Mountain Life Support

It's spring again, the season of renewal and anticipation. In a good year, you've had your fill of snow and cold by now. There's only so much you can stand of the climbing wall and the swim center. Summer's coming, and you're mad to get out. But wait--the trails are too muddy and the roads are too wet. The only sensible choice, it seems, is skiing the chutes in the north Bridgers.

Sensible? Skiing with zero tolerance? At any moment you can run out of turning room or out of snow altogether. Razor-sharp rocks await your miscalculation. On a good day, you just tear up your skis. On a bad day...well, on a bad day, you're going to need more than band-aids and ibuprofen.

Whatever the season, if you're spending a lot of time outside, someday you'll find yourself with a broken friend. Maybe he bonks his head while rolling his kayak, maybe his cam comes loose and he falls 20 feet leading a pitch, or maybe she hits the front brake too hard on a steep downhill. What are you going to do?

To help your friend, you're going to have to think and act quickly, but calmly. Work it out ahead, just like any other part of your sport. Practice it. Be able to do it with confidence.

First, ABC. How's her Airway? Is she Breathing? Has she got Circulation (i.e., a pulse)? This is a universal treatment--the most highly trained personnel do the ABCs. And remember, at all times, protect the injured person's neck.

If there is no breathing or pulse, start CPR. But wait one--if the injured person's head is crushed, with brain matter on the ground, he's dead. Sometimes we have to accept that dead is dead. If you can't accept that young vigorous people die from extreme sports, you need to rethink participating in them. We all have to decide what risk we're willing to take. Me, I'm not going more than 20 feet up anything I can't walk upright on, or anyplace I can't simply open my mouth and breath air.

So if your broken friend needs CPR, and he's not permanently dead, protect his neck and start rescue breathing and chest compressions. Do it till help arrives or you're too worn out to continue. Without hypothermia, professionals generally stop after 20-30 minutes if there is no response. In near-drownings and electric shock, you have a pretty fair chance for quick success.

If your friend is badly injured, but breathing and has a discernable pulse, your ABCs include checking for chest wounds that may be leaking air. Tape a plastic bag over the wound, unless it makes the victim more short of air. Control severe bleeding by applying a wad of cloth and pressure directly on the wound. Do your ABCs over again.

Now, D--prevent Disability. Protect her neck. Check circulation in all the parts. Press on her fingernails and watch for the color to come back--it should be less than two seconds. Check sensation in all the parts with a light touch. Loosen clothing if needed. Check for Deformed extremities. Generally, splint these where they are, unless the circulation or the sensation is abnormal. Then, if help will take a while, you may have to carefully return the part to its usual position before splinting. If she loses circulation to the part when you move it, then you're doing the wrong thing.

Finally, E is for Environment and Exposure. You need to protect your friend from further injury. If he's at risk from falling rocks, you may have to very carefully move him to safer ground. Get him dry and keep him warm. Provide fluids, if it's going to be a long while before you get to the hospital. Now you have to decide whether to call for help and wait, or to just "throw and go." There's no fixed answer, but remember the oldest rule in the doctor book: "First, do no harm." Hauling your buddy yourself risks aggravating his injuries. Generally, skilled help can arrive in a reasonable time and you're oftentimes much better off waiting.

Keep in mind that this little summary can't make you a competent rescuer. If you haven't taken a wilderness first aid or first responder class, now is a good time. They're sponsored by MSU's Experiential Education department. Call Mike, 994-7673, or visit

Dean Center, M.D. was a physician for many years at Family Doctors' Urgent Care in Bozeman.