Working in the Wilderness

The landscape gliding by the helicopter is breathtaking. Sheer vertical walls of dark rock 1,000 feet tall fill the window. Here and there spruce trees cling to the rock walls. Fields of snow and ice feed waterfalls that drop hundreds of feet into turquoise lakes. But I’m not on this helicopter to watch the scenery. I’m aboard a Royal Canadian Air Force (RCAF) CH-149 Cormorant over Vancouver Island in British Columbia to see how they perform mountain rescue missions.

In many parts of Canada, outside of the towns, roads are almost nonexistent. Airplanes and boats are the main transportation. Performing rescue missions here takes highly specialized training and equipment. Part of the flight crews on RCAF rescue aircraft, both helicopters and airplanes, are highly trained search and rescue technicians (SAR techs). They are qualified paramedics, scuba divers, parachutists, mountaineers and survivalists. EMS World spent several days in Comox, BC, learning how they train and carry out missions under extreme conditions.

The Canadian Forces School of Search and Rescue (CFSSAR) is located here at Comox, along with a dedicated SAR unit, 442 Squadron. This unit, equipped with both airplanes and helicopters, is responsible for SAR in all of British Columbia and the Yukon, as well as up to 200 miles off the coast. Missions may take them as far north as near the North Pole.

SAR techs were established in 1944. They are very closely organized along the lines of the U.S. Air Force pararescuemen, with one important difference: SAR techs never deploy to combat zones and have no combat role. However, they often train with USAF pararescue units in subjects common to both organizations, such as medicine, outdoor survival and parachuting.

The CFSSAR has been at Comox since 1998. It graduates one class per year of 10–12 SAR techs. One interesting feature of the school is its use of civilian contractors for portions of the training. “We want the best available resources for our students,” explains Sgt. Sean Calis, one of the instructors.

Selection Process

The selection process for new students is rigorous. They can come from any section of the Canadian military: ground, air or naval. They have to meet minimum physical and medical requirements and pass a battery of aptitude tests. A selection board from the headquarters of the Canadian military picks 30 candidates for preselection screening by the school. School instructors then choose who will be admitted.

“We’re looking for people who are, first of all, physically fit,” Calis says. “Mental endurance is also a big factor; the preselection process is very stressful. A student must also have an aptitude to learn, be good at adapting to unusual situations and be a team player. Our role is noncombatant. We want people who can work well with civilian personnel and responders on a daily basis.”

The selection process occurs in January and lasts two weeks. Candidates are put in a high-stress wilderness environment (Calis didn’t want to be too specific, so as not to give away the process to potential candidates).

“They are physically and mentally tested to the point where we break every one of them,” Calis says. “Every individual will fail some part of the test. We want to see what a candidate does after they fail. Do they keep going or give up? Once they graduate they’re going to be in small teams, in very remote, severe environments, and have to be able to take care of themselves and their patients for potentially several days.”

Once selected for the school but before they arrive, candidates have to study anatomy and physiology manuals and take an exam during their second week. They must pass this test, or they are sent home.

The next phase is ground operations. Candidates are taught how to use chain jaws and climb trees to retrieve gear caught in branches, as well as basic woodcraft skills such as navigation with map and compass, survival skills, fire making, using boats and making shelters. There is a big emphasis on teamwork and problem solving. This section lasts about two weeks.

The next section is the medical training. In the past, instructors taught the medical section. Then leaders decided to provide a certificated program for the SAR techs, and the British Columbia Emergency and Health Services Commission[cq] was awarded the contract to provide paramedic training for the SAR school. The SAR tech students get the same training, both classroom and clinical, as BC primary care paramedics. They receive the same amount of hospital and ambulance time as civilian paramedic trainees. All instructors have gone through this program, as well as a facilitators program. While civilians do the teaching, military instructors do the evaluations. At the end of the SAR tech course, each student gets a SAR tech certificate and a British Columbia Ambulance Service paramedic certificate.

In January the students travel to the Arctic for survival training. School instructors teach some sections of this, and native Inuit contractors teach others. Topics include survival, tracking, navigation (depending on how far north you go, GPS doesn’t work), shelter building, winter SAR, winter travel and more. They want the students to be comfortable in the extreme environment of the Arctic.

The Royal Canadian Navy gets them next for a five-week scuba diving course. They get the same course as navy divers, plus advanced techniques such as penetrating overturned or sunken vessels to search for survivors in air pockets.

The next phase is parachute training for five weeks. Civilian contractors teach portions of this course. “We spend three weeks in Yuma, AZ, which has excellent weather, with a civilian company,” Calis says. “We also bring in civilian instructors for advanced and update training for our school instructors. We do jumps at night, into water, into confined areas with a specially padded suit—just about anywhere we think we can land safely.”

The students then go to Alberta for climbing instruction from civilians. Most of the time is spent on rigging rope rescue systems. The final two weeks of school entail complete rescue scenarios from start to finish, with a wide variety of situations to test students’ knowledge, critical thinking and stamina.

Graduation and Beyond

The graduation ceremony is as unusual as the course. With their friends and family watching, all the graduating students and their instructors parachute into the ceremony to receive their SAR tech wings.

But the learning, skill building and testing does not end with graduation. Twice each year, every SAR tech in the RCAF has to take an exam covering all topics. About 15%–20% of each exam covers medical subjects. They also have to finish training modules every month at their local unit.

Every year SAR techs go into hospitals for a week and do ER time to perform IVs, administer medications, conduct patient exams, etc. They also spend time in the OR inserting LMAs and reviewing airway management with the anesthetists.

Every 18–24 months each SAR tech returns to the school for recurring medical training. This is under the direction of the British Columbia Ambulance Service and includes using human patient simulators. Over a week it covers new equipment, procedures and protocols, and includes review of standard skills such as use of AEDs, CPR, airway and IV techniques.

Leaders of the SAR tech program have to decide what skills to include, balancing what it costs to train everyone versus how often these skills are used. For example, for a while all students were ACLS trained and able to intubate. But that skill wasn’t used very often, and the cost to keep up the training was prohibitive. So the school dropped the ACLS training and switched to using LMAs for advanced airways.

An annual standards conference is held to determine things like changes in procedures and what new equipment will be used. The school has input on how things are taught. Any changes are done on a military-wide basis, so everyone uses the same equipment the same way no matter where they’re stationed.

“We also send some of our people to an annual special-operations medical conference in Florida to see new gear and hear about new procedures,” Calis says. “We send some of our people to other types of conventions and conferences to keep up to date on all of our skill sets. In addition, we take feedback from the operational units and will change or add training based on what they want and need in the real world. There is two-way communication between the school and the operators.”

After School

“New SAR techs fresh out of school are called the ‘third man’ because they are not qualified yet,” explains Sgt. Glenn Hood, a SAR tech team leader with 442 Squadron at Comox. “Once qualified, he becomes a team member. Then, once he can lead a team in a training situation, he is called a restricted team leader. The final level is team leader. Team leaders do all the training of the new SAR techs and are in charge of a team of two SAR techs on actual missions.

“We try to keep 60% of our staff team leader-qualified,” Hood adds. “At the beginning of each day, the team leader and the aircraft commander discuss the day’s training so the entire crew gets their training needs met.”

No matter where in Canada a SAR tech is based, they have to keep their skills up. They have to do quarterly skill qualifications in all major knowledge areas: medical, scuba, survival, rope rescue, etc.

“At any given time there are 26–30 SAR techs assigned to 442 Squadron,” Hood says. “We have a primary mandate for responding to boats in distress and aircraft accidents. We get tasked to handle these types of missions immediately. We have a secondary assignment for humanitarian missions. Missions originate with the Rescue Coordination Center, which gets a request from the Royal Canadian Mounted Police if they are unable to handle a mission or need our specialized equipment or training. These types of missions include missing or injured hunters, hikers and mountain climbers. We also perform medevac missions in poor weather when we are the only ones who can fly due to the capabilities of our aircraft.”

Their primary medical kit is called the penetration kit. This can handle most medical situations. SAR techs can parachute with this kit attached to them. For trauma, they have what they call the Sked kit, which is a Sked sled filled with trauma and immobilization gear. They carry a Propaq LT, which is a compact monitor with three-lead, SpO₂, temperature and BP capability. It is ruggedly built and can take a lot of abuse, like being in a kit dropped by parachute. They also carry stand-alone SpO₂ monitors and a glucose monitor. A satellite phone can be used to consult with doctors. The aircraft also carry kits for different types of rescue scenarios, such as mountain climbing, winter and water.

There are always two SAR techs on every aircraft responding to a mission. Depending on how many victims are involved, there may be up to four on one aircraft or helicopter. Or a DHC-5 Buffalo may meet the helicopter at an airfield, transfer its two SAR techs and then act as a communications relay high over the scene, with all four techs aboard the helicopter.

If an incident is far from a hospital, the helicopter may perform the rescue, meet the Buffalo at an airport, and transfer the patient and SAR techs to the aircraft for a faster flight to definitive care. The 442 Squadron gets a fair number of patients from cruise ships that run along the coast to and from Alaska. They use the helicopter to hoist them and then meet a Buffalo at the closest airport to transfer the patient for a flight to Victoria or Vancouver.

“Parachuting into the mountains into an austere environment is very dangerous,” says Hood. “The safety of the whole team is paramount. The Buffalo travels faster and stays in the air longer than the Cormorant helicopter. Typically we use both types on a mission. The Buffalo will go ahead of the helicopter to try to find the exact site of the rescue. If possible, we try to communicate with the people on the ground using emergency radio frequencies. This allows us to better size up the situation to determine if we’ll parachute out of the Buffalo or wait for the helicopter. Before we parachute into a scene, we are looking for something that is life-threatening to justify the risk of parachuting.

“We also have to make sure we jump onto the correct crash. There are many crashed airplanes in our area that have been there for years and never been found. With the helicopter, you can always get back into it, so it’s not such a big deal to deploy by hoist, check out a scene and get back in and move to another search area.”

All aircraft and helicopters carry extensive camping equipment that can be deployed by parachute if crews think they will have to stay with a patient overnight or for several days. They have a supplemental medical kit with extra gear for extended care, including antibiotics and a protocol for using them. In remote areas not easily accessible by helicopter, such as the far northern Arctic areas, it may take several days for techs who parachute in to arrange transport out.

Working in these hazardous conditions can take its toll. One SAR tech said it is not a question of if you will get injured, just when. Several SAR techs and rescue flight crew members have lost their lives on missions over the almost-70-year history of the SAR tech program. But the bottom line is that highly skilled and trained crews are prepared to respond anywhere they are needed in the wilds of Canada.

Barry D. Smith is ground CQI coordinator for the Regional Emergency Medical Services Authority (REMSA) in Reno, NV. Contact him at bsmith@remsa-cf.com.