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Original Post
David Vogel · · Lake Forest, CA · Joined Apr 2015 · Points: 1,290

Ouch, that hurt! 

Edit edit edit...ya ya ya...

I wrote about this in excruciating 8/10 pain, on many heavy medications, "thumbing" on my phone (to distract from pain) and convinced climbing was over forever. Accurate in reporting yet with an altered attitude. Initially I was not my nice and normal self due to the combination of trauma, pain, and opiates. I don't want to add confusion or misrepresent anything climbing related. My accident has become very personal to me. IMHO these threads can get rather mixed up on both ends, although a lot of good can come out of them at times. Thanks to everyone for the support, it truly helped me in my recovery. I really mean that when I say that. Sections of this thread also helped me through my own process. On the plus side, last time I checked in with my Doctor, he said "Are you climbing?" (I smiled in response). Then he said "Well you're doing MUCH better than I thought!" Needless to say I'm stoked to be climbing again! - David

DannyJ · · San Diego, CA · Joined Sep 2015 · Points: 70

Thanks for sharing, David. Very interesting synopsis. It sounds like no one really took charge of the situation in a competent and complete manner. Wish you the best of luck in your recovery.

amockalypsenow · · San Diego · Joined Nov 2014 · Points: 715

Thanks for sharing. I appreciate the story, as a climber and current EMT. Nobody needs to play monday morning qb about any of the actions that happened. Good news is you are alive and did not suffer brain damage. I have also been injured... life will go on, and in the meantime, you can slow down and study or code or write or do many other immobile things with a big increase in focus, patience, and maybe a new perspective. Good luck with your recovery.

Kent Richards · · Unknown Hometown · Joined Jan 2009 · Points: 83

Bump for encouraging other climbers to get at least WFA (Wilderness First Aid), and to practice those skills now and then.

Glad your injuries weren't worse.

Beau Griffith · · Fresno, CA · Joined Sep 2016 · Points: 20

Very captivating story. So sorry for your injury but very glad that you are going to be alright. I am not qualified to give sound medical/financial or legal advice but I encourage you to seek someone out to help with that depending on your insurance situation as I understand that the right strategy can save you a considerable amount of money.

But at the end of the day you kept your foot and, most importantly, your mind. Good luck and feel better soon.

Backstep · · Redlands · Joined Aug 2016 · Points: 5

David,

Thanks for sharing your accident. I truly hope you feel better and heal well.

About a month ago I fractured my calcaneus in Joshua Tree, and while my story isn't nearly as exciting as yours, it does give me somewhat of an idea of what you're going through. I'm reminded again that accidents from climbing come when least expected, and from complacency; yours from a seemingly routine downclimb, mine from missing a crash pad, etc... It's a humbling thought.

It's going to seem like an eternity, getting back on your feet. I've been off my right for over a month and I'm going a little crazy, but the end is in sight, just as it will be for you. When the time comes, I recommend highly getting a knee scooter over crutches, they are so, so much better! Also, people have been injured worse and come back to climbing. Look up Ammon McNeely's story if you haven't heard it. He nearly lost his foot in an BASE accident, and recovered, and is climbing again.

Good luck, and I know it's cliche but try to keep positive attitude through it all!

Matt

Dan Evans · · Phoenix, AZ · Joined Mar 2013 · Points: 85

So don't take this as criticism, I am simply posting it here for future reference and anyone elses' know-how in case they ever find themselves in a similar situation. From my experiences and the training I have received, it is generally not advised to apply a tourniquet to anything either below OR on the knee/ankle or elbow/wrist for active bleeding on the arms or legs due to the position of the arteries and the tibia/fibula and radius/ulna preventing the TQ/apparatus from effectively applying enough pressure to stop the bleeding.

I am assuming you are an EMT (or other type of EMS responder) based off the verbiage used in your OP so as you may know, a lot of today's EMS treatment protocols have been based around feedback from medical personnel (and combat medics) in Iraq/Afghanistan.

Quick background on me, I was active duty in the Marine Corps infantry for 8 years with 2 deployments to Afghanistan (completed live tissue trauma training on pigs and am currently an EMT/pre-nursing student) and we were always instructed to apply tourniquets as high up on the affected limb as possible (ie. proximal brachial/femoral region). Although I have not personally seen the studies to back this up (mostly because I've never looked into it), we were told it was because limbs without adequate perfusion can be salvaged for up to 4-6 hours even after a TQ has been applied. Also when arteries are severed or cut they naturally retract and constrict as a natural clotting mechanism. So if the entry wound is on your lower leg, the actual artery itself may very well be higher than where the blood is appearing to originate from.

I've been on patrols with guys who were missing one or both of their legs, and on one occasion we weren't able to land a MEDEVAC helicopter for over an hour. For that specific case, the doctors were able to salvage the parts of his legs that were below the TQ. I think he finally ended up getting to a trauma center 2 - 2.5 hours after he was injured.

So I guess my point is that I do not believe you should worry about using a TQ in a situation where evacuation is likely within the next hour. Figured I would share my experience, as no offense but most stateside EMT's do not deal with amputated limbs or gun-shot wounds very often (if ever) and it is easy for anyone to learn/apply.

Anyway, you did what you had to do and it worked in this case so for that good job. Sorry to hear about your injury and wish you a speedy recovery. Everyone has their moments, thanks for taking the time to share.

Rando Calrissian · · Unknown Hometown · Joined Apr 2016 · Points: 5

Wow! That is surely a trip to remember. I wish you a speedy and complete recovery!!!!! Thank you for posting this, as someone with a severe medical condition I like to read accident reports so I can learn and stay safe. All the best

20 kN · · Unknown Hometown · Joined Feb 2009 · Points: 1,348
Daniel Evans wrote: and we were always instructed to apply tourniquets as high up on the affected limb as possible (ie. proximal brachial/femoral region). Although I have not personally seen the studies to back this up (mostly because I've never looked into it), we were told it was because limbs without adequate perfusion can be salvaged for up to 4-6 hours even after a TQ has been applied. Also when arteries are severed or cut they naturally retract and constrict as a natural clotting mechanism.
I was trained as most others are--apply the TQ low. I dont really understand what the advantage of applying it high? An artery may or may not retract a bit when damaged, but they will not clot themselves. As I am sure you know, an untreated, completely severed artery can result in death quickly if not rectified. It wont fix itself.

I actually got hung up on a medical board on a related question. The question was "Your platoon took fire, one of the operators is down with a severed femoral artery. Pinching, TQ and direct pressure does not stop the bleeding. What do you do?" I got hung up on that question for some time and after speaking to the medics I learned the correct answer is QuikClot hemostatic combat gauze. After the entire "Black Hawk Down" incident with the operator who was killed as a result of a cut femoral artery, it seems that a lot of the instruction that's come fourth after that incident has been to use hemostatic gauze when possible, before a TQ, as the gauze can rectify critical injuries that TQs cannot, and it wont result in the loss of any limbs.

OP: Sorry to hear about your incident. I had a similar thing happen awhile back so I know it sucks a bit. You'll heal up and be back climbing in no time though I am sure. Rest up.
Dan Evans · · Phoenix, AZ · Joined Mar 2013 · Points: 85

@20kN/Ranivorous Troglodyte:

When I initially joined in 2007, we were trained to apply the TQ 2" above the wound if it was above the joint or 2" above the joint even if the wound was below the joint. Then in 2009/2010 for reasons mentioned above pertaining to limb salvage times, they changed the Combat Life Saver/TCCC curriculum to encourage application of TQ's as high as possible. I'm guessing this was likely due to the fact that it is just easier to apply them to the same spot every time under extreme pressure. (EDIT: I also think this change was made to ensure that first responders were able to "capture" the artery if it had retracted. And 20kN, I realize that the arteries retracting/constricting on their own is not enough to actually stop the bleed--I was just trying to say that they do this as a physiological response in an attempt to stop the bleeding and may potentially affect TQ placement.)

Granted military EMS protocols are going to slightly differ due to the fact that you have people actively trying to kill you during the treatment process, whereas stateside at the crag you have ample time to apply a hemostatic agent before applying a TQ. For us, to treat active bleeds on extremities we simply applied 1-2 TQ's as required and covered it with a pressure dressing when able. When I went through live tissue training we had to stop a femoral bleed in a pig using quikclot powder (similar to the Black Hawk Down scenario) and the process was fairly time consuming: soak blood, quickly apply hemostatic agent, hold pressure for 5 min., check to see if it worked, if not, soak blood & repeat process--this was time we simply didn't have in country. So this course of action was only recommended if the artery was severed in the groin region where a TQ would be ineffective or as a last resort for a carotid bleed (one of those "it's not recommended, but do it as a very last resort if they're going to die").

Another difference being that we were trained to treat patients off of the acronym MARCH (Massive hemorrhage, Airway, Respiratory, Circulation, Head Trauama/Hypothermia) whereas EMT's are taught Airway-Breathing-Circulation. This was simply due to the fact that we were more prone to massive-hemorrhages in our line of work than airway/respiratory compromise for obvious reasons and given that an arterial bleed can kill you in 90 seconds, they decided to ingrain that into our heads.

I think for climbers and everyday civilians who are not formally trained in EMS, it would be much easier and realistic for them to make an improvised TQ than carry around and learn how to use hemostatic gauze (ie. quikclot, etc.) while climbing. I know I don't carry first aid supplies when I climb, it stays in my pack at the base or in my truck depending where I am.

And thanks Ranivorous Troglodyte, I appreciate it. I'll take a look on medpub and see if I can find anything related to the findings that guided the changes I mentioned above.

Dan Evans · · Phoenix, AZ · Joined Mar 2013 · Points: 85

Also I sort of question the decision by the ambulance crew to turn around after you refused treatment. I think they would have been well within their right to say your mental status was altered from loss of blood and take you anyway. But then I again I wasn't there, and maybe you played it off better than you actually felt.

Jimmy Downhillinthesnow · · Bozeman, Montana · Joined Mar 2013 · Points: 10

I participated in a rescue at Hidden Valley a few years ago and was very impressed with everyone who helped, both in terms of training and compassion for the guy who was hurt--which was good because his injuries turned out to be life-threatening. I'm sorry your experience wasn't optimal.

As far as tourniquets go, I'm a medical student going into emergency medicine. I don't know specifics, but from what I do know the concerns over tissue damage from a tourniquet are not as severe as people thought 20 years ago (like Daniel Evans said, those of us in civilian medicine owe a huge debt to what was learned in Iraq and Afghanistan). If in doubt, put one on.

Hope you heal up quickly.

Crackist · · Palm Desert, CA · Joined Feb 2016 · Points: 5

I was in a damn hurry. Also, she expressed a fervent interest in learning as much about trad as possible. I love the positive energy in getting new people into trad.

I discussed with my partner the importance of finding your own way off, so I let her try and figure out the walk-off. We go down an easy tall and wide crack system which at first seemed like a possible way to get down, but then it turned into a 20 foot drop to a ledge. Since we were there are no other climbers were below us, I used it as an opportunity to show her how to build a gear anchor. I made a bomber anchor and lowered her to the ledge. What I should have done is cleaned the anchor and walked off the other side of the formation, but that would have taken another 20-25 minutes but I was obsessed on more climbs, so I decided to down-climb unprotected. I like easy solo's and 4th class scrambling a lot. I was kind of treating the situation like training for future climbs when you get stuck and have to solve your way out of a problem.

The book calls this section a 5.6. What was annoying was my rack, it was obstructing my climb much more than it would if I was climbing up.

You were in a "damn hurry" but didn't mind losing time by letting a beginner lead the way down? Doesn't seem like you were really as obsessed with hurrying as you're making it out to be, but sure, insist that was the culprit, as opposed to having made very poor judgements and not knowing what you were doing. You couldn't deal with a rack while downclimbing? seriously? and ultimately did blame the gear before saying ultimately it was you? Sounds like you're quite inexperienced yourself in descent downclimbs, and other aspects.

As you describe yourself only as a 5.8 leader in profile, don't you still have plenty to learn yourself, before playing instructor to others? Too many of those nowadays, due to ego or cluelessness or sociopathic disregard for others or whatever else, who end up passing on bad habits and erroneous thinking along with their "instruction."

Maybe reassess and recalibrate, or not. Do heal up.

Dan Evans · · Phoenix, AZ · Joined Mar 2013 · Points: 85
Crackist wrote:You were in a "damn hurry" but didn't mind losing time by letting a beginner lead the way down? Doesn't seem like you were really as obsessed with hurrying as you're making it out to be, but sure, insist that was the culprit, as opposed to having made very poor judgements and not knowing what you were doing. You couldn't deal with a rack while downclimbing? seriously? and ultimately did blame the gear before saying ultimately it was you? Sounds like you're quite inexperienced yourself in descent downclimbs, and other aspects. As you describe yourself only as a 5.8 leader in profile, don't you still have plenty to learn yourself, before playing instructor to others? Too many of those nowadays, due to ego or cluelessness or sociopathic disregard for others or whatever else, who end up passing on bad habits and erroneous thinking along with their "instruction." Maybe reassess and recalibrate, or not. Do heal up.
There is a huge difference between being a strong climber (i.e. climbing 5.8 vs 5.12) and having experience. I am a 5.8/5.9 trad leader and I've been trad climbing for 5 years and am by no means a gumby. Anyone regardless of climbing ability can learn rescue systems, "rock sense" problem-solving, route finding, etc. And I am fairly certain the OP lowered his partner off the down climb in question (unless I read it wrong). My point is do not judge someone solely based off their grades listed in their profile as they are frankly irrelevant to experience.
Crackist · · Palm Desert, CA · Joined Feb 2016 · Points: 5

Irrelevant? Hahaha. Then climbing schools should hire more 5.8 leaders as guides.

Dan Evans · · Phoenix, AZ · Joined Mar 2013 · Points: 85
Crackist wrote:Irrelevant? Hahaha. Then climbing schools should hire more 5.8 leaders as guides.
Guiding companies hire guides for guiding clients on routes AND teaching essential systems/skills. I am not a guide, therefore I will at no point be required to guide a client on a 5.10/5.11 trad route above the limit I am comfortable leading. Conversely, I am fully capable of teaching self-rescue to a friend as I have become proficient in the skills over years of training and practice. I have been on plenty of climbs in the 5.6 - 5.9 range where a fall would've resulted in my death. Way to sound like a egotistical twat though.
Crackist · · Palm Desert, CA · Joined Feb 2016 · Points: 5
This post violated Rule #1. It has been removed by Mountain Project.
Dan Evans · · Phoenix, AZ · Joined Mar 2013 · Points: 85
Crackist wrote:Hard climbing isn't the sole determining factor, but it's not unimportant, twat. Many hard climbers are lousy at teaching, and therefore wouldn't make good instructors. But 5.8 is such a very, very novice level. There's more for that person to learn than to have to teach others. Besides, he is indeed out there instructing on trad climbing, not self-rescues and the rest that you're bring up David, after you recovered fully, when you continue to and do improve and eventually climb, say, 5.11's and acquire additional awareness and skills along the way, you are going to look back at your 5.8 leading days and see poor methods and holes in your understanding that you hadn't known before. One of those versions of you makes a better (and more responsible) instructor.
I never said it wasn't important, but your post was extremely condescending and basically implied that because he was a self-proclaimed 5.8 leader, that he was somehow out of his element. Poor decision? Maybe, but don't we all make one at one point or another?

And I'm sorry but 5.8 trad, especially in J-tree, Tahquitz, Yosemite, and other old school areas are far from a "very novice level." Hence why I've been stuck at the grade for 4 years now and I follow 10b/c trad/11- sport (mostly due to the fact that I do have time to dedicate 4-5 days a week to climbing outdoors like most other mortals able to achieve said grades). There are a lot of factors that play into leading trad because the likelihood of dying increase exponentially, most of which have nothing to do with the skills required to get yourself off of the summit of a route.

And so what? The guy who taught me to trad climb was a 5.8 trad leader? Again I'm confused as to what is different between a 5.8 climber teaching someone how to put a cam in a crack, sling crafting, preventing zipper effect, gear anchors, etc. versus a 5.12 climber teaching the same skill sets?
Dan Evans · · Phoenix, AZ · Joined Mar 2013 · Points: 85

Obviously if I'm a 5.8 leader and I decide to take a novice on a 5.8 route at my supposed limit that is a very poor choice where my ability to climb a certain grade will directly affect the outcome of the day. I realize that grades are important in this regard and not the point I was trying to make.

FrankPS · · Atascadero, CA · Joined Nov 2009 · Points: 275
Crackist wrote:Hard climbing isn't the sole determining factor, but it's not unimportant, twat. Many hard climbers are lousy at teaching, and therefore wouldn't make good instructors. But 5.8 is such a very, very novice level. There's more for that person to learn than to have to teach others. Besides, he is indeed out there instructing on trad climbing, not self-rescues and the rest that you're bring up David, after you recovered fully, when you continue to and do improve and eventually climb, say, 5.11's and acquire additional awareness and skills along the way, you are going to look back at your 5.8 leading days and see poor methods and holes in your understanding that you hadn't known before. One of those versions of you makes a better (and more responsible) instructor.
Your criticisms are unhelpful and uncalled for.

5.11 leaders fall, too.
Bill Lawry · · New Mexico · Joined Apr 2006 · Points: 1,523
FrankPS wrote:5.11 leaders fall, too.
Hah - wish I had Frank's wit.
Guideline #1: Don't be a jerk.

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