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Questions for Doctors about long bivvies?

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 mikedlr 13 May 2020

Next Tuesday we'll be running a session about “Medical dilemmas on long bivvies….severe headaches, black digits, the squits and more” which will be hosted on YouTube by the Alpine Club Library
I was wondering if anyone here would like something specific to be discussed or has any questions?  If you reply here I'll take it into the session for you or if you watch live on YouTube on Tuesday 19 May at 7:30 pmyou can ask questions via the chat (need to have a YouTube account which has a channel created to do that, but you don't need to have any videos uploaded). 

YouTube Link:  https://www.youtube.com/watch?v=aGiRckNzglE&

The session will be run run by a panel of four doctors expert in the area - David Hillebrandt, Chris Imray, Paul Richards and Jeremy Windsor.

http://www.alpine-club.org.uk/news/club-news/679-alpine-clubcast-7-19th-may-at-19-30

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 etsallen 15 May 2020

I believe in taking my home amputation kit - do you think the doctors would agree?"

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 nicks 15 May 2020
In reply to etsallen:

I guess we’ll find out!

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 Samseabass 15 May 2020
In reply to mikedlr:

I’ve heard you shouldn’t melt glacial snow for water due to micro particles of rock which can damage your gut? Seems kind of unavoidable. Be good to see what the Doctors say on this?

Second question is around which specific markers are most important to look out for if a partner is feeling sick or has a headache which could be altitude related and what actions can be taken if descent isn’t an easy, immediate option. 
 

Third question would be what do docs carry in their first aid kit on a day route. Most shop bought first aid kits seem excessive and full of pointless stuff you’ll never use. 

Post edited at 16:00
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 mikedlr 15 May 2020
In reply to etsallen:

Have to say that after hearing about Aron Ralston having to cut off his own arm with a pen knife ( https://en.wikipedia.org/wiki/Aron_Ralston - "it was not a Leatherman but what you'd get if you bought a $15 flashlight and got a free multi-use tool." ) I've often wondered. This thought got renewed recently after listening to a few too many "Sharp End" podcasts whilst driving. I do believe in dual use equipment, so my "home amputation kit" probably consists of a Petzl Spatha, a climbing sling as a tourniquet, a small amount of iodine from a first aid kit and whatever material for the blood - but how do you get through the bone??? What about a Victorinox saw? Is it good that the Victorinox climber is missing exactly that tool (compare hiker for example)  The other sharp gear I might have, an ice axe or a snow saw, probably just wouldn't cut it (groan). So what are reasonable other small additions to a standard climbing kit to make improvised operations possible?  What's realistically worth trying (amputating seriously bad frozen bits???) and what's better just left no matter how bad it seems?

We'll make sure the doctors get your questions for sure. 

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 althesin 15 May 2020
In reply to mikedlr:

The book explains in great detail the amputation procedure, it's good, he snapped the radius and ulnar, sharpened his knife on the rock a bit and cut the tendons, muscles, skin and worst of all- nerves

Post edited at 16:49
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In reply to mikedlr:

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 mikedlr 19 May 2020
In reply to David Hillebrandt:

Probably something missing from your post David?

The Wikipedia article gives some idea of the procedure already which is enough for me since I really don't see this as one to prepare for, but I have seen relief of blood pressure under nails (Spatha probably adequate - this was done with a very heated paperclip) and a few other small operations I guess it would be worth doing if stuck for a long time. 

From the Sharp End I've noticed that the American wilderness medicine courses for the public seem to be more extensive that the ones we have.  Are there any in the UK that cover "more advanced" home procedures.  I'm disappointed to learn that the ballpoint pen breathing method doesn't seem to really work  - https://uk.reuters.com/article/us-health-breathing-pen/forget-about-saving-a-life-by-plunging-a-pen-through-the-neck-idUKKCN0XP32Q  (Spatha again - they seem to suggest you need a scalpel??).

Since the advice in most cases seems to be "call us first"*, I guess turning up for the meeting tonight will be wise so that you can at least say you listened to their advice.

We'll close questions here around 18:00 tonight with the session starting at 19:30 ( https://www.youtube.com/watch?v=aGiRckNzglE&).  As I said before the questions on YouTube can come in during the live chat and will be answered extensively at the end of the session.

* From Reuters: “ Kamali said people should always call 911 first if someone is having difficulty breathing. / `Trying to perform this without any medical type of experience would potentially lead to consequences and failure,' he said. `It’s something I would not recommended people take on.'"  - not so useful if you are stuck on a glacier waiting two days for rescue like Tom in Alpine ClubCast 5 - https://www.youtube.com/watch?v=4dBXD3e-clI&

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 Frank R. 19 May 2020
In reply to mikedlr:

Ok, I'll bite, sorry it's not exactly bivvy related, but you have mentioned trauma and injuries yourself

It might be a bit speculative, but unfortunately it's somewhat based on a real story (the person I knew didn't make it)  

Tension pneumothorax. Traumatic injury at a semi-remote location without readily available local MRT but not any expedition (with a lifeline or doctor at basecamp). Say some remoter region of Caucasus or Balkans. Rockfall or fall, chest hit, broken ribs, perhaps multiple traumatic injuries but tension pneumothorax as the most pressing. No medical professionals at scene, it is not a "serious" expedition, just a couple of friends but partners have basic wilderness first aid knowledge. Feasibility of laic diagnosis, successful needle decompression and supporting the casualty, when professional aid is at least several hours to day or two away? Feasibility of the whole incident in the first place (i.e. just a freak stroke of bad luck or something slightly less rare)? Thanks.

Post edited at 17:17
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 mikedlr 20 May 2020
In reply to Frank R.:

Hi Frank

Your question didn't get answered in the main session but we did get into a discussion afterwards and I brought it up.  In my non-medically trained way I'll attempt to report what they answered - hopefully if I missed something important someone will correct.

The fundamental answer was that if your partner gets complex multiple trauma in a wilderness situation that's very serious and it's quite likely that the victim will die. There are procedures that a doctor can use to help but these just aren't practical without medical training, so "do the simple things as well as you can".

  • control any bleeding*
  • keep the victim warm (doctors mentioned that any drop in body temperature plays havoc with blood clotting) - giving them dry clothing
  • keep them comfortable and get shelter
  • ensure that they have controlled access to hydration and food where appropriate
  • provide emotional support and reassurance
  • keep trying to call for help

Then, if you can't get any support in, the victim will "either get better or die" - you shouldn't beat yourself up if they die, there's probably nothing you could have done. If they get better then you will eventually be able to evacuate them or get help. 
 

* from listening to sharp end podcasts I've learned that you should almost always examine the wound to treat it, cutting off clothing if needed. 

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 mikedlr 20 May 2020
In reply to mikedlr:

Apart from Frank's question, I think we got through most of the other questions that were put here and on YouTube.  You can find the live recording and some others on the AC Library YouTube channel - https://www.youtube.com/channel/UCgoaAomJnfVxyo62Rkkv76A. If there's anything missed that's important to you please do say. 

As far as the self amputation goes, the recommendation seemed to be access to a psychiatric specialist.  I can see how a chat with a psychiatrist would have really helped Aaron:

"hey Doc, do you think you could go to coverage and call the mountain rescue" / "Sure, I'll just get you comfortable then back in a few hours." / "Thanks that's really set my mind at rest." / "That's what we're here for. would you like some analgesics in the meantime? Given your slightly agitated state I think it's recommended?" / "oh, you're a darling".

There was one serious point in the video that for Frostbite amputation can and should wait given that the doctors can sometimes do really major reconstruction. The warning being not just that self amputation would be stupid but also that you have to be careful of local surgeons wherever you are.  The example was given of a person who had their frostbitten bones put "into their belly" for recovery ("revacularisation??") so they could be reused during a reconstruction giving them back most of the length of their fingers.

For notification of future lectures on YouTube you can subscribe to the channel or to the lectures playlist. https://www.youtube.com/playlist?list=PLQbmSqzPEpCESDWoKMRRYFDl155Qh4-0V

For further mountain oriented medical advice I'll point you to the BMC's free medical advice service on their website (aren't they great)

https://www.thebmc.co.uk/how-to-get-mountain-medicine-advice?s=4

Post edited at 10:58
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