Re: Wilderness Emergency Preparedness/Communications/Training pt.

(CAUTION: LONG POST)
There are several key safety issues involved in "high-adventures" in
isolated areas.

As has been discussed in other posts, preparation for and ANTICIPATION
of potential problems is absolutely imperative. It is my experience and
observation that many of the tragedies that are experienced are often a
result of insufficient preparation or education about risk factors on the
part of leaders and youth. So many things can go wrong as a result of
natural hazards (such as lightning, rockfall, whitewater, floods, etc.).
Add to that the physiological impacts of sudden illness, injury, etc.,
that create an adverse "domino effect" resulting in tragic consequences
we often read and hear about. Naturally, when it is a Scouting event, it
gets far more press than non-Scouting events which suffer a tragedy, might
receive. Statistically, Scouting trips still have one of the best safety
records of any youth organization in the world, but risks are always
present.

Any one countermeasure which might be invoked in this "chain of events"
can be enough to mitigate or reverse the progression of events. However,
lacking those resources, the end result can be catastrophic.

Obviously we are dealing with statistical probabilities, and in some
situations, no matter how well prepared you are, "mother nature" has the
advantage, and we "mere mortals" are going to suffer the consequences.

In Scouting, preparedness is our "watchword." But we don't always do all
we can to fulfill those obligations. Yes, you can "nitpick" an outing to
the point of saying, "well it's just too risky, so we aren't going to even
attempt it. But maybe that's not all bad. So here are a few ideas about
invoking effective countermeasures to mitigate risks:

1. Strategic planning:

Reach out for experts with the resources and extensive
experience and expertise, preferably who have been where you are
going. If they cannot go on the trip with you, get them to share as much
of their experience as they can well in advance of your trip. If you
don't have access to experienced persons, call Forest Rangers, National
Park Service Rangers, et al, and get in-depth information on the area you
plan to travel. Ask in-depth questions about "what-ifs" to try to
anticipate weather, natural hazards, physiological/environmental risk
factors.

2. Failsafe plans:
As with any trip, map out where you plan to go, camp, and return for each
day, and make sure every leader and member knows the plan. Be sure that
someone at home has all this information, and can serve as a "callback"
point in case of emergency, to contact other parents, request search and
rescue if the group doesn't return on time, as scheduled, etc. Be sure
they have copies of vehicle descriptions, license plate numbers and names
of everyone in the party. This information can be invaluable to public
safety agencies seeking a "lost" group or individual. Give your plans to
the park/forest rangers/ local mountain rescue or law enforcement agency
so they already know where/what you are doing and what to expect if you
have a problem.

3. Shakedowns:
Do small "conditioning trips" to be sure everyone can physically keep up
with the rigors and demands of the trip, and to better assess their
equipment and skills; This gives an opportunity to "fix" things before the
"big trip." It also greatly helps group dynamics to see who the real
leaders are, and who might be "problems" under some circumstances.
Reflecting with the Scouts and Leaders after each shakedown allows
everyone to benefit from the experience of each member and to better
understand what problems may arise and how best to deal with them.

4. Tabletop Exercise:

With as much information as you can gather, sit down with the Scouts and
the adult leaders, and carefully go over the routes, discussing hazards,
risks, and asking for "what if" scenarios for each eventuality that might
be anticipated.

examples:

1. Crew Leader John Smith gets giardia, too sick to hike out, what do we
do?

2. Scout Leader Joe Jones has chest pain and breathing difficulty, ten
trail miles from nearest phone or ranger station.

3. Scout Timmy Tenderfoot is stung by a bee and has an allergic reaction
on the trail, with 5 trail miles to the nearest road or phone.

4. The "desert rat" patrol's canoe hits a rock and rips a hole in the
side so big it can't be repaired on the river. We don't have enough canoes
to carry their gear and them too, and the closest landing is ten miles
downriver.

Research has shown that such "preparedness exercises" often give the
participants some good "mental preparedness" to react to real situations
calmly and effectively which can save lives and avoid panic.

EMERGENCY RESPONSE ACCESS:

Then we need to consider fallback. Previously, it has been thought that
"preparedness will always get us out of a serious situation." True, it can
mitigate most things...but if you have a serious, life threatening injury
or illness, the only measures which can be undertaken in a field setting
with first aid skills may not be enough. The lifesaving "golden hour"
from time of injury to time of delivery to a trauma center, in serious
trauma situations can only be achieved through rapid contact with
emergency services, response of aeromedical helicopters, and evacuation to
level II or I trauma centers for definitive care. Beyond that "hour" the
probability of surival diminishes almost exponentially.

Communications which are effective and reliable throughout the course of
the trip, then become the only means of access for such emergent
situations.

So how do you find effective communications?

CELLPHONES

Cellphones have limited effectiveness. Unless you have taken one or more
of them to the area, and tried them out in most of the areas you will be
in, you are not guaranteed to have coverage. Sometimes, in mountain
settings, you may have to hike to a high point to "hit" a cell site.
Cellphones operate at frequencies in the 800 mHz range, with low power so
are limited to "line of sight" access to cell sites. Other problems are
often associated with battery life and failure of electronics.
REDUNDANCY is critical. Having multiple spare batteries, more than one
phone, and phones with different carrier companies that you know to be
functional in that area is essential. Contact your service provider to
get a "footprint" map of their service area. More than likely unless your
high adventure site is close to a major interstate highway or populated
area, cell service will not be available or reliable. Cellphones do NOT
work well in canyons, so don't count on them. In fact, most
communications equipment that is portable does not fare well in canyons or
where obstructions exist. Going to a high point such as a peak or ridge
will almost always enhance communications access for any type of
equipment.

SATELLITE CELL PHONES
Satellite Cell phones are available and certainly are the most reliable
method of communications anywhere in the world since their "footprint" is
essentially anypoint visible to a "geosynchronous communications
satellite." The drawback is that they are expensive, and not everyone
has access to them.

GPS Locators (Geosynchronous Positioning Satellite Locators)
GPS receivers are becoming less expensive and can be most valuable for
transmitting exact latitude and longitude coordinates from the point of
where assistance may be needed. Mountain Rescue and Civil Air Patrol can
effect very rapid responses when such coordinates are transmitted by radio
to the emergency communications centers. Often you can borrow one for a
trip from a business or government agency.

HAM RADIO (two-meter amateur radio)

HAM (amateur) radio is probably the best and most reliable alternative in
the two meter band. Many extensive ham radio repeaters cover many
mountainous and isolated terrain areas from high locations. Extensive
"patching" capability and comprehensive monitoring by amateur operators
provides reliable communications and access to emergency response
providers. Scouts and leaders can get a "no code" two meter ham license
rather easily by taking a training course from local "ham clubs" and
taking the "novice" and then the "no-code" tech license exam. Cost of
high quality hand-held two meter portables from various vendors such as
Radio Shack, Uniden, Kenwood, et al is very reasonable; and worth it's
weight in gold, if you have an emergency. Redundancy is still critical.
Multiple batteries, and multiple radios are needed for reliability and in
case the group gets separated. These radios are so light and small that
they are not any burden at all to carry.

Radio communications for coordinating trips, travel, getting help for
breakdowns or "getting lost," informing others of
changes in itinerary is absolutely essential and can save much lost time
and frustration while en route or returning from a trip. In some cases,
equipping a vehicle with a high power mobil radio and having the hiking
group check in periodically with "base" can alleviate a lot of problems
and greatly enhance coordinating for pickups, food drops, change of plans
and most of all emergencies that may occur.

There are those who say "keep high tech stuff out of the wilderness
experience." Unfortunately, this view while aesthetically pleasing, is
potentially very dangerous for reasons already discussed. So long as the
trip goes well without "complications," the need for "high tech"
assistance is minimal. But for those times when it is necessary, it may
be the difference in life or death! If nothing else, it can save you a
lot of lost time and coordination problems when "murphy strikes" and
things get weird.

TRAINING:
You cannot get enough! Remember that if you are going to be responsible
for the health and safety of Scouts, you need to do everything you can to
be ready for eventualities. This includes not only extensive first aid
and CPR, but additional training in "Wilderness first aid" techniques.
There are a number of good Wilderness first aid books, one by William
Forgey, M.D., that are packable, and give excellent references for
everything from minor first aid to field medical techniques and
medications that can be lifesaving. However, the book alone won't do it.
Many outdoor programs offer "wilderness first aid modules" in addition to
regular first aid courses just for that application and are well worth
taking.

EMERGENCY RESPONSE TRAINING COURSE (RED CROSS)
You need to take a comprehensive first aid course such as the new Red
Cross "Emergency Reponse" course. It is the next highest level training to
EMT and takes about 50 hours. But it is well worth the time and
experience, because it give you much needed in-depth knowledge of
assessment, obtaining emergency assistance, and rendering in-depth care.
It is vastly superior to the shorter 8-hour "community first aid/cpr"
courses which are now the minimum requirement for BSA leaders on camping
trips and high adventures.

The training is not just for leaders! Scouts and Explorers absolutely
should take this training. I have been teaching this course to our youth
for the past two years, and they really respond well to it. Many adults
have commented that they would almost rather have the Explorers rendering
emergency care because they are so good at it!

Just as you need first aid/cpr, you also need wilderness survival and
light rescue knowledge. Courses such as those offered by "Papa Bear"
Whitmore and the National Outdoor Leadership School (NOLS) or Outward
Bound, et al; are extremely useful. Similarly, if you are doing aquatics
on rivers and lakes, under BSA aquatics regulations, you need "Safety
Afloat/Aquatics Training and ideally, experienced leader(s) with
such abilities. It goes without saying that aquatics requirements must be
strictly adhered to. A moment of exception such as a Scout not wearing a
life vest on a river trip, can result in tragedy. This is one area where
a "no-nonsense" policy must be rigidly enforced and Scouts and Leaders
must be made aware that violations may be fatal, and the "lesser penalty"
may result in them being sent home forthwith. While negative
reinforcement is not the ideal in Scouting, it can be minimized by showing
Scouts video-tapes of the force of moving water and how river-rafters and
canoeists without life-vests have been tossed into moving waters and
quickly drowned in hydraulics or other hazardous situations.

This "real world" experience can be quite sobering, without causing fear.
It is often aid that "knowledge is power" and the ability to educate
Scouts and leaders about anticipating and preventing risks
with proper equipment and procedure will go a long
way toward enhancing safety awareness.

COMPREHENSIVE MEDICAL KITS:
Consult with physicians, especially those with outdoor medical experience,
as well as EMT's/Paramedics, and get them to help you design a good field
first aid kit. Remember that first aid kits are more than bandaids, and
aspirin. You don't need to carry a "portable emergency room" with you but
there are some key medications and equipment that can be lifesaving in a
field setting. Dr. Forgey's book provides excellent lists for this area.
Some medications are by prescription only, but may be essential to your
kit. Ask your physician advisor to give you a prescription and a
notarized letter giving you "standing orders" to administer those
medications to the members of your trip. Be sure you are trained by the
physician and that he is comfortable with your ability to administer such
medications.

GET GOOD MEDICAL HISTORY AND PHYSICAL EXAMS FOR ALL PARTICIPANTS
Be absolutely sure you know what the medical history and susceptibility of
each member of the trip may be. The high adventure physical form is a
must. Be sure to note any allergies to insects, foods, etc., and other
pre-existing medical conditions such as asthma, heart condition, etc.
Designate Scouts and Leaders to be "medics" to deal with those issues.
DON'T put all your "eggs in one basket" by having only one person trained
medically. Remember the military adage, that sometimes "the doctor needs
a doctor." So you better have several layers of fallback in case your
resource becomes a victim.

KNOW WHAT THE LOCAL EMERGENCY RESOURCES ARE AND HOW TO GET THEM QUICKLY
Check in advance about mountain rescue, whitewater rescue, medical
helicopter availability, and local hospital/trauma center
resources/ambulance services. Don't "assume" that those services are
always close by and readily available. Generally they are, but you need
to know for sure. If not, consider options to compensate.

Part 2 will be sent in the next posting to follow:

I heartily concur with another post which paraphrased an adage to "plan
for the worst and expect the best, and you will not be disappointed."

It would be most interesting to have additional input and discussion on
these topics from others who are similarly experienced.

Bob Amick, EMT-B, Explorer Advisor, High Adventure Explorer Post 72,
Boulder, CO, and Longs Peak Council Exploring Training Chair

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