A Case Study in Backcountry Emergency Triage and Decision-Making: Fall-Induced Facial Trauma

Rocks are the worst. Hope it heals well.

Sorry to hear of your accident and glad you are on the mend.

After an accident, anxiety, panic symptoms and vagal reactions should not be confused with true shock which is a life-threatening manifestation of circulatory failure.

https://www.ncbi.nlm.nih.gov/books/NBK531492/

Psychological shock. Fight, flight, freeze, or faint.

Like a health care executive in the oval office.

Interesting and enlightening writeup. I had a similar (not nearly as bad) fall while traversing the Great Smoky Mountains along the AT a couple weeks ago. At the end of my 2nd 32 mile day, on an “easy” section of trail, only 2 miles from the trailhead, I tripped on loose rock covered by leaves. I believe cognitive fatigue combined with darkness contributed to the fall. Although “graceful”,  my face slid across the ground when I rolled, splitting my face along the side of the eyebrow. It was dark, and I was solo. My wife was waiting for me at the trailhead two miles down the trail. I thought I was fine until I touched my now wet with blood face. I immediately applied pressure and used my shirt as a compress. I used my phone and headlamp to inspect the damage (easier said than done in the dark). I also garmin messaged my wife (also carrying a messenger) that I had fallen and was assessing. I felt better with a comms path established. Repeated use of Excedrin during the day made clotting slower than I would have liked. I eventually regained my composure, taped everything up, and completed the walk to the trailhead. This was the 1st time I’ve experienced a medical issue while hiking. Having my med kit accessible in my hip pocket helped a lot.

I learned a valuable lesson about shock or shack adjacency, that there’s no self recognition while going through it.

All my life I’ve engaged in high impact or high risk activities, whether sport motorcycling for 30+ years with some racetrack time or high impact sports.  I’ve had more than my fair share of injuries and my response was always first “you idiot” followed by an almost clinical “lets get on with it”.  No drama or panic.

Which is why I was really surprised one day after a mishap on a fall motorcycle ride in the country.  My bike went into a deep tank slapper, I went temporarily blind, then momentarily passed out while in the midst of a high side.  This is a pretty accurate recreation except mine was precluded by violent bar shaking tank slapper and then I landed on my scapula after being launched many yards.

My reaction was same as past history “you idiot… get on with it”.  Why wouldn’t it be?    I saw my bike off the side of the road in a culvert next to the forest and when I reached down to pick it up by the handle bars, my left arm wouldn’t even budge.  Brain sent signal, arm did nothing.

I had absolutely no idea that I had even injured the arm.  It was a very remote stretch of road and I was lucky to quickly hitch a ride to a diner 15 miles away.  When I got there, I couldn’t locate my wallet and assumed the guardian angel that took me there and had since left stole it and so I asked the proprietor to call the police.  Just batshit nuts.

Of course, the wallet was in the tail pack like always.  Some things in my mind weren’t working normally but everything seemed normal.  I was doing all the right things in my mind: slowing things down, taking the correct steps to assess the situation, had zero fear or panic.  But it didn’t matter.  My mind went into ‘auto mode’ and decided the reaction for me and I had no control over the details.

In the end I had a 4″ crack down my scapula and no use of the left arm for about 6 months.  18 years later its still a major factor in my backpack choice.

A lesson I took here for backcountry travel is that if suffering some significant trauma, look for signs that your decision making or perception don’t make sense.  Once confirmed, second guess ALL your major decisions.

It also points to the criticality of having a fellow traveler if engaging in a high risk route.  Self-reliance is great but you may not even know your mind is scrambled.

The list of 1st aid materials used suggests you carry slightly more than a minimalist first aid kit.  Care to share what your standard FAK is for trips into the mountains?  Mine is, admittedly, often decent with meds but very light on gauze, hydrostatic dressing, etc.

Not RJ, but I do carry a more substantial FAK than many. I built it around things I could not quickly and easily reproduce in the backcountry while hiking. There is very little redundancy in my gear so I try to bring lightweight options which can prevent me from having to destroy one piece of gear to manufacture a subpar version.

Meds:

• acetaminophen
• ibuprofen
• loperamide
• diphenhydramine
• aspirin (low dose)

Supplies

• gloves (1pr)
• good tweezers (1)
• Poison Ivy wipes (1 wipe)
• CAT tourniquet (1)
• sterile compressed gauze 4.5″ x 4.1 yds, z-fold (1)
• sterile rolled gauze 2″ x 4.1 yds (1)
• sterile 4.4 gauze sponge (2)
• med tape (24″)
• triangular bandage, 40″ x 40″ x 56″ non-woven with safety pin (1)
• Q-tip (2)

Foot/skin care

• leukotape or KT tape
• body glide
• lip balm

Gear Repair, etc

•  gear aid tape (1′)
• needle w/24″ thread
• eyeglass repair kit (2 screws, 1 screwdriver)
• gorilla tape (3′)
• rope (45′)

As you can see, my main priority is controlling blood loss and covering burns. I cook over a fire regularly, and I frequently travel through active hunting areas, accidents happen. I have heard many stories from other hikers of irresponsible shooting in some of these places. I used to carry quick clot impregnated gauze pads, an Israeli bandage, and a vented chest seal, but have thinned them out for the most part. Sometimes I will reintroduce one or another if it is the height of general gun and I am going somewhere hunters are likely to be very active. It is not uncommon to see people hunting with dogs, from vehicles, in stands and blinds, and on foot all in the same day here.

Edit to add – This BPL thread by Patrick Craddock is very informative and hits on wound care a lot. Irrigation, tetanus vaccination, foreign body removal is highlighted as very important. I have not added a 10mL syringe to my kit, but I do consider it. I think in a situation where I had significant debris, I would consider melting/poking a small hole in a water bottle lid and spraying water through it, or, I would use the ziplock method described in the thread.