincture widely around but not into open blister
Apply donut of felt adhesive moleskin around blister but not directly on blister
Cover blister and moleskin with paper tape or moleskin
Open blisters
Trim off dead skin
Apply benzoin tincture widely around but not into open blister
Apply hydrocolloid dressing (Compeed, Spenco, Band-aid Blister)
Apply donut of moleskin around blister, on top of hydrocolloid dressing
Thermal Burns
First degree: skin reddened, no blisters
Sunburn, although can have small blisters, is usually first degree
Aloe containing creams on the skin help healing
Creams containing pramoxine and menthol, local anaesthetics with low potential for allergy, available over-the-counter, usually as anti-itch creams; work well to control the pain
Pain control with over-the-counter analgesics appropriate: naproxen (generic Aleve) and extra-strength acetaminophen (generic extra-strength Tylenol) combination appropriate if no history of allergy to them, pregnancy or breastfeeding, peptic ulcer disease, or kidney impairment
Second degree (partial thickness of skin): blisters but sensation intact in middle of burn
Third degree (full thickness of skin): blisters but numb in burn due to nerves and other deep tissues being burnt
Recognize second degree (partial thickness) vs third degree (full-thickness) burns: check for sensation in burn

Large area burns cause large fluid loss and requires lots of hydration
High-risk areas for complications: 
Palms and soles
Circumferential burns around fingers
Face and airway
Genitals
Immediate treatment: if still hot, cool, but don’t freeze
Secondary treatment for second or third-degree burns
If ruptured blisters, debride (trim) dead skin with clean scissors or knife 
If open, protect with clean, slightly moist or non-adherent bandage
First day standard basic hospital treatment is thick coat silver sulfadiazene (e.g., Silvadene; prescription-only) cream to cut down pain and protect from infection; shaving cream has been recommended as a field expedient; Silvadene only used for first day as later interferes with healing skin
Bacitracin instead of Silvadene on face as Silvadene may cause permanent staining of skin
Second day on, standard basic hospital treatment is to gently clean with plain soap and water. and use bacitracin ointment (over-the-counter) twice a day; bacitracin in many personal wilderness first aid kits and Silvadene in some team kits
Avoid Neosporin or triple-antibiotic ointment as neomycin is famous for causing blistering allergic reactions like poison ivy
Evacuate or not?
First-degree burns require pain control but evacuation usually not needed
Second-degree burns in high-risk areas should generally be evacuated
Third-degree burns (no sensation in burn) should be evacuated and seen at a burn unit as take long time to heal, may require skin grafts
Burns not high-urgency for evacuation unless life- or limb-threatening complications
Life- and limb-threatening complications
Inhalation injury, usually from burns in enclosed space such as tent: hoarse, soot in sputum, soot in mouth and nose are clues
Circumferential full-thickness limb burns, treated by escharotomy: cutting hard burned skin (eschar) with a scalpel or knife if needed to preserve circulation (advanced skill, physicians and flight nurses)
Circumferential chest burns treated by escharotomy if needed to preserve breathing
Nosebleed
Common problem, especially with dry air in winter; may also come from blow to nose or picking nose
Most commonly anterior nosebleed; posterior nosebleed rare, but hard to control and rarely causes death, mostly in those on blood thinners
To control anterior nosebleed, squeeze nostrils together firmly for 10 minutes by watch; lean forwards to prevent blood going down throat
Afrin (oxymetazoline) or neosynephrine decongestant nasal sprays (in some wilderness first aid kits) stopped 2/3 of nosebleeds in an Emergency Department study
Tranexamic acid (TXA), carried in pill or IV form in some medical kits, very effective when used in nose to stop bleeding
In rare cases, may need to pack anterior nose; QuickClot Combat Gauze best, don’t use paper tissues that dissolve in blood as don’t help 
 Injuries 
Types of Injury
Bruise/Contusion
Strain: stretching injury to muscle, or tendon that attaches muscle to bone
Sprain: partial ripping of fibrous band that connects bone to bone
Fracture: broken bone
Closed fracture: no break in skin connecting to fracture
Open (“compound) fracture: break in skin connecting to fracture (significant risk of bone infection; bone does not resist infection well)
Dislocation: separation at joint between bones
Management of Acute Musculoskeletal Injury
RICE for immediate pain control:
Rest: decreases pain
Ice: decreases pain
Compression (elastic bandage): decreases swelling which decreases pain
Elevation: decreases swelling which decreases pain
RICE treatment not advised after first 6 hours, particularly ice; graded return to activity better than ongoing rest
May also want to take pain medication, especially if needed to assist with exit/evacuation from field; naproxen and acetaminophen combined best over-the-counter choice unless reason not to take
Ankle Twists
Most common injury in backcountry is twisting injury of ankle
Some injuries are obviously deformed and are fracture-dislocations: should be gently but firmly brought back to anatomic alignment and splinted that way, and patient evacuated without bearing any weight on affected ankle; should have splint ready before realigning as usually will not stay realigned without splint being immediately applied
Some not obviously deformed and might be fractures or sprains
Validated, easy-to-use criteria for obtaining ankle X-rays or foot X-rays after twisting injury of ankle: Ottawa criteria (see reference)
If doesn’t need X-rays, doesn’t need urgent or even may non-urgent evacuation to Base, might be able to treat and have person walk (hobble) back to Base or continue with task 
Treatment
If available at Base or nearby, may ask for an aircast type brace to be sent in to patient
May tape ankle with adhesive or duct tape to support anterior talofibular ligament
Open Fractures
Very important to prevent infection in bone, very hard to treat, may require weeks of intravenous (IV) antibiotics
Gently clean off visible dirt
High-pressure irrigation as described in wound section, but use twice as much irrigation as would use for simple flesh wound
Sterile dressing
Open fracture higher urgency for evacuation than closed fracture; time to definitive care affects likelihood of infection 
If person with open fracture has antibiotic in personal first aid or medical kit, should educate person that taking antibiotic early may decrease likelihood of bone infection
Joint Dislocations
Some joint dislocations (finger, toe, patella = kneecap) may be easy to reduce, others harder
For some closed finger injuries, without X-rays, hard to tell if dislocation, fracture-dislocation or fracture, but in backcountry, attempt at reduction may be appropriate, and realigning may help even with fractures
For wilderness first aid level of training, may attempt to reduce finger, toe and patella dislocations; should not attempt to reduce other dislocations without more advanced training
Reducing dislocations sooner decreases pain and joint damage
Attempting to reduce dislocation will cause brief increase in pain but worth it to decrease longer-term pain and joint damage
To attempt to reduce finger and toe dislocations, grasp firmly on either side of dislocation and pull firmly apart;
To attempt to reduce patella dislocation, not knee joint location, (usually patella slides off laterally = outside of knee), gently straighten knee joint and patella usually spontaneously slips into position; if knee totally straight and does not reduce, may firmly try to push back into place 
For finger/toe/patella dislocations, if does not reduce or patient does not tolerate, splint it “as it lies” and evacuate to more definitive care or bring higher level of medical provider to patient to attempt reduction
Reduced finger and toe dislocations generally splinted by taping to next finger or toe (“dynamic splinting”) to prevent additional injury
Those with reduced patella dislocations may walk on leg but should try to avoid full bending of knee as may dislocate again
Those with reduced finger, toe or patella dislocations need medical follow-up with primary care physician or orthopedic surgeon but not urgently
For other dislocations, either “splint it as it lies” and evacuate for more advanced medical evaluation and treatment, or arrange for more advanced medical provider to come to patient 
Splinting Principles
On the street, principle is “splint it as it lies”; in backcountry, may realign bones to decrease internal bleeding and pain and make splinting more effective
May attempt to realign long bone fractures with one or two people: grasping to either side of fracture and pulling firmly apart; stop if significant resistance 
For long bone fractures, splint (immobilize) joint above and joint below
For fractures at a joint, immobilize long bone above and below
Splints should be comfortable: no pressure points that might cause skin ulcers, use padding whenever possible
Splints must prevent fracture from moving, which requires more than two sticks and two wraps
A mat of thin sticks or reeds held together with duct tape and wrapped around a padded arm or leg makes an excellent splint
Sleeping pads can make excellent splints
Some packs have removable back-padding pads that serve well as splints
May use scissors to cut rectangular section of plastic one-gallon milk, water or windshield washer fluid jug and keep in water bladder or back pad pouch of pack as a free lightweight splint; may combine such splints with duct tape to make longer or thicker splints
Compartment Syndrome
Compartment syndrome caused by blunt trauma to muscle compartment or nearby bone fracture
Muscle compartments: groups of muscles bounded by walls of tough fibrous tissue
Most common compartment to develop compartment syndrome is anterior compartment of lower leg
Usual way compartment syndrome develops (natural history):
Swelling from trauma causes pressure in compartment to build up
Pressure finally gets to be more than the pressure inside the capillaries (smallest blood vessels) and they collapse; no blood getting to muscles, causes muscles to start dying, making muscles swell
Pressure in compartment gets greater than pressure in veins removing blood from compartment; veins collapse, blood can no longer leave the compartment so compartment swells
Increasing pressure damages sensory nerves traveling through the compartment, may find numbness in compartment and beyond it 
Increasing pressure next damages motor nerves, may find weakness beyond compartment 
Increasing pressure next collapses arteries traversing compartment, cuts off blood supply to area beyond compartment
Entire part of leg or arm supplied by artery dies.
Suspect compartment syndrome when
Severe pain, swelling, and tenderness in one compartment of leg or arm
Late signs and symptoms: beyond compartment, lose sensation, then lose motor strength, then lose pulse beyond compartment
Should suspect compartment syndrome before veins collapse and get to definitive care at trauma-center hospital where can measure pressure and compartment
Treatment is surgery called fasciotomy: cutting open skin and fascia (thick fibrous bands around compartment) 
Some suggest cold or elevation but no evidence they help and might hurt
If suspect compartment syndrome, increase urgency of evacuation or try to get surgeon to patient to perform fasciotomy
If suspect compartment syndrome, good to consult with someone with higher level of knowledge about this, ideally physician or surgeon
Trauma Principles
“The Golden Hour”
Catchy phrase that encapsulates the idea that major trauma is a surgical disease, and
Only place to get appropriate surgery is in a hospital, ideally a trauma-center hospital that specializes in multisystem trauma, and
Death rate a function of how long until you get trauma victim to hospital
In urban trauma, fixable problems often to kill trauma victims in the first hour, so
Speed is essential to getting patient to hospital, and more important than most field treatments
Rare exception to this rule is reducing a tension pneumothorax in the field; other field interventions of limited or no benefit
“The Golden Day”
Catchy phrase that encapsulates the idea that those injured or lost in the backcountry, if not found and rescued in the first day, much more likely to die
The golden hour concept does not apply in the backcountry; almost impossible for backcountry trauma victim to get to the hospital within an hour
Those with things that can be fixed in severe urban multisystem trauma generally kill those in the backcountry before they can be found and rescued
Therefore other priorities in taking care of backcountry trauma patients than urban trauma patients
Priorities for backcountry multisystem trauma patients include
Prevent additional injury with splinting and protecting spine during loading into litter and during evacuation
Avoid decubitus ulcers (decubiti, bedsores) by making sure that pressure on high-risk areas such as just above buttocks (sacrum) by: padding voids under neck, lower back, and knees; having thick soft padding under this area; keeping area dry, tilting the litter from side to side from time to time; and allowing patient to move if possible to reduce pressure on this area
Control slow bleeding with pressure bandages, ideally with hemostatic gauze dressing
Prevent infection by cleaning wounds and applying antibiotic ointment 
Maintain normal temperature (helps control bleeding) 
Rehydrate (helps prevent kidney damage)
Feed (helps prevent hypothermia)
Prevent deep venous thrombosis and pulmonary embolism by allowing to move legs if possible and avoiding constricting tie-ins on legs 
Prevent pneumonia and respiratory failure by encouraging alert patients to take deep breaths and cough, providing gentle firm pressure on injured ribs to protect them during deep breaths or coughs if needed
Identify worsening pneumothorax; try to arrange for definitive field treatment (“needling the chest”; see )
Look for developing compartment syndrome and if found, increase urgency of evacuation to prevent permanent damage to leg or arm
Lightning Strikes
Review lightning safety from Field IV curriculum
Lightning strikes may cause
Immediate death
Unconsciousness or decreased level of consciousness 
Long bone or other fractures from the blast
Burns
Vasospasm: cramping of muscles in walls of arteries, making it difficult or impossible to detect even a carotid pulse
Paralysis of respiratory muscles, stopping breathing
Triage (sorting: deciding who to treat first) of group hit by lightning
Those showing signs of life tend to recover without first aid
Those without signs of life might be dead or might be saved by simple first aid; go to them first
Those hit by lightning are not “electrified” and are safe to touch
Even if unable to detect carotid pulse, heart may still be beating, give artificial respiration (mouth to mouth or 
Head Injury
Loss of consciousness or persistent confusion after a blow to the head is an indication to exit or be evacuated from the field for medical evaluation
Worsening mental status after a head injury may be a sign of worsening brain injury; but keeping someone awake after a head injury will not improve outcome
Most important first aid for severe head injuries is to check carefully for any constriction across or around the neck that might block veins draining blood from the brain and increase intracranial pressure
Flat or coma position is acceptable for head-injured patient; up to 30° of head elevation may help slightly.
Pelvic Fractures
An “open-book” pelvic fracture can cause someone to bleed to death internally
Open-book pelvic fractures require major force, such as a motor vehicle accident or fall from a significant height
Splinting an open-book pelvic fracture with a binder around the top of the thighs (not on the pelvis itself, but at the level of the greater trochanter of the femur) may be lifesaving
When doing a secondary survey on a major trauma patient, one and only one person should try to press the pelvis together; if it moves, that person should hold it in place until someone can apply a pelvic binder
A pelvic binder can be improvised from a pack hipbelt; if a frame pack, may take hipbelt off of pack and use separately, if soft pack, may place empty pack on top or underneath patient to provide extra warmth and stabilization, using hipbelt as pelvic binder
Possible Spinal Injury
Suspect spinal injury in alert patient with minor injury to back or neck and weakness, numbness or pain down arm or leg
Suspect spinal injury with alert patient with major injury and pain in neck or back
High-risk mechanisms for spinal injury:
Fall with loss of consciousness 
High-velocity impact (motor vehicle accident, climbing falls, high-speed skier or biker)
Falls more than 1 m (3 feet)
Landing on head or buttocks (axial compression of spine) 
If suspect spinal injury in alert patient:
Tell patient to hold spine still and not move it much
Protect patient’s spine from additional injury
Do not need to “immobilize” patient 
Patient may move self with assistance
May be able to use NEXUS rule with physician consult and oversight to rule out need for cervical spine protection
NEXUS rule (“NEXUS criteria”) is an emergency physician using the following wording to examine a patient:
…ruling out cervical-spine injury in patients with blunt trauma: the absence of tenderness at the posterior midline of the cervical spine, the absence of a focal neurologic deficit, a normal level of alertness, no evidence of intoxication, and absence of clinically apparent pain that might distract the patient from the pain of a cervical-spine injury. 
If major injury and not alert, or unconscious, suspect spinal injury and “immobilize” spine 
Do not use unpadded backboards, as dangerous and may cause permanent damage to skin on back; use full-body vacuum mattress or padding to restrict spinal movement in litter
May apply cervical collar if not in full-body vacuum mattress, as long as collar fits well and does not torque neck or cause significant pain
When moving patient with suspected spinal injury, do so slowly, carefully and gently, taking care to not torque the area of suspected spinal injuryChest Trauma
Pneumothorax and hemothorax
Review evaluation for and treatment of tension pneumothorax and sucking chest wounds from Breathing Assessment and Management section above
May have non-tension pneumothorax that gradually develops into tension pneumothorax; rare
May get bleeding into chest cavity: hemothorax; cause of decreased breath sounds on affected side; may be enough to cause shock or trouble breathing; rare
Broken rib or bruised ribcage
Rib belt or strapping with tape only recommended while playing contact sports; otherwise do not help pain much and make pneumonia more likely by restricting breathing
Pain medications appropriate if patient has them in personal first aid or medical kit
Patient or assistant may hold pressure against broken or bruised ribs to protect them when taking a deep breath or coughing
Taking a deep breath and coughing important to prevent pneumonia, especially if patient smokes or has asthma
Review flail chest and sucking chest wounds from prior primary survey section
Abdominal Trauma
Most dangerous abdominal injury is laceration and bleeding from injured solid organ: liver or spleen
Liver is under right side of ribcage; injury to this area or ribs above it should make you suspect liver injury
Spleen is under left side of ribcage; injury to this area or ribs above it should make you suspect spleen injury
Symptoms of liver or spleen laceration include increasing pain in this area, signs of shock (increasing pulse, sweaty, pale, anxious), and developing generalized abdominal pain and tenderness, or abdominal swelling
Open book (bad) pelvic fractures may cause enough bleeding in abdomen to cause symptoms similar symptoms
If suspect internal bleeding, upgrade evacuation urgency and consider calling, or asking Base to call, for medical helicopter
Other internal injuries (blunt trauma to pancreas, bowel) not as immediately threatening but need to be evaluated at trauma center
Submersion (Near-Drowning)
If respiratory arrest, do artificial respiration with mouth-to-mouth or mouth-to-mask ventilation
If cardiac arrest, follow guidelines in prior section on Circulation: Cardiac Arrest
If might be trauma, protect the cervical spine
If hypothermic, treat hypothermia
Background
Almost all injuries and deaths from wild venomous snakes in mid-Appalachians due to Crotalidae (pit vipers): various rattlesnakes, copperheads,  and water moccasin (cottonmouths); rattlesnake bites most common
Pit vipers have eyes with elliptical pupils; other mid-Appalachian snakes have round pupils and angular heads compared with local non-poisonous snakes
Pit vipers not aggressive, most bites provoked by humans handling snakes, especially when intoxicated, but may occur if accidentally step on or near snake
Trying to catch  or kill wild mid-Appalachian snake for identification dangerous and useless: treatment based on signs of envenomation, not species of snake  
May take zoomed-in cellphone picture of snake from safe distance; if can identify as non-venomous, or send picture to someone who can identify as non-venomous, do not need to treat for venomous snakebite
Pit viper venom 
Venom may be injected when snake bites
Venom used for hunting, many bites of humans and dogs defensive and no venom injected (“dry bite”; about 1/3 of bites)
Venom has mix of poisons, most of which cause local tissue destruction, some of which less commonly cause body-wide illness; main problem is local tissue destruction unless multiple envenomated bites or bite to infant
With multiple bites may see shock or generalized bleeding; very rare
Signs and Symptoms of Envenomation
Signs: swelling, pain, and bruising at bite, usually within a few minutes to an hour, rarely delayed by 
Symptoms: coppery taste in mouth, anxiety (but may have this even if not envenomated), tingling in hands and feet (but may also occur from hyperventilation from anxiety with no envenomation)
Treatment
Long list of things proposed for North American pit viper bites now know to be harmful by causing worse local tissue damage 
Do not apply a tourniquet or lymph constrictor
Do not apply ice, snow or dry ice
Do not shock with electric cattle prod
Do not incise with a knife or scalpel or apply suction
Do not give alcohol to drink
Do not apply a compression bandage (Ace wrap)
Do not apply meat tenderizer
If evacuating in litter, do not elevate arm or leg or have it hang down, fine to keep at normal level next to body; best to keep in straight to neutral position in case of bad swelling
Treatment
Clean and bandage as for any wound
Do not cut open or force irrigation fluid into puncture wounds
Get person back to Base and then to a hospital as soon as possible as may need antivenin (antivenom); contact Base and have Base check for nearest hospital with access to antivenin (antivenom) and make sure person is transported there
If possible, splint limb for comfort (dubious benefit) but do not allow splinting to interfere with evacuation
If no symptoms or signs of envenomation at first, have patient walk out to Base
If have symptoms of envenomation, consider a carry-out if resources available but person may walk if able 

Red Flags
Conditions that warrant evacuation from field or consultation with more medically knowledgeable person to discuss
More medical knowledge = better able to evaluate such problems, recommend more advanced training such as Wilderness First Responder or Wilderness Emergency Medical Technician
Hypoglycemia
Is low blood sugar
Most common in diabetics on pills or insulin injections
May occur in those exercising heavily, or not eating enough, or hour or two after eating sugary food
Symptoms: similar to low blood pressure, lightheadedness, sweaty (“cold and clammy”), shaky, may even lose consciousness
Treatment: lie flat, elevate leg (improves delivery of blood to head, which means delivery of blood glucose to head), give quick-energy food
Low blood pressure makes hypoglycemia symptoms worse; if also dehydrated, give fluids and salty food  
If recovers completely, no need to evacuate, may continue with task
Chest Pain
Red flags: 
Chest pains that last for more than a minute or two; usually not serious but might be serious problem
Chest pain with shortness of breath or sweating
Chest pain that comes on with exertion and goes away with rest, suggests narrowed artery to heart
“Heart Attack”: two meanings
Sudden cardiac arrest from irregular heartbeat
Occlusion (complete clogging) of coronary artery (“crown” of arteries around heart that supply heart muscle) = myocardial infarction
Classic chest pain of myocardial infarction:
Pressure-like substernal pain (under breastbone)
Associated with nausea, sweating, shortness of breath, and radiation to left or right arm (left arm more common, right arm more diagnostic of myocardial infarction)
Many if not most myocardial infarctions do not show classic symptoms
If person has myocardial infarction, taking aspirin decreases likelihood of death and may limit heart damage (note “stump method” under prior legal section)
Aspirin 
Is blood thinner
Accounts for beneficial effects in myocardial infarction
Aspirin not appropriate if concern for increasing bleeding
If faced with cardiac-sounding chest pain (or other medical conditions) in backcountry, a radio or telephone consult with a physician may help decide appropriate actions
Decreased Level of Consciousness
Red flags: decreased level of consciousness that does not improve promptly such as simple fainting or heat syncope; or, recovering but serious cause such as heatstroke
Long list of medical conditions that may cause confusion or decreased level of consciousness, including but not limited to
Hypoglycemia (low blood sugar): if might be cause, give sugar or other sweets, will not hurt if not hypoglycemia; review section on nutrition in Field III curriculum
Simple fainting (review discussion above under heat syncope: lay flat and elevate legs)
Heatstroke: review  separate section on heatstroke above
Hypothermia:  review separate section on hypothermia above and in Field IV curriculum
Coma (recovery) position appropriate whenever significantly decreased level of consciousness, to protect area from vomiting or reflux; review section earlier on airway management 
Seizures (Fits)
Many types of seizures, but most common is generalized tonic-clonic seizure
May come from sleep deprivation, excess caffeine, stress, recreational drugs such as cocaine or methamphetamine, or alcohol or benzodiazepine (e.g., Xanax) withdrawal 
May be from prior brain damage or abnormality: epilepsy
May be aura first: person
Usually in those with history of seizures
Main risk is from injury during seizure
Protect patient having seizure from injury 
Do not try to force jaw open during seizure: may cause injury
Most seizures stop in a minute or so
After seizure, normal to have postictal period:
Decreased level of consciousness, may last minutes or an hour or so 
May be incontinent of urine or stool
May bite tongue but rarely serious lacerations
Care is supportive: keep appropriately warm or cool, protect airway, once conscious enough to tolerate, give food and fluids
If recovered adequately may walk out under close supervision
Other Red Flags
At wilderness first aid level, don’t expect much knowledge of other medical problems
Should know “red flags” that are reason to get someone out of field to more advanced medical personnel
Abdominal Pain Red Flags
Persistent localized tenderness
Fever
Persistent vomiting
Getting worse over 12 hours
Known pregnancy
Vomiting and Diarrhea Red Flags
Blood in vomit or diarrhea
Fever
Ongoing abdominal pain with persistent tenderness
Significant dehydration
Urine Red Flags
Urinary tract infection symptoms (urinary frequency, urgency, and pain on urination = dysuria) with fever, chills or sweats (pyelonephritis = kidney infection) or vomiting
Blood in urine (hematuria)
Cough Red Flags
Shortness of breath
Fever
Coughing up lots of colored phlegm

Fever Red Flags
Confusion or decreased level of consciousness 
Severe headache
Stiff neck
Vomiting
Head Red Flags
Persistent blurred vision
Uncontrolled nosebleed or other bleeding
Head injury with decreasing level of consciousness 
Airway compromise

Immediate Stress Reactions 
May include physical, emotional, cognitive, and behavioral components; signs and symptoms may be present 
Generally occurs at time of the incident or within 24 hours
Immediate stress reaction is response of normal person to abnormal situation, not sign of psychological weakness or chronic psychiatric problems
Physical symptoms may include: 
Profound fatigue and weakness
Fine tremor or muscle twitches
Diaphoresis (sweating)
Vasovagal orthostatic hypotension or vasovagal syncope (simple fainting)
Nonspecific lightheadedness
Nonspecific headache
Difficulty focusing one’s eyes
Nonspecific difficulty hearing
Palpitations (feeling of racing or irregular heartbeat
Dyspnea (shortness of breath) and chest pain with or without hyperventilation
Nausea, vomiting, diarrhea, or abdominal pain
Sensation of lump in throat (globus hystericus)
Emotional symptoms may include: 
Anticipatory or generalized anxiety (anxiety about the future, or unconnected with any present danger or fear)
Strong fear or even panic reactions
Psychological shock (described later) 
Survivor guilt uncertainty (guilt over surviving when others have died)
Acute grief reactions
Depression
Intensified or inappropriate emotional reactions to normal occurrences
Cognitive symptoms may include:
Blaming others (sometimes even those who are logically blameless) for the critical incident
Generalized confusion
Inability to concentrate
Inability to perform simple calculations
Poor attention span
Memory lapses
Anomia (inability to find the right words)
Inability to distinguish the difference between serious and trivial concerns
Inability to make decisions; and
Greatly increased (or greatly decreased) alertness and awareness of surroundings
Behavioral symptoms are relative to person’s normal behavior, may vary widely; include: 
Changes in normal activity patterns 
Changes in speech patterns
Withdrawal
Angry outbursts
Hypervigilance (increased suspicion and attention to one’s environment or even outright paranoid behavior)
Changes in interactions with others (i.e., spouse, friends, team members)
Increase or decrease in appetite or alcohol consumption
Sleep disturbances, including early morning awakening, early insomnia, hypersomnia, and generalized fatigue
Visits to health professionals for seemingly minor or even nonexistent problems
Psychological First Aid: Initial Actions
May encounter search and rescue team members having immediate stress reactions, and may be person best qualified to deal with situation
SAR team members may and should perform on-scene psychotherapeutic “first aid” 
Look for those showing signs of stress (even if not immediate stress reaction} and try to arrange rest breaks
Look for those with immediate stress reactions:  person walking about aimlessly, a person sitting and staring blankly (unless simply exhausted), or person behaving irrationally 
First step: isolate person from the sights, sounds, and smells of incident; have person 
Face away from the incident
Get on the other side of vehicle, boulder, hillside 
If smells prominent, move person upwind
If person should not be moved, place object to block patient’s view 
When engaged in on-scene psychological “first aid,” peers (SAR team members or similar} may ask “Hey, are you OK?” even if not acceptable coming from mental health worker who is not peer
For simple basic psychological first aid, may just need to lend a sympathetic ear
Psychological First Aid
If need to prompt person to start talking, start asking about facts first, and only after developing rapport, start asking about feelings

Monitor person and arrange extra help if seems necessary
Group interventions (such as formal Critical Incident Stress Debriefing = CISD) never appropriate at a scene 
Defusing session (without great emotional depth) at Base Camp at the end of each shift, led by a mental health professional, or when a particular Field Team returns to Base, might be appropriate for very stressful operations
According to Dr. Mitchell, founder of Critical Incident Stress Management, more formal sessions should be held only completely away from hazards and distractions of a Base Camp during a search

“Haste Makes Waste” but in search and rescue, haste also causes injuries and may cause, and has caused, team members to become additional patients
Sense of urgency appropriate during rescue, as in somewhat to very hostile environment, and medical conditions may deteriorate during long evacuation
Urgency of evacuation should be determined by team leader based in part on patient’s medical condition
Certain conditions are very time-critical: bad things that might be fixable at a hospital but not in the backcountry; examples include
Brain injury with decreasing level of consciousness
Internal bleeding with worsening signs of shock
Certain conditions are not time-critical, examples include
Closed long-bone fracture, adequately splinted, with intact distal neurovascular status (circulation/pulse, sensation, movement) intact 
Possible isolated cervical spine injury with no neurological symptoms such as numbness, tingling or weakness of arms or legs
The more medical knowledge and experience, the better can assess how time-critical patient is; may need to be reassessed during evacuation and have urgency increased if patient deteriorates
Urgency of evacuation should be determined by team leader based in part on weather, terrain and team’s condition
If team is exhausted or small, urgent evacuation makes team member injury more likely and may want to slow pace of evacuation
If storm approaching, may want to speed evacuation
Examples of urgency-based evacuation decisions:
Call for a medical helicopter? 
Risk of crashing
Extremely expensive, tens of thousands of dollars
May be appropriate for time-critical patients
Use an ATV on a rough trail to evacuate patient?
Risk of injury to patient high, best saved for time-critical patients
Bumpy ATV ride very dangerous for patient with bad hypothermia, might cause cardiac arrest
For stable patients, waiting to get litter team for carry-out to road likely better choice
Start an evacuation with an improvised litter or carry rather than waiting for a Stokes litter?
Hard on team
Hard on patient, especially if fractures 
Increases risk of injury to patient and team
May be appropriate to get time-critical patient to helicopter landing zone or ambulance
Bivouac and wait for team with litter and extra litter bearers to arrive?
With stable patient and litter team arriving soon and nice day, makes sense to wait
With unstable patient and/or uncertain when litter team will arrive and/or deteriorating weather, may make sense to start improvised evacuation 
More medical knowledge, experience and expertise means better decisions about evacuation urgency; might be able to use cellphone to contact someone with more medical knowledge and discuss case, preferably physician with wilderness EMS experience
 
Poles and blanket stretcher
Poles and parka stretcher
Poles and packstraps carry
Split coil piggyback carry
Sling piggyback carry

Electromagnetic waves
Wavelength and frequency
Electromagnetic spectrum
Effect of frequency on getting through steel stud grids in buildings (UHF better), and bending around and over hills (VHF better)
AM vs FM
Speaking loudly on FM causes overmodulation that decreases transmitted signal strength
How speaking loudly may cause audio distortion on any mode
Radio 
Specific bands and frequencies provided for general background and personal reference but we do not require members to memorize any bands or frequencies
AM
Aircraft band (~121 MHz)
CB (26-27 MHz)
FM
VHF low band (49-108 MHz: long car antennas, old sheriff/police/fire frequencies)
VHF high band (150-216 MHz): ASRC Special Emergency shared frequencies 150-155 MHz; 2-meter Ham band 144 MHz, CAP VHF 148 MHz
UHF low band (450-806 MHz): Family Radio Service (FRS) and EMS Med Channels frequencies ~460 MHz, 
UHF high band (900-952 MHz)
Wide and narrow frequencies: older wide frequency radios not allowed to be used, all common 
Cellphones (800-2600 MHz) 
Simplex vs Duplex
Landline telephone or cellphone: duplex
Push-to-talk radio: simplex
Radio Extenders
Retransmitter = remote base
Repeater
Trunked systems
How trunked systems operate: different than simple simplex or repeater systems
“800 Mhz” trunked public-safety systems
800 MHz trunked systems may not compatible with standard public safety FM radio systems, but may be able to interconnect them
Cellphone systems
ASRC Frequencies
ASRC licensed by FCC to use certain 155-band VHF FM radio frequencies
Public safety VHF “155” band
May only use for public safety operations and training; using for personal or routine business operations is forbidden
Shared with other public safety agencies on a “don’t interfere with others” basis
155.160 MHz: Alfa; ASRC/MRA “national” frequency
155.280 MHz: Charlie; was a Bravo but decided not to use any more
155.205 MHz: Echo (Virginia SAR interoperability channel)
155.220 MHz: Foxtrot
155.175 MHz: Golf
155.235 MHz: Hotel
155.265 MHz: India
155.295 MHz: Juliet 
May use two specific pairs of these frequencies for portable repeaters: some ASRC Groups have portable repeaters
150.775 MHz: Romeo; may use simplex between handheld radios or as handheld transmit frequency, paired with repeater output on another ASRC frequency
150.790 MHz: Sierra, may also use simplex between handheld radios or as handheld transmit frequency, paired with repeater output on another ASRC frequency
Example of repeater pair: handhelds transmit on Romeo (150.775) and receive from repeater on Charlie (155.280)
Business VHF  “150” band:
May use for ASRC, Group or Corps non-emergency business
Shared with other business users
151.625 MHz: Lima-1 
National interoperability channels 
National emergency channels on both VHF and UHF bands that common handhelds like Wouxun and Baofeng will operate on
Most but not all newer public safety radios (fire, EMS, police) will operate on these channels
Frequencies do not need to be licensed to ASRC to use for emergency operations and training
155.7525 MHz: VCALL10
151.1375 MHz: VTAC11
154.4525 MHz: VTAC 12
158.7375 MHz: VTAC13

Antenna radiation patterns and effective radiated power (ERP)
Rubber duck antenna: radiates power most directions but not off tip of antenna: since radiates in many directions, lowest ERP
1/4 wave antenna: radiates power mostly perpendicular to antenna
Base-loaded 5/8 wave antenna (Mag-mount, mobile antennas): radiates power very much perpendicular to antenna
Stacked-element collinear antennas (Base antennas)radiates power extremely much perpendicular to antenna
High-ERP antenna receives better as well as transmits better, but just perpendicular to antenna, very directional
Effect of ground plane on radiation pattern/ERP and use of cars, human bodies as improvised ground planes: put radio on your head
Effect of reflectors on radiation pattern/ERP and improvised reflectors of human body or metal; for VHF 155 MHz band (ASRC frequencies), optimum distance about 20” (1/4 of the ~2-meter wavelength, or about half a meter); need to aim at Base 
Regardless of antenna design, works better with line of sight to other radio; may want to hold radio up (easier with speaker-microphone attached), climbing rock or tree, or walking up a hill
If your antenna and radio cannot reach Base, you may be able to reach another team that can relay to Base

Turns off speaker until senses strong signal
Just avoids annoying background static hiss
On older radios, controlled by knob
On newer radios (e.g., Wouxun, Baofeng), controlled by menu option, but such radios usually have Monitor button that temporarily disables squelch (Woxun: second button below push-to-talk, BaoFeng: button right below push-to-talk, single click for flashlight, press and hold to monitor)
When trying to listen for a weak signal, turn squelch off by dial, menu or pressing monitor button

“Private Line” = Continuous Tone Code Squelch System
Turns on speaker only when signal is strong enough (standard “carrier squelch”) and when hears a particular subaudible tone (like a particular musical note) 
In shared frequencies in crowded urban areas, cuts down on having to listen to irrelevant radio traffic
PL tone may be added to outgoing radio transmissions (“PL encode” or “PL transmit”) and/or added to the existing carrier squelch (“PL decode” or “PL receive”)
ASRC recommends, for ASRC frequencies, use particular PL code (3A = 127.3 Hz) to all radios transmit only
ASRC recommends not using PL decode on ASRC frequencies; not usually used in crowded urban areas; if program in PL decode for receiving, may not hear some radios that don’t have a PL code, or the right PL code, set for transmit  
 of Radios
High-end commercial handheld radios $3000-$8000 each
Cheap radios that are legal for ASRC VHF low-band frequencies, Interoperability VHF low-band and UHF high-band (Wouxun, Baofeng, others) $100-200 each; suitable for individual members to purchase and use, also may use on amateur (ham) 2-meter and UHF frequencies if get ham license

Announcing FCC callsign: Base’s job
For repeaters or remote base: press and hold push-to-talk button for a second before speaking or your first words will not get through
“You, this is me”
Elements of communication style
ASRC Prowords
Phonetic spelling
Conciseness
Compose concise message before pressing push-to-talk
Break long transmission with “break… continuing” to allow priority radio traffic to break in; or say, “How copy so far?” then release push-to-talk
“Base, this is Team Alfa, permission to go direct with Team Bravo?”
Clear the Net
Secure the Net
Mayday = French m’aider (‘help me’)  
Cellphones
Cellphones are UHF radios with internal antennas, and may benefit from an improvised  ground plane, but unless know where nearest tower is, reflector (holding few inches in front of your center of mass) less helpful
Texting may get through (only a few data packets) when cannot make voice contact (lots of data packets); may press Send and then hold cellphone on top of your head as will keep retrying the data packets for a minute or so
As with radios, climbing a rock or tree or walking uphill may help
Land 
Information conveyed by various colors

How to read coordinates from paper map edge ticks
Latitude and Longitude Variants
Degrees, minutes and seconds (DD° MM’ SS”)
Decimal degrees (DD.DDDDD)
Degrees and decimal minutes (DD MM.MMM)
UTM Variants
Universal Transverse Mercator (UTM)
Military Grid Reference System (MGRS)
US National Grid (USNG)
 
Practice plotting routes between  points on a map, using orienteering concepts from Field III, and identify on map where plan to use each of the concepts
 
How to transfer .gpx files between a smartphone GPS app or a dedicated GPS unit and a laptop computer in Base
Transfer to Garmin GPS from SARTopo
SARTopo: “Export”
SARTopo: “Download GPX File”
SARTopo: Choose object to download
SARTopo: “Export”
SARTopo: Save file 
Plug GPS into USB port 
Windows: Copy file to  GARMIN/GPX folder on Garmin GPS
Transfer to smartphone GPS app from SARTopo
SARTopo: “Export”
SARTopo: “Download GPX File”
SARTopo: Choose object to download
SARTopo: “Export”
SARTopo: Save file
Pair smartphone with laptop via Bluetooth (Windows 10: Start  > Settings  > Devices > Bluetooth & other devices)
Windows 10: Start  > Settings  > Devices > Bluetooth & other devices
Windows 10: Send or receive files via Bluetooth
Windows 10: Send files > choose the device you want to share to > Next
Browse > the file or files to share > Open > Next to send it > Finish
Smartphone: accept and put in proper file folder
File folder varies with GPS smartphone apps 
Transfer from Garmin GPS to SARTopo
Plug GPS into USB port
SARTopo: “Import”
SARTopo: “Choose files”
SARTopo: navigate to the GARMIN/GPX folder on the GPS
SARTopo: Select objects to import
“Import”
 Transfer from smartphone GPS app
Pair smartphone with SARTopo laptop (Windows 10: Bluetooth: Start  > Settings  > Devices > Bluetooth & other devices)
Windows 10: Start  > Settings  > Devices > Bluetooth & other devices > Send or receive files via Bluetooth > Receive files
Send file from smartphone via Bluetooth
Windows 10: Send or receive files via Bluetooth > Receive files
, Management and Leadership
Synonyms
Esprit de corps
Employee/member engagement
Human Capital
Engagement
Meaning
Autonomy
Growth
Impact
Connection
Recognition
Recognition as salary for volunteers
Need for positive reinforcement and support
Negative effects of destructive criticism
Trust
Technical competence
Truthfulness, especially about bad things
Have, and show, concern for welfare of team members
Have, and show, interest in team members and their opinions
Organization or Team Prestige
Member pride in field team or SAR organization
Prestige of SAR organization or field team

Emotional condition and emotional support (reference prior section on Psychological First Aid)
Physical condition and physical support (food, drink, warmth)
Dealing with normal field team frustrations with Base and engaging sympathy for those in Base
Using members’ first names
Developing other people skills
Role of the family liaison
Physical support: place to be, sheltered and a bit private, food, water, place to rest
Emotional support
Developing rapport with family
Keeping family informed, and relaying family information to Base staff
Keeping family from interfering with operations
Keeping family integrated with search efforts to avoid family freelancing
Dealing with family in the field
Emotional: be prepared for grief reaction if Status 3 (or even Status 2) find: have picked a field team member with good people skills to work with family in the event of a find
Physical: be prepared for family to refuse to leave the area if Status 3 or Status 2 find: family may require evacuation assistance themselves, or a bivvy in place until coroner allows body to be moved
Telling of death: 
Avoiding euphemisms such as “lost” “passed on” or “gone”
Using the “D” word (“dead”)
Not blathering, just being there to answer questions and maybe a hand on the shoulder: being supportive
Keeping yourself mentally healthy: see earlier section on immediate stress reactions and psychological first aid
 
Experience leading field teams, with a Field II or I assigned as mentor, either on simulations or actual searches, in
Hasty tasks
Sweep tasks
Line search tasks
Serving as flanker for search dogs or mantrackers
Self-evaluate performance of each phase of task:
Briefing by Base
Assembling field team
Assessing team members’ capabilities and limitations and comparing with assigned task
Briefing field team
Delegating duties/positions as appropriate
Acquiring the necessary equipment for task
Completing Task Assignment Form (TAF)
Performing task
Assessing for completion of task
Assessing team members’ condition at end of task and arranging for rest and rehab or return to duty as appropriate
Debriefing field team members
Debriefing task with Base
Practice using a tracking stick to
Measure and mark footprint length
Measure and mark on tracking stick stride length
Use stride length on tracking stick to search for next sign
Mark sign
Follow track over different track surfaces
Practice managing a large team doing a saturation/close-spaced line search placing and removing flagging at edges of strips of search segment as being searched

Techniques mostly used in cave rescue, or areas of tumbled rock at base of cliff, or during a disaster in a collapsed structure
Paving
When patient assisting with own rescue
Put people in holes to prevent patient falling into hole, or to provide foothold 
Turtling
For narrow crevices: no room for litter bearers on sides
Someone gets on hands and knees with litter on back and crawls, or litter slides over “turtle’s” back
Variant with person on stomach called snaking or low turtling
Lap pass
Used in canyons and keyhole passages
Line of rescuers sit crossways in passage with feet or knees on one side and buttocks on other
Rescuers use hands to slide litter across laps  
 
Nylon rope care, including concerns about acid exposure, weld-abrasion and “don’t step on the rope”
Uncoiling and stacking a rope
Casting a rope
Coiling and inspecting a rope
Single-point anchors
Wrap-3, pull-2
Modified basket hitch
Specific knots
End of line
Simple figure 8 (stopper knot)
Figure 8 on a bight (loop at end of rope)
Figure 8 follow through (figure 8 loop tied around object
Joining lines
Figure 8 bend (same as figure 8 follow through but tying two ropes together)
Anchoring to object such as top of litter: clove hitch
and Lowering
Overview of Belay Principles
When a belay is needed
Trade-offs between belay redundancy vs efficiency of evacuation
Belaying a Climber
Belay calls
Sitting hip belay
Mechanical belays
Münter hitch
Dual Prusik knots and pulley
Belaying a Rappeller (Bottom Belay)
Belaying a Litter for Semi-Tech Uphill
Tree belay uphill
Mechanical belay
Dual Prusik knots and pulley
Petzl I’D or similar
Rope Team Rotation Uphill
Lowering Devices
Tree belay downhill
Mechanical devices
Figure 8 descender
Rappel rack
Petzl I’D or similar
Rope Team Rotation Downhill
Hauling Systems
Standard calls
Roles, including ratchet tender, haul team captain, rescue specialist (rigging boss)

NCRC Standard
National Cave Rescue Commission (NCRC) has standard patient packaging, patient tiein and litter rigging
For cave rescue, temperature essentially always the same
One standard cave rescue litter: Ferno Model 71 plastic basket litter
Makes standardization easy
ASRC Best Practices
Varying above-ground weather from very hot to very cold, from very dry to very rainy
ASRC Groups use different litters and different packaging materials
Not possible to be as standard as NCRC 
ASRC emphasizes principles and best practices  
“Immobilization”
Good to restrict motion of fractured bones to prevent additional damage and additional pain
Good to prevent movement of unstable spinal injuries
Bad to keep patient from moving, more likely to develop pressure sores on lumbar area that may be debilitating or fatal, especially if a spinal injury and cannot move self
Bad to keep patient immobilized, as movement of legs, in particular, helps prevent blood clots (deep venous thrombosis) that may break off and go into lungs (pulmonary embolism), sometimes fatal; good general rule to have litter patients move as much as possible, and tighten and relax calf muscles regularly to keep  blood circulating and prevent clots
Full-body vacuum mattress
May be used simply as padding and insulation under patient
If used without creating wrinkles, no pressure points to cause skin necrosis (bedsores)
May be pumped out to serve as spinal immobilization or leg splinting
No need for foot straps to keep patient from sliding out bottom of litter if pumped out, and distributes stress evenly so ideal for patient with multiple injuries
Easy to clean
Bulky and heavy
British say backboards may only be used to slide patient out of crashed vehicle, and patients must never be strapped to a backboard; if unconscious and unable to protect own spine, should be in full-body vacuum splint/mattress in backcountry, or on orthopedic scoop stretcher in city
The Elements
Depends on litter and available materials and patient injuries if any
Generally want insulation around patient with waterproof shell around insulation
Want waterproof shell rigged so water does not accumulate on patient or drain into patient: opening on side 
Generally want easy access to patient: opening on side with monitoring equipment such as BP cuff
Many different packaging methods available in literature 
Backs, helmets and packs of litter bearers as protection from rockfall when hear “ROCK!”
Excretion
Medical blue pad under patient in case urinates or has a bowel movement
 Consider stopping evac for patient to urinate or defecate; better than the alternatives.
Tiein
Falling out of litter on flat, grassy trail: not much of a problem, just needs a strap or two across patient if that
Falling out of litter on steep slope that might require a belay for the litter and maybe have litter bearers clipped into litter: 
More danger if falls out
Needs to be well-secured with multiple straps
Should be protected from sliding out bottom of tilted litter; straps under feet usual, may need to have strap just under one foot if broken leg, or seat harness if both broken legs or pelvic fracture
Falling out of litter on vertical or very steep evac will probably kill patient, should have seat harness tied into main lowering or raising system  
Old ASRC standard packaging for metal Stokes basket from 1970s (see reference) still usable for most situations
May add seat harness for vertical  or very steep evacuations
May leave fairly loose for relatively flat carry-0uts
May need to modify for different litters
Custom-built or commercial spider or other strap systems acceptable, but best if straps, buckles or other strap fastenings rated for life safety; Velcro or similar fastenings not recommended unless used with some other system to better secure patient in litter
Support to keep patient from sliding down in litter or out of litter
Tie-in webbing under feet standard
Need to ensure foot tie-in does not constrict around ankles and cut off circulation or cause pain
Need to insure that patient’s feet do not slide off of foot tie-in
Depending on patient injuries, available litter and packaging supplies, may need to modify packaging and tie-in as needed
Head injury: nothing pressing or potentially pressing on neck
Arm, leg or other fracture: minimal pressure on fractured area
If injured leg, alternate means to keep from sliding out bottom of litter, such as seat harness suspended from rails at head, or support under only one foot 
Medical Considerations
For fractured arms or leg, especially if sticking up due to splinting, want to avoid tiein straps going across them and causing pain and maybe making injury worse
For head injury, want to make absolutely sure no compression of neck with straps, cervical collar, or other packaging: this will make brain injury worse by impeding venous drainage from brain and increasing pressure in brain that interferes with blood flow there
For chest injury or lung illness on one side, generally want bad side up with so that more blood goes to good side on bottom to pick up O2  
Loading Patient
“Log roll” of potentially multiply-injured patient to place patient in litter no longer recommended; may cause increased damage to pelvic fracture and increase internal bleeding
“Many hands” method best: have as many people as possible gather around patient, lift, and then slide litter under patient 
May be on both sides of patient and slide litter in from one end
If needed due to terrain, people may be on one side of patient if needed, and slide litter in from end or side
If not enough room, such as in a crevice at bottom of cliff, may pass webbing straps under patient and have people standing on rocks above assist with lifting patient

Standards and Best Practices
As with packaging, NCRC has standard for rigging the two most common cave rescue stretchers (Ferno 71 and Sked)
ASRC Groups use many different litters so best practices rather than one standard method
Litter Yoke
At this level of training, do not cover rigging litters for vertical evacuations, only rigging to head of litter for semi-tech evacs
Simply clipping rope to rail at head with carabiner, or tying single knot onto rail at head, not recommended
If top rail breaks, system fails
Knot or carabiner slips back and forth, causing sudden shocks to litter, patient and litter bearers
Need to attach a rope to one end of the litter for belay, lowering or hauling
Generally not good for patient to hang upside down 
Abdomen presses on diaphragm and interferes with breathing
Blood rushes to head which may make head injury worse
 Sometimes want head down just a bit
Dehydration
Shock
Bad hypothermia 
Benefits of head-up position generally outweigh risks, so standard is to attach to head of litter and have litter bearers to try to keep as flat as possible if patient condition indicates
Some Groups attach a loop of rope or webbing to head of litter and leave there all the time
Called a “yoke”
May clip rope into litter with figure 8 loop and steel locking carabiner
As with any rigging, yoke should be long enough that angle between two parts of the yoke where rope attaches should be acute and narrower than 90° (right angle); an angle wider than 90° multiplies the force in the yoke and may contribute to yoke failing if shock load
Do not want too long, as then knot at end of rope is too far away for litter bearers to reach if need to clear when stuck on an obstacle; ~60° angle about right
Direct Rigging
May tie rope directly into head of litter without separate yoke
Traditional to use a bowline (easily adjusted) instead of figure 8 loop (hard to adjust)
As with permanent yoke, goals of tie-in at head of litter are:
Ensure rope is securely attached to head of litter by looping around top rail and perhaps tying clove hitches
Ensure that if top rail breaks, rope is still attached, by running rope around a couple of struts near the head
Having the rope in a “Y” shape, where the rope comes to a knot and then two branches of the rope go to either side of the head of the litter 
Using bowline allows easy adjustment to get to optimum ~60° angle
 
This curriculum is to ensure that those credentialed to Field Level I meet the following educational goals. 
Safety, Health and First Aid 
Learn aspects of mid-Appalachian terrain, climate, weather, botany and zoology pertinent to SAR team members serving in the field.
Learn basic mid-Appalachian geography, including the different geographic provinces.
Learn the danger and likelihood of injury or illness from flora and fauna, including animal and insect attacks, and irritant plants.
Learn the basic climate and weather of the mid-Appalachian region, including common seasonal weather patterns.
Learn about emergency stream crossings, as an individual and as a group.
Communications
Learn how to set up and properly operate a radio station at Base, including siting the antenna, ground plane effects and dangers associated with Base antennas, and logging both equipment and communications.
Land Navigation
Using a GPS or smartphone GPS app, learn how to ascertain and communicate DD MM.MMM coordinates of a given location to a helicopter as a landing zone (LZ)
Operations, Management and Leadership
Learn aspects of personal characteristics relevant to search and rescue leadership, including characteristics of a good leader and the practice effect. 
Learn what human task switching and multitasking are, and the implications for wilderness search and rescue.
Learn what modern science tells us about decision-making in emergencies, including the work of Gary Klein, the advantages and disadvantages of heuristics (rules of thumb), specifically including premature closure, attribution bias, and confirmation bias, and the interaction of Wilhelm Paulcke’s objective and subjective hazards.
Learn about the different levels of situational awareness, including perception, comprehension and projection to the future, and how to support situational awareness through changing the environment, directly improving situational awareness of your team by sharing your comprehension and projection to the future, and monitoring for slow deterioration in situational awareness.
Learn about selective attention, including the work of Chabris and Simons (“the gorilla in the room” video) and Trafton Drew with radiologists, and how narrowing of attention due to stress may cause major errors in wilderness search and rescue.
Learn how to learn more about human nature, as reflected in the artes liberales of the medieval universities, and the lessons of Shakespeare and Machiavelli.
Learn how our genes affect us, as laid out in the work of Darwin (The Origin of Species) and Dawkins (The Selfish Gene) and E.O. Wilson (Sociobiology), especially as related to altruism and motivation and risk-taking of search and rescue group members and our search subjects and patients.
Learn about personality types, including charisma, contentiousness, specific personality characteristic of emergency services workers including SAR group members, and attempts at personality classification starting with the ancient “four humors” of sanguine, choleric, melancholic, and phlegmatic and more modern takes on trying to classify personality types, and psychopaths and sociopaths.
Learn about leadership strategies, including the writing of Francis Fukuyama (The Origins of Political Order) about the Mandate of Heaven, Stephen Covey’s 7 Habits of Highly Effective People, lessons from the Emergency Department about how to interact briefly but effectively with people in time-constrained urgent interactions, and strategies for leadership succession.
Learn what a whacker is and why field team leader and other leaders need to know how to evaluate and manage whackers, including why we have heroes, why SAR teams are whacker-magnets, the beneficial effects of projecting confidence contrasted with the Dunning-Kruger effect, the ancient Greek concept of hubris, the dangers of dogmatism and Dale Carnegie’s advice as to how to avoid it (How to Win Friends and Influence People).
Learn best practices for leading volunteers, including how to avoid being an autocratic leader who drives away volunteers, understanding business leadership best practices as found in the writings of Frederick Winslow Taylor (The Principles of Scientific Management) and W. Edwards Deming (Fourteen Points for Management).
Learn the basic principles of rhetoric, including the purposes for learning rhetoric, the basics of public speaking, and Aristotle’s and Iszatt-White’s principles. 
Learn about different business and government management and leadership styles including management by exception, laissez-faire management, charismatic leadership, task-oriented leadership, autocratic command-and-control leadership, transformational leadership, the role of psychological safety in leadership, thought leadership (memes), the role of rules vs. best practices, and sources of authority for leaders.
Learn principles of good followership, including the role of experienced members as educators and mentors rather than assuming leadership roles, and the role of Socratic questioning in leadership, education and mentoring, adult learning principles and best practices for raising safety or other concerns with a leader.
Search
Learn basic terminology and concepts used in search theory and planning, including areas of expertise/types of SAR, search strategy/planning terms and concepts including models for determining search area, bike spoke model for initial search planning, common types of search task, and canine-specific terms.
Learn how to fit the terms listed above into a mental model of the usual search management process for a medium-sized, including assigning reflex tasks, using models to establish a search area, using planning areas to assign Probability of Area (POA), segmenting the area into searchable segments, using clues to reassess plans, planning for a find, and concluding or suspending a search. 
Learn best practices for setting up an attraction station.
Learn best practices for leading a large team in a saturation/line search task. 
Rescue
Learn how to tie and use a Münter hitch for belaying,  and lowering; learn how to tie a butterfly knot (Alpine butterfly) and its uses; and learn how to tie and use a Radium load-releasing hitch.
Learn how to rig and manage lowering and raising systems including mechanical braking systems and 3:1 hauling systems for steep low angle rope rescue (steep semi-technical evacs), including using a Radium load-releasing hitch and other rigging to switch from lower to raise and from raise to lower. 
Learn the advantages and disadvantages of single-line systems, single-line systems with a separate backup, and dual-capability two-tensioned line systems.
Learn general principles for setting up a helicopter landing zone (LZ), and principles for those on the ground interacting with a helicopter crew, including essential elements of safety.
 Curriculum
, Health and First Aid

Mid-Appalachian geographic provinces: Coastal Plain, Fall Line, Piedmont, Blue Ridge, Great Valley (Shenandoah Valley, Cumberland Valley), Ridge and Valley, Allegheny Front, and Allegheny Plateau
Elevation effects on precipitation

Dangers from fauna
Bears
Mountain lions
Coyotes
Feral pigs
Humans
Bees and wasps (review from Field IV)
Dangers from flora
Review poison ivy from Field IV
Stinging nettles
Thorns
Giant hogweed

Climate vs weather
Continental vs. maritime climates
Elevation and latitude effects on temperature and flora
Climate change effects on the mid-Appalachians
Hadley cells
Prevailing westerlies, the Great Lakes, the Gulf of Mexico, and their effects on precipitation including the rain shadow effect
 Hurricanes
Nor’easters
Polar vortexes and bomb cyclones
Summer weather and thunderstorm patterns 
Using smartphone apps and reading the sky to predict very near-term weather
Emergency Stream Crossings
Minor stream crossings that just require hopping from rock and pose no risk of drowning do not require PFDs
Cross large streams with swiftwater with PFDs unless don’t have PFDs and safer to cross stream without PFDs than wait
If stream flow enough to cause hydraulic jumps (sudden changes in depth of water), best not to ford if deeper than mid-shin; may suddenly “jump” up to knee and knock over
Heavy rains may turn dry gully into stream difficult to cross on way back; may be best to make temporary bivouac and wait for water level to drop if no reasonable high-water alternate route
Best to spend some time looking for best crossing place
Wide is generally best as water not as deep and water slower
Best is often where stream breaks into multiple smaller stream braids
Avoid stream crossings right above waterfall, rapids, or log jam (strainer): high danger of drowning if fall in water
Best to have pack hipbelts off and shoulder straps a bit loose, but not so loose as to flop around and unbalance, so can abandon pack if fall into water
Walking stick as crossing aid for individual crossing
Very helpful to use a walking stick, improvised from a sapling if needed
Face upstream, so force of water presses walking stick into bottom, shuffle sideways
Maintain two points of contact (both feet, or one foot and walking stick) at all times
May also use two trekking sticks if have them, keeping three points of contact at all times
Group crossing
Best is with a long wooden pole, long enough for group to all hold onto without crowding
May link arms onto pole and go across as group
Pole is oriented parallel to river
Cross river with pole in front in direction of travel
May also do this as a group without a pole if no pole; strongest person is upstream to break current
Triangle crossing
Teams of three at a time cross
Heaviest or strongest is upstream
Three people get close, facing in
Hold waist of person to right (or left)
One person moves feet and then stands still while next person moves
Belayed crossing
If use a rope for a belay for first person, set up belay above crossing point, preferably at curve in stream so that current will swing person to far side 
Belayed person in stream not tied in but holds onto loop at end of rope so can let go and swim if needed
Once first person across, can tighten belay line as handline for others to use; stand downstream of handline
Move belay line anchor to far side and upstream to make safer crossing belay for last person 

Considerations for placing Base antennas with reference to communications efficacy, high points and ground planes, and dangers including wind and lightning
How to assemble handheld radios, and properly handle sign-in/sign-out of such radios
How to change handheld radio batteries
How to set up and use battery chargers
How to identify and prioritize batteries for charging or sign-out
How to determine when battery charging is complete
 and FCC Rules
FCC rules under which ASRC operates
Use and number of units allowed for each FCC licensed frequency used by ASRC
Announcing the ASRC callsign
Concerns with interference with other channel users
Duties and responsibilities of Net Control
Following ASRC Communications best practices on the ASRC Radio Crib Sheet
Using the Equipment Log to track radio equipment and the Communications Log to track radio traffic 
Land  How to use a GPS or smartphone GPS app to ascertain and communicate DD MM.MMM coordinates of a given location to a helicopter as a landing zone (LZ)
If LZ is to be at current position, GPS device or GPS smartphone app, center GPS map at current position and in menu, switch coordinates to DD MM.MMM (menu varies with different versions of device or app) and read off DD MM.MMM coordinates 
If LZ is not at current position, and given USNG or UTM coordinates, make sure GPS device or smartphone GPS app is set to USNG or UTM coordinates, create waypoint using given coordinates, then switch to DD MM.MMM coordinates and read off coordinates of waypoint
, Management and Leadership

Characteristics of a good leader: are they inborn? Maybe
The practice effect: Malcolm Gladwell (Outliers): Genius is just lots of practice so can learn to be leader; maybe
True answer likely a bit of both

Difference between human task switching and multitasking
Requirement for much practice to be able to multitask, and only for very simple repetitive functions
Implications for volunteer wilderness search and rescue: not enough practice to multitask, and heavy task switching leading to forgetting some tasks
Some people much better at task switching than others, may not be able to change even with practice
 
Gary Klein
Work of Gary Klein (Sources of Power): Most psychological theories of decision-making just plain wrong
When have time, as in Base, tend to use traditional methods of decision-making:
Deductive logical thinking
Analysis of probabilities
Statistical methods
Especially in time-sensitive, high-urgency situations, as during urgent field decision-making, instead use:
Intuition
Mental simulation
Metaphor
Storytelling
Role of experience, practice and having heard stories in emergent decision-making
Heuristics
Heuristic = mental shortcut/rule of thumb, often unconscious
Advantage of heuristics: fast, usually right
Disadvantage of heuristics: sometimes wrong, causing bad outcomes; biases leading to heuristic error to be vigilant for:
Premature closure and “wrong but strong” errors
Attribution bias and “satisfaction of search”
Confirmation bias and anchoring bias
Familiarity bias
Social proof bias
Commitment bias
Scarcity bias
Subjective vs Objective Hazards
Wilhelm Paulcke’s Hazards in Mountaineering
Objective hazards: in the environment such as
Rockfall
Avalanches
Slippery rocks or ice
Steep slopes and cliffs
Swift-running streams
Stinging nettles and poison ivy
Sharp branches just waiting to poke out the eye of a nighttime searcher
Subjective hazards: see heuristics above

Level 1 situational awareness: perception
Level 2 situational awareness: comprehension 
Level 3 situational awareness: projection to the future
Supporting situational awareness 
Changing the environment
Directly improving situational awareness of team by sharing comprehension and projection to the future
Monitoring for slow deterioration in situational awareness “bringing the water to a boil slowly so the lobster doesn’t notice”

Work of Chabris and Simons (“the gorilla in the room” video)
Work of Trafton Drew with radiologists
Narrowing of attention due to stress may cause major errors in wilderness search and rescue; role of practice in reducing stress and secondary narrowing of attention
Learning 
Liberal arts education based in the artes liberales of the medieval universities
Plays of Shakespeare
Machiavelli’s “The Prince”
 and Human Behavior
Darwin (The Origin of Species)
Dawkins (The Selfish Gene)
E. O. Wilson (Sociobiology)
Evolutionary psychology
Altruism and motivation
Risk-taking

Charisma
Contentiousness
Specific personality characteristic of emergency services workers including SAR group members
Attempts at personality classification
Ancient “four humors”
Sanguine
Choleric
Melancholic
Phlegmatic 
More modern takes on trying to classify personality types
Psychopaths and sociopaths

Francis Fukuyama (The Origins of Political Order) and the Mandate of Heaven
Stephen Covey’s 7 Habits of Highly Effective People
Lessons from the Emergency Department about how to interact briefly but effectively with people in time-constrained urgent interactions
Strategies for leadership succession
 
What a whacker is
Why field team leaders and other leaders need to know how to evaluate and manage whackers
Why we have heroes
Why SAR teams are whacker-magnets
The beneficial effects of projecting confidence
The Dunning-Kruger effect
Ancient Greek concept of hubris
Dangers of dogmatism and Dale Carnegie’s advice as to how to avoid it (How to Win Friends and Influence People)

How to avoid being an autocratic leader who drives away volunteers
Business leadership best practices
Frederick Winslow Taylor (The Principles of Scientific Management)
W. Edwards Deming (Fourteen Points for Management)
Rhetoric
Uses Of Rhetoric
Learn how to persuade others
Learn how not to be persuaded by others
Essential for democracy and good group decision-making
Public Speaking Basics
Essential for briefing large field team
Project to entire audience: speak to person in back row
Roving eye contact engages audience
Don’t let stress tighten vocal cords, keep pitch low
Take deep breaths, push lots of air through vocal cords to project voice
Pause regularly, don’t rush
Aristotle’s Rhetoric
Aristotle’s definition of rhetoric: the ability, in any particular case, to see the available means of persuasion
Types of rhetoric:
Deliberative
Forensic
Epideictic
Methods of persuasion
Credibility (ethos)
Emotions and psychology of audience (pathos)
Patterns of reasoning (logos)
Use ethos with 
Wisdom (phronesis)
Virtue (arete)
Good will (eunoia)
Iszatt-White’s Leadership
Communicate vision by adapting content to suit audience 
Highlight intrinsic value of vision by emphasizing how represents ideals worth pursuing 
Choose right language – words and symbols – to make motivating and inspiring 
Use inclusive language that links people to vision and makes them feel part of process

Management by exception
Laissez-faire management
Charismatic leadership
Task-oriented leadership
Autocratic command-and-control leadership
Transformational leadership
Psychological safety in leadership
Thought leadership (memes)
Rules vs. best practices
Daughenbaugh and groupthink: dangers of a cohesive in-group combined with an authoritarian, charismatic leader causing tunnel vision
Danger of leader asking question then proposing leader’s own solution in stifling alternatives 
Sources of 
Jones, LaValla and Long
From place in change of command
From expertise
From charisma and past interpersonal relations
From “referent authority”: granted by team members (related to Mandate of Heaven)
Iszatt-White
From being able to provide information
From being able to reward or punish
From subordinates granting authority

Medical experts requesting to not be placed in leadership positions and why
Types of adult learning, Neil Fleming’s VAK/VARK model
Visual
 Auditory
 Read/write
 Kinesthetic
I hear and I forget, I see and I remember, I do and I understand
Malcolm Shepherd Knowles (The Adult Learner); adults are
Autonomous and self-directed
Have accumulated a foundation of expertise and knowledge
Are goal oriented
Are relevancy-oriented
Are practical
Need to be shown respect
Experienced members as educators and mentors
Experienced members supporting junior members rather than assuming leadership roles
Socratic questioning in small-group leadership, education and mentoring
Search 
Search Theory and Strategy Overview
Reflex tasks: get people into field ASAP
Bike wheel model
POS = POD × POA
Picking an Initial Planning Point (IPP)
Point Last Seen (PLS)
Last Known Position (LKP)
Establishing a search area
Past history of those lost in area
Statistical models of lost person behavior
Time-Travel models based on trails, roads, elevations
Trail-based POA
Looking for decision points (places one is likely to go off the trail) where subject might have gone astray
“Heat map” combining above
Planning Areas and Segments
Creating  Planning Areas and assigning POA to them
Mattson consensus method for assigning POA to Planning Areas
Creating searchable Segments and using them to create tasks using TAFs 
Ongoing Planning
Using clues to revise POA of different planning areas and priority of tasks assigned to different segments (shifting POA)
Planning for find vs suspension
Terms used in SAR, their definitions, and their implications
Areas of expertise/types of SAR
USAR: Urban Search and Rescue 
Urban Search
Wilderness Search and Rescue
Rescue
Recovery
Search Strategy/Planning Terms and Concepts
ICP: Incident Command Post
Base
LKP: Last Known Point
PLS: Point Last Seen
IPP: Initial Planning Point
Planning region
Searchable segment
POA: Probability of Area
POD: Probability of Detection/POC: Probability of Containment
POS: Probability of Success
MPQ: Missing Person Questionnaire 
GIS: Geographic Information System
Statistical model for determining POA
Travel-time model for determining POA
Trail-based model for determining POA
Mattson consensus method for determining POA (“Mattson”)
Shifting POA
Decision points (places one is likely to go off the trail) 
Sweep width
Bike wheel model
Axle
Rim
Hub
Spokes
Reflectors
Common types of search task
Reflex search task
Containment search task
Hasty search task
Sweep search task
Line (saturation) search task
Mantracking search task
Cutting for sign (signcutting) search task
Airscenting dog search task
Trailing dog search task
HRD (Human Remains Detection) search task
UAV (unmanned aerial vehicle = drone) search task
Manned aircraft search task
Canine-specific terms
Field team vs Dog team
Alert (dog team)
Refind (dog team)
 Station
Big difference from attraction station on road with vehicle vs backpacking into an area and staying for days at “camp-in”
Plan to have the attraction station last the duration of the search, or at least post waterproof directions to safety once members stationed there leave
Making sure that members assigned to station, especially if far from a road, have adequate food, water, gear and experience to stay there for allotted time
Make sure station has adequate communications, even if requires setting up remote base or repeater or relay
Make formal plan in case subject arrives at attraction station
Plan attraction methods
Sound: whistles, megaphone, air horn, and listening
Sight: string line and note system used in Pacific NW
Smell: cook lots of good-smelling food on a stove

Leading and managing a large team on a close-spaced saturation line search is much harder than leading a small hasty or sweep team and qualitatively different
Review technique for placing and removing flags from prior level curriculum
Review field team management from prior levels
Review “people skills” covered earlier in this curriculum
Role of a Field Team Leader for large field team
FTL does no searching, does not take place in line, only does leading and managing
Need to obey ICS guidelines on span of control (review) and delegate Assistant Team Leader for each end of line
Need for communications equipment to support  
Communications with Base 
Communications between Field Team Leader and both Assistant Team Leaders at ends of line
Inexpensive Family Radio Service (FRS) radios may be used for internal Field Team communications; may also use Bluetooth communications between FTL and ATLs, but need to install app while have data connection before heading into field 
Spacing
May be specified by Base
May be requested to adjust spacing based on amount and type of vegetation cover
May be requested to do a Northumberland Rain Dance once get to assigned area to determine spacing
During briefing in Base should discuss strategies for nearly-impenetrable areas of brush
Skip such areas, mark and leave for another team or search mode
Stop team, mark progress, and collapse entire team to closer spacing to search brushy area

Münter hitch
Tying
Using for belay
Using for rappel
Using for lower 
Butterfly knot (Alpine butterfly knot): tying, uses
Radium load-releasing hitch: tying, uses, how to lower using it
Steep Semi-Tech
Definition of steep semi-technical evacuation: even if “low angle” by fire service, steep enough that litter bearers should be clipped into litter rail
Best practices for clipping litter bearers into rail, including length of Prusik loop tie-in
Rigging single-point anchors
Tensionless hitch for static line (useful as handline)
Anchor strap (may work with fire department that has these)
Wrap-3 pull-2
Basket hitch and modified basket hitch
Rigging and managing a simple lowering system
Figure-8 descender
Rappel rack
Petzl I’D
Rigging and managing a simple raising system
Why and how to rig with Radium load-releasing hitch if not using Petzl I’D
How to lower with a Radium hitch
How to rig a 3:1 mechanical advantage hauling system both with the main line and with a separate line (Z-haul), including a dual-Prusik safety on the main line and on a separate belay line
How to manage a mechanical advantage hauling system including roles and calls
How to switch from raise to lower and back again
Using Radium hitch
Using Petzl I’D 
Helicopter 
LZ (Landing Zone) Principles
“What the pilot wants, the pilot gets”
No (invisible to pilot) power or telephone wires or barbed-wire fences nearby to kill everyone on the aircraft and maybe those on the ground
Nothing laying on the ground (tarps, tree branches, scene restriction “police line” tape, bottles or the like) that will fly up in the 60-80 mph (100-130 kph; hurricane-force) downdraft and kill someone on the ground or foul the rotors and kill those on the aircraft
No loose material like dust or colored smoke that will fly up in the downdraft and interfere with the pilot’s view of the LZ (if accessible by road, might ask local fire department to wet down loose soil)
Nothing sticking up that will puncture the fuselage and kill someone on the aircraft (may need to cut off bushes and saplings)
Flat and level
Big enough that aircraft’s rotors will not hit vertical things like trees or light poles and explode in a cloud of high-velocity shards that will kill everyone in the vicinity: 100 feet x 100 feet (30 x 30 meters) is good for medical helicopters, although some will accept 60’ x 60’ (18 x 18 m); may need bigger LZ for larger military aircraft
Some indication of the wind direction and speed on the ground (either visual or by radio to the pilot)
Clear approach and takeoff lanes aligned with the prevailing wind so aircraft can approach and most importantly take off into the wind
During day, may mark corners of LZ with orange traffic safety cones
At night, may mark corners of LZ with 
Orange traffic safety cones with headlights or flashlights inside
Reflective Scotchlite or similar reflective markers; parkas with reflective trim held down by heavy rocks work well
Road flares
Lights outlining the LZ but that will not glare into the pilot’s eyes and blind him or her; also lights on any nearby obstructions if possible; NO flashing red lights or similar; bright personal headlights are fine; if use brighter vehicle headlights, traditional to use them to mark X across center of LZ and have people in vehicles ready to turn off lights if pilot says “lights off”
Glaring light into eye of pilot of large heavy object overhead strongly discouraged
Secure boundaries to keep people from walking into the LZ and having a helicopter land on them or get their heads chopped off by the main rotor or tail rotor but without yellow “police-line” scene restriction tape that will get sucked into rotors
All nearby vehicles should have their windows, doors and hoods close so they don’t get ripped off by the downdraft
“What the pilot wants, the pilot gets”

Vectoring in pilot or crew chief by radio:
Give coordinates in format pilot wants, often DD MM.MMM
Give pilot helpful information on local features relative to LZ, such as lakes, streams, peaks, water/radio towers, schools or other large buildings, tennis courts, swimming pools, high power lines, or major road intersections
Notify the flight crew when you:  
Hear the aircraft
See the aircraft
Direct pilot to location using clock method: pilot is facing 12 o’clock (“We’re about 2 o’clock from you”)
Give pilot other information about LZ:
Type of LZ (e.g., meadow, field, road, construction site)
LZ surface (i.e., field, grass, concrete, gravel, dirt, snow covered)
Boundaries of LZ (i.e., trees, houses, wires, fences, towers)
Approach and departure pathways
Approach aircraft only after crew chief or pilot signals or tells ground team members to do so
Only those with business with helicopter crew approach helicopter
Litter team carrying patient; 
Team leader who needs to talk with aircrew
Personnel getting on helicopter for transport to another location
Difference between hot load and cold load
Hot load principles:
Eye protection required
All loose objects, long hair, lanyards or the like must be secured
Rotating rotor well-known for chopping off heads; need to crouch as approaching aircraft, even if carrying litter
Helmets no protection against rotors but may protect against flying debris (no fire helmets: duckbill on back tends to pull off in high winds)
Generally approach from downhill where more room under rotor unless crew chief or pilot says otherwise
Stay away from tail rotor at rear of aircraft: pilot cannot see; watch Indiana Jones: Raiders of the Lost Ark as far as regards rotors and one’s head
Litter captain keeps eye contact with crew chief or pilot during approach

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Old versions are posted in the ASRC Archive at http://archive.asrc.net.
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