# CUCC Expedition Handbook: Rescue

## CUCC Expedition Handbook

# Rescue

A brief guide to carrying out a rescue on expedition. Based on a document from Oxford University Cave Club by Gavin Lowe.

### 1. Introduction

This booklet aims to give some information that may be of use in the event of a rescue being necessary. You should read it and familiarise 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 Austrian cave rescue organisation should be called upon to help. However, there will be a considerable delay before they arrive (especially if the call-out is at night): 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 guide. 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.

### 2. How to avoid being rescued

Caving on expedition is more dangerous than in Britain for a number of reasons:

- 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 before pushing on.
- It is significantly colder which means you won't survive as long if immobilised without additional help.
- If you are in a new cave, no-one may know where to find it. If you are pushing virgin passage, rescuers may not be able to tell which of several possible routes you have decided to explore.

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.

Make sure at least one person not involved in a trip knows how to find the cave you intend to explore - if you wish to explore a cave you have just found, leave someone on the surface and be sure they can find the way back to camp!

#### 2.1. Precautions

Before going caving, write trip details in the call out book at top camp.

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. To help with this problem it is best to give two times - the expected time back, and the definitely late time back. This gives rescuers some idea of just how overdue you are. It's also useful to give an expected time at the entrance as well as at top camp or the car park.

Make sure that your gear is in decent nick, 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 are kept at top camp and/or the cave entrance.
- 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;
- A candle: when lit inside a bivvy bag, this will keep you very warm; see section 4.3.
- Enough carbide for your trip – and a little spare in case your trip is longer than expected – and a spare battery for your electric.

When walking in the mountains you should carry the same stuff, and also a compass and a good map. A GPS may sometimes be more useful, but is not a substitute for map and compass and the skill to use them.

Don't go shaft bashing on your own: if you have an accident, nobody will know where to find you - it could be years before they find your body :-).

### 3. 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.

#### 3.1. Responsibilities and personnel

CUCC 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 organised: to know what you are responsible for doing, and who is responsible for other specific tasks. 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 victim(s), to find out what is wrong, to give as much help as possible, and to guide other rescuers to the victim(s).
[Surface controller]
  Responsibilities: keep track of who, and what equipment, has gone underground; arrange for more equipment to be ready, and to go underground, as necessary; liaises with other rescue authorities; arrange rota systems if necessary; arrange for plenty of food to be ready for rescuers emerging; to arrange for evacuation of the victim once they reach the surface.
[Underground controller]
  Responsibilities: to be in overall control of evacuating the victim(s); 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.
[Victim monitor]
  This person should ideally be a doctor, and certainly somebody cheerful and talkative. Responsibilities: to monitor the condition of the victim, and to watch out for any deterioration; to keep them cheerful and informed of what's happening; to protect their head against rocks knocked down, or against any bumps. If this person is separated from the victim while passing an obstacle, then somebody else should be temporarily appointed to take over their responsibilities.
[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.

#### 3.2. 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 3.7;
- a group's call out time is reached: goto section 3.3;
- somebody arrives at camp with news of an injury: goto section 3.4;
- somebody arrives at camp with details of some other problem: goto section 3.6;
- lights are seen or whistles heard on the mountainside, but nobody arrives at camp: goto section 3.8.

#### 3.3. 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 victims' surface gear is still at the entrance: if not, or their underground gear is there, then they are probably lost on the mountain (see section 3.8). Take a radio (if available) so as to communicate with top camp.

One caver should head down the cave quickly, carrying just the mini rescue kit (see section 3.5.1), with the aims of:

- locating the party;
- sorting them out as far as possible with the available equipment;
- guiding other rescuers to the victims;
- reassuring them that help is on its way.

This person should cave quickly but carefully.

The others should follow behind carrying the equipment listed in section 3.5.2 and a bag of hauling gear (section 3.5.4). 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 victim. Their secondary aim is to start getting the victim(s) out of the cave, if they have sufficient personnel.

Another three cavers should follow about half an hour behind, carrying the equipment of section 3.5.3. Their aim is to start getting the victim(s) 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.

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 4.2.

If a caver is too knackered or ill to get themselves out, then goto section 4.1.

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.

#### 3.4. 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 3.5.1);
- the gear to prevent the victim's condition from deteriorating (section 3.5.2).

Their aim is to:

- locate the party;
- reassure them that help is on its way;
- give as much first aid as possible (see section 4.2);
- prevent the deterioration of the victim(s).

Three more cavers should follow carrying the baby bouncer, the stretcher, and a bag of hauling gear (sections 3.5.3 and 3.5.4) if there is any chance of it being needed.

More cavers should follow with more hauling gear, food and carbide (see section 3.5.5).

Meanwhile, the Austrian rescue authorities should be alerted. Ask the BergRestaurant (if it is open) or the Loser Hütte to radio for help, or phone directly if a working mobile phone and german speaker are on hand. Failing this, contact base camp and get them to alert the rescue services. However, there will probably be a delay of at least 4 hours before they reach the cave (longer if it is dark). Do as much as you can in this time. A German speaker is almost essential for this - if not available, it may help to know that the Toll Road manager speaks English, though there is no guarantee that you can get hold of him.

If there are any other cavers in the area, alert them as well. Other expedition groups should be willing to help with any rescue (as, equally, CUCC should be ready to lend them assistance if they have an accident). If other groups are in the area, make sure they know CUCC's mobile phone numbers, and get hold of theirs, if they are so equipped. Do this before a rescue occurs!

Most people at base should walk up the hill, carrying more rope, rigging gear, food, and carbide, as needed. One person, ideally a German speaker, should stay behind to liaise with the Austrians.

If rescue in a stretcher is necessary, goto section 4.4.

If the caver is able to get themselves out, with help from the others, then goto section 4.1.

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 organising a rota system if it looks like being a long rescue, and carry food and some bivvy gear to the cave entrance.

#### 3.5. 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.

##### 3.5.1. 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;
- Foam 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.

##### 3.5.2. Equipment to prevent deterioration of the victim

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.

##### 3.5.3. Equipment to start evacuation of the victim

The following equipment is designed to start getting the victim(s) out of the cave:

- baby bouncer from stretcher;
- the stretcher;
- a bag of hauling gear (see below).
- All this equipment should be carried in by the second wave of rescuers.

##### 3.5.4. 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, if available and charged.

##### 3.5.5. 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, wire cutters (to cut them out of their equipment).

#### 3.6. Other problems

This is most likely to be either somebody too knackered or ill to get themselves out of the cave: see section 4.1.

Stuck cavers can probably be extricated using hammers and chisels, or washing up liquid as a lubricant, or simply by providing slings and things to help them push, pull or climb in the right direction. 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 or cut important rigging in the process). Small knives may be useful if space is restricted, and a pair of wire cutters or similar could also be useful.

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. People have been able to escape in all the flooding incidents CUCC have experienced so far, although in some cases they may have to sit it out. Floods invariably render pitches impassable rather than sumping anything off. Leave the victims a dump of food, carbide, dry clothes and a stove, somewhere where they will see it, but where it won't get washed away. If spray is a major problem, electric lights might be worth providing. 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 (eg. light failures).

#### 3.7. What to do if a member of your party is injured

Give as much first aid as possible (see section 4.2).

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 4.3.

If you only have two people in the group you have to decide whether to stay with the victim or go for help. This is why it is generally safer to 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), or when other cavers in the cave may pass this way, and how much the victim's condition is likely to deteriorate if you leave them. If you must leave an injured, confused or unconscious caver, secure them against further falls.

#### 3.8. 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 possible, carry a GPS pre-loaded with waypoints or a tracklog for the route you intend to follow, as well as a selection of other strategic waypoints in case you have to change plans. Include spare batteries - remember that a map and compass continue to work without power - a GPS won't!
- If you are going walking, leave details of your intended route in the call-out book. Include likely alternatives in case of bad weather in your plans. Try to use one of these if at all possible, rather than changing to a completely new plan. Carry a good map of the relevant area;
- Carry a radio or mobile phone if possible. Don't forget also the means to phone base camp in case you drop into the wrong valley or elsewhere where the radio won't work;
- If you are going to get lost, carry a bivvy bag and spare food and water with you. A signal mirror can enable you to be seen over a large distance in fair weather;
- If you do get hopelessly lost, find a sheltered spot, huddle up together, and wait for morning or better visibility. During an electrical storm, avoid sheltering in the mouth of a cave, or in a tent into which a radio/aerial cable runs. Avoid closed depressions where cold air may pool. See section 4.3;
- Don't just follow old lags blindly: learn the mountains and routes early in the expedition; this will help you when shaft-bashing, as well.
- If a team hasn't returned within a few hours of sunrise, then check with base camp, and start a more full-scale, systematic search. Don't overlook the possibility that they may have found their way down the mountain somewhere unexpected.

### 4. Rescue techniques

In this part I'll describe a few techniques that may be useful in the event of a rescue. Familiarise yourself with these techniques before you actually need to use them.

#### 4.1. Dealing with knackered or ill cavers

If this is the case, give the victim 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 victim'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 victim (with a 2:1 advantage); the victim can use the other length of rope as a handline.

If necessary victims can be hauled through vertical squeezes in the baby bouncer. On large pitches, tandeming will help to give moral support, and means that somebody is on hand to help with change-overs. See section 4.6 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.

#### 4.2. First aid

This treatise 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 OUCC Proceedings 12, and an article by John Fogarty on the Cavers' Digest.

Do the following in sequence:

- Don't panic. Be methodical. Don't be rushed into hasty action. Keep your reason. Don't put yourself in danger.
- Get the victim out of immediate danger: loose rocks, for instance, or cold water. Mind yourself; be careful. Moving the victim: see back.
- Make preparations to take the victim out. Unless the injury is obviously trivial, all accident victims 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.
- Consciousness. Is the victim able to talk? If so, ask them if they can feel and move their limbs. If not, ensure an airway.
- 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.
- Pulse. Compare the victim's pulse with your own. Shock – severe blood loss – the victim has a fast, thready, weak pulse; they are cold, clammy and sweaty. If you are in no doubt that the victim 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 carotid pulse (try it on yourself).
- Can't feel a carotid pulse. If you really can't, the heart has stopped working effectively. The victim 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 victim 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 breaths 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.
- Back. Don't move the victim 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 victim has pain on one spot on pressing, they have a back injury. If in doubt, play safe and treat as one.
- Log roll: With three people, move the victim 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 victim 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.
- Bleeding. If they are obviously bleeding, press on it with your hand or a pad (ie. 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.
- 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 pencil & survey paper 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.
- Chest. If the victim 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 victim can't breathe properly.
- 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.
- 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.
- Broken bones. The rule here is to immobilise 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.
- 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 20 lbs 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 15 lb 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.
- Heat. Exposure is a risk, especially for immobile victims. 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 victims might puke and block their airway, and the injured might go into shock and do the same. See section 4.3. Get them out.
- Antibiotics. It is worth starting an antibiotic regime after significant cave injuries.
- Painkillers. Painkillers are a good idea if the victim 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) depress respiration and make the victim more likely to suffocate. They shouldn't be given where there is reduced consciousness, and definitely not if there has been a head injury. 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 victim screams whenever you put pressure on their injuries, then you'll probably treat them more gently.
- On the way out: keep talking to them; keep checking the pulse – if they weren't shocked before, they might become so.

#### 4.3. Keeping warm

There's a lot you can do to keep either yourself or an accident victim 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 victim 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 victim 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.

#### 4.4. Rescuing a victim on a stretcher

##### 4.4.1. Loading the stretcher

Wrap the victim in a sleeping bag inside the stretcher. Be very careful moving the victim, especially if a spinal injury is suspected. See 'back' above.

##### 4.4.2. Treatment of victim

The victim'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 victim's condition, looking out for any deterioration, and should make sure that the victim's head is protected at all times.

Other rescuers should also help to keep the victim 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.

##### 4.4.3. 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. This only works in wide passages.
- 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.
- On exposed traverses or crossing loose boulder slopes, it may be dangerous or impractical to have several carriers on the traverse line or slope at once. In this case, a tyrolean may be rigged to haul the stretcher across (see below for hauling systems):

  Austrian CRO hauling Becka across loose slope in 161

At all times somebody, preferably a doctor, should monitor the condition of the victim.

##### 4.4.4. 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 victim.

##### 4.4.5. Counterweight method

The counterweight hauling system is illustrated in figure XX. 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 victim will be pulled up. The counterweight should clip himself into something at the top of the pitch. If he is the same weight or lighter than the victim then he will find himself moving up the rope – pulling up on the rope attached to the victim will compensate for this. It is important to have a lifeline from above and a trailing line leading to the bottom of the pitch: these can be used for controlling the ascent of the victim.

##### 4.4.6. Hauling systems

A simple hauling system with a 2:1 mechanical advantage is illustrated in figure XX. A rope is taken from the victim, through a pulley-jammer (figure XX) 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.

Practice setting up a pulley jammer before you need to use it. Pass a rope through a pulley, and then through a jammer on the 'up' side; attach the pulley and jammer together using a krab; then anchor the pulley jammer by passing a maillon through the krab.

The Austrian cavers who rescued Becka in 1989 used a mechanical winch for hauling, at least on the entrance pitch. This has the theoretical advantage of being operable by just a couple of people, but in practice kept slipping over sideways into a position where it couldn't be used at all. Moral: the simpler you can make it, the less there is to go wrong. Simplest of all is to have lots of people pulling - but you need lots of space so this is only really effective on an entrance pitch. One person must be in charge of a hauling team and "stop!" means stop immediately. Although it is easier to lower off with a team pulling than with a pulley-jammer or similar, it is essential to avoid pulling the rescuee into danger or where he cannot be manoeuvred. Necks have been broken this way!

Austrian CRO hand winch in operation at 161

#### 4.5. Helicopter rescue

If you have cause to call out the Austrian rescue, then they will most likely turn up with a helicopter if at all possible. This is a very effective method of evacuation, and will save the injured party much delay and possible rough handling to get across the plateau. However, do not rely on a helicopter being available. On Becka's rescue in 1989, a small Alouette helicopter was used, but not everyone got a ride back, as these cannot fly at night, and must therefore be back at their base before sunset. You will also not see a helicopter if visibility is crap or if it is needed for some military purpose - civilian rescue is a "background use" for this kit, though, as with the RAF Mountain Rescue in the UK, real rescues are regarded as better training than any exercise.

If a helicopter is to land near an entrance, there must be no loose clothing, Inglerip bags or anything else which could be blown up by the downdraught and into the rotors. This is not usually achievable, so the chopper will most likely land some distance away. Do not approach the helicopter until signalled to do so, and then always stay in the 180° area in front of the machine, where the pilot can see you. The tail rotor and exhaust stream are extremely hazardous places!

Becka Lawson being moved on the winch cable to a safe landing place

#### 4.6. Local difficulties

In this section are a few ideas for dealing with particular problems that may be found in our caves.

161 - Kaninchenhöhle
  No particular difficulties since the squeeze was bypassed and potentially even easier if there is a route from your accident site to the Scarface entrance. Biggest problems are likely to be due to potential distance of victim from entrance and people getting stuck somewhere where no-one can find them. Consider carefully whether it would be easier to take a victim out of the Scarface entrance (remember the entrance area is small and the surface hack down to Stogerweg or up to the col may need rigging). This may be more a function of where Top Camp is, where people are coming from, and what is already rigged.
Wet pitches
  There is a significant risk of flash flooding very quickly after heavy rainfall, as there is no soil and very rapid run-off. CUCC cavers have been hit by flood pulses in 41, 113, 115, 145, 161, 164 and 182 at least, and not just in persistently rainy years - thunderstorms can appear from blue sky in minutes on the plateau. Others have been forced to wait out floods for several hours in Wolfhöhle and Sonnenstrahlhöhle. In the former case, flood waters started to rise again before those trapped were happy to exit and a further wait was necessary - meanwhile the rescuers were completely lost in the mist on the surface!
Poor visibility
  Don't think that because you are the rescuers, you are immune from hazards. One rescue party got lost on the plateau for so long that those they were helping had rescued themselves before the rescuers found the cave!
183 - Bovist und PuderZucker Höhle (Puffball)
  Significant risk of flash flooding after heavy rainfall. Entrance area unstable, care needed when people milling around or moving at the same time with the victim.
136 - Steinschlagschacht
  As the name suggests, stonefall is a risk, though modern rigging makes the whole place much safer than the early eighties route. There are some impressively exposed traverses which may remain rigged from year to year. Be very careful to check the condition of the ropes at the start of an expedition, and be quite sure your competence in the techniques needed to get across are up to scratch. The traverses could be very hard to get a stretcher across, so don't take risks with boulders (or anything else) in Chile.

### 5. 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. A particularly relevant extract is on this site.
- 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:
  - 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".

- Rescue topics:
  - Caving Accidents: Management from Site to surface. An article by Dr. D.Gibson in the 1987 NPC Journal.
  - Trapped by flood in 113, 1980
  - Sitting out flood in 145, 1984
  - The 1989 rescues
  - Hit by flood pulse in 182, 1991
  - Mislaid for 27 hours in 161, 1993
- Expedition Handbook - Intro
  - Prospecting guide
  - Surveying guide
  - Rigging guide
  - Photography guide
- Full Index to area 1623
- Back to Expedition Index page
- Back to CUCC Home page