If you’re sick or injured in the backcountry there are many possible scenarios with many possible outcomes, but most have one thing in common: Rescue will take longer than you might expect. To give a clearer understanding of why, this purely fictional scenario describes a typical rescue from start to finish. Do note that each scenario is completely unique.
Chapter 1: The Scenario
To begin our story, let’s consider this: It is early June and you’re working on summiting all of New Hampshire’s 48 4000-footers. You’re hiking on Davis Path, traversing the Montalban Ridge — taking the long way — with the objective of summiting Mt Isolation (4004′). You’re not doing this alone, but rather you’re with a trusted friend. You get on trail bright and early at 06:00 hours from the parking lot at the southern end of this ridge. Your plan is to visit several mountains along the way: Mt Crawford, Mt Resolution (via a bushwhack) Stairs Mtn, Mt Davis (also via a bushwhack), then finally Mt Isolation. If all goes according to plan, you will finish the 4000-footers list on Mt Isolation by mid-afternoon — congratulations. Your friend has already finished their list and you’re next; you’re both very experienced hikers.
It’s good that you’re not alone, even though the ideal party size for safety is four (a patient, a caregiver, and two runners). It should be noted that both of you are carrying a decent amount of gear; all of the essentials plus more. Both of you have your cell phones, but neither of you is carrying a Personal Locator Beacon (PLB). You’re relying on your determination, experience, luck, and each other. The weather is average for June, in the mid- to high-40s up high, but it’s supposed to be sunny for the entire day albeit very windy. The higher summits forecast is calling for winds in the 60s out of the northwest with higher gusts. Knowing this, you hypothesize that the winds on the more-sheltered summits you’ll be reaching for will offer reduced wind speeds. This assumption will indeed be correct as you will see first-hand in a few hours. To help you stay on your feet, you’re both bringing trekking poles just in case the winds are still excessive.
Skipping Ahead
Let’s fast forward a bit speeding up the day. You made it to all of the mountains you planned to hit and are closing in on Mt Isolation itself. It’s been a great day so far. There are very few bugs thanks to the breezes, it’s sunny, and just really nice out — absolutely perfect for this special hike.
Upon arriving at the spur trail for Mt Isolation you both consider dropping your packs for the tiny detour to the summit and back but you wisely decide against doing this. You figure you’d would really like to linger up there for a bit, to eat, to rest, and to celebrate. Moreover, your partner speaks up declaring the notion is a bad idea asking: “What if one of us gets hurt?” This calls to your better judgement so upon further reflection you agree. As it turns out neither of you become injured, summiting is uneventful, and the packs come off your backs only to access your food. You don’t know these things going in but being prepared for the worst is just smart. Anyway, just imagine if someone did get hurt and the packs were left behind. That’d be awkward, at best.
After you experience the as-expected diminished winds on the summit and continue along the ridge, you’re both comfortable going on deciding to bypass the sheltered Rocky Branch Trail and aim for the more exposed higher elevation junction of Glen Boulder Trail, about a half mile from Boott Spur itself. The winds are still out of the northwest, as forecast, so this section, while definitely exposed, is still going to offer some topographic sheltering and you’re convinced that what lies ahead will be manageable. And you’re right. You do manage just fine — for a while.
Ascending to just over 5000-feet you reach the junction. As expected you do encounter stronger winds, the alpine sedges swaying hypnotically in the breeze, but this is expected and you both take out your poles. Up to this point they’ve been secured to your packs. The winds, being that this is the highest point on your hike, are indeed “ripping something wicked,” but they’re diminished compared to what is going on on the Rock Pile and on the northern Presidential summits. Wind speeds in your location are in the 30-40 mile-per-hour range.
As you hike you’re reminded of what a glorious day it is. The temperatures end up being about ten degrees warmer than that which was forecast making it feel downright comfortable with the wind. You both have wind shirts and warm layers but these stay in your packs — for now. You’re both wearing (not-cotton) t-shirts at this point. On the bottom you wear “zip-offs” with the lower legs zipped off. Sunglasses and sunscreen are both in use. The sheet of paper that has “48” written on it is attached to the back of your pack, secure but fluttering in the breeze. The noise of the paper is what you’re focused on at the moment as you begin your descent toward Gulf Peak (formerly Slide Peak, 4804′). You have a huge grin on your face. That’s when it happens.
It’s really bad timing on the part of the wind. An atypical gust — the Mighty King of Gusts — slams you down to the ground, hard. It happens just as your leg is tight between two rocks. The upper part of your lower left leg carries its momentum forward, but the lower part is held fast between the rocks. The twin snap feels audible above the wind and probably is. You scream as it happens. This is heard above the wind. Your friend turns toward you, his face drops. By the angulation he sees — not being a doctor or anything — he states that it looks like your lower left leg is completely broken. You, now being the patient, the smile erased from your face, know this to be true. You’re experiencing considerable pain. You have a broken leg and you’re miles from anything.
Chapter 2: What Now?
There’s nobody around that you can see at this time. Not one person is visible from behind or ahead. It’s late enough in the afternoon that it’s very unlikely that anyone will be coming up trail. It looks like you’re on your own. At least for now.
As was noted, your friend is a pretty experienced hiker, as are you. Luckily you have both taken a Wilderness First Aid (WFA) course so you kind of know what to do and what to expect. While gritting through the pain you both layer up. The pain, wow, was never fully described in the classroom. You put your wind shirts and warmer layers on and replace your pant legs. You leave your left one off, of course. Your friend is carrying a foam sleeping pad and is carefully handing it to you in the wind. It’s not easy, but you’re able to get it under you with his help. It is important to get off the ground and get sheltered up at this point and you know this. You’re comfortable at the moment but you’re no longer hiking. You will begin to cool off fast, and it’s getting later in the day.
Seeking Help
Now that your immediate needs are met, your friend pulls out his cellphone. The carrier on that phone is AT&T but there is no cell signal. Your phone, with Mint Mobile, is likewise useless. But then your face lights up as you remember something from your WFA class, though. The instructor, as you recall, said: “Try dialing 9-1-1 anyway. You might not have cell service, but you might be able to reach a 9-1-1 repeater and reach an operator anyway.” Excitedly you remind your friend of this little known fact then you both try it pressing the buttons on your phones. Fortunately this works and by way of a repeater on the Mt Washington summit your friend is able to reach a 9-1-1 operator. He describes the situation, gives your location, now you wait. (See communications footnote.)
If it didn’t work, your friend would have to shelter you in place as much as possible and make his way toward the nearest source of help. In this situation this would be the Appalachian Mountain Club’s (AMC) Lakes of the Clouds Hut. Granted, he could also try for the Mt Washington summit, but considering the elevation gain, going to the hut would be the wisest choice. Your friend would leave you a few more clothing items and a bit more food and water wishing you well while you wished him the same. Having a reliable hiking partner at this stage is a blessing. If by yourself, unable to get a call or text out, with the limited chance of seeing anyone coming up trail, you could find yourself in a life-threatening situation at worst, and at best a long and painful wait. Having a PLB at this point would be worth its weight in gold.
If others were there, these steps could be carried out while the first aid was going on, or the others could be used as runners seeking help while your friend stays with you. But they’re not so you’re doing things in a logical, necessity-driven order. The fact is you’re stuck about a half mile from Boott Spur with a broken leg! But already you can see how things could be much worse.
But you’re not alone and the call was made, and the Fish and Game (F&G) Department has been given the information. They have reached out to the AMC and to the Mt Washington State Park. They are assessing the situation at arm’s length for the moment. Now let’s return our attention to the scene.
Giving First Aid
After these initial steps your friend pulls traction on your lower leg straightening the bones, reducing the angulation. This hurts like hell, but you try to maintain your control and instead endure the pain the best you can. Once straightened, being it’s a lower leg, your friend releases the pressure and works calmly on creating a makeshift splint to hold the leg in-line and protect it from further injury. If only this stopped the relentless pain. It does help, however.
You both have additional layers, extra food and water, and the situation is being managed pretty well, all things considered. Now it’s time to improve the sheltering situation using a tarp, a bivvy, or whatever is at hand. This would include sitting on a pack or on fir boughs (below treeline) to get off the ground if your friend hadn’t brought that pad. Your friend also had a tarp so that goes over you. Awesome. You’re pretty comfortable, albeit still in a lot of pain, though no longer in immediate danger of succumbing to hypothermia. Which, yes, is possible even on a nice day in June.
Chapter 3: Wheels in Motion
As noted the calvary is on the way. The first to arrive on scene — almost an hour after the incident — are members of the AMC’s “Hut Croo.” They have medical training and are able to put hands on the situation. They are soon joined by a couple of folks from the Mt Washington State Park. The Hut Croo removes the crude split and replaces it with a front-country splint. What your friend made for you is fine, but the Croo is able to provide a modern improvement due to having more advanced supplies. They also have a litter. Two F&G Conservation Officers show up, too. You’re not going to be hiking yourself out so it’s time to get you in the litter. To package you up, as they say. Someone asks if you need to use the bathroom before they go through these steps and put you in the litter. You decline but are grateful they asked.
The lead Fish and Game officer on-scene determines that the best course of action will be to get you to the summit of Mt Washington so that you can be transported by truck or van to the base of the mountain and to medical professionals. A National Guard airlift medivac isn’t on the table due to its availability — which is usually the case except in rare circumstances — and the winds which are supposed to increase into the night are also of concern.
On-scene there are two Hut Croo, two State Park personnel, two F&G officers, and you and your friend. The F&G officers radio their Incident Commander, now positioned at the base of the Auto Road, and advise that more people are going to be needed but while they wait, the six people on scene can begin to slowly and carefully carry the litter back toward the junction and to Boott Spur. The Incident Commander decides to initiate a call to the Androscoggin Valley Search and Rescue (AVSAR) team. He gives the AVSAR dispatcher the details of situation and asks that they make a “call-out” to all members the team. The dispatcher is told that they’d like to have at least twenty people on-scene ASAP, but no additional supplies are needed.
The AVSAR dispatcher, now alerted to the situation, begins the process of forming a text message using a special communications tool: the “One Call Now” system. Within a few moments a text message blast is sent to all sub-teams within AVSAR and they are advised to report to the F&G Incident Commander at the base of the Auto Road. One of the members, coming from Gorham, is asked to pick up the AVSAR trailer and bring it to the base of the Auto Road, as well. None of its contents will be needed in this scenario, but it’s still good to be on-scene and ready for whatever. It’s also helpful to team members as this will become a rally point. Other team members respond, grab their packs, and make their way to the Auto Road. The first wave is supposed to show up within the hour and to provide ETAs if they won’t make it in time for the first wave.
At this point the F&G Conservation Officers wait and about 45 minutes later a dozen or so AVSAR volunteers arrive on scene with more on the way. A Conservation Officer asks them to hop into the back of a pickup truck and drives them to the lower parking lot at the summit. The team members hop out of the truck and start descending to you, initially on the upper part of the Tuckerman Ravine Trail. The half dozen folks helping you at this point have managed to get you to Boott Spur. Your friend is carrying your pack and trying to stay out of the way.
The Calvary Arrives
The first wave of AVSAR personnel descend the Mt Washington cone and head toward you. The six people carrying you for the last half mile are visibly relieved to see the group show up and they gently set the litter down while six AVSAR personnel step in. Before raising the litter like the well-oiled machine that they are, one medically-trained member asks you some questions and takes a moment to get your vitals and to check your leg. Your boot and sock are off and the medical person gently squeezes your big toe. As she does this the toe turns white as pressure is applied. She then releases the pressure and the toe becomes flush with blood once again confirming capillary refill ensuring the limb is receiving an adequate blood supply. She then touches one of your toes and asks you which toe she’s touching. You respond naming the toe being touched which informs her you have sensation. Lastly she asks you to wiggle your toes to confirm you have digital movement. Check. This process is meant to check your circulation, sensation, and movement or CSMs as it’s referring to. The process is repeated at roughly 15 minute intervals. The multiple checks are necessary as the jostling in the carry out and the leg probably swelling may lead to CSM changes. If any of these three tests fail, it’s probable that the medic would loosen the splint.
About 15 more AVSAR personnel, following the process of the first wave, arrive on scene. With extra bodies to perform the litter carrying toward the summit, the Hut Croo are relieved by the F&G and make their way back to the Lakes of the Clouds hut and their overnight guests. The State Park employees are heading back up to the summit anyway, ready to head home, and simply walk up with the group. They will sleep well tonight. Now, with so many volunteers helping out, the litter is almost constantly in motion, stopping only for one or two more CSMs checks and to change out litter bearers. The whole procession is making good time.
Chapter 4: The End Game
You finally reach the lower summit parking lot and a F&G pick-up is right there waiting, ready to have the litter loaded into it along with a half dozen people and their packs. Your friend is seated next to you as you lay in the litter in the first truck. As soon as you and the team are safely seated the driver starts down the Auto Road. One more F&G truck is standing by along with a State Park vehicle and both are filled with people. They also head down and before long all vehicles are at the Auto Road base with an awaiting ambulance on site. Once you’re transferred from the litter to the ambulance they take off toward the hospital. The litter is then handed over to Auto Road staff for the night. The State Park folks will drive it up in the morning and will ask the Hut Croo to hike up to retrieve it.
The Incident Commander sticks around until all of the AVSAR volunteers check back in and his people and equipment are safely returned. He goes back to his office — dropping off your friend at his vehicle along the way — to begin the paperwork and to prepare an official statement to the press about this four-plus hour rescue (this was a fast one). As you’ve probably already heard: because of your Hike Safe card and your preparedness, this one’s on them.
Regarding your 48 finish… sorry, but you’ll have to come back for Isolation another day. Being carried doesn’t count.
COMMUNICATIONS FOOTNOTE: It is also possible to text 9-1-1 in New Hampshire. Moreover, newer smart phones, when a signal to text is absent, can utilize satellites as an alternative method and they can also offer Lat./Lon. or a UTM position. Refer to your smart phone’s documentation for specifics.