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Feather
Moderator
USA
358 Posts |
 Posted - Feb 13 2005 : 11:45:05 AM
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Teresa,
How are you doing? I'm sure we'd all like to know. Also I'd like the incident we had to serve as a learning opportunity for everyone. So whoever was there please comment on how we did (both good and bad), because we so rarely have an incident like this.
I'll give background to everyone else who wasn't there this weekend, Saturday Feb. 12. Desert Kayak and Canoe Club, got on the river with 11 people in our group (8 DKCC people, and 3 friends including Nate Herbeck from the Kayak Shed). We broke up into 2 separate groups to eliminate congestion on the river. Teresa was located in the 2nd group with Bolkan, Pat, Krista, and a friend of Lanson named Kooma.
This part of the story was told to me 2nd hand but I will relay as accurately as I can. When going through one of the upper rapids Teresa flipped and before she had the chance to roll hit her head on a rock. She then exited the boat and immediately began complaining of head pain, and that she needed help. Once she got to shore it was identified that she had a neck injury and was put on Bolkan's boat (upside down on shore) and immobilized.
Meanwhile downstream the other 6 of us were playing and essentially having a great time on the river. Kooma met us a quite a ways downstream and told us of the incident and that he was going for help. At that point Jarrod climbed out of the canyon to get help on the road with a request for a backboard and a raft. Nate, his friend Scot and Kooma went downstream to find help another way and the rest of us hiked back upstream. We decided to use the Westside of the canyon due to ease of access which helped us out tremendously.
Once Lanson, Jim and myself reached Teresa, I saw Val Shaull was there with a friend and a raft. The 1st group did a great job keeping her warm, relatively comfortable and stabilized. I was the only paramedic so I evaluated her and came up the same diagnosis that everyone else had already come too, a neck injury with no loss of consciousness or sensation. Her helmet was intact but later on when her helmet was creating pressure pain, I removed it and found a good size bump on her head under her balaclava, it was later found to be a cut (all under her Pro-Tec helmet).
The organized rescue took a while to unfold. The best extraction point was slightly downstream of our location, on the other side of the river. The first Rescue crew arrived and once they found out she was stable, didn’t want to give us a backboard due to liability. Now if she were unstable they would have given us anything we wanted…I think. This is where Nate and Val really came in handy. Nate had arrived with the first rescue crew and being a local was able to be a great liaison for us. And Val, being a retired Portland firefighter was a great resource to organize our needs with them, on the other side. He and his friend paddled their raft back and forth across the river so many times they must have worn out the riverbank.
Anyway, despite not getting a backboard from the rescue guys, we did get some warm chai tea in a thermos, blankets and hot packs. This was crucial because it had been a least 1.5 hours from the initial incident. They also got medics, water rescue, and the local High Angle Rescue Team in route.
Once the Skamania Sheriffs water rescue team arrived things started picking up steam. They had their cold water immersion suits, flippers and the whole shebang…but no raft. Good thing Val had his. We ferried over a backboard, c-collar (which we weren’t able to use due to all the gear Teresa had on and the skirt that was already in place and acting quite well as a neck restraint), and backboard restraint. Once on the board and secured we maintained manual neck stabilization on the raft as we ferried her over to the other side, assisted by the water rescue guys (Frogmen as Val called them). Once over to the other bank the raft was lined down the shore using throw bags and the frogmen. Val e-mailed me about this and I totally agree that the frogmen were a liability to the raft and the patient during the lining down. Several times they were caught between the rocks and the raft. I’m glad none of them were hurt as well.
Once on shore we carried Teresa of the raft up the embankment still using manual neck stabilization transferring it from Val to Jim Gaines on shore. We met the Skyline Hospital paramedic who took over patient care. At this point the high angle rescue team was starting to set up their gear. Bolkan, Pat and Krista stayed while the rest of went in Val’s raft back downstream to our boats to kayak the rest of the way out.
After doing shuttle I went to Skyline hospital to see her and she was just being taken to X-ray, still on the backboard.
I would like to point out that Teresa was in great spirits the whole time despite being in pain. She was joking and constantly asking for alcohol (Baileys if I remember correctly). Everyone who was there did a great job. I just heard that she was diagnosed with a C-1 fracture (the vertebrae right next to the brainstem people) and was in stable condition at some Portland hospital.
We need to remember that this is an adventure sport, and sometimes unexpected adventures happen, even on our everyday rivers.
This river is somewhat remote with a hard working, but still volunteer, rescue organization that takes time to respond and set-up. The river is also not their element and sometimes need to be watched also. If it weren’t for everyone’s diligence that day, things could have easily turned out different. This is one of those times where one can say that they truly saved someone’s life or at least the quality thereof. As it was this rescue took at least 2 hours (I’m sure I’m being conservative but I didn’t have a watch) and we happened to have all the elements we needed for a good rescue; time, right equipment, correct actions by the initial group, a patient with a great attitude and a lot of people.
I hope we all think about this and use it as a learning experience for our next trip, cause it can happen to any one of us.
Please write back any suggestions, or questions. See you all on the river.
P.S. As an aside to this when Lanson and I ran Husum, Lanson stated he felt like he slid down the log a bit, so please scout this before running it. I ran it right and didn’t notice anything, but he went middle.
Chris Feather
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yaknski
Class III
223 Posts |
Posted - Feb 13 2005 : 1:10:15 PM
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Teresa,
Thinking of you and a speedy recovery.
Dave Turner |
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paw
Class VI
794 Posts |
Posted - Feb 13 2005 : 1:12:16 PM
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Chris gave a good summary, but Krista and I can relate some things that happened before everyone else arrived.
Our group of five was running a little behind the others because of a slow start. Teresa said she wasn't feeling very "on it" and I was hanging back because this was my first time in a kayak on a river in a year and a half and I also didn’t want to let T get behind us. As we went into Corkscrew Kuma (sp?) told Krista he wasn’t sure of the best line and advised that she not necessarily follow where he went. After Kuma led into the rapid Krista went next with Teresa close behind. CB caught a play wave at the top and I was bringing up the rear. As I went through the rapid I saw Teresa come up out of her boat and Krista paddling toward her. Chris and I gave chase and since Krista was with T we started focusing on the yard sale. Krista yelled that Teresa was hurt so I abandoned T’s kayak and went to help the ladies. Teresa couldn’t swim and was in between Krista’s and my kayaks. We agreed that Krista would get on shore and I would push T to her. Krista got T in the classic neck stabilization hold while T was floating on her back in the eddy. Chris and I got out of our boats and we all started conferring with Teresa about what she experienced and what her condition was. She was lucid, scared, and in pain. She had some blood around her face and she said her head and neck hurt. She had flipped somewhere in Corkscrew, set up for a roll, and smacked the top of her head very hard on at least one rock. She stuck out her tongue for us and there were two deep cuts from her teeth on the end of her tongue. We did a quick check for level of consciousness and other injuries and determined she was OK except for the head/neck. Since she was immersed up to her armpits and starting to get cold, we needed to get her out of the water, but Krista and I were VERY concerned about the condition of her c-spine and Teresa was clear that she didn’t want her neck to move AT ALL. We flipped CB’s boat upside down on a reasonably level spot and started trying to figure out a way to get her out of the water. Krista continued to maintain c-spine stabilization while CB and I got our hands under T’s torso and used a paddle shaft under her knees. We did the “1-2-3” thing and carefully moved her to the bottom of the kayak. It hurt her some, but we stabilized her there and she got to feeling OK again. We then started trying to figure out some way to better stabilize her neck. Krista told me to roll up my sprayskirt, so that became her cervical collar for the next six hours. We left all of her gear on because we figured she would stay warmer and we didn’t want to risk any movement. We then sent Kuma for help. We put my life jacket under her head and CB’s lifejacket over her legs for warmth and support. About then a rafting party came up and I flagged them down and asked for help. Luckily Val was in the rafting party and brought a huge amount of experience in both emergency response and river rescue. He confirmed our initial evaluation and helped us start scoping out options. We were in a place between two significant rapids (Waterspout was just downstream) and in a very steep canyon. As the next few parties of kayakers went through we started asking for warm liquids for T to drink, sent a few more of them to call for help, and got a space blanket from one of the parties. Around then is when Chris Feather, Lanson, and Jim showed up and Chris’ story picks up from there.
I spoke to Chris B earlier and Teresa is in Emmanuel Hospital Trauma Center in Portland. She'll probably be there for at least a few days it sounds like. She has a 3mm anterior fracture of her Atlas (C-1) and the doctors are contemplating how they are going to keep it stabilized as she heals.
Lessons Learned
- This is my first c-spine injury experience in the wilderness and it was kinda scary to think about how trapped we were. It was unthinkable to go downstream and it took a lot of gear and expertise to get Teresa safely to the top of the canyon. The accident occurred around 11:50am and Teresa didn’t get to the top of the canyon until almost 4:00 (I think). We held neck stabilization the whole time and that really limits your options unless you have professional rescue gear.
- Even though we had very limited equipment we were able to improvise a reasonably good situation (all things considered) in terms of neck stabilization and core temperature control. We would have been in much worse shape if Val hadn’t come by and if we hadn’t got the hot tea and blankets. The ambulance Paramedic told us that her temperature was 97.1 when he got her into the ambulance and 97.6 when he got her to the hospital.
- Playboats like CB’s have a nice flat bottom which makes for a good platform and insulation from the ground. I hope we didn’t crush it too bad.
- Krista and I were VERY happy we have been preparing for something like this by taking swiftwater rescue training and wilderness first aid. I am not confident we would have been about to respond as well as we did in those first few minutes if we hadn’t been to those courses. I recommend that everyone get first aid training.
- Val and later Chris Feather (who is a practicing Paramedic) brought a HUGE degree of professionalism to the scene and made me feel much better as the event progressed.
Experience is what you get right after you need it... |
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Jim Gaines
Class VI
USA
1243 Posts |
Posted - Feb 13 2005 : 1:18:54 PM
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As I saw things it was very obvious that that all those who were with T from the onset and the rest of us who offered further support after water extraction were just enough and skilled well enough to offer assistance rather than hinderance.
I have seen accident scenes become congested by well wishers and wanna helpers, but yesterday each group leader of several different groups were able to contain their groups and quickly exit the area after offering assistance. Our primary request after I got there was for Heat Packs and hot drink. No one passing had them. I was a bit surprised to see how many people did not have a first aid kit, but lots of people offered a space blanket. At the site where T was stabilized, we had 9 support people, each with skill set to be of assistance. As the extraction of T was underway, I could see that we Kayakers and Rafters had a diiferent way wanting to facilitate the rafts decent to the shore line extraction point. I saw Pat Wright doing a great job of controlling the tether line from shore to raft, but he no support, IE some one to help physically support him while he traversed the rock and slippery shoreline. The frog men were often times getting pressed against rocks by the raft or I saw on more than a few occassions, the frog men at the back of the raft getting stuck and having to stop the raft until they could stablize. I am sure all the rafters and Kayakers saw this as being unnecessarily dangerous but well intended action. The rescue team on shore sought us kayakers and rafters expertise on teh river conditions when they were thinking about getting T further down river by floating to the top of the remaining rapids, removing her from the raft then portage the litter and T around to a safe spot where we could put her back on the raft. Nate Herback and myself were able to quickly squash that idea, as being too potentially hazardous to T. No rafter/ kayaker was going to let that happen. The rescue team was just yielding to the experience of the river runners. So if you didn't think your opinion and experience isn't respected here is a case where it is highly respected.
I had to ask for some help while I was stabilizing T's neck and trying to walk up slope backwards, we lacked an outspoken Incident commander on shore, but that was the rescue/ ambulance teams responsibility I thought. When it didn't happen I heard the kayakers/ rafters calling the instruction. I was happy to see all the skilled help where T was initially stabilized and I was happier to see that we able to minimize any confusion and delay of getting T out of the gorge, (at our end of the deal). It was nice being a part of the solution, and nice having a redundant supply of skills and a balance in personalities involved.
It was especially nice to have T be a super patient. I do believe however that as a group we are seriously lacking in comic relief, and relief zippers.
I would like to get some of teh Heat Packs provided by the Ambulance/ volunteers, we used for T those were great. Once we figured out how they worked, thanks Pat, they were outrageous.
Paddle Safe, enjoy the waters. |
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Lanson
Class VI
USA
1547 Posts |
Posted - Feb 14 2005 : 08:34:19 AM
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The only thing that I would like to change about the story was that Nate and Kuma paddled down and Scott and Jarred hiked out. It's important to mention that we stayed in groups so nobody was off wondering around on their own.
One thing as a group during the midst of the extraction I think could have been done better was communicating our paths out of the river, either by hiking or boating out.
Chris F, Jim, and I didn't tell Jarred and Scott that we were going to hike up back to T (although he probably assumed that's what we did when he came back not finding us). Also, one of us probably should have stayed behind with our gear so other paddlers didn't see a bunch of boats on the side of the river and assumed another accident took place or went looking in the canyon for us. Though this is not likely, I've heard it discussed in a SWR class before. The other area of communication that we could have handled better was upon leaving the scene. We thought that we were all going to paddle out together. But between scurrying to the raft to hitch a ride and all the other commotion with getting gear, T, etc up the embankment the message was lost. When we got back to our boats, we waited around fifteen minutes for the remaining people who could paddle to come down as we weren't sure if plans changed. Again, it was pretty obvious that they climbed out, but we didn't know for sure.
I'm not saying that all communication was bad. It was excellent for the most part, but there are things here that we can learn from. I for one realize a definate need for a first aid kit which a lot of us never paddle with. Also, it may be beneficial to start carrying a dry bag with some two-way radios for communicating in times of separation. I'm not talking about during paddling, but in the case of an event like this happening and have to split the group or even during scouting. I think in all the group did great, especially the initial stabilzation group. You guys rock. I for one really appreciated the mood of the group. Very calm, serious, but kept a level of cool with a couple of jokes here and there and light statements. When I first got there I was expecting to see T howling in pain and a lot of blood as we were told her helmet cracked and she had a nasty cut. The ease of the conversation brought a certain levity to the group.
I'm glad that people stayed out of the way when there was nothing they could do and let the leader of the situation maintain control. If you were asked to do something you did it, if not you stayed out of the way, avoiding accidental contact with T and her stabilization.
Sorry this happened and let's make sure we take something away from this experience so we know what to do and what not to do if something like this is ever to happen again.
I just hope that T is okay. She's definately in my prayers.
Be safe,
Lanson |
Edited by - Lanson on Feb 14 2005 09:52:12 AM |
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Kevin
Webmaster
USA
173 Posts |
Posted - Feb 14 2005 : 11:49:40 AM
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Update from Teresa:
I just spoke with T in the hospital in Portland. She has two breaks in her C-1, but they are in the right position and should heal OK.
There is a chance she'll get to come home tomorrow. She has a physical therapy session.
She is getting to wear a brace that goes from her hips to her head to keep things immobilized for the next 6 weeks. Oh Joy! Makes it hard to chew. I guess its a diet of Smoothies.
Overall she sounded good. Tired, but good. Says she is getting to experience a whole lot of new drugs.
I suspect there will opportunity when she gets back for us to help her out during her recovery. We'll know more of what she can and can't do in time.
Thats all for now.
Kevin |
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McHolehog
Class III
245 Posts |
Posted - Feb 14 2005 : 12:18:23 PM
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Great write up on what certainly could have had a much worse outcome. Happy Theresa is on the mend.
The safety and coordination of all folks was the key to getting her help. Well written with lessons learned.
It made its' way onto the PDX forum and someone wrote back asking about a backdeck roll as a way of ?preventing? this! I don't know about the rest of you, but the only time I do a "rodeo" roll is when it's the one that's there and ready to be used (usually, but not always, when playboating), otherwise it's whatever roll I'm set for. In this case it was just an unfortunate mishap.
Thanks,
Mick |
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Bob
Class VI
917 Posts |
Posted - Feb 14 2005 : 6:28:38 PM
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I would like to thank the people who contributed to this thread for providing so many details. I think those details are the most important thing for learning from an accident.
Teresa, get well soon.
- Bob |
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Kristen
Class I
USA
48 Posts |
Posted - Feb 15 2005 : 08:19:00 AM
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Theresa please get well soon. I'm so sorry to hear that a fellow paddler was hurt but so glad to hear that T was surrounded by some great experienced people to help her. Safety is no joke as the saying goes and although we hate to think about the worse being prepared for the worse is really a lifesaver. Great job everyone.
Best wishes to Theresa in a speedy recovery.
Kristen |
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Evan
Class IV
330 Posts |
Posted - Feb 15 2005 : 6:52:24 PM
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You guys are awesome! Well done.
I really don't have much to add, just a couple of semi-random thoughts.
The first is that I would have no trouble with the club outfitting a rescue stash with things like hot-packs for use by members -- if you all would take the stuff along. Seems like almost as good a way to spend the dues as the spring party. I used to belong to a caving club which had a huge rescue cache but that was a bit different because it was designed for people to grab on their way out of town on a call-out. But if we could pool our resources to be ready, that would be great.
There is a story about a sea kayaker failing his British Canoe Union certification exam because he didn't bring a thermos of tea! So maybe I shouldn't be so quick to laugh at the stuffy britts. What is the current thinking on giving liquids to trauma victims? Good or bad? From what I've read the heat in the beverage doesn't really do much for core body temperature but sugar helps a lot. Did I get that right? Space blankets are ok but maybe as much extra insulation as you can muster and use safely is something to consider. And watch the helpers standing around in case they get chilled!
Finally, Feather referred to T's condition laying on the boat as "stable". I don't know the official emergency responder stuff but I consider known injury plus wet/outdoors life threatening. I was on a cave rescue one time and watched our caver-paramedic very forcefully argue for medivac on those grounds and then argue that the flight had to go to the regional trauma center rather than the local hospital. Someone else was in charge and that can get dicey but he was a great advocate.
No criticism, really. You are the people I'd want to be with if I ever got munched. I'm really learning from your good example.
Speedy recovery, Teresa! Hope to hear your side of the story at Atomic one of these weeks. But it sounds like with a brace that long, they may have to prop you in the corner! |
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Tress
Moderator
USA
374 Posts |
Posted - Feb 15 2005 : 9:52:23 PM
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Thank you, thank you, thank you to everyone there who helped me out. Given that it was 2 fractures in my C-1, I feel indebted to you all that I'm still alive and functioning! Spinal cord damage at the C-1 can mean total paraysis and life on a ventilator. Yikes. Also, given the total time of the rescue, the conditions you all were working in, the number of times I was transitioned (from water to land, land to backboard, backboard to boat, boat to shore, shore to basket, the haul up the hill, and the move to the ambulance, I feel very lucky to have sustained "only" the fractures.
Anyway, I'm very happy to be home again and getting around. Thank you so much everyone.
~*tmo~*~
I had a feeling that I could go on forever, if there were only river enough and time. But there weren't.
John Graves, Goodbye to a River, ch. 18
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paw
Class VI
794 Posts |
Posted - Feb 15 2005 : 10:26:45 PM
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Evan - Good comments/questions. Here are a few thoughts in response, based on my training and experience:- We weren't awesome - Teresa was. She exhibited a great deal of awareness, bravery, and good humor that made the process go much better than it might have. She also prepared well in terms of dressing for the conditions (I cringe to think of what condition a person in a wetsuit might have been in). Teresa's humor kept all of us (including her) going. I'm glad we had the minimal level of training to initially get her into a safe situation.
- Hot liquids are a great aesthetic lift. Hot liquids per se do little to raise your core temp. However, they make you feel better and they can provide needed hydration. Sweet or carb-laden hot liquids can provide a very necessary calorie boost. (The Chai tea was great in that regard!)
- The space blanket did a LOT. It provide NO insulation, but its value as a vapor barrier shouldn't be underestimated. The wool blankets and neoprene were very important, but the space blanket kept evaporation to a minimum (~500 cal/gm-water?). More importantly, the kayak (upside down with a nice flat bottom) gave us a flat, stable, well-insulated platform to hold her on.
- It was life threatening. In retrospect, T's neck injury could have turned very serious (or worse) with a little movement. We didn't know that at the time, but it is important to suspect it with any probable spine injury. Hypothermia was another serious risk, but given Teresa's preparation and our ability to "pile more on" she did OK. (Core temp of 97.1F is early stage hypothermia.)
- Helicopter evacuation was not an option in that narrow canyon (with overhead obstructions)...
We all need to learn from this. I learned some things about better communication and recognizing when our capabilities were needed (I wish I had stepped in before the raft-lining operation started). Any number of us could have carried gear that would have helped (Sam-split, space blanket, dry clothes, fire starter, more water, etc.). Most importantly, we all need to have basic emergency training (e.g., first aid) so we can recognize when someone is in a seriously compromised situation and help them with basic stabilization and life support until the pros arrive.
I think the situation went as well as could reasonably be expected, all things considered. I wish it hadn't happened. But most importantly, I hope Teresa recovers quickly and completely! Get well soon, Teresa!
Experience is what you get right after you need it... |
Edited by - paw on Feb 15 2005 10:46:17 PM |
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paw
Class VI
794 Posts |
Posted - Feb 15 2005 : 10:29:31 PM
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YOU'RE HOME! SUPER! Get well soon. Let us know what we can do for you.
Experience is what you get right after you need it... |
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Lanson
Class VI
USA
1547 Posts |
Posted - Feb 16 2005 : 08:47:30 AM
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T, glad you made it back. Good luck with the recovery and let us know if you need any help with anything.
Lanson |
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Feather
Moderator
USA
358 Posts |
Posted - Feb 16 2005 : 9:45:42 PM
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Evan,
You have a great point about a stable injury. The environment and other factors certainly play a role in how I decide a patient's overall condition. In this instance keeping her still and eliminating all unneccesary movement was the most important. She was warm enough with plenty of good help, in a safe location and lots of time to effect a quality rescue. Her medical condition was good for a fractured vertebrae, no deficits or loss of consciousness. Most importantly in all this, is a patient's state of mind. T was very "with it" and her ability to keep everything in perspective helped tremendously. Had she been less cooperative I most certainly would have changed my diagnosis of "stability". I've developed a good gut instinct from seeing incidents at work and doing ski patrol. I always take this 6th sense into account when evaluating any scene. Everything was pointing to a stable incident.
In regards to fluids for a patient, that's a bit more touchy. For the record when someone suffers a head injury, you shouldn't give them any fluids or food because they may vomit. Now the outdoors is full of variables, and what I'm about to say is my opinion not a reccomendation for anyone else to do the same. We all make our own decisions in first aid.
That being said, I believe that once a concussion or other major head injury has been ruled out (determined not to be probable), that taking care of the patient's needs and desires become #1. When anyone is in a situation like this their mental well being is extremely critical, and supporting a positive attitude is just as important. This includes being honest, keeping them informed, making jokes, being positive and letting them have some ownership of their rescue as well. If T wanted fluids or food, I was going to give it to her, because a severe head injury would have already presented itself. I even offered her a piece of Powerbar, which she refused. Warm fluids help give the feeling of being warmer even if she isn't actually being warmed. I know it tasted good to me, so I knew it would for her too. Practically, it may only provide sugar, but mentally it's a whole lot more.
I hope I answered your questions, and if you have more please write back. I love talking about this stuff.
Chris Feather |
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Kristen
Class I
USA
48 Posts |
Posted - Feb 17 2005 : 09:27:03 AM
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Here's just a thought maybe it would be helpful to organize a speaker or presentation that address the type of equipment to have in a first aid/mcguyver kit for white water and flat water paddling to talk with our club.
When I flat water paddle I keep one dry bag always packed that has a first aid kit and some other nice survival equipment. Such as:
1. First aid kit
2. Emergency blanket - provides wind protection and also the orange color could help people to find you.
3. Extra water - that came in handy one summer day last year when I paddle for 5 hours on the Columbia
4. Waterproof headlamp. If you don't have one buy one. They are super handy!
5. A Cliff bar or other stable food source
6. extra nylon rope
7. Sunblock
8. Waterproof matches
9. Extra fleece layer
10. Spare cell phone with a charged battery. Any cell phone can call 911.
It all fits in a dry bag that I take with me whether I'm going for 30 minutes or 3 days.
Perhaps this could tie in with the Paddlefest thing in June. Again Kudos to you guys for being resourceful.
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Incident on Middle White Feb. 12, 2005
