A couple of years ago I was cragging next to a guy who took a nasty ground fall (VERY lucky as injuries weren't life-changing or ending, but he was knocked out, bleeding and in bad shape). His partner has just finished a Wilderness First Responder course the week prior and after the fall went into full first aid algorithm mode. The partner was borderline panicked but did a fine job and we all helped stabilize the guy and roll him off of his harness full of cams.
I was on a mountain rescue team for 10 years and in my experience, there's basically nothing you can do without ALS, advanced kit and drugs. You simply have to wait for rescue. I tried to calm the partner down, explained he was doing great, and that we just had to wait. Once rescue arrived there was a doctor who took control of medical. The partner talked to the doc and said "damn I forgot to check for battle sign" to which the doc said "so what, what could you have done?".
It's really disempowering, but I wish more people understood that accident victims in remote settings are either stable or going to die. In my years on the team we only had three subjects who were truly on the edge. In two cases the only reason they survived is because we immediately had a helicopter that flew us in and the patient out. The third died during transport while we were in brutal conditions at night. Every other victim was either miserable or already dead as it simply takes a long time for help to arrive. It wouldn't surprise me if this story is a bit different in Europe (I'm in the US) where the travel times for helicopters are incredibly short (and therefore fast) and the rescue services are world-class.
Your post has some good points and tools I wasn't aware of, thanks!
Thanks Justin, that's great insight. I have a friend who had his arm ripped off by a boat propeller (well, twisted off), and he went a pretty long time without pain meds before he saw a professional, in fact he said he didn't feel anything until the surgeon poured ice onto his stump (he had his arm sewn back on). Also have a friend who rapped down El cap with a missing finger. Oh, and the you've got Joe Simpson and Doug Scott crawling down mountains to survive. Not sure if I included it in the piece, but I once got a nasty burn on my thumb after picking up a frying pan that was very hot (I thought the stove was off, but it had a slight flame still), and thought it might be trip ending (it REALLY hurt). All I did was put my hand in a pan of water straight away, and slept with it in the pan till morning, and somehow, the thing was 100% better! I think the aim of such a first aid kit is really a 'patch up' kit, that aims to carry out makeshift repairs, so you can either get down without doing too much damage, or give the illusion of control, but really, when it comes to an accident, it's all down to ones ability to be stoical about it.
Damn, that boat propeller accident is awful! Great stories and examples, too. I have never considered burns in the mountains (you did include it in the post) and that's a huge takeaway.
You know, your very last sentence is so damn important. I'd be happy to read a post just about that (maybe you already have?!). People vary a lot with how much they can naturally handle stress of an emergency, as well as blood, body parts bending the wrong way, etc. Thinking creatively and remembering your skills can become 10000x more difficult and, unfortunately, you don't really know until you experience it.
Years ago I climbed Middle Cathedral with a random partner from Camp 4. She was a totally solid climber but it took us awhile and we topped out as it was getting dark. I remember rapping into the dark void of that gully being a little wild, but I was focused and happy about the day of climbing, and confident I could reascend if I'm missed a station. I didn't realize until we got to the ground how nervous my partner had been. She later told me how glad she was to be with me, as I was so calm and focused. I'm not a great climber, but have rambled around in the dark enough that it didn't bother me too much. It obviously wasn't an emergency or a huge deal, but those are kinds of experiences where partners really reveal themselves. While she leaned on me, she also also kept her shit together which was awesome.
If things get weird, will you show up for me? Will you keep your shit together? I've had people show up for me big time. Those are the people who I go into the mountains with. With the rest I just go single pitch sport climbing. :)
My experience of codeine is that it is completely useless for stopping pain (opposite to the highly effective co-proxamol which really did stop pain nicely - before some medical genius banned it and replaced with the useless codeine-paracetamol "cocodamol") - however it causes massive constipation (which GPs always seem to fail to warn their patients about, thereby needlessly burdening NHS with longterm haemorrhoid and anal tear patients) - however this does make it a useful anti diarrhoea drug. Tramadol is a separate chemical - supposed to be a stage heavier duty. But for many people it still doesn't do much for pain, while also causing nausea. At the high end, Oxycodone is highly effective, and has some capability to stop extreme pain from severe injuries, but no UK doctors will give it to you (even when you do have a severe injury - unless maybe if you are dying from cancer or something). I might have saved a few from a severe back injury and kept in my mountain kit, and might have given one to my mate when he decided his ankle hurt too much to walk off Snowden horseshoe years ago - and 5 mins later I might have been unable to keep up with him as he ran down the mountain singing... ;-)
I think Dr Shipman caused far more pain to be endured, and by so many in the UK, than he did to anyone he killed, now that doctors are terrified of prescribing effective pain relief, even to the dying.
Not sure if it's that or if it's plain stupidity. I think they were always pretty crap on pain meds in UK. I'm regularly advising people with severe nerve pain from disc injuries - I've recently had GPs refusing to give them pregabalin (non-narcotic, non-addictive, and highly effective for nerve pain) while giving them six boxes (literally) of valium (which is potentially addictive and is not actually a pain killer at all) - meanwhile I'm advising friends with severe anxiety who really could benefit from a bit of valium, but GP shit their pants and give them propranolol which doesn't work. I don't think there is any explanation except increasingly crappy dumbed down education and training, and most (not all) being pretty thick - paper pushers who's job is to do what the computer tells them. Can't count how many have tried to listen to my chest by placing stethoscope on outside of my t-shirt - apparently they removed stethoscope 101 from the curriculum... But with pain meds there also seems to be a significant element of just not caring about their patients. Def there are still some good drs - but seems to be distinctly a minority. Sorry I've rambled off topic! Thanks for the article - def useful. I'm also of the "duct tape around a pencil" school - can use it to splint, sling, patch up wounds probably more effectively than conventional bandages.
Great post, Andy. Refreshing.
A couple of years ago I was cragging next to a guy who took a nasty ground fall (VERY lucky as injuries weren't life-changing or ending, but he was knocked out, bleeding and in bad shape). His partner has just finished a Wilderness First Responder course the week prior and after the fall went into full first aid algorithm mode. The partner was borderline panicked but did a fine job and we all helped stabilize the guy and roll him off of his harness full of cams.
I was on a mountain rescue team for 10 years and in my experience, there's basically nothing you can do without ALS, advanced kit and drugs. You simply have to wait for rescue. I tried to calm the partner down, explained he was doing great, and that we just had to wait. Once rescue arrived there was a doctor who took control of medical. The partner talked to the doc and said "damn I forgot to check for battle sign" to which the doc said "so what, what could you have done?".
It's really disempowering, but I wish more people understood that accident victims in remote settings are either stable or going to die. In my years on the team we only had three subjects who were truly on the edge. In two cases the only reason they survived is because we immediately had a helicopter that flew us in and the patient out. The third died during transport while we were in brutal conditions at night. Every other victim was either miserable or already dead as it simply takes a long time for help to arrive. It wouldn't surprise me if this story is a bit different in Europe (I'm in the US) where the travel times for helicopters are incredibly short (and therefore fast) and the rescue services are world-class.
Your post has some good points and tools I wasn't aware of, thanks!
Thanks Justin, that's great insight. I have a friend who had his arm ripped off by a boat propeller (well, twisted off), and he went a pretty long time without pain meds before he saw a professional, in fact he said he didn't feel anything until the surgeon poured ice onto his stump (he had his arm sewn back on). Also have a friend who rapped down El cap with a missing finger. Oh, and the you've got Joe Simpson and Doug Scott crawling down mountains to survive. Not sure if I included it in the piece, but I once got a nasty burn on my thumb after picking up a frying pan that was very hot (I thought the stove was off, but it had a slight flame still), and thought it might be trip ending (it REALLY hurt). All I did was put my hand in a pan of water straight away, and slept with it in the pan till morning, and somehow, the thing was 100% better! I think the aim of such a first aid kit is really a 'patch up' kit, that aims to carry out makeshift repairs, so you can either get down without doing too much damage, or give the illusion of control, but really, when it comes to an accident, it's all down to ones ability to be stoical about it.
Damn, that boat propeller accident is awful! Great stories and examples, too. I have never considered burns in the mountains (you did include it in the post) and that's a huge takeaway.
You know, your very last sentence is so damn important. I'd be happy to read a post just about that (maybe you already have?!). People vary a lot with how much they can naturally handle stress of an emergency, as well as blood, body parts bending the wrong way, etc. Thinking creatively and remembering your skills can become 10000x more difficult and, unfortunately, you don't really know until you experience it.
Years ago I climbed Middle Cathedral with a random partner from Camp 4. She was a totally solid climber but it took us awhile and we topped out as it was getting dark. I remember rapping into the dark void of that gully being a little wild, but I was focused and happy about the day of climbing, and confident I could reascend if I'm missed a station. I didn't realize until we got to the ground how nervous my partner had been. She later told me how glad she was to be with me, as I was so calm and focused. I'm not a great climber, but have rambled around in the dark enough that it didn't bother me too much. It obviously wasn't an emergency or a huge deal, but those are kinds of experiences where partners really reveal themselves. While she leaned on me, she also also kept her shit together which was awesome.
If things get weird, will you show up for me? Will you keep your shit together? I've had people show up for me big time. Those are the people who I go into the mountains with. With the rest I just go single pitch sport climbing. :)
My experience of codeine is that it is completely useless for stopping pain (opposite to the highly effective co-proxamol which really did stop pain nicely - before some medical genius banned it and replaced with the useless codeine-paracetamol "cocodamol") - however it causes massive constipation (which GPs always seem to fail to warn their patients about, thereby needlessly burdening NHS with longterm haemorrhoid and anal tear patients) - however this does make it a useful anti diarrhoea drug. Tramadol is a separate chemical - supposed to be a stage heavier duty. But for many people it still doesn't do much for pain, while also causing nausea. At the high end, Oxycodone is highly effective, and has some capability to stop extreme pain from severe injuries, but no UK doctors will give it to you (even when you do have a severe injury - unless maybe if you are dying from cancer or something). I might have saved a few from a severe back injury and kept in my mountain kit, and might have given one to my mate when he decided his ankle hurt too much to walk off Snowden horseshoe years ago - and 5 mins later I might have been unable to keep up with him as he ran down the mountain singing... ;-)
I think Dr Shipman caused far more pain to be endured, and by so many in the UK, than he did to anyone he killed, now that doctors are terrified of prescribing effective pain relief, even to the dying.
Not sure if it's that or if it's plain stupidity. I think they were always pretty crap on pain meds in UK. I'm regularly advising people with severe nerve pain from disc injuries - I've recently had GPs refusing to give them pregabalin (non-narcotic, non-addictive, and highly effective for nerve pain) while giving them six boxes (literally) of valium (which is potentially addictive and is not actually a pain killer at all) - meanwhile I'm advising friends with severe anxiety who really could benefit from a bit of valium, but GP shit their pants and give them propranolol which doesn't work. I don't think there is any explanation except increasingly crappy dumbed down education and training, and most (not all) being pretty thick - paper pushers who's job is to do what the computer tells them. Can't count how many have tried to listen to my chest by placing stethoscope on outside of my t-shirt - apparently they removed stethoscope 101 from the curriculum... But with pain meds there also seems to be a significant element of just not caring about their patients. Def there are still some good drs - but seems to be distinctly a minority. Sorry I've rambled off topic! Thanks for the article - def useful. I'm also of the "duct tape around a pencil" school - can use it to splint, sling, patch up wounds probably more effectively than conventional bandages.