Oxford University Cave Club
Expedition Rescue Guide
Gavin
Lowe
A brief guide
to carrying out a rescue on expedition.
Contents
Responsibilities
and personnel
Equipment
to prevent deterioration of the patient
Equipment
to start evacuation of the patient
What to do if a member of your party is injured
Rescuing
an unconcious caver from a rope
Dealing
with knackered or ill cavers
Rescuing
a patient on a stretcher
Introduction
The booklet was written with the main aim of teaching members of Oxford University Cave Club techniques that may be useful in the event of a rescue, particularly on expedition in Spain. I have now made it publically available in the hope that others will find it useful. I accept no responsibility for any injury resulting from the use of techniques discussed here. I would, however, welcome comments upon the booklet.
You should read this booklet and familiarize yourself with the contents before you need to perform a rescue.
On most expeditions there are a couple of incidents that lead to some sort of rescue operation getting underway. Nearly always these are caused by groups just being slow and missing their call-out times. While these false alarms are annoying, they do provide useful practice in case there is ever a real rescue.
In the event of a serious injury, the Spanish cave rescue organization should be called upon to help. However, there will be a considerable delay before they arrive: it is your responsibility to do as much as you can in this time.
It is most important in a rescue that the rescuers do not neglect their own safety: having one injured caver is unfortunate; having a rescuer injured as well is a nightmare.
There are three main parts to the booklet. This first section makes a few general points about rescues, about how to avoid rescues, and equipment you should carry with you for use in an emergency. The second part describes the procedure to be taken in the event of a rescue. The third section describes techniques that may be useful in a rescue.
How to avoid being rescued
Caving in Spain is more dangerous than in Britain for a number of reasons:
A lot of the rock is somewhat chossy
and friable so beware of holds breaking on you: this has been the cause of the
two most serious accidents we have had in recent years.
The caves are longer and harder; as
well as making it more likely for you to have an accident, this means that a rescue
will be a lot harder.
The caves are less well travelled than
in Britain, so there is often a lot of loose rock about, especially at the top
of pitches. If it is safe to do so, garden this rock, but not if there are
cavers or ropes below you; the best time to do this is during the initial
exploration.
Some of the rigging may be a little
dodgy, because it has been done on a pushing trip. Moral: take time to make the
rigging safe.
Therefore
CAVE CAREFULLY.
Do not go caving if you are ill or particularly knackered. Take a day off to recuperate. Also, don't be scared to turn back early if you don't feel up to a trip.
Precautions
Before going caving, write a call out time in the back of the log book. Be realistic about the time you set: allow yourself enough time to achieve the goals of the trip, with a bit spare to allow for minor cock-ups; but don't set the call out time too late--if there is a problem, you will want to be rescued earlier rather than later.
Make sure that your gear is in decent knick, particularly your lights. If you have any trouble with your gear, make sure you sort it out before your next trip.
When going caving you should take with you:
A first aid kit: these should be
available on the gear order;
A balaclava: this will help keep you
warm while surveying if nothing else;
A survival bag--not a space blanket as
these don't work as well: Ben Lyon sells good ones that fit safely inside a
helmet;
A candle: when lit inside a bivvy bag,
this will keep you very warm; see section 14.
Enough carbide for your trip--and a
little spare in case your trip is longer than expected--and a spare battery for
your electric.
A pulley--essential if you do have to
carry out a rescue, and also useful for tackle hauling.
When walking in the mountains you should carry the same stuff, and also a compass and possibly a map (the Adrados maps are best).
Don't go shaft bashing on your own: if you have an accident, nobody will know where to find you.
If you discover some new cave, and the route to the new stuff is not obvious, then create some way markers: either build cairns, or leave something like a tacklebag at the start. This will help rescuers to find you if you do have an accident. It will also help other explorers to find the way to the sharp end!
Incidents
There are various sorts of incidents that may need some sort of rescue action.
A caver being injured.
A caver becoming stuck.
A caver becoming unable to exit the
cave because of either knackeredness or illness.
A group of cavers getting lost in the
cave.
A group of cavers getting lost on the
mountain.
Total light failure.
Cavers becoming trapped by floods.
A group of cavers being slow and
missing their call out time.
Statistically the most common cause for a rescue is the last. Fortunately actual injuries are very rare.
Responsibilities and personnel
OUCC tends to be a fairly anarchic bunch, not much into ``leaders'' and ``chains of command''. However, in a rescue it is important to be well organized. People should be appointed to the following positions:
Runner.
Responsibilities: to go down the cave as quickly as possible while not compromising their own safety, to contact the overdue team, to find out what is wrong, to give as much help as possible, and to guide other rescuers to them.
Surface controller.
Responsibilities: to keep track of who, and what equipment, has gone underground; to arrange for more equipment to be ready and to go underground as necessary; to liaise with other rescue authorities; arrange rota systems if necessary; to arrange for plenty of food to be ready for rescuers emerging; to arrange for evacuation of injured cavers once they reach the surface.
Underground controller.
Responsibilities: to be in overall control of evacuating the rescuees; to ensure adequate communications with the surface; to appoint people to work out how to pass each obstacle, planning ahead; to arrange for each obstacle to be derigged and for the equipment to be carried forward; to ensure tired rescuers take a break before they become too knackered and make a mistake.
Patient monitor.
This person should ideally be a doctor, and certainly somebody cheerful and talkative. Responsibilities: to monitor the condition of the patient, and to watch out for any deterioration; to keep them cheerful and informed of what's happening.
Stretcher controller (``Head'').
This person should be in charge of the movement of the stretcher, and give instructions to the other rescuers. They should normally be very close to the patient's head, with their hands on the front handles, so as to keep the stretcher steady, and to protect the patient from falling rocks. The job of stretcher controller will swap around very frequently, but each controller is responsible for ensuring that the next is in position before relinquishing control.
Obstacle controller.
This person should be appointed by the underground controller to work out how to pass a specific obstacle. They should rig haul lines and lifelines if needed; they should also rig independent safety lines for the rescuers, if needed. If possible, they should hammer off any projections that are likely to get in the way.
Try to keep good spirits up within the rescue team. If possible, swap round so that nobody gets too tired. Stop for an occassional rest and brew.
Don't shout at each other, and avoid getting irritated. Be patient while others are rigging, and don't harangue them; if possible, give them a hand.
Remain quiet while others are trying to communicate.
Any rescue will be a long affair, so pace yourself.
Rescue procedure
There are various ways in which you will realise that some action is needed:
a member of your party is injured:
goto section 9;
a group's call out time is reached:
goto section 5;
somebody arrives at camp with news of
an injury: goto section 6;
somebody arrives at camp with details
of some other problem: goto section 8;
lights are seen on the mountainside,
but nobody arrives at camp: goto section 10.
Cavers overdue
If a group is overdue then you should aim to start rescue procedures as soon as the call out time is reached. A group of four cavers, ideally including a doctor, should go to the cave immediately. If it is dark they should leave a light at the entrance to guide other rescuers. Check whether the overdue cavers' rucksacks are still at the entrance: if not they are probably lost on the mountain (see section 10). Take a radio so as to communicate with camp.
One caver, the runner, should head down the cave quickly, carrying just the mini rescue kit (see section 7.1), with the aims of:
locating the party;
sorting them out as far as possible
with the available equipment;
guiding other rescuers to the
rescuees;
reassuring them that help is on its
way.
This person should cave quickly but carefully. If the runner comes to a junction and has to decide which way to go, then he should leave a note (paper and pencil in the mini rescue kit) telling the next wave where he has gone; if it later becomes obvious that he has chosen rightly or wrongly (e.g. by finding a pitch that is either rigged or unrigged), he should go back to that point and rewrite the note, telling the next wave the correct route to go.
If you have reason to believe route finding may be difficult then you should send out several runners, in pairs; if a pair finds the rescuees, then one should head out as soon as possible to guide others to them.
The others should follow behind carrying the equipment listed in section 7.2 and a bag of hauling gear (section 7.4). They should cave carefully and preserve their energy as far as possible, as it may be a long resue. Their main aim is to prevent the deterioration of the patient. Their secondary aim is to start getting the patients out of the cave, if they have sufficient personnel.
Another three cavers should follow about half an hour behind, carrying the equipment of section 7.3. Their aim is to start getting the patient out of the cave if they think they have sufficient personnel.
Further cavers should follow carrying the rest of the rescue gear after a further half hour, if necessary. Avoid taking too much gear underground, as it will only get in the way.
When the overdue cavers are found, one person should head out to let everyone else know what the situation is. If those underground are sure that they can sort out the situation, then the rest of the rescue can be stood down.
If there is an injury, goto section 6.
If a caver is too knackered or ill to get themselves out, then goto section 12.
Meanwhile, those left at camp should: prepare the rest of the rescue gear; radio base camp to tell them to stand by; cook lots of food. They should rest and await word from the cave.
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Figure 1: Scheme for cavers overdue |
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Word of injury reaches camp
If word of an injury reaches base then a group of about three cavers, ideally including a doctor, should go to the cave immediately. If it is dark they should leave a light at the entrance to guide other rescuers.
They should head down the cave quickly, carrying:
the mini rescue kit (see section 7.1);
the gear to prevent the patients'
condition from deteriorating (section 7.2).
Their aim is to:
locate the party;
reassure them that help is on its way;
give as much first aid as possible
(see section 13);
prevent the deterioration of the
patients.
Three more cavers should follow carrying the spine splint, the stretcher, and a bag of hauling gear (sections 7.3 and 7.4) if there is any chance of it being needed.
More cavers should follow with more hauling gear (7.4), food and carbide. Avoid taking too much gear underground, as it will only get in the way.
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Figure 2: Scheme for injured cavers |
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Meanwhile, the Spanish rescue authorities should be alerted. Ask to use the refugio radio if necessary. Failing this, radio to base and get them to alert the rescue services. Go to the Guardia Civil (local police) and ask for espeleosocorro. Alternatively, you can contact local cavers via Juan José; his number is Oviedo (85) 211790. The rescue services will need to know:
Name and location of the cave;
Depth of the accident;
Time of the accident;
Condition of the patient.
However, there will probably be a delay of about 12 hours before they reach the cave. Do as much as you can in this time.
If there are any other cavers in the area, alert them as well.
Most people at base should walk up the hill, carrying more rope, rigging gear, food, and carbide, as needed. One person, ideally a Spanish speaker, should stay behind to liaise with the Spanish.
If rescue in a stretcher is necessary, goto section 15.
If the caver is able to get themselves out, with help from the others, then goto section 12.
As soon as possible, word should be sent to the surface, giving instructions to those there.
Those left at camp should cook lots of food, and rest: you should save your energy as you will probably be needed later. If possible start organizing a rota system if it looks like being a long rescue, and carry food and some bivvy gear to the cave entrance.
Rescue kit
This section lists some of the gear that may be useful in the event of a rescue. This equipment should always be at camp in case it is needed. If you are reading this at camp, then check that it is.
In particular, a bolt kit should remain permanently with the rescue kit, and a second bolt kit should be quickly available (it can be taken shaft bashing, but should be returned to camp each evening).
The mini rescue kit
The following gear should be carried by the first rescuer down the cave. It should be packed in a prussik bag in advance, ready for immediate action.
first aid kit containing plenty of
bandages and temgesic;
2 Sam Splints;
2 survival bags;
spare carbide;
spare batteries;
spare bulbs, carbide jets, etc;
food;
candles and lighter--good for making
heat;
waterproof paper and pencil, for
writing messages.
Equipment to prevent deterioration of the patient
The following equipment is designed to prevent deterioration of injured cavers; it should be carried in by the first wave of rescuers:
underground first aid kits;
sleeping bag;
stove, brew kit and food.
Equipment to start evacuation of the patient
The following equipment is designed to start getting the patients out of the cave:
spine splint;
the stretcher;
a bag of hauling gear (see below).
All this equipment should be carried in by the second wave of rescuers.
Hauling gear
Two or three tackle bags should each be packed with the following, for rigging past particular obstacles, including short pitches:
a 25m haul line;
a 25m life line;
two 20m safety lines for rescuers to
clip into;
a bolt kit, with lots of spits;
plenty of tapes, wires, hangers,
maillons, krabs, pulleys.
Additional longer ropes should be packed for longer pitches, as appropriate. Also, a drill should be carried down.
Other rescue gear
Plenty of food and carbide will be needed on a long rescue.
The following gear may be needed in particular situations:
Crow bars, shovels, etc., for digging
open collapsed chokes;
To free a stuck caver: hammers,
chisels, washing up liquid (as a lubricant), large knife (to cut them out of
their equipment).
Other problems
This is most likely to be either somebody too knackered or ill to get themselves out of the cave: see section 12.
Stuck cavers can probably be extricate using hammers and chisels, or washing up liquid as a lubricant. You may need to cut them out of their caving gear, so take down some large knives (but be careful you don't injure them in the process).
If cavers are flooded in, then it's probably best to leave them: sending more rescuers down may lead to the rescuers also being trapped. After the big storm of 1988, the 2/7 streamway started to drop after less than 24 hours. Leave the cavers a dump of food, carbide, dry clothes and a stove, somewhere where they will see it, but where it won't get washed away. When you think the water is dropping again, send a team down to make sure they are alright, and to give moral support.
It should be obvious how to deal with most other problems (e.g. light failures).
What to do if a member of your party is injured
Work out how they got injured, and avoid getting yourself injured in the same way. If they are in immediate danger, and you can do so without risk to yourself, then move them away from the danger, but be careful of their back (see section 13).
See Section 11 for techniques for rescuing an unconcious caver from a rope.
Give as much first aid as possible (see section 13).
If the injury is minor, and you are sure you can cope, get them out of the cave.
For more major injuries you should prevent their condition from deteriorating while sending somebody out to get help. If you are near a campsite get them to the camp--or bring the camp to them--and keep them warm. Failing this, put them into a survival bag (which you should have with you) and insulate them from the ground--get them to sit on a rope, a kit bag, or you. See section 14.
If you only have two people in the group you have to decide whether to stay with the patient or go for help. This is why you should always have at least three in a team. Your decision should be based upon how soon you would expect the rest of the expedition to come and rescue you (how soon is your call out time), and how much the patient's condition is likely to deteriorate if you leave them. If in doubt, stay with the patient. Do not leave a patient with reduced consciousness. You should also never leave a patient who you believe to be dying.
Cavers lost in the mountains
There's not really a lot you can do about this. Walk along the route they should be taking, blowing whistles. But don't get lost yourself. It's a good idea for the rescuers to carry sleeping bags and bivvy bags in case they do get lost. If you have no luck, then leave them: they'll have a miserable night, but they'll survive.
Morals:
Don't get lost in the mountains: always
carry a compass, and know the bearings back from the caves;
If you are going to get lost, carry a
bivvy bag with you;
If you do get hopelessly lost, find a
sheltered spot, huddle up together, and wait for morning. Avoid sheltering in
the mouth of a cave in an electrical storm. See section 14;
Don't just follow old lags blindly:
learn the mountains early in expedition; this will help you when
shaft-bashing, as well.
If a team hasn't returned within a few hours of sun rise, then inform ICONA, and start a more full-scale, systematic search. Don't overlook the possibility that they may have found their way down to base camp.
Rescue techniques
In this part I'll describe a few techniques that may be useful in the event of a rescue. Familiarize yourself with these techniques before you actually need to use them.
Rescuing an unconcious caver from a rope
If a caver is unconcious and hanging on a rope then you have about ten minutes to get them down; otherwise, the build up of toxins in their body will kill them.
There are two techniques for rescuing a caver in this condition. You should practice both before you need to use them.1
If you have rebelays to pass, untie them on the way up. Even when the rebelays are protecting the rope at hideous abrasion points, the rope will be fine without the rebelays for one rappel. It might end up a little fuzzy but it probably won't break. If the rebelays are moving you away from a waterfall or something, turn the rebelay into a deviation.
Brute force method
Not everyone can do this. It's not a question of skill, it's physics. If you have good upper body strength and are very proficent on rope, you may be able to pickoff someone who weighs 40% more than you do. On a good day, when you're fresh. That figure is a rough estimate based on observations of people doing it. Try it yourself and see where your limits are.
1.
Climb to unconcious caver, remove his feet from footloops;
2.
Clip a safety line between your seat harness and patient's;
3.
Detach patient from all except weighted point of attachment;
4.
Climb above patient;
5.
Climb a bit further and take patient's weight onto your main attachment point;
6.
Remove patient's last ascender;
7.
Change over to rappel; this may be physically impossible;
8.
Rappel safely to the ground.
Step 7 is what gets people. Perfect changeover technique helps, a poorly fitting seat harness may doom you to failure.
Counter balance pick-off
This technique allows you to lift somebody much heavier than yourself. You need one carabiner in addition to your normal SRT kit. The key to this is to keep things neat. Avoid wrapping lines around each other: the friction will destroy the advantage of the counterbalance and complicate things immensely.
1.
Climb to patient, remove his feet from footloop;
2.
Clip safety line between your seat harness and patient's;
3.
Detach patient from all except weighted point of attachment;
4.
Climb above patient;
5.
Clip a carabiner through your upper ascender;
6.
Run your long cowstail through the carabiner and back to patient's seat harness on the closed side of his Croll;
7.
Climb with small steps until the knot at the near end of the cowstail touches the carabiner;
8.
Stand up on your footloop, disconnect your croll, sit down on the cowstail;
9.
Pull patient up to the carabiner on your upper ascender; if the patient is much heavier than you, put your knees under him, pull up on his seat harness and rock backwards, pushing up against him;
10.
Rig in the patient's descender; lock it off; remove patient's last ascender;
11.
Stand up on your foot loop and lower patient onto his descender;
12.
Derig the long cowstail from the carabiner;
13.
Clip in to the patient, as close as possible to the patient's descender;
14.
Unlock the descender; remove your ascender; abseil safely to the ground.
This pick-off uses the patient's descender; if you are not comfortable using his to control a two person load, prepare to put your descender on his harness.
One perk of this method is that you are under the patient and can better control the descent. Rather than just plunking the patient dirrectly at the base of the drop and then climbing off of him, you land first and can manouver him to a good place.
Dealing with knackered or ill cavers
If this is the case, give the caver as much help as possible. Maybe some food and encouragement will be enough (a Carbide Assist: light a flame under their butt, and out they go).
You can help them by rigging a combined hand line-life line on climbs: belay a rope to something solid at the top of the climb, passed through a krab on the patient's harness, and then back up to somebody at the top of the climb; the person at the top can lifeline and help pull the patient (with a 2:1 advantage); the patient can use the other length of rope as a handline.
If necessary patients can be hauled through vertical squeezes in a harness. On large pitches, tandeming will help to give moral support, and means that somebody is on hand to help with change-overs. See section 16 for details of dealing with particular obstacles that are to be found in our caves. Consider setting up a temporary camp site to let them get some rest, and try again when they are feeling stronger.
First aid
This booklet does not aim to deal comprehensively with first aid. You should familiarise yourself with the first aid manuals from the bibliography.
The following information is based on an article by Tom Houghton in Proc. 12, and an article on the Cavers' Digest.
Do the following in sequence:
1.
Don't panic. Be methodical. Don't be rushed into hasty action. Keep your reason. Don't put yourself in danger.
2.
Get the patient out of immediate danger: loose rocks, for instance, or cold water. Mind yourself; be careful. Moving the patient: see back.
3.
Make preparations to take the patient out. Unless the injury is obviously trivial, all accident patients should be brought to the surface as quickly as possible. Beware those who have been hit on the head but look `all right now'. They could be bleeding inside the skull and unconscious or dying in a couple of hours. Get them out.
4.
Consciousness. Is the patient able to talk? If so, ask them if they can feel and move their limbs. If not, ensure an airway.
5.
Airway. Pull the jaw forwards, and keep it there. This stops the tongue lolling back into the windpipe. The ideal position is `sniffing the spring air'--head forwards and chin up. An unconscious patient will die rapidly without an open airway. If they puke or look as if they might, roll them on their side and let the vomit come out--but see back. If there is any muck or whatever blocking their airway, get it out.
6.
Pulse. Compare the patient's pulse with your own. Shock--severe blood loss--the patient has a fast, thready, weak pulse; they are cold, clammy and sweaty. If you are in no doubt that the patient is like this, they need an intravenous line and lots of fluid--but you probably don't have these or the knowledge to use them safely. Get them out. Don't give them fluids by mouth: the guts stop working in shock, and so you're only giving them something to puke up.
If you can't feel a pulse at the wrist--there is a muscle on each side of the neck running in a straight line from just below the ear to the inner end of the collarbone. If you put your fingers just in front of this muscle at its midpoint and press in gently, you will feel the cartoid pulse (try it on yourself).
7.
Can't feel a cartoid pulse. If you really can't, the heart has stopped working effectively. The patient needs chest compression (`cardiac massage'). By this stage you are probably on a hiding to nothing, but the drowned and the hypothermic can survive for surprisingly long periods with a stopped heart, so try and keep trying, for a couple of hours if necessary, until skilled help arrives. You might just be able to get them going again.
Technique: this has recently changed slightly, as a result of research. Get the patient onto a firm flat surface on their back. Press over the lower third of the sternum (lower edge of your hand 2 fingerbreadths up from the bottom of the sternum). Keeping your arms straight and using the weight of your upper body, lean with the heels of your hands on the middle of the breastbone, giving relatively short pushes. Say `one thousand', release saying `one', do it again. Don't do it too quickly.
If you're on your own, give fifteen squeezes and then give them two breathes of air--head in the `morning air' position, pinch the nose, seal your lips over theirs and exhale firmly. If there is someone else there, get them to do the breathing while you continue with the chest compression: give five chest compressions followed by one breath.
The time to learn how to do this is when you don't have to.
8.
Spine Don't move the patient till you've felt their back, or if they are paralysed or lack sensation anywhere. Feel all the way down the spine. You will feel a row of regular bumps; if there is a gap or a step, or if the patient has pain on one spot on pressing, they have a back injury. If in doubt, play safe and treat as one.
If there is any possibility of a neck injury, put them in a neck splint. This can be improvised out of a doubled piece of karrimat and a belay belt.
Log roll: With three people, move the patient as a unit without bending or twisting, like a log. Don't forget the head: don't turn, drop or bend it, but keep it part of the log--they might have a neck injury, especially if they've had a blow to the head. In this fashion, get the patient out of harm's way onto a flat, firm, horizontal surface. Don't move them again until you've got them onto a Neil Robertson stretcher, or similar.
9.
Bleeding. If they are obviously bleeding, press on it with your hand or a pad (i.e. a firm wodge of anything reasonably clean) for five or ten minutes without peeping to see if it's stopped. If it doesn't stop, keep pressing.
10.
Head to toe survey. Using your hands and a flashlight, examine every part of the patient's body. Start at the head and work down to the toes. Talk to the patient. All along the exam make sure he can feel your hands. See if he can grip you hands firmly and equally. You are looking for additional wounds, swellings, eccymosis (black marks from pooling blood), tenderness, etc. Always do this survey. Write down the results.
When you have worked out what is wrong, write down the results. You should have some permatrace in your first aid kit for this; alternatively use a page from a survey book. Write down the following: who it is, what happened, when, location, observed injuries. Give it to whoever is going for help.
11.
Chest. If the patient has difficulty breathing, or pain on breathing, ensure an airway and look at the chest (open the clothing, look at both sides). If there is a wound on the chest, put a pad on it to stop air leaking in and letting the lungs down. Look at the movements; if one bit goes in while all the rest comes out, and vice versa, put a big pad on that bit to hold it in--that is a `flail segment', a bit of chest wall that has come out and is moving independently of the rest, and while it is free the patient can't breathe properly.
12.
Distals. For an arm this is the radial pulse (thumb side of the inner wrist) and sensation on all fingers. For a leg this is the dosalis pedis (between and above the big toe and first toe) as well as sensation in all toes. Always make sure you can find these before you start treating a wound, dislocation, or break on that limb.
13.
Bandage major wounds. If there are avulsions (flaps of skin and tissue) fold them back in approximate place and bind in place. If the wound bleeds more, then put more stuff on top of it. Do not remove old dressings before you put on the new ones. This will just cause bleeding to start again. Try to put sterile material on the wound (hah!). Don't try to clean out dirt or mud unless you know exactly what you are doing. Always recheck distals after doing anything significant.
14.
Broken bones. The rule here is to immobilize the joint above and below the break. This is done by binding the limb to the body or to rigid splints. Strap a broken leg to the sound one. Try not to move the broken part. If the break is severely angulated then you may have to reposition it before it can be splinted, but do this only if it is required for transport.
15.
Dislocations. It is hard to tell the difference between dislocations and breaks. You need training and experience. Treat dislocations as breaks unless you have good reason to believe otherwise (patient tells you it has happened before?).
To reduce (move the bone back to anatomical position) a patella (knee cap), pull on the ankle (with about 20lbs of force) while another person holds the patient and another holds the knee cap. Let the patella slide back into place slowly to avoid trapping nerves and blood vessels behind it when it locks back in place. It can take minutes for the bone to start moving back in place. Be patient. Recheck distals.
Note: The patient screams and moans a lot during relocations. You must be the source of calm and reason during this time. If you are not up to the job then get someone who is.
To reduce a shoulder have the patient lie face down with the arm over a ledge. Tie a 15lb rock to the wrist and wait for up to an hour. Recheck distals. Note that attempting to relocate a dislocation always runs the risk of causing an amputation to be required later.
16.
Heat. Exposure is a risk, especially for immobile patients. Change wet gear for dry if someone else is wearing drier gear. Put into a survival bag (which you have in your helmet of course). Put into a sleeping bag if you've got one. Sugary food can be a good idea, but be careful; drowsy patients might puke and block their airway, and the injured might go into shock and do the same. See section 14. Get them out.
17.
Antibiotics. It is worth starting an antibiotic regime after significant cave injuries.
18.
Painkillers. Painkillers are a good idea if the patient is in pain. Pain can worsen effective fluid loss by causing fainting, and it makes the casualty more difficult to move, quite apart from any humanitarian considerations.
On the other hand, powerful analgesics (the morphine-based ones such as Temgesic) depress respiration and make the patient more likely to suffocate. They shouldn't be given where there is reduced consciousness, and definitely not if there has been a head injury. A non-exhautive list would be: chest injuries, head injuries, abdominal injuries, cases of severe shock and hypothermia. In head injury you're looking for any depression of consciousness caused by intracranial bleeding, and if the punter's been knocked goofy by drugs this can be difficult to spot.
Also, if the patient screams whenever you put pressure on their injuries, then you'll probably treat them more gently, so you shouldn't be aiming to prevent all pain.
19.
On the way out: keep talking to them; keep checking the pulse--if they weren't shocked before, they might become so.
Keeping warm
There's a lot you can do to keep either yourself or an injured caver warm. Ideally get them into dry clothing, into a sleeping bag, and insulate them from the ground. Sit them on a rope, a tackle bag, knee pads, or you. Put them inside a bivvy bag or under a survival blanket, and light a candle or carbide flame in with them: the heat given off by the flame is significant, and can be a life saver. Alternatively, put a carbide generator inside their furry suit.
Hot drinks for an injured caver are probably a bad idea on the whole. Patients with head injuries can spew them up and inhale them, and somebody who isn't drowsy now may be later. (Spew does horrible things to lungs.) Similarly with internal injuries; the patient's condition can change quickly. Also, any serious injury patient is likely to need to go to an operating theatre when they get out, and the stomach has to be empty for a general anaesthetic. Although stomachs normally empty in 4-6 hours, serious injury and stress can paralyse the normal peristalsis so a trauma patient can keep stuff swilling around in the stomach for ages. On the other hand, if you're sure there's been no serious injury, hot drinks help keep up core temperature and supply fluid and sugars, so if you're just extracting someone because their tin leg broke, then fine.
Rescuing a patient on a stretcher
Loading the stretcher
1.
Put a cervical collar on the patient;
2.
Put the patient into the spine splint;
3.
Put a harness on the patient;
4.
Tie the patient's legs together;
5.
Put the patient into a sleeping bag, allowing access to the harness;
6.
Anchor the patient to the stretcher, to prevent them sliding around.
Be very careful when moving the patient, especially if a spinal injury is suspected. See spine above.
Treatment of patient
The patient's morale is very important. Keep talking to them, reassuring them, and telling them what's happening. Appoint somebody--ideally a doctor, and certainly somebody cheerful and talkative--to be in charge of this. They should also monitor the patient's condition, looking out for any deterioration, and should make sure that the patient's head is protected at all times.
If the patient vomits, roll the stretcher upside down to clear the airway. If they are unconcious, it may be a good idea to haul them in a horizontal position and upside down, so that if they vomit, they do not choke.
Other rescuers should also help to keep the patient happy. Refer to them by their name, not ``the body''. When talking to them, say your name, so they know who they're talking to. Avoid stepping over them and dropping mud in their eyes.
Horizontal stretcher movement
Along horizontal passages there are various ways of moving the stretcher.
Several carriers on each side of the
stretcher holding the handles, possibly with shoulder straps so as to spread
the weight. Few of the passages in our caves are wide enough to do this.
Carriers are situated along the
passage, and the stretcher is passed along between them, either over their
backs, or under their legs.
One caver crawls on hands and knees,
with the stretcher on his back; two others control the ends of the stretcher.
In flat out crawls, the stretcher can
be pulled through with a rope.
At all times somebody, preferably a doctor, should monitor the condition of the patient.
You will often find that several rescuers get stuck behind the stretcher. Allow them to get past as soon as possible.
Vertical stretcher movement
For hauling a stretcher up anything except for very short drops, you will need some sort of hauling system. You should also have an independent life line to the patient.
It is a good idea to ensure all belays are high up, and the point of attachment to the stretcher is quite low down. Otherwise you will haul the stretcher to a point still some way below the pitch head. Plan how you are going to get the patient off the pitch head before starting to haul. It is useful to have an additional short haul line to the base of the stretcher: this makes it much easier to tip the stretcher if you can't get a high enough haul point.
Normally it is easiest to haul the stretcher in a vertical position. However, it may be best to haul the stretcher in a horizontal position, particulary if there are leg or pelvic injuries, where you want the legs high and the head and chest lower.
Pulley jammer
A useful component of any hauling system is a pulley jammer, which is illustrated in figure 3.
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Figure 3: Pulley-jammer |
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Practice setting up a pulley jammer before you need to use it; it is very hard to
work out how to do this from first principles. Attach the jammer to the rope,
upside-down. Then pass the rope through a pulley, below the jammer. Next,
attach the pulley and jammer together using a krab. Finally anchor the pulley
jammer by passing a maillon through the krab.
Counterweight method
The counterweight hauling system is illustrated in figure 4. A rope is attached to the stretcher, and passed through a pulley at the top of the pitch. A rescuer, the counterweight then attempts to prussik up the other side of the rope. As he does so, the patient will be pulled up. If he is the same weight or lighter than the patient then he will find himself moving up the rope--pulling up on the rope attached to the patient will compensate for this. It is important to have a lifeline from above.
Alternatively, the counterweight can clip himself into something at the top of the pitch, and prussik on the haul rope from there. In this case, somebody else should climb up next to the patient.
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Figure 4: Counterweight hauling method |
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Hauling systems
The simplest method of gaining mechanical advantage is to belay a rope at the top of the pitch, run it down and through a pulley attached to the stretcher, and then back up to the top of the pitch; here it is normally best to run the rope through a pulley jammer to the haulers.
A simple hauling system with a 2:1 mechanical advantage is illustrated in figure 5. A rope is taken from the patient, through a pulley-jammer (figure 3) at the top of the pitch, to another jammer. This second jammer is attached to a pulley, through which a rope runs. The second rope is anchored at one end, and the other end is hauled upon, thus providing a 2:1 mechanical advantage.
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Figure 5: A simple 2:1 hauling system |
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In practice, we have found that it is best to combine these two methods to give a 4:1 mechanical advantage. About three people should then be adequate for hauling. An extra advantage of this set up is that the patient moves more slowly and smoothly.
Local difficulties
In this section are a few ideas for dealing with particular problems that may be found in our caves. As caves are extended, plans should be made to deal with any obstacles that are encountered.
Some of the caves round Top Camp are very cold, particularly near the surface, where there is a lot of snow and ice around. If an accident happens here, it will be very important to keep the patient warm. See section 14.
2/7: Pozu Jultayu
The biggest problem with a rescue from 2/7 will be the depth of the cave. It might be necessary to move the camp with the rescue, to allow rescuers to sleep between shifts.
Paradise rift
A diagram of a suggested way of hauling an injured caver is given in figure 6. A bolt with a pulley should be placed at `A' on the outside of the rift, overlooking Flying Rébellés, for use with a safety line. The main haul line should be attached at `B', roughly above the widest part of the rift, slightly nearer the way out.
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Figure 6: Paradise Rift |
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If the patient feels able to climb the ladder, with help, he should be lined/hauled
up it, to the squeeze into the rift. If he feels unable to climb the ladder,
then it should be removed to get it out of the way. At the squeeze into the
rift, somebody should be positioned to pull the patient in. He should then be
hauled up the widest part of the rift, and manoeuvred through the squeeze just
below `B', using the ropes to lift his weight.
Seventh Heaven
Here it will probably be necessary to pull the patient through in a harness, again. Place two bolts directly above the squeeze.
Further reading
This document has, at best, scratched the surface of cave rescue techniques. The following publications give general information about cave rescues:
David Judson (ed), Caving Practice
and Equipment, especially chapter 17, ``Accidents to Cavers'', by Dr John
Frankland.
Jim Eyres and Dr John Frankland, Race
against Time. The story of the Yorkshire CRO, hilarious, and very
informative.
Steve Hudson, Manual of US Cave
Rescue Techniques. Needs to be taken with a pinch of salt.
The following give information about first aid:
Joan's first aid notes: aimed
particularly at this expedition.
Dr Peter Glanville, First Aid for
Cavers.
James A. Wilkerson, Medicine for
Mountaineering and other Hazardous Activities. Earlier editions are called
Medicine for Mountaineers.
St John's Ambulance, First Aid.
The following give information about vertical rescue techniques:
Neil Montgomery, Single Rope
Techniques, especially chapter 9, ``Self Rescue from a Vertical Cave''.
Mike Meredith, Vertical Caving,
especially chapter X, ``Mini-rescue''.
Footnotes
The descriptions of these techniques are due to Rebecca Jones.
1999-05-02