Re: Backcountry Emergency: Evaluation
Norman J. MacLeod (gaelwolf@MARLIN.SSNET.COM)
Sat, 3 Jun 1995 18:05:28 EDT
From the perspective of a search and rescue (SAR) professional, you did the
right thing. Head injuries are very tricky. Your Scout could easily had a
concusion or skull fracture in the type of mishap you outlined, and there is
no way of ruling these types of injuries out with the mishap history you had
at hand. If there had been a concussion, skull fracture, or subdural
haematoma (ruptured blood vessles within the cranial cavity, with bleeding
that can cause pressure on brain tissue), the boy could have seemed alright
for a time, and then deteriorated too rapidly for recovery.
When you have something like this, without a good idea of what the exact
extent of the injuries are, it is far better to err on the side of extreme
caution than to try to outguess the person's medical condition based on your
observations. Chances are that a trained trauma physician would have made
the same call you did, under the circumstances. At your level of training,
waiting to see what might happen would have been rather unwise, and possibly
life-threatening, had the boy hit the rock with only a little more force
than he actually did.
I, and I believe most other SAR folks, prefer that people err on the side of
caution instead of leaving things so long that a SAR-OP might have an
adverse conclusion. While there are times when SAR missions are called for
situations where we end up feeling as if we have been called out on a false
alarm, there are more times when we end up wishing the mission had been
mounted hours or days earlier than it was. Lots of folks would prefer to
"tough it out", which can often lead to serious problems.
As a side issue here, I would like to ask you how you felt regarding your
level of emergency medical training when you were confronted with this
situation. Did you feel as if you were pretty far out of your depth, or did
you feel as if the training you had helped you to be equal to the task? Do
you think you should seek a higher level of training as a result of what
your Troop experienced in this instance?
Personally, I am a very strong advocate of all adult Scout and Guide Leaders
becoming trained to at least the level of a wilderness first responder
(WFR). Courses to meet this requirement are fairly readily available
throughout large portions of North America, and similar courses are offered
in Europe, Australia, and several other countries that have large areas of
territory that is fairly remote from the nearest hospital. There are also
EMT-W (Emergency Medical Technician - Wilderness) courses available for
people who have completed at least basic EMT training, which is readily
available in the USA.
I also advocate that Scouts who participate in adventure activities such as
backpacking and river trips be trained in a higher level of wilderness first
aid skills than most Scouts routinely receive as part of their normal
badge-work. As a Leader, you have at least some self-interest in the level
of their training, since the accidents don't happen only to the kids... Can
your Scouts evaluate and treat your injuries and then evacuate you to a
trail-head? Worth thinking about, eh?
Now that a lot of folks are learning that internal frame packs are not the
be-all end-all of backpacking technology, and we have decent numbers of
external frame packs again, have you recently practiced lashing three frames
together to build a decent orthopaedic evacuation litter? This type of
improvisation uses up two 25 metre lengths of 4 or 5 mm synthetic line, but
can become a critical skill if someone gets injured several kilometres from
the trailhead in bad weather.
Terry Howerton Sakima Group, Inc. SCOUTER Magazine Kansas City