monitoring each other's pulse


Original Post
jktinst · · Unknown Hometown · Joined Apr 2012 · Points: 0

The "first aid/rescue links page" discussion going on currently has made me think again about the situation of the leader dangling unconscious after a fall since that is one of the more difficult scenarios to deal with and one that has all sorts of contradictory information floating around. This made me wonder if there exists a light, portable system that could let each climber reliably know whether his partner lying or dangling unconscious at the other end of the rope has a pulse. It would seem that knowing this would be critical in determining what to do next. I'm really not up to date on smart technology but it seems that a Fitbit watch would only sync to the partner's cell if he's close by or there is internet available. I also don't know if something that can monitor the rate of a healthy heart could also make the distinction between a weak pulse and a non-existent one.

Latro · · Unknown Hometown · Joined Mar 2012 · Points: 0

I don't know what I would do with that information. If I believe my partner has no heartbeat, I have to get him on a flat surface with me (or another rescuer) in 2 minutes. Would I cut a rope to drop him if needed? Down solo or up solo?
And if it is due to traumatic injury, is there a point? Besides lightning induced cardiac arrest, what else might cause this and be reversible under these conditions?
And any accident that could cause loss of heartbeat could also easily damage or dislodge the sensor or it's communication string. So I wouldn't feel comfortable 'slow-rolling' a body recovery. But (to me) that seems the most likely effect of such knowledge. If so, then the system should highly reliable. I suggest testing it on a crash test dummy by inserting it in a stone washer for jeans.

highaltitudeflatulentexpulsion · · Colorado · Joined Oct 2012 · Points: 0

I don't know what you'd do with this knowledge. If someone is hanging unconscious on a rope, they've only got a few minutes to live. So would confirming a heartbeat slow down your reaction? It shouldn't. Would an absent heartbeat confirm he's dead so you can take your time on the recovery? Sounds equally awful. Monitoring shouldn't change your reaction.

Bill Lawry · · New Mexico · Joined Apr 2006 · Points: 1,407

Think of it as the ultimate kind of voyeurism. When your partner is out of sight and making progress, you can couple a) how slowly the rope is moving with b) his / her heart rate.

Think of how you will feel when the heart rate is at a casual 100 BPM and quickly builds to a race-y 160 and the rope stops moving. You're liable to sh** your pants too!

Bill Lawry · · New Mexico · Joined Apr 2006 · Points: 1,407

Seriously, I'm not sure I would trust a lack of heart beat to mean anymore than maybe the darn thing has malfunctioned.

.... still, I'm inspired about the other aspects. The heart beat could be recorded for background to the video of that sick lead. Or maybe some ludicrously highball boulder-y crux!

Ben Brownell · · Unknown Hometown · Joined Feb 2016 · Points: 0

Assessing a pulse is important but not your first priority. Your top priority will be to make sure your partner has a viable airway, next make sure they are breathing and then check for circulation. I think your best investment is in backcountry medicine. If you partner doesn't have a pulse in a situation like this they are dead. If your partner has a pulse but doesn't have an open airway you have a chance of fixing that if you can reach them in time. Just my .02 cents

jktinst · · Unknown Hometown · Joined Apr 2012 · Points: 0

What I was taught is that, especially in an unconscious person, pulse and airway go (almost) hand-in-hand. If they don't have an airway, their pulse is unlikely to keep going much longer (and of course, if there's no pulse, there's no breathing either). Pulse just struck me as the more likely vital that could be monitored from a distance.

To answer other comments: no, this is not about battlefield triage but yes, the knowledge would indeed affect my course of action. In fact, the more I think about it, the more it seems that having a way to monitor each other's pulse would be quite useful. There can't be too many pursuits besides climbing where your life is as much in the hands of a single partner and yet you are fairly far (timewise) out of reach of each other a lot of the time and in an environment that makes most basic first aid a serious challenge.

If my second collapsed while belaying me (hoping that he was using an "autoblocking" belay device), I would start by hollering for help. If only one helper arrived quickly and my monitoring system registered no pulse I would get the helper to tie me off and then go straight to confirming the absence of pulse and initiate CPR on my belayer if he could. If there was a pulse, I'd have the helper confirm airway then (assuming there is airway) get him to belay me down so there would be two of us to finish assessing the victim, provide first aid, place him in a semi-comfortable recovery position, etc. If no one came after the fist calls, knowing that there is no pulse would probably get me to keep hollering/phoning for help a lot more than if there was a pulse (as I kept going about getting myself down as fast as I could).

If my leader is dangling unconscious, the fact that he has no pulse would indeed mean that I would have to bring him, as fast as possible and regardless of other considerations, down to a flat(ish) surface where I could confirm lack of pulse and initiate CPR immediately after a very quick asessment for other possible major traumas (mainly major hemorrhage), airway blocage, etc. The EDK munter pass-through method that I've described in the past or the munter pop method would allow me to quickly pass a knot between the climbing rope and a length of cord added to the free end of the rope (and normally kept with the belayer). Therefore, even if the fall-catching pro is well-above half-rope height, I would be able to bring him down to the ground or belay ledge if that's the first/best surface available. The steps would be: switch from ATC to munter, lock-it off, counterbalance climb till I reached the victim, and counterbalance rappel with the victim the rest of the way, passing the knot along the way when required.

If he had a pulse, his being unconscious after a fall would automatically mean head trauma. Head trauma severe enough to result in persistent loss of consciousness (particularly if it happened despite wearing a helmet) means a strong possibility of C-spine trauma as well, which can be made a lot worse by lowering the victim unaccompanied if he's going to bump into things on the way down. The risk of the top fall-catching pro popping during counterbalanced climbing/lowering+rappelling will also look quite different (at least to me) depending on whether or not there is a pulse (unless that top pro is a bolt, of course). Finally, at this point, there is no way of knowing if my leader is one of those people who are extremely susceptible to suspension trauma and may die from it within 5-10 minutes but, based on the data I've seen, those are a minority.

Over the past few years, I've been devising and testing a procedure that can let me bring an unconscious leader down with me quite quickly after climbing/ascending to him. This also requires attaching the spare cord at the end of the climbing rope. Therefore the procedure could be aborted at any point, letting me immediately switch to the fast counterbalanced climbing/lowering+rappelling described above if I should find, as I am ascending towards my partner, that his pulse has just stopped.

Tim Benson · · Longmont,CO · Joined Apr 2010 · Points: 0

This strikes me as similar to the avy beacon offered by Mammut that indicates if the buried victim has pulse; perhaps useful in a multiple burial triage situation. However, the beacon only reports either a pulse, or "unknown". It doesn't presume to pronounce a victim pulseless.

Note: this information may have changed over the past few years but it's what I recall while I was researching several beacons.

Ben Brownell · · Unknown Hometown · Joined Feb 2016 · Points: 0

True I think the pulse would be the easiest vital to monitor from a distance. I just don't think knowing it before you get to the victim will change your reaction unless the pulse isn't there. Then you know realistically that is a recovery and not a rescue situation but I don't think I would trust it personally. There is also the chance for the signal to be shielded going through some funky terrain like roofs or wandering routes. That may block the signal and give you a false reading.

In response to your first comment if you wanted to know the quality of the pulse I think you would need something that can give you a basic heart rhythm so something with leads in a few locations like an EKG.

I do think this could be helpful in getting an idea of when your partner is about to fall so you can prepare for the catch!

Just to satisfy my curiosity do you have a medical background/training?

jktinst · · Unknown Hometown · Joined Apr 2012 · Points: 0
Ben Brownell wrote:...Just to satisfy my curiosity do you have a medical background/training?
Just basic first aid certification plus whatever climbing-related first aid I've been able to pick up through reading (and thinking) about it.

Ben Brownell wrote:...I just don't think knowing it before you get to the victim will change your reaction unless the pulse isn't there. Then you know realistically that is a recovery and not a rescue situation...
Seriously?
will ar · · San Antonio, TX · Joined Jan 2010 · Points: 215

The issue that I see is you can't visually check that the sensor is in place. I'm a little skeptical that this theoretical sensor would be able to reliably stay in place as your thrutching up off widths and chimneys or taking trauma inducing falls. If you get a positive signal that confirms your partner has a pulse, but the absence of a signal doesn't mean that your partner doesn't have a pulse, just that the sensor isn't detecting one.

jktinst wrote: If my second collapsed while belaying me (hoping that he was using an "autoblocking" belay device), I would start by hollering for help. If only one helper arrived quickly and my monitoring system registered no pulse I would get the helper to tie me off and then go straight to confirming the absence of pulse and initiate CPR on my belayer if he could. If there was a pulse, I'd have the helper confirm airway then (assuming there is airway) get him to belay me down so there would be two of us to finish assessing the victim, provide first aid, place him in a semi-comfortable recovery position, etc.
First person to your belayer checks ABCs (or CAB) and acts accordingly. Knowing that the belayer has a pulse present is going to save maybe a few seconds.

I guess I don't see a huge benefit to knowing right away if my partner has a pulse or possibly does not have a pulse in a situation where we're looking at probably an hour if we're lucky before someone shows up on scene with meds and an AED and often several hours before definitive medical care.

EDIT: This may be one of the worst case scenarios, but it's definitely not the most likely. You will probably get more bang for your buck focusing on being able to use what's in your self rescue and first aid kits, working through simpler, but more common self rescue scenarios, basic trauma interventions (hemorrhage control, sticks and rags, etc), and decisions you might face like staying with your partner vs going for help.
jktinst · · Unknown Hometown · Joined Apr 2012 · Points: 0
Ben Brownell wrote:... There is also the chance for the signal to be shielded going through some funky terrain like roofs or wandering routes. That may block the signal and give you a false reading...
will ar wrote:The issue that I see is you can't visually check that the sensor is in place. I'm a little skeptical that this theoretical sensor would be able to reliably stay in place as your thrutching up off widths and chimneys or taking trauma inducing falls. If you get a positive signal that confirms your partner has a pulse, but the absence of a signal doesn't mean that your partner doesn't have a pulse, just that the sensor isn't detecting one...
These comments made me realise that I must have removed (or pasted over) by mistake a point in my longer reply that indicated that if the system could reliably distinguish between strong, weak and no pulse, you'd expect that it could also distinguish between no signal (from breakage, malfunction or terrain) and no pulse.

Tim Benson wrote:This strikes me as similar to the avy beacon offered by Mammut that indicates if the buried victim has pulse; perhaps useful in a multiple burial triage situation. However, the beacon only reports either a pulse, or "unknown". It doesn't presume to pronounce a victim pulseless...
Good point about the liability issues of stating "no pulse", which would obviously lead some people to conclude "no rush and, therefore, no reason to take risks in a rescue because he's already dead".

I really don't know what form this system would take. Others are assuming you'd need to wear multiple EKG pads (and wires) that might not stay on while climbing but I had no such assumption to begin with. What did that Mammut beacon use as a sensor system for the pulse? I'm thinking that a neck monitor/collar would probably be the least intrusive and least likely to get ripped out.

EDITED TO ADD: was the heart monitor reading detectable through the whole range of beacon detection capability or was it something that would kick in only after you've narrowed the position of the victim down to a fairly small radius?
will ar · · San Antonio, TX · Joined Jan 2010 · Points: 215
jktinst wrote: These comments made me realise that I must have removed (or typed over) by mistake a point in my longer reply that indicated that if the system could reliably distinguish between strong, weak and no pulse, you'd expect that it could also distinguish between no signal (from breakage, malfunction or terrain) and no pulse. .
I've never seen a device that can distinguish between a "strong" and a "weak" pulse (strong/weak dosen't refer to heart rate), but that doesn't mean one doesn't exist. The best way to tell if someone has a strong vs weak pulse is with your fingers. Take an ACLS course (actually don't, I see no benefit to you as a climber in a self rescue scenario) or get some experience with medical devices and you may see the gap between reality and what you're hoping for.
Patrick Vernon · · Estes Park, CO · Joined Jan 2001 · Points: 910

An ekg doesn't tell you if someone has a pulse. Also, without the ability to lay hands on a patient, medical devices can be extremely unreliable.

Em Cos · · Boulder, CO · Joined Apr 2010 · Points: 0

It's an interesting idea, but there are a lot of practical problems with this idea, both in implementation and usefulness.

The fitbit you mentioned and other wrist-sensor based HRM are not terribly accurate, even for the exercise/training purposes for which they were designed. Even the best HRM with chest sensors are far from foolproof and simply not designed to assess a pulse in the way we need to when medically assessing a patient.

If your partner were to become unresponsive where you couldn't immediately reach them, how would this device help you? If it registers no pulse, does that mean the signal is not coming through, the device has been damaged, the sensor has slipped out of place, or the patient has a pulse that is not being picked up by the sensor? You can't assume they are a lost cause just because this device doesn't tell you they have a pulse, so the actions you take will be exactly the same as if you had no device at all.

If this device registers a pulse, that tells you that in that moment they are alive, but it certainly does not tell you that they are stable, do not have life threatening injuries, and may not lose that pulse at any moment. You still have to get to your partner as quickly and safely as possible, so the actions you take will be exactly the same as if you had no device at all.

There is so much more to assessing a patient than simply their pulse, and so much more to assessing a pulse than simply present/not present. Honestly, if a potential climbing partner asked me to wear some sort of heart monitor so that in case I become incapacitated they can decide whether they should try to help me quickly or not, I'd find someone else to climb with.

Matt Stroebel · · Lakewood, OH · Joined Apr 2011 · Points: 40

Under ideal conditions Bluetooth will only transmit 33 ft. So its unlikely that you'd be able to get the data anyways. If you used phones as an intermediary transmission device the system would only work in places with good signal, which rules out a huge swath of climbing areas. Combine this with the fact that a fall that would render the climber/belayer unconscious would have a high likelihood of damaging or dislodging the device. On top of that, you already mentioned that a fitbit probably wasn't designed to measure a weak or non-existant heartbeat.

It's not a bad idea, but without purpose building a system designed to operate in a climbing environment it's unlikely that you could rely on the data to be accurate even 50% of the time an accident occurred.

Padraig · · Unknown Hometown · Joined Jun 2010 · Points: 100
jktinst wrote:What I was taught is that, especially in an unconscious person, pulse and airway go (almost) hand-in-hand. If they don't have an airway, their pulse is unlikely to keep going much longer (and of course, if there's no pulse, there's no breathing either). Pulse just struck me as the more likely vital that could be monitored from a distance.
If you truly want some monitoring and believe that airway and pulse go hand in hand (at least enough so for emergency evaluation purposes), why not focus on airway instead and keep an open line with two way radios to monitor the breath sounds of your partner. It shares the potential drawbacks already mentioned of sensors (microphone) becoming dislodged to the point of not picking up the intended thing to monitor during a jarring fall, but provides the added benefit of actual communication in non-emergency times.

I still wouldn't climb with a partner that insisted on it though.
Brandon.Phillips · · Alabama · Joined May 2011 · Points: 0

I think the bottom line is that you will never have enough information to adequately assess a patient from a distance. Wilderness medicine has two underlying concepts: 1. Follow your order of operations and 2. Do the best you can with what you have available.

Assessing ABC's will always be more important than C-spine precautions, unless you have the resources to do both at the same time.

I also can't think of a device short of an EKG that could monitor this (and then you would have to be able to read an EKG). You lose a radial pulse when your systolic bp drops below 90. This means a person is in shock, though if monitoring only a radial pulse (like a fitbit does) they would appear pulseless. Also, if you are relying on a man-made implement to measure this, you could never rule out that it wasn't damaged/ destroyed in the fall.

If you follow any of the these lines of questioning to the logical conclusions, they all come to this: You have to get to your partner and do a full primary assessment before you can rule out any life threats.

Kevin Deininger · · Arvada, CO · Joined Dec 2016 · Points: 0

I think knowing the other person's pulse would only be helpful in very rare situations when rescuing. I don't foresee a lot of situations where one's reaction would change a lot versus not knowing their pulse. Also, every time the battery failed, the radio signal was blocked, or the device slipped off the skin due to an awkward move, you'd think your partners' heart had stopped. I think such a device would give so many false positives to have little use.

I think much more important is addressing the risks that cause injuries in the first place. Do you know of any situations where someone would have been saved if their partner had known their pulse? Your chances of saving someone's life from knowing CPR are very very low. There are very few rock climbing injuries that fall in this middle ground; the majority of injuries either do not require immediate medical help in order to save the person's life, or are fatal regardless of if someone was there to perform CPR.

More important is in my opinion is to focus one's attention on good safety practices while climbing - wearing a helmet, tying knots before repelling, bailing on routes if you can't protect them, Grigris, always protecting even on easy sections, using locking beaners where unclipping risk could cause injury, protecting repels with Prussiks etc.

jktinst · · Unknown Hometown · Joined Apr 2012 · Points: 0

A bit late for the follow-up. I drafted this in Dec., waited to post while looking for more info and then forgot about it. I was reminded of it by the in-suspension CPR thread.

The life signs monitoring feature on the Mammut Pulse Barryvox beacon seems to be based on 3D movement sensing on the transceiver itself and I suspect that we're talking significant body movements, not shallow breaths, let alone heart beats. I can see that this might provide some information to help triage multiple avalanche victims but it doesn't seem like it would be particularly useful for an unconscious climber dangling on the rope. So it looks like my musings about a lightweight heart monitoring system for climbers were just wishful thinking, at least at this point. However, every time I see snippets about wearable tech from the annual Vegas tech conference and elsewhere, I can't help thinking that an effective solution that would be useful for climbing is getting closer to the consumer market by the day.

Regarding what to do with (or without) the information, clearly, the first order of business is to get the victim and either the rescuer or a helper (or all three or more) asap someplace where a full, hands-on assessment and first aid can be performed, no matter what the monitor may have said. However, that "asap" principle covers lots of different options and, without one or more helper(s), faster methods generally imply more risks. The pulse monitor would simply have added a key piece to the large amount of information the rescuer needs to process while away from his partner to select the option that makes the most sense to him from a speed and safety standpoint.

Finally, my second post above was fired off quickly, trying to illustrate how pulse monitors might inform the choice of rescue procedure. I realized afterwards that it needs correction.

This...

jktinst wrote: ... The EDK munter pass-through ... or the munter pop method would allow me to quickly pass a knot between the climbing rope and a length of cord ...(and therefore)...The steps would be: switch from ATC to munter, lock-it off, counterbalance climb till I reached the victim, and counterbalance rappel with the victim the rest of the way, passing the knot along the way when required...

...was hasty.

My enthusiasm for fast munter-based knot-passing methods got the better of me. Switching the braking system from ATC to munter before initiating the rescue procedure would require using a prusik-munter-mule-overhand. That's precisely what a classic knot-pass would use as well so it wouldn't make sense to waste time doing this switch early on, with no knot to pass, if a knot would have to be passed later.

[Last paragraph removed on edit]

AndrewArroz · · Unknown Hometown · Joined Jan 2016 · Points: 0

I suspect more climbers die from bee stings and rattlesnake bites than die from things this "system" would prevent.

Guideline #1: Don't be a jerk.

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