Mountain Medicine

Two Scottish GPs face more than QOF targets as part of busy mountain rescue team 

THE SCARIEST PART was when the helicopter was falling out of the sky and we didn’t know where it was going to come down – because we were all underneath it in a line.”

Dr David Syme is describing a fateful day back in 1987 when he and other members of the Killin Mountain Rescue Team set out on foot to help a climber who had fallen on the snow-covered peak of Ben More. They watched in horror as the rotor of a Wessex helicopter, which was attempting to drop off two further rescuers, hit a rock, causing the aircraft to crash and slide down the hillside towards them.

“Once it had stopped,” he continues, “we just did things because we needed to do them.”

Among the things they needed to do was crawl in through the tail of the smouldering helicopter, pull the crew members out and attend to their injuries. Tragically, one of the men had been thrown from the chopper and was beyond help.

“We had spoken to the pilot and he had assured us that it wouldn’t explode, because the fuel they use doesn’t explode,” says Dr Syme, in what seems to me a modest attempt to play down his courage on that occasion.

The following day, at first light, the team recovered the body of the climber whose fall had instigated the incident.

No place for a broken leg

Most mountain rescues end differently. Not only do rescuers not end up having to rescue each other, but the vast majority of people are brought out alive. Recent figures from the Mountain Rescue Committee of Scotland (MRCOS), the umbrella body that oversees the country’s 28 mountain rescue teams, reveal that out of 491 rescues last year, there were 20 deaths.

There is no doubt this figure would be a lot higher were it not for the volunteers who staff these teams. It is a fact that, for Dr Syme, a volunteer of some 25 years’ standing, is hugely satisfying. “What I say to team members is this: if someone’s got a broken leg and they’re halfway up a Scottish mountain in winter, they’re going to die [without assistance]. If we take them off and make them no worse, we’ve done a huge amount,” he says.

While there is no requirement for rescue teams to have a doctor involved – nearly all members are firstaiders, and many have a specific licence to administer opiates and prescribe from a limited formulary – most of them do.

Dr Syme’s involvement began when he moved to Killin to work as a GP at the age of 29. Originally reluctant to join (“I’d done a bit of walking but I wasn’t what you would call a mountaineer”), he soon found himself part of the team, hill-bound with stretcher and medicine bag, administering treatment in an environment somewhat different from the one he was used to.

What is in his ‘medicine bag’ – oxygen, Entonox, vacuum mattress, defibrillator and splints – is largely determined, he says, by the story of what’s happened. The same is true for his mode of travel, which could be anything from a Land Rover journey to a long hike to a short helicopter ride, or a combination of all three.

Working on an exposed hillside presents obvious challenges. “In the casualty department, they would cut the clothing off you in a minute. We can’t do that,” he says. “So you tend to run your hands down the body, pressing. If you get a response you might unwrap that bit.

“Usually in a bad fall you’re worried about head injuries and rib fractures. If there is the latter, they might have damaged the lungs underneath. There could be internal organ damage and bleeding. There may be leg fractures. Most often, you’re just expecting to stabilise people. You can reduce fractures and provide pain relief.”

What began almost by chance for Dr Syme became a big part of his life, so much so that he was for 15 years the MRCOS’s medical officer, overseeing the medical aspects of the service and playing a part in the exchange of information with rescue services abroad.

Training of a different sort

His successor in that role, Dr Stephen Teale, who took over the baton two years ago, is similarly ensconced in the mountain rescue habit, though his decision to get involved was perhaps more predictable. A long-time climber, he has been volunteering for 18 years and is currently part of the Braemar Mountain Rescue Team.

“A team like Braemar is a climbing club,” says Dr Teale, a GP who practises in Insch. “So there’s always somebody you can go to the hills with.”

With his climbing experience, Dr Teale is part of the technical, rope access, side of the team, as well as offering his medical expertise. When I speak to him, in November, the winter rescue season is well under way for the Braemar team. They have been training for the colder months – when they usually see 10 to 15 major rescues – throughout the autumn.

Keeping in tip-top shape is crucial for the kind of terrain they cover, which includes the likes of Lochnagar, a major winter-climbing area, and Creag an Dubh Loch, south of Ballater.

“A technical lower on some of the big cliffs is a high-risk activity,” says Dr Teale. “Creag an Dubh Loch, our biggest, is 1,000 ft – and we’ve got 800ft ropes. They reach the ground just by the stretch in the rope,” he says.

The height is only part of the adversity. On one rescue of a man with a broken ankle at the bottom of Creag an Dubh Loch, Dr Teale and his colleagues narrowly escaped an avalanche which would have swept them over a 30ft drop. The rucksacks they had put down minutes earlier, on their way in to see the patient, were not so lucky. “The cliffs are very slabby and smooth – the snow builds up on the face and it tends to slip off. There’s absolutely no way of avoiding that sort of danger,” he says.

And once he’s got to a patient, the weather often intervenes further, hampering the assessment of a casualty. “It is such a hard environment to work in because you can’t take your gloves off, it’s always windy, and patients are always well wrapped up.”

The kinds of injury seen by Dr Teale are in keeping with the locality. “Long-bone fractures and lower limb fractures are probably the commonest injuries. And for us as a winter team covering the Cairngorms, hypothermia is common. We also see a significant amount of trauma coming from Lochnagar and a lot of injuries that result in death.”

Downward trend in fatalities

Sadly, deaths continue to occur among the hill-going public, but a report published last year showed a distinct downward trend in fatal incidents over the last couple of decades.

One possible factor is highlighted by Dr Syme: “When I started, someone would hurt themselves and one of their pals would have to run down and raise the alarm. Now they can phone up and that makes for a quicker rescue,” he says.

Another factor, suggests Dr Teale, is that nowadays people are better equipped when they visit remote landscapes. “They don’t go out into the Scottish hills without doing a navigation course and other preparation.”

Nevertheless accidents will continue to happen and no matter the advances that are made, there will always be weather in which helicopters cannot fly and terrain that can only be reached on foot or by rope. At times like this a patient stuck out in the middle of nowhere has to be thankful that volunteers like Drs Teale and Syme are prepared to give up their free time to come and help.

  • Adam Campbell is a freelance writer and regular contributor to Summons. He lives in Edinburgh

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