An accident at Bedrock Rapid approximately two weeks ago (@9/22).
I know one of the people on that trip, and encountered that same trip two days later. We discussed the incident at length. Due to the nature – and outcome – of this incident, there are valuable takeaway points that could be helpful for others in a similar situation. As such, I have received approval to share my knowledge of the incident in this forum, but I only do so with the following conditions:
1. To protect people’s privacy, I will not identify any of the persons involved.
2. I will only provide information and details regarding the incident that have been related to me by those involved. No one reading this should speculate or make further assumptions.
3. The details contained in the following narrative are the sum total of details I will reveal regarding who, what, when, and how events unfolded.
I will refer to the primary rescuer as “rescuer”, and to the victim as “patient”. There were several other people who played key roles in the response to this emergency. All of these people were participants on this river trip. Also to protect privacy, I will refer to other rescuers and participants of this trip, as persons “A”, “B”, and so forth.
About half of the trip participants had made successful runs at Bedrock, including the rescuer, who was holding in the ‘pick-up’ eddy at the bottom of the rapid. Rescuer observed another boat from his party entering the rapid, and missing the line that would take the boat down the right side of Bedrock. This boat hit the upper end of the island and went sideways, with the boatman being ejected from his boat and onto the nose/upper end of the island. As he fell off the rock and into the water on the left side of the island, his boat flipped and landed on top of him, then both the boat and boatman went left of the island at Bedrock. At this point, this boatman becomes the patient.
The rescuer, who was closest in proximity, immediately left the eddy to make his way to the bottom of the island to affect a rescue. Along with the rescuer, two other of the trip’s members, A and B, were very near the rescuer’s boat, and they were able to get the patient out of the water and onto their boat. Both of these boats reached the shore at the same time, and while A tied off the boats, rescuer and B got the patient to shore, where they removed patient’s PFD and checked for respirations and pulse. The patient was blue in color, was not breathing, and had no pulse. While rescuer initiated CPR, B assisted with compressions, and continually monitored for a pulse. They continued compression-only CPR for approximately 4 – 5 minutes. The patient then began sputtering, spat up a very small amount of water, and regained spontaneous respirations. Everyone on the trip responded to the scene as quickly as possible. About the time patient was showing a response to treatment, participants C and D arrived, and immediately provided additional assistance with patient care, and began planning for an evacuation. Within a short time, patient was verbally responsive, with a strong, regular pulse and was aware of his surroundings and events.
Rescuer retrieved the satellite phone to call NPS for assistance and evacuation. From this point on, the patient was able to maintain his current level of consciousness, was ambulatory with assistance, and was able to help himself get to the helicopter when it arrived. Follow up reports via satellite phone the next few days confirmed that the patient had been evaluated and observed for at least one day in the hospital, then was released with no apparent deficits or permanent injury resulting from this event.
The primary reason for sharing details of this incident should be obvious. First, the rescuer recognized the severity of the situation, and realized he had to act very quickly. Second, when the rescuer assessed the patient, he and others immediately began compression-only CPR. This is a takeaway point worth talking about.
There has been an increasing body of evidence that compression-only CPR can be very effective in certain situations. For instance, as the sole rescuer on a scene, or perhaps even having witnessed the cardiac arrest, immediate initiation of treatment is critical. Once a victim is in cardiac arrest, there is little time to act and have a positive outcome.
Basically, in cardiac arrest, the heart is not performing its function of effectively delivering oxygenated blood to vital organs – namely the brain. Normally, the function of the heart maintains what is called ‘perfusion pressure’ (the precise necessary perfusion pressure differs with specific organs). This perfusion pressure is also particular to ‘coronary perfusion pressure’, which essentially provides much-needed oxygen to the heart muscle itself. In cardiac arrest, all perfusion pressure ceases to exist. When effective compressions are initiated, the perfusion pressure can slowly rise to an effective level thereby oxygenating these vital organs. When compressions stop, perhaps to give rescue breaths, that perfusion pressure again drops to zero. The time it takes for the perfusion pressure to reach an effective level is also unclear, and differs to specific organs. The point is, once compressions begin, maintaining the achieved perfusion pressure is important. Further, in many cases it is likely that the residual air remaining in the lungs – and the oxygenated blood in the cardiovascular system from before cardiac arrest will contain sufficient amounts of oxygen to perfuse some vital organs for a short time. Fast, deep and effective compressions can often move enough of this residual oxygen and oxygenated blood to the organs without the immediate need for rescue breaths. If and when a second rescuer arrives, that rescuer can give rescue breaths without the first rescuer interrupting compressions. From this, it is logical to deduce that maintaining a perfusion pressure, vs. having it fall and rise several times, would lead to more positive outcomes. Again, there is an increasing amount of evidence that supports this idea.
It is very important to note that compression-only CPR is not recommended – or necessarily effective – in all situations. However, in this case it seems to have led to the best outcome one could ask for. I would recommend everyone research this topic on your own, and evaluate for yourselves. Also, I would recommend talking with your CPR instructor about this issue when you take your next refresher course.
Given all factors, this particular situation is one in which compression-only CPR was indicated – and ultimately effective.
This incident had the best of all possible outcomes, due to the actions of everyone involved. Personally, I would like to give the best compliments and kudos to all. This was a potentially tragic situation that turned into a job very nicely done!!
Finally, it is critically important that ALL of the members of this trip deserve credit for their actions during and after the accident. EVERYONE on this trip should be proud of the role they played in such a successful outcome!