First-Aid situations you've encountered in the backcountry

DieselRanger

Well-known member
Likely a less common scenario: I've been involved in rescuing two people who developed High Altitude Pulmonary Edema (HAPE).

First case was a gentleman in his 40's from Ohio who had been acclimatizing at about 8,000 feet for a few days prior to a volunteer trail building trip higher up. We had a short hike from 10,000 feet to about 10,800 feet, set up camp. Next morning, the first work day, he had a headache, which went away with hydration, food, and some ibuprofen. We always have everyone take it easy the first day, with lots of breaks, and we work as close to camp as we can, with the plan to work higher over the week as everyone acclimates. That evening, he felt OK, was jovial and engaged. 2nd morning, he had a headache again, and felt weak. This was when we *should* have hiked him out. We asked him to hang back at camp and take it easy. By the end of the work day (~2pm or so) he said he felt a little better, but not great. He ate lightly for dinner and turned in early. It rained heavily that evening and all night, so everyone was in their own tents. When we got up the 3rd morning, he was difficult to wake, had a wet cough, and once we got him up he was clearly disoriented with a weak, fast pulse and shallow breathing. He had said he couldn't get comfortable laying down at night, it felt like someone was standing on his chest while laying down. We immediately began evacuation. During the very slow walk out, he developed pink, frothy sputum (cough goo), and I ended up running 2 miles to a vehicle, driving down a rough 4x4 road to the nearest landline and calling rescuers while my co-leader piggyback-carried the patient to his car and drove to meet rescuers. When rescuers got to him, his SpO2 was 45%, equivalent to a climber at approximately 25,000ft of elevation, and they estimated he was within 2 hours of death. 15 minutes on a CPAP machine and he was awake, alert, and in good spirits and back up to about 85% as the mountain rescue then drove him to the hospital. He spent 3 days in the hospital on a CPAP machine. Lesson learned: carry a stethoscope and a pulse oximeter, and get a baseline from everyone in the group prior to starting off. I also ended up buying a DeLorme (now Garmin) InReach due to a separate close call a couple years later.

Second case was a Div III basketball player in his early 20's from Kansas. He had spent the week prior to the volunteer trip at sea level, rushed back home for the trip, drove all night to the rendezvous point at 9,000 feet. Toured around for the day, slept poorly that next night, then the next day carried a 45-lb pack from the trailhead at 10,000 feet, over a pass at 11,800 feet and down to the campsite at about 11,000 feet. Said he felt fine - no headache, no complaints. First work day, no hiking, but lots of rock work and digging doing campsite rehabilitation. He worked hard, like he was training - we asked him to take it easy and slow down. By 3pm he was visibly tired. Crashed in his tent for a couple hours, came out for dinner, ate like a horse, then puked it up about an hour later - headache and nausea. We sent him to bed and checked on him regularly. At 11pm I was woken by my co-leader who said he was in bad shape, but my co-leader needed rest, so I took over - brought the stethoscope. Patient had a dry, hacking cough, rattling chest that sounded like a broken harmonica, and was at the edge of consciousness, restless and moaning. My pulse oximeter's batteries had died sitting on the shelf at home, but I didn't need it to know he was exhibiting classic HAPE symptoms. I asked if he could get up, and he could barely keep his feet, so hiking out in darkness (never desirable) wasn't an option. Grabbed my InReach and flipped on the SOS and started coordinating with rescuers, who initially were going to hike in the same way we came, and stretcher him out via a longer trail, but one that didn't have a climb up. However, as the patient's vitals continued to deteriorate over the next couple hours, that became less of an option, and they arranged for a helicopter at first light. When they arrived, his SpO2 was 52%. He spent a week in the hospital.

The first case was more typical of HAPE victims. Per the rescuers in the first case, AMS (Acute Mountain Sickness - the headache, nausea, etc) generally develops within a few hours of exposure to altitude, and it generally disappears 24-48 hours afterward as the body acclimates. However, for reasons unknown, AMS symptoms may disappear while HAPE is developing. HAPE *usually* develops after about 72 hours of exposure to altitude. You can see the potential for a gap between AMS disappearing and HAPE developing - and the victim taking that as a sign to push on, higher and deeper into trouble, farther from easy rescue. In the second case, however, onset was so fast there was little we could do - from the first case, when I went to bed at about 8:30 pm I figured we had the night to let him rest and hike out the next morning. Nope. Rapid Onset HAPE is rare, but apparently there's a statistical correlation between it and age/fitness - the younger and more fit you are, the more likely that can happen. It may be that older people generally are more aware of their limits and are less likely to push into the "red zone," giving their body the time it needs to adjust, but the mechanisms by which the body acclimates aren't fully understood despite decades of study by the USAF, NASA, and academia.
 
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mezmochill

Is outside
forgot these incidents ...
skull penetration by hard object during vehicle rollover (fatal), bicycle rider hit by high speed car (fatal), broken toes, cracked bones in feet, snakebite (non-fatal), jellyfish stings, stingray attack (painful), carbon monoxide poisoning.
i'm sure there's more incidents - I'd just have to sit down and remember them all.
if you are out there a lot - you see a lot of stuff happen to people.

Moral: Good training prevents 95% of this stuff happening to YOU!!

K-Y
With global warming increasing, backcountry jellyfish injuries are dramatically on the rise!
 
most of the issues ive dealt with where in the Marines. 8 cases of Heat exhaustion, 1 heat stroke, 2 cases of HAPE. and was the first to act on a Negligent discharge into another's right arm. surprisingly no hypothermia or frost bite from the artic or winter training.
we where short Corpsman so i helped the ones we had alot. been taping ankles, and lots of other stuff since kindergarten thanks to going to work with my dad alot. (hes an athletic trainer), so i did alot of the more menial stuff for my platoon.

worst ive had to deal with since is my 2yr old son busted his face while walking on pavement and had a nice nosebleed.

we have decent kits but mostly just use bandages for little stuff. ive thought about downsizing and losing some of the trauma stuff but id hate to need it and not have it, when i could help.
 

kmacafee

Adventurer
Guiding a Mountain Bike trip on North Rim of GC. Client fell asleep with his feet propped on fire ring and Crocs melted to his feet. Wilderness EMT Certified at the time but no training for that situation. Wrapped the crocs to his feet and transported him to the hospital in Kanab. Moaned and screamed the multiple hours it took to get him there and the smell was pretty bad. Doc at Kanab sedated him and he was transported to St. George. They removed the crocs and I believe grafted skin from somewhere else to his feet. He did not walk for months.
 

craig333

Expedition Leader
Hape is pretty scary. They say it can happen even to your group leader, the guy you'd least expect. Training and least a small trauma kit. On a Jeep run the Jeep behind me rolled five times. No one (except me) had anything other band aids. Luckily other than a bump on his head he was uninjured. Thank god for for a good full cage. I've been very lucky and treated mostly very minor injuries but so many close calls. Alcohol and white gas are a poor mix. Saw a lumberjack at a competiton put an axe into his foot. Every now and then those ambulance crews get a work out.
 

BritKLR

Kapitis Indagatoris
Former Tac-Medic/EMT. Not in the back country, but miles from anywhere...Walking along the Rio Grande Gorge bridge outside Taos, NM when a car strikes a 60 yo male. The impact rips his lower right leg off, throwing the leg 25 meters down the road and shatters his left leg. Driver flees. With the help of several Good Samaritans, I fashion a tourniquet out of a roadside stick and two belts, dress the stump and splint the broken leg with a surveyors stick and rags. We place the severed leg in a bag and into a cooler. The life flight helo takes over an hour to get there. He survives but loses the leg. God bless his tenacity and all the good sams that helped out! .....btw, the perp was caught and the case is still pending.
 

Pacific Northwest yetti

Expedition Medic
I have some pictures, from recent patients- but they are kind of graphic. Have been debating posting here, and discussing treatments- or starting thread w/ a warning in the title.

Nothing, bad- 5cm laceration under the chin, some infections, and a extremely bruised knee from a broken line hitting it. Would be the most interesting Trauma, but have had lots of sick call, clinical stuff, Pneumonia , Bronchitis, Replaced two fillings, a few broken arms, and one broken ankle. Bruises, cuts scrapes, eye injuries, etc All the past few months working remotely in Alaska, for the fishing industry.

I would be happy to discuss any questions, or if folks wanted to know more.
 
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