This sort of hard decision happens at lower elevations. In some ways harder: The Death Zone scenarios obliges you to abandon the victim to save the rest of the party. At lower elevations it's often less clearcut.
The difference usually amounts to
- better weather
- shorter distances to more moderate terrain.
- easier access to machine assistance (skidoo, helicopter)
- shorter travel to good medical facilities.
- Usually altitude sickness not an issue. (All of my outdoor stuff has been below 10,000 feet)
Because of the mitigating circumstances, it's not usually as cut and dried. But:
Mountain sickness (altitude sickness) you need to descend. Not now. Right NOW. I think it was in Freedom of the Hills, or Mountaineering Medicine mentioned that sometimes as little as 300 feet can make a difference.
Hypothermia once you get cold enough that shivering is starting to taper off, is very hard to deal with in any outdoor situation, let alone above timberline.
Once you have a person who is no longer mobile you have a compound problem:
Keeping a person who cannot walk warm is difficult. His heat production is dropping to something like 1/3 of what an active person is using. He is likely at least damp from sweating. Lying on the ground is a good heat sink. This becomes more pronounced if he is going into shock.
You also have to worry about everyone who is standing around getting cold. People donate their parka as ground insulation under the victim. In the excitement (panic?) of the moment people aren't monitoring each other for signs of hypothermia. It is very easy to end up with the smaller, thinner members of the expedition to get shivering cold and no one notices. (This is a particular problem with day trips -- you usually don't have the extra gear you need to make an emergency camp.)
I talked to a Search and Rescue organization. "How many people does it take to rescue someone who can't walk?" His response was that it took 12. 4 people with the stretcher at any given time. 8 people who carried some of the stretcher bearer's gear and would swap off with them. In rough terrain it would take 6 or 8 on the stretcher, with lots of scrambling to get to the next position.
The stretcher bearers were slow. Sometimes it made more sense to have some of the party shuttle with packs, making several trips. (Two pack trips = 3 times the distance -- there, back, there, Three pack trips = 5 times the distance.)
I've yet to have someone who can't walk, but I had one case where a young man tore ligaments in his ankle. He could put zero weight on his foot. To get him the fairly short distance (somewhere under a km) to a clearing where a helicopter could land:
- Two sturdy people to be his human crutches.
- four people moving ahead of the trio trying to reduct the amount of dead fall that interfered with walking. Two of these stayed behind to help the victim party across non-movable deadfall.
- Various other people took their own gear to the clearing, then went back for the gear of the victim and his aides.
Normally you stretcher someone only to a clearing where you can get a helicopter, or a road where you can get a 4WD. But not many choppers have operational ceilings above 12,000 feet. And in wilderness settings most of our roads are there for logging or are remnants from previous eras. There are few above timberline unless it was a pass.
There is a reason that first aid manuals say, "transport victim to medical facility" A big part of wilderness first aid is really 'second aid' -- how to deal with the problem until you can get help. Most of this simplifies to keep the blood inside, keep warm and quiet -- while his clock runs out. Meanwhile communicating with someone that you need help, and preparing a place for it to arrive, if by air. Often even doing this much is difficult.
Good leaders know this: Accidents kill. The same sort of thing that is no big deal when you are a ten minute drive or even an hour drive from the nearest hospital become a big deal indeed when help is a day or two away. So you take extra care to keep them from happening.
Steps you should take:
- Game out scenarios where you have an non-walking incident, and how you will respond for the current situation. I did a lot of trips with kids -- mostly 14-18. Boys who had been on multiple trips had usually taken at least Saint John's Emergency First Aid (4 hr), and many had SJ Standard (16 hour) Staff were required to take Wilderness FA (40 hour) or Wilderness EMT (80 hour)
Anyway, one of the things I would do around the campfire after we'd done a hefty pass, is to set up a scenario of an injury accident at that location. The point here, wasn't to tell them how to do a rescue, but to see how hard a rescue is. With teens this is the best way I've found to get them to listen when I say, "Be careful" On senior trips, I would coach a 'victim' ahead of time, and they would have to get the victim to a place to camp. Since they were also in charge of picking camp spots this put them in a dilemma -- camp soon at an awful spot, or keep going to a better spot. My favorite spot for this was a skinny ravine on the north side of Mumm pass in Willmore Wilderness. The trail crosses the creek (or IS the creek) 67 times in 4 km. Everything that isn't cliff or scree is wet or covered in 10 foot alder and willow. Two hours of moving someone with a 'broken ankle' is very convincing case for "don't do that!"
- We often would do a day trip as part of a trek. Something out of the way of our route. Usually spectacular scenery, but also a chance for party members with bad feet or stomach issues to heal for a day.
Take a good look at required gear for day trips. In my latter days running trips, I had the boys in effect bring a reduced backpack. They could leave all their food behind, and depending on weather much of their spare clothing. I required sleeping bag each, and 1 tarp per two people, a layer of clothing, rain gear, and toque. This amounted to about 12 pounds. Since most of them had been carrying 30-40 pounds, this was still light enough to keep spirits high, but eased my mind about having to spend the night away from camp.