Thursday, 23 January 2020

Canada - The Glencoe Connection

I found this in google docs from when I was doing this course. I am not sure where I pinched most of the info but it certainly gives an insight into this remarkable man.  More recent research suggests that his wife hated the Glencoe rain!  Certainly the legacy he has left us with an estate to walk and enjoy resembling more British Columbia than Scotland and another piece of the incredible layering of history ancient and modern that we have in the Highlands.  Sadly the £20 a year "to the poor of Glencoe" has stopped some time ago!

Lord Strathcona - The Glencoe Connexion Part 1

In the old days of warring clans in the Highlands of Scotland, the Grants of Strathspey were summoned to battle by alarm fires kindled on the mountain tops of Craigellachie, and when the clansmen faced the foe their battle-cry was "Stand fast, Craigellachie." It was at another Craigellachie, in the heart of the Rocky Mountains of Canada, that a distinguished descendant of the Grants, in 1885, drove the last spike which completed the construction of the first transcontinental railway in Canada. The event was one of the most important in the history of the great Dominion, for it welded indissolubly into one mighty nation a number of provinces and districts stretching for 3,700 miles across a vast continent. The man was Donald Alexander Smith, the grandson of one of the Scottish Grants. Better known as Lord Strathcona and Mount Royal, this great Empire-builder of the Victorian era, and one of the founders of the Dominion of Canada, most worthily adhered throughout his life to his ancestral motto, "Stand fast."
On many occasions apparently overwhelming difficulties and discouragements had shattered themselves against his invincible patience and courage. And from none of his herculean enterprises did he emerge so triumphantly as from the stupendous task of building and financing the Canadian Pacific Railway, whose completion was signalized by the ringing blows on that spike in the rocky gorge of the Canadian Craigellachie. Such was the crowning triumph in the life of one who, forty-seven years previously, had arrived in Canada a poor but well-educated Scots lad, and who started his career in that country as a clerk-apprentice to the Hudson’s Bay Company at a salary of £20 a year and his food. When he died, his estate was valued at over £4,500,000.
The romance of Lord Strathcona’s life lies in the fact that it covers the whole period of the romantic and extraordinary development of Canada from an almost trackless wilderness to a mighty and prosperous Dominion within the British Commonwealth of nations. When Donald Smith went to Canada in 1838 in a small sailing ship, the voyage occupied forty-four days. Before the end of his life he frequently made the same journey in a week in a liner owned by the company of which he was a director.
In the fourth decade of the nineteenth century more than half of Canada was a game sanctuary of the Hudson’s Bay Company, owned and ruled by that ancient corporation of Gentlemen Adventurers solely in the interests of the fur trade. Even when Donald Smith had been over thirty years in the service of the Hudson’s Bay Company, and while on the site of Winnipeg, in what is now Manitoba, he refers in his correspondence to a projected visit to Ottawa as "leaving here for Canada."
Infancy of the Dominion
The Dominion of Canada was created as an idea in 1867, twenty-nine years after Donald Smith had arrived in that country, but in reality its western boundary ended at Ontario. All beyond, namely Rupert’s Land and the North-West Territory, was the ancestral estate of the Hudson’s Bay Company. So well established was the proprietorship that the Government of Canada, in 1868, sent a deputation to England to treat for the purchase of one-third of the area of Canada from the Governors of the Company.
The transfer was completed, through the good offices of the British Government, on terms which ended the monopoly of the Company while still permitting it to retain considerable land from which, as the country was opened up to settlement, it stood to gain its principal revenues, rather than from the age-long trade in furs. —Much could be written to show how primitive was Canadian life, and how unpeopled that vast and rich territory when Donald Smith first set foot there. The contrasts furnished by the changes in his own long life must suffice for the purpose.
A Tradition of the Family
He went to Canada well-equipped. He had education and character. There was a tradition in his mother’s family that one of his hardy Scottish ancestors had learnt to write by tracing his letters with a stick in the ashes that fell from the peat fire in his father’s cottage on the hillside. But in Donald Smith’s boyhood there was a good school in Forres, where he was born in 1820, and he left it well grounded in Latin and mathematics to enter at once a lawyer’s office in the same town. In after life, Lord Strathcona often said that the reason why poor Scots boys so frequently rise to distinction in all parts of the world is the native love for learning in even the humblest, and the excellence of the old-time Scottish schoolmasters.
Donald Smith’s first job in Canada was counting rat skins. The Governor of the Hudson’s Bay Company at that time was an autocrat who studiously kept his subordinates in their place. On one occasion Donald Smith, after getting no reply to his letters asking for permission to see a doctor, as he feared he was threatened with blindness, left his post for this purpose without permission. As a punishment he was banished to Labrador, and ordered to make the journey thither in the dead of winter, and to start within thirty minutes. For an instant the young man hesitated, bitter words came to his tongue, and the temptation to throw up his job suggested itself. Then came to mind the old battle-cry of the clan, "Stand fast!" and Donald Smith controlled himself, and within the allotted half-hour had started on the terrible journey, which took months to complete on snowshoes.
Reduced to Eating Moss
One of his Indian companions died on the road from hardship, and Donald and the other Indian were reduced to eating moss. The Scotsman won through, and lived to be the successor of the autocratic governor who had so sorely tried his patience and endurance. No one could possibly have imagined that this young Scotsman, who was destined to remain for twenty years in the desolate isolation of Labrador, had any chance, under such conditions, of ever rising to the eminence he afterwards attained. There was a postal service only twice a year. Such a position as that of factor in the Hudson’s Bay service in Labrador was considered even by the officers of the company as little better than banishment for life. But Donald Smith possessed qualities which enabled him to rise superior to any circumstances, and in course of time he became chief trader. Then he married, and before long had established a home the like of which for comfort and even luxury had never been seen in the whole of Labrador. He was the first man to establish a farm, a vegetable garden, and a flower garden in that country; the first man to construct a proper road; and he introduced the first wheeled cart ever seen there.
The Wonder Farm of Labrador
He imported from the north of Scotland cows, sheep, horses, poultry, and garden and farm seeds, fertilized his land with fish, and, short as the summer was, grew crops and flowers which filled the Indians, fishermen, and his own colleagues and visitors with astonishment. Plants which would not mature in the open air he grew under glass. Labrador had an area nearly five times that of Great Britain, and not in all that vast country could there be found a farm like that of Donald Smith’s. Long afterwards Lord Strathcona used to say that he had never felt lonely during the whole of his long service in Labrador. Even the wild flowers of the country provided him with an interesting study. But naturally his chief interest was his work in the fur trade, and he made his post profitable beyond all precedent, owing to his good management and his extraordinary enterprise in developing new sources of revenue.
When Donald Smith started work in Canada at £20 a year, be adhered strictly to a standard he had set himself, namely to save at least half his income. As he rose in the service he continued to practise thrift on a larger scale. Factors in the Hudson’s Bay Cornpany then received a definite share of the profits, and even before he had begun to figure in public affairs Donald Smith had saved several thousands of pounds. He invested the money in some of the prominent commercial enterprises which began to be formed as Canada started to rise to a position of importance in the world.
As the Americans say, the thrifty factor got into these profitable enterprises "on the ground floor." Such was the reputation which even at that time he had gained for commercial shrewdness, that other factors entrusted him with their savings for investment according to his own judgment. Thus his influence in financial circles soon grew to importance. The turning-point in Donald Smith’s life occurred when his services were transferred from Labrador to Montreal. From comparative isolation he now found himself in the centre of all the commercial activities of Canada, just at the moment when the country was entering upon a new era of expansion. Here he had already become associated in financial matters with his cousin, George Stephen (afterwards Lord Mount Stephen), at that time a successful business man in Montreal.
A delightful story is told about the first meeting of these two men. Fresh from Labrador, and carrying a new carpet bag of a pattern and colouring like a futurist painting, Donald Smith entered his cousin’s office, while his wife and child, their arms full of brown paper parcels, stood outside in the road. The successful city man was none too pleased to be so unexpectedly confronted by his relation in such an unorthodox manner, especially in his place of business. Smith, himself, could not understand why his cousin seemed so uneasy about his presence in the office.
However, the acquaintance thus formed was soon improved upon, and these two cousins afterwards found fame and fortune together, as associates and co-partners in some of the most daring and successful enterprises ever conceived in Canada, particularly in the building of the Canadian Pacific Railway and the St. Paul, Minneapolis and Manitoba Railway. When Donald Smith took charge of the Montreal office of the Hudson’s Bay Company, it was at a time of crisis in the history of the venerable institution, and also of Canada itself. Following the purchase of the territory of the Company by the Dominion, difficulties arose when the Government sought to extend their jurisdiction westward into the prairies. There occurred in Manitoba the revolt of the French and half-breed inhabitants, known in Canadian history as the Riel Rebellion. The seriousness of such a situation may be realized when it is said that the means of transportation were then so primitive that an armed force could not be transported to the scene of the rebellion within a shorter period than ten months. Donald Smith was now recognized as the most able and influential man in the Hudson’s Bay service, and the Government of Canada sent him to the West as a commissioner to try and pacify the rebellious colonists.
End of the Rebellion
Largely owing to his efforts in shrewdly dividing these lawless elements, even when he was a prisoner in the rebel fortress, and by restraining the extremists, what was practically a bloodless revolution fizzled out. Manitoba was made a province of Canada, and Donald Smith was elected a member of its first Legislative Assembly. Then followed his great adventures as a railway builder. When he arrived in Canada there was not a single mile of iron railway in all that vast country. It was not until 1847 that the first consignment of iron rails was imported from England, for use on a few miles of tram-roads running over wooden tracks, upon which were nailed a flat surface of iron plates. The first of these Canadian tram roads, over which the carriages were pulled by horses, was opened for traffic in 1836. Donald Smith and his associates had to overcome stupendous difficulties and discouragement in building, and especially in financing, the pioneer railway across Canada. The first train to undertake the through journey of more than 2,900 miles from Montreal to the Pacific coast left Montreal on the 28th June, 1886.
First Ocean to Ocean Railway
The completion of the first transcontinental railway across Canada was, however, not only a triumph over physical difficulties of an almost insuperable character. It was much more. It represented a piece of empire building of the utmost importance, not from a geographical point of view alone, but also in a political sense. The building of the Canadian Pacific Railway saved Canada for the Empire. No estimate of the character of Donald Smith and his associates in that daring and gigantic enterprise, that regards them only as great men of business and overlooks the political importance of their life-work, can be either complete or fust. Their names are worthy of being included among the greatest empire builders of the past. It may come as a surprise to many readers to be told that there was at the period referred to a very real danger that the United States would annex not only the western prairie country and British Columbia, but even the whole of what is now the Dominion of Canada.
In the first place, there was not that fullness of sympathy and understanding of Canada on the part of the Motherland which the man who afterwards became Lord Strathcona did so much to promote during the later years of his life. Then there was a strong feeling of enmity in the United States against England arising out of the Alabama episode and other incidents of the American Civil War. Even after British Columbia joined the Canadian Confederation, there was a very strong separatist movement in that province, owing to the fact that the promised railway to link them with the Atlantic had not materialized.
American Eyes on Canada
The American Press in the eighteen-sixties contained many articles in which the annexation of Canada was openly advocated. Britishers to-day refer often to our great ideal: One Flag and One Empire. So did the Americans of that period. It was said by them that the time had come for the consolidation of all the peoples on the American continent, from the Polar Seas to the Gulf of Mexico, under one Flag and Government—that of the United States. Sir John Macdonald, the great Prime Minister of Canada, once wrote that he was convinced beyond any doubt that the United States Government was at that time resolved to do all it could, short of going to war, to obtain possession of Western Canada. It was quite natural that envious eyes should be cast on that great and fertile territory by those in the victorious Union who considered that in the war between the North and the South England had sided in certain ways that were provocative of very great bitterness with their enemies.
Canada’s Inhospitable Seaboard
The isolation and uninhabited condition of the Canadian West at that time is almost unrealizable by us to-day. Apart from Indians, there were only a few thousand inhabitants in the Canadian North-West. Neither Canada nor England could then have defended that country by force of arms. It was practically impossible for troops to reach the Western plains in the winter time from the Atlantic, except through the United States. The only methods of transportation were sleighs in the winter and canoes in the summer.
During the Riel Rebellion, the probability of the rebel half-breeds receiving military support from the Fenians in the United States was a very real danger for a while, and even in 1869 a Committee of the United States Senate left it on record that the annexation of Western Canada was "but a question of time." Now that the friendship between the great American nation and the British Empire is so firmly established, cemented as it has been by the blood of both peoples in the World War, these references to a period long past can be made dispassionately, and, indeed, the events in question are now regarded only with curiosity.
"An Unbroken Series of Colonies"
They are mentioned here merely to throw into bolder relief the great services to the British Empire of Lord Strathcona and his friends, whose indomitable pluck and perseverance in building the first transcontinental railway realized the vision of the Scottish pioneers of the Red River and of some of the greatest English and Canadian, statesmen—namely "an unbroken series of colonies, a grand confederation of loyal and flourishing provinces" stretching from the Atlantic Ocean to the Pacific Ocean. Curiously enough, when Donald Smith and George Stephen bought the half-built derelict and red-with-rust St. Paul and Pacific Railroad, and completed it, about 1878, there followed a veritable "invasion" of Canada from the United States, but it was a peaceful invasion of farmers, hungry to take up cheap land in the fertile prairies of Manitoba. That movement northwards has continued to this day, and the hundreds of thousands of American farmers who have entered Western Canada have always been prominently associated with its development, and by their enterprise have helped very materially to make the prairies one of the largest and most productive granaries of the British Isles.
Completion of the "All Red Route"
In still more recent times Lord Strathcona and the great railway company which he, more than any man, helped to build, figured in the realization of another of the grandest dreams of empire. In 1891, the famous "Empress" line of steamships, comprising the finest liners on the Pacific, was inaugurated in connexion with the transcontinental railway route. When, in 1903, the same company acquired a fleet of steamships on the Atlantic service, the "All Red Route" westward between the Motherland and the Orient became a splendid and successful reality. When he was eighty-six the "Grand Old Man" of Canada, as Lord Strathcona was called, speaking of his connexion with Canadian railways and steamships, said that in looking back it seemed to him only a few years since he had heard on every hand the gloomiest prophesies of disaster when he was engaged in building the first railway across Canada.
He could afford to smile at the recollection of such prophets of woe, whose very names are already forgotten. He, too, would prophesy, in his turn. But how different was the vision of this Greatheart from that of the prophets of the ‘seventies! A few years more, said Lord Strathcona, and he hoped to see steamers crossing from Great Britain to Canada in three and a half or four days, and travellers from England transported to the Pacific in eight days altogether. Lord Strathcona did not live to see this dream of his old age realized, but there is little doubt that it will be realized, and, perhaps, before long.
The crowning romance of Lord Strathcona’s life was undoubtedly his wonderful career as High Commissioner for Canada in London. He was seventy-six years of age when he entered upon the duties of that exalted position, and yet he continued in office for another eighteen years, winning for himself and Canada such renown as would have assured his place in history even had these eighteen years covered the whole of his public career. His venerable figure, his strong personality, and the amazing vigour of his speeches in public impressed to an astonishing degree all who saw and heard him. He was regarded as the very incarnation of the spirit of Canada. At a bound he became one of the best-known and most popular figures in the public life of London. He did everything on a grand scale.
Strathcona’s Regiment of Horse
When the South African War broke out in 1899 he raised the famous mounted regiment, afterwards known as Strathcona’s Horse, and asked the Commander-in-Chief of the Army in Canada to draw on his account to the extent of £150,000 for the purpose of equipping this unique contribution to the Imperial Forces. He was greatly embarrassed when his name appeared as the donor, as he had wished his connexion with the matter kept secret, and the mounted regiment to go forward as a gift from Canada and not from himself.
This was no affectation, whatever cynics might think. As a matter of fact, Lord Strathcona was always a most secretive man. He was known to remark to his closest associates, "Nothing is secret when more than one knows it." He was a man of boundless generosity, and many of his benefactions were never made public. He had a great sympathy for human suffering, as was shown by his many princely gifts to hospitals, and he regarded the medical profession as the most blessed of all. The Royal Victoria Hospital in Montreal, which he and Lord Mount Stephen built and endowed at a cost of nearly £400,000 is only one of the many institutions of the kind which he enriched. Although Lord Strathcona spent so many years in the wilds of Labrador, there was nothing of the rough backwoodsman about his personality or manners. He was a courtly, polished man. Even in Labrador his courtesy to everyone with whom he came in contact was as pronounced as his thrift.
Ability as a Letter Writer
No one could write a better letter of business, congratulation, or condolence. He was a master in the art of composition. Punctilious in official and social life, Lord Strathcona delighted in hospitality. No host ever succeeded better in giving his numerous guests the impression that he was mainly concerned about their personal comfort, and his thoughtfulness and activity in promoting the happiness of every visitor who came under his roof was extraordinary. During his long term of office as High Commissioner, the community of interest between the Motherland and Canada increased enormously under his guidance.
One of the remarkable traits of his character was that he appeared unconscious of the customary limitations of old age. He purchased a great sporting estate at Gencoe when he was eighty-five, and lived to see many of the trees he planted there grow to a considerable size. When he was over ninety the light in his office in Victoria Street, London, was often burning at 10 o’clock at night, and he was still at his desk. Sometimes, when he was about eighty-five, Lady Strathcona would call at the office late in the evening, because her husband had evidently forgotten all about his dinner!
Man of Abstemious Habits
He was a most abstemious man. Not only was he a non-smoker, but he was also a moderate eater, and in his old age his custom was to eat a light breakfast, and then work all day without anything to eat until dinner at seven, or eight, or even ten o’clock. One peculiarity of his habit of remaining late at the office should be mentioned. If Lady Strathcona was out of town the High Commissioner would invariably write to her late every night, and he would never allow anyone else to post that letter, always going out to do so himself. He had extraordinary good health, and even when nearly ninety went out in all kinds of weather. Once, on a bitterly cold day, he stood for an hour and a half on Victoria Station, on the occasion of a royal departure, wearing only his uniform. His friends felt concerned, as many a younger man had contracted pneumonia through far less exposure, yet Lord Strathcona turned up at the office next morning as well and as energetic as ever.
In his old age, Lord Strathcona suffered somewhat from deafness, due to having stood too near a small cannon when it was fired from his yacht off Oban. But he said himself that he had noticed no appreciable weakening of his physical powers until he met with a carriage accident in British Columbia when he was eighty-eight years of age. To the very last month of his life he remained in harness. Lord Strathcona could not bear to waste any of his time. In the early autumn of 1913 he had paid what proved to be his last visit to his Glencoe seat, returning to London accompanied by Lady Strathcona. At that time there was no indication that before long he was to suffer the greatest bereavement of his life in the death of his most devoted wife.
Severance of a Loving Union
Early in November Lady Strathcona contracted what at first seemed a common cold which, however, developed into influenza and pneumonia, and after an illness lasting only five days she died, thus ending a marital partnership that had been entered into more than sixty years before. Lord Strathcona died on the 21st January, 1914, and was buried beside his wife in Highgate Cemetery, London.
David Gunn
UHI Institute Cultural History Degree

Wednesday, 22 January 2020

A reminder of blood and tears

Having spent yesterday formatting and upgrading Fiona's desktop to Windows 7 from XP I took some files off including some with stuff I didn't deem important and had thought long gone but Fiona obviously thought was worth keeping.  I am glad she did as there's a host of pictures and documents I had binned off my own various computers years ago.  Some pictures of patient care and some letters including my HPC revalidation as a Professional Paramedic from 2005/6. Section G7.  Quite a reminder of the level of care in tricky places I used to provide never mind the A/E  work, Ambulance and theatre electives.  "the busiest mountain rescue team in Scotland" was maybe true back then but not now as Lochaber MRT hold that title. Here's some mountain stuff cut and pasted from the scanned version:
I was quite good at sticking sharps in folk in tricky places
Section G7 Report
  • Description of areas of professional practice
  • Three Patient Histories
I work for the busiest mountain rescue team in Scotland, Glencoe Mountain Rescue which is a voluntary service similar to the RNLI. We are funded by the Highland Constabulary (Police) and uniquely by the Scottish Executive (Parliament).  I am insured for medical duties including invasive skills by the Highland Constabulary (Police) and when treating a patient will have been called to do so by the Police.

The number of trauma victims and ill patients treated by me practicing for the above rescue service ranges from 26 to 50 per annum. My duties includes the  initial rescue response tailored to the injury or illness, logistical organisation for completion of the rescue task, scene safety of the patient, and rapid assessment and critical interventions at the scene. 

My duties also include liaison with other search and rescue agencies to carry out the primary role of Glencoe Mountain Rescue which is to find, treat as appropriate, and stabilise patients for onward transport via rescue techniques to hospital.  

The medical aspect of rescue provided by me would include:
Scene safety, history of the present complaint or injury, primary survey, resuscitation according to UK Resuscitation council guidelines, splinting and packaging and providing adequate analgesia.  As an example of clinical skills I will provide three examples of patients treated by me:

Patient 1. 
Narrative:  19/02/05 While en route in blizzard conditions to evacuate the body of a fallen mountaineer in a remote location, a rescuer was seen falling over 400ft on hard neve (hard snow).

Scene :  Safe as fallen mountaineer landed on less steep ground

Initial assessment:  Airway with “C” spine control, Patient Alert and Vocalising and Responding to Pain. Breathing rate 12/20 and pulse rate less than 100bpm. Rapid body survey indicated only one chief complaint which was a badly deformed and broken ankle which was exposed and examined for distal circulation which was absent. Cold was an issue as it was -6c and wind was 40/80 knots so protecting the limb from cold injury was also priority. SAMPLE history unremarkable

Treatment provided: The patient was cannulated by me with a 18g Safelon cannula in the antecubital vein. Cyclimorph 15 was drawn up and diluted in 10mls of sterile water (1.5mg per ml) and slowly injected using a visual analogue scale (VAS) to gauge effect from the patient.  When a therapeutic effect and adequate analgesia was achieved which in this case was 4 the ankle was pulled by me and circulation returned.  A rigid vacuum splint was applied.  The patient was put in a warm pre heated casualty bag

Rescue: The patient was evacuated for 3 hours via a circuitous route to avoid avalanche traps until a SAR helicopter was able to come in and uplift him to the Belford DGH.

Outcome: Transfer by road after initial assessment to regional orthopaedic unit for pins and plates and patient is now fully mobile and recovered.  Total rescue time 11 hours

Patient 2. 
Narrative:  22/06/05 while instructing students on an MEL course an instructor stepped back off a ledge and fell “bouncing” 60ft into a gully/watercourse (Lady’s Gully)

Scene :  Steep but made safe. Patient lying in water and unresponsive

Initial assessment:  Airway,“C” spine control and jaw thrust.  Breathing inadequate SAO2 at 80%  so initial resuscitation by BVM and then return of consciousness to GCS circa 11 (aVPu) and SAO2 96% with spontaneous respirations and adequate tidal volume. Breathing 12/20 and pulse 90bpm.  Obvious bleeding from scalp wounds but no other external bleeds found during rapid body survey. Conscious level alternating between AVPu and aVPu. Body check revealed tender left side thorax with good breath sounds and lumbar spine pain. SAMPLE history unremarkable. Core temp 36c by tympanic thermometer.

Treatment provided: O2 at 15l/min (SAO2 100%), Cervical Collar, The patient was cannulated by me with a 16g Safelon cannula in the antecubital vein flushed to keep open.  Patient packaged good lung down in modified recovery position (WEMS guidelines) even though no obvious lung injury -  in a formed vacuum mattress and casualty bag

Rescue: The patient was evacuated immediately after packaging by SAR helicopter which arrived 2 hours into rescue.

Outcome: I accompanied patient to local DGH for handover where he continued to improve.  No fractures or life threats found.  Admitted for observation for 2 days while obvious concussion resolved adequately for release.  Patient 6 months on still has memory problems which are slowly resolving. Post traumatic psychological injury regarding “trusting himself” not yet resolved.

Patient 3. 
Narrative:  29/12/05  a Lady of 57 years running down mountain path to a bridge in the dark goes over the side into a deep gorge 15mins walk from main A82 road. Husband phones 999 via mobile immediately and local police collect me and other team colleagues called out via radio net

Scene :  Patient found below 60 ft drop face down in water with bubbles from mouth.  Other rescuers arrive and we pull her onto large slimy water worn boulders at side.

Initial assessment:  Airway,“C” spine control and attempted jaw thrust.  Breathing absent

Treatment provided: Initial BVM unsuccessful as head jammed among large rocks with no flat ground around.  Vocal cords not visible via laryngoscope so I elected to intubate using a 37f Combitube Airway.  Successful esophageal intubation visible by chest rise and good breath sounds. Ventilations by colleague via BVM and catheter mount.  Patient had been in cold winter water for 35 mins. and no signs of circulation.  Defib attached and slow sinus rhythm with ectopics observed.  Patient  core 32c but not accurate as water in ear which affects the tympanic thermometer.  Rapid body check revealed no obvious sings of external bleeding but history suggested internal injury and bleeds.  Packaged with spinal precautions and  attached to defib in casualty bag. Rope raise to path and stretcher to awaiting road ambulance. En route to road patient goes into VF and one shock results in RSC. 10 mins later goes into VF again and 3 shocks as per UK Resuscitation guidelines for special circumstances delivered as patient trauma vs. hypothermia victim.  CPR and delivery to road ambulance with no further shocks.

Rescue: The patient was evacuated immediately as “load and go”  - as far as is possible in a technical rescue situation

Outcome: Patient blue lighted to local DGH where pronounced life extinct due to traumatic injuries.

I hope that the above actual case histories show some of the range of professional practice regarding my work for the Police as medical officer to Glencoe Mountain Rescue.

David Gunn
Wednesday, 18 January 2006

Friday, 3 January 2020

Self Improvement and Peter Pan Syndrome

The philosopher and author Jordan Peterson aptly describes a "Peter Pan" effect when boys don't grow into men by their mid 20's and take personal responsibility for the direction of their lives. He's quite a contentious philosopher but there is much truth in what he says. He hints that when men do come out of being a "lost boy" (some of us had to grow up much, much quicker than that) its ok to rediscover the freewheeling attitude of youth, try different new things or throw yourself back into old things with gusto. Basically get some youth back into your old bones and soul.

Cloughs Cleft E25b FFA
Climbing re-discovered for me is my late life Peter Pan effect I think. I have been among the mountains and trying to be a climber since I was maybe 13 years old. Not always very successfully as an early rescue of myself and friends proved when at 16 years old Hamish and the team rescued us from an icy North Face of Aonach Dubh when I was left at the end of the frozen rope in an icy gully. Mountain Rescue involvement was long part of that growing as a person as at that time it was a small rescue team very strapped for cash. It was where all active local mountaineers migrated to or were co opted to help out as rescues were a moral obligation and often there just were not enough team members, and it was the only way someone was going to be recovered. This only really changed in the mid 1980's. The only way it could happen was if the local or visiting mountaineers went out and made up a rescue team. Folk were called up by phone, grabbed out the bar or co opted when up staying with a friend on a climbing trip. Often these were among the best mountaineers of their generation and from Glencoe School of Winter Mountaineering. It was in effect also a climbing club. As a young lad  learning to become a mountaineer and having a love of the mountains could be overshadowed by tragedy and a normalisation of dealing with that. Putting somebody in a body bag at the foot of a route then climbing the same route at some future point and with a smile on your face because you had enjoyed it seemed ok. So I suppose like other lads in Highland Glens who took to climbing, the two things, MR and Climbing ran in parallel and were a little bit firewalled from each other. Although making the same mistake on "Big Top" as a climber who we new was killed by not extending the runner on the bulge and step on the last pitch was thought provoking, as was the fact it had started raining hard while literally hauling the rope a bit at a time to the top. Character building. Not really.

I always thought that was ok as it never stopped me exploring and climbing some of the hardest routes of that time. Over that forty five or so years, forest work, falls and accidents took its toll a bit. Crippling back injuries, chainsaw cuts and broken bones, a debilitating chronic illness and also some mental health issues from trauma and tragedy not all MR related all at one point came to a head and I turned my back to the mountains and hated them. When an old back injury came back to haunt me and I couldn't walk I sold all my climbing gear. That was it over with the mountains as places that take too much - or that was how it seemed.

I was on my first rescue at 15 years old and on reflection the early years were a golden period where the tragedy was never permitted by my mentors to interfere with the climbing as they were climbers and mountaineers above all else, and that allowed me to develop into one as well. I would be very wary of allowing my son even now a good climber in his mid 20's to be involved in what is now a more organized but not necessarily a better service. I think firstly you need to become a good climber/mountaineer for yourself before allowing the mountains to show you the dark side on a regular basis. It's too easy to become a rescuer rather than mountaineer who rescues, as it was back when obligated by a small population with few mountaineers and local necessity to form a rescue party.
A bit of sport fun at Glen Lednock

These musing are leading somewhere. Its maybe a bit of stream of consciousness stuff. After selling my kit and hating the mountains, five years later and after much rehab  I could run again despite a hip impingement picked up on an MRI and raced my bike and then really got into ski touring.  Due to my son getting the bug again for climbing it got me back up to the wall and training and ending up having to buy some climbing gear. I was really well supported by lifelong friends especially Sean MacNeil who donated his old climbing rack to me. In just about everything I do I try and apply myself to be the best I can. Be it self taught spey casting for salmon, to sport climbing or skiing. If you work hard at it you improve. 

Currently I do a lot of core work, yoga stretches and conditioning and follow the lattice plan and despite the years I see progress. There is lot I can't do but I am blessed with strong fingers and arms and I am getting there and seeing progress. Self improvement doesn't stop when you get a free bus pass. Climbing and the mountains re discovered are giving back that feeling of being part of a unique tribe of wanderers and seekers among or over the high tops, and meeting like minded folk. It's not always about grades although for me that's a measure of indoor success at the walls and being goal focused it provides a measurable result. While at a wall folk chat about what they have done, where they have been or life in general and its good social. The same is true out at the crags. I also have Fiona belaying me and despite being unable to climb because of her surgery and drug side effects she also supports me. In many ways its much harder for her as its a reminder of what she can't do, but despite that she participates and supports often acting as trip photographer when away exploring. It's great to enjoy the mountains again and to have forgiven them. They are in the end benign lumps of rock but they allow us space to be free. This quote sums it up better than I can:

“The secret of the mountain is that the mountains simply exist, as I do myself: the mountains exist simply, which I do not....I ring with life, and the mountains ring, and when I can hear it, there is a ringing that we share” Peter Matthiessen, The Snow Leopard

Avalanches, Hypothermia, Cojones and a Ramble

I thought I would share a few thoughts based on some lectures and doctors I have listened to this autumn at training weekends, and my thoughts on where research and changes in best practise may take us as ski (or mountain) rescuers. 

My area of interest is avalanche, although we already knows that avalanche survival is best looked at from an education and prevention as well as effective self rescue perspective. Asphyxia is the killer, with hypothermia temperature drop being too long and too slow to have the same metabolic protection you get getting dunked fast in freezing water due to how good modern clothing is in retaining heat. To survive the victim needs to cool rapidly for a protective effect in slowing the metabolic demand for oxygen, and snow itself is also an insulator. That does not mean prolonged burial victims cannot survive (Burnett survived 23 hours, and victims at NR event 18 hours) but it does make the effects of hypoxia more devastating as cooling is too slow to have much of a protective effect. 

Victims who may have expired from hypoxia may paradoxically feel warm to the rescuers touch under clothing as the good clothing retains some warmth. In hospital potassium levels are the best survival indicator and the ICAR guideline sets them quite high as there is theoretically no bottom line temperature or top line level of potassium where survival is not possible. The reality is however that raised potassium means often means a dead victim as cells leach out potassium and die.

If you dig them out fast then you might save them. Avoiding getting taken is the better option so education is key. The standard ICAR survival graph shows a better chance if recovered in less than 15 minutes. 

Avalanche victims are also trauma victims and I would hate to see the hauling out of victims with poor handling by SAR crews and no other rescuers present. I left MR because I witnessed such an event and took the folk involved to task.  Good careful handling of avalanche victims is vital and was one of the main pillars we built the BASP EMT course on, and which it continues to promote. It's nice to see that what we started some 20 years ago as "casualty packaging" is now the norm in Scottish "Cas Care" so we in BASP got a few things right - and first!  

Aberdeen, Dundee and Glasgow have ECMO which has been shown to be better than currently used extra corporeal rewarming. This then raises the question of the old adage "getting the right patient to the right hospital in the right time". With  SAR Helo capability this then raises the possibility of direct transfer of a severe hypothermia victim to a trauma or re warming centre? Maybe after triage at a local hospital or on scene? 

We also have who will bring intensive care to the patient. 

Survival from profound hypothermia is better in the young and those who cool rapidly specially in extremely cold fresh water see Anna Elisabeth Johansson BĂ„genholm as an example. Another paradox from rapid cooling immersion in very cold water may be water in the lungs enhancing the rapid core cooling and not decreasing survival as used to be thought and possibly increasing survival as the core cools rapidly. Scottish examples of survival include a little girl in the ski area at Cairngorm who a friend (RAF MRT) resuscitated. 

When it comes to decisions, folk including rescuers can be more worried about buck passing and watching their arses than making command decisions on what's best for the victim by telling folk how its going to be.  ight for the patient as an advocate and get them to the best place.

Its still fecking cold even with a dry suit!

On the subject of cojones, balls, testicles or whatever as an analogy for courage and making decisions.  Every winter a plethora of outdoor centres, guides and instructors take to the Scottish hills with "clients", "students" or whatever educational label can be attached to define a teacher/pupil relationship in the mountains.

In times of avalanche risk which in winter there often is - such as "considerable" then with local knowledge and attention to the SAIS forecast then some safe venues for climbing or general mountaineering can be arrived at. The average weekender isn't daft and watches where these led groups go and gets a free ride on someone else's knowledge and decision making process's, which  by and large is better than theirs (you would hope) as they have (an assumed) qualification and experience.

When the risk gets into the "localised" (minefield) or bands of the brown/red cake on the wagon wheel of death, then approaching corries and climbing venues, or picking routes of descent becomes much more thought provoking and life threatening. 

There is a commercial imperative to give a paying "client" value for money among the organised groups with clients. That clients are safer under instruction is I think true.  But when macro decisions of route choice become micro decisions on the ground in high risk conditions the lay hill going public are not perceptive enough (IMHO) to see the minute adjustments in route choice made by a guide or instructor, nor the process by which decisions are made dynamically as the journey unfolds. All it takes is a shortcut across a gully apron to where a guide might be roping up and they the followers might enter the white room.

So what am I getting at. I guess that there are some days when the risks as so high that the commercial imperative should be put aside.  It sets a bad example during high risk periods that in all conditions safe routes can be found.  There are enough dead guides and instructors to show that this is the case.  If they can get taken then what about Joe public who follows in their path. The public perception is that if there are professional groups in locations it must be safe for them too. 

Tales From the Debris Pile - Again!

Skier triggered avalanche on a popular off piste run with extensive crown wall.
West aspect of Glencoe Mountain
I wouldn't say I am risk averse, but this weekend when faced with crossing an open slope on ski's above the Cam Glen Gulch I bottled it. It felt so dodgy and with that gaping below me after having done a stability test and seen the results I thought it a turn too far. It made me feel like a chicken shit though. On my first MTB XC race back in December I ko'd myself on a practice lap and didn't remember the the first lap until my bruises hurt, and on the second race of the season I tore the labrum of my femoral head clambering over windblown tree's with the red mist of battle  I didn't feel a thing and finished quite well up the field. My total of fractures is quite impressive and most folk I road race with will tell you I will mix it up in the pack.  All good excuses for being a chickenshit! This last two months has been quite reflective though with my disc prolapse, as at one point I thought maybe I couldn't ski again. I looked back at all the friends who I have lost to the mountains. As Tom Patey once said "never underestimate the importance of staying alive". A maxim he didn't do too well with himself having abseiled of a plain gate krab that Hamish had discarded as the gate was fecked. All good excuses for me backing off, but there you are.
137 landing on.  The debris had turned 90 deg right and traveled along the valley floor into the gulch.
Even with an airbag above such a massive terrain trap was no go for me!
Avalanches torque and squeeze and I guess I have seen too much and having been on the wrong end I am twitchy. My winter business of avalanche safety gear is not about making money as I am sure many will attest to as I sell at rock bottom prices. Prevention is a key component as is learning lessons and sharing thoughts and information. The prevention side didn't work this weekend sadly, with the loss of someone else who I new (but not well).  The causes and circumstances are too close to home and tragic and the loss is grievously felt among the folk I help in the ski patrol and their friends.   I will put some general pictures up in the manner of which I have done before and hope that we all continue to celebrate those who live life at full tilt going to meet their maker with the perfect carving turn on the fantastic snow we have this spring, while also making sure the candle of those who live life to the full burns for longer if we can learn from it.
50cm  Avalanche JENGA

I feel a bit like an old sage at times issuing warnings of avalanches and sometimes feel like some old sage in an alpine valley warning that over the next ridge there are demons, or if you trip trap over the rickety bridge the Troll will get you. Maybe I am Billy Goat Grough!

Snow pit site Sunday with the sad recovery of the victim in the background

Avalanche & Hypothermia Resuscitation. Part 2

The Past ..........

The Future ...............
"If the airway of a patient who was buried more than 35 minutes is free, the physician should not give up hope, even in the absence of vital signs," (Dr. Brugger said) "Especially if the cardiac arrest occurs during the rescue procedure or transport, that has been frequently reported, they should be treated optimistically and transported under continuous cardiopulmonary resuscitation to a centre for extracorporeal rewarming"

That statement highlighted above is not new.  Even 12 + years ago at the excellent "Freezing to Death" seminar hosted by Cairngorm MRT and Glenmore Lodge this was discussed. This seminar came about in particular because of a terrible tragedy involving a family with children on the plateau in bad weather in the summer, as well as few bad winters for avalanche accidents.  Conclusions at that time were that Glasgow could supply the necessary equipment for re-warming but the time taken to get it into action was hours. Only Aberdeen could get things up and running in a timely manner and had the most up to date equipment. North sea disasters and oil money made this a reality from necessity. Within Ski Rescue at that time we had Prof Page and  Mr (now Prof) James Ferguson from ARI as our medical advisers. Both were key players in treating those from Piper Alpha. I was there at the time representing GMRT along with Dr Ian MacLaren from Ski Patrol.

At the seminar there was a kind of West/East split with medical professionals in the West taking the view that trauma was also a major factor and overflying would jeopardise lives that could be saved from early interventions. Trauma was the priority with more conservative re-warming such as "Bear Huggers" and lavage.  For hypothermia II and III this is fine even though it is little more than boiling the kettle and putting a duvet over the patient with a hair dryer under it. But, if your a trauma victim or in old fashioned terms mild to moderately hypothermic then this will save your life.
Bair Hugger (Giant Hair Dryer - It Works Though!)

However.  If the victim is an immersion or avalanche victim without life threatening trauma and has hypothermia III or IV then the above statement from Dr Brugger becomes very important as Aberdeen is the only place to go, and controversially someone has to make that decision.  Watching the BBC news reporting of the terrible avalanche tragedy in the Chalamain Gap I thought it bold and entirely appropriate seeing the victims being taken into Aberdeen. Whether that decision could have been made on the West I don't know.  

With a contract SAR helicopter service  more hypothermia IV victims without life threatening trauma could/should be taken to Aberdeen as it's the only definitive center for re warming in Scotland with ECMO and a team that can be up and running fast.  How this will work if at all from the West of the country I don't know.  It's extra flying time for sure, but only by going for it and starting case studies will it ever be known if extra lives are saved.  Perhaps another seminar to nail down these issues is long overdue.  My own take is that we Scotland have enough cold victims to formally declare that like Alpine nations we have our own definitive re-warming centre and an integrated mountain/ski rescue and ambulance service working with SAR helo assets to make it work.  

Conclusion: This was all discussed in "Freezing to Death" all those years ago so it's not new.  Flying logistics, weather and injuries might make this transfer to a specialist centre a very rare occurrence indeed, but if it's ever going to happen then with all this change to single services then maybe it's time for folk to sit around the table and chew the fat over it. Another seminar?

CPR during transport to hospital Auto Pulse