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<h2 id="tophead">CUCC Expedition Handbook</h2>
<h1>Rescue</h1>

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

<h3><a name="s1">1.</a> Introduction</h3>

<p>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.</p>

<p>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.</p>

<p>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.</p>

<p>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.</p>

<p>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.</p>

<h3><a name="s2">2.</a> How to avoid being rescued</h3>

<p>Caving on expedition is more dangerous than in Britain for a number of
reasons:</p>

<ul>
<li>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.</li>

<li>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.</li>

<li>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.</li>

<li>It is significantly colder which means you won't survive as long if
immobilised without additional help.</li>

<li>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.</li>
</ul>

<p>Therefore:</p>

<p>CAVE CAREFULLY.</p>

<p>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.</p>

<p>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!</p>

<h4><a name="s21">2.1.</a> Precautions</h4>

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

<p>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 &ndash; 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.</p>

<p>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. </p>

<p>When going caving you should take with you:</p>

<ul>
<li>A first aid kit: these are kept at top camp and/or the cave entrance.</li>
<li>A balaclava: this will help keep you warm while surveying if nothing else;</li>
<li>A survival bag &ndash; not a space blanket as these don't work as well;</li>
<li>A candle: when lit inside a bivvy bag, this will keep you very warm; see
<a href="#s43">section 4.3</a>.</li>
<li>Enough battery for your lights for your trip &ndash; and a spare battery.</li>
</ul>

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

<p>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 :-).</p>

<h3><a name="s3">3.</a> Incidents</h3>

<p>There are various sorts of incidents that may need some sort of rescue
action.</p>

<ul>
<li>A caver being injured.</li>
<li>A caver becoming stuck.</li>
<li>A caver becoming unable to exit the cave because of either knackeredness or
illness.</li>
<li>A group of cavers getting lost in the cave.</li>
<li>A group of cavers getting lost on the mountain.</li>
<li>Total light failure.</li>
<li>Cavers becoming trapped by floods.</li>
<li>A group of cavers being slow and missing their call out time.</li>
</ul>

<p>Statistically the most common cause for a rescue is the last. Fortunately
actual injuries are very rare.</p>

<h4><a name="s31">3.1.</a> Responsibilities and personnel</h4>

<p>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:</p>

<dl>
<dt>[Runner]</dt>

<dd>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). </dd>

<dt>[Surface controller]</dt>

<dd>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.</dd>

<dt>[Underground controller]</dt>

<dd>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.</dd>

<dt>[Victim monitor]</dt>

<dd>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. </dd>

<dt>[Obstacle controller]</dt>

<dd>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.
</dd></dl>

<h4><a name="s32">3.2</a>. Rescue procedure</h4>

<p>There are various ways in which you will realise that some action is
needed:</p>

<ul>
<li>a member of your party is injured: goto <a href="#s37">section
3.7</a>;</li>
<li>a group's call out time is reached: goto <a href="#s33">section
3.3</a>;</li>
<li>somebody arrives at camp with news of an injury: goto <a
href="#s34">section 3.4</a>;</li>
<li>somebody arrives at camp with details of some other problem: goto <a
href="#s36">section 3.6</a>;</li>
<li>lights are seen or whistles heard on the mountainside, but nobody arrives
at camp: goto <a href="#s38">section 3.8</a>.</li>
</ul>

<h4><a name="s33">3.3</a>. Cavers overdue</h4>

<p>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 <i>is</i> there, then they are probably lost on the mountain
(<a href="#s38">see section 3.8</a>). Take a radio (if available) so as to
communicate with top camp.</p>

<p>One caver should head down the cave quickly, carrying just the mini
rescue kit (<a href="#s351">see section 3.5.1</a>), with the aims of:</p>

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

<p>This person should cave quickly but carefully.</p>

<p>The others should follow behind carrying the equipment listed in
<a href="#s352">section 3.5.2</a> and a bag of hauling gear
(<a href="#s354">section 3.5.4</a>). They should cave carefully and preserve
their energy as far as possible, as it may be a long rescue. 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.</p>

<p>Another three cavers should follow about half an hour behind, carrying the
equipment of <a href="#s353">section 3.5.3</a>. Their aim is to start getting
the victim(s) out of the cave if they think they have sufficient personnel.</p>

<p>Further cavers should follow carrying <a href="#s355">the rest</a> of the
rescue gear after a further half hour, if necessary.</p>

<p>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.</p>

<p>If there is an injury, goto <a href="#s42">section 4.2</a>.</p>

<p>If a caver is too knackered or ill to get themselves out, then goto
<a href="#s41">section 4.1</a>.</p>

<p>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.</p>

<h4><a name="s34">3.4</a>. Word of injury reaches camp</h4>

<p>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.</p>

<p>They should head down the cave quickly, carrying:</p>

<ul>
<li>the mini rescue kit (see <a href="#s351">section 3.5.1</a>);</li>
<li>the gear to prevent the victim's condition from deteriorating
(<a href="#s351">section 3.5.2</a>).</li>
</ul>

<p>Their aim is to:</p>

<ul>
<li>locate the party;</li>
<li>reassure them that help is on its way;</li>
<li>give as much first aid as possible (see <a href="#s42">section 4.2</a>);</li>
<li>prevent the deterioration of the victim(s).</li>
</ul>

<p>Three more cavers should follow carrying the baby bouncer, the stretcher,
and a bag of hauling gear (sections <a href="#s353">3.5.3</a> and <a
href="#s354">3.5.4</a>) if there is any chance of it being needed.</p>

<p>More cavers should follow with more hauling gear, food and lights
(see <a href="#s355">section 3.5.5</a>). </p>

<p>Meanwhile, the Austrian rescue authorities should be alerted. Ask the
BergRestaurant (if it is open) or the <span lang="de-at">Loser
H&uuml;tte</span> 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.</p>

<p>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!</p>

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

<p>If rescue in a stretcher is necessary, goto <a href="#s44">section
4.4</a>.</p>

<p>If the caver is able to get themselves out, with help from the others,
then goto <a href="#s41">section 4.1</a>.</p>

<p>As soon as possible, word should be sent to the surface, giving
instructions to those there.</p>

<p>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.</p>

<h4><a name="s35">3.5</a>. Rescue kit</h4>

<p>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.</p>

<h5><a name="s351">3.5.1</a>. The mini rescue kit</h5>

<p>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.</p>

<ul>
<li>first aid kit containing plenty of bandages and painkillers;</li>
<li>Foam Splints;</li>
<li>2 survival bags;</li>
<li>spare batteries;</li>
<li>spare bulbs, head-torches etc;</li>
<li>food;</li>
<li>candles and lighter &ndash; good for making heat;</li>
<li>waterproof paper and pencil, for writing messages.</li>
</ul>

<h5><a name="s352">3.5.2</a>. Equipment to prevent deterioration of the
victim</h5>

<p>The following equipment is designed to prevent deterioration of injured
cavers; it should be carried in by the first wave of rescuers:</p>

<ul>
<li>underground first aid kits;</li>
<li>sleeping bag;</li>
<li>stove, brew kit and food.</li>
</ul>

<h5><a name="s353">3.5.3</a>.
Equipment to start evacuation of the victim</h5>

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

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

<h5><a name="s354">3.5.4</a>. Hauling gear</h5>

<p>Two or three tackle bags should each be packed with the following, for
rigging past particular obstacles, including short pitches:</p>

<ul>
<li>a 25m haul line;</li>
<li>a 25m life line;</li>
<li>two 20m safety lines for rescuers to clip into;</li>
<li>a bolt kit, with lots of spits;</li>
<li>plenty of tapes, wires, hangers, maillons, krabs, pulleys.</li>
<li>Additional longer ropes should be packed for longer pitches, as
appropriate.</li>
<li>Also, a drill should be carried down, if available and charged.</li>
</ul>

<h5><a name="s355">3.5.5</a>. Other rescue gear</h5>

<p>Plenty of food and spare lights will be needed on a long rescue.</p>

<p>The following gear may be needed in particular situations:</p>
<ul>
<li>Crow bars, shovels, etc., for digging open collapsed chokes;</li>
<li>To free a stuck caver: hammers, chisels, washing up liquid (as a
lubricant), large knife, wire cutters (to cut them out of their equipment).</li>
</ul>

<h4><a name="s36">3.6</a>. Other problems</h4>

<p>This is most likely to be either somebody too knackered or ill to get
themselves out of the cave: see <a href="#s41">section 4.1</a>.</p>

<p>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.</p>

<p>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, water, 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.</p>

<p>It should be obvious how to deal with most other problems (eg. light
failures).</p>

<h4><a name="s37">3.7</a>. What to do if a member of your party is injured</h4>

<p>Give as much first aid as possible (see <a href="#s42">section 4.2</a>).</p>

<p>If the injury is minor, and you are sure you can cope, get them out of
the cave.</p>

<p>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 &ndash; or bring the camp to them &ndash; and keep them
warm. Failing this, put them into a survival bag (which you should have
with you) and insulate them from the ground &ndash; get them to sit on a rope, a
kit bag, or you. See <a href="#s43">section 4.3</a>.</p>

<p>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 <b>must</b> leave an injured, confused or unconscious caver,
<b>secure</b> them against further falls.</p>

<h4><a name="s38">3.8</a>. Lost in the mountains</h4>

<p>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.</p>

<p>Morals:</p>

<ul>
<li>Don't get lost in the mountains: always carry a compass, and know the
bearings back from the caves;</li>

<li>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!</li>

<li>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 <b>good</b> map of the <b>relevant</b> area;</li>

<li>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;</li>

<li>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;</li>

<li>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 <a href="#s43">section 4.3</a>;</li>

<li>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.</li>

<li>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.</li>
</ul>

<h3><a name="s4">4.</a> Rescue techniques</h3>

<p>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.</p>

<h4><a name="s41">4.1</a>. Dealing with knackered or ill cavers</h4>

<p>If this is the case, give the victim as much help as possible. Maybe some
food and encouragement will be enough (a "Carbide Assist" used to be the way to do this: light a flame under
their butt, and out they go). </p>

<p>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.</p>

<p>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
<a href="#s46">section 4.6</a> 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.</p>

<h4><a name="s42">4.2</a>. First aid</h4>

<p>This treatise does not aim to deal comprehensively with first aid. You
should familiarise yourself with the first aid manuals from the
bibliography.</p>

<p>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.</p>

<p>Do the following in sequence:</p>
<ul>
<li>Don't panic. Be methodical. Don't be rushed into hasty action. Keep your
reason. Don't put yourself in danger.</li>

<li>Get the victim out of immediate danger: loose rocks, for instance, or
cold water. Mind yourself; be careful. Moving the victim:
see <a href="#back">back</a>.</li>

<li>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.</li>

<li>Consciousness. Is the victim able to talk? If so, ask them if they can
feel and move their limbs. If not, ensure an airway.</li>

<li>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' &ndash; 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 &ndash; but see <a href="#back">back</a>. If
there is any muck or whatever blocking their airway, get it out.</li>

<li>Pulse. Compare the victim's pulse with your own. Shock &ndash; severe blood
loss &ndash; 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 &ndash; 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.</li>

<li>If you can't feel a pulse at the wrist &ndash; 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).</li>

<li>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.

<ul>
<li>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.</li>

<li>If you're on your own, give fifteen squeezes and then give them two
breaths of air &ndash; 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.</li>

<li>The time to learn how to do this is when you don't have to.</li>
</ul></li>

<li><b><a name="back">Back</a>.</b> 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.</li>

<li>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 &ndash; 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.</li>

<li>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.</li>

<li>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, ecchymosis (black marks from pooling blood),
tenderness, etc. Always do this survey. Write down the results.</li>

<li>When you have worked out what is wrong, write down the results. You
should have pencil &amp; 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.</li>

<li>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 &ndash; 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.</li>

<li>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.</li>

<li>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.</li>

<li>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.</li>

<li>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?).</li>

<li>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.</li>

<li>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.</li>

<li>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.</li>

<li>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 <a href="#s43">section 4.3</a>. Get them out.</li>

<li>Antibiotics. It is worth starting an antibiotic regime after significant
cave injuries.</li>

<li>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.</li>

<li>On the way out: keep talking to them; keep checking the pulse &ndash; if they
weren't shocked before, they might become so.</li>
</ul>

<h4><a name="s43">4.3</a>. Keeping warm</h4>

<p>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
 flame in with them: the heat given off by the flame is
significant, and can be a life saver. </p>

<p>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.</p>

<h4><a name="s44">4.4</a>. Rescuing a victim on a stretcher</h4>

<h5>4.4.1. Loading the stretcher</h5>

<p>Wrap the victim in a sleeping bag inside the stretcher. Be very careful
moving the victim, especially if a spinal injury is suspected. See
<a href="#back">'back' above</a>.</p>

<h5>4.4.2. Treatment of victim</h5>

<p>The victim's morale is very important. Keep talking to them, reassuring
them, and telling them what's happening.  Appoint somebody &ndash; ideally a
doctor, and certainly somebody cheerful and talkative &ndash; 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.  </p>

<p>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.</p>

<h5><a name="s443">4.4.3</a>. Horizontal stretcher movement</h5>

<p>Along horizontal passages there are various ways of moving the stretcher.</p>

<ul>
<li>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.</li>

<li>Carriers are situated along the passage, and the stretcher is passed
along between them, either over their backs, or under their legs.</li>

<li>One caver crawls on hands and knees, with the stretcher on his back; two
others control the ends of the stretcher.</li>

<li>In flat out crawls, the stretcher can be pulled through with a rope.</li>

<li>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):
<div style="text-align: center">
<a href="l/rltyrl.html"><img alt="Tyrolean stretcher haul thumbnail" 
src="i/rltyrl.jpg" width="200" height="134" /></a>
<p class="caption">Austrian CRO hauling Becka across loose slope in 161</p>
</div></li>
</ul>

<p>At all times somebody, preferably a doctor, should monitor the condition
of the victim.</p>

<h5><a name="s444">4.4.4.</a> Vertical stretcher movement</h5>

<p>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.</p>

<h5><a name="s445">4.4.5.</a> Counterweight method</h5>

<p>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 &ndash; 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.</p>

<h5><a name="s446">4.4.6</a>. Hauling systems</h5>

<p>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.</p>

<p>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.</p>

<div style="text-align: center">
<a href="../1623/161/l/rl89a.htm"><img
alt="Austrian CRO hand winch in operation at 161"
src="../1623/161/t/rl89a.jpg" width="123" height="181" /></a>
<p class="caption">Rigging for stretcher vertical lift</p>
</div>

<p>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. <b>Moral</b>:
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 <b>immediately</b>. 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!</p>

<div style="text-align: center">
<a href="../1623/161/l/rwinch.htm"><img
alt="Austrian CRO hand winch in operation at 161"
src="../1623/161/t/rwinch.jpg" width="123" height="181" /></a>
<p class="caption">Austrian CRO hand winch in operation at 161</p>
</div>

<h4><a name="s45">4.5</a>. Helicopter rescue</h4>

<p>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,
<b>do not rely</b> 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 <i>must therefore be back at
their base before sunset</i>. 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.</p>

<p>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&deg;
area in front of the machine, where the pilot can see you. The tail
rotor and exhaust stream are extremely hazardous places!</p>

<div style="text-align: center">
<a href="../piclinks/rl89c.htm"><img src="../tinypix/rl89c.jpg"
width="118" height="179" alt="" /></a>
<p class="caption">Becka Lawson being moved on the winch cable to a
safe landing place</p></div>

<h4><a name="s46">4.6</a>. Local difficulties</h4>

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

<dl>
<dt>161 - <span lang="de">Kaninchenh&ouml;hle</span> </dt>
<dd>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.</dd>

<dt>Wet pitches </dt>
<dd>There is a significant risk of flash flooding <b>very quickly</b> 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, 182 and 264 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 <span lang="de">Wolfh&ouml;hle</span> and
<span lang="de">Sonnenstrahlh&ouml;hle.</span> 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!</dd>

<dt>Poor visibility </dt>
<dd>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!</dd>

<dt>183 - <span lang="de">Bovist und PuderZucker H&ouml;hle</span> (Puffball)
</dt>
<dd>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.</dd>

<dt>136 - <span lang="de">Steinschlagschacht</span> </dt>
<dd>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.</dd>
</dl>

<h3><a name="s5">5.</a> Further reading</h3>

<p>This document has, at best, scratched the surface of cave rescue
techniques. The following publications give general information about cave
rescues:</p>

<ul>
<li>David Judson (ed), <em>Caving Practice and Equipment</em>, especially
chapter 17, "Accidents to Cavers", by Dr John Frankland.
A particularly relevant extract is <a href="cpne.htm">on this site.</a></li>

<li>Jim Eyres and Dr John Frankland, <em>Race against Time</em>. The story of the
Yorkshire CRO, hilarious, and very informative.</li>

<li>Steve Hudson, <em>Manual of US Cave Rescue Techniques</em>. Needs to be taken with
a pinch of salt.</li>

<li>The following give information about first aid:
<ul>
<li>Dr Peter Glanville, <em>First Aid for Cavers</em>.</li>
<li>James A. Wilkerson, <em>Medicine for Mountaineering and other Hazardous
Activities</em>. Earlier editions are called <em>Medicine for Mountaineers</em>.</li>
<li>St John's Ambulance, <em>First Aid</em>.</li>
</ul></li>

<li>The following give information about vertical rescue techniques:
<ul>
<li>Neil Montgomery, <em>Single Rope Techniques</em>, especially chapter 9, "Self Rescue from a Vertical Cave".</li>
<li>Mike Meredith, <em>Vertical Caving</em>, especially chapter X, "Mini-rescue".</li>
</ul></li>
</ul>

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