Any time you have to utilize self-rescue techniques, you’ll more than likely have to deal with an injured partner. The most useful first aid skill is assessment of injuries, a critical skill for all medical personnel as well as anyone who recreates outside, including climbers. These skills are pertinent, whether you’re at the local crag or on a remote ridge in the Himalayas. There are many effective methods to assess a climber who is injured, and below is one of these accepted techniques. Whatever your method, the most important thing is to know it by heart and be thorough. The life of you or your partner might depend on it.
The first thing to do is assess the scene: Is the situation safe? Are there any hazards that will cause my partner or myself more harm? These include physical dangers such as rock fall and avalanches but can also include weather (lightning, wind) and environmental dangers (extreme cold, high altitude). Once you have addressed these and feel that you are safe from them, you can now begin a rapid primary assessment of life-threatening injuries by following the acronym ABCDE.
The ABCDE of Assessment
A – Airway with Cervical Spine Stabilization Q: Is there air moving in and out? Think: Look, listen, and feel. If the climber has sustained a fall that could have damaged his spine, stabilize his neck and protect his spine. A: YES – Move on to B. A: NO – Look for cause of obstruction. If you see something, remove it. Attempt to open the airway with jaw thrust or head tilt-chin lift and begin CPR. Call for help immediately.
B – Breathing Q: Is the patient breathing, and if so, how? Fast rate, uneven chest rise, or laboring to catch their breath? A: YES – Breathing without difficulty, move on to C. A: NO – No breathing = begin CPR and call for help. A: NO – Labored breathing = Position for comfort, reassure, give oxygen (if available), and call for help.
C – Circulation: Q: Does the climber have a pulse? Check multiple locations (radial/wrist, carotid/neck, femoral/groin). A: YES – Move on to next question for circulation. A: NO – Begin CPR, call for help.
Q: Is the climber bleeding profusely? If so, where? A: YES – Find source (Look on the ground, the chest, abdomen, pelvis, and thighs. Remember bleeding can be internal) and stop bleeding with direct pressure, elevation, or tourniquet. A: NO – Move on to D.
D – Disability: Q: Is the patient fully alert? A: YES – Move on to E. A: NO – Assess by AVPU scale. How do they respond? Call for help. A – Awake V – Verbal P – Pain U – Unresponsive
E – Environment: Q: Does your current environment offer danger to patient’s condition? A: YES – Protect your patient and limit exposure. Get them dry, warm, insulated from cold ground, and out of the wind. If at altitude, move lower if possible. A: NO – Think about evacuation or continuing to climb if no injuries.
Remember to reassess your partner as often as needed based upon injuries; identify resources and dangers of your current situation, and all potential methods of evacuation. To learn more about assessment and caring for injured climbers, read about wilderness medicine and consider taking a Wilderness First Aid (WFA) or Wilderness First Responder (WFR) course.