First Aid in the Mountains: Dr Naomi Gough’s Approach
Dr Naomi Gough is a recreational climber and medical doctor. Over the years she has responded to a range of accidents in remote settings, including the mountains, both professionally and as a bystander. Naomi shares her approach on first aid care when someone is injured in a fall in the alpine backcountry. The approach is adapted from the principles of the Joint Trauma System and applied to the New Zealand alpine environment.
New Zealand alpine backcountry has its own distinct risk profile. Due to the climate, fevers, illness from extreme altitude, heat or cold are reduced compared to many other alpine settings overseas. However, it can be deceptively isolated due to location, comms issues and unpredictable weather. I’ve focused, therefore, on how to manage accidents where evacuation of the patient is delayed.
It is assumed that anyone operating in this environment is trained in basic first aid and competent to provide first aid to trauma, including major haemorrhage and airways. The following is not a revision of basic first aid and assumes that the reader already has basic first aid knowledge. Technical terms are used. This is a discussion on how I think some of the first aid principles can be adapted in the New Zealand alpine setting.
My Priorities
Following an accident in any alpine environment, my priority is to avoid preventable death. This includes not just for the injured person, but the whole group at the accident scene as well as the incoming rescue party.
Unfortunately, not all deaths are preventable, even in falls that have been initially survived. When you are a long way from help, injuries may not be survivable if they require a “golden hour” response (the critical time after a serious accident when the patient receives crucial medical treatment). If you know and follow the basics, however, you will increase the chance of survival for the patient and keep everyone else involved safe as well.
When applying care where the person has survived, I prioritise three parts of the first aid algorithm:
- Making good decisions so that I don’t become a liability too – because you’re no use to your mate if you injure yourself.
- Recognising potentially fatal injuries and acting on them urgently.
- Preventing hypothermia.
Common Survivable Injuries in a Fall
Head trauma
A common injury in a survived fall is head trauma. If someone has hit their head badly, is confused and deteriorating, I regard this as an emergency. Call for help immediately using your emergency communication device.
If the patient has a brain bleed, they need hospital care and surgery as soon as possible. Decisions that unnecessarily delay this care will reduce the chances of survival. If the patient is still conscious and able to move and cooperate, use this time effectively to move them to an accessible evacuation point for when help arrives. If the patient is unconscious, then DRSABCD (Danger, Response, Send for help, Airway, Breathing, CPR, Defibrillation) applies or whichever other first aid algorithm you are familiar with.
Spinal injury
If someone has a suspected spinal injury and is poorly positioned on the mountain, I want to reposition them flat on their back in a safe location away from falling debris if it is possible to do so. If they are wearing a pack or harness, these can be used as a secure way to drag them. This is also the opportunity to protect them from hypothermia and place a thermal barrier underneath them, like a pack, to insulate them from the ground or snow.
Injured limb
If someone has injured a limb, I splint the limb and then focus on the three good limbs that can help to move them. They may still be able to assist in rescuing themselves so long as the other limbs don’t subsequently get injured too. As an added benefit, their risk of hypothermia drops as long as they are still moving.
Injured eye
If someone has injured an eye, the approach is the same as for an injured limb. Create a shield for the eye, and make sure the other eye is protected from injury. As long as they have one good eye, they can still assist in their rescue.
Make Use of Everything
Climbing kit has multiple uses, so make use of it.
- Packs can be used as thermal mats or cut down for a makeshift stretcher.
- Slings make tourniquets.
- Ice tools and stakes can be used to increase traction on tourniquets and splints.
- Harnesses can become pelvic binders.
- Emergency blankets can be used as a moisture barrier or a visual aid for search and rescue.
- Hand warmers can be used to assist in maintaining the patient’s core temperature along with warm layers and wind barriers.
- Sanitary pads can be used as clean dressings and for the relief of pack chaffing.
Other Considerations
Realistically, serious injuries, such as major arterial bleeds where you can’t stop the bleeding or airways that you have to actively manage, may fall into the category of non-survivable injuries. This is given the location, and tools you have available. The situations where you are most likely to be able to help in remote areas is early identification, calling for help, prevention of hypothermia and deterioration of less serious injuries. The first aid teaching applies.
I’m mindful that if calling a rescue, there’s an accountability to the rescuers and their families. They are taking risk on your behalf, so the most responsible thing to do is not to have an accident.
Kindly written by Dr Naomi Gough, FAFPHM MBBS
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PHOTO CREDIT | Martin Vaclavu - Naomi Gough