- Email: [email protected]
Wilderness rescue
Wilderness Rescue by Merry Minckler, R.N.
St. Patrick Hospital's Life Flight frequently ventures into some of the most beautiful yet remote country in America. On Monday, August 8, 1983, I was working my usual afternoon shift as a flight nurse in the emergency room of St. Patrick Hospital in Missoula, Montana. At 5:52 p.m. the tone sounded on my beeper, indicating a message from the 911 dispatch would follow. Seconds later, the request was made for Life Flight to be dispatched to the wilderness rescue of "an injured hiker" in the North Fork area of the Blackfoot River. No further description of the victim's mechanism of injury, physical status after injury, or his specific location were available at the time of the call. There is no paramedic organization in Montana. Many of the emergencies Life Flight responds to are also responded to by firemen, law enforcement officers, Forest Service personnel, and quick response units. Q.R.U.'s are organized groups of people in areas and towns surrounding Missoula who are often first responders to medical emergencies. Q.R.U. members demonstrate varying levels of training, from basic life support to E.M.T. skills. As it turned out, because this was a wilderness rescue, no one at the scene had 18 HOSPITALAVIATION, NOVEMBER 1983
medical knowledge or capabilities. At 5:59 p.m. Life Flight was off the ground--a response time of seven minutes. Pilot Dave Buck, flight nurse Merry Minckler, and L.P.N.-orderly Mike Henderson made up the flight crew. The third crew member on flights is either the house orderly or a registered respiratory therapist. Thirteen flight nurses and three pilots make up the staff of the Life Flight program. The Bell Jet Ranger helicopter is positioned at the nearby helipad for twenty-four hour response to emergency transfers or rescues. In its two-and-one-half year existence Life Flight has been called nearly six hundred times. Flight time was 36 minutes on that clear and sunny day to travel the 59 miles to the particular location in the North Fork area. To the nurses' questions, the only additional information given on the victim was that he was "awake and having trouble breathing." At 6:35 p.m. the helicopter landed on a sandbar with a surface of many smaller rocks and bushes. Two teenage relatives of the victim met the helicopter. Essential equipment was gathered and the hike to the
victim began. The terrain was rugged; large slippery boulders , steep gravel slopes, dense timber and p o o r footing were the trail following the boiling waters of the North Fork. At one point we helped each other down a ten foot vertical rock wall in order to continue on. Fallen trees had to be walked upon like bridges, one time literally connecting one point in our path to another, over an intimidating drop to rocks below. At 7:05 p.m. we reached a point across the river from the victim. He was laying on a flat rocky surface at the base of a diff. Three men were at the scene, one of the victim's relatives from camp and two packers. The packers roped a fallen tree in the water to secure it as a means for crossing the water. Minimal equipment was taken as we crossed the 10-15 feet on the log over the loud, white, rushing waters. The "injured hiker" laying on the warm, flat small rock surface was a 32-year-old man from Arizona, who had been climbing an impressively high, vertical rock cliff alone. Between 2:00 and 4:00 p.m. he slipped, falling thirty feet to the rocky table below. i
"While it had taken only 30 minutes to hike to the 'i scene from the helicopter, coming out was a different
story." i
The man was conscious yet restless and agitated. Respirations were stable with regular breaths and full, equal chest wall movements. There were no anterior chest pains or wounds. The noisy waters made it difficult to assess breath sounds but the patient was able to cooperate and breathe deeply enough for me to hear air moving in all lung fields. There was no neurological deficit. A five centimeter laceration was noted over the right occiput. A compound fracture of the right elbow with distal pulses present was noted. Facial cyanosis, the ashen appearance of the rest of his skin, a fast thready
pulse of 120, and a palpable systolic pressure of 60 defined his shock status. His skin was cool and dry. His abdomen was soft with hypoactive bowel sounds, again difficult to assess with the noise of the water. There was considerable abdominal tenderness and guarding. His pelvis and legs seemed uninjured except for bruising and pain in both heels. He complained of thoracic spine and right posterior flank discomforts. Ringers lactate was rapidly infused through a large bore W. MAST pants were applied, inflating only the leg compartments initially as the patient strongly protested the pressure of the abdominal section. Immobilization of the head and spine was achieved with a Philadelphia collar and KED. O2 at 8-10 liters was delivered by mask. Cardiac monitoring was done. The fractured right elbow was immobilized. The patient was placed on the helicopter stretcher. At this time the systolic pressure was 70-80 with a pulse of 94-120. The stretcher was lifted d o w n over the rocks to the water's edge. With one man straddling the log at the head of the stretcher and one at the foot, the injured man was carefully inched across the precarious log just over the rushing waters.
"In t h e b l a c k night, t h e s o u n d s of t h e d a n g e r o u s North Fork w a t e r s n e x t to u s c o n s t a n t l y r e m i n d e d u s of our n e e d for c a u t i o n . " One priority with this rescue was to try to move the patient out of the wilderness as soon as possible to avoid lower temperatures and darkness. The nature of the gorge and the impending darkness made it impossible for any helicopter to get closer to the victim. While it had taken only 30 minutes to hike to the scene from the helicopter, coming out was a different story. For the next 4~/2 hours, as many as 15 people worked vigorously to move the man out of the rugged wilderness to the camp where Dave Buck had moved the helicopter. More manpower was needed for the strenuous task of lifting the 6' 1", 190-pound patient over boulders, across sliding gravel slopes, up steep inclines, through
dense trees, and across the fallen tree that spanned the hazardous drop to rocks.below. To move the patient safel3/up the ten-foot rock wall required standing the stretcher on end while men below and above lifted the patient straight up. When rest was required by the rescuers, the stretcher was usually put in a semi-Trendelenberg position on the boulders. Dave Buck flew the helicopter to a nearby camp and to the Seeley Lake area 25 miles away to pick up people to assist the rescuers. He also put on more fuel while the patient was being carried out. Belts attached to the stretcher provided better grips for carrying the man. A Stokes litter brought by the Seeley people made carrying less difficult. The forest was dark by 9:30 p.m., so flashlights were required to check every step taken. Three or four people would plot out the most accessible path for short distances and shine lights to guide us to each point. In the black night, the sounds of the dangerous North Fork waters next to us constantly reminded us of our need for caution.
Radio control with the emergency physician was only possible when the pilot w o u l d take off and fly the helicopter above the mountains to relay communications from our position deep in the gorge. The patient remained coherent and moderately anxious. His systolic pressure slowly but continuously improved, reaching 116 by 10:30 p.m. His pulse gradually stabilized between 86-94 by 9:15 p.m. Supportive treatments continued. Abdominal tenderness and guarding increased yet the abdomen remained soft. Skin color was noticeably improved with 02 administration. We reached the camp at 12:30 a.m. A quick assessment revealed a restless but oriented patient with a systolic pressure of 118, after 3225 cc. of IV fluid, a pulse of 94, hypoactive bowel sounds, no respiratory distress, increasing abdominal distress, and the inability to void. The patient was loaded onto the helicopter. A complete report was radioed to Dr. David Brook of St. Patrick Hospital's emergency room, and 34 i
r
~
~
Surface
IS YOUR HELIPORT PROPERLY LIGHTED ?
otunirtg {geliport Ligtjting D? tem. Complete--Comprehensive--
Innovative!
N I G H T FLIGHT OPERATIONS ARE H E R E TO STAY! The DOWNING SURFACE FLOODLIGHT is a new DOUBLE DUTY fixture. It not only illuminates the surface of your landing area, (for excellent "no-guess" depth perception, without glare,) but it also becomes one of the string of perimeter lights that outline the area. Two to eight of these floodlights -- corner, surface mounted, will illuminate and help outline your heliport, depending on its size. Low overall cost. The SURFACE FLOODLIGHT is one of five basic light fixtures and visual aids in the DOWNING HELIPORT LIGHTING SYSTEM: = SURFACE FLOODLIGHT! • PERIMETER LIGHT • STROBE LOCATING BEAC n N I
• HELIPORT V.A.S.I. • RADIO RECEIVER CONTROLLER!
Extend Your Safe Flying Hours By Installing the DOWNING HELIPORT LIGHTING SYSTEM ELECTRONICS, Free Estimate! Write or Call: D O W N I N G PH: (213) 360-3791
INC.
10218 Donna Ave., Northridge, Cal. U.S. 91324
(For Information, CircLe 27 on Inquiry Card)
HOSPITAL AVIATION, NOVEMBER 1983 19
PROGRAM
DATA
FILE
The following information about
hospital-based aeromedical helicopter programs is current as of December 1, 1983:
- General
Life Flight and hospital crews remove a critical patient from a Bell JetRanger after landing at St. Vincent Hospital in Missoula, Montana.
64 58 79 27
programs cities heIicopters commercial operators - Services
minutes after take-off Life Flight arrived at the hospital. Two hundred miles had been traveled by Dave Buck in the Life Flight helicopter to complete this unusual rescue. The patient was admitted to the emergency room with vital signs of 98°-88-20-110/86. A stat CBC showed a hematocrit of 28.9, a hemoglobin of 9.7, and a WBC of 14,700 with a left shift. Four units of blood were typed and cross-matched. Chemistry results included a 232 SGOT, 82 SGPT, 764 LDH, 90 Amylase, and normal electrolytes. 350 cc. of urine collected by insertion of a Foley catheter revealed a large blood content on urinalysis yet an IVP was normal. Multiple x-rays revealed an undisplaced fracture of the posterior aspect of the 10th right rib, a stable anterior compression fracture of T-11 T-12, a comminuted posterior fracture of the left calcaneus with impaction and displacement, and a compound comminuted fracture of the right olecranon process with marked separation. A great deal of tenderness and extensive bruising over the ischial tuberosities were present. A peritoneal tap was grossly positive for blood and surgery was planned. A laparotomy revealed a hemoperitoneum. The liver, spleen, stomach, kidneys, and major vessels were intact. Two units of blood were given in OR. The scalp laceration was repaired and open reduction with internal fixation of the right elbow was completed. 20 HOSPITALAVIATION, NOVEMBER 1983
The patient recovered satisfactorily after a 15-day hospitalization. Traumatic pancreatitis with an amylase of 286 presented the most severe complication. O n August 24, 1983 the patient was discharged using crutches, a Jewett brace, and an ace dressing to the right elbow, which had regained good range of motion. Instructions for recheck by an orthopedic and general surgeon on August 26, 1983 were agreed upon. He flew to Arizona to rejoin his wife and two-year-old daughter. •
-
-
11% 11%
Shared services Competing services (same city) - Helicopters-
LongRanger AIouette AStar JetRanger FH- 1100 TwinStar BO-105 Bell 222 Agusta 109
26 13 13 4 1 10 7 2 3 28%
Twin-engine - Manufacturer-
French American W. German Italian
45.6% 41.8% 8.8% 3.8% -Operator-
Rocky Mountain Qmniflight Evergreen Air Methods Airwest Other operators Hospital operated - Program
Merry Minckler, R.N., is a 1971 graduate of St. Patrick Hospital School of Nursing in Missoula, Montana. Her twelve years of nursing practice include experience in ICU, Medical-Surgical, and emergency room areas. Her last seven years of practice have been in emergency room nursing. She joined the Life Flight program at St. Patrick Hospital emergency room in January of 1983.
1972-1977 1978 1979 1980 1981 1982 YTD 1983
Start
18 7 6 4 2 22 5 Dates
-
4 7 13 5 12 13 10
St. Patrick Hospital's Life Flight frequently ventures into some of the most beautiful yet remote country in America. On Monday, August 8, 1983, I was working my usual afternoon shift as a flight nurse in the emergency room of St. Patrick Hospital in Missoula, Montana. At 5:52 p.m. the tone sounded on my beeper, indicating a message from the 911 dispatch would follow. Seconds later, the request was made for Life Flight to be dispatched to the wilderness rescue of "an injured hiker" in the North Fork area of the Blackfoot River. No further description of the victim's mechanism of injury, physical status after injury, or his specific location were available at the time of the call. There is no paramedic organization in Montana. Many of the emergencies Life Flight responds to are also responded to by firemen, law enforcement officers, Forest Service personnel, and quick response units. Q.R.U.'s are organized groups of people in areas and towns surrounding Missoula who are often first responders to medical emergencies. Q.R.U. members demonstrate varying levels of training, from basic life support to E.M.T. skills. As it turned out, because this was a wilderness rescue, no one at the scene had 18 HOSPITALAVIATION, NOVEMBER 1983
medical knowledge or capabilities. At 5:59 p.m. Life Flight was off the ground--a response time of seven minutes. Pilot Dave Buck, flight nurse Merry Minckler, and L.P.N.-orderly Mike Henderson made up the flight crew. The third crew member on flights is either the house orderly or a registered respiratory therapist. Thirteen flight nurses and three pilots make up the staff of the Life Flight program. The Bell Jet Ranger helicopter is positioned at the nearby helipad for twenty-four hour response to emergency transfers or rescues. In its two-and-one-half year existence Life Flight has been called nearly six hundred times. Flight time was 36 minutes on that clear and sunny day to travel the 59 miles to the particular location in the North Fork area. To the nurses' questions, the only additional information given on the victim was that he was "awake and having trouble breathing." At 6:35 p.m. the helicopter landed on a sandbar with a surface of many smaller rocks and bushes. Two teenage relatives of the victim met the helicopter. Essential equipment was gathered and the hike to the
victim began. The terrain was rugged; large slippery boulders , steep gravel slopes, dense timber and p o o r footing were the trail following the boiling waters of the North Fork. At one point we helped each other down a ten foot vertical rock wall in order to continue on. Fallen trees had to be walked upon like bridges, one time literally connecting one point in our path to another, over an intimidating drop to rocks below. At 7:05 p.m. we reached a point across the river from the victim. He was laying on a flat rocky surface at the base of a diff. Three men were at the scene, one of the victim's relatives from camp and two packers. The packers roped a fallen tree in the water to secure it as a means for crossing the water. Minimal equipment was taken as we crossed the 10-15 feet on the log over the loud, white, rushing waters. The "injured hiker" laying on the warm, flat small rock surface was a 32-year-old man from Arizona, who had been climbing an impressively high, vertical rock cliff alone. Between 2:00 and 4:00 p.m. he slipped, falling thirty feet to the rocky table below. i
"While it had taken only 30 minutes to hike to the 'i scene from the helicopter, coming out was a different
story." i
The man was conscious yet restless and agitated. Respirations were stable with regular breaths and full, equal chest wall movements. There were no anterior chest pains or wounds. The noisy waters made it difficult to assess breath sounds but the patient was able to cooperate and breathe deeply enough for me to hear air moving in all lung fields. There was no neurological deficit. A five centimeter laceration was noted over the right occiput. A compound fracture of the right elbow with distal pulses present was noted. Facial cyanosis, the ashen appearance of the rest of his skin, a fast thready
pulse of 120, and a palpable systolic pressure of 60 defined his shock status. His skin was cool and dry. His abdomen was soft with hypoactive bowel sounds, again difficult to assess with the noise of the water. There was considerable abdominal tenderness and guarding. His pelvis and legs seemed uninjured except for bruising and pain in both heels. He complained of thoracic spine and right posterior flank discomforts. Ringers lactate was rapidly infused through a large bore W. MAST pants were applied, inflating only the leg compartments initially as the patient strongly protested the pressure of the abdominal section. Immobilization of the head and spine was achieved with a Philadelphia collar and KED. O2 at 8-10 liters was delivered by mask. Cardiac monitoring was done. The fractured right elbow was immobilized. The patient was placed on the helicopter stretcher. At this time the systolic pressure was 70-80 with a pulse of 94-120. The stretcher was lifted d o w n over the rocks to the water's edge. With one man straddling the log at the head of the stretcher and one at the foot, the injured man was carefully inched across the precarious log just over the rushing waters.
"In t h e b l a c k night, t h e s o u n d s of t h e d a n g e r o u s North Fork w a t e r s n e x t to u s c o n s t a n t l y r e m i n d e d u s of our n e e d for c a u t i o n . " One priority with this rescue was to try to move the patient out of the wilderness as soon as possible to avoid lower temperatures and darkness. The nature of the gorge and the impending darkness made it impossible for any helicopter to get closer to the victim. While it had taken only 30 minutes to hike to the scene from the helicopter, coming out was a different story. For the next 4~/2 hours, as many as 15 people worked vigorously to move the man out of the rugged wilderness to the camp where Dave Buck had moved the helicopter. More manpower was needed for the strenuous task of lifting the 6' 1", 190-pound patient over boulders, across sliding gravel slopes, up steep inclines, through
dense trees, and across the fallen tree that spanned the hazardous drop to rocks.below. To move the patient safel3/up the ten-foot rock wall required standing the stretcher on end while men below and above lifted the patient straight up. When rest was required by the rescuers, the stretcher was usually put in a semi-Trendelenberg position on the boulders. Dave Buck flew the helicopter to a nearby camp and to the Seeley Lake area 25 miles away to pick up people to assist the rescuers. He also put on more fuel while the patient was being carried out. Belts attached to the stretcher provided better grips for carrying the man. A Stokes litter brought by the Seeley people made carrying less difficult. The forest was dark by 9:30 p.m., so flashlights were required to check every step taken. Three or four people would plot out the most accessible path for short distances and shine lights to guide us to each point. In the black night, the sounds of the dangerous North Fork waters next to us constantly reminded us of our need for caution.
Radio control with the emergency physician was only possible when the pilot w o u l d take off and fly the helicopter above the mountains to relay communications from our position deep in the gorge. The patient remained coherent and moderately anxious. His systolic pressure slowly but continuously improved, reaching 116 by 10:30 p.m. His pulse gradually stabilized between 86-94 by 9:15 p.m. Supportive treatments continued. Abdominal tenderness and guarding increased yet the abdomen remained soft. Skin color was noticeably improved with 02 administration. We reached the camp at 12:30 a.m. A quick assessment revealed a restless but oriented patient with a systolic pressure of 118, after 3225 cc. of IV fluid, a pulse of 94, hypoactive bowel sounds, no respiratory distress, increasing abdominal distress, and the inability to void. The patient was loaded onto the helicopter. A complete report was radioed to Dr. David Brook of St. Patrick Hospital's emergency room, and 34 i
r
~
~
Surface
IS YOUR HELIPORT PROPERLY LIGHTED ?
otunirtg {geliport Ligtjting D? tem. Complete--Comprehensive--
Innovative!
N I G H T FLIGHT OPERATIONS ARE H E R E TO STAY! The DOWNING SURFACE FLOODLIGHT is a new DOUBLE DUTY fixture. It not only illuminates the surface of your landing area, (for excellent "no-guess" depth perception, without glare,) but it also becomes one of the string of perimeter lights that outline the area. Two to eight of these floodlights -- corner, surface mounted, will illuminate and help outline your heliport, depending on its size. Low overall cost. The SURFACE FLOODLIGHT is one of five basic light fixtures and visual aids in the DOWNING HELIPORT LIGHTING SYSTEM: = SURFACE FLOODLIGHT! • PERIMETER LIGHT • STROBE LOCATING BEAC n N I
• HELIPORT V.A.S.I. • RADIO RECEIVER CONTROLLER!
Extend Your Safe Flying Hours By Installing the DOWNING HELIPORT LIGHTING SYSTEM ELECTRONICS, Free Estimate! Write or Call: D O W N I N G PH: (213) 360-3791
INC.
10218 Donna Ave., Northridge, Cal. U.S. 91324
(For Information, CircLe 27 on Inquiry Card)
HOSPITAL AVIATION, NOVEMBER 1983 19
PROGRAM
DATA
FILE
The following information about
hospital-based aeromedical helicopter programs is current as of December 1, 1983:
- General
Life Flight and hospital crews remove a critical patient from a Bell JetRanger after landing at St. Vincent Hospital in Missoula, Montana.
64 58 79 27
programs cities heIicopters commercial operators - Services
minutes after take-off Life Flight arrived at the hospital. Two hundred miles had been traveled by Dave Buck in the Life Flight helicopter to complete this unusual rescue. The patient was admitted to the emergency room with vital signs of 98°-88-20-110/86. A stat CBC showed a hematocrit of 28.9, a hemoglobin of 9.7, and a WBC of 14,700 with a left shift. Four units of blood were typed and cross-matched. Chemistry results included a 232 SGOT, 82 SGPT, 764 LDH, 90 Amylase, and normal electrolytes. 350 cc. of urine collected by insertion of a Foley catheter revealed a large blood content on urinalysis yet an IVP was normal. Multiple x-rays revealed an undisplaced fracture of the posterior aspect of the 10th right rib, a stable anterior compression fracture of T-11 T-12, a comminuted posterior fracture of the left calcaneus with impaction and displacement, and a compound comminuted fracture of the right olecranon process with marked separation. A great deal of tenderness and extensive bruising over the ischial tuberosities were present. A peritoneal tap was grossly positive for blood and surgery was planned. A laparotomy revealed a hemoperitoneum. The liver, spleen, stomach, kidneys, and major vessels were intact. Two units of blood were given in OR. The scalp laceration was repaired and open reduction with internal fixation of the right elbow was completed. 20 HOSPITALAVIATION, NOVEMBER 1983
The patient recovered satisfactorily after a 15-day hospitalization. Traumatic pancreatitis with an amylase of 286 presented the most severe complication. O n August 24, 1983 the patient was discharged using crutches, a Jewett brace, and an ace dressing to the right elbow, which had regained good range of motion. Instructions for recheck by an orthopedic and general surgeon on August 26, 1983 were agreed upon. He flew to Arizona to rejoin his wife and two-year-old daughter. •
-
-
11% 11%
Shared services Competing services (same city) - Helicopters-
LongRanger AIouette AStar JetRanger FH- 1100 TwinStar BO-105 Bell 222 Agusta 109
26 13 13 4 1 10 7 2 3 28%
Twin-engine - Manufacturer-
French American W. German Italian
45.6% 41.8% 8.8% 3.8% -Operator-
Rocky Mountain Qmniflight Evergreen Air Methods Airwest Other operators Hospital operated - Program
Merry Minckler, R.N., is a 1971 graduate of St. Patrick Hospital School of Nursing in Missoula, Montana. Her twelve years of nursing practice include experience in ICU, Medical-Surgical, and emergency room areas. Her last seven years of practice have been in emergency room nursing. She joined the Life Flight program at St. Patrick Hospital emergency room in January of 1983.
1972-1977 1978 1979 1980 1981 1982 YTD 1983
Start
18 7 6 4 2 22 5 Dates
-
4 7 13 5 12 13 10