Hi there, everybody. Welcome to another episode of Cloudbase Mayhem. I have to apologize yet again for getting these out a little bit late. I am not living at home. We had rented our house out back June 1st before the race, and it's proving very tricky to book library time and get the sound quality good enough and book people right now, so I'm having trouble with that, but we will get back on normally scheduled programming as soon as we can. I do have a fantastic show for you today with Justin Grisham, an ER doc, an emergency physician, and newer paraglider, but very, very stoked, who reached out to me a long time ago. He'd listened to the Matt Wilkes podcast. We've done a couple of those with Matt now, a good friend of mine in the UK.
I hope you heard those, but about just medical assessment. He just wanted to kind of expand on his own training and what he's learned, what he's seen, and share all that love and knowledge with all of you. So we'll get into that here shortly, but we just had a great chat. I'm really excited to share this with you. A couple quick bits of housekeeping. I've got a whole new stack of really beautiful recaps, hats, and new swag in the store. Go to cloudbasemayhem.com and check out the store. We're carrying the Bassus Rausch Swiss Chrigel gloves now and a bunch of new Patagonian t-shirts, and stuff, so check those out if you're in need of some gear for flying.
The gloves I used in the race, actually, they're really pretty neat. And the other bit of housekeeping is the X Red Rocks. We are fully going forward with this hike and fly race. It's a three-day stage race, three-day, two-night stage race at the Monroe Fly-In that is now the biggest fly-in, I think, by far in North America every fall. And the fly-in is the 27th. It's the 27th of September to the 2nd of October, and the race is going to be that weekend, Friday, Saturday, Sunday, so September 30th, October 1st and 2nd. We've got two divisions, the pro division and the adventure division. In the pro division, there's a $5,000 prize for first place. Scoring is super simple. If you win the day, you get one point. If you get second, you get two points and on down.
So whoever has the least amount of points at the end of the three days wins the grand prize. It's going to be a lot of fun. It's going to allow us to make things harder. It's going to make it easier at the end of each day to kind of moving forward because it's a stage race, so we'll all get to start together and probably won't all be ending together at the end of each day. And certainly the pro division, because it's going to be pretty tough. But the adventure division is open really to anybody and you just got to be comfortable hiking and taking care of yourself in a mountain environment and getting off probably different launches. But the pro division is going to have a lot of top landing and be physically pretty tough and really tough courses. But it's all going to be a blast and it's all going to take part in during the fly in, which is just awesome.
So I know it's tough getting to the States right now with the whole Delta variant taken off. And so I know a lot of people aren't allowed to travel. And from here, we were hoping to get a bunch of international pilots and a bunch from the ex-alps and stuff in this. So we shall see. Hopefully that'll get better and that can still happen. But if you are overseas and think you can make it, reach out to me, we'll make a spot for you. And if you're interested, just to learn more or to sign up, go to xredrocks.com. There's a lot more information there. That's it. That's it for housekeeping. Let's get into the show. We talk with Justin Grisham about medical decision making, common injuries in free flight, the primary and secondary assessment, emergency evacuation planning, heat injuries, cold injuries, how to deal with water and how to deal
with a patient and what you should be carrying in the wilderness environment. And I found all this just awesome. I always learn something new from these. I think it's the knowledge that we as a community really need to be dialed in with and understand and share. And because it does happen and the better prepared we are, the better the outcomes will be. Enjoy the show.
Justin, man, I think this has taken us like two years.
It's taken a long time. And I'm excited to have this opportunity to chat with you. I wish we were doing it live. It sounds like you were in Chelan right before I was. We could have done it then. That would have been great. But I thought a cool place for us to start is you reached out to me when you first reached out to me, you had listened to the Matt Wilkes podcast and kind of inspired by that and started using your background to teach about
medical wilderness first response and medical things in the wilderness environment, which is what we're doing, hang gliding, paragliding all the time. So we've been kind of trying to align for quite a while here, and we finally got the opportunity to do so. So why don't you tell everybody your background, why you kind of reached out to me and why it makes sense for us to do this?
Yeah, thanks, Gavin. It's I'm glad we're here. It's pretty cool to be talking, even if it's not in person. So, yeah, I listened to the podcast with Matt Wilkes, and that was a real big inspiration for me, as well as just starting to fly and be part of the community and unfortunately, starting to see a lot of people get hurt. So my background, I'm an emergency medicine physician. One of my fellowships is in wilderness medicine. And then before that, I was an EMT and a medic, both for the National Park Service and then in Salt Lake County on their mountain rescue team doing all their on the mountain rescues, which, as you know, there's there's a lot of people who fly in Salt Lake City, whether it's paragliders or speed flyers or the so the occasional hang glider and so, you know, working in there.
And that was well before I was a pilot. We rescued a lot of folks. And I don't think I really appreciated the sport or kind of what it it took until I started flying. And then as I as I started flying, I realized, like, it's it's pretty out there. I even compared to all the other sports I've done, Alpine climbing and back country skiing and, you know, even, you know, big climbing expeditions to South America and stuff, I don't think I've ever felt more alone than paragliding. And so, you know, as I started thinking about it and thinking about like, well, what would I do if I got hurt in this situation and then and then seeing some accidents on the hill or in the mountains, I felt like there was a need to spread a little bit of love in the community and kind of spread some knowledge and maybe help some people get out of bad situations.
So that was I guess that's what I'm hoping to do, kind of spread some stuff and spread some knowledge.
Yeah. And we're going to reference a lot of the courses that you put together. These are all kind of half an hour courses on a bunch of topics that we're going to go through right now. But those of you listening, go to the show notes on this in this podcast. And there's a whole bunch of YouTube's that Justin has created specifically for these. So what do you think? Should we just take it from the top and go through it?
Yeah. Yeah. Let's just go through top to bottom. And these videos are these are all from a course that I teach a few times a year. I teach like an in-person paragliding first aid course. Usually that's in somewhere in Colorado where I live, even though I've traveled for a few of them. You know, I just I want to spread the love and spread the knowledge. There's a lot of good courses out there as far as medical courses. And usually they're cheaper than an SIV. So I encourage people to try to get some sort of knowledge. But these are these are a good starting point. But yeah,
we've talked about this quite a bit with our club. And I think some other clubs are even doing it. I know they've done this in Jackson, but it almost seems like clubs around the world, not just here in the States, is pertinent no matter where you fly, but should be kind of, you know, could almost sponsor this kind of thing or at least do the three day version of Woofer, you know, the kind of the re-up version and just keep people tuned in. What I have found in every emergency I've been involved in and unfortunately now I've been involved in a ton is it's, you know, you have the emergency, you do the debrief. A lot of things you've done right as a team. Some things always have not been done or could be done better, which is why you do a debrief.
But, you know, it's one of these things where a lot of the same stuff keeps happening because you have the incident, you do the debrief and then you kind of, you know, you waffle on, you know, making the first aid kit really as bomber as it should be. You don't put the back board in the retrieve vehicle. You know, all the little things that we can really shore up, I think, as clubs and kind of have, you know, we've talked about it. We should have a lockbox at the main LZ where whoever's going on retrieve can just go in there and get everything, you know, there's the medical box. And we know that that it's we've got it with the retrieve driver because, you know, it's kind of expensive to make up five of them. So anyway, this I'm sure you've talked about some of this stuff in your thing, but it seems like this is just something that it sure would be nice if, you know, everyone in the community could do it.
But, you know, like you said, it does take time. It does take money to get, you know, to certainly go through woofer. That's pretty intense to 90, of course. So it'd be nice to anyway. I like how you've broken this down and making it kind of piece by piece and tack more tackleable. I
think it's pretty analogous to flying right. I've learned and continue to learn the same lessons flying over and over and sometimes feel like I don't always remember mistakes that I've made flying. I think medicine is the same way. You know, it's there's a reason we do thousands and thousands and thousands of hours training when we go through medical school and residency and everything else. And I don't think you need that necessarily to take care of your friend who crashes. But, you know, consistent practice is something I've seen with the last class I taught, which was in Boulder. And a bunch of the students in that class, they get together once a month, once every once every two months and just meet at the hill before they fly. And they just kind of talk about some stuff for a little bit. And that's something that keeps those skills pretty fresh in their mind.
And and I trust them a lot more if I'm the one who crashes. Sure. To take care of. So I think there's a lot of like little things that can go. But it takes it does take a lot of work. And this isn't fun stuff to think about. You know, it's fun to think about flying. And it's fun to plan whether it's not it's not fun to think about what you do in an emergency. And that's probably one of the barriers to it. And I don't know how we can kind of get over that as a community.
Yeah. I mean, unfortunately, it's just so relevant to this community and we we have to go through this pain,
literally, metaphorically. But yeah, well, let's let's go through this. And, you know, the one thing I would say we need to add to this, you know, at the bottom in the last one, a lot of people have been reaching out to me lately. And not to distract. Practice from what you're going to be telling us here, but is a little in reach briefer, you know, a half an hour show on best practices there, because, again, it's like, you know, most people take it out of the box, learn how to turn it on, maybe learn how to turn on tracking, and that's about it. You know, and those little guys can be or something similar pretty much in every rescue I've been involved in. We haven't had cell and that suddenly becomes something that's really critical. Just, you know, just knowing where to find your position so you can give it out and give it over to the radio and that kind of thing.
It's you know, it's it gets real frustrating if you get slowed down.
Totally. And maybe I was thinking about putting something together like a lessons learned from search and rescue and and there's probably a lot of thoughts on this in the community, but don't don't people shouldn't expect to be seen from the sky. You know, everyone loves helicopters. It's really hard to spot a paraglider in trees or or on the ground. And depending on what color it is, you know, I fly a bright orange wing. And sometimes even that's hard to find. I mean, it's it is so hard to see people to to find people, whether you're walking around or from the sky. I think there were some lessons learned, probably with with the Kiwi search. Yeah. Yeah. It's a
good opportunity. We've never really done a proper debrief of that. I was just hanging out with Bill up in Chelan. And that's on the that's on the docket. We really need to do it for a lot of people. They just need a little bit more time. And it's probably time to do it now. But there's I think I mentioned this when I just mentioned the Kiwi incident months ago, you know, the color of the wing was a big one there. He had a blue and white wing, which was really not visible. And the other was that we had and I was one of them dozens of people with really good glass within feet of where they ended up finding him in the first search. And I mean, I was looking right. I was looking at where he ended up being and he didn't move between where he, you know, when he landed and and a few weeks later when they actually found him, it's really hard to see somebody.
It is really hard that many trees. It's just phenomenal. He was a big dude and the wing wasn't packed away. It was you know, we don't really know what the wing configuration was those first days, but you know where they found it, it was separated from him. So, you know, I did move quite a long way. So who knows? Like what it was like when we were in there. But still, we were right. We were standing on him and we didn't see him.
Yeah, I think I think in the US, Aside from a few areas that are real close to metropolitan centers that have really well-trained rescue teams, and expecting self-rescue is is the way to go, and kind of what should be everyone's expectations when they start to think about, "What am I going to do to plan for an emergency?" How am I going to practice for this? What are kind of my mental thoughts going through this? It probably should be I'm going to get myself out of this or my friends are going to get me out of this.
Yeah, rely on your own crew. I think that's that was the other thing that wants to come up in every rescue I've ever been in, we're way more or just more used to the wilderness environment than a lot of the search and rescue teams. And we're just we understand what's going on. We understand what free flight is all about. And we've got all the resources. We've got the in reaches and we've got the first aid kits and we've got the radios. And, you know, we we we understand operating out there. So we're much more we're much more effective and fast for sure.
Yeah. Radios are a huge a huge thing. There's no other population of athletes that I've rescued who have radios. You know, in the US, climbers don't carry radios. I didn't rescue any sailors. I was never doing the maritime thing. I'm sure they all have radios. But, you know, paragliders have radios and communicating that with a search and rescue team is is huge of you because, you know, we're used to being able to talk on the phone with folks, that's not going to happen if you can get them on the radio. There's even teams that can triangulate radio signal. And that's not that hard to do. Like the National Park Service can do that pretty easily. But yeah. So all this sounds like this
sounds in some ways like your first topic, medical decision making that.
Yeah. So, you know, making medical making medical decisions is is is an amazingly complex kind of set of ideas. But I think it can be boiled down and it's really analogous to how we make decisions flying. Paragliding is a really complex sport. There's a luckily for all of my patients, I'm a much better physician than I'm a paragliding pilot. I'm still learning a lot about flying a paraglider. And I think I learn more every day. And but there's so many similarities here. And so much of it comes. Down to preparing yourself beforehand. We pre make a lot of decisions when we fly. I think we've all probably pre made decisions as far as when we're going to toss our reserve, right, if X, Y and Z happens or X happens.
And I'm I'm this close to the ground. I'm just going to throw my reserve. It's a pre made decision to kind of make that decision faster. And medical decision making is is the same way you can pre make a lot of your your decisions. We talk about an ODA loop, right? And this is a military thing that a lot of fighter pilots kind of coined and started using and an ODA loop, if you think of, you know, kind of four letters in a circle and it's first you observe and then you orient yourself to a situation. You decide on a course of action. You act according to that decision. And then you re observe what's going on.
So this is kind of how humans not only make decisions, but make fairly complex decisions and then look at how those decisions affected their environment and kind of affected what's going on. So say, like, you know, analogous to paragliding, you would be like, OK, hey, you know, I'm on a which line do I take? OK, so maybe I'm going to, you know, kind of head off to the right a little bit. So I'm observing everything around me. I'm looking for, you know, do I see any other wings going up? Do I see birds circling? You know, I'm orienting myself to the situation. What's my wing feel like? What do I see on the ground? What does all the data from my instrument telling me? I decide on a course of action. I turn right or see like maybe there's a lefty line over here, you know, and I've decided on that. I act on it and then I'm re orienting and re observing to my situation to see if I screwed up or not, like, oh, no, that was the wrong decision.
Should have turned left. Medical stuff is the same. You know, you see a patient and maybe they're bleeding heavily on the ground. We know the number one cause of death and trauma is just bleeding. And it's really, really simple. If you take if I if people take nothing else away from any of the talks or the lectures that I give, it's like just stop bleeding, you know, that that takes care of almost 90 percent of preventable death and trauma. You know, there's a lot of stuff we can't fix. I can't fix massive head injuries. I can't fix big, big injuries to the heart. But blood that's spilling out on the ground, you know, I can fix you can fix a six year old can fix it with the proper training, you know. And so, you know, kind of pre making that decision.
Right. I know that if I see I observe a lot of blood spilling out of someone who just crashed, right, coming out of a big wound on their leg or a big wound on their arm. I've already oriented myself to that situation. I see the blood. I know what's going on. I've pre made that decision in my head. I'm putting a tourniquet on that limb to stop that bleeding. That's a decision that I made sitting in my house, you know, on my couch, drinking a beer and I've already made that decision. Listening to this podcast, you know what to do there. And then you can just decide on it. And that's going to make all of our decision making faster. Now, that requires some medical knowledge. But more important than that, I think it takes some imagination. I think. I think sitting at home with that beer or maybe we're caught in traffic or, you know, maybe you're sitting in the LZ because the weather sucks and you didn't get to fly, but going through some scenarios in your head and preparing yourself for them and kind of playing the what if game.
You know, what if this person crashes and it looks like this? What am I going to do? Or, hey, I'm going to go try to fly this big line with my friends. What happens if we crash? If someone goes down halfway through this, how what are we going to deal with that? That imagination can really set us up for success.
Yeah, I like that. And I also like backing that way back. And, you know, there are certain people I love flying with because, you know, the night before they've set up the telegram group and, you know, they've done the spreadsheet for resources, phone numbers, you know, who to contact. You know, all that stuff's kind of done. So you're not trying to do it when something happens and then trying to figure it out by radio, you know, or something else or crappy cell phone service. And, you know, it just it just removes a lot of the what ifs.
Totally. I love that you brought up cell phone numbers, something I've been trying to do and haven't been great at it is before I go fly with my friends, if it's people I don't know or I don't already have it written down, just like, hey, scribble down your emergency contact phone number for me, because I don't I mean, you know, I don't know a lot of these guys outside of guys or gals outside of flying. And if they crash. I don't think I would know who to call if they were unconscious. And that's something as a community, I think we can do a lot better. And people don't like to think about that stuff. And I get that. Right. I mean, there's a time and a place for it. I think when you're walking away from the car is when to think about it, not when you're on launch, putting your harness on. Sure. Yeah. But it's something I definitely think we could do better as we as we kind of work towards this paradigm of like, how do I make medical decisions?
There's a few key points that help us make better decisions. And again, this isn't just medical stuff. It's it's it relates to so many aspects of life. But within the medical realm, it's going to help you either save your life or save your friend's life, and that's knowing what to look for. So when we're observing a scene, when we're looking at a patient, you have to know specifically what to look for. Otherwise, you're going to probably be pretty overwhelmed with kind of sensory information and most of it's going to be useless. And so as you know, folks kind of go through a few of these lectures and look at stuff or take a course, it's worthwhile thinking about, well, what order am I going to look for things because some things kill people faster than others.
So blood talk about this blood spilling out in the environment is going to kill you the fastest. So that should be the first thing you look for and the first thing you kind of observe and orient yourself to. And that's going to be. That's the only thing on my mind until I make sure that there's nothing else going on with that patient. So you're talking a really
good, thorough, you know, get your hands around underneath to make sure there's nothing being held in by pants or clothing or harness and make sure there's no blood,
make sure there's no blood. Totally. And and to know to look for that first and then to know, you know, second is to look for airway stuff and make sure that their airway is open, that they're able to move air through their through their mouth or nose, hopefully both, you know, and if something's wrong with that to fix it, but to have a paradigm to look for and to look for one thing at a time in a specific order and that specific order, it's another primary assessment lecture. It's it's you first you look for massive bleeding and then you look for airway compromise, then you look for breathing like respiratory stuff. Are they actually getting enough air in then circulation? Right. Is their heart beating enough that there's actually, you know, are they in shock?
You know, do they have a low blood pressure? So there's not enough blood and oxygen getting to important stuff like brain and heart and then finally, like a hypothermia and a C-spine assessment.
And
you're going to go through some of these, I know.
Yeah, we'll touch on them. I think, you know, it's hard to you know, these are 40, 50, 60 hour courses. But I think there's some there's some key stuff people can walk away with.
You mentioned tourniquet. What's the current? I just want to leave people with a clear. Are we still are we still doing tourniquets? Are we just doing pressure? Is, you know, can you put a bunch of rags and tie it with a tourniquet? So the rags are applying pressure. So you're not really just hit on that briefly. And then I'd love for you to hit on to airway or low blood pressure. What can we do there in a wilderness environment to help that?
For sure. So I'm a huge fan of tourniquets. I am I'm a military flight doc. So I work with our helicopter teams, you know, everyone in the military. We've been using tourniquets for for 20 years, the last the last 20 years of conflict to great success.
If if you're only going to carry one thing in a first aid kit as a paraglider or a base jumper or a speed flyer or anything that involves high velocity sports, I would carry a commercial made tourniquet. And that's a North American rescue like cat tourniquet is probably the easiest one to get your hands on out there. There. So tourniquets are key for stopping bleeding. Commercial tourniquets are far superior to everything else out there. I have seen some improvised tourniquets work right. Like a belt around a limb. We recently had a speed flyer crash in Colorado. And that that pilot's partners put a belt around around that pilot's leg.
And it was a semi effective tourniquet. But what the other research studies show is that usually that doesn't work and you need a commercial tourniquet. I think people are scared of tourniquets because there's a lot of medical superstition around them. But the end game is that you can put a tourniquet on and you can leave it on for two hours without any ill effects. I could put a tourniquet on my arm right now. Use
one. Yeah, just
use one. Yeah. So no question asked. You should take it. You should have a tourniquet, know how to use it. If there's massive bleeding or any hint of massive bleeding, put the tourniquet on. You can always take it off later on. OK, great. And so that's that's kind of the takeaway. I'm a big fan of pressure bandages, too. And oftentimes we'll start with a tourniquet and then kind of put a pressure bandage on that same wound and then slowly loosen the tourniquet and oftentimes that pressure bandage will take care of it. You can then take the tourniquet off. But your first bet should be to just put the tourniquet on. That tourniquet is your safety net in massive bleeding and it takes care of the problem. So you can start to think about other things. Hmm. Great. Right. So airway wise, mainly positioning.
So positioning is always the first bet with airway stuff. Patients usually, if they're conscious, will position themselves in the best way for them to breathe. And it's really important to recognize that because sometimes as well-meaning rescuers will be like, oh, no, no, no. You have to lay down on your back and lay down on your back and we'll position them. Humans don't breathe very well on their back. Right. I snore at night. I think we've all heard people that snore at night when they lay on their back. That's because, you know, a lot of the soft tissue of our airway just occludes it normally. Then you add in a head injury or, you know, maybe they've actually hit their face and have some bleeding or some broken bones in their face. Laying back flat on the back is really, really bad for breathing.
So you should let the patient position themselves. No one is going to compromise their own spine by moving.
If they have a broken back or a broken pelvis, they're not going to they're not going to move and hurt themselves. And we even do that in professional EMS. Now we know that the best and the safest way for someone who's been in a car accident to get out of that car isn't for us to lift them out of that car. It's to put a C collar around their neck and just have them get out of the car themselves because they're going to protect their own back better than anyone else. And and it's the same way, you know, for a paraglider who's crashed. And so there are some more advanced airway techniques. The one that I'm a huge fan of that I teach to everyone I can get my hands on is called a nasal pharyngeal airway, which sounds really fancy. It's a plastic tube you put in the patient's nose
and a nasal pharyngeal airway. We use this a lot in the military. I can teach an eight year old to put this in. I'll put one in a course and walk around with it for an hour. It doesn't bother you. It's just it is literally just a plastic tube that you have in a first aid kit and you put in a nostril and it'll hold the back of someone's airway open. And so if you have an unconscious patient, they're a lifesaver. I mean, it is a half ounce piece of equipment that will do something that you really can't do on your own because it's really hard to hold someone's airway open for a long period of time on your own. But you can drop an NPA, a nasal pharyngeal airway, and it'll do it for you. And if you're ever nice
list on the in the show of kind of your your first, yeah,
totally, totally. You know, and I don't carry much. I see people carrying these huge first aid kits. And, you know, my first aid kit fits in like a like a sandwich baggie, like a Ziploc sandwich baggie. Yeah. And I think you should only carry stuff that you can't either make yourself or get out of the patient's pack and that kind of stuff. Yeah, it was
interesting when I did the Alaska thing. My a good friend of mine that I do a lot of backcountry skiing with is that one of the ER docs here in town. And so I had him come over and he whittled it down to almost nothing. You know, really, is all I need, Terry, is I need beyond this your toast, man.
Exactly. Oh, yeah. I mean, it's so true. Or, you know, stuff you can't make up like I I can't make up medications on my own. So I carry meds because I'm like, I can't make a med. I can make a splint out of damn near anything. You know, so I don't I don't carry a Sam splint. I don't carry anything like that. I carry things I can't make on my own. That
was my next question. So you may have heard. You know, a few years back, my my ex app supporter and very good friend, Ben, broke his back on a terrible landing in in Nevada. And this was one of these in reach, you know, helicopter. It was kind of a big process. It all went really well, except in Nevada, the the the ambulance that came in and kind of stabilize them and everything before the helicopter came in. They're not allowed to carry narcotics. Oh,
that's terrible.
We yeah. And it's it's a Nevada state thing. And so he had a dislocated shoulder and, you know, and a broken back. And he was in a lot of pain, obviously, mostly from the shoulder, because the back was, you know, when I got to him, I got him four seconds after he crashed. I was on him right away. But this was one of these communications things to the guys that didn't know that he crashed. And he didn't know what was going on. which was a thousand feet and sending and the first aid kit was in one of their trucks. And we didn't know we had a first aid kit. We did. We didn't know he had it. So this poor guy, my best bud, laid there for two and a half hours before getting in a helicopter without any drugs and the ambulance showed up and he couldn't give him anything.
And so this was just I mean, that's the thing that's in my first day. Get. Always now is, you know, 400 whatever grams, that what it is for ibuprofen and some oxy and some heavier stuff just in case, um, but you know, I think this is another thing that I think people are really nervous to use, so maybe talk about when and when not sure
As far as pain control, you know, my go-to to start off with all these things is 800 milligrams of ibuprofen and a thousand milligrams of Tylenol.
And if you take, you're doing the mix too, yeah? That sounds like that's the way to go these days. It
truly is, and that's what we use in the emergency room all the time, um, to start off with that. That is the equivalent pain control of 10 of oxy, um, and it doesn't get you high. Now, okay, narcotics certainly have their place. I don't routinely carry narcotics in my bag because there's a lot of legal stuff around that, um, on you know, and that's like routine. Like, if I'm just going up to Boulder or Lookout to fly or something like that, you know, metropolitan kind of flying, I'm not carrying narcotics, um, you know, there's a, there is a place for it in the back country, I think, um, but I'm always going to start off with the Tylenol Motrin combo, and you can retake that about every four hours for 24 hours, and it works pretty well.
I walked about 20 miles out of the Utah back country with Um, with that cocktail, and it wasn't great, but it definitely, like, it'll definitely get you out, so
800 milligrams. Add all that's exactly what I took when I crashed back at the end of March, and it just made such a difference. It was so great, and then a thousand Tylenol.
thousand of Tylenol, yeah. And that's a really safe combination. Um, and contrary to popular belief, you know, you can... someone who's on the ground and you can eat and drink. I mean, don't, don't go smorgasbord, but you
Um, you know, anyone who can eat and drink, you should, because these rescues are going to take a really long time, and that patient needs to stay hydrated, and drinking is going to be much better than any IV anyone is going to get you anyway, so
Let's, let's totally clean this up. Is there ever a time where you wouldn't give the 800 1000 cocktail, uh?
If someone is not conscious enough to, like, put the pills in their own mouth and take a drink of water themselves and swallow, I'm not giving them anything in their mouth.
Okay, so nothing. So, head injury? Still, it's okay. It's
okay yep
Great, okay. I'm glad you cleared that up, because there's—if they're—I'm always here. No, you can't give it if they've had this or that, or this or that. Man, I think it's pretty nice to get people out of their pain.
Now, yeah, you know, you're gonna get a better patient assessment. You're gonna be able to figure out what's going on better if the patient's pain is controlled, and everyone's life is easier if you're carrying that patient out. You're gonna be more comfortable if they're more comfortable, right? Um, gotcha. So, yeah, other things we can do, you know, we kind of talked about some, um, some massive bleeding stuff, some airway stuff. Circulation is, is hard, right? Um, in, you know, professional EMS, and this kind of stuff we're moving to where, you know, we even give blood products, you know, in the field. The last, um, you know, big, um, paragliding crash in Colorado that I was a part of, right? We had actually bags of blood there on scene at the health center and helicopter crew brought in. That's clearly you're not going to carry that with you. That's not, that's like a luxury.
But, you know, what you can do is recognize shock early on. You know, we've all heard things like, so shock is just low blood pressure, and what we're really worried about is vital organs—the brain and the heart—not getting enough blood and, therefore, not getting enough oxygen that's being carried by the blood. There's a lot of different types of shock. the one really, almost every paragliding incident and injury is going to be hypovolemic shock, which just means you've lost so much blood that your body's having a hard time keeping up
the hard
thing there is, there's really nothing we can do about that outside other than get to the hospital as fast as possible, which really just means recognizing it as fast as possible. And so things like, you know, maybe a patient that was talking to you in clear sentences is now starting to get a little bit groggy, I would start to worry about a head injury, but also the fact that maybe, you know, their blood pressure is going down, or someone who had nice pink nail beds, you know, initially, now their nail beds are kind of gray or blue, you know, um, you know, their hands don't look nice and nice and pink, nice and fleshy, their hands are starting to feel kind of cold.
Those are all signs that that someone's going downhill. What we can do in that situation is keep them as absolutely warm as possible. So something we know in trauma is that the colder you get, the more you bleed, right? So in medicine we talk about this as the the terrible triad, or triad of trauma, which is in essence like the more the colder you get, the less you're blood clots, the less your blood clots, right? The more acidic you get, kind of like, you know, your acid builds up in your body because you're losing blood, and then you get colder because you're losing blood, and it starts this terrible cycle.
And so trauma patients of any sort, but especially high velocity trauma like flying injuries, you should keep them as absolutely warm as possible. Things that I've had a really good luck with, I mean, you don't have to carry a sleeping bag with you, right? Wings, like wrapping someone up in their wing, keeps them pretty warm. Um, I've popped patients reserves, right? Um, I'll pull their reserve out of their harness and wrap them in that if it's not already out, and that keeps them pretty warm. Getting them off the ground, yeah, with any use the use the patient's reserve, not your own, of course. Um, anything you can do to get them off the ground, you know, um, laying like, you know, kind of laying their own harness out or taking the foam out of their harness
or if you're on a vulva and you have a sleeping pad, getting them off the ground to kind of insulate them, and then that combined with a like a reflective space blanket, which are super light and super cheap, that'll really warm someone up quite a bit. And if you can do that super early on, really at the end of your primary assessment, when you're looking for all the things that are going to kill your patient right here, right now, you've checked to make sure that they're not bleeding out onto the ground, that you know they're breathing, that they're moving air in and and out of their lungs, you've plugged any big holes in their chest, that kind of stuff with a, you know, any sort of fabric, any sort of sticky sticky fabric, uh, that's what we'll talk about next. Get them warm and get those patients as absolutely warm as possible, um, and that's going to help save their life because they're going to bleed less if they're warm, great.
And then the other big one is, you know, look for big old holes in their chest, and you have to look with your eyes Carefully with your hands. Um, when paragliders hit, especially if they land in a tree or there's sharp rocks or this kind of stuff, it's pretty easy to put a hole in your chest. Um, and to put a hole in your chest wall, something I recommend that people carry, it's called a chest seal. It's just a sticky piece of plastic. It's about a six-inch diameter circle. It's the stickiest thing; it's almost like a, like a rap trap, kind of sticky. And you peel the side off of it, and you know, once you find a hole in someone's chest, you just slap this thing on. And they're vented, so have a one-way valve in them.
And so if someone has started to accumulate, you know, a dropped lung, a pneumothorax, where they have air that's compressing their lung down, kind of air in the wrong space of their chest, not in their lung, but in between their lung and the chest wall, as they breathe, it'll push that air out this hole because that air is caused by having just a big old hole in your chest. And that's something you can do really early on to save someone's life, and so kind of going through that, and that's—I mean, and that right there, that's my first aid kit. Like, we've gone through all of it. I carry a tourniquet, I carry a nasal pharyngeal airway, right? I carry a chest seal to plug holes in the chest, and I carry something to keep my patient warm and something to keep them comfortable. As far as meds, that is the—that's it.
Yeah, you know, if we're going to add anything onto that, I'll maybe add a little bit of tape. I'll probably have some duct tape around a trekking pole, anyway, um, and a compression bandage, like an Israeli bandage.
Okay, great, but that's all that on the website. Everybody go get this stuff right now, yeah, Amazon
Jeff Bezos is going to make a lot of money off this podcast right here, right, right, right? Yeah, that's awesome. Don't worry if they're
affiliate links. It's okay, yeah.
Um, and that's really it. That's the primary assessment. It's just to see what's gonna kill your patient, your buddy, who just crashed in front of you right here, right now, and fixing it. And you don't move on to the next thing; if you find something, you fix it. You know, you're not gonna stare, stare at half your wing that's collapsed and not fix it. Don't do the same thing with, you know, medical stuff. Super
Interesting, you haven't mentioned any of the stuff I think you're going to mention next, you know, the common paragliding, paragliding injuries. You know, we think of broken backs, broken ankles, we think of all the stuff that snaps, but none of that is, is the stuff that we lose people over, is it? It's, you know, it's this bleeding and chest holes, and then that kind of blunt force trauma that you bleed out, well.
Here's one of the problems with, and a challenge in preparing for, a lot of these things is we're preparing for low-frequency, high-consequence events—things that don't happen very often, but if they do happen, are absolutely disastrous. And human brains don't deal very well with those kind of situations, right? Things that we don't see all the time, we kind of push to the back of our mind and don't really think about, you know, the really, really horrible stuff. This is when it pays to have a, a pretty active imagination and kind of be able to imagine this kind of stuff. As far as common paragliding injuries, you know, it's the most common stuff is what you said, it's rolled ankles, maybe a broken ankle.
Maybe a broken wrist because someone puts their hand out as they tumble when they do a plf when they're not supposed to, a dislocated shoulder. Most paragliding injuries aren't very serious. All right, the stuff that I think people should focus on first is, all right, what's—what are the ways that I can save someone's life if I absolutely have to? And a lot of the injuries, like we said, massive head injuries, massive internal bleeding, you can't do anything about, so focus on the things we can do things about, which is kind of what we just talked about. And then focus on the other common stuff, and the other common stuff is all orthopedic injuries. So it's broken bones, well, broken bones.
Um, as long as you're not bleeding to death because of them, you know, in the wild, you splint it in the way that is the most comfortable for the patient. Whatever is most comfortable for the patient, splint it like that. Put as much padding around that thing as possible, put something stiff on the outside, and tape the hell out of it. It's really not rocket science. You don't want to tape it too tight so that they're losing circulation, right? If they could move their fingers before you put the splint on, they should be able to move their fingers after they put the splint on, or their toes. Um, and, and there's certainly a little bit more of a science to it than that, but that's—that's the end game is you're really putting something firm, like a trekking pole, even a stick, on that Um, that broken bone, that injury, just so that patient doesn't have to use their muscles to stabilize it.
Um, as far as time frame wise, if you're talking about simple orthopedic injuries, right? Like a broken arm, a broken leg, you know, you really have quite a bit of time to get to the hospital and get that thing fixed, as long as it's not cutting off any sort of blood supply downstream. And so, something that's useful to learn how to do is, you're going to have to is to like actually know how to find a pulse somewhere. And finding pulses can be hard for medical professionals, much less like non-trained folks. And so, a really easy way to do that is if you just take, you know, take say your thumb, for example, and you guys and people can follow along as it's just take like the end of your thumb and just squeeze the nail bed for a few seconds. And that whole nail bed is going to turn white as you squeeze it with your other hand.
And then, if you just let go of it, it should turn back to pink within two to three seconds.
Right, yeah. So, under your nail, yeah, that's because we're all healthy. We're sitting, you know, here nicely, and hopefully, you know, if it didn't have that, we'd have problems. And so that's a great indicator of how much blood supply that is getting into your hand. Like, it should turn back to pink within two to three seconds. If it takes longer than that, there's some issue going on. Now, that issue could be a lack of blood supply because of kind of global shock, because there's just not enough blood in general. But if there's a broken bone above that, you know, say your arm's broken and you look at that thumb and you squeeze it and it takes a while to go from white back to pink, well, then I'm a little more worried about that broken bone cutting off some blood supply. And if I ever have any question, luckily, we have the other non-injured side of the patient that we can compare it to.
So, I'm going to squeeze the thumb on their non-injured side and see, and if that turns right back to pink, well, then I know that I have a problem on the broken side. So, anytime there you have Question about a patient you know, and well, is this normal? Or is this normal because humans are weird, right? We have all sorts of screwy stuff with us. Just compare left to right, you know? We're lucky in that we're kind of given this, this great comparison, um, to see what's, uh, what's abnormal and what's normal within that person. So someone who does have blood supply that's cutting, you know, a fracture that's starting to like maybe cut off some blood supply to that extremity, that's someone that needs to get to the hospital, you know, as soon as possible. That's something that, you know, needs to be reset professionally and kind of yanked on, and that kind of stuff, um, and that's hard to do outside, and it's hard to do without a lot of training outside is
There is, there ever any, you know, for you guys doing this professionally, what happens when you've got a patient who's, you know, pretty with it and, uh, they're making sense and, you know, they're not panicking, they're not in shock, and you identify something along these lines like, "Yeah, I thought you were all right for three hours, but I think we need to hit your SOS." What if they resist? Is that just, are you in any kind of, you know, "Hey man, I don't have insurance, no I'm fine," you know, "Can you just?" What, what should you do in that situation? Is it just always patient care, no matter what? No.
It's a, I mean, it's a free country. I've had patients on professional rescues that I've treated for life-threatening anaphylaxis that then refused to go to the hospital, and we're like 10 miles in the backcountry, um, and it's, it's a free country. They're allowed to do whatever they want as long as they're completely with it. The thing that I, I will remind everyone of is that in, in the United States, the Mountain Rescue Association, which is kind of the overarching body of mountain rescue crews in the U.S., which are predominantly volunteer, right? And the Mountain Rescue Association is the one who, like, sets the standards and, and kind of as far as skills and all this stuff, they have a rule and a guideline which is that mountain rescue should be free, because people will wait to hit that SOS button if they think they're going to get charged.
And the Coast Guard found this out too. The Coast Guard figured out that the riskiest rescues that they were doing were sailors who were afraid to call for help until things got really, really bad. And the Mountain Rescue Association is the same thing. So if, if you hit, you know, if you call 911, you hit the SOS and you know one of these great volunteer rescue teams comes and gets you, they're not going to charge you. Now, if there's a helicopter involved and it's a private helicopter, they're probably going to charge you, right? If they, if they take you to the hospital in Salt Lake, I can say that, you know, we flew, um, Life Flight, which is a company out there that flies a lot of rescue missions. They have a hoist ship, which is amazing. In the United States, they write off about 10 million dollars of rescues a year out of the kindness of their heart. If they don't take you to the hospital, usually they don't charge you.
Yeah, yeah.
And by the way, a life flight membership for your family is 60 bucks a year. Pretty cheap, yeah?
Yeah, that's a different company. That's a company I have, but it is worth it to get those. I mean, everyone calls himself, everyone calls himself life fly, right? But it is worth it. All, all these helicopter companies have a membership if you're flying in their area. I mean, 60 bucks, like, you know I... yeah, I just bought a new backpack, right? To, to fit my kid into it. It costs a lot more than 60. Exactly.
That's very cheap insurance. I love getting that renewal every year. Yeah, heck yeah! Most people don't get that renewal.
After you walk for a while outside, if they're pretty hurt, they change their mind on calling for a rescue. Hitting the party, yeah, yeah, everyone should expect for it to take a really, really long time to get an injured person out of the backcountry. So even well-trained professional mountain rescue teams with the nicest stuff, right? In Salt Lake, we had a two-piece titanium litter with a wheel and all this fancy equipment. We would, it would take us between three and four hours to move a mile. Yeah, and that's with professional people.
yeah
I mean, if you're doing this on your own with like a litter you've put together out of ski poles and and all this other kind of stuff, it's brutal. It's brutal. You really are only moving to an evacuation area, yeah? Um, and it goes and along those same lines, right? If the patient can walk, let them walk. Like, the best way to the hospital is the fastest way to the hospital, um, right? And that might be a helicopter.
i love it
We're a pedantic bunch, but that might not be a helicopter. And we talked about this in Chelan, where like, you know, out on the flats, I was, you know, I was in my friend's Subaru, you know, playing doctor and chasing the gaggles around. And if someone crashed, I'm like, well, you know, it might be a while helicopter. I'm probably just going to put them in the back of the Subaru and start driving, you know, rather than sitting out on the flats and waiting for, waiting for someone to show up. Sure, sure. So the other things I see a lot in paragliding are
Right, okay. Um, people get sweaty when they're walking uphill, and then they don't really dry off because they're paragliding, and then they go fly and they get cold. And it's important to notice because people make really, really bad decisions when they get cold. They get crabby, they don't make good decisions, they rush things. That we're not as good athletes when we're cold, so I think you're actually more likely to crash and more likely to kind of tumble in the landy and that kind of stuff. And it's important to notice that people get sweaty when they're walking uphill. The real differentiation there, as far as like hypothermia and cold injuries, is that if someone has any sort of altered mental status because they're so cold. And what that really is is like, you know, if they act drunk because they're cold, that's a pretty serious thing.
That's someone who you probably need to be looking at getting out of there. You need to be warming up very rapidly, and you probably need to be calling for a rescue up until that point, which is usually—that's the point where you're going to be calling for a rescue. And you're probably going to be like, shivering has stopped well before that point. If someone's shivering, well, I don't think they should fly because they're just going to get colder sitting in a chair, right? If you're shivering, you can warm yourself back up outside. It's the point at which our bodies stop shivering that we have a really hard time warming ourselves back up. And to that same note, like, calories are your friend. Like, hot drinks make us feel good, but you need sugar to warm
yourself back up, and that's the point where you need to warm
yourself back up, and you know, we see this a lot in, in Colorado. Um, I moved to Colorado from the northwest, and you know, the northwest, it never really gets that cold in Seattle. And Colorado, god, there are some really, really cold flying days, and it's, and it's really easy to launch, you know, on the foothills, and it's, it's reasonably warm, and you get up high and it's really, really cold, and be able to recognize kind of those stages of hypothermia yourself, I think, can be really important. Yeah,
I always worry when I go through, you know, when when the whole wing is shaking because I'm shaking so hard, and then it stops and I'm 2,000 feet higher than I was when I was really shaking. I started thinking, oh god, you know, you have, uh, there's there's a lot of things I think too that we need to be really careful of there. You know, I have frozen my fingers badly enough a few times, not frostbite, but that they don't come back for months, and that can't be good for my tissue. You know, it's not, and and that, you know, hypoxia, we've done getting hypoxic, we've talked a lot about in in other episodes and stuff too, but it's, you know, spring flying or even mid-summer flying in our desert environments when you're really tall. I, I have often thought, man, if I had a blowout right now, I barely know my name.
I'm not too sure I could handle it, you know, you just, you're so cold that you're, you know, you're way beyond what you should, you should be, you know, playing tennis, you shouldn't be a paraglider
Totally, it's yeah, I—you know, I—I ice climb a lot, that's my other passion, and I can tell you that the stupidest decisions I've ever made in the mountains are being really cold ice climbing. I mean, the worst angers I've ever made, and the only times I've ever screwed up tying myself in, it's—it's all been when I'm really, really cold, really
cold and
We, you know, we—I mean, you know, you've talked to Matt and he's been on here. You know, he's certainly the expert as far as hypoxia and and just, you know, I'm really, really cold and I'm really, really cold and I'm making—we do a lot of the same stuff with our our army pilots. We actually put them in an altitude chamber and drop the pressure. We take them up to 28,000 feet and just to prove to them how big of idiots they are when you're up there and and it really is. Everyone is a just a blithering idiot and everyone has a tell and I think it's important to find your tell. Like, I get really giddy. I'm a—I'm a pretty happy dude when I'm hypoxic and, you know, I'm fun to be around. Um, some people aren't. That some people are assholes, some people see things. It's really important to kind of find your tell and there's probably more hypoxic events than we know about paragliding, I think.
Yeah, yeah, yeah. I think a lot of people don't, you know, I've talked to a lot, experienced it a lot. I'm also, I'm the giddy person, but it's, but when I'm like that, I have the first time I recognized I had no idea was talking to Nate Scale. I've said this on the podcast before, but when I first moved here, started going tall, of course, because you're in Idaho, and I had never experienced that. And it was very late in the day, big day from here, deep into Montana, and I, I'd sucked up all my oxygen, so I was out, and I was really tall at 17, and Nate called me on the radio. I was about 20k ahead of him, and he said, "You know, just, hey Nate, check it in. Where are you?" And I thought I perfectly said, "You know, it's awesome, and I'm here, and it's great, and everything's fine." And he responded back, "You"
like a, I didn't understand one thing you said, and I thought, "Oh, it must be because my visor is down." I'd learned that if my visor is down, you know, it gets kind of garbled, like the wind comes in there and screws up my transmission. And then I realized that, in thinking this, I went and reached and put my visor up. That was already up. The visor was black. I mean, I should have known that the visor was already up, and I thought, "Okay," and I put it up and said the same thing.
and I was like, "Oh my god,"
And he said, "Yep, no, not any better. You sound like a moron." And I just thought, "Wow." I then I realized I'd just been kind of flying around and just looking at stuff. I had no plan. No, I didn't really know what I was doing. I was just paragliding, but with no knowledge that I was paragliding. Wow, holy cow, I think I better dial down
here, it's just this wild, this wild dream that we found ourselves. This is
Awesome! Oh yeah, wait a minute, I'm paragliding. This is awesome! Oh yeah, wait a minute, I'm paragliding. Yeah, it's pretty
Yeah, it's, um, and you know, it's a result. Like, if you're hypoxic, you're gonna get cold a lot faster, you know? And you know, and it goes for the same. I mean, if you crash on top of, you know, crash at 13, 14,000 feet in California or Colorado, one of these, like, you know, your patient's gonna have a lot harder time staying warm. Your patient's gonna have a lot harder time, you know, clotting their blood and not bleeding. Altitude kind of makes everything worse and, uh, so and it's, I think it's important to, uh, to look at it, makes head injuries worse. You know, a head injury at altitude is going to be considerably worse at a head injury at sea level because of the lack of oxygen. So I'm going to be much more careful about evacuating someone with even a minor head injury if they're up high and kind of get them out faster, get them down faster. You know, the solution is always just to go down, you know? That, that is the solution to all altitude-based illness.
But yeah, it's, um, uh, the, the question has come up before about, you know, well, if we have, you know, if, if, if you have extra oxygen, you're going to have a lot of oxygen and you're going to have a lot of oxygen, there should I put it on the patient while this isn't necessarily always true? Um, you know, oxygen can't hurt people in all the situations we're talking about within, like, paragliding and trauma or head injuries. Oxygen is just going to help them. So if you have extra O's, you know, if you have some O's in your harness or the patient still has some, keep them on those oxygen, even turn it up a little bit. It's just going to help them.
You know, and I don't know if this was just placebo effect or what, but when I crashed in in March, and like I said, the first thing I did is I took the uh and that, I mean, immediately, because I just thought, okay, there's a lot of pain coming here. And uh, so I took that immediately. And then I, you know, I, I had just taken off, so I had a completely full oxygen bottle, so I, I started, I just sat down, okay, just chill out for a bit, and I felt like it really helped. I don't know what I did, but it was, it was just nice. It's probably just nice to have something else to think about how
High up, were you? You were in the mountains, weren't you? I was in the mountains.
but I wasn't that tall; I was probably 7500
8000, and you're pretty well, you're pretty
Yeah, yeah, no big deal. Yeah, there's, um, you know, altitude is definitely one of the kind of special considerations with paragliding. There's really no other sport out there that you can climb so rapidly and, and you know, we're kind of limited by our, our own fitness. And all these other sports where paragliding, you can get shot to the moon and then, and then really see some rapid altitude effects that otherwise we only see in, in, you know, power sports aviation. So there's some other, like, kind of cool special, um, I guess considerations that I think everyone should know about paragliding, one of which, when you're, when someone crashes, whether they came down under their reserve or they're under their wing, the most dangerous thing after they hit the ground is being attached to that wing.
okay so
There was, uh, not too long ago, a paraglider in the UK who crashed into a tree and was alive, and then when they did the helicopter evacuation, the downdraft from the helicopter caught her wing. Oh no, and she didn't, and she didn't survive it. And so, if you're, if you hit the ground and you're still conscious, you know, the first thing you should be doing is getting out of your wing. That is the single most dangerous thing there. People crash and then get drug all the time, especially with reserves. You know, reserves, a fairly large piece of fabric that catches the wind pretty easily, and so, you know, and if you're the first one on scene, to someone detaching them from their wing is vital to them not getting hurt.
And that double goes for if you're bringing a helicopter in, you know, the, these helicopter crews probably haven't dealt with paragliders before, you know, maybe, maybe some of them, right? Like the Utah crews all have, a lot of the Colorado crews have, but otherwise we're We're a pretty small community, and so not only making sure that the patient it has been unattached in the wing, but everyone's wings are like put away, not just concertina in a ball and put under a tree. I mean, everything needs to be put away before the helicopter comes in. The wind under those helicopter blades can be up to 200 miles an hour, and those catching wings, the worst case scenario is it can catch a wing and take the helicopter down, sure. And so, and that goes for helmets, that goes for harnesses.
And that goes for the helicopter, and that goes for the helicopter.
Just everything needs to be put, anything that can catch the wind needs to be put away nicely. And when you roll up on scene with these hook knife, everybody
have a hook knife have
a hook knife and
Remember, you know it's
cheaper to hook knife risers than this start hook knife and lines, yep. So and
They've cut really easy too, yep.
They do, um, you know, we all know the dangers of landing in water statistically, and the only good data we have on paragliding injuries comes out of, uh, funny enough, Turkey for the most part. And there's a little bit of data that comes out of, it, France. We're trying to fix that with the United States. Um, we're trying to revamp kind of the big accident reporting system that USHPA has to make it a little more academic and to pull in, so to make it anonymous, and people can report stuff sort of like the American Alpine Club has accidents, North American Mountaineering, that they publish every year. And I think publishing the same thing for paragliding would do nothing but help our community. Sure, yeah, to see the accidents and to see, maybe not where they're occurring, but I, I know it's going to be the same accidents over and over, but until those get published, until everyone's looking at them, I don't think we're going to start changing things a whole lot, right?
Yeah, yeah, bingo. So...
but drowning, funny, uh, interesting enough, like there's not that many drowning injuries in paragliding. Wow, you know, we all talk about it because it can certainly be catastrophic, but the, you know, the study I was reading about it and I was like, "Oh my god, it's so bad, it's so bad, it's so," you know, it was like less than 10 over a 10-year period in Turkey. Wow.
interesting yeah
And and maybe that's because we're doing things right and being really careful around water, yeah.
I think people are really terrified of that. I mean, that was one of the first things I learned when I first learned, you just can't go in the water. Yeah, I remember Will Gatton, I talked about that a lot in the Rockies because we were flying near a lot of water, and between the water and us was often just nothing but trees, you know? And, uh, you know, should we go in the tree? Should we go in the water?
And, uh, yeah, but I think it's really—it's that's one of the—there's many other things that should be, that should be drilled into our minds that aren't, but I think that's one of the things that is. I think people are just really wary of water. I know they had a bad one up at Nationals and Panama, the Canadian Nationals, uh, a few years back, and then I
Mean, there's a bad one on the Oregon coast, yeah, one of the cliffline sides. The worst
Yeah, worse. But yeah, I mean, I think if there's, uh, you know, there's, there's any kind of current or action to the water, you're really in trouble, yeah.
You know, I've only landed in the water, uh, once. It was, um, in an SIV with Henzie, and it was very intentional. All right, I threw my reserve intentionally to see what it was like, and I was amazed at how fast my wing filled with water, you know, um, after I hit the ground, yeah.
It's the wrong way up. You're, you're in trouble for sure.
Yeah, other stuff, um, that I don't think a lot of people think about is if you, you know, all right, so you're making this decision to go in the water and you're in trouble, and you're in trouble between, oh, do I land in the water or land in the trees? And you choose the trees, which is probably what I would choose, is to land in trees over water if you're hanging there, especially if, if you're kind of semi-conscious or unconscious or just hanging there for a long time. And there's a lot of pressure on our leg straps, um, that pressure will actually kill you eventually. It's called harness syndrome. It's something that we deal with a lot in climbers, we deal with a lot in industrial rescues, so the guy's working on power lines and the guy's working on big, uh, you know, windmills and this kind of stuff. What happens is if you're dead hanging in a harness that's compressing the veins of your lower extremity, there's not going to be enough pressure there to cut off blood supply into your legs, but there's enough pressure to cut off blood supply out of your legs.
So if the blood can go into your legs because those, the harness traps aren't enough to compress the arteries kind of feeding our legs, but they will compress the veins. draining blood from our legs. Then all the blood, literally all of your blood, will pool in your legs until there's not enough to keep your heart going. Good God, never even heard of that. Yeah, it's something that doesn't get talked about a lot now. It's, it's pretty rare. I mean, you have to be unconscious, hanging in your leg straps, probably for a half hour. It can kick in as soon as 15 to 20 minutes, but probably for a half hour there. And so the thought, it's easy to fix, the thought being there is you just need to reposition that patient's blood, and you're not going to be able to reposition or yourself back into our normal kind of seated paragliding position.
So something where you know your legs are a little elevated, you get the pressure off the straps. And so I'm not a big fan of people, you know, like running up the tree and thinking that they can, you know, perform this miraculous tree rescue and repel out of the tree with their friend. I think that's fraught with danger. Um, tree rescues are really, really hard. It's high angle rescue in a, in a pretty, uh, dynamic environment in which you don't really know what brand
is, and you're not going to be able to
hold you, but you can easily reposition someone by just tilting their harness back so their pressure is not on their legs, so you know they're not pulling blood in their legs. And I think that's really, really important, something I would like to look into. Um, I do a lot of hike and fly; that's really how I got into the sport, and what I love about paragliding and and fly with a, you know, a lightweight harness and usually a front mount reserve. And I don't think that hanging from a front mount reserve kind of mounted to our character is going to be a really important thing for us, because we're going to be doing a lot of things with our carabiners. I don't think you'd have the same problem with that harness syndrome of, uh, kind of hanging from your leg straps as you do from like a traditional reserve that's pulling from like shoulder bridles, yeah.
I don't think you would either, because the front mounts really lay on your back. It's one of the real, it's one of the things that people don't really understand when they throw a front mount reserve. I mean, depending, some of them wrap all the way through your shoulders, but the ones that just go to your carabiners will lay you out and
They're going to be a really important thing for you to do, so I
Think that's one of the things that you really have to be active to do, uh, and I know this because that's how I landed when I crashed in March. It was under a front mount, but you have to grab your risers and pull yourself up so you can still do a PLF. That's—that's really important. So, you know, you have to—it's—it's—it's an extra thing that's, uh, I learned from Dylan doing the, you know, acro training out within the spring. But yeah, that's—that's something. I mean, obviously, if you have time, you know, yes, if you're on your back, you've got some padding, hopefully, but it's not the greatest way to land. You know, you could be better to land on your feet and PLF. So, if you—if you—you know, once you've thrown the front mount, you'll find your—you're with most of them that just go to the carabiners, you're in kind of an awkward position. Yeah, that's—that we could, which can be rectified, but you got to be active to do it.
Interesting. Well, that's good to know. Um, and so maybe pluses and minuses there, right? You're gonna, if you are caught in a tree, you're gonna hang in a better position, but you know, that sounds like a real recipe for a back injury or a pelvis injury.
Yeah, and a lot of the really, you know, unfortunately, if you've got a front reserve, you're probably, you know, it's probably a small reserve, and those are problematic anyway. But you're also on probably light kit, and most light kit doesn't have any back padding; it's only got it under the butt, uh, or a lot of it does, and that's the problem if you're laying on your back, yeah.
I, I agree with that. The other thing that's kind of a special situation that, um, we should really know how to do—paragliding is, uh, it's called a pelvic binder. So there's a lot of pelvis injuries and, um, all high-velocity sports, and the really bad, uh, pelvic injury that we worry about is called an open book pelvis. Literally, your pelvis kind of opens up like a book; it becomes wider than it should be, and when that happens, it tears apart veins on the inside and you can bleed a lot into your pelvis. And so the way we fix that is by making the pelvis smaller, and, uh, what we do is you literally just take any sort of strap. I've done it with, um, like a, like the strap that goes—that we use for the, like, pack up, like our nose real nicely.
If you're going to do, like, a real nice pack on your wing, you can take that, and it's, it's really just wrapped around about the level of the bottom of your zipper on your pants. You wrap it around both legs and you just make that thing as absolutely tight as possible, and that compresses down the pelvis so you don't bleed as much into your pelvis, and that will save someone's life. So every, anyone who hit the ground hard—I don't care they hit the ground—if they hit the ground hard, that when I walk up to them, they haven't stood up yet because they're hurting, I just bind their pelvis. If they're not walking out of there, bind their pelvis. You're not going to lose anything by it, and you might save their life because pelvic injuries are really hard to treat. Oh god, they just, they bleed so much, and it's internal bleeding; you can't otherwise do anything about, wow.
Interesting, Justin. I know we're up against a time frame here for you kicked out of the library. I just want to go through, I've got two things. You know, in your list, there's a couple things we haven't talked about, so take a list, take a look at it, and just see if you want to tap into any of them. And then my last question is, I thought about this before we even started talking. In your profession, you obviously see a ton of trauma, and now you're a pilot. Uh, you know, it's kind of like me with motorcycle riding. You know, I used to be really into bikes growing up, and I had one in college, which I definitely shouldn't have had, and there were just so many things that I didn't want to talk about, and I had a lot of injuries there that were bad. You know, so many head injuries and that kind of thing that I just thought, yeah, that's this isn't a good sport for me.
Whereas, you know, paragliding, we see a lot of injuries. I would like, my question is, you know, with your background and you now, you know, getting into flying and seeing all of this, is it making you more hesitant to fly, more excited to fly? Does it just change your perspective on flying, and maybe how should the rest of us, you know non-emergency trained people maybe think about it, so I'll let you stew on that and then look at, look at this list and see what else we should be talking about here in your final minutes as
Far as the list things, I think the only thing we haven't, we touched on a little bit with emergency evacuation planning there. I have a bunch of like, uh, sheets in there that you can fill out, kind of examples of sheets to like pre-plan for emergencies, but I think that's the real key is to like, you don't want to be looking up what the closest hospital is after there's an incident that's already started. You need, if it's, you need to know. And each, I think each club in each hill should have these plans pre-written and in an easily accessible place. We humans become really stupid and stressful situations, so anything you can do to take a cognitive burden off of yourself in these situations will only lead to better outcomes.
So, and if clubs want help with that, I am more than happy to help, you know, write up these plans and do this kind of stuff and kind of spread that love in the community. I think it's something every club should have for every common site that you know clubs are flying at. Awesome. So as far as, uh, you know, my own thoughts flying, yeah, it has definitely made me a more cautious pilot. It's made me cautious as far as you know when I fly and and kind of the risks that I'm willing to take and I'm willing to take, I'm certainly not the guy tossing down really big wing overs right above the LZ. You know, I know the consequences and I've seen a lot of the consequences where I think it affects me the most is is honestly watching other people fly.
I, I, I tend to worry a lot about other, you know, my friends flying and watching folks who are even newer than I am get into it and make risky decisions. And I think we have an opportunity in the sport to really acknowledge the risks. I think Chrigel talked about this a lot in the past and I think it's a great opportunity to really acknowledge the risks. I think Chrigel talked about this some on the podcast he did with you or, you know, this, it's a risky, it's a risky profession and to act otherwise is kind of disingenuous, right? And to accept those risks and I think seeing all this and honestly, I mean, I saw 10 years of paragliding accidents before I ever picked up a wing and so like I knew the risks going into it doing it. Man, well, it looks safer than speed flying, right? You know, it looks fun and it is fun and that's, that's what it is, right?
Um, and safer than, safer than base jumping, so sure, but um, you know, I, I think we should all have a An honest acknowledgement of the risks and and what we can do to to mitigate those risks, and that's really what seeing a lot of injuries has given to me is like, "Hey, you know, these things are out there and there's a there's a good chance they'll happen, and we all need to either come to terms with that or start playing golf exactly."
Uh, Justin, I, I really appreciate your work. Uh, those of you listening, please do go to the show notes; he's put together some awesome stuff here. And thank you for your offer with the clubs; I think you're gonna get a lot of people taking you up on that. And, and just thanks for doing what you do. We need people like you. Uh, I tell my buddy Terry that all the time; he's been dealing with COVID all year and those guys are wiped out. And, uh, but I just, yeah, thank you for doing what you do and thanks for educating us. And I'll see you next time. Bye-bye. And being a part of this nutball community, well...
Thanks, Gavin. Thanks for, thanks for spreading the love and spreading the stoke and, uh, it was a good conversation. I hope we get to, uh, chat again sometime. I
Do too, that'd be great. See you, bud. Cheers, if
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