2011 - JMFrost - Caving First Aid and Rescue

Transcript

1. JMF - December 2011 First Aid and Rescue on Caving Trips - A Personal View
2. Talk Summary • Is caving dangerous? Why? • What do cavers die of? • What first-aid / rescue gear do we have? • Accident Response • Callouts, Rescue & Unhealthy Attitudes • Further Reading
3. Is Caving Dangerous? To the lay person (+ parents!), caving appears extensively risky and dangerous. You should by now appreciate that a considerable portion of the sport of caving concerns risk reduction and mitigation – from the first day we adapt our behaviour for the underground environment. A BCA analysis suggested that the overall fatality rate (~1 per year) was less than that experienced on the roads by cavers traveling to the caving regions. Caving is safer than the drive up there... Vs.
4. Caves are super stable...
5. A Long way from a place of safety... However: * No telephones, * No radios, * No helicopter rescues, * No GPS / EPIRB. Caving hasn't really benefited from the INCREASE in safety of open-air sports due to technological advance in the last 50 years. Most First Aid courses assume Paramedics are ten minutes away. Even the 'outdoor' or 'expedition' courses assume communication is somehow possible (satellite phone, EPIRB etc.)
6. If an accident occurs, you WILL be alone and dealing with it by yourselves for a number of hours (perhaps 4—6hrs typically, in the UK). Someone on the surface must therefore instigate the rescue. → The 'Callout' System or Send someone for help? First aid courses are useful, but keep an open mind on what to apply underground. The quality of care you can give underground is extremely limited. Serious injury is likely to result in death. If the injury has occurred as a result of conditions (i.e. weather), you must carefully consider what to do with respect to ensuring the survival of the other members of your party, including yourself. So... ?
7. What do cavers die of? Novice cavers are terrified that the GEAR will kill them (rope or gear failure). Essentially this never happens. CRO dealt with 11 sports caving incidents in 2006: Floods – 3 Falls – 2 Exhaustion – 2 Jammed on SRT rope – 1 Marooned – 2 Lost – 1 The particular compound danger with caving is exhaustion leading to lapses of judgment, falls etc. You must be prepared to turn a trip: The cave will always be there – “Death is for ever”
8. Prevention... Don't fall down anything big. Don't drown. :) Keep warm, keep fed. Cold / Wet / Hungry & insufficient thermal protection → Exhaustion Exhaustion → Slipping Slipping → Injury & etc. Lots of cave rescue incidents are related to wet conditions
9. The potential accidents, circumstances, strength and makeup of team underground, weather, expected rescue response, logistical situation, cave passage & etc. are so variable that there are no hard rules for what to do in an accident: → you will have to rely on your judgment. ← BUT, you can still prepare and practice. * Always carry a sensible amount of rescue/first aid equipment * Get a first aid qualification * Think about and try to understand caving accidents Thermal management is probably the most important thing
10. Lost in the Dales Dales are a series of ~N-S valleys Generally, walk either E or W + down off the fell to get back to the minibus Think about where you are, how to get back in poor viz / blizzard. Consider taking back bearings, stashing GPS at cave entrance. (With suitable waypoints - otherwise your GPS is useless!)
11. Equipment You're unlikely to have much... carrying gear in caves is a logistical challenge. * Basic gear around your neck (i.e. always with you) * Minimalist First-Aid kit in SRT Bag (almost always with you) * Rescue Tackle Sac / Grab bag (minibus) * Underground Camp First-Aid Kits (in-situ)
12. 'Leader' Equipment ( Watch + Knife + Whistle + backup light(s) + spare jammer + first aid + survival bag + FOOD ) EVERY TRIP → you should feel naked without ←
13. Leader Equipment Knife • Cut Rigging Rope • (i.e. Bar Pot, student jammer'd in roof) • Cut Tackle Sacs Lanyard / Harness • (i.e. Quaking OUCC, burnt-out to free) • (i.e. Jarv suspended, Large Pot) • Mid Rope Rescue • Fix light (contacts) • Cut Cheese (99% of use!) Petzl Spatha & minimalist Swiss-army knives seem popular choices
14. Leader Equipment Whistle • Communicate on big pitches • 1 Whistle → Stop / Attention • 2 Whistles → Rope Free / Oh. Kay. • 3 Whistles → Something Wrong / Returning • 6 Whistles / lots → HELP! • When lost / separated from group • To guide rescuers to your location • Lost on the fell • Stop you getting lost / dead reckoning in fog Compass
15. Leader Equipment Survival Bag (Ours are mostly transparent) About 8ft long Get inside & sit with knees drawn up, pull up over head like cowl Light candle and place Between legs (inside) Sit on rope / tackle sacs etc. To avoid contact with rock Spoon for Survival
16. SRT Bag First Aid This is first aid. No plasters, no antiseptic wipes.
17. Micropore Tape / Steristrips → Wound Closure Candles / Lighter / Matches → Warmth Pencil / waterproof paper → Notes to outside world Triangular Bandage → Big wound / making a sling Drugs (in film cannister with matches): Ibuprofan / Paracetamol / Dihydrocodeine → Pain Killers (Nb: Illegal to prescribe medicine, so instead say “I have some ibuprofan, would you like some?”) Loperamide → Diarrhea (long blue / yellow capsules) SRT Bag First Aid
18. Pre-tibial Laceration - i.e. Tetley 2005 (not actually a photo Of Tetley!) SRT Bag First Aid Micropore Tape / Steristrips → Wound Closure These are surprisingly effective... BUT, can't stick to blood (no sticky tape can), so compress till bleeding stops, wipe away coagulating blood on surface etc.
19. Grab Bag Bothy Bag (good for lunch!) Blizzard Bag Full (serious) First-Aid kits - sam splints, sutures Enough stuff to make a large difference...
20. So someone's had an accident... DON'T PANIC! Get them off the rope ASAP (suspension trauma). Don't run off – you're the casualty's lifeline (the Golden Hour of first aid). If multiple casualties – Triage (assess which to treat first). The casualty will have a massive adrenalin hit: calm them down, get them to stay still, assess them Even seriously injured casualties act embarrassed Take time. Write things down. Do a head-to-toes survey. Beware quiet casualties – a sign of serious injury / deep shock.
21. (In every first aid kit)
22. Callouts Callouts are the method by which we deal with the lack of underground to surface communication which would allow a reactive rescue. A very loose callout is no callout at all (i.e. 12hrs+ for a 4hr trip?). You should do everything you can, short of risking life or limb, to make your callout. Perfectly reasonable (IMHO) to have a separate ETA & callout. Size of callout relative to predicted time of trip varies considerable – strength & endurance of party, whether party could split in even of accident + have some come to surface, and likely surface conditions / timing of rescue (i.e. Dawn callouts). 1.5 x the predicted 'everything going smoothly' time is a ballpark figure If you never come close to a callout, even with screw ups / surprises, your callouts are probably too lax. … but, be prepared to cut trips short to make your callout...
23. Should I call the Rescue? Default position of – YES! In the UK, you will be put in touch with a cave rescue coordinator. These are seriously experienced cavers & cave rescuers. They will talk to you, assess the situation, and organise a suitable and proportional response. One nice & productive thing to do rather than fret in the minibus as a callout draws closer is to pack food & (ideally hot) drink, and take with you to the cave entrance. In many caves you can see whether the first rope is still present and confirm they're underground (i.e. not lost on the fell). Sometimes you can shout down the entrance pitches + communicate (particularly, Derbyshire), or meet the first exiting caver. Pay attention to lights on the fell as you walk up, in case they're lost and in some strange location. → In Yorkshire this certainly puts you in a position of much more knowledge (+ better phone signal!) for when you call the rescue. → Beware the pissed cave hut bullshitter ←
24. Calling the Cave Rescue Phone 999 Ask for POLICE Ask for CAVE RESCUE (You may have to argue with the operator!) Operator Stupidity: (be prepared!) * May try and fob you off on Fire Service / Ambulance / Coastguard (NO NO NO!) * Will keep on asking you for a postcode Where are you? Always get YORKSHIRE police (not Cumbria, not Lancashire) when in Yorks From West to East you are likely to be in a place such as: Easegill (Bull Pot Farm), Leck Fell, Masongill, Kingsdale, Ingleborough, Kirkby Lonsdale In Derbyshire you're likely to be near Castleton Mendips, you are probably near Priddy, or Charterhouse (also near Priddy) Wales – OFD: Pen-y-cae / Swansea Valley, Neath: Neath Valley, or Aggy/Daren: Llanngtock
25. Dangerous Attitudes “If you take first aid equipment, you're clearly planning to have an accident!” – Sounds unbelievable, but I've heard it before... “I better go to rescue them then... As soon as I've finished this beer.” – Unfortunately the nature of caving huts + evening call outs mean that whoever is left in a vaguely sober state & responsible position will have a lot of pissed fuckwits to marshal, as well as a rescue to organise. Beware the university : regional club relationship.
26. Dangerous Attitudes “Just put some butter on it and go to bed...” – advice to a 19 year old girl who'd fallen on the wood stove and got 2nd degree burns over most of both of her forearms (skin dangling off), and was visibly shaking with shock (eventually they were convinced to take her to hospital...) More and more panicked talking over beer is less helpful than having a simple plan & preparing (i.e. filling thermos, packing tackle sacs, putting together caving gear, charging mobiles, changing headlight batteries etc.) Designated drivers are pretty useful too :-X
27. http://www.oucc.org.uk/current/clubdocs/rescue%20guide.pdf – OUCC / Gavin Lowe – Expedition Rescue Guide http://www.furbrain.org.uk/musc/first_aid.pdf – MUSC First Aid by Dr Phil Underwood Link dead, local Google Drive copy - https://drive.google. com/file/d/0B3IVS9y2g3bAR1d0RTY4ZFhSSWs/edit?usp=sharing Further Reading
29. Jarv's Favourite 1st Aid Book Pete Steele (MD) was an expo doctor to a number of mountaineering & far from help expeditions, and then a wilderness GP ('From Everest to Yukon'). Book is to the point, contains information on high international / dangerous procedures that have to be carried out when 'far from help'. Hour long Lecture on his life: http://www.bris.ac. uk/centenary/listen/lectures/steele.html ~£2.81 2nd hand from Amazon Tiny, light, water resistant pages, good to read in advance, also suspect it'd be a good reference 'at the time'
30. Jarv's Favourite 1st Aid Book 1988 Version has the most Amusing illustrations 1999 otherwise appears mainly unchanged
31. Jarv's Favourite 1st Aid Book It really doesn't mess about...
32. • Open the airway • Stop any bleeding • Keep them warm • Get help (Dr Phil Underwood, MUSC 'First Aid for Cavers') Minimal Summary