Wilderness rescue no walk in the woods

[Wayne Harrison]

Wilderness rescue no walk in the woods
Members of a Radford University outdoor club learn to treat wilderness accident victims.
By Hart Fowler
Special to T he Roanoke Times

RADFORD -- A couple is enjoying a leisurely bike ride on a scenic path through the wilderness. Approaching the couple is a downhill mountain biker barreling down an intersecting path.

The guy rolling quickly downhill hits a jump and leaves the ground at the point where his path meets that of the other two riders. There is a violent collision between the two unsuspecting cyclists. The front tire of the airborne bike nails the victim in the face.

Both riders are thrown. One of the bikes careens into the third rider, who is thrown to the ground.

All three have been severely injured. One is lying on the ground unconscious, tire marks lining his face. A large dark spot on the downhill biker's exposed belly may be a sign of internal bleeding and it appears he is having an asthma attack. The third cyclist is bleeding from the multiple lacerations she was left with after she fell to the ground.

Later, a group of eight backpackers happens upon the grim scene. The closest hospital is more than two miles away.

How do they react?

That was the setup for a recent wilderness first responder course simulation conducted by the Wilderness Medical Associates organizations at Radford University's Selu Conservancy. The backpackers and the bikers were played by the 11 students enrolled in the course.

Wounds were applied with realistic-looking fake blood, makeup, and wax in order to prepare the students for the real thing.

"This is more experiential education instead of classroom work," said instructor Chris Perry, a physician's assistant and paramedic who traveled from Portland, Maine, to teach the eight-day course with assistant and fellow paramedic Scott McQuilkin. "It's good to know theory, but medicine is a hands-on experience."

Perry videotaped the participants' reactions to the scene, documenting how they utilized the treatment protocols they had studied throughout the week. The course teaches students how to assess and treat patients when there is no quick access to a hospital. Students are forced to improvise with whatever they have at hand. Sleeping bags were cut up and used to pad a splint; foam from a sleeping pad was used to cushion a makeshift stretcher. Climbing ropes were used to strap down patients and tie splints.

"The realism of the scenario is one of the key points that made this course so valuable for me," said Bryan Simon, a Radford University nursing student and outdoor enthusiast. "You don't get the opportunity to practice that often."

Like Simon, about half of the participants are Radford University students. Chambree McClure, who played the part of the wounded woman, studies outdoor recreation and is using the course to prepare her for an upcoming class that involves a month-long wilderness excursion.

"You definitely learn how other people respond to a situation," said McClure as she wiped fake blood off her leg after she'd been treated. "You learn what it is like to be the victim, just without the pain."

Other participants are taking the course to earn certification that will qualify them to lead backpacking, canoeing, climbing, and/or caving trips. Phil Bohannon leads backpacking trips for Blue Ridge Mountain Sports in North Carolina, and is taking the course again to become re-certified as a wilderness first responder.

"I've learned stuff in this program that wasn't around five years ago," Bohannon said. "The fact that the instructors works at a hospital is also nice because they can teach us how to communicate with the ambulance when we get the patients to the trailhead."

Though Bohannon said he mainly "patches a lot of blisters" as a trail leader, he does believe his training was essential when he had to perform CPR on a hiker in cardiac arrest.

"It was amazing how everything clicked back in," Bohannon said. "When I performed CPR it was almost instinctual."

David Goodman is the director for RU Outdoors, a student-led outdoor club that sponsored the wilderness rescue program. Students must complete a similar course to lead outdoor trips for the club. Goodman believes the realistic and situational method of teaching is a key part of dealing with catastrophic events.

"Those are severe situations because it is so chaotic, and there is so much going on," Goodman said. "Much of it is dealing with that stress factor, what I'm going to do under fire?"

The students seemed to handle their simulation with a collective calm as they used the rescue protocols studied during the week. After breaking into groups and treating the three victims, all gathered to aid the fallen rider who suffered the brunt of the impact. "Watch your backs and lift on three," Perry said to the group before they lifted the improvised stretcher that held the patient. They then carefully carried the stretcher down to what would be the trailhead where the patient would be treated by paramedics.

"If we didn't do these realistic exercises, responders wouldn't be as effective," said Perry before he played the tape for his debriefing session. "We teach them troubleshooting methods, how to improvise, and how to communicate as a group."

He continued: "It's about being confident and calm in stressful situations. It teaches them not to be queasy around the sight of blood. Sometimes students don't know until they take the class."

http://www.roanoke.com/news/nrv/wb/wb/xp-66046

[NZcaver]

For what it's worth, I found Wilderness Medical Associates to be an excellent training provider (I did my WFR through them last year).

Check out their courses, articles etc at http://www.wildmed.com

[Rick Brinkman]

Since when is 2 miles from a hospital--wilderness????

For that matter, when is 2 miles from anywhere--wilderness????

Sorry, but I live in a place where 40 minutes from a hospital on the highway is REALLY fast response.

Caving???? I figure reponse time for here for a caving accident is 6-48 hours to get just a first responder TO the patient.

This is NOT the Montana wilderness areas you've been reading about in the NSS News. Up there??? Expect NO rescue other than your caving buds.

Good overall training though. ANY training is good training.

[RescueMan]

Since when is 2 miles from a hospital--wilderness????

For that matter, when is 2 miles from anywhere--wilderness????

Given that it's a newspaper account, you can be pretty certain it contains errors. The scenario was more likely two HOURS away - well beyong the "golden hour".

But even if it was just two miles, if that was two miles by litter carry then it's a wilderness setting.

- Robert

[NZcaver]

Since when is 2 miles from a hospital--wilderness????

For that matter, when is 2 miles from anywhere--wilderness????

Depends. In that situation, if it was difficult terrain and none of the bikers or hikers had any cellphones or other communication devices - it could be considered a "wilderness situation". The critical factor here is TIME.

Or when writing that piece, the author may have simply misinterpreted what he was told. WMA and other providers often talk about "2 hours or more from definitive medical care" as being relevant to wilderness medical protocols. Of course this probably applies to most caving accidents, as well as many mountaineering, backpacking, and even mountain biking ones. Ironically, it can also apply in urban settings too. Like being trapped in an elevator, for example.

The wilderness context exists precisely because not all medical emergencies can be responded to quickly by "scoop and run" street EMTs. Therefore the WFR and WEMT courses focus on more prolonged patient care, movement, and monitoring. Students are also trained in additional protocols that FRs and EMTs are not. This makes the WFR an 8-day course, instead of 4 days like the regular FR. Qualified street EMTs can also opt to do a one-week course to upgrade to WEMT.


PS - What Robert said...

[George Dasher]

I bet the article should have said, "Two miles from the trailhead." The hospital was most-likely a lot further down the road.

Those were well-prepared backpackers, especially since they had rope and were willing to cut up their sleeping bags. More likely, it would be one or two day hikers who would encounter the scene--or other mountain bikers. The cut-up female would be in the best position to render help, if she could.

I once saw a similar accident almost happen in the woods. I was mountain biking up a steep grade, which in my case equalled pushing my bike up the hill while trying not to step on my tongue. There was a hunter about 30 feet in front of me on the trail. A mountain biker came flying down the mountain, and around an uphill turn. He caught air on a rock outcrop. He missed the hunter by inches, then landed, and came barrelling by me. Then he was gone. The hunter and I just looked at each other. His jaw was down and his face was white, and I know I looked no better. It was a scarey moment.

Still, back to the thread, I sure the practice was a learning experience.

[Barry14319]

2 miles from a hospital in a cave can be a long ways from help and should be considered a Wilderness situation.
This is one reason for describing the distance in a cave in hours and not in feet.
Just my 2 cents

[George Dasher]

Barry: You're right.

But a reporter won't have known that.

[NZcaver]

2 miles from a hospital in a cave can be a long ways from help and should be considered a Wilderness situation.
This is one reason for describing the distance in a cave in hours and not in feet.
Just my 2 cents

Particularly when you consider the possible time-line involved. For example:

Accident occurs, companions provide initial first aid
Caver(s) take down patient info, and some head out of the cave to seek help
Caver(s) walk/run/drive to nearest civilization to make the call
Local EMS responds, but may not be trained/prepared/comfortable with entering cave - so they call for more help
Cave-trained agency personnel and/or volunteers arrive and enter the cave
Teams bring in medical, evacuation, communication, rigging etc equipment, as needed
Patient is given medical attention by responders, and packaged in a litter (if necessary)
Patient is assisted/carried/dragged/hauled out of the cave, and up/down the mountain into a vehicle/aircraft
Patient is driven/flown to the hospital
You time ends NOW. Whew!

Based on this time-line, I would consider an accident almost anywhere in a cave to be an appropriate occasion for trained companions and/or responders to use wilderness protocols. Next time you're somewhere in a cave, think if all of the above could be acheived inside 2 hours - let alone within the "golden hour".

[RescueMan]

I would consider an accident almost anywhere in a cave to be an appropriate occasion for trained companions and/or responders to use wilderness protocols.

Does that include field amputations?

[NZcaver]

Does that include field amputations?

As I'm sure you know, the wilderness protocols that WMA teach doesn't include amputation at the neck or anywhere else.

FYI - with proper training and in the appropriate situation (and with additional caveats), they do include:

Clearing C-spine
Reducing simple dislocations of the shoulder, patella, or digits
Wound cleaning and removal of foreign objects
Administering epinephrine for anaphylaxis
Administering epinephrine for severe asthma
Cessation of CPR in unresponsive patients after 30 minutes

[fuzzy-hair-man]

I remember that the Tasmanian miners rescued not so long ago had thought out plans for how they would go about amputating their legs (I presume they were pinned).

OK it's a mine and not a cave but I have heard stories of cavers needing to amputate body parts as a result of being caught in rock fall and having crush injuries. I am also told that these were not done under anesthetic
These may be just tales however, but I could believe it.