Mauna Kea Emergency Medical Procedure

Introduction

Mauna Kea is an isolated work location, many miles from the nearest professional EMS (Emergency Medical Service). It is important that all of the employees working on the mountain understand the procedures that should be followed in case of a medical emergency.

Preparedness

The primary source of first aid assistance must be at the work location itself. Each facility should maintain a stock of emergency first aid supplies and equipment. At the minimum, this should include a backboard with "C" neck brace, a first responder kit, and medical oxygen. All employees should have current first aid training and experience in using the equipment available to them. Each facility may elect to have some staff members undergo EMT training, which is a 300 hour course, with frequent refresher classes to keep prepared. Each facility should establish a regular schedule for first aid drills, testing of emergency and safety equipment, and test driving the EEV (Emergency Evacuation Vehicle).

Evacuation

If facility vehicles are inadequate, and an accident victim needs to be transported to an EMS location or must meet an EMS vehicle, the EEV (emergency evacuation vehicle) is available. The purpose of this vehicle is to provide a convenient means of transporting an injured party down the mountain. The EEV has a removable stretcher that will make the transfer of a victim easier. It is also stocked with emergency first aid supplies, but should not be considered as the primary source of these items. Each facility is responsible for it's own medical supplies. In a lot of cases, when the injured party does not need to be put in a prone position, it will be more convenient and faster to take the patient down in a facility vehicle, rather than in the EEV.

It has been suggested that patients be put on the stretcher so their feet will go in the vehicle first, making the downhill ride more comfortable, especially if there are head injuries.

The EEV is equipped with a cellular phone (936-0281). Make sure the phone is activated whenever the vehicle is used. Keys to the EEV and instructions on it's use are kept at each facility - the location should be made known to all staff members.

Every use of the EEV must be reported to MKSS. Please read the vehicle section of this manual for instructions about the EEV.

Logistical Considerations

Once an accident or illness occurs, it is important to evaluate the seriousness of the problem, and adopt a plan of action. Before this can be done, it is important to understand the services available, their limitations, and the means of contacting them.

EMS Service: If professional EMS (Emergency Medical Service) is needed, the basic plan should be to evacuate the victim and meet the EMS personnel somewhere down the road. EMS is available from both the Hawaii County Fire Department and PTA (Pohakuloa Training Area). PTA is closer to Mauna Kea, and can potentially respond more quickly than the Fire Department. EMS personnel from the County and PTA can be dispatched either by ambulance or helicopter.

Helicopters: Ideally, helicopters can provide the fastest service during a summit emergency. However, they have not proven to be reliable during past rescue operations. For this reason, all emergency plans MUST focus on evacuation to lower altitudes. If a helicopter can meet the rescue team at the summit, or on the way down, professional assistance will be available sooner, but you MUST be prepared to handle the emergency using ground based transportation.

Hawaii Island Fire Department: The County of Hawaii has two helicopters that are small, not instrument rated, and not suited for high altitude flights. They may be available for transporting EMS personnel to the summit, but only under ideal conditions. Generally, the helicopters have been used to meet at Hale Pohaku of Saddle Road. The helicopters can be put in the air rapidly, but are only available from 0800 to 2000 each day. The County helicopters are not allowed to carry persons under cardiac arrest. If helicopter service is desired, inform the 911 operator when your emergency call is made.

Army National Guard: The Hawaii Island National Guard has two Blackhawk helicopters that are available to the County for emergency circumstances. These helicopters are capable of flights over 14,000 feet and in less than ideal weather conditions. Although they are very capable aircraft, rescues are not their primary mission, and logistical preparations may delay their dispatch for over an hour. The request to put these helicopters into service must come from the Hawaii County Civil Defense. If helicopter service is needed at the summit, inform the 911 operator of the seriousness of the emergency, and ask them to call Civil Defense (935- 0031). If this service has been requested, a follow up call to Civil Defense is advised.

PTA: PTA does not have any helicopters permanently stationed at their site, as they are brought in by the individual training units. When the PTA helicopters are available, they are generally large enough and powerful enough for flights to the summit under reasonable weather conditions. The primary mission of these helicopters is to provide emergency service for the training exercises taking place. The training operation must be suspended before the helicopters can be assigned to a rescue operation. This will delay their dispatch. The 911 operator can also be asked to check on the availability of the Pohakuloa helicopters.

If you know that a helicopter has been dispatched, tie a ribbon to the vehicle antenna to identify it and to indicate wind direction to the pilot. Possible helicopter landing sites include the hunter's check station at Saddle road, the roadway at Hale Pohaku, the first parking lot at the beginning of the paved road, and the 2nd parking lot, just below the 13,000 foot level. See the accompanying map.

Ambulances: Both the County Fire Department and PTA have ambulances available. Since PTA is located at the 36 mile marker on Saddle Road, they can potentially arrive first at an accident scene. These fully equipped ambulances are very heavy, and in the past, both the county and PTA vehicles have had difficulty driving up even as far as Hale Pohaku. Personnel involved with the evacuation must always be prepared to drive the victim to Saddle Road, and possibly further. Arrangements may also need to be made to have a vehicle drive down to meet an ambulance to transport EMS personnel to the location of a victim.

Communications

911: The Island wide emergency phone number is 911. This number should be used for all emergency situations. It will connect you with the County Police Department, who will in turn, contact the Fire Department dispatcher, PTA medical clinic, and Civil Defense. Make sure the seriousness of the emergency is made clear, and request for help from PTA or Civil Defense if the situation warrants it.

Direct Contact with EMS Agency: After 911 is called, direct contact with the County Fire Department or the PTA medical clinic may be useful if there are changes in conditions or new information is available. When the victim's life is in jeopardy, direct contact with the dispatched agency is also helpful in making sure that they understand the seriousness of the victim's condition. The County Fire Department Dispatcher can be reached at 961-8336. The PTA clinic phone numbers are: 969-2431 and 969-2433, and Civil Defense is 935-0031. They can, in turn, contact the ambulance or helicopter using their emergency radio system. The EEV is equipped with a cellular phone (936-0281) that can be used to keep in touch with those agencies involved.

Meeting Place

Once contact has been made with 911, it is important to establish a primary meeting location. Because of the uncertainty of the helicopter service, the primary meeting place should be the hunter's check station at the Saddle Road 28 mile marker. This is at the bottom of the Mauna Kea access road, about 30 to 40 minutes from the summit. An ambulance from Hilo, and a vehicle leaving the summit will meet there at about the same time. On site rescue personnel should always make this their basic plan. Once mobilized, the actual meeting place might change depending on the availability of a helicopter, and the source of an ambulance. The cellular phone in the EEV should be very helpful for making these changes. The color of the EEV and the flashing red light should make it easy to spot on the road.

Hale Pohaku is the secondary meeting place. This site can be chosen if mobilization from the summit allows the ambulance to get a head start, or if a helicopter is dispatched.

The First Parking Lot on the Summit Road pavement is the third choice of a meeting place. This location might be chosen if it is known that a helicopter has been dispatched, or if it is felt that the patient couldn't survive the rough cinder road. For instance, it is difficult to perform CPR on a patient on that road.

The fourth choice for a meeting place would be the second parking lot on the access road. This might be chosen if the helicopter pilot feels that this is the best place to land under the current weather conditions.

The fifth choice of a meeting place is the accident site itself, and should only be used if there is no means of transporting the victim without professional assistance.

A worst case scenario might occur when the patient cannot be transported down the road, a helicopter is not available, and the ambulance cannot drive above HP. Someone from HP could then be contacted to drive the EMS personnel to the victim.

Plan of Action

The plan of action must take into account the seriousness of the accident, medical abilities of the on site personnel, the first aid equipment available, and the limitations described in the previous sections.

Examine the Victim in order to determine the extent of the injury or illness. In particular: Is the patient conscious? Is the patient breathing ? Is there a pulse? Is there heavy bleeding? Is there a neck or back injury?
CALL 911 and be prepared to provide the following information:
- Your Name and Location (summit of Mauna Kea, Hale Pohaku, etc.). If the victim is in serious condition, tell the dispatcher that you are closer to Pohakuloa, and would like them to be called in case they can provide faster service. You can also ask for the operator to contact Civil Defense for activation of the Blackhawk helicopters.
- The number of victims involved.
- A description of the circumstances surrounding the injury or illness.
- A description of the victim's symptoms.
- Let the 911 operator know how urgent it is to meet EMS personnel.
- Describe the weather conditions if a helicopter flight is being considered. Wind speed, cloud cover, and visibility are the most important factors in determining if a helicopter can be sent.
- Establish the prime meeting location as the 28 mile mark on Saddle Road. Contact may be possible further up the road depending on the availability of a helicopter and the time needed, on site, to mobilize the victim. The EMS agencies have all been sent a copy of the Access Road Map for reference.
- Describe the vehicle that will be driven to the meeting place. If the EEV is used, it is a dark red Ford van, with white lettering on the side; "Mauna Kea Observatories Emergency Evacuation Vehicle". There is a flashing red light on the top. Give the operator the cellular phone number (936-0281).

Distribution

This memo will be updated and redistributed every year to all facilities, the County Fire Department, Civil Defense, and PTA in order to remind all staff members, and to inform new staff. Please make copies and distribute among your staff. If you have suggestions for improving this document, please contact the MKSS Hilo office. Phone: 935-3371, fax: 969-7673

Emergency Evacuation Check List

EXAMINE THE VICTIM
CALL 911 WITH THE FOLLOWING INFORMATION
- YOUR NAME AND LOCATION
- THE NUMBER OF VICTIMS
- DESCRIBE HOW THE ACCIDENT OR ILLNESS OCCURRED
- DESCRIBE THE VICTIM'S SYMPTOMS
- INDICATE THE URGENCY NEEDED FOR TREATMENT
- DESCRIBE THE WEATHER CONDITIONS
- ESTABLISH THE PRIMARY MEETING PLACE (SADDLE ROAD)
- DESCRIBE THE VEHICLE USED TO TRANSPORT VICTIM

Important Phone Numbers

936-0281	EEV Cellular Phone
911	COUNTY OF HAWAII EMERGENCY SERVICES
935-0031	COUNTY OF HAWAII CIVIL DEFENSE
961-8336	COUNTY OF HAWAII FIRE DEPARTMENT DISPATCHER
969-2431	PTA MEDICAL CLINIC
969-2433	PTA MEDICAL CLINIC
969-2441	PTA FIRE DEPARTMENT
969-2442	PTA FIRE DEPARTMENT
969-2401	PTA POST HEADQUARTERS (If no answer at clinic/FD)

Meeting Sites

SADDLE ROAD
HALE POHAKU
1ST PARKING LOT
2ND PARKING LOT
ACCIDENT SITE

Last updated October 31, 1997

Ron Koehler
koehler@ifa.hawaii.edu