Oxford University Cave Club Expedition Rescue Guide

by Gavin Lowe

A brief guide to carrying out a rescue on expedition.

I accept no responsibility for any injury resulting from the use of techniques discussed here.

I would welcome comments upon the booklet.

The guide is also available as a gzipped postscript file here.

The LaTeX source is available on application.

You may mail me Gavin Lowe, here.

Part I

The booklet was written with the main aim of teaching members of Oxford University Cave Club techniques that may be useful in the event of a rescue, particularly on expedition in Spain. I have now made it publically available in the hope that others will find it useful. I accept no responsibility for any injury resulting from the use of techniques discussed here. I would, however, welcome comments upon the booklet.

You should read this booklet and familiarize yourself with the contents before you need to perform a rescue.

On most expeditions there are a couple of incidents that lead to some sort of rescue operation getting underway. Nearly always these are caused by groups just being slow and missing their call-out times. While these false alarms are annoying, they do provide useful practice in case there is ever a real rescue.

In the event of a serious injury, the Spanish cave rescue organization should be called upon to help. However, there will be a considerable delay before they arrive: it is your responsibility to do as much as you can in this time.

It is most important in a rescue that the rescuers do not neglect their own safety: having one injured caver is unfortunate; having a rescuer injured as well is a nightmare.

There are three main parts to the booklet. This first section makes a few general points about rescues, about how to avoid rescues, and equipment you should carry with you for use in an emergency. The second part describes the procedure to be taken in the event of a rescue. The third section describes techniques that may be useful in a rescue.

1 How to avoid being rescued

Caving in Spain is more dangerous than in Britain for a number of reasons:

A lot of the rock is somewhat chossy and friable so beware of holds breaking on you: this has been the cause of the two most serious accidents we have had in recent years.
The caves are longer and harder; as well as making it more likely for you to have an accident, this means that a rescue will be a lot harder.
The caves are less well travelled than in Britain, so there is often a lot of loose rock about, especially at the top of pitches. If it is safe to do so, garden this rock, but not if there are cavers or ropes below you; the best time to do this is during the initial exploration.
Some of the rigging may be a little dodgy, because it has been done on a pushing trip. Moral: take time to make the rigging safe.

Therefore...

CAVE CAREFULLY.

Do not go caving if you are ill or particularly knackered. Take a day off to recuperate. Also, don't be scared to turn back early if you don't feel up to a trip.

2 Precautions

Before going caving, write a call out time in the back of the log book. Be realistic about the time you set: allow yourself enough time to achieve the goals of the trip, with a bit spare to allow for minor cock-ups; but don't set the call out time too late---if there is a problem, you will want to be rescued earlier rather than later.

Make sure that your gear is in decent knick, particularly your lights. If you have any trouble with your gear, make sure you sort it out before your next trip.

When going caving you should take with you:

A first aid kit: these should be available on the gear order;
A balaclava: this will help keep you warm while surveying if nothing else;
A survival bag---not a space blanket as these don't work as well: Ben Lyon sells good ones that fit safely inside a helmet;
A candle: when lit inside a bivvy bag, this will keep you very warm; see section .
Enough carbide for your trip---and a little spare in case your trip is longer than expected---and a spare battery for your electric.

When walking in the mountains you should carry the same stuff, and also a compass and possibly a map (the Adrados maps are best).

Don't go shaft bashing on your own: if you have an accident, nobody will know where to find you.

If you discover some new cave, and the route to the new stuff is not obvious, then create some way markers: either build cairns, or leave something like a tacklebag at the start. This will help rescuers to find you if you do have an accident. It will also help other explorers to find the way to the sharp end!

3 Incidents

There are various sorts of incidents that may need some sort of rescue action.

A caver being injured.
A caver becoming stuck.
A caver becoming unable to exit the cave because of either knackeredness or illness.
A group of cavers getting lost in the cave.
A group of cavers getting lost on the mountain.
Total light failure.
Cavers becoming trapped by floods.
A group of cavers being slow and missing their call out time.

Statistically the most common cause for a rescue is the last. Fortunately actual injuries are very rare.

4 Responsibilities and personnel

OUCC tends to be a fairly anarchic bunch, not much into ``leaders'' and ``chains of command''. However, in a rescue it is important to be well organized. People should be appointed to the following positions:

Runner.: Responsibilities: to go down the cave as quickly as possible while not compromising their own safety, to contact the victims, to find out what is wrong, to give as much help as possible, and to guide other rescuers to the victims.
Surface controller.: Responsibilities: to keep track of who, and what equipment, has gone underground; to arrange for more equipment to be ready and to go underground as necessary; to liaise with other rescue authorities; arrange rota systems if necessary; to arrange for plenty of food to be ready for rescuers emerging; to arrange for evacuation of the victim once they reach the surface.
Underground controller.: Responsibilities: to be in overall control of evacuating the victim(s); to ensure adequate communications with the surface; to appoint people to work out how to pass each obstacle, planning ahead; to arrange for each obstacle to be derigged and for the equipment to be carried forward; to ensure tired rescuers take a break before they become too knackered and make a mistake.
Victim monitor.: This person should ideally be a doctor, and certainly somebody cheerful and talkative. Responsibilities: to monitor the condition of the victim, and to watch out for any deterioration; to keep them cheerful and informed of what's happening; to protect their head against and rocks knocked down, or against any bumps. If this person is separated from the victim while passing an obstacle, then somebody else should be temporally appointed to take over their responsibilities.
Obstacle controller.: This person should be appointed by the underground controller to work out how to pass a specific obstacle. They should rig haul lines and lifelines if needed; they should also rig independent safety lines for the rescuers, if needed. If possible, they should hammer off any projections that are likely to get in the way.

Try to keep good spirits up within the rescue team. If possible, swap round so that nobody gets too tired. Stop for an occassional rest and brew. Don't shout at each other, and avoid getting irritated. Any rescue will be a long affair, so pace yourself.

Part II

RESCUE PROCEDURE

There are various ways in which you will realise that some action is needed:

a member of your party is injured: goto section 9;
a group's call out time is reached: goto section 5;
somebody arrives at camp with news of an injury: goto section 6;
somebody arrives at camp with details of some other problem: goto section 8;
lights are seen on the mountainside, but nobody arrives at camp: goto section 10.

5 Cavers overdue

If a group is overdue then you should aim to start rescue procedures as soon as the call out time is reached. A group of four cavers, ideally including a doctor, should go to the cave immediately. If it is dark they should leave a light at the entrance to guide other rescuers. Check whether the victims' rucksacks are still at the entrance: if not they are probably lost on the mountain (see section 10). Take a radio so as to communicate with camp.

One caver, the runner, should head down the cave quickly, carrying just the mini rescue kit (see section 7.1), with the aims of:

locating the party;
sorting them out as far as possible with the available equipment;
guiding other rescuers to the victims;
reassuring them that help is on its way.

This person should cave quickly but carefully. If the runner comes to a junction and has to decide which way to go, then he should leave a note (paper and pencil in the mini rescue kit) telling the next wave where he has gone; if it later becomes obvious that he has chosen rightly or wrongly (e.g. by finding a pitch that is either rigged or unrigged), he should go back to that point and rewrite the note, telling the next wave the correct route to go.

If you have reason to believe route finding may be difficult then you should send out several runners, in pairs; if a pair finds the victim, then one should head out as soon as possible to guide others to the victims.

The others should follow behind carrying the equipment listed in section 7.2 and a bag of hauling gear (section 7.4). They should cave carefully and preserve their energy as far as possible, as it may be a long resue. Their main aim is to prevent the deterioration of the victim. Their secondary aim is to start getting the victims out of the cave, if they have sufficient personnel.

Another three cavers should follow about half an hour behind, carrying the equipment of section 7.3. Their aim is to start getting the victim out of the cave if they think they have sufficient personnel.

Further cavers should follow carrying the rest of the rescue gear after a further half hour, if necessary. Avoid taking too much gear underground, as it will only get in the way.

When the overdue cavers are found, one person should head out to let everyone else know what the situation is. If those underground are sure that they can sort out the situation, then the rest of the rescue can be stood down.

If there is an injury, goto section 6.

If a caver is too knackered or ill to get themselves out, then goto section 11.

Meanwhile, those left at camp should: prepare the rest of the rescue gear; radio base camp to tell them to stand by; cook lots of food. They should rest and await word from the cave.

People         |          Gear           |       Responsibilities 
_________________________________________________________________________
Runner (1)     | Mini rescue kit         | Locate victims; give immediate 
               |                         | support; send word to surface.
Second wave (3)| Gear to prevent         | Prevent deterioration of victims'
               | deterioration (section  | condition; start extraction if 
               | 7.2) and some hauling   | possible.
               | gear (section 7.4)      |
Third wave (3) | Stretcher, baby bouncer,| Start extracting victims.
               | hauling gear            |
               | (section 7.3)           |
Fourth wave    | More hauling gear, food,| Continue extraction. 
               | carbide.                |

Figure 1: Scheme for cavers overdue

6 Word of injury reaches camp

If word of an injury reaches base then a group of about three cavers, ideally including a doctor, should go to the cave immediately. If it is dark they should leave a light at the entrance to guide other rescuers.

They should head down the cave quickly, carrying:

the mini rescue kit (see section 7.1);
the gear to prevent the victims condition from deteriorating (section 7.2).

Their aim is to:

locate the party;
reassure them that help is on its way;
give as much first aid as possible (see section 12);
prevent the deterioration of the victims.

Three more cavers should follow carrying the baby bouncer, the stretcher, and a bag of hauling gear (sections 7.3 and 7.4) if there is any chance of it being needed.

More cavers should follow with more hauling gear (7.4), food and carbide. Avoid taking too much gear underground, as it will only get in the way.

People         |          Gear           |       Responsibilities 
_________________________________________________________________________
Runner (1)     | Mini rescue kit, first  | Locate victims; give immediate 
               | aid kits, gear to       | support; Prevent deterioration
               | prevent deterioration   | of victims' condition; send word
               | (section 7.2)           | to surface
Second wave (3)| Stretcher, baby bouncer,| Start extraction if possible.
               | hauling gear            |
               | (section 7.4)           |
Third wave (3) | More hauling gear       | Start extracting victims.
               | (section 7.3)           |
Fourth wave    | More hauling gear, food,| Continue extraction. 
               | carbide.                |

Scheme for injured cavers

Meanwhile, the Spanish rescue authorities should be alerted. Ask the refugio to radio for help. Failing this, radio to base and get them to alert the rescue services. Juanjo's number is Oviedo (85) 211790. However, there will probably be a delay of about 12 hours before they reach the cave. Do as much as you can in this time.

If there are any other cavers in the area, alert them as well.

Most people at base should walk up the hill, carrying more rope, rigging gear, food, and carbide, as needed. One person, ideally a Spanish speaker, should stay behind to liaise with the Spanish.

If rescue in a stretcher is necessary, goto section 14.

If the caver is able to get themselves out, with help from the others, then goto section 11.

As soon as possible, word should be sent to the surface, giving instructions to those there.

Those left at camp should cook lots of food, and rest: you should save your energy as you will probably be needed later. If possible start organizing a rota system if it looks like being a long rescue, and carry food and some bivvy gear to the cave entrance.

7 Rescue kit

This section lists some of the gear that may be useful in the event of a rescue. This equipment should always be at camp in case it is needed. If you are reading this at camp, then check that it is.

7.1 The mini rescue kit

The following gear should be carried by the first rescuer down the cave. It should be packed in a prussik bag in advance, ready for immediate action.

first aid kit containing plenty of bandages and temgesic;
2 Sam Splints;
2 survival bags;
spare carbide;
spare batteries;
spare bulbs, carbide jets, etc;
food;
candles and lighter---good for making heat;
waterproof paper and pencil, for writing messages.

7.2 Equipment to prevent deterioration of the victim

The following equipment is designed to prevent deterioration of injured cavers; it should be carried in by the first wave of rescuers:

underground first aid kits;
sleeping bag;
stove, brew kit and food.

7.3 Equipment to start evacuation of the victim

The following equipment is designed to start getting the victims out of the cave:

baby bouncer from stretcher;
the stretcher;
a bag of hauling gear (see below).

All this equipment should be carried in by the second wave of rescuers.

7.4 Hauling gear

Two or three tackle bags should each be packed with the following, for rigging past particular obstacles, including short pitches:

a 25m haul line;
a 25m life line;
two 20m safety lines for rescuers to clip into;
a bolt kit, with lots of spits;
plenty of tapes, wires, hangers, maillons, krabs, pulleys.

Additional longer ropes should be packed for longer pitches, as appropriate. Also, a drill should be carried down.

7.5 Other rescue gear

Plenty of food and carbide will be needed on a long rescue.

The following gear may be needed in particular situations:

Crow bars, shovels, etc., for digging open collapsed chokes;
To free a stuck caver: hammers, chisels, washing up liquid (as a lubricant), large knife (to cut them out of their equipment).

8 Other problems

This is most likely to be either somebody too knackered or ill to get themselves out of the cave: see section 11.

Stuck cavers can probably be extricate using hammers and chisels, or washing up liquid as a lubricant. You may need to cut them out of their caving gear, so take down some large knives (but be careful you don't injure them in the process).

If cavers are flooded in, then it's probably best to leave them: sending more rescuers down may lead to the rescuers also being trapped. After the big storm of 1988, the 2/7 streamway started to drop after less than 24 hours. Leave the victims a dump of food, carbide, dry clothes and a stove, somewhere where they will see it, but where it won't get washed away. When you think the water is dropping again, send a team down to make sure they are alright, and to give moral support.

It should be obvious how to deal with most other problems (e.g. light failures).

9 What to do if a member of your party is injured

Work out how they got injured, and avoid getting yourself injured in the same way. If they are in immediate danger, and you can do so without risk to yourself, then move them away from the danger, but be careful of their back (see section 12).

Give as much first aid as possible (see section 12).

If the injury is minor, and you are sure you can cope, get them out of the cave.

For more major injuries you should prevent their condition from deteriorating while sending somebody out to get help. If you are near a campsite get them to the camp---or bring the camp to them---and keep them warm. Failing this, put them into a survival bag (which you should have with you) and insulate them from the ground---get them to sit on a rope, a kit bag, or you. See section 13.

If you only have two people in the group you have to decide whether to stay with the victim or go for help. This is why you should always have at least three in a team. Your decision should be based upon how soon you would expect the rest of the expedition to come and rescue you (how soon is your call out time), and how much the victim's condition is likely to deteriorate if you leave them.

10 Cavers lost in the mountains

There's not really a lot you can do about this. Walk along the route they should be taking, blowing whistles. But don't get lost yourself. It's a good idea for the rescuers to carry sleeping bags and bivvy bags in case they do get lost. If you have no luck, then leave them: they'll have a miserable night, but they'll survive.

Morals:

Don't get lost in the mountains: always carry a compass, and know the bearings back from the caves;
If you are going to get lost, carry a bivvy bag with you;
If you do get hopelessly lost, find a sheltered spot, huddle up together, and wait for morning. Avoid sheltering in the mouth of a cave in an electrical storm. See section ;
Don't just follow old lags blindly: learn the mountains early in expedition; this will help you when shaft-bashing, as well.

If a team hasn't returned within a few hours of sun rise, then inform ICONA, and start a more full-scale, systematic search. Don't overlook the possibility that they may have found their way down to base camp.

Part III

RESCUE TECHNIQUES

In this part I'll describe a few techniques that may be useful in the event of a rescue. Familiarize yourself with these techniques before you actually need to use them.

11 Dealing with knackered or ill cavers

If this is the case, give the victim as much help as possible. Maybe some food and encouragement will be enough (a Carbide Assist: light a flame under their butt, and out they go).

You can help them by rigging a combined hand line--life line on climbs: belay a rope to something solid at the top of the climb, passed through a krab on the victims harness, and then back up to somebody at the top of the climb; the person at the top can lifeline and help pull the victim (with a 2:1 advantage); the victim can use the other length of rope as a handline.

If necessary victims can be hauled through vertical squeezes in the baby bouncer. On large pitches, tandeming will help to give moral support, and means that somebody is on hand to help with change-overs. See section 15 for details of dealing with particular obstacles that are to be found in our caves. Consider setting up a temporary camp site to let them get some rest, and try again when they are feeling stronger.

12 First aid

This booklet does not aim to deal comprehensively with first aid. You should familiarise yourself with the first aid manuals from the bibliography.

The following information is based on an article by Tom Houghton in Proc. 12, and an article on the Cavers' Digest.

Do the following in sequence:

Don't panic. Be methodical. Don't be rushed into hasty action. Keep your reason. Don't put yourself in danger.
Get the victim out of immediate danger: loose rocks, for instance, or cold water. Mind yourself; be careful. Moving the victim: see back.
Make preparations to take the victim out. Unless the injury is obviously trivial, all accident victims should be brought to the surface as quickly as possible. Beware those who have been hit on the head but look `all right now'. They could be bleeding inside the skull and unconscious or dying in a couple of hours. Get them out.
Consciousness. Is the victim able to talk? If so, ask them if they can feel and move their limbs. If not, ensure an airway.
Airway. Pull the jaw forwards, and keep it there. This stops the tongue lolling back into the windpipe. The ideal position is `sniffing the spring air'---head forwards and chin up. An unconscious patient will die rapidly without an open airway. If they puke or look as if they might, roll them on their side and let the vomit come out---but see back. If there is any muck or whatever blocking their airway, get it out.
Pulse. Compare the victim's pulse with your own. Shock---severe blood loss---the victim has a fast, thready, weak pulse; they are cold, clammy and sweaty. If you are in no doubt that the victim is like this, they need an intravenous line and lots of fluid---but you probably don't have these or the knowledge to use them safely. Get them out. Don't give them fluids by mouth: the guts stop working in shock, and so you're only giving them something to puke up.
If you can't feel a pulse at the wrist---there is a muscle on each side of the neck running in a straight line from just below the ear to the inner end of the collarbone. If you put your fingers just in front of this muscle at its midpoint and press in gently, you will feel the cartoid pulse (try it on yourself).
Can't feel a cartoid pulse. If you really can't, the heart has stopped working effectively. The victim needs chest compression (`cardiac massage'). By this stage you are probably on a hiding to nothing, but the drowned and the hypothermic can survive for surprisingly long periods with a stopped heart, so try and keep trying, for a couple of hours if necessary, until skilled help arrives. You might just be able to get them going again.
Technique: this has recently changed slightly, as a result of research. Get the victim onto a firm flat surface on their back. Press over the lower third of the sternum (lower edge of your hand 2 fingerbreadths up from the bottom of the sternum). Keeping your arms straight and using the weight of your upper body, lean with the heels of your hands on the middle of the breastbone, giving relatively short pushes. Say `one thousand', release saying `one', do it again. Don't do it too quickly.
If you're on your own, give fifteen squeezes and then give them two breathes of air---head in the `morning air' position, pinch the nose, seal your lips over theirs and exhale firmly. If there is someone else there, get them to do the breathing while you continue with the chest compression: give five chest compressions followed by one breath.
The time to learn how to do this is when you don't have to.
Back Don't move the victim till you've felt their back, or if they are paralysed or lack sensation anywhere. Feel all the way down the spine. You will feel a row of regular bumps; if there is a gap or a step, or if the victim has pain on one spot on pressing, they have a back injury. If in doubt, play safe and treat as one.
Log roll: With three people, move the victim as a unit without bending or twisting, like a log. Don't forget the head: don't turn, drop or bend it, but keep it part of the log---they might have a neck injury, especially if they've had a blow to the head. In this fashion, get the victim out of harm's way onto a flat, firm, horizontal surface. Don't move them again until you've got them onto a Neil Robertson stretcher, or similar.
Bleeding. If they are obviously bleeding, press on it with your hand or a pad (i.e. a firm wodge of anything reasonably clean) for five or ten minutes without peeping to see if it's stopped. If it doesn't stop, keep pressing.
Head to toe survey. Using your hands and a flashlight, examine every part of the patient's body. Start at the head and work down to the toes. Talk to the patient. All along the exam make sure he can feel your hands. See if he can grip you hands firmly and equally. You are looking for additional wounds, swellings, eccymosis (black marks from pooling blood), tenderness, etc. Always do this survey. Write down the results. When you have worked out what is wrong, write down the results. You should have some permatrace in your first aid kit for this; alternatively use a page from a survey book. Write down the following: who it is, what happened, when, location, observed injuries. Give it to whoever is going for help.
Chest. If the victim has difficulty breathing, or pain on breathing, ensure an airway and look at the chest (open the clothing, look at both sides). If there is a wound on the chest, put a pad on it to stop air leaking in and letting the lungs down. Look at the movements; if one bit goes in while all the rest comes out, and vice versa, put a big pad on that bit to hold it in---that is a `flail segment', a bit of chest wall that has come out and is moving independently of the rest, and while it is free the victim can't breathe properly.
Distals. For an arm this is the radial pulse (thumb side of the inner wrist) and sensation on all fingers. For a leg this is the dosalis pedis (between and above the big toe and first toe) as well as sensation in all toes. Always make sure you can find these before you start treating a wound, dislocation, or break on that limb.
Bandage major wounds. If there are avulsions (flaps of skin and tissue) fold them back in approximate place and bind in place. If the wound bleeds more, then put more stuff on top of it. Do not remove old dressings before you put on the new ones. This will just cause bleeding to start again. Try to put sterile material on the wound (hah!). Don't try to clean out dirt or mud unless you know exactly what you are doing. Always recheck distals after doing anything significant.
Broken bones. The rule here is to immobilize the joint above and below the break. This is done by binding the limb to the body or to rigid splints. Strap a broken leg to the sound one. Try not to move the broken part. If the break is severely angulated then you may have to reposition it before it can be splinted, but do this only if it is required for transport.
Dislocations. It is hard to tell the difference between dislocations and breaks. You need training and experience. Treat dislocations as breaks unless you have good reason to believe otherwise (patient tells you it has happened before?).
To reduce (move the bone back to anatomical position) a patella (knee cap), pull on the ankle (with about 20lbs of force) while another person holds the patient and another holds the knee cap. Let the patella slide back into place slowly to avoid trapping nerves and blood vessels behind it when it locks back in place. It can take minutes for the bone to start moving back in place. Be patient. Recheck distals.
Note: The patient screams and moans a lot during relocations. You must be the source of calm and reason during this time. If you are not up to the job then get someone who is.
To reduce a shoulder have the patient lie face down with the arm over a ledge. Tie a 15lb rock to the wrist and wait for up to an hour. Recheck distals. Note that attempting to relocate a dislocation always runs the risk of causing an amputation to be required later.
Heat. Exposure is a risk, especially for immobile victims. Change wet gear for dry if someone else is wearing drier gear. Put into a survival bag (which you have in your helmet of course). Put into a sleeping bag if you've got one. Sugary food can be a good idea, but be careful; drowsy victims might puke and block their airway, and the injured might go into shock and do the same. See section 13. Get them out.
Antibiotics. It is worth starting an antibiotic regime after significant cave injuries.
Painkillers. Painkillers are a good idea if the victim is in pain. Pain can worsen effective fluid loss by causing fainting, and it makes the casualty more difficult to move, quite apart from any humanitarian considerations.
On the other hand, powerful analgesics (the morphine-based ones such as Temgesic) depress respiration and make the victim more likely to suffocate. They shouldn't be given where there is reduced consciousness, and definitely not if there has been a head injury. A non-exhautive list would be: chest injuries, head injuries, abdominal injuries, cases of severe shock and hypothermia. In head injury you're looking for any depression of consciousness caused by intracranial bleeding, and if the punter's been knocked goofy by drugs this can be difficult to spot.
Also, if the victim screams whenever you put pressure on their injuries, then you'll probably treat them more gently, so you shouldn't be aiming to prevent all pain.
On the way out: keep talking to them; keep checking the pulse---if they weren't shocked before, they might become so.

13 Keeping warm

There's a lot you can do to keep either yourself or an accident victim warm. Ideally get them into dry clothing, into a sleeping bag, and insulate them from the ground. Sit them on a rope, a tackle bag, knee pads, or you. Put them inside a bivvy bag or under a survival blanket, and light a candle or carbide flame in with them: the heat given off by the flame is significant, and can be a life saver. Alternatively, put a carbide generator inside their furry suit.

Hot drinks for an injured caver are probably a bad idea on the whole. Patients with head injuries can spew them up and inhale them, and somebody who isn't drowsy now may be later. (Spew does horrible things to lungs.) Similarly with internal injuries; the patient's condition can change quickly. Also, any serious injury victim is likely to need to go to an operating theatre when they get out, and the stomach has to be empty for a general anaesthetic. Although stomachs normally empty in 4-6 hours, serious injury and stress can paralyse the normal peristalsis so a trauma victim can keep stuff swilling around in the stomach for ages. On the other hand, if you're sure there's been no serious injury, hot drinks help keep up core temperature and supply fluid and sugars, so if you're just extracting someone because their tin leg broke, then fine.

14 Rescuing a victim on a stretcher

14.1 Loading the stretcher

Wrap the victim in a sleeping bag inside the stretcher. Be very careful moving the victim, especially if a spinal injury is suspected. See back above.

14.2 Treatment of victim

The victim's morale is very important. Keep talking to them, reassuring them, and telling them what's happening. Appoint somebody---ideally a doctor, and certainly somebody cheerful and talkative---to be in charge of this. They should also monitor the victim's condition, looking out for any deterioration, and should make sure that the victim's head is protected at all times.

Other rescuers should also help to keep the victim happy. Refer to them by their name, not ``the body''. When talking to them, say your name, so they know who they're talking to. Avoid stepping over them and dropping mud in their eyes.

14.3 Horizontal stretcher movement

Along horizontal passages there are various ways of moving the stretcher.

Several carriers on each side of the stretcher holding the handles, possibly with shoulder straps so as to spread the weight. Few of the passages in our caves are wide enough to do this.
Carriers are situated along the passage, and the stretcher is passed along between them, either over their backs, or under their legs.
One caver crawls on hands and knees, with the stretcher on his back; two others control the ends of the stretcher.
In flat out crawls, the stretcher can be pulled through with a rope.

At all times somebody, preferably a doctor, should monitor the condition of the victim.

14.4 Vertical stretcher movement

For hauling a stretcher up anything except for very short drops, you will need some sort of hauling system. You should also have an independent life line to the victim. It is a good idea to ensure all belays are high up, and the point of attachment to the stretcher is quite low down. Otherwise you will haul the stretcher to a point still some way below the pitch head. Plan how you are going to get the victim off the pitch head before starting to haul.

Pulley jammer

A useful component of any hauling system is a pulley jammer, which is illustrated in figure 5. Practice setting up a pulley jammer before you need to use it; it is very hard to work out how to do this from first principles. Attach the jammer to the rope, upside-down. Then pass the rope through a pulley, above the jammer. Next, attach the pulley and jammer together using a krab. Finally anchor the pulley jammer by passing a maillon through the krab.

Counterweight method

The counterweight hauling system is illustrated in figure 3. A rope is attached to the stretcher, and passed through a pulley at the top of the pitch. A rescuer, the counterweight then attempts to prussik up the other side of the rope. As he does so, the victim will be pulled up. The counterweight should clip himself into something at the top of the pitch. If he is the same weight or lighter than the victim then he will find himself moving up the rope---pulling up on the rope attached to the victim will compensate for this. It is important to have a lifeline from above and a trailing line leading to the bottom of the pitch: these can be used for controlling the ascent of the victim.

Hauling systems

The simplest method of gaining mechanical advantage is to belay a rope at the top of the pitch, run it down and through a pulley attached to the stretcher, and then back up to the top of the pitch; here it is normally best to run the rope through a pulley jammer to the haulers.

A simple hauling system with a 2:1 mechanical advantage is illustrated in figure 4. A rope is taken from the victim, through a pulley-jammer (figure 5) at the top of the pitch, to another jammer. This second jammer is attached to a pulley, through which a rope runs. The second rope is anchored at one end, and the other end is hauled upon, thus providing a 2:1 mechanical advantage.

In practice, we have found that it is best to combine these two methods to give a 4:1 mechanical advantage. About three people should then be adequate for hauling. An extra advantage of this set up is that the victim moves more slowly and smoothly.

15 Local difficulties

In this section are a few ideas for dealing with particular problems that may be found in our caves. As caves are extended, plans should be made to deal with any obstacles that are encountered.

Some of the caves round Top Camp are very cold, particularly near the surface, where there is a lot of snow and ice around. If an accident happens here, it will be very important to keep the victim warm. See section 13.

F64

The most obvious barriers to any rescue are the squeezes The Fierce Ladies of Cannock and Bad Habits. Early in any rescue, a team should be sent with hammers, chisels, and a drill if possible, to widen these. I believe that it would be impossible to get a stretcher through these squeezes in their present state; if this arises, you will need to get the Spanish to blast them. If necessary, a camp site can be set up at the base of Old Bore's Hill while the squeezes are being widened and bolted.

The first squeeze encountered on the way out should be fairly easy. A bolt in the roof will help to lift the victim through the squeeze.
The next squeeze should also be fairly easy, as gravity will be helping. Make sure the victim is well belayed so he doesn't fall down the pitch. It will be necessary to have a couple of rescuers perched near the top of the ladder: make sure they are well clipped in.
The Second Fierce Lady would be a bitch. The first couple of bends will have to be widened for a stretcher. The squeeze up to the top level will also have to be widened: a bolt in the roof and a haul line will help here; also somebody can lie in the bottom of the rift and help push up. From there, it should be possible to pull the stretcher out with a haul line, but be careful to prevent them from falling down the rift: people underneath and a bolt above may help.
The First Fierce Lady will also have to be greatly widened to fit a stretcher round the corner, probably using a drill. Bolts in the roof may help: there are a couple of bolts in place, but these are probably not in the right place. It may be possible to remove quite a lot of rock from the far side using a lump hammer.

Some pitches still have loose rocks at the top (e.g. They Come at Night, Cool for Cats). These should ideally be gardened while the pitch is being rigged, but it may be necessary to do some more gardening in the event of a rescue.

C3

Manx Manoeuvre and Vacuum Cleaner will need to be widened.

Many pitches will need extra bolts putting in: have somebody bolting ahead of the victim.

On the tyrolean on the Moose Hole, it will be necessary to allow the victim to gently swing out across the pitch.

On the Entertainer, it may be easiest to lower the victim to the bottom, and then haul up from the old brew site, rather than negotiating all the rebelays.

Gotta Have Faith is a tight rift, and will need some planning. Crunchy Frog will need widening. The victim can be looked after in the campsite while this is being done.