Patient Extraction With The Stokes Litter

Two days ago our hand crew was limbing pine trees near a boat launch/campground area, hoping every crackle of radio transmission would materialize our resource order to Colorado, New Mexico, Montana, or California; we were getting so desperate, even California was looking adventurous. At four o’clock in the afternoon we’d given up hope for the day. The mod leader gave everybody a momentary reprieve with the “shut it down” yell, seizing all chaos, commanding the chainsaw hyena roar to end, the gas fumes to simmer. He threw the non-verbal index finger in a propeller motion towards the sky – load it up; we’re rolling. Just then, the radio came alive. But before we could get the details for our much-anticiapted vacation to the mega campaign fire, the news of an upexpected assignment sadly trickled thru: somebody fell from cliff or waterfall… they are messed up… we are responding to assist… possibly carry them out.

Now, after having successfully assisted in the aforementioned event  – looking back upon the sequence of decisions, terrain, resources present – and having participated in a crew-wiled AAR for the incident, there are some key points I’d like to illustrate for consideration and development:

1) Before arriving on scene, we had trouble establishing communication with our Point of Contact (POC) for the incident. We’d learn soon that the site of the incident was inconveniently “down in a hole”, with spotty cell service and unreliable radio coverage. Where we were to report to was unclear.

2) At the trailhead, a handful of ambulance or search and rescue vehicles with personnel stood by. I wanted to know who they were, what they were doing on the incident, who was in charge, etc. Instead of freelancing my interest, I “gaggled” up, in a circle, with the rest of the crew, and awaited instructions. Our hand crew supervisor was making his way down the trail, to tie in with our POC and establish communication. The further he went down into the drainage, the fainter his transmissions were becoming; a FF1 Trainee shortly followed to act as a human repeater.

3) At approximately 5:30pm, after standing at the trailhead for ten minutes, our hand crew lined out in tool order. One mod leader radio’d the supervisor, asking if we should be bringing a litter or any medical supplies with us. “No. We’re ok”. So with hardhats, gloves, and yellows we started hiking – no headlamps, tools, food or water. In hindsight, this was a mistake that everyone owned a part of and agreed on: we should not have been going in without supplies, not knowing when we’d be getting back out.

4) Along the trail, we passed other hikers, high angle mountaineers, search and rescue members, and the mother of the victim. Each had their own intentions, emotional states, and reasons for being there. Most of the people were there for the incident, however, a few chiawawa looking dogs with oblivious owners seemed to think it a great day for a nice trek. Closure of the trail had not been established, and with washouts and loose rock, some spots were less than ideal for fitting two wide. I made a mental note of spots which would present a challenge in the event we’d hike the victim out.

5) Upon arriving to the location, there were 10 or 12 other people already on site. Our instructions were to wait at a distance for more instructions. During this idle time it was decided to send a group for headlamps and water. I volunteered. I set the pace back to the trucks, a bit fast. Afterwards, at the AAR for this incident, an idea was presented to the group which states “Don’t kill a village to save one”. Reflecting back, I can see how in haste we make decisions improperly, not carefully weighing each one. This applies also to not grabbing our gear before heading down. Sometimes one person isn’t worth jeopardizing the lives of many. Its a tough notion to settle with.

6) At the trucks, and before returning, I radioed our mod leader to see if anything else was needed. No. But a wheel for the litter was in the back of the search and rescue truck – “ask them about it. And also some lenses for eyeglass for the crew supervisor”. Got it.

7) Upon returning, the high angle mountaineers began extracting the victim from the cliffside some 200 ft below. We waited for instructions at a distance, listening to random whistles being blown and ignorantly guessing what each tone meant in relation to the action. Once the victim was up on the trail, we were quickly briefed on how this would play out and how to operate the stokes litter: 4 people at a time on the litter. The two in front have the most weight, and the two in back mostly steer. When you get tired, let the line of people walking behind you know, and you’ll get swapped out. If the rocks along the trail are big, lift the patient up to avoid hard, jerky movements. “Any questions? Ok, you you you and you – start up here, grab a hold. Ready?”

8) We sent a group out ahead of the litter to move rocks and prepare for the log across the trail where we’d be caterpillar-moving the patient over. We all had headlamps on and quietly began conversing with one another about food, about resource orders, and girlfriends, on the dark hike back uphill.  We could hear and faintly see the creek running under a waxing moon.  I felt like a good guy, doing something worthwhile, having worthwhile aimless talk with my crew, wondering if I was hearing the creek or a cougar in the twigs and grass.

1 hour and 29 minutes later the patient was at the ambulance.

After packing somebody with serious injuries out on a litter for the first time, I learned a lot about how to improve my own conduct for next time. In the aftermath, I contemplated things like going in prepared, not being hasty and jeopardizing people unnecessarily, how to pre prepare the escape route by moving obstacles, trying to establish a sense of order with adjoining resources, etc. But, perhaps most importantly, I also learned about what it means to assist. You’re not running the show, you don’t have a guaranteed specific role, and some people might not appreciate your presence. In an emergency situation like this one, everybody is needed to fill gaps in the general plan established. If the plan changes, the people assisting need to adapt to the new plan, fill the new gaps, and get on with it. Too many hurt feelings over who gets to help and who doesn’t, or who fills what roles – those sort of dilemmas are clearly dangerous. Humility, patience and empathy go a long way.

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