Rescue Situation in Prescott…

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.

photo by Julian Gonzalez

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?

Communicate

  • 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.

Regroup

  • Make sure the scene is safe, people are safe and everyone has a job.

Approach

  • Designate one or two people to approach the victim while being careful not to cause further injury or create further danger.

Initial Impression

  • What is the condition of the injured person?  
  • Are they in a safe location, can they be moved to a safer location?

Examine

  • 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

Monitor

  • 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?

Deformity

  • Are there any obvious deformities?
  • What is their chief complaint? Where does it hurt?
  • Do all the “chunks” feel normal?

Exposure

  • 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.

“If an individual receives a heavy blow to the head or face, he may suffer a brain concussion, which is an injury to the brain that involves a temporary loss of some or all of the brain’s ability to function. For example, the casualty may not breathe properly for a short period of time, or he may become confused and stagger when he attempts to walk. A concussion may only last for a short period of time. However,if a casualty is suspected of having suffered a concussion, he must be seen by a physician as soon as conditions permit.Remember to suspect any casualty who has a severe head injury or who is unconscious as possibly having a broken neck or a spinal cord injury! It is better to treat conservatively and assume that the neck/spinal cord is injured rather than to chance further injuring the casualty.” – WildernessManuals.com – Head Injuries and General First Aid Measures

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.

photo by Julian Gonzalez

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
  • Weakness
  • Dizziness
  • Palpitations (feeling that the heart is jumping or pounding)
  • Confusion
  • Sluggishness fainting
  • 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 Assessment

  • 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.

Circulatory Assessment

  • 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?
Vital signs should be continually monitored.  Repeat the Secondary Examination every 15 minutes or so and note changes in the patient’s condition.

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.

photo by Julian Gonzalez

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?

Dave Creech is a successful business owner and entrepreneur based in Phoenix, Arizona. He shares his personal story and lifelong passion for travel and rugged outdoor adventure through his blog at WildernessDave.com. David’s focus has been on trip stories, gear reviews, Wilderness Medicine and a series of articles aimed at introducing Yoga to hikers and backpackers as a path to staying fit, healthy and injury free.

[nrelate-related]

Comments

  1. I’ve never been a first responder for any wilderness accidents, but I was the first one on site for a multi-car accident that resulted in a Ford Explorer rolling, going airborne, and then landing into oncoming traffic on the interstate, right in my lane and right in front of me. I pretty much did the same thing you did, but I wasn’t able to devote too much attention to the driver of the car, it was a road rage incident and the other driver was trying to fight him. It took a bit to keep him from coming over the guardrail after him. But we did get the basics, are you ok, what day is it, what year is it, what’s your name, etc. He clearly wasn’t in that good of a mental state, but he was up and moving, just dazed.

    • Wow…I’ve never been on a road-rage scene. That would definitely complicate the situation. I have been first response on several large car accidents on freeways, but luckily the emergency crews can get to those so much faster that there’s not much for me to do except make sure no one moves the injured parties. In one case I did have to stop some serious bleeding because the guy was going to bleed out before the EMTs got there. Did your situation, and being involved in it to the extent you were, change your perspective in any way? I know for me, every time I’m involved in something like this it makes me re-evaluate my med-kit, my skill level, etc. and makes me think about how I would want response to be handled if I were the one in the accident….

      • Yeah, it did make me change my perspective. It was only a few years ago, but it made me reconsider getting a cell-phone. I had stopped carrying any sort of first aid kit by then, and I decided to put a few supplies in my truck afterwards. I still don’t have a good kit, that’s one of the things that’s next on my list. It does wake you up to the dangers of road rage, the two drivers had apparently been at it for miles before the accident.

        • Do you have rubber gloves in your kit? Rubber gloves are my number one most important item in a car first-aid kit. I’ve never been on an accident that did NOT have blood and gloves are the easiest way to stay safe while still being able to respond.

  2. Just wanted to drop you a note of thanks for being there and responding on this incident. The driver and the owner of the vehicle (and dog) are both very close friends of mine. In the last 12 months I have lost an alarming number of friends and I know how easily this could have added to that so I thank you for your time and willingness to get involved to assist a complete stranger.

    • Any time…as much as I hate seeing accidents like this happen, it’s always nice when the outcome is as positive and fortunate as this was. I’m glad I could do my part.

  3. Fred & Jeannie says:

    Dear Dave,
    That was our son,in that truck. His wife was in the race, and he was hurrying to get to her next stop when he hit the soft dirt in his friend’s truck. They were married last July, so you are a blessing to our family and we thank you with all our heart and soul.

    Our son is doing well, though his ear was nearly torn off and had to be stitched back on, his breast bone is broken and a process on his vertebrae broke off. His wife, graduated last Saturday as a physical therapist, and her family came to, Utah, to celebrate. Thank you for helping Dustin to be there, too, and for your having the experience and knowlege so you could be the first responder who would make a difference. We owe you.

    Bless you for helping.

    • Fred and Jeannie,

      I’m so happy to hear your son is doing well. Dusty was very lucky and I’m glad I was in a position to help. We were very fortunate to have professional rescue close enough to get him out of there and to the hospital within a reasonable time frame.

      When I spoke with Kiki at the hospital, she was still very upset and worried about Dusty. It’s very nice to hear she was able to finish school and that Dusty could be there to celebrate with her and the whole family. Please tell them I said HI, and I wish them best of luck.

      Dave

  4. Erica Johnson says:

    Dear Dave,

    Dusty is my brother, and I also am so grateful for people like you who are not only trained, but kind and concerned enough to quickly respond in a crisis situation! Thank you so much for all you did for Dusty and for posting the story for us to see and appreciate. I can’t believe he made it alive out of that smashed vehicle-our whole family so thanks you for being there for him and also to take the time to follow up at the hospital.

    All’s well that ends well, and you certainly helped this trauma end as well as possible! Thanks to your girlfriend, too for her concern and assistance.

    With BEST REGARDS,
    Erica

    • Erica,

      I like to believe, perhaps naively, that anyone would have done the same thing. I was a little surprised that no one else came down the hill until the Forest Service arrived on scene. Luckily, the first Forest Service personnel to arrive was also a trained Wilderness First Responder and was able to carry out his own assessment of the situation as well. This was one of the few occasions where I was happy to see a person ejected from the vehicle. I don’t know how we would have gotten to him if he hadn’t been. Dusty was very lucky and handled the whole thing very well.

      BTW, the girl was my buddy’s wife. She was very helpful, especially in being able to keep an eye on the dog so we had one less thing to worry about.

      Thanks again, I’m glad he’s doing well.

      Dave

  5. I haven’t had this kind of experience but I’m sure that it was quite overwhelming. It’s great that you were one of the quick responses during this incident. Thanks for sharing your tips, by the way. I’ve been noting your points as I read along.

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  1. […] buddy Bryan does a lot of bike races (he was the reason I was in Prescott for the Whiskey Off-Road).  A few weeks ago he asked me, kinda of last minute, if I wanted to go camping with him for […]

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