Advanced Rescue Technology's Senior Editor/Staff Writer Mike Spivak recently spoke with Tim Kovacs, a wilderness-trained paramedic and EMS administrator for Terros Behavioral Systems, in Phoenix, AZ, and the current president of the Mountain Rescue Association (MRA), in Golden, CO, on the unique field of mountain rescue.
RT: What is the history and function of the Mountain Rescue Association?
Kovacs: The MRA was founded in 1958 in the state of Washington. The association's mission is to provide mountain rescue responses and mountain safety education. The MRA, which has 85 units spread across the United States, Canada and other countries, is the only group in the U.S. that certifies and accredits rescue teams in the three main mountain rescue disciplines: wilderness search; technical rope; and snow and ice rescue. It is designed to unite different teams to share knowledge, improve rescue techniques and develop guidelines.
RT: Are mountain search and rescues performed mostly by paid or volunteer providers?
Kovacs: Fully 99% of search and rescues in the United States are still responded to and operated by volunteer or non-profit units. We've been trying to educate people that no matter what they hear about charging for rescues, we will never let that be a factor in responding. We will respond regardless of whether you have money or insurance.
In terms of call volume, a typical MRA team handles 25 to 60 calls per year, but it can vary from squads that answer only 1 call per year to squads that answer 300 calls per year.
RT: What distinguishes mountain rescue from other types of rescue, particularly urban search and rescue?
Kovacs: For one, the type of equipment used. We use all of the ropes and carabiner hardware, but we also carry items that can be used for multiple purposes, since we're going to be more focused on things that can be used for multiple tasks. We might use 7/16" rope instead of 1/2" rope, which is standard in urban search and rescue. We might use aluminum and lightweight carabiners and hardware rather than full steel because we need to have lightweight and compact equipment, since we have to carry these items on our backs.
We might take along a Bauman Bag, which is a large Cordura nylon bag that converts into a rigid stretcher when you put a backboard or vacuum mattress inside of it. Sometimes our teams will carry that instead of a full Stokes litter. We also carry whatever communications gear we think we will need. Often, we enter areas that lack good radio communications, so we set up portable radio sites. We may station one of our members on a peak in order to act as a human repeater and repeat messages back and forth between the site and the command post. We also carry clothing, food and liquids for any victims we find.
RT: What type of medical equipment do you carry?
Kovacs: We have to take a minimum of 48 hours worth of personal survival gear, which includes basic to advanced life support medical gear. In the summer we carry lots of fluids; in the winter we carry heat-generating devices such as heat packs or warm gas inhalators. Depending on the situation, the medical equipment can range from simple trauma and airway equipment to intubation gear. I tend to have a small pack where I carry two IV setups and enough equipment to intubate someone. I don't carry the full set of intubation blades, which consists of two handles and 9 blades, but carry two blades and one handle, three different size tubes and a small bag-valve mask. I also carry two oropharyngeal airways. It's everything that you would find in an ambulance except in much smaller quantities. We also use this equipment for multiple purposes. For example, a nasopharyngeal airway might be used on the end of a big syringe to irrigate a wound.
RT: How many people are dispatched on a typical mountain rescue team?
Kovacs: For a team to receive full MRA certification, it has to have a minimum of 25 personnel, five of whom must be trained at the mountain rescue technician level or above. A typical mission could involve as few as 6 or 7 people or as many as 35. It depends on the situation. The average response is around 15 people.
In regard to dispatching teams, sheriff's officers are largely responsible for providing search and rescue in their counties, though fire departments are becoming more involved in this as well. Typically, we work with a sheriff's deputy who acts as the assigned search and rescue coordinator. Sheriff's offices provide administrative and logistical support and can get you the resources you need. They are very supportive of mountain rescue teams, as are fire departments. They take more of a command role for searches because most sheriff's offices can send their deputies to school to be trained as search managers. On the other hand, they take more of a back seat during rescues, which are still in the realm of rescue teams. After working with the sheriff's office, we'll then work with ambulance and fire service personnel on or near the scene. Once we arrive on scene, we follow the incident command system.
Every team that responds out from a trail head must have at least one person who can operate at a Wilderness EMT level. We have a rank structure similar to other public safety organizations and it's up to the operations leader to decide who's going to a site. Often, we have different types of skills represented on a team. We might have climbers or mountaineers who aren't EMTs, but who are specialists in high-angle environments. We might also have physicians who aren't expert climbers, but who are really good in medicine.
RT: What type of training do mountain rescue team members typically have?
Kovacs: The MRA favors the Wilderness EMT and Wilderness First Responder type training. You have to know what is going to happen beyond the golden hour, since you can be with that person for a long time. You have to think about how to get the victim to purge, to urinate, etc., and you have to be aware of how to keep the person warm and not lose hydration.
RT: How many total hours of training do most team members have?
Kovacs: The average would be about 200-300 hours the first year and 100-140 hours the second year, and that includes wilderness medical training.
RT: Are team members required to be proficient climbers and hikers?
Kovacs: Most of the MRA teams have climbing and mountaineering as their foundation. In some teams, every member will be a mountaineer, while in others, there will be a core group who are mountaineering specialists and others who are not expert climbers but who know how to get around and understand the basics of climbing. We also have support people who stay at the base camp or command post to assist with communications.
RT: Tell me about the physical training required to earn a spot on a team.
Kovacs: Most teams, even those at the entry level, require trainees to take formal physical fitness and agility tests, including everything that you would typically find in fire department training. Additionally, during the first few months of probation, members are required to go out on climbs and have their physical ability assessed and observed.
RT: What type of medical emergencies are you most likely to encounter?
Kovacs: Most of what we find are upper and lower extremity fractures. Everyone we run across is generally hypothermic to some extent and they're often dehydrated because they're usually not equipped for the weather. We also see suspected back, neck and head injuries. There's also rescue shock, where the person subconsciously lets their adrenaline drop when they see rescuers arrive. They drop their energy reserves and their body stops fighting. This can have a refractory effect, so our job is to keep their spirits up, maintain their body heat and keep them going until we get them out of where they are.
RT: Do most calls involve climbing or mountaineering incidents?
Kovacs: No. At least with respect to the MRA units in the United States, less than 1/2 of 1% of the people we respond to are climbers or mountaineers. A full 99.95% are hikers and regular people who just get in a little over their heads.
RT: What are the typical calls you respond to?
Kovacs: People who are lost or who don't anticipate changes in the weather are common calls. A lot of it has to do with knowledge and not respecting nature as much as they should. Weather can really do people in quickly. For the high-angle incidents that we respond to, it's usually someone who will climb up a mountain but cannot get down, or they may not have the proper mountaineering training and they either get stuck or fall.
RT: Is there a limit to what you can respond to?
Kovacs: No mountain is too high. However, weather and environmental conditions often present obstacles. For example, if we cannot get a helicopter into the site, we may have to enter on foot, which may mean 6 hours to reach a scene. Access is really the only problem. Other than that, there is no place that we cannot go. We're trained to be specialists in high angle, vertical and high altitude situations, deal with the most severe weather conditions and be self-sufficient for a minimum of two days without any resources.
RT: You mentioned helicopters; how are they used to rescue people?
Kovacs: We use them to transport personnel and equipment; to transport the patient out of the site in the event a safe landing zone is made available; and to perform what we call external load techniques, which means hanging a rope underneath to rescue someone or conducting cable hoist operations.
RT: How many people can a typical helicopter carry?
Kovacs: Unfortunately, rescue helicopters in the United States are underpowered and small. They tend to be either Bell 500s or 206L Rangers, which are quite small. Often, they are loaded down with medical and other equipment, with usually one to two people inside with their personal gear.
RT: Who cares for the victim once he is inside the helicopter?
Kovacs: With most of the mountain rescue teams, including mine, even if the person has no medical complaints, we'll put a medical person in the helicopter with them so that they get a full medical checkup. There are hidden things that can happen and we want to be prepared for them. For example, people usually are out in the elements for a long time. Perhaps you run across a person who didn't take his insulin and forgot to mention this to you at the time of his rescue because he was happy to get out. His condition would then start to deteriorate and he would need medical attention.
RT: You mentioned public safety helicopters. Are medical helicopters used in mountain rescue situations?
Kovacs: There are medical helicopters throughout the country that are typically operated by private companies. They are usually generous in giving rides to rescue personnel to get into sites. However, as a rule, medical helicopters land at a full landing zone and take a patient; they don't perform a rescue. Occasionally, we'll get help from the military. They have large Chinook helicopters that can carry half of our team with equipment. However, by regulation, the military cannot compete with other helicopters if there's a local resource that can perform the same function.
RT: Given that most incidents happen from lack of knowledge, is education an important factor in keeping people safe?
Kovacs: Absolutely. The MRA has two mottos: to provide rescue and to provide mountain safety education. Knowledge is power. The more people know, the more they will be able to make an educated decision as to what their risk is.
We have a series of public safety education programs. One is called Back Country Safety and another is called Avalanche Safety. We have campaigns to educate the public about wearing helmets, and we have a campaign coming out that discusses the hazards of indoor gym climbers trying to go out in the mountains and climb on rocks. They learn everything they know in the gym and then they go out and forget to take into account the weather or the fact that they have a one-hour hike approach to make and all they brought was a can of soda.
RT: Can you tell about one of your more memorable mountain rescue calls you responded to?
Kovacs: We had a mission in a mountainous, rugged region of Central Arizona near Humphrey's Peak in Flagstaff. An individual had reportedly been stuck for one to two days on a ledge several hundred feet above the ground. One of our team physicians went on the lead climbing crew. It was dark and air support was not available, so instead of coming from the top down like we prefer, we came from the bottom up. As the crew got close enough to initiate voice contact with the victim, they noticed the person stand up on the ledge and walk back and forth a few times. Then, all of a sudden, he grabbed a couple of rocks and threw them down at us. One of the rocks hit our team physician on the left side of his body. The impact broke his arm and gave him several other injuries. Since the victim was breathing and was on a ledge where he was safe, we figured he was not in any immediate danger and we then shifted into evacuating the team physician, who was in excruciating pain, and ultimately helicoptered him out.
Once we evacuated the doctor, it was then daylight and we came from the top down in a multiple-hour operation to evacuate the victim.
RT: Was he combative when you reached him?
Kovacs: By the time we got to him, he was really run down and tired. Prior to reaching him, we sent a two-person rappelling team down and spent a lot of time just above him and out of his reach talking to him, assessing him and gaining his cooperation.
RT: Is it unusual for victims to turn on their rescuers like this?
Kovacs: Yes, it's really unusual. It's not unusual for a person in a desperate situation to try to grab one of us, hang on to one of our ropes and try to yank us off the mountain, but nothing like this. We've been fortunate that in 30 years of operation, we've had only 3 injuries, and the injuries sustained by the physician in this incident were by far the worst of any of them.