The prolonged hospitalization of a victim within a cave sounds quite feasible and sensible, on the face of it. Many people say, “Why not treat him in there?” Do not believe it – a complete nightmare. Dr John Frankland in the 1986 sump rescue symposium stated that a “quick patch up and an immediate drag him out” approach is vastly better than carrying intensive care units, drugs, a surgery team, sensitive equipment, food, clothing, sleeping bags, and psychotherapy and rehabilitation personnel in to the victim. In the very great majority of cases such a situation is just not feasible or practical. There is perhaps a case for hospitalization in a dry, friendly part of cave beyond a short sump not that far in, so as to aid the transportation of gear, but if a victim is that close to safety then extraction would be far simpler anyway.
Hospitalization must be distinguished from the relatively short and temporary treatment of the victim. Certainly, in most cases, a victim could be detained in a cave for several hours whilst patching up work is carried out, the route out is improved if necessary, and a strong rope laid through the outward sump(s). Depending on the injury, it may be possible to improve the victim’s condition to an extent where his chance of survival through the exit sump(s) and the remainder of the cave is greatly increased. Even here there are many considerations: problems of exposure and hypothermia, the possibility that the injury cannot be properly diagnosed in underground conditions, deterioration of the victim’s morale and rising stress levels, and the possibility of litigation if the victim deteriorates and dies.
To conclude, unless there are exceptional circumstances, in-cave hospitalization is not an option. Realistically, the most that can be done is to allow the victim several hours to recover and be treated to increase his chances before commencing the outward journey.
Sump Rescue – A Few Thoughts
- Call out Procedure (The system below is the one used by the Welsh section other sections have their own call out procedure.)
- A list of named divers to be contacted in the event of a rescue call out is issued by the Welsh
- Section. Initially only one diver on the list is contacted and he will then decide which further
- Divers are to be contacted, taking into consideration their knowledge of the system concerned and their ease of access to the site, as Time is an important factor. Divers living further a field can also be contacted to be put on `standby’ (It could be advisable to make there way to the site) as there equipment may be of use. Even if they are not required to dive. In case the rescue operation is prolonged and backup divers are needed. Having decided which other divers need to be contacted by the rescue coordinator the diver should make his way to the site. In the unlikely event that none of the call out divers is available names should be taken from the list of qualified divers on the address list under the call out list. These can be identified by the initials DQ after their names.
- Before any rescue operation can be initiated in any caving situation it is very important to carefully assess the circumstances and conditions. This is especially important when the extra hazard of water takes a role in the event. The water involved may be either in a passage which is normally flooded a sump or, alternatively, normally dry passage flooded due to adverse weather conditions. A major factor to consider when deciding on the form that the rescue will take is whether the cavers involved are divers or non divers.
Several situations will be considered. They are as follows
- Supply of food/clothing to non divers trapped by flooding
- Removal of non diver from cave where flooding has sumped passages.
- Removal through flooded passage when non diver is injured.
- Removal of diver from a sump if he is injured and so unable to dive out himself.
- Search for an overdue diver either in dry passage beyond a sump or searching the sump itself
Incidents involving non-divers
It is sometimes possible that even after taking the most sensible precautions, cavers will get caught in a cave which has flooded. Unfortunately it is more likely to happen to less experienced and often less well equipped cavers who have taken insufficient notice of weather conditions, especially when entering systems known to be liable to `flash floods’. In these circumstances it is to be hoped that the party can find a safe area where they can sit and wait for the water levels to drop allowing them to leave by a dry route.
Note this is statistically the most common reason for divers to be deployed. e.g. little Neath river cave.
- On finding a caver or group of cavers stranded by floodwater the decision must be taken whether it is safer to try and take the cavers out of the cave or leave them until the water level drops. This decision is normally taken by the rescue controller – if time allows. If there is no immediate need for them to be evacuated e.g. injury, it will be necessary for a supply of food and a source of warmth to be provided in case of a prolonged stay. In cold damp conditions exposure can set in very quickly without the person concerned being aware of what is happening. Watertight rocket tubes make good carrying containers for food etc. Some of the larger or more complex caves have permanent rescue `dumps’ containing supplies and even in some cases telephones connected to safe areas of the cave where trapped cavers are likely to be.
- If the cavers are located in an area of the cave which is not suitable to `sit out’ the weather it will be necessary to make use of diving equipment to move them. The non-diver should be kited out with only essential kit to avoid any further confusion or alarm. This would include a single bottle and valve, a mask and lights. Also plenty on neoprene should be worn clear concise explanation of what is going to happen and what is expected of him must be given. It is very important to stress that he MUST keep the valve in his mouth and breathe through it, not his nose, and he MUST NOT let go of the line – things which are second nature to experienced divers. He should be placed between two divers who can then guide him through the sump. This is only advisable if the area to be passed is roomy and not too long. It is possible that if small awkward parts of the cave are flooded that it would be safer to move the cavers not out of the cave but to a safe area to await dropping of the water levels.
- If a non-diving caver is found to be injured beyond a sumped passage his removal through the flooded area must be seen as a high risk undertaking and considered as a last resort. Any possible’ on the spot’ first aid should be administered and then he should be strapped into a stretcher if he is unconscious. He should be provided with a full face mask and bottle rig as this reduces the need for his co-operation during the dive. If the victim is conscious a standard valve and bottle can be used one person must be responsible for ensuring that the mouthpiece remains in the patients mouth at all times throughout the dive instructions to clear ears should also be given. Even if a caver appears to be unconscious it is still important to give a brief explanation of what is happening to him. Often the ability to hear remains after the ability to respond is lost. And panic induced by not realising why he is being strapped down and his face covered etc could have a detrimental effect on his condition if he is already in shock. In the case of a caver who is conscious it is better to immobilise the injured limb(s) with splints and use standard cave diving gear.
Rescues involving divers
- If a diver is injured on the far side of a sump it may be possible for him to get himself out with assistance from other divers. Having administered appropriate first aid to the diver he should be given assistance to kit up with a minimum of gear. Cylinders should be arranged to give the injured diver the fullest. If the sump is large enough it may be possible to ‘tow’ the injured diver especially if he is unable to fin It is still important that the diver being helped maintains contact with the line. It is advisable to have a diver in front of and behind the injured party to guide and assist where necessary. It is important that the condition of the injured diver is assessed constantly for any signs of deterioration .A more seriously injured diver will need to be placed on a rigid stretcher and transported as in . Unfortunately to pass some sumps this would not be possible. And the need to use a less rigged stretcher or in some cases no stretcher and the victim towed this must be seen as a last alternative.
- The search for a missing diver or divers needs careful planning. It is obviously better to use divers who know the sump to search it. It is very important that the search is carried out in a methodical manner to reduce the risk of failing to search any area of the cave. Each rescue divers should be allocated a specific area/sump. This should not only ensure that all areas are checked but also that valuable time is not wasted with two rescue parties checking the same area All` nooks and crannies’ should be checked however unlikely they may seem. It is possible that if a diver got lost in a sump that he may have found an airspace, no matter how small, and is `sitting it out’ awaiting help. If his equipment is working normally and he either has or is provided with enough air to get back through the sump then after initial checks as to his state of health and ability all he needs is a line out. It is important that the risk to the search divers is always considered. If the missing diver has suffered equipment failure the situation must be approached with care. The available oxygen in a small airspace can be used up fairly quickly and if the stranded diver sees an available source of air in the rescue diver’s equipment then panic and desperation may overcome rational behaviour. Uncontrolled removal of a diver regulator must be avoided at all cost especially in a restricted sump where confusion could result in neither diver having adequate air supply with tragic consequences. When searching for a missing diver large air margins are needed to allow for longer search periods and the emergency provision of air in a situation similar to the above. If the missing diver is not located within the sump then any dry passage beyond must be explored in the same methodical manner. The search must continue until the missing diver is located. If the search parties locate the body of a missing diver the risk involved to the search divers in retrieving the body must be considered. There is a precedent of a body being found but left when retrieval proved too difficult without endangering the safety of others.
Points to remember
- The controller for the rescue divers should also be a diver so that he is aware of the situations.
- A log should be kept of who is in the water at any one time, where they are, when they went too, cylinder capacity, and when they return. This may also prove useful for planning subsequent dives.
- An adequate supply of cylinders must be available. These should be as large as practical forthe job in hand. If possible the facility for refilling these should also be available close by.
- During a long rescue divers should be rotated so that each diver dives for the minimumnumber of trips.
- On the journey to the sump the divers should if at all possible go in empty handed with non-divers carrying their gear. This will leave them as fit as possible for the dive.
- If the non-divers are unused to carrying diving gear they should be given instructions as to the need for care e.g. not dropping cylinders and not banging regulators heavily.