Reflections on Rescue Medical Care

All of us had an interest in first aid. Some more than others. I was an early school leaver with no qualifications other than cutting down trees and hard work. Then I was persuaded by Fiona that I was clever and bored at school so should do some adult learning and get some qualifications, so I decided I wanted to become a doctor. Along the way I collected qualifications in human physiology, pharmacology and eventually became one of the first UK paramedics. I never got to be a doctor but I did get invited into the Royal College of surgeons Faculty of Pre Hospital Care as a founder member and BASICS full member.  Life is journey and I would never swap these early years in the woods and the people I met for any degree, or the adventures life brought later. Some of the best of which was my time with Joint Services Mountain Training and the folk I met and had fun with.

Reflections

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 by the establishment, and those adopetd based on taking the better aspects of the American DOT Emergency Medical Technician and Paramedic programmes for pre hospital care (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 the 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 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 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, so it's an integrated approach.

The rescue team leader takes overall control of the rescue including the evacuation, this leaves the medical folks to treat the patient, often led in much the same manner as an A/E trauma but without the monitors and scanners. 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 not an article.  I like to think this team approach might just have made the difference for a few poor souls.

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 with my advanced skills 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 Laerdal FR 1 delivered 27 shocks to a patient before her heart re started.

Rod MacIntosh who later became a course director for BASP EMT on his EMT course in 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 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 looks 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 having soloed some big routes and survived some epics and lost friends, 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. Ski rescue certainly has it moments and digging an avalanche victim out still alive was a bonus rarely enjoyed in mountain rescue.

A probe find by the author. 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. It’s good to know there are folk willing to bust a gut to go out in all weathers and make a difference. 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 had 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 10 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 bike and ski. Goals for 2022 is to still send onsight a 7a sport route in better style. I had an epic on the Tunnel Wall route “Uncertain Emotions” but still doing ok sending the odd  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 and of course the hard working ski patrol pro's on hard dayshifts 

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 this wasn't comfortable for the patient or me! 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

Avalanches, PTSD and Talking

First Published winter 2014 

Forgive me if the dates are out for the events below. 36 years of this shit melds one event into another a bit, and I didn't keep a diary. However my memory is imprinted with the thoughts and things that happened, and what's below is a snippet of bad things and perhaps the only ones that could be written about, as others are too messy. I hope it helps those who are struggling and makes them realise they are going to be ok as they are normal.  Take care, your families need you whole.

Incidence of PTSD after being avalanched

I have been reading a book on trauma. Not physical trauma but the trauma of stress and anxiety from a normal person being exposed to an abnormal event and having major psychological issues often years later. Dealing with disasters such as Lockerbie the RAF has an excellent and pro active approach, and the struggle to come to that point after generations had refused to acknowledge this form of trauma is at the heart of the book. The common term these days is PTSD.

Reading the book evokes many memories for me, and in particular some not very good ones. While I no way would say that I saw or dealt with anything like a big air crash, I had my moments finding friends dead, watching friends get killed at work and removing pieces of what used to be someone from debris of one type or another, including helicopters. These moments were overcome with the support of friends, family and mainly my stoical and loving wife and immediate family. We the rescuers get some acknowledgement, but I don't know how the partners our immediate confidantes put up with it as there is nothing there for them but hassle. Family are the real heroines and hero's of medicine and rescue.

In the 1990's the UK medical profession was still burying its head in the sand about PTSD and certainly in civilian MR to have acknowledged a problem was not the done thing. At that time I was very much the main medical provider in our local MRT and on my first year as deputy leader. This had been the worst period I could ever recall for a series of fatal accidents and very serious injuries. I had become a full BASICS member and done their pre hospital courses, and with doctors advanced trauma/medical courses, and had already done the first pilot Scottish ATLS course under Ian Anderson at the Victoria Infirmary. With A/E electives, and done ambulance service placements on the first Paramedic response units in Dundee and Motherwell via the Scottish Ambulance Service. I already had 20+ years of attending accidents under my belt.  But the winter of 93 onwards were a succession of putting into practise many new skills for the first time, including the first use by an MRT of a defib. Pain was treated by IV opiates, and that winter I decompressed my first tension pneumothorax and also got a Royal Marine resuscitated who went on to live a meaningful life. His name was Simon. You remember the names of the success's. It's easy, as there aren't very many!

Winter 93/94 was a difficult year coming  through with a new start Hamish having retired and new leadership, but the stress's of that process had taken a tole and there was a cost to good folk who didn't deserve to be hurt. That summer was as busy as the winter, and as autumn came early at the end of September the mountains already had heavy snow. October we were at a helicopter crash involving aircrew from PGM, folk that we all new well having worked with them on films for Glencoe Productions. It  had a rotor strike on the hill above Ballachulish. I will not forget finding a pair of legs sticking out of the peat in torchlight. When the snow came in storm depth two folk were buried in an avalanche and dead in Summit Gully. Two weeks later after four day search we find a young man dead in an icy gully after a bizarre series of events involving a "medium".  She turned out to be correct on the location! Then the traditional Xmas and New year "come up and get me" flashing lights, followed by severe winter blizzards leading to extended road closures. At this time I was working as the solo ski rescuer/patroller at Glencoe Mountain on weekdays, so was often rescuing skiers by day and climbers by night and night were often broken as we had Esther my daughter newly born.

Doing this stuff and going home to your family as if nothing has happened is not "normal"

John Greive was the leader of the team from 1993. A very good mountaineer with an intimate knowledge of Glencoe, John had strong instincts and quickly these gut instincts would ring alarm bells if things don't feel right. A lot of lives have been saved because he has run with these. John and I made an unlikely pair as the new leadership. I can honestly say that he was an exemplary leader. Often last off the hill or last onto the SAR helo to get off the mountain until sure his troops were safe, and willing to fight any "jobs worth" who interfered with patient care or caused delay in someone getting help. Victims sometimes need that kind of advocacy in mountain rescue. Cut through the bullshit and bureaucracy and get them help, then deal with any fall out later.

GMRT in action at an avalanche BEM. John Greive Team Leader

So, when in February 1994 John is on the radio saying a group (who were not climbers) had walked up into the entrance of  the access corrie to the Buachaille and not returned, the wife of the missing walkers is at the Kingshouse and things don't feel right to him - then believe me you stop eating your tea and take notice. A father, son and friend had gone for a look up into the Corrie and not returned. The preceding days the head wall had been loading, but climbers had come down it and as its a couple of thousand feet to the entrance then we thought and hoped the missing folks were just stuck in the dark.

A group of us including Steve Kennedy, Pete Harrop and Malcolm Thomson were in the lead with Hughie, Wull and Kenny Lindsay and others team members strung out behind. We went into the entrance gully and were in among broken wind slab avalanche debris, we then worked our way up to the little re-entrant that comes down from the "Dwindle Wall" side. I was all for getting stuck in and starting a spot probe search. Steve stopped and said he wasn't happy and I remember saying "come on lads lets just get stuck in" when Steve said "listen" and then shouted "avalanche!" I hadn't heard or seen anything, but folk were scrabbling up the rocks out of the gully and I followed suite although at first it seemed surreal, the rumble and huge blocks from a  monster of a big wet slide flowing past and up the sides like the tide lapping our feet as we scrambled up soon made it seem pretty damn real. Steve's instincts saved the lives off about seven Glencoe MRT that night. We jogged off the hill high on adrenaline and retired to Clachaig for a dram. We were shaken badly by how close a call it had been.  A lot of wives and kids nearly lost their partners and dads and as deputy leader I should have been less complacent.  It was that close to tragedy its hard to believe we got away with it and one of those things we thought best kept quiet as it was so nearly a further big tragedy to what now apparently lay beneath the snow. Next day we were up the hill again, and the slab debris had about 40ft of hard wet frozen snow debris on top. Hard to probe, hard to dig. The RAF MRT came and helped and put in a huge amount of work digging and trenching. Due to being fairly near the road the TV crews could access the scene so we were under their watchful eye. Four days of hard work and we had to give up as it was too deep. The 3 walkers remained buried.

Adrian "Hands" lands an anti sub heavyweight CAB on the A82 to take us to an avalanche BEM 1992. 

A few days later truly a massive blizzard strikes, roads are closed and we get a call that three climbers are missing from Curved Ridge. We parked the yellow rescue trucks bang in the middle of the A82 at the Kingshouse junction and  SAR 177 with Adrian "Hands" as pilot land on.  I was first on as observer up front, with Ronnie Rodger in back, we fly around the mountain on what is a blue sky morning with feet deep snow covering everything.  John suggests we fly the East face "Ladys Gully" Central Buttress side but we see nothing at first.  I get "Hands" to overfly the Chasm which you could have skied down.  The Devils Cauldron was filled level. Snow depth for that about 180ft (that spring it was fun to climb up the 180ft snow chimney and the back wall of the Devils Cauldron). We got winched out below Central Buttress at about "Pontoon" the rock climb, and start to zig zag the slope when Ronnie finds a glove then a few feet further down a crampon. We know we are on the right track and call up the team who included Mick Tigh who offered his climbing clients as spot probers. After a couple of hours Tony Sykes who was then in his first year in the team shouted he had found something. He was right under the rocks of Central Buttress. Blue sky had gone and we were now in a blizzard, but in about an hour we had dug out the three victims all on top of each other in a tangled mess of trauma and equipment. The following day early morning I am back up to the ski rescue and passing the Buachaille and looking across at where three other folk are still buried and it clicks that at any point in the next weeks/months John or I will get a call to look at something nasty in or poking out of the snow. Something happened at that moment and I still remember it. Like my happiness switch clicked off and a knot in my stomach.

Living next to the vehicles gave me the task of keeping them clear. 

Often 3 or 4 rescues each weekend in the 90's. Pre mobile phone.

The wife of the missing father and son came to stay in a Bed and Breakfast just around the corner from me, and was waiting for us do do something when the thaw came. It was to be a very long wait.  The local vicar was very good with her, and "chapeu" to the local Police in particular Sgt Kenny Lindsay who acted as her link to what was happening. Knowing she was waiting on resolution was a constant burden for her and for us. Meanwhile climbers fall off and get killed, injured and skiers break bones including the UK head of marketing for Sainsbury's who breaks his back on the Fly Paper and who I have to deal with. Thankfully he made a good recovery, but not many folk get a private ambulance to the airport for transfer to a spinal unit. It was a fantastic ski season with sun and 6 weeks of skiing back to the car at Glencoe

The RAF teams have an odd probe of the big tip over the coming weeks, but nothing is found. Then one day early April a walker phones the Police as he says he smells something. John calls us out and though there is no smell (maybe we are used to it) we have a probe around as the level of debris has reduced by about 20 feet. We find victim one at a depth of 2 meters. An hour later and a bit away we find number two. Number two's recovery - something happened inside me. I didn't get upset by physical trauma having seen plenty (and suffered some myself) and had by this time been on the recovery of well over a hundred fatal victims just in the mountains never mind the other stuff. I stayed digging for the next hour until we found number three at the very spot we had been standing the night we all nearly got buried. This wasn't a troubling scene visually, yet somehow it broke something in me as there was a big pocket or space around the victim. I dropped my probe, didn't speak to anyone and just walked off the hill. I crossed the bridge at Lagangarbh and the local undertaker had three grey fibreglass coffins open with the lids off leaning against the stock fence at the side of the path. I glibly remarked that trade had been good this winter. Three weeks later I got a donation of £350 for the team in the post from him.

GMRT Stalwart Walter Elliot and the late Alan Findlay digging deep

I walked past the coffins, up onto the road and thumbed a lift to Clachaig where I got pissed on Scrumpy Jack and had to be taken home. What Fiona, Esther and Duncan made of this slobbering drunk I have no idea, but I can just recollect Fiona laying me on the couch and taking off my boots and covering me with a blanket. At some point in the night I tried to get up to bed and fell down the stairs breaking all the pictures on the way down. What patience and tolerance my family must have.

I moved on from the above (I thought) and until five years ago was still involved in MR and dealt with many more horrific events including people burning in helicopters and finding another two climbing friends (Dougie and Bish Macara) dead. It all diminishes you, but by that time I had a better coping mechanism and new about debriefing, and the pub!

I was fortunate that from 1994 I had many good friends in the team who were not frightened to call me an arse if I got decisions wrong, and also support me as I supported them when some events became overwhelming. You know who you are - so thanks guys.  It wasn't until I left the rescue team which was in Jan 2009 after yet another triple fatal avalanche (where I found the last victim by probe) that I realised that since 1994 my happiness button had faulty wiring.  In the intervening years folk would say of me at times that I was a driven man.  I would drive myself into the ground physically running and racing my bike and seemed to cope with the extreme stress of life and death decisions yet I would get random  anxiety attacks over very minor things. My local GP sent me to speak to someone who over a few months talked me back over things until a light went on what my head was telling me, that I had been feeling like undertaker in winter, not a medic. With rethinking and knowledge of this faulty thought imprint I was sorted, the light back bright, and I was released from a thinking trap that winter equals death and loss. 

When it  all works and a life is saved then it's worth it

Dealing with nasty things has a cost. It's all very well being in a rescue service, but you are also volunteering your family for it, and they are the foundations for you at the sharp end. Don't take that for granted, and make sure they get recognition and be sure to be aware of colleagues who might struggle. It's not a weakness. It's simply not normal to deal with abnormal disturbing events and not have a normal reaction. When your head's sorted you can still deal with tough shit and know you are ok.

Why am I sharing this now? Winter 2013 was a nasty one for avalanches. The emotional toll on some of the rescuers dealing with the avalanche that took our cycling buddy Chris has hit some folk hard and I had my own involvement with that. Even as a ski patroller there was no avoiding the toll with the loss of Danny in an avalanche off the West of Glencoe Mountain and the events both leading to this, and the toll on friends and ski patrollers after. I had my own complacent re visit of the white room and an injured hip and spine to deal with, but had the time to be an ear to listen to folks and easily conclude that 2013 would fuck up some folks.

2014 was the shittest winter weather I can recall in a while, although paradoxically the sheer volume of snow made everyone wary, so despite the most recorded avalanches at least no one died. The baggage of 2013 like a rollover lottery carried over though, and I think its time we all recognised that it's human and normal to suffer after abnormal events. Help is out there and books like the one mentioned de mystify what happens to us. Maybe if folk like me are more open about it then the subject gets an airing and folks who are struggling can get the support they need.

Trauma. From Lockerbie to 7/7

A newer local MR rescuer said to me this winter "all you do is run around looking for beepers - what do you know about digging up avalanche victims".  Not a lot I said, other than it requires no brains. Avalanche education and prevention gives me more satisfaction.

Post Script.
I realise this blog post makes uncomfortable reading.  It certainly wasn't comfortable to write. It has been a work in progress from 2013 when a member of a local MRT came to see me very troubled by some events.  Then another had a tough time with depression, and in the meantime a few folk couldn't put some events behind them and every conversation was dominated by a specific avalanche event.

My purpose in this blog post is to show there is nothing wrong. That asking for help is not a weakness and that your family can only take so much and give so much.  Help is available but has to be sought. If not for your sake then the families. To not be troubled by the pain of misfortune from the loss of young lives -  now that would be abnormal!

Mu dheireadh de na fir beinne

The Strath of Glencoe and neighbouring Glen Etive has many legends stretching back into ancient history. From Irish/Scots and bardic legends such as Deirdre and Naoise through to Clan battles, massacres and folk of fame and authorship.

Such ancient legends are incomparable with the people who have made the Glen their home and hefted themselves and families to these hills and Glens in modern times. Many of these were shepherds trying to make a living from an austere and difficult landscape.  Sheep were not the highlanders friend in bygone days. But the sheep soon became a big part of the highland economy, and the folk who tended them hardy souls, and by necessity damn good mountaineers. Through this they became the very backbone of early rescue from the mountains and later formative in the creation of Scottish mountain rescue teams. Along with fellow men and women from the estates the contribution of these families to this way of life and especially to mountain rescue should not be overlooked.

Sadly Glencoe lost the last of these hill men this week when Walter Elliot passed away.  Vicki Sutherland wife of Alastair current Chairman of Glencoe and Glen Etive Community Council summed Walter and the Elliot's very well in a community Facebook post:

"Our neighbour up the Glen, and Alisters childhood friend Walter Elliot passed away on the 11th July in his 91st year. Walter died in the small white cottage in the heart of Glencoe where he and his 5 siblings were all born. Their parents moved to Glencoe from Luibeilt which lies between Corrour and Glen Nevis in 1922. Their Father Wattie Elliot was a Shepherd and Stalker and long before any formal Mountain Rescue Team was formed rescued people off the hills in Glencoe. Both his sons, Willie and Walter were members of the Glencoe Mountain Rescue team first formed by Hamish MacInnes. Walter, also a shepherd and stalker was awarded an MBE for his services to the Mountain Rescue. Walter & Willie, both unmarried lived at Ach-na-Beithe with their sister Doris. Hogmanay at the Elliot's was the traditional place for all in the Glen to bring in the New Year, The tiny low ceiling rooms were packed to bursting and Doris provide a spread of Venison sandwiches and Clootie dumpling and the whisky flowed! The Glen will not seem the same with the death of the last of the Elliots at Ach-na-Beithe and we will mourn the passing of the old way of life and the "craic" that was always to be found there"

Its hard to sum up a family that was not only in the heart of the glen but its beating heart. The epitome of Highland hospitality and the very spirit of mountain rescue in early mountaineering's heyday in Glencoe. Walter Senior was part of an ad hoc shepherd group along with the other local keepers helped on occasion by the Scottish mountaineering club (summoned by a telegram sent to the SMC clubrooms) who undertook long epic rescues. One in particular taking a couple of days on Stob Coire nam Beith for a rock climber with a broken leg as the telegram was missed by a day because no one was at the club room to receive it. The chap survived! Undermanned, with poor equipment but a blithe spirit in often trying conditions it was to this the two young Elliot boys served an apprenticeship as shepherds and rescuers, later being the very foundation of Glencoe Mountain Rescue Team. The respect shown to the family by team leaders past and present such as Hamish MacInnes, John Greive and Andy Nelson, and from the teams members was always evident, and the Elliot's wise counsel often sought on a difficult rescue where a shepherds knowledge of the terrain got the team down on an path to safer easier passage, or their keen eye spotted a car parked up too long, or maybe a strange light, over the years saving dozens of lives. If parked up at Achnambeithach the rescue team was never short of a cup of tea or a venison piece if Willy had been stalking. New year was not complete without a visit to Achnambeithach, and the cottage itself has witnessed many dramas, such as the man laid out in the Sunday parlour dead after his recovery from the mountains by old Walter and helpers. The Stramash when he unthawed alive as he was obviously hypothermic is the stuff of legend. All those needing help were taken in and while a family member such as Doris was calling out the team many poor souls had an ear and tea while help was on its way.

The family were good to me as daft young man. Walter himself leading the way when I myself was rescued as a teenager with some friends. I was fortunate to have been on many rescues with Walter. He was a great hill man with an intimate knowledge of Glencoe and a really good mountaineer. Anyone who has helped gather sheep from Glencoe and Glen Etive will be aware that you need a good head for heights and be damn good on your feet. So its very sad that the last of the Glen's, and perhaps its greatest shepherd mountaineer, has gone. It is the end of an era both literally and figuratively, my few words just cannot do justice to that passing.

Below are a few pictures of some of the shepherds, all of whom were rescuers and folk who loved the mountains. Truly the passing of legends and end of an era.

Alastair MacDonald top left and his search dog Roy. Alastair was shepherd in Glen Etive and the Buachaille and worked closely with the Glencoe shepherds at clipping and gathering times.

Taking the stretcher upfront  local shepherd Alan Findlay son of long time rescue team stalwart and Achtriochtan Shepherd Huan Findlay

Picture left Huan Findlay and right Peter Weir. A shepherd and Forest worker doing the stretcher graft. 

An Achtriochtan shepherd in more recent times, Sandy Watson

2nd from left Willie Elliot accompanied on his left by rescue stalwart Wull Thompson and right by Sandy Whelan's.  Also well known guide Jeff Arkless, husband of Brede Arkless the UK's first female guide.

Sandy Macewan Gleann leac na Muidh Shepherd and nephew of the Elliots

Walter Elliot on the left and Alan Findlay right digging out a deeply buried avalanche victim

Top right Walter Elliot senior on a rescue from the Coire Gabhail circa 1930's

Walter Elliot Jnr on the right digging out an avalanche victim. Midnight Hogmanay 1980 Creise

Willie Elliot going to be spy in the sky on Rescue 134 with John Anderson 1978

During the 1960's and early 70's many MRT's became "special constables" to gain insurance cover. Above are a mix of Oban and Glencoe rescuers from "Y" Division Argyll.  When GMRT was able to get its own insurance cover folk quickly left the "Y Fronts".  To be fair "Y" Division exerted no influence and left local MRT's to it, and the policemen who came out were terrified. The exception was Sandy Whelan's who both as an ex RM Commando and local bobby on the beat was himself a mountaineer. 

An early rescue of a fatal avalanche victim circa 1957 from opposite the Elliot's cottage up in a gully just West of the AER decent path to Clachaig road end. The young Elliot brothers would no doubt have been in there digging.

The highlighted links "Strange Light" and "rescued as a teenager" are to another couple of tales.

Being Searchable

Who knows what this winter will throw at us in these uncertain times. For sure the ski areas that are open may well be very busy indeed not only with regulars, but snow hungry off pisters who normally ski the alps and may well be complacent about our smaller mountains that punch above their weight literally when it comes to avalanches. 

Nothing substitutes good planning and knowledge to avoid getting avalanched, but the very nature of the sport is uncertainty and with enough risk exposure bad things can happen. It's fair to say as ski patrollers and hard charging skiers that means us. The point has been laboured often enough by me that nothing substitutes having the three essentials of transceiver, shovel and probe and being slick with deploying them effectively, and managing the scene well, which comes down to practice. 

Sadly mountaineers do not have the same philosophy as off piste skiers and tourers about companion rescue, and the focus is very much on prevention such as the SAIS "Be avalanche Aware".  All well and good, but sadly when buried often the mountaineering victims cannot be found in a timely manner by companions, and worse still organised rescue even if on scene quickly has few means of finding them other than probing, or with luck a search dog. Recco is not a panacea for this, but it does add an incremental gain and every year lives are saved by it as victims are found alive. From burial, avalanche search statistics show that companion rescue gives the best chance of survival, then Recco and also in the alps avalanche dogs, with least live recoveries from formal probe lines. Probe lines do find folk alive but not often, and while most victims are eventually recovered by a probe strike it's down to the sheer numbers of searchers and length of time poking in the snow, all mostly at the wrong end of the survival probability curve. Spot probing, a random poke in the snow in likely spots also occasionally results in a survival, but that's down to luck unless it's a really small confined slide. If you're searchable you're found more quickly and more likely to survive.

Recco continues to be accepted into more clothing brands and now also into mountaineering clothing as the "be searchable" message gets through to the winter recreation public.  Recent additions are Patagonia and Arcteryx into mountain specific technical garments. The Recco SAR pod is now with more helicopter based search and rescue units such as Air Zermatt, PHGM and CS Chamonix and to sites across North America. Quite a few notable success stories from this, and not all avalanche based with some in water or in dense forest.  When the helicopter flies at a height of 100m, it is able to scan an area that is 100m wide. When the speed of the helicopter is 100 km/h this translates to 1 km2 coverage within six minutes.

As the UK's trainer for Recco I am happy to offer advice on training on the system to anyone interested. I also sell aftermarket reflectors and for BASP members and patrollers I can offer a discount. I can do either single pocket reflectors to be carried, or helmet reflectors. Two reflectors are the optimum to carry. Please note if you have an Ortovox transceiver that is less than 4 years old it will already have a Recco reflector inside its workings as a backup. 

Unlike a transceiver search along a flux line, Recco harmonic radar is a straight line to the victim and a Recco R9 detector is equipped to search both harmonic radar and 457kHz transceiver simultaneously. The 457kHz is analog allowing a greater range than digital and the ability to hear more than one signal and detect overlap. When nearer the victim the Recco becomes primary and a second rescuer hones in on a digital transceiver signal - or vice versa. Who cares who finds the victim first as speed is the key. If you're not searchable then the odds are stacked against you until someone pokes you or it thaws.

2 x Recco reflectors £40

Ortovox 3+ Transceiver £209

Ortovox "Beast" Shovel £47.50

Ortovox 240 alu Probe £35

Be searchable!

Avalanche Education. Problem or Solution?

What is intended to be the solution to avalanche incidents is education of the mountaineering public. Making them aware of pre-trip planning, weather and avalanche forecasts, and human behavioural issues. Cognitive thinking traps using the popular acronym FACETS is one example of softer "thinking" skills now used as part of the education package.

FAMILIARITY

Parties traveling in familiar terrain made riskier decisions than parties traveling in unfamiliar terrain. This effect was especially pronounced for parties with substantial experience and training.

ACCEPTANCE

Group members want to be accepted by members of their parties. “Accident parties that included females made riskier decisions than parties of all males. The effect was most pronounced in parties with little avalanche training. It is notable that these were precisely the parties in which women were least likely to participate.”

CONSISTENCY

Parties that were highly committed to a goal – a summit, ski slope or an objective in deteriorating weather – made riskier decisions than parties just out for a day. This effect was most pronounced in parties of four or more.

EXPERT HALO

Accident parties often contained a de facto leader – someone who was more experienced, older, or more skilled. Novices were more likely to follow the leader into dangerous situations than when novice groups made decisions by consensus.

TRACKS/SCARCITY

Parties took more risks when they were racing a closing window of opportunity, such as competing with another group for first tracks.

SOCIAL FACILITATION

When skilled parties meet other people in the backcountry, they are more likely to take risks than parties that are less skilled. This effect was most pronounced in groups with the highest levels of training.

Most of the education of mountaineers is based on avalanche avoidance such as "Be avalanche Aware", a very sound proposition, but every year dozens of avalanche incidents are reported, some with victims buried, or missing for long periods before recovery, sadly dead.  And they are not "Searchable". Despite superb forecasting and reliable weather data its “plus ca change plus c'est la meme chose” same old same old.

Q. Is there a tendency for avalanche trained folks to have more avalanche accidents not less?

Could it be that certainty is being implied via processes, to an environment where no such thing is possible – ever!  Facilitated by educators such as instructors, guides, and others? Folk leave training courses feeling more educated and empowered as they have more knowledge. Maybe thinking they will have travel in avalanche terrain a bit more dialled. Is it a false sense of more certainty where none exists?

Q. Is there ever certainty in steep snow covered terrain?

Educators spend a lot of time on bells and whistles during training to imply gaining some degree of certainty during snowpack analysis to make decisions on safe travel. I understand the need for bulking out a course to paying guests with the commonly taught practical "doing" things, like  rutsch blocks, column tests and snowpack study, with other investigative stuff.  But its not future avalanche forecasters they are teaching, its recreational mountaineers and skiers and these investigative skills are perhaps irrelevant distractions from self and spatial awareness.  Off most value in these “tests” is a group stopped then talking, communicating concerns, and making collective decisions. This pause is often when individual concerns are aired, and leader decisions can be challenged or discussed. As the proverb goes “in the land of the blind the one-eyed man is king”. Some knowledge can be better than none in the right head, but ask yourself if it’s the one leading your group, are you being listened to, and do you feel happy with where your all at. Listening to that bad feeling from someone in a group can save lives. Speak to individual survivors of an avalanche incident and a precognition feeling will have occurred to many but may have been ignored or supressed. I think it was Reinhold Messner in “The 7^th Grade” who said ignoring these precognition feelings is folly. Its been 35 years since I read that book but this comment stuck as it resonated with events in my own life even then as a survivor of a couple of near misses to me that took friends, although these were not all on the mountains.

Precognition or prescience is not paranoia but often your senses and sensory awareness picking up recognizable patterns, perhaps from previous life events and experiences. 20:20 hindsight is no use when you can't breathe so we should heed the senses.

As a personal example. One day way back mid 1980's a friend Paul Mills who was fairly new to winter climbing said he wanted to climb No 6 Gully a classic grade 4 in Glencoe. He wanted to do it the old fashioned way to see what it was like cutting steps, no ice screws, a single rope and just some pegs and slings. Off we went soloing up the banked out lower pitches on soft snow until we got to the last and main ice pitch where Paul belayed me from the ice cave, and I set off up the icy corner to a peg runner and cut hand and foot holds until over the top. 

I was going to go over to belay across to the right where a little chimney finishes up. A couple of steps and my senses went into overdrive. The top bowl was loaded with a deep yet dryer slabby snow blown in from cross loading, and I would have to cross it with the pitch below me to go over if it slid. I didn't like it at all, so I back climbed all the way back and down to Paul, a not inconsiderable use of energy and adrenaline. He was not best pleased but regardless the decision was made to solo down the post holes we made on the up, so it was ok with care. 

We exited the gully and met a group of four lads one of whom was the boyfriend at the time of local girl Mary Anne, daughter of one of my climbing partners Wull. We had a chat and they asked why we had back climbed down and Paul took the piss a bit saying the step cutting had worn me out and I was an old fearty. I mentioned the exit snow and that I wasn't happy with it but didn't labour the point.  

We headed back to the village and later learned that  two had gone over the pitch in an avalanche and it also caught the other two lower down. All 4 went out the bottom of the gully over the luckily banked out first pitch terrain trap and all the way, almost to the stream crossing. Several hundreds of feet! They were all cut up and bruised with the worst injury a broken wrist, so extremely lucky.  I was asked later as to why I hadn't talked them out of it. I am sure that I felt it was a personal choice and that my prescience wasn't enough to talk someone else out of it. And yet both before this and after heeding this precognition saved my life. I am not a risk avoider having done many daft things including soloing. But ignoring that inner voice going "whoa there" is also a big part of what I didn't go on to do.

I also read a very good article based on the French SERAC database on touring accidents sice published in Montagnes magazine which is worth translating:

https://www.montagnes-magazine.com/actus-accidentologie-premiere-analyse-ski-randonnee?fbclid=IwAR1hMxSRc7RK9VtV0AR5Y_wPM5O2llGGFrKxQ8iha_4zWl8rHvIIWjZRUDI

A key passage: "The first striking result confirming the central place of humans in the preservation of their security is the following: in almost half of the accounts (49%, n = 35) a risk is perceived, intuition or felt , to a greater or lesser extent. aware by the participants, but they maintain their commitment. Conversely, 13% (n = 10) of respondents report an avalanche event whose onset or extent completely surprised them. In avalanche events more than elsewhere, practitioners describe perceiving the danger, or at least the intuition that something is wrong, but they "go there anyway". Thirty-five practitioners describe that they sensed a dangerous situation, but maintained their commitment for various reasons, which sometimes cannot be explained to themselves"

Q. Do avalanche safety tools, like the three essentials (beacon, shovel, probe) ABS/Avalung increase risk acceptance?

We humans fail – period. Only when we have checklists and procedures that compensate for our proneness to error can we (to some extent) either prevent the failure or mitigate failures consequences. Safety tools are an essential part of that mitigation. If we cannot predictably and 100% reduce the risk, we can at least reduce some of the consequences. Carrying the tools to reduce the consequences should not comfort us to increase the risk, but it subtly it does. Wearing a helmet skiing as an example you just go faster. Having an ABS folk push the envelope and ski sketchier terrain which up to a point they might get away with on a clean runout, but not if there is a terrain trap. Risk appetites go up when folk carry consequence reduction tools when it shouldn't. That is in essence being human, and fallible.  

I listened to a good podcast from Silverton Avalanche school in the San Juans Colorado a few days ago on this very subject "risk homeostasis". Silverton is an area where we have family connections as my wife’s brother lived there until recently before moving further down the pass to Durango, his wife was secretary for Ouray SAR at one time. The guy from the avalanche school there (it’s the oldest in the USA) gave an example of going to the top of a 32 deg slope with a group and getting them to dump their beacons, shovels and probes and any ABS within the group, then asking them to ski the line. They all threw their teddys out the cot, but it should have made no difference. Its either safe to ski or its not. No grey areas.

And for fecks sake, who in their right mind skis a slope in the knowledge that they might need the mouth piece from an Avalung in their thrapple in case their entombed and literally then have to breath from the crack of their arse!

 Q. What do we know before we go, and what should we do while we are going?

• The worst folk to be with are consciously incompetent, or reckless and impulsive. The next worst are ignorant and unconsciously incompetent
•  
• The best folk are UIAGM Guides or other mountain professionals including seasoned and trusty amateurs who you trust, who listen and make considered decisions i.e those who have both an unconscious and conscious competence.
•  
• For the amateur needing to get good experience, this is a process towards the same level of unconscious and conscious competence as the professionals. This helps prevent bad experience - hopefully!

Among the winter mountains we ditch certainty and embrace uncertainty and make decisions accordingly. 

To survive until pensionable age a high level of respect for the mountains while their guest is required, and letting them tell you if your welcome or not that day. Heed what they tell you and heed your precognition.

We do not conquer the mountains we travel among them, and when we get avalanched its on us for not listening and not seeing. An avalanche course may be an important tool along the way, but so is understanding your Johari window.