"in-suspension" CPR ??

I don't mean to dampen your enthusiasm but you are really spinning your wheels here.  I have been a paramedic for over 30 years and CPR in the best of situations rarely has a good outcome.   As I said before, if you choose to do CPR you are really only doing it to make yourself feel better and those around you feel better.   Outside my job I have performed CPR on a total of 5 people, all traumatic arrests, all died.   I did CPR to help the survivors cope with the loss and make them think everything that could have been done was done.   The harsh reality is someone who is pulseless and non breathing in a wilderness setting or setting where help is more than 15 minutes away is dead.   

I would be more concerned with a airway management situation or severe bleed scenario.   

I'm not saying don't do it, I'm just saying don't expect it to do any good except help you deal with the tragic accident.   Of course I would do compressions on a partner, for a while at least but I know in reality that it's not doing any good.

I have been a fireman/paramedic for the Los Angeles Fire Department for 30 years and have done CPR on traumatic full arrests hundreds of times and have never seen a save, I take that back, there was a gunshot to the chest, we did CPR and got him to a trauma center and he got into surgery right away and he ended up staying alive for 2 days and then died.   

If you are concerned about effective compressions it is impossible while hanging or any other but a flat hard surface.   You need to press hard and fast.  If you don't feel the sternum break away from the ribs after the first few compressions you probably aren't doing it deep enough.   That aint gunna happen while hanging from a harness.   

Kevin Mokracek wrote:

I'm not saying don't do it, I'm just saying don't expect it to do any good except help you deal with the tragic accident.   Of course I would do compressions on a partner, for a while at least but I know in reality that it's not doing any good.

I have been a fireman/paramedic for the Los Angeles Fire Department for 30 years and have done CPR on traumatic full arrests hundreds of times and have never seen a save, I take that back, there was a gunshot to the chest, we did CPR and got him to a trauma center and he got into surgery right away and he ended up staying alive for 2 days and then died.   

If you are concerned about effective compressions it is impossible while hanging or any other but a flat hard surface.   You need to press hard and fast.  If you don't feel the sternum break away from the ribs after the first few compressions you probably aren't doing it deep enough.   That aint gunna happen while hanging from a harness.   

It's not quite so dire as that... but it's still so dire that the initial question of the thread is pointless.  I've had a few traumatic arrest patients survive to be neurologically more or less intact, but they all lost pulses either in the emergency department or within a few minutes of arrival to the ED.  The time getting the patient to the ground in the initial scenario eats up your entire window for resuscitation in a penetrating trauma patient. Just getting to them and assessing them eats it up in a blunt trauma arrest. 

I am a novice on this, but just wish to add my experience to the mix:

I once performed CPR on a victim with no pulse/breath after a large ski accident and head trauma. The victim did regain pulse/breath, was able to get to a local facility within an hour and more regional facility within two by helicopter. The victim ultimately did not make it, but hung on for a week.

I know for sure that had I done nothing, the victim would not have made it to the hospital. Debating whether my attempts were useful also would not have helped.

Scott O wrote:

Wilderness clamshell thoracotomy is the next logical step...

Mateo San Pedro wrote:

Wilderness clamshell thoracotomy is the next logical step...

I always carry a Lebsche knife when I climb. 

jktinst: You asked a good question, and it's great that you're thinking through possible rescue scenarios, wanting to be prepared for every possibility, and eager to put your CPR training to good use. You received replies from at least a handful of current and former EMTs, WFRs, and WEMTs, some with many years experience, and unless I missed something there is total consensus. Yet you come back with, basically, "I know I've only done this on a dummy, but I think I'm right and you're all wrong."

You seem to be operating under a couple assumptions - first that CPR is a lot more useful than it really is. It can make the difference between life and death in some cases, I don't want to downplay that. But it has the best chance of effectiveness when started very quickly after arrest, needs to be on a flat sturdy surface, and when an AED and/or more advanced care can reach the patient very quickly as well. 

Second, that "some CPR" is better than none... or ineffective CPR could "tide them over". Yes, your partner could have a medical cardiac arrest in a climbing situation. That doesn't change the fact that the best course of action for you is to call rescue services, and get them to the ground as quickly as possible, without endangering anyone's safety further. Stopping in your efforts to get them to the ground to try to rig some sling based chest compressions will at best be useless, at worst will delay their access to emergency services and possibly put you at risk, as dealing with self-rescue systems is complicated and dangerous enough during a stressful situation without adding unnecessary complication to it. 

The best that can be said for your plan is that you could comfort yourself that delaying getting them to the ground (as long as you don't compromise your own safety in the process) likely made no difference, because whether traumatic or medical, a full cardiac arrest in a wilderness situation is almost always going  to have a fatal outcome. 

Matt Himmelstein wrote:

More recent references say don't do CPR while in the water because of ineffectiveness, difficulty in keeping victim and rescuer above water and risk of further complications. However, that ineffectiveness does not necessarily translate to option 2 since that would be a very different approach which would not be possible in the water (and, of course, suspended on a wall, you have essentially nothing but air around you).

To be clear: I have no intention of disregarding all the expert opinions put forward here and insist on using one of these options instead of rushing the victim down to a flat surface.

mountainhick wrote:

Take a self rescue course and get back to us about that kind of speed. I don't know anyone who could get an unconscious patient down that fast unless it's a simple lower no higher off the deck than 1/2 rope length, i.e. lower straight to the ground.

You know, not everyone who comes up with unconventional ideas is a noob.

I have not performed the following sequence from beginning to end but I feel that I have practiced the individual steps enough and tested other similar sequences in full to have a pretty good idea how long each step takes.

If the fall-catching pro is around 35m or not much higher (for a 60m rope) and there is no ledge higher up.

- Top-rope lower the victim while checking that the top fall-catching pro is not budging.

- Assuming no budging, lock-off the ATC with 3m left at the tail end of the rope (or between the ATC and the harness knot).

- Counterbalance climb/lower to the meetup point.

- Perform quick assessment (and hopefully no urgent first aid is required or can be applied in suspension).

- Collect gear from the victim's rack (in this fast scenario, I'm assuming that most of the gear is on a sling).

- Keep CB climbing/lowering till the victim is deposited at the previous belay station.

- Unclip the pros from your strand as you go up and reclip them to the victim's strand (preferably with extensions to keep the same minimum number of pros clipped between you and the victim in case the top pro should fail, while allowing you to "remotely guide" the victim around obstacles and onto the ledge).

- Aim to build a rappel anchor by beefing up a progression pro that's already in place where there are other placement options (using the 3m pf rope remaining to adjust the final position).

- Set a prusik from the victim's strand to the anchor to keep the victim tethered while setting up the rappel.

- Get onto the anchor and pull the rope from the pros above.

- Install the rope for rappel and get on it.

- Remove the victim's prusik tether and adjust his rope to have just enough slack for the rappel.

- Rappel to the victim making sure that he does not roll off the ledge.

Like I said: 4-5 minutes to get both of you down to the main belay station if there's no undue delay, less if there's an intermediate ledge; but clearly it could be more if there are complicating factors, like fumbling with the gear, a longer initial assessment, need for immediate first aid action (eg major hemorrhage), etc. Another complicating factor, of course, is if the fall was from higher up (top pro 40 m high or more). In this case, you lose the time advantage of the full CB climbing/lowering described above and you're better off (ie, you're both slightly safer and the procedure is almost as fast) setting up the anchor at the meetup point (again using the extra 3m of rope to get to the right spot) and tandem rappelling with the victim from there.

PS: the fast options discussed above are definitely not for self-rescue novices and their application in practice would be entirely under the responsibility of the user. I gloss over many details, assuming that those familiar enough with self-rescue could fill in the blanks. In addition, even though the situation calls for the second to rescue the leader, the rescuer needs a solid leading experience to be able to evaluate (in real situations, not just in theory) the risks involved and his degree of comfort with those risks; as well as the special circumstances and potential complications specific to each situation.

Em Cos wrote:

...The best that can be said for your plan is that you could comfort yourself that delaying getting them to the ground (as long as you don't compromise your own safety in the process) likely made no difference, because whether traumatic or medical, a full cardiac arrest in a wilderness situation is almost always going  to have a fatal outcome. 

Again with the wilderness thing.

jktinst wrote:

Again with the wilderness thing.

Yes, because the situation you are describing is likely a wilderness situation, in first aid terms. Meaning medical care is delayed. Otherwise, the steps to take are straightforward and outlined in your first aid class: call 911, scene safety, assess patient, begin CPR (which requires a flat surface), etc. 

There are many potential problems with the self-rescue scenario you described. And again, this attitude of "I've never done this in a real situation, but I've practiced so I think I know better than others who have." 

Regardless of how you get your partner to the ground, you need to 1. Get rescue on their way if possible 2. Get to your partner and assess, apply first aid as indicated/possible 3. If CPR is indicated, recognize that you need to get them to the ground as quickly as possible, or at least a large ledge, and that delaying that to try to give ineffective chest compressions while you're both hanging in a harness will not help and could make things worse. 

Em Cos wrote:

Yes, because the situation you are describing is likely a wilderness situation, in first aid terms. Meaning medical care is delayed. Otherwise, the steps to take are straightforward and outlined in your first aid class: call 911, scene safety, assess patient, begin CPR (which requires a flat surface), etc. 

There are many potential problems with the self-rescue scenario you described. And again, this attitude of "I've never done this in a real situation, but I've practiced so I think I know better than others who have." 

Regardless of how you get your partner to the ground, you need to 1. Get rescue on their way if possible 2. Get to your partner and assess, apply first aid as indicated/possible 3. If CPR is indicated, recognize that you need to get them to the ground as quickly as possible, or at least a large ledge, and that delaying that to try to give ineffective chest compressions while you're both hanging in a harness will not help and could make things worse. 

So the Gunks are wilderness then? Interesting.

And which scenario would that be? I've already said that I have no intention of disregarding all the expert opinions put forward here and would not attempt in-suspension CPR in this situation. Now if you're talking about the fast lowering scenario I described last, I'd love to hear about the experiences of the experts who have done it better in real life-and-death climbing self-rescue situations.

As for getting rescuers on their way first thing, as far as I am concerned that falls squarely in the category of the details that I intentionally glossed over assuming that those familiar enough with self-rescue could fill in the blanks, as I indicated in the PS.

Kevin Mokracek wrote:

 The harsh reality is someone who is pulseless and non breathing in a wilderness setting or setting where help is more than 15 minutes away is dead.   

Important caveat: CPR on drowning and avalanche-suffocation victims has a relatively high success rate, even in a wilderness setting (and I stress the word relatively). CPR on lightning strike victims has a more than zero success rate, even in a wilderness setting. 

jktinst wrote:

So the Gunks are wilderness then? Interesting.

In a medical sense, potentially yes. As could be somewhere like an airplane (speaking from experience), an interstate through BFE, or many other surprising places.  Delayed access to care=medical wilderness (My first two times through WEMT/WFR they taught >2hours, now they just say delayed access). 

Ancent wrote:

I am a novice on this, but just wish to add my experience to the mix:

I once performed CPR on a victim with no pulse/breath after a large ski accident and head trauma. The victim did regain pulse/breath, was able to get to a local facility within an hour and more regional facility within two by helicopter. The victim ultimately did not make it, but hung on for a week.

I know for sure that had I done nothing, the victim would not have made it to the hospital. Debating whether my attempts were useful also would not have helped.

The odds were never in your favor but your efforts at least gave his family time with him in the hospital and may have saved someone else's life via organ donation too. I'd say that's worthwhile.

OP, it's cool that you're thinking about this but I'd say your effort is better spent focused on climbing as safe as possible so you DON'T have to deal with this.

- Counterbalance climb/lower to the meetup point.

- Perform quick assessment (and hopefully no urgent first aid is required or can be applied in suspension).

I've only had one circumstance in which I was required to use my rescue skills. But, that situation and critical thought of most other rescue scenarios I personally would encounter on the climbs I do, I disagree with the counterbalance climbing/lowering. There are situations for it, but you're not going to be in control enough while climbing to provide a safe enough lower, in my opinion. If you were to slip and fall yourself, you could both potentially be out in space or swing to an area of rock that resembles the dawn wall. Additionally, you will have to unclip gear at some point, creating fewer "safety nets" from zippering. Also with the counterbalance bit, you're not going to be able to apply first aid until you are both secured. You only have control over one axis of movement(up/down) while doing a counterbalance climb/lower. What happens if you feel the safest course of action would be to reverse course? You're not going to be able to down climb with a person being your counterbalance.

- Set a prusik from the victim's strand to the anchor to keep the victim tethered while setting up the rappel.

- Rappel to the victim making sure that he does not roll off the ledge.

You should invest some time into learning about the rescue spider. It can be created with a couple figure 8 knots, and an alpine butterfly hitch. The prusik by itself isn't the best way to secure a victim. For reasons as to why, look at any rope solo thread ever made. The spider keeps both the rescuer and the victim "on belay" or "on rappel" the entire time. You are able to control the victim much, much easier and safer. And with the spider to never have to travel to the victim after the initial lower or rappel.

The most efficient rescue plan(in my opinion): Tie off the victim. Prusik up to the victim. Build an anchor and tie victim in while removing them from the rope. Assess the situation(injuries, distance to trail head, food/water and my own mental state). Decide if the gear above the rescue anchor is required to extricate yourself from the situation. Single strand rap to lowest belay anchor. Lower victim, or climb back up to the the victim. Rap to the ground. Doing the right rescue thing might be to drop your pack, grab a water bottle and sprint to the trail head. You have to know your limits in knowledge, skill, and endurance. Your number 1 priority should be you(the rescuer) in a rescue situation. The only blame that will be put on your shoulders is that which you give yourself.

I tell my partners that unless I remain conscious, their first course of action should be to get me to a "safe" spot, tie me off and get help. I want at least one person surviving. I also don't go into a wilderness area unless I think my partner can get themselves to safety without me.

Eliot Augusto wrote:

When it came to being taught CPR it was drilled into us that one of the most common failures in the application of CPR was the rescuer not applying enough pressure. If you don't know, you have to break the sternum. I can think of fewer than a half dozen climbers who could break bones via a bear hug, and not with fast enough iterations to be considered CPR. So yeah, getting them to the ground should be a priority.

Just a point of clarification. You don't HAVE to break the sternum at all.  Whoever told you that is flat wrong. You have to compress the chest EDIT: 2" - 2.5" (my prior 1-1.5" was wrong) on each compression.  Some ribs may break, the sternum itself rarely breaks except on the elderly, and even then, it's uncommon.

You are right though - effective CPR via bear hugs is pretty much impossible. By encircling the chest, you're actually constricting the chest cavity and restricting blood flow. Not to mention that it would be absolutely exhausting. Research shows most trained rescuers (EMTs and paramedics) can only sustain "perfect" CPR for about 2 minutes, at which point their form begins to devolve and the quality of compressions decreases.  And that's with the patient on the ground, supine, and the rescuers elbows locked, letting gravity do all the work.  Bear hugs?  I would guess the average fit climber would have 10-15 compressions worth of energy before your biceps flamed out.

jktinst wrote:

So the Gunks are wilderness then? Interesting.

A couple years back I was climbing at Peterskill, so basically the Gunks, and witnessed a 30' headfirst ground fall. By the time I got to the base, the injured party was hanging face down in the talus with agonal respirations, and responsive to pain only. I coordinated the rescue. We extricated him and began treatment. At the 20 minute mark, the rangers arrived with oxygen, a litter and cervical collar. Just as we finished loading him into the litter (~30 minutes post injury), the patient went into respiratory arrest. I ventilated the patient for the ~20 minute carry out to the parking lot. Over 1 hour had elapsed from the fall until we were able to transfer the patient to ALS care and get a large bore IV. The chopper landed about 8 minutes later with a flight nurse and real interventions. He was at Westchester General's Trauma Center at around the 90 minute mark.

This was an ABSOLUTE best case scenario which began on the ground (not hanging on the end of a rope) with 10+ rescuers instantly on site, several of whom were trained and experienced medical personnel.  If the patient went into cardiac arrest at any point prior to arrival in the parking lot, it's an absolute guarantee he would not have survived even the carry out.  Just some real numbers and data for you to consider....

Jon H wrote:

Just a point of clarification. You don't HAVE to break the sternum at all.  Whoever told you that is flat wrong. You have to compress the chest 1" - 1.5" on each compression.  Some ribs may break, the sternum itself rarely breaks except on the elderly, and even then, it's uncommon.

(This year) American Heart Association teaches 1/4-1/3 the chest depth... At least according to my CPR cert two weeks ago (at the health care provider level).

 Gonna be a lot more than 1"-1.5" on most people.