NCRC Orientation to Cave Rescue

After two rescue incidents in one five-month period at Cassell Cave (one mine, one thankfully not), I resolved that it was time to learn the basics of cave rescue. The Eastern Region of the National Cave Rescue Commission (ER-NCRC) was holding a two-day orientation class at the Elkins, WV, Volunteer Fire Department. Rick Royer and I of the Gangsta Mappers attended and were joined by roughly 35 various folks from far and wide. Tom and Jill had come down from New Jersey. There was a good turnout of Highland County (VA) Survey folks and many young cavers from the area.
Class started promptly at 8am in the big upstairs room in the fire house. Cindy Reid, an Elkins High School senior, was organizing the weekend as part of a senior service project and she did a great job. We received lectures on the cave environment and equipment, accident callout procedure, the SAR command structure, search techniques, and important medical conditions (hypothermia, hypoglycemia, hypohydration). Before lunch we split into three groups to have more hands-on training on cave communications systems (mostly old Vietnam-era army phones), patient assessment (feeling along limbs looking for obvious deformities), and patient movement (getting them out of water or danger and how to move them onto a backboard). Then we had a short break for lunch.
After lunch the real fun began. We divided up into four groups of about ten each; my group met with Julia and Dusty from Ohio. Dusty was used as the patient and we learned how to rig a litter and package the patient for transport. First we put a short backboard (an Oregon Spine Splint) on him and got his head immobilized with some tape. Then the litter was prepared; it was of the Ferno type and looked like a big orange plastic sled with handles along the sides and a rope running around the edges. It's about two feet wide and eight feet long. We tied webbing to the perimeter rope in a few places and layed the vapor barrier (a large tarp) in. Then came a pair of wool blankets followed by Dusty in the backboard. Padding was added under the hollows of his knees and neck. Then the blankets were wrapped over and topped off with the tarp. The webbing then came into play as we fashioned three big X's across his body, one at the torso, one abdomen and thighs and one at the legs. This whole cumbersome setup kept him warm and securely fastened no matter what angle the litter might be held at. We tested this theory by turning him upside down, on his feet, on his head and through various shakings. Note that this treatment is not a good idea for real patients!
After the packaging was complete, we learned about transportation. Ideally, you can do a six-man (or woman) carry with three people grabbing the handles on either side with a medic attending to the patient at all times. Caves, however, are rarely cooperative in this regard, so we had to learn lots of other techniques including passing (people line the path and pass the litter along), turtle (one or two people crawl underneath the litter supporting it on their shoulders while two others balance it), pavement (people lie on their backs head to crotch and pass the litter along on their stomachs) and simple hauling (using the tag-line attached to the head of the litter). Julia constructed a "cave" using plastic crates, a hazardous materials response truck, a boat, various peices of plywood and a healthy dose of imagination. We negotiated this obstacle course with great enthusiasm and then let Dusty out to breath for a while.
After a short break, Dusty went back into the litter and we got to play with the Obstacle Course. Normally, this would be done outside in the town park across the street but today was cold and rainy, so we had to play inside. Cindy had constructed a fake cave out using the materials available. We had to negotiate narrow spaces between chairs, crawl under three large fire engines (avoiding the transmission oil), pass the litter up and over a row of lockers, get it up the stairs, enter the women's bathroom, pass the hapless Dusty over the stall and finally out a narrowly openned door into the corridor beyond. This successfully occupied the day and we retired to dinner tired and satisfied.

Sunday, the day of the mock rescue, was rainy and cold but spirits were high. Time to put theory into practice. We assembled at 8am again. Rick Lambert, one of the students and a natural and experienced leader was picked to be Incident Coordinator (IC) for the rescue. He would coordinate other leaders in getting the rescue accomplished. Rick stood up and gave us the information he had: a guy named Ben had emerged from nearby Bowden cave hypothermic and a little incoherent. The information they'd gotten from him was that his brother Toby and two other people were still in there. Toby was hurt and bleeding profusely.
Rick immediately determined who in the student group had medical training (a doctor and an EMT) and who had been involved in the Gangsta Mappers survey of the cave a few years ago (Rick Royer and Barry Horner). These four people along with two of the experienced Highland County people formed the Initial Response Team (IRT) and left immediately. The rest of us took a more leisurely time to gear up and convoy out to the cave entrance where we were further organized. Along the way, the light rain turned into light snow.
Once at the cave, Rick organized things more thoroughly. Jill was assigned the crucial task of Entrance Control and stationed at the entrance with a pad of paper and watch. She noted who was in the cave, when they went in and what they had with them. As people emerged, they were duly noted as such; it doesn't do to perform a successful rescue only to find that several people are still lost in the cave!
A two-person Communications (Com) team familiar with the cave entered first bringing a quarter-mile spool of wire and a field phone. The other end of the wire was left at the entrance attached to another phone. Jaque and Dave were picked as the Aboveground and Underground Coordinators (AC and UC) to organize operations there. Kevin and I were picked to lead litter teams 1 and 2 and told to find team members. We would enter with the litter once the patient(s) had been found and get them packaged for transport. Jaque grabbed several other people and began erecting a tarp for a triage area. A stove was brought out along with a folding table and various hot drink powders. Her crew began to brew up hot beverages to be taken into the cave by the litter teams. Things seemed well in hand under Rick's experienced leadership.
At this point, Steve (one of the instructors) approached me and told me to follow him. We talked to Rick for a little while when suddenly Steve put two fingers to Rick's chest and said, "Bang! You just had a fatal heart attack! Charles is now the IC."
Whaaaa?! Rick quickly briefed me on the current situation and left me holding the radio. Fortunately, he had set things in motion quite well and they proceeded without too much input. I mostly wandered back and forth between entrance and the commissary (where they had lit a fire) getting advice from various instructors and students alike.
Finally, we received word that the IRT had located the "Toby" near the Shower Room but that the other two people were nowhere to be seen. Since Toby was reportedly bleeding (though this turned out not to be the case), we should have sent in a litter team hot on the heals of the Comm team; neither Rick nor I thought of it until it was too late. But, better late than never; I sent in Litter-1 along with the Underground Coordinator (who also should have been dispatched long since). Meanwhile, portions of the IRT continued to search for the other two patients.
Communication had been a problem. At Glenn's suggestion, I picked Seth to man the surface side of the phone line and report anything that was going on to me. We also needed to determine Toby's condition and more details which I had neglected to think of earlier. With Seth on the line and Dave in the cave, communication improved. It had started to snow outside so I relocated to the spatious mouth of the cave to be closer to the action. Litter-2 got their material ready nearby.
Soon we received word that they had dropped the first litter in the water while packaging Toby and the blankets had gotten waterlogged. Could we please send in the other litter? Litter-2 was still standing by, but I didn't want both teams in-cave until we knew where the other two patients were. Instead, Jaque and her crew russled up more blankets and packed them in waterproof bags. I sent two members of Litter-2 in with this load reserving the rest until the others had been found.
The IRT eventually found a second patient "David Bowie" (no relation) with a broken collar bone (?). He was cold but mobile and they were walking him out. Apparently, Ben's initial story had been confused. There weren't three people left in the cave, there were three people total. Since all patients had been found, the situation was now an evacuation. I dispatched the remaining personell (including the long-suffering members of Litter-2) into the cave. Some of the IRT personell had surfaced and took a turn replacing me as IC, Jill as EC, Seth as surface comm and Jaque and Missy as surface support (everybody caves!). We accompanied the remains of Litter 2 into the cave to help with the evacuation.
Many of us had been in Bowden before; the main entrance leads to a large passage with a winding stream. It was a simple matter to just walk upstream until we encountered the other teams. We encountered David Bowie after a hundred yards being escorted out (arm in sling) by the IRT doctor and several others. We loaned them two people and continued to the main evacuation several hundred yards farther on past the register and the Star Room.
It was certainly hard to miss the evacuation party! There were probably 25 people in the walking passage buzzing around the litter. Lights of all sorts everywhere and people moving purposefully toward a common goal. The nucleus of all the activity was Toby (aka Dusty, the same guy we'd spent a few hours torturing on Saturday) in the orange litter. Dereck (the EMT) was the medic and was never far from his head constantly talking to him. Rick Lambert and Barry Horner were coordinating the litter movement with amazing success. Wherever people were needed, they would magically appear. If four people were needed to carry Toby over a short bit of walking passage, there were at least seven available. If we needed to slide him across some large breakdown, a dozen people materialized sitting with their legs forming a log bridge. Streams were crossed by handing the litter from person to person. I participated in about 30' of turtle carrying.
Every fifteen minutes or so, we would stop and check vital signs. The Comm team (which was bringing up the rear, coiling wire as they came) would report to the surface. Dave was buzzing around coordinating these underground activities with great efficiency. An outer swarm of instructors (invisible in their pink and white "angel ribbons") mostly hung out behind the litter judging our performance. Energy levels were extremely high and everyone was acting very professionally and it really seemed like a real rescue situation. Kevin appeared with a video camera and interviewed several people. I was surprised at how easy it was to stay in character!
Finally, we negotiated the litter through the large entrance room and up through a tight bit to the entrance itself. There was a bit of a bottleneck as Kim (the new EC person) had to check us off as we came out. When we finally assembled in the entrance, the time was 12:40 pm. We'd gotten the call at 8am. This was much quicker than anyone had expected.
We returned to the Firehouse for a debriefing. The instructors were genuinely impressed at most aspects of the Mock. In particular, they were impressed at the speed and efficiency with which we moved the patient and the degree of proffesionalism. Communication needed work--not the Comm team itself, but those in the cave getting information to those outside.

All in all, it was a fascinating procedure and one which will definitely be useful in future rescue situations. I learned a lot in two days and see now where I personally need work. I would encourage anyone interested in caving or SAR to take this course. It is open to all levels of caver and is a lot of fun for the money.

Things I wish I'd known about Incident Coordination beforehand...

• Remember the "span of control". Rely on and listen to the people in your command structure.
• It's "patient", not "victim"!
• Someone should be listening to the phone at all times.
• Entrance control is crucial, especially at the end of the rescue.
• Write (or have someone else write) everything down. Notes cannot be too detailed.
• Make sure IRTs have a definite check-back time (half-hour in, half-hour out). If they have a Comm team, they can phone in.
• Make sure cavers who do not know the cave are teamed with cavers who do. Maps are very useful. Later parties can just follow the phone wires.
• When you get information from the UC or IRTs, make sure it is complete (where, when, what, who, vital signs, etc).
• Never assume that the information given to you by the patients is correct and complete.
• If there's a known, urgent injury (such as bleeding) and the location is narrowed down, a litter team should be sent in even if the IRT has not located the patient yet.
• The UC's place is in the cave once the IRTs have been dispatched and the action starts.
• The patient should never be left unattended. Someone, preferably the Medic, should be at his side talking to him all the time.
• You can never have too many people helping to move the patient.

The Home Cave

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