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September, 2006
Mountain Medic - Accident Leadership
By Jon Tierney
IIt's late in the day, you and your group have been on the trail since early morning and you are looking forward to a mellow evening in camp. Suddenly a loud shriek pierces the air and you turn back to see one of the group members sliding down a slippery rock and then drop fifteen feet onto the rocks below. From the look and sound of things one would say you now have a situation!
In my experiences in responding to wilderness emergencies and in teaching emergency medicine I have come to believe that the initial organization and leadership of the scene is the most important ingredient of the response. First leadership must be established. This can be especially challenging in a group of peers where no prior leadership structure was organized. Time is of the essence and consensus based decision- making can slow things down quite a bit. On the other hand, a clueless dictator can turn a tough situation into a nightmare. Clearly the ideal technical leader for this situation would be someone well-versed in medicine and rescue, who has a high level of outdoor skills and a knowledge of the terrain. Additionally the leader should have the respect of the group and be able to solicit ideas from group members and turn the best ideas into actions.
Pre-planning and preparation before the trip leaves the road is a simple way to overcome some of the leadership challenges during a wilderness emergency. Some things to consider before you leave the road:
1. Make a detailed route plan. Include time estimates, distances, landmarks, elevation, bearings, etc.
2. Have some alternatives. What if we start late, encounter slow travel condition or the weather turns bad?
3. Review escape routes. What are the options at various points along the way.
4. Think about communication. Is there cell signal, where is the nearest highway, etc?
5. Establish the trip goals. Is everyone on the same page about the objective?
6. Know your peers. What are the strengths and weaknesses of each member of the party.
7. Leave an emergency plan at home.
8. Carry adequate equipment and extra food. Fast and light is only good to a point. Have what you need to keep it safe and fun.
Now back to dealing with your buddy in the rocks and to organizing the best course of action.
The first step is to step back. STOP! (Slow Down, Think, Observe, Plan). The clearer thinking that results from taking a few seconds to catch your breath and look around will be well worth it. You have many things to consider, organize and act on relatively quickly.
The first decision to make is whether it's even possible to help your friend. Is the scene safe or will more people be hurt trying to help? Let's presume it's okay to proceed.
Each situation will have different priorities to consider. However, some general tasks will always need some level of attention. These include medical care, group care, equipment care, getting help and evacuation. In the perfect world each of the tasks could be assigned to an equally skilled leader. In reality you may find yourself assessing the patient while at the same time coaching one person on how to light the stove, another on where and how to set up the tarp and consoling the patient's best friend. Can you say multi-tasking?
Let's explore each of these areas a bit more.
1. Medical care. This includes the assessment and care of the patient. It would be best to assign this to someone who has at least completed a wilderness first responder or first aid course. The medical leader needs to communicate their summary of the problem and the medical needs in terms of gear and evacuation. The simplest things to do are often the most valuable and can be done by anyone. Keep the patient warm and dry, move them to a shelter location, talk to them, give them food and drink if a you are a long way out.
2. Group care. Taking care of the group is often forgotten in an emergency and is most critical in extreme weather conditions. This can range from a periodic quick update on the situation to setting up shelter, preparing food and drink and insuring that everyone, especially the care-givers remain warm and dry.
3. Equipment care. Assign someone to collect and protect all the group gear. Probably at least one person has dumped out their pack trying to find their first aid kit! Gather it up and put in a tent. A mental inventory list should be made of the available gear. Choose the best uses for each piece of gear - i.e. using tent poles to construct a splint isn't such a good idea if you need to set up the tent. This person could also go out and collect poles if a splint or litter is needed.
4. Getting Help. Wait a minute before immediately sending someone for help. Take the time to decide what you need. Does the situation even warrant outside help? If so, assign someone to figure out options for getting it. A critical brain injury warrants an attempt at air evacuation while a sprained ankle might be assisted out by the group. What are the capabilities of the local responders who will come to help. If sending runners to the road, try to pick competent and fit people to go. Be sure they know the location of the accident and bring information about problem. It should be clear where they are going and what the back-up plans are. Do the runners have money to make a phone call or the keys to the car at the trailhead?
5. Evacuation. If evacuation is needed what type will it be? Will you wait on scene for help, self-evacuate to the road or do a combination of each. If you will be evacuating with the group start someone on constructing a litter, flagging the best route out, or repacking gear. If a helicopter evacuation is hoped for then find and prepare a landing area.
The bottom line is that a lot is going on during a wilderness emergency. Solid situational leadership, good training, and a well-thought out pre-plan go a long way toward a good outcome. It doesn't hurt to have a little karma on your side as well!
Jon Tierney is an internationally licensed IFMGA mountain guide and paramedic. He has been guiding and instructing mountain skills, wilderness medicine and outdoor leadership since the early 1980s. He is also a lead instructor for Wilderness Medical Associates. Jon currently owns Acadia Mountain Guides and Alpenglow Adventure Sports.
Email nick [at] noumbrella [dot] com with your questions, comments and concerns.
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