Monday, 15 April 2019

A Q&A sheet for the NTS of my time in GMRT


GLENCOE VISITOR CENTRE 2019 EXHIBITION:  MOUNTAINEERING

GLENCOE MOUNTAIN RESCUE TEAM SECTION

General information:

Name:    Davy Gunn

Dates in GMRT: Aspirant member 1972 to 1975 
Full member (at 18 years old) 1975 to 2009

Role(s) in GMRT: Primary role as Medical Officer, Team Medic and Deputy Leader and interim roles as Treasurer and Team Leader.

Q&A:

1)    What inspired you to join the GMRT?
At about 14 years old I would see my neighbour Cecil MacFarlane go out with his rescue dog. He asked me to go out on the avalanche training days and they would bury me for the dog to find. I was already obsessed with the mountains and with a local pal Euan Grant we would go exploring the mountains. At one point we came off the hill and found there was a rescue on the north side of the Aonach Eagach and they needed help, so I went up with Walter Elliot a local shepherd and Sandy Whellans the local police man and helped out. I was maybe 15 at the time. For the next 3 years I would just turn up and help when I could. I wasn’t allowed to be full member of the team until I was 18 and could be covered by the Police insurance and the rest of the team were confident that I was competent. I climbed quite a lot for a young boy on reflection and this also resulted in Euan and I along with two others getting rescued ourselves off the north Face of Aonach Dubh in winter conditions when I was 16 year old. It just seemed a logical and natural thing as a mountain person to also be a part of the team which also had most of the active mountaineers in the area as members and who were among the best mountaineers in the UK at the time. Maybe I hoped some of their talent would rub off. I think some did!


2)    What were the typical types of rescues you attended during your early year’s with the team?
My first rescues were very early 1970’s so no mobile phones and very, very rarely a helicopter so a typical rescue weekend at busy periods would include at least one rescue from Clachaig gully sometimes three or often long stretcher carries such as one particular weekend I remember two consecutive nights taking badly injured climbers from the Lost Valley Buttress to the roadside. Hard work. There were also many very long searches for people missing somewhere in the area. Without a helicopter these were all footwork and often we would be out for 2 or 3 days. This changed for the better mid 1970’s when RAF Leuchars had the Wessex helicopter and we didn’t rely on the slow and old Whirlwind which had to refuel several times on its way from RAF Lossiemouth and could not stay on scene very long. It also only had a 60 foot winch capability. The Wessex was a game changer for mountain search and rescue.

3)     How did GMRT rescues evolve over the years you were a member of the team?
From the early 1980’s there was a huge increase in folk coming to the mountains for recreation and with it a very big increase in accidents. Winter mountaineering especially grew in popularity and these gave the team many a challenging and often tragic rescue. To meet these challenges the team grew from a close knit group of shepherds, forestry workers and local professional climbers of about 20 members on average up to 30 members. Before this the teams seldom had any money and I can remember Dennis Barclay the team treasurer of the time presenting accounts at our AGM with - £45 in the bank.  Money to replace kit and for personal equipment just was not there. Hamish Macinnes was very good at trying to scrounge kit from suppliers and we were never short of socks and thermal underwear. Without some legacies and donations, we just couldn’t have operated. Thankfully the Scottish government gives mountain rescue a grant so this eases the burden of overheads and costs.

4)   What was your most dangerous/challenging rescue?
There were many. Some were challenging technically, some medically as the teams medical officer and as a Paramedic, and some emotionally due to the sad loss of often young lives. Each one stands out as an event but one particular rescue which had elements of all, was the recovery of a young local climbing guide who I knew. I was lowered 300 feet to him with some large rockfall from above and had to make his partner safe as she was in danger from falling rocks and a belay that was coming apart from the rope tension. I had to isolate her from the climbing rope and belay system while her partner was swinging out in space hanging off the end of the rope not far from us. I had to sort her out and then recover his remains and get them a further 200 feet to the ground.  Such were the perilous state of the teams finances at the time that Dennis the treasurer didn’t think the team had enough money to replace the personal rock pitons and slings and karabiners I used.

5)  At the beginning of your career what medical support were GMRT able to offer casualties on the hill?
 Hamish always encouraged first aid and medical training for the team and we had the general mountain rescue kit of that time plus some extras such as portable oxygen and Laerdal resuscitation equipment that had come from Chris Bonningtons Annapurna expedition where sadly a local climber and rescuer Ian Clough was killed. We also had opiate pain medications that could be given into a muscle for pain relief. As this was used up and became hard to refill and replace Hamish tasked me with finding replacement kit which I did Much of that kit then went on to become standard issue to many other rescue teams. I suppose looking back I just was given the role of teams medical officer by Hamish!

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.

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 a 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. A couple of SAR aircrew from Lossiemouth also came on board and gained registration. 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. It’s illegal to call yourself a Paramedic if not registered. I also went on to gain many other medical and mountaineering qualifications many of which supported my roles in the team.


6)    How has modern training and technology revolutionised the medical support provided to casualties?
Pre Hospital medical care has evolved in all the emergency services and there is a much bigger emphasis on a structured methodical and algorithm based evaluation of the patient and critical interventions needed to get the sick or injured to definitive medical care. Medical training is now a much larger part of a mountain rescuers training and rather than core individuals having key skills there is an emphasis on everyone having core medical skills.  Mountain rescue now runs its own in house “Casualty Care” training to meet this. 

Around 1991 Tony Cardwell and I, through B.A.S.P 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 main course for advanced medical care for mountain rescue and ski patrol. It still runs to this day which Tony and I are very pleased about and still attended by mountain rescuers. These EMT’s are the backbone of medical provision in Scottish MR and no advanced training or paramedical skill could mean anything without these fellow team players. Often my role was medical team leader keeping a close eye on things 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 solo climbing Clachaig Gully or being lowered 500ft down Swastika or down Central Grooves in some of the longest lowers the team has done.
Many of the Glencoe 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. However,  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 intra venous “Cannulation” into a cold frightened and distressed patient was a skill I was 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. Doing an IV in -12c in the dark and wind in a cold patient was a challenge but it could be met with skill.

As a paramedic I had a range of other resuscitation equipment and analgesia to bring to the patients. While I could and did intubate, and provide advanced skills, these poor souls were often too far gone, but there were success’s and close attention to maintaining the patient’s airway and delivering oxygen were crucial.  The other aspect of taking advanced medical techniques to the mountains is having 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 from WW1! but with pre hospital care as a core concept of rescue there was a rethink and re design of some kit. Quite a lot of pre hospital medicine was influenced by dated military practise and so was 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. I knew this from many of my training courses and placements some of which were taught by war surgeons and veteran battlefield medics so could take this learning back to the EMT courses and MR.  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 then a helicopter as fast as possible to the medical team at the local hospital constantly being updated by me directly or via the Police so that their A/E and surgical team were ready. Often in serious cases I would accompany the victim to the hospital. One such case involved a Royal Marine who I successfully resuscitated on the side of the Aonach Eagach then him going “off” on the helicopter and then accompanying him to hospital while still actively resuscitating him after a difficult evacuation. His remarkable survival I am particularly pleased with.

I had the first ever defibrillator in Scottish MR delivered in 1990 from Marquette Electronics via RL Dolby. Some ridicule from many in MR circles ensued with comments of “all you Glencoe guys 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 many shocks to a patient before her heart re started. I also introduced Pulse Oximetery or SpO2 into MR and although SpO2 is not so reliable in mountain injuries due to cold and the oxygen dissociation curve moving left, 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

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 and Glencoe MRT 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.
Regardless of these tools 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.  Mountain rescue is a combination of medical and technical rescue and involves good decision making at the scene for the benefit of the patient.
I think perhaps it was the total of all these changes I helped bring that encouraged some folk to nominate me for my MBE which I received in 2005

7)    If you had only one piece of equipment you could take out on a rescue, what would this be?
A good waterproof!

8)  What was your most memorable rescue with GMRT?
Mid 1990’s while deputy leader and while John the team leader was away on a business trip to Spain I had a call one Sunday night from the Police saying that a walker was overdue in Glen Etive. It was very warm sunny June weather and settled. Along with 40 RAF MR personnel and 16 of Glencoe and a helicopter from RNAS Gannet we searched all of Monday with no sign. John arrived back and we continued the search everyday that week searching a huge area and still no sign. On the Friday afternoon the local chief constable arrived at our base and called us all back off the hill and was calling the search off. The helicopter left our temporary base and on its way back to Gannet had one last fly up a very deep gully on the South face of Stob Dubh which had been looked into by RAF MR and overflown by the helicopter before a couple of times. On this occasion about 200ft down the North gully wall and about 100ft from the floor of the gully the winchman saw a tiny red speck on the gully wall but due to the deep gully being so narrow they couldn’t fly in closer to look. They asked if a medic (me) and some others would like to check it out so Andy Nelson and I plus two RAF who also volunteered to help were picked up and flown to the top of the gully.  While we climbed down the gully wall un roped for speed, the aircrew picked up John Greive and a couple of other GMRT and flew them to the bottom of the gully.  Andy and I found the missing person (Mr Robert Sparks) badly injured (spinal, head and chest injuries) and at first thought he was dead. But he then opened one eye and spoke to us.  He had several deep wounds all clean courtesy of the maggots on the wounds and blue bottles swarming around.  Meanwhile climbing up to us from below was John who was using a deer antler to get purchase on the grotty steep muddy and sheer rockface. A sight to behold on its own!  I treated Mr Sparks as best as possible and we gave him sips of water as he was dehydrated but not too severely as he was able to lick some moisture from moss next to his head on the ledge on which he lay.  We had him airlifted off and after several months of hospital treatment and rehab he recovered well and we met him up at Clachaig with his wife and he treated us to free beer as a thank you. One of the more bizarre but heart-warming aspect of the search was that every morning, and despite the odds of him surviving decreasing, his wife would put up a chair and table and sit just along from base having a picnic and never giving up hope.  The BBC later did a re-enactment for a programme, but it didn’t involve GMRT and did not do justice to a remarkable survival and an element of luck.

9)  How has avalanche detection technology evolved during the past 40 years?
Until the late 1980’s most avalanche victims were mountaineers and they were found mostly by a probe line. A line of searchers with narrow metal “probes” some 9ft long pushed into the snow at intervals by a line of rescuers walking in row until something was felt.  Search and Rescue dogs also played a part, but often pre mobile phone and when helicopters were less common the scent was well dispersed before rescuers could get to the scene. In general rescue came too late for avalanche victims as they would have succumbed to a triad of hypoxia a lack of oxygen, hypercapnia re breathing their own expired air and hypothermia becoming too cold to survive.  Modern technology such as avalanche beacons which transmit a signal were becoming common among off piste skiers in the 1980’s and into the 1990’s and allowed companions to search for friends and dig them out from under an avalanche quickly saving many lives since. The three essentials are an avalanche beacon to locate the victim, a probe to accurately pinpoint where to dig and a good shovel to dig the victim out. The more shovels and people to do so the better chance of survival. Rescuers themselves also carry these beacons and essentials so they can find each other, but sadly mountaineers in Scotland in general do not. The emphasis in Scotland has been on education so avalanche accidents are avoided. By the nature of the mountains though, and increasing numbers going into the winter hills its inevitable that some folks are still caught in an avalanche and most often these are triggered by the victims themselves. Sadly the biggest cause of multiple deaths in any single incident on the Scottish mountains remains avalanches. Another very good development for allowing folk to be searchable is Recco, a passive system incorporated into may ski garments. This tiny little reflector strip is two little antennas joined by a diode that reverberates at a specific frequency when hit by radar. No batteries are neded and its small and lasts for ever. Rescuers carry a detector that scans the avalanche and the radar hits the reflector and sends the signal back at double the strength allowing rescuers to find victims quickly and it also works from a helicopter increasing the search area covered. Its recommended that folk carry two Recco reflectors and have one on either side of their body or on a garment. At £25 each its £50 to be searchable and save your life. This technology is still evolving and already has saved many lives throughout the World.


10) How important was the introduction of the Scottish Avalanche Information Service 30 years ago?
Very Important. The SAIS has raised the public awareness of avalanches and has become a part of every winter mountaineer and skiers pre trip planning.  The resident or local mountaineer and skier has some knowledge of the snowpack and its history from daily observation. The visiting mountaineer and skier does not have this advantage, and so a daily SAIS forecast gives them an idea before arriving in the area of what the avalanche risk for a forecast area is, and the places where risks are greatest and to be avoided. This allows them to modify their plans and reduces risk and so rescues.
In addition through education and the  SAIS “Be Avalanche Aware” project it also gives tools to heighten awareness while already out on the hills and  what to look for during the mountain journey, with key points and places where a mountaineer or skier can take stock and re evaluate the avalanche risk.


NB.
While this Q/A represents my own time in mountain rescue, it would be possible to interview any of the members of GMRT or indeed any MR team and compile an equal storyline of adventure and misadventure. This just happens to be mine and it is not unique. A rescue team is exactly that, a team of individuals coming together and working to help persons in distress. Everyone in a team is of value and contributes to this common goal. I would like to pay particular thanks to the two leaders of GMRT who I had the pleasure of working with in my time. In particular John Greive who took over from Hamish (big boots to fill) in the early 1990's and at a time when the team had some of the biggest searches and busiest years in its history. A leader from the front who would not shirk from the dangers of the mountains or from being an advocate for the rights of those needing help, be it their right to pursue the sport they love with freedom or their privacy if things went wrong.