OUCC Proceedings 12 (1986)
|OUCC Proceedings 12 contents|
by Paul Cooper
Paul and Richard, our expedition medics, found their services called upon more in 1986 than ever before...
The principal value of a doctor on a caving expedition is to deal with a serious accident, particularly so one deep underground. Few non-medics, however, realise just how impotent even the most experienced doctor would be in such circumstances.
Richard and I had just completed a 3-hour walk up to the Vega Aliseda from Base Camp at los Lagos. It was by now approaching midnight and indeed we had needed hand torches to find the campsite. It was a fine clear night; in camp there was brandy and mugs of hot chocolate, and whilst we sat round chatting I could point out, to those interested, the Andromeda nebula shimmering away close to the northern horizon.
Top Camp was full, and several different trips were being planned for the morning. Just that day Graham and Dave had dropped into Ridge Cave from 2/6, and since it seemed as if Ridge Cave itself had sumped, it needed surveying and then detackling so we could all concentrate on F20. This was a prospect many were not looking forward to.
Below Graham and Dave, deeper down in the same system, Ursula and Fred were pushing a possible sump bypass, followed by Neil and Dan on a photographic trip. They had gone underground earlier and did not know of the Ridge - 2/6 connection.
At about midnight Dan staggered into the calm of top camp. His message was concise and clear and yet it not sink in. He repeated it. Richard and I both remember the frightening details which to us spelt out an appalling accident.
Ursula had fallen. She was in the streamway at the bottom of the cave and had been knocked out (he thought) but was now conscious. She was very dizzy and could not stand. She could not hear on one side, with what she said was water in her ear. She could not use one of her arms.
It took a little less than an hour to set up the rescue. Richard and I had both done this before; we had a "game plan" worked out, and so, soon after 1.00am we were already abseiling into the cave. Dan had estimated the time of the accident at between 6.00 and 7.00pm: it would take two hours to reach the streamway, so we would be with her about nine hours after the accident.
I abseiled down the 130m entrance shaft feeling very frightened indeed. Richard and I admitted to each other afterwards that neither of us expected to find Urs still alive. The story that Dan had related meant that she had probably broken the substantial bone which forms the base of the skull. Few people with such an injury survive, even in a modern intensive care unit, and Ursula was in a cold streamway 650m underground. Further, it was quite possible that blood was now collecting in the tight space between the brain and the skull - this is a neurosurgical emergency for which the only treatment is to drill a hole in the skull. I have done this, but only in a sterile operating theatre - to do so in a cave would be desperate measures indeed.
In our tackle bags we carried, as well as a drill, intravenous fluid, antibiotics, bandages and the like. I had also packed a plastic sack. Richard saw me do so but didn't ask what it was for.
We reached Ursula at about 3am. She was very cold, very tired but very much alive. She said afterwards that we arrived bounding with enthusiasm, but all I remember is intense relief.
I quickly checked her over. It seemed as if, apart from an impressive black eye, she had not come to any serious harm. It is however possible for casualties to deteriorate dramatically some hours after a head injury, and so I was keen to leave the cave as soon as possible. We did delay, however, long enough for some hot food. The three cavers had been underground for twenty hours by now and were very hungry: I am sure that hot food and drink is as important a part of a cave rescue as all the medical equipment, and requires no expertise!
Ursula needed a lot of help to reach the surface. She could manage to prussik, albeit very slowly, but needed another caver on hand to help with each changeover. Richard tandemmed up the big pitches with her, and we all joined in with singing to the keep up her morale. We finally arrived at the entrance shaft in the the early afternoon. Half-way up I met Ian sitting on a little ledge, and as I prussiked past he handed me a cup of tea. It was very welcome.
I gave Ursula a more thorough check-up later that day. She had been very lucky and there was no sign of any serious damage. However, several weeks later she still cannot hear properly on that side. This makes me think it very likely that she did indeed fracture the base of her skull.
For those interested I append our "game plan":
The immediate problem in Alpine cavers rescue is, in my experience, lack of accurate information about the state of the casualties. For that reason we do not mount a full-scale rescue straightaway. Instead a team of three goes underground, with at least one doctor if possible. One is designated as a "runner". He goes as fast as possible and with minimal tackle. His job is to find the casualties, improve their morale and guide the two rescuers to them. These two bring the bulk of the rescue equipment. I do not think the slight delay this means is of any significance compared to the long delay already in reaching them, and the "runner" can anyway administer immediate first aid. Besides our rescue tackle we carry intravenous fluids, airways, antibiotics and injectable painkillers. Such equipment can only be used by medically trained cavers and therefore, as well as the doctors, several cavers in our club are also practised at putting up a drip and giving injections, and detailed instructions are included in the ready-packed ammo cans. We of course also carry a fibre pile sleeping bag, and a stove and food.
When we find the caver we can then send the "runner" back out with a message for the surface. It is important for the doctor to assess if a stretcher is required, how many cavers will be needed and if a helicopter should be arranged. These arrangements should all wait until the casualty has been properly assessed as it probably saves little time, but would be extremely expensive, to do so prematurely.
The remaining cavers on the surface, who should in the meantime have been resting, can now organise a full-scale rescue if necessary. They can arrange radio links with the cave entrance, order a helicopter and summon cavers from nearby areas. In the meantime the injured caver is hopefully in good hands.
This plan has fortunately never been tried on a seriously injured casualty, as our rescues have involved cavers who have all been able to help themselves out of the cave with assistance. I would very much welcome any views on the conduct of a major rescue in a remote deep cave.
1986 was an unlucky year: earlier in the expedition Fred had a boulder fall on his face, resulting in a broken tooth and a very deeply torn lip. Fred could make his own way out of the cave, but getting him to hospital presented different logistical problems, in the absence of an expedition vehicle. The very greatest thanks, therefore, go to our German visitor Franzjorg Krieg, who dropped his plans so as to drive Fred to Oviedo to be stitched up.
Incidentally, the first time Fred ventured underground after having his stitches out was the trip describe above...