FALLING ROCK- DISLODGED BY DAY-PACK, POOR POSITION

California, Yosemite Valley, Cathedral Rocks

On August 12, Sarah Sand (59) and eight friends started up the Gunsight, the class 4-5 gully between Middle and Lower Cathedral Rocks. David (58), the leader, had been bringing friends on this climb for several years. As usual, he had given the beginners, including Sarah, at least one day of instruction at a local climbing area to get them competent at basic skills.

By 1130 they had scrambled up the 2nd and 3rd class scree slope to the base of the first roped pitch, a 70-foot buttress blocking the gully. The Gunsight is full of loose rock, so at this point, as was his habit, David talked about rockfall hazards and made sure they all had their helmets on.

The group waited at the base of the pitch while David climbed. At the top he set down his day pack while he established an anchor. The rock surface was solid, with just a few chunks of granite scattered about, but the pack brushed a grapefruit-sized piece and sent it rolling toward the edge.

David lunged after the rock, but he knew it was too late. He yelled “Rock! Rock!” hoping the group would hug the cliff as he had stressed in his talk. Everybody below yelled “Rock!” and ran for cover. Sarah was standing on a ledge along one wall of the gully, 30 feet away from the rock’s fall-line. She started to move but thought better of it and crouched down where she was, covering her head.

The rock bounced outward, striking her in the back, on the lower left ribs. There was instant pain in her side. In a few minutes it was clear that this was not a blow she was going to recover from on the spot, nor would she be able to walk out, so two members of the group went for help while the rest tried to make her comfortable. After half an hour, Sarah’s stomach started burning. She thought it was just nerves, or maybe heartburn, so she took a couple of Tums.

The reporting party drove up to the NPS SAR Office at 1415, about two- 0and-a-half hours after the accident. I left for the scene 15 minutes later with two other team members. When we arrived, at 1515, Sarah was lying on her back on a sloping ledge, kept from sliding down the gully by her friends. She was fully alert and outwardly calm, even displaying a sense of humor. There was nothing in her personality that might raise the alarm. Her vital signs were normal for her, she could breath without difficulty, and her lungs were clear.

There was pain where the rock had hit her and the site was only bruised, with no significant deformity. It hurt to move and she could feel a “crunchy” sensation suggestive of broken ribs.

The “heartburn” under her diaphragm increased when we pressed gently on her abdomen. Palpating the left upper abdominal quadrant caused “muscle” pain in that area and also down her left arm. Deep breathing caused pain in her lower chest and down her arm. (With no trauma besides the rock’s impact, the arm pain was probably “referred” pain, a frequent symptom of internal bleeding.) There was no abdominal rigidity or guarding.

Her symptoms did not seem to have worsened much over time except for an increase in “heartburn” along her sides, but all of these observations were signs of potentially serious internal bleeding, and the mechanism of injury suggested damage to her internal organs.

We gave Sarah oxygen and IV fluids, and packaged her in a litter. Because of the mechanism of injury and our physical exam, we were able to rule out the need to immobilize her spine, making packaging faster and more comfortable for her. The oxygen and IV seemed to ease the pain, but if she did have serious internal bleeding, she would need surgery as soon as possible. The most important field treatments were gentle handling and a fast rescue.

We had hoped to evacuate Sarah by helicopter short-haul, but shifting winds aloft made the tight quarters in the gully too dangerous. As other team members arrived, they began rigging belays, and with the help of a guiding line, we worked our way down the gully, lowering the litter over short drops and negotiating very loose terrain. When the litter briefly dipped footward over a steep section, Sarah fainted until she leveled out again—a strong indication of blood loss.

We reached the road at about 2000, eight hours after the accident. Sarah went by ambulance, then by helicopter to Doctors Medical Center in Modesto. She was admitted as a “code blue”—a patient in a life-or-death situation—and taken to surgery. The hospital staff estimated that by the time she arrived, she had lost a third of her blood to internal bleeding.

Sarah had seven broken ribs, a damaged kidney, and a ruptured spleen—the primary source of bleeding—as well as other complications that arose during her recovery. The spleen was removed and over the next two months she was in and out of the hospital several times. She returned to work and normal exercise.

Analysis

David: “I’ve been climbing and watching my step for 40 years. But when I put that pack down, I just wasn’t careful enough. I’ve relived it in my mind 100,000 times.”

Almost every climber has caused rockfall. Most of us were simply lucky that the trajectory did not include our partner. David is right—you simply cannot let down your guard.

David had suggested to his friends that they avoid falling rock by flattening themselves against the cliff. That is often the right move, but if you have time, first look up to judge the rock’s path. Maybe what you see will suggest a better response, realizing, of course, that rocks can take crazy bounces. Also, avoid belaying or standing around under the climber if you do not need to be there. If you cannot keep everyone out of the way, take a small group in the first place. This had been David’s practice in the past and will be in the future. He also made the point that the tendency of a large group of friends to socialize may distract them from the business at hand. Finally, this case is a good reminder that blunt trauma often results in a hidden but potentially fatal injury. (Source: John Dill, NPS Ranger, Yosemite National Park)

(Editor's Note: The lengthy description of patient assessment and care was left in to demonstrate what the quality of emergency care in the wilderness should look like.)