After breakfast I left my buddy Bryan to get ready for the race and milled around Whiskey Row in the crisp morning air watching the mountain bikers warm up. Saturday was the 50 Proof Pro Race followed by the 25 Proof Amateur Race of the 9th Annual Whiskey Off-Road Mountain Bike Event. Bryan and his team were competing in the 25 Proof. I had come up to Prescott for the weekend to help cheer Bryan on, take pictures and offer support. Bryan’s wife, Amanda, and I were to drive up Thumb Butte Road to the overlook where the riders would be trudging up a steep grade before making a sharp turn on to a single-track trail that would lead them back down the mountain.
Amanda and I waited until Bryan’s Race was kicked off in true Prescott style…two crusty old locals dressed in 19th century western wear shooting their revolvers into the air signal the start of the race. After a brief stop at an outdoor retailer for local trail maps, we were headed up Thumb Butte Road to the overlook to wait for Bryan.
The road to the overlook wasn’t too bad. It was a worn, twisty dirt road up the mountain but it had clearly seen regular use. It was very narrow, at points not wide enough for two cars to pass. Cut in to the mountainside, the road had a steep rock wall on one side and a nearly sheer drop down the mountain on the other side and the shoulder at the drop off was very soft in places. Near the top, Forest Service Personnel was guiding traffic and helping people park along the shoulder. He had us park close enough to the edge to force Amanda to climb through the cab and get out of my truck on the driver’s side.
The overlook where everyone was staged to greet the racers was only a couple hundred yards away. We reached the top and I took photos of the riders and spectators as we waited for Bryan. Once Bryan had come through, our work was done and we headed back to the truck. My plan was to get Amanda back in to town to wait for Bryan, and I would head out for an afternoon hike and meet up with everyone later for the concert that night. As we started toward where the truck was parked, a guy in a Toyota Forerunner was pulling out to head back down the mountain road. He paused next to use to say hi and asked if we needed a ride. There was a gorgeous white Husky-Mix dog in the backseat and while we fawned over the friendly puppy we explained that our vehicle was very close and we were happy to walk. He insisted it was no trouble and we politely declined again. He waved good-bye as he pulled away and Amanda and I chatted about what a beautiful dog he had.
As we reached my truck, movement caught my eye on the mountainside and I looked up to see a vehicle tumbling down the steep, rocky grade. It took a second for me grasp the reality of what I was seeing and all I could say was “OH SHIT OH SHIT OH SHIT OH SHIT!” Then, instinctually, I stripped off my camera and Camelbak, threw them in the back of my truck and took off down the road toward the accident as fast as my legs would move. I could hear Amanda running behind me, asking if that was the truck with the dog. I knew it was but did not want to admit it out-loud.
The truck had stopped, inexplicably, less than halfway down the mountainside. I could see it clearly from the road once I reached a point directly above the mangled wreck. Not knowing what I would find, I knew time was not on my side. I pulled my phone, keys and wallet out of my pocket and tossed it to Amanda and telling her to call 9-1-1. Then I bolted down the slope, sliding, scrambling and hopping through the boulders and brush.
I quickly found the dog. She had been ejected from the vehicle, seemingly early in the roll, and seemed to be OK. I grabbed her leash as she approached me and did a quick check to make sure she wasn’t bleeding or showing any obvious injuries. She looked OK enough and anxious to get to safety, so I yelled for Amanda to call her and sent her up the slope. Then I continued my quick descent toward the vehicle to find the driver.
As I got closer, I could see the Forerunner had caught up on a rock outcropping and had just barely avoided tumbling the remaining 300+ yards down the mountainside. I could hear the motor still running as I approached and that’s when I saw the driver. He had also been ejected from the vehicle only about 30 ft from where the Toyota precariously hung to the rock. I could see he was propped up against a rock and sitting up (good signs) and I quickly worked my way to him, calling down to let him know I was on my way and not to move.
Anatomy of a Crisis
Survey the situation
- Am I in danger?
- Is the victim OK? What is the Mechanism of Injury?
- Speak to the injured person, even before you get to them…don’t sneak up on them.
- Try to communicate, talking is the fastest and easiest way to asses the mental condition of the injured person.
- Make sure the scene is safe, people are safe and everyone has a job.
- Designate one or two people to approach the victim while being careful not to cause further injury or create further danger.
- What is the condition of the injured person?
- Are they in a safe location, can they be moved to a safer location?
- Primary Survey
- Secondary Survey
- Collect Vital Data (SOAPnote)
- Formulate a Rescue Plan
Assign and Delegate
- In a group, give everyone a job and delegate responsibilities
- On-going assessment
- Rescue Plan
I quickly looked him over as I approached and, though he was scratched and bleeding from head to toe, none of the lacerations were deep enough to need immediate attention. So when I got to him my focus was on assessing his mental state, then I could work on assessing physical injuries. I asked how he was doing. It may sound like a ridiculous question to ask an accident victim but their answer can tell you a great deal about their mental state. He answered calmly, saying that he thought he was OK. I introduced myself and asked his name, which he quickly was able to give. So far so good. I then asked him if it was alright if I touched him so I could check him out for some basic injuries and he answered in the affirmative.
Patient Assessment: The Primary Survey
Find out what happened, find any life-threatening injuries, treat life-threatening injuries, prevent further injury from occurring.
Central Nervous System
- What was the Mechanism of Injury (MOI)?
- Are they complaining of neck or back pain?
- Do they have sensation or movement in all four extremities?
- Are there any obvious deformities?
- What is their chief complaint? Where does it hurt?
- Do all the “chunks” feel normal?
- Where are they?
- Are they complaining of being cold, hot or wet?
- Do they feel hot, cold or damp?
I continued asking him questions as I checked him for injuries, trying to determine his Level of Consciousness (LOC) while also determining the level of his physical injuries. I asked if he knew where he was, what day it was, why he was here. All of his answers were clear and positive. I also asked if he remembered what happened, and could give me any details of the accident. He relayed the story to me in enough detail for me to be confident he had not been knocked unconscious and had probably not suffered a major concussion.
The physical check was encouraging as well. He had some bruising and lacerations from head to toe, but no obvious deformities. He had sensation in all extremities, good circulation and respiration. His right shoulder seemed to sag a little and I asked about pain there, which he confirmed. He had also scraped his head on the right side bad enough to have pulled the skin away from part of his right ear. The surface injury was superficial enough that the bleeding had already stopped on it’s own. There is always the worry of a possible head injury, so I continued to encourage him to stay as still as possible and not move his head. I performed a quick cervical check and nothing felt out of place, nor did he complain of any sensitivity or pain. Everything seemed to check out on the initial assessment and he was very lucky.
He explained that he had lost traction on the road and began to drift on the loose dirt. Before he could regain control, the vehicle hit the mountainside and then careened across the road and off the edge. He recalled the drop and his experience in the vehicle as it rolled stating, undoubtedly, it was the scariest thing he’s ever experienced. He also recalled being ejected from the vehicle and assured me he hadn’t moved a single step from where he had landed. He then asked about the dog and I let him know the dog was found in good shape.
Symptoms of Dehydration in Adults
The signs and symptoms of dehydration range from minor to severe and include:
- Increased thirst
- Dry mouth and swollen tongue
- Palpitations (feeling that the heart is jumping or pounding)
- Sluggishness fainting
- Inability to sweat
- Decreased urine output
All of these symptoms can not only be the underlying cause of many backcountry medical emergencies, but will also make rescue and medical aid that much more difficult to administer. Assessing a patient’s level of dehydration is important and in extended rescue situations, keeping the injured person hydrated (if possible) is a primary concern.
I made sure he was comfortable and we began our wait for professional rescue. Dehydration can complicate any medical situation, so I asked if he was thirsty. I told him I had seen some water bottles up-slope and could get him one. I worked my way up to where much of the debris from the crash had spilled (it was a yard sale all the way down the mountain). I found two water bottles and spotted a larger water container that might have some water in it for later. He drank the first water bottle pretty quick and I used part of the second to wash some of the dirt and blood from his face. He also asked if he could have his ball cap because the sun was in his eyes, so I found that and brought it to him.
It took a while before anyone came down to us. The first person to join us was a Forest Service guy, also with Wilderness First Responder training. I had kept the victim engaged and talking while making sure he didn’t move around. I was beginning my second assessment when the FS Responder arrived and I let him do the assessment. He confirmed all of the conclusions I had reached on my initial assessment, making me feel better to have a second opinion confirm my own.
Patient Assessment: The Secondary Survey
Measuring and recording vital signs helps you understand how much Oxygen the brain is getting and sets a baseline for later assessments.
- Respiratory Rate: Count the number of breaths per minute (10-20/min)
- Respiratory Effort: Observe the ease or difficulty with which they breathe.
- Ask if they feel shortness of breath or are having a hard time breathing.
- Heart Rate: Find the pulse and count for one minute (50-100 bets/min)
- Effort: Blood Pressure Cuff is ideal, but you can also check the pulse at different locations for strength of pulse.
- If you have trouble locating a pulse at the extremities it may be a sign of low blood-pressure.
Central Nervous System
- Establish the Level of Consciousness (LOC)
- AWAKE: Conscious and Alert (how alert and aware are they?)
- VERBAL: Unconscious, but responds to sound
- PAINFUL: Unconscious, but responds to pain
- UNRESPONSIVE: Unconscious, comatose
Integumentary System (Skin)
- Skin color: Is there perfusion of blood to the skin?
- Skin temperature/moisture: Are they hot or cold to the touch? Are they wet, dry or sweaty?
As more rescue personnel arrived on scene and better equipped medical service was available, we got him patched up and stabilized. They were able to get a cervical collar on him to protect his spine, we got his right arm in a sling to stabilize that shoulder and I continued to make sure he had water.
Eventually, full rescue was on site and in the cramped space available to us, we got him strapped into a rope extraction rescue stretcher and the pro-crew hauled him up the slope while I collected their gear and helped haul it out.
All together, the rescue operation took almost 3 hours and the Forest Service had to clear-cut a 10ft wide direct path from the road to where we were. The response crews did a good job of handling the situation safely, quickly and efficiently. If I have any complaint at all, it is that many rescue personal are more apt to treat the situation more-so than the patient. At one point he was actually asking for more water and no one was listening until I made them give him water.
The whole time, the truck was still running and all of us were concerned that it would catch fire and complicate our rescue effort. But it never did. Once the road was cleared of emergency personnel and vehicles, a large crane truck and wrecker came in to extract the mangled Toyota.
I believe I did everything I could and I followed the procedures as I had been trained to. Later I visited the hospital and talked with the wife of the guy we’d rescued. She was shaken up, but glad he was not hurt worse. This was not the first accident I have witnessed, nor the first one where I was the First Responder. It has reminded me of the importance of Wilderness First Aid and First Responder training for all of us who spend time in the backcountry. If you can find a certification course near you, it is well worth the time, money and effort to go through the training. You never know when it will be YOU in this situation.
I would like to hear your stories. Have any of you been in a first responder situation? How did you handle it? What did you learn from it? How did it change your perspective on safety and preparedness in the outdoors?