Patient Access
Patient Access is the process of moving from your current location to the location of the patient. Occasionally this is as easy as walking a few steps when they have fallen at your feet. As the complexity of the access increases so does the number of skills and experiences you must have in order to gain access as efficiently as possible.
The mnemonic TRAPD can be used to remember the skills associated with patient access and rescue.
T-Transitions
R-Raising
A- Ascend
P-Prevention/Planning
D- Descend
Transitions
A beginning is the time for taking the most delicate care that the balances are correct.
Manual of Muad'Dib by the Princess Irulan. Frank Herbert, Dune
Transitions are dangerous. Knot passes, converting from up to down, untying knots and taking of crampons are all examples of system changes or transitions that increase the amount of factors that can fail.
Weather changes and transitions from climbing mode to rescue mode are larger picture adaptations that should be considered while traveling in climbing environments.
Raising
Raising, also known as hauling is the act of pulling a climber up. While the assistance provided by gravity almost always makes going down to the stricken climber there are times when patient access is best suited for raising them to the belay. A simple case where this may be true would be a climber being belayed from above directly off the anchor and then is struck in the arm by a falling rock rendering that arm broken and unusable. The injured climber is fully capable of communicating an ability to assist but can not climb without help. The needed help may be conducted in the form of a 3:1 mechanical advantage system in which the belay rope is run through a carabiner attached to the loaded line with a friction hitch.
This simple system may provide enough assistance for the injured climber to finish the climb completing the patient access task.
Ascending
Ascending is the term used to describe directly climbing up the rope. Much of the fire and rescue community calls this act climbing. This course is directed toward those familiar with the term climbing related to moving upward using hand and foot holds provided by terrain. We will therefor refer to climbing as the recreational activity and ascending as moving up a rope.
While we have differentiated between climbing and ascending keep in mind that climbing up to the patient using top rope or lead techniques may be a much more sensible solution compared to ascending. The simplest example of this would be a simple hike up to the ledge where the injured climber is located.
There are four components of an ascending system.
1. A seat
2. A step
3. A progress capture (ratchet)
4. Appropriate system back up.
The seat provides the ability to stop during the ascent. It generally consists of the person ascending attaching the rope to their harness using the progress capture.
The step provides the person ascending to move upward from the seat and move the rope through the progress capture in order to regain the seat at a higher point. This is frequently conducted by attaching a friction hitch to the rope being ascended above the progress capture and attaching a foot loop to the friction hitch. The foot loop becomes the step.
The progress capture is used to allow the seat to be moved up the rope after the step up occurs and slack pulled through the progress capture. A common example of a progress capture is an assisted braking device such as the Petzl Gri-Gri.
While not a component of the system directly facilitating the ascension using appropriate back ups during the ascent is highly recommended. Many variations of ascending systems use techniques not rated with the same strength and failure prevention as our primary climbing systems. Examples of common back up systems include tying knots below the progress capture and placing hard knots into a carabiner attached to the belay/rappel loop below the ascending system.
Prevention/Planning
The patient access process is a major transition in and of itself. As discussed during the Transition section the change from one system to another is ripe with failure points. The change from a recreational climbing mindset to a rescue mindset can be dramatic. The urge to rush into the rescue (rescue fever) must be controlled. Taking the time to plan steps for gaining patient access can go a long way in preventing the situation from getting worse instead of better.
Slow is smooth. Smooth is fast.
Descending
Descending is the process of getting down. Descending should be thought of as equally important to climbing as it makes up 50% of the time spent in the mountains. There are some key differences between going up and going down that should be considered.
- Going down is gravity assisted which tends to increase the speed of any mistakes.
- Going down is often conducted later in the day, during changing conditions and when we are tired.
- Going down is often more equipment and system dependent.
- Going down is often done more passively and without the attention generally given to climbing.
These factors place additional risk to downward movement when compared to upward movement.
Types of Descent
Walking off: Walking off a climb may be the easiest and safest of all options for getting down.
Down climbing: Down climbing requires a significant skill set as it requires gaining foot holds that are less observable than while climbing up. Down climbing would seldomly be the best option for accessing an injured patient.
Rappelling: Rappelling is the act of descending a fixed rope. This can be done using a single rope tied off (fixed) to an anchor or using two strands of a rope secured (not fixed) either in its middle or two different ropes tied together with their near middles secured (not fixed to the anchor. The not fixed two rope rappel allows for rope retrieval after the descent.
Lowering: Lowering is the act of descending in which the lowered climber/rescuer is tied into a rope which is then released under control of another person. Lowering consists of the rope moving with the person being lowered.