Ooh, that looks painful. Can you walk on it?

Hypothetical:

You're on Bondcliff with one hiking partner. Middle of February, 12 noon, clear day, 10F, little bit windy. Your partner takes a tumble...snap, crackle, pop. Broken ankle. What do you do? Answers will vary because different people carry different quantity and quality of gear. What would YOU do? Details, please.

call 911---

I would call 911, if the phone worked and report the accident. Then . . .

I always carry a sleeping bag and closed foam pad so I would try to help them get to just below treeline, which is relatively close on Bondcliff. I would then try to get them set up in a spot where they can sit on the pad, in the sleeping bag. I would prop them up against something. I also carry a stove and fuel so I would leave that with them, with food and extra clothes. IF I had gotten through to 911 and given them our location, I would stay with the person keeping us both fed and hydrated until help got there, if I couldn't get through to 911, I would hike out and get help and come back in for them.

Did this happen to you ????

sli74

It depends. IMHO (and a non-medically or emergency trained one at that) a best guess would be to see if the person could move with my help – the goal being to get below tree line (not that far from bond-cliff proper).

If we could get below tree line and the person seemed to be with it enough to function enough to eat, and stay warm, I would likely setup a good windbreak or snow shelter, get them in a sleeping bag (or two), make sure they had water and food and try to go for help (with the goal of reaching another hiker who could continue on to Lincoln woods ranger station, or reach it myself).

Depending on how easy and the moving was, how much pain the person is in, and how much snow pack there is, I might try to move the person a little farther than just tree line (so they are out of the wind as much as possible).

I don’t know how I would handle the case where they are in so much pain they can’t move. :-o

I’ve heard you shouldn’t move someone with a broken bone, but hell, how long can they last on Bondcliff without being able to move to stay warm?

I guess checking for cell phone coverage would be easy to forget, but a good idea!

There's no point calling 911 until you've established the extent of the injuries, the resources you have with you, and formulated a plan. Assuming the patient isn't in immediate threat from the elements I'd first evaluate their condition with a thorough examination. (I'm going to assume the person cannot hike at this point.) Then, get them on a pad, more clothing, in a sleeping bag, etc. From Bondcliff summit it's not that far to good shelter, so I'd probably get them there as best we could, set up bivy/tent/shelter as best we could. If I had a stove (we should) warm up some fluids.

Depending on how many people we had and what communications devices we had, then I'd start formulating a plan. If we could call 911 we'd do so and give them the status and the plan. Extra folks (who would just be in danger hanging around above treeline) would probably be sent down for help/guide the rescuers/get out of danger after we appropriated what gear was needed by the folks staying with the patient.

Then, huddle down and conserve energy. Keep monitoring the patient's vital signs, recording them over time. If need be, start a fire.

-dave-

Lots of jokes come to mind....

... its just a flesh wound - suck it up.
... oh man, that's gotta hurt.
... man, you are so screwed.

Remember the #1 rule of rescue - don't make a second victim. I'd say layer up the rescuers but my own adeneline in these situations could keep a dead horse moving for hours. The real risk to me comes later.

Get the primary survey done in 20 seconds.
Get them off the ground sitting on a pad or their pack and into their emergency gear in less than 5 minutes. Use questions like, if I help you, can you sit on your pack? The real risk here is the environment not the broken leg.

Complete the secondary survey and determine the course of action then call or send for help if you have the resources.

Stats will show that your (his/her) chances of survival are not too good above treeline. Therefore, as mentioned by others, the priority is to stabilize the injury and get them below treeline quickly. I recall the prayer from "The Patriot" "Lord make me fast and make me accurate." (?) Hypothermia will creep up so quickly. If the shock spiral starts your screwed. It might be better to walk them out in pain. Pain and fear are great motivators especially when served with doses of confident reassurance.

If I can help them down with an arm over the shoulder, not loading the foot I would try this right off. Might even do it without splinting the leg but the "official" position is to splint first. I don't think I could make BUF splint it in the time I have in those conditions. Of course a roll of duct tape and a separated pole might do the trick in the time available though I usually carry neither.

That little steep part below the summit is the crux. Getting a leg injury down that would be tough. Too narrow to walk side by side. I'd like to think I'd improvise with my twin 5mm lines but in reality, I think I would do series of hug steps where they hop on their good leg. I'd go down first just in fron of them facing the slope and together lower them down to me. Definitely put on my crampons first. There is nothing that gives you the confidence that you get from stamping a 12 pointer into the ground.

Below treeline. Eat and drink and pee. Generally, broken ankle is a self rescue. Here I would beef up the splint and prepare for the walk/drag out. I would favor a travois drag set-up hooked up to my pack. With enough food and water I could pull that for days.

I had a similar training scenario in WFA and everyone died. The times I had rescues they all lived, but I owe that to the learning from WFA. I wrote an article about a winter emergency self rescue we did once and could post it if there is interest.

I evaluate his condition. You say broken. If he can walk with assistance I’d splint it, let him use crutches/hiking poles if necessary and help him get below treeline. Before leaving the ridgeline I would make contact with someone I trust if all I had was a cell phone. Let them know the situation and when to expect us at the trailhead and our route of travel. If we are not there by a certain time I would ask them to inform the Forest service of the situation. If the Forest Service/AMC wants to send someone looking to check our status if we haven’t arrived on time and I no longer have communications that is fine, better safe than sorry. Once off the ridge re-evaluate his condition (vitals, etc) and the chances of getting him out that day. If that isn’t possible then set up camp and see what it looks like tomorrow. I have walked on a broken ankle for a very long time and I’m a Winnie, it’s not particularly pleasant but it’s definitely not the end of the world. I am assuming that this isn’t a displaced fracture or an open fracture. If that is the case things would be done differently.

Keith

Every response so far is reasonable. Get out of the exposure, keep warm, continually check vital signs.

The only other things I would do is:
If it is a compound fracture, or out of alignment I would set the bone before splinting. (They are going to hate you.) Setting the bone may reduce bleeding and swelling in the affected area, but it is not likely to cause more damage than is already there. If the bone is sticking out, then you should wash with *treated* clean water and push it back in. You may be saving their leg as infection can set in quickly. I wouldn't set a bone without a WFA though.

If it is a femur break the person may be in grave danger of bleeding to death. You will likely not be able to move them. Their best bet may be for you to put them in the "recovery position" protect them from exposure as best as you can and go and get help. (If no cell phone) If you have contact with the outside world, then they will instruct you whether or not you should stay with them.

If you are asking these questions you may be a good candidate for WFA training.

-percious

The original question stated that responses would vary depending on gear carried. Let's assume a conscious victim, injury consistent with simple fracture or severe sprain in the region of the ankle, no other injuries.

What gear do you carry that would be useful? Does thinking about it lead you to think of additional gear you could carry?

For myself, I think I'm going to carry some extra twine (for lashing together a travois and/or building a frame for a wigwam-style shelter), and a small saw blade (for cutting limbs for said travois and/or shelter). And I'll be extra likely to carry a serious winter bag on longer winter dayhikes. (It's ten miles back to lincoln woods. With a bad ankle, that's probably twenty hours. A stop for rest will probably be necessary at some point.)

percious said:

Every response so far is reasonable. Get out of the exposure, keep warm, continually check vital signs.

The only other things I would do is:
If it is a compound fracture, or out of alignment I would set the bone before splinting. (They are going to hate you.) Setting the bone may reduce bleeding and swelling in the affected area, but it is not likely to cause more damage than is already there. If the bone is sticking out, then you should wash with *treated* clean water and push it back in. You may be saving their leg as infection can set in quickly. I wouldn't set a bone without a WFA though.

If it is a femur break the person may be in grave danger of bleeding to death. You will likely not be able to move them. Their best bet may be for you to put them in the "recovery position" protect them from exposure as best as you can and go and get help. (If no cell phone) If you have contact with the outside world, then they will instruct you whether or not you should stay with them.

If you are asking these questions you may be a good candidate for WFA training.

-percious

Click to expand...

It might sound like semantics but it really isn't for several reasons. Let me say you are not setting the bone. At best you are placing the limb into the anatomically correct position.

The other comment if it is a femur fracture then this has gone from a slight diversion in plans (a possible broken ankle) to an immediate life threat and entirely different plans must be made. More importantly than the femur fracture was how it happened. Usually you don't get femur fracture(s) without serious trauma to other parts of the body, including the head. If it is only a mid level femur fracture a traction splint would be needed before the spasms start occuring. That will make a tremendous difference in the patients comfort and significantly reduce continued bleeding. I'll avoid saying more on this so it doesn't go way off the topic that was originally raised. Of course if someone asks I'll be happy to put in my $0.02.

Keith

Great thread!

Well, As a solitary day-hiker, I'll assume I found the victim just after the accident. If my cell phone worked I'd call in the position and situation, then follow the instructions I would receive from the 911 folks.

If the cell phone did not work, I would first help the person down below treeline. I've broken both ankles a total of three times, so I'm sure the idea of freezing to death would be sufficient motivation for the victim to accept help and get down below treeline. They couldn't hike all the way out, but getting well below treeline should be easy. Either way, at that point I would give them all my food and water and extra clothing. If I hadn't yet changed out my sweaty under-layers to my dry ones, I'd make them change into those if their own under-layers were sweaty. I'd bundle them up as much as I could, then get them into my bag, and if they had a bag they would be doubled. I'd make a bed of boughs to insulate them from the ground.

Then, I'd tell them to hang tight and start hauling arse for Lincoln Woods to summon help, and let the experts take care of business.

I welcome any constructive comments on this course of action.

Happy Trails

forestnome said:

Either way, at that point I would give them all my food and water and extra clothing. If I hadn't yet changed out my sweaty under-layers to my dry ones, I'd make them change into those if their own under-layers were sweaty.

Click to expand...

I'd have a problem with this, as you may be creating a second victim by your actions. Never give away what you need to stay safe, warm, and well-fed.

-dave-

Interesting question!

I don't carry my cell phone with me in the winter. No matter where I put the thing (even inside my jacket) for some reason the cold seems to sap the battery (guess thats what the cheapest made-in-Korea phone I could buy gets me .) So for me calling 911 would be out of the question. So I guess I would be put in a situation of determining:

a) can I splint it and said person "reasonably" walk?

b) If said person can not walk, then do I feel I have the energy to carry this person out by making a travois (always carry my folding saw with me....ALWAYS .)

or

c) If I can get said person to "reasonable" shelter below tree line or as close to the Wilderness trail as possible, then I can beat feet out for help.

I have started carrying an Emergency Bivvy sack and Emergeny Tube tent shelter. I also carry a basic first aid kit and survival kit. With all these things I feel I could make this person reasonably comfortable should I need to leave them and go for help.

Of course, all would be easier if I had a PLB......but If I could afford one of those then I could probably afford a cell phone whose battery does not die once the temps drop below 32 degrees .

B.

NewHampshire said:

Of course, all would be easier if I had a PLB......but If I could afford one of those then I could probably afford a cell phone whose battery does not die once the temps drop below 32 degrees .

Click to expand...

Even if you had a PLB, it might be many hours before anyone arrives to help. You probably need to attend to this person's needs right now and for the next several hours. The cell phone or PLB won't help with that.

Wilderness First Aid Training

Great thread, really makes me think. I did a quick search for WFA courses and found this site for the Northeast:

http://wfa.net/index.shtml

Kevin

No one is dishing out pain killers? I read recently of someone walking out about 7 miles with what ended up being a broken leg.

I would call 911 as soon as a major ankle problem is determined, if you wait until you get into shelter you may lose coverage. For all you know, they may have an active helo exercise in the area and will want you to move the minimum necessary since they can't land below treeline.

One assumption that everybody has made so far is that the trail to Lincoln Woods is broken out. If there has just been a noreaster and you had to break a couple feet of powder to get to Bondcliff from Guyot campsite, there's no way you are going to walk parallel down the trail ~4 miles to Wilderness Trail. Probably too hard to lug them back over Bond unless they can walk, so all you can do is get them comfortable below treeline before you walk back the broken trail to Zealand Hut for help if you can't call 911.

It sounds good to drag them out yourself but even if the trail is broken it would be unrealistic for most people. At a minimum 911 could meet you 3 miles in with snowmobiles, not sure whether in case of emergency FS would allow them in Wilderness.

If the victim can bear weight, my vote goes for *keep walking*. However, that depends on the type of break and the bone(s) involved.

I, too, have walked a long way on a broken ankle, but it was "only" the fibula, which supports a mere 15% of one's body weight; the tibia takes the other 85%. The fibula is the smaller, outer lower leg bone. In my case the bone was completely fractured but only minimally displaced. Yes, it hurt but I was able to hobble out. Thankfully, it happened on a trail in Arizona in 70-degree temps, and thankfully, I didn't know it was broken until about a week later.

Now, if the bone's pokin' through, THAT's another story...

David Metsky said:

Even if you had a PLB, it might be many hours before anyone arrives to help. You probably need to attend to this person's needs right now and for the next several hours. The cell phone or PLB won't help with that.

Click to expand...

Quite true. By "easier" I meant that I would not have to walk out alone, with said hiker tucked away somewheres, since that means the time of rescue would be DOUBLE than if we hunkered down and let the SAR folks come and get us.

But honestly, this is why I would not do such a remote hike with only myself and another person. If we bring one or two extra people into this equation then we have just increased the odds that carrying said hiker out without waiting for any SAR help have just increased.

Brian