David Shema
As Mountaineers, we are committed to learning from our experiences. We examine every incident that happens on a Mountaineers trip for opportunities to improve the ways we explore and teach. Our volunteer safety committee reviews every incident report and picks a few each month to share as examples of ‘Lessons Learned’. The trip report below describes what happened on this trip, in the leader’s own words, and outlines the lessons the leader has identified. In some cases, we offer additional key learnings from the incident.
Sharing incidents creates an opportunity to analyze specific incidents and also identify larger incident trends. We appreciate every volunteer trip leader who takes the time to share their incidents and near-misses so that others can benefit. We ask that readers engage critically and respectfully in the spirit of sharing and learning.
Gothic Basin, North Central Cascades – 4 August
FROM THE INCIDENT DATABASE: LEADER INCIDENT REPORT
LEADER
A participant (let’s call him Zac – not real name) placed his weight on his right pole on the side of the trail and the trail side gave way, leading to him tumbling down a roughly 65 degree slope about 30 feet back to the trail (we had just started descending switchbacks). He is about 200 pounds and had a 40-pound pack, so he had considerable momentum. Fortunately, the slope was very brushy and dirt with few rocks, so his fall was considerably mitigated. The trail itself was somewhat rocky and hard and might have contributed to his injuries. This was at about 9:58am Sunday August 5. The group was close to him at the time.
PARTICIPANT
A member of our group who was a few feet behind me, slipped and lost his footing on a slippery rock which caused him to fall 20-40 ft. down the side of a switchback. I expecting the worst after seeing him literally disappear in front of my eyes, however he was conscious and in serious pain when we got to him.
LEADER
I was leading from behind and heard the group shouting that a serious fall had happened. I quickly caught up with everyone and directed them to follow the directions of our Wilderness First Aid (WFA) designate (also a medical doctor). She was at or near the lead of the group. She assessed the scene for safety and determined that Zac was on the trail so we followed the trail to him.
There was considerable blood on the trail, Zac's clothes, and his head. The WFA designate put pressure on what appeared to be his main head wound. I took over so that she could perform other WFA duties. Zac was conscious and seemed coherent. Breathing and pulse were good (16 to 18 ppm and in the 80's respectively). He complained of considerable pain. We did a quick C-spine assessment (he was laying on his side so his back and neck were readily exposed). We saw no cause for concern in that regard.
We had considerable difficulty stopping the bleeding but it turned out the main reason was we didn't correctly find the location of the wound itself. The flow and his hair obscured the true location. After about 10 minutes we did get the bleeding to stop. The blood loss was substantial but far from being life threatening.
We further assessed injuries and determined the left wrist was the worst, with considerable swelling and great pain. His right knee also had very substantial hematomas (the WFA designate was confident it was a hematoma from her professional experience; I couldn't say). He had a number of other abrasions and bruises but nothing serious. There was a small wound above his nose and its bleeding was also difficult to stop but the amount of bleeding was minimal.
We were able to move Zac into a more comfortable seated position and soon carefully tested his legs to see if they could bear his weight. They could and he was keen to start evacuating himself, but we stopped him (we were far from being ready for that). His right arm was also able to help him get up, etc. We continued to assess him, including further testing his mental state. We bandaged his head wounds effectively, put a splint on his wrist with a sling, and bandaged his right knee. We also cleaned him and the area up as best we could.
Throughout we were considerably helped by the rest of the group and passersby in terms of traffic control, retrieving resources, etc. A nurse, a doctor, and some people with search and rescue related experience came along at various points and contributed opinions that were usually helpful.
By 10:40am we were confident we understood Zac's injuries and abilities and, while we thought he could be mobile, we doubted he could make it all the way to the trailhead. We had about 3 more miles to go, there would be a couple of tricky stream crossings (tricky for his state), and the trail was often narrow with poor footing. So I decided (with the consensus of others involved) to use my Inreach Messenger to signal an SOS. Due to tree coverage we didn't actually start texting with them until 10:52am. We expected that at the least Search and Rescue could start getting organized and meet us part way if need be.
By 11:30am the group was moving again and we soon found Zac could make quite good progress. Zac's gear had been split amongst 4 people so he had no load (but was using a pole) and others (including myself) were not too overloaded. He was in good spirits and clearly very active mentally. We were mostly in trees so the Inreach messages were delayed but were working. We found out the Sheriff’s office was involved. Somewhere around 12:30pm a helicopter came into our area. They couldn't see us due to the trees but as it turned out they lowered an EMT to the ground and by talking to passersby he learned that we were below. He came down and further assessed Zac and the situation. He had radio contact with his control base, etc. He continued with us as we walked Zac out. A helicopter evacuation didn't seem needed and there was another issue it had to attend to. It also needed maintenance before long but we could have arranged a helicopter evacuation if needed. It's possible Zac declined the helicopter evacuation (I wasn't part of that conversation as I was attending to other tasks (and it was primarily a medical decision and others were better qualified in that regard)). The EMT agreed our medical assessment and treatment were appropriate and sending the SOS when we did was appropriate.
By about 1pm we were at the road that is the first part of the trail. About 15 minutes earlier Zac had become considerably less responsive. He was still moving but a little slower. He was answering questions well but had seemingly become mentally exhausted from the day's events and the pain. The EMT had been trying to arrange a vehicle to come get Zac and within 5 minutes it did so. They provided a quick ride to the trailhead where an aid car (ambulance) was waiting. Two more EMTs further assessed Zac and tried to talk him into using their services to go to the nearest hospital. They were concerned because he had head injuries. He declined that, mainly because it would likely be a cost to him. He made that decision on his own in discussions with them. Other than the aid car EMTs, we were all reasonably comfortable that declining their services was not a serious risk.
Around 2:30pm, Zac left with me to Swedish Hospital in Issaquah. I was his driver for the trip and he and we have known each other for about 12 years, having done many hikes and backpacks together. We arrived at Swedish at 4pm. They assessed and treated him and discharged him at 11pm. He stayed at my house overnight. He ate and drank well at my house, conversed normally, and slept about 12 hours. Later today I'll return him to his apartment and Tuesday I'll help him visit a general practitioner.
At the emergency ward, Zac received 3 stitches for his forehead wound, 5 stitches for his back-of-the-head wound, a professional splint and sling for his wrist, wrappings for his knees, and prescriptions for pain medicine. He was advised to see an orthopedist for the wrist (which he will). He was also told that he would be in considerable pain for a few days and that otherwise all his wounds will heal with time.
Lessons Learned
LEADER
We'll think about this more, but my thoughts so far are that nothing could have been done to avoid the incident. Zac made a simple mistake that he knows to not do and in the course of many years of being on trails had not made despite probably millions of such steps.
Our response proceeded very well. We were fortunate in that weather and timing were pretty much ideal, Zac is very strong, and he has a high tolerance for pain and a strong will. We were also fortunate that the Sheriff's office so readily used a helicopter and EMT to assist.
I'm also pleased I had a PLB (Personal Locator Beacon) and lots of first aid supplies (and the rest of the group had a good amount too). Having a doctor on the trip was wonderful. I believe I would have treated Zac similarly given my WFA training but our WFA designate’s expertise meant that we had little doubt about our decisions. Having two sets of hands with relevant training surely helped (though I'm sure our WFA designate would have managed wonderfully with anyone's assistance). Passersby (of which there were many) were very cooperative and did not seem to have adverse reactions.
The experience with the PLB was instructive. A clear view of the sky is important, so I'll make a point of that in the future. The communications between the PLB people and search and rescue and my primary contact (my wife) was also very considerable (10 phone calls in total). They were very pleased to get extensive details on our trip from my wife, along with details on my training, etc. That reduced a lot of confusion and stress for them.
There was room for improvement in that we could have been more complete in following head-to-toe and patient assessment procedures. We did quite a good job of them but found later that mistakes were made. Fortunately, they were not consequential but in different circumstances could be. I'm sure the significant bleeding was the biggest contributor to this issue (we were rushing to stop it).
I found that my requests for group assistance were not followed as well as I expected at times. In retrospect I believe I should have been more specific in asking specific people to do a specific task with some details on how to do the tasks and then watch to ensure they start doing them. There were no real negative consequences in this case but if weather or other conditions had not been favorable there could have been complications. This is a part of group dynamics that I was familiar with in theory but didn't apply properly.
There was an element of 'fog of war' throughout the whole incident but IMHO that is to be expected. Taking time to keep everything perfectly organized, review procedures, review options, etc. could lead to other issues.
PARTICIPANT
Be extra, extra careful on slippery rocks.
