Cold, Wet and Hurt

     Attack One responds to a report of a hunting accident with a patient hurt in a fall. Additional information indicates the patient is severely injured from a fall from a tree, and identifies a rendezvous point for a hunting buddy who has hiked out of the woods where the accident occurred to summon assistance. Additional equipment dispatched includes an engine and a ladder truck for manpower and transport equipment, and an EMS unit.

     It's a cold December day, with snow covering the ground. The Attack One crew and arriving EMS unit find a hunter on a rural road. He tells them the victim fell about 25 feet from a deer stand in a tree. The injured man is at least a mile off the road, and it may require some effort to find him again. The crew asks the hunter what type of injuries may have occurred, and he indicates the man fell on his back and can't move or feel his legs. The injured man had soaked his hunting suit with urine, so his friend had covered him with his own outfit before leaving to seek help. He estimates his friend's weight at 200 pounds.

     There are other immediate challenges to address as well. The hunter seeking help is already very cold, having sacrificed his suit for his injured friend. His assistance will be needed to find the man, so he has to be outfitted with warm clothing to hike back into the woods and out again. Additionally, his description of the accident gives great concern about spine injury, hypothermia and potentially other trauma. The crew will need to carry in spine-immobilization gear, a basket to carry the victim out, first aid gear and plenty of blankets. Tracking the pathway will be difficult, and air support could be beneficial. The closest available helicopter is an air ambulance that can be utilized for both location assistance and victim removal-if the initial report is accurate and a landing site can be found.

     Several crew members are familiar with the wooded location and feel they may be able to move ahead more quickly to find the victim with the aid of the hunter. The rest of the crews can then follow with the gear from the ladder truck and the manpower to do a long carry. Two members take the first aid gear and blankets and make their way into the woods. Radio communications will be maintained, and the advance members' hiking pathway will be crudely tracked. Air ambulance personnel can also determine the fastest removal pathway, so all crews and the helicopter are assigned a common tactical channel.

     Seventeen minutes later the first crew locates the victim. He is a 25-year-old man, and his description matches the initial information. He is cold, in severe pain from a back injury, and has no sensation or movement below his belly button. He is incontinent of urine. Crude examination reveals a broken left wrist, but no other injuries. The pulse oximeter finds a pulse rate of 50, saturation of 95% in his fingers and a respiratory rate of 18. A palpable blood pressure of 90 is obtained through his clothing.

     At this point the helicopter and the rest of the caregivers with the immobilization gear are about five minutes away. The decision is made to rapidly package the injured hunter in blankets, remove his wet clothing and have him prepared for complete immobilization when that gear arrives. This can be done safely without moving his spine or exposing him to the ambient air, which is about 25ºF. His wet clothing is leading to rapid heat loss, and lying in it has begun to blister his skin where it's in contact with the frozen ground.

     The rescuers remove the wet clothing by placing the oldest blanket under the patient-carefully, so as to avoid moving his spine. His wet clothing is split with trauma scissors. Several more blankets are wrapped around him (with caution taken to keep them dry), then his clothing and the first blanket are peeled away (again carefully, to prevent spine movement). By the time the additional crew arrives, he is ready to be placed on their backboard and into the basket.