Survive the scenario

11:27 a.m. on March 17, 2018 (EDT)
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It can be entertaining to contemplate survival scenarios sometimes. Let's see if we can make it interesting.

You are out with a friend on a longer day hike, have been hiking for about five hours on a trail in a park that's fairly remote and no cell service. Say something in the subalpine - rocks, granitic sand, pine trees, a few manzanitas and the occasional patch of grass.

Your friend while taking a picture takes a header off the trail into a rock. He loses consciousness. Comes to a few minutes after you get to him. His head hurts, his leg hurts, there's some blood on his leg. He's not quite oriented but he's being insistent on going the rest of the way.

You're in steep terrain, he has a Camelbak with water, snacks and windbreaker. You have the ten essentials and the same - water and food, and whatever else you take on trips of this sort.

It's three hours before sundown, and you haven't seen anyone for about two hours because most people visiting this park don't hike more than 2-3 miles. You're about eight miles out - you'd planned to bag the peak you've been hiking to, and a little slower than anticipated, but you're both usually okay going back in the dark. It's probably going to approach the low 30s at night - it's been in the low 70s all day. If you walk about a quarter mile back down the trail, there's a small stream to get water. You're down to a bag of trail mix. The area you are in is on flight paths for major airlines, but rarely sees any lower flying aircraft. Budget cuts mean there won't be a ranger on the trails til the weekend, since they only patrol when it's very busy and it's the middle of the week - you're out on a day off. Probably not going to see help for a while.

What's the plan?

How does the plan change when you are on a week long backpacking trip, carrying the gear you usually carry, and the scenario is more or less the same?

12:21 p.m. on March 17, 2018 (EDT)
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Good one Lori,

I would camp right there, build a fire and check my friend in the morning. 

Depending on his condition I would either help him down the 8 miles, or go get some help. 

I was on a backpacking trip once when a friend noodled his ankle.  It was one that had been injured many times before playing lacrosse.  We made camp on the spot for three days to allow him to heal up some.  We made him some crutches, and divided up all his gear among the rest of the crew.  We had an ace bandage and some pain killer.  Self rescue is the best when it is feasible. 

1:16 p.m. on March 17, 2018 (EDT)
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It's mostly my goal to get people thinking - that's a reasonable response.

I'll wait til there are more answers to chime in with the Wilderness First Responder version. Unless someone beats me to it.

There are a few wrong answers, but no single correct answer - you do what you can do at the time, given your level of training, the situation at hand, and what you have with you.

1:27 p.m. on March 17, 2018 (EDT)
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Not my sort of trip based on the scenario for several unimportant reasons, but I'll play...

1 Assess the damage to my partner. That really drives the rest of my decisions. If he can be safely mobilized I start working on getting him out. If not I work on keeping him stable until help arrives.

2 Once I can safely take some focus off of my partner I use my inReach to first notify my wife that I'm going into SOS mode. That means I will likely have no satcom with her until the event is over as I'm led to believe they will lock down your device so you can only communicate with rescue services. Then I fire off the SOS and advise that I am either en route with a head wound victim and request to be met with assistance on trail or road as situation warrants or I tell them I have an immobilized head wound victim and need assistance to come to us.

3 Continue to monitor and stabilize victim in either scenario. Things can progress rapidly for the worse with head wounds and they can present in an odd manner if cognition is impaired.

4 Eat some cheese because the fat will keep me fueled and comforted so I can continue to think and perform clearly. Well and because I like cheese.

OK, your move. Do you go with the volcanic eruption blocking our escape route or the giant spider attack? Usually the second round is something to totally disrupt your first round solutions so you have to rethink everything :)

3:27 p.m. on March 17, 2018 (EDT)
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I’d ask how the photograph came out.

Then assess all injuries as well as the immediate reality of the situation and then make a decisive move. I’ve been known to drop all my non essential gear such as camera, tripod and any thing else non-essential and just leave that stuff to facilitate a search and rescue or just a rescue. Not kidding, I’ve cast several thousands of dollars worth of equipment aside and left it way out there to take care of a friend. Keep her or him warm, dry and hydrated is the first goal as well as yourself, then see what is most practical. 

It is best to be prepares for unknowns in a practical manner and then be as flexible as need be.

8:32 a.m. on March 18, 2018 (EDT)
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Bivvy right there and attend to your partner.  The loss of consciousness is a very bad sign.  Attend to his bleeding and do a thorough survey for other injuries, esp. spine and neck.  Monitor his vital signs, state of awareness and keep notes.  Keep him prone with the head slightly elevated (the concern is swelling of brain tissues from trauma).

Start signalling.  I would use a signal mirror on overflying aircraft and randomly around the horizon.  Build  a fire - both warmth and a signal. Fires will get the attention of park personnel - make the smoke conspicuous if at all possible.  Contain the blaze and don't let it spread.

Make noise with a whistle.  Develop a good a shelter as possible from local materials and what you have with you.  My pack always includes at least a minimal bivvy sack.  I will keep warm going down to the water source periodically.  Keep your partner hydrated, but don't feed.

Make enough racket and they will come....

9:44 a.m. on March 18, 2018 (EDT)
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Hit the SOS button on the PLB / satellite communicator. People with concussions should not be left to go to sleep to see how they are in the morning, sometimes the next morning they are dead.

10:34 a.m. on March 18, 2018 (EDT)
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So a couple of things right off the bat.  We don't take hikes that leave us hiking in the dark, period.  We're not OK with that.  So take that off the menu for us.  But let's change your scenario to the same situation, with us camping in your spot, and a couple of hours before sunset, the same thing happens.  The only difference here is that we now have sleeping bags and a tent...but we're still a day's hike from medical attention, and night is coming...Oh, and we are never down to a single bag of trail mix...grin.  Did we leave a trip plan with someone?  Then there is a chance that person will report us missing, which would be a very good thing--see notes on a fire below.

And we are not trained medical personnel.  But I have been treated for a potential concussion, and additional activity can make those a lot worse.  I was warned about that.  So the idea of getting this person to hike out right now is not such a good one. Not good for him, and unlikely for him to be able to do it successfully with his reduced mental capacity from the concussion.  Neither is leaving him/her behind and alone all night while you head off to get help.  Remember that he is not all that mentally competent right now, and might, at the very least, lose his balance while standing up to test his leg...and make things a lot worse.

I also want to know more about his leg.  Is it just bruised, or is it broken? That would change things for me.  If it is badly broken, with the potential of blood loss, then all bets are off.  I hike out immediately, leaving him as well prepared for the night as I can.  But let's assume that it is only badly bruised, or a joint sprain on top of the scrape.

I that case I vote for carefully tending the person all night  (including checking on them multiple times, waking them up.  Yes.)  Immediately building a fire for warmth--and who knows, maybe a very alert ranger will see the illegal fire and come to confront us!  Collect enough firewood to keep the fire going, even in the day.  Because if this is mountain lion country, I want my patient to have a fire going even after I've left the next day.

Bring up lots of water for the patient and me...I will need to get well hydrated and have at least one bottle to take with me on my hike back down the hill in the morning.  The rest is for the patient.  I can live without food for a day.  All the food goes to the patient, but in very small doses, because a concussion can lead to nausea.

In the morning, if he is doing better, we can see if he wants to try to hike out, or wait while I hoof it for the trailhead and get help---presumably getting back well before the day is gone.  That is also true if he is feeling worse.  (I might be able to hike partway and meet another hiker, and lean on them for help--but I don't like to count on being lucky.)

And you don't say much about the condition of the trail.  If it is a well-marked, easy to follow trail, then hiking in the dark might be an option.  If it's a scramble, or a series of use trails, then not in a million years. 

 

 

12:00 p.m. on March 18, 2018 (EDT)
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In a subalpine location I can't see how using a whistle, a signal mirror or anything short of a satellite phone is going to do any good. There won't be phone coverage. 

If the subject wakes up quickly after the accident that is a good sign.  A leg that hurts with some blood is usually a contusion.  The way you described the accident, there is a very good chance that the subject will be capable of walking down in the morning.   I see a lot of S&R searches at night for people that just got stuck in the dark or sprained an ankle.  Many people have little experience with being injured and make a big deal out of minor injuries.  I do not like the idea at all of putting people at risk hiking in the dark to find someone that made a dumb move.  Self-rescue is best when it is feasible. 

For a subject that is really hurt, your first aid kit will be of little or no use.  Knowledge of first aid is important as in treating shock, immoblizing joints, etc  Then going to get help in the morning is still the best bet, otherwise it is likely to have two accident victims. 

4:32 p.m. on March 18, 2018 (EDT)
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"I do not like the idea at all of putting people at risk hiking in the dark to find someone that made a dumb move. " 

Ppine, I would cordially disagree with you on this point.  In my SAR experience, we were hiking (and technical climbing) frequently in the dark - at least 85% of our operations (my estimate) took place partially or completely in the dark.  Properly equipped, night hiking need be no more hazardous than hiking in the daylight.  In hot weather, night work will often be cooler.  The lighting equipment available now is light years ahead of what we had back in the day.

The farthest I have used a signal mirror effectively was 11+ miles and that was in a mountainous environment. A lot will depend on your local topography.  High on a ridge, mirrors are great; down in a valley, not so much.

We never based the urgency of our ops on whether in our estimation the victim had made a dumb move.  Get them out, evaluate them later.  The most hazardous op in which I was involved was the extraction of two victims from a crumbling mine shaft (huge and continuous rock fall).  When we got them out, somewhat to our surprise, they went immediately to jail and did not collect $200.  They had just committed burglary and were sneaking away with lights out which is why they fell into the 100 foot deep shaft.

9:52 p.m. on March 18, 2018 (EDT)
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hikermor,

I am very glad that there are dedicated people like you willing to go out there in bad weather at night to rescue people.  Some people really need help. 

The S&R group around here is dedicated, and I have had several discussions with them recently.  One of their problem groups is young people that get too high (intoxicated in various ways) and then they get confused and can't figure out how to get home.  This is upsetting to me.  Maybe we need to charge people for extractions. 

9:53 p.m. on March 18, 2018 (EDT)
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The actual NOLS protocol, as taught to Wilderness First Responders, runs something like this.

Do a full assessment on the patient. Airway, bleeding, circulation, and where is the pain? One of the things you do immediately upon finding there is a mechanism of injury for spinal damage is to immobilize the head and keep them in a safe place, on the ground, with as little motion as possible to get them to the safe place. And then you evacuate them.

In the scenario, it would be first an assessment, then a safe place - not in the boulder field - with the cooperation of the patient in keeping himself from compromising the spine too much, get him back on the trail. Then get him set up for the night. No helicopter is going to fly at dusk. Some SAR teams do operate at night. Build a big fire and get him wrapped up in one of the large contractor bags I carry, keep him hydrated, and as calm and immobile as possible.

It would be possible to clear the spine IF he becomes oriented enough later. If he is not a reliable reporter because he is disoriented you cannot consider his feedback good enough to do a reliable spinal assessment. The concerns here that trigger the evacuation are the loss of consciousness, possibility of spinal injury and the disorientation. There may be internal bleeding or other issues - a WFR would be monitoring his vitals as well and that would likely become evident as we are trained to recognize shock.

In the morning SAR would be mobilized and there shortly, because in my case, someone had my plans and called the correct authorities when I did not make contact the previous night. That, NOT THE PLB, is the last resort of choice - electronic devices, as any of us know who have volunteered for SAR, fail or muck things up often enough that while I carry one I will NEVER rely upon it for a last resort. I can point you to one search that was publicized in the papers where the SPOT did absolutely no good, and list other incidents where it either misdirected SAR or was not used properly, or just did not work. In this situation like so many, even if I activate it when he falls, there will likely be only a ground team if anyone responds at night. They won't be set up to haul him out of there with spinal stabilization. They would be able to radio it in, and help me set up a LZ in the morning.

Stay within your scope of competence, do your best. If you find such scenarios just make you anxious - there are wilderness first aid trainings to be had. Not everyone is ready to make the commitment to the 80 hour WFR training, but there are three day WFA and even shorter wilderness focused first aid courses to be had.

9:56 p.m. on March 18, 2018 (EDT)
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ppine said:

hikermor,

I am very glad that there are dedicated people like you willing to go out there in bad weather at night to rescue people.  Some people really need help. 

The S&R group around here is dedicated, and I have had several discussions with them recently.  One of their problem groups is young people that get too high (intoxicated in various ways) and then they get confused and can't figure out how to get home.  This is upsetting to me.  Maybe we need to charge people for extractions. 

 Our SAR team has always been adamant about not charging - once the news gets out that you might be billed, people will postpone calling and we will have to switch the name of the game to Search and Recovering the bodies.

I have been told before "I was charged for the search" by people - what you might be charged for is medical treatment administered in the field by a medical professional. One guy insisted it was a charge for the SAR - when asked how much he paid, it was $7k. Chump change - a search involving a helicopter exceeds that in the first fifteen minutes. If charged for the full multi-day search including helo, ground teams, fuel, resources expended, you would be filing for bankruptcy - and most of us are volunteers. Not all - the parks have paid staff. But sheriff's deputies get paid. We did not. What we get for our trouble is a pro deal on gear, sometimes a sandwich or dinner made by people volunteering to run a chuck wagon for us, and a "good job" from the sheriff. Sometimes a hug from the family. Most teams associated with county sheriff's offices are nonprofits and can take donations of money, time or gear, had you the inclination to help in other ways if you are too gimpy to keep up with a team running 5 mph with a loaded pack.

6:10 a.m. on March 19, 2018 (EDT)
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NH instituted the Hike Safe program a few years ago and it has been discussed at length here and elsewhere since. Basically, what NH says is that if you screw up and need to be rescued you have to pay for it. If you followed the rules and acted within reason they don't have to charge you. In either case, if you paid the fee for the Hike Safe card, or paid for a hunting or fishing license, you were covered. So far they have only charged a few people as far as I know. They aren't trying to make money. They are trying to get people to stop being stupid.

Here in NE a lot of rescues are cold weather mountain things so they make every attempt to reach the victim asap rather than wait for morning. Night rescues and night carries using teams to haul an immobilized individual off the mountain take place in all seasons. In the rare case where a helo evac makes sense they often carry the victim up to meet the rescue, again immobilized on a litter.

I both agree and disagree on the PLB points you make Lori. They have limitations, but are better than nothing. The two way communication of the inReach is worth the added expense to me for many reasons not the least of which is that a response verifies someone heard your call for help. Still, a simple PLB can be a life saver so I wouldn't discourage folks from carrying them. You are absolutely correct it won't save your life in many cases, but it may at least make the hunt for your corpse go faster ;)

Thanks for the game. It is always fun to test the brain and to see other folks answers. Reading all the wisdom in your "correct" answer made me laugh because anyone that smart wouldn't be outbound that late in the day on an unfamiliar trail with an idiot who tries to kill himself taking selfies. Those were the unimportant reasons I mentioned this wasn't my sort of trip!

9:11 a.m. on March 19, 2018 (EDT)
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I agree that charging for SAR is generally a bad idea, for the reasons stated above.  Such a policy would adversely affect the outcome of too many ops.  The NPS adopts a middle ground stance.  Victims are not charged, unless they really screw up, blatantly breaking laws and the like, and if that is the case they get a bill.  What often happens is a charge from the ambulance company which transported the victim once we had reached the road.

Just a quibble about getting the victim out of the boulder field.  I would move the victim as little as possible because of the high likelihood of spinal injury and the difficulty of detection in the field.  I have witnessed physicians miss such injuries.  Over time, we became more inclined to deploy a backboard, even without overt detection, just based on accident history.

Ppine makes an excellent point about booze in the backwoods.  SAR made me a teetotaler, after dealing with countless cases of excessive drinking and the resulting problems.  Our routine incident involved a traumatic fall, alcohol was involved, occurring late in the day.  I usually pulled out of my driveway into a setting sun (or even later).

Of course, in southern AZ we were occasionally called out for a cave rescue - definitely operating in the dark then, no choice.

10:16 a.m. on March 19, 2018 (EDT)
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As with everything, it depends. Move the victim, don't move the victim, depends on what's going on. Trying to stabilize anyone in an unstable boulder field sounds like I'm at risk too.

I have seen two way devices cause families a lot of trauma. Cf: the case of the mislaid device - it sat there for two days prompting the adult daughter to call me, asking what to do about it. I told her to wait til the end of the trip. Hard to do when he's supposed to be out there for a week. Then the strange texts started. Then Dad started to text again, reassuring her. What happened - he left it on a stump to get a satellite connection, packed the tent, and hiked off without it. Someone found it and didn't know how to use it. Dad backtracked along his route and asked everyone he saw if they found it, and lucky him, ran into the guy.

I got a text from an InReach - a friend lost someone on the trail. I texted back for her to not do too much before she contacted the sheriff dept, to stay safe, and silence reigned for six hours. Then I got the text she sent ten minutes after her last one - the one where she found him. So many people would have dropped the dime, I sat there waiting forever for the other shoe to drop and trusting she was contacting law enforcement.

I could go on... and on...

I don't use two way devices. I am most likely to get a sat phone after my current PLB's battery requires replacement. Nor will I rely on that either as a last resort.

11:46 a.m. on March 19, 2018 (EDT)
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I guess it would depend on the boulder field.  Some are solid, and others are death traps and you would have to move, regardless.

I must say the experiences recounted in this thread disincline me to spend the big bucks on some sort of PLB.  i go to the wild for solitude and serenity, and the Spots and InReach, etc. do not seem to contribute. I will just leave word with some one(s) dependable.

I survived for decades before PLBs, sat phones, and all of that.  The lack of alternatives encouraged, nay, demanded, self reliance....

Lori, this is  winner of a thread.  Any more on tap??

 

11:46 a.m. on March 19, 2018 (EDT)
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Like we have talked about before you have two really important responsibilities any time you go out there.  Number one is don't get hurt. Take the safe route. Number two is stay found. Maintain awareness of your location and your situation. 

12:06 p.m. on March 19, 2018 (EDT)
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In the time I've been carrying the inReach, I and my family, both at home and across the country, have found it a very useful tool. The messaging and tracking features allow my wife and daughter to participate in the trips they aren't able to join me on. The up to date, localized weather forecasts are invaluable here in the NE mountains. When I am on my more ambitious rambles my family around the country can follow my track so they know I'm not dead..yet. When a trip falls apart and I need to arrange transport on the fly the combination of text message and gps location makes things amazingly easy to coordinate. That is all before even considering using the device in an emergency.

The fact that you've encountered folks who didn't seem able to use a tool properly is not the fault of the tool. Their bad experience does not negate my positive experience. I'll keep doing what works for me and let you folks worry about what you think other folks should do.

12:34 a.m. on March 20, 2018 (EDT)
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Sorry, late to the accident scene...

My 2¢: 
The fact your pal was out a few minutes before coming to is not good at all.  The other injuries as described are incidental.  Usually no lasting harm results from getting clocked on the noodle, but if the vic has a brain bleed - and they may - time is of the essence. 

You should not assume the vic can walk out.  Their condition can suddenly decline, and you will not be prepared to deal with this when it happens.  Find a stance as close to the accident as possible and make the vic comfortable.  You cannot do anything for the vic if the head injury is serious.  About all you can do by staying the night is watch them die, if that is the case.  Thus I am compelled to get help ASAP.  I can make the 8 mile walk out under the conditions described without water or warm clothes.  I have a good light.  I am comfortable with night travel, especially if retracing a trail traveled earlier the same day.

I would not waste precious time collecting wood and building a fire; anyway the vic may not be capable of managing the fire, later.  I always carry a day-and-a-half pack on long day excursions; it will have the clothing to hunker down for an evening, and also have a space blanket.  I will leave my pack of stuff with the vic, and all the water and food.  I'll advise him to stay awake, and upright, and not to get up for anything other than a bathroom break. 

Once I get my bud situated, I am off.  I may be in a hurry, but  running is an unnecessary risk.  If SAR chooses to do a night rescue, ETA back at the scene is about eight hours from the moment I start back.  That is a lot of time for a TBI to go unattended, but every minute counts.

If the event occurred several days from a road head, the scenario changes, depending on if other people are in the area, or proximity to a remote ranger outpost.  Time is against you if there is a brain bleed, since it could be two days before the vic gets medical attention, if others are not in the area.  This scenario illuminates the inherent risk of truly remote trekking in parties of less than three, as a party of two necessitates leaving the injured to their own wiles for at least some amount of time while help is summoned. 

Ed
  

9:33 a.m. on March 20, 2018 (EDT)
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Leaving the victim is a dicey call; in an actual situation, it might or might not be a good option.  Might be better to hike a short distance to a high spot and try calling on a cell phone.  Signaling will likely bring resources to bear quicker.  if you do luck out with the call, you can convey the urgency of the situation.  I have seen a good signal fire bring assistance at least a couple of times..

Any SAR unit worthy of the name will scramble immediately - pedal to the metal and no holds barred.

Years ago (1969-70),our unit spent months searching for a hiker who had left his injured companion to seek help.  We haven't found him yet and people are beginning to be discouraged.  The injured hiker eventually made his way out

9:57 a.m. on March 20, 2018 (EDT)
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In the West, subalpine usually means cold even in summer.  A person in shock is going to have trouble staying warm with a space blanket.  Big mountains often are far from anything. Cell coverage is not likely. 

I appreciate the thoughts of those involved in S&R about who should pay.  I can tell you that I have taken the $15,000 plane ride after a broken femur in a mule wreck.  I had good insurance but they only paid 5k.  I convinced them to pay a little more because the plane and EMTs were the only source of med treatment and morphine. 

2:10 p.m. on March 20, 2018 (EDT)
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.  That was not a  trivial expense, to say the least!  In the jurisdiction in which I worked - Pima County, AZ - my understanding was that if the Sheriff ordered the plane or helo, the victim was not charged.  Different story if the victim called for the ride.

Of course, we always used choppers - two sources - AZ highwaay patrol or more often, especially for injured victims - local military ships - your tax dollars at work - productively, I might add....

3:55 p.m. on March 20, 2018 (EDT)
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Want to know more? Take the Wilderness Medicine Institute (now known as NOLS Wilderness Medicine) quiz, and make sure to check all categories & difficulty levels. 

http://wmiquiz.com/quiz/index.asp

Good luck!

4:24 p.m. on March 20, 2018 (EDT)
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I agree with LoneStranger on the In Reach two way communication; I've been using one with no snafus or issues for over five years now. It's a great tool and especially for my mostly solo trekking. I've posted this many times before, but I have a protocol for my trips whereby I send one message when I've stopped moving for the day and leave the unit on to receive a reply from my wife. Then I turn it off. For me, it's 99.99% a  communication device; to date, I've fortunately never engaged the SOS for feature for me or anyone else.

I have occasionally sent a message for others with it also.

There was that one time where I sent a "I'm ok and checking in" message for a guy in my group and his wife blew up my device with hundreds of words of response (chopped into many , many separate limited texts) about kids getting lice, and school projects, and bunches of other family type minutia. After that I became a little more judicious in offering. 

12:28 p.m. on March 21, 2018 (EDT)
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Its been a while since I've commented on TS. As a WFR, my first priority is to stabilize the patient where he or she is. My concern is that he or she lost consciousness, even though regained, and wants to continue. Go through the litany of questions, what day is it, where are you, do you know what happened? Immediately call for help. (Epirb, Sat phone, etc.) Three hours should be plenty of time to get a helicopter in. Although the victim regained consciousness, this situation could worsen very quickly. After a thorough assessment of injuries, determine if the victim is able to move to a location better for helicopter landing area. One thing to consider, is the altitude. This can have an adverse affect on head injuries. Keep the victim awake, talk to them and continue to monitor their condition until help arrives. Walking out for help not a good idea as the patient may fall asleep and not wake up. Any concussion is serious, especially with a loss of consciousness, and the obvious response that the victim wanted to continue. "Hey, I'm OK." As I once said to climbing buddy that had an injury and wanted to continue, "We're not going any higher, 'cause I don't relish carrying your body any more than I have to".

5:39 p.m. on March 21, 2018 (EDT)
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hikermor said:

Leaving the victim is a dicey call; in an actual situation, it might or might not be a good option.  Might be better to hike a short distance to a high spot and try calling on a cell phone.  Signaling will likely bring resources to bear quicker.  if you do luck out with the call, you can convey the urgency of the situation.  I have seen a good signal fire bring assistance at least a couple of times..

ppine said:

In the West, subalpine usually means cold even in summer.  A person in shock is going to have trouble staying warm with a space blanket. 

In the case of a serious head injury, time is not on your side.  You really don't have a choice, you must seek help.  In any case you cannot do anything for such an injury so staying put accomplishes little.   If the vic goes into shock you can do little for them in this situation, as raising their feet above head level exasperates the head injury, while keeping the vic upright risks shock becoming the primary threat.  I survived a head injury and six week coma in my youth after being found in my garage, laying unattended anywhere from 4 to 14 hours after sustaining the injury.  I have to deal with many issues caused by being subjected to intracranial pressure for that amount of time.  No doubt I would have been better off receiving prompt attention.  I would likely not have survived 24 hours without medical attention. 

There is a misunderstanding about the directive to not let a head injury vic go to sleep.  The intention of this advice is to keep them awake so you can monitor their condition, and if they deteriorate, summon help.  This is all fine if help is a 911 call away, but what action are you going to take in the middle of nowhere?  Simply keeping them awake accomplishes nothing.  Falling into a coma is not like falling asleep; you cannot keep someone conscious who is lapsing comatose.

As I mentioned previously, in addition to the space blanket my pack includes warm layers sufficient to overnight in the open, given the weather one normally anticipates. For around freezing that includes long johns, fleece top, down jacket, gloves, fresh socks, and balaclava.  The benefit of the space blanket is primarily to reduce drafts and heat loss due to convection.  And that is significant.   If the vic is so shocked that cold becomes a primary danger, it is likely the additional time spent waiting for help will present even greater mortal peril than can be attributable to the cold. 

The method I mentioned of getting help was based on resources I would have at hand and the circumstances of the setting.  I do not carry tech in the city, let alone the BC.  I have been called a Luddite.  If I ran into someone else, I'd certainly attempt to commandeer their assistance to expedite response time.  Signaling is great - if anyone sees it - AND understands it - AND bothers making the effort to react, AND their reaction is appropriate and effective.  I've asked people if they know the various distress signals and responce protocals; most do not.  Signaling when no one is searching for you and no one is likely in the vicinity is not a high probability activity.  In any case if you need to leave the vic to get to a high place (recall this is an alpine setting) to signal or call, you may as well hike those 8 miles on trail to the road head  than spend about the same time climbing (xc in the dark!) not even sure if you can make the objective or obtain a radio signal.  Perhaps flashing at a plane at night is worth the gander, but I would not be spending time making fires or attention getting ground markings, as the objective is getting help ASAP.  I'll bet hiking out is far faster than waiting for daylight or hoping someone near by reacts appropriately to flashing lights and fires.

Ed  

10:45 a.m. on March 22, 2018 (EDT)
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Fellow Luddite here.  This is, of course,  situation in which there is no good option.  Note that the problem goes away with a slightly larger size; three people, and one stays with the victim, signalling all the while while the other goes for help; four folks, even better, because two hike out for help.  Even with people going out, I would advocate strenuous signalling -don't rely on just one strategy to bail you out.

Some years ago, I and our group (six all told) ran into a very similar situation, encountering a victim injured by rockfall, with a very serious contusion on his forehead (saved by his climbing helmet, which was shattered).  Our group included an ER physician, something I had not known until the emergency unfolded.  We also had decided to carry along our SAR radio at the last minute and were extremely fortunate in being able to make contact and summon a helicopter.  We gave a quick course in litter handling to bystanders, a quick and routine hoist operation, and our victim was in the ER about 2 1/2 hours after the injury.  Sometimes there is safety in numbers..

Without the radio contact, the victim would have been in the field at least twelve hours, and then????

11:18 a.m. on March 22, 2018 (EDT)
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Hello Eric. I respect your opinion.  You have spent plenty of time in the bush. 

You said "three hours is enough time to get a helicopter in."

I have been seriously hurt only once in a remote location.  There were no helicopters available was the only message we got after several people went out and found cell coverage in eastern Oregon.  People have this idea that they will extracted soon and be in a hospital eating chocolate pudding with a cute nurse.  It took me all day with a busted femur to get to a hospital in Bend, OR.  I was carried out to a vehicle and went 100 miles and over many cattle guards at high speed to a ranch airstrip. A fixed wing plane was used and that was the first morphine after about 9 hours. 

The more remote the location is, the more caution you need to use.  Last month I was visiting with an old friend of almost 40 years that is a retired salmon fisherman from Port Angeles, WA.  He told us for the first time about getting his rain gear caught in the main spool on a seiner and getting caught up in the net breaking his neck at sea somehwere near Craig, Alaska.  His ordeal to get to a hospital in Seattle took around 18 hours.  He was lucky to live and still struggles with pain and nerve damage. 

Be careful and don't get hurt is the best advice of all. 

11:59 a.m. on March 22, 2018 (EDT)
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ppine said:

Be careful and don't get hurt is the best advice of all. 

That is so simple and yet so important. I'm really glad you said it.

By integrating the concept of not getting hurt into every action, before, during and even after a trip, many serious injuries or worse can be avoided...maybe. It can't prevent all issues, but it goes a long way to preventing the preventable ones ;)

As for the avowed Luddites up thread I salute your intent. I brought nothing electronic with me for most of my life. Traveling deeper into places where footprints are rare over the last few years I've found the inReach useful to keep family happy and at least make the body recovery faster if I screw up.

I do use it to message my wife several times a day, but I know Pat uses it on a very limited basis and I've heard of others who never message at all. My point is that it doesn't have to intrude on your trip any more than you want it to. It only has to be within easy reach in an emergency, not even turned on. PLBs are much cheaper and simple, but lacking two way communication can run into the issues Lori mentioned earlier.

Even if you travel in large groups for safety having emergency communications can be a real help as in hikemor's example. If you travel as a duo or alone it really is just a smart way of hedging your bets. Keep it turned off, but close at hand and you Luddites won't even know it is there unless you need it.

3:18 p.m. on March 22, 2018 (EDT)
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Indeed vigilance against getting hurt is definitely SOP on trips far from help. 

Often we expose ourselves to mishaps with little forethought.  I busted an arm while fetching water from a lake.  I slipped on a wet log of driftwood while camping with three friends.  Had I been thinking properly I would not have stepped on that log at all.  It was four days until I saw a doctor and received a cast.  Fortunately the break was not displaced and caused only discomfort and inconvenience.   

There are dozens of similar opportunities for crisis just doing ordinary hiking and camping: tenting under widow makers, hanging out under cone shedding conifers, traversing slippery grass slopes or hard crust snow, cooking inside tents using liquid fuels or canisters, XC night travel, running, jumping and rock hopping, even walking can result in an ankle twist that becomes nexus to a crisis.  When far from help every move needs to be assessed for risk, avoided if deemed not worth the risk, and otherwise carried out with intent and focus. 

Ed

11:48 a.m. on March 23, 2018 (EDT)
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ppine, thank you. I should have clarified. The OP described a park with manzanita and regular ranger patrols, as well as other hikers. I assessed that this area is fairly well traveled, and close to a major population center, hence the number of day hikers. That is why I described a helicopter rescue would be possible before sundown. At the very least, a helicopter rescue could happen at first light. Of course, the situation you describe is much more remote. And when I instruct and describe issues for my canoe expeditions, I am clear that rescue, in the event of a serious injury, may be weeks away. First off, even in the Barrens fixed wing access is not always available. The land may not be safe to land, the river may be in a canyon, or too shallow. Away from the Barrens, such as the Yukon, similar issues for fixed wing exist. Rotor craft present another issue. Rotor craft burn large amounts of fuel. So long distance rescues involve establishing fuel caches. Then there is the weather. I have called in on sat phone for the pick up and been told that they would get to us in two or three days after the weather cleared. When I share information in seminars about canoe expeditions, I reinforce how important it is for at least two members of the party have WFR. I've only had one serious incident on any of my expeditions. Fortunately, it happened near the end of a trip. One of the team was horsing around and dislocated his shoulder very badly, and it turns out, chipping the joint. We couldn't reset it. So a local Selkirk FN had a skiff and he took our team member by skiff back up river to a village with a  nurse. She was unable to to help. What followed was a 10 hour drive to WH and hospital. In places close to population centers, help can be close. In remote places, help may be days or even weeks away. If Lori's event had happened on one of my expeditions, we would stay put to monitor the victim's situation and, if possible, notify for possible rescue. One thing to remember if a serious injury were to occur on one of my trips, is that it could be a death sentence. For instance, your broken femur might have the possibility of sepsis. With limited medicines even in my exped med kit, the issue is that your situation could worsen quickly. Amputation may be necessary and that presents other problems. Your broken femur may be a death sentence.

12:34 p.m. on March 23, 2018 (EDT)
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You describe helos as only operating in daylight.  I have been on plenty of helo operations that occurred after dark, and that was some years ago.  Night vision capability is now more common.  

2:47 p.m. on March 23, 2018 (EDT)
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Thanks Eric for the clarification. 

You are absolutely correct.  The triage doctor told me a year later he gave me a 50/50 of making it due to the complications from blood clots.  My leg swelled to twice its normal size.  I took two units of blood in the hospital to make up for it.  I wore the compression device for the lower legs.  Once at home I injected myself every morning to prevent blood clots for about 6 weeks.  Now walking in the woods feels like a gift from God. 

My advice is still don't get hurt. 

5:18 p.m. on March 23, 2018 (EDT)
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a lot depends on the assessment of the injuries. if it is a serious head injury or immobilizing leg injury, very risky to leave a disoriented person alone, and very hard to get someone with a serious head or leg injury to move very much in any event.  in the day hike scenario (no sleeping bags, no shelter, little food, no means of communication, 30 degree overnights), the healthy person might have to make their injured friend comfortable and go get help, or else both end up dead. that depends on what is on your backpack; if i had a down sweater and a little more insulation, whether that's a spare fleece or leaves/brush, i might opt to spend one uncomfortable bivouac but would definitely head out the next morning to get help if co-hiker were not able to make it out. Absent an assessment the person could not or should not move, with an 8 mile hike to civilization and 3 hours of daylight, i would try to have both hikers get out or make as much progress toward civilization as possible, if their physical condition would cooperate.  

another is the weather. there aren't enough facts here to know what a 30 degree night out will feel like given the gear you have. a bivouac in some combination of a trash bag and backpack, with some reasonable layers, perhaps; with inadequate insulation, it's a serious hypothermia risk. 

for the day hike, it also depends on anticipated trail traffic the next day. given what i would probably carry, one uncomfortably cold trash bag night is possible, but two (esp with no food or stove) would be dangerous, so if i thought we wouldn't see anyone the next day (midweek, budget cuts, etc), i don't think it would be sound to plan for the healthy hiker to wait in those conditions until the weekend.

xxxxxxxxxxxxx

weeklong trip, totally different posture. that means you're toting sleeping bags, tent or tarp, gas and a stove, a lot more food. makes waiting until the weekend and a likely ranger or passing hiker much more feasible.  but if i thought the head injury were really serious, i would probably get my friend comfortable in a tent and bag and head for help regardless, because the more quickly you treat a serious head injury, the more likely you are to save the person. 

11:53 a.m. on March 24, 2018 (EDT)
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hikermor, you are correct that rotorcraft can operate at night. However, in Lori's description the terrain appeared to be steep and mountainous. While it could be possible to get a helicopter in for rescue, the crew chief would have to make a careful assessment of the risk. And to be clear, while some helicopter crews are capable of operating at night, not all are able to do so.

6:16 p.m. on March 24, 2018 (EDT)
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Most helicopters require ground contact and cannot fly at night.

What was news to me was that many of them are not available in the day time. 

9:04 a.m. on March 25, 2018 (EDT)
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In my experience, helos operated at night in steep, mountainous terrain, especially when the situation was urgent.  The crews undoubtedly saved many victims' lives by their actions. Nocturnal hoist ops were common.   Of course, with a stable victim, operations were deferred for daylight.  The situation Ppine experienced in very different from southern Arizona, where you have raw, screaming wilderness immediately adjacent to urban centers.  Helos were much more available in that setting.

Our helo crews were military, with time in Vietnam.  They loved the change from their routine duties.

10:52 a.m. on March 25, 2018 (EDT)
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Back around 1980 I flew a lot in Alaska and the pilots we had were all from Viet Nam except for one crop duster.  We had very wet conditions with bad visibility and tight performance envelopes.  They all said the same thing.  "Sure it is tough flying, but at least no one is shooting at us."  They were a great group of people and it was a good thing because our lives were in their hands every day.  We gave them all nicknames.  "Cadillac",  "Wild Man", "Squeaky", and "Grizzly Adams."

11:37 a.m. on March 26, 2018 (EDT)
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When I was growing up, my father had a helicopter operation and I worked summers with him and with other pilots.  We ran 47G3B2s and Hughes 500s. While there were some very good pilots which came with Vietnam experience, operating as we did, in the PNW, there were some pilots who didn't measure up. I recall several who had no knowledge and experience with mountainous terrain and altitude and air density, as in SE Asia, they were usually flying in very dense air. None that I can recall practiced power off autorotations, which my father practiced regularly. Having grown up around aviation, my experience flying in the Yukon and NWT, there are/were pilots I would fly with and others I wouldn't get on board with. Several are no longer with us.

In any case, if a member of the team is injured, the exact circumstances will determine proper procedure. A recent example was a young woman who went from sea level to hike with friends in the Rockies. In that situation, she had a severe headache, but did not want to slow the party. Finally, they all decided to stop but did not get her to a lower elevation. Within an hour she was dead. I encourage everyone to get certified in WFR, not just WFA. The rule is, that if the victim is more than an hour away from help, you are the help, the First Responder and the decisions you make could save a life or not. In this scenario, any head injury, particularly with a loss of consciousness, is a very serious one. Altitude, temperatures, the victim's overall health, can make an already bad situation worse. On my expeditions, I require every member of the team to provide a detailed health history. This may come off as overly invasive to some, but one should remember that a serious injury or illness can endanger other members of the team.

12:35 p.m. on March 26, 2018 (EDT)
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This is one of the more interesting thread discussions we've had in a while. I think in part because of two main factors- one, people's interpretation of the situation described (as we can see two people can read the same sentence very differently), and two, there is no clear cut right or wrong answer here. This isnt just a black and white scenario. One persons answer could be right one time and wrong the next. What I do see (as a general consensus) and what I would agree on, is that being prepared both in terms of the terrain- gear carried (and possibly communication with potential aid) and knowledge/ability. You are your own first line of defense- don't take unnecessary risks and be prepared to deal with a worst case scenario.

As someone with a standard CPR certification this makes me more interested in perusing a WFR course.

4:57 p.m. on March 26, 2018 (EDT)
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Thanks Eric. We flew with Temsco Helicopters out of Ketchikan.  Mostly Hughes 500Cs for moving around the bush, and Bell Rangers for hauling core samples and freight.  The Bell's have a two blade prop and make a whop-whop sound.  Nobody lasts in SE Alaska for 3 days without plenty of experience with mountains, rain, glaciers and flying over the ocean experience.  I have been in plenty of autorotation practice events. Wild Man did it all the time.  He got a big kick out of all of the alarms on the dash board going off when the engine was off.  A guy lost his turbine on a Ranger when I was there. He autorotated into a soft muskeg and was not hurt.  His wife was visiting and they had to walk back to camp which took two days.

I had nothing but great respect for all of our heli pilots.  We had some long days where we could only travel 5 miles overland.  The pilots were willing to fly in bad conditions all the time saving us a ton of work. It rained 150 inches a year on our project area.  We had a met station to measure it. 

There are many right answers for these scenarios.  In the really wet rain forest falling down was a common occurrence. Sometimes we slid a long way.  Caution became the by word. We forded rivers all the time and jumped out of helicopters into snow banks above treeline. We ran into bears every day, many at close range. It was definitely not boring. 

5:00 p.m. on March 26, 2018 (EDT)
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8:25 p.m. on March 26, 2018 (EDT)
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I think you have nailed it.  The scenario proposed very often may not end well, regardless of what action a companion may take - plenty of real world examples.

I responded once to an injured person whose companion had run out about two miles to seek aid.  I remember running at top speed,with full pack, back with him to his injured companion.  When we arrived on scene, his companion was dead.

5:13 a.m. on March 27, 2018 (EDT)
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Not gonna play the game. I saw somethings were addressed. Kuddos to  patman and LS.. yes communications is a great divider. @ERIC NICE to see you commenting again. You been missed. 

5:45 a.m. on March 28, 2018 (EDT)
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ppine, you may have misunderstood. Nearly all helicopter pilots practice autorotations. However, most cut power, reverse the pitch and take it down to about twenty or so feet above the ground, then reengage power and pitch before they contact the ground. A few, like my father, would never reengage power and the skids would be on the ground before he did so. His philosophy was that if you lose power, you won't be able to reengage to soften the landing.

Thank you Denis.

10:55 a.m. on April 2, 2018 (EDT)
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Not getting upset and staying fresh is the best for the injured person.  Have a level head and make good choices.  Getting rest then decide the best action is always the best.

Every scenario is different but keeping a cool head is always best.

May 24, 2019
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