Print Edition - 2016-02-04  |  Health and Living

To Prepare for the Worst

- Post Report, Kathmandu

Feb 4, 2016-

Accidents for starters come unannounced. They can take place anywhere, anytime. It’s a matter of being prepared with the right set of skills and equipment to deal with the situation at hand. Anuj D Adhikary explores stories of two medics, specifically Wilderness First Responders, who used their training and judgment to tend to patients in physical distress . 

Trekking Guide

Jagan Timilsina 

In light drizzles of a monsoon evening came a shriek of skidding tyres and a deafening crash. On the sharp bend by the Trishuli Highway, the traffic came to a grinding halt and what followed were loud moans and cries of pain. A bus full of passengers had 

had a head-on collision with a truck in Dhading’s Beni Ghat bazaar. 

Chaos and confusion ensued. Visibly shaken, passengers from the ill-fated bus got off one by one, as 

did the truck crew. Some limping while others bloodied with bruises and lacerations.

Trekking guide Jagan Timilsina and adventurer Sam Worth were on a microbus just a pick-up behind the bus but in a deep slumber didn’t see it happen. The loud noise and sharp brakes woke everybody up. It was by pure chance that the 31-year-old mountaineer and his company were both certified medics, and as had their training mandate, they rushed to help. Always handy with his first aid kit, Jagan got to work without a second to waste. Here is his account:

It was devastating to see the fear and pain in people. Many were disoriented and trying to make sense of a mishap they just survived. By this time, people from the nearby market rushed in to help and while everybody was brought to safety.

I tended briefly to a handful of injured people but realized the injuries they sustained weren’t grave. When I turned towards the bus, I noticed the driver struggling to get out of the bus but could not move from his seat. He was stuck thigh-down in a tangle of metal and wire of his cockpit smashed against the truck. To make matters worse, I could see a pool of blood on the road. The driver was losing a lot of blood. At this point I knew we had to act fast.

Sam and I got to the cockpit. We had to rescue the driver. We tried to tear out the seat while another tried to unscrew the handle bar. During this period I made sure he was reacting to our presence and talked to him to keep him conscious. We checked his pulse every so often, but things were looking bleak.

It was terribly sad to see how slow the emergency services arrived and even when they did, they were ill-equipped. Instead of taking the lead, they ended up waiting for our instructions. I knew I had to stay calm and composed, especially during an emergency like this. By this time, a huge crowd had gathered about taking pictures of the driver’s ordeal. It was heartbreaking. However, we tried not to get distracted and kept our attention on the problem at hand.

A tourniquet would have helped here but with shards of glasses all around, it would have further complicated the problems. Therefore, we focused on freeing him from the seat, which seemed of immediate priority. Yet all attempts failed. I noticed his pulse was getting weaker and he was getting nauseated and less responsive to verbal and physical stimuli.

Getting hold of a bystanding police personnel, I asked a police personnel to summon a bulldozer and tow the bus back from the truck. After putting all our energies together to pull the bus back, the driver’s leg was finally freed, but not without dark pigmentation from the trauma and a compound fracture at his ankle. By the time we put the injured driver in the ambulance and on his way to the hospital, we had altercations with several individuals, including the security staff. It was because just getting him out wasn’t important, but to get him out alive was. And that’s what we were trained for, with time but of essence.

Perhaps I would have simply been a face in the crowd, taking photos of the ordeal and cringing at the site of bloodied patients and a bone sticking out of the driver’s broken ankle. But thanks to Wilderness First Aid training I received, I was able to act professionally and even with limited resources, I’m glad to say that we rescued the driver alive from the crash alive and rapidly evacuated him to the nearest medical facility.

Mountain Biking Guide

Shyam Limbu

The windy trails of Mustang, the last Kingdom of Nepal, draws thousands of travellers every year and the holy pilgrimage site of Muktinath is no exception. Exceedingly over the years, the region has gained a reputation as a mountain biking and trekking mecca, for domestic and international tourists alike. Not everyone however is able to handle the high elevation and suffer varied symptoms of high altitude sickness that can be gradual or rapid, mild or severe. Such was the case with a mountain biking clique in Muktinath when a client developed rapid symptoms of altitude sickness and guide Shyam Limbu had to act swiftly to what could have possibly been a fatal case.

In mid January this year I was on a 16-day mountain biking trip with clients and everything was seemingly perfect, with the season and weather in our favor, though slightly cold. Our routes followed the cross-country hills from Kathmandu to Pokhara along backroutes, via Nuwakot and Arughat. The countryside was stunning and we reached Pokhara before no time. The group was very much in good shape to comfortably navigate until Pokhara, after which things took a different turn.

After boarding a rocky flight to the windy town of Jomsom, we assembled our bikes in the surreal desert landscape of lower Mustang and took a jeep up towards Muktinath after breakfast. From Pokhara’s 900m in altitude, we reached Muktinath’s 3,800m. Though this route is one that many travellers take, it can definitely take a toll on an untrained body.

It was then that a client started complaining of chest pain and showed symptoms of mild altitude sickness. People generally tend to think it’s only slight discomfort and nothing too serious. Nonetheless, I prepared to treat him and abate the situation as he had tell-tale signs, which included difficulty in breathing, tired and weak at rest, coughing, headache and slow pace of movement. “Are you able to breathe fine?” I’d ask him, but he would nod and tell me it’s from tonsil inflammation. As a test, I asked him to walk on a straight line with the toes of his one foot touching the heel of the other. He failed to do so, and I deemed it could be acute mountain sickness. However, I didn’t want him to get too nervous about the situation, so didn’t tell him it could be from high altitude though I kept an eye for deteriorating symptoms.

Unfortunately, they did. As I continued to monitor the patient’s skin color, temperature and moisture, the signs were obvious: pale and ry with signs of dehydration. I inquired about his sleeping, eating and fluid consumption pattern, to which he said he hadn’t gotten much sleep the night prior and neither had he eaten well or drank plenty of water. This may well have been a contributing factor for the predicament.

With his complaints of headache getting worse, I decided it wouldn’t be a sound idea to let him sleep, and that would aggravate the situation. Rather he would have to be alert and good senses. I kept talking to him while the rest of the group cooperated and helped with getting soup and hot water for our mate. Meanwhile I arranged for us to be transported to Jomsom so that we reached lower altitudes where the condition would hopefully improve.

Along the 45-minute jeep ride down, we kept him warm and had garlic soup with lots of hot water. We’d descended nearly 1,100m when we arrived in Jomsom. Though it was quite dark, we checked into a hotel and wrapped him in sleeping bags and blankets as he complained of cold. More hot water, soup and bread followed by the fireplace.

For the rest of the night on regular intervals I continued to monitor his vital signs to include his level of responsiveness, heart rate, respiration rate, temperature, pulse and so forth. It was a relief to see rapid improvement in his condition. His skin color turned from pale to 

pink, and he was getting more responsive to stimuli and aware of his orientation. By the break of dawn, he had fully recovered and after a hearty meal was ready to continue the biking trip.

It is therefore crucial to identify and tend with priority patients with high altitude sickness. Left untreated, the patient might fatally suffer from pulmonary edema or cerebral edema, which are lungs literally drowning in fluids and brain inflammation, respectively. I’m glad I was trained and equipped to successfully treat the patient that night in Muktinath. It was a reminder that anybody, regardless of their physical build, is prone to sickness and mishaps, especially in the outdoors at high altitudes. And more importantly, one should be properly trained to attend patients in any such cases to improve their chances of survival.

Published: 04-02-2016 09:03

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