John Ellerton, holder and faculty member of the Diploma of Mountain Medicine and Medical Officer to the MRC England & Wales, looks at what you need to do in the event of a mountain incident.
Sending for Help
When an incident takes place in the mountains of the UK, collect your thoughts - the emergency services will need to know what has happened, the nature of the injuries and the position of the incident.
Mountain rescue in the UK region is well served by over seventy voluntary teams. They are equipped to a high standard and work closely with the Search and Rescue helicopters and Air Ambulance services. Consequently, only minor injuries should come within the scope of treatment and evacuation by the companions of the injured. The rule for all other cases is to make the casualty safe, to start first aid, and to send for mountain rescue.
The situation elsewhere in the world varies, and it is worth spending some time researching the availability and contact procedure for the rescue services before you travel. Member countries of the International Commission for Alpine Rescue (ICAR-CISA) have published a guide to International Emergency Telephone Codes & Mountain Rescue Services on their website (http://www.ikar-cisa.org). Remote destinations may have no organised rescue service and it may takes days or even longer for help to arrive. In many places, rescue and medical care can be very costly so adequate insurance is advisable.
More on calling for help abroad
While waiting for the emergency service, basic first-aid treatment should be given. Think ‘Safety, then follow ABC and DEF below (if appropriate)’.
Safety: are you and the casualty safe from further danger?
If not, try to make yourselves safe either by moving or anchoring yourselves. Is the casualty responsive?
A - Is the casualty’s airway open?
If necessary, open it by a simple jaw thrust or chin lift. An open airway is essential; if the casualty is unconscious or semi-conscious, the tongue can fall back blocking the airway and cause death from asphyxia. After trauma (physical injury after an accident), gently stabilise the neck in the straight-line (neutral) position with your hands. Try to avoid further movement the neck. Continually check that the airway remains open, adjusting the casualty’s position as required.
B - Is the casualty breathing?
Look, feel and listen for breathing. Basic Life Support should be started, if you are trained, when the casualty is unconscious and shows no signs of breathing, and it can be continued until help arrives, and where there is a chance of recovery (lightning, drowning, heart attack). It is usually futile in casualties with internal injuries and is probably best to defer in cases of severe exposure/hypothermia until expert help is available. An unconscious but breathing casualty should be put in the ‘recovery position’ if possible. In cases involving trauma take care that the neck remains in a neutral position. Always, check the airway is still open.
C - Is the circulation adequate?
Stop any bleeding from wounds by elevation and direct pressure with dressings or clothing. The pressure needs to be applied continuously for at least 10 minutes. Internal bleeding should be suspected if the casualty has sustained blows to the chest or abdomen or broken thigh bone (femur). Loss of blood leads to shock; the casualty will be look white, feel cold and be sweating. The pulse may be rapid and the casualty anxious. Lay the casualty down and possibly raise the legs. The condition often deteriorates and all steps should be taken to facilitate the rapid arrival of the Mountain Rescue Team and, if possible, a helicopter. A record of the pulse rate and conscious level is very helpful.
D - Is the casualty disabled due to damage to head or spine?
Record the casualty's conscious level - Alert, responsive to voice, responsive to pain or unresponsive? Has the spine been damaged? If so, do not move the casualty unless essential for safety reasons. Maintain the head in the normal straight (neutral) position with your hands.
E – Prevent exposure
Prevent exposure (hypothermia) by sheltering the casualty from the wind and rain. Wrap them in as many layers of clothing as possible and encased in a 'poly bag' or other impermeable barrier. Do not forget to insulate the head and underneath the casualty. Even mild hypothermia worsens the outcome of many injuries. See Box 2 for more detail.
F – Check for fractures?
If present, immobilise the limb by the simplest method available. In the case of the arm, pad it and bandage it to the chest, and in the case of the leg, pad it and bandage it to the other leg.
Further points to consider in the UK
Large, organised groups should bear in mind that the Mountain Rescue Teams are a finite resource and it is wrong to assume their availability.
A helicopter may arrive before the Mountain Rescue Team. Extinguish all flames and secure all equipment. To attract the attention of the helicopter stand facing it with both arms up in the air making a Y shape. The downdraught can knock you over, so make sure you are in a safe position. Do not approach the helicopter until clearly signalled to do so by the pilot.
Prevention is better than First Aid! Most injuries are lower leg sprains and fractures; appropriate footwear is important. The majority of climbers killed in the UK as a result of a climbing accident die from a head injury. A helmet, whilst not being 100% effective, can make the difference between living and dying. GPS systems, whilst being useful, are no substitute for carrying a map and compass, and knowing how to use them.
The routine carrying of a suitable head-torch would save many needless call-outs. And finally, whilst mobile phones can be very useful in emergencies, any temptation to use them in the hills to call the emergency services in non-emergency circumstances should be resisted. If you are not sure whether it is an emergency or not, please investigate a little yourself first before reaching for your phone.
Your mountain rescuers are unpaid volunteers and rely on charitable contributions. Your consideration and a ‘Thank you’ go a long way to ensure the service continues. For further information see the Mountain Rescue Council.
INFOBOX 1: In the event of a mountain incident:
Stay calm. Take time to assess the situation and decide what to do.
- What should be done immediately to safeguard the group?
- If anyone is injured, remember A,B,C,D,E then F - see General Treatment
- Determine your exact position on the map and consider the options for:
(a) Descent to safety. What will the terrain be like? How far to reach safety? Are you sure you can carry the casualty? Will the casualty’s injuries be made worse by travel? For example, spinal injuries following a tumbling fall.
(b) Finding shelter. Don’t use up valuable time and energy unless you are sure about finding shelter.
(c) Staying put. Will your situation be resolved if you stay where you are?
(d) Seeking help. Remember that even when a rescue team has been alerted help might not arrive for several hours.
You might decide to seek help and still do (a) or (b) or (c)
If it is decided to seek help
If you have a mobile phone:
- Try to conserve battery life by having all the details to hand before phoning. Write them down if possible.
- If there is no mobile coverage at your location consider whether it might be worth moving to another location to phone from.
- Check to see if your party has other mobile phones with a better network cover; phones on ‘emergency calls only’ do not receive return calls.
INFOBOX 2: CALLING FOR HELP
When phoning for help phone 999 and ask for POLICE and MOUNTAIN RESCUE.
When connected provide:
(a) Location of the incident (grid reference, map sheet number, name of mountain area and description of the terrain).
(b) Number and names of people in the party and their condition.
(c) Any injuries and names of casualties
Be ready to provide the following additional information:
- Telephone number of the phone you are using and any other phones in the group.
- The nature of the incident – what happened?
- Time of the incident.
- Weather conditions including wind speed and visibility at the accident site.
- Equipment which is at the accident site (warm clothing, group shelter etc.).
- Any distinguishing feature / marker / colour at the accident site.
- Location of where you are phoning from - if different from accident site.
INFOBOX 3: GOING FOR HELP ON FOOT
Remember to take all the details shown above. Write them down if possible.
- If possible, leave at least one person with the casualty.
- If possible, send two or more people for help.
- Make the casualty’s location easily seen by search parties.
For alerting other parties or directing a mountain rescue team to your location:
Six blasts on the whistle (or six torch flashes) repeated every minute
For more advice on mountain safety see the rest of the BMC website and the Mountaineering Council of Scotland
INFOBOX 4: HYPOTHERMIA
Hypothermia occurs when a person's heat loss exceeds their heat generation. To avoid hypothermia, use a two-pronged approach by dressing appropriately and avoiding exhaustion. Modern mountain clothing is very effective at conserving heat in a wide range of climates; wind resistance and keeping the surface of the body dry are important factors when choosing clothing. The best way of generating heat is muscular exercise. Bear in mind that to maintain this you should eat carbohydrate snacks and drink regularly during the day. Alcohol, even the previous night, can significantly reduce your exercise endurance.
The symptoms of hypothermia start with feeling cold, apathy, clumsiness and stumbling followed by shivering. More severe hypothermia is recognised by confusion, lack of shivering, an inability to walk and finally coma. In the early stages, increased insulation, warm drinks and 'carbs' should allow a retreat to safety by walking. Established, severe hypothermia is more difficult to manage as sudden movements of the casualty can precipitate a cardiac arrest.
Insulate the casualty as best as you can without disturbing the casualty's position too much and call for a Mountain Rescue Team. Even people with severe hypothermia showing 'no signs of life' have been resuscitated successfully but when to start Basic Life Support is complex and best discussed with the Mountain Rescue Team before you start.