SCENARIO – You have been tasked to a search and rescue into a canyon in the Blue Mountains. A family party of five went bush-walking and have not been seen for 4 days. The weather has precluded Police from conducting their own search until today. They tell you that two young men related to the family have refused to wait for the weather to clear and also entered the canyon from the opposite end to try and find the family themselves. They have not returned in the time they predicted and you and your team are to enter the canyon from the top end in search of these most recent presumed casualties. This was the opening scenario for our most recent batch of HEMS registrars when out for their official canyon rescue training. How would you handle such a mission? What environment are you being asked to enter? What resources could you expect? Why do Sydney HEMS feel it is vital that not only our Special Casualty Access Team paramedics are trained to the utmost for these roles but also the doctors who accompany them?

WHY WE TRAIN – Sydney is uniquely located. The Great Dividing Range is a continent long spine of hills and mountains that brushes up against the Sydney basin making it easily accessible to the five million outdoor-a-philes living there. At this point the range becomes The Blue Mountains, a roughly 11,000m2 area with long ridges up to 3,896ft above sea level, criss-crossed by a labyrinth of gorges up to 2,490ft deep.

This is not an alpine environment. Our mountains are heavily wooded with dense vegetation and featuring long flat plateaus ending in sheer sandstone cliffs hundreds of meters high. The further down the canyons one ventures the more likely we are to meet our tiger snakes, scorpions, funnel webs, an array of other spiders and our good friends, the leeches. Along with the unfriendly biology, the canyons also form a trap for the elements with wind, water and cold all funnelling into these deep tight places meaning that on a 33C day above, the canyoner below might be trapped in 4C water for a prolonged period. With the increasing popularity of outdoor pursuits the canyons play host to an increasing array of bushwalkers, climbers, abseilers, mountain-bikers, hikers, campers and assorted training groups. Our rescues have included troops of scouts, army units on field exercises and more than the occasional backpacker. In the past week,on a single day we were looking at potentially four simultaneous rescue situations in the Blue Mountains at the same time. The ease with which people can get into serious trouble is summed up by one of our veteran SCAT paramedics as “90 per cent of people abseiling down a 100ft cliff have no idea how they would get back up that rope if they needed to…” Classic situations involve patients trapped by floodwaters coursing down a canyon bringing large amounts of broken timber with it, abseilers drowning whilst caught halfway down a waterfall and daywalkers missing a single exit path out of a canyon that sets them on a path that would see days if not weeks before they again hit civilisation.

Prolonged (over 24hours) extrications of even simple orthopaedic injuries present hazards of survival in the elements to all team-members and the members of other services we call upon to assist us. Straightforward interventions such as RSI and mechanical ventilation of the compromised patient suddenly present huge logistical hurdles as seen in the recent extrication of an intubated patient.

HOW WE TRAIN – Our SCAT paramedics require rope skills, water navigation skills, orienteering, mountaineering, stretcher manoeuvring and manipulation. They must work towards mechanical advantage with ropes when presented with cliff and boulder as barrier to their stretchered casualty. They must carry in over difficult terrain everything that they or their casualty (or attendant doc) might require to survive.

In passing appreciation of these challenges to our new docs the requirements including abseiling into an unseen cave, swimming/scrabbling/crawling the canyon to multiple unknown casualties, engaging in critical care interventions with limited equipment and under time pressure of approaching weather to then extricate and transport stretchered patients to a safe point of extrication. They also got a cup of hot chocolate. They were also paid to do this.