I’ve been quite lucky personally in the backcountry, but I’ve dealt with a number of others that I’ve been responsible for. The scariest one, hands-down, was a woman who had spontaneously developed internal GI bleeding, and was going into serious shock, while I was leading a trip on a remote stretch of coast in Chilean Patagonia.
Internal issues are obviously very hard to diagnose in the field, and she was clearly going downhill fast. This was before sat phones became required equipment on those trips, and we couldn’t get a response from the Navy on the regular VHF hailing channels. I finally made the call to active the EPIRB, but in that part of the world, that could still mean 24 hours or more before a response. In desperation, we finally hiked to a fishing village, found someone with an open boat and enough gasoline to make the 11-mile trip to the closest port town with a hospital. It was upwind against a 15-18 knot breeze and opposing seas. Did I mention it was an open boat? It was brutal trying to transport someone that way who was in pain with every slight movement.
More than any other backcountry first-aid experience I’ve had, that one really spooked me. Had just a few factors been different – such as if we hadn’t made the decision to cross a very exposed, 3-mile channel the day before, if there hadn’t been a village within hiking distance…we could have had a grave situation on our hands.
My take home lessons from that? Always have multiple contingencies planned, make sure your systems are tested, know the emergency response options in your area, and be conservative when it comes to internal/GI issues in the backcountry. Better to evac someone for something that turns out to be benign, than have someone going into septic shock, hours or days from qualified help. And we tend to focus a lot on injuries that can happen in the backcountry, but first aid scenarios that don’t involve injuries happen too. And you don’t need to be in a remote part of the world for all of that to be true.
