You are a paddle raft guide on the Penobscot River in Northern Maine. Due to high snow levels in the Northeast the river is running close to 3000 cfs and the Cribworks, a challenging Class V is quite pushy. Having successfully run the rapid you eddied out downstream and river left of the main drop prepared to rescue any swimmers. The next raft is captained by a first year guide who misses his line in the rapid and bounces through the rocky center of the rapid losing two passengers in the process. One passenger disappears in the rapid, the second surges ahead of the raft and is picked up by a downstream safety boat. After a few anxious minutes you see the first passenger entangled in a loose throw rope just below the surface of the dark water. You quickly cut the rope and pull him into your raft unresponsive with no pulse or respirations. There is a deep laceration on the back of Joe's head below his helmet. After a few minutes of CPR his pulse and respirations return and he awakens with no memory of the event ten minutes later. Bleeding from his head laceration was controlled with direct pressure when his pulse returned and has now clotted. At 10:55 AM Joe is awake and alert, his pulse is 76 and regular, and his respirations are 16 and easy. He says he has a headache (6) and feels nauseous; his normal pulse is 72 and regular. He is stiff, sore, and bruised in numerous spots from contact with the rocks. His neck hurts and is tender at C-4. His right knee is painful (3), tender, and slightly swollen with good ROM and CSM; he thinks he can walk. Joe recalls peeing before launching about an hour or so ago but not the color of his urine. You have three bars on your cell phone. The hospital in Millinocket is at least an hour away assuming you can find a vehicle and drive fast on the gravel road.
What do you think is wrong and what can you do about it? Click here to find out.
Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.