OUCC Proceedings 12 (1986)

by Tom Houghton

These notes are for your help in the event of a major accident such as a fall or a roof collapse. They are not a substitute for qualified aid. They are designed to help you bring a victim alive to the surface.

Whatever you do, a major injury inside a remote system on expedition may well mean death. Know your caving techniques, and take care.

DO THE FOLLOWING IN SEQUENCE:

1) DON'T PANIC. Be methodical. Don't be rushed into hasty action. Keep your reason.

2) GET THE VICTIM OUT OF IMMEDIATE DANGER - loose rocks, for instance, or cold water. Mind yourself; be careful. Moving the victim - see BACK.

3) MAKE PREPARATIONS TO TAKE THE VICTIM OUT. Unless the injury is obviously trivial, all accident victims should be brought to the surface as quickly as possible. Beware those who have been hit on the head but look 'all right now'. They could be bleeding inside the skull and unconscious or dying in a couple of hours. GET THEM OUT.

4) CONSCIOUSNESS. Is the victim able to talk? If so, ask them if they can feel and move their limbs. IF NOT, ENSURE AN AIRWAY.

5) AIRWAY. PULL THE JAW FORWARDS, AND KEEP IT THERE. This stops the tongue lolling back into the windpipe. The ideal position is 'sniffing the spring air' - head forwards and chin up. An unconscious patient will die rapidly without an open airway. If they puke or look as if they might, roll them on their side and let the vomit come out - BUT SEE 'BACK'. If there is any muck or whatever blocking their airway, GET IT OUT.

6) BLEEDING. If they are obviously bleeding, PRESS ON IT with your hand or a pad (i.e. a firm wodge of anything reasonably clean), for five or ten minutes without peeping to see if it's stopped. If it doesn't stop, keep pressing.

7) PULSE. Compare the victim's pulse with your own. SHOCK - severe blood loss - the victim has a fast, thready, weak pulse; they are cold, clammy and sweaty. If you are in no doubt that the victim is like this, they need an intravenous line and lots of fluid - but you probably don't have these or the knowledge to use them safely. GET THEM OUT. DON'T give them fluids by mouth: the guts stop working in shock, and so you're only giving them something to puke up.

IF YOU CAN'T FEEL A PULSE AT THE WRIST - there is a muscle on each side of the neck running in a straight line from just below the ear to the inner end of the collarbone. If you put your fingers just in front of this muscle at its midpoint and press in GENTLY, you will feel the carotid pulse (try it on yourself).

8) CAN'T FEEL A CAROTID PULSE. If you really can't, the heart has stopped working effectively. The victim needs chest compression ('cardiac massage'). By this stage you are probably on a hiding to nothing, but the drowned and the hypothermic can survive for surprisingly long periods with a stopped heart, so TRY, AND KEEP TRYING, FOR A COUPLE OF HOURS IF NECESSARY, UNTIL SKILLED HELP ARRIVES. You might just be able to get them going again.

TECHNIQUE: this has recently changed slightly, as a result of research. Get the victim onto a firm flat surface on their back. Find the middle of the breastbone - the top end is between the collarbones, the bottom at the apex of the 'V' between the ribs. Keeping your arms straight and using the weight of your body, lean with the heels of your hands on the middle of the breastbone. Say 'one thousand', release saying 'one', do it again. The idea is to have long firm squeezes and short releases. Don't do it too quickly.

If you're on your own, give fiteen squeezes and then give them some air - head in the 'morning air' position, pinch the nose, seal your lips over theirs and exhale firmly. If there is someone else there, get them to do the breathing while you continue with the chest compression.

The time to learn how to do this is when you don't have to.

9) BACK. DON'T MOVE THE VICTIM TILL YOU'VE FELT THEIR BACK, OR IF THEY ARE PARALYSED OR LACK SENSATION ANYWHERE. Feel all the way down the spine. You will feel a row of regular bumps; if there is a gap or a step, or if the victim has pain at one spot on pressing, they have a back injury. If in doubt, play safe and treat as one.

LOG ROLL: With three people, move the victim as a unit without bending or twisting, like a log. Don't forget the head: don't turn, drop or bend it, but keep it part of the log - they might have a neck injury, especially if they've had a blow to the head. In this fashion, get the victim out of harm's way onto a flat, firm, horizontal surface. Don't move them again until you've got them onto a Neil Robertson stretcher, or similar.

10) CHEST. If the victim has difficulty breathing, or pain on breathing, ENSURE AN AIRWAY and look at the chest (open the clothing, look at both sides). If there is a wound on the chest, PUT A PAD ON IT to stop air leaking in and letting the lungs down. Look at the movements; if one bit goes in while all the rest comes out, and vice versa, PUT A BIG PAD ON THAT BIT to hold it in - that is a 'flail segment', a bit of chest wall that has come out and is moving independently of the rest, and while it is free the victim can't breathe properly.

11) DEFORMITY. If either leg is bent out of shape, try to straighten it out by pulling down on the foot. You might have difficulty doing this, especially if the victim is awake; but if the deformity is gross or if the part beyond it is going blue, you should try. Arteries in fractured limbs can be kinked or blocked over the fracture. Support arms by putting them inside clothing, or applying a sling if you can. Look for wounds on the limbs; these might connect with the fracture, so it is important to keep dirt out of them. Put a pad on, with pressure if there is bleeding.

Splint broken limbs; strap a broken leg to the sound one; ideally put the victim on a stretcher.

12) HEAT. EXPOSURE IS A RISK, especially for immobile victims. Change wet gear for dry if someone else is wearing drier gear. Cover with a space blanket (which you have in your helmet, of course). Put into an Eskimo or other sleeping bag if you've got one. Sugary food can be a good idea, but BE CAREFUL; drowsy victims might puke and block their airway, and the injured might go into shock and do the same. GET THEM OUT.

On the way out - keep talking to them. Keep checking the pulse - if they weren't shocked before, they might become so.