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Why I work as a mountain rescue doctor

Dr John Ellerton describes how mountain rescue has enhanced his GP career

Dr John Ellerton describes how mountain rescue has enhanced his GP career

On a snowy February day, my wife and I finished a climb on Helvellyn in the Lake District. We were walking down the valley in the fading light thinking of tea and cake when two vehicles came up the narrow track towards us. They were a rescue party. They stopped and people started piling out and putting on huge rucksacks. I asked:

‘Do you need any help? I'm a doctor.' There were a few mutters, then someone said: ‘You'd better come along'.

That was 1984. I was a pre-registration house officer and it turned out to be my first rescue. It is usual that offers of help are politely refused, as the team does not want to take on well-meaning but unskilled assistance.

However, in this case the casualty had a fractured pelvis and was on a ledge 2m by 1m about 15m up an ice climb. They really did need a doctor – even one who had been qualified for seven months.

The adrenaline, the buzz and the daring are important and they keep you going for weeks after a rescue. But like most rescuers, I'm not in it for the heroics or the publicity. Rather it's the down-to-earth camaraderie of working with a small group of people from every background. Being thrown together regularly to complete a challenge is sufficient in itself to diminish egos.

It's 24 years since that first rescue and I still revel in a difficult callout. This year I had to climb down about 100m of steep, stepped icy ground at night with another team member to reach a casualty perched inches from an 80m vertical fall. The wind was blowing at 40kmph, the temperature was -5°C. But I had absolute confidence in my belayer and the team in support above.

Qualifications

The first and most important qualification needed to be a mountain rescue doctor is to be a mountaineer.

Mountain rescue in the UK is a free service provided by trained, unpaid volunteers working in teams under the auspices of the police. Its ethos is to rescue those in need. We don't aim to judge those who get into difficulty, control people or police the outdoors.

Most of the 2,500 or so members are motivated by a wish to put something back into their sport. There are about 70 teams, and each is independent and has its own character defined by its geography, workload and income.

The busy teams do 70 to 100 callouts a year, and they tend to have purpose-built bases and lots of state-of-the-art equipment. But that does not make them better. Less prominent teams are just as highly trained, committed and organised, and often have more fun.

Working in them is more like being in a group of mates who are out for a good time. Teams are supported by the RAF, air ambulance and coastguard helicopters and are funded by public donations – busy teams raise about £40,000 a year.

Team members are trained to a very high standard through a national system called Casualty Care, which goes far beyond first aid. They have an exemption in the Medicines Act to use drugs in an emergency and have been legally using morphine for more than 50 years. The mountain rescue doctor is called in for more thorough assessment and treatment techniques.

To impress such a highly qualified team, aspiring mountain rescue doctors should have a stint in anaesthetics and BASICS as well as emergency medicine. Of course, training in a warm hospital or even an upturned car is not the same as the real thing, where forgotten kit is hours away, the oxygen will only last 40 minutes and it will take two hours to carry the casualty to a road.

Fortunately, most mountain medicine is of a minor nature – for example, an uncomplicated lower leg fracture. So be prepared to get your hands dirty and do other tasks – carrying a stretcher is a great leveller.

Serious injuries

41183193Some casualties, however, will have life-threatening injuries and then the team's medical officer needs to use all their expertise. Over the years I have cared for 157 seriously injured casualties, most of whom have suffered trauma – a reflection of the geography of Patterdale and the steep wall of Helvellyn in particular, which rises for 250m above Red Tarn. The techniques I have used give a flavour of what a doctor might have to do (see box left).

Even with mobile phones, and even if the first rescue team members leave within 20 minutes of the callout, we usually arrive about one hour after the accident. Often, though, we are much later. You need a cool head to balance the weather conditions and evacuation plan, the equipment and competence of the team, and the necessity to improve the casualty on site.

Many mountain rescue doctors confine themselves largely to their team. In addition to callouts, they have training and fundraising commitments, as well as commitments to their own families, paid work and personal mountaineering goals.

A few of us explore teaching and the national and international mountain rescue scene. Many of my personal achievements over the past eight years have come from these fields.

I like to pass on these experiences to others – I have written a textbook on mountain rescue and material for the International Commission for Alpine Rescue (ICAR). I also teach the UK diploma in mountain medicine. You meet like-minded doctors with a passion for the outdoors and learn that even full-time, paid rescue services share the ethos of our voluntary teams.

We also discover new ways to do things – for example, how do we roll out a new generation of opiate analgesia to replace intramuscular morphine? Our NHS doctors in training have had a rough time of late. It's great to see them on a windswept mountainside, still with enquiring minds and endless enthusiasm.

Mountain rescue In a nutshell..

The highs...
• Making a difference on a rescue
• Working in a true multidisciplinary team
• Developing a new rescue base and seeing how it revitalises a team
• Teaching and writing for casualty carers and doctors
• Travelling twice a year to a new mountain region for the International Commission for Alpine Rescue

The lows...
• What's a weekend?!
• Hours of work that can often come to nothing
• Seeing a person transformed from having a
‘great day out' to a mangled corpse because they chose the wrong option

Advanced medical techniques

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