lessons from the camp fire in butte county

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I was on a large search a couple of weeks ago, and in the time spent wandering around the woods I had some time to think about solid ways to be found in if you’re lost or injured.

I spent 72 hours doing body search and recovery up in the Camp Fire‘s wake, and had some similar time to think about fires ripping through a town. What I would do when I got home, what I would do if a fire was coming close, and what things would look like afterwards.

campfire

To date there are 631 people missing in the Camp Fire. Our task was to search homes and vehicles for bones and bodies.

Fast Moving Fires are Faster Than You Think

What I didn’t understand about fast moving fires is that they move really fast. Not only towards your home, but also towards the road you were planning on using to evacuate. That road is also cluttered with vehicles. So are the dirt roads you’re imagining you can take to get around those other clogged roads. If thousands of people need to flee and there are 4 roads to get out on, a lot of people won’t get out in time.

With the right combination of distance, fuel, and weather, a fire 10 miles distant can be on your doorstep in a matter of hours. Like the fire could start 10 miles away while you’re buying popcorn at a movie theatre and burn your house to the ground before the credits roll.

And that assumes you were awake. If the fire is a lightning strike at night, it can move quickly before anyone spots it. Maybe you’ll have twenty minutes, maybe, if you wake up to the sounds of police PA systems announcing evacuations.

We’re Conditioned to Wait and See

Especially if you live in California, you’re used to fires burning somewhere in the distance and kicking up smoke. You know people who’ve lost homes but chances are that you’ve been fine, even when fires were a few miles away. The Lions Fire started burning about 10 miles from my house, and churned away for months. The Lost Fire showed up later in the year, also about 10 miles away, and likewise stayed put.

So my (and probably your) experience with fires is that they kick up smoke but you can live relatively close to them without much actual damage. We wait and see, which generally works, right up until it doesn’t. Once the fire is close enough to be dangerous, there’s simply too many people that need to leave. The fire doesn’t care about the traffic jam, it’s coming regardless.

Everything In Your Home Will Be Incinerated or Vaporized

We found metal socket wrenches welded together. Cast iron pans melted (requires over 2000f temperature). Cars drooping because their frames melted. Some of the 631 missing will never be found, completely consumed by the intense heat.

For the most part, homes were either entirely fine or entirely destroyed, and destroyed buildings make up more than 90% of the town of Paradise. We often needed to use Google Street View printouts to see that a house was actually in the lot we’re looking at because now it was a 6 inch high pile of ash. The terms other searchers used were “zeroed”, “wiped out”, “vaporized”, “war zone”, “obliterated”, and “nuked”.

Safes were melted, all metal was melted, all ceramic and glass melted or shattered. Plastics, cloth, and wood were entirely absent from the scene, entirely vaporized.

paradise-cars

The shiny stuff is the aluminum from the radiator which melted and leaked like water. Note the power lines in the background, draped on a vehicle.

Defensible Space Is Not a Panacea But It Works

Some of the intact homes had burn marks from wooden fences that abutted the home, or perhaps a dead-ish bush. Things that could readily catch fire and with direct connection to the home worked like kindling to ignite the siding, deck, or roof rafters.

One thing I didn’t personally see was an intact home that had a lot of plant debris littered about in the yards. Even if the home was metal, with the heat of a burning tree or bush a few feet away, it will radiate enough heat into the metal to ignite the walls and interior.

That said, I’m sure plenty of homes with defensible space went up as well. Just because you clear around your house doesn’t mean you’re safe, but it is the law in California and seems to increase your chances.

Make a List Right Now of What To Evacuate With

Start a spreadsheet and tape it to the inside of a couple of doors. Put on there things that you can throw into a couple of backpacks. Some items from our list that might be on yours:

  • Passports, cards, cash.
  • Laptop, phone, charging cables.
  • Firearms.
  • Underwear, socks, two pairs of clothes.
  • Empty all medicine cabinets and medication areas into a bag, bring the bag.
  • Keepsakes / jewelry that fit into a shoebox.
  • Handheld 2m radios, with chargers.
  • Both cars.

It’s not hard to grab these items; you could fill two backpacks inside of five minutes provided you have made the list earlier so you’re not having to think. Thinking capacity will be in short supply, do your prepwork now.

Realize again that if your home burns everything left inside will be incinerated. When you’re sitting there on the couch relaxing, now is the time to make the list.

Make a List Right Now of Evacuation Instructions

In addition to things to-take there are things you may want to do before you go. Again, here are some things on our list that may be on yours:

  • Put propane, gas, and other containers far away from anything that can burn. The far edge of your driveway, the middle of a large parking lot, etc.
  • Turn off the gas to your home. You know how, right?
  • Run a garden hose (not on) from the spigot to the driveway (firefighters can potentially use it).
  • Turn on all lights.
  • Shut all windows and doors, leaving them unlocked.
  • Move flammable items away from windows and doors.
  • Fill water buckets and leave them in the driveway (again, a firefighter or otherwise do-gooder might be able to knock down a small fire).
  • Put one 2m handheld radio in one car, the other in the other car.

Fill Out and Carry FEMA Family Emergency Communication Plan Cards

For more than fires, these allow you to do two core things now, while you have time:

  • Plan where you’d meet up with family members. First, second, third, and fourth options.
  • Have all contact information for your family members and necessary services written down.

You can get these over on FEMA’s site. If you think it’s a pain to figure this information out now, imagine what it’s going to be like in the few minutes you have before an evacuation. Worse, imagine trying to guess at family members’ decisions as an emergency is unfolding and you’re separated from each other.

Update Your Insurance

After the people get home to the utter and complete devastation of their physical possessions they will immediately be faced with the question of “what happens now?” Much will depend on your insurance. In particular this means:

  • If you’re going to rent an apartment or hotel in the short term, who’s paying for that? If you’re a homeowner, you’ll still be paying the mortgage on your incinerated home.
  • Does the rebuilding cost actually reflect how much you’re insuring for?
  • Have you inventoried your items? This can be a full blown app, or you just walking through your home with your phone on video, commenting on the make/model of everything that you see. Doing the app version takes more time, but it does offer the benefit of quantifying the cost of your possessions which you’re just otherwise guessing on.

None of the insurance items will take that long to complete but can be the difference between a big problem (losing everything with good insurance) versus one that you’ll never financially recover from (everything just gone).

Say it Out Loud: I Might Lose My Home and Possessions in a Fire

Death is something we intellectually know will happen to us and day by day we get a little closer to that magic day, hour, and minute when it’s our turn. But a lot of things that we could do to plan better (a will, a trust, advanced healthcare directives, etc) get punted I believe because no one wants to entertain the reality. And death is something that absolutely will happen to you.

You probably won’t lose your home and possessions in a fire, but you might. And accepting that reality, along with the few-hours of work necessary to safeguard yourself, is something that I guarantee a lot of residents of Paradise, Ca would advise.

before and if you get lost in the woods

Earlier this morning I overheard that a missing hiker we’re looking for has been found deceased. Unrelated, there’s an additional missing person we’ve spent a lot of time looking for. I got to thinking a bit about the major things that can really help if you end up in trouble, mainly from a perspective of a guy like me finding you.

searchingbrad

Me, out looking for someone, fall of 2018.

This isn’t a list a of survival items, although some things can serve a few purposes. This is the internal musings in my head and the collective wisdom of other rescuers I’ve spoken with in the many, many hours we spent looking. Often we say “you know what would make this guy a lot easier to find ….”

Cell Phone Coverage (or) A Spot/ InReach

If you have cell phone coverage or carry a Spot or InReach device, you can not only signal out but (provided sar teams know you have it) we can generally activate it from our side and get your position. Even without that, simply being able to track your device in your direction of travel can be huge. I personally use an InReach and our SAR field teams use them as well.

Someone Who Knows Where You Were Going

Be as specific as you can be. If you’re going to make choices in the field, tell them that. Whatever’s in your head, we want to know so we can try to imagine what you’re up to. Are you going to get to some particular thing come hell or high water, or do you have a backup plan? Just give us something to work with so we can tighten up our search areas and not just look at a huge forest and guess.

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Dead center is a teammate conducting a search. At barely 100 feet, in bright red with reflective stripes in mid day, he’s still not that easy to see. “Earth tones”, laying down, you look like a lump of dirt.

A mylar “space blanket”

These things are dirt cheap and somewhat useless at keeping you warm in truly cold conditions, but they have four excellent characteristics.

  1. They are noisy as hell. Secure one under some rocks and let a chunk of it blow in the breeze. The crinkle sound is distinct to other forest sounds.
  2. They are sort-of-shiny and visible to the naked eye. They stand out like a sore thumb in the sea of brown and green that is nature.
  3. Predator drones flying overhead can spot them fairly easily. Really.
  4. With half pinned to the ground with a rock with a good view overhead it makes a great eye-catcher for folks looking from the air and for ground teams crossing your area.

Whistle

Newer backpacks have crummy-but-okay whistles built into the sternum straps. Personally I carry (and put in my kid’s pack) a Fox 40 which is cheap (~$7), small, and truly loud enough to cause hearing damage so cover your ears when you blow it.

Someone who knows your shoe model and size

When you walk around, you change things. Some durable surfaces like asphalt might not take a print, but if you walk onto one from the dirt you might leave a dirt print on the roadway. When you hop across that creek and land on the soft material on the far side, chances are you’ve left a pretty decent print. But none of that matters if we don’t know what you’re wearing.

print

If you’re lost and I find this print, how do I know it’s yours? Give me a make/model/size and I can track you across a forest. Without that,  in a trafficked area your prints are in the noise of everyone else’s.

Non earth colored tones

My team was getting briefed the other day for a missing hiker. The guy giving the info out says “… subject is wearing olive pants, and gray shirt, and a dark green pack…. “. That’s perfect if you want to go into combat, but a searcher would basically have to walk right over  you to see you. Drop a shadow over you or some foliage and you blend in like a rock. Wear something with some color in it, a color that stands out in a shocking way. I have a light blue shirt, a bright orange CamelBack, and a bright orange beanie. My snow jacket has little neon highlights. My backcountry backpack has blue and green contrasting colors.

Try to wear something that contrasts against itself. Nature has a few bright colors but it doesn’t usually have sharp lines of bright colors contrasting against other colors.

flyboys

You don’t have to dress like this, but take a page from the book. Bright contrasting patterns really stand out.

Fire starting equipment

This doesn’t need to be much. Survivalist gear is neat but I’d trust a mini bic lighter and little fire starters all day long, wrapped in a zip lock. Yes, fires keep you warm, but they also smell. The smoke is visible from a long way off and if a chopper with a FLIR is looking for you it’s like trying to find the sun in the sky mid-day: not challenging.

Use a knife, or a sharp piece of granite if you’re really unfortunate, to scrape kindling from bigger pieces of wood.

Final Thoughts

None of this stuff (except the satellite beacons) is expensive. You could fit all of it in your hand and squeeze, and gear wise you’re out $20. So as a reminder:

  1. Text someone your plans when you go out, along with a picture of the bottom of your shoe with the make/model/size. If you’ve texted/emailed them the shoe stuff already, just stick with the plans.
  2. Bring a whistle, fire starting gear, and a space blanket.
  3. Satellite beacons are really handy not just for you but for other people in trouble you may come across.
  4. Wear something bright. You don’t need to look like a neon sign, but don’t do a great job of blending in, either.

it’s a long way down

“Down slow!” came out of my my mouth and I stepped backwards into the void with 800 feet of air underneath me. Since joining Mono SAR, I’d heard stories about Dana’s Third Pillar. It’s the name tossed around for one teammate to scare another.  The tallest climb in our county, it’s in rarified air as having exceedingly high consequences, requiring solid technical skills, and hosting weather that can change in minutes.

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That huge scary ass thing is Mt Dana’s Third Pillar.

Three hours before that, my phone rang. An automated voice recording came on going something like this:

Team, we have a callout. Report of an injured person on Third Pillar Dana. Please bring technical gear and Rescue 3. We’ll be staging at the airport for helicopter insertion.

In 21 minutes I went from sitting on my couch to being in a Ford F350 loaded with teammates and gear, barreling up the 395. Readiness and response times are critical: people call us when they’re hurt or otherwise in trouble. Getting the job done right means getting it done fast.

“Technical gear” means all the stuff for rigging. With it you should be able to lower someone, raise someone, lower yourself on a rope, ascend a rope, and create anchors. Not shown is 50′ of 8mm and 30′ of 6mm rope.

tech

My base technical equipment, aka my “RFR kit”, named after the Rigging for Rescue curriculum that we base our practices on.

We got to the airport and went through our briefing. How many people, who was hurt, the nature of the injuries, stuff like that. For these I always have a pencil and a pad handy because random tidbits of data fly out that you allow you to assemble a narrative, be it medical or perhaps trying to put yourself in a lost person’s mind. If they’re lost, what do we know about them and what are they inclined to do and not do?

If it’s medical, when did they get hurt? Did they report something on a 911 call that two hours later they don’t remember saying, perhaps indicating ACR or a more serious TBI? Stupid little things aren’t so stupid, and I’m not smarter than my pad and pencil so I write everything down.

3rdgoingup

My team leader ahead, we’re on Dana Plateau headed to the summit of Third Pillar.

We decided we could beat the chopper if we headed in on foot so we packed up and drove to the trailhead. The folks on my team move fast. No matter how fast you’ve ever seen me move, I have to use everything I’ve got to keep up with a few folks in particular. They kick my ass on the way up and can standing glissade on the way down.

3rdpillar

Me, going down. Someone was hurt about a 100′ below me. The boulders and snow are about 800′ down.

I balked at the idea of being litter attendant, which is the job shown above. You go over the edge, find the person, treat their injuries, attach them to our rescue system, and guide the whole thing back up again. I’m well trained on all of that, but the “going over the edge” for lack of a better term is just scary as hell.

On the walk up though I did the math. I had the most medical training, held the highest license, and had the most patient time. I had gone through five days of professional rescue rigging taught by the best of the best barely two months before. I practice this stuff. Two days before when camping with the kids we rigged a mechanical advantage system to pull a snag widowmaker down.

I stepped through every component of the rigging systems in my mind. What they should and would look like. I knew the people who’d be running them, and I have and would again trust them with my life.

I re-volunteered for attendant. I had a teammate who’ve I’ve done a lot with double check me. I double checked him. We do it in silence because solid systems setup correctly don’t need explanations.

The screaming in my head before I went over the edge was loud: neurons were ganging up like angry peasants with pitchforks and torches. Fortunately, all I had to eek out was, “Down slow” and my team lowered me where my own nerves probably wouldn’t. Once over the edge it was game time.

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My team on top of 3rd pillar, I’m over the edge coming up. Mono Lake and the 395 in the distance.

I’ve told my daughters that when things get hard you need to listen to that part of you that won’t quit, and tell all the other parts to shut up. The original line was “…the patient is the one with the disease…”.  In emergency medicine, you can say “The patient is the one with the emergency.” At that moment there’s someone hurt that needs help, I get to have my emergency later.

I stopped by Vons at midnight after I got back, bought a pack of frozen yogurt popsicles, drove home, and hopped back on my couch and ate the whole box. My PS4 game was still waiting for me where I left off.

a busy summer for mono rescue

This post contains graphic content. 

To quote Forrest Gump, Search and Rescue (SAR) is like a box of chocolates: you never know what you’re going to get. Like most first responders the bulk of SAR work is actually fairly mundane and uneventful. But 2018 has proven to be one for my record books. While last week’s volume has been high with nearly a call per day (and two in one day), they’ve also required some of our most advanced skills.

The Sheriff’s Office has clarified its policy on posting pictures so I feel a little more comfortable sharing some of the work we’ve done, hence this post.

chopperout

January 1, 2018: the year started with me getting hoisted out of a CHP helicopter. This would be the least exciting thing I did all year.

On the first day of January, 2018, we responded to a fallen climber. I’ve written about it previously so I won’t belabor things. Eight months later though I’m amazed that something so mind-blowing at the time (getting lowered out of a chopper to treat a heavy trauma patient) wouldn’t rank amongst the more trying moments of my SAR career.

rfr

Me, training, in the yellow gloves. Rigging for Rescue. Horseshoe Piles, Mammoth Lakes.

The amount of training I’ve been through in the last year has been nothing short of incredible. There is of course all the team specific training we put on ourselves. We build mechanical advantage systems and haul heavy loads across parking lots. I rappel off almost everything to learn the different friction feels of various ropes through various descent control devices coupled with different friction hitches.

But then there’s the formal training. Weeks in Alaska getting my Wilderness EMT. The five day Rigging for Rescue basic series. Stop the Bleed. It’s just a non-stop battering ram of advancement in technique, repetition, and locking it in with your teammates.

training

Hauling trucks around the parking lot, practicing mechanical advantage systems.

Most of us have been through training that we’ll never use. It’s rare that you learn something, get good at it, and then 24 hours later you’re using it in the field to save lives. But this year that’s exactly what happened.

mainfield

Mechanical advantage systems in the field, saving actual lives instead of moving trucks around parking lots. Less than one week after our most recent training on the same topic.

On July 29th, our team was dispatched to “a call from help” coming from the Conness Glacier. Trapped underneath roughly two tons of granite, a man was pinned with crush injuries. The same mechanical advantage skills we had been practicing all summer, skills designed to lift patients and rescuers up through vertical space, quickly transformed into a technique to precisely move thousands of pounds of granite.

connessrock

I debated about including this picture. But it’s hard to capture the real anguish for the patient and the urgency of our team in words alone.

glacierview

A small chunk of the Conness Glacier in the background, our team working at the base of Mt Conness. Many of those boulders are loose, including some that are the size of passenger cars, weighing several tons.

conness

Those mechanical advantage rope systems deployed again. I’ve got the blue gloves on, the patient draped over me.

Moving boulders off trapped climbers is not a skill practiced by most rescue teams, let alone something they’ll ever do in the field. Crush syndrome is one of those topics you learn in EMT school that is glanced over: it’s common enough in urban settings because of motor vehicle accidents but in that urban world a hospital is generally not far away. Having a crushed patient in your care for hours, no one needs to tell you that field amputation is a real possibility if your team can’t get the job done. Even if you can extract, the rhab-d clock has been ticking from the start with no mercy.

guardian

Extracted, our patient leaves the Conness Glacier onboard Guardian 2-3.

The call up on Conness in late July scrambled me a bit. It’s hard watching someone in pain, and harder still when the math is not in your favor. My teammate told me later that the rock is what hurt him, we saved his life. Intellectually I know that but the trauma, pain, and adrenaline of the whole operation (nevermind the part where we had to climb onto and off of a glacier ourselves) was a lot to process. The next day our team met up at lunch and disinfected our equipment.

subway

My teammate (and others) after a late night call last week. Laying on the asphalt, eating Subway sandwiches: heaven.

The next night I found myself in an elderly woman’s tent, 7 miles in, an IV bag hung ingeniously by a stethoscope (good work, H40 crew). Treating her, I was happy: she was not actively dying in front of me. My blue nitrile gloves were more of a formality than anything really protecting me from gushing blood or CSF. There was urgency and we needed to do our jobs, but compared to the last few calls this was downright pleasant.

The calm didn’t last.

ducklook

Me in helmet and goggles, looking at the helicopter hoist wire out of frame. NE of Duck Lake.

24 hours later our team would again be dealing with crush trauma, a call remarkably similar to the one from only a few days prior. Perched on rocky mountain top, an operation that most rescue teams will never perform played out with spooky deja vu.

alexcrush

Normally I cannot show a picture like this, but the patient has allowed it to be public.

Another aspect of SAR is that we’re all volunteers. Our day jobs sort-of care about our SAR responsibilities, but it gets old for them fast. In California we’re protected by the Labor Code, but you can tell it grinds on people when you leave in the middle of meetings or your coworkers need to pick up your slack. The first time or two it’s exciting, but eventually I’m pretty sure it gets old for them.

This isn’t getting into the impact it has to our families or friends, all of which end up being “SAR widows”. The phone rings, the world stops, and I’m out the door. I might be back in 10 minutes, 10 hours, or in rare cases 10 days. Emergencies are quite inconsiderate like that and while we have other good medical providers and riggers on the team, we’re a small team. In the second picture above, counting the guy taking the picture, there were five of us.

Five people to handle three mechanical advantage systems, extricate a patient, communicate with our base and the overhead choppers, and provide medical care, all at the same time.

The next day I went camping with my kids, happy to take a break from SAR and spend some time with two little people in the prime of their lives that weren’t suffering from massive trauma or medical illness.

While walking around Devil’s Postpile, my phone rang. SAR call: Devil’s Postpile, right less than a mile from where I was standing. A deputy that I work with walked the girls over to the ranger station and got them into the Junior Ranger program while I rigged a raise and lower system for the litter team, extracting a patient.

deputy

My kids wondering exactly where dad is going.

At the same time, an 8 year old boy was reporting missing in a remote part of the county, our team responded. The next day (yesterday), a patient was airlifted for medical reasons.

We were notified that our team will be covering a large portion of Tuolumne county because wildfire has shut down critical highways in their area, blocking their team from access.

Today is a new day and I don’t know where it will lead. I do know that my harness has my technical gear. My medical bag is restocked. The battery on my team radio is charged. The fuel tanks are full on our rescue trucks. Three gross Cliff bars that don’t melt in the summer are zipped back into my pack.

And I know I’m lucky enough to work with a team of professionals that I would and do trust my life with more often than I can count.

 

the vt prusik max over one, 6 over 1, 5 over 1, etc.

As a disclaimer, I’m not a professional rescue rigging instructor. I’m on a sar team and do the work and often I’ll need to understand something myself more clearly. Breaking it down step by step I can share that process with others, and maybe you can benefit from it too.

Before you put your life or anyone else’s life on a rope system you should (seriously) get professional training, including about any topic I’m showing you.

Basically the single vt prusik on a twin tension system can replace the tandem prusik belay (TPB). The TPB seems great except that it’s nearly impossible to maintain that level of focus for an entire operation. Slack and user error get introduced early. You can watch professional rescuers in training screwing up the TPB all day long. For years SAR teams have been comparing the twin tension with TPB model and it’s not hard to convince folks to move to twin tensioned vt setups.

Studies and videos show a critical problem of the TPB: long catches. Falling 8′ before the prusik arrests your drop can be the difference between you dropping into a ledge and decking, not to mention the dynamic load that is created and transferred. You can run a single asymmetrical (shown below) vt instead of two normal prusiks because with a normal prusik only half of the six loops are really holding the load. So two normal prusiks are needed to actually create six grabs. With an asymmetrical vt you get all but two loops to grab, coupled with better heat tolerance.

In general, a better is a twin tension system with a single vt prusik on both the main and the belay.

vt1

Step one. Start at the anchor side and keep wrapping towards the load. The amount of wraps you’ll make depends on the vt’s width and the host rope’s width.

vt2

Take the longer (load) end, and wrap it around as such.

vt3

Tuck the longer (load) end under the bar you just made, and pull. Dress it down, make everything tight and have both eyelets equalized.

A couple of other notes from my own research.

The VT Prusik is a brand name of Blue Water Ropes and cost ~$30 a piece. It is not acceptable to use some other sewn-eyelet cords and imagine them as VT’s. The studies you’ll read about are unique to Blue Water Ropes’ product so unless you know what you’re doing, stick with Blue Water. It’s about the material, strength, grip, and temperature rating: switching to random sewn eyelet cords does not give you that.

Conveniently there are two colors, tan and black. The 7mm is only available in tan, but the 8mm comes in tan and black. Make your life easier and buy 7mm tans and 8mm blacks so you can grab one and know what it fits.

The 8mm VT fits 9mm ropes and above, and is basket rated at 29.5kn.

The 7mm VT fits 8mm-9.5mm ropes, and is basket rated at 22.6kn.

Four VTs on your rack now cost you $120. But consider that the end-to-end rating of an 8mm is 20kn, allowing it to be used as an extender, basketed for quickdraw, etc.

my sar medical bag

I was having a discussion with some folks about this topic so I thought “hey Eric, you should sit on your ass and write about it, bro.”

I really think buying medical equipment that you’ve never trained on is a bit silly: it’s akin to buying random tools at the home improvement store thinking “well you never know, I might just need this rivet gun one day.” Everything I carry is something I’ve used in the field or at home, and was part of my training from either basic first aid, my WFR, or my WEMT. When some dude is bleeding in front of you is not the time to stare at the piece of gear you got from Amazon and try to figure it out: take a class.

Also, our sar team has its own medical bags which I often use instead. We have a “first out” bag which carries basic airway, bleeding, and assessment gear. We have O2 tanks we can bring in, litters, vacuum splints, etc. But there’s only a couple of bags and if we’re on a search or otherwise not in a simple “the single injured person is at coordinates xxx.yyy, sss.tttt”, I don’t like running around in the field with my own personal wimpy backpacking first aid kit (my team’s minimum for me personally). Also, I use this for my family and keep it in my truck for whatever randomness the world provides.

medfront.jpg

I have allergies so I use unscented deodorant. TheMoreYouKnow.jpg

For starters, you can see it’s pretty small. The bag itself is sort of a piece of crap but it works and if something breaks on it I won’t be sad.

medopen

It’s not the size that counts. -_-

I put the stethoscope on top because I didn’t like how it was getting bent inside the pack. If I’m going to use it I’ll throw it down my shirt while I get other stuff ready so I’m not freezing someone to death with a 0 degree piece of plastic on their skin.

medlayedout

Not bad for a little bag, right?

So here’s my list of what’s in there, trying to group things:

Assessment, since you can’t fix problems you don’t know about and handing off patients to paramedics/hospitals with a “I dunno” response makes you rightfully look like an idiot.

  • BP cuff. I keep a pediatric at home and if I needed I can toss this on a kid’s thigh and get X/palp with a pedal artery.
  • Pulse oximeter. Handy not only at altitude up here, but also gives you a pulse nice and easy so you can move a bit quicker.
  • Thermometer. Temple and forehead, I won’t lie: this is mainly for home use with sick kids. It also doesn’t work under 50 degrees F.
  • Stethoscope. Getting good lung sounds is pretty important for diagnosing HAPE, pneumothoraces, etc.  Plus you can say “auscultate” which is pretty tight.
  • Pupil light. More often than not I use it to read something or stare down a patient’s throat.
  • Emergency Spanish for Fire/EMS. Small booklet, but good luck doing anything if you can’t talk to someone.

Bleeding. For the most part, by the time a sar team gets to you a massive arterial hemorrhage isn’t going to be treatable. Most sar responses are well outside the golden hour, but that doesn’t mean all hope is lost. Also, I have this kit with me in my truck and have been to enough motor vehicle accidents to know that I can actually be there fast enough sometimes, even if just in a good samaritan role.

  • Tourniquet. Spooky and dangerous, these are actually back in vogue and for my training was the preferred mechanism of stopping an uncontrolled bleed. Refer to your training for usage and ischemia management.
  • Gauze. One roll because if you need more than one roll you need like a million, or a tourniquet.
  • Triangle bandages (x3). So these can double-duty as crummy gauze.
  • Bandaids. Sometimes it’s just that easy.
  • Povidone iodine pads. In my WFR training (where you may not have sterilized water) these little bastards can be squeezed into a water bottle killing off germs and making a diluted wound irrigation fluid that won’t harm skin.
  • Medical tape. Good for taping gauze/stuff down on wounds. Also good for deadlifting days to put on your shins so the bar doesn’t cut you up when lifting heavy. #SubtleBrag

Airway. This is actually fairly legit (in my opinion) to carry because for sar you tend to have long carry outs and if homeslice loses consciousness things can go bad quick.

  • I used to carry a whole mini-fleet of OPAs but a single NPA with a lube pack is way lighter, smaller, and more versatile. Yanking an NPA out takes a second and if someone is U on AVPU I’d rather have an NPA in than an OPA. Pulmonary aspiration of vomitus is a big deal with scary high death rates.
  • Valve mask. More applicable to motor vehicle accidents and random urban life than sar.

Medications. This is all about your protocols, your prescriptions, your scope of practice, and how much liability you want to handle. Again, some of this stuff is for me and my family’s use: do your own math and consult your training.

  • Aspirin, chewable 81mg. If a patient is having a heart attack you might just save their life or add a decade (or more) to their clock.
  • Diphenhydramine. Allergic reactions are common and life threatening ones aren’t the rare rainbow-unicorns from twenty years ago.
  • Electrolyte tabs. It’s pretty normal to find people exhausted and cramped up. An hour’s rest, some electrolytes, and fluids can make the difference between walking someone out and carrying them.
  • 500 MG amoxicillin (x6). Not for sar, but if on an extended trip into the boonies this buys me two days of bacterial combat to get them (or me) handed off to higher care.
  • Prednisone. Again nor for sar, but I’ve had my own life saved by this stuff so I keep it on me.

Doo-dads. Rounding out the edges, things that are handy.

  • My protocols, written down, staring at me in the face. It’s so easy to get carried away in the moment.
  • Pencil, rite-in-the-rain EMS vitals sheet. Use some of that medical tape to secure your notes to an unresponsive patient’s leg.
  • Gloves, cloth mask. BSI, PPE, scene safe! I put gloves everywhere so there’s no excuse not to wear them. Open the top pouch: gloves. Open the waist belt pouches on my frame pack: gloves. What’s up my butt? Gloves! Gloves everywhere, baby. Combined with a sharpie you can make cool balloon animals for kids with gloves too.
  • Tweezers.
  • Trauma shears. Nothing says “I care” like cutting someone’s $300 GoreTex pants off of them.
  • Vet-wrap for stability. The colorful stuff that you see on a horse’s ankle is called “vet wrap“. Dirt cheap, multicolored, and self-adhesive. You won’t be sad if you never get it back.
  • Triangle bandages. They come with safety pins and can double duty as gauze or making slings/wraps.
  • Burn gel. I’m not into most goofy creams and ointments but burn gel really does work and people really do burn themselves.
  • Antibiotic ointment (speaking of goofy creams). I know most hospitals like to work on non-gooey wounds so this isn’t really a sar thing. But if you’ve got a dirty environment and a couple of days until definitive care I can’t see this as a bad idea.

So there you go, that’s what I keep with me most of the time. Starting back at the top I recommend that you go out and get your training: WFA, WFR, EMT, RN, MD, DO, witchdoctor, alternative Eastern healer, whatever. Just learn how to treat others and yourself and equip yourself with tools for jobs you know how to do. Otherwise you’re that dude with an inch of dust on your rivet gun and no idea when or how to use it.

Oh, and a word about batteries. For my sar radio I have a six AAA spare battery pack in my pack, made up of lithium batteries which are really your only option in the cold. My pulse ox has two lithiums in it at, put the thermometer is so limited I keep the batteries out and just pop them in if I’ll use them, which is normally at home with a sick kid.

i still hate heights

Any official operation we do as members of search and rescue is run by the Sheriff up here, and as such I can’t really talk about specifics. Also when I’m touching a patient both out of HIPAA and general decency I can’t talk about the person(s) involved very much. You can read up on the official story  with officially release details, and the Sheriff released this video for public consumption. I’m down there on the bottom.

So this story really isn’t about the rescue as much as it’s about what it’s like for this particular guy to get a call on my phone and find myself in a world that I’m still coming to grips with.

For starters, the part you don’t see in the video is where my buddy and I got lowered out of that helicopter, by a little wire, with all our packs and gear, onto those rocks, a half hour before that.

So let’s backup a bit to the point where I found myself at a lonely municipal airport, geared up: harness, mountaineering boots, helmet, goggles, radio, full pack. The helicopter crews start to rip the gear off slowly but surely: all the excess weight must go. Seats, spares, everything. Hauling my teammate and I up into the mountains takes a lot of power and to carry us the rest must go.

I’m surrounded by paramedics, the CHP flight team, other SAR members, and law enforcement. Radios crackle with updates, and I’m noticing that this all seems totally normal to them.

A little voice gets into my head:

It’s time you come clean and tell these people that you have no business here.

I try to shake it off, just figuring it’s the jitters. The pilot does his last fuel calculation and we load in. Sitting on bare metal, clipped to a bolt on the flooring, and holding onto the back of the pilot’s seat (the only seat left), the blades start slowly whirring.

leavingearth

My buddy and I in the back, red helmets, taking off.

The voice comes back, trying to bargain with me:

You’re on the team and technically you’re trained for this but this is the real deal. The is the stuff you see on Youtube. You’re not that guy. You’ve managed to get here, but you’re not supposed to be. You better tell them they have the wrong guy.

A classic case of imposter syndrome, I was feeling it in earnest. Putting myself on the couch, was it actually imposter syndrome or was it my deathly fear of heights scrambling for leverage? I even got worried that my feet would fall asleep being crunched up on the chopper floor. Wouldn’t that be hilarious: rescuer tumbles out of helicopter because his foot fell asleep.

I first decided to get into search and rescue, bluntly, because my daughter’s life was saved by a team like that. Maybe knowing that I’ll never be in the incredible PJ squad has me always feeling like I’ll never really be “enough”, and that it’s a cast of heroes that do the real work and my place is more centered around getting them coffee than being on the the pointy edge of the spear.

laurelhill

This was the first fire truck I ever ran a call on. Laurel Hill, Norwich, CT.

The first time I ever responded to a 911 call I was 18 years old running code 3 to a motor vehicle accident (“mva, car vs motorcycle” in dispatch parlance). I distinctly remember the feeling of “Oh shit, there’s no one else coming, it’s just us.”

I think for the average Joe Citizen when you call 911 you imagine this Hollywood-esque crew of Dwayne Johnsons rushing towards you, equipped with everything and flawless. But when you’re the one getting the 911 call it’s a very different story. You’re aware of your shortcomings. You’re trying to remember everything from your training. You’re trying to be aware of the things that won’t let you stay focused. You’re trying not to get hurt yourself but really you know you took this job because you wanted to help people and a bit of risk is part of the package.

LeeViningFall

My team and I, doing our thing, in the middle of nowhere.

The voice kept talking to me, but I went back to that realization I had as a teenager: this is your job and people are relying on you. If you don’t want to do this, quit later, but for now do your f’n job kid. You trained, you have a solid team that will back you up. They’re relying on you. The patient is relying on you. He’s hurt, he needs your help.

The crew chief hooked me onto the hoist wire and unclipped my tether. The spitwadded toilet paper in my ears did its best to muffle the rotor noise. I don’t remember going over the edge, but I do remember looking up at the underside of the AStar helicopter, dangling from its hoist wire: RESCUE was written in large, bold letters underneath it.

Touching down on the ground, I unhooked the wire. Meeting up with my other teammates we got started on our jobs. I don’t know if I’ll ever feel like I belong in this work, serving with these amazing people. But I sure as hell will try to keep up with them, not let them down, and take care of my patients. The voice in my head can quiet down and take a number.