Thread: Buffalo Mountain skier death analysis thread

I've punctured maybe a thousand femoral arteries, and later compressed perhaps a hundred of them, and they are not always that easy to manage. You have to find the femoral pulse over the femoral head and adequately compress it, which usually requires abducting and externally rotating the leg a bit. It takes a fair amount of force. In a young thin skier type it would normally be easy to find the femoral pulse, but perhaps not so much part way down a couloir.

Originally Posted by Summit

My assessment: This was bad luck. Nothing more.

I'm not a big fan of the "shit happens" analysis because I think it gets overused, but sometimes - like this time - it is appropriate. Still, you try to learn and be prepared

Originally Posted by sfotex

One tip I picked up from a guide was putting your ice axe/tool between your pack and and your back thru the grab loop. That way you can fish it out if you get into a tight spot (but, obviously doesn't help much if your sliding)

^^^
This got a bit glossed over, but I'm all about this trick. It won't help you self arrest, but it will make it easier to transition back to crampons if you need to downclimb or climb back out. Combined with a harness, it can enable you to clip into the buried axe while you transition to/from skis, thus making some very steep and exposed transitions far safer. If, like me, you like to take photos on while skiing steep slopes, clipping in can help you balance as you pan across the hill.

I sell quite a few whippets to people at the store I work at, and I like to make sure I explain that one should think of them as a climbing aid, balance aid during jump turns, and rudder during a fall. It's decently unlikely that a whippet can self arrest you at skiing speeds, but at least it'll keep your head from hitting first (ask me how i know)

The best safety gear you're carrying for steep skiing are your EDGES, and it's amazing how few people take good care of them. Keep your edges sharp and your skis waxed and you'll find that your skis are much more predictable and easy to ski on steep terrain. (Not at all implying that this was the case in the accident, just trying to bring up general pointers)

I hope Jeff would appreciate that his tragedy has sparked a discussion about safety.

Arresting on ice at speed aint gonna happen with any tool, but, as Sam says, a tool might get you oriented in a better position.

There are two ways to arrest with a Whippet: fist stab and cross body. I've experimented quite a bit with both techniques in a range of snow conditions. The fist stab is ineffective as an arrest technique in most (although not all) conditions, but it can help you get into a better orientation in a fall and is useful to stabilize on an ascent, i.e., sort a like a handhold. Using the cross body arrest, after practice, a Whippet can be as effective as a light ice axe in many conditions. It's saved my ass a few times.

Having skis on your feet makes arrest much more difficult. This has been discussed before wrt team arrest.

Straying from the meat of the thread: IME, a Whippet is the preferred (safer) tool in at least one circumstance, i.e., a rope leader on a glacier with bridged crevasses, where the Whippet can be used to probe bridges.

Originally Posted by coreshot-tourettes

Femoral artery compression kills the blood supply to the whole leg which may help more than direct pressure. I was always taught that if the blood is exiting the wound even under direct pressure to go for artery compression immediately.

I have started carrying an Israeli bandage and Celox/Quikclot in a trauma kit attached to my waistbelt. The neat thing about the Israeli bandage is that it allows the bandage itself to exert lots of pressure on the wound without becoming a tourniquet. (It can be used as a TQ and sling as well) The Celox is a very fast clotting accelerator that can stop even large bleeds near-instantly. Celox won't help internal bleeding obviously.

I've done femoral artery compression on a number of occasions (I'm a general, vascular, and chest surgeon). Without surgically exposing the artery it's very hard to get good control, and even harder to keep it. It's hard even with surgical exposure. That doesn't mean don't try, but don't count on it. And in a skiing situation remember that femoral artery compression means exposing the groin, which means heat loss. I like the idea of the Israeli bandage--it's no more effective than direct manual pressure but it frees up the rescuers' hands, especially if they're trying to evacuate the victim. As far as the quick clot goes it's pretty rare to have uncontrollable external bleeding in a blunt trauma situation, as opposed to the military situation with penetrating trauma. My son, who's a medical student in the Air Force and an ex Squaw patroller, says that they're taught that the Quick Clot is not as effective in the field as in experimental situations. The problem is getting the stuff to the actual bleeding site from the artery, not just the spot where the blood is coming out of the skin. (The military protocol is to apply a tourniquet immediately and then return fire until it is safe to provide further aid.) Given the low chance of needing it I would save the space and the weight for other gear. The one area where external bleeding can be common in blunt trauma and severe is head trauma, with scalp bleeding-the scalp can really bleed. (I once spent a lot of time dealing with a trivial injury to the spleen while the patient tried to bleed to death from his scalp laceration--finally the anesthesiologist at the head of the table managed to convince us to deal with it.) A surgical stapler can rapidly control scalp bleeding. As far as stapling other lacerations it's probably best to leave them open in the field--just bandage them. The risk of infection in a stapled wound in nonsterile conditions is very high. Closing a wound is done to simplify care and for looks--an open wound is less likely to get infected than a closed wound and will close on it's own, can be closed later, or can be skin grafted. Closing it, except for the scalp, doesn't do much good in an emergency. If you do staple a scalp wound push down firmly with the stapler to try to get all the layers of the scalp closed--the bleeding vessels are between the skin and what's called the galea--which is basically the underside of the scalp tissue.

^^
I was reading about the military tourniquets they are using (http://combattourniquet.com/military-tourniquet.php)
the other day and how they have had cases where 2 or 3 make shift tourniquets were put on with limited or no effectiveness, then the CAT goes on and controls the bleeding. In fact, there is a problem with fake CAT tourniquets being produced that aren't effective. Guess the point is that it seems to take some specialized gear to make an effective tourniquet.

Originally Posted by sfotex

^^
I was reading about the military tourniquets they are using (http://combattourniquet.com/military-tourniquet.php)
the other day and how they have had cases where 2 or 3 make shift tourniquets were put on with limited or no effectiveness, then the CAT goes on and controls the bleeding. In fact, there is a problem with fake CAT tourniquets being produced that aren't effective. Guess the point is that it seems to take some specialized gear to make an effective tourniquet.

Looks like an excellent device. My only objection would be the rarity of use in a recreational situation. The military recommends that each soldier carry one-but the risk of traumatic amputations and other major limb trauma is very high in the current theater of war. It comes down to how much gear you want to carry. I guess I take a pretty nihilistic view of first aid gear, since I don't like weight--I figure that given the time it takes to evacuate someone either they will survive without specialized gear, or no amount of gear will save them. I doubt that gear--quick clot, a tourniquet, or anything else the party could have carried would have saved Jeff. The principle in trauma surgery is the golden hour--you have one hour to begin definitive treatment (that usually means in an operating room) before the odds on survival go way down.

I have a question--how widely available is long line helicopter evacuation? I know they have that capability in the Tetons, but it's a very specialized skill and I suppose it's not available in areas that get less concentrated use than a National Park. Anyone know?

Originally Posted by old goat

I've done femoral artery compression on a number of occasions (I'm a general, vascular, and chest surgeon). Without surgically exposing the artery it's very hard to get good control, and even harder to keep it. It's hard even with surgical exposure. That doesn't mean don't try, but don't count on it. And in a skiing situation remember that femoral artery compression means exposing the groin, which means heat loss. I like the idea of the Israeli bandage--it's no more effective than direct manual pressure but it frees up the rescuers' hands, especially if they're trying to evacuate the victim. As far as the quick clot goes it's pretty rare to have uncontrollable external bleeding in a blunt trauma situation, as opposed to the military situation with penetrating trauma. My son, who's a medical student in the Air Force and an ex Squaw patroller, says that they're taught that the Quick Clot is not as effective in the field as in experimental situations. The problem is getting the stuff to the actual bleeding site from the artery, not just the spot where the blood is coming out of the skin. (The military protocol is to apply a tourniquet immediately and then return fire until it is safe to provide further aid.) Given the low chance of needing it I would save the space and the weight for other gear. The one area where external bleeding can be common in blunt trauma and severe is head trauma, with scalp bleeding-the scalp can really bleed. (I once spent a lot of time dealing with a trivial injury to the spleen while the patient tried to bleed to death from his scalp laceration--finally the anesthesiologist at the head of the table managed to convince us to deal with it.) A surgical stapler can rapidly control scalp bleeding. As far as stapling other lacerations it's probably best to leave them open in the field--just bandage them. The risk of infection in a stapled wound in nonsterile conditions is very high. Closing a wound is done to simplify care and for looks--an open wound is less likely to get infected than a closed wound and will close on it's own, can be closed later, or can be skin grafted. Closing it, except for the scalp, doesn't do much good in an emergency. If you do staple a scalp wound push down firmly with the stapler to try to get all the layers of the scalp closed--the bleeding vessels are between the skin and what's called the galea--which is basically the underside of the scalp tissue.

^Quality post.

Originally Posted by old goat

I have a question--how widely available is long line helicopter evacuation? I know they have that capability in the Tetons, but it's a very specialized skill and I suppose it's not available in areas that get less concentrated use than a National Park. Anyone know?

Long-line, if i recall correctly, is technically transporting anything using a...long line. Short-haul is the 'dope-on-a-rope' transport of personnel or victims. Coolstine would be the best one to answer this. I'm not aware of any county SAR teams with short-haul capacity, but i may well be wrong. In the NPS we require a ton of training and certifications for any pilots, spotters, or dopes. It sounds like they flew medics to the next ridge on this incident, so when you add in the rigging time for a short-haul it may not have made much of a difference in getting the first medics on scene. Theoretically evac could have been quicker w/short-haul, tragically that didn't end up as a factor...

Originally Posted by old goat

Looks like an excellent device. My only objection would be the rarity of use in a recreational situation. The military recommends that each soldier carry one-but the risk of traumatic amputations and other major limb trauma is very high in the current theater of war. It comes down to how much gear you want to carry. I guess I take a pretty nihilistic view of first aid gear, since I don't like weight--I figure that given the time it takes to evacuate someone either they will survive without specialized gear, or no amount of gear will save them. I doubt that gear--quick clot, a tourniquet, or anything else the party could have carried would have saved Jeff. The principle in trauma surgery is the golden hour--you have one hour to begin definitive treatment (that usually means in an operating room) before the odds on survival go way down.

I have a question--how widely available is long line helicopter evacuation? I know they have that capability in the Tetons, but it's a very specialized skill and I suppose it's not available in areas that get less concentrated use than a National Park. Anyone know?

I subscribe to the minimal first aid supply thing too for personal outings, but I thought I would throw the CAT thing up there since we were talking about tourniquets.

Life Flight in Utah has hoist capabilities. We use them a lot in the Wasatch. Their are many other factors involved in its use though. No hoisting after dark, wind/temps/altitude/trees play a big part too. Government ships have a lot less regulations on them vs. a private service ship too. Even an LZ to get a flight nurse to the patient can make a big difference.

Here's some pics from a hoist we did last summer on a skier that slide into a moat in a tightish chute and had a C5 fracture and open head wound. We hoisted in 2 team SAR team members with a flight nurse and hoisted the nurse and patient out.

Navy helicopters from NAS Whidbey often assist in rescues in the deep wilderness in the WA Cascades. It's a training opportunity for them.

A few years ago on a high route in a very remote part of NCNP, a guy in our party slipped on a steep firm snow traverse, took a ride and smashed into a ledge. He dislocated his shoulder and was in bad shape. We were 2-1/2 days of mountain travel from the nearest trail. We had a PLB, but really did not want to push the panic button. Fortunately, we had two MDs in the group. They drugged up our bud and the two docs, with the assistance of a third guy, managed after several attempts to get the shoulder back in place. The guy was still in bad shape so we changed our traverse plans and evacuated him via an alternative route. And, no, we did not report the incident to ANAM.

In Colorado, the only helicopters with hoists belong to the National Guard. Their machines do not normally have the hoist attached. They will not attach the hoist to their helicopter until they first fly to the scene and survey it. Then, they may decide to return to base, attach the hoist, and return to the scene.

Add to that issue weather complications and Colorado being generally higher altitude (many Colorado valley floors are higher than most peaks in the rest of the continental US).

very tragic.

i'm one of those guys at the head of the table..

from reading the story

In all probability the victim suffered a fracture of one or both femora in combination with pelvic and possibly other internal injury resulting in a large and continuous blood loss over several hours resulting in exsanguination.

compression of arteries will no do anything in those cases.

There is little you can do or carry to effectively manage high energetic blunt force trauma on-site. (well short of carrying several large bore IV's and liters of warm IV fluids which is rather impractical, and even then, managing several hours is pushing (it a lot) without blood transfusion)

I want to point out that my feelings about first aid gear and treatment are based on my experience with very small parties--usually 1-3 people--in semi remote locations like the Sierra and the Wind Rivers. Larger parties with skilled medical support in very remote locations can certainly make use of much more extensive equipment and advanced techniques. I have no experience with that. I would also point out that doctors in general are not good first responders--if you're hurt you'd be better off with my son than with me helping you.

Originally Posted by Summit

...(many Colorado valley floors are higher than most peaks in the rest of the continental US).

that john denver's full of shit man...

regarding self-arrest.

Self-arresting is similar to using a transceiver. You have to practice and you have to practice a lot before it's any use in a real emergency.
Practice with one method is better than no practice with "the best" method.

And I would like to offer my condolences.

Yes, of course, practicing arrest is essential. But, practicing an ineffective arrest method is the same as no practice at all. Practice arrests of falls from all positions, e.g., feet down while on your side, head down while on your side, head down while on your back (tricky0, with skis (tricky), without skis, with a big pack, with a small pack, etc., etc., etc.

Originally Posted by old goat

...I would also point out that doctors in general are not good first responders--if you're hurt you'd be better off with my son than with me helping you.

Kind of off-topic, but it's an interesting observation. I'm an EMT-B patroller and twice this year I rolled up on accidents where there was a passer-by physician already there but I pretty much put them off to the side because they weren't getting the 1st responder things done correctly. They were both a little shocked at first, but both times ended up saying ^^^ afterwards. One was a neurologist and I forget what the other one was, but it wasn't emergency or general practice.

Originally Posted by JRiph

In all probability the victim suffered a fracture of one or both femora in combination with pelvic and possibly other internal injury resulting in a large and continuous blood loss over several hours resulting in exsanguination.

compression of arteries will no do anything in those cases.

There is little you can do or carry to effectively manage high energetic blunt force trauma on-site. (well short of carrying several large bore IV's and liters of warm IV fluids which is rather impractical, and even then, managing several hours is pushing (it a lot) without blood transfusion)

True enough, but without detailed information about the nature of the injury it's hard to tell if it was all internal or what. In the above scenario, as you know, traction on a large bone fracture may help reduce internal bleeding.

I guess that my training would have given me a bigger toolbox of tricks to try than the victim's partners were able to get on-scene over the phone, and maybe none of them would have worked but I would have been trying.

Edit to add second thoughts.

Originally Posted by BRUTAH

the ice ax is way better than the whippet. ...

When I had a tech fitting failure on my boots, walked out of my skis in steep spring conditions terrain, I turned over to arrest and I dug the the whippet in under my chest with all of my weight, this resulted in the shaft of the pole snapping instantaneously right where the pole meets the whippet. The head lost purchase right away and I was in a rock pile/tree clump before I could do any thing else. Being that I was very close to death and would mostly likely not be here now if not for a quick SAR team, I dont ski steep terrain in firm conditions anymore, but if I did I would never use a whippet again. Had I had my axe in my hand like I used to do before purchasing a whippet, I think my life would be a whole lot better right now.


But like Sam said, the whippet at least got me on my stomach and changed my course enough so it was not my head taking the impact but my legs instead.

TC, was that the original Whippet design or the new design? I have both, although I modded the original to disperse the load of the head/pole connection.

Originally Posted by Big Steve

TC, was that the original Whippet design or the new design? I have both, although I modded the original to disperse the load of the head/pole connection.

inquiring minds want to know.. I'm a cheapass and still use the old one (i also like that it's removable, and the rust adds character.. but I digress), and I'd like to know if I should be considering the upgrade. I credit that thing with saving me several times, but I'm not opposed to better gear at all.

TC - do I understand your description correctly that the pole failed under or around the pole grip, or was it further down by the flick-lock?

Also, i think this was brushed over earlier. The victim was, if i remember correctly, wearing a helmet. Do this!

I'm no expert on the matter, and I'd happily defer to someone who is, but it's been my understanding that the polystyrene ski and climbing helmets, though done in one big hit, will do a far better job of preventing a concussion or brain injury (and they're lighter). When I got a several concussions a few years back, i spent some time looking into it and subsequently changed my habit of bringing my old hard-shell climbing helmet along on ski tours. I now bring my ski helmet (giro g10), or a petzl meteor. New helmets are light, and your brain is your most valuable piece of anatomy, so there should be plenty of incentive to bring one along. I see a surprisingly large number of old timers and even guides sporting no helmet or an old school plastic helmet, yet in terms of preventing major epics or life altering injuries it's hard to beat the safety to weight ratio. All it takes is hooking a tip on icy corn, tumbling in some crust to change your world in a big way.

Sam, the old one can be modified to make disperse the load head/shaft connection, but it renders the head non-removable in the field. I too would like to hear about the specifics of TC's failure.

First and foremost, although I appreciated the emotionally compelling account posted by the surviving brother, I appreciate even more the effort by everyone in this thread to examine this incident in detail so that we can be safer. (Quite the welcome contrast to the usual fatalism theme of "accidents happen" which reminds me of this excerpt from the video my toddler daughter keeps watching, which is equally ineffective.)

Question though: can anyone come up with a skiing fall -- starting from sort of at least moderate speed -- in firm conditions on steep terrain that was successfully arrested, whether by ski pole self-arrest grip, ice axe, or ski pole tip?

I suppose this is along the lines of "It depends on what the meaning of the words 'is' is." -- i.e., how do we define at least moderate skiing speed, firm conditions, and steep terrain? But I'm skeptical.

I do have a self-arrest ski pole grip, but I acquired it originally for skinning with ski crampons, since if the skinning is difficult enough to require crampons, it's difficult enough to entail the possibility of a fall. But a skinning fall is starting at essentially zero speed, so a falling skinner has a brief window of opportunity to self arrest.
Since I acquired the self-arrest grip, I've also gotten into glacier travel (the usual roped for the ascent, unroped for the descent), for which I also think a self-arrest ski pole grip makes lots of sense, maybe even mandatory. (And I've come to appreciate it on weird non-snow approaches.)

However, since I have the Grivel Condor, which easily retracts, I seldom deploy it while skiing, since I'm concerned that it's more likely to injure me in a fall than to arrest a fall.

Anyway, those are my thoughts and perceptions to add to the mix. I wish we all could have started this exchange outside of the recent tragedy, but at least some valuable safety discussions have arisen from it.

Originally Posted by Jonathan S.

First and foremost, although I appreciated the emotionally compelling account posted by the surviving brother, I appreciate even more the effort by everyone in this thread to examine this incident in detail so that we can be safer. (Quite the welcome contrast to the usual fatalism theme of "accidents happen" which reminds me of this excerpt from the video my toddler daughter keeps watching, which is equally ineffective.)

Question though: can anyone come up with a skiing fall -- starting from sort of at least moderate speed -- in firm conditions on steep terrain that was successfully arrested, whether by ski pole self-arrest grip, ice axe, or ski pole tip?

I suppose this is along the lines of "It depends on what the meaning of the words 'is' is." -- i.e., how do we define at least moderate skiing speed, firm conditions, and steep terrain? But I'm skeptical.

I do have a self-arrest ski pole grip, but I acquired it originally for skinning with ski crampons, since if the skinning is difficult enough to require crampons, it's difficult enough to entail the possibility of a fall. But a skinning fall is starting at essentially zero speed, so a falling skinner has a brief window of opportunity to self arrest.
Since I acquired the self-arrest grip, I've also gotten into glacier travel (the usual roped for the ascent, unroped for the descent), for which I also think a self-arrest ski pole grip makes lots of sense, maybe even mandatory. (And I've come to appreciate it on weird non-snow approaches.)

However, since I have the Grivel Condor, which easily retracts, I seldom deploy it while skiing, since I'm concerned that it's more likely to injure me in a fall than to arrest a fall.

Anyway, those are my thoughts and perceptions to add to the mix. I wish we all could have started this exchange outside of the recent tragedy, but at least some valuable safety discussions have arisen from it.

Johnathan, on the day a few years ago that Greg Allen and I skied every drainage on mt washington, I got to the GG first (first run of the day), clicked in, made one tenative turn in airplane, felt pow, got excited, and opened it way up for a few more turns. After about 3 more turns, the snow turned into very hard white ice/neve, i lost my (very sharp) edges, and tumbled and slid a ways, including over a snow covered rock. After getting some air off the small rock, I landed feet downhill on my side and got the whippet in, quickly arresting my fall with the help of my edges. The snow was so hard that I had trouble skiing on it slowly. Allen and I changed over 3/4 of the way down and front pointed back out. I wasn't saved entirely by the whippet, but it would have been virtually impossible to stop that slide with only skis.

Sort of embarrassing, but hopefully that qualifies as steep, moderate +, and skiing speed.

I've never used or even seen a condor, but I've always worried about how the grip puts the pick further from the hand, it seems like it would cause it to deflect. Has that been your experience at all?

Originally Posted by sfotex

A ski pole tip will at least get your feet below you, better to hit feet first then head first .

So I just spent 2 weeks in Europe, and noted no open uses whippets over there, and the general attitude is
disdain towards them.

And a whippet would/will allow higher chance of self arrest or at least better control of speed on a sliding decent on semi steep ice...

Screw the Euros disdain towards them.. I choose the higher probability of living..

.

Condolences to Jeff's family and friends..