Fall – Case Study
- November 27, 2019
- Posted by: meaganrivers
- Category: Newsletter - Case Study Responses
Narrow Miss? – You are on a three-day southern Utah canyoneering trip in late October with 3 friends. You are all in your mid-twenties. It is the afternoon of day two, in a very narrow side canyon when come up to a “pour off” where your side canyon joins a bigger flow. It’s about a 12-foot drop with a sketchy move river right that you’ve been told is the way down. Your most adventuresome friend, Liz, skinny with the nickname “squirrel,” says she’ll give it a try and before you know it she’s starting down. Liz gets down the first four feet and all of sudden she slips and tumbles down the remaining nearly vertical eight feet to the sandstone rock below. Now you wish you hadn’t rejected the helmets because “they weighed too much.” You can’t quite see what Liz hit (it happened so fast) but she landed with an audible “thump” and she isn’t moving
Scene Assessment: You are 12 feet above her. The ground is cool and wet due to the seeps around you. Little to no danger of rockfall or flash floods. You have 50 feet of 7 mm perlon (tensile strength 1325 kg or about 2915 lbs) but no place to anchor.
Primary Assessment: When you finally get to her you are very relieved to find her with patent airway, breathing, and no major hemorrhaging. She is still unresponsive. Nothing other of note.
#1 SAMPLE: Liz is unresponsive, no answers. As a friend you don’t think she is allergic to anything. She, like the rest of you ate a good breakfast two or two and half hours ago. You have all been watching how much you drink as you’re waiting for the “good drinking water” at the spring that’s supposed to be another hour ahead of you at the campsite you are hoping to spend the night at. You think Liz pinched a loaf this morning (but aren’t sure) as she went behind a big boulder about two hours ago. You don’t know where she is on her menses.
#1 Physical: You find a bruise and small cut on her forehead. Otherwise normal though she is unresponsive (which worries you greatly)
#1 Vitals: Heart rates and respirations seem to be normal at 80 and 16. Unresponsive.
Setting: You are in Grand Staircase-Escalante National Monument. It is 12 miles to the trailhead and your cars at the end of the canyon and 6 miles back up stream to where you started, at the end of a deserted dirt road. There is no cell service and no way out of the canyon except one Class 4 scramble about 5 miles down canyon. You have a SPOT satellite messenger. It is late Oct. Temps in the slot canyon are cool (maybe 60 degrees) right now, about 2 pm, though you know it’s hot up on the top.
What do you do? (Assessment, Anticipated Problems, Plan, and (immediate) Treatment)
Assessment: A 27 year old female suffered an eight foot fall while scrambling. She is unresponsive with bruise and small cut on forehead. Vitals otherwise normal.
SAMPLE unremarkable as far as you know. Treatment – keep her warm.
Anticipated Problems: TBI and increasing ICP; spinal issues; hypothermia; transport, communication.
Plan: Thankfully you had the perlon. You find a big anchor rock and tie it off and two of you use it as a hand line to very carefully down climb to her. One of you stays topside in case a belay is needed to get her back up and to lower your packs down to you. You hold her head and neck hand stable. You log roll her to get her off the cold ground and on to one of your sleeping pads. You cover her up with a hat and jacket.
Ten Minutes Later
#2 SAMPLE: It is ten minutes after you have gotten to Liz who is now conscious and responding to your questions. She complains of nausea, a headache, and especially about the bruise on her forehead. Liz states she is on oral birth control and tells you she is allergic to seafood and iodine. She last had her period 3 weeks ago. You accurately guessed the rest.
#2 Secondary Physical: A little more calmer you do a slower physical on Liz and find a couple of minor cuts and scrapes on her legs. Nothing else of note.
#2 Vitals: HR and RR continue at 80 and 16. Liz doesn’t remember the fall, though she knows her name and where she is.
What do you do? Assessment, Anticipated Problems, and Plan
Assessment: Liz, a 27 year old female suffered an eight foot fall while scrambling. She complains of a significant headache (7/10), nausea, and a scratched and sore leg. AOx3. Liz has been warmed with jacket, hat, and by sitting on sleeping pad. Spinal assessment normal. Cut cleaned on head.
Anticipated Problems: Increasing ICP, secondary TBI, hypothermia, transport, communication, campsite location (flash flooding)
Plan: You try to use your SPOT messenger but in the narrow slot canyon you get no connection to a satellite. You ask Liz if she thinks she can walk and she says yes. You would prefer not to have move much but you can’t stay where you are, at least overnight as you need to find a campsite safe from flashfloods. While going back up stream to where you entered the slot canyon would be shorter (6 miles), your car was shuttled down to your exit point and you have no way of knowing if anyone else is there and if not it would be another 10 miles on a seldom used dirt road until pavement and road where you could reasonably expect to get cell phone coverage or flag down a vehicle. So, you decide to continue downstream towards the exit point and your car (even thought it is 12 miles) and to the scramble out where you might be able to get out of the slot canyon and up to where the SPOT can connect with a satellite.
You have a group meeting and decide that as long as Liz can walk and she doesn’t get any worse (vomiting, worsening headaches, lowered LOC, erratic respirations), you will slowly walk downstream and camp at the nearest elevated (safe from flashfloods) campsite to the scramble out, which would allow one or two of you to climb out of the slot canyon enough to send message on SPOT if Liz gets worse. You know the best thing is to just let Liz rest, but you don’t see how that gets her out of the slot canyon and you know an outside evacuation wouldn’t happen until the next day at best. So you go with the slow walk out
Your friend still up above the drop-off lowers the packs with the ropes. You regrettably feel it’s safest to sacrifice the perlon rope so your friend can use it as a hand line descending. You cut off the short section left on the ground at the base and leave the rest. You carefully and slowly continue, ensuring that Liz does not have a second accident and TBI.
Late that afternoon/early evening you get to the bottom of the one way up and out of the slot canyon in either direction for 5 miles, to where you might be able to connect with the outside world. Liz is still feeling queasy, with a headache and no appetite. What do you do?
- Do you all climb out and call for an immediate evacuation (And risk having Liz climb a sketchy Class 4 route given her condition and a worry about a second TBI? When could your reasonably expect rescue given the late time of day)?
- Do you send one or two of you up to call for help? (When would help arrive? Would they come in overland? Via chopper? If via chopper, it can’t land in the narrow slot canyon; how would you get Liz out?)
- Or do you use the pretty good campsite up above the flash flood line near the bottom of the exit and spend the night? (If so what do you do during the night? a. Keep her awake? b. Wake her up every 2 hours or so to ensure she isn’t getting worse? c. Let her sleep and hope for the best?)
While there is not right answer to any of these questions you probably don’t want to risk Liz scrambling up an exposed and dangerous, even if relatively easy, route (#1). Besides you would still probably be stuck there for the night. You probably don’t want to split your group on an exposed and dangerous exit, especially late in the day (#2). And assuming they safely got to the top and were able to call for help, Liz is probably still not getting out until the next day. So, probably your best bet is #3, spend the night at the pretty good campsite. In terms of what you do during the night (c) is likely your best bet as sleep is the best medicine for Liz and were she to get worse in the middle of the night what would you do? The Class 4 exit route is hazardous in daytime; it would be particularly treacherous at night, as would trying walk out the rest of the way. Therefore, since there’d be little you could, let her sleep (probably with someone right next to her keeping a close eye and ear on her. In addition, it couldn’t hurt to have Liz sleep with her head and upper body elevated at 20-30 degrees.