I'd get to the girl, first I wanted to make sure Maggie was stable.
Maggie was well bundled up which made a quick primary survey
almost impossible. I put my hands under her jacket and tried to feel along the
bony aspect of the back of her neck. I pressed down on each vertebrae while asking
if she was having any pain, numbness, or tingling. She said no.
I tried to move my fingers systematically around her skull
feeling for any ridges, deformities, warm tangles of blood, boggy swelling.
Nothing.
I quickly checked the pulse in her wrist—strong. That was a
good sign, she had a decent blood pressure and wasn’t tachycardic, which meant
she wasn’t going into shock (yet) from some hidden injury that was causing
blood loss.
Maggie was alert and talking to me the whole time, she said
one of the girls on the hike had lost control coming down too fast from the
top. Maggie lunged after her, also losing her footing and going head first down
the steep and rocky terrain. Now I was getting worried about this unknown girl and
felt fairly certain that Maggie had no immediate threats to life or limb (despite my
woefully brief and incomplete initial survey). I asked the 3 young girls with her to try their best to keep
each other warm, to continue talking to Maggie. I asked them to send someone over to me if she
suddenly became confused, nauseated, or started complaining of numbness or
tingling.
I scurried over the slippery rocks to the second cluster of people,
perched on the lateral aspect of the slope. A young girl was buried under a
similar assortment of raingear and jackets, crying out in pain. Two of her
teenaged friends were huddled against her, shivering in their thin hoodies and
track pants. Her legs were splayed awkwardly but with no visible deformity,
blood spattered the rocks near her feet. Under the hood of a green raincoat I
could see that her hair was thickly matted to one side of her face with blood
that appeared to have come from her scalp. Her cheek was also cut, just under
the eye. She opened her eyes when I asked her to and told me she’d started
coming down the mountain and couldn’t slow down, she didn’t know how she’d
fallen or if she’d been knocked out.
Her pupils were of equal size, they constricted when she focused on my
face, she knew where she was, and who she was there with.
Again I wrestled with the tangle of clothing trying to feel
her neck and scalp. She said she had no neck pain but yelped whenever I touched
her head, especially near her forehead. It seemed impossible to locate the cut
as all the blood had dried in the lumpy nest of hair. I looked in her ears and under her nose for blood or clear
fluid that might indicate she had fractured her skull. Dry. She didn’t have the
characteristic pattern of bruising associated with basal skull fractures, the
bluish tinge behind the ear or black circles referred to as ‘raccoon eyes’.
I felt her wrist, trying to locate her pulse. As I measured
her heart rate, which was fast but not worrisome, she complained of pain. I was
reassured though, by the lack of a sickening crunch or odd angle to the joint,
something I’d come across many times in the Whistler emergency
department. I put my hands under her jacket, asking her to take deep breaths
while I felt her chest rise and fall. Her rib cage felt stable and she said she
had no troubles breathing. Good. She had a blood pressure and no
breathing issues. I felt her belly,
tested the bones of her pelvis for pain or instability. She cried out in pain
when I brought my hands down her left thigh and leg. I couldn’t feel any
swelling or grinding under my pressure, the leg didn’t seem shortened but it
was hard to tell and I didn’t want to move her limbs unnecessarily.
Somewhere in all of this I found out that the man with them
was Father Henry, the priest who had been escorting a church group up the
mountain, which is a famous pilgrimage for Catholics. Maggie was the other leader of the group, which left him
running back and forth between the two huddles, with one cell phone (and
sometimes two) pressed to his face.
It was during my assessment of Tina that I too started to
shiver. Suddenly the combination of wind, fog, sweaty T-shirt, and stillness
left me very cold and wishing I’d brought more clothes. I pulled on
my damp wool shirt and windbreaker. Once I was crouched behind Tina with my hands along side her jaw
and neck to stabilize her cervical spine, I realised that if I was that cold, the girls lying on the
ground were in even bigger trouble.
At this point an athletic Swiss
couple, each dressed in layers of hi-tech looking gear, arrived and offered
extra coats to pile on the injured hikers. The woman pressed up against Tina’s
legs, the man against her right side. Tina’s two friends took up positions on
the left. A tall middle aged Scotsman came up and suggested we use his large
backpack as something to put underneath Tina.
I cringed with the realization that I should have thought of
that ages ago.
CAcBCDE. Catastrophic
bleed. Airway/c-spine. Breathing. Circulation. Disability. Environment.
All of this had been drilled into me again only weeks ago at the Advanced Trauma in Community course I’d
taken. Environment. As in, assess
complications due to environment such as cold
temperatures and adjust to protect against these dangers.
And so there we were.
All of us freezing, worried, and wondering how long it would take for
the mountain rescue crews to arrive, if they were sending a helicopter, and if
the helicopter would even be able to land amidst the fog and wind. I asked one of the girls to take over
c-spine for me as I went back to check on Maggie. She was well bundled up and
had a similar gathering surrounding her. The tall and quick thinking Scotsman
and his wife were monitoring her. This gave me peace of mind over the nagging
thought that I was ignoring one of the casualties. Maggie was still alert and
oriented, nothing had changed since I had first assessed her. She said she was
more worried about Tina than anything else. I tried to reassure her before
running back to my post: holding on to Tina’s neck.
We heard ambulance sirens in the distance which gave us hope
that help was soon to arrive, hopefully with blankets at least and and possibly
stretchers.
“Wait!!!” I asked
Matt, the teen to my left, to grab my nearby camelback.
“I had an emergency
blanket in there this morning…did I leave it in or put it in my other pack??
Ohhh…”
And then I remembered the brief conversation I had had with
myself before heading off this morning. “I
am only going on a road ride and a run, I am definitely not going to need my
emergency blanket or my headlamp.”
Of course.
Dammit! We really could have
used that emergency blanket now.
Tina was shivering uncontrollably to the point where her teeth chattered
causing her to cry in frustration, “Get
me OFF this mountain!!!! Where are they??”
We tried to calm her by talking about Justin Bieber, the hot
blankets that awaited her, the exciting helicopter ride she was going to
have…it distracted her for short periods of time. Father Henry would threaten
to start singing if Tina went quiet for too long. This proved to be an effective
technique for getting her to start talking again.
By now, over an hour had gone by since I arrived on the
scene. I thought about sending the
teens down with one of the hikers who was offering to help. Were they going to get hypothermia while trying
to keep their friend warm? Were we only creating more casualties by keeping
them with us? What was the legality of sending minors down the mountain with
strangers? What if we were up here until the middle of the night? I remembered
only a couple of months ago a woman being stuck on Carrantuohill until 4am
waiting to be stretchered off the mountain with a broken ankle. At least now they could get down safely
in the daylight. For the time being we decided to keep them with us.
Surely
mountain rescue was going to arrive any minute.
