AMR Reach And Treat: Who we are and what we do

Who we are and how we came to be

The American Medical Response (AMR) Reach And Treat (RAT) Team is a group of EMT's and Paramedics in the employ of AMR Northwest that are specially trained to respond to medical emergencies, special rescue situations, and search and rescue missions regardless of location. We are able to administer full advanced life support medications and care available on an ambulance, and are equipped to support a patient until resources can be called in to evacuate the patient to the hospital. We cover the any and all backcountry areas in Clackamas County, Oregon, including part of Mount Hood.

The program started in 1988 by Buck Medical Services, the local ambulance company at the time. The program was started out of three items of concern. First, there were a large number of injured and ill persons located in extreme and backcountry locations within the ambulance response area who were not receiving proper ALS care until hours later, when they could be evacuated by SAR teams to a waiting ambulances. Second, there were an increasing number of Paramedics and EMT's who were getting injured while trying to treat patients in locations requiring special training to access. Third, SAR personnel were getting injured on SAR missions and having to rely on first aid until evacuated.

In 1988 a pilot program was launched, and in 1989 the program was implemented full time. There are now two Reach And Treat capable ambulances staffed seven days a week. The units are based in Sandy, Oregon, and are available 24 hours a day. One unit is moved up to Government Camp between the hours of 8am and 10pm. We are often the first SAR trained personnel on scene. We are responsible for running normal 911 calls, as well as agency response calls and special standby calls. Agency request calls can range from Sheriff's Departments, Forest Service, Ski Area's, and SAR Teams. Special standbys often include search operations outside our normal response area, movie stunt filming, and extreme risk sports events. Public agencies that call the RAT Team are never billed for our services. Only the patient or their insurance receives a bill for transport. If we are called out on a rescue, and reach the patient to find they need no medical treatment, the patient is not charged. Charges only occur with some treatments, and with transport in the ambulance.

The RAT Team does not participate in searches. If called to a search, we will stand by and provide medical care for SAR personnel until the victim is located. At that time we will go into the field to begin treating the victim. If the victim is in a known location, meaning no search is needed, we will often begin to access the patient before other SAR teams arrive.

Reach And Treat Training And Capabilities.

AMR Employees wishing to become members of the RAT Team are required to take a yearlong initial training course. This course consists of about 146 hours, of which only 22 are spent in the classroom. All the rest of the time is spent in field instruction. By the end of the class students are required to complete a fitness test. This test is done wearing a 45-pound weight vest. The test consists of three miles around a quarter mile track. During each of the first four laps, the student must ascend and descend one flight of stairs. During each of the second four laps, the student must ascend and descend two flights of stairs. During each of the last four laps, the student must ascend and descend three flights of stairs. This event has a one-hour time limit. Also, during the year of initial training, if you miss any classes, you are dropped from the program. At the end of the initial training, RAT Members are trained in:

SAR Operations
Navigation
Personal and rescue equipment
Advanced medical training in the wilderness setting
Basic mountaineering
Basic rock climbing
Basic ice climbing and glacier travel
Night operations
Litter attending
Avalanche level 1 training
Swift water rescue
Canyoneering

RAT Members are then expected to keep up their skills by attending six other trainings each year, as well as retaking the fitness test each year. There is also a written and practical skills test each year.

All of these training standards are a minimum, and most members are trained quite a lot higher than this in specific fields. At the end of the initial RAT training, new members at a minimum are able to access patients in the following conditions:

Any patient located on hiking, skiing, or snowshoeing trails, under any weather conditions deemed safe by the RAT Team members.
Any patient located at the top, bottom, or on a high angle object (i.e.; rock cliff, ice wall, snow slope, building, etc.), which does not exceed the lengths of rope available to the RAT Team on site and can be accomplished by belayed ascent or descent. This may be done under any weather conditions deemed safe by the RAT Team members.
Any patient located on or along an alpine route, which does not exceed a NCCS rating of Grade II, Class 2, under any weather conditions deemed safe by the RAT Team members.
Any patient located on mixed terrain that does not exceed any of the above statements.

As stated above, these are minimums, and any RAT member qualified to a higher level is allowed to perform rescues at that level as long as it is deemed safe by that rescuer.

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