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Oston 2004 Expedition Report

Picos de Europa, Spain

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Medical Officer's Report

Mike Hopley

The Risks

Caving is a very safe activity when conducted carefully. Expedition caving, however, is more dangerous than the usual club caving in Britain. The main difference is that expedition cavers are more remote from immediate medical assistance; the caves can also be deeper and more difficult than a standard weekend trip. The camp at Ario is only a two hour walk from the car park at Los Lagos, from where the hospital in Arriondas may easily be reached within an hour's drive. But that does not imply that medical assistance is within three hour's reach. In terms of the actual time taken for outside help to reach a caving casualty, we are more remote than we appear - hence the need for an increased degree of self-reliance in urgent situations. It is also helpful to be able to treat minor injuries and illness without resorting to a time-consuming trip to the doctor!


All expeditions must prepare adequately in order to protect the health and safety of their members. Preparation for this year's expedition was much the same as in previous years. All members received a refresher basic first-aid course of six hours duration; two members (including myself) received more advanced training from the company Wilderness Medical Training, in association with the Royal Geographical Society. This training covers the full range of likely injuries and illnesses that may be encountered on expedition, and teaches how to treat these up to the point of evacuation.

The basic first-aid training was provided by Dr. Tariq Qureshi of O.U. First-Aid Unit. Organising these sessions was surprisingly difficult; Dr. Qureshi is considering beginning the process earlier next year, so that training takes place in Hilary term instead of Trinity. It is hoped that earlier preparation will allow training to be completed before the pressure of exams becomes too severe.

A useful rescue practice was held in the Mendips. We practised casualty evaluation and treatment for a mock accident, and used hauling systems to move the "casualty" part of the way out of the cave on a stretcher.

The medical equipment remained largely unchanged since last year, with restocking as necessary. Personal first-aid kits, which every caver carries underground, were much the same as before. I made a complete inventory of the medical kits; a few items needed to be removed or replaced since they had passed their expiry dates. This check should be made every year before expedition. The dates on a few of the items suggested that

I made slight changes to the organisation of the medical kits, which was already well thought-out. Medium and strong painkillers were moved from the "open access" wound care kit to the "restricted" infections kit, to discourage casual or covert use. I created two new kits: rescue 2 and the underground IV kit. Rescue 2 is a smaller version of rescue 1, which was previously the first medical kit to take down a cave in the event of a rescue. I suggest that rescue 2 be used in preference to rescue 1, except when the cave is known not to be tight. In a tight cave, the extra bulk of a larger kit may slow the rescuer. Rescue 2 can be fitted inside a prussic bag. The underground IV kit is intended to allow intravenous fluid therapy to be started rapidly in the case of severe shock - a potentially life-saving measure. In addition to one litre of fluids, it contains two giving sets pre-packed with all the equipment needed to start treatment. One set has a large cannula; one set has a small cannula. I recommend that the small cannula is set up first; once therapy has started, the more difficult large-bore cannulation can be attempted to give faster fluid replacement. Extra equipment remains in the injections kit at camp.

I wrote a new set of first-aid guidelines for expedition caving, which amends the first-aid information contained in the rescue guide. The rescue guide remains our main reference document for cave rescue, but some of its first-aid advice is not appropriate to expedition caving. The new guidelines should take precedence.


Ironically, most of the minor incidents involved me - minor burns, generic gastro-intestinal infection and falling rocks in the kitchen. Other complaints included small cuts, foot pains, (probably overuse) and mild sunburn. All were easily resolved.

The only incident of importance was a major dislocation of the knee. Astonishingly, this happened inside our tent. I was not present at the time, but found out the next morning. Unfortunately this injury meant an end to the casualty's expedition. Since the injury was stable and the casualty secure, it was easy to deal with; I had the luxury of consulting my books without urgency. With the assistance of our other WMT-trained member, I splinted the casualty's leg. I also gave some ibuprofen to reduce the swelling. He was unable to walk. Following a call to the emergency services for advice, a helicopter was sent to evacuate him. I was not allowed in the helicopter, nor could they tell me where they were going; however, I was able to pass my notes to them.

There was some confusion following a communication breakdown between the casualty and his parents, but this was resolved - although it did involve me acting as detective for a day in Arriondas! The casualty returned home safely and is expected to make a full recovery, provided that he rests sensibly.


OUCC expeditions are safe and well-prepared for medical emergencies. However, there is always room for improvement: