by CAMERON McPHERSON SMITH
copyright 1996
INJURIES AND ILLNESS
Because nothing would be more tragic or indefensible than letting a partner succumb to serious but easy-to-treat injuries, you must know how to deal with some basic potential problems. Some say that a little bit of knowledge is dangerous. It's not that the knowledge is dangerous; it's just that people are lazy, or cavalier (or both), and convince themselves that a particular crumb of knowledge is universally applicable. One area where this just does not wash in first aid. Certainly you must be aware of the basic concepts, but just as certainly an aspiring alpinist must take some basic first aid instruction. The American Red Cross offers such courses everywhere and all the time; there are no good excuses here. Take one, and while in it consider how you would apply what you learn in a remote alpine setting. A list of other organizations giving courses is provided in the bibliography. A few basics are outlined below. They do not 'prepare' you for the mountains. In fact, it's better if they inform you just enough that you are compelled to take proper training (and they should; you are a creature of flesh and bone subject to the bothersome laws of physics, e.g. gravity). On most climbs, training exercises close to home, you really have little to fear so long as you climb safely and keep in mind a few basic potential problems. On longer, larger climbs, more isolated from help, you are extending yourself and knowing how to cope with injuries is critical - at least, those injuries treatable on a mountain with whatever type of first aid gear you carry. Consider your personal safety margin, as discussed in the section on The Ten Essentials, and prepare yourself accordingly. Problems Related To Cold
Frostbite
Low temperatures can freeze the very fluids of your cells. This is frostbite. Rest assured, it is as terrible as it sounds. Freezing most often occurs in the extremities, which are deprived of normal volumes of warming blood as the body conserves this to keep the core temperature up. This is easy enough to understand and protect against (usually) with proper attire. In freezing wind there is little practical defense against frostbite on the nose unless you choose to wear some type of mask; turn your head from the wind as you can. The fingers should be inside gloves, but this isn't much defense if you don't keep the blood moving; at a long, cold belay, or on a long cold lead, occasionally windmill your arms or otherwise work your fingers to keep the blood flowing. The blood in your toes should be OK so long as it is properly insulated (with good boots and socks) and is not prevented from flowing by tight boots, tight crampon straps or too many layers of socks. If you experience real pain in the extremities when it's below freezing, but there is still a bit of color in the tissue, you must assume frostbite is beginning. Warmth can be found in the blood-rich armpits and crotch, and you can bury your hands or toes here as needed. Gentle, controlled warmth is what you need, not the slapping, maniacal rubbing and pummeling of Hollywood. It is pure torture to rewarm this way, as the blood refills the capillaries and your nerves begin shrieking, but it's better than full-fledged frostbite. If your fingers or toes go numb and they appear hard and colorless on inspection you may well suspect frostbite has set in. DO NOT REWARM ON THE MOUNTAIN. If you do, and the tissues freeze again, the damage will be far worse. A person can make a descent (albeit clumsy) with numb, frozen digits, but rewarming of real frostbite is usually extremely painful and the climber will have to be helped or carried down - far more dangerous and difficult. Once you reach 'civilization', get to a hospital for proper treatment. In remote and expedition-style situations, you'll have to act accordingly. Hypothermia
While frostbite effects specific body parts, hypothermia is a much more serious condition which affects the whole body. Hypothermia is the loss of body heat to the extent that performance of bodily functions is impaired. Your body temperature can be lowered in four ways, illustrated in Figure XX. In climbing or other cold-environment activities, heat loss usually occurs by convection - the principle is illustrated in Figure XX. Convection heat loss can quickly - figuratively at least - 'suck' away a human life. You must protect yourself from wind and water, as discussed in the section in The Alpine Layer System. You must be able to identify the symptoms of hypothermia and treat the patient accordingly. Though each individual will exhibit different types and degrees of symptoms, hypothermia may be suspected when a person begins to feel cold (perhaps despite appropriate clothing) and has some change of mental attitude that seems odd to their partner. The hypothermic climber may also begin to exhibit clumsiness, slurring speech, failing at simple tasks and generally becoming ineffective at attempts to control their muscles. If things have progressed further (profound hypothermia), the hypothermic person may be found to be indifferent to self or others, ignoring tasks usually a habit. It is possible that they are simply unwilling to do any work, even if they appear to be able to help out; this can complicate diagnosis. If the person's heart rate is lowered, their breathing is shallow and they have stopped shivering, you have a major case on your hands. Those with mild hypothermia (e.g. have not yet lost all muscular control, are still somewhat functional and rational, though see the exception above) can be helped out rather simply. The key is controlled warming - don't go overboard in panic. Get the person out of the wind and cold. Give them warm (not scalding !) drinks, change their clothes if wet, and get them inside a warm sleeping bag. You may get in with them to provide extra heat, but keep the warm drinks flowing. Warm their abdomen more than their extremities, but keep an eye out for frostbite, which they may be developing as their body heat is already compromised. A profound hypothermic in a remote alpine setting is a grim proposition. This is because nearly any action by the 'rescuer' can cause the heart to attempt to resume normal activity, which it probably cannot do. The heart begins an irregular rhythm and soon expires. If the hypothermic climber is found to be immobile - due perhaps to being wedged in a crevasse - sudden exertion, rough handling or other stimulus to the heart can kill them as surely as a bullet in the head. At this point I must stop and ask you to spend the necessary dollars on Hypothermia, Frostbite and other Cold Injuries, edited by J. A. Wilkerson (published by the Mountaineers). If you digest the information in this slim volume you're doing yourself a major service. Do not climb without knowing it's contents upside-down and backwards. Problems Related to Falling or other Trauma
Damaged Joints and Broken Bones
Falling with a helmet and some decent protection on the lead is usually not physically injurious; the problem is that in alpine climbs decent protection is not always available, and falls may be long and rough. Minor cuts and bruises are just that - minor - and can be left to deal with until you get home. More serious injuries such as sprains should be dealt with by trying to prevent exertion of the injury, again until you get home and can deal with them properly. Broken bones are very serious as they may immobilize the injured person (causing problems in climbing) and can cause internal injuries (even worse). Broken bones need to be relieved from exertion, perhaps just by avoiding the use of the bone (I assume you'll be trying to get the heck off the mountain in such a case). If the pain is too great try a painkiller from your first aid kit and only then try to immobilize the wound with a splint. A number of splints made with climbing hardware likely to be carried by a light, two-person alpine team are shown in Figure XX. For more professional treatment you must seek training elsewhere. Shock
A fallen climber may be stunned or otherwise in shock. Depending on the circumstances you may have no choice but to move them before you can determine whether they have a back injury which could be complicated by movement. Just getting them down from their lead, or up to your belay (unless you can safely ascend or descend to them), can be a major operation. A person in shock may be incoherent or unconscious and have a weak but racing heartbeat. They may appear rather pale in the face. Once you reach your partner you must apply a few basics. Get the person warm with a sleeping bag or jacket or whatever is immediately at hand, but do not overheat them. You must now survey your partner for injuries and treat as necessary. First, look for back injury and weigh the danger of moving them against objective dangers (e.g. rockfall). Next, check that they are breathing; look for any airway blockage such as their tongue, snow, ice or rock. Next look for bleeding and stop it as you can. Remember that the tourniquet is for the most extreme cases only - for serious bleeding learn to use the pressure points and direct pressure. A bandage may be cut from the lining of your clothes.
There is no doubt that alpinism can be dangerous, but you have to remember that no-one is forcing you to stick your neck out. Go out, have a blast, and return safely even if it means quitting early. There's no shame in being alive. Problems Related to Altitude
Mountain Sickness
Up to about 8,000 to 10,000 feet most human bodies in reasonable physical shape will be able to adapt to the thinner air; but individual variation makes it possible for nearly anybody to get mountain sickness (the body being pushed beyond it's ability to adapt to thin air). The symptoms are usually headache, loss of appetite, nausea and a generally rotten feeling altogether. A preventative is to ascend slowly, giving the body time to adjust, but this is pretty unrealistic for the average person trying to get in a peak or wall over the weekend. If you're such a person the best defense is to be in excellent card-vascular shape; jogging, swimming or hiking can all help put you into condition. If you do get mountain sickness the most effective remedy is to descend to a lower altitude and more air. There are far worse conditions, such as pulmonary oedema and cerebral oedema, but I cannot discuss these here. Best to read XXXXXXXXXXX by Charles Houston and be prepared if you go to higher altitudes.
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