Career focus: Mountain rescue medicine
Stephen Hearns, specialist registrar in emergency medicine and medic for a Scottish mountain rescue
team, outlines what is required to be an "action hero"
Mountain rescue teams in Britain undertake over 800 emergency rescues a year.1
In Scotland these involve the care of 170
people with injuries and illnesses and over
30 deaths annually (preliminary data from
my study of Scottish mountain rescue
major trauma). The role of the 70 mountain rescue teams in Britain is to locate
casualties, assess and treat their injuries,
and evacuate them to hospital. Many
teams enlist the help of a team doctor.2
These doctors are involved in training and
emergency rescues.
Background
A wide range of medical problems may
befall mountaineers. Accidents result from
slips, falls, and avalanches. They are often
precipitated by navigational errors, lack of
experience or equipment, and adverse
weather conditions.
Accidents occurring in remote mountainous environments are complicated by
many factors. Time to inform the emergency services may be prolonged, as may
time for evacuation to hospital. The medical assessment and treatment of casualties
is made more difficult by weather conditions, poor light, limited equipment, and
limited assistance.
The commonest problems are, as one
would expect, lower limb injuries. In
Scotland almost 10% of mountain casualties are suffering from medical illnesses,
and major trauma occurs in 5% (data from
study of Scottish mountain rescue major
trauma).
The role of the doctor
An appropriately experienced doctor
can bring unique skills to mountain casualties. Patient assessment is likely to be
more rapid and accurate when performed by a doctor. The doctor can
administer effective analgesia intravenously and drugs for medical emergencies and can provide invasive skills
such as cannulation and advanced airway
management. Another important role
for a doctor may be to decide to transport the casualty directly to the most
appropriate facility for definitive care,
rather than simply the nearest hospital,
especially if a helicopter is being used for
evacuation. It is often useful if the doctor travels with the patient during transfer to hospital in order to monitor the
patient's condition and provide a face to
face "hand over."
In the event of fatal incidents, doctors
also have the ability to pronounce life
extinct at the scene. This helps the work of
the police and may remove the need for
inappropriate resuscitative efforts being
continued until the casualty arrives in hospital.
The mountain rescue doctor also plays
an active part in medical training for other
team members. This may involve organising formal training courses or less formal
training during exercises. Doctors are also
able to help with the medical aspects of
debriefings after rescues and to follow a
casualty's progress in hospital, thus allowing positive feedback for the team members involved in the rescue. The doctor
may also be responsible for a rescue team's
medical equipment.
A day in the life of a mountain rescue doctor
Winter 1998. The pager goes off at 6 am: a girl is missing near Loch Lomond. My
colleague Stephen Hearns picks me up, and we travel to the incident location. A
team of police officers and the police helicopter have been searching all night for
the girl and requested some extra help at first light. As we arrive, the girl turns up
safe and sound.
After this we travel up to Arrochar and ascend a mountain for the training session
originally planned for the day. We practise snow belays and avalanche risk
assessment.
In the afternoon the team leader gets a call from the police to say that a walker has
fallen on the mountain adjacent to us and that a Royal Navy helicopter is en route.
Thirty minutes later we climb aboard the helicopter, which takes us to the incident
location. We are winched down to the casualty. He has fallen a long way and is dead.
We are on steep ground, and the process of lifting the casualty on to the stretcher is
slightly hazardous but made more safe by a team mate above who has rigged up a
belay to protect us and the stretcher. We traverse the hillside to the helicopter, which
takes us down to the waiting ambulance and police at the roadside.
As we are about to go home, we receive a call about another casualty. A student has
fallen in Glen Orchy (30 minutes away) while ice climbing and is seriously injured.
We make our way there as quickly as possible by road. When we arrive we find that
the helicopter is waiting for us; the helicopter winchman is already on the mountain
with the casualty. Five minutes later, we are looking out of the helicopter door into
the darkness, as the casualty is winched up. He is unconscious. We insert an
oropharyngeal airway. Breathing and circulation assessment is made almost
impossible by the noise and vibration in the helicopter. Stephen and I decide not to
take him to the nearest hospital but to go in the opposite direction to the nearest
neurosurgical facility. We request that an anaesthetist and the accident and
emergency consultant are standing by.
We land at Southern General Hospital in Glasgow and hand over the patient. Job
done, except for the fact that my car is now 70 miles away.
Eddie Crawford general practitioner registrar, Glasgow, and doctor for Arrochar Mountain Rescue Team
Training
There are currently no requirements or
guidelines as to what constitutes appropriate training and experience for mountain rescue team doctors. Even if there
were they would be difficult to enforce as
mountain rescue is a voluntary service and
it is up to teams and team members to
decide on their policies at a local level.
Since 90% of casualties rescued are suffering from a traumatic injury, with 5% suffering from major trauma, it would seem
appropriate that mountain rescue team
doctors have experience and training in
trauma and airway management. This
would ideally include experience in an
accident and emergency department.
Suitable training courses are the advanced
trauma life support course and the pre-hospital trauma life support course.
The British Association of Immediate
Care runs several prehospital courses,
some of which are intended for preparation for the examination for diploma in
immediate medical care by the Royal
College of Surgeons of Edinburgh. These
courses cover aspects of management of
medical emergencies and trauma applied
to the prehospital environment. There is
no course specifically for mountain rescue
doctors in Britain. It is essential for mountain rescue team doctors to inform their
medical defence union about their involvement in prehospital care of casualties.
All members of mountain rescue teams
should be able to work independently and
safely in the mountains. This requires skills
in navigation, rope work, and movement
on steep ground and in adverse winter
conditions. A degree of physical fitness is
also required. Mountain rescue involves
lengthy searches and carrying heavy equipment and casualties on stretchers for prolonged periods, often in severe weather conditions. A good sense of humour is also
essential.
Courses covering mountaineering and
mountain rescue skills are run regularly at
the Glenmore Lodge Training Centre near
Aviemore and at Plas y Brenin in Wales.
Most outdoor centres run "mountain
leader" courses, which cover a wide range
of mountaineering skills. Specific skills
such as technical rescue, radio communications, and working with helicopters can
be gained after joining a team.
All civilian members of mountain rescue teams, including doctors, are unpaid
volunteers. Most teams use pager or telephone systems to call out team members,
who carry pagers at all times and attend if
they are available at the time of call out.
The annual number of calls out varies
from five to 100 for a few busy teams.
Appeal of mountain rescue medicine
Mountain rescue doctors face the challenge of using their medical skills in a
uniquely testing and inhospitable environment, and the work provides an incentive to maintain your skills and physical fitness. Many experiences and skills can be
gained while working and training for
mountain rescue: mountaineering skills
are constantly improved, and opportunities arise for training in advanced driving,
off road driving, radio communications,
and helicopter aeromedical evacuation.
The importance of effective teamwork
and the skills of good leadership can also
be observed and slowly acquired. Being
lowered down a mountainside to a casualty on a winter's night or being suspended
30 metres above a river on a Tyrollean traverse on a training exercise requires you to
trust in your team mates' abilities and your
team leader's decisions. Such skills are
invaluable for the everyday medical practice of any doctor.
What is required of a mountain rescue team doctor
- Mountaineering experience
- Physical fitness
- Team player
- Trauma management training
- Commitment
- Understanding partner
- Own helicopter (not really, we made this one up)
Drawbacks
Involvement with mountain rescue
requires considerable commitment, which
may not be compatible with a busy full
time job, especially one with an on-call
commitment. Most teams train for one day
a month, and it is important to attend as
many of these as possible. Accidents tend
to happen at weekends, when the hills are
busiest, and teams are often called out at
night because people have become overdue or have fallen while trying to descend
in the dark. This can put a strain on relationships and can be physically and mentally tiring.
Doctors who climb or walk in the mountains often do so to escape from stressful
jobs and to get away from the strains of
dealing with ill patients. This sense of
escape and love of the mountains can be
affected by seeing injury and death in this
environment. There is also the potential
risk of injury to team members during
training and rescues. These include road
traffic accidents, falls, and helicopter incidents.
Stephen T Hearns, specialist registrar in emergency medicine, Western Infirmary, Dumbarton road, Glasgow, and doctor for the Arrochar Mountain Rescue Team, Argyll, Scotland
Email: Stephen@frontlinemedics.com
studentBMJ 2001;09:43-84 March ISSN 0966-6494
- Mountain Rescue Council. Handbook of the Mountain Rescue Council. Mountain Rescue Council, Penrith, 1998.
- Hearns ST. First aid training and equipment in UK mountain rescue teams. Pre-hospital Immediate Care 1999;3:215-8.
