Thursday, 31 July 2014

Pull the Trigger!

Failure to pull the trigger is a big problem. Easilly refilled systems allow you to practice or at least pull early without fear of time and a monetary refill penalty if the slide does not propogate. A consequence reduction tool - but only if there are no terrain traps, and trauma will always be an issue. Better to avoid getting avalanched by good planning and choices but a good additional insurance to have on your back.


Clinical Paper

The effectiveness of avalanche airbags 

Abstract

Aim

Asphyxia is the primary cause of death among avalanche victims. Avalanche airbags can lower mortality by directly reducing grade of burial, the single most important factor for survival. This study aims to provide an updated perspective on the effectiveness of this safety device.

Methods

A retrospective analysis of avalanche accidents involving at least one airbag user between 1994 and 2012 in Austria, Canada, France, Norway, Slovakia, Switzerland and the United States. A multivariate analysis was used to calculate adjusted absolute risk reduction and estimate the effectiveness of airbags on grade of burial and mortality. A univariate analysis was used to examine causes of non-deployment.

Results

Binomial linear regression models showed main effects for airbag use, avalanche size and injuries on critical burial, and for grade of burial, injuries and avalanche size on mortality. The adjusted risk of critical burial is 47% with non-inflated airbags and 20% with inflated airbags. The adjusted mortality is 44% for critically buried victims and 3% for non-critically buried victims. The adjusted absolute mortality reduction for inflated airbags is −11 percentage points (22% to 11%; 95% confidence interval: −4 to −18 percentage points) and adjusted risk ratio is 0.51 (95% confidence interval: 0.29 to 0.72). Overall non-inflation rate is 20%, 60% of which is attributed to deployment failure by the user.

Conclusion

Although the impact on survival is smaller than previously reported, these results confirm the effectiveness of airbags. Non-deployment remains the most considerable limitation to effectiveness. Development of standardized data collection protocols is encouraged to facilitate further research.

Keywords

  • Avalanche accidents
  • Mortality
  • Safety equipment
  • Burial prevention

Sunday, 27 July 2014

Overtime, or is it Over Time!

As Fiona prepares to leave BASP for pastures new, she has been going through some old ZIP drives and found some old stuff of mine.  Here's a wee article she found about a rescue team training day which was followed by attending a rescue on the Cobbler for a climber with a serious head injury. Apologies if its a bit rough and naff but I was just learning to write articles.

This was my first evening at JSMTC.  It's kind of freaky finding the article today as I have been drafting a future Blog post about the way I feel JSMTC is responding to my partial retirement and the actions of line management. On the day in question in 1998 my line manager was Capt. Glynn Shepard. A great bloke and one of the best  line mangers I have had the privilege to work under at the centre

OVERTIME
How about a Canyoning training practise suggested the leader (John).  O.K says the team, where?  Let’s get a chopper and fly into the gorge above the German camp Kinlochleven at the end of April suggests the leader.  O.K we say.  Two Sundays later we have an interesting day with me a bit twitchy as I start a new job at 7.00pm that night.

It all begins at the new rescue centre.  We meet, and as usual plans are laid back.  Rescue 137 arrives to find a semi comatose bunch of ex hippies and thrusting youth ready for action.  Wet suits and other apparel are donned by John who has a cunning stunt in mind.  We land amid the alder clad brush above Kinlochleven in a scene that would do justice to the classic Vietnam chopper book “Chickenhawk”.  Paul Moores decides to climb into the gorge and simulate a broken neck.  Rudimentary belays spring up all around as a variety of MIC’s and prawn fishermen try to assert who is best with ropes.  The result was functional rather than aesthetically pleasing, and a truce was called.  Paul is packaged ready for hauling when a shout is heard and John  falls backward over a 20’ raging waterfall and disappears off downstream.  John reappears some 30mins later wondering why nobody went to his aid as this perhaps wasn’t a planned exit?
 
John Greive about to jump into the River Leven up at "The Worlds End" pools to add a bit of spice to the scenario
Much hauling and cursing sees the casualty transported to a clearing in the wood and all 15 of us pile in for the flight back to base.  Coffee and biscuits later, the winchman runs in to find John as they  “have a job” and need 2 team plus “the medic” - me.  In we pile.  Ronny, Paul Moores and I.  No word yet from RCCK as to where the job is.  We fly over the by now wet and gray hills southward for 30 mins.  Word is the casualty is in a serious condition after a long fall . We fly up through the mist to the ridge which leads over to the casualty and spot figures waving frantically. The chopper lands on and out we pile running along the ridge and down to get to him. 

We find the casualty on a grassy ledge 80’ below where he fell.  He is very injured and needs to go to hospital quickly.  He is unfortunately surrounded by doctors and nurses from a medics hillwalking group.  Many pale anaemic doctor types looking 16 but probably 30 years begin to be assertive in the company of us aliens from the sky.  Diagnosis’s abound.  It soon becomes apparent that none are as slick as they thought, and good old fashioned naked aggression from us seems to get things back under control.  As a peacemaking gesture the oldest looking of the bunch was given the cannula to put in.  This he did with gusto, but when he seemed perplexed as no blood came out the end it became apparent that unlike the cannula, he wasn’t the sharpest tool in the box.

The casualty  was quickly packaged and carried down a little way till the chopper could come in and lift him.  After this the helo landed again on the ridge, and after a sprint back to get on board we were winging our way to The General Suffering hospital in Glasgow. 

After a 15min flight we landed on what appeared like a Tesco car park miles from the A/E entrance.  Winchy and I disembark with the casualty onto the back of a flat bedded van with two gum chewing pirates dressed as nurses on board.  I am met with  “ah like yer truss jimmy - musta been some party”, referring to my state of the art Petzl guru harness.  After a short journey we entered the A/E and do our handover.  The casualty has spinal injuries as well as a pneumothorax and pelvic fractures, so all in a good bit of teamwork  between SAR crew and MRT, we feel chuffed. 

Some time later  I need a pee.  Wandering around I see a doppelganger - bugger me, its Ronnie!  “How’s it going Dave? I’ve been wandering around for ages.  The choppers gone to Glasgow airport with Paul.  How are we going to get back home?”  I see a clock and its 5.00pm.  I start at 7.00 so it looks like a bad start in my career as an honorary soldier.  Several phone calls later the Police agree to take us to the airport.  The police duly arrive and drive us like the clappers through Sunday football traffic to the airport police station.  Good news is that I can phone wifey to say I may be late for tea.  “Where the ****k  did you say you are!”  she says incredulously.  Bad news is that they won’t allow us onto the airfield to look for the chopper unless we get searched.  So, off we go in our S&M kit with all the dangly jingly bits, accompanied by sniggering from the pale anaemic wee jimmy’s who think their smart. 

We eventually get ushered to a small departure lounge and meet up with the SAR aircrew.  It seems that such is the paranoia about terrorism that despite having a big yellow budgie with RAF on the side, and flying suits/helmets etc, that they also had to be body searched and they are not amused.  Beep goes the body scanner again - ****k it goes Davy.  Off we go then, eventually, and try and find what is a big  ****k off helicopter in Glencoe, but which looks like a wee budgie when we eventually find it among some 747’s.  We eventually get on board and ages later get permission to taxi out among the giants.  We take off into the gathering gloom and fly North West down Loch Lomond.  After 50 mins of juddering and shivering we land back in Glencoe where a  quick shave and change sees me racing off to start my new job.

I’m in the door at JSMTC at 7.00 exactly,  and sort out the gear.  First student in is most unimpressed by the gloomy weather,  and a bit ratty.  His first words to me;  “fuckin ell mate - must be fookin boring stayin in this place” - Great joy at being paid overtime in my new job, and having had a nice wee day out, I said nothing.

David Gunn
April 1998


Back in the day when I could cannulate invisible veins on hypothermic patients and get some opiates onboard.  Hundreds of theatre hours don't prepare you for shutdown patients who still need analgesia.

Wednesday, 25 June 2014

Glencoe Bike Hire and Family Cycling

Route 78 which we link into from the village is proving ever more popular as links are joined.  It must be one of the most scenic in the UK and is so accessible from the various entry points and link cycle paths along its length to Oban.
Looking up the Pass of Glencoe
Beside Loch Achtriochtan in the Pass
Family friendly, with a beautiful smooth surface along most of its length. The views over Lochs Leven, Linnhe and the Firth of Lorn are stunning. Some run out of steam after circumnavigating Loch Leven and others make their way past West to Highland Titles and its paths, or all the way around Port Appin and even Lismore.
Coeffin Castle on Lismore.  Lord of the Rings
Cycling is a great day out for the family on Route 78
I am getting bike hires from quite a few folk getting the early bus up to Glencoe from Buchanan St Glasgow then hiring bikes to explore Glencoe and its local cycle paths up to Clachaig, or orbiting around then down to visit the NHS centre, then travelling down the cycle route, stopping for lunch then coming back to take the evening bus back.
North shore of Loch Linnhe over Corran.  Stunning views
We are really lucky to have such family friendly low cost activities in our area. Bike hire £20 a day and enjoy all the area has to offer.
Tea Shop at a Village Hall for a well earned rest
The Loch Leven circuit by hire bike from Glencoe and you get views like this

Wednesday, 28 May 2014

Bike Hire to Discover Glencoe

What better way to explore one of Scotlands most famous glens. On the main Citylink bus route it's possible to arrive on the morning bus from Glasgow or Edinburgh and bike all day visiting historic sites or just chilling down the cycle track getting a feel of the landscape and sea. We have geocache treasure hunts and places for families just wanting an easy cycle trip.


We provide maps of places to visit and know the geography, geology and history of the area very well indeed and can help you find places to go by bike.

Day bike hire from 8.30am until 17.00pm £20.  Half day hire from 13.00 until 17.00 £15

Multi day hire discounts and group discounts for larger groups

Easy trails and paths to Discover Glencoe and surroundings

Friday, 23 May 2014

Avalanches, PTSD and Talking

Forgive me if the dates are out for the events below. 36 years of this shit melds one event into another a bit, and I didn't keep a diary. However my memory is imprinted with the thoughts and things that happened, and what's below is a snippet of bad things and perhaps the only ones that could be written about, as others are too bloody messy. I hope it helps those who are struggling and makes them realise they are going to be ok as they are normal.  Take care your families need you whole.
Incidence of PTSD after being avalanched
I have been reading a book on trauma. Not physical trauma but the trauma of stress and anxiety from a normal person being exposed to an abnormal event and having major psychological issues often years after. Dealing with disasters such as Lockerbie the RAF has an excellent and pro active approach, and the struggle to come to that point after generations have refused to acknowledge this form of trauma is at the heart of the book. The common term these days is PTSD.

Reading this book evokes many memories for me, and in particular some not very good ones. While I no way would say that I saw or dealt with anything like a big air crash, I had my moments finding friends dead, watching friends get killed and removing pieces of what used to be someone from debris of one type or another, including helicopters. These moments were overcome with the support of friends, family and mainly my stoical and loving wife and immediate family. We the rescuers get MBE's and at least some acknowledgement, but in reflection I don't know how the partners our immediate debriefers put up with it as there is nothing there for them but hassle. They are the real heroines and heros or medicine and rescue.

In 1990's the UK medical profession was still burying its head in the sand about PTSD and certainly in civilian MR to have acknowledged a problem was not the done thing. At that time I was very much the main medical provider in the local MRT and in my first year as deputy leader. This had been the worst period I could ever recall for a series of fatal accidents and very serious injuries. I had become a full BASICS member and done their PHECS and doctors advanced trauma/medical courses and had already done the first pilot Scottish ATLS course under Ian Anderson at the Victoria Infirmary. With A/E electives, and ambulance service placements on the first Paramedic response units in Dundee and Motherwell via the Scottish Ambulance Service.  I already had 20+ years of attending accidents under my belt.  But the winter of 93 onwards were a succession of putting into practise many new skills for the first time, including the first use by an MRT of a defib. Pain was treated by IV opiates, and that winter I decompressed my first tension pneumothorax and also got a Royal Marine resuscitated who went on to live a meaningful life. His name was Simon Kapong. You remember the names of the success's. It's easy, as there sadly aren't very many!

Winter 93/94 was a difficult year for us as the team imploded which divided loyalties over leadership. It came through with a new start and new leadership, but the stress's had taken a tole and there was a cost to good folk who didn't deserve to be hurt. That summer was as busy as the winter, and as autumn came early at the end of September the mountains already had snow. October we were at a helicopter crash involving aircrew from PGM that we all new well having worked with on films for Glencoe Productions. It  had a rotor strike on the hill above Ballachulish. I will not forget finding a pair of legs sticking out of the peat in torchlight. When the snow came in depth two folk were buried in an avalanche and dead in Summit Gully. Two weeks later after four day search we find a young man dead in an icy gully after a bizzare series of events involving a "medium".  She turned out to be correct in the location! Then the traditional Xmas and New year "come up and get me" flashing lights, followed by severe winter blizzards leading to extended road closures. At this time I was working as the solo ski rescuer/patroller at Glencoe Mountain on weekdays, so was often rescuing skiers by day and climbers by night. Fiona and I had previously worked in Europe as ski instructors before deciding to settle and start a family.
Doing this stuff and going home to your family as if nothing has happened is not "normal"
John Greive was the leader of the team from 1993. John is still the Glencoe teams leader to this day. A very good mountaineer with an intimate knowledge of Glencoe, John has strong instincts and quickly these gut instincts ring alarm bells if things don't feel right. A lot of lives have been saved because he has run with these. John and I made an unlikely pair as the new leadership. I was very opinionated and a bit of a "bull in a china shop" and we didn't always see eye to eye. I can honestly say that he is an exemplary leader. Often last off the hill or last onto the SAR helo to get off the mountain until sure his troops are safe, and willing to fight any jobs worth who interfered with patient care or caused delay in someone getting help. Victims sometimes need that kind of advocacy in mountain rescue. Cut through the bullshit and bureaucracy and get them help then deal with any fall out later.
GMRT in action at an avalanche BEM. John Greive Team Leader
So, when in February 1994 John is on the radio saying a group (who were not climbers) had walked up into the entrance of  the access corrie to the Buachaille and not returned, and the wife of the missing is at the Kingshouse and it doesn't feel right to him - then believe me you stop eating your tea and take notice. A father, son and friend had gone for a look up into the Corrie and not returned. The preceding days the head wall had been loading but climbers had come down it, and as its a couple of thousand feet to the entrance then maybe, we thought, the missing folks were just stuck in the dark.

A group of us including Steve Kennedy, Pete Harrop and Malcolm Thomson were in the lead with Hughie, Wull and Kenny Lindsay and others behind. We went into the entrance gulch and were in broken wind slab avalanche debris, then worked our way up to the little re-entrant that comes down from the Dwindle wall side. I was all for getting stuck in and starting a spot probe search. Steve stopped and said he wasn't happy and I remember saying "come on lads lets just get stuck in" when Steve said "listen" and then shouted "avalanche!" I hadn't heard or seen anything, but folk were scrabbling up the rocks out of the gully and I followed suite although at first it seemed surreal, but the big roar and huge blocks from a  monster of a  slide roaring past and up the sides like the tide lapping our feet as we scrambled up soon made it seem pretty real. Steve's instincts saved the lives off about seven Glencoe MRT that night. We jogged off the hill high on adrenaline and retired to Clachaig for a dram.  We were shaken badly by how close a call it had been. A lot of wives and kids nearly lost their partners and dads, and as deputy on scene I should have been less complacent.  It was that close to tragedy its hard to believe we got away with it, and one of those things we thought best kept quiet as it was so nearly a further big tragedy to what now apparently lay beneath. Next day we were up the hill again, and the slab debris had about 40ft of hard wet frozen snow debris on top. Hard to probe, hard to dig.  The RAF MRT came and helped and put in a huge amount of work trenching. Due to being fairly near the road the TV crews could access the scene so we were under there watchful eye. Four days of hard work and we had to give up as it was too deep.
Adrain "Hands" lands an anti sub heavyweight CAB on the A82 to take us to an avalanche BEM 1992. 
Before the big ones!
A few days later truly a massive blizzard strikes, roads are closed and we get a call that three climbers are missing from Curved Ridge. Although folk will talk about the snow of winter 2014 that one in the 90's was the worst I have ever known.  We parked the yellow rescue trucks bang in the middle of the A82 at the Kingshouse junction and land SAR 177 with Adrian "Hands" as pilot.  I was first on as observer up front with Ronnie Rodger, and we fly around the mountain on what was a blue sky morning with feet deep snow covering everything.  John suggests we fly the East face "Ladys Gully" side and we see nothing, but I get "Hands" to overfly the Chasm which you could have skied down.  Devils Cauldron was filled level. Snow depth for that about 180ft (that spring it was fun to climb up the 180ft snow chimney and the back wall of the Devils Cauldron). We got winched out below CB at about "Pontoon" the rock climb, and start to zig zag the slope when Ronnie finds a glove then a few feet further down a crampon. We know we are on the right track and call up the team who included Mick Tigh who offered his climbing clients as spot probers. After a couple of hours Tony Sykes who was then in his first year in the team shouted he had found something. He was right under the rocks of CB. Blue sky's had gone and we were now in a blizzard, but in about an hour had dug out the three victims all on top of each other in a tangled mess of trauma and equipment. The following day early morning I am back up to the ski rescue and passing the Buachaille and looking across at where the other three other folk are still buried and it clicks that at any point in the next weeks/months John or I will get a call to look at something nasty in or poking out of the snow. Something happened at that moment and I still remember it. Like my happiness switch being switched off and a knot in my stomach.
Living next to the vehicles gave me the task of keeping them clear. 
Often 3 or 4 rescues each weekend in the 90's. Pre mobile phone.
The wife of the missing father and son came to stay in a Bed and Breakfast just around the corner from me, and was waiting for us do do something when the thaw came. The local vicar was very good with her, and I take my hat off "chapeu" to the local Police, in particular Sgt Kenny Lindsay who acted as her link to what was happening. Knowing she was waiting on resolution was a constant burden for her and for us. Meanwhile climbers fall off and get killed, injured and skiers break bones including the UK head of marketing for Sainsbury's who breaks his back on the Fly Paper and who I have to deal with. Thankfully he made a good recovery, but not many folk get a private ambulance to the airport for transfer to a spinal unit - no pressure on the medic!  It was a fantastic ski season, not unlike the one past but with more sun and 6 weeks of skiing back to the car at Glencoe

The RAF teams have an odd probe of the big tip over the coming weeks, but nothing is found. Then one day early April a walker phones the Police as he says he smells something.  John calls us out and though there is no smell (maybe we are used to it) we have a poke around as the level of debris has reduced by about 20 feet. We find victim one at a depth of 2 meters. An hour later and a bit away we find number two. Number two's recovery something happened inside me. I didn't get upset by physical trauma having seen plenty (and suffered some myself) and had by this time been on the recovery of well over a hundred fatal victims just in the mountains never mind the other stuff I can't share. Yet I stayed for the next hour until we found number three at the very spot we had been standing the night we all nearly got buried. This wasn't a troubling scene visualy, yet somehow it broke something in me as there was a big pocket or space around the victim. I dropped my probe, didn't speak to anyone and just walked off the hill. I crossed the bridge at Lagangarbh and the local undertaker had three grey fibreglass coffins open with the lids laid at the sides leaning against the stock fence at the side of the path. I glibly remarked that trade had been good this winter. Three weeks later I got a donation of £350 for the team in the post from him.
GMRT Stalwart Walter Elliot and the late Alan Findlay digging deep
I walked past the coffins, up onto the road and thumbed a lift to Clachaig where I got pissed on Scrumpy Jack and had to be taken home. What Fiona, Esther and Duncan made of this slobbering drunk I have no idea, but I can just recollect Fiona laying me on the couch and taking off my boots and covering me with a blanket. At some point in the night I tried to get up to bed and fell down the stairs breaking all the pictures on the way down. What patience and tolerance my family must have.

I moved on from the above (I thought) and until five years ago was still involved in MR and dealt with many more horrific events including people burning in helicopters and finding another two climbing friends (Dougie and Bish) dead. It all diminishes you, but by that time I had a better coping mechanism and new about debriefing, and the pub and team get together's and socials helped my colleagues and me.

I was fortunate that from 1994 I had many good friends in the team who were not frightened to call me an arse if I got it wrong and support me as I supported them when some events became overwhelming.  You know who you are - so thanks guys.  It wasn't until I left the rescue team which was in Jan 2009 after yet another triple fatal avalanche where I found the last victim by probe that I realised that since 1994 my happiness button had faulty wiring.  In the intervening years folk would say of me at times that I was a driven man.  I would drive myself into the ground physically running and racing my bike and seemed to cope with the extreme stress of life and death decisions, yet I would get random  anxiety attacks over very minor things. My local GP sent me to speak to someone who over a few months talked me back over things until a light went on that my head was telling me I had been feeling like undertaker in winter, not a medic. This of course wasn't the case, its just that somehow an event, an image and a period of time had imprinted that thought. With rethinking and knowledge of this  faulty thought imprint I was sorted, the light back bright and I was released from a thinking trap that winter equals death and loss and often even pre winter psyching myself up for it. Stangely it didnt affect my climbing because I was in control, so the lack of control over when a tragic event might occur was obviously subliminaly there all the time.
When it  all works and a life is saved then it's worth it
Was this PTSD?  I don't know. What I do know is that dealing with nasty things has a cost. It's all very well being in a rescue service, but you are also volunteering your family for it, and they are the foundations for you at the sharp end. Don't take that for granted, and make sure they get recognition and be sure to be aware of colleagues who might struggle. It's not a weakness. It's simply not normal to deal with abnormal disturbing events and not have a normal reaction. When youre head's sorted you can still deal with tough shit and know you are normal.

Why am I sharing this now? Winter 2013 was a nasty one for avalanches. The emotional toll on some of the rescuers dealing with the avalanche that took our cycling buddy Chris has hit some folk hard.  Even as a ski patroller there was no avoiding the toll with the loss of Danny and the events both leading to this, and the toll on friends and ski patrollers after.  I had my own complacent re visit of the white room and an injured hip and spine to deal with, but had the time to be an ear to listen to folks and easilly conclude that 2013 would fuck up some folks.

2014 has been the shittest winter weather I can recall in a while although paradoxically the sheer volume of snow made everyone wary, so despite the most recorded avalanches at least no one died.  The baggage of 2013 like a rollover lottery carried over though, and I think its time we all recognised that it's human and normal to suffer after abnormal events. Help is out there and books like the one mentioned de mystify what happens to us. Maybe if "Heavy" and guys like me are more open about it then the subject gets an airing and folks who are struggling can get the support they need.

Trauma. From Lockerbie to 7/7

A newer local MR rescuer said to me this winter "all you do is run around looking for beepers - what do you know about digging up avalanche victims".  Not a lot I said, other than it requires no brains. Avalanche education and prevention gives me more satisfaction.

Post Script.
I realise this blog post makes uncomfortable reading.  It certainly wasn't comfortable to write and in no way felt like an exercise in navel gazing. It has been a work in progress from 2013 when a member of a local MRT came to see me very troubled by some events.  Then another had a tough time with depression, and in the meantime a few folk couldn't put some events behind them and every conversation was dominated by a specific avalanche event.  This winter another person has struggled to the point of needing help as a rollover from the same event.  My purpose in this blog post is to show there is nothing wrong. That asking for help is not a weakeness and that your family can only take so much and give so much.  Help is available but has to be sought. If not for your sake then the families. To not be troubled by the pain of misfortune from the loss of young lives -  now that would be abnormal!