Glissade Aid Case Study
After reaching the summit you are descending Buckeye Peak, an almost 13,000 foot peak in Colorado. You return to the top of the snow filled gully you laboriously ascended an hour or two earlier. The snow is deep but the avalanche hazard low. You pull out your ice axe—you’ve been dying to use it—and hop up, landing on your butt to glissade that baby. You scream in joy all the way down and then leap to your feet to watch one of your buddies follow you. It looks like she too is having a blast, snow flying high over her head as she rockets down the slope, when near the bottom you see her start to go sideways and then suddenly she catapults through the air and lands off to the side. You quickly posthole up to her.
Scene and Primary Assessment: You are on a 30 degree slope with low avalanche hazard. It is moderately cold (20 degrees F.) but with a nasty, maybe 20 MPH wind, otherwise safe. The rest of your 5 person crew more carefully descends the slope to join you. Terry has an airway, she is breathing rapidly and painfully. You don’t see any blood or major disabilities. She moans and barely acknowledges you when you ask her how she is and what is wrong.
Secondary Physical: Terry’s physical is normal until you get to her chest. She almost screams when you palpate the right side of her chest. You decide you need to look under her parka. It makes you glad you were smart enough to bring an sleeping pad with you on this winter climb. You pull out it out and get her to sit on it. You then unzip hier parka and pull up her shirt. She moans as you do and you watch her rapid breathing but there seems to be minimal movement on her hurt side. You gently put you hand on the ribs to determine if you can feel anything wrong. Your hands are too cold to feel much and you are worried about the icy wind so you quickly pull the shirt down and zip up the coat. You are super worried and wonder if it’s worth even completing the physical in this exposed spot, but you are this far along, you just hurriedly finish it, finding nothing else of note.
SAMPLE Assessment: Symptoms as noted above. Terry is looking scared and pale. No allergies. No relevant history. In terms of medicine, Terry is taking just naturopathic medicines including zinc, ginko, and something else she can’t remember. She has never felt like this or had a collision like that. She has been drinking regularly (one and half water bottles since leaving the hut this morning, plus coffee and instant milk with granola this am), ate a reasonable sized lunch, and had a good breakfast. She was doing fine, “outs” all normal, and enjoying the climb and the exciting glissade, until it ended with her losing control and slamming her side into a boulder.
Vitals: Round 1 – HR 112, RR28, AOx4. Round 2 (15 minutes after accident) – HR 120, RR 32, AOx4 but anxious..
Setting: ~12,000 in the Central Rockies. Skies are clear, about 20 degrees F., but there is a nasty wind above treeline. There are some crusty drifts up here, but down below snow conditions are near perfect. It’s almost 2 pm, February 18. Less than a half mile to a 10th Mountain Division Hut (with wood stove, solar lighting, bunks, etc.), or 3.5 miles to a trailhead, mostly, but not entirely downhill. You had cell service on the way up but you notice that your battery is dead. You have a recharger at the hut, which also has a first aid kit (though you have no idea what is in it) and you’ve been told a rescue sled. It’s you and four other friends, not counting Terry. You all have daypacks with extra clothes, some left over lunch, maybe a liter of water left each, avalanche gear (shovel, transceiver, and probe), ice axes, helmets, plus that sleeping pad.
You think about a snow cave but figure it isn’t far to the hut so you ask Terry if she can walk. She can, but with difficulty, so you take her pack and slowly walk down to your skis, which are waiting just below the real steep stuff, close to treeline. By the time you get to the skis Terry is stumbling and only able to go at a snail’s pace. You decide to get to the trees, let Terry rest, and reassess before getting on the skis.
Reassessment: Round 3 of Vitals – HR 128, RR 36; V on the AVPU scale. You all take a break and then do a reassessment of Terry’s condition. Now out of the wind you are able to fully expose Terry’s chest. Terry moans as you carefully work the jacket off and pull up her shirt. You see a big bruise starting to appear on the right side. It appears she is mainly using her left side to breath. You gently place your hand on the right side, the hurt side, and you feel crepitus. It seems part of the chest wall is moving independently of the rest of the chest wall.
You are now about a quarter mile, and a relatively easy ski, from the hut. It is 3 pm.
Let’s face it, Terry (and you!) are in a world of hurt. You have at minimum broken ribs along with a possible flail chest. It’s cold, windy, and will be dark soon. And what are you really worried about?? (see Anticipated Problems below for answer to that).
Assessment: Terry, a 25 year old female, tumbled down a steep snow slope at 15-20? mph, striking a boulder with her right side. She has apparent broken ribs and possible flail chest. She is in respiratory distress. Vitals deteriorating, with rapid HR and RR. V on AVPU scale.
Anticipated Problems: Hypothermia, pneumo- or hemothorax. Evacuating someone V on the AVPU scale. Approaching darkness. Fellow rescuers staying warm. Depending on where people are from (flatlands or high in the Rockies) and how long they’ve been at hut, altitude illnesses.
Plan: Keep Terry warm, allow her assume position of comfort to ease breathing. Keep an eye on your whole team – everyone could be getting cold. Send two of your best and strongest skiers down to the hut to alert anyone else there of the accident and to get rescue sled, high calorie food, and sleeping bag(s). They should check to see if anyone else at hut has cell phone coverage or other emergency communications. If so SAR should be alerted to potential emergency rescue request. Your two buddies should be prepared to return with sled ASAP, and if there isn’t one at hut one returns to share the bad news while the other starts to build improvised sled. Send another party member to start to scout easy route down for sled to hut. It will likely be getting close to dark by the time you are all are back to the hut so best bet is likely to hunker down to spend the night. If enough personnel, have someone scout landing zone for a helicopter before it’s too dark. If no emergency communications are available possibly send two good skiers with knowledge of trail, keys to at least two vehicles, copy of SOAP notes, and “10 essentials” down to alert authorities. Depending on Terry’s condition, be prepared to wait for first light for rescue or self-evacuation. Only in life or death situation would nighttime self-evacuation be recommended.