Will Stanhope

Rick Stevensonwrote:

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

Bruno Schullwrote:

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

[ wall of text full of speculation ]

Right on cue...

Bob Harringtonwrote:

.... an exception being Red Rocks, where Las Vegas metro fire handles SAR.  

While this is an accurate statement in many jurisdictions throughout the United States (Fire/Rescue often handles SAR oversight/direction), this is not correct. LVMPD handles SAR response for the greater Las Vegas area, NOT LVMFD.

now back to our regularly scheduled shitshow of bickering

Thanks for the correction.

Let's please agree on some basic ideas about what we are trying to accomplish when we discuss this accident (in no particular order):

1. Understanding of a very tragic accident so that we might learn from it. The injury and its unique consequences and emergency nature are one that climbers (or any First Responders) need to understand.

2. Understand that we are not blaming ANYONE for the manner in which events transpired. We have no legitimate cause for that and our assumption is that those on the scene did their very best in very difficult and likely actively changing circumstances.

3. Understand, IF mistakes were made, the difference between actual mistakes and negligence, which is far more serious and we certainly have NO EVIDENCE negligence was present. We ask that the routine review of this event by relevant authorities be made public if possible, to minimize any mistakes in the future by all parties.

4. Understand that the first-hand account that we have would have been an emotionally charged one (Will's Partner) with probable incomplete information as to the decisions and factors that influenced them that were being made. We should limit our responses based on this fact (and I am as guilty as anyone in this regard).

5. Understand that rapid evacuation is the IDEAL but, we have no information that it truly would have made a difference in the victim's tragic outcome. The nature of intracranial hemorrhage is a serious as it gets and once set in motion the victim is in extremely serious peril no matter what heroic efforts are made.

Eventually, ideally, a true analysis of the accident and response will come out. All that we ask is that the public be assured that best efforts were made, and ideal allocation of available resources will go forward to prevent, as much as possible, such tragedies from recurring. We can easily envision changing circumstances that caused unavoidable delays in the evacuation and a complete description of what took place would reassure the public.

The climbing community's role: Number one of which would be the routine use of helmets (ie and maybe a petition to insist that the climbing companies we patronize require their sponsored athletes to wear them or potentially lose sponsorship or their photo incentives) as that likely (but not certainly!) would have made more difference than anything else this tragic day.

Use a helmet: That is the clear take home message or you've got no one to blame but yourself (nor do I blame Will! I'm an old crusty that still doesn't use one much and neither do my partners! We just have to do our collective best to normalize their ubiquitous use just like we have for motorcycle riding).

@ Rick, 

You made a new account a few days ago just to comment on this thread.  

• You put your foot in your mouth giving advice to a neurosurgeon. 
• You evaded answering any real questions about what you would do.  
• You made sweeping assumptions about people's experience, training, traumas, and so on. 
• And you completely miss the point that this thread is explicity for speculation, discussion, and analysis of injuries and accidents. 

We get it.  You support SAR.  Why don't you start a SAR appreciation thread?  I'm serious.  That would be cool.  People could post stories and pictures, and we could celebrate their work.

Apart from that, you're not going to get any traction here unless you contribute something productive. 

From Wikipedia and intended as further educational information for First Responders or those who would like to seek such training. It lays out more clearly than my brief posts the reasoning behind the need for rapid evacuation to a higher level of care of any accident victim that has sustained a blow to the head. We do not definitively know the specifics of Will's injuries, but this information is valuable to this community regardless.

The "Lucid Interval" post blunt trauma to the head:

"In emergency medicine, a lucid interval is a temporary improvement in a patient's condition after a traumatic brain injury, after which the condition deteriorates. A lucid interval is especially indicative of an epidural hematoma. An estimated 20 to 50% of patients with epidural hematoma experience such a lucid interval.[1][2]

Description:

When related to hemorrhage, the lucid interval occurs after the patient is knocked out by the initial concussive force of the trauma and then temporarily recovers, before lapsing into unconsciousness again when bleeding causes the hematoma to expand past the extent for which the body can compensate.[3] After the injury, the patient is momentarily dazed or knocked out, and then becomes relatively lucid for a period of time which can last minutes or hours.[3] Thereafter there is rapid decline as the blood collects within the skull, causing a rise in intracranial pressure, which damages brain tissue. In addition, some patients may develop "pseudoaneurysms" after trauma which can eventually burst and bleed, a factor which might account for the delay in loss of consciousness.[4]

Because a patient may have a lucid interval, any significant head trauma is regarded as a medical emergency and receives emergency medical treatment even if the patient is conscious.

Delayed cerebral edema, a very serious and potentially fatal condition in which the brain swells dramatically, may follow a lucid interval that occurs after a minor head trauma.[5]

Lucid intervals may also occur in conditions other than traumatic brain injury, such as heat stroke[6] and the postictal phase after a seizure in epileptic patients.[7]:

Source: Wikipedia

Bruno Schullwrote:

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 

You would put an NPA in a patient with a head injury? That's a good way to kill someone

Bruno Schullwrote:

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? 

Great,  carry a trauma patient with a known head injury down a steep trail on your back with no spinal precautions.  Between this and your statement about an NPA I really doubt you were an EMT as you claim,  and if you were your instructors failed you badly

C Hwrote:

Thanks for your comments C H. 

I'll ignore the insults and focus on the content. 

You raise specific issues that we can discuss.  That's great. 

Regarding NPAs, I carry these basically for the very rare case that I might have to leave an unconcious patient to go get help (I carry three sizes which isn't the full range but you have to limit materials somehow). I've inserted NPAs in patients in a front country setting as an EMT, and I didn't really consider them for the backcountry until it was suggested to me by an emergency room PA who taught a WFR I took.  This was confirmed by my Airforce PJ friend who is often my reference for these things.  There was a short time when I re-considered, following a really great thread on this site about first aid kits, in which a trauma doc explained that the situations where an NPA could make a difference were so vanishingly small that they were not worth the weight and space.  In terms of using them in a patient with a known head injury, my understanding is that the contraindication involves the possibility of accidentally inserting the NPA through a fracture into the cranial cavity.  Is that what you were suggesting?  That's a valid concern, but it would have to be balanced against keeping an airway open, which of course is important.  So, there's merit to your claim, but it's definitely not as simple as you suggest.  

Regarding spinal stabilization, you probably didn't read my posts above, which is understandable.  To repeat, before moving a patient like Will, I would absolutely try to stabilize the spine in some way, probably with a modified Sam splint and padding.  Obviously this is not ideal, but I would definitely try if there were no better options.  

Sometimes in these cases I ask myself, what would I do if my daughter was the patient?  What if I was one of the first responders, and my daughter was lying there in Will's condition?  Would I want to wait for two hours?  (the time between the arrival of the first responders and helicpter).  Or would I want to get her down ASAP?  

If my daughter was loosing conciousness, I would carefully inspect her oral and nasal cavity, make a decision about the risk of some kind of internal fracture, and perhaps insert an airway.  Then I would make the best cervical support that I could with the materials I had, and I would carry her down. If there were nine or ten other people to help, this would definitely be possible, and to insit that it would not is obtuse.  

It's easy for SAR folks to mock this kind of "amatuer" response, but sometimes somebody needs to just step back and say, "OK, what mkes the most sense here?  Do we need ropes and litters and a high angle rescue, or should we just carry this patient down to the trail?"

Bruno Schullwrote:

Thanks for your comments C H. 

I'll ignore the insults and focus on the content. 

You raise specific issues that we can discuss.  That's great. 

Regarding NPAs, I carry these basically for the very rare case that I might have to leave an unconcious patient to go get help (I carry three sizes which isn't the full range but you have to limit materials somehow). I've inserted NPAs in patients in a front country setting as an EMT, and I didn't really consider them for the backcountry until it was suggested to me by an emergency room PA who taught a WFR I took.  This was confirmed by my Airforce PJ friend who is often my reference for these things.  There was a short time when I re-considered, following a really great thread on this site about first aid kits, in which a trauma doc explained that the situations where an NPA could make a difference were so vanishingly small that they were not worth the weight and space.  In terms of using them in a patient with a known head injury, my understanding is that the contraindication involves the possibility of accidentally inserting the NPA through a fracture into the cranial cavity.  Is that what you were suggesting?  That's a valid concern, but it would have to be balanced against keeping an airway open, which of course is important.  So, there's merit to your claim, but it's definitely not as simple as you suggest.  

Regarding spinal stabilization, you probably didn't read my posts above, which is understandable.  To repeat, before moving a patient like Will, I would absolutely try to stabilize the spine in some way, probably with a modified Sam splint and padding.  Obviously this is not ideal, but I would definitely try if there were no better options.  

Sometimes in these cases I ask myself, what would I do if my daughter was the patient?  What if I was one of the first responders, and my daughter was lying there in Will's condition?  Would I want to wait for two hours?  Or would I want to get her down ASAP?  

If my daughter was loosing conciousness, I would carefully inspect her oral and nasal cavity, make a decision, and perhaps insert an airway.  Then I would make the best cervical splin that I could with the materials I had, and I would carry her down. If I had nine or ten other people to help, this would definitely be possible, and to insit that it would not is obtuse.  

It's easy for SAR folks to mock this kind of "amatuer" response, but sometimes somebody needs to just step back and say, "OK, what mkes the most sense here?  Do we need ropes and litters and a high angle rescue, or should we just carry this patient down to the trail?"

Unless you've developed X-ray vision,  inserting an NPA into someone with known head trauma is contraindicated by protocol,  and I know of multiple instances where an EMT or paramedic has not taken it into account and has ended up killing the patient. 

Spinal stabilization is not just about C-spine. The entire spine needs to be considered.  Carrying someone on your back like you're some sort of superhero when spinal precautions are indicated could paralyze them,  and if the injury is high enough in the cervical spine could cause their breathing to shut down. 

Both would be considered negligence, even under Good Samaritan laws that protect volunteers,  because you are not acting as a prudent medical professional would in similar circumstances. 

And as someone who has taught at SAR conferences and has working relationships with SAR professionals,  your characterization of a bunch of SAR members hanging out chatting on their walkies unconcerned about a patient deteriorating is grotesque and imflamnatory and further shows what an unserious person you are. 

C H, I guess there are experienced people who disagree with you.  As I'm sure you know, there are different opinions about the best care in the emergency medicine field.    

Stepping back, you basically argue yourself into a position where there is no choice possible except the longest and slowest evacuation, whatever the consequences might be.  That doesn't seem sensible.  

I'll go back to two important questions: what would YOU have done if you had been Will's partner?   What would YOU have done if the patient was your son or daughter?  If you were in this situation, at the base of this wall, with the parking lot so close, if somebody told you it would take 4 hours to get your child to a hospital, would YOU think that was OK?  These are important questions to consider.  A similar situation could happen to any of us tomorrow.  

I think it's interesting to frame this in terms of one's own family because you are painfully confronted by the mental trap of saying to yourself, "Well, this patient might die or be permanently impaired, but there's nothing I can do about that because protocols are protocols." 

Regarding my comments about SAR, the simple fact is that they appear to have spent a long time on site.  Too long, I would say, but of course some people won't agree.  That's fine.  There are always different opinions.

Last, as somebody said a few pages ago, who would ever have thought that SAR people were such a sensitive and self-righteous group?  Do you really think you and your collegues are beyond reproach, or that external perspectives can not be helpful?  

As I said to Rick, if you want to start a SAR appreciation thread, go for it.  You could celebrate your work there, and it would be a really cool addition to MP. 

Didnt think this thread would turn into a dick measuring contest between SAR and other medical professionals.

think its easy to couch quarter back this situation. SAR did their best, even if they made the wrong choices in hind sight. SAR and first responderds are not perfect and yu can not expect perfection, despite wanting to deliver it at any incident as a responder.

One of the things about my rescue training and training I have done for SAR teams and high angle rescue teams is things shift in what is the best way to respond to head and spinal injury. This is coming from a rope access, entertainment rigging world where performers/people are sometimes on building 400ft tall, or in the backcountry on the side of Mt. Watkins.

many moons ago, I was taught, and used to teach, that you try to stabilze a neck/spinal or head injury on wall when the patient was suspended in their harness and they were not actively able to help, were unconcious, and / or there was no ledge or other place to propery do those kind of things. Things like put a c-collar on while suspended.

Now? Dont fuck around and get them to the ground and to definitive care ASAP.
In many rescue training it was painfully obvious trying to stabilize while manipulating a patient down a wall was absolutely not helping and likely could cause a lot more damage. Moving quick and getting the patient to ground was determined to be much more important than stabilizing a spinal injury in SITU on wall with a suspended patient. (I'm almost sure that some folks will disagree, or were trained differently)
So to Bruno's point, If i were there, I probably would consider huffing an individual outta there since many times, time to care would be more important to patient than waiting, which I think is the main sticking point here between the 2 camps it would seem.

Of course its all a huge grey area of what is the right choice in a fucked up situation and decisions have to be made. SAR made theirs that day, and in reflection it seems from the information we have, might have not been the best course of action.
Is it a tragedy? yes. Should SAR be shamed? No. Could it have turned out differently? Thats all conjecture now.
In the end its a shit moment that opens the door to improved responses if we take the time honestly to review the response without ego.

Thank you all of you who selflessly put yourselves out there as SAR members. You deserve all the respect, and I hope to never need the wonderful people that help so many folks in their most dire situations. You all rock.

Bruno, do you this with every event that you hear about?

When the police fail to solve a crime, do you go on the internet and post endlessly, manufacture stories about how the cops were probably just sitting in a donut shop, and describe how you would have singlehandedly solved the case and captured the criminal? And when an experienced detective describes the challenges in solving crimes, do you accuse them of being "beyond reproach" and then keep persistently asking questions while ignoring the informed responses you get?

When read an obituary about someone dying in the hospital, do you go  the internet and manufacture stories about the mistakes the surgeons made, and describe what you would have done that was so much more effective? And then when an actual surgeon - not the imaginary "neurosurgeon" you keep referring to here - explains how your claims are not correct, do you accuse them of being "sensitive" and "self-righteous"?

When an airplane crashes, do you ... ?

There are people on the internet that will tell you that they would have prevented 9/11 if they were on the plane. Because they would have just busted down the door and overpowered the hijackers and flown the plane to safety themselves. Anyone that tells them why that plan would have certainly never worked is just wrong. And when they make these claims there are even more people that will "like" their stories because they also want to believe they would have done the same thing.

Bruno, I'm sure, that you are sure, that if you were on Omaha beach on D-Day, you would be the guy that just charged up the hill and killed all the nazis, while all the other guys were cowering behind the hedgehogs.

Are you a know-it-all hero for every bad event you hear about, or do you just have some sort of hang up for this particular event and people, that you know nothing about?

Rick, that's a really unhinged post.  It's says alot about your state of mind.  Calm down.  

This is an injuries and accidents forum.  The whole point is to analyze events like this, not to blame and shame, but to understand and learn. 

Go back and read my summary of the many factors that might have contributed to this tragedy--that's the sort of thing this forum is for.  

The whole SAR thing blew up when people (not me) questioned the long response, and the SAR defenders jumped in to defend their own. 

I'm no hero.  On the contrary, I have a deep sense of my own inadequacy.  

But I've been involved in enough first responder situations to know that I would try to do something, and figuring out what that might be is important and instructive.

Rick Stevensonwrote:

Bruno, do you this with every event that you hear about?

When the police fail to solve a crime, do you go on the internet and post endlessly, manufacture stories about how the cops were probably just sitting in a donut shop, and describe how you would have singlehandedly solved the case and captured the criminal? And when an experienced detective describes the challenges in solving crimes, do you accuse them of being "beyond reproach" and then keep persistently asking questions while ignoring the informed responses you get?

When read an obituary about someone dying in the hospital, do you go  the internet and manufacture stories about the mistakes the surgeons made, and describe what you would have done that was so much more effective? And then when an actual surgeon - not the imaginary "neurosurgeon" you keep referring to here - explains how your claims are not correct, do you accuse them of being "sensitive" and "self-righteous"?

When an airplane crashes, do you ... ?

There are people on the internet that will tell you that they would have prevented 9/11 if they were on the plane. Because they would have just busted down the door and overpowered the hijackers and flown the plane to safety themselves. Anyone that tells them why that plan would have certainly never worked is just wrong. And when they make these claims there are even more people that will "like" their stories because they also want to believe they would have done the same thing.

Bruno, I'm sure, that you are sure, that if you were on Omaha beach on D-Day, you would be the guy that just charged up the hill and killed all the nazis, while all the other guys were cowering behind the hedgehogs.

Are you a know-it-all hero for every bad event you hear about, or do you just have some sort of hang up for this particular event and people, that you know nothing about?

Rick, techniques and protocols evolve through constant and sometimes critical evaluation. Perhaps Bruno’s questioning could have been more diplomatic but I don’t perceive it as an indictment of SAR. 

I will add, in my opinion, regs and protocol are valuable, but sometimes (as Mr Rogers alluded to) it is preferable to go off script and make the tough decisions regardless of SOP. 

Have a great day. 

This stuff is so comical to read. If one of the members on the SAR team had said: “Fuck this, it’s gonna take too long. I’m going to be a hero and make it happen.” Imagine if they then proceeded to drop the patient on his head while trying to carry him down unsecured. You guys would be on here asking WTF were they thinking.

There’s asking questions to understand, and then understanding the explanation you’ve been given by experienced personnel. That’s understandable.

What’s happening in this thread is not that. It’s wild speculation by people who are completely ignorant about rescue work and how it is conducted.

I’m not here defending the honor of SAR everywhere. I’m pointing out how stupid the speculation sounds to those of us who work to rescue people day in and day out.

You can call it whatever you please. At the end of the day, most of you talking about how you would do it different sound so out of touch with the reality of rescue work and EMS that you may as well be writing a Hollywood action script. 

Please just let it go and wait for the details. If you really care, reach out to the SAR team themselves and ask for their side. I bet it’s more enlightening then making shit up on MP. 

Nate, I respect your views, but you've framed this in a disingenuous way. 

It's not a matter of one member of the team saying, "Fuck it, I'm going to be a hero," it's a matter of the team, or the leader of the team, deciding that it's taking too long, the risk of waiting is greater than the risks of evacuating the patient in a different way, and everybody working together to get the patient down more quickly.  Of course, they're bound by protocols, regulations, and especially by the risk of liability, so I understand this was probably impossible.  

Also, there's not going to be some kind of official report with all the information everybody seems to think will be forthcoming.  Are the details and decisions of these cases every released?  Unlikely. 

So forget about SAR, and accept that we have the information we have.  

If you were at the base of the wall with your son or daughter in the same condition as Will, and the regular kit that you carry when climbing, what would YOU do?

If you say, "I'd call for SAR, keep their airway open, hold C-spine, treat for shock and exposure, and wait as long as necessary," I'd say you're not being honest. 

Bruno, I can appreciate many of the things that you've brought up here. But I think you're wrong about the following.

If every SAR member thought of every rescue (or potential rescue) as, "what would I do if it were my son or daughter", they wouldn't be able to function. Isn't a part of being able to function effectively in a situation that uncertain and stressful, is the ability to remove the emotion (to at least some degree) and deal with the situation? I can't think of anything more emotional for most folks than their kids. Projecting one's kids into these possible situations is counterproductive. Your persistence about this in this thread makes you come across as believing SAR personnel are not personally invested enough to effectively carry out a rescue. I wouldn't guess you truly believe this. . . or maybe you do. 

I've been the only responder to an accident where my partner was knocked out in a big fall, fairly remote location, middle of winter in CO. Reading Dr. Boondoggle's post about the "Lucid Interval", that almost exactly describes what happened with my partner during the situation. He ended up with a concussion, subdural hematoma, broken shoulder, broken hand. I knew he had potentially serious injuries at the time, but I had no idea at the time that he was potentially as close to death as was apparently the case. 

Stay safe out there everyone!

Bruno Schullwrote:

If you say, "I'd call for SAR, keep their airway open, hold C-spine, treat for shock and exposure, and wait as long as necessary," I'd say you're not being honest. 

That’s actually what I would most likely do, Bruno. 

I’m sorry that you find it so unbelievable. I know from experience that people don’t suddenly turn into superheroes capable of single-handedly carrying a trauma patient down wet talus. No matter how much you want to believe it’s possible, it’s generally not. The facts we do actually know about this case seem to state that an entire team was unable to carry a trauma patient down wet talus.

I respect you and have always had cordial exchanges with you. Even now. What I’m finding disingenuous though is your inability to understand that they most likely did not stand around in the parking lot chatting and wasting time. The response was probably the best they could muster given all the different variables in play. There probably wasn’t any lack of effort organization, or sense of urgency, but shit gets complicated fast. I’m sure they likely learned something. I just highly doubt that this was a giant case study of errors in organization and expediency the way you seem to believe it was. It happens all the time. Even in the alps.

Rescue work and EMS is complex. Even though and other posters keep insisting that it must not be.

And no one has really even mentioned the fact that he survived (if I recall correctly) 10 days in the hospital which does have some decent implication that transport time wasn’t a factor…its an indicator that the trauma to his brain was too deep and too severe to be survivable. 

NateCwrote:

And no one has really even mentioned the fact that he survived (if I recall correctly) 10 days in the hospital which does have some decent implication that transport time wasn’t a factor…its an indicator that the trauma to his brain was too deep and too severe to be survivable. 

https://pmc.ncbi.nlm.nih.gov/articles/PMC4533344/ 

Theoretically, time from injury to surgery may be an important factor to rescue brain from secondary ischemia due to compression and/or intracranial hypertension by ASDH. In general, prompt evacuation of ASDH has been recommended in patients with indications for surgery.50,51) This recommendation may be supported by the following studies. Seelig et al. demonstrated a 30% mortality in patients with ASDH operated within 4 hours after injury and a 90% mortality in those more than 4 hours after injury. It has also been demonstrated that the duration from injury to surgery was significantly shorter in patients with a functional recovery than with a fatal outcome, suggesting the importance of prompt evacuation of subdural hematoma.5,53) It has also been reported that there were trends indicating that earlier surgery improved outcome, although the time from injury to operative evacuation of ASDH with regard to outcome morbidity

So, yeah, faster is better.

The published timeline said Will was transported to hospital at 4h mark. At that point he had to be evaluated, CAT-scanned, evaluated by neurologist/radiologist. He had to get prepped for surgery.

I am quite sure  Doctor Boondoggle can provide best case estimate of long it takes for a patient with suspected subdural hematoma to go from the door to OR.

If you don't trust Boondoggle MD, you are welcome to deep dive here - https://pmc.ncbi.nlm.nih.gov/articles/PMC11599324/