Augusta Half Ironman

Sunday Sept 30th

I spent the afternoon out at the Augusta Half Ironman medical tent. Luckily there were no serious injuries on my watch - mainly exhaustion, cramping and some blisters. Powerade and bandaids were my medicine of choice for most of my patients. It was inspiring to see such a large group of motivated athletes! The triathalon was sold out with 3,400 participants!

Fishhooks in the ED

Impaled by a Fish Hook! Fish hooks are great at snagging fish and fingers. There are a number of novel techniques for their removal. In this situation after performing a digital block (numbing up the whole finger) we used the needle cover technique which is described below from the FPnotebook website. In this case as the fishhook was embedded fairly superficially and only had one barb it was very effective. We also up dated the patient's tetantus and washed out the wound throughly after removal!

Technique: Needle Cover Technique http://www.fpnotebook.com/surgery/der/fshkrmvl.htm

1. Indications
   1. Large hooks with single barbs
   2. Barb superficially embedded
2. Images
   1. Needle Cover Technique
      1. 
3. Technique
   1. See Preparation above
   2. Advance 18 gauge needle along entrance of fishhook
      1. Insert parallel to shank
      2. Bevel pointing toward inside curve of hook
      3. Longer edge of needle matches end of hook angle
   3. Disengage barb by advancing fishhook
   4. Pull and twist hook so hook point enters needle lumen
   5. Back the needle and hook together out of the wound

 

DiMM day 7

We finished the week with an awesome scenario. Two members of our group had a "Mtn biking accident" and ended up about 150 meters down a very steep hillside on the side of guardsman pass. We rigged a system to extricate Scott, who was unconscious with raccoon eyes using full spinal immobilization in a litter with 3 attendants. This was a complicated extrication given it required two systems given our rope length wasn't long enough to reach the patient.

Later in the day we did high angle rescue with a horizontal litter. We did scenarios that encompassed both lowers and raises with the horizontal litter.

Overall this was an awesome course. I feel I have a much better concept of how to rig two rope systems and also do companion rescue.

Nick saves my life as I hang mid-cliff!

2012 DiMM Rock Class

I finished off my time in salt lake with some climbing on Sunday morning - awesome Mexican food at and another Mtn bike ride!

DiMM day 6

View looking down towards Brighton

Today we hiked up a bit further through a talus field to a sheer cliff face. The scenario was a rappeller was stuck mid cliff unable to ascend or descend. We developed a system with two lines - a main line and belay line. The belay line was setup with tandem Prussiks on a radium release. The main line was set up with a double plaquet system with a 3:1 attached. We lowered an attendant down, he attached with long tailed double bowlines to the patient ( and Purcell Prussiks). We then raised them both to release tension from the climbers rope and untie him. We then lowered them both to the ground.
Sounds a lot easier in words than it was in practice. We then repeated this setup in smaller groups.



Double plaquet system for main line demonstated in our cabin

DiMM day 5

Today we did companion rescue and learned to escape a belay, switch between raising and lowering and create simple mechanical advantages. We also tried a counterbalance rappel.

Confusing looking! The orange and yellow line is prussiked to the working end on the main line (climbers rope) creating a 5:1 to raise the climber. The system is safe as the ATC is in autoblocking guide mode, making this a hands free system

DiMM day 4

Focused on low angle litter raises and lowers with attendants. More to come later.

Belays with tandem prussiks, and 540s. radium release in line.
Raises with 3:1, 5:1, and 9:1 compound systems.
Lowers with scarabs, brake bars

Also redirects for anchors and tension lines.

Emily is secured into a litter - Purcell prussicks are used as chest and leg straps, girth hitched to her harness. A frost knot is used to attach the litter to the system.

Dimm Day 3

Today was another very full day! We worked on lowers with one and two person loads. We did a lot of physics and talked about strengths and safety is various systems.
Learned how to lower with atc's, brake racks. Built radium release systems for belays systems.

Salt Lake City: DiMM Day 2

So for this course I'm going to attempt to give more details about what we do each day. Hopefully I'll be able to keep it up most evenings:)  The day started out with some breakfast and some discussion and rope cutting. We fashioned a Purcell prussik system from 6mm cord and two other prussiks and a 10m cordellette from 8mm cord. Then we headed out to Storm Mtn to do some climbing. The name was fitting as it rained quite a bit while we were there. The locals swear it never rains - was actually quite refreshing and better than baking in the sun. Below are my notes from the discussion.

Andy demonstrating using a prussik on a second line as a back up

Mountain Rescue Philosophy

Characteristics of Systems-

Whistle test- Everyone could let go and no one dies
Critical point - no one critical point - redundant - if someone cuts one rope nothing catastrophic occurs

Speed- fast vs slow, time involved, pt outcomes, risks - Basically when you set up a system you have to take a lot of factors into account - is the patient's condition time sensitive? what additional risks with "quicker" system?
Safety- helmet, gloves, closer than 1 body length -requires a tether

Rescue Roles:

Main line- build anchor, operate system
Belay line - same
Edge - transition - protecting rope
Attendant - with pt
Leader

Dave demonstrating multiple types of anchors

Priorities- self
- team
- pt
- environ/ equip

Knots we tied:

Overhand
Overhand on bite - hard to untie
Overhand follow through - bend

Figure 8
Figure 8 on bite
Figure 8 follow through - Flemish bend

Double fisherman

Anchors:

ERNEST: Equalized, Redundant, No-Extension, Solid, Timely

Knot decreases strength by 30 percent

High strength tie off.

3 wraps and figure 8 on bite.

Wrap 3 pull 2 with sling
Wrap 2 pull 1 with sling

Tie cordellette with bolin

Tie double knit for master point for redundancy.

Once at Storm mtn we went over some basic rappelling technique and discussed backing up belays on a single line with an autoblock or prussik. We also discussed rappelling with 2 lines. With a partner they can rig a belay line, using a munter hitch off a second anchor, which they back up with a prussik. Or if descending alone you can back up the system with a prussik on the belay line. We tested out both methods on the rock.



Dave demonstrating ascending

Next we discussed ascending a fixed line. We set up a partner belay from the top and using the purcell prusik system ascended the rope. One waist prussik was attached to the belay loop and to the rope, the shorter purcell prussik (basically two adjustable loops attached to a bite of rope that becomes a prussik). This second prussik was used for a foot hold. So basically you stand on one leg, push the waist prussik up, sit down, pull the foot prussik up and continue on all the way up. A good work out!!! 



Me ascending with prussiks



 After going over some anchors we headed down to the Salt Lake City Sherrif's office and learned about about SAR operations in the county. Then it was back up to Brighton for dinner. More to come tomorrow!

Salt Lake City/ DiMM Day 1

On Saturday Sept 8th I headed back to Salt Lake City for the 3rd portion of the DiMM course through the WMS. The course didn't start until Sunday - so I had most of Saturday to enjoy the area.

Adam picked me up at the airport after an uneventful flight. After some relaxing and some lunch we headed up to Guardsman Pass for some mountain biking. I borrow his Niner EMD which was a lot of fun. I'll add the name of the trail later. It was awesome though because we rode past some of the areas I'd gone back country skiing during my avalanche course in February. It was really cool to see the same area in the summer - or almost fall I guess - as all the leaves were changing. Our ride was a bit more interesting as I got a flat tire - which didn't seem to be an issue since Adam had a spare tube - however after we used his 2 CO2's to fill it up - and all the air leaked right back out we figured out the spare tube also had a leak. Luckily (unlike me) he carries patches - so we patched the initial tube (looked like the classic snake bite pinch flat). Luckily some guys with a pump rode by and we borrow it. Rest of the ride wasn't too eventful luckily :)

Sunday before I had to be up at Brighton we went for a hike toward Blanche Lake. We sorta got a late start to the day - so didn't quite make it all the way to the lake. (3.7 miles and 2700ft increase in elevation) I think my lack of altitude adaptation (and probably fitness) didn't really help. Regardless it was a beautiful hike.

Sunday night I moved into my new accommodations up at Brighton Chalets. We had dinner together as a group. It was cool to see people I've met through prior courses - and even from other wilderness medicine endeavors. We discussed course expectations - and plans for the week.

More to come!

Beach!

While the DNC was in Charlotte my family (Mom, Dad, grandmother and Stephen) decided to rent a house down at North Litchfield. I had a couple days off at the end of the week - so Comet and I headed down to join them.

Luckily I have no real wilderness medicine stories to report. I did step on a sharp shell - and removed a small piece from my heel with some tweezers. Otherwise enjoyed the time running on the beach, riding a old rusted huffy beach cruiser and watching comet frolic in the water and then roll in the soft sand.

We had planned on taking stephen's hobie cat out - but weren't able to find good beach access.