Expedition and Wilderness Medicine Weekend

Myself (Harry Holkham) and James Thyng took ourselves off on a course to give ourselves an introduction to “Expedition and Wilderness Medicine”.

We were probably the two least experienced people on the course (medicine wise). James has completed one semester of medicine so has yet to see a real patient and  I am a PhD student in pharmacology so I have an amazing knowledge of all the stuff you really don’t need to know to treat someone. I exhibited in one of the discussions regarding the use of lidocaine for pain relief - I pipe up “it blocks the fast sodium current and undergoes CYP3A4 dependent metabolism” but was unable to say what dose I would actually give (for the record 3 mg/kg or 7 mg/kg with adrenaline. What we lacked in clinical experience with made up for with our love of rope and shiny metal things.

We were the first to arrive at Shining Cliff on the Friday night to a hut that put most of ULMC’s official trips to shame - heating, 3G coverage and separate bunk beds! However, the hut did lack a suitable table for a table boulder - probably for the best as I still have broken heels! After having a quick perve at the rock we settled down and broke the world record for the longest game of bananagrams (probably due more to James’ dyslexia and my own inability to spell words longer than three letters). We were slowly joined by the rest of the participants and spent the rest of the evening getting to know them.

The start of Saturday was a little delayed due to the instructor having a tyre blow out (deja vouse?) on his journey in. Following an introduction to expedition and wilderness medicine (which did include us feeling very envious about the places our instructor has managed to go under the pretence of work) we were thrown into training sessions about approaching casualties, taking details, airway management and breathing (using an Ambu bag so any of our would be casualties can now be slightly less worried about the prospects of us performing mouth to mouth on you!).

The first part of the afternoon was spent learning how to use various forms of stretchers and different ways to immobilise casualties. We followed this by being shown the ropes, literally, we practiced crevasse and cliff rescues. I had to remain a bit hands off for this part as crutches and cliffs don’t work excessively well and we could have ended up ending the simulation for me! But I managed to show off my pulley system skills and James managed to become the instructor’s star student as he re-racked the slings so well (great training from ULMC I think!), however, this did land him with a job for the rest of the weekend!

Next came an introduction to search and rescue techniques, and then we had a “suprise” emergency call as a Duke of Edinburgh group had managed to go AWOL. After trudging through forest (or the path for myself) we found two of our instructors pretending to be cold D of E participants, although I don’t think they needed to pretend too hard about being cold. We took them off to a hospital that bore a striking resemblance to our hut and we were allowed to relax a bit.

Our attention to the next lecture wavered slightly as the smell of cooking filled the hut (I was going to say I think the ULMC committee should cook on all meets next year but I shall wait and see who is elected first) but it didn’t go too far as it was about radio communication which meant we got to play with expensive toys. Myself and James suddenly became members of a “Ski Patrol” in the Swiss alps and you will be happy to know that our reports were good enough for the helicopter to find us, brought us the right resources and knew what casualties we had.

Next came some wound management knowledge. While I don’t think I shall be rushing to stitch up members of the club if anything happens in the UK I’m sure the knowledge will no doubt be useful. The most useful knowledge I learnt that day was probably relating to the control of major hemorrhage (loads of blood going somewhere), before the course I was pretty confident about what to do about blood squirting out of the body but my knowledge was rather limited about what to do if there was blood disappearing into the body (to somewhere it isn’t meant to be). Learning how to recognise and deal with this will hopefully never be useful, but as I regularly go into settings where it might take a couple of hours or more for the emergency services to reach us it might prove to be invaluable.

Previously I had only been trained at how to stabilise a spinal injury in water (I was a lifeguard - fairly important information) and in circumstances where there is likely to be rapid access to secondary care. For example when I had my accident, despite my moaning, I was surrounded by a team from East Midlands Ambulance Service (something I will be eternally grateful for) after about 10 minutes. Therefore the method I taught to Jim on the fly was pretty good. However, this would not be great in the middle of nowhere. So how to use a c-spine collar is something that I am now quite happy I know.

Knowledge of splinting limbs is also something that I am glad I have improved my knowledge on, it could be the difference between a walk out and a long wait for mountain rescue.

In the evening me and James introduced the course to the pan game and I became the champion of spoons!

Sunday started with an alpine start, but for a lecture not climbing! We had a quick safety overview to basically tell us not to kill ourselves in the scenario training we would have later. Off we went to learn about more stretchers, leg traction and how to remove a helmet. The last two in particular are things that I thought were particularly relevant.

After lunch I was thrown in at the deep end with some scenario based training. I was a team leader for a group of 15 cavers in Thailand (which bears a striking resemblance to the Peak District by the way). We came across an injured mountain biker with a definite forearm fracture (James’ speciality) and we treated her for a spinal injury as a precaution. While we were treating her CJ came to visit, there was a rockfall which injured two climbers. I left two members of my team to deal with the cyclist and to extract her to the village and the rest got hands on with the incident. I think we managed the incident relatively well considering we had limited equipment. I managed to radio in air support (I hope they have insurance) and they managed to find us but that took 30+ minutes. I assigned James as patient lead for one of the casualties, who was critically injured, despite the best efforts of James and his team she didn’t make it. The rest of my team managed to stabilise the other casualty and packed her up into a stretcher, I managed to set up a surprisingly bomber anchor using only slings to protect her lower off and we carried her to the helicopter. The debrief was pretty positive, given the circumstances there wasn’t really anything we could have done for James’ casualty.

After this we were transformed into a cave rescue team to find some trapped cavers. The casualty I took control of had suffered massive leg trauma (femoral artery bleed). I managed to control this with a combat tourniquet pretty rapidly and immobilised her c-spine. We then managed to extract her from the cave. After this I thought being in a cave on crutches wasn’t such a good idea so took myself outside and set up an anchor ready for the extraction of the next three casualties. James ended  up dangling out of a hole stabilising the head of an incredibly cold casualty. One casualty didn’t make it (she was too deep in the hole for me to get to, but I assume she had pretty massive trauma). The petzl nao also showed itself off to its best in the cave, so much so it was commandeered by the team leader!

We were reincarnated again as a team of trauma medics at a road traffic collision. Car vs motorbike (with two riders). I was designated leader of the car (kept being assigned as I wasn’t much use anywhere else as I couldn’t move much). The driver had c spine tenderness and was exhibiting neurological symptoms but was otherwise stable. Me and another guy, Nathan, stabilised her C-spine and Nathan kept hold of her, keeping a check on her vital signs until more members of the team were free. We also had a rider under the car. Upon arrival she was barely conscious but deteriorated rapidly despite IV fluids (cannulae are amazingly easy to put in when they are made of cardboard), pelvic splinting and extraction she showed no signs of responding to CPR so the team leader called it. It transpired she had a massive abdominal bleed - not a lot we could have done in that situation. This allowed us to focus on the car casualty. We extracted her maintaining her spine in neutral alignment and packed her off to hospital. The other motorcyclist was attended by James’ team - I don’t know the details but he did his job as she made it.

Final scenario was a rejig of the one before. Again I took the casualty under the car, this time she had both her lower legs amputated during the accident. We got her out from under the car ASAP, shut off the bleeding using tourniquets and stuck her on some IV fluids. I was on her head, we got the helmet off, she remained conscious, but drowsy, throughout. We got her on the scoop and into the ambulance. I even remembered to report it in by radio this time! We had self driving ambulances so we went back to help with the other patient. We extracaited her from the car, and packed her off to hospital too. This time James wasn’t so lucky, he had to fight with the massive abdominal bleed and lost her. I make that a 2-2 draw.

Then time for the quick hut clean up and home.

I’m certainly very glad I attended the course, and I certainly learnt a lot. Unless what I do activity wise drastically changes some bits won’t be very useful. I doubt the club will go and buy a spinal scoop, and anyway even I wouldn’t carry it everywhere and however much the poo hit the fan I can’t think of many situations where someone in the UK would appreciate me cannulating them and giving them some fluids. So am I going to start carrying a set of cannulae and fluid? No. Am I going to start carrying a pelvic sling and some CAT tourniquets? Probably.