The Risk Management section here covers global risk management issues within Quest. For specifics by course type or area search under land or water courses in other navigation areas.

Document originally created 4-2004 by Jason Erdman
Last update 8-2005

In many ways this wiki serves as our new Risk Management Manual. This wiki is a way for us to disseminate our information regarding risk management and other areas so it is a living document and accessible to everyone.

Table of Contents
I. Risk Management Plan Purpose

II. Quest Mission & Goals

• Mission Statement - at bottom of page
  
• Operational Goals

III. Risk

IV. Staff

• Ranks & Descriptions
• Make-up
• Instructor Notebook and Reference Guides
  

V. Emergency Action Policy & Principles

• Philosophy
• Legal Liabilities
• Emergency Notification Procedures
• Emergency Action Principles
• Climate of Outdoor Emergencies
• General Guidelines for Safety
• Specific Weather Hazards
• Health Related Conditions
• Common Medical Problems

VI. Evacuation

• Evacuation Considerations
• Documentation

VII. First Aid Kit

VIII. Rescue Kits

IX. Forms

• Medical Waiver
  
• Assumption of Risk
• Incident Report

Risk Management Plan Purpose The purpose of Quest’s Risk Management Plan is to identify all of the steps and actions within the agency that are designed to prevent and/or minimize the amount of risk during every day operations.

Quest courses generally involve activities perceived by the general public as risky. When we think of risk, we often think of physical danger. Much of the risk taking on Quest courses is less physical than it is mental and emotional: learning to confront one's fears; dealing with inevitable conflicts; or learning to accept oneself. Physical risk taking is usually more “perceived” than real, where safety systems protect physically, yet do not insulate participants from height, personal challenge, or personal responibility.

Risk Management Committee
The risk management committee is comprised of the Quest Executive Director, Associate Director, and current Professional Intern. The duties of the Risk Management Committee are to review and make changes to the Risk Management Plan that will assist in reducing the amount of risk in the program’s activities. The committee must also gather all of the course information from the previous year which includes participant hours, incidents and future recommendations for an annual safety report. Any changes to the Risk Management Plan must be agreed on by the entire Committee.

Quest Operational Goals

• Promote the development of outdoor leadership skills by training leaders to provide safe and responsible outdoor experiences using wise and prudent judgment.
• Develop and promote academic opportunities in outdoor leadership.
• Offer the BU community and others unique recreational and personal growth opportunities.
• Provide adventure-based experiential contract courses in a variety of settings that meet the needs of organized groups.
• Work with university groups to promote the development of organizational and leadership skills.
• Promote the development and implementation of adventure-based experiential curriculum for on-campus academic offerings.
• Explore values and male/female roles through peer-level experiences between faculty, students, staff and the community.
• Provide a clearinghouse of information and resources on adventure-based experiential learning.
• Provide consultation to organizations and schools that promote the expansion of adventure-based experiential education.
• Act as a contributing institutional member of the Association for Experiential Education and other professional groups.
• Offer travel to other countries and other regions in the United States to promote cultural diversity and awareness of other peoples and their heritage.

Risk
Risk is the potential to lose something of value to us.

Risk Management
The systematic analysis of one’s operation for potential risk exposures and then setting forth a plan to reduce the severity and frequency of such exposures.

Safety
The condition of being safe; freedom from danger, risk, or injury.


Staff There are several levels for Quest staff: observer, assistant instructor, instructor, & course coordinator. On any given trip there is a course coordinator, and several instructors and assistant instructors. Each position has specific requirements, which are detailed in much more specifics and more current in the Instructor Notebook.


Staff Makeup
As of 2005 the Quest staff consisted of approx. 30-40 student leaders of varying levels. Most are assistant instructors and instructors, with a few as course coordinators. There was identified a need to recruit more staff, as the program in the last two years alone the program has grown from a staff of less than 10 to its current level.

There is also a pool of per-diem facilitators that are used for primarily contract based courses. These per-diem staff are made up of both former Quest staff along with other professionals from the surrounding community.

In the Fall of 2003, the Freshman Leadership Experience (FLE) was created. This program was designed to bring in new students their first year at school, and expose them to Quest with discounts on trips/free programs. This program has continued each year since and has expanded in scope. It is now the primary format in which Quest staff are found.

Our courses represent a diverse gathering of participants and groups. Some are college students needing to recreate for the weekend. Others are family members seeking to share adventures with loved ones. Many more of our participants are members of educational and human service groups who take specially designed Quest courses. All are seeking adventure experiences within a safe framework. Four elements are common to all Quest courses. These key links in our courses are EXPERIENCE, REFLECTION, ENVIRONMENT and RISK.

Course Coordinator Checklist

Pre-Course Responsibilities

• Check with Staffing Coordinator for other members of Instructional team.
• Meet with Associate Director to review destination, staffing issues and agenda of the pre-course meetings.
• The length of time in advance that the pre-course meeting is held is dependent on the type of course. For all extended courses, the initial contact between members of the instructional team should be at least one month in advance. On courses of this duration, instructors will find it necessary to meet several times prior to course date.

Pre-Course Meetings: Agenda Guidelines

Remember to take clear notes if needed and distribute one copy to each member of the instructional team. Note the following:

Course goals

• Participant profile (age, population, experience level, special needs, medical issues)
• Logistics: Decide who will be responsible for food, equipment, vehicles.
• Course program: Plan the course program down to the last detail dividing responsibilities accordingly.
• Determine teaching outline and divide responsibilities according to staff experience, needs and goals.
• Define the roles and responsibilities of each instructor. Be sure to include apprentices in the planning, allowing them input when appropriate.
• Anticipate and discuss potential problem areas.
• Confirm van reservations about 1 1/2 weeks prior to the course and several days before course starts with the Logistics Coordinator.
• Confirm room and AV reservations.
• Check with the A.D. regarding cash advances and course package. Coordinate special needs with Logistics Coordinator.
• Pick up course packets from the Associate Director
• Course packets should include: Copy of Contract or Participant list, AOR/Med Form Course Report Form, Emergency Number Sheet, Accident/Incident Form, Extra Blank Medicals
• Discuss the debriefing methods that will be used at the end of the course.
• Make sure that all of the proper paper work for the course is taken care of.

Emergency Action Policy & Principles
Philosophy of Safety in Risk Activities

Many Quest activities are perceived by the general public as more dangerous than everyday activities. Certainly a challenging outdoor activity is more likely to produce bumps and bruises, skinned fingers or knees, and possibly muscle strain and fatigue than a walk in the park. Because of the nature of these activities, risk is eliminated only if we don't go. But if all precautions are taken, staff can all but eliminate the chance of serious injury or death. All staff bear a clear responsibility to do everything possible to prevent accident or injury. When we choose to lead these activities, our task becomes the preparation of ourselves and others, through technical training, physical and mental fitness, good judgment, and prior planning, to deal with the risks involved. The more inherently dangerous the undertaking, the more care, training and preparation are needed for success.

While leading others, hazards should never be sought for their own sake. Artificially increasing real danger for its own sake is inappropriate. Our goal should be to achieve success by anticipating risks and by reducing the impact of real danger. Mastery of good leadership means anticipating danger, acquiring skills, knowledge and experience, and mentally preparing to cope with any possible emergency.

Safety is an integral part of every Quest program and process. Safe practices must be woven into the fabric of every course and exemplified by the actions of each instructor. Safety involves not only proactive prevention but also adopting an attitude of "What if ...?" toward every experience. "What if the snow starts?', "What if someone slips and falls?", "What if night comes before we get back to the trailhead?". "What if....?"


Legal Liabilities and Instructors

Like many other organizations, Quest attempts to provide safe activities. Our exposure to legal problems is reduced when policies and procedures, as well as good judgment are exercised at all times. Policies and procedures are designed to minimize participant exposure to danger and thus reduce the chance of unjustified legal action. Every instructor has the responsibility, as the direct service provider, to understand and follow all prescribed procedures and policy. Improvisation is allowable only if conditions indicate that it increases the safety involved in a program or to cope with an emergency. Course coordinators are the only decision maker if there is deviation from pre-defined techniques, plans, procedures and policies. Before making any changes be sure that all actions will stand the scrutiny of the A.D., the Director, Campus Administrators and the legal system.

Responsibilities:

• You are responsible for providing the safest possible experience for your students. You are the expert and guide who provides all the necessary information to ensure their safety. As risk increases, your awareness and preparation should also increase.
• Students are entitled to know the nature and scope of the risks involved in the activity before beginning. The Assumption of Risk form explains both general and specific risks involved in each activity. A particular site or environment may have additional hazards that will also need explanation and instructions on how to avoid the hazard. Individual site hazards must be indicated in the field since each participant must have an appreciation for the risks and nothing works better than a concrete example. Students may not perceive danger where it may be obvious to you. You may have to balance your enthusiasm for the activity against a student's reluctance to participate. It is important to remember that students never surrender the right to freely choose to participate, or not to participate. Appropriate information about risks and taking responsibility for these risks allows the participant to make an informed choice and clarifies commitment.

* Quest safety policies will be the standard by which your conduct will be judged, by Quest. If an accident occurs because you failed to follow Quest policies, then Quest will not support your actions in court.

* Legally your actions will be judged by a national "Standard of Care". This standard shifts as sports and activities evolve. This is why regular staff training occurs --to keep you up-to-date on the latest in equipment, training, and technique.


Specific areas of legal vulnerability:

Alcohol/Drug Policy:
Quest does not condone the use of alcohol or drugs. Any participant visibly under the use of drugs or alcohol will not be permitted to take part in any Quest course. Likewise, any staff member visibly under the influence of drugs or alcohol will not be permitted to lead a group on a course and may be released from their duties with Quest.

Transportation:
Driving to courses may be the most dangerous part of the activity and involves everyone in the group. Exercise greater caution driving with the group than you would driving alone. Staff should be checked out on proper vehicle usage and safety including driving and backing with a trailer. Quest staff must have a clean driving record in order to drive University or State vehicles.

Site management of students:
First, never underestimate the ability of a student to forget instructions as soon as they are given. As the degree of risk increases, so does the need to keep a closer eye on all participants. Second, each site has its own inherent hazards and students should be informed of these hazards and the need to stay within specific boundaries.


Emergency Notification Procedures

Within the university environment there exists a chain of command and responsibility. As a Quest instructor you perform somewhere along that chain. If an accident happens, certain individuals within the chain of command must be notified. Small emergencies or injuries that can be adequately dealt with in the field do not require notification. These incidents should be documented in the course report and accident/incident report form. If an emergency is serious enough to require EMS personnel, hospitalization, loss of a student, evacuation, or if a crime or death occurs, then the notification system should be initiated. Other circumstances that require notification include but are not limited to assault (including rape or attempted rape), theft, runaway, or other illegal or grossly immoral acts. If there is any doubt about the seriousness of any situation, notify the Associate or Executive Director to get advice.

Should notification be necessary, the first person to contact will be either the Associate or Executive Director, who will then take the next appropriate actions, including notifying other administrative officers. If neither of these persons can be reached, the Assistant Vice President of Student Life is contacted. Their number is listed on the emergency number sheet included in all course packages.

Instructors are reminded to keep an accurate time diary of their actions so that events can be reconstructed for EMS and/or rescue personnel, Quest and university officials, and for later documentation. Instructors are required not to speak to the media during or immediately after an emergency situation. If a member of the media asks for a comment, simply state that, “I have no comment” or “An official spokes person from the university will answer your questions.” Local law enforcement, EMS or university spokespersons should be the only people giving out information if, and until, an investigation is made.



Emergency Action Principles

Outdoor adventure leaders must understand certain realities of the outdoor emergency. Many accidents occur several hours or days from EMS support. Until help arrives, the group is totally dependent on the leaders of the group to manage the accident and protect the physical and psychological well-being of the rest of the group. A leader must think twice before putting him/herself at risk for the sake of an individual victim. While nobly motivated, all attempts to rescue must be balanced against possible danger to rescuers and the entire group.

The realities of a true emergency situation suggest that each instructor be prepared technically and psychologically to develop an effective strategy. Certain matters of policy provide guidelines. Of course, all participation in the activity should cease and all resources of the group should focus on the situation at hand. First, if numbers in the group allow, at least three people will comprise a group going to get outside help. One of these should have some Quest leadership experience. Before departure, this group will be fully aware of the information to be provided to EMS, including but not limited to: time of accident, time of departure to get help, nature and extent of any and all injuries or illnesses, what first aid was administered and at what times, how many people remain in the group, what the intended actions of that group are, and the age, gender, and general health and condition of victims. Write this information down, including sketches and maps. Because all situations are different, leaders should use discretion in choosing a course of action and remain flexible. The messenger party should conserve energy in case a return trip with rescuers is necessary. Speed is important but not if it puts this group in danger.

Second, the person with the most first aid training should provide care and remain with the victim. Other members of the group should be continually assessed for signs of shock, stress and panic. Having the group active and involved with the plan to resolve the emergency keeps the group from dwelling on the accident itself, prevents psychological breakdown and keeps morale up.

Third, all leaders in conjunction should assess the situation before choosing a course of action. Risks to rescuers, participants, and bystanders should be identified and assessed. The first actions should be to stabilize the site of the accident in order to alleviate further danger and create a positive atmosphere for coping with the problem. If you have no training or experience in the type of rescue required you should wait until someone with training arrives, if possible. Types of special rescues include: Whitewater Entrapment, High Angle Rock Face, Cave Entrapment, Injury or Evacuation.

The group staying with victim should prepare to bivouac, eat, drink something warm and prepare shelter. One person should be actively observing each injured person at all times, watching for resumed bleeding, cessation of breathing or heartbeat and the onset of shock. Monitor vital signs and log them. Understand the protocols of giving food or water to a victim and act accordingly.

The Climate of Outdoor Emergencies

Specific information on dealing with medical emergencies on Quest courses can be found in our medical protocols.

Most emergencies result from a combination of adverse environmental and human factors. Understanding the interaction of these elements is the first step in prevention. Many of our activities occur in what would, by common standards, be considered hazardous terrain. The environment of accidents includes factors of:

• TERRAIN: steepness, altitude, rocky trails, mud, wet rock, falling debris, ice, snow, river rapids, altitude
• WEATHER: wind, rain, heat, cold, snow, sun, ice, mud, lightning, altitude
• EQUIPMENT: harnesses, hardware, stoves, clothing, boats, ropes, helmets
• LOCATION: distance to trailhead, distance to EMS, accessibility
• ANIMALS AND POISONOUS PLANTS

Human factors that influence the climate of emergencies include:

• FATIGUE: conditioning or lack of it, prolonged exertion, lack of sleep
• SKILL LEVELS: both leader and participant
• EXPERIENCE: both leader and participant
• JUDGMENT
• MEDICAL CONDITIONS: allergies, illness, and injuries
• STRESS: physical, psychological, emotional
• ATTITUDES: appreciation of risk, teamwork and others
• GROUP DYNAMICS: cohesion or dissonance
• LEADERSHIP ABILITY
• DECISION MAKING
• PRE-PLANNING
• OTHER HUMAN INTERFERENCE AND INTERACTION

Almost all outdoor adventure emergencies include both environmental and human factors. Participants should be informed of anticipated factors at the start of the course and of any changes occuring during the day. This lets people know what the hazards are and how they can be avoided. It sets the stage for safety consciousness and is seen as an integral part of the course.

Example: A group is hiking along the falls trail at Ricketts Glen in fall. It has been raining and the group is both cold and tired. A greater chance for a slip or fall exists than if the day had been dry and warm.

Environmental Factors: exposed rocks; steep, wet, slippery trail, distance to trailhead.
Human Factors: fatigue, cold hikers, inattention to trail.

By making the group aware that accident potential has increased, students will become more aware and take better care about their footing and each other. At times the potential increases so much that the best course of action is to stop and set up camp, particularly if weather and fatigue are dominant factors.

General Guidelines for Safety

While each different activity has specific safety practices relevant to that activity, some general rules apply. As the length or difficulty of an activity increases, more attention should be made to pre-planning. If a course is new or has not been done recently, or if assisting staff is new to the activity then more pre-planning should be done.

Pre-planning activities include:

• Time Management Plan; Pre-trip meetings, times of departure and return, trail/river time per day, meal times.
• Route Planning; Trailheads, campsites, escape routes, points of difficulty, daily travel distance.
• Climate Control Plan; Anticipate range of weather, proper clothing and shelter, sanitation plan.
• Energy Control Plan; Food, water, travel distance and terrain, conditioning, planned rest periods.
• Emergency Plan; Notify authorities of plans, have evac. plans, appropriate first aid gear and training, medical histories.
• Knowledge; Use of equipment, especially stoves, climbing gear, PFDs on water, rescue gear, first aid.

Specific Weather Hazards

Hazards that present immediate danger to the group include lightning, radical temperature drop, prolonged exposure to sun, extended rainfall, strong winds, unexpected snow, or any other powerful change in the weather for which the group is not prepared. An understanding of the climate for a specific area will provide clues to what weather can be anticipated. For instance, a summer backpacking trip to the San Juan mountains of Colorado is likely to experience most, if not all, of the following; extreme heat, strong winds, rainfall, snow at higher elevations, or lightning on any given day. Special attention should be paid to travel during the transitional seasons- the change from fall into winter and winter into spring. The fast movement of powerful fronts can cause the weather to deteriorate quickly and with little warning.

* Lightning

Danger for a direct hit is highest close to high, sharp ridges, and near trees. However, danger from ground current is a more likely hazard. Electricity from a lightning struck will dissipate by taking the path of least electrical resistance. Groups should spread out over a large area, but within sight of each other to minimize the chance of more than one person being hit. A person who is struck can then be assisted because others were far enough apart to be unaffected. Wet rocks, chasms, fissures and chimneys, wet ropes, cables and streams all are natural lightning paths and should be avoided. Spark gaps are places where the current crosses a shorter air space rather than a longer ground route. Rock overhangs, cave mouths, depressions and ditches may be spark gaps and should be avoided. Being elevated from the ground by squatting on frame packs (pack side up) or foam pads protects from ground current. Caves offer protection only if deep and dry, otherwise they are possible spark gaps or sources of induced current.

* Cold Emergencies

Hypothermia (the dangerous drop in core body temperature) is the single greatest danger from cold. Contributing factors include; poor physical condition, fatigue, immersion in cold water (wearing thoroughly soaked clothing can be considered immersion), wind chill, dehydration, and not enough to eat. Poor conditioning and fatigue can be prevented through proper pre-planning and good trail judgment. Immersion emergencies can be prevented on river trips by proper use of wetsuits, spray jackets and other clothing, and use of good judgment by matching difficulty level with skill level. On the trail, proper rainwear and "layering" of clothing reduces the possibility that dressed immersion will occur or wind chill will drive down body temperature. Avoid sitting in snow or on cold, wet rocks as heat is lost quickly through conduction. Hats and hoods protect from heat loss through the head and neck, where up to 15% of body heat is radiated. In cold weather, food and water intake should be nearly continuous, particularly for stressful activities or sustained efforts, such as peak assaults. The importance of water intake in cold weather cannot be stressed too heavily. During cold weather there is less perspiration water loss so the danger is less apparent. People do not feel as thirsty as in hot weather. Cold air siphons heat out directly from the lungs while breathing. Lower humidity at higher altitude also contributes to dehydration by accelerating evaporation of perspiration and reducing humidity in the lungs. Dehydration distorts blood chemistry, thickens blood and reduces circulation, all of which contribute to reduced body efficiency and the onset of hypothermia.

Symptoms of Hypothermia:
It is not necessary to know all the stages of hypothermia to know that an emergency exists. Remember the first symptom is simply feeling cold. Shivering is a reaction to feeling cold and indicates that immediate action should be taken. A simple adage says that it is easier to stay warm than to get warm. Whenever the weather is cold, or participants are wet and/or in the wind, hypothermia is a threat. Everyone should be checked regularly by asking how they feel. At times, victims will deny being cold so their behavior should be observed. Hypothermia victims experience loss of motor control and so are prone to misstep while walking, slur their words while speaking, or stop talking altogether, pulling zippers and closing buttons may be impossible. Because blood flow to the brain is reduced, judgment is poor and decisions made are suspect. Leaders should monitor each other, increase communication and use a buddy system to make sure that everyone is observed. Often symptoms fail to appear altogether.

Treatment Protocols:
Dressed immersion should be treated immediately by first removing wet clothes and replacing with dry. Shelter should be made and travel curtailed for the day. For conscious victims, warm food and hot drinks should be administered. An external heat source should be used. A very good technique is to isolate the victim in a dry sleeping bag with minimal clothing. Water bottles filled with hot water can be dried and placed inside the bag with the victim, heating from the torso (Armpits, Chest, Throat, Crotch, Abdomen) outwards. Rapid heating of the extremities can cause tissue damage and increase the circulation of hyper-cooled blood back to the torso, making the condition worse. Popular theory suggests that other participants join the person in the bag to provide the external source of heat. This is a bad idea for several reasons. Often when one person is hypothermic, others are borderline too and at best offer little excess heat to the victim. Giving up this excess heat may be enough to take more than one person into hypothermia. Water bottles, which can be replaced when cool, offer a much hotter source of heat, as skin may tolerate temperatures up to 160 degrees. Care should be taken to avoid scalding and spilling. Doing this requires a stove, pot and fuel. Day trips into cold weather conditions should be so equipped. Food and liquid should never be forced into an unconscious victim.

An unconscious hypothermia victim should be evacuated as soon as possible. A lead (messenger) party should travel ahead of the evacuation party to activate EMS so they are waiting at the trailhead. As with all unconscious victims, vital signs should be monitored continually. If bad weather exists at the time of a hypothermia crisis the leader should use judgment in deciding to evacuate or wait. If evacuation endangers other party members, then evacuation should be delayed or another rescue plan developed. Changing conditions should also prompt a review of emergency planning. Even when a person recovers from severe hypothermia, their condition should be checked by a physician as soon as possible.

* Frostbite

Frostbite is the actual freezing of tissue, most often occurring on ears, fingers, toes, nose and cheeks. It is caused by the diversion of circulating blood from the extremities to the body core. Hypothermia and frostbite often occur together but each can happen without the other. In superficial frostbite the skin affected is pale and greyish white. There is seldom any feeling in active frostbite areas, though there is sometimes pain. Often the victim is unaware of superficial frostbite until someone else points it out.

Deep frostbite affects the underlying tissue as well as the skin. In deep frostbite, skin may appear yellow, white, or mottled blue. Tissue damage is potentially extensive in deep frostbite.

Treatment Protocols:
Treatment of superficial frostbite is simply to protect the affected area from further cold. Skin should be treated gently. Rubbing the affected area is dangerous. Add heat at normal or slightly above normal body temperature. Immersion of the affected area in warm (no more than 102 degrees) water is effective. Check and treat for hypothermia.

For deep frostbite re-warming the extremity is not recommended unless it is assured that the victim will be out of the cold for an extended period. A bivouac or emergency shelter is not sufficiently protective. The affected areas, in any case, should be protected from further heat loss and tissue damage. Evacuate as soon as possible. Treat for hypothermia.

Important things to remember about frostbite:

*Frostbitten tissue is vulnerable to injury; always be gentle.

*Frostbite is liable to occur at the same time as hypothermia; always treat for
hypothermia in any frostbite situation.

*Those with previous frostbite are more susceptible to reoccurence.


Heat Related Conditions

Heat Stroke:
A life threatening condition where the body's cooling resources have failed. Victim usually has extremely hot, dry skin. There is little evidence of active perspiration, though skin may be damp due to residual perspiration from heat exhaustion. Breathing is rapid, as is pulse. Victim should be cooled by application of ice, cold water or by immersion. Treatment should continue until victim's body temperature is returned to near normal. Liquids should be given if victim is conscious. Follow-up by a physician is called for.

Heat Exhaustion:
A non-life threatening condition that can lead to heat stroke if left untreated. Victim usually has cool skin that is still damp from perspiration. Faintness, shortness of breath, anxiety, dizziness, weakness and sometimes vomiting indicate possible heat exhaustion. Treatment includes removal to shade, administration of cool liquids by mouth, and avoidance of strenuous activity. Care must be taken to prevent cross over to heat stroke.

*Fainting and cramps can also occur as a result of heat. Fainting due to heat should be treated as other fainting; by rest, lowering of the head, monitoring of vital signs and checking for other symptoms. Cramps can be treated by the addition of salts to the system. Highly diluted Gatorade can be used to treat.


Review Our Medical Protocols


EVACUATION
In any severe emergency, evacuation should be considered. The responsibility for this decision resides with the coordinator, who should consider several factors. These factors interact and each combination is unique. No simple formula will allow you to arrive at an automatic decision to leave or stay. The one constant is that if a situation is serious enough to consider evacuation, then all group energy should be put to achieving a successful resolution of the existing crisis. Participation in the activity at hand should cease. All leaders should confer, exchange ideas and information, and the group should be informed of decisions made and what is expected of them.

The decision to evacuate or not is one of the most serious a leader will ever make. Leaders should be open to suggestion but choose an option quickly because time is an important factor in any injury. Remember however, the safety of the group is more important than the safety of one person. No plan should be made that increases the risk to any team of rescuers, messengers, bystanders, or participants. Evacuations are arduous physical and psychological ordeals and the group's resources are strained well beyond normal limits. Choose wisely!


Evacuation Considerations

The primary concern is the severity of the injury in terms of needed medical care, measured against the possibility of increasing the risk to the victim or other group members by traveling.

The following conditions usually indicate that an evacuation can and should take place:

• The victim can walk, and walking will not make the injury worse, and the travel time/distance to the trailhead will not result in night travel or increased risk to the group from other factors.
• The victim cannot walk but the group can provide support and the other conditions listed above are in place. Remember, a group of ten carrying a litter travels at less than 1/2 mile per hour.
• Injury is life-threatening and evacuation will not endanger the rest of the group.
• Location or condition of site is itself endangering to the victim or the group.
• Other conditions that in the judgment of the leader indicate evacuation.

The following indicate situations where evacuation is not recommended:

• Injury can be treated effectively on site and victim can reasonably continue to participate in the activity.
• Moving the victim is likely to compound injuries and the site is safe for bivouac.
• Professional rescue is close enough that this is a better option than group transporting.
• Injury is so severe that moving the patient at all is life-threatening.
• Evacuation increases the danger to the rest of the group.
• Any condition that in the judgment of the leader prohibits safe evacuation.

Documentation

• All decisions, considerations, and differences of opinion about an evacuation should be noted and written into reports .
• All plans attempted even those discarded should be written into documentation along with reasons for discarding.
• Conditions should be constantly monitored for change and plans reevaluated in response to changing conditions.
• Notification procedures should be started as soon as possible, which means immediately after EMS is contacted.
• All forms and reports should be filed quickly and comprehensively upon return. All leaders should write reports of their perspective on the situation and submit with the course report materials. Participants may be solicited to submit written statements.
• A meeting with the Directors and all staff present at the incident will be scheduled soon after the incident.
• Any and all follow-up meetings and recommendations will be documented.
• Student staff safety committee will review all reports, documentation and decisions.

First Aid Kit
A well equipped and maintained first aid kit is the single most important piece of safety equipment, short of a fully functioning brain. Keeping the first aid kits supplied and in good clean condition is the responsibility of all instructors. All leaders should be familiar with the contents of the kit and at the beginning of any course should make sure that all the necessary items are in the kit. At the close of a course a responsible leader will replace items used, remove trash, and clean the pack.

Quest uses the same first aid kits for most courses. Each kit should be inspected pre and post course to ensure it is properly stocked.

An Expedition Kit contains items used for medical emergencies that may require long periods of time before medical help is available. The Day Trip Kits do not contain these items.

Staff should avoid the temptation to move items from one kit to another. Supplies are located in the cabinet. If supplies begin to run low the coordinator should indicate this in the course report and materials will then be ordered. Contents of the kit are not listed in this manual but are posted in E.R. Staff have responsibility to monitor kits and their use effectively, especially to replace any items used immediately upon return and to clean trash out of the kit.


Quest First Aid Kit Contents Listed Here


Rescue Kit Contents Here

Screening and Preparation of Participants

Quest serves a wide population, which includes students, faculty, staff, and community members. Community participants can range from young children to people in their 50's or 60's. Participants are provided a waiver form, which provides an extensive list of potential hazards for outdoor activities. A health form is also provided, in which the participant lists current health status, history, and emergency contact information.

If participants are part of an extended expedition, such as mountaineering in Mexico, they are provided extra information by the trip leader regarding specific conditions. For example: altitude, cold, heat, traveling to foreign countries.


Quest Incident Report Form

Course Activity/Location/Date:

Course Coordinator:

Instructors/Asst. Instructors:

Please describe the incident:

What were the events leading up to the incident?

Was First Aid treatment administered? If “Yes” who and what materials were used?

To Do
1. Submit report to Quest A.D before Monday Meeting.
2. Review Incident during Monday Meeting weekend discussion.

Note: If you need more space to write, please use the back of this sheet.