No.1: Safety series: be prepared and stay safe:
No.2: working as a team on the water:
No.3: swim, chase, throw:
No. 4: get the advantage
By Chris Brain
In the fifth part of the Paddler safety series we will be looking at incident management. Why do things go wrong, what can we do to avoid something happening and if it does happen how do we deal with it.
It is important to remember that there is no substitute for professional training in this area and this must be combined with experience to effectively use the ideas and techniques contained in this series. This article is not intended to replace formal training.
Our previous articles have focused on preparation, simple rescues, working together on the river and above all avoiding incidents happening in the first place. The techniques covered in this article assume that you have read the previous chapters.
Why do incidents happen?
Rather than starting with looking at how to solve the problem, we should think about why the problem occurs in the first place. When I look back at most of the incidents and situations that I have had to deal with on the river, they are rarely caused by an individual freak occurrence or one catastrophic moment or bad decision. Usually these incidents can be traced back to small decisions and moments earlier on in the day which create a snowball effect gathering momentum until it is too big to control, leaving us with our bigger incident to deal with at the end. Even simple things like not bringing food or arriving to the river late or putting on wet kit can all start the process towards a future incident. Our job is to spot these issues early and deal with them before they contribute to something bigger.
As paddlers we can borrow the research already available in this field and apply it to our environment. In 2004 Ian McCammon wrote a paper which detailed his investigation into the human factors that contributed to 715 recreational avalanche incidents taking place between 1972 and 2003. McCammon states that, “Even though people are capable of making decisions in a thorough and methodical way, it appears that most of the time they don’t.”
McCammon suggested that the common factor in all the incidents that he studied was the mental shortcuts that we use to speed up our decision-making process in everyday life known as heuristics. We use these mental shortcuts every day in our life so that we don’t have to process too much information for our routine tasks, however if we apply these shortcuts to an environment as dynamic and individual as the river we can quickly become mislead by them and make mistakes. He categorized these common processes, referring to them as the heuristic traps. I have summarised these traps briefly here.
If we know the venue well, we assume that it will always be the same and we behave and do things the way we always have done. Since we know the venue well, we are also more likely to expose ourselves to more risk than those who are there for the first time.
Continuing with the plan because it is the plan. Here we might follow-up on one bad decision with another, continuing down this path simply because it was our original intention and we feel we must see it through to the end.
As humans, we have a need to be accepted by our peers and this has a strong effect on our behaviour and decision-making. McCammon suggests that we are far more likely to take risks if we believe that those around us will accept us.
If we are being watched (or filmed) then we are more likely to expose ourselves to higher risks than we would otherwise.
Scarcity of resource
If we perceive that our resource is rare (e.g. water levels), then we will take higher risks because of this. If we have travelled a long way to get to our venue or we don’t have many opportunities to take part in our chosen activity then we will push ourselves in a more dangerous way than we would if we had these conditions regularly.
The halo effect
Simply put, we are more likely to take risks in the presence of an expert. However, McCammon suggests that the issue lies in who we see as an expert and that we may be drawn into this trap due to someone’s personality and our own perceptions of them rather than being guided by their actual experience and/or qualifications.
Being aware of McCammon’s heuristic traps is one thing, but activity trying to avoid falling into them is another thing.
Avoidance starts with effective planning, gathering up to date information from a variety of resources and making good decisions right from the start. Try to come up with a range of options for your day out on the water, what is our ideal plan? However, do we have options that are less risky should water levels be higher than expected? Do we have a ‘safer’ and ‘safest’ plan? Bearing in mind that our safest plan might be to not get on the water at all.
Good communication is also critical to avoiding an incident occurring. We want to create an environment where everyone can contribute to a successful trip. By having appointed (or self-appointed) leaders, we risk creating a culture of ‘followership’ and we can quickly fall into the trap of the Halo Effect mentioned above. Yes, we might have people who take more of a lead role, but we should be empowering our team to help with decisions, to feel able to question any decision made and ultimately take responsibility for themselves as much as possible.
Removing risk completely isn’t something that we can do with 100% certainty and in some cases an incident could be completely unforeseen. We need to be observant for the moments that can be seen and strive to make decisions that will have a positive impact on the outcome of the trip. Many issues in the outdoors arise when the group is mismatched with the environment and we should be mindful of this when we are planning our time on the water
When it comes to first aid, as paddlers we have some priorities for our casualties, we need to keep them breathing, stop bleeding and keep them warm
Keep them breathing
Our biggest fear in paddlesport in probably having someone unconscious or trapped in the water, our first job is to get their head above the water and get them out. For these kind of situations a hands-on approach (if it is safe to do so) typically has more success than one involving complicated rope systems. If your casualty is floating in the water, clip them into a sling and pull them to the side while you are still in your boat so you get them out of the water as quickly as possible.
Shout at them and check for a response, open their airway and check if they are breathing. If they are not breathing pinch their nose, lift the chin and give them five breaths. If they still haven’t shown any signs of recovery start CPR giving 30 compressions followed by two breaths repeatedly. At this stage someone needs to be calling for help, (if you are on your own, do the five breaths followed by a minute of CPR before you call for help). When giving CPR push down hard in the centre of the chest (with a depth of about a third of their body), try to avoid the PFD absorbing your force so either go underneath the PFD straight onto the chest or remove it if you can. Keep your CPR going and remember someone else could take over if you become tired.
When we are out on the river we don’t usually fix people, all we do is provide a temporary solution until someone else with better kit/knowledge/skills takes over. Most of our first aid is minor (cuts, grazes and bumps) and we need some simple solutions for that. The issue that we have as paddlers is that traditional first aid items such as plasters and dressings don’t tend to work very well in the wet on their own.
A product that has been a real game changer for me when giving first aid on the riverside has been Vetrap. Produced by 3M,Vetrap is a self-cohesive bandage, it contains latex so isn’t affected when it gets wet, it is stretchy and only sticks to itself. It also sticks even if we are wet so it is perfect for us.
The product was originally aimed at the animal care market (as the product wont stick to fur) but for paddlers the applications are far beyond that. Anything from broken fingers, to grazed knuckles, twisted ankles and giving shoulder support can all be managed with this product. As it is only a bandage and not a dressing you will still need something underneath it if you are trying to stop bleeding, but Vetrap will certainly help keep that dressing in place when you are on or next to the river.
If we are stopping a major bleed (which is a rare injury in paddlesport) we need something bigger and better to do the job. I carry a military dressing which can give plenty of compression and has a big pad on it too. These dressings are usually vacuum packed and are about the size of a cassette tape so are very easily carried in a first aid kit.
I try to keep my first aid kit quite simple.
Emergency instructions and a casualty card – including a pencil to write on it with
Gloves – let’s keep things as clean as possible
Antiseptic wipes – keeping minor cuts clean
Plasters and steri strips – for dealing with small injuries
Military dressing – these give better compression and are easier to use
Melolin pads – which can be cut down if needed to use with the vetrap
Vetrap – multiple uses, I don’t leave home without it
Shears – if you are going to cut a cag or drysuit it is much easier than using your river knife
Face shield – for CPR
Tape – always handy to have a little bit in a first aid kit
Triangular bandage – cut to an XL size from plastic sheeting so it can go over PFDs and bigger people
My spare inhaler – just in case it’s needed
b 300mg tablets for heart attack
Rehydration sachets – for dehydrated paddlers
Ibuprofen and paracetamol – simple pain relief
Tick remover – avoid lyme disease by getting rid these little critters
If our casualties don’t have enough energy to produce their own heat their temperature will most likely be dropping, having some spare emergency food is always a good idea on any trip. I carry a couple of energy bars and energy gels on most days out on the river which should be enough to give most paddlers a boost.
Don’t forget how tiring swimming is and if one of your team has been in the water they will have used up a huge amount of energy and will have had a burst of adrenaline. I try to encourage most swimmers to have a quick bite to eat if they can to replenish their energy levels as after their swim the last thing I want is for them to be in the water again on the next rapid.
If our swimmer (or injured paddler’s) extremities are getting cold I carry a few items of kit which should help in this situation, a buff and a set of mittens. A buff is great because it can be used in so many ways to warm head, neck and hands and the mittens are easy to put on to warm up the hands, putting on gloves when wet and cold is never easy!
If our paddler still can’t get warm I carry a survival jacket made by a company called Blizzard. Based in North Wales they make a fantastic material called reflexcell which is significantly warmer than a standard foil blanket due to its complex construction. Blizzard use this material to create a ‘one size fits all’ type jacket and then vacuum it down to the size of a few slices of bread so that its easy to carry and store in the back of our boat. The good thing with the blizzard jackets is our cold paddler can still move and work on generating their own heat. You could certainly paddle wearing this jacket although I wouldn’t want to run anything hard in it.
If we are going to be waiting for help to arrive we must consider not only keeping our casualty warm but also keeping ourselves and the rest of the group warm too. We can wrap our casualties up in as many foil blankets as we like, but if we don’t have a way of keeping ourselves warm we will need help in the long run too, a perfect solution this issue is a group shelter.
A simplistic piece of equipment, think of it as a flysheet for a tent which is pulled over several people to create a micro climate inside. Having the team sat in the shelter not only gives structure but it also creates heat which will help to keep your injured paddler warm as well as the rest of the group. Many modern shelters are lightweight and can of course be used repeatedly, they are great for lunch stops and planning meetings by the riverside too!
I often say that you, your brain and a phone are the most important things that you can have with you when dealing with a situation, you would be surprised what you can do with a bit of improvisation and motivation, however once we have dealt with our immediate issues we have the problem of what do we do now?
Calling for help is essential to dealing with a situation, in the UK we would call 999 (or we can call 112.) We can also text for help in the UK too, which may be useful if our phone signal cannot sustain the call for long enough to give information effectively. To use this service, we need to text the word REGISTER to 999 and then respond saying YES to the terms and conditions and then our phone is set up ready to go.
We should do this at home before we go paddling rather than in the heat of the moment. When we text for help the emergency services will confirm that the message has been received, if we don’t get that confirmation we should try again. Remember that If we need mountain rescue we should ask for the police first and then mountain rescue.
Mobile phones will also work across the various networks to make an emergency call, so just because your phone doesn’t appear to be connected to your regular provider there is a chance you can still pick up signal from one of the other networks.
To get out of somewhere we need a way of knowing where we are first. I tend to find that many paddlers are not the best at carrying maps, often knowing the river from memory and guidebook descriptions rather than using accurate topographical information. This can make it hard to get help to a specific location especially when you are not near a road.
There are so many options for digital solutions to map available currently, I subscribe to the Ordnance Survey software in the UK which allows you to download and print maps at 1:25000 or 1:50000 scale. I print and laminate my map and then annotate it with the various important rapids, hazards, features and access/egress points too.
Most modern smart phones also have a GPS function and we can download maps to them. There is of course an issue with phones not being fool-proof and that they can run out of battery but at least it could serve as a backup. You can also download software which you can use to give an accurate location, in the UK I use an app appropriately called…..”Grid Reference.”
Having a way of recording information when we are dealing with an incident is also useful. Many people use pre-made casualty cards where they can write down the information you need accurately. When we are waiting for help to arrive we should be monitoring our casualty and if they are not fully alert we should be placing them in a safe airway position (recovery position) with their away open so we can continually check their breathing. Remember keep them breathing, stop bleeding and keep them warm.
The walking wounded
If a casualty can move themselves and is relatively pain-free in doing this, it is probably worth heading somewhere where they can get access to help a little bit easier. Our PFDs and spraydecks can make good improvised slings in this instance and we should go with an ethos of supporting the casualty where they feel comfortable. I also carry an XL plastic triangular bandage which I have made at home out of an old survival bag. This rolls up pretty small and gets packed into my first aid kit and is useful for giving support and immobilising casualties.
If someone has a major injury or has suspected spinal damage, we should keep them immobilized where they are. In this instance, I would only move a casualty if there was an issue of danger or that their airway was compromised due to their body position.
It is well worth keeping your first aid knowledge up to date and going on a dedicated first aid course is certainly the best way. There are all sorts of first aid course options out there, try and choose the one that best suits your needs as a paddler operating in a potentially remote environment.
Thank you to Patrick Beavis, Michelle Marr and Molly Zeidler for the photographs and Ian McCammon for his excellent research.
Chris has been kayaking, canoeing and coaching for the last 15 years and runs his own business Chris Brain Coaching, delivering paddlesport coaching, safety and rescue courses and REC First Aid Training. http://www.chrisbraincoaching.com. Email: firstname.lastname@example.org
Chris would like to thank Pyranha Kayaks, Palm Equipment, VE Paddles and Go Kayaking for making fantastic kit and their continued support. Photo: Patrick Beavis