Tuesday, 12 March 2019

Avalanches, Beacons and Being Searchable

1. Learn How to Interpret the Avalanche Forecast. Don't get avalanched ......

The Avalanche Danger Scale uses five progressively increasing danger levels: Low, Moderate, Considerable,  High and Extreme. It indicates the likelihood of avalanches, how they might be triggered and recommended actions in the back country. However, the wording is very brief and does not include a meaningful indication of risk. Below is an explanation of each danger level, including the transitions between levels, signs of instability at each level and the implications of slope angle, aspect and elevation.
Understanding the SAIS forecast as acting on it could save your life
Travel is generally safe. The snow pack is well bonded and natural avalanches will not be seen except for small sluffs on extremely steep slopes. Human-triggered avalanches are unlikely except in isolated locations in extreme terrain. The danger will usually be from wind-driven snow in gullies and chutes or deposited across very steep open slopes near ridge lines. Ski or board one by one as smoothly as possible without falling if you suspect the formation of wind slab. Be aware of shaded, north to east aspects where the danger may be transitioning to Moderate. There are few fatalities at this danger level.

This is the most difficult danger level for back country skiers and boarders to assess snow stability. Many of the usual indicators such as cracks, settling, whumpfing and signs of recent avalanche are absent, especially at the lower end of the moderate level. Key indicators are any recent snowfall, and wind deposition. Snow pack tests may help assess stability.

Conditions are generally favourable for travel providing routes are chosen carefully. The snow  pack is only moderately bonded on some steep slopes. Areas of danger are usually restricted to certain types of terrain such as bowls and gullies. The altitude, aspect and type of terrain where danger can be expected are usually detailed in the Avalanche Forecast. Remote triggering is unlikely, so you only need to be concerned about the steepness of nearby terrain features.

Human-triggered avalanches are possible. Ski or board carefully, one by one, in suspect terrain and avoid high loading of the snow pack by spreading people out on the uphill track. Carefully evaluate the stability of very steep slopes (steeper than 35°) and aspects identified as potentially dangerous in the Avalanche Forecast.

Be especially careful if the higher elevation band in the forecast, or the danger on other aspects, is Considerable. There is a significant difference in instability between Moderate and Considerable. Don’t get sucked onto higher, steeper and more dangerous slopes. Although naturally triggered avalanches are not expected, ice climbers should watch out for the sun warming steep collection zones above their climbs. If deep-slab instability due to a persistent weak layer is mentioned in the Avalanche Forecast, you need to pay careful attention to the terrain. Avalanches from such a layer are not only likely to be large and extensive, they are completely unpredictable. Unless you have specific local knowledge, keep off large open slopes at this danger level if the forecast warns of a persistent weak layer.

29th March 2013 using the older SAIS Graphic for localised considerable hazard
Persistent Weak Layer March 2013

Click pics to enlarge

Large Slab Triggered off persistent weak layer 30th March 2013
Fatal Avlx x 1 Skier Glencoe
Conditions have become much less favourable. The snow pack is only moderately or poorly bonded over a much larger area of the terrain. Human triggering is possible by a single skier on steep slopes and aspects mentioned in the Avalanche Forecast. Remote triggering of avalanches is possible, so the maximum steepness of the slope above you should be used when deciding if you want to continue.

Instability indicators mentioned in Moderate danger above will likely be present. Back country touring at this danger level requires good route finding skills, and experience in recognising dangerous terrain and evaluating slope stability. Keep to slopes of less than 35°, especially slopes at the altitude and aspect indicated in the Avalanche Forecast. Remember that remote triggering is possible. Typically the scree fans at the bottom of gullies start out at around 30° and the slope steepens as it gets higher. Keep off such slopes at this hazard level. The remarks about persistent weak layers in the previous section on Moderate danger level also apply to this danger level.
New SAIS graphic as stripes for localised "considerable"

Reports such as the above showing stripes as areas of  localised "considerable" risk  to North and South within a moderate NW to SW aspect and considerable risk NE to SE. This is the sort of thing that it's easy to become complacent about as its a common feature of the Scottish winter. You might very obviously if you have any sense, stay well clear of the NE to SE aspects but wander into a high risk situation on descent on the N to S aspects.  The majority of avalanche incidents in Europe occur in these moderate to considerable forecast days as they occur most frequently in the season and folk become complacent (the familiarity heuristic) and that's why route choice approaching a climb and thinking about descent options prior to leaving and during a trip as wind and weather change should become part of your thinking.

Conditions have become dangerous, most often as a result of significant amounts of new snow, snowfall accompanied by wind or the snow pack becoming isothermal and threatening wet-snow avalanches. The snow pack is poorly bonded over large areas and human triggering is likely on steep slopes (steeper than 30°). Remote triggering is likely and large natural avalanches are to be expected.

Stay on slopes that are flatter than 30° for any part of the slope and be aware of the potential for avalanches from slopes above. If you do decide to walk ski or board on less steep slopes, be very aware of the surrounding terrain to avoid inadvertently crossing the bottom of steeper slopes or cutting down a steep convex rollover.

Usually this level of hazard is only present for a few days at a time. The smart back country traveller will stay in simple terrain until conditions improve. If you are caught out on a multi-day trip you may have to dig in and wait for travel conditions to improve and the avalanche danger to lessen.

These stripes in the avalanche forecast. My take is to think of them as landmine strips blown by the wind, lurking in eddies from cross loading when the wind blows across as well as down or over a slope, the colour of them is the sensitivity of the pressure plate to you the trigger. If there are enough of them the explosion will propagate setting of others, or if the surrounding slope is weak enough then it will slide with it. As you can see there are areas of High on slopes with a localised "considerable" and a"considerable" risk to the South.  A lethal combo of  narrow safe travel options making for events that will take lives if you don't tread warily and navigate with extreme care.

Extreme danger levels are rare in Scotland as usually this level is associated with buildings and roads or alpine villages under threat, and usually the result of unusually large amounts of new snow. The snow pack is weakly bonded and unstable. Numerous large avalanches are likely. The weight of the new snow can trigger avalanches on layers buried deep in the snow pack. Natural avalanches can release on slopes of less than 30° Back country touring is not recommended and often impossible. Avoid all avalanche terrain and keep well away from avalanche path run outs.

Avoid Groupthink
In psychology "Groupthink" or "Risky Shift" behaviour is well known in groups and most of us will be aware that we have given in to it or even encouraged it. I strongly believe that in avalanche incidents in Scotland this groupthink or risky shift has become the biggest education issue and maybe why we see large group incidents or group events as occurred in the Cairngorms when two separate groups were avalanched last winter. Much has been made of the quick response from folk training in the corrie who helped.  And good on them. What I am about to say is not a reflection on these helper folks choices, as I am sure they stayed in safe terrain.  The  "however" bit though is that just by being there and numbers increase with lots of MRT's training, and groups under instruction, then a larger "Groupthink" takes place. Groups less experienced or not under instruction maybe feel safe, what McCammon labels  as Social Facilitation.  I would call this a  "risky shift". It's often this way in the climbing and skiing honey pots such as the Northern Corries where folk gather. Aonach Mor or ScRL in Glencoe are other places. Even if the waggon wheel of death shows Red on these slope aspects, they are still the places to be seen by the instructor masses who are now at the height of their annual gatherings with paying students. These are the places instructors are familiar with, and therefore where less experienced folk feel safer with an apparent safety in numbers. They maybe went there when they were on a course. Group thinking on a large scale perhaps.

Better minds than mine have already written about risky shift and here's an excellent article on it The Risky Shift Phenomenon and Avalanches. This kind of stuff has been getting applied to avalanche instructor training for a while by AAA.  Do current winter mountain training schemes  include enough if anything on this sort of thing?  I put this as a question, as I am certainly not in a position to know, and maybe it is already covered. What I do know is that there is nothing that can change the pretty piss poor odds if buried and that pretty universally all of us involved in avalanche education are trying to jump forward and get to "no rescue".

No matter what we do, mountains and people are unpredictable. As a keen off the piste skier I have to accept that luck is also in there as well, as on good snow days I am first in the que and having gone through the forecasts, stability tests you are only left with how the snow feels under you ski's and gut instincts. Sometimes it's a very subtle thing where in the morning it feels wrong, and by afternoon the snow "feels" safe.  I don't know how the feck that would stand up in court! I also know its taken 40 years and I still can't always be sure it all won't go tits up one day. I also know that it pays to voice your opinion when in a group, and make your own choice, not getting swept along by the group and it's most vocal leader. Beware Risky Shift!

"Destiny is a good thing to accept when it's going your way. When it isn't, don't call it destiny; call it injustice, treachery, or simple bad luck"   Catch 22 by Joseph Heller

For backcountry travel, side stash/off piste, or indeed anything out of ski area and uncontrolled, always carry the three essentials of transceiver, shovel and probe and do a pre depart group beacon test and practise.

If you need an airbag you have fucked up but might survive. If you need your transceiver you have fucked up and probably won't!

2. Get a Beacon, Shovel and Probe. Some Transceiver Observations:

Some findings and observations from using these popular avalanche beacons on the last avalanche training courses in both shallow to very deep (3m+) burials. They are all adequate with the exception of the original tracker which although it might work is old. The newer version of the Tracker DTS/Tracker 1 is a bit better and still on sale. The T1 is a 2 antenna beacon and suffers from null points/signal spike unlike the excellent Tracker 2 (not being reviewed here) which is super fast. These 3 antenna beacons are all good purchases, but like all technology when used for scenarios that are not simple then their effectiveness is challenged and quirks come out. Only realistic practise with the beacon you own will make you the user aware of what these are, and work arounds.  What this means is practise and realistic scenarios to challenge you the searcher. That's what Beacon training parks are there to help you with. I have attempted to be non biased but declare a conflict of interest as I am an Ortovox retailer.

Auto revert or random transmit from rubber-neckers is the curse of the avalanche search. Be aware of it when on a long search, and be aware if its preset on or you have to activate it as part of the pre trip beacon check.

These beacons were used at the Glencoe BCA beacon training park and on scenarios created on ski 's and off piste in the ski area while searching for an analog Ortovox F1, analog SOSF1ND (re boxed F1), old Tracker 1's and 2's and a Tracker 3. All students were taught the primary basic search patterns of searching in series, in parallel, and micro grid, and only after lots of practise was marking used, and then only in the context of relying on a basic reliable search method should marking fail. All the three antenna beacons looked at here that show multiple burial icons did at varying times show multiple victims when only one was present and most often in deep burials. After group auto revert and radio/phone checks this still occurred when only one beacon was transmitting. This was from the very long pulse cycle of the old F1's getting the processor confused, but it also occurred in the deep burials with newer beacons and I wondered if each side of the deep beacon flux line was seen as a separate signal. Solving these issues is why we all need to practice.

I do a special offer of the pro level Ortovox S1+ to SMR and Ski Patrol. For professionals I recommend folk wanting an upgrade to consider this very advanced Beacon with its unique visual games type display. It takes you straight to the victim, has a very reliable "mark" feature and a host of other built in pro features such as actually displaying visually where each victim is with distance, a longer range (55m) than other digital beacons (most are 25m) and of course the smart antenna that gets you found faster. It has lots of programmable extras and via the menu in extremis the 3 mark feature can be overridden to 4+>. Also incorporated is a Recco reflector inside as back up and the smart antenna to get you found. In testing the unique "deep burial" mode solved the conundrum that less experienced users find in the Glencoe BCA park when some of the units are 1.5m+ buried. I have to teach the BCA "pinpoint in a line" and other advanced techniques to solve these usually, but the S1+ does them very well. If you are a pro or take groups this has other features that are useful, not least the partner check. https://www.ortovox.com/uk/shop/avalanche-emergency-equipment/avalanche-transceivers/s1-/
Ortovox 3+
I  sell a lot of these to ski patrollers and some MRT's (Killin MRT have 30). Very simple to use and reliable. The marking function on the 3+ is reliable but of course like all beacons marking gets problematic beyond marking 3 beacons.  The 3+ on deep burials suffered occasionally from null points and a signal was then re-acquired after switching back to transmit briefly, then back into search so easily solved. Students like its speed, simplicity and very clear display. Default auto revert is ON.  This would be my beacon of choice as value for money for most folk. It has the right balance of speed, ease of use and simple but reliable features including smart antenna orientation helping a victim be found more easily and a built in Recco strip so the victim is more searchable from a longer distance by the Recco system on organised rescue.  

BCA Tracker 3
The Tracker 3 is small, and can easily be carried in an inside pocket.  Its very fast processor is good, but the advertised range which is 40m is a little optimistic and I would say in most cases its only 30m necessitating a narrower search strip and a little more work from last seen point to signal pickup. The T2 is still faster IMHO and has a slightly longer range. The T3 doesn't mark a victim but will "suppress" one beacon in close proximity for 1 minute allowing the searcher to get away and lock onto another victim. I didn't always find this very reliable. However, it's "big picture" mode was useful in showing directions and distance to other beacons and did what it says, give a bigger picture but with the mark feature so much more reliable in newer beacons its just not as good as marking IMHO. Auto revert is default OFF.  Worth upgrading to Firmware 3.3 if you have one as it definitely improves the beacon. Its a great beacon for single searches or if you are better trained in avalanche searching. 
Mammut/Barryvox Element
The Element and its more expensive brother the Pulse are very popular beacons from Mammut with the internals from Barryvox a company with a long pedigree in avalanche beacons.  The one used had the latest software and had a very good range. The analog in the Pulse version is superb for an experienced searcher as the search distance increases to 60m (I got a signal at 67m on one). The Pulse in analog is also good acoustically as you can hear the pulse tones of different beacons.  The Element is purely digital and does not have the rescue send or unmark features of the Pulse. The Element like it's big brother suffered a lot from the "STOP" icon, requiring the user to stop and wait while the processor updated. On a couple of scenarios this got too long and only by switching from search back to transmit quickly and back to search was the signal eventually reacquired. Of the ones used here it seemed slower than previous models with the older software. Auto Revert Default ON
The original digital beacon, the Tracker DTS.  Plenty going 2nd hand as folk upgrade. These should be retired due to age IMHO. Save your dosh for a 3 antenna model. 
Tracker DTS 2nd edition. Also getting on a bit and only 2 antennas
The ubiquitous Tracker 1. Still on sale and probably the most common beacon carried for years.  It still works and is quite fast even if it only has two antenna's. I want to slag it off as we recommend that everyone these days has the more accurate 3 antenna beacons. However, the damn thing still works quite well. The additional training requirement of teaching how to overcome signal spikes is no big deal, most of the time. But, when it is it's time consuming. It is a lot less effective in deep burial scenarios and students must be taught to spiral probe, or probe in a grid to locate a deep victim, which takes a lot more time. Like its superior big brother the Tracker 2 the T1 has "SP" or spotlight mode which I have always liked as it narrows the search angle directionally and spotlights the next victim so you can then get away from the found victim, move to the next signal and allow it to lock onto it as it becomes the closest. Sometimes it's possible to jump from continuing with a micro grid search having used the SP mode and get a lock on the next victim. I tell my students get an upgrade to 3 antennas as its much better.  But, the T1 is still ok (only just - but consider an upgrade!) and it shows how far ahead of its time is was, but now there are better options IMHO. Auto revert default OFF
Tracker 2
Whats not to like. The Tracker 2 is a real workhorse. Reliable and easy to use. The first 3 antenna Beacon. If this had a "mark" feature it would be tremendous. Sadly it hasn't but, if you learn to search properly, along with using the SP mode you can be just as fast, therefore a slightly longer training requirement and its less out the box usable for multiple burial scenarios but is tremendous for a single victim search.

This new transceiver looks excellent and hopefully I will have one to review at some point. Coming from a company that has a good track record this should be an excellent beacon. I will write it up after a test

Your money would be well spent on any of the ones listed apart from an old version T1 or old out of warranty Tracker DTS. Even the 2nd edition ones are not worth your money, even though there are lots 2nd hand. Most often its from folk upgrading to a 3 antenna one so why be cheapskate and buy one off them. Get a 3 antenna one. These are just some thoughts from trying lots of beacons on the market and this is just one review. There are no bad ones and they all have quirks, so get out and practise as its really important you are slick as someone is depending on you.

Note. If you use old analog beacons to practise you may find the multiple victim icon coming on intermittently. These old beacons have much longer signal pulse and digital beacons sometimes interprets this as two signals.

3. Get some Training and Practice Digging

Learn how to interpret the days SAIS forecast and some basic snowcraft

Learn how to use your transceiver effectively

Learn how to find, digout and take care of an avalanche victim
Learn how to dig effectively as time is oxygen and your shovel is the key to living or dying. Can you resuscitate your friend or provide first aid if they are injured ?

4. Recco. Mountaineers are not Searchable - most of the time ...............

Don't get buried! But if you do you want to be searchable 
and found FAST!
Recco is another important part of the organised rescue strategy. Education and avalanche avoidance is primary, being found early by companions if it goes wrong is vital and prior practise makes this work. Organised rescue requires a triple response: Dogs, Recco and Probe Lines. Until now Scotland has only been able to apply two of the three unlike alpine rescue avalanche search where for years all three have been used. Survival is time critical. Much has been made of trauma being the main factor in poor survival in Scottish avalanches. Largely based on recent tragic avalanche incidents where trauma has clearly been the dominant factor.

These anecdotal observations and opinions make easy it to forget the victims where triple "H" syndrome has been the killer of which there have been many over the last decades. Anecdote though is not enough, and there is no recent data set from necropsy studies in Scotland, (if there is its not readily available). One thing is sure, being searchable and getting found quickly increases survival. Some Scottish MR teams already have Recco as part of their search strategy (Tayside, Glencoe, Cairngorm MRT's) and Cairngorm, Glencoe and Nevis Range Ski Patrol. A good thing. I can imagine nothing worse than a victim recovery delayed because a search team did not have a detector and the victim is found to have either a Recco reflector or a harmonic on them. Recco is of course for "organised rescue". Everyone including Recco and the clothing manufacturers endorse the view that not getting avalanched through education and training is better than needing any search devices which may be too late. However, in the real world shit still happens and unless someone is "searchable" a rescuer cannot find them readily even if the poor victim has bottomed out of the survival curve. We should not forget Robert Burnett's remarkable 22 hour survival in the Southern Cairngorm's. All victims surely deserve the benefit of the doubt and rescuers throwing all resources at an attempt for a live recovery.
Small sticky reflectors that can be attached to boots or helmets
As "off piste" and "Backcountry" skiing grows in popularity there is every reason to imagine that being more searchable can save lives.  Nothing can replace education and prevention, or fast effective companion rescue with beacon, shovel and probe, but as ski patrols and MR teams take up Recco and the reflectors can be bought and carried then the chance of getting found alive by organised rescue if on scene quickly increases. I would recommend two reflectors to mountaineers, One front top and one back bottom.
Sewn in reflector

So Recco is here in Scotland and its great to see the take up by enlightened Scottish rescuers adopting alpine best practise. Who knows when Recco will save a life, but if it does it's job then its been donation money well spent.
Live recovery of a victim located by her Recco reflector from 3m burial
Glencoe Ski Patrol doing a precautionary combined 457mhz transceiver search and Recco harmonic search. The R9 detector searches both, and at close range can find many other harmonic devices such as mobile phones.

The reflector for Harmonic Radar or RECCO

Thursday, 24 January 2019

Reflections on Rescue Medical Care

Way back in through the mist of time as a young mountaineer and volunteer rescuer I remember after yet another harrowing mountain rescue wondering what more I could do for the broken often quite young folk we evacuated. Frequently they were in acute pain and circling the drain hole of life, where survival was at best 50/50 and some sadly not making it home. Mountain Rescuers whether medical/clinically minded or technical have to make two immediate choices on scene. Is it better and safer for the patient (and rescuer) to first rescue the patient from the scene before medical interventions, or is it a critical situation for the patient where immediate medical intervention must take place before rescue from the scene in order to save the patient’s life.

3 Avalanche Victims injured Twisting gully. Hamish overseeing and me doing the splinting. 1977
Let’s be clear, rescue from the scene with good basic first aid is the default position and one which mountain rescuers in Scotland are very adept. But back in the early 1980’s nothing much had changed in the application of basic first aid in the UK for decades. Ambulance service staff were a transport service with limited interventions and the same was true for search and rescue. Pre Hospital care was in its infancy. Changes in the UK were on the way, often reluctantly and based on taking the better aspects of the American DOT Emergency Medical Technician and Paramedic programmes for pre hospital care (i.e think Emergency Care on the Streets by Nancy Caroline) and ATLS the American“Advanced Trauma Life Support” course for accident and emergency doctors coming across the pond.

Late 1980’s I was already as far up the ladder as I could go for “First Aid” and was lucky to be invited onto the first Scottish and only second UK ATLS course. ATLS is a structured approach to managing trauma. I had also done some college courses and gained qualifications in human physiology and pharmacology to help with  background knowledge as a Paramedic and for my next stage which was Advanced Cardiac Care including paediatric care and a course with BASICS the British Association of Immediate Care Specialists. After some clinical placements at that time requiring 40 intubations and at least 40 emergency cannulations this allowed me to become registered as a state registered paramedic of which there were probably only half a dozen in the UK by 1991. I was maybe first in Scotland? I know of a couple of SAR aircrew who also came on board but i am not sure if they were before me. Later came the Health Professions Council (HPC) which I successfully registered with as a Paramedic. The public randomly attribute being a Paramedic to all providers of emergency care, but in fact it is a protected title and those that use it are trained beyond the level of most, and it's not easy to get registered. Its illegal to call yourself a Paramedic if not registered.

Taking this structured and algorithmic ATLS approach to treating immediate life threats (AcBCDE) reducing pain and reducing complications from hidden injuries unseen by using a proactive approach to managing and immobilising a patient (a form of packaging) then perhaps we also could reduce both mortality (deaths) and morbidity (long term consequences) in the mountains as well. It was worth trying. The challenge was applying this in a hostile mountain environment safely, with benefits to the patient, and no delay in rescue or rescue safety compromise beyond that already acceptable to a group of skilled mountaineers. This also required other rescuers coming on board and acting much like the core group of practitioners you will see at any major trauma in a UK A/E dept with folk working simultaneously on various aspects of care.  In addition for mountain rescue, also aspects of physical rescue from the scene such as belays, ropes etc need taken care of so it's an integrated approach.

The rescue team leader takes overall control of the rescue including the evacuation and this left the medical folks, often led in much the same manner as an A/E trauma team to me. I have to pay tribute to Hamish MacInnes for supporting this, and to John Greive who took over after Hamish retired and at a time when, and for almost a decade after there was a big increase in rescues overall and in particular victims with life threatening trauma. Patient centred care with John leading from the front and co ordinating some very difficult rescues leaving me to treat the patients worked well. While this article is about the medical aspects it should never be forgotten that mountain rescue is a team business and strong leadership medically and of the rescue in general gets things done safely and timely. There were times when objective dangers nearly changed the outcome, such as avalanches but these are best talked about over a dram.  I like to think this team approach might just have made the difference for a few poor souls who were able to have a life.

Me patching up on Central Buttress with Andy Nelson who is now GMRT Leader asking is it Henna or Blood
Many of the team's first aiders became BASP EMT’s and were very adept at managing a patient well and my advanced skills were not always required or appropriate. One skill I had which I used more frequently than any other was to give intravenous pain relief with strong opiates or similar medications. Sticking a needle or “Cannulation” into a cold frightened and distressed patient was a skill I was strangely very good at and gladly so for many folks who went from high pain scores to comfortable while enduring long tortuous evacuations over rough ground or down long climbing routes such as North Buttress hanging beneath my legs for 500 feet in bad weather when no helicopter could fly.

As a paramedic I had a range of resuscitation equipment and analgesia to bring to the patients. While I could and did intubate, these poor souls were often too far gone, but close attention to maintaining the patient’s airway and delivering oxygen were crucial.  I had the first ever defibrillator in MR delivered in 1990 from Marquette via RL Dolby. Some ridicule from many in MR circles ensued with comments of “all you will give them is a curly hairdo” from the legendary Mick Tigh.  However, within a year the defib was in action several times and on one occasion the later model Laerdal FR 1 delivered 27 shocks to a patient before her heart re started.
Rod MacIntosh now course director BASP EMT on his EMT course 1999 doing treatment on steep ground. After being delivered by a sea king I managed to get for the scenarios
Around 1991 Tony Cardwell and I, through BASP  the British Association of Ski Patrollers started the BASP Emergency Medical Technician Course. For some 14 years we took turns as course directors. We had the course endorsed by the Royal College of Surgeons (Ed) to give it a bit of clout and for many years pre “Cas Care” it was the go to course for advanced medical care for mountain rescuers and ski patrol. It still runs to this day which Tony and I are very chuffed about. These EMT’s were/are the backbone of medical provision in Scottish MR and none of my advanced training could mean anything without these fellow team players. Often my role was medical team leader keeping a close eye and only stepping in if I had some intervention they could not give such as (rarely) a chest decompression, or when things were going a bit South (a very rare requirement) and my having slightly more experience and diagnostic skills might change the treatment. I take my hat off to them as a very skilled bunch capable of making a difference if I was there or not. Apart from the obvious medical skills one obvious advantage I often had was being very fit and a strong climber so could always get to the patient needing care be it Clachaig Gully or 5 pitches up Swastika or Central Grooves the tale of which I have also hyperlinked.

The other aspect of taking advanced medical techniques to the mountains is medical equipment that’s up to the job. The kit for immobilising fractures had not changed much for decades. Some teams still had Thomas splints but with pre hospital care there was a rethink and re design of some kit. Quite a lot of pre hospital medicine was influenced by dated military practise and some of the equipment. For example, MAST or “Military Anti Shock Trousers” squeezed blood into the patients core like a G suit but then they bled out more (letting the tap run with the plug out) or fluids used to replace lost blood volume increased blood pressure but were not the only true colloid which is blood carrying oxygen, and so morbidity was increased as they bled out. The pre hospital treatment of shock we took and applied was to plug all the holes you can see by looking at the patients back, front, left and right, maybe apply a tourniquet or coagulation dressing, and a helicopter as fast as possible to a surgeon at the local hospital constantly being updated by me directly or via the Police so that their A/E and surgical team were ready.

Geoff Lachlan, Dave Sedgwick, Brian Tregaskis and Belford staff were great support on and off the hill and Dr David Syme then medical doctor to the mountain rescue committee was tremendous support in supporting trials of new kit to me with a view to making them standard MR issues if worthy. Also no article would be complete without acknowledging the tremendous support from within BASP from Dr Ian MacLaren consultant in A/E Monklands and the late Dr John Scott London HEMS both who encouraged and trained me over the years. In particular "the doc" Ian Maclaren who was huge support and always there at the end of the phone for a debrief after a difficult resuscitation. Later players coming into the mountain pre hospital trauma side from the clinical/medical were such as Ian Macconnel then resuscitation officer at Wishaw General who crossed to the light after helping out on EMT courses and being rescued (it's ok Ian so was I!). Ian later joined GMRT and took over as medical officer from me when I left. My last ALS course was by invite from him down to Crosshouse hospital to see how I compared to the hospital pro's. I think I did ok as I passed, despite a hangover. It's well worth asking him to describe running a defib refresher for the teams EMT's at the old Glencoe Police station while a local worthy was locked up in the cells. The noise from the Laerdal Heartstart 2000 put the offender of his head, it's a very good tale.

One vital bit of kit I was pleased to introduce first to mountain rescue was the American “Hartwell" Vacuum Mattress. Spinal injuries are not uncommon in fallen mountaineers.  Before the vacuum matt we had no way of immobilising these life changing injuries. We were also the first to routinely apply extrication collars which when used appropriately are life and limb savers. I am absolutely sure GMRT saved many people from devastating life changing injury by the careful handling and immobilisation of their spinal or neck injury. I also had LOTS or “Level One Trauma Splints” sent across from the USA and some of these excellent splints are still in use. Other notable imports were the Colorado “Wiggies” casualty bags to keep the patient a bit warmer and the first Pulse Oximeters to monitor SpO2.  
Trussed up like a Turkey and going no where. Packaged!
LOTS splints in action
SpO2 is not so reliable in mountain injuries due to cold and the oxygen dissociation curve moving left, but it also gives a pulsatile flow rate (HR equivalent) and a wave form to monitor how strongly the blood is flowing and the heart is beating. This also proved useful when reducing fractures into alignment to ensure blood flow. A useful tool in the context of other checks. I am very pleased that maybe my skills and the equipment brought to bare made a difference. What I hope you take out of this is that at the time of my training, pre hospital care was in its infancy and up a mountain advanced medical care thought impossible. Speaking purely about the rescue team I was involved with I can with some pride say they bought into the concept whole heartily and along with the teams leaders and enthusiastic first aiders/EMT’s we achieved a quality of medical care and patient centred decisions which was ahead of its time. Chapeau to all those folks, some of whom are still rescuing the day and night shift.

Morphine and Cyclizine on board then package. Hartwell Vacuum Matt in use below Ossians cave 
One of my first mountain rescues was an avalanche when about 16 so in 1972 when I was a team apprentice and mad on climbing. I wasn’t allowed to be full member until I was 18 and could be insured. The climbing I did as a youth gave my parents many sleepless nights not least of when rescued hanging at the end of a rope November 1972 on the North Face of Aonach Dubh with Euan Grant and two others, all stuck when the rope ran out in an icy gully. It was kind of fitting that my last Glencoe mountain rescue was also an avalanche where 3 folks had lost their lives and I probed and found the last victim.  As a medic and climber I was oblivious to background issues and driven by sticking to the guidelines that have proven to save lives such as ICAR’s for avalanche victims. When seeing these ignored by another agency, I would speak my mind. This often brought me into conflict with them and sometimes other rescuers. In the heat of battle/rescue things happen and its important to talk about them and learn for the next time. Fiona was struggling to continue to support me. 30 years married 3 kids and wondering if her husband would come back and if she was to be a single mother takes its toll. Families need 100% confidence that their partners rescue colleagues are their “brothers keeper”  and she began to doubt this. I knew I could look after myself up a mountain but it was just plain not fair on the family if they were scared of loosing their dad. I still miss it though, that sense of tribe and sense of purpose, and ironically as an older mountaineer with decaying skills I think I would be safer as just a grunt on the ground working for others at the sharp end, but that’s nostalgia perhaps. Ski rescue certainly has it moments and digging an avalanche victim out still alive was a bonus rarely enjoyed in mountain rescue.

My probe find. Yet another sad tale of mountaineers not "being searchable"
The unsung heroes of MR are those back home. Seldom acknowledged, they get no fancy gear allowance, free dinners or the kudos of membership of an exclusive tribe. And it is exclusive. Don’t imagine it's easy getting out of a warm bed on a bad night to wander over the Aonach Eagach looking for someone. Rescue team members need exceptionally good hill and mountain skills and not everyone has them or is a good fit to an often very close knit group.  I was fortunate that my rescue colleagues were often my climbing partners and so working together on a rescue was easy. I would say it’s still mostly the same and I see a very dynamic and young rescue team in action now and doing a great job. I don’t think that when I hear the whack of rotors going over the house or knowing there is a rescue, the increased heart rate and wondering what it is will ever leave, but it’s good to know there are folk willing to bust a gut to go out in all weathers and make a difference. I can’t quantify if I did, but maybe. Also these folks now have access to TRIM something not available to my generation. Stress did take its toll at times. PTSD and Talking

Day shift work, no head torch required
These days I still rescue from the mountains on day shift with Glencoe Ski Patrol. That as mentioned also has it’s moments, but that’s another story. I have let my Paramedic registration lapse as at 62 I don’t feel my clinical skills are sharp enough and the yearly CPD is a toil. I do complete the ski patrol training requirements and annual refreshers so not all my skills are lost, and new ones are found as things change.  For the last 8 years I have run avalanche rescue courses and become a trainer for Recco. I am also a pro member of the American Avalanche Association and an Ortovox avalanche safety partner. I train MR teams in Recco and advise on other aspects of avalanche equipment and rescue. Oddly to just about every other team than the one I was in for 38 years! Joking aside, they have a plethora of knowledgeable folk of their own.  Climbing is still a big part of my life and I still run, bike and ski. Goals for 2019 is to send a 7b sport route in better style. I had an epic on the Tunnel Wall route “Uncertain Emotions” but still doing ok sending up to 6c/7a and V6 so life in the old dog yet.
Me contemplating getting my leg over the "Snotter" 6b+ last year
Thanks to all my colleagues past and present and most especially my family. And safe rescuing to all those on the 24 hour shift that is mountain rescue. 

Here's a selection of pictures from a collection of many. All survived!

Sean, Malcolm, Ian, Frazer and Paul waiting on the yellow taxi.  Rock climber both lower legs #

Pneumothorax (see the air around the eyes, surgical emphysema). and frostbite

North Buttress in winter. Direct spinal injury and lowered by Andy Nelson on ropes for 500ft between my legs. Rescue from the scene due to bad weather.
As above with bony injury obvious.  Good recovery though

Keep your ice axe in your hand while self arresting

Warthogs go into the ice not your palm

Wearing a ring rock climbing
Pattern Bruising - what lies beneath?

The stranger side of MR. Called to a burn victim camping who had sat on the BBQ. Treatment was immersion in the river Etive then burn gel.

Thursday, 13 December 2018

Ortovox 3+ Transceiver

Items highlighted in yellow make a tremendous combination with the benefit of an extendable shovel over the rescue kit. In addition you get a transceiver that has a mark/flag feature and built in back up Recco reflector, as well as smart antenna technology.