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973 lines
44 KiB
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<title>CUCC Austria Rescue Guide</title>
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<body>
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<center><h2>Cambridge University Caving Club<br>
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Expedition Rescue Guide</h2></center>
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<p>Based on a document from Oxford University Cave Club by Gavin Lowe
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<p>A brief guide to carrying out a rescue on expedition.
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<h3><a name="s1">1.</a> Introduction</h3>
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<p>This booklet aims to give some information that may be of use in the event
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of a rescue being necessary. You should read it and familiarise yourself
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with the contents before you need to perform a rescue.
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<p>On most expeditions there are a couple of incidents that lead to some
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sort of rescue operation getting underway. Nearly always these are caused by
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groups just being slow and missing their call-out times. While these false
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alarms are annoying, they do provide useful practice in case there is ever a
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real rescue.
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<p>In the event of a serious injury, the Austrian cave rescue organisation
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should be called upon to help. However, there will be a considerable delay
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before they arrive (especially if the call-out is at night): it is your
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responsibility to do as much as you can in this time.
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<p>It is most important in a rescue that the rescuers do not neglect their
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own safety: having one injured caver is unfortunate; having a rescuer
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injured as well is a nightmare.
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<p>There are three main parts to the guide. This first section makes a few
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general points about rescues, about how to avoid rescues, and equipment you
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should carry with you for use in an emergency. The second part describes
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the procedure to be taken in the event of a rescue. The third section
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describes techniques that may be useful in a rescue.
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<h3><a name="s2">2.</a> How to avoid being rescued</h3>
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<p>Caving on expedition is more dangerous than in Britain for a number of
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reasons:
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<ul>
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<li>The caves are longer and harder; as well as making it more likely for you
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to have an accident, this means that a rescue will be a lot harder.
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<li>The caves are less well travelled than in Britain, so there is often a
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lot of loose rock about, especially at the top of pitches. If it is safe to
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do so, garden this rock, but not if there are cavers or ropes below you; the
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best time to do this is during the initial exploration.
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<li>Some of the rigging may be a little dodgy, because it has been done on a
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pushing trip. Moral: take time to make the rigging safe before pushing on.
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<li>It is significantly colder which means you won't survive as long if
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immobilised without additional help.
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<li>If you are in a new cave, no-one may know where to find it. If you are
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pushing virgin passage, rescuers may not be able to tell which of several
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possible routes you have decided to explore.
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</ul>
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<p>Therefore
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<p>CAVE CAREFULLY.
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<p>Do not go caving if you are ill or particularly knackered. Take a day off
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to recuperate. Also, don't be scared to turn back early if you don't feel up
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to a trip.
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<p>Make sure at least one person not involved in a trip knows how to find
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the cave you intend to explore - if you wish to explore a cave you have
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just found, leave someone on the surface and be sure they can find the way
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back to camp !
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<h4><a name="s21">2.1.</a> Precautions</h4>
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<p>Before going caving, write trip details in the call out book at top camp.
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<p>Be realistic about the time you set: allow yourself enough time to
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achieve the goals of the trip, with a bit spare to allow for minor cock-ups;
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but don't set the call out time too late---if there is a problem, you will
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want to be rescued earlier rather than later. To help with this problem it
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is best to give two times - the expected time back, and the definitely late
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time back. This gives rescuers some idea of just how overdue you are. It's
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also useful to give an expected time at the entrance as well as at top camp
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or the car park.
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<p>Make sure that your gear is in decent nick, particularly your lights. If
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you have any trouble with your gear, make sure you sort it out before your
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next trip.
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<p>When going caving you should take with you:
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<ul>
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<li>A first aid kit: these are kept at top camp and/or the cave entrance.
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<li>A balaclava: this will help keep you warm while surveying if nothing else;
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<li>A survival bag---not a space blanket as these don't work as well;
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<li>A candle: when lit inside a bivvy bag, this will keep you very warm; see
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<a href="#s43">section 4.3</a>.
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<li>Enough carbide for your trip---and a little spare in case your trip is
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longer than expected---and a spare battery for your electric.
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</ul>
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<p>When walking in the mountains you should carry the same stuff, and also a
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compass and a <b>good</b> map. A GPS may sometimes be more useful, but is not
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a substitute for map and compass <i>and the skill to use them.</i>
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<p>Don't go shaft bashing on your own: if you have an accident, nobody will
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know where to find you - it could be years before they find your body :-).
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<h3><a name="s3">3.</a> Incidents</h3>
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<p>There are various sorts of incidents that may need some sort of rescue
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action.
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<ul>
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<li>A caver being injured.
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<li>A caver becoming stuck.
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<li>A caver becoming unable to exit the cave because of either knackeredness
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or illness.
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<li>A group of cavers getting lost in the cave.
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<li>A group of cavers getting lost on the mountain.
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<li>Total light failure.
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<li>Cavers becoming trapped by floods.
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<li>A group of cavers being slow and missing their call out time.
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</ul>
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<p>Statistically the most common cause for a rescue is the last. Fortunately
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actual injuries are very rare.
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<h4><a name="s31">3.1.</a> Responsibilities and personnel</h4>
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<p>CUCC tends to be a fairly anarchic bunch, not much into 'leaders' and
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'chains of command'. However, in a rescue it is important to be well
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organised: to know what you are responsible for doing, and who is
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responsible for other specific tasks. People should be appointed to the
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following positions:
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<dl>
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<dt>[Runner]
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<dd>Responsibilities: to go down the cave as quickly as possible while not
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compromising their own safety, to contact the victim(s), to find out what is
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wrong, to give as much help as possible, and to guide other rescuers to the
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victim(s).
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<dt>[Surface controller]
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<dd>Responsibilities: keep track of who, and what equipment, has gone
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underground; arrange for more equipment to be ready, and to go underground,
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as necessary; liaises with other rescue authorities; arrange rota systems if
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necessary; arrange for plenty of food to be ready for rescuers emerging; to
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arrange for evacuation of the victim once they reach the surface.
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<dt>[Underground controller]
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<dd>Responsibilities: to be in overall control of evacuating the victim(s);
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to ensure adequate communications with the surface; to appoint people to
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work out how to pass each obstacle, planning ahead; to arrange for each
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obstacle to be derigged and for the equipment to be carried forward; to
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ensure tired rescuers take a break before they become too knackered and make
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a mistake.
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<dt>[Victim monitor]
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<dd>This person should ideally be a doctor, and certainly somebody cheerful
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and talkative. Responsibilities: to monitor the condition of the victim,
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and to watch out for any deterioration; to keep them cheerful and informed
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of what's happening; to protect their head against rocks knocked down, or
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against any bumps. If this person is separated from the victim while
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passing an obstacle, then somebody else should be temporarily appointed to
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take over their responsibilities.
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<dt>[Obstacle controller]
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<dd>This person should be appointed by the underground controller to work out
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how to pass a specific obstacle. They should rig haul lines and lifelines
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if needed; they should also rig independent safety lines for the rescuers,
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if needed. If possible, they should hammer off any projections that are
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likely to get in the way.
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</dl>
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<h4><a name="s32">3.2</a>. Rescue procedure</h4>
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<p>There are various ways in which you will realise that some action is
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needed:
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<ul>
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<li>a member of your party is injured: goto <a href="#s37">section 3.7</a>;
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<li>a group's call out time is reached: goto <a href="#s33">section 3.3</a>;
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<li>somebody arrives at camp with news of an injury: goto
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<a href="#s34">section 3.4</a>;
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<li>somebody arrives at camp with details of some other problem: goto
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<a href="#s36">section 3.6</a>;
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<li>lights are seen or whistles heard on the mountainside, but nobody arrives
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at camp: goto <a href="#s38">section 3.8</a>.
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</ul>
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<h4><a name="s33">3.3</a>. Cavers overdue</h4>
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<p>If a group is overdue then you should aim to start rescue procedures as
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soon as the call out time is reached. A group of four cavers, ideally
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including a doctor, should go to the cave immediately. If it is dark they
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should leave a light at the entrance to guide other rescuers. Check whether
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the victims' surface gear is still at the entrance: if not, or their
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underground gear <i>is</i> there, then they are probably lost on the mountain
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(<a href="#s38">see section 3.8</a>). Take a radio (if available) so as to
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communicate with top camp.
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<p>One caver should head down the cave quickly, carrying just the mini
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rescue kit (<a href="#s351">see section 3.5.1</a>), with the aims of:
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<ul>
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<li>locating the party;
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<li>sorting them out as far as possible with the available equipment;
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<li>guiding other rescuers to the victims;
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<li>reassuring them that help is on its way.
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</ul>
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<p>This person should cave quickly but carefully.
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<p>The others should follow behind carrying the equipment listed in
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<a href="#s352">section 3.5.2</a> and a bag of hauling gear
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(<a href="#s354">section 3.5.4</a>). They should cave carefully and preserve
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their energy as far as possible, as it may be a long resue. Their main aim is
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to prevent the deterioration of the victim. Their secondary aim is to start
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getting the victim(s) out of the cave, if they have sufficient personnel.
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<p>Another three cavers should follow about half an hour behind, carrying the
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equipment of <a href="#s353">section 3.5.3</a>. Their aim is to start getting
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the victim(s) out of the cave if they think they have sufficient personnel.
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<p>Further cavers should follow carrying <a href="#s355">the rest</a> of the
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rescue gear after a further half hour, if necessary.
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<p>When the overdue cavers are found, one person should head out to let
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everyone else know what the situation is. If those underground are sure that
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they can sort out the situation, then the rest of the rescue can be stood
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down.
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<p>If there is an injury, goto <a href="#s42">section 4.2</a>.
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<p>If a caver is too knackered or ill to get themselves out, then goto
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<a href="#s41">section 4.1</a>.
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<p>Meanwhile, those left at camp should: prepare the rest of the rescue
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gear; radio base camp to tell them to stand by; cook lots of food. They
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should rest and await word from the cave.
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<h4><a name="s34">3.4</a>. Word of injury reaches camp</h4>
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<p>If word of an injury reaches base then a group of about three cavers,
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ideally including a doctor, should go to the cave immediately. If it is dark
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they should leave a light at the entrance to guide other rescuers.
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<p>They should head down the cave quickly, carrying:
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<ul>
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<li>the mini rescue kit (see <a href="#s351">section 3.5.1</a>);
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<li>the gear to prevent the victim's condition from deteriorating
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(<a href="#s351">section 3.5.2</a>).
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</ul>
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<p>Their aim is to:
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<ul>
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<li>locate the party;
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<li>reassure them that help is on its way;
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<li>give as much first aid as possible (see <a href="#s42">section 4.2</a>);
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<li>prevent the deterioration of the victim(s).
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</ul>
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<p>Three more cavers should follow carrying the baby bouncer, the stretcher,
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and a bag of hauling gear (sections <a href="#s353">3.5.3</a> and <a
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href="#s354">3.5.4</a>) if there is any chance of it being needed.
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<p>More cavers should follow with more hauling gear, food and carbide
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(see <a href="#s355">section 3.5.5</a>).
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<p>Meanwhile, the Austrian rescue authorities should be alerted. Ask the
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BergRestaurant (if it is open) or the <span lang="de-at">Loser
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Hütte</span> to radio for help, or phone directly if a working
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mobile phone and german speaker are on hand. Failing this, contact base
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camp and get them to alert the rescue services. However, there will probably
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be a delay of at least 4 hours before they reach the cave (longer if it is
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dark). Do as much as you can in this time. A German speaker is almost
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essential for this - if not available, it may help to know that the Toll Road
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manager speaks English, though there is no guarantee that you can get hold of
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him.
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<p>If there are any other cavers in the area, alert them as well. Other
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expedition groups should be willing to help with any rescue (as, equally,
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CUCC should be ready to lend them assistance if they have an accident). If
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other groups are in the area, make sure they know CUCC's mobile phone
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numbers, and get hold of theirs, if they are so equipped. Do this before
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a rescue occurs !
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<p>Most people at base should walk up the hill, carrying more rope, rigging
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gear, food, and carbide, as needed. One person, ideally a German speaker,
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should stay behind to liaise with the Austrians.
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<p>If rescue in a stretcher is necessary, goto <a href="#s44">section
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4.4</a>.
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<p>If the caver is able to get themselves out, with help from the others,
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then goto <a href="#s41">section 4.1</a>.
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<p>As soon as possible, word should be sent to the surface, giving
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instructions to those there.
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<p>Those left at camp should cook lots of food, and rest: you should save
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your energy as you will probably be needed later. If possible start
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organising a rota system if it looks like being a long rescue, and carry
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food and some bivvy gear to the cave entrance.
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<h4><a name="s35">3.5</a>. Rescue kit</h4>
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<p>This section lists some of the gear that may be useful in the event of a
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rescue. This equipment should always be at camp in case it is needed. If
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you are reading this at camp, then check that it is.
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<h5><a name="s351">3.5.1</a>. The mini rescue kit</h5>
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<p>The following gear should be carried by the first rescuer down the cave.
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It should be packed in a prussik bag in advance, ready for immediate action.
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<ul>
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<li>first aid kit containing plenty of bandages and temgesic;
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<li>Foam Splints;
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<li>2 survival bags;
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<li>spare carbide;
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<li>spare batteries;
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<li>spare bulbs, carbide jets, etc;
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<li>food;
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<li>candles and lighter---good for making heat;
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<li>waterproof paper and pencil, for writing messages.
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</ul>
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<h5><a name="s352">3.5.2</a>. Equipment to prevent deterioration of the
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victim</h5>
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<p>The following equipment is designed to prevent deterioration of injured
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cavers; it should be carried in by the first wave of rescuers:
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<ul>
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<li>underground first aid kits;
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<li>sleeping bag;
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<li>stove, brew kit and food.
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</ul>
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<h5><a name="s353">3.5.3</a>.
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Equipment to start evacuation of the victim</h5>
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<p>The following equipment is designed to start getting the victim(s) out of
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the cave:
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<ul>
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<li>baby bouncer from stretcher;
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<li>the stretcher;
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<li>a bag of hauling gear (see below).
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<li>All this equipment should be carried in by the second wave of rescuers.
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</ul>
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<h5><a name="s354">3.5.4</a>. Hauling gear</h5>
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<p>Two or three tackle bags should each be packed with the following, for
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rigging past particular obstacles, including short pitches:
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<ul>
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<li>a 25m haul line;
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<li>a 25m life line;
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<li>two 20m safety lines for rescuers to clip into;
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<li>a bolt kit, with lots of spits;
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<li>plenty of tapes, wires, hangers, maillons, krabs, pulleys.
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<li>Additional longer ropes should be packed for longer pitches, as
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appropriate.
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<li>Also, a drill should be carried down, if available and charged.
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</ul>
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<h5><a name="s355">3.5.5</a>. Other rescue gear</h5>
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<p>Plenty of food and carbide will be needed on a long rescue.
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<p>The following gear may be needed in particular situations:
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<ul>
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<li>Crow bars, shovels, etc., for digging open collapsed chokes;
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<li>To free a stuck caver: hammers, chisels, washing up liquid (as a
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lubricant), large knife, wire cutters (to cut them out of their equipment).
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</ul>
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<h4><a name="s36">3.6</a>. Other problems</h4>
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<p>This is most likely to be either somebody too knackered or ill to get
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themselves out of the cave: see <a href="#s41">section 4.1</a>.
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<p>Stuck cavers can probably be extricated using hammers and chisels, or
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washing up liquid as a lubricant, or simply by providing slings and things
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to help them push, pull or climb in the right direction. You may need to cut
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them out of their caving gear, so take down some large knives (but be careful
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you don't injure them or cut important rigging in the process). Small knives
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may be useful if space is restricted, and a pair of wire cutters or similar
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could also be useful.
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<p>If cavers are flooded in, then it's probably best to leave them: sending
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more rescuers down may lead to the rescuers also being trapped. People have
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been able to escape in all the flooding incidents CUCC have experienced so
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far, although in some cases they may have to sit it out. Floods invariably
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render pitches impassable rather than sumping anything off. Leave the victims
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a dump of food, carbide, dry clothes and a stove, somewhere where they will
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see it, but where it won't get washed away. If spray is a major problem,
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electric lights might be worth providing. When you think the water is
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dropping again, send a team down to make sure they are alright, and to give
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moral support.
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<p>It should be obvious how to deal with most other problems (eg. light
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failures).
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<h4><a name="s37">3.7</a>. What to do if a member of your party is injured</h4>
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<p>Give as much first aid as possible (see <a href="#s42">section 4.2</a>).
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<p>If the injury is minor, and you are sure you can cope, get them out of
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the cave.
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<p>For more major injuries you should prevent their condition from
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deteriorating while sending somebody out to get help. If you are near a
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campsite get them to the camp---or bring the camp to them---and keep them
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warm. Failing this, put them into a survival bag (which you should have
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with you) and insulate them from the ground---get them to sit on a rope, a
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kit bag, or you. See <a href="#s43">section 4.3</a>.
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<p>If you only have two people in the group you have to decide whether to
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stay with the victim or go for help. This is why it is generally safer to
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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.
|
|
|
|
<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>Morals:
|
|
|
|
<ul>
|
|
<li>Don't get lost in the mountains: always carry a compass, and know the
|
|
bearings back from the caves;
|
|
|
|
<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>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>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>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>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>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>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.
|
|
</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.
|
|
|
|
<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: light a flame under
|
|
their butt, and out they go).
|
|
|
|
<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>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.
|
|
|
|
<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>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>Do the following in sequence:
|
|
<ul>
|
|
<li>Don't panic. Be methodical. Don't be rushed into hasty action. Keep your
|
|
reason. Don't put yourself in danger.
|
|
|
|
<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>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>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>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 <a href="#back">back</a>. If
|
|
there is any muck or whatever blocking their airway, get it out.
|
|
|
|
<li>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.
|
|
|
|
<li>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).
|
|
|
|
<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>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.
|
|
|
|
<li>The time to learn how to do this is when you don't have to.
|
|
</ul>
|
|
|
|
<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>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.
|
|
|
|
<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>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.
|
|
|
|
<li>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.
|
|
|
|
<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---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>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>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>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>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>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>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>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>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>Antibiotics. It is worth starting an antibiotic regime after significant
|
|
cave injuries.
|
|
|
|
<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>On the way out: keep talking to them; keep checking the pulse---if they
|
|
weren't shocked before, they might become so.
|
|
</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
|
|
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.
|
|
|
|
<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.
|
|
|
|
<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>.
|
|
|
|
<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---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.
|
|
|
|
<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.
|
|
|
|
<h5><a name="s443">4.4.3</a>. Horizontal stretcher movement</h5>
|
|
|
|
<p>Along horizontal passages there are various ways of moving the stretcher.
|
|
|
|
<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>Carriers are situated along the passage, and the stretcher is passed
|
|
along between them, either over their backs, or under their legs.
|
|
|
|
<li>One caver crawls on hands and knees, with the stretcher on his back; two
|
|
others control the ends of the stretcher.
|
|
|
|
<li>In flat out crawls, the stretcher can be pulled through with a rope.
|
|
|
|
<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):<br>
|
|
<center><a href="l/rltyrl.htm"><img src="t/rltyrl.jpg" width=200 height=134>
|
|
<br>Austrian CRO hauling Becka across loose slope in 161</a></center>
|
|
</ul>
|
|
|
|
<p>At all times somebody, preferably a doctor, should monitor the condition
|
|
of the victim.
|
|
|
|
<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.
|
|
|
|
<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---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.
|
|
|
|
<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>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>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><center><a href="../smkridge/161/l/rwinch.htm"><img
|
|
src="../smkridge/161/t/rwinch.jpg" width=123 height=181><br> Austrian CRO
|
|
hand winch in operation at 161</a></center>
|
|
|
|
<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 <u>must therefore be back at
|
|
their base before sunset</u>. 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>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
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chopper will most likely land some distance away. Do not approach the
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helicopter until signalled to do so, and then always stay in the 180°
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area in front of the machine, where the pilot can see you. The tail
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rotor and exhaust stream are extremely hazardous places !
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<p><center><a href="../piclinks/rl89c.htm"><img src="../tinypix/rl89c.jpg"
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width=118 height=179></a><br>Becka Lawson being moved on the winch cable to a
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safe landing place</center>
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<h4><a name="s46">4.6</a>. Local difficulties</h4>
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<p>In this section are a few ideas for dealing with particular problems that
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may be found in our caves.
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<dl>
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<dt>161 - <span lang="de">Kaninchenhöhle</span>
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<dd>No particular difficulties since the squeeze was bypassed and potentially
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even easier if there is a route from your accident site to the Scarface
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entrance. Biggest problems are likely to be due to potential distance of
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victim from entrance and people getting stuck somewhere where no-one can find
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|
them.<br> 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.
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<dt>Wet pitches
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<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
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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 <span lang="de">Wolfhöhle</span> and
|
|
<span lang="de">Sonnenstrahlhöhle.</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 !
|
|
|
|
<dt>Poor visibility
|
|
<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 !
|
|
|
|
<dt>183 - <span lang="de">Bovist und PuderZucker Höhle</span> (Puffball)
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|
<dd>Significant risk of flash flooding after heavy rainfall.<br>
|
|
Entrance area unstable, care needed when people milling around or moving
|
|
at the same time with the victim.
|
|
|
|
<dt>136 - <span lang="de">Steinschlagschacht</span>
|
|
<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.
|
|
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|
</dl>
|
|
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<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>David Judson (ed), Caving Practice and Equipment, especially
|
|
<br>chapter 17, "Accidents to Cavers", by Dr John Frankland.
|
|
<br>A particularly relevant extract is <a href="cpne.htm">on this site.</a>
|
|
|
|
<p>Jim Eyres and Dr John Frankland, Race against Time. The story of the
|
|
Yorkshire CRO, hilarious, and very informative.
|
|
|
|
<p>Steve Hudson, Manual of US Cave Rescue Techniques. Needs to be taken with
|
|
a pinch of salt.
|
|
|
|
<p>The following give information about first aid:
|
|
|
|
<p>Dr Peter Glanville, First Aid for Cavers.
|
|
|
|
<p>James A. Wilkerson, Medicine for Mountaineering and other Hazardous
|
|
Activities. Earlier editions are called Medicine for Mountaineers.
|
|
|
|
<p>St John's Ambulance, First Aid.
|
|
|
|
<p>The following give information about vertical rescue techniques:
|
|
|
|
<p>Neil Montgomery, Single Rope Techniques, especially chapter 9, "Self Rescue from a Vertical Cave".
|
|
|
|
<p>Mike Meredith, Vertical Caving, especially chapter X, "Mini-rescue".
|
|
|
|
<hr>
|
|
|
|
<!-- LINKS -->
|
|
<img alt=">" src="../../icons/lists/0.png"><b>Rescue topics:</b><br>
|
|
<img alt="--->" src="../../icons/lists/1.png">
|
|
<a href="http://www.pennine.demon.co.uk/NPC/1987/DRGIBSON.HTM">Caving
|
|
Accidents: Management from Site to surface</a>. An article by Dr. D.Gibson
|
|
in the 1987 NPC Journal.<br>
|
|
<img alt="--->" src="../../icons/lists/1.png">
|
|
<a href="../years/1980/report.htm#rescue80">Trapped by flood</a> in 113, 1980<br>
|
|
<img alt="--->" src="../../icons/lists/1.png">
|
|
<a href="../years/1984/log.htm#rescue84">Sitting out flood</a> in 145, 1984<br>
|
|
<img alt="--->" src="../../icons/lists/1.png">
|
|
<a href="../years/1989/rescue.htm">The 1989 rescues</a><br>
|
|
<img alt="--->" src="../../icons/lists/1.png">
|
|
<a href="../years/1991/log.htm#1991-182-7">Hit by flood pulse</a> in 182, 1991<br>
|
|
<img alt="--->" src="../../icons/lists/1.png">
|
|
<a href="../years/1993/log.htm#1993-161-18">Mislaid for 27 hours</a> in 161, 1993<br>
|
|
<img alt=">" src="../../icons/lists/0.png">
|
|
<a href="index.htm">Expedition Handbook</a> - Intro<br>
|
|
<img alt="--->" src="../../icons/lists/1.png">
|
|
<a href="look4.htm">Prospecting guide</a><br>
|
|
<img alt="--->" src="../../icons/lists/1.png">
|
|
<a href="survey/index.htm">Surveying guide</a><br>
|
|
<img alt="------>" src="../../icons/lists/2.png">
|
|
<a href="findit.htm">Taking bearings</a> to locate caves<br>
|
|
<img alt="--->" src="../../icons/lists/1.png">
|
|
<a href="rigit.htm">Rigging guide</a><br>
|
|
<img alt="--->" src="../../icons/lists/1.png">
|
|
<a href="photo.htm">Photography guide</a><br>
|
|
<img alt=">" src="../../icons/lists/0.png">
|
|
<a href="../infodx.htm">Index to info/topics pages</a><br>
|
|
<img alt=">" src="../../icons/lists/0.png">
|
|
<a href="../indxal.htm">Full Index to area 1623</a><br>
|
|
<img alt="--->" src="../../icons/lists/1.png">
|
|
<a href="../areas.htm">Area/subarea descriptions</a><br>
|
|
<img alt=">" src="../../icons/lists/0.png">
|
|
<a href="../index.htm">Back to Expedition Intro page</a><br>
|
|
<img alt=">" src="../../icons/lists/0.png">
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<a href="../../index.htm">Back to CUCC Home page</a><br>
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