# Maybe for something different??



## Outdoornut (May 10, 2010)

Just wondering...would you guys (and gals) be up for a wilderness scenario??


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## LucidResq (May 10, 2010)

Please please please please.


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## foxfire (May 10, 2010)

Oh yeah!!!!!!


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## 8jimi8 (May 10, 2010)

where's the scenario?!


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## Outdoornut (May 10, 2010)

8jimi8 said:


> where's the scenario?!



It's coming...see above ^ =)


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## Outdoornut (May 10, 2010)

*Apparently you can't go back and edit lol...Here is is*



Outdoornut said:


> It's coming...see above ^ =)



Here's the first part of the scenario: 

You are one of three leaders on a three month backpacking expedition. You are leading three groups of 5 students...college aged who are all very experienced within the wilderness context (given the three months!) each student has a topo map and compass and know how to use them. It is early April in the mountains of North Carolina and the weather is ‘spotty’ with rain/drizzle at lower elevation and snow/ice at higher elevation. However, your entire group is prepared for whatever weather changes might occur and sport 20lb packs to prove it!

Your group is now at “base camp” which is 20 miles from the road (note: it is the first clearing that has been large enough for your entire group to stay together…the previous nights your group had to split up into three separate camps). “base camp” is right beside a fork in the trail…both of which end at another campsite (which is 2,000ft above where you currently are) but one has gradual elevation being 8 miles long and the other  very steep elevation and hazardous trial but is only 5 miles. You and the two other leaders have been giving the group of students opportunities to ‘fend for themselves’ and decide that this would be a great learning experience. The night before there was some slight flurrying but now (around 9-10 in the morning) though the air is chilly, the sky is clear and only a few patches of snow/ice are visible on the ground.  You and your fellow leaders will take the shorter trail at higher elevation to the second campsite and the three groups of students will take the longer trail and meet up with you there. You tell the students to take their time and enjoy themselves but to get to camp before dark which is possible (they have been averaging about 6-8 miles a day in their individual groups of 5). 
You and your fellow leaders reach the campsite before any of the students (as expected) and go about setting up camp (getting firewood etc..) gradually students start to arrive in groups of twos and threes and gradually it starts to get darker as late afternoon settles in. The groups busy themselves in collecting more firewood and getting food cooking…the temperature is starting to drop, the wind is picking up and it looks like it may start to snow at any minute. It is not until everyone is standing around the large campfire when someone makes a discovery…Ryan is missing. Somehow the 22 year old sports and recreation major never made it to camp and noone knows where he is. 
You and your two fellow guides decide to wait another hour to make sure Ryan isn’t simply hiking slower (he has a minor in photography and has been stopping throughout the trip to take pictures). An hour goes by and no Ryan. You decide to ask Kenneth, Ryan’s roommate and best friend, to see when the last time it was he saw Ryan. The other student frowns and tells you that he hasn’t seen Ryan since “base camp” that morning when Ryan woke up not feeling well and they separated into their different groups of five. You and your fellow guides casually question the rest of the group without success…no one remembers the last time they saw Ryan but they do know that he wasn’t feeling well and apparently had been taking a lot of bathroom breaks that morning before they left. 
You and your fellow guides are facing a dilemma. Ryan is a severe diabetic but hasn’t had any trouble during the entire duration of the trip (three months, which he himself has admitted is ‘crazy’) and usually carries snacks with him ‘just in case’.  But this disappearance has red flags written all over it. 
What should you do? It is now nearly 9pm, it’s not completely dark but the group is starting to look for their headlamps and more layers as well…it’s steadily getting colder…you can now see your breath in the air and many of the students are shooting you concerned looks (up until this trip you have been camping in lower elevation and this will probably be your coldest night so far). Already Kate, 18 year old English major from Arizona, is shivering and standing so close to the fire she’s basically in it (she’s so cold she’s claimed not to be hungry and has given her share of the dinner to Matt who is scarfing it down joyfully).  Others in the group are also picking at their food and a couple have already put up their tents and have gone to bed.
Ok….what would you do in this situation?? For current purposes you get to decide what you and what the other guides are going to do. What your concerns are within the larger group, what to do about Ryan etc…

NOTE: You are in the wilderness. The guides have cell phones but they do not work where you currently are or even back at your ‘base camp’. The road that is 20 miles from base camp is gravel, one lane and has ‘patchy’ cell service (the road it 2 hours from an ‘urban’ town). 
Your outside contact won’t contact proper authorities unless he doesn’t hear from you in 48 hours (at which time you should be over the peak of the mountain and within cell phone service).
For this particular trip (which is only 6 days long) you have 6 regular med kits (two per group of five) each holds various sizes of gauze, scissors, basic medications, an assortment of things categorized for ‘bites/stings’ including two epipens (always wondered how we got permission to get them) an irrigation syringe, ice pack, ace bandage, tweezers, band aids, ‘blister stuff’, and some triangular bandages thrown in for good measure. Ryan carries his own ‘emergency kit’ which has his insulin, sugar tablets, meter with strips, and extra snacks. If you assume Ryan has his pack, it also has in it his ration of food for the day, two extra pairs of pants, four extra shirts, four pairs of extra socks, camp shoes, sleeping bag (0 degree), sleeping mat, headlamp (with extra batteries) and personal toiletries and trekking poles. 

Hehe….go for it!!
P.S. Let me know if anything is unclear (I think I went a bit overboard) once you decide what you would do…I will tell you where Ryan is and his current medical status (aren’t you curious…??)


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## EMSLaw (May 10, 2010)

At the moment, this seems to be a search and rescue.  

Bad on the company that organized this for not making sure there was a satellite phone or radio available for emergencies, but since we have to deal with what we have, and not what we'd like to have, no use crying over it now.  Presumably, this means additional resources would be very difficult.  

So, it's nighttime, it's dark, and it's freezing cold.  You have a group of kids.  The first decision to make is whether to start the search now, or sit tight, wait for daybreak, and hope that your missing person makes it through the night.  Given the lack of experience in the group, this still might be the best option.  You have one victim now, but you run a serious risk of creating several others bumbling around on a steep trail in the dark.

Do you at least know what trail the missing hiker was on?  Better to search 8 or 5 miles than 13.  Was the trail clearly marked, or was there a distinct possiblity of wandering off the plot?  What is the distance to get over the mountain to an area where help can be summoned?  Is it likely to take longer to get over the mountain, or to hike the 30ish miles back to the road?  Either way, you're probably looking at 2 days to additional help.  Damn, wish we had that satellite phone right now.  Oh, well.

This situation is all kinds of bad, because if he's in a hypoglycemic situation, he could be dead (of that or hypothermia) before you can find him.  I'm not liking his chances.  By the way, my experience is that if he's not capable of walking out for whatever reason, you're going to be taking a day or more to carry him.  You'll be lucky to cover a mile an hour with an improvised litter carrying your hypowrapped patient.


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## Seaglass (May 11, 2010)

(I've never done real SAR, so this is just for kicks. I'm curious about doing it someday, so feedback is welcome.) 

I'm making a few assumptions. If the weather's bad, I'm not going to bet that the usual cell phone spot will be working. I'm also gathering it'll take as long to get there as it will for our emergency contact to call authorities (?), so forget it. 

One team leader and the kids stay put for the night. In the morning, if the weather's alright, they can follow us back along the trail until we meet up. If we don't meet up, they hike out for help. 

Meanwhile, I'd take the other team leader, a tent, a kit, supplies for a few days, and go back along the trail. I wouldn't deviate from it unless I saw some concrete signs that Ryan had gone that way. In that case, I'm not going any farther if we lose his trail, and I'm going to leave all sorts of signs wherever we turn off for the benefit of the rest of the group. If the weather gets scary for us, we hunker down for the night and resume in the morning. I'm assuming we're properly dressed for the weather, have some great battery life and spare batteries for the headlamps, and all that good stuff. If we reach base camp without finding him, we wait there for the rest of the group and for SAR, which will be on its way before we can reach a place where we can contact anyone (again, assuming I'm reading it right). We won't split up. 

Oh, and I'm gonna talk Kate into eating at least a little before I go. And give a lecture about the buddy system. And have a talk about getting a satellite phone with the company, whenever I get back.


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## Mountain Res-Q (May 11, 2010)

So, commuications are basically out of the question... so...  your first responsibilty is to the group; the needs of the many outweight the needs of the few.  If you say that as a group you are prepared for winter weather conditions, fine... now worry about the missing man.  If the safety of the group is in question, get them moving out if condition allow, otherwise stay put and keep them astable.  First priority is not to play hero... that is my job .  If conditions safely allow, choose your best two people (most fit, most experience, and knowledgable) to hightail it out to make a SAR Notification.  Remember that statistically, a true outdoor survival situation last no more than 3 days.  Statistically if you are lost in a wilderness environment and you are missing for more than 72 hours, your chances for suvival drop to 4%.  Therefore it is VITAL that TRAINED RESCUERS launch a mission ASAP; that means people with the training and capabilities in Lost Person Behavior, Search Managaement, Man Tracking, Nordic Rescue, OHV Rescue, Mounted Rescue, amd other SAR Disciplines get going NOW!  Search is an Emergency!  I would rather be notified and cancelled a hour latter than only get notified after the suject has been overdue for a day or more, which will only increase the size of the search area and decrease survival chances.

After that, the most likely course of action for the rest of the group could also be the most costly unless everyone is capable, and based on the group dynamic, they are not.  As a leader of the group you would likely wish to either utalize the group to search for the missing man or take a few capable folks with you to search, leaving the rest behind at camp with instruction to stay or push on the following day.  From a SAR standpoint, I HATE THOSE OPTIONS and just know that those are the choices that will be made and either result in locating the missing man (and would seem to justify the action) or will turn into a SAR NIGHTMARE when the Professionals arrive and now face a dozen+ college students wandering in the woods without communications as they yell out "Marco".  

However, if I was the Group Leader, with my background, I would, after sending out two of the best to make the notification to SAR, backtrack with one other to the PLS and start my own Hasty Search, utalizing my knowledge and abilities in Mantracking, Signcutting, and Lost Person Behavior to do what every SAR Team tries to do at the start of every search, move fast and try to locate the subject in those first crucial hours.

The Medical information provided does little to change the choices I make.  Yes, from a SAR Standpoint, the subjects Medical Status factors into the Search Urgency Classification, but should not be a motivating factor that prohibits me from make objective desicions that might (if influenced) endanger the group or Rescuers.

As a SAR Professional that will likely get the page for this mission around 0300 hours, and be ready to go by 0305, here is my opinion.  Based on the information provided, this suject rates a 18 to 21 out of 33 on the Standard Search Urgency Chart, or a "Measured Response" that could be viewed as a "Urgenct Response" by some.  I want to move fast (and safe) if possible.  Secure Maps, Communications, and send in your Hasty Team by the fastest route and means available; where they will do as I would have; signcut and track.  Get additional resources in play for deployement at first light; this includes Tracking Teams, a GREAT Canine Trailing Team, Mounted Teams, OHV Teams, and possibly Nordic Teams.  Depending on the extended weather forcast, also look into a helo for aerial search.  All Teams WILL have at least an EMT or OEC in the group.  ALS/Technical Rescue group should also be in play for rapid Access, Stabilization, and Transport (LAST).  Deploment of Teams:  Tracking and Canine Trailing at the PLS/LKP.  OHV, Nordic, Mounted and Area Search Dogs will be deployed inward; trailing running, trail blocks, passive search tactics, and clue awareness are KEY for these Teams with the goal of containing him and making the Tracking and Trailing Teams more effective.  Area Dogs to be delployed upwind and at high points.  Nordic Teams to th high elevations (hopefully by helo to work down).  Mounted, OHV, and Ground Pounders along trails on the search parameter to be owrk in to the PLS.  The Helicopter should be dirrected to search areas based on Lost Person Behavior as extablished by the Search Manager and Command Staff.

Lucid, War, Summit, am I missing anything?


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## mycrofft (May 11, 2010)

*First step getting in cell range.*

Lawyer up.


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## Outdoornut (May 11, 2010)

*To elaborate a bit more...*



EMSLaw said:


> At the moment, this seems to be a search and rescue.
> 
> Bad on the company that organized this for not making sure there was a satellite phone or radio available for emergencies, but since we have to deal with what we have, and not what we'd like to have, no use crying over it now.  Presumably, this means additional resources would be very difficult.
> 
> ...



You'tr not positive which trail Ryan took. He was *told* to take the longer trail with his group and you have no reason to believe he would deliberatly disobey your orders (he is a friendly, trustworthy guy, eager to learn and a quick learner too!). As for the trails: you are in the backcountry...every couple hundred feet or so there is a white blaze painted on a tree....but other than that the trails are not marked and are only wide enough for one person (with a pack on) to walk on. The trail "switch backs" so it would be relativley hard to miss it (on one side of the trail the ground is always going down and the other is always going up). 

Your trip is only 6 days. You still have three more to go...it is roughly 15.5 miles to get 'over' the mountain. To get on top of the mountain it's only 1.5 miles but it goes up 1,200ft elevation in that short hike and for every 100ft of elevation one goes up you have to add an hour to hiking time...not to mention that you probably would be hiking through 4-6 inches of untouched snow which would probably add a couple more hours.


P.S. Just let me know when ya'll want the next part of the scenerio. I suppose I could have just given you the second part (in all it's medical glory) but this was a scenerio we were given in one of our "crisis management" lessons and I wanted to give you the entire effect.^_^


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## LucidResq (May 11, 2010)

Mountain Res-Q said:


> Lucid, War, Summit, am I missing anything?



I definitely agree with your priorities. Activating SAR would be first on my list, and I'd want to send one of the leaders along with one or two of the best students to do so.

I'm wondering if it would be faster to get to the road for cell service, or if you might gain cell service by gaining altitude. Again, I'm not familiar with the NC mountains, but I've found in many places out here in the Rockies, you won't have service forever but if you get in the right clearing high enough, you'll have perfect service. Just a thought. Better to not risk it though, probably, and go where you know you've had service. 

It's hard to say without actually knowing the group, being familiar with the area/climate/terrain or being in the weather conditions, what I'd do about starting our own search. I'm considering two options: 

a) Leave a leader at base camp with any kids who aren't ready to go out tonight, and take a small group of the most well-prepared, willing and in best shape with me to head back down the longer trail, because if he did get started, it seems like this is where he'd most likely be. Hasty search with plenty of audibles. Instruct the second group to start down the shorter trail in the morning and meet us at base camp and we'll go from there. 

b) Take the whole group down to the base camp tonight. Since I have another leader with me, it doesn't seem unreasonable to have us split up, one leader with each group and each take a trail down. Like Mountain mentioned, it kills me to break the group up so much, but I'm hoping this other guide is competent enough to manage any problems that might come up, and at least we know where the other group is and where they're headed. 

The reason I'm anxious to start the search immediately is that we'll be waiting forever otherwise, there's no guarantee the weather will be good tomorrow, and if these kids get too cold or what not, at least they will be with leaders and we can stop and set up quick shelter and get warm at any time. 

Either way, if we all reach the base camp, still haven't found him and still don't have help, I'd want to do a quick hasty search of the area surrounding the camp and a bit of the trail leading up to it, and then we're all coming back and having a quick lesson on line searches.

Now that we've thrown out a variety of ways to try to find him, can we find him?


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## Outdoornut (May 11, 2010)

*and your patient...*

Ok. 

You and your leaders make this decision. You, a second leader and 4 of the most experienced, best in shape students will head back down the longer trail the students took (because Ryan is an experienced hiker and knows his way around a map and compass you figure that it’s more likely he has gotten injured or is having a medical emergency than is lost). Since you questioned the other students and the only responses you have gotten is that Ryan was last seen at “base camp” you assumption is that he is probably there or near there. 
 You will take enough food for your group of six and Ryan for two days and all of your packs (and two med kits). The third leader will remain with the larger group of students (monitoring each for signs of hypothermia and keeping a special eye on Kate) the next morning will start down the shorter trail to “base camp”. 



Your group of rescuers head back down the trail without any signs of seeing Ryan. Since it is dark and your entire group is starting to get tired your pace is steady but not very fast. You reach “base camp” let’s say around 5am. At this lower elevation there is no snow but it is damp from what looks like recent rain fall and the white sky looks like it may rain again…the air is humid but a slight breeze gives a chill to the air.  

Your group separates to head to the designated ‘bathroom areas’ your group had set up the night your entire group spent there. You are alerted from a shout from your fellow leader…Ryan has been found. 
You quickly follow the call through the middle of “base camp” into the woods and down a hill about 20 yards. Ryan is lying horizontally across the hill; his right leg and shoulder are up against two random trees. He’s covered almost completely in dirt as well as several scratches, his pack is lying next to him and it looks like he attempted to retrieve the sleeping bag from it as it is laying half on his upper body and half of it still in the pack. 
As you kneel down next to him he is shivering slightly but Ryan opens his eyes to look at you. First he looks slightly confused and then attempts a weak smile “what took you so long?” he mumbles, his speech is slurred. He slowly tries to tell you what happened in slurred short sentences but keeps stopping…forgetting what he is saying you piece together the following:He started hiking with the rest of the group the day before, but was slightly behind them as he had had to run to the bathroom right when everyone was leaving. He started on the trail behind them but a couple miles in realized he had forgotten his emergency kit back where he had gone to the bathroom. He headed back to get his kit, got sidetracked 	taking some pictures and when realizing how late it was (and far behind he was) he attempted to hurry…slipped coming up the hill, fell and rolled down it before hitting the trees where he came to a stop.

Ryan tells you that he did hurt but nothing really hurts anymore. He also tells you that he was shivering worse but “he’s not as cold anymore”. While you have been talking to him your other guide has been working on a head to toe assessment and informs you of the following. Ryan’s HR and RR are both slow and weak, the cuts on his face/neck are superficial, his skin is pale and cold, his right shoulder is dislocated with a possible broken arm as well (it’s hard to tell because it is still jammed up next to the tree), and he has a right mid shaft femur fracture (CSM is nearly non-existent in his right foot) and his LOR seems to be slowly decreasing and to top it off…it’s starting to drizzle.
It’s now around 7am. The other members of your search party (the 4 students) are waiting for your orders. You have around 8-9 hours before the larger group wanders into camp and remember you are 20 miles from the road that has “sketchy” cell service and then 2 hours from town.

Let me know if you need any more info.


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## Trayos (May 11, 2010)

> “what took you so long?” he mumbles, his speech is slurred


 Possible head injury, or could be a sign of a hypoglycemic reaction/the advancing hypothermia. 


> fell and rolled down it before hitting the trees where he came to a stop.


 Possible trauma, what is the approximate distance he traveled?


> Ryan tells you that he did hurt but nothing really hurts anymore. He also tells you that he was shivering worse but “he’s not as cold anymore”.


 He is in advanced hypothermia, and should be wrapped in a blanket/sleeping bag (if possible to do so without aggravating injuries). 





> . Ryan’s HR and RR are both slow and weak, the cuts on his face/neck are superficial, his skin is pale and cold,


again, hypothermia.  





> his right shoulder is dislocated with a possible broken arm as well (it’s hard to tell because it is still jammed up next to the tree), and he has a right mid shaft femur fracture (CSM is nearly non-existent in his right foot) and his LOR seems to be slowly decreasing and to top it off…it’s starting to drizzle.


The right foot is a high priority, as it seems to be in stages of frostbite. He needs to be warmed up, and should be wrapped a dry covering, such as a sleeping bag/blanket. Continue to talk to him, and attempt to have him consume warm fluids, while setting up a tarp or other structure to keep the rain off of him. I honestly don't know how extricate a possible broken limb from confinement, unless the tree can be cut out enough to splint the arm and move it down to his body.





> It’s now around 7am. The other members of your search party (the 4 students) are waiting for your orders. You have around 8-9 hours before the larger group wanders into camp and remember you are 20 miles from the road that has “sketchy” cell service and then 2 hours from town.


 I think it is safe to say that this trip will not be continuing in the near future, can 2 of the students find their way back to the rest of the group, and have them return to your location? You should task the other two students in setting up shelters/preparing fluids. When the rest of the group returns, I would task an adult and student to return to the road and attempt cell phone service, planning out where they are to go ahead of time (so we don't lose two more members). The rest of the group should make camp near the pt. and attempt to make both warm fluids/liquid meals (I am assuming traditional backpacking fare, it should be liquid-y enough for him to consume if he does not have head/neck injuries.)

They should also work on making a signal for SAR crews to spot them from the air, is there room enough to make a fire?

 I have no official WFR or W-EMT training, only skills from boy scouting.


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## Mountain Res-Q (May 11, 2010)

Priority 1 remains the same, and I wonder why it has not been done yet.  Get outside help started.  You may think you can do this on your own, but experience has proven to me that this is an arrogant belief that can lead to disaster.  If nothing else, outside SAR resources are a backup, just in case.  And no matter what the OP writes, his little group are neither searchers or rescuers.  They lack the training to act in those roles at 100% effectiveness, something that true SAR Teams train in religiously; SAR Teams respond when NO ONE else can get the job done and have no backup, meaning that we need to be 100% prepared.  GET SAR RESOURCES NOTIFIED ASAP.

Meanwhile, medically you are on your own in what appears to be a FA/BLS capacity.  Fine.  All medical findings are secondary to one:  hypothermia, which the subject is obviously close to, if not in, severe hypothermia.  A couple facts that should direct you thoughts and actions:

1.  When your liver temp (your core) reaches 92F you start losing the ability to clot blood.  Why is that important?  Because this subject also has trauma and internal injuries.  What good is splinting and patient packaging if you subject bleeds out in a hour?

2.  Contrary to what people are led to believe, YOU CAN NOT REWARM A SEVERELY HYPOTHERMIC PATIENT IN THE PREHOSPITAL SETTING FAST ENOUGH TO MATTER, especially in the wilderness setting.  All the "tricks" they teach you (warm fluids, heat packs to the groin/armpits, your body heat, etc...) are effective to an extent in moderately hypothermic patients.  Why?  Because the subject’s body is fighting to warm itself from the inside-out.  You are supporting that by removing the outside heat draining influences and replacing it with a warmer environment.  When the subject stops shivering (which he is close to), the body has virtually given up on warming itself.  So now all your interventions are on their own and (at best) will slow down the process of hypothermia and _maybe_ stabilize their peripheral temperature.  Consider what hospital staff will do for a severely hypothermic patient:  lavage by way of every orifice they have, hot water circulating blankets, heat lamps, warm air ventilation, warm IV fluids, etc. and all that together may raise the core temperature by 1-2 degrees an hour.  So we do not have all that in the pre-hospital word, and surely not in my backpack, do you really think you can raise the core temperature fast enough to matter?  Not that we do nothing:

So, I would:  take my road flare out of my pack (yes I said road flare) and start the biggest fire I can... I have a Team Leader for my team that started an entire tree on fire (on purpose) for 2 moderately hypothermic subjects.  While I am doing this, someone else needs to strip the patient and get in a bag with them while others build a shelter out of mylar blankets that has only one opening pointing straight at the fire.  Those blankets might be laughed at by most, but this shelter will reflect heat in a matter that can turn the shelter into a sauna.

Food and water is key; so we need to get stuff warmed up.  People will say that warm fluids will help raise the core temperature.  BS!  Just try this experiment:  Take 100 litters of 90 degree water and add one litter of 130 degree water... now what temperature does the 101 litters have?  Do you think that adding a canteen of warm water to a severely hypothermic patient is gonna raise the core temperature at all?  The reason I want water in this subject is that hypothermic patients need the ability to circulate blood to the entire body in order to get heat (carried by blood from the core) to where it is needed to battle the cold.  Dehydrated patients (which he probably is) have blood that is sludge; blood that has lost the ability to circulate heat effectively.  Food is energy.  Energy is heat.  He needs the calories.  Now, newbie EMTs will say, "no food and water to any patient."  Why?  What is the worst that you can do?  You need to throw every heat producing thing you have at the patient in this case or else he will die of exposure slowly.  Nothing is worse than death.  Not to mention the possibility for diabetic issues in this patient... so he needs the sugar.

As far as the other injuries go, what can you do past stabilizing possible fractures and dislocations temporarily?  The hypothermia is the most important thing and everything else is secondary!  If he is in an odd position when found, move him gently into a situation that makes warming easy... fracture and spinal care be damned... do nothing to make those possible injuries worse, but do not focus on them yet.

In SAR we have the acronym LAST.  Locate, Access, Stabilize, Transport.

Now, you located the subject as fast as possible already.  Access to the subject was not an issue.  Stabilizing is in the works.  Transport to a Hospital is a priority that needs to be moved into the works ASAP since you need to get him out.  That is why the SAR Notification that should have been put in the works long ago is key.  No one is gonna come to help if you do not ask adn you can not provide hypothermic care effectively if you throw the patient in a makeshift litter and haul ***... he will be dead by the time you get him out (a struggle that will take FOREVER).  Stabilize... then transport.  While most would want a Helo in this case, hate to be the one to break it to ya, but not always possible in the mountains with bad weather.  But, I have other ways.    Until SAR gets there, you need to make stabilizing a priority, followed by make considerations for transport.  Occupy the group with tasks, inclusing making a litter and finding a clearing to set up a signal out of logs/rock that can be identified by a helo, just in case.

Until then do EVERYTHING you can to warm him.  Stabilize fractures as long as this does not interfere with warming.  Spinal Care?  Not a priority compared to warming him; move the patient gently (as you should otherwise) and continually assess all possible injuries, but let no treatment interfere with warming!


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## mycrofft (May 11, 2010)

*Remember to balance your "oughta's" (tasks)...*

...against time (before sunset, before rescue, before you collapse), manpower, and relative benefit.


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## EMSLaw (May 11, 2010)

mycrofft said:


> Lawyer up.



"Sir, you're familiar with satellite phones?"
"And you're familiar with the area?"
"And you knew there was no cellular phone reception?"
"And yet you didn't see the need for a more robust means of communication?"

Yeah, that's going to go well.


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## EMSLaw (May 11, 2010)

Mountain Res-Q said:


> Priority 1 remains the same, and I wonder why it has not been done yet.  Get outside help started.  You may think you can do this on your own, but experience has proven to me that this is an arrogant belief that can lead to disaster.  If nothing else, outside SAR resources are a backup, just in case.  And no matter what the OP writes, his little group are neither searchers or rescuers.  They lack the training to act in those roles at 100% effectiveness, something that true SAR Teams train in religiously; SAR Teams respond when NO ONE else can get the job done and have no backup, meaning that we need to be 100% prepared.  GET SAR RESOURCES NOTIFIED ASAP.



I agree.  You're going to need help.  You might need evac for him, givne his condition.  I stand by my original assessment of the whole situation as a soup sandwich.  Little good can come of this. 



> Meanwhile, medically you are on your own in what appears to be a FA/BLS capacity.  Fine.  All medical findings are secondary to one:  hypothermia, which the subject is obviously close to, if not in, severe hypothermia.  A couple facts that should direct you thoughts and actions:
> 
> 1.  When your liver temp (your core) reaches 92F you start losing the ability to clot blood.  Why is that important?  Because this subject also has trauma and internal injuries.  What good is splinting and patient packaging if you subject bleeds out in a hour?
> 
> ...



I agree.  And don't forget the possibility of a fem-fem bypass.  But either way, he needs rewarming.  And yes, I agree - once the patient is into the stage of severe hypothermia (a core temp of less than 90F), then he cannot be effectively rewarmed in the field.

Also, remember that when the body gets cold, blood flow to the extremeties essentially cuts off.  The return of peripheral circulation is what causes the secondary drop in body temperature when rewarming is begun.  Therefore, you want to focus your direct rewarming efforts on the core.

I would go with the fire, but I would also make a hypo wrap for the patient with at least two sleeping bags and some vapor barriers - tarps if you have them, if not, then tents.  Warmed nalgenes or charcoal heat packs on the neck, armpits, and groin.     

Absolutely strip him out of the cold wet clothes - that gives you a chance to take a better look at his injuries anyway.  Oh, and don't forget to make him a diaper - a plastic garbage bag, his coat, and some duct tape will do you.  Cold diuresis is going to make him pee.  A lot. 



> Food and water is key; so we need to get stuff warmed up.  People will say that warm fluids will help raise the core temperature.  BS!  Just try this experiment:  Take 100 litters of 90 degree water and add one litter of 130 degree water... now what temperature does the 101 litters have?  Do you think that adding a canteen of warm water to a severely hypothermic patient is gonna raise the core temperature at all?  The reason I want water in this subject is that hypothermic patients need the ability to circulate blood to the entire body in order to get heat (carried by blood from the core) to where it is needed to battle the cold.  Dehydrated patients (which he probably is) have blood that is sludge; blood that has lost the ability to circulate heat effectively.  Food is energy.  Energy is heat.  He needs the calories.  Now, newbie EMTs will say, "no food and water to any patient."  Why?  What is the worst that you can do?  You need to throw every heat producing thing you have at the patient in this case or else he will die of exposure slowly.  Nothing is worse than death.  Not to mention the possibility for diabetic issues in this patient... so he needs the sugar.



The "no food" thing doesn't apply in the wilderness context.  I agree, he's going to need to get his  blood sugar back up, because his body needs it to generate the heat.

He's stopped shivering, which is an ominous sign of severe hypothermia.  Given the effects of hypothermia on the heart (he'll start producing J-waves, for instance), I agree that's the top priority, though pain and hypovolemic shock (exacerbated by his likely dehydration) is also going to be a concern.  

Okay, so, let me see if I have a full AA'P list here...  In order from greatest to least concern based on what we know now.

Assessment
1. Severe Hypothermia
2. Possible Hypoglycemia
3. Unable to clear spine 2* AMS
4. Possible FX of femur/pelvis
5. Dislocated R Shoulder
6. Broken R Arm

Anticipated Problems
1. Continued hypothermia w/ cardiac complications.  Death.
2. Insulin Shock
3. Unstable Spinal Injury
4. Continued Pain.  Hypovolemic Shock.  
5 - 6. Continued Pain.  Damage to Shoulder and arm.

Plan
1. Hypothermia wrap.  Rewarming.  Evacuation.
2. Monitor BGL, provide simple sugars.  
3. Monitor.  Stabilize.  Attempt to clear if pt. becomes A&O.
4. Splint.
5. Consider reduction of shoulder dislocation.
6. Splint.

Of course, if you have wilderness medical people with you, you can reduce the shoulder possibly, and improvise a traction splint for the femur FX with some rope and a hiking pole.  

This is a high risk patient.  Immediate evacuation is called for.  

I'll just dial them up on my trusty satellite phone... oh, wait.  

By the way, if you choose to walk him out, it'd take probably 2 days plus to hike the 20 miles.  I don't think that's a good idea.  For now, I'd probably bivvy down and, if I haven't already, send someone to summon help.  With a GPS hack if you can get one.


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## Trayos (May 11, 2010)

Now I'm going to be carrying a road flare on backpacking trips, never really thought about signaling for rapid SAR before.

Out of curiosity, Mountain Res-Q, what would you recommend taking along as a basic first aid set while doing  multi-night (but not dramatically extended) backpacking trips?


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## Mountain Res-Q (May 11, 2010)

Trayos said:


> Now I'm going to be carrying a road flare on backpacking trips, never really thought about signaling for rapid SAR before.
> 
> Out of curiosity, Mountain Res-Q, what would you recommend taking along as a basic first aid set while doing  multi-night (but not dramatically extended) backpacking trips?



I am a minimalist.  Everything should have at least two purposes.  When it comes to medical gear that is hard to do.  I kinda follow the thinking of the Old-Timer SAR Medic and Current FACEP/Trauma Center MD that istructs us from time to time.  His personal (non-SAR) medical gear consists of 1 4x4, duct tape, IBU, and MS.  No lie.  He believes that if your boo-boo is more than 1 4x4 can manage than you need to get the hell out of there anyway.  Slap the 4x4 on, tape it, use whatever other gear can be used to make splints and bandages, hit yourself up with some IBU or MS if needed and GET OUT on your own.

If you try to prepare for every medical posibility, you care likely to be carrying WAY TOO MUCh unused gear with you... gear that can be replaced with other items that you are carrying with you or can be found in nature.  And it is not the possibilities I can prepare for that are likely to be encountered... it is the really wierd crap.

I recommend to my First Aid Team members go to Wally World, buy a $10 FA Kit, tear it open, add in some personal meds and call it good.  For the EMTs, OECs, and Medics, we may carry more than that, but not much, in your standard Blitz Pack.  If specific medical gear is needed and can not be fashioned using your greatest tool (YOUR BRAIN) than it can be brought in to you and you will just have to make do.  Think of all teh things you carry in your pack that is non medical that can be used medically.  Why carry splints and trianglar bandages taht just add weight and take up space when you have hiking poles, sticks, clothing, etc that will do the job intended  but does nto look as cool.  That is what makes a real wilderness provider; not the certification or training, but the ability to take a really screwed up situation and setting and do just what you would in the urban setting, but with less gear, delayed transport, less manpower, and issues that can not be contemplated until you sit there and realize, "crap I need XXX" or "what about XXX" and realize that you need to think on your feet and do what needs to be done however it neesd to be done.

My medical gear includes:  A few 4x4s, tape, mini shears, assorted meds, ashesive bandages, tweezers, 2 military issue trauma dressings, and 2 triangular bandages.  And that is overkill.  If I was not an EMT and SAR Medical Team Leader, my entire medical gear would consist of the military dressings and asorted medications.



P.S.  As far as the Sat Phone thing goes... I have never had success with them and will not carry one.  I do have my Radio, but even if I did not, when you enter the wilderness you do so on it's terms... do not expect help to be there fast or at all... you entered that environment for a reason... LIVE WITH IT... or Die because of it.


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## Outdoornut (May 11, 2010)

EMSLaw said:


> "Sir, you're familiar with satellite phones?"
> "And you're familiar with the area?"
> "And you knew there was no cellular phone reception?"
> "And yet you didn't see the need for a more robust means of communication?"
> ...



Haha...ok, ok. Point taken...you all can have your satelite phone!! 
When we do scenerios we usually don't get one....I think simply because the last thing you want people (who are training to be wilderness leaders) to do is to be like "oh, it's cool...we called for help." which, don't get me wrong is *VERY* important but help is *still* 20 miles away, and you *still* have a patient to take care of. 

But realistically, yes you would have a satalite phone as well as a couple cell phones and you would probably be checking in with someone once a day (this person would know your entire schedule, EAP, and keep you updated on the weather if it has changed at all etc..). But again, whether help is 2 hours or 12 hours away you still have to care for your patient until they arive....I think the reasoning behind this scenerio leaving out the satalite phones is because it is ment for those doing it to focus not on "help is coming, help is coming, help is coming" but rather what to do immediatly for the patient and then perhaps even how you would go about organizing getting help....but no clue...I didn't write it (stole it actually...shhh don't tell 

Good responses though...so now that you have a satalite phone what would you do differently??


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## Mountain Res-Q (May 11, 2010)

Outdoornut said:


> Haha...ok, ok. Point taken...you all can have your satelite phone!!
> When we do scenerios we usually don't get one....I think simply because the last thing you want people (who are training to be wilderness leaders) to do is to be like "oh, it's cool...we called for help." which, don't get me wrong is *VERY* important but help is *still* 20 miles away, and you *still* have a patient to take care of.
> 
> But realistically, yes you would have a satalite phone as well as a couple cell phones and you would probably be checking in with someone once a day (this person would know your entire schedule, EAP, and keep you updated on the weather if it has changed at all etc..). But again, whether help is 2 hours or 12 hours away you still have to care for your patient until they arive....I think the reasoning behind this scenerio leaving out the satalite phones is because it is ment for those doing it to focus not on "help is coming, help is coming, help is coming" but rather what to do immediatly for the patient and then perhaps even how you would go about organizing getting help....but no clue...I didn't write it (stole it actually...shhh don't tell
> ...



I agree with your scenerio having no commnications.  If you rely on technology in this setting, you are asking for trouble.  Cell Phones, Sat Phones, GPS, etc...  take it if you must, but that is not a savior.  Have other means to deal with communciations and navigation.  Like I said, you are entering that environment on it's terms.  If you are not preapred for that, GO HOME or be prepared to meet me...


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## Mountain Res-Q (May 11, 2010)

LucidResq said:


> Either way, if we all reach the base camp, still haven't found him and still don't have help, I'd want to do a quick hasty search of the area surrounding the camp and a bit of the trail leading up to it, and then we're all coming back and having a quick lesson on line searches.
> 
> Now that we've thrown out a variety of ways to try to find him, can we find him?



Close Line Grid Searching is a last resort.  I would hold off on that.  For your active search methods you should start with a Hasty, Tracking/Signcutting, Open Line, and then Close Line.  And the Professionals shoudd get a shot at it before College Students destroy clues.  Remember that in SAR we are never looking for the missing person... we are looking for clues.  Clues led to the missing person.  

"Can we find him?"  LOL.  Of course I will; dead or alive.  I am a Professional despite what people think.


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## mycrofft (May 12, 2010)

*Maybe I'm ignorant...well, yes, I really am, but .....*

....ring ring "Hello?"
"Ah, the satellite phone worked. Yeah we have a man down in a hiking group, he's pale" (yaddidda yaddidda for half a battery) " and ...".
"Sir/Madam, where ARE you?".
"Uh, hm...in a valley?".<_<


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## Outdoornut (May 12, 2010)

mycrofft said:


> ....ring ring "Hello?"
> "Ah, the satellite phone worked. Yeah we have a man down in a hiking group, he's pale" (yaddidda yaddidda for half a battery) " and ...".
> "Sir/Madam, where ARE you?".
> "Uh, hm...in a valley?".<_<



Two words: map and compass. ^_^

Even the places I have been that have been *in* the backcountry (which apparently is defined as being 8-12 hours from help) there is a topo map availible for the trails...or at least the area you are in and even if there is a trail...you use a compass to make sure you are where you need to be.

GPS is pretty neat but it would be kinda dumb to rely soley on that. They don't always work (bad weather, deep canyon, valley etc.) and personally...I think thee is something a little creepy about relying compleltey on a piece of technology (but it *could*  just be me


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## Veneficus (May 12, 2010)

*I'm not even remotely an expert at this*

but I have a few observations and questions.

First, I agree with EMSlaw, I would definately have a satphone with me. I wouldn't rely on it, but at some point you have to prepare that if something can go wrong it will. (especially if you have ever been in the wilderness with me) The satphone, while not really the tool of purists, has the potential to summon help fast, and that lone makes it worth the weight. Let's face it, in this day in age, there are way too many inexperienced, out of shape and unprepared weekend warriors, who overestimate their own capabilities. While calling for help may show "you couldn't handle it" I don't think it should cost somebody life or limb to prove they could or couldn't. 

I also like the idea of being a minimalist. If I have to carry it in and out, it will be well worth it. Otherwise, it is not coming. I certainly am not filling my pack full of "what if" medical gear. Especially since as MTResQ pointed out, you can never be prepared for every eventuality. I am a black cloud too, even 10 minutes from a hospital I seem to get calls that there was no way to see or prepare for. 

One thing I have learned in all of my varied experiences is: the fewer important/moving parts something has, the better it works. When you start getting into all kinds of electronics, you need batteries. Batteries are heavy. They always seem to fail when you need them the most too. electronics require special care, usually cannot get wet. (especially your batteries) Don't get me wrong, I am not foreign legion minimalist, with a piece of fishing line and a knife to survive in a tropical environment for a week, but the more you have the more something will go wrong, both with the equipment and or a person. (I have never had a sherpa to carry 1000 lbs of my gear)

Well I promised a question. 

Does anyone get paid or offer to carry a bunch of medical equipment "just in case" for money? I knew a medic many years ago that made a living going on expiditions with people. From oil and gas exploration to vacationers in the outback. It seemed almost a unique job. I have never met anyone who did the same prior or since. If somebody is planning to carry around all kinds of medical crap, why not get paid for it no? There have got to be some weekend warriors who would pay for a "medic" to go with them. Maybe not enough to make a living, but a good side job. Especially if you have all kinds of SAR and wilderness quals. right?


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## Outdoornut (May 12, 2010)

Veneficus said:


> Well I promised a question.
> 
> Does anyone get paid or offer to carry a bunch of medical equipment "just in case" for money? I knew a medic many years ago that made a living going on expiditions with people. From oil and gas exploration to vacationers in the outback. It seemed almost a unique job. I have never met anyone who did the same prior or since. If somebody is planning to carry around all kinds of medical crap, why not get paid for it no? There have got to be some weekend warriors who would pay for a "medic" to go with them. Maybe not enough to make a living, but a good side job. Especially if you have all kinds of SAR and wilderness quals. right?



Some companies will...it depends on the organization. Most of the time outdoor organizations (such as NOLS) run so many 'small' expeditions at one time it's impractical to hire JUST a medical person for each party. However, if you are a guide/instructor and happen to be an EMT (or WEMT or whatever) you will be doing both...but you wouldn't be working in the context of being the "medical staff" you would be a guide and everything else would be secondary to that.

Now there are some major expedition companies (mountaineering companies for one) that do hire medical staff (only) but those staff are usually physicians or NP's that specialize in high altitude illnesses. 

But again you might be able to find smaller companies that will hire you to go along as an assistant guide but mostly "in case" anything majorly medical happens (colleges/universities programs, boy scout troups, private groups, summer camps, wilderness therapy/youth at risk camps/programs etc..)

hmm, hope this is helpful...there are various "outdoor' job listings at NOLS.edu so you may find one there if you're interested. B)


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## Veneficus (May 12, 2010)

Outdoornut said:


> Some companies will...it depends on the organization. Most of the time outdoor organizations (such as NOLS) run so many 'small' expeditions at one time it's impractical to hire JUST a medical person for each party. However, if you are a guide/instructor and happen to be an EMT (or WEMT or whatever) you will be doing both...but you wouldn't be working in the context of being the "medical staff" you would be a guide and everything else would be secondary to that.
> 
> Now there are some major expedition companies (mountaineering companies for one) that do hire medical staff (only) but those staff are usually physicians or NP's that specialize in high altitude illnesses.
> 
> ...



me and the great outdoors is inviting disaster, I was thinking more along the lines of a company that offers such services.


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## Outdoornut (May 12, 2010)

*there must be a story...*



Veneficus said:


> me and the great outdoors is inviting disaster, I was thinking more along the lines of a company that offers such services.





You don't get along with the outdoors? and disaster? There has to be a story behind that comment ^_^ or are you just a city slicker? 

But yeah you can hire out guides that work for companies. You can go onto NOLS website today and hire one of their guides and I am sure many other companies would do that as well (rent-a-guides hehe...so many comments I could make!!). But I am thinking they are probably pretty expensive...then again you would have an experienced guide with medical knowledge (WFR, WEMT) probably some SAR experience as well...so yeah I can see it being worth the $$ (heck! it's how I am going to make a living!!).


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## Mountain Res-Q (May 13, 2010)

Outdoornut said:


> or are you just a city slicker?



Flat Lander...  :glare:


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## Eydawn (May 13, 2010)

How does the pt. respond to you getting sugars into him? As you strip him down from the wet clothing, what do you see visible injury wise? 

Your first fail as group leaders was not ensuring that EVERYONE had a dedicated buddy on this "fend for yourself" gig. So you've got a diabetic photographer kid? He gets a buddy, maybe 2, both with maps and extra supplies. No offense... hindsight being 20/20 and all that. 

Pulse? Respirations? Skin color and temperature? Does he have peripheral pulses? 

Package this guy as well as you possibly can- get a vapor barrier between him and the ground as your foundation. That way, when he's all bundled up, all you have to do is lift him on the tarp into the basket when your SAR folks finally get to you. I agree with improvised splinting of the femur; I would attempt manual relocation to re-establish CSM and splint in place with whatever materials are handy. With as screwed as he is, you're not going to compromise stability of fractures or decrease possibility of positive outcome much by doing this. If you're really worried about pelvic fx, do an improvised pelvic wrap as you bundle this kid up, and splint the arm beforehand as well. 

What is your terrain like? You're 20 miles in on the trail... are there off-shoot access trails? Any juxtaposition to 4X4 trails?  Are you near a decent helicopter landing zone? It may be faster to just have them shoot you the bird right off the bat if conditions and terrain permit. If you lead backpack treks in this area often, do you have coordinates for campsites on your trail that you can send out with your "contact" group? If not, now is a good time to start figuring out where you are and draw up some rough coordinates so at least there's SOMETHING more than general directionality to go off of. 

As far as the chickie who was close to the fire and gave away her dinner, you may want to consider that she may become a second patient if you're not careful... she sounds like she's in the beginning stages of hypothermia as well. Food time for chickie! 

I would also make sure everyone else in the party is well cared for. If you've got some sort of better/closer access than the trail, I'd string some of your people out along it within visual/shouting distance of each other to make it easier for SAR to home in on you... You're in for the long haul, that's for sure. 

Wendy
CO EMT-B


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## Outdoornut (May 13, 2010)

Mountain Res-Q said:


> Flat Lander...  :glare:



I don't even know what that means... :unsure:


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## EMSLaw (May 13, 2010)

Mountain Res-Q said:


> Flat Lander...  :glare:



Is that what you mountain people call those of us who are not?


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## Outdoornut (May 13, 2010)

Eydawn said:


> How does the pt. respond to you getting sugars into him? As you strip him down from the wet clothing, what do you see visible injury wise?



Cuts, scratches, bruises...nothing to indicate internal injuries (yeah...poor guy might as well give him a break in something!)



Eydawn said:


> Pulse? Respirations? Skin color and temperature? Does he have peripheral pulses?



I think I posted this ealier...?? :unsure:



Eydawn said:


> What is your terrain like? You're 20 miles in on the trail... are there off-shoot access trails? Any juxtaposition to 4X4 trails?  Are you near a decent helicopter landing zone?



Hmm. Ok, here's a bit more info on the trail: You are in the NC mountains, the trail is well-known (in other words, maps are availible, it's online etc.) but not easily accessible except by foot. The road that leads up to the trail head is gravel and winds up the hill in "switch back" fashion (one side of the road goes up, the other side goes down) the road is *in* the woods (heavily forested) and is one lane (one of those if someone is coming from the other direction one of us is going to have to pull over...somewhere deals). Once you reach the trail head there is a small clearing (to park maybe two cars) and the trail immediatly starts a gradual ascent up for about 200 feet. After that the rest of the 20 miles are moderate/sketchy (not to hard, lots of roots, rocks, couple trees in the middle of the path) the forest is thick around you. Your group had a hard time finding a place to camp and so they had to split up into two smaller clearings (about a quarter of a mile from each other). These campsites are not labled on the map..they are just 'clearings' backpackers have found/made. There is nowhere for a helicopter to land. Poor Ryan.




Eydawn said:


> As far as the chickie who was close to the fire and gave away her dinner, you may want to consider that she may become a second patient if you're not careful... she sounds like she's in the beginning stages of hypothermia as well. Food time for chickie!
> 
> I would also make sure everyone else in the party is well cared for. If you've got some sort of better/closer access than the trail, I'd string some of your people out along it within visual/shouting distance of each other to make it easier for SAR to home in on you... You're in for the long haul, that's for sure.



Good thought! The one thing we're constantly told (and I do mean constantly) is that you have to constantly keep an eye the entire group (and each individual within the group) even if there is an injured person. The mistake now would be for all the leaders to direct all of their attention on Ryan and neglect the rest of the group. I would definitly have someone (probably another girl) assigned to Kate (I think this was her name...hehe) make her eat something, drink some warm fluids, make her a hot waterbottle to go to bed with. 

I once went on a backpacking trip it was  March and we ended up backpacking through 8 inches of snow with it snowing on us. We camped at about around 2,000 ft (give or take...we hiked up 1,000 but drove up quite a bit) in the snow. By the time we made camp everyone was cold, and tired no one wanted dinner we just wanted to go to bed. Our instructor gave us a lecture of which I would be giving to the rest of the group about the importance of eating and drinking when it is cold outside. 

I bet even though the rest of the group (excepting Ryan and Kate) seems 'ok' they are dehydrated. When it is cold outside you don't think about drinking water...cause you don't have that gross sweaty feel and because your water is cold too. I would set a goal for them "in about say...two hours...that waterbottle needs to be empty". 

Man...now I want to go backpacking!!!


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## Eydawn (May 13, 2010)

At this point, if your closest access point is that trailhead 20 miles out, you'd be best off improvising a litter and having your group try to evac this kid partway out yourselves. You're looking at 4 days or so here what with having to send runners out the 20 miles to GET HELP, help deploying, and getting up the trail to you... I'd hunker down until dawn (but I'd send the strongest hikers/runners right now) and then get moving in the morning. Even if you can only make it 5 miles, that's still a reduction by 1/4 of the total distance SAR has to evac you out in. 

Sounds like it's pretty hard for y'all to get lost on this trail, you have a known direction of travel back to civilization... so time to get creative. What kind of materials could you improvise a litter out of?

There's a good chance this kid is gonna die no matter what. That doesn't mean you have to just sit there and wait for it to happen... 

Wendy
CO EMT-B


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## Mountain Res-Q (May 13, 2010)

Eydawn said:


> At this point, if your closest access point is that trailhead 20 miles out, you'd be best off improvising a litter and having your group try to evac this kid partway out yourselves. You're looking at 4 days or so here what with having to send runners out the 20 miles to GET HELP, help deploying, and getting up the trail to you... I'd hunker down until dawn (but I'd send the strongest hikers/runners right now) and then get moving in the morning. Even if you can only make it 5 miles, that's still a reduction by 1/4 of the total distance SAR has to evac you out in.
> 
> Sounds like it's pretty hard for y'all to get lost on this trail, you have a known direction of travel back to civilization... so time to get creative. What kind of materials could you improvise a litter out of?
> 
> ...



So, you would start moving this kid immediately and ignore the BASIC principles that make up the SAR World?  LAST!!!  Locate, Access, Stabilize, and Transport.  You do not transport until the subject is stable.  In this case you can not expect the kid to survive being boardline severely hypothermic and moving him.  Stabilize him first.  As you say, he might die if you stay or go, so give him the best chance possible.  Also, consider the weather.  It will make your litter carry out REALLY hard and slow things down.  On the other hand, if you stay put and work on keeping the kid alive and stabilized he may be in a position to asist in his evacuation if the hypothermia is stabilized (something you can not do on the "road") and (better still) you may be able to wait out the storm and allow for a break in the weather where you can get a helo in for evacuation.

I stand by my original posts.  Priority 1 is SAR notification.  Priority 2 is making sure the rest of the group is secure.  Priority 3 is the patients hypothermia (remember what I said medically about hypothermia in the wilderness environment in previous posts).  Priority 4 is the other injuries.  Priority 5 is dealing with evacuation.  Until 1-4 are handled, 5 should only be a considertion that you are planning for, NOT the plan itself.


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## Mountain Res-Q (May 13, 2010)

Flat Lander:  People from the Valley or Bay Area (urbanized areas in general) who have no place in my mountians for various reasons:

Flat Landers will walk down the middle of my 35 mph road and yell at me for almost hitting their kid that is running back and forth across it.  Just because I live in the mountains does not make it an ammusment park.

Flat Landers will slam on their breaks and shut down a 55mph highway to take pictures of Free Range Cattle becasue (and I quote) they have "never seen cows in their natural habitat".

Flat Landers will go "camping" in my backyard and bring a boom box, generator, capacino maker, and complain that we do not have a McDonalds on every coroner.  Then they (no lie) will get into a gun flight at a high alpine lake with a rival gang.

Flat Landers drown in my rivers becaue they do not realize that 38 degree water that is running at 3500 cfs is a bad deal... and then try to sue us for failure to rescue their child that they shoved in the water.

Flat Landers NEVER take their trash honme with them.  They will literally dump bags of garbage on the roads and leave cans, bottles, and broken sleds in my backyard.

Flat Landers think that America has been subdued and is one giant playground.  They have no clue that we still have environments that existed in the days of Indians and the Wild West... and it will kill you.  And, no, we are not obligated to save you when you enter my mountians without a clue and screw up.  We try... but reality is that we may not be able to.

Flat Landers wither drive too fast or too slow on Mountain Roads...  Never a middle ground.

Flat Landers, although having the right to be in my Mountains, have no business here and are likely to kill themselves or others doing something stupid that makes sense from the perspective of someone that lives in an area where Starbucks, McDonalds, Wal Mart, Freeways, and the like are their ONLY reality...  I live in the Mountains on it's terms and it is my reality... just I do not belong in urbania, many people have embraced a society that has rejected the wild, but wants to visit it with an urban mindset that WILL NOT work here... just MHO.  B)


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## EMSLaw (May 13, 2010)

I have to agree with Mountain.  I think the kid is a priority evac0back to the world, but given the conditions, carrying him out is not likely to be an optimum solution.

One thing I've taken out of my own training is that it's a lot harder to carry someone any distance than you might think.  Carrying a litter even a mile with eight strong, healthy, full-grown men left us all beat.  You want to go 20 miles?  That's an invitation to disaster.  

I don't want to scream for a high-risk evac if I don't have to, but the location, inaccessible location, and patient acuity all militate in favor of risking a chopper evac.

That said, you have to summon help first.


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## Outdoornut (May 13, 2010)

Mountain Res-Q said:


> Flat Lander:  People from the Valley or Bay Area (urbanized areas in general) who have no place in my mountians for various reasons:
> 
> Flat Landers will walk down the middle of my 35 mph road and yell at me for almost hitting their kid that is running back and forth across it.  Just because I live in the mountains does not make it an ammusment park.
> 
> ...



Ha!! I love it!! Especially since I totally admit to once having been a flat lander (still have the tendencies from time to time...will admit to having driven more than two hours to get a Starbucks ^_^ ). Moved to the mountains a few years ago...definitly was a different place to live...lots of trees, 'real' wild animals (never forget the day the trash company had to come move our dumpster outside our apartment because bears had broken into it). Now...can't stand *not* being in the mountains...*even* without a Starbucks


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## Eydawn (May 13, 2010)

Mountain Res-Q said:


> So, you would start moving this kid immediately and ignore the BASIC principles that make up the SAR World?  LAST!!!  Locate, Access, Stabilize, and Transport.  You do not transport until the subject is stable.  In this case you can not expect the kid to survive being boardline severely hypothermic and moving him.  Stabilize him first.  As you say, he might die if you stay or go, so give him the best chance possible.  Also, consider the weather.  It will make your litter carry out REALLY hard and slow things down.  On the other hand, if you stay put and work on keeping the kid alive and stabilized he may be in a position to asist in his evacuation if the hypothermia is stabilized (something you can not do on the "road") and (better still) you may be able to wait out the storm and allow for a break in the weather where you can get a helo in for evacuation.
> 
> I stand by my original posts.  Priority 1 is SAR notification.  Priority 2 is making sure the rest of the group is secure.  Priority 3 is the patients hypothermia (remember what I said medically about hypothermia in the wilderness environment in previous posts).  Priority 4 is the other injuries.  Priority 5 is dealing with evacuation.  Until 1-4 are handled, 5 should only be a considertion that you are planning for, NOT the plan itself.



I didn't say you should move him before stabilizing him. I'm saying that with your extended time window, you should consider getting him closer to your access point as soon and as safely possible. You have a lot of hands available. You don't have to he-man rah rah up the trail and bounce the crap out of the kid; you don't have to go while the weather is still craptastic. You can definitely take your time and make sure the kid is nice and stable (as much as he can be) before you attempt to move. If moving isn't working, then you can hunker down 300 yards away from where you started. 

Nowhere did I indicate that it was preferable to take off in bad weather without stabilizing... I assumed that it would be inferred that those would be considered first. My bad. 

We've already established that a helo is not an option unless we have the option of calling in military resources for a live lift with a penetrator. Is that possible in this scenario? If it is, that changes the picture a bit. As it stands, I'm going on the assumption of no helos. 

At this point, I'm assuming we've provided for the safety of the group, as no further information on that has popped up. I'm assuming we've splinted the injuries and begun rewarming as much as we can for this kid. Of course you're not going to move someone who's not stable. 

What I am saying is that it may be advantageous to decrease the total evacuation time by being proactive. 

As far as the LAST acronym, your location is on this trail (as long as you stay on it, they're going to find you there), your access point is 20 miles away, you've already initiated stabilization, and it's going to be a lot easier on rescuers to use a litter/wheel for 15 miles after hiking in than it will to go for 20 miles. (Again, I've reread the posts and is there potential for any 4x4 access? ATv's? Something?) It also will keep the college kid group from freaking out. The best thing you can do to keep up their morale and make them more proactive is to give them something constructive and useful to do. 

I agree that carrying the litter is a major b!tch. This is why you need a lot of people to effectively conduct a rescue. As far as the kid being able to help with his evacuation with a broken femur... not very likely... while I would agree with that evaluation for someone who's just hypothermic, this kid's injuries kind of preclude that. 

Wendy
CO EMT-B


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