This past summer I went exploring with my great friend and photography colleague Erin Babnik. One afternoon we had quite a trying and harrowing experience. Here is the story. I'll follow that up with some thoughts on wilderness medicine as I recently became a certified Wilderness First Responder, which was very much influenced by this experience. If you've read the story before, you can skip down to the bottom.
The image above is of Tre Cime, and you could perhaps call it the sweetheart of the Italian Dolomites, loved by the Germans and Italians, and frequently visited by them in droves. It needs no introduction. Erin Babnik and I spent a couple days here during our recent travels in the area. At this point on our trip the weather had begun to fall into a pattern that was far less than ideal that consisted of clear mornings and stormy afternoons, usually with clouds forming so thick that by the end of the time when the shooting would be good, there was no light to be seen; but by morning, they were gone again! It was wearing us down as it made it difficult to get the really great light we of course wanted. However, we mustered up some hope on this particular afternoon as the storms rolling through seemed charismatic, especially when the lightning started striking off in the distance as we hiked out in pursuit of our yet-to-be-found compositions.
When we first got to this spot, I had not even placed my gear down, or even turned around to look at the view when I saw a flash in my peripheral vision and an almost instantaneous BOOM crackled through the air. Erin and I jumped and spun on our heels in the direction of the flash, and only moments after we began to hear the unmistakable sound of falling rock echoing from within the chambers and canyons between the massive peaks of Tre Cime and across the valley. It was immediately evident that lightning had just struck one of the peaks of Tre Cime directly, exploding rock apart, which now crumbled down somewhere in between the monoliths. We stopped, stared, and verbally expressed our awe as the crumbling resumed for a length of time, slowly fading as the last few smaller rocks found their way down to their final resting places. We tried to see the rockfall, but there were no visual signs of it. When the shock of the experience wore off, we knew that we needed to get to work. We had an opportunity to get shots of lightning around Tre Cime, maybe possibly even striking the rock formation again. How amazing that would be! We were bummed that we hadn’t left 10 minutes earlier… maybe we could have captured that strike!
We loaded up our fastest and largest memory cards, set our cameras to burst mode, and began firing away. It was not dark enough to do long exposures, and neither of us own a lightning trigger, so the spray-and-pray method was all we had. Our buffers filled, and the cameras began to lag. It seemed like every time we stopped firing to let the buffers catch up—sure enough—the lightning would strike! It was frustrating to say the least. The clouds rolled over the peaks, and strikes continued, seemingly getting further and further away, as we continued to miss them while our cameras caught their breath. I ended up catching a few strikes, this particular one being the best. I was excited to have caught it, but that’s not the end of the story!
Satisfied with what I had captured, I relaxed, stepped back from the camera to let myself take in what it was I actually seeing. It’s easy to forget the moment that you are experiencing when you get lost in the camera and the pursuit of the image. Soon after I began to focus on my surroundings, and the beauty I was so lucky to experience, I heard something. A distant cry racing through the air across the valley. It was vivid and clear, bouncing of the huge walls of rock like a megaphone. A few moments passed and it hit us again, only this time we understood.
‘HILFE… HEEELLLLLPPPP! HILLLLFE’
To be quite honest, our world is so full of noise, and crying wolf, initially hearing this had no effect on me. The scenarios ran through my head, ‘oh, someone’s down there screwing around.’ And I didn’t think much more of it. We began scanning the trails below, looking for people and who the yelling was coming from. It was then that we noticed two people hobbling around the corner just north of the saddle.
Ok, they had my attention. Erin’s too. That audio cue zeroed our vision in to the source. The two people were close to each other, but too far away for us to understand what was going on with them. Erin began to yell down to them, and while I can’t remember exactly what she said, it had something to do with asking what the problem was. She chose to go to their aid, and I decided to stay up with our gear. “Grab my first aid kit and bring it to me if I yell up for it!” She shouted as she trotted down the trail. I watched her descend, quickly reaching them as they crested the saddle. They huddled together for a few moments, but they were still too far for me to be able to tell what was going on. Shortly after, Erin yelled up to me for the first aid kit, which I quickly found, along with my trekking poles and a surge of adrenaline to rush to the aid of a person in need. If you follow my work, you may recall my story on a previous image about how I had flared up a chronic knee issue when I first began my trip. Luckily, as I raced down the trail, that injury, which I had slowly been recovering from, was now not an issue. Just in time!
When I reached them, they had already begun their descent down the trail to the nearby refuge hut. (You can see the trail to the hut in the image going down the bank on the left side of the peaks.) As I closed in, it became clear what was going on. They were two climbers, a man and a woman, and the woman was slowly limping her way down the trail, flanked by her male companion on her left and Erin on her right. Blood covered the woman’s right leg, and as I caught glimpses of her right arm from behind, I could see that her hand was completely red, and a couple of her fingers were now only vaguely recognizable as…fingers. The man acknowledged me reaching them, and began to fill me in on what happened as Erin gently held onto the woman and gave her verbal cues about where to step, trying to find the path of least resistance.
The lightning strike we had witnessed, and the resulting rockfall, had a victim. Them. They were climbing when it happened and were on their second belay when the lightning struck and went right through them. Worse still, they were in the path of the rockfall, with the woman bearing the brunt of the onslaught. Smaller remnants of the rocks were stuck in the man’s chalk bag and his climbing helmet was smashed as proof, if the tattered appendages of the woman weren’t already proof enough. He seemed to be fine, and braced her, trying to help her take the weight off of one leg which she seemed not able to bend, as they made their way down the trail towards the hut.
We eventually reached the hut, and since we had sent a passing hiker ahead to it to alert the staff, they rushed out to help, trained to be able to properly manage these situations. As the two climbers were rushed inside through the dining room and into a distant room, Erin and I stopped and watched them disappear around that corner. We glanced around at some of the other people who had ultimately walked down the trail with us, exchanged various terms of amazement and shock, and eventually left the hut to return to our gear, which was still sitting up on the mountain where we had been shooting.
When we reached our gear and began packing up, the distant drumming of an E-vac chopper grew louder. It landed, people walked out to it, holding a stretcher…obviously the injured woman, and then it flew away. It seemed like she would be totally fine, and we later learned from a staff member of the hut where we were staying that she had a broken arm and leg. It makes me all the more amazed that the woman made it that far with such substantial injuries!
I’m glad that the couple are safe, and (I imagine) are now recovering fully from the disaster. It’s interesting to look at this picture and think that at the moment I shot this, they were most likely back within the peaks, fighting for their lives and trying to get out safely. I’m glad to have this image as a reminder of the experience.
A couple weeks ago I returned home after a jam-packed 5 day instruction course that involved 30+ hours of pre-course prep work in order to become a certified Wilderness First Responder. This training gives me the tools to respond to situations exactly like the one you just read. After these events unfolded, Erin and I found ourselves frequently asking if we did the right thing, and if not, what was the right thing? As I worked through the course, I began to piece together the proper protocol for something like this, but it was still a confusing situation. By the time our paths crossed with the couple, they had already gotten themselves that far. There was still a danger of of lightning. Her injuries were unclear. A hut with plenty of help was not far away(maybe a 15 minute walk at a normal pace).
So what was the right course of action? Well, it's not exactly black and white, but, it's pretty easy to rule out a lot of potential dangers and anticipated problems. My training as a WFR gave me the skills to properly assess a situation very quickly, and then organize a proper response. The first thing to always do, known as the primary assessment, is to check the three critical systems an individual needs to live. The circulatory system, the respiratory system, and the nervous system. Given the fact that this person had just walked themselves to this point, it was pretty safe to conclude that the circulatory system and respiratory system were functioning. The more pertinent questions to ask at this point, since the person had been showered by falling rock, were was her spine injured, and/or did she suffer a blow to the head strong enough to cause a traumatic brain injury? Being knocked unconscious by a blow to the head is strong evidence that a traumatic brain injury may have occurred. But, I don't recall anyone saying anything about her being knocked unconscious. Also, the trends of a persons mental state can also indicate that something is wrong with the nervous system, and this lady was awake and oriented, not degrading mentally, further suggesting that she had not suffered a TBI. In hindsight, I think it was safe to rule out that it wasn't a concern.
The only thing left to check with the three critical systems was her spine. And this is where things get a little grey. She had just walked out of where the couple were climbing. No small task. Could she have done it with a spinal injury? Well, maybe. A spinal injury isn't always debilitating, so the fact that she had just traveled the distance that she did doesn't really allow me to conclude that she was clear of a spinal injury. In hindsight it probably would have been worth while to have her lay down and do a full spinal assessment in the field. But, you also have to consider the scene. Actually a 'scene size up' is the very first thing you do when approaching a patient in the field. Simply put, is everyone on the scene safe from potential further injury? Well, in this case, maybe not. There was a storm passing through with lightning. More grey area. Given that scenario, and the fact that she had just traveled the terrain that she did, I would have skipped the spine assessment and moved on to other matters. At this point, it is safe to conclude that this person is not in any IMMEDIATE life threatening danger, other than the possibility of getting directly struck by lightning. And that went for the now, 6 people standing up on a very exposed saddle, with a lightning storm looming nearby.
At this point, I would have moved on to what's known as the 'secondary assessment'. Basically taking a look at the injuries the person has sustained, how urgent of treatment was necessary, and what potential problems may develop. From my inexperienced recollection of the person, she had suffered a substantial wound to her fingers, had bled a lot, and her right arm and leg were very painful, but from what I remember, did not show any disfigurement. With a wound, the first priority is to get it to stop bleeding, which I honestly don't remember if it had or not. I wasn't that interested at the time in looking too closely. It was obvious she had done quite a bit of bleeding, as her arm and parts of her leg were covered in it. The immediate threat with bleeding is volume shock, or a massive loss of bodily fluid(blood or water). It's highly unlikely that bleeding occuring in outter extremities like this will cause volume shock in any short amount of time. Probably not even over a longer period of time if left unchecked. There just isn't enough blood moving through that area for that to occur. This would have been ruled out in the primary assessment as it would ultimately be a problem with the circulatory system. Other than a lot of pain, this wasn't a life threatening issue that needed a high risk evacuation. The other concerns were her limbs, which she was saying were extremely painful. Fractures? Maybe, hard to tell. As stated earlier, they didn't seem to be disfigured, and obvious sign of a fracture. Ideally when a fracture is suspected, you would want to check the circulation, movement, and sensation of the appendages beyond that fracture. So in this case her fingers(which at this point were badly mangled) and hand, and her toes/foot. Checking this would indicate if circulation and/or the nerve bundle supplying the appendage had been compromised. This can result in long term damage and has to be addressed immediately. It would have been relatively easy to check her foot and toes, but her hand, not so much considering her substantial injury to the fingers. Even still, is doing all of that worth leaving the person at risk of environmental dangers? And if we did do it, and determined that CSM was impaired, is it worth a 'high risk' evacuation of having a chopper come and land on a narrow saddle? My hindsight assessment is NO. Especially considering that a hut with a landing zone was a mere half our down the trail. Something WFR's learn is being able to properly determine risk involved with evacuation. There is a saying, don't plan a high risk evacuation for a low risk problem. That would have definitely been the case in this specific scenario.
Further more, the persons wishes need to be respected. The couple did not want a helicopter evacuation because they were worried about the cost. As a WFR I can't force anyone to do anything, and they didn't want that, so... end of story! Off to the hut you go. It's funny however, because sure enough, the couple was evacuated from the hut via helicopter. But that may be more a result of Europes chopper-happy nature rather then the immediate medical needs of that particular patient.
So there's that. It was very interesting for me to think back on this incident in hindsight with the training I now have. There is always grey area in these situations, but in the end, I'm just happy they got out of there and will be ok. I can't think of any situation where her injuries would have caused any major problems down the line. It's possible should could have suffered permanent damage to her hand, but, considering what happened... she's lucky. Hope you enjoyed the read! If you have experience with wilderness medicine, I'd love to hear your thoughts on the situation!