Stuck in the Wall

Setting:  Northern Face of the Obispo Peak, Altar Volcano - Ecuador

Three climbers are opening a new route in the northern face of the Obispo peak in the Altar Volcano. They are climbing a mixed alpine route at 300 meters above the ground and are at an elevation of 5,100 meters above sea level. At around 17h30, a boulder loosens under the grip of the lead climber and falls. A piece of the large falling boulder hits the left leg of the belayer slightly above his knee, 30 meters below. The belayer immediately feels a crushing pain in his leg, but still has to belay the lead climber back to the ledge he is belaying from. 

Subjective:

The patient is a 22-year-old-male who had a large boulder fall and hit the upper part of his leg above the knee. He did not lose responsiveness, is alert and oriented. He is complaining of severe pain to his left upper leg, and cannot put weight on it. 

Objective:

Patient exam: the patient belayed his lead climber down to the ledge, has a large abrasion on his upper left leg. Patient cannot bear weight on his left leg, there is tenderness and pain when doing a physical exam, but has good CSM’s in all of his extremities. 

Vital Signs:*

Time 17h30 

LOR A+Ox4

HR 76 Strong, Regular

RR 18 Regular, Easy

SCTM Pink, warm and dry

Symptoms: Pain and tenderness in left leg

Allergies: None

Medications: None

Pertinent Medical Hx: None

Last in/out: drank 2 liters of water, urinated 2x with a normal BM

Events: The fall of the boulder was not caused by a fainting event

WHAT IS YOUR ASSESSMENT AND PLAN?

DO NOT peek at the next section without answering this first.

Assessment:

Possible femur fracture, we have a mechanism of injury as well as pain and tenderness. 

Plan:

• Stabilize the left leg with available gear (ice axes, pads, jackets)

• Send a third member down with a verbal SOAP note to the nearest town, 8 hours away to get a helicopter evacuation. 

Anticipated Problems:

• Hypothermia, spending the night in an exposed ledge at a high elevation. 

• Dehydration

• Internal bleeding

• Loss of CSM’s

The tale continues:

The two climbers decide to spend the night on the ledge, bivouacking and drinking water from ice stalactites nearby. During the night they make signals to another climbing party that is camped in the valley below them. While some climbers down in the valley thought they were making signals showing their progressions, others thankfully realized it was a distress signal. A Spanish team with some Ecuadorians went up early in the morning, reaching the injured climber at 9h00. The injured climber was strapped to the back of one of the rescuers, and between 4 others they started descending the patient down. Once they reached the base of the wall, the helicopter from the nearby town had arrived. The patient got on board and the helicopter took off. Once the patient arrives at the hospital, a femoral condyle fracture is confirmed. 

Take away points:

• The lead climber wanted to descend as fast as they could while the patient wanted to spend the night, despite the pain, and plan the descent for the next day with more light. An important and crucial decision was made, because descending that same afternoon would mean that the climbers would be stuck in halfway through the wall, without a ledge to sleep on. Although it is important to consider that the climbers didn’t have bivouak material and spending the night at that elevation and with that exposure could have led to severe hypothermia. 

• It was important to send the third climber out for help, with a verbal SOAP note, to start prepping the helicopter. The helicopter arrived at the same time the patient had been lowered from the wall at 17h30 the next day. If the third climber hadn't been sent out, the patient would have had to wait longer, potentially worsening his injury. 

• The climbers had a poorly suited first aid kit that helped very little in the emergency.

• The climbers knew how to send signals through lights, luckily there were people in the valley that also knew what the signals meant and it helped getting more resources for the rescue.