Dr. Keith Conover demonstrates disclocation treatment.
Friday started out as a pretty good day. It was a warm and sunny early September morning in 1996 in the Wicklow mountains near Dublin, Ireland and twenty nine students, all experienced mountain rescue personnel from Ireland, Scotland, and Wales were concluding a week long Wilderness EMT program, taught by physicians and paramedics from the Pittsburgh, PA based Wilderness EMS Institute (WEMSI).
At the same time, 57 year-old Michael Kennedy, an avid hiker from the small coastal town of Greystones in County Wicklow, started off for a hill-walk into those very same mountains. He anticipated a scenic trip that would take him through the Glendalough (Valley of the Two Lakes) valley, past an old mining village, and following a horseshoe shaped route, back to his car. All told, it should take about six hours. Michael told his family that he wouldn't be late.
A year earlier, Dr. Keith Conover, a founder and the medical director of WEMSI, had met with members of the Irish Mountain Rescue Association and the Dublin-Wicklow Mountain Rescue Team over a few (well, several) pints of Guinness, following a mountain rescue conference in the United Kingdom, where he had been a speaker.
Dr. Keith Conover demonstrates disclocation treatment.
Frequently caring for ill and injured parties, high in those hills of southern Ireland, they saw the value in the advanced wilderness medicine that WEMSI taught. Thus, the plan for the 1996 course was laid.
The students of that first class in Ireland reviewed basic physiology, the pathophysiology of wilderness injuries and illnesses, and pharmacology. They learned advanced assessment skills and techniques for C-Spine clearance, dislocation reduction, suturing, and casting. Procedures as simple as starting and maintaining an IV gained new complexity in the outdoors. But, no one knew how soon some of those new skills would be needed!
Suturing practice.
At about the same time that the students were completing their final exam, our intrepid hiker stopped for a break. A brief snack and several drinks from his thermos refreshed him and he continued on.
Nearing six, the class received their graduation certificates and headed to the local pub to celebrate. The instructors and several of the staff packed their gear and relocated to Dublin, where they would participate in the first joint mountain rescue conference between the Mountain Rescue Conference of England & Wales and the Irish Mountain Rescue Association.
Out on the hillside, Michael tripped. The pain was sharp and intense and his walk was over. Worse yet, on a week day afternoon, there were few, if any, other walkers in these remote hills who might have been able to come to his aid. With less than two hours to darkness, Michael considered his options. None were good.
While the WEMT students celebrated and the conference delegates gathered, Michael began crawling, hoping to reach a spot where he could at least signal for help. Darkness fell and Glendalough was deserted. His walk had taken him several miles from the nearest track and he was out of view from the valley below. Exhaustion ended his attempts to crawl out. Settling in to wait, he regretted that he had been prepared only for the day-walk that he had anticipated. Lacking a torch (flashlight), food, or proper clothing for the night chill, he knew that his painful, swollen ankle was just the beginning of his troubles. Settling down, he waited.
Michael's family was concerned and his son began a search of the car parks in the area around Wicklow. The staff at a local hotel suggested a public car park nearby, where he located his father's car around midnight. He returned to the hotel and called the police who conducted a search of the local area without success.
Even Irish celebrations wind down eventually and most of the WEMT graduates returned home near 0100. At 0133, their mountain rescue pagers announced Michael's heretofore-unknown plight. The Dublin-Wicklow and the Glen Immal Mountain Rescue teams jointly cover the southern Irish countryside and with an efficiency borne of frequent use, activated their call-out plans. While over 200 additional mountain rescue personnel partied or slumbered nearby, they assembled on site and commenced search operations. Their strategy was to blanket the known tourist routes with quick moving teams entering from various access points through the valley and along the flanking hill sides. The night was clear but moonless and the temperature which had been near 18oC earlier that day had dropped to 5oC. The rescuers, who had so recently participated in the WEMT program, thought back to the lectures on the effects of, and the treatment for, hypothermia as they searched. Though grateful for the presence of the personnel at the conference, they hoped that more help would not be required.
0400, and Michael finally saw the lights of a rescue party; but they were over a mile off and passing above him along the hillside. Fighting despair, pain, and the cold, he wished for a way to signal.
The search parties were equally distressed at the first flashes of lightning. They knew a cold rain would make the search more difficult and Michael's chances of survival, worse. Wait, though; the sky was still cloudless and there was no thunder...and the flashes were coming from the valley! Michael had remembered his camera and was using the flash strobe to alert the rescuers to his location.
Using their radios, the teams triangulated a more precise fix on his position and soon vectored in. As the teams arrived at his side, Michael was assessed and treated for his hypothermia. While the evacuation team prepared for Michael's carryout, the medical personnel elected to use one of the skills they had recently acquired; namely the use of fiberglass casting material to splint his distal tibial fracture.
Waiting for Evac.
Casting material, applied with the proper technique, allows for a comfortable conforming splint that accommodates angulations while remaining secure. It is particularly useful in wilderness settings since it is lightweight and takes little space in a pack. Several packages can be applied together for additional strength or to create longer splints. If an angulation is reduced prior to splinting, the "cast" provides more security and comfort than is possible with typical rigid splints. While vacuum splints offer similar characteristics, they are expensive, bulky to pack, require a selection of sizes, and a vacuum pump.
What falls down, must come up!
The remainder of the evacuation was uneventful and both sunrise and Michael's grateful son greeted him at the car park. Back in Dublin, the rescue team explained to a rather confused A&E (Accident and Emergency) physician, that they had indeed applied the splint themselves; on the hill. No, the casualty (patient) had not been taken to another hospital first. "Yes, it did do quite a nice job, didn't it?" they agreed. "With all of the resources that I have available to me," said the physician, "I couldn't have done a better job myself."
President Robinson opened the conference herself, and commended the rescue team in her opening remarks for their fine performance and mentioned the use of the new procedure. It was also announced on the national radio in conjunction with reports on the conference. Though, minor in itself, what was significant was the introduction of a new level of medical care offered to this country's victims of wilderness incidents. Ireland has no paramedics. Out-of-hospital care is provided by dedicated and capable EMT-Bs who wish to do more. Paramedics in the U.K. perform similarly to EMT-Is in the U.S. But, as in the U.S., these mountain rescue teams, driven by the necessity of their environment are fast becoming leaders in the delivery of out-of-hospital care.
Michael Treacy is Deputy Team Leader of the Dublin-Wicklow Mountain Rescue Team, a Nationally Registered EMT and a WEMT Instructor. He teaches first aid programs to various groups and leads wilderness trips.
Jack Grandey is Director of Applied Informatics at the University of Pittsburgh Medical Center and a flight paramedic for the STAT MedEvac System. He is a founder and Operations Director of WEMSI, a founder of the Allegheny Mountain Rescue Group, and a supervisory instructor for the Eastern Region of the National Cave Rescue Commission.
Here are some photos from the Dublin training operations:
Thumbnail Images with Links to larger images.
Medium Images (384 x 288)
 |
Designed by a member of  |
 |
| Maintenance Data:
casting_call.html Date Last Revised: March 16, 1998 |
