Will Stanhope

Khoiwrote:

I knew using that word would draw out a response...

I think it's logical to use the clock on one's phone to tell the time and ascertain how much time has passed.

Do you disagree?

I think it’s silly one way or another to assume that the belayer was paying attention to the time line in any sort of reliable fashion, oh cuz you know of the TBI her partner was experiencing.. did you not even read the above comment from a medical professional who said that humans are pretty bad judges of time during moments of stress? And that’s from a medical professional who says they’ve responded to a thousand ambulance calls..

Tony Danzawrote:

I think it’s silly one way or another to assume that the belayer was paying attention to the time line in any sort of reliable fashion, oh cuz you know of the TBI her partner was experiencing.. did you not even read the above comment from a medical professional who said that humans are pretty bad judges of time during moments of stress? And that’s from a medical professional who says they’ve responded to a thousand ambulance calls..

I read Christian's points about humans being bad judges of time, and in my reply I acknowledged my agreement accordingly. Did you not read that?

Like I said, despite knowing very well how bad we can be at estimating the passage of time I still believe that, even during moments of high distress, we aren't that bad at reading a 3 or 4 digit number on our phone screen.

Do you think one's ability to read the time on one's phone goes out the window during moments of high distress?

Rick Stevensonwrote:

Interesting point, but let's give Dr. Boondoggle a chance.

Of course, according a comment I read on Mountain Project:  If he is going to actually step up and volunteer his time as a First Responder to an Emergency and take charge of an evacuation his skills in assessment and evacuation procedure will be very much on the table for discussion.

I'm looking forward to those discussions.

Well Rick, If you actually read the totality of my comments you will find that I believe I cut SAR as much slack as I possibly can given the information presented. I stated clearly that we don't know what went down that day but the account relayed by the victim's partner suggested strongly that there was unnecessary delay in evacuation of the victim despite ominous signs in the presence of a closed head injury. That does not mean she was right and she may have a skewed interpretation of events, but there still are important lessons to be learned from this accident.

The idea is not to turn the thread into all about me, but you asked so as a former General Surgery Resident at a major University Medical Center that was a Level 1 Trauma Center, now retired MD, I have run the trauma codes there (with a board certified trauma surgeon attending looking over my shoulder, mostly) and during my Neurosurgery rotations was the Neurosurgery Resident on Call responsible for the initial neurological evaluation of every trauma/altered mental status secondary to CVA patient that came in while I was on service. This was in addition to being responsible for as many as 45 inpatient Neurosurgery patients on any given day while on service and enjoying those 100-hour work weeks. Good times.

I also have my own personal history with brain trauma: 3 skull fractures and 6 concussions by the time I was 13yo. I still have the depression in my left parietal if you want to feel it sometime. Yes, it is probably what is wrong with me. So, I may have more interest in this topic than some.

I tried to make it as simple as possible for those that have minimal training and it really is a very simple decision tree: Every single individual that has had a loss of consciousness secondary to blunt trauma should be transported as soon as possible to the nearest receiving facility capable of managing their complete care. This loss of consciousness is always a profound insult to the brain, be it from low blood pressure from any number of sources (ie trauma to chest or abdomen) or this case: blunt trauma to the head with worsening neurological signs after an apparent period of lucidity which is one of the most profound medical emergencies we will encounter. The complete differential diagnosis that encompasses a loss of consciousness secondary to blunt trauma is beyond the scope of this thread, but I will tell you with 100% certainty that potentially extremely bad things are going to happen in the next hour(s) and that the patient needs to be moving towards care asap. We can't take chances in delaying care even though it may turn out to not be serious after all and they may seem fine on initial assessment or even deny care. If they have lost consciousness, get them moving towards care no matter what anyone says. Minutes count and if you wait until they turn south again it is probably too late. Stop. Period. End. 

If anyone reading this learns something and god forbid, has to use this knowledge to activate EMS then it's worth it to me.

I will reiterate that SAR is often in an impossible situation that is very difficult to manage given the complexity of emergency response in the mountains (weather, terrain, team safety etc etc) and they deserve our thanks for responding to this accident. In all likelihood, they did their very best.

However, if in the final postmortem analysis if avoidable delays were incurred then procedures/training should be put in place to remove whatever barriers may have created obstacles so such delays or errors in assessment can be avoided as much as is humanly possible in the future. For the assembled audience in this thread, I joined the discussion in the hope that anyone present who is put in the position of First Responder might benefit. I also have no evidence that errors were in fact made by anyone.

I will also say again, as I have posted previously, the victim's fate that day was not decided by any one factor other than not staying home. As such, no one else is responsible for this tragic outcome and I would defend SAR or anyone else from that accusation. Blaming is not what we are doing here. We are just discussing, as is appropriate for this forum, this incident so that we all might learn something and maybe make a difference in the future.

Best Regards, Dr. Boondoggle MD

Ps. I am sorry, but I choose to remain anonymous as MDs are often harassed online for any number of reasons. Take from that what you will, it is what it is. Believe me, I am aware of the irony of my chosen nickname.

If I would have known the can of worms I was cracking open when I brought up SARs response, I probably would've kept my mouth shut. Papal infallibility has apparently got nothing on SAR. Respectful questioning, with copious caveating, seems to have somehow morphed into me ungratefully and maliciously slandering the good members of SSAR.

I'm gonna stick to bringing my dog to the crag and having her scarf some sammies. Maybe trundle some rocks and chip a few holds while I'm at it. 

Will, RIP.

The urge to gossip on line about an accident is understandable. Doing so before any facts are out is crass, however. First few pages of this thread, ugh. Maybe some of you will go out under a similar cloud when its your turn.

At least Stanhope's partner's letter gave the gossips some meat to argue over. Better'n a grave side fist fight I suppose, though I think more would be accomplished with a fist fight.

Do a little SAR bashing. Flex some entitlement. Parade the toxic masculinity. Lay down the law (that no one listens to).

Finish up with "wear your helmet's kids!"

Every accident brings out the accident gossips. Just like every dog thread brings out the same, three, guys.... for 10 pages.

Of course most of us would like to know what happened, then think about our own climbing. But the way these gossips raise topics, as accusations really, is a sad reflection of the person doing it.

You know who you are.

Khoiwrote:

Do you think one's ability to read the time on one's phone goes out the window during moments of high distress?

YES. All of your normal judgement and abilities often go out the window during moments of high stress. This isn’t an opinion, it’s been confirmed by a lot of studies, a lot of analysis from accidents, etc.  

This is what Christian was telling you but you just keep ignoring it like you have some special life experience that supersedes a person who says they’ve responded to thousands of ambulance calls. Are you in the med/SAR field or some other high stress environment?

Tony Danzawrote:

YES. All of your normal judgement and abilities often go out the window during moments of high stress. This isn’t an opinion, it’s been confirmed by a lot of studies, a lot of analysis from accidents, etc.  

This is what Christian was telling you but you just keep ignoring it like you have some special life experience that supersedes a person who says they’ve responded to thousands of ambulance calls. Are you in the med/SAR field or some other high stress environment?

So we aren't going to agree on that point

John Tuttlewrote:

Well Rick, If you actually read the totality of my comments you will find that I believe I cut SAR as much slack as I possibly can given the information presented. I stated clearly that we don't know what went down that day but the account relayed by the victim's partner suggested strongly that there was unnecessary delay in evacuation of the victim despite ominous signs in the presence of a closed head injury. That does not mean she was right, and there still are important lessons to be learned from this accident.

The idea is not to turn the thread into all about me, but you asked so as a former General Surgery Resident at a major University Medical Center that was a Level 1 Trauma Center, now retired MD, I have run the trauma codes there (with a board certified trauma surgeon attending looking over my shoulder, mostly) and during my Neurosurgery rotations was the Neurosurgery Resident on Call responsible for the initial neurological evaluation of every trauma/altered mental status secondary to CVA patient that came in while I was on service. This was in addition to being responsible for as many as 45 inpatient Neurosurgery patients on any given day while on service and enjoying those 100-hour work weeks. Good times.

I tried to make it as simple as possible for those that have minimal training and it really is a very simple decision tree: Every single individual that has had a loss of consciousness secondary to blunt trauma should be transported as soon as possible to the nearest receiving facility capable of managing their complete care. This loss of consciousness is always a profound insult to the brain, be it from low blood pressure from any number of sources (ie trauma to chest or abdomen) to this case: blunt trauma to the head with worsening neurological signs which is one of the most profound medical emergencies we will encounter. The complete differential diagnosis that encompasses a loss of consciousness secondary to blunt trauma is beyond the scope of this thread, but I will tell you with 100% certainty that potentially extremely bad things are going to happen in the next hour(s) and that the patient needs to be moving towards care asap. We can't take chances in delaying care even though it may turn out to not be serious after all and they may seem fine on initial assessment or even deny care. If they have lost consciousness, get them moving towards care. Stop. Period. End. 

If anyone reading this learns something and god forbid, has to use this knowledge to activate EMS then it's worth it to me.

I will reiterate that SAR is often in an impossible situation that is very difficult to manage given the complexity of emergency response in the mountains (weather, terrain, team safety etc etc) and they deserve our thanks for responding to this accident. In all likelihood, they did their very best.

However, if in the final postmortem analysis if avoidable delays were incurred then procedures/training should be put in place to remove whatever barriers that may have created obstacles so such delays or errors in assessment can be avoided as much as is humanly possible in the future. For the assembled audience in this thread, I joined the discussion in the hope that anyone present who is put in the position of First Responder might benefit. I also have no real evidence that errors were in fact made.

I will also say again, as I have posted previously, the victim's fate that day was not decided by any one factor other than not staying home. As such, no one else is responsible for this tragic outcome and I would defend SAR or anyone else from that accusation. Blaming is not what we are doing here. We are just discussing, as is appropriate for this forum, this incident so that we all might learn something and maybe make a difference in the future.

Best Regards, Dr. Boondoggle MD

Ps. I am sorry, but I choose to remain anonymous as MDs are often harassed online for any number of reasons. Take from that what you will, it is what it is. Believe me, I am aware of the irony of my chosen nickname.

Condolences to all of Will’s loved ones. 

Dr HB, since you seem to be the SME here, maybe you could offer an opinion about my following question. I’ll apologize in advance if this is deemed inappropriate. 

It’s been speculated that Will was potentially dependent on alcohol, if this is the case, would measures be taken to prevent withdrawal while he was presumably comatose?  I know that alcohol withdrawal can be dangerous and life threatening on its own and speculate that it can be extremely serious for a person with a head injury. I wonder if this could have contributed to Will’s unfortunate downturn? Do medical professionals ask family members or friends about this or is there testing done to ascertain this? 

The reason I thought of this was I have a family member who had a stroke that was showing signs of agitation. This person was a heavy nicotine user and I believe that when this was known to the docs, they administered something that eased the withdrawals and the agitation subsided. 

I will delete this question if anyone asks me to. 

 The partner in this accident was not in the middle of the emergency when they told their side of the story to Climbing Magazine.  I certainly know that if it was myself reporting on an accident that I was part of the response to I would absolutely look at and document my phone records and also the digital files from my camera to establish time lines.  Thats actually what I do when timing car to car climbs and is as far as I know common practice in the digital age. Discrediting the actual only witness to the event seems to also be the new standard in this age of only believing what you want to believe. 

^^ Daniel - sounds like he died too soon to have alcohol withdrawal come into play, unless I am misinterpreting things.  

-physician who works in an ICU setting regularly, but not a first responder of any type.  

EDIT: sorry, I thought he died en route to the hospital.  I see that wasn't the case as noted a couple replies below.  But Dr. Boondoggle has cleared the air - and this matches what I have seen in ICU settings for comatose patients.  

Re Helicopters: Weather includes Wind. Wind, especially in canyons are squirrelly. Add reduced visibility in rain and now you have a nuts situation.

A 15 minute climber's trail up a boulder field/talus slope is easily 30 minutes plus loaded with gear and ropes. Slippery talus is a minefield for broken extremities and more. Carrying out a patient of most any size strapped into a litter and totally under rescuers care is delicate, at best.

Helicopters, while wished for, are usually dispatched via a system focused not only on availability but also safety protocols as has been mentioned.

Will's partner did very well.

The wail of a mother when learning her child has passed is beyond the bounds of description.

As climbers we wail and gnash our teeth in sympathy for the climber and their friends and family.

This thread is alive and throbbing not sleeping in the back of a lecture hall. Keep it open.

chris treggewrote:

^^ Daniel - sounds like he died too soon to have alcohol withdrawal come into play, unless I am misinterpreting things.  

-physician who works in an ICU setting regularly, but not a first responder of any type.  

I did a bit of internet research and it seemed like around 10 days was when the withdrawals can be life threatening. This coincides with Will’s downturn from reported info. I treat internet info with necessary skepticism so this is why I asked my question here. 

Thanks for your reply. 

Daniel Shivelywrote:

I did a bit of internet research and it seemed like around 10 days was when the withdrawals can be life threatening. This coincides with Will’s downturn from reported info. I treat internet info with necessary skepticism so this is why I asked my question here. 

Thanks for your reply. 

This is a known complication and is routinely managed in the Trauma critical care and ICU setting. Alcohol is such a common denominator in trauma (ie car accidents, assaults, suicide attempts) it is generally well managed with appropriate sedation. I wouldn't associate the two timelines unnecessarily.

John Tuttlewrote:

The idea is not to turn the thread into all about me, 

Thanks for the detailed description of your impressive medical credentials.

But the question was whether you had any hands-on experience with evacuations in a wilderness SAR team.

And thanks for "cutting SAR as much slack as you possibly can." It's very generous of you.

Rick Stevensonwrote:

Thanks for the detailed description of your impressive medical credentials.

But the question was whether you had any hands-on experience with evacuations in a wilderness SAR team.

And thanks for "cutting SAR as much slack as you possibly can." It's very generous of you.

I can see you are not a generous person and have an axe to grind. You asked, and were told. 

That's all the engagement you will get from me.

I think he's miffed

John Tuttlewrote:

This is a known complication and is routinely managed in the Trauma critical care and ICU setting. Alcohol is such a common denominator in trauma (ie car accidents, assaults, suicide attempts) it is generally well managed with appropriate sedation. I wouldn't associate the two timelines unnecessarily.

Thanks for the reply. I’m not making any assumptions, I was just interested in the protocol and wanted to introduce more info for anyone who may be faced with a similar situation. 

A tough situation for all involved. 

John Tuttlewrote:

I can see you are not a generous person and have an axe to grind. You asked, and were told. 

That's all the engagement you will get from me.

Since you asked, I'll tell you little about my background:

SAR volunteer who has served on three teams in California over thirteen years. Participated in about 200 missions over the years. I was never paid but I have a few plaques. No longer in the field although I support a local team occasionally with logistics, and managing gear etc. My day job was a general contractor, but I am now retired.

I do what I can, but I'll keep working on being a generous person.

I'm not an MD, just a lowly WFR. I've worked with many doctors as it's quite common for ER docs, nurses, EMTs etc. to serve as field members of a team. Many times I've carried a litter alongside an ER doctor that could be making $200/hr (or whatever they make these days...) They are volunteers also. All incredible people who make tremendous sacrifices, and show great compassion and humility, many of then while balancing full-time jobs.

Of course you know practicing medicine in the field is very limited and few teams carry any medical equipment beyond basic first aid and splints. No one does brain surgery or really anything that can mitigate a TBI in the field, or on a helicopter, or in an ambulance. The priority is always to evacuate safely and quickly, with whatever resources are available.

I encourage anyone to volunteer with their local SAR team. They are always in need of motivated people. The most important qualification is a willingness to participate consistently. It's not easy, but it's rewarding. Bring whatever skills you have. There's always a place for a strong hiker, climber, or even an MD that never finished their residency and was never licensed. There are many ways to be contribute, and most people appreciate the generosity.

I'm a bit out of date so I don't know what current protocols are, nor the civilian side very well, but hypertonic saline is a pretty sanguine, indirect intervention to address ICP (the higher salinity fluid draws fluid out of tissues). 

Fwiw, higher level military medics are being trained and given practice scope to drill burr holes in the field to reduce ICP. But obviously that's an unlikely latitude to make it to the civilian world. Too bad though, since the cost/benefit is incredibly in favor of drill, baby, drill. 

Tony Danzawrote:

This is what Christian was telling you but you just keep ignoring it like you have some special life experience that supersedes a person who says they’ve responded to thousands of ambulance calls. Are you in the med/SAR field or some other high stress environment?

No tony, it wasn't. Khoi is a sharp dude, he knew exactly what I meant. I used the exact same method of verifying time stamps (within +/- 1min) when I went back over my phone calls to verify - and I took one quick screenshot of my lock screen about a min after the team arrived, so I could know what the response time was (less than 10min from second call, less than 15 from first call, in case you're wondering).

-Nearly useless reminder that most will ignore: There's valid critiques in almost every post here, yet we still don't have concrete information from all sides. Until we do, everything we post is fairly speculative. I'm perfectly happy to say that, in an ideal world, we adhere to a golden hour, don't skimp on resource allocation, and correctly identify high priority pts. Whelp, sometimes shit happens, sometimes the closest Trauma Center is not 5min away and it's not worth the stabilization stop to delay more definitive care, sometimes the skies suck, and sometimes we bitch about it on MP in circles. again, I hope *(as dr boon and others have mentioned) that we take the opportunity to consider the personally applicable lessons we can take away from this, and also consider adding skills or tools to our own kit... never know when it might come in handy.