FALL ON SNOW - SKI MOUNTAINEERING

Alaska, Mount McKinley, West Buttress

On June 28 at 1315, a climber (32) fell while skiing down from the fixed lines on the way to the 14,200-foot camp. National Park Service Ranger Dave Weber and a Volunteer-In-Parks doctor watched as the climber fell towards the bottom of his run. He fell forward while moving at a high velocity and a sudden deceleration brought him to an abrupt halt in the snow. Due to the fact that the skier was ambulatory very soon after the fall, NPS personnel did not respond immediately to the scene. At 1400, one of the climber’s partners reported, “He thinks that he broke a rib.” His partners were instructed to assist the climber from their tent to the NPS medical tent.

The patient assessment care report (PCR) notes pleuritic left focal anterior rib pain and vital signs within normal limits (except an elevated blood pressure, of which the patient had a history). Due to the fact that the NPS helicopter was in close proximity on another mission, the climber was continuously monitored to determine whether an evacuation would be required. Although he did not exhibit any signs or symptoms of an underlying lung injury, concerns about the possibility of a pneumothorax prompted continued assessment. Later that afternoon it was determined that an evacuation would be necessary and this information was relayed to Talkeetna.

During a resupply flight that afternoon, the climber was loaded into the helicopter and flown to the 7,200-foot camp. He was released to return to Talkeetna via an awaiting taxi service plane.

Analysis

The potential for a life-threatening injury was the justification for the air evacuation of the climber from the 14,200-foot camp. This evacuation emphasizes an important point concerning rescues facilitated by the NPS on Denali. Due to the remote and dynamic mountain environment, evacuation decision-making differs markedly from that in the 911 emergency system. The risks involved with rescue operations, including air evacuation, from 14,200 feet, although manageable, can never be negated. It is for this reason that we do not utilize these resources before careful scrutiny. It is always prudent to make evacuation decisions based on likely scenarios and the information gathered during on-going patient assessments. However, there are times that due to weather, resource availability, and other external factors, decisions must be made based on the possibility of the worst-case scenario unfolding. (Source: David Weber, Mountaineering Ranger) (Editor's Note: There were a number of medical issues on Denali this year. These were not considered “accidents” because they did not happen as a result of climbing. The HAPE and HACE cases that happened because of ascending too rapidly, however, are counted—and reported on—though not all appear in the narratives above. The medical episodes included several separate guided clients and two nonguided climbers developing AMS and then HAPE signs and symptoms after a normal ascent time; and a 5 5-year-old client with a previous history of a kidney stone who experienced severe abdominal pain. All these resulted in evacuation from the mountain.)