More serious accidents, especially those that involve injuries require some extra activities. The Rescue Organizer is responsible for a fair amount of fact gathering, sort of like a reporter. If someone has paper and a writing instrument (great to have in any First Aid Kit), start jotting down some quick notes like:

• Where exactly is the accident scene?
• When did the accident take place?
• How can professionals get to this site if needed?
• Who are the victims and their contact information?
• Do they have any apparent injuries? (This will be updated when first aid is initiated)

Now it is time to figure out how best to access the victim/s. The mnemonic RETHROG (Reach, Throw, Row, Go) is great for evaluating your options. In some cases, response time will determine which option will be used. For instance in a heads down pin, you need to get to the victim very fast. This often requires a mix of boating, wading, and swimming - fast, simple, and higher risk. It doesn't hurt to come up with a plan B in case the original one access plan fails. It is crucial to consider setting safety for the rescuers as well, perhaps a boat downstream and throw lines in strategic positions.

The Rescue Organizer (and others) should take the mental (or written) notes above and evaluate (assess) the situation. Do we have time? Is the victim stable? Can the situation degrade (hypothermia for instance)? Is there a potential for back/neck injury? Adjust your rescue strategy accordingly. Now that you have determined your options, considered safety and "what if?", you are now ready to perform the rescue.

When a person is injured, you really need to take care to avoid further damage. First Aid training is essential. If someone in your paddling group has special First Aid skills like EMT training, consult with them and have them lead all First Aid efforts. Neck and spinal cord injuries are tricky business. Great care needs to be taken when moving victims with these injuries to avoid paralysis. If the person has drowned, remember your ABC's (Airway, Breathing, and Circulation). You may need to perform CPR in the river before extricating to shore. Perhaps you can get them quickly to a flat rock. Is the person exhibiting signs of hypothermia? Check and see if your group has extra clothing and perhaps plastic lawn/leaf bags to warm the victim. Have someone gather spare clothes and start a fire while the rescue is in progress. The sooner you can stabilize the victim, the better the outcome. One other point, nearly all of these cases will require further professional medical attention. Don't take NO for an answer. Continue to add to your notes from above as they will be necessary later on.

Once the victim is stabilized, you may need to plan for evacuation. For less serious injuries, the victim may be able to ride out on a raft or canoe. For broken arms or shoulder dislocations, they probably should be walked out. Assign someone to go with them. More serious injuries may require some sort of stretcher. A stretcher can be improvised if necessary but it is probably better to get professional help. The notes above give you a good start on a Patient Assessment Form (SOAP Note) necessary for communicating with SAR teams. If you brought along a cell phone, see if you can get a decent signal. You may need to climb up a bit higher - it is certainly worth a shot. In some cases, you will need to send a runner downstream. If paddling, send two boaters and a copy of your notes. Take time to practice your communication delivery. You may need to add a few more notes. Once you decide to get professional help - STAY PUT! It will take some time for them to arrive, perhaps 4 - 8 hours.

Think before you leap - sometimes easier said than done. In some rescues like a heads down pin, time is of the essence. Fortunately, most rescues allow time to work out an appropriate and safe rescue plan. I have found in most incidents, someone needs to take charge and coordinate activities. Coordination saves a great deal of time and effort, it also saves lives.

When an accident occurs, peoples first reaction is shock and disbelief. It takes a moment before reality sinks in and we need to take some sort of action. People behave differently under stress and this is no time for chaos. As a trained rescue person, you (and others) need to a quick assessment of the situation:

• Is the victim stable?
• Are they upright?
• Are multiple people endangered, which need immediate attention?
• Is there danger of the situation getting worse?
• What are our immediate assets (people and equipment)?

Fortunately, most rescues are simple like assisting a boater safely to shore. Entrapments are far more serious and typically need a bit of planning to ensure success. For serious rescue efforts, a rescue organizer should be determined and not necessarily the trip leader. A leader directs efforts, maintains communications, and coordinates multiple activities involved in these types of rescues.