Walking Well: Injuries

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One misstep is sometimes all it takes. Even if your hiking partner happens to be both an experienced outdoorsman and a physician, a simple fall on a steep slope can require a full-fledged rescue involving no less than 23 people, a harrowing evacuation, a nighttime trip to the hospital, and emergency surgery. Here is Dr. Vernier's firsthand account of what really happens during a mountain rescue. In the following weeks, we'll bring you his advice on how to prevent and treat backcountry illnesses and injuries.

On my Appalachian Trail through-hike, I had the opportunity to watch, and to wholeheartedly thank, the Erwin area rescue team for their magnificent performance in a serious medical emergency.

The crisis began at 11:20 a.m. on the Monday of Memorial Day Weekend. Elmer Cheesman (then age 56, Newark, New Jersey), our lead hiker, slipped on a wet tree root, heard his ankle snap, and fell down the mountain with his pack on.

We found him about five minutes later attempting to crawl onto the trail. He was hardly able to move his body or talk and was in obvious severe shock. Because any movement was painful, it was difficult to turn him over in order to diagnose the injury. To examine him, I had to dig a terrace below the trail so that I could stand on the 45-degree slope. Removing his boot and socks was difficult. After gentle and limited examination I felt there was either an ankle fracture or a severe sprain.

We sent Mike Herr, another member of our group, off on a forced eight-mile march to Erwin, the nearest town, to get help.

I treated Elmer with two Tylenol (600 mg) with codeine (60 mg) and ibuprofen (400 mg) for pain and inflammation. To treat his shock, we wrapped him in his sleeping bag against the damp cold—a difficult task because of his ankle pain. Since Elmer was cold and hungry, Warren "Smoke" Hubbard (the other member of our four-person party) and I fed our patient hot cocoa and warm mashed potatoes as additional therapy for his shock. Then we sat down to wait—and to plan for the night in case no one came.

After a while Elmer began to feel better and even wanted to try putting weight on his foot in order to walk out. We persuaded him otherwise. We tried to fashion crutches but could find no suitable pieces of wood and concluded that crutches do not grow on trees.

Several southbound hikers passed and agreed to communicate our plight. One mentioned that if they had not left their cellular phone in the car, we could have called 911.

After several hours we were depressed because help had not arrived, darkness was approaching, and we had no way to move Elmer to a safe spot on the steep mountainside for the night. In desperation Smoke thought he could see a slightly less steep spot about 50 yards down the mountain where we could set up a tent and carry Elmer. This was not a promising prospect.