Will Stanhope

Strong minds discuss ideas.

Average minds discuss events.

Weak Minds discuss people.

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.

In my experience, alcoholic patients also tend to bleed quite profusely when dealing with ICH (Inter Cranial Hemorrhage) - which in Will's case, may have contributed to why his ICP (Inter Cranial Pressure) rose as much as it did and why he decomped where he otherwise may not have.  

Where people blame the response time, I am hesitant to do so - because it's also possible that he would have passed away even if it was a quick transport time and he was attended to by a Neuro Surgeon in short order. Not all brain bleeds are save-able (location and depth matters greatly). I am curious if TXA (Tranexamic acid - an antifibrinylitic used to stabilize bleeding) was administered at all in the prehospital setting, and where along the transport he had started to seriously decomp. Some of these details would allow us to point fingers since they are what dictate how we allocate otherwise limited resources. Without them, we must remind ourselves that we are only speculating from our armchairs. 

It's more likely than not that proper protocol was followed and its entirely possible that he didn't show signs of decompensation until late into the transport, or perhaps even in the hospital itself. But, obviously, HIPAA is a thing, so those details would likely only surface in an internal case review somewhere down the line. 

John Tuttlewrote:

Strong minds discuss ideas.

Average minds discuss events.

Weak Minds discuss people.

That's a great quote John!

But I must confess that I will continue to discuss people. I think the thousands of SAR volunteers around the world deserve more acknowledgement, and I will always try to mention them in relevant discussions. BTW, It's a weekend now and many of them will be sacrificing their free time for training.

Of course this thread is about an event, so I guess that puts everyone involved in the "average" category.

But let's raise the bar, and discuss ideas. I'd love to hear from some strong minds. 

What are your ideas for improving SAR response times in the field?

Bro is definitely miffed!

While we're at it, what are trad dogs creditials? I mean if he's not SAR he needs to stfu

I really hope Trad Dog gets what I'm doing here, like really that was tongue in cheek af

Everyone just whip them out to compare size and get it over with.  

@ Trad Dog, 

Your points are interesting (the biology always is) and I'm not saying that to be ironic or critical.  However, I think there is a logical flaw here.  We can't let the fact that Will's injury might or might not have been survivable influence the decision to evacuate him as quickly as possible.  There's no way the SAR folks could have known whether or not his injury was survivable--they just had the information that there was a patient with a blow to the head, an intial loss of consciousnss, and deteriorating condition.  If Marina's description is accurate, and we have no reason to beleive that it is not (indeed her clarity and competence make me more likely to believe her) then this was obviously a patient that needed to be evacuated ASAP. 

@ Rick Stevenson

I appreciate your perspective, and SAR volunteers do deserve recognition and respect. But that shouldn't prevent us from raising questions about this response, just as we would with any other person or incident. Nothing about SAR personal should make them exempt from analysis, reflection, and learning. In fact, a strong argument could be made that, precisely because their work is so critical, they should be subject to a high level of scrutiny.  

Even if the timeline is not perfect, and Will got to the hospital in 3 hours and not 4, that's far too long for what is essentialy a front country setting.  As I said earlier, this is not the wilds of Alaska.  How long is the hike from the parking lot to the site where Will was? About 20-30 minutes?  Why didn't somebody just hike up there and evaluate him, instead of relying on phone communication? What were they waiting for?  

Even if we take a helicopter completely out of the equation, there should be protocols to evacuate patients so close to the road in such a popular climbing spot.  

My guess is that rules based on liability and not necesarily patient care, and the inertia of organizations trying to respond quicky and flexibly, prevented a faster response.  

Bruno Schullwrote:

@ Trad Dog, 

Your points are interesting (the biology always is) and I'm not saying that to be ironic or critical.  However, I think there is a logical flaw here.  We can't let the fact that Will's injury might or might not have been survivable influence the decision to evacuate him as quickly as possible.  There's no way the SAR folks could have known whether or not his injury was survivable--they just had the information that there was a patient with a blow to the head, an intial loss of consciousnss, and deteriorating condition.  If Marina's description is accurate, and we have no reason to beleive that it is not (indeed her obvious clarity and competence make me more likely to believe her) then this was obviously a patient that needed to be evacuated ASAP. 

That's not the basis of my argument - though re-reading my comment, I can see how somebody might think that.

Generally, the decision to fly somebody to a trauma 1 center is predicated on their condition and resources available at that time (this includes trauma teams and the cases that they are currently dealing with). If the patient is stable during transport and the trauma teams are at capacity with complex cases, then you'll see rotary crews pass somebody off to an ambulance or fixed wing for a regular trauma transport. It's just what happens sometimes. I have participated in this process on many occasions, sometimes in ICU rigs with patients that are critical and would clearly benefit from being flighted directly to a trauma 1 center. Some of them appeared to be stable when we got them, and then they suddenly code in our ambulance shortly after. Technically speaking everybody would benefit from the highest level of care as fast as possible at all times - but that's simply not how real life works out. Same reason why we usually don't have physicians, blood, or advanced imaging on our ambulances, even though it would definitely result in improved patient outcomes. Resources are limited.

I only brought up survivability because we simply can't blame the transport time for his death if we don't know if that's what killed him or not.

For example, if it turns out in the autopsy that his ICH was significant & inoperable due to it's location (which happens when the procedure to relieve ICP would result in significant damage to vital tissues enveloping the site of hemorrhage) or pathophysiology - then it's possible that his fate was sealed once the initial injury occured. Meaning that even if the rotary crew had every bit of information and chose to fly him directly to the trauma center, the case still could have been virtually hopeless - i.e. transport time not being the decisive factor in the patient's outcome. It's important to pay attention to the fact that the rotary service could only make decisions based on their protocols, the MOI, signs + symptoms that they can observe, and the vitals that they have available to them. They do not have CT-vision superpowers.

That being said, there are certain in-hospital interventions that can give the patient a better chance of surviving even the most inoperable ICH cases, so, again - obviously it's always nicer to be under the care of a good trauma team sooner rather than later - even if only marginally so in certain cases. However, resources are limited, and sometimes hard decisions must be made based on the field that is laid out in front of those who must make such decisions. 

I'm not saying one thing or another happened - I'm simply saying that without knowing the full scope of what happened, we simply can't make informed judgements about who, if anybody, is at fault in Will's death.

Trad Dogwrote:

I'm not saying one thing or another happened - I'm simply saying that without knowing the full scope of what happened, we simply can't make informed judgements about who, if anybody, is at fault in Will's death.

That's great perspective and I appreciate your response.  

I think we actually agree on a great deal.  I highlighted the above because this might be the crux of our missunderstanding (if we are missunderstanding each other).  

I do not want to blame the emergency response for Will's death.  His death may or may not have been sealed the moment he fell.  

I'm asking questions about the length of time it took from receiving the call to getting this patient to a hospital.  Whether or not the length of time made any difference in this case is unknown.  But the time seems long, and it could have made a difference.  As you said, the many people involved in the emergency response had no way to know--their job was simply to get him to a hospital as safely and quickly as possible.  

Incidentally, you mentioned doctors on ambulances or helicopters.  I'm originally from the US, but where I live now In Switzerland they often dispatch a "Notfall Artz" or "emergency doctor" to incidents to assist the regular ambulance crews.  I've been involved in two incidents where the emergency doctors were on scene, and it made a huge difference in patient outcomes in both cases.  I know that they are also working on using drones with cameras and speakers to deliver defibrilators to patients in urban areas.  

Perhaps some people with local knowledge and those with experience in emergency response can offer some insight on the following: 

1-An accident happens in Squamish and an emergency call is made.  Does this call go to a general emergency response center (police, fire, ambulance).  I only ask because here in Europe it can get complicated.  For example, if you're climbing in Chamonix, you can call a general emergency number or you can call the PGHM directly.  I know that kind of service doesn't operate in Squamish, but I guess what I'm suggesting is, when the call was placed, it probably went to a general emergency response, correct?

2-An ambulance is dispatched to the site, or as close to the site as possible, probably the parking lot near the wall.  Is it correct to assume that the first responders were a regular ambulance crew?

3-I can understand that a regular ambulance crew is not going to hike up 30 minutes through steep terrain to find a patient.  So, when in this process is a higher level of response activated?  Who makes these decisions?  Is there a central authority which could call out SAR?  For that matter, what SAR teams or resources exist around Sqamish?  Are there any locations where SAR personal are the first responders, and would that make sense for call outs are climbing areas like Squamish?

4-A SAR team arrives on site.  What would be their first priority?  I assume it would be making sure that the scene was safe for their personel.  Then, I assume that they would try to contact the party and decide how best to evacuate the victim.  As carrying a litter over steep terrain involves many people, is time consuming, and airway management can be complicated, what other possibilties exist?  When I got my EMT certification decades ago, we trained with these sort of chair devices.  You could put a C-collar on a patient and carry them up in a sitting position up and down stairs relatively easily  Would this have been an option?  

5-It sounds like Will was not unconcious when the ambulance first arrived.  If he had evidence of a head injury and a deteriorating LOC, wouldn't the priority be to get him down as safely and quickly as possible?   How would this be done at this location?  Could a few of the SAR volunteers have simply put a C-collar on him and carried him down on their backs, or helped him down with their arms around his shoulders?   

6-If I had been in that situation, and I felt that I was loosing the patient, I think I would have made a improvised C-collar from a Sam splint, inserted a nasopharyngeal airway if I felt it was possible and would help, stabilized his broken foot with whatever was available (a trivial injury but the pain would probably not have been trivial) and just carried him down on my back or with the help of other climbers.  

7-How did this in all liklihood play put?  What could have been done differently?  And what would each of us have done in the similar circumstances?  

The approach to the base of Rutabaga from the parking lot is about 15 minutes, not 30 minutes, even with a pack. And while it is an uphill approach, I wouldn't call it a steep approach. A significant portion of the approach goes through the Grand Wall Boulders, so that section of the approach is on a well-used well-travelled trail network.

The latter portion of the approach does become a little more technical, but no where remotely close to dangerous, you're still hiking through a forest en route to a massive granite monolith.

Does anybody here know who Owen Clarke is?

He's the person that wrote the article that everyone is using here as the source of truth. I'd wager that most everyone skipped over the author's name. We usually do. I don't know anything about him either except that he's a journalist that wrote a bunch of articles for Outside, Climbing, and other media websites owned by a corporate media conglomerate. He also writes fantasy fiction and you can hire him on Upwork if you like his style.

But like Cherokee said, people love to gossip. Once they hear something they don't much put any thought into where they heard it. Especially if is an interesting story. 

People who sell stories for a living are usually good storytellers. Good storytellers get people talking.

So let's carry on trying to figure out exactly what happened during this event, using an account of the event told by a person most probably never even heard of, until now.

BigCountrywrote:

Bro is definitely miffed!

While we're at it, what are trad dogs creditials? I mean if he's not SAR he needs to stfu

I really hope Trad Dog gets what I'm doing here, like really that was tongue in cheek af

I really hope that the people who aren't SAR don't stfu.

It's quite entertaining reading some of these posts. We literally have folks saying "If I were there I would have carried him down on my back!"

Everyone should try carrying an unconscious person sometime. I'm not talking about giving your pal a piggy back ride. An actual, unconscious patient. Bonus points if it's a six-foot tall male.

C'mon SAR teams, why do you even bother with those litters? Just carry them out on your back!

And Trad Dog, apparently we can make informed judgements. We have all the information we need, provided to us by an article written by someone who got their information from one person and published an article on an ad-strewn website owned by a media mogul.

Trad Dogwrote:

In my experience, alcoholic patients also tend to bleed quite profusely when dealing with ICH (Inter Cranial Hemorrhage) - which in Will's case, may have contributed to why his ICP (Inter Cranial Pressure) rose as much as it did and why he decomped where he otherwise may not have.  

Where people blame the response time, I am hesitant to do so - because it's also possible that he would have passed away even if it was a quick transport time and he was attended to by a Neuro Surgeon in short order. Not all brain bleeds are save-able (location and depth matters greatly). I am curious if TXA (Tranexamic acid - an antifibrinylitic used to stabilize bleeding) was administered at all in the prehospital setting, and where along the transport he had started to seriously decomp. Some of these details would allow us to point fingers since they are what dictate how we allocate otherwise limited resources. Without them, we must remind ourselves that we are only speculating from our armchairs. 

It's more likely than not that proper protocol was followed and its entirely possible that he didn't show signs of decompensation until late into the transport, or perhaps even in the hospital itself. But, obviously, HIPAA is a thing, so those details would likely only surface in an internal case review somewhere down the line. 

Yes, many clotting factors are made in the liver and depending on the extent of liver disease present in the alcoholic patient they often have elevated bleeding times.

In this particular case we just don't know how that may have contributed. 

These days, afaik, there is nothing beneficial about alcohol consumption. It is both a pro-inflammatory agent (promotes unwanted clots) in moderate use, and in chronic use results in severe liver disease. Many end stage Alcoholics die of complications from liver disease. 

However, we have no evidence that alcohol addiction actually contributed to this accident or it's outcome. By report the victim took a severe blow to the head in which case, intracranial bleeding is virtually expected.

Hey Rick, 

One of my very best childhood friends (we're both in our fifties now) is a smoke jumper based out of Mazama (his day job) and an Air Force PJ (his side gig).  He deployed a few times time Afghanistan, Africa, and other places.  When my daughter was born, he grabbed a Sat phone, hopped in an Air Force vehicle, and drove overnight from the air base in Ramstein to visit.  I have a picture of him in uniform holding my newborn daughter.  As you can expect, he's an unusual guy.  I would say that his work represents the absolute pinnacle of SAR, and listening to him talk about his jobs is both entertaining and enlightening.  

I can absolutey guarantee you that, if he had been hanging around in the parking lot during this incident, probably wearing some homemade shorts he sewed in the gear loft of the Smokejumper base, some weird neoprene toe shoes, an old T-shirt that smelled of smoke, and an Afghan Pakol on his head, he would have jogged up the trail, put Will on his back, and carried him down, laughing and joking the whole way. 

My guess is that the SAR folks hung around with their buddies "staging" in the parking lot, chattering on their walky takies and assembling their gear, while a patient 15 minutes away slowly lost conciousness?  Good work. 

In any of these conversations, climbers often get blamed for not self-rescuing.  However, you are poking fun at the idea that somebody with the means could and should not improvise, do their best, and try to get somebody out as quickly as possible. 

You can't have it both ways, you know?  You can't complain that people should self-rescue, and then argue that self-rescue is impossible, unrealistic, or unsafe.   

I've presented an idea of what I would have tried to do, based on my training and experience. I am 6'4" and could definitely carry somebody on my back with lots of breaks (I've done it before) so my aproach would probably have worked for me, but obviously it would be different for everybody.  And obviously it would be dependent on the patients condition and my assessment.  

Serious question: If we take what is written at face value, what would YOU have done in this situation?  If you had been Will's partner, or if you were in the parking lot at the time of the incident, or if you were part of the SAR team, what would you have done?

I suspect that you will deflect here and not deign to answer this question, but I'm serious. What would YOU have done?  

Do you have anything constructive to offer, or do you want to continue posturing about your great experience and the irreproachable nature of SAR?

P.S. Why don't you treat journalists with the same respect you treat SAR members? 

STFU JFC

I despise hitting a like for any of Bruno's posts but I'll admitt when I do it. ^^^

Bruno Schullwrote:

 If we take what is written at face value, what would YOU have done in this situation?

You aren't asking me what would I have done. You're asking me to make up a story. That's what you did, you made up a story where you were the hero who singlehandedly saved the day. (Or where your friend was the hero? It was hard to follow.)

I won't make up a story about something that I didn't do. You can accuse me of deflecting, but it's a pointless hypothetical. If you cannot understand why, I cannot help you.

The more relevant question is: What will YOU do going forward?

The rescue personnel will undoubtedly debrief and discuss what went well and what went wrong, as they do after every mission. They will identify actionable areas of improvement and take steps to implement what they can with the resources they have. They'll keep training, and maybe someday they will be as competent as you think you are.

Most of them will do this in their spare time, for no compensation. I know you think I'm an asshole for feeling this this way, but I do think it's admirable when people volunteer to help others. I do give more credit to people who do things vs those who tell stories about what they would have done. But it seems your value system is different.

And they will keep responding to missions. They have likely already responded to a few since this incident occurred. They may have saved some lives during that time. But most of these missions never appear on Mountain Project.

For me, I will continue to help out in a support role, doing stuff like attending meetings, making recommendations based on my experience, acquiring and organizing gear, participating in fundraisers, providing emotional support to team members after traumatic events. It's not as sexy as carrying people out on my back, but it helps.

To be honest Bruno, I don't really care what your answer is. Because it's just words. Maybe wait, and respond after you've actually done something.

PS: Happy Mother's day to all the moms on SAR teams. I know for some of you, your day will be interrupted by a text message announcing a mission. And I know some of you will go. Thank you.

Bruno Schullwrote:

Perhaps some people with local knowledge and those with experience in emergency response can offer some insight on the following: 

Interesting questions!  I don't have much local knowledge of SAR response in BC, but I do know a lot about it in the US, or at least California.  I did talk to a woman last summer in BC who is on a volunteer SAR team in the Vancouver area, and it sounded a lot like her team operated a lot like volunteer teams in the US - volunteers working under the direction of local law enforcement to respond to non-roadside incidents.

1-An accident happens in Squamish and an emergency call is made.  Does this call go to a general emergency response center (police, fire, ambulance).  I only ask because here in Europe it can get complicated.  For example, if you're climbing in Chamonix, you can call a general emergency number or you can call the PGHM directly.  I know that kind of service doesn't operate in Squamish, but I guess what I'm suggesting is, when the call was placed, it probably went to a general emergency response, correct?

In the US, 911 calls go to a 911 dispatcher.  They determine the nature and location of the emergency, and dispatch the appropriate response.  Might be an ambulance, might be local law enforcement, might be highway patrol - the dispatchers figure out what agency has the jurisdiction and responsibility to respond to the call. In California and most (all?) western states, the responsibility for responding to non-roadside incidents falls to the County sheriff's office, so many volunteer SAR teams are affiliated with a county sheriff's office.  Exceptions are some federal lands where the feds handle SAR response, e.g., Yosemite, Grand Canyon, Rainier.  Smaller parks have agreements with the local governments for how to cooperate on SAR.  On USFS and BLM lands, the county sheriff generally handles SAR response, an exception being Red Rocks, where Las Vegas metro fire police handles SAR.  

Yes, it gets complicated and I don't know how exactly it work in Squamish.

2-An ambulance is dispatched to the site, or as close to the site as possible, probably the parking lot near the wall.  Is it correct to assume that the first responders were a regular ambulance crew?

Probably not.  It would depend on how dispatch handled the call, and this incident should have gone to LE/SAR.  Then when LE/SAR figures out how they're doing the evacuation and gets things rolling, they let EMS know when and where to meet them.

3-I can understand that a regular ambulance crew is not going to hike up 30 minutes through steep terrain to find a patient.  So, when in this process is a higher level of response activated?  Who makes these decisions?  Is there a central authority which could call out SAR?  For that matter, what SAR teams or resources exist around Sqamish?  Are there any locations where SAR personal are the first responders, and would that make sense for call outs are climbing areas like Squamish?

In the US, the 911 call goes to dispatch, dispatch determines who's responsible for it (generally some law enforcement agency), and that responsible agency calls out SAR if necessary.  Squamish has a volunteer rescue team, and it sounds like they were the first responders to this incident.

4-A SAR team arrives on site.  What would be their first priority?  I assume it would be making sure that the scene was safe for their personel.  Then, I assume that they would try to contact the party and decide how best to evacuate the victim.  As carrying a litter over steep terrain involves many people, is time consuming, and airway management can be complicated, what other possibilties exist?  When I got my EMT certification decades ago, we trained with these sort of chair devices.  You could put a C-collar on a patient and carry them up in a sitting position up and down stairs relatively easily  Would this have been an option?  

Just like in your WFR class - the first priority is scene safety for the responders, public, and subject.  

C-collars have fallen out of favor.  Based on the scant info available, a reasonable plan would be to stabilize the patient in full body vacuum splint, put them in a litter, and move them down the talus assisted by a rope from above.

The other obvious option is a helicopter evacuation, which was ultimately what they did.  I don't know where that resource would come from in Squamish.  That can be very quick, especially if the agency in charge has a helicopter, as many large urban areas do.  The problem in rural areas is that helicopters are located far away and have other responsibilities.  In California for example, many SARs in rural areas involve highway patrol or military helicopters, and it can take a lot of time to obtain them - chain of command and all that.  Also, helo crews can and do refuse missions due to weather, not having a crew available, not having a crew certified to do the operation being requested, the helicopter is down for maintenance, the helicopter is on another assignment... the list goes on and on. It all takes time to arrange and execute.

Also, cliff side hoist or short haul in bad weather is a pretty dangerous operation for everyone involved.

5-It sounds like Will was not unconcious when the ambulance first arrived.  If he had evidence of a head injury and a deteriorating LOC, wouldn't the priority be to get him down as safely and quickly as possible?   How would this be done at this location?  Could a few of the SAR volunteers have simply put a C-collar on him and carried him down on their backs, or helped him down with their arms around his shoulders?   

I assume that was a priority.  Carrying an adult male on your back for any distance is not realistic.  Try carrying a 170 lb. pack down a talus field.  Now imagine the pack is behaving like it has a brain injury - uncooperative, combative, vomiting, bleeding, and screaming in your ear.  In the long run, the litter will be quicker, safer for the patient, and safer for the rescuers.

6-If I had been in that situation, and I felt that I was loosing the patient, I think I would have made a improvised C-collar from a Sam splint, inserted a nasopharyngeal airway if I felt it was possible and would help, stabilized his broken foot with whatever was available (a trivial injury but the pain would probably not have been trivial) and just carried him down on my back or with the help of other climbers. 

Self-rescue is a good option.  If it's feasible, it's often the fastest, because mounting a rescue takes time.  But again, I think you are vastly underestimating the effort it takes to carry someone.

 

7-How did this in all liklihood play put?  What could have been done differently?  And what would each of us have done in the similar circumstances?  

My speculation is that the SAR managers knew they were faced with bad weather, a badly injured subject, and some challenging terrain.  They probably concurrently made a plan A and plan B - plan A, send a ground team with a litter, and bunch of people, and some rope rescue gear; plan B send a helicopter that can either hoist or short haul.  This all takes more time than most people realize.

Thanks Bob for informed response. It's good to hear from someone that has actual experience.

Unfortunately I think your answer will just give the haters more material for speculation.

It's a tough job, and it can take an emotional toll. There's trauma of seeing bad stuff, and hearing family member's responses to bad stuff (much worse, btw)

On top of that volunteers have to put up with people with who say shit like this:

Bruno Schullwrote:

My guess is that the SAR folks hung around with their buddies "staging" in the parking lot, chattering on their walky takies and assembling their gear, while a patient 15 minutes away slowly lost conciousness?  Good work. 

So far eight people have signaled their approval for this shit, and another guy bragged about how he approves of it.

This type of ignorance is pretty common on social media. Read any of the Facebook comments about a rescue and many of the responses are full of know it alls, and other wtf nasty stuff.

Climbing forums used to be better quality. But this thread shows that they have devolved to the worst of social media. 

So now we have our answers, and readers have a choice:

They can agree with the assessment made by a long-time experienced SAR volunteer. 

Or they can agree with the assessment made by the guy that has a friend that has superhero SAR powers.

Stay classy, Mountain Project / OnX Backcountry

That's great information Bob, thanks for the detailed response. 

From the article, it sounds like the first responders got there in about fifty minutes, with the initial plan to carry Will down in a litter, and then changed plans to call for a helicopter, which arrived about two hours later. 

With all the back and forth between departments and agencies, I can definitely understand the time delays to get the helicopter. And if the only way to transport Will was to fully package him in a litter, that would obviosuly have taken time as well.

So the two hour time window is understandable but unfortunate.  

Maybe part of the problem is the binary choice between a litter and a helicopter.  Obviously, a litter is safe in the sense that a packaged patient is protected from further trauma, but considering it takes so much time, it might not be safe at all.  

The picture from the article shows nine or ten first responders at the scene, and they look well-equipped and fully-prepared.  Is there really no way they could have gotten Will down faster? 

As I asked earlier, what about those fixed chair carriers?  Are they still used?  Or two people from the SAR team could have made an arm-chair (litterally) and carried him down with others supporting and stabilizing from in front and behind.  

When I worked as an EMT, we used both methods.  I've carried people up and down flights of stairs in tight stairwells (the urban equivalent of a talus field?) and I can say that it isn't easy, but it can definitely be done with two people.   And if there were ten people, it wouldn't be too hard or too unsafe.  Granted, that was in the late 80's in New York City, and I'm sure it's not protocol now, but it's definitely possible.

Basically, there must be a point where getting the patient down as fast as possible takes precedence over packaging in a litter or waiting for a helicopter.  Will obviously had a serious head injury, and he potentially had spinal trauma and/or other internal injuries, but with his level of conciousness deteriorating as described, I would say that the head injujry should ahve taken precedence over other concerns. 

To quote the neurosurgeon above:

"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.... 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.... If they have lost consciousness, get them moving towards care."