Hi there, everybody. Welcome to another episode of the Cloudbase Mayhem. We've got a different show for you today. About a month ago, actually, when this comes out, it would be almost two months ago, I was over in the U.K. doing a little film tour with Cross Country Magazine and Ed Ewing and did a couple classes with Jocky Sanderson up at the Lakes District at his place. And I got a great ride. One of the guys in the class, Matt Wilkes, gave me a ride from the lakes back to Edinburgh and put me up that night for my flight the next day to Sweden. And on the road, I learned all kinds of fascinating things about high altitudes and what Antoine Girard and Tom de Dorlodot and those guys, Horatio Lawrence, are doing over in the Himalaya. Matt studies high altitude physiology. He's got some really cool projects that we get into in the show, but he's also an ER doc.
I've been on a lot of expeditions, especially in the mountains. That's kind of his expertise. We thought it'd be really interesting to talk about trauma and assessing a casualty and how to fix people up and how to behave in a wilderness and remote environment, what you need to have in your first aid kit, what you need to be studying. If you're paragliding and going into remote areas, what you need to know, what you can do to be part of a successful rescue and retrieval operation. And getting people back to safety. So we talk about a lot of things in this podcast that I think is just incredibly valuable for our community, whether you're a hang glider, paraglider, base jumper, or you just play in the mountains.
Matt's an anesthesia and intensive care doctor. He lives in Scotland in Edinburgh. He specializes in extreme physiology and remote medicine. He has practiced in Nepal, Bolivia, and New Zealand and honed his remote trauma skills as a flight physician. For the East African Flying Doctors, picking up casualties in countries including Somalia, South Sudan, and the Democratic Republic of Congo. Really cool background. He's been a lead doctor or medical advisor for multiple expeditions, including the largest group ever to camp on the summit at Kilimanjaro. Matt is the director of Adventure Medic Magazine, holds a master's degree in mountain medicine, is a fellow of the Academy of Wilderness Medicine, and is currently undertaking a PhD studying the interaction of altitude.
Matt won a golden badge for a World Cup, and we're very proud to have him at our office. He has had a couple of articles recently cross country about the studies he's doing on Tom and Horacio and those guys in the Himalayas. You may have seen, he's had a couple of articles recently cross country about the studies he's doing on Tom and Horacio and those guys in the Himalayas. Fascinating stuff, I think you're going to really enjoy this. A couple items of housekeeping before we get into it. You know we're doing this giveaway for the blue fly burial, I've been calling that the blue sky burial, I'm sorry to Alistair down in Australia. And I've given away one of my DALORM units, tracking devices. devices. And by the time this comes out, we will have decided that I will make that announcement via the interwebs and Facebook and all that kind of thing, but getting some awesome ratings. And thank you all so much for, for putting those up. Uh, that's been fantastic.
And what this is all about is just spreading the word. So let's get into it. Uh, get your notepads out. All the things we talk about here, as I say, in the podcast are going to be are in the show notes on cloudbasedmayhem.com. So, uh, let's get into it and learn how we can fly safer and help our fellow comrades out. If something goes wrong, please enjoy this, uh, this information dense podcast with, uh, Matt Wilkes, my buddy in Edinburgh.
Matt Wilkes, so cool to tie into you, man. Thanks so much for your time and doing this. I'm really excited to talk to you about all things, uh, accident and trauma and first aid and making sure people are healthy and hypoxia related. Uh, thanks for coming on the show.
Thanks so much for having me, man. I'm, uh, I'm really excited and quite honored, quite honored to be on given all the usual folk you have along.
Yeah. Well, you know, this, so this is going to be a little bit of a different episode. Uh, you and I just had some time together in the UK about a month ago, flying around in the lakes up with jockey and Ed and all those guys, which was super fun. And I have to admit something to you when you gave me a ride back to your, uh, lovely little Casa and Edinburgh and up in Scotland, I was totally exhausted. I was in the back seat and I was just trying, so hard to stay awake. And as soon as you started talking, I was like, damn, I got to listen to this. You've got, you got all kinds of amazing knowledge. Uh, for those who don't know on the, you know, the listeners, give us a brief for your background. What have you been studying? What have you been doing? And, uh, what are you excited about?
Sure. So, um, I'm a doctor. I live in Scotland, in Edinburgh, and my special interests are extreme physiology and remote medicine. Uh, I've worked in a few different countries, but mostly Nepal, Bolivia, and New Zealand. And I spent a little while as a flying doctor for the East African flying doctor service, going to places like Somalia, South Sudan, and Congo. And that really gave me a nice flavor of remote trauma. One of the things is I started paragliding about five years ago, and I'm right slap bang in the middle of intermediate syndrome. So I'm very, very passionate about telling people about safety, partly because I care a lot about the health of pilots, but also because if I've trained a bunch of people up, they might be able to help me if I crash.
Yeah. Yeah. Yeah. Copy. When I was up there, we were talking about first aid and what belongs in our kits. Well, you know, what did you learn from, you know, you were the expedition doctor on the big Kilimanjaro expedition a few years back when everybody went up to fly off the top, tie in what you learned on that and, and what we should be carrying with us.
Sure. So, um, I mean, Wings of Kelly was a really interesting trip. Um, medically, I think it's a really interesting trip. I think it's a really interesting trip. We were really pleased because we got a hundred odd paraglider pilots up, a few TV crews, loads of porters, everyone got to the top of Kilimanjaro and everyone came down safely. So for us, we were really pleased about that. And we took 72 kilograms of medical kit. And I think if there was one thing I learned on that trip is that there is no such thing as the perfect medical kit. It depends absolutely on what you're planning on doing. For paragliding, uh, I guess we want it to be lightweight. I think we want, to make sure that anything that we carry in our kit is stuff that we can confidently use. So I might carry stuff that's slightly different to people who've got say wilderness first responder training or first aid at work training, or people who just want to carry stuff to deal with bumps and bruises.
But I'll tell you if you like what I've got in mind, you can tell me what you've got in yours and, uh, we'll see if they match. Yeah. Sounds good. Let's do it. The first thing that I carry in mind is I keep my kit in a, in a roll top ultralight dry bag, because I think that's a really nice sort of thing to route around in. And it also saves weight. You kind of stuff it into either under your seat or where you want to keep it. I've got some rubber gloves. I've got two pairs of that. And I think the thing is that actually the chances of catching anything when dealing with a casualty in a trauma situation is remarkably small. And I think people need to remember that, but looking after yourself first and foremost, a great idea. So I take a couple of rubber gloves. Um, I take some fabric plasters. I take some Steri strips, which are these little wound closure strips. The thing about them is you don't put them on like a plastic.
You don't kind of layer them all up. You have a nice little gap between them. And that just helps the wound heal nicely. Uh, I take a triangular bandage because it's a good way of kind of, you can make it into a sling where you can tie people's ankles together and come onto that a bit later where you might want to do that. Uh, I take an absorbent field dressing. So a way of stopping bleeding by applying direct pressure to a wound, loads of different ones. The really good ones out there are kind of battlefield dressings, or they're called the Israeli field dressing. And that's where you have kind of pad of stuff attached to a bandage. So you can kind of compress a wound and have a big kind of dressing over it as well. I also carry a bit of zinc oxide tape, great for blisters, great for kind of sticking things together. I carry a couple of painkillers, uh, ibuprofen and paracetamol. That's the acetaminophen in the States.
I carry some energy gel, uh, and I carry disposable heat packs. I got four of them. The idea being that you can apply them to the groin and under the arms if you need to help warm somebody up. And they're also good for your hands. Permanent mark. To make notes. I carry a knife as part of my paragliding kit in general. And I also carry something called a Sam splint, which I would highly recommend.
Yeah. Excellent. You know, I was involved for those of you listening to you. You don't, I'm not, we're not expecting you to remember all of that. All of everything that we're talking about will be either links or in the show notes, uh, cloud-based mayhem.com under this episode. So everything we're talking about here, we're going to have a very detailed notes about, uh, what Matt is recommending Matt. We, I was involved in rescue. A year ago. Well, actually last August. And one, a couple of the things that one of the pilots that was involved in that rescue, a good friend of mine, Revis had that I thought was really valuable. We had to call it a helicopter on that one. And this rescue was one of these that just everything went perfectly. It was amazing. Uh, we had a great team. Everybody was very knowledgeable. We had a lot of gear, but he, he had a pretty badly broken leg.
Uh, we got pretty immobilized right away and we brought in a helicopter. And one of the things that really helped because this was kind of a mountain rescue in a very remote place that, uh, the life flight folks were, were really psyched about was, uh, he had an emergency blanket, just one of those cheap silver, you know, little things that folds down into nothing. And we were able to use that as a big wind sock, you know, little stuff like that. And like you said, a magic marker, he had a pen and a little bit in a little, uh, notebook. And so we were keeping all of his vitals. And so when the medical team showed up, uh, they were, they were super impressed with that. And that's, I think information that folks like you folks like us, it's kind of like, Oh, just writing it down. But folks like you, when you arrive on the scene, I guess it comes in pretty handy.
I think it's incredibly helpful doing that. And I think one of the, um, one of the things that people sometimes worry about in all this casualty care stuff is will I get sued? And the answer is no, broadly, as long as what you do is proportionate to your skill level, sensible. You keep in mind that you're, you're in a difficult situation and you're doing your best. And you essentially, as long as you do to somebody, what you'd like someone else to do to you, you're going to be fine. There are good Samaritan laws in countries that back people. However, should you ever find yourself in a situation, having notes just about what you've done, they don't have to be fancy. They're just going to be the times when things happened or the treatments you've given really, really help. The other thing is that as a doctor, perhaps receiving someone in intensive care or in the emergency department notes at the time, fantastic in piecing together what happened.
I'm less of a fan of those really like packed down to nothing blankets, except as windsocks. The reason is, is that what those are designed to deal with is they're designed to reflect back radiant heat. Now, if you've just run a marathon, you're going to be radiating tons of heat and they're great. If you come across a casualty who's cold in the wilderness, they're not going to be radiating heat. They're going to have kind of shut down. They're going to have kind of shut down. They're going to have kind of shut down as much as possible. What you actually want there is a blanket or something like bubble wrap that actually contains pockets of air and that will actually help keep somebody warm.
Okay. Maybe instead of one of those emergency blankets, for that kind of case, it's just some flagging, which is super light. It won't come in very handy for first aid unless maybe you're creating your own splint. I could see that being pretty useful in terms of tying off. You know, a trekking pole or something to somebody's leg, you kind of using it like duct tape, but then at least, you know, it was just helpful for the, for the, for the heli pilot to know, because we were, we were kind of down in this Canyon and it was quite windy and it came in really handy for him. In fact, he might not have been able to land without it.
Oh, absolutely. And I think that's one of the things where paragliders are pretty amazing. I mean, if you look at what Isabella and Jamie Messenger accomplished in Nepal after the earthquake, it really,
it really, it really, it really, it really, it really, it really, it really,
showed that skills that paraglider pilots have, you know, we know how to use GPS. We know if someone's coming to land a helicopter, what's going to matter to them, like things like the wind direction. We know how to look after ourselves in the outdoors. And that's one of the reasons why I think doing podcasts like this are really important because as paraglider pilots, we can go to some pretty gnarly places. A paragliding crash can be a pretty serious deal, but actually we have a lot of the skills and a lot of the foundations to turn the situation around to its best.
So the next thing I'm going to ask you is about how paragliding accidents differ from, you know, your kind of typical wilderness accident. But before we get to that, there was some confusion on our accident about painkillers. And, you know, we didn't give him anything because we had all been kind of told or worried about kind of the downstream effects. And what we learned when the medical team showed up was, hey, this guy's in pain. Whoa, it's give him something. Unless it's head trauma, then it's absolutely okay to give him something. And someone in pain can do a lot more damage to themselves than someone that's, you know, comfortable. So do everything you can to make somebody comfortable. So, you know, I don't want you to get in any trouble. I recognize that there's some, maybe some gray area here, but how would you, how would you teach folks who don't really have narcotics training to deal with pain?
Sure. I mean, I think treating, you know, pain in the wilderness is super important, partly because it's just a kind and compassionate act. You know, we'd want it done to us, but also because it actually improves how they do. If someone's pain is relieved, it reduces bleeding, it helps them maintain their energy reserves, and it means that they're more likely to do better. So I think it's an incredibly useful thing that you can do. And it makes you feel better too. If you treat someone's pain, you kind of, you feel like everything's moving in the right direction. So I think there's kind of general ways to treat pain, of which the kind of primary things are reassurance. You want to talk to your casualty. You want to let them know what's going on.
If there's a few of you, you can assign somebody just to talk to them and keep them company.
You want to splint anything that can be splinted. And this is one of the kind of, I think, going to be the recurring theme in this podcast is splinting is an incredibly powerful way to relieve somebody's pain and anxiety. You want to protect them from the environment. So keep them warm. Giving the thing, people, things like food and drink will do a lot for their overall pain and comfort. And then you can give them specific medicines. One of the worries that people have about giving food and drink is there's that kind of dogma that if someone's going to go to hospital and have an anesthetic, they should have an empty stomach. That's not really true. Anyone who comes into hospital as an emergency and goes for an operation,
the anesthesiologist will deal with them as if they had a full stomach anyway. So it's not really a thing. What your rescuer said is true, though. If someone has a head injury or you think their conscious level is not normal, then giving them something to eat and drink might make them choke. So that's not a good time to do it. But otherwise, things to eat and drink is fine. And then there's the case of specific drugs. So in terms of drugs, what did you guys have with you at that point?
We had, I think some of the people had like a paracetamol, you know, of course we all had ibuprofen, you know, some kind of minor stuff. And then I believe a few people had like oxycodone.
Okay. That's, that's quite mighty. Yeah. So I think the sort of number one rule to me is always give.
The dose of that is one gram, which is usually two tablets, assuming that the person is over 50 kilos. And you might say, is paracetamol going to help a broken leg? And the answer is actually it will help a little bit. One of the nice things about paracetamol is it's absorbed very rapidly as well. So it does kind of, it'll get there sooner. Ibuprofen and paracetamol works synergistically. So the two of them together works better than both of them individually. So ibuprofen is a good thing to give. However, if somebody is bleeding a lot, then ibuprofen can affect the way their blood clots. So best avoided. If someone has stomach ulcers, then you should avoid it. And if somebody has asthma that's triggered by ibuprofen, then you should avoid it.
So the easiest thing if someone's asthmatic is say, have you taken ibuprofen before? If they have, it's safe to give it to them. If they haven't, don't.
So what kind, what could we do? What should we have that's stronger than either acetaminophen or ibuprofen? And when should we not use it?
Is there a case? So a lot of it depends on actually where you're going. As paragliders, we travel. And one of the things you have to be very careful with is going through places like the Middle East with anything stronger than ibuprofen and paracetamol. Even things like codeine, which you can buy over the counter in the UK can land you in trouble over there. So that's one thing. So if you're going to somewhere like India via Dubai, think about what you're taking in your first day of care.
Stronger options. So there are two main drugs that are kind of the next level up. One of them is called codeine and the other one is tramadol. So I'm using the UK names here, but if you Google them, you'll get the American ones. Codeine is not a great drug, but is available. So it's an option. It's not a great drug because about 10 % of people who are taking it, it does nothing for. The reason why is that in the body, the body converts it to morphine and some people just can't convert it. So it's useless for them. Tramadol is a good painkiller. It makes some people feel pretty dizzy and pretty weird, but I think it's effective. And I think that's a good option under these circumstances.
The next step up in strength is morphine and oxycodone. Certainly in the UK, you can't get hold of those you are a doctor. And even then they're very stringent sort of regulations about having them with you. I imagine the guys who had them with you, they'd been given them by their doctor for them. Is that right? Yeah,
exactly. It would have been from another injury or, you know, as you know, I've been in the hospital quite a bit with surgeries over the years.
I think that was me. You've got to be pretty careful about giving other people drugs that have been prescribed for you. I think that's one of the areas where you can end up in a bit of legal hot water. If there's a problem.
Okay. So use something not quite that extreme. Use the tramadol or
codeine. Yeah. But Hey, if I find myself in the middle of the wilderness with you and you've got it, I'm going to want it. And the answer, I think the answer with all drugs is you can't really take out what you've put in. So particularly in a wilderness setting, when you're dealing with strong drugs, give little bits. Often. Okay. And in the case of morphine and kind of drugs like oxycodone, we're talking every 20 minutes and that's when it starts to take effect. Is there an injury that you wouldn't? I think you've got to be very careful with strong painkillers. What strong painkillers like morphine and oxycodone do is they depress your breathing. And to some extent they depress your conscious level.
So anyone who has a head injury, I'd be cautious with anyone who, has a chest injury, um, where it's messing with their breathing. I would be cautious with, but like I say, we're dealing with strong drugs here and actually something that I think you can go such a long way with reassurance, keep me some warm food, drink ibuprofen, paracetamol splinting that actually, if you've done all that stuff, you're 90 % of the way there. Anyway,
let's get into assessment. How are paragliding accidents different? And what, what, what typically are you looking for in a, you know, in a wilderness setting?
The first thing to look at is the difference between operating in a wilderness environment and operating in an urban environment. And the differences to me are that in a wilderness environment, you might have limited equipment, you might have limited people, and you might have limited expertise. Also, the timescales can be very different. If you have a crash in the middle of Edinburgh, an ambulance will be there in eight minutes. If you have a paragliding crash in the middle of the Scottish Highlands, a helicopter will be there in eight minutes. If you have a helicopter might be there in two, three hours. The other thing about operating in the wilderness is that there's an environmental threat. So and that affects your casualty as much as it affects you, there might be cold, there might be rain, there might be snow. And I think the final thing is that, and this sort of applies throughout the podcast is that a lot of the evidence on how we practice in wilderness medicine doesn't come from work in the wilderness, it comes from work done in urban ERs, or it comes from,
you know, military data. Essentially, every time we have a good war, we update our first aid practices.
So a lot of the stuff that's come out of Iraq and Afghanistan have changed the way that we do things. And what it means is that you're balancing, you know, these limitations that I talked about of equipment and time, you're balancing threats to the casualty from the environment, you're balancing knowledge that comes from a whole myriad of places. And that means that when you're operating in the wilderness, it's all about judgment, there aren't a lot of right or wrong answers. And to my mind, that makes it incredibly interesting and a really fun place to practice. But it makes it harder. And it means that you need to think about stuff. And I suppose the next logical question from that is, you know, how do you judge stuff? And I think it comes down to what I was saying earlier, as you get more experience, your judgment gets better.
But fundamentally, act within your limits. Keep in mind that principle of first do no harm, and think, would I want something done to you? You know, and if if I'd want something done to me, do it to the casualty that you're looking after. So that's quite a long winded answer. But that that is, I think why wilderness practice is different to urban practice. So your next question was, how do you actually approach a paragliding accident? How do you assess a casualty? So I guess, I don't know, I mean, it sounds like your accident was incredibly well run. But you can tell me if your experience is the same as mine. But whenever you see an accident. First of all, everyone's shocked so nobody does anything and then everyone rushes over. And then there's another lull when no one does anything because they're working out what to do.
And then suddenly people spring into life. In an ideal world, that you know a leader bit starts appointed people start delegating and stuff starts happening. Has that been your experience?
Daniel már Hoodie Yeah, it has. This one was kind of unique because we were all Of course up in the air, it just was discuss game are very, very high when this accident happened. And so I don't think anybody actually saw it happen. We just got the call over the radio from, from Trey, the victim, uh, Hey, uh, shit, I'm hurt really bad and I need help right now. And, uh, and so we were, as we were flying back to that general area, some people were able to land pretty near where he was. A lot of us weren't because we were too far downwind, but the whole, you know, Nate scales, good friend of mine just stepped in right into the leadership role and everything he said was perfect. You know, here's what we need to do guys. Don't make it worse. Matt, you stay high. Cause you're the only one that's going to be able to get cell service. So you keep circling around at 18 grand and you coordinate with a search and rescue and you coordinate with us on the ground.
Cause once we're down there, we're not going to have cell service. And, uh, he just, by the time we got to the victim, everybody was lined up with what they needed to be doing. And so it was just, it just was bang on really fast, really quick. Very coordinated. And a lot of that was probably like you said, because we had time while we were still trying to navigate down to him and get back. And it was, you know, the middle of the day and the Rockies, it was booming. And, uh, the, you know, the, the number one thing was, Hey, let's not make this worse.
Absolutely. And I think you you've hit so many interesting points in that and, and, you know, well done on doing that as well. Cause that's not an easy situation to manage. I guess what you want to do is you want to short circuit the time between everyone going, Oh shit, somebody's crashed to that point where everyone in the group is safe. Everyone's working together. Communications are being established in the casualties being treated. And it's that bit that's, that's pretty difficult and it's pretty difficult, especially in groups that don't know each other. Um, and in groups with different degrees of experience. And the other thing that you kind of alluded to there is the fact that you're all up in the air. And when there's an accident, it's very easy to become fixated for all the right reasons on helping the victim.
But if they've crashed in a particular area and you fly there, then you've got to think, is there a chance that the thing that made him crash is going to make me crash? Exactly.
Exactly. And
so it might be safer to land downwinds to land elsewhere, or if you're all on the ground, sometimes you have to, you know, quite forcibly get people to hang back. And make the scene safe before you go anywhere near the casualty. And one of the things is making the scene safe, I think is hugely important, is loose gear. As you know, if you've seen a helicopter downwash that in a paraglider will not mix. So having, you know, it's one of the things that generally speaking in an accident, everyone wants a job, but some people are more or less confident than others and a really nice job for people who aren't confident with dealing with a casualty is getting them to land. to tidy up everything that's going on to make the scene safe to put rocks on gliders to pack things away so no one else can come to any harm while you're dealing with the casualty yeah
i was gonna say you know another example it's too bad that i've got so many examples to use well it means
it's worthwhile us talking about yeah
it really is i mean i i guess i would just say that you know one of the things you learn when you go through wilderness first response which listeners i would if you're a paraglider you need to get this training if you haven't it's just so critical if you're flying in remote places but it's just that whole stop think slow down you know that the tendency is just to rush and we had a pretty bad accident uh almost two years ago now at the at the u.s nationals in the owens where a pilot very you know he did a great job by landing near the victim uh but in his hurry to get to the victim you
know he's not able to get to the victim he's not able to get to the victim he
left his glider out and it caused so much problems i mean it it was you know one it delayed the heli coming in two we thought we had a second victim you know it just just that one minute of organizing your stuff packing up a wing you know a wing out means you've got a problem so you know you're at a competition there's 130 people in the air suddenly you've got massive confusion tons and tons of radio calls oh shit we got somebody else down we didn't have anybody down we had somebody trying to help and it was just it caused a lot of confusion so not calling that person out they did a great thing by trying to help but it's just you know these little things you really have to think
it through absolutely and and you know communications is a whole other thing in itself so i mean let's say we so let's say we're all standing in the landing field and we see someone come in and crash so what we need to do we need to make sure that the scene is safe so we need to look around and think they've been hurt could i be hurt could my friends be hurt as you say take your time there's a you know like medical cliche that when you run to a cardiac arrest take your own pulse first because that at least kind of chills you out right then what you need to do as you approach is survey the whole scene so look at them in the context of how they've fallen you know which bits might be hurt what have they done they've done a lot of things they've done a lot of things that have landed on what's wrapped around where's their wing what might drag them all these things
and then comes the hardest bit really which is somebody stepping up to lead and you know you can use the term leader or you know it's sometimes better i think to use the term coordinator because it's a bit less emotionally charged and it's a bit more about what they're doing and it doesn't matter who that person is in fact it's often better if it's not the person with the most medical knowledge sure because you want the person with the most medical knowledge looking after the casualty and so someone steps up and says my name is gavin my name is matt i will coordinate this situation and suddenly everybody goes ah brilliant and things start to flow and that coordinator what you want them to do is to be able to keep surveying the whole scene so you want them to stand back you want to get the coordinator wants to assign people to look after the casualty depending on how they're doing it and then you want to get the coordinator to look after how many people you've got they might want to assign someone just to talk to the casualty they might want to assign some people to look after the loose gear clean up the scene they might want to assign somebody to take notes they might want to assign somebody to work out where they are get grid references and start getting ready to communicate with the outside world and get help all of that will depend on how many of you there are but it's that kind of leadership and coordination that makes these things run smoothly i think there's a flip side to that as well which is that of being a good follower which is that if someone's had the balls uh to step up and say i will coordinate this
do your level best to support them and that doesn't mean um blindly following orders if they say i think we should saw their legs off then totally reasonable to question that before you get out the hacksaw but uh it means trying to reduce the amount of bandwidth that's taken up so things like if they give you a sensible task you go and do it and then you come back and say i've done it you close the loop of communication okay great and it sounds like you guys did that amazingly in your
yeah it went really well you know one of the things and i wrote an article about this one of the things that i think was a big eye-opener for everybody there and these were all guys who are had been in the sport a long time now it's it's just uh it's just the sport we've all seen accidents it's it's a different kind of thing but it's it's a different kind of dangerous thing we partake in but you know typically in sun valley you know it's it's rare to fly with one other person uh that day we had almost 15 people in the air it was a little kind of a mini comp that nate organizes every year so we had you know you never want an accident to happen but that it did it happened on the perfect day because we had assets and and i what what blew me away is you know i think we tend to be a little bit cowboy about uh just in the sport about oh hey
go go deep and for me it was it was a huge reminder that you know if you go down in a remote place and you don't have a lot of people around your chances are they go way down i mean when we got the helicopter in there and we got a board up to up to tray you know we had to carry them less than a half a mile and you know it was it wasn't great terrain but it wasn't terrible terrain there were 10 of us everybody there was really fit and it was really hard work i mean if there had been two of us no way i mean he would have been out there all night for sure and the other thing we learned was that you know in a lot of places you know search and rescue the professionals are going to take a lot more time and be a lot slower than your own community you know so number one use your own community first and these days with the warm and spot and tracking it's just so fantastic that you know we had people come up to us that had just been watching you know they weren't flying that day and they were like oh my god they were just watching what was happening on on live tracking and went hey something's wrong well why are why is everybody in one place in the middle of the day you know something's happening i'm going to go up there and help or see what's going on and so you know rely on your community first i guess the takeaways are you know rely on your community first but also you know think about going low in a remote place maybe a little bit more than you did this is not something to take cowboy all the time because man it's hard to get somebody out
absolutely and you know the ideal number of people to move a casualty is 16 over rough ground that's kind of a sustainable number if you're going to do it for a long while because anything less than that is totally exhausting but the other work oh totally man right i did a uh i did a master's degree in mountain medicine and we were generally abused by our instructors carrying people and you know in the wind and the rain and yeah you do absolutely feel it i think one of the things that's a really good way of practicing all this stuff is simulating it and i think it's a really good way of practicing you know that's how we train ourselves as a community because as you say we are a great community and we are likely to be first on scene so one of the things that i would massively recommend is if you have a day that's not flyable in your club or you know where you're all on take off and um the gliders are still in the bag then you know someone go and wrap themselves around a tree and everyone else try and fix it and that that brings up so many interesting things it gets you working together as a team and you know you're not going to be able to do it all at once so if something happens in real life you're already in role but it makes you work out things like do we know the location of our landing field where would we direct an ambulance to drive to do we know how to call mountain rescue or search and rescue in our particular location all of these things kind of come up when you run through it and the more realistic you can make it short of actively crashing the better a simulation it will be and the more worthwhile a learning experience it'll be
yeah matt let's talk a little bit about your experience with mountain rescue let's get into some specifics uh we've got somebody that's had what you call a major crash not a minor crash sure what what are you know take me through the list here you've written them out for me but you know like airways and helmets and uh controlling bleeding let's let's go through some of that stuff let's
get stuck in sure so it's worth mentioning sorry that when i use the term trauma here what i'm talking about is kind of sudden severe physical injury not the emotional side of it the kind of medical use of the word trauma okay so you turn up you've done all the stuff we talked about making it seem safe people are communicating people are getting help first of all you've got to assess your casualty now this is something that's kind of best learned on a course really there's all these different approaches you know cabcd all these things that you pick up on wilderness first responder and they're best kind of practiced and gone through but basically they're asking four questions the first question is is there obvious bleeding the second is are they breathing normally the third are they fully conscious and the fourth can you identify any injuries and that's kind of what all these different approaches are trying to do uh let's start with bleeding i
think if someone has a major paragliding crash chances are if they're going to die it's because of bleeding i guess you can divide bleeding into two different things you can divide it into internal bleeding and external bleeding but the thing about bleeding is you've got to look for it and there's little rhyme that sometimes helps blood on the floor plus four more and these are the places that you're going to look for bleeding so blood on the floor is external bleeding it's surface wounds it's open fractures it's scalp lacerations and four more the sites from internal bleeding which is chest abdomen pelvis and thighs and you might think i can't do anything about internal bleeding but actually you can and that's one of the reasons why we're talking about it
so first of all you've got to find where somebody's bleeding from and in the wilderness when it's cold that might mean getting into some shelter and systematically either looking under bits of clothing bit by bit so you know open the jacket a little bit look on that side then the other side maybe feeling around the back but either way be thorough and be systematic and then having identified it there's a few general things that you can do and this is all stuff that's kind of come out of the military medicine things from iraq and afghanistan and the first thing is this idea of the first clot is the best clot so in your blood there are all these different factors platelets clotting factors all these things that are in a finite amount so when you're bleeding your body's doing the best to plug that gap if you then move that clot it's going to have less stuff to plug it with second time round so what that means in practice is you want to minimize how much you move somebody you want to avoid repeating the explanation you're
toes and toes that were around your feet that you needed a minute or two more times that's the whole
nést up feeling so if a load pain by bothered you might be just very significant it's not you see you have too much that going to happen it's going to sc yer just my and you see it in an operating theater you know when someone's anesthetized casualty you know when someone's anesthetized or the patient gets cold it's an effect of of the anesthetic and you can actually see they bleed more until you warm them up again it's so noticeable so let's say you've identified some bleeding and let's let's start with external bleeding there are lots of different ways to treat it you know you get things like people say they elevate the limb or you know put pressure on the pulse point or all that sort of stuff
that may help the thing that really helps stop external bleeding is pressure and that means getting your bandage that's in your first aid kit and putting it on the wound even if it's an open fracture even if there's a bone there and keeping that pressure on until you get to care okay so and so people often ask about tourniquets with that one they say oh well i could put pressure on but why not just put on a tourniquet and then that will you know stop all blood flow to that limb tourniquets are sort of back in fashion because in the iraq and afghanistan conflicts people are being blown up by improvised explosive devices and so this were young people who would lose a limb and then if you put a tourniquet on that it was life-saving but they'd lost the limb anyway if you put a tourniquet on somebody
they will almost certainly lose that limb and so you should only use a tourniquet if you think that they have a life-threatening injury and you don't mind if they lose the limb because they're bleeding so much from it that they're going to die if you don't stop it gotcha
okay does
that does that surprise you is that a surprise it does
yeah it does i i didn't know i mean that that's what i learned from tourniquets but like you said they were they were back in fashion i didn't know that that was still that that's you can put a tourniquet on you're going to lose the limb i didn't know is that
well it is it is pretty much because in the same way that i said the first clot is the best clot if you keep taking the tourniquet on and off then you'll just get washed out of the clot so right you're
not doing anything yeah yeah
when you put it on you want to keep it on and this comes down again to that wilderness medicine thing of where's your evidence coming from and in this case our evidence is coming from military medicine where tourniquets are totally appropriate for military medicine fashion you can't necessarily apply to us what happens to us okay we've talked about external bleeding and we said external bleeding you want to basically put pressure on with something but in a paragliding crash in a really heavy crash you know you're going to break some fairly major bones and chances are if you're going to die it's from internal bleeding so you might think there's nothing you can do it's internal but actually there are things that you do so i said sources of internal bleeding blood on the floor plus four more so you can bleed into your chest your abdomen your pelvis and your thighs can you do anything about bleeding in the chest not really anything about bleeding in the abdomen not really but the pelvis you can do quite a lot for so the
pelvis is a ring and if you fracture it you tend to break it in two places in the same way that you can't break a ring in the same way that you can't break a ring in the same way that you can't break a ring in one place we have these things polar mints in the uk you can't break a polar mint in one you know in one place you can't do that with the pelvis and what the pelvis tends to do is it tends to open up a bit like a book and that creates space for bleeding it's very painful but as a paraglider treating a fellow paraglider you can close that book so what you can do is you can tie something a jumper a triangular bandage around their pelvis and bring it back together to reduce bleeding you're basically splinting their pelvis and the way you do that is uh this is if you're listening to the podcast what you need to do is to stand up and to feel down your hips until you feel a bump on the outside of your thigh and that's called the greater trochanter of the femur that bump is basically at the level of the middle of your flies and it's around that level that you want to tie your pelvic binder the mistake people make is they think hips and they do it too high they kind of end up doing it at the level of the belly button but if someone's broken their pelvis and you bind that pelvis at the right level you will make it less likely for them to die from that bleeding matt
silly question how do we know if somebody's broken their pelvis uh
they tell you generally speaking okay okay it hurts it hurts like hell really so they used to they used to say that um you know people used to talk about springing the pelvis and all that sort of stuff which was a bit medieval if you feel someone's pelvis very very gently and it's broken you and they will know but equally there's actually no real harm in binding the pelvis anyway so someone's had a heavy crash just get on and do it uh so if you uh google binding the pelvis and bind the pelvis and bind the pelvis and bind the pelvis and bind the pelvis and i can put up a few uh diagrams on your website as well that will show you where to put the pelvic binder and you know how to tie up the ankles and things so you you do it well great
was that was that clearly expressed enough yeah
great and then like i said those of you listening we'll have all that up in the show notes we'll have these uh examples and maybe some links and that kind of thing in the show notes great cool thanks so
that was the pelvis so uh the other place where someone can bleed is in their thigh so they basically they break their thigh bone and the answer to that is splinting when people are bleeding they're bleeding because their anatomy has become distorted and what you need to do is try and restore the anatomy to a normal position and that is not only very pain relieving but reduces bleeding as well now in the case of a broken thigh that's actually quite difficult but if you were to tie uh you know big sticks around the thigh being careful with sticks and things about pressure area so if you're going to put anything that's knobbly directly onto someone's skin you want to put a little pad between it or something because if that's on there for a long time and that can cause the skin to break down and so you want to minimize the movement of that thigh and that will also help reduce bleeding what
uh what about ephemeral artery uh tell me more well if there's if there's bleeding in the leg is that what we're assuming we're
assuming that's bleeding in the leg
yeah you got you got internal bleeding into the thigh are we assuming that they've got you know that you've gotten uh you you've broken your leg and that's nicked or cut the femoral artery and then so
femoral artery bleeding is that you're dead are you but it comes under the category of bad for sure yeah um actually most of the time when there's bleeding from injuries like this it's bleeding from veins rather than from the artery okay so even when you break your thigh the blood the bones themselves are very very rich in marrow and in blood flow and it's bleeding from there that tends to be the problem and if you have a big femoral artery bleed you're probably in quite a lot of trouble well
that that's what i was asking about the you know if you had a thigh bone break and you want to splint it or mobilize it are you are you in are you potentially exposing the femoral artery to being cut if it hasn't been cut could you could you do more damage not
really because actually the femoral artery is only close to the surface right up in the groin okay as you get further down the thigh bone that's less of an issue okay so splint it splint it yeah i think if there are any key messages that i was going to have from this podcast it's keep them warm be nice to them and splint it okay all right great uh airway and helmet yeah so having an open airway is obviously key to staying alive if you're a rescuer opening someone airway can save their life the question is how do you know when it's not open and how do you open it when it's open an entirely closed airway will be one where you can't hear any breath sounds going in and out one that's partially obstructed will be one where you uh hear gurgling or snoring there's two ways of opening an airway the first thing to do is to have a look in their mouth don't kind of sweep your finger around or anything where you can't see but if there's anything obvious in there that you can easily pick out take it out and
then you can either do the kind of first aid style head tilt chin lift that you'll have seen or you can do something called a jaw thrust and a jaw thrust again this is a this is where you you act it out in your own home but if you feel behind your ears and run your fingers down the back of your jaw you come to the point where it turns and you get this kind of 90 degree angle as it goes towards the front of your face and what you do is press hard with two fingers on that 90 degree angle so the bottom teeth come directly forwards does that make sense yeah i'm doing it yeah is it painful yeah it hurts good it has a couple of advantages the first is that if they are truly truly unconscious
and you do that and they don't flinch you know they're truly unconscious
sometimes when you do that actually that's enough stimulation for them to regain consciousness and you think oh brilliant i'm a hero and then you let go of it and the stimulation goes and they become unconscious again so it's quite hard work and it might be that you have to maintain it for a while it might be that you need somebody to help you to take over from you when you're doing it so those are two ways to open an airway again i would heartily commend looking that up on youtube or something like that to show demonstrations of people doing it and the advantage of the jaw thrust is that it doesn't move the head and neck so that kind of shades into spinal protection at that stage gotcha okay uh helmets yeah take them off well i guess we've got open-faced and closed-faced helmets in paragliding we were just talking about opening the airway and knowing whether the airway is open or closed if someone's talking to you you know the airway is open so if someone's talking to you you don't have to take the helmet off
if someone isn't or you think the airway's closed you've got to take the helmet off to know what's going on taking off a helmet is basically a game for two players first of all remove any sunglasses goggles spectacles anything like that cut or loosen the chin strap and get your helper to support the head now if it's uh by support the head i mean keep it still on the neck if it's an open face helmet you just kind of move it upwards and backwards in an obvious way full face helmet uh so again remove any sunglasses goggles glasses have your partner support the head and then tilt the helmet back first of all so the nose and the chin are clear pull the helmet apart at the sides and then tilt it forwards to move it up and over the base of the skull and then lift it gently from the casualty again loads of really good youtube videos on that i'm
going to put you on the spot here matt about open and closed face helmets it's very timely i'm just rereading for about the 10th time uh dennis pagan secrets of champions you know as we get closer to the X-Alps and the this is all hangies back in the day and but still totally relevant to the data it's just awesome information in there and they there's a pretty good discussion in one of the chapters about the pros and cons of a full face helmet that all the old hangies used to always use full face helmets and i don't know if they still do but the they were talking a lot about you know that maybe that wasn't the best thing because in a crash scenario uh the doctors were saying listen i'd rather put a face back together than have a snapped neck uh that often
things sitting out off your chin and you go in hard on your face the obvious you know thing that happens is you snap your head back really fast and and you can break your neck do you have an opinion on that can i is that yeah i want to
vocalize well no no i agree actually i mean i think if you look at the mountain bikers yes they use full face helmets but they have neck braces as well to stop the helmet stop the scenario described the head being snapped back if you have a full face helmet on its own it's just a big thing and you're not going to be able to take a lever for your neck so the advantage of having a full face helmet is if you have a minor crash then your face is going to be prettier but if particularly i guess if you're hanging you're kind of coming in chin first if there is the opportunity for your head to snap back then if you've got a full face helmet on it will snap back with more force okay so i fly i fly with an open face helmet
copy great listener beware do whatever you think fits you okay great we should we should get the helmet off if they've got uh problems breathing for sure uh and i would imagine just also if it's just bothering them you know if it's yeah it's uncomfortable get it off uh of course be careful if there's a potential spinal injury so let's let's let's move there that's obviously the the number one thing i think people are concerned about when when you crash flying things around in the sky so
here is where we get into the controversial stuff so this is excellent this is good wilderness medicine use your own judgment territory and so i think by way of a disclaimer uh what's coming next is my opinion it's an opinion that i think is largely shared by organizations like the wilderness medical society published guidelines on this so it's not two-way out there but it is still not quite the conventional medical wisdom i guess if someone crashes a paraglider heavily you've got to think about what could have happened and i think there's kind of five options the first is that it's uninjured the second is that they've injured it so they've broken one of the bones but the spinal cord the bit that we all care about is totally fine and no matter how much you jiggle their neck it's going to remain totally fine the
third option is that the spine is actually injured and unstable so if you move their head and neck they will get injured and they will get injured and they will get injured and they will get neurological injury the fourth is that they've already got a neurological injury and if you move it it'll make it worse and the fifth is that they're so injured you haven't got a clue what's going on and the thing is is you might just say let's just immobilize everybody and if you're in an urban environment maybe that's a good idea but if you're in the wilderness then we're recognizing more and more the problems of spinal immobilization so i don't know have you ever been on a spinal board no sucks i've
carried people on them it looks terrible yeah
so um spinal immobilization as traditionally done so a neck collar blocks on the side of the ears tape across the top and a body kept still is incredibly distressing for the person who it's being done to you deeply uncomfortable and if they're semi-conscious then you know if they vomit they can lose their airway control and if it's not been done well and generally speaking when it's not done well the head's secured but the body isn't actually what you've then done is wiggle the spine around even more so actually spinal immobilization can cause quite a lot of harm also we were talking earlier about how being a rescuer is hard and how moving somebody out of remote terrain is incredibly arduous if someone's got full spinal protection and you're doing it properly it will massively delay you getting that person to hospital and it may put the rescuers in danger as much as the casualty
so can you sort of see how it might not be such a good idea all the time sure you know so when we talked about those different injuries that someone's spine can have what we really want to do is work out who are the ones with an uninjured spine or a stable spine injury where an injury will never occur because then we don't need to do all this stuff and who are all the other ones where they've got an unstable spine injury and if you wiggle them around they'll get worse and that is not easy that is where the judgment comes in and there's kind of a couple of ways of doing it the first is just on the balance of probability so if
you look at there's a fact there's a great database in the uk called the banger mountain database which is from wales and they've looked at all the accidents in the kind of welsh hills that have come through their hospital department and they found out that if you die from it's usually a fall that they deal with um and you've got a spinal fracture the chances are is that is a major unstable spinal fracture that's not a big surprise if you live and you apply kind of conventional wisdom 50 of those people should have full spinal immobilization but actually only 14 have a spinal injury and only two percent have an unstable spinal injury so
for those you know 50 odd percent of people who think conventional wisdom says i should package these guys up actually for 48 percent of them you're giving them a prolonged extrication an uncomfortable time and a chance of making their other injuries worse so yeah so it's kind of fascinating yeah well it's really difficult i think it's the thing i find most difficult in the context of wilderness medicine so the next question is are there is there anything you can do to work it out there are criteria which sort of apply here one of them is called the nexus criteria and the things we're making sure that we're making sure that we're making sure that we're making sure that we're making sure that we're making sure that we're making sure that we'reừng
Neveda the new Stage
Stage is are they intoxicated again this applies more in the emergency department than when paragliding but you never know god i hope not yeah okay it's the same it's the same deal uh the next question so you've established they're a sound mind basically the next question is are they so injured that they can't cooperate with you what's known as distracting injuries uh so to my mind all of those three tests are asking basically the same thing are they okay for you to examine them if they've passed those then what you want to do is feel incredibly carefully down the bones in their neck so you start at the very top of the head and you take your time since it's hard to find the bone and you press very firmly on the sticky out bit of the neck bones going down their back and if it's painful when you press on it and not painful on the muscles on the side but actually on the bone they fail and you need to immobilize their spine
equally if doing that or even not doing that they've got weird or absent sensation in their arms or in their legs or they can't move it or they've got pins and needles or when you try to take the helmet off that gave them pins and needles anything like that then they fail the test as well hopefully that makes sense so basically you say are they alert are they drunk are they so injured that they can't cooperate no they're all right i'm going to test them so i'm going to test them by feeling down the bones in their back is that painful no good did they have any numbness pins and needles inability to move stuff weird sensation in their arms or legs no great they pass don't need to immobilize them okay so that's that's the best that we've got so far though interestingly most paragliding accidents are lumbar spine fractures and this rule only applies to the neck so there are no rules okay gotcha i
mean i mean really there really is a lot there's a lot we can do but there's there's huge limits to remote uh wilderness medicine and it seems to me spinal is one of them i mean this is where we need help
definitely but it's also probably the most difficult and immediate question for you to solve yeah you know your buddy's crashed in the middle of nowhere there's only a few of you are you going to keep him still or are you going to get out so for for people that
you know don't practice this like you do on a really regular basis this sounds like something you almost need in a notebook yeah
oh totally and um you can just google it it's called the nexus criteria i mean i google it from time to time yeah yeah that's
that's that's really handy matt thanks for
that that's right one of the other things is that actually all the people i've seen who are conscious and have broken their neck they know it before you do sure like they tend to hold
on to it and they're like oh my god i'm gonna have to
hold their head so still that you know they might even put their hands on the side of their head and they really really don't want to move it yeah so if they're sitting there fully alert and conscious happily moving their neck freely and they can walk i'd be really tempted to get them to walk out okay do we have any more to say about that before we move on to cpr i don't think so i think uh the only question is if you are going to immobilize somebody do it properly keeping the head still and the body still is really important the best thing to do it on is something called a vacuum mattress because the kind of classic flat backboards that you see weren't designed for that they were designed to extricate people from cars and they tend to give people pressure sores and try and immobilize someone in neutral alignment so kind of how you'd lie if you were like normally on your back but remember the overall goal in all of this stuff and this is quite cutting edge and quite difficult even for people who do this professionally the overall goal is to minimize risk to you first and foremost and then to the casualty okay and that is the only thing that you can do and that is the only thing that is what you have to keep in mind the whole time okay so
let's let's jump to cpr everybody always needs a review of cpr when do we need it how long can we reasonably expect to do it for in a wilderness setting all that kind of thing well
i think cpr is really interesting because by and large the answer is don't um i think again it's coming back to this of what what is your evidence designed for so cpr is designed for somebody who has a heart attack and a heart attack and a heart attack in the middle of a city to keep them going until someone arrives with a defibrillator restarts their heart and takes them to hospital and done well it is very very effective in somebody whose heart has stopped because they've had an accident because they've experienced trauma it's usually due to them having very major internal injuries so the chance of surviving a cardiac arrest with or without cpr due to the heart attack is very, very effective.
trauma especially in the wilderness setting is very, very small and so i'm not saying don't do it but what i'm saying is when you're starting cpr in the wilderness setting you have to be so pragmatic because it's some if you're going to start it you kind of want to keep it going until you get to hospital but think about the safety of your group think about what your rescuers can and can't accomplish think about where you are before committing to something like this and i think something like starting cpr okay and that's an incredibly difficult thing isn't it because you know your body's crashed you can't feel a pulse you think i'm going to start cpr but actually you know no one's coming for six hours and it's cold and it's rainy look
after yourselves first yeah yeah sure okay
good advice uh is there anything else on on trauma and uh fixing people before we move on to what's next? i know you're most passionate about
um i don't think so i think it comes down to the that simple stuff of uh first do no harm if you want something if you're happy happy having something done to you do it to somebody else act sensibly make notes but remember you can do stuff and be systematic in what you do and think about the safety of your group as much if not more so of the safety as the casualty i
would say too i think one of the most valuable things about the the rescue that i was involved with uh last summer was you know we did we did a pretty major debrief with everybody that was involved right afterwards and like you said when you do these simulations this wasn't a simulation this was real but we all learned so much and mostly what we learned was that you know in many ways even though this one went perfectly uh there were pretty much all of us could have been more prepared you know like having having search and rescue and the hospital and people that are really valuable in these kind of scenarios on speed dial um being able to use your radio you know having a ham license for example knowing how to use repeaters um being really familiar i mean it's great that we've got these satellite trackers but when you need to start using them to send out gps coordinates and uh dropping pins and letting people know where you are these things take practice it's all fine and good to go yeah i got all the stuff but you got to know how to use it
totally and simulations brilliant for that and i think debriefing is it is such a powerful thing when done well debriefing can be harmful as well i think whenever you know there are accidents particularly with people you know but even in hospital it's incredibly emotional and people are self-critical first and foremost people are always thinking i shouldn't have done that i made stuff i should have done that i didn't act fast enough i look like an idiot all that kind of stuff so debriefing is a really useful thing but it needs to be done in a trusting and compassionate and emotionally generous way and if you know you're a group of buddies in a club and something really major happens and you want to debrief it consider debriefing it either with a doctor from the hospital who looked after the patient or you know even email me and i will happily kind of go through the incident with you i've done it for a couple of people in my club on one occasion and there is always stuff to learn there's always stuff to learn from me and hearing about people's incidents but remember be nice to yourself and to everyone else when you're talking over what's happened cool
cool well thanks for that matt uh okay on to our our next subject which i just think is fascinating and uh something we we deal with quite a bit here in the rocky mountains we get really tall and we fly with oxygen but we run out sometimes and we stay really high sometimes and i've had my own quite interesting experiences with hypoxia uh this is your little cat's cradle what are you what are you doing in this space i know it's some of the stuff you're limited about what you can talk about but uh run with that for a bit uh
so this is the stuff i love so um the my kind of interest in all my sort of exhibition and wilderness stuff is high altitude physiology i think it's completely amazing in terms of what it does to the body i think it's completely amazing in terms of what we don't know and i think it's even more amazing when you start to look at paragliders flying super high so we had antoine girard kind of blow everybody's mind in the summer really um by flying above broad peak without oxygen and you kind of i sort of looked at that and just thought how how did he do that and i've got a whole bunch of ideas i think that maybe he was a little bit acclimatized i think that maybe paragliding is just not very hard work and he didn't spend very much time at peak altitude i think perhaps he was completely spangled he was completely out of his mind but he's just such a damn good pilot that he got himself out of it totally fine uh maybe uh he's just a physiologically superior human being and he's just a i don't know but what he did was amazing and what other people who've flown up there like brad zander and people like Tom de Dorlodot and you know folk like you who've gone really really high
we don't know what's happening to them but it's really interesting yeah
give give some background for those who don't know so those of you who didn't hear about this antoine girard uh a couple times ex-athlete french guy who beat the altitude record by a considerable margin this summer in in in the himalayas he flew above broad peak which is one of the 8 000 meter peaks i've wanted to get to 80 uh a one uh 8 150 meters eight 8 150 meters uh yeah without oxygen pretty cool stuff and
he'd only been in country 22 days which if you think that somebody might climb everest and it might take them 40 days to do that uh that's a pretty amazing thing i
mean so i remember you telling me when we were on our drive that you know really by the books uh by the science he should have died correct
well i think the truth the truth is we don't really know because we don't know what was happening to his body at the time but it's certainly a remarkable remarkable thing to have done and so kind of out of my interest in the altitude stuff and kind of inspired by what people like antoine and tom de dorado and harassi lorenzo have been doing out in the karakoram i got together with a few people uh many of you in the uk scene will know adrian thomas he's a a gin pilot um and professor of zoology at oxford um many of the states might know michael michael vagala who's uh started the free flight research lab over there and then there was a couple of other people from the uk a lady called lucy hawks who's a remarkable scientist who looks at the migration and the flight of bar-headed geese who are crazy interesting birds in terms of their ability to fly and they're very interesting birds and they're very interesting to tolerate high altitude and an altitude scientist called martin mckinnis and we got together and formed something called the free flight physiology project to look into just this stuff how do guys fly up so high how are they okay when they do it how do we make it safer for them
so cool so what do you what are you learning and how are you studying it so
uh the first work we did was uh with tom de dorado um and harassi lorenzo and the search projects when they went out to the karakoram in june um i know you've had a lot of time to do that but i'm going to on the podcast and that was an inspiring one for me to listen to actually um i can't really thank tom and harassi enough because i pretty much just emailed them and said hello i'm not a very good pyroglider pilot and i'm really into science do you want to take a load of my stuff to the karakoram and they were nice enough to say yes and to make a real effort in the process and tom's fiancee potentially now wife um sophia pinheiro was also incredibly helpful in the logistics side of stuff and what we did is we put um a device called a hexaskin uh which is a kind of it's a bit like a base layer with a whole bunch of sensors on tom and harassio and tom flew up to uh 7 450 meters which is a personal record for him and harassio flew a bit lower carrying all this kit and unfortunately this is the teaser i can't tell you all the stuff i found because
it is being published in the scientific literature at the moment and they're very picky about results not being released before they go live but it was interesting and based on that great story i know based on that to look into some of that still further uh i've again kind of cold called been taken on by a professor uh dan and portsmouth in the uk called mike tipton who runs the extreme environment lab down there and he's got a high altitude chamber that can simulate uh not only the kind of altitude that these guys are reaching when they fly paragliders but also the cooling that goes on in terms of environmental lapse rate and convective cooling and so we are currently building a very high fidelity paragliding simulator
uh down in the uk so it's so cool um i'm really really excited about it and this is a actually this is a really good moment for a shameless appeal
i'm pretty much funding this myself i work apart from as an expedition doctor i work in the nhs um doing kind of uh intensive care and anesthesia stuff and so at the moment paying for the simulator through extra shifts so if any fantastic scientifically minded human wants to contribute do you get in touch i will take your money with open arms
yeah and in fact listeners this is this is actually super important and critical and also wicked fun uh some some of the findings you you did share with me a little bit and i'm hoping we could talk maybe about some of the generalities but uh those of you are listening this is this is it's it's really really cool and incredibly applicable i'll share a brief story it wasn't my own uh when i first moved to sun valley uh matt bieschner we call him farmer lives down the street from me total air jedi and you know back in the day we didn't fly with oxygen we just thought you know we were very cowboy about it and kind of like the climbing everest without oxygen we didn't really think we needed it and you know one day for what a particular you know we we don't know exactly that's the that's the craziness of hypoxia uh you know maybe the night before he went to bed a little bit late had a couple beers definitely wasn't partying but you know next morning had some coffee so he was probably mildly dehydrated again we don't really know uh hiked up sun peak rather than taking the lift so you know a little bit of exertion in the morning takes off with nate they they start going back and forth and then they're like oh my god i'm so tired i'm gonna go back towards bora and up over uh trail creek pass and he's at like 13 000 feet you know for us really really low that this is not where we get concerned about hypoxia at all and
that's known as orbit right
right and this you know this is nothing we're basically right on the deck you know so but the day's shaping up it's it's looking good and uh and he they've got a navigation question he's not really sure about which way they should go so he called but feels totally fine
and he calls back nate this is farmer uh what are you thinking and nate responds back you're speaking gibberish i can't understand you what the hell's wrong with you and matt kind of confused goes i feel fine there must be something wrong with my radio he's thinking this you know and he he calls back nate this is farmer where are we going and nate goes you sound like a two-year-old what what the hell's wrong with you you know check your you know check your radio but you you don't sound right dude and uh and about the same time he starts talking to nate and he's like all the feeling in his hands and feet um it's quickly lapped up into his arms and legs uh he started losing his vision it all started going really tunnel vision on him and he realized holy shit i'm i'm i'm wicked hypoxic and uh you know he recognized it pretty quickly the only way he was able to fly his glider is kind of jesus christ pose he put his arms all the way through his toggles because he couldn't feel his hands and he spiraled down to the ground and of course on the way down he started feeling better and he started feeling better and he started feeling better but um you know this is relatively low uh this is not even you know our our o2 systems typically turn on at 10 000 feet but you know often i wish they didn't until i was at like 15 000 because i feel like i'm wasting oxygen but anyway regardless something was different about him physiologically that day that we cannot predict and you know potentially put him in a really dangerous situation and like i said we we call him an jedi for a reason he's he was the one that we let circle around at 18 000 that day calling the shots for the rescue for three hours so you can get an idea of what kind of pilot this guy is so it's it's like some of the things you found that i find just fascinating is that often physiologically what's happening is the opposite and correct me if i'm wrong but the opposite of what would say should happen on paper correct
potentially i mean i think one of the things that's super interesting about paragliders as opposed to mountaineers is that we we go up to these high places but we're not exercising we're not trekking or climbing and pretty much all the research that's been done above 5 300 meters which is where the roads stop um has been done on trekkers and mountaineers so actually you know we don't know very much about what happens when you sit still in these conditions but are exposed to the cold and we don't really know what the margins are but we don't know what are because you know someone like antoine or you know someone like your your buddy that you've just described you know what what are the margins between them being fine being a bit goofy sounding silly flying like jesus christ or falling out of the sky yeah and we we've no idea and the other thing is how much better would you be if you flew in a competition at you know 10 000 feet or a bit less and had oxygen on you know would you be making better decisions and would you be making better decisions you know oxygen cylinders are pretty lightweight so you know just because you're not completely out of your mind maybe you perform better in situations where you really really want to perform if you're on an oxygen at a lower altitude so there's there's tons of stuff to do with this i think is really interesting yeah
from my own experience too i think what what's nerve-wracking to to an extent about it is is you know like when that story with matt where he thought he was speaking to me and i was like oh my god i'm not going to be able to do this and he sounded like an idiot um i had my own very similar experience with it on a huge day here uh i i'd run through my oxygen tank so i was up above 16 000 a lot that day uh so i was going through the oxygen and near the end of the day and you know this was seven or maybe eight hours into the flight i was out of the oxygen feeling totally fine at one point i think i was a little over 17 000 and nate was a little bit behind me and i was like oh my god i'm not going to be able to i called him on the radio and exact same thing gavin you sound like an idiot i can't understand you and i was using a full flight full face helmet with a visor and we'd learn that if i had the visor down and it was a black visor you know i mean it was very obvious if i had it down or up and and it was down and when it was down it would kind of whistle like the air would whistle through the helmet and so it made my comms pretty poor so nate's thought was that my my visor was down and he said that gavin you know your visor must be down and i was like oh my god i'm not going to be down and of course you know i should know that anyway i'm looking through the thing but i you know first thing oh something must be wrong as i reached up to see if my visor was down even though it's black and it wasn't it was up and so i called back and you know i kind of got myself together and i thought i'll just try to speak slow more slowly and called him back same thing gavin you sound like an idiot and then i realized that i'd been flying around for an indeterminate amount of time with no idea that i was really flying around i was just looking at things and there was this big there was this big mining encampment down below me and i was just kind of aimlessly wandering around the sky and i thought holy shit gavin you're flying a paraglider dude get it together and so i i dialed down a couple thousand feet and uh and then suddenly kind of the whole world came back into focus and i you know i carried on my happy way but i thought wow this is this is really interesting because at the time i had no idea i felt like i was totally fine and communicating fine and behaving fine and i wasn't i was kind of out of my head
and has that changed the the way you fly now have you made changes based on that well
you know yes and no i mean in a sense it was an unusual day i mean we on on any good day we we always fly with oxygen we don't we don't do the whole cowboy thing ever anymore because we've learned i mean not only is it dangerous but it's also just it keeps you warmer it's just it's it's like having a little you know a little baby blanket on your back it's just it helps everything and so we always fly with oxygen but in those cases you know i have an on-demand system i mean in those cases where it's a big long day there's not a lot we could do what i would like to do is make it so i could change it and it didn't turn on at 10 000 it came on at say 13 or even 15 so i was using less of it i was using it more when i really needed it but i haven't made that change
absolutely it sounds like your buddy would have really needed that actually at a lower altitude well
and then that's it you know and so now you know one of the things that i've written about quite a bit and actually in the next uh cross country i talk about this a lot but i think we under value uh nutrition physical fitness all these things that i think people don't think about too much when when it comes to paragliding because we're just sitting in a harness harness steering around and it's not you know quote unquote physical but you know i think to fly big lines and you know and fly long
you incorporate good health good sleep hygiene good nutrition being physically fit i mean it's that is a really taxing thing to do to fly all day uh you know your brain takes a lot of calories and i think we need to feed it right and feed our body right so feed our body well uh to take on these kind of missions because they're big they're demanding oh
definitely and you know all the trauma stuff that we talked about at the beginning you know prevention is better than cure we don't want to be in a situation where we're not able to do anything we don't want to get it to that stage so all the stuff that you're talking about about you know not just showing up so you can do well on the day but being in good form so you fly your best and don't crash i think is absolutely crucial yeah
and i mean i think that you know this sport tends to you know like a competitions and stuff you know the the partying side of this sport's a big a pretty big thing but you know it only takes one time and i think like in one of the previous episodes in chris santa croce's talk he talks about the the random factor and you know we all need to be thinking about the random factor and how do we limit that and one of the easiest ways is to you know if you're flying compromised you're flying compromised and compromise is being hung over or being tired or you know any the myriad of things that cause us to be not at our at our top level is maybe a better day to go for a bike ride you know we're going paragliding paragliding is dangerous definitely
and i think part of the reason why i've not really commented on that is because you know i think it's it's it's it's it's it's it's it's it's you know so many of your other podcasts address that sure so much better and with so much more experience than i have you know listening to bill belcourt's one the other week and one of the questioners says i'm having a hard time at home should i fly and he was i thought he was very good about just saying no yeah like that is not the day to be flying you know you want to show up a hundred percent and i couldn't agree more and one of the reasons why i like your podcast so much
you know and talking about ground handling and talking about you know what we call in the uk like admin like having everything sorted when you're on the hills so you're not worrying about your zips undone do you have your you know do you have your barrier switched on all these things that you guys know a lot better than me but are crucially important yeah
i mean i i think you know in in the end we're all doing this because it's a lot of fun but i think we just you know i think what the podcast has done for me is just it's made me more serious you know it's made me like listen this is a serious thing we're doing and we talk about this and we're talking about this and that but how can we how can we eliminate in some cases or at least uh greatly reduce greatly increase our odds and greatly reduce the risks and you know because because we can have a huge margin and i think it's about maintaining that margin the best you can and i think you know all this knowledge that you've given us here uh really helps that you know sometimes let's face it sometimes it's it's it's gonna go wrong and uh the more
knowledge we have the better definitely and i i think um you know i sort of approach this from a different angle because i've seen so much wilderness trauma relative to other people that i think the first year of paragliding i was sort of blown away when i didn't die
and then you kind of then you start running the risk of of intermediate syndrome which has been talked about at a huge length but which i'm so aware of because there are incredible parallels in medicine particularly in something like anesthesia where you think this is totally easy and then you get yourself into a whole lot of trouble and so i you know as much as anyone i kind of struggle to find that balance between thinking everyone who flies a paraglider is definitely going to crash because that's what all the mountain rescue people tell me and i've been flying 300 hours i'm gonna be totally fine and it's um yeah it's it's always i think a dynamic place to sit isn't it absolutely matt
are there any resources or any other kind of things that you know for those that are interested and we should all be interested that we could uh that we should be checking out yeah
absolutely um so my absolute favorite book on all things uh kind of wilderness medicine is called first aid and wilderness medicine um by duff and gormley are the authors and that is a physically very tiny book published by cicero and contains everything i've ever needed to know while out on expedition or in the wilderness there's also the oxford handbook of expedition and wilderness medicine by a guy named chris johnson and a book uh by a mountain rescuer so not a doctor uh called catherine wills and that's kind of a bigger kind of hardback book called outdoor first aid i've also written a couple of articles for cross country one about wilderness medicine stuff which goes through a lot of what we were talking about in the podcast and the other on altitude and paragliding and this would also probably be a good point to say that cross country has been incredibly supportive of all of this stuff so if i was going to shout out to anyone i would also very much shout out to them finally there is a website that i'm also involved with called theadventuremedic.com and we have a large number of articles about core skills in wilderness medicine and first aid
fantastic great well we'll have all that up on there matt thank you so much for sharing all that that was just fantastic i think some great knowledge a reminder to everybody out there that you know first aid cpr is not enough get it out there and do your do your wilderness first response course get the books that matt recommended be involved you know this is where we are the community we're the ones that can help each other out first so uh learn this stuff make sure you've got it in your pack make sure you got a good first aid kit uh reach out to myself or matt with any questions and matt thank you so much man i appreciate it thanks for your time this is really valuable stuff thanks so much for having me it's been a pleasure cool see you buddy i
hope you enjoyed that man there's a lot of information there i was taking notes as we went along and prodding my body as matt was uh explaining some of those things it makes me realize uh how much more i need to know and i've done tons of wilderness first response and uh been a responder on a number of rescues and just makes me realize that the this learning process is is always happening so i know you got something out of that so hope you enjoyed it uh if you need any more answer do you have any more questions please reach out to me or matt i've got his details in the show notes and i'll see you next on cloudbasedmayhem.com as always always ask for us a buck a show this is a listener supported podcast i hope you appreciate not having ads on here i certainly do and uh and that just comes from you guys uh sending us a buck a show so please don't send us a dollar paypal takes way too much of that wait till you listen to 10 or 15 and you really dig it and then uh send us accordingly you've got uh you can support us through paypal that's the link on that it's on the website cloudbasedmayhem.com or through patreon where you can kind of set it forget it
me just putting out content you only pay when content comes out that's on patreon.com forward slash cloudbasedmayhem on there you can see a bunch of footage from north of gnome the project that dave and i did across alaska and be rewarded with t-shirts and hats and all kinds of other stuff if you support us through patreon so that's a pretty cool way to do it i by the time this is out there i'll be in europe uh in the final preparations for the X-Alps uh wish us well they're pretty excited about this the stoke is very very high we've been training super hard for a long time and we're going to be doing a lot of things in the next couple of weeks i get to go back and have another run at crossing the alps with a bunch of cool folks and i'm pretty excited about that so if you're not familiar with the X-Alps i don't know where you've been living but uh they they do an awesome job with live tracking and we've all got heart rate monitors and it's just really cool 24 hours a day on the X-Alps.com Red Bull X-Alps.com so july 2nd that kicks off i think the prologue little mini race before it is the 29th of june so yeah we're in the closing hours here of the X-Alps and we're going to be doing a lot of getting ready for the quote-unquote the toughest adventure race on earth so yeah pretty excited got some great shows coming up for you i sit down with caroline paul some of you may have seen her ted talk or her talks with tim ferris she does some great she's a ex paraglider and a firefighter and done all kinds of cool stuff climbing to nollie and amazing things we talk about bravery and women and some really cool stuff not necessarily paragliding specific but just life specific i think you're going to enjoy that and then i have some great talks coming up about wave and sailplanes and a whole bunch of other things so uh see you on the next show thank you so much for your support and uh talk to y 'all again soon cheers