Advanced Rescue Technology's Senior Editor/Staff Writer Mike Spivak recently spoke with Butch Feldhaus about the challenges associated with cave rescue. A veteran sport caver, EMT and member of the cave and cliff rescue team for the Chattanooga/Hamilton County (TN) Rescue Service, Feldhaus recently retired as national coordinator for the National Cave Rescue Commission (NCRC).
RT: What are some of the challenges of the cave environment?
Feldhaus: First, there is a total absence of light. You have to supply all the light in a cave. Second, caves are cold and humid, so there is a potential for hypothermia. Finally, caves can be rugged. It can take 12 or more hours to get a patient who is trapped a few hundred yards inside a cave to the entrance because of vertical drops.
I remember a rescue we did where medics from an ambulance pulled up at the end of a dirt road and they were going to rescue a guy who was trapped a mile and a half back in a cave. When they saw us putting on wetsuits and padding, they decided that they weren't prepared to go into the cave to rescue this guy. When they learned I was an EMT, they gave me their jump kits. When I later returned them, they probably had to throw them away because they were so trashed. To get to this patient, we had to swim, go through tight crawl ways and mud, and go up and down drops.
RT: How important is time in a cave rescue?
Feldhaus: We always talk about the golden hour in EMS care. With caves, we sometimes talk about the golden 8 hours or longer. It's not like when you have an accident on First and Main-- you drive the ambulance there, load the people inside and take them to the hospital. You have to know how to cave to do this, you have to be comfortable in the environment, and you need to arrive on scene able to take complete care of yourself for at least 24—48 hours, which means you'll have food, water and gear.
RT: What types of injuries do you treat?
Feldhaus: Injuries are typically to the long bones of the body, and hypothermia is a concern after a certain amount of time, as the patient may not be dressed for the environment. For example, they'll be wearing blue jeans and a T-shirt, which absorb all the water and cause them to get cold. They will probably be in a small group without sufficient light and personal protective gear like helmets.
RT: Do you ever rescue experienced cavers?
Feldhaus: There are two extremes: new people who go into a cave and have no clue what they're doing and get themselves hurt, or experienced, veteran cavers who had been doing something well and then cut a corner or got into a new cave that had rock fault problems. Most of the rescues we've done tend to be evenly divided between the two.
If I get a call that a professional caver needs to be rescued, I'm going to be worried, because if it's one of the guys who's been doing it a long time, they're probably in a grim place pushing the limits. They're going to be hard to get to and hard to rescue.
RT: Are most cave rescues successful?
Feldhaus: The vast majority are successful. There have been incidents where the patient expired on the way out of a cave because it can take a long time to get to them. Also, injuries are such that you can't tell how the patient will do. Falls are the No. 1 mechanism of injury in a cave, and people can get busted up internally. You can't crack someone open to do X-rays in a cave, so there have been people who expired, and that's demoralizing. By and large, if you get the right people en route to a scene, it will be a successful rescue.
RT: What are important considerations when rescuing a patient?
Feldhaus: Before you do anything, put on rubber gloves, because there is trauma that you sometimes can't see, since cavers typically wear coveralls, helmets and other equipment. It may take awhile for the blood to get to the surface, but if you grab someone and pull back a hand covered with blood or other body fluids, you need to be protected.
Then, survey the scene to find out if anything is threatening the person's life. Many times, people fall into water in a cave, so you have to get them out of that water. Do the ABCs or whatever your local protocol is, secure the person, make them comfortable, and get them off the cold ground because hypothermia will kill them.
Additionally, you have to do an assessment--even a neurological and secondary assessment. Write it down, because it may be four to five hours before you get out of the cave, and you'll never remember all of that information. The most important thing you want to do, and many people don't think about this, is ask what it will take for the medical team and rescuers to get to this person. Did you have to climb a steep slope that they're going to need a rope for? Are there vertical pits in the way? You have to make notes on where the patient is in the cave, and you may need to have flagging tape so that if you're too tired to go back in, others can find the person. I always carry a roll of flagging tape and hang it on rocks as I go out so everyone can find their way to the patient.
RT: What training is available for cave rescue personnel?
Feldhaus: The NCRC has weekend seminars that are orientations to cave rescue. We have our own incident command system. If you're on the top of an incident where the command post is set up, it would look just like a regular incident command system. Then there's another incident command system that gets set up underground, so you would learn about that. You would learn how to move a patient through a cave, which is difficult, and how to secure them in a litter. You would get exposed to verticals, and the training would include some medical issues. At the end of the weekend, you would probably do an easy mock rescue, where someone would lie down in the cave a few hundred feet from the entrance and you would rescue them.
The next step would be week-long training. The NCRC offers an eight-day seminar. Level 1 of that training covers different aspects of cave rescue from a team member standpoint. For example, what is a team member's place within the incident command system and what is their place on a haul system? You would need to be able to look at a haul system and see if it's assembled properly.
During the week-long training, we spend a lot of time above ground running people through obstacle courses. We go out to cliff sites, where everyone can see in broad daylight, and we set up haul systems. We call them 'ups and downs,' and we do as many cycles of those as we can. Above all, we emphasize safety first and conservation--there's no training exercise that is worth busting up formations. Later in the week, we take the whole group underground and do the same things. People then discover that they can be 10´ away from someone and not hear a thing the other person is saying because of the constrictive nature of the passage. They also find out that there are no trees underground to rig ropes to!
At the second level of training, you learn how to take the approach of someone who is leading a team of rescuers and the responsibilities of that position.
Level 3 gets into advanced problem-solving. For example, you'll have a water day where you handle only water problems in a cave. When I conducted the Level 3 program, we went into a cave with two carabiners, a piece of rope and one light. We simulated a bad accident. A small group of rescuers had to do a self-rescue with what little equipment they had, and they learned a lot about what you can do with almost nothing. At Level 3, you get into complex rigging systems and the physics of those systems. Additionally, at Level 3, we have people set up a haul system blindfolded.
At the instructor qualification level, you go in for eight days and also student teach, write lesson plans and learn how to educate adults.
Participants have to demonstrate proficiency in tying knots, in handling haul systems and in patient packaging and assessment. It can take anywhere from two to three nights to demonstrate these skills. On the last day of the training sessions, we have a huge mock rescue, usually with multiple victims and sometimes with multiple caves. We may have the easy 'patient' who just needs to be walked out, all the way to the 'critically injured person' at the back of the cave and at the bottom of a long drop, who needs to get out of the cave now. It's a tough eight days.
RT: Are students certified after completing the training?
Feldhaus: The NCRC does not certify people. We train, but we're not a certification agency. There's debate about that. Certification introduces liability concerns, and we're not that type of organization.
RT: What are minimum qualifications for members of a cave rescue team?
Feldhaus: If I were setting up a cave rescue team, I would bring you in as a provisional member, and during your provisional time, you would have to be involved in caving or be an EMS person who shows proficiency in the outdoors. Then, I would require that you go to an orientation class to see if cave rescue is something you can dedicate your time to. Within the first year of your membership, you should complete a first responder or wilderness first responder medical course, and perhaps the NCRC Level 1 course, plus all of the things that your team would require, such as emergency vehicle operation and bloodborne pathogen training. Finally, throughout the ensuing years, I would require that you have continuing education, possibly every other year because of the expense involved, and attend cave rescue training or specialized training, such as how to deal with hazmat incidents in caves.
In addition, a cave rescue team must have specialized gear and members should receive specialized training. Since most rescue squads cannot afford that, what I suggested to local rescue squads when I was national coordinator for the NCRC was that they form an initial response team of five or six people who could respond to 'no-brainer' type incidents, like drunk teenagers who can't find their way out of a cave. The team should also know what resources are available to them within a 90-mile radius of where they are.
RT: How are cave rescue teams funded?
Feldhaus: There are teams that are totally funded by the members of the team. Ninety-nine percent of the gear that I own for cave rescue, I paid for out of my own pocket. If it was not for the generosity of the rescue squad I'm on, I would have also paid for my own training.
Our team is a county agency. We're non-compensated county employees. We have a budget that comes from the county, because in addition to doing cave rescue, we take care of cliff rescue. However, our squad does a lot of fundraising--direct mail, telephone soliciting--you name it, we've done it. There are other teams that are funded by federal grants, and federal agencies like the Bureau of Land Management may put together their own cave rescue teams.
RT: Are most cave rescue personnel volunteers?
Feldhaus: I do not know of any full-time cave rescue units. I know there are full-time paid firefighters and rescue-type people who also happen to be members of a cave rescue team in addition to their other duties. In California, a number of my colleagues are members of the sheriff's rescue squad. It's their full-time job, but of course, they do other things too.
RT: How important is interagency cooperation in cave rescue missions?
Feldhaus: It's important, because you basically have one cave rescue resource for an area. You have to have groups from other areas come in to help.
Typically, we call as many as five other cave rescue teams. We may only get five or six people from each group, but by the time you get that many people from that many teams, you've got a good group of people to handle a cave rescue.
We go into Alabama, Georgia and all the other counties in Tennessee. When you're in there, you're there at the invitation of the emergency management agency for that area, so you need to know what their protocols are and work under their incident command system. What happens is you set up the incident command system based on multiple jurisdictions. All of the jurisdictions will agree on one person being the operations chief, and that will be the person who will run the operation. That person is usually highly skilled and trained in all aspects of EMS plus caving, and can explain to the local rescue squad, which has no idea what's involved in getting a person out of a cave, why it's taking so long.
RT: What are the current controversies in rescue techniques and procedures?
Feldhaus: There's always debate about vertical rescue techniques. Do you go with soft interfaces and load release hitches or can you still use the classic systems that utilize mechanical devices? What is the best way to belay? These are classic debates that are going on both in the underground and above-ground world.
RT: What do you think about billing people who are rescued from caves?
Feldhaus: I think it is a dangerous practice. As a community, we have to come together, and we have tax systems to handle this. If a house burns down, we have a fire department funded by "x" amount of dollars or we somehow distribute the cost of these expensive operations among the community. We either need to charge people and not get the money from the rest of the community, or we need to get the money from the rest of the community and not charge people. If they've done something really stupid, go after them through the legal system. If they violated laws, prosecute them.
The second thing is that I'm a volunteer. If the team or organization that I work for turns around and bills you for an operation, then I wonder about my volunteer status, because you're paying for the service. That takes the whole issue of my liability to a different level. Not that I would deliver care any differently; it's just that I feel comfortable with the insurance that I carry and with my role, because I'm a volunteer and that's the way I want it to be. If you are billing somebody, you're also setting up a precedent that you're always going to be there. We are volunteers. Sometimes, we go on vacation!
Equipment Needs for Cave RescueProper equipment is crucial to the success of any cave rescue mission. Butch Feldhaus says there are a number of considerations that go into the purchase and use of ropes, helmets, lights, clothing and other gear taken on rescues.With respect to ropes, Feldhaus says his team uses static kernmantle rope and that size is often dictated by local protocols. "The local team has its governing documents which tell it what size rope to use," says Feldhaus. "Some use 1/2" rope, while others use 7/16" rope." Because of the rugged terrain found within most caves, rescuers must wear sturdy helmets, says Feldhaus. "You want a helmet that has a four-point suspension. It has to provide good head protection and good shock absorption, and it has to be that four-point deal so it stays on your head. You have to have a chin strap, because if you lean over and your helmet rolls off, you've lost your light too." Lighting is another issue. While some commercial caves may have lights, most natural caves have no source of lighting. "You want to have three independent sources of light, and independent means you don't take the bulb out of one to put it in the other one to work," explains Feldhaus. "Your main source of light should be able to last for the entire duration of the mission, or if the battery doesn't last for the entire trip, you have two batteries. The primary light source should be helmet-mounted and totally hands-free in operation (except to turn it on and off). The second source of light should be helmet-mounted and be able to get you from your furthest point of penetration into the cave out, so if your lamp craters, you can turn around, put this other light on and walk out of the cave. The third source should be something that will work with the other two. I usually carry a little Maglite on a lanyard around my neck. You put it around your neck and under your arm so that if it gets hooked on something, you hang your arm and your neck, not just your neck." Protective clothing is also imperative for the cold, damp, humid environment. "You have to have the proper caving attire," says Feldhaus. "Turnouts are probably the worst thing to wear in a cave, because you'll die of hyperthermia. They're just too heavy. What you need is clothing that will protect you and keep you warm, but that you can also get cool with. I have expedition-weight polypro, and basically over the top of the polypro, I'll wear a T-shirt and a pair of workout shorts. If the poly gets wet, it dries out quickly. That's for normal caving and cave rescue in this area. Sometimes, if I'm going to be in there a long time, I have a ballistic nylon jump suit that I'll wear over the top. I also have a full wetsuit for when we do caves that have a lot of water." Shoes are an important part of the package, says Feldhaus. "In the old days, you used to wear these huge clodhoppers. Now, a lot of people are going for real thin, rubber boots that have Vibram soles on them and a steel toe inside. They wear wetsuit booties inside of them for the cushion, and they work well. You just want to have something that's sturdy, you want to avoid having really long shoe laces so that you don't get hung on things, and you want to have something that grips." Appropriate gloves are also important. "If you're doing rope work, gloves with leather palms on them are important. If you're caving, cheap, rubberized gloves to keep your hands clean are important. Surgical rubber gloves are of paramount importance to protect your hands from body fluids. A lot of people will put those on underneath their leather gloves, because leather gloves will not protect you from body fluids: If they become soaked with body fluids, they will keep those fluids against your skin longer than if you had just brushed against them or wiped them off with a towel. I like caving with neoprene hunting gloves--they keep your hands toasty and clean. It really comes down to personal preference, but you do want to protect your hands." Finally, Feldhaus says good wool or cotton socks are useful, and knee and elbow pads are crucial for when crawling to rescue a patient inside a cave. In addition to clothing, rescuers need to bring with them special litter and vertical rescue gear, immobilization products, underground communications equipment and cave-oriented medical kits. "Litters are important. Just as you can carry a patient out of cave, you can carry a lot of gear into the cave with them," says Feldhaus. The stronger the litter, the better. "Wire baskets do not work, because they do not slide across gravel and rock. They hang up on things, and little things can poke through the wire mesh and seriously hurt a patient. We've always stayed away from litters that break apart, because when you get the patient in a haul system, you don't want them to come undone." With respect to immobilization products, Feldhaus says much of what is used above-ground can be used underground as well. "We don't use inflatable splints-- that's pretty universal. A lot of times, people have already immobilized a patient's injuries just with stuff they have in their caving packs. I've seen some really ingenious ways to splint peoples' arms with rappel racks and cave packs. I saw a mock collarbone stabilized with a life jacket, and the arm was properly positioned and totally immobilized." Communications is often difficult underground, but Feldhaus says it is becoming easier with the development of special cave radios that operate at low frequencies. "They're basically modified CB radios that work at extremely low frequencies so you can go into a cave and speak with someone's radio through hundreds of feet of solid rock. These units fit in a box about the size of an average suitcase and are incredibly directional." Finally, rescuers need to take with them a cave-oriented medical kit, which should include first-aid items to clean and bandage wounds, heat packs for keeping IVs warm and certain drugs carried per protocol. Other necessary items include wool and plastic blankets for warmth and water-resistance, small oxygen tanks and IV bags per area protocol. --Mike Spivak |