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Safety Highlight – Concussed!   Snow Falling From Cedars
Lessons from Mountaineer Incidents

Seattle Climbing and Seattle Safety committees are experimenting with raising awareness of safety issues that can arise on climbs, scrambles, backcountry skiing, and other Mountaineer activities. Previous Safety Highlights and other information are available on the Safety Committee’s web page.

Identifying information has been removed or disguised.

-- Dave Shema, Seattle Branch Safety Officer

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Blows to the head can be very difficult to assess, especially in the backcountry.  There may be few signs of injury. 

Asking the right questions to learn of symptoms can be an art - head trauma patients may answer a specific question in the negative (e.g. "Did you see stars?") and be too disorientated to address the intent of the question.

The student involved in this incident provided some suggestions.

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January, 21, 2012 - east side  of the Gold Creek Winter Recreation Area, Snoqualmie Pass

Injuries: head trauma with possible concussion

Cause of Accident: Snow/ice falling from tree

One student was struck on the head by a lump of snow falling from a tree. She felt like she was hit by a heavy weight. She had no signs of physical or neural damage. Her pupils were equal and responsive to light. She did not see stars. She remained fully conscious and responsive to questions. She said she felt sleepy. She seemed to improve for a short time, then after talking with other students, decided to return home in her car driven by her passenger, who was the other person in her carpool.

The student went to the ER, waited for hours, and left without being seen by a physician.

Leader:    

No warning signs. She was just in the wrong place at the wrong time. The snow/ice could have fallen at any time. It was not triggered by her or anyone else, The tree was a very tall conifer.

Student:

I'm doing okay. I did go to the ER, but there was a several hours long wait, and as the vision changes were clearing up, I decided to head home. I have a big lump on my head but no lingering effects.

I do have some suggestions for the safety committee as a result of this incident. Let me preface this by saying that I am a trip leader with some first aid training and prior snowshoeing experience. I've taken Avalanche Awareness, and I'm comfortable reading snow conditions. The leaders of the fieldtrip did mention that snow could fall from trees onto the trail, particularly in the woods. There wasn't a whole lot that could have been done to prevent the incident -- I was just standing in the wrong place at the wrong time, and when the snow fell, the wind hadn't been blowing at all.

I think we need to have some clear, standard guidelines as to how leaders should respond to a head injury. The report doesn't mention that, while I did not see stars, I did have vision changes (blurry and darker than usual), felt nauseous, and felt rather dazed. I knew where I was and I wasn't confused, but I definitely felt out of it -- like I was having an out-of-body experience almost. I was glad when several other people on the trip volunteered to help me get home.

One thing I would suggest is that, when several pounds of snow fall or someone hits his/her head rather hard, the leader should never ask the person with the head injury what s/he wants to do. Even if that person is responsive to questions, it's pretty disorienting to have something like that happen. Have a plan -- for example, the co-leader or participants in that person's carpool will make sure that person gets back home safely and gets checked out. I felt some pressure to keep going, and as I mentioned, I really didn't feel great.

Had something like this happened on a hike I was leading, here is what I would have done.
1. Stopped and fully assessed the situation, getting the opinion of the MOFA leader as well. I'd take into account things like distance from start and destination, seriousness of the injury, and whether or not another hike leader was present on the trip.
2. Made sure the person had adequate time to sit, drink water, and eat something.
3. Make a decision whether or not to go forward and leave two people with the injured party (if assessed as a minor injury), go forward and send the injured party back to the trailhead and to home (if we were only a short way in, as we were on Saturday), or turn the whole group around to get everyone back to the trailhead safely. In the last case, I would likely accompany the person to the nearest hospital/ski patrol to get first aid care.

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