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Patient Care

My First Wilderness Rescue

The following is an excerpt from Kevin Grange’s book Wild Rescues: A Paramedic’s Extreme Adventures in Yosemite, Yellowstone, and Grand Teton. 

"Old Faithful EMS, respond to the area around Iron Springs for a vehicle off the roadway.”  

The page sent Sam and me sprinting to the apparatus bay. Iron Springs was a picnic area 45 minutes north of Old Faithful on the Grand Loop Highway. 

“You asked when the summer season would begin,” Sam yelled as we roared out of the apparatus bay. “It’s begun!”

As the ambulance sped past the bubbling mud of Fountain Paint Pots, we rounded a corner and encountered a large animal jam. Two dozen bison had formed a defensive line across the two-lane road, stopping traffic in both directions. I shut off the sirens as we approached so as to not send the bison stampeding into the crowd of picture-taking tourists. I chirped the siren, but the bison barely looked up. I honked, but they’d heard that before. We continued to approach slowly, the grill guard of the ambulance inches from their tawny hides, but they stood firm. We needed to get through. A person was dying. Yet I couldn’t drive around them, because the landscape itself was also a fragile protected area. I laid on the horn again. 

Nothing. 

Suddenly, Sam grabbed the intercom. “Hold on, Lodgepole. I have an idea.” 

He reminded me we were in the land of large carnivores. “Grizzlies, wolves, and mountain lions,” he said, “who all feast on bison, right?”

Sam handed me the mic. “Let’s hear your best mountain lion roar.” 

I drew in a big breath, depressed the black button, and emitted a scream: “Ah-ah, ah! Ah-ah, ah! Ah-ah, ah!”

My scream was high-pitched and pitiful, somewhere between a cougar and Robert Plant’s banshee howl at the opening of Led Zeppelin’s “Immigrant Song.” But it worked. Baby bison, who didn’t know better, skittered off the roadway on thin, coltish legs. The older bison, with thick, rangy coats, didn’t quite buy it, but they stepped aside grudgingly as if to honor my attempt. 

‘It’s Not Going to Be Comfortable’ 

Once we passed the bison herd, I hit the gas, and dispatch informed us a ranger was on scene. The accident had occurred at Iron Springs, where a series of S-shaped curves had a notorious history of slingshotting vehicles 40 feet into the woods. 

“I have three patients,” the ranger announced. “Two with minor wounds, and one critical, going in and out of consciousness.” 

The ranger’s name was Chris, and he worked in the Canyon District of the park. Sam and I had never run a call with him before. 

“Copy,” I replied over the radio. “ETA, 20 minutes.” 

Sam took the mic from me and requested a helicopter. “We’ll land the bird right at the accident scene on the highway.” 

We’d been driving for half an hour by then, and we still had 20 minutes to go. We’d hardly reach our patient within the golden hour, let alone transport them to definitive care. This meant that instead of receiving a CT scan and lifesaving surgery, our patient would likely be succumbing to the “trauma triad of death.” 

When we arrived on scene 20 minutes later, Sam and I grabbed a backboard and our BLS bag and started down the steep embankment, sidestepping ankle-deep through small loose stones known as scree. Two of the occupants stood roadside, uninjured. We couldn’t see the car, but they pointed and told us it was somewhere down in the woods.

“Rock!” Sam yelled as he sent a small boulder rolling toward me. I leapt aside, barely preventing the rock from hitting me in the chest. 

As the slope leveled out, we found the car among scattered rocks and broken trees. It was clear that when 34-year-old Andie Howard dozed off, her Toyota Camry had launched down a steep 40-foot slope, miraculously landing upright. Andie’s Camry looked like a dented soda can with four wheels, but the passenger compartment was relatively untouched. 

“She’s alert and oriented,” Chris announced as we approached. “But she’s slow to respond and lethargic.”

He’d placed Andie on a nasal cannula and was delivering low-flow oxygen via two small prongs. He’d also wisely covered her with a warm blanket to prevent hypothermia and placed a cervical collar around her neck. I could see glitterlike shards of glass in her brown hair. A good Samaritan bystander who’d come over to help crouched in the backseat, holding Andie’s head in a neutral, inline position on the assumption that she likely had a spinal injury. 

“ETA on the helicopter, 15 minutes,” dispatch announced over the radio. 

We performed a quick assessment and found, as Chris had, that Andie was alert and oriented but slow to answer and complaining of stomach and shoulder pain. In addition to the head injury, she could likely be bleeding internally. And the shoulder pain? That could be Kehr’s sign, referred pain that suggested a potentially life-threatening ruptured spleen. 

“We need to get her out of the car and up to the road immediately,” Sam said. 

We had four rangers and two bystanders on scene to assist. Chris raised the steering wheel to create space, and Sam moved the driver’s seat back and reclined it slightly as I slid a rigid backboard under Andie. 

“There’s only one way to do this, and it’s not going to be comfortable,” said Sam. Like a quarterback calling out the play, he assigned us all positions and then said, “Is anyone not ready?” 

Chris and I steadied our grip and remained silent. 

“OK, moving on three. One…two…three!” 

Using our combined effort, we rotated Andie toward the driver’s door, laid her down on the backboard, and then used it to move her out of the car and onto the ground. 

Once Andie was belted to the backboard, we lifted her again and moved her toward the road, stepping over downed trees and rocks, carrying the backboard, two on each end and two on the sides. Andie was a large woman, and it took all our collective effort to lift her. 

“Stop,” I called out, my back muscles spasming.

“Lower,” Sam ordered. 

We set Andie down, reset, and then lifted once again. But after moving a few feet, we had to rest once more. We could barely lift her on flat ground; between the steep slope and gravity, it was too much. 

“What’s the plan?” I asked. 

Sam said Yellowstone had a technical rescue team, but the members would have to come from all parts of the park. It would take hours. With Andie’s lethargy and internal injuries, he didn’t think she’d last that long. 

So that’s it, I thought to myself. She’ll die, and the environment will win this one. 

Raw Power

But just then Emily and Rachel, Old Faithful’s fire officer and district ranger, arrived in a light rescue, a small fire truck loaded with tools like the Jaws of Life for vehicle extrication. They heard our dilemma and had an idea. 

“You need raw power. We have an electric winch on the front of this rescue,” Rachel said. “We’ll attach the winch cable to the top of the backboard. You lift, and we’ll pull!” 

Emily’s and Rachel’s improvised idea was audacious, but hell, we knew it just might work.

I scrambled up the hill, grabbed the cable, and brought it back down to Sam, who secured it to the top of the backboard. On Sam’s count we lifted Andie as Emily activated the winch. Then, slowly and methodically, we moved up the hill, taking short breaks every few moments to rest.

Once we arrived at the road, we quickly moved Andie into the ambulance and obtained a set of vital signs as I searched for a site to place an IV. Andie had poor venous access, but after multiple attempts I was able to place an IV. It was a small, pediatric-sized catheter that looked comical on her thick arms, but I didn’t care; we now had venous access through which we could administer pain medication and, if necessary, normal saline to raise her blood pressure. 

We heard the rhythmic whoosh-whoosh-whoosh of the helicopter approaching. I glanced out the ambulance window to see the bird cresting over the mountains. I’d never been so excited to see a helicopter in my whole life. It descended through the thin clouds and golden sunlight like a heaven-sent angel with a spinning halo of rotor blades.

As I listened to Andie’s breath sounds once again, assessing her for a collapsed lung, I could feel the momentum trending in our favor. The location of the accident scene, terrain, and poor access had presented challenges, but we’d adapted and overcome. Andie would now be transported by air to a trauma center, her life would be saved, and the score would be Old Faithful EMS 1, the environment 0. 

Taking the Win

At least that was my assumption. But when the flight team hopped out and the pilot took a look at Andie, he pulled Sam and me aside and said, “We can’t fly her. She’s over the weight limit.” 

“What?” I asked. “No!” 

The pilot informed me it was a safety issue. Andie weighed too much.

Sam quickly turned to me. “Looks like we’ll have to drive her to the hospital.”

Sam and I hopped in back of the ambulance, and Chris took the wheel, hightailing it to West Yellowstone. There we’d transfer care to paramedics with Hebgen Basin Fire District, who’d transport Andie the rest of the way to the hospital. As we raced around tight curves and bounced over rolling frost heaves, the ambulance pitching and swaying like a small boat on big seas, we gave Andie fentanyl for pain, saline to maintain her blood pressure, and Zofran for nausea. Once we’d performed most of our paramedic interventions, Sam encouraged me to think of the prolonged transport now as nursing. “We’ve stabilized her, so now it’s all about making a connection with her and ensuring she’s warm and comfortable.” 

Andie’s condition didn’t really improve on the way to West Yellowstone, but she didn’t get worse, so we took it as a win. 

Sidebar: On Finding EMS and Working as a National Park Paramedic

While I worked as a lifeguard in high school, I didn’t find EMS until my early 30s. No one in my family had pursued a career in EMS or fire, so it wasn’t on my radar until a restaurant coworker raved about an EMT class he was taking. I enrolled in a Wilderness First Aid class and then an EMT class and loved everything about them—the people and the team-based approach; the blending of critical thinking with practical skills; and, of course, helping save lives. I eventually attended paramedic school at UCLA before working for the National Park Service and Jackson Hole Fire and EMS in Wyoming. 

While I began in urban EMS, I love working in wilderness medicine and the “wildland urban interface” so much more. The challenges of the environment, limited resources, and long transport times really make it exciting and, at times, terrifying. Plus I love the “all-hazards” aspect of rural and remote EMS. You get to do everything: EMS, fire, wildland fire, hazmat, search and rescue, tactical EMS, and more. With the extended transport times, as an EMS provider, you often get to go down the entire treatment algorithm for a complaint, versus the 5–10 minutes you’re with a patient in an urban setting. 

As for the National Park Service, I cannot recommend working for the agency enough. With the publication of my new book, Wild Rescues, I receive e-mails from people every day who are interested in working for the NPS. Many of the bigger parks have summer seasonal and term positions for EMTs and paramedics: Yosemite, Grand Canyon, Glen Canyon, Lake Mead, Mount Rainier, Olympic, Smoky Mountain, Yellowstone, Grand Teton. These jobs are primarily during the summer, but a few, like Yosemite, hire winter medics. Search for positions at www.USAjobs.gov; most appear in early January. 

Another option is to what I do: work in a “gateway town” in the wildland urban interface where you have both urban and wilderness elements. Jackson Hole is great, as are other outdoor towns in Colorado, Montana, New Hampshire, Vermont, Oregon, Washington, and beyond. 

Kevin Grange  is a firefighter-paramedic in Jackson Hole, Wyo. He is the award-winning author of Lights and Sirens: The Education of a Paramedic and Beneath Blossom Rain: Discovering Bhutan on the Toughest Trek in the World. 

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