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 cloudbasemayhem.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, cloudbasemayhem.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 as much as possible. And what you actually want there is a... 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, 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 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, you crash, just get on and do it. Uh, so if you, uh, Google binding the pelvis, and I can put up a few, uh, diagrams on your website as well, that'll show you 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 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, criteria, which sort of apply here. One of them is called the Nexus criteria. And the thing to remember is it wasn't really designed for this. It was designed to see who comes into an emergency department and needs an x-ray.
But it's the only one that's really kind of been used in an outdoor setting.
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 undervalue, 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, 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 cloudbasemayhem.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, cloudbasemayhem.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 cloudbasemayhem 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.