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Partner ewtotel


Aug 31, 2006, 5:29 PM
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Is there a "right" response in this sort of accide
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Regarding http://www.rockclimbing.com/...hp?p=1441330#1441330 (The climber they are currently searching for in Colorado...)

I've been wondering since I read this ... is there a "right" decision in this case? I don't know what I'd do ... Can any of the SAR guys jump in?

(I'm not wanting to second guess anything Powers did, I just want to try to decide how I will react if the same thing ever happens to me...)

My mind pulls me in both directions... as I'm sure his did.


jmeizis


Aug 31, 2006, 7:04 PM
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You've got to wonder how serious the injury to the head was that Mr. Powers didn't try to walk out with him. I can only assume that it was serious enough that he didn't think he should be moved. In consideration of that it seems like he may of not had a lot of choice. Depending on how well travelled the area is he may have made an intelligent decision knowing the likelihood of rescue was very slim. Decisions under constraints like that are, to say the least, difficult. One can always look back and realize what they should have done, but it's hard to see the forest from the trees.

Someone more familiar with the area would probably have a better idea on how travelled the area and what the actual constraints of the problem were.

Hope they find him.


overlord


Sep 1, 2006, 3:06 AM
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it depends(tm). on many factors.

how well traveled is the area, the seriousness of injury (can you afford to wait?), distance to nearest communication opportunity etc.

and its a hard call to make. if he cant be moved, i wouldve probably done the same thing. but now that i know that a victim might wander a bit (didnt even think of it before), id try to seek a way to minimize the risk. like laying him down and telling him hes not to move no matter what.

oh, and thats the reason why you should always hike in group of at least three ppl. so one can always get help and one remains with the wictim.


climbingnurse


Sep 2, 2006, 2:46 PM
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Well, I have a fair bit of medical experience/knowledge and I'm still not sure what I'd do in this situation. In the field, it is extremely difficult to figure out the severity of a head injury. Even with a CT scanner, MRI, and all the other gizmos I have at work, it often comes down to "let's see what happens when/if he wakes up".

If the patient is awake but incoherent I think I'd try and help him walk out. If walking him out wasn't an option I'd be hesitant to leave him as there's a really good chance he'll wander off and find a really good hiding spot (which is probably what happend in this case). I might just tie him to a tree if that's really my only option. (That said, I've had patients wiggle out of leather restraints, so that might be futile too.)

If he was unconscious but protecting his own airway and I couldn't carry him out (which is a very difficult thing to do even on flat ground) I think I'd probably run for help. That too has its problems though. What if a mountain lion stumbles on him? What if he wakes up and wanders off? What if I can't find the spot I left him? It would be very difficult for me to leave someone like that.

If he was unconscious but not protecting his own airway, well then he's completely screwed. Nothing I can do unless I can call the cavalry from where I am inbetween rescue breaths.

People I climb/hike/whatever with often say "Gee, it's great to have an ER nurse with us." My standard response is "that just means I'll know exactly how screwed you are." The wilderness is a really bad place to need a nurse/medic/doctor/whatever. I am not likely to be able to provide any more care than someone with basic FA training could. The only difference is that I'll know how futile it is.


climbingnurse


Sep 2, 2006, 2:51 PM
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oh, and thats the reason why you should always hike in group of at least three ppl. so one can always get help and one remains with the wictim.

Sure, and you shouldn't drive in the rain, or drink to excess, or go climbing, or have sex, or run with scissors, or...

Really, the safest thing you can do is sit at home on your couch and wait for that heart attack at 55. That way you will die accident free. Good for you.


Partner tgreene


Sep 2, 2006, 3:21 PM
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Honestly, if I were in that particular situation, I believe I would have waited out the night with him, just because I was always taught to never let a concussion victim fall asleep...

If Lance was actually unconcious for 4 hours, then the "Golden Hour" had long since expired anyway, now add another 2-4 hours to get out and back w/ SAR, and who knows what could happen. Also, a lone individual racing through the mountains at night, in order to get a rescue team to his friend, greatly increases the odds of having 2 victims. This is why most rescue operations are called off during dark hours.

I pray that he's found alive! :angel:


norm1057


Sep 2, 2006, 3:25 PM
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I have been an EMT-B Firefighter for a few years. If my partner loses consciousness due to a head injury and is not recovering rather quickly, I would immediately head off the mountain for help. It would be entirely too much work to extricate a victim in this condition a mile and a half alone. The patient in this case took his fall at 10 pm. Waiting till he regains consciousness at 2 am is entirely too long to be waiting to do something. Head injuries can be quite serious and hard to diagnose as climbingnurse stated. However, a prolonged loss of consciousness is a definite sign your friend is in deep trouble and requires definitive care from a hospital. It will be interesting to see how this case will end up. From the other post, I would agree with parts of this story not adding up. But this could also be due to a typical media misconception. I hope it ends well.


give_r


Sep 2, 2006, 3:39 PM
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Remote/Wilderness FA and Remote/Wilderness First Responder courses are well worth taking. I was amazed at the things I didn't know and now feel naked if I'm climbing without my first aid kit in my bag. I've heard of doctors and para-medics that have learned lots of new things from these courses. Not to say that in a difficult situation like this one, that training would mean a life saved, just a different mentality towards trying to solve it or prevent it in the first place...


teddyp324


Sep 2, 2006, 5:21 PM
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As I said in the actual post about the accident, the injured climber was not able to be taken out by his partner. The injuries he sustained would have been made worse if his partner had tried to move him. I personally would have been better prepared and not been out that late at night, but I would have stableized the person and imeditaly gone for help. Unfortunatly it is looking more and more like a search for a body now that its been 4 days. We can still hope for the best and that the SAR teams find him alive.


majid_sabet


Sep 2, 2006, 7:11 PM
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I seen few cases like this in my time so here is my 2 cents on this incident based on field experience.

When you are in the wilderness situation with head injuries on party of two, you got only two options.

1- run and get help leaving partner behind hope to get back soon with SAR .



2- stay with partner till morning, think about plan B and C , hope he does not die on you while doing CPR all night and go thru nightmare of messing with blood and .....


Based on how bad his injuries were (we do not know that) partner may made the right thing to go for SAR leaving partner behind.

Dealing with reality

1- Injured partner wonder off not knowing where he was going and he is still lost (after 4 days, its going to be very bad).

2- He is lost cause he wants not to be located due to whatever (I seen that a few as well).

So what you do in their case, I do not know, I could tell you that most people never think about plan B and it's application in the wilderness thinking every thing is going to be fine or this may never happen to us etc but you must have plan B, C, D,E .

Letís just hope for the best

Majid

(


lhwang


Sep 2, 2006, 7:27 PM
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I'm not sure how comfortable I feel commenting on this because I don't know the whole situation, but I will just add that with head injury, you often need to consider the possibility of a C-spine injury (ie if the mechanism of injury is a fall).

Even if the person is walking around and moving normally, they could still have a C-spine injury. I can only assume that Mr. Powers made the best decision he was comfortable with given the circumstances and am so sorry that he had to make that kind of judgement call.


teddyp324


Sep 2, 2006, 7:37 PM
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I have had a C-spine injury and the MOI was a fall, and I didn't know I had 2 compressed and fractured vertibre until i went to the ER... Neither of the people involved had wilderness medical training, and I think anyone who does outdoor activites should have basic 1st aid skills.


reno


Sep 2, 2006, 9:33 PM
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Lots of replies in a single post. None of them are intended to be personal attacks.

1.
In reply to:
it depends(tm). on many factors.

This is exactly, 100% correct.

2.
In reply to:
I was always taught to never let a concussion victim fall asleep...

This is not emphasized anymore. At least not very much. If they have a concussion, they can go to sleep, no problem. It's best if they sleep on their side, rather than on their back, just in case they puke (wouldn't want them to aspirate... wouldn't be cricket, you know.)

3.
In reply to:
Even if the person is walking around and moving normally, they could still have a C-spine injury.

The chances of this are so rare as to define unmeasureable. The National Emergency X-Ray Utilization Study (a.k.a. NEXUS) used several clinical criteria to evaluate the probability of spinal injury. The results (verified by repeat study, meta-analysis, etc.) show that spinal injury without signs is almost a myth (IIRC, they had 2 out of 35,000 patients that had a vertebral fracture, and neither of those had cord damage.) Point being this: If they don't have symptoms of a spinal injury, they don't have a spinal injury.

4.
In reply to:
something about the "Golden Hour."

There is no such thing as a Golden Hour. It's myth, urban legend, and a marketing ploy. There is no science behind the idea of a "Golden Hour."


Partner ewtotel


Sep 2, 2006, 10:11 PM
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The chances of this are so rare as to define unmeasureable. The National Emergency X-Ray Utilization Study (a.k.a. NEXUS) used several clinical criteria to evaluate the probability of spinal injury. The results (verified by repeat study, meta-analysis, etc.) show that spinal injury without signs is almost a myth (IIRC, they had 2 out of 35,000 patients that had a vertebral fracture, and neither of those had cord damage.) Point being this: If they don't have symptoms of a spinal injury, they don't have a spinal injury.

I have heard of the NEXUS criteria used for evaluating c-spine injuries, but really know nothing about it ... this isn't my area. I had never heard of this part of the study, which I find intriguing. I've been googling for a while to see if I can locate the actual study, but all I've found is 105,000 references to it. If you know of a place online I could read more, I'd appreciate it.

(I'm particularly interested because of all the grief my partner and I got from all our EMT, Paramedic, and nurse friends after I walked out of the gorge after a long fall to the ground.)


reno


Sep 2, 2006, 10:19 PM
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I have heard of the NEXUS criteria used for evaluating c-spine injuries, but really know nothing about it ... this isn't my area.

I'll send you a PM with more info, as this open thread isn't really the right place for such information.


lhwang


Sep 3, 2006, 9:00 AM
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In reply to:
2.
In reply to:
I was always taught to never let a concussion victim fall asleep...

This is not emphasized anymore. At least not very much. If they have a concussion, they can go to sleep, no problem. It's best if they sleep on their side, rather than on their back, just in case they puke (wouldn't want them to aspirate... wouldn't be cricket, you know.)

3.
In reply to:
Even if the person is walking around and moving normally, they could still have a C-spine injury.

The chances of this are so rare as to define unmeasureable. The National Emergency X-Ray Utilization Study (a.k.a. NEXUS) used several clinical criteria to evaluate the probability of spinal injury. The results (verified by repeat study, meta-analysis, etc.) show that spinal injury without signs is almost a myth (IIRC, they had 2 out of 35,000 patients that had a vertebral fracture, and neither of those had cord damage.) Point being this: If they don't have symptoms of a spinal injury, they don't have a spinal injury.

Agree 100% that the "no sleep if you're concussed" rule is no longer emphasized. We do recommend though that someone try to wake them up every few hours or so just in case they have an expanding brain hemorrhage or something like that.

If you look at the NEXUS criteria to rule out clinically significant neck injury, which are: 1) no midline C-spine tenderness, 2) no focal neurologic deficit, 3) normal level of alertness, 4) no evidence of intoxication and 5) no painful distracting injury, you can probably imagine at least a few wilderness scenarios where one of the criteria would be met. Especially with #3 and #5, (and maybe #4 too given some of the climbers I know!)

I agree it's rare, but I did make this mistake once in the early days of my residency and although the patient turned out to be okay, I've never forgotten it. Also, during my elective orthopedic surgery rotations in Thailand and Indonesia where they get a LOT of trauma (damn motorbikes), we saw at least a case a week where the patient had been walking around initially then ended up having a C-spine injury. So it can happen, and it can have serious consequences. And actually, if you look at a validation study of the NEXUS criteria published in the Canadian Journal of Emergency Medicine, of the 35,000 patients, there were 4,309 patients who had none of the 5 clinical criteria and of those there were 8 radiologic injuries, 2 of which were clinically significant.

I think you're right that your average layperson probably wouldn't be able to adequately assess neurological status or use the NEXUS criteria properly, so I still think it bears repeating that if you fall 15 feet and whack your head, do consider the possibility of a C-spine injury.

ETA: Reno, you may also want to check out the Canadian C-spine Rules as these are slightly different from the NEXUS criteria and were found to be more sensitive and more specific in a study published in the New England Journal of Medicine.


reno


Sep 3, 2006, 3:56 PM
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I think you're right that your average layperson probably wouldn't be able to adequately assess neurological status or use the NEXUS criteria properly, so I still think it bears repeating that if you fall 15 feet and whack your head, do consider the possibility of a C-spine injury.

Agree, in principle. But in a case of a looming disaster, I don't think it's prudent to spread the fear of possible spinal-cord damage to the point it stops people from evacuating to safety. As a paramedic, I often hear people tell the story of "some dude" who "had an unstable c-spine fracture, was up and walking, then turned his head the wrong way and fell over paralyzed." Considering how many times I've heard some variation of that story, I have to wonder where all the paralyzed people are....Must be a city full of 'em in South Dakota or something.

In reply to:
Reno, you may also want to check out the Canadian C-spine Rules as these are slightly different from the NEXUS criteria and were found to be more sensitive and more specific in a study published in the New England Journal of Medicine.

Yep, read them, like them, agree with the data. But getting American doctors to adopt research from anywhere other than the US is kinda difficult. There's some amazing ortho literature from Russia, India, and Eastern Europe. But you think that a doctor at Man's Best Hospital will follow it? Not on your life.


ghostguy6


Sep 3, 2006, 7:58 PM
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There is no such thing as a Golden Hour. It's myth, urban legend, and a marketing ploy. There is no science behind the idea of a "Golden Hour."
I believe this expression has carried over from heart attack victims, a heart attack/ stroke victim stands a better chance of finding the cause of the problem within 1 hour.

The decision has to many variables to give an accurate answer, type of injury, surroundings, weather conditions, gear available etc all play a major factor in any situation,

What I can say is always prepare for the worst possible outcome. Even a small but well stocked first aid kit can be of great use to those who know how to use it. If you carry a first aid kit with you don't be afraid to add a few things you might need. I added a set of pen flares and I can say the extra few grams of weight more than paid off in the long run. Everyone who goes out into the wilderness should at least have some basic first aid knowledge and knowledge of how to react in an emergency.


reno


Sep 3, 2006, 10:24 PM
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In reply to:
In reply to:
There is no such thing as a Golden Hour. It's myth, urban legend, and a marketing ploy. There is no science behind the idea of a "Golden Hour."
I believe this expression has carried over from heart attack victims, a heart attack/ stroke victim stands a better chance of finding the cause of the problem within 1 hour.

Actually, the original use of the phrase was coined by R Adams Cowley, a trauma surgeon in Maryland who was trying to get funding for a "trauma center" hospital. He stated that he had data that showed a remarkable increase in survivability of injury if the victim got to surgical care within an hour. Thus, he termed it "Golden Hour."

Problem is there is no such data. Best info out there shows 71 minutes for humans, and 60-something minutes for animals (dogs, IIRC.) There's no data that shows one hour is a magic number. It was a marketing ploy, no more.

The concept is valid: Critically ill and injured people need to get to a doctor as soon as possible, but "Golden Hour" is no more than a catchy phrase.

Sorry for the thread drift.... this is one topic I've lectured on and spoken about at various conferences, as it's one of my personal peeves.

There is no Golden Hour. Period.


porcelainsunset


Sep 3, 2006, 11:23 PM
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What about the golden rule, dose that still exist?


fmd


Sep 4, 2006, 6:06 AM
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In reply to:
Lots of replies in a single post. None of them are intended to be personal attacks.

1.
In reply to:
it depends(tm). on many factors.

This is exactly, 100% correct.

2.
In reply to:
I was always taught to never let a concussion victim fall asleep...

This is not emphasized anymore. At least not very much. If they have a concussion, they can go to sleep, no problem. It's best if they sleep on their side, rather than on their back, just in case they puke (wouldn't want them to aspirate... wouldn't be cricket, you know.)

3.
In reply to:
Even if the person is walking around and moving normally, they could still have a C-spine injury.

The chances of this are so rare as to define unmeasureable. The National Emergency X-Ray Utilization Study (a.k.a. NEXUS) used several clinical criteria to evaluate the probability of spinal injury. The results (verified by repeat study, meta-analysis, etc.) show that spinal injury without signs is almost a myth (IIRC, they had 2 out of 35,000 patients that had a vertebral fracture, and neither of those had cord damage.) Point being this: If they don't have symptoms of a spinal injury, they don't have a spinal injury.
4.
In reply to:
something about the "Golden Hour."

There is no such thing as a Golden Hour. It's myth, urban legend, and a marketing ploy. There is no science behind the idea of a "Golden Hour."



UH OH!!!! somebody needs to inform NREMT....Might want to inform the life flights of this also so that they dont have to be in a damn rush all the time...... Oh BTW...Dr. Adam Cowley had said LIFE THREATENING for the Golden hour......


fmd


Sep 4, 2006, 6:48 AM
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What about the golden rule, dose that still exist?


Excellent point.........


reno


Sep 4, 2006, 7:26 AM
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UH OH!!!! somebody needs to inform NREMT....Might want to inform the life flights of this also so that they dont have to be in a damn rush all the time......

We're trying.... believe me, we're trying. :D


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