The Pasayten Wilderness in the North Cascade mountains of Washington state is both extremely beautiful and very remote. It's also where Joel Reid, a senior Wilderness Medicine Training Center and Outward Bound instructor, was hiking with his students on the final leg of a fifty day Outward Bound Leadership Course last fall. The fifty day course is designed for people interested in future work as outdoor leaders and is broken into skills blocks that include sea kayaking, rock climbing, mountaineering, a teaching practicum, and early on, a WMTC Wilderness First Responder course. The following story of sudden injury and a challenging evacuation is told by Joel....
Trailing behind the group, I witnessed the fall. The fall didn't look too bad but he immediately screamed out in pain and grabbed his right ankle. After a quick assessment he reported limited range of motion and he was unable to bear any weight. The entire back of his ankle, along his Achilles tendon was painful and tender with no bruising and limited swelling, he had good circulation, sensation and motor function distal to the injury.
After some bushwacking and a river crossing the group found a place to camp for the night and we started to look at our options. We were still ten miles from the nearest trailhead and it was 3500' up and over Slate peak to get there. I made a sat phone call to my course director to request assistance for an evacuation. Finding a horse packer to come in seemed like the best plan, however it was a weekend in the middle of hunting season and most were booked. It would be a two day wait, but this still seemed like the best option as there was no way he could walk out. While waiting we cut up an extra shirt and built a SAM splint cast to immobilize his ankle.
The day the horses were supposed to arrive I got a message that they had encountered deep snow and turned back. We were on our own. At this point we were about day away from the course end and running low on food so it was hard not to get time stressed. The only option was to try to carry him out. We took his pack and emptied it. I cut two holes in the bottom for his legs, stuffed a pad inside, and told him to crawl in. After he painfully squeezed his splinted leg and the rest of his body into the pack several students helped me strap him on and stand up. At first it wasn't so bad, just a really heavy pack! Shortly thereafter I questioned whether or not we could actually carry him ten miles like this.
That day was a slow five mile slog wallowing through a mud pit of a trail almost up to our knees. Two students and myself took shifts of 10 to 40 minutes trying to keep forward progress and carefully timing our breaks with waist level logs and rocks in which to set him down on. The next day we left the mud pit and started uphill toward Slate Peak. After a couple miles we were met by three Outward Bound staff members who had come in to assist. We made good progress until we were stopped by deep snow that had us postholing up to our knees with a 150 lb pack. We then wrapped our patient in a sleeping bag, pad, and tarp, tied him up and using the whole group, dragged him the rest of the way through the snow. Once at the road we were able to put him in a litter and slide him down the snowy road to the vehicles. He spent seven miserable hours in the pack that day and never complained once! Later that day the doctor suspected a partially torn Achilles tendon but after an MRI it seemed as though some of the bones in his ankle had shifted slightly out of position causing extreme pain and limited range of motion; a fairly rare injury.
All in all, it was a fast, successful evacuation and one of the highlights of the entire course. The whole group had to come together and help out another team member because no one else was coming to our aid. For the students it turned out to be an incredibly valuable experience that allowed them to use skills just learned in their Wilderness First Responder course; it also allowed me to test out the backpack carry, something I had taught numerous times but never tried. It works!