time is the enemy: ischemia and infarction

In many wilderness medicine curriculums a core area of focus is distal CSM. Distal being “away” (in this context from the heart) and CSM being circulation, sensation, and movement. Blood and nerves tend to be wires hanging out in the same conduit throughout your body, collectively known as neurovascular bundles. Slice one and the results are clear: blood pours out and everything south of the severed nerves now has no feeling and muscles don’t work. Pretty terrible. Definitely something to avoid.

nvb
The yellow and red stuff makes it so you get blood, can move muscles, and feel things. You generally don’t want to have that get trashed.

In wilderness medicine you additionally have to deal with those neurovascular bundles getting pinched or squeezed. Even something as common as a dislocation, definitely something with lots of trauma (like a fall) that jammed a bone into some weird position, can now be putting sufficient force on blood and nerves that it went from a nuisance problem potentially life threatening.

In search and rescue, time is always against you. Consider a typical situation:

  1. Someone slips on a rock when backpacking and plants their next foot into a hole, bending their ankle in a way that baby jesus never intended it to move. It’s now 0800 just after breakfast.
  2. The patient tries to move around a bit and see how bad it is. Yep, it hurts like hell. They confer with their friends and decide there’s no way they can walk out. They need help. It’s now 0815.
  3. The friends get to a mountaintop where they can get a cell signal out and call 911, explaining the situation. It’s now 1130.
  4. Search and rescue gets mobilized and a helicopter is put on alert status. 1140.
  5. SAR is staging at the trailhead a few miles from the patient, packing the right gear. The helicopter has been re-assigned to a case of massive head trauma. No chopper today. 1200.

I’ll stop there as even before the first boot step moves in the patient’s direction four hours has already elapsed. You can chop that time down by having a $250 satellite communicator (and $15/month service plan), but it’s still going to take a while for folks to get to that patient and really this article is written towards the folks providing that medical care.

DelormeInReach
My preferred satellite communication device these days. GPS, bad-but-useable text messaging, tracking with a map folks at home can see, an SOS feature, and a good amount of battery life.

My training has taught me that infarction (tissue death) happens within about two hours. It’s not the same for all tissues, but for the arms/legs/hands/feet I go with 120 minutes. Pinch that blood supply off for that length of time and the tissue distal from it is deader than Firefly.

Fortunately ischemia (restriction of blood flow) is typically not an all-or-nothing thing. A bone jammed up against a tube of moving blood might block it a little, a bit, a bunch, or entirely. Think of having a plastic bag over your head versus one with a small hole in it. With the sealed plastic bag, you’re pretty dead pretty fast. With the small hole in, you can eek out a few more moments of life. The more restriction, the bigger the problem. So maybe you’ve got more than two hours since the ischemia might not be so complete. That’s hardly wonderful news since rescue response times can be all over the map with “a few hours” being optimal if the patient’s position is known, authorities were alerted immediately, and the terrain is not too difficult. If a patient’s location is unknown, response times to the tune of days is not uncommon.

And then you have transport time, which of course is wildly dependent upon terrain, the patient’s injuries, available air assets, and the size and ability of the ground crew.

Time is the enemy in other ways as well. Hypothermia in some climates, hyperthermia in others. Increasing intracranial pressure, HAPE, HACE, and a host of other problems get worse the longer they are left untreated. And generally by the nature of the operation you can assume they already have gone untreated for a prolonged period of time. With some exceptions, a properly trained wilderness medical provider can slow or even reverse many of these life threatening conditions.

litterlower
There’s nothing easy about transport.

By constantly remembering the impact of time on our patients, both before we got there and after they are in our care, we can do several things:

  • Shorten the list of serious problems that higher levels of medical care need to focus on. Instead of clinical moderate hypothermia, a patient now might simply want a second blanket on arrival to the hospital due to your interventions.
  • Save a limb. The next time you hug a loved one or stand on two feet, imagine not being able to do that quite so easily. By ensuring proper perfusion our patients can fully live out their lives.
  • Provide more insight to higher levels of care. If our attempts at providing perfusion are inadequate (perhaps through manual alignment in accordance with your training and agency protocols), it’s a clear signal that other issues such as acute compartment syndrome might be at play.
  • Slice and dice between the the original chief complaint (an unstable and painful ankle) and new issues such as dehydration and heat illness from laying in an unshaded spot because of the ankle.

One way that time can be somewhat of your accomplice if not outright friendly:  keep track of things you may want to do during transport and execute them when appropriate. If a belay needs to be rigged, take some vitals. If the litter team is scouting a route, toss in some more heat packs.

And although an entirely separate conversation, haste can also be your enemy. Rigging a belay takes time, but is obviously better for the patient than chucking him or her down a cliff. We want to move fast, but only as fast as safety and the patient’s interests will allow.

Going back to the example of the injured ankle, if the ground team gets there at nightfall and a storm sets in, if perfusion isn’t an issue and there’s no immediate need of extraction would be it safer to set up camp for the night, wait out the weather, and then proceed with daylight and dry footing 12 hours later when potentially more rescuers are available as well? That’s a very big question and can’t be answered in a hypothetical: much more information is needed that only a real scenario would be able to address. I only bring it up to to balance against rapid transport as a rule, rather than a probable option.

My writing is commentary on my training and personal experience. I try as often as I can to discuss patient care with medical teams I interact with in order to learn where I can improve and provide better outcomes. Please don’t substitute my writing for comprehensive and recognized medical training.

 

 

hartley springs campground

With five sar missions in the last week, I left town (and cell service) for the weekend. Destination: Hartley Springs Campground. Located about 20 minutes north of Mammoth Lakes the decided (as best I’ve been able to tell) lack of a “spring” is the reason I wanted to go there. The intense 16/17 winter has left snow everywhere, even in July. Much of it will stick around until next summer. With that snow is melt, and with that melt is water. Combine warm summer air and you get mosquitoes: lots and lots of mosquitoes.

I can handle mosquitoes but purposefully putting myself into the midsts of clouds of them is insane. Yes, I know about permethrin and DEET. I use a tent. I have coils. But “managing” mosquitoes for a weekend is tolerable but best avoided altogether.

hartleysprings
Our little slice of paradise, at Hartley Springs Campground.

Not only is there no natural water in Hartley Springs Campground, but there’s also no plumbed water: you need to bring all your own. There’s also no trash cans, no bear boxes, and no real anything. Some porta-potties, picnic tables, and a fire ring is about as fancy as it gets. The upshot is that it’s free to stay there and maybe 10 minutes from June Lake (20 from Mammoth Lakes) if you forget anything or just want to buzz into town for a bit.

It was also packed: we got the last spot when we showed up on a Friday around 4pm. It’s a haven for dirt bikers and 4x4s as well, so expect lots of poorly muffled exhausts blaring around you. Not in a horribly obnoxious way, but definitely in a you’ll-know-you’re-around-dirt-bikes sort of way.

rigging
In my sar pack I need to carry webbing, carabiners, and 50 of 8mm. Apparently that and a milk crate allowed me to set up swings and with my winch a zip line.

Verizon has a bit of coverage there, but no dice for AT&T. We had come through here a couple of months ago and there were little snow patches around so I safely bet that by now it should be bone dry and indeed not a single mosquito was found.

So especially in the non zany busy season if you’re looking for a free campground and can handle your own water and trash, give Hartley Springs a once-over. There’s a bit of dirt roading to do on the way in, perhaps a passenger car might have a tough go of it, but any AWD should be fine. I think I saw a couple 2wd passenger cars; I’d certainly give it a shot. If you do go up in a 2wd perhaps stick to a busier time period so that if you get stuck there’s a high likelihood that someone can help you out.

WFR vs WEMT (Wilderness First Responder vs Wilderness EMT) for search and rescue

As I study my WEMT material, I’m pondering the differences between the two courses thus far. Currently a WFR, I’m headed up to Alaska in the fall for a multi-week WEMT course. Sleeping in a bunkhouse with my other classmates, on a somewhat remote Alaskan island (population 741), I’ll have 8am-8pm class 6 days a week, in addition to the months of material I’ve had to go over in advance (doing it now) and the WFR I needed just to register.

 

I started writing a whole primer on the various levels of wilderness medicine but I deleted it all as the topic is huge. Instead, I’ll try something new and focus on the title: WFR vs WEMT, specifically for search and rescue folks.

study
WFR is the books on the right. WEMT is the books on the left *and* the books on the right.

WildernessFirstResponder

Coming in with roughly ~100 hours of training is the Wilderness First Responder, or WFR, pronounced “woof-er”. This swiss army knife of wilderness medical response is the expected level of quality sar team members and outdoor guides need.

  • Laser beam focused on the task and environment. You’ll learn nothing about ambulance gear because hey: there’s no ambulances in the wilderness.
  • While still a multi-week time commitment it’s possible for most normal people to figure out a way to pay for it and take the time off.
  • Available in a lot of parts of the world.
  • Fairly uncomplicated focus on critical system stability. Identify and treat the things that are field manageable, identify and prioritize transport for the things that need higher levels of care.
  • By being able to dismiss the urban setting and ambulance (or better) equipment, things get simple pretty fast.
  • You are not operating under an agency’s medical direction so your protocols (reducing dislocations, clearing spines, administering epinephrine, stopping CPR, and declaring dead people dead) is actually much more than an EMT would be able to do provided you’re in a wilderness context (typically defined as two or more hours from definitive care).

wemtpatch

Coming in with roughly ~200 hours of training (tack on another 100 for the WFR you generally need to take the course) is the funky WEMT or EMT+W. It’s basically an EMT+B with special focus given to non-ambulance gear and prolonged care and life support in an austere environment.

  • You can have way more patient exposure if you want it. As an EMT-B you can be treated like shit and underpaid riding around in ambulances with horrible working hours. But hey, it’s work and more importantly it’s experience.
  • On a SAR team you’ll probably be the, or at least one of, the primary medical providers as WEMT is a rare designator that few people trot around with. Again, experience.
  • You can expand your reach by riding ambulances, joining (typically smaller) fire agencies, and even working in hospitals or at a local physician’s office.
  • With all that experience, you can move towards being a paramedic (EMT-P) if that suits you and you have the time/money.
  • You’ll understand more of what’s going on with your patients at a physiological level and have a broader understanding of chronic and acute disease.

The real benefits for WEMT comes down to experience and advancement. Working as an EMT-B sucks for most people. You’ll make roughly $12/hour, which is what I currently pay my babysitter and she sits around watching Netflix not dealing with death around the clock. Even paramedics make roughly $17/hour, and that’s after spending $10,000 – $20,000 to go to paramedic school and after having worked as an EMT making peanuts long enough to get the experience to even apply to paramedic school.

All that being said, your ability to gain experience and advancement as a WFR is basically zero, strictly from a medical perspective. You’ll be limited to the patient contact you have in SAR which can be pretty thin. Also, you’re hogging it and not letting others on your team drink from the firehose that is the primary medical provider role.

It was explained to me when I got my USCG Captain’s License: this means you can do the job, you don’t get good at it until you’ve done it a lot. When you first get your driver’s license you’re a terrible driver. It’s the years of driving experience on top of the license that make you decent. The same goes with all skills including medicine.

Captains with a license but not a lot of time running commercial ships are referred to as “paper captains” on the waterfront: it’s not a term of endearment. Whether it’s driving a car, flying a kite, or diagnosing hypovolemia you are better at it the more you do it.

wemt
Typical SAR work. You’re a long way from an ambulance.

Search and rescue is basically an all volunteer system, as it always has been. Going back to 1000AD, search and rescue is a side gig. And in a big way, that’s what makes it so great. Everyone is taking time away from their families, taking time off work, and prioritizing helping others. I heard a joke the other day that to get into sar you need to take the psychological test, and fail it. Getting a chance to work with these outstanding people is a privilege. And of course it is a privilege and not a right to treat a patient when they are in one of the scariest moments of their life.

Everyone in sar needs to make the decisions for themselves as to how far “good enough” is. Perhaps because I’m a bad climber, middle of the road tracker, and crummy mountaineer I think my medical skills are where I can do the most good. It’s not lost on me that my own daughter’s life was saved by a sar team’s medical chops.

If you’re a WFR and keep your skills sharp, I’ll work with you anytime. I’ve seen firsthand a WFR keep someone alive for hours in a jacked up situation before evacuation could occur. If you’re a WFR and want to get more time with patients and perhaps go onto other aspects of medicine short of nursing or doctoring, consider the WEMT route.

 

the evolution of my sar packing

Mono Search and Rescue got called a few days in the early afternoon and we finished up around 0500 the next day: roughly 14 hours of humping and pumping through ice and snow, waiting around, treating patients, and rigging rescue lines/anchors/stuff. After some sleep I checked the back of my truck:

sarmess
Rat’s nest of line, wet gloves, dirty socks, dirty gaiters, consumed medical gear.

SAR packing seems to be based around three key concepts: mandatory, optional, and spare capacity.

Mandatory Gear

Bivy sack, head lamp, dry socks, and things of that nature: stuff that you’re going to carry no matter what. Most of those items are specified by my team but I toss a couple of my own in there too. I’m sort of a dork so I wear my helmet to almost anything except blazing sun mid-day and my own medical go-bag.

All of this stuff is in my pack, ready to go.

Optional Gear

Next to my pack is a milk crate full of optional items. My tent (as opposed to my tiny bivy), my backpacking cooking gear, crampons, snow shovel, helicopter goggles, etc.

The reality is that I can’t bring everything you’d ever want so on a operation-by-operation basis an educated guess is made. Headed to the desert? Extra water. Headed up a snowy mountain? Snow anchors.

Spare Capacity

Another reason you can’t load up on everything you want from your own gear is that team gear has to be lugged out as well. The litter, oxygen tanks, vacuum splints, long ropes, and all nature of climbing and medical equipment beyond your personal gear needs to head out as well.

And remember that you need to balance all of that with the fact that the more you’re lugging the slower you go and the less nimble you are. With more gear you get to your patient(s) slower and your agility at transporting them out is reduced.

sarclean
Cleaned up, ready to go. Mandatory in the bag, optional and clothes in the crate. Down bag de-compressed and puffy.

I’m still relatively new in my SAR career so I imagine I’ll be learning and refining as I go. And then there’s winter, which in a place like Mammoth really goes haywire. My own personal gear is much bigger, overnight gear is bigger, and between skis/boots/crampons/splitboard/snowshoes it’s tricky as hell to walk around.

camping along the mojave road

Another entry in my #MojaveRoad series because I’m too lazy to write it all down at once (original article here).

One thing I really dug about this trip was how free form the whole thing was. It reminded me a lot of sailing in the sense that with all that self sufficiency comes freedom. We planned on two nights near the Colorado River to meet up and start but after that it was an open road: think Thelma & Louise minus the ending.

Big Bend of the Colorado

Since I was coming from Mammoth and my buddy from San Diego, we met up near the starting point of the Mojave Road at the Big Bend of the Colorado, a Nevada state park with camping situated on the Colorado River.

20170508_094652
We got to hang out in the river for a bit before mid day when we all got heat sickness.

It’s not a terrible campground, but it’s definitely a utility locale. It was expensive, bland, and you could hear engine brakes from the nearby highway. Oddly far from most businesses it was still unfortunately suburban at the same time. The bathrooms were clean and it’s super close to the start of the Mojave Road so there’s that.

IMG_20170508_161611939_HDR
My friend and I trying not to die from the heat and doing some route planning at Big Bend of the Colorado, Nevada State Park.

Mid Hills Campground

Our handy dandy (and extremely over detailed) Mojave Road guide mentioned numerous camping sites but they all had one thing in common: no camping signs.

20170510_105612
This sign or several like it can be found at every location mentioned by the guide as “a good place to camp.”

We actually found a really cool place on our own but there was a huge pile of dead squirrels on it. Who brought the carnage? Beats me. I was fine with staying there and just parking a truck on top of the gore: out of sight, out of mind. My friend’s wife was a voice of reason however and we moved on. And lucky we did, because we found our way to Mid Hills Campground. With potable water, firepits, a picnic table, and a 5,000 foot elevation to keep things cool it was a great idea for the $12 nightly fee.

Mid Hills is also roughly smack-dab in the middle of the Mojave Road and easily accessible in one night from the Colorado River in a day provided you aren’t stopping to smell every non existent flower.

IMG_20170509_174033377
Dinner at Mid Hills campground, somewhere in the desert at 5,000 feet: note the juniper trees in the background.
IMG_20170509_190433417_HDR
My buddy and his son, Mid Hills Campground. It really was a welcome break from the lowland desert valley.

From Mid Hills, we shot back onto the Mojave Road and quickly realized that we were probably okay on gasoline. It should be noted that probably being okay whilst in the middle of bum-fuck-egypt means you’re not really okay.

So we made a pit stop in Baker, California. I hope I do not offend any of Baker’s 745 residents by saying that there wasn’t much going on. And although it took us out of the wilderness a bit, there are practical matters to attend to (like ice and fuel), and additionally if the original Mojave Road pioneers had a Taco Bell up in Baker you can bet your ass they would have hit it up.

bakerlol
Baker has ice, fuel, a Taco Bell, motel, two auto shops, and other travel stuff.

Fast forward maybe 100 miles from Baker, back on the Mojave Road: a couple of river crossings, a dry lake bed you can do donuts in, and the rock travel monument thing. We made it! We’re done, at least to where most people stop as the road technically continues on for another 11 miles.

Afton Canyon Campground, California

For most people Afton Canyon represents the end (or the beginning, if headed west-to-east) of the line, and as such the Afton Canyon Campground is a perfect spot to hang your filthy sun hat. Tables with awnings, potable water, and non-horrible toilets make this place functionally cool but the nearly constant rumble of freight trains and amazing scenery make it more than that.

anton
Afton Canyon Campground is a bit like being on Mars in the best way possible. The constant freight trains, the desolation, and the scenery makes the place pretty amazing.

The problem of course is that it’s eight million degrees there so unless you enjoy dying slowly of hyperthermia I think you’ll make your time here brief. Perhaps in the winter it’s a very different story: I checked the forecast for tomorrow (June 27) and it’s 109f.

As a final note, remember that the desert is weird. The alpine forests tend to have a mountaineer-ish vibe, and beaches have a chilled out vibe. Deserts just have a weird vibe. I’ve lived on the Sea of Cortez (including the summer), Vegas, Phoenix, and Southern California: I’m familiar with deserts. There’s a certain kind of person who arrives at these hells-on-earth and sees them as a paradise. I can appreciate the desert for what it is but that’s a far cry from wanting to exist there long term.

Keep your wits about you. Someone killed all those squirrels and left their piled up corpses in the middle of an otherwise nice camping area. Could it have happened up here in Mammoth or down in San Diego? Maybe, but it didn’t. It happened on the Mojave Road and that shouldn’t surprise anyone.

maps for the mammoth / june / eastern sierra (mono/inyo/yosemite)

I looked at my rather beefy selection of local maps and thought it might help some others figure out what they could use. For reference, here’s a link to the Mammoth Lakes Welcome Center.

For anyone looking to explore the area a bit via their computer, check out CalTopo if you haven’t before. CalTopo also gives you some awesome route planning options and you can print out your maps from home (for free).

Have fun and be safe!

two trucks in two days

The entire social media presence of Mammoth Lakes is on the “buy sell trade“. Someone stole your fishing pole? Need a place to rent? Heard a weird noise? It all goes there.

So I’m sitting on the couch doing my EMT+W homework and Charlotte hands me her phone and says, “You see this?”

2QlhTxQ.png
Yep, that’s stuck.

So some realities start to collide:

a) I’m on a search and rescue team, with the sole desire to help people who are in various shades of screwed.

b) I’m literally sitting there studying how to help people (medically, but the point stands).

c) I have a gassed up off road rig with a big winch on the front and a bunch of recovery gear sitting in the driveway, backed in.

So I call the dude up. We make plans to meet in 15 minutes and I text another buddy of mine from Mono SAR who’s got a likewise dope 4×4 set up.

Mind you, Friday morning there was another guy posting about he got stuck out at Lake Crowley which I handled myself before work with just a simple tow strap. But for this big ass Ford Expedition it required nearly 25,000 pounds of pull power.

c5yKVJa
Off course it had to be getting dark, full of mosquitoes, thick mud, and cold water. Of course.

Two winches, two snatch blocks, me revving my engine to keep the electricity going, and the stuck Ford with street tires in 4L. We popped the guy out, told him we hoped he had a better time in the Sierras, and to hit us up anytime he’s got problems.

Honestly it’s really nice to be a position to help people. I feel like not only do you get a chance to come to someone’s aid when they’re in a tough spot, but doing it for free with a cheerful attitude can really spread some positivity in this world.

It’s fairly well known that our country is quite polarized politically and ideologically these days. Half the people in that shot above probably voted for Trump, the other half hate his guts. There are ties that bind us only if we form and tighten those accords. Lincoln famously said, “We must not be enemies, but friends.” Not only do we need to keep from loathing one another, but we must also purposefully reach out and be kind.

So I’d ask of you the same thing I’d ask of myself: try to help folks out in whatever way you can. Not for money or notoriety but from the simple truth that living in a world where we are kind and helpful to each other is the only kind of world we want to live in.

laurel lakes road

I sometimes refer to Mammoth as “outdoor Disneyland”. Minus surfing, the Eastern Sierras has nearly iconic status for anything set in the wilderness. Racing down snow covered mountains, climbing up ice shoots, fishing in gurgling creeks, and mountain biking through beautiful forests: you could do it all in the same day if you had enough time.

So today for lunch we headed over to one of the nation’s best skate parks here in town, then hit the dirt roads cutting through Sherwin Creek Campground and made a left towards Laurel Lakes.

Laurel Lakes Road apparently has earned a designation as a “dangerous road”, and fair enough: if you don’t have a fairly decent vehicle and skills to match you very well may end up dead. In fact, the latest fatality was about two years ago.

laureldrop
Yep, miss a turn or slide out and it’s a loooonnnnnnggggg way down.

Fortunately for me and the kiddos, we we had a nice drama free time. In fact, I only drove up halfway yesterday by myself and traversed the rest on foot to get a sense of what was going on. Satisfied it was within my and my truck’s ability range, I thought it would make a great lunch stop.

laureltruck
There are worse places in the world.

An advantage to going places that are a pain in the ass to get too is that there’s less folks there and the people who do make it happen tend to be more experienced and thus more responsible. There was barely any trash and minus some tree-trunk carvings from local kids it was in perfect condition.

laurelcreek
Fire ring past the giant “don’t drive through here” boulders, creek behind the kids.

I’m not sure of the camping restrictions up there, but there are some tastefully laid out fire rings. If you get up there, please be responsible and treat the place with the respect it deserves.

This is also the road you can take to Bloody Mountain, although we stopped before the final switchback sets: there is still too much snow.

If you have a couple of hours to kill, a high clearance 4×4, off road tires, and a locking dif or two, head on up. Alternatively you could mountain bike or hike the one-way ~4 miles: there’s little traffic on this route and it’s pretty easy to see folks coming ahead.

laureltrashbag
It matters.

As a final note, the first thing I set up these days for any kind of backcountry stop is a trash bag. Not only do you have a quick spot to toss your own things, but having a big bag around makes you more likely to pick up existing trash that someone else didn’t address.

lots of sar training this spring

Every since joining the Mono County SAR team, I’ve been working closely with existing members and my 2017 cohort. In no particular order, here are the various skills we’ve been dialing in:

  • Ice and snow anchor use and placement. Flukes, pickets, and snow bollards.
  • Rock pro anchor use and placement (climber speak for “protection”). This is for 20 kilonewton (2.4 ton) rescue loads, typically consisting of at least two sets of three independent banks of protection. You should be able to hang a Honda Civic off our rescue rigs.
sarchopper
Rescue teams being able to radio a chopper in loaded with a paramedic and hoist should make you feel better about paying your state taxes.
  • Running top speed and jumping down Bluejay, landing on our back traveling head first, sliding to our doom. No worries, just use that ice axe and self arrest without piercing your femoral artery.
  • Helicopter insertion and patient hauling, courtesy of the awesome H40 crew at CHP’s Central Division. Popping smoke grenades, grabbing the hooks without getting zapped, rotor wash everywhere, and giving your patient a fastpass ride: it’s hard to not get stoked when you see that work out smoothly.
littercarry
San Diego Mountain Rescue, performing a litter carry. I’m in the back there somewhere.
  • Tracking training (which is nearly an art form), complete with sage-on-the-hill trackers who will track people in the woods just for fun and to see if they can. One guy on our team has a sandbox of sorts at his front door and asks everyone to leave an impression so he can keep seeing different tracks.
  • Blood borne pathogens and what they mean to a first responder. Want to catch some hep c? What about working on patient A, then going over to patient B without changing out your gloves, spreading whatever goo patient A has on patient B?
  • Radio training, to include all repeaters and frequencies used by air crews, law enforcement, and municipalities throughout the county.
  • Mountain navigation, chasing down small markers scribbled on small pieces of wood across a forest and scree field. As a Navy trained sailor with a USCG captain’s license, I had to work hard for this practical and written test.

Nevermind the examinations, gear signoffs, medical provider qualifications, immunizations, pack signoff, and take home tests.

And we’re not even close to halfway done with training at this point. Really it’s just enough to turn our 2017 cohort into a field effective team for the summer.

loadedup
The back of my truck is in go-mode for the summer. Pack, uniform, “maybe” gear. Even spare undies.

Then there are the self-study sessions groups of students will do for practicing various skills, typically high angle rope work and patient care.

July marks the typical beginning of rescue season. Right now the Lakes Basin is pretty inaccessible because of snow, PCT thru-hikers are skipping the High Sierra (my backyard), and major campgrounds are scheduled to only be open for two months this year.

So even though the backcountry is pretty treacherous right now, road closures and applaudable risk analysis have kept most folks from getting into trouble. That said, the sheriff could be getting ready to hit the call-out button right now.

*As a rule, I will not and cannot discuss any particulars of search and rescue operations that approach the realms of patient privacy and law enforcement.