This article portrays a case-study on group dynamics and the unfortunate turn of events that resulted in a wilderness first aid scenario. It can be used for training student and staff leaders in a college or university setting who plan to utilize the great outdoors as the medium for the growth and development of students. The facts are based upon a real life situation.
Background
Grand Canyon National Park is located in northern Arizona. According to the National Park Service, Grand Canyon National Park “encompasses 277 miles of the Colorado River and adjacent uplands…..the Grand Canyon is one of the most spectacular examples of erosion anywhere in the world…Grand Canyon is unmatched in the incomparable vistas it offers to visitors on the rim (National Park Service, 2012).” Rim- to Rim backpacking trips are popular, but should not be undertaken by those who are inexperienced in the outdoors. The Grand Canyon can be a forbidden place. Unfortunately, heat related illnesses, injuries and death are commonplace in the canyon every year. (Ghiglieri & Myers 2001).
The Sequence of Events- Pre-trip Preparation?
A party of five individuals came together for a Rim-to-Rim backpack trip in the Grand Canyon in an unusual and random way. “Bill” (aliases will be used throughout this case study) had obtained the much coveted back country permit for the first day that the North Rim of the Grand Canyon was due to open in the spring of the season. Unfortunatley, Bill ended up with an injury to a hip which prevented him from participating in the trip. Bill gave the permit to Gail, and several others joined the expedition in random ways. The group was essentially two groups of strangers, a group of three who were well acquainted and a pair of two who jumped on the permit via invitation at a last minute opportunity. The dynamics of the group is important because most of the individuals were strangers and the group did little to get together to plan for the trip prior to departure. In fact, several of the trip members met for the very first time on the ground in the Grand Canyon. Communication prior to departure was limited and as a result, each individual showed up to the trailhead with too much individual and group gear. Each individual packed for a 4- day back country trip (i.e. – tent, sleeping bag, stove, food etc.) Pack weight averaged 38-45 pounds.
Rim-to-Rim Backpack- North to South
The trip departed from the North Rim. The North Rim is known to be quite remote and is a thousand feet higher in elevation than the South Rim. On day 1, the National Park Service opened the gate for the road to access the North Kaibab Trailhead at 8am. This was unexpected and proved to be problematic because all of the Grand Canyon National Park literature warns hikers and backpackers about being in the Canyon in the heat of the day. It is unknown why the National Park Service does not open the gate at an earlier time on the first day of the season. Nevertheless, no one in the group was aware (or checked on) the time that the gate would open prior to departure that morning.
“Grand Canyon is, above all else, a place of extremes. It is necessary to take appropriate precautions depending upon seasonal variations in trail conditions….During the hotter months…it is crucial that hikers have the discipline to begin their hike well before dawn or after 3pm. Success in the summer can be as simple as staying off the trail and out of the sun between 10am and 4pm pamphlet distributed by Grand Canyon National Park, North Kaibab Trail, 2012).”
The gate is located on Hwy. 67, approximately 45 minutes from the trailhead. By the time the party got to the trailhead and began their descent, it was almost 10am. As they descended, the heat of the day became more and more intense. To compound the situation, the first two water stations on the trail were inoperable. Debbie and John had water treatment tablets, but because of the elevation and sheer cliffs adjacent to the trail, it would be hours before they would have access to any water source such as a river. It took the party 6 hours to arrive at the halfway mark- 6.8 miles, at the Cottonwood Campground. There was a water station there and they were able to refill their Camel Backs and Nalgene bottles. The permit that had been obtained, again by Bill (who did not participate in the trip), did not allow for camping at the half-way mark. Instead, the party had planned to descend the entire 14 miles of the North Kaibab Trail that first day and would camp at Bright Angel Campground at the infamous Phantom Ranch at the bottom of the Canyon. When the party arrived to the half-way mark, they were tired, some had blisters, and all contemplated staying at Cottonwood for the evening. Debbie in particular, was fairly adamant in questioning the group about the need to “push on.” Several individuals felt that the terrain had become easier and that the last half of the journey would be manageable. Still, others noted that they wanted to arrive to Phantom Ranch that evening so that they would have a fair amount of time to just “chill” before the challenging ascent. Gail and Edith wanted to get to Phantom because they had prepaid for some meals and did not want to forfeit the money (nor the food). After a long arduous conversation, Debbie reluctantly caved in to peer-pressure and onward, the group descended.
After only a couple of more miles, Chris became ill and vomited due to a heat related illness. This caused yet another hour and a half delay to the group. It was starting to get dark and everyone was extremely tired, irritable, and ready to end their day. Chris became disoriented and a bit anxious. He became uncooperative and began to charge ahead of the others. Edith sped ahead to stay with Chris and as a result, the party undecidedly split into two groups (a 2-person group and a 3-person group). About ten minutes later, Debbie who incidentally, was the individual who had argued to stay at the half way point, took her eyes off of the trail for a split second and tumbled to the ground. She had apparently turned her right ankle on a rock on the uneven rugged terrain. When she fell, she landed on a sharp rock on the trail with her left knee. She fell hard and sustained serious injuries to both legs- an inversion injury to right ankle and a very deep laceration to the left knee. Again, it is very important to understand that the North Rim is very remote, few people hike the trails on this side of the Canyon, and for an injured person, there are few options. The fall took place at approximately mile marker 11. Thankfully, Gail was a registered nurse and she was able to control the bleeding in the knee. After some time had passed, the party was able to help Debbie to her feet and she gingerly and very slowly dragged herself into Phantom Ranch via assistance from her trekking poles and a headlamp. It was possible that her ankle was broken and it was probable that she needed stitches in her knee. It was very dark by this time and all individuals were forced to use a headlamp to navigate the trail. Some individuals proved to be more prepared than others. Several discovered that their headlamp was quite dim, while others had a brightly lit headlamp to illuminate path before them.
As if this unfortunate turn of events was not enough, still another injury occurred. Chris (the disoriented and agitated individual) and Edith found themselves in a very precarious situation. Chris tripped and fell forward into Edith knocking her down. Both individuals fell down an embankment into a patch of cactus. Luckily, their fall was not deep into the Canyon, as this part of the trail was not very steep, and the patch of cactus stopped them. They were able to get up and to climb out, and Edith had many painful tiny cactus thorns embedded in her hands and skin throughout her body.
It was between midnight and 1 am before both groups finally reached Phantom Ranch. Debbie took off her hiking boot and her right ankle immediately swelled to the size of a large grapefruit. She could not sleep due to the throbbing pain in both of her legs. Sunrise came early and Debbie was helped to the Ranger Station for medical attention. A backcountry national Park Ranger, who was a trained law enforcement officer with wilderness medicine training, evaluated her injuries. The ranger instantly advised Debbie that she was a “medical emergency” and needed to be airlifted from the bottom of the canyon via National Park helicopter. The ranger was certain that Debbie needed stitches in the knee as there was “tissue exposed” around the wound. The Ranger also suspected that the ankle could be fractured due to the degree of swelling and the discoloration/bruising that she observed, and she was cautious of infection due to the bacteria found in the Canyon. Within an hour, the Grand Canyon National Park “heli” team flew Debbie out of the canyon to the national park heli pad where she was transported by ambulance to the North Country Grand Canyon Hospital/Clinic. Debbie was treated by Dr. Tom Myers, co-author of “Over the Edge: Death in Grand Canyon.” An x-ray was taken of the ankle, and the results were inconclusive because of the degree of swelling. Dr. Myers ordered that her ankle be placed in a boot and advised that an MRI was recommended for additional characterization once the swelling subsided. The wound on the knee was irrigated, flushed and cleaned. The left knee required 10 stitches to close the wound. Dr. Myers also prescribed a series of antibiotics to prevent infection in the wound. Debbie was released from the clinic and spent several nights recovering in a hotel room as she awaited the arrival of the party from the bottom of the canyon.
Meanwhile, John, Gail, Chris, and Edith, had several days to rest at Phantom Ranch before they attempted to ascend the 9.5 miles of the Bright Angel Trail to the South Rim. For the ascent, the permit allowed the party to camp half-way up at Indian Gardens Campground the first night. Chris was given fluids and salty food, as well as other foods to combat the dehydration. Chris regained his strength and wits. Edith and the Park Ranger spend hours with tweezers removing the cacti thorns from her skin. The Ranger put alcohol on her hands to prevent infection. The then party of four ascended up and successfully navigated the series of switchbacks to the top of the South Rim. The rim-to-rim backpacking trip had proved to be a very challenging, complicated and life changing adventure.
The response
This case study provides a good illustration of the importance of participant screening, pre-trip planning and information, group dynamics, environmental hazards (terrain, weather, plants, water stations) and participant characteristics in an effort to reduce the potential for accidents in the field. Although accidents are called “accidents”, because mishaps occur, proper planning can reduce the instances of mishaps resulting in accidents. Pre-trip planning was essentially nonexistent and information needed to be given to all participants. A pre-trip meeting needed to occur. It is possible that allowing the two people to join so close to the trip date was an error as this did not allow for any group bonding. Pre-trip training on how to pack, fitness, particularly as it relates to adjusting to heat is vital on a trip like this. Group dynamics could have been addressed and defined prior to the trip. Skills and expertise could have been delineated. The trip was fortunate to have a nurse however back country medicine differs from front country medicine in many ways. Proper first aid supplies were not discussed.
Although all members of the party were relatively fit, fitness levels can be challenged in extreme heat. Level of fitness and preparedness needed to be determined prior to the trip to make the determination about where to spend the first night. Additionally pre-trip group work would have aided in the conversation at the Cottonwood Campground.
The late start of the hike was due, in part, to the late opening of the trail and the distance from where the hikers were staying and the trailhead. The original trip leader should have been aware of the start time. When the group started later than planned, there should have been conversations about the plausibility of finishing the hike in one day. The lack of water at the first two stations was probably a fact known by the Park staff and a group leader would have been able to learn this with a meeting with Park staff prior to the hike.
Dehydration is a serious illness and the lack of water at the first two stations should have been a clear indication that the group needed to stop at the half-way mark. Once a person becomes dehydrated it takes a significant amount of liquid and time for the body to absorb ingested liquid. The fact that the individual was combative and disoriented indicates that his body was already going into shock and the group was facing a life threatening situation. Symptoms of shock include: alerted mental status, restlessness and combativeness. If the shock is not attended to, patients will experience nausea and vomiting, drop in blood pressure and increase in respiration (Limmer, O’Keefe, Grant, Murray, & Bergeron, 2001). When one member of a team becomes dehydrated it is a good time to stop and make sure everyone is staying hydrated.
The person that fell and injured an ankle and knee was not treated in any conventional back country way. The bleeding was stopped, but the person should not have been allowed to walk on a probable broken foot. The team should have stopped there and if no one was able to make a splint or stokes basket or if the team was too weak to carry the injured individual, the group needed to stop at that point and assess their situation. The fact that two people, including a disoriented man, continued ahead only put the rest of the team in more peril.
“Humans play important roles in most of the processes leading up to accidents and in the majority of measures aimed at accident prevention. Therefore, it is vital that models of the accident process should provide clear guidance about the links between human actions and accidents”
Further analysis of this trip using Hale’s Dynamics of Accidents Model as outlined in (Curtis, 2011) follows;
Environment Hazards
Terrain – a downhill hike sounds easy, however it is complicated by the steepness (a vertical drop of 5,850 feet) the condition of the trail, the weight of backpacks, and the fitness of participants
Weather – Weather was a definitely a mitigating factor in this incident. The participants were in an environment with high heat and dry weather. “Dry heat…often deceives people. They continue to work or remain exposed to excess heat beyond what their bodies can tolerate. As noted by (Limmer, et.al, 2001), “this is why you may see problems associated with dry heat exposure more often than those seen in moist heat exposure (pg. 432).” Additionally dry heat emergencies are aggravated further by dehydration, fatigue and pre-existing medical conditions. (Limmer, et.al, 2001). Additionally the heat increased with time and as the team descended.
Equipment – Not only did the individuals have too much equipment, they carried too little water, and were ill prepared for medical emergencies.
Human Factor Hazards
The case does not specifically address the exact fitness level of the participants, however, when high temperatures and dry heat are thrown in the mix, even the best conditioned athletes can experience dehydration.
Experience: it is unclear if any of the participants had any experience in this type of backpacking or any experience together.
Skills: Though there was a nurse with them, they did not have anyone familiar with backcountry medicine. Additionally, basic backpacking skills (i.e. what to pack for this particular type of trip, how to navigate difficult terrain) seemed to be lacking. Most of the group used personal backpacking equipment lists or old stand by lists such as those found on an REI web site as a guide. Back packing equipment lists should be modified depending upon the unique characteristics of the expedition. For example, even though this was a 4- day trip, a day pack containing a sleeping pad and tarp would have been more appropriate than a 50-60 liter backpack with sleeping bag and tent. The team did not meet beforehand, so most people over packed for the trip rather than sharing the load.
Communication: With no pre-trip communication between group members, the communication process for the group was severely hampered. The communication throughout the trip was very poor.
Accident Potential – in summary
There were a number of factors that played into the accident potential for this team. However, many of these factors are common to hikers and backpackers and can be addressed through planning and preparation. Pre-trip meetings, packing lists, information about weather conditions, physical condition, information on the terrain, communication, emergency procedures, etc. are all helpful in reducing accidents. Expedition teams should come together for a common purpose and the needs of the team should be put before the needs of self. This is a helpful case study that many can learn from- a perfect storm with pain and challenges and a team that is willing (and able) to share their story.
References
Curtis, R. (2011). Are we safe? Balancing the ‘good stuff against the bad stuff’. Princeton University Outdoor Action and Outdoor Ed.com
Ghiglieri, M.P. & Myers, T. M (2001). Over the Edge: Death in Grand Canyon. Puma Press Books.
Hale and Glendon Model retrieved on 12/17/2012 from https://www.ilo.org/safework_bookshelf/english?content&nd=857170645
Limmer, D., O’Keefe, M.F., Grant, H.D., Murray, R.H., & Bergeron, J.D. (2001). Emergency Care (9th Edition). Brady/Prentice Hall Health: Upper Saddle River, New Jersey.
National Park Service, Grand Canyon National Park retrieved on 12/12/2012 from https://www.nps.gov/grca/index.htm
Authors Note
Drs. Diane Waryold and Cathy Clark hold Associate Professor rank in Human Development and Psychological Development at Appalachian State University. They specialize in college student development and coordinate a cognate area in College Outdoor Program Administration (COPA). Questions can be directed to [email protected] or [email protected]
