leadership training--1st hand experience of being a rescuee

[Lbeale]

I want to thank everyone who participated in the leadership training yesterday for helping me get back in my boat, towing me to the launch and getting me and my gear into my car, driving me home, getting me into my house, and making sure I was okay.

As I was getting out of my boat during a mild surf landing, I pulled a ligament near my kneecap. It happened that quickly. That was the bad news. The good news was I was paddling with people who knew how to get me back to the launch in a timely, efficient manner with the least amount of pain.

The names of people who were helpful are many so please excuse me if I forgot someone. Thanks to Scott and Brian for picking me up and carrying me, to Rick for making sure we had a coherent plan to get me back to my car and home, to Alan Moore for his kind words and compassion, to Patty and Dee for being supportive, to Bill for pulling me off the beach in a long tow.

A special thanks to Scott, John, and Deb for doing the long haul of a tow to the launch (did we make it back in record time?) and driving me home. I literally could not of made it home without you.

I never ever thought I would need to be rescued on Saturday or, that I would injury myself getting out of my boat. Injuries will paddling always happened to somenone else, not me. But now I know first hand, what a timely, well-orchestrated rescue really means to someone who is injured, in pain. Finally, it REALLY does make a difference to paddle with people who know how to conduct a rescue.

I also apologise for any inconvience I may have caused to any of the participants. Les

[eneumeier]

Hi Les,

I was not there but have spoken with a couple of people who were. Please have a doctor look at your knee!!!

Liz N.

[Brian Nystrom]

Dealing with an injured paddler is not an "inconvenience", it's a duty that we all assume when we enter trip leader training. It's part of the "job" and when you get right down to it, it's valuable real-life experience. The fact that were such a cooperative "victim" (no screaming) - and you don't weigh very much - made it pretty easy.

What's the prognosis on your knee? I hope you're feeling better.

[Lbeale]

Thanks Liz--I plan on going to the Doc's tomorrow--

My experience as a rescuee was insightful to me and hopefully, might be helpful to trip leaders. It may be just me but I suspect that some rescuees might have a similar experience.

(1) When I was injured, I tried to down play what happened --denial or embarrassment or shock--I'm not sure--but quickly I talked myself into believing that I was okay and, if I sat down and waited it out during lunch, took two aspirins magically, the pain would disappear and I would be fine. I'd get right back in my boat and continue the leadership training. The thought of turning back was not even an option I considered. I was not trying to be tough, but rather, I was trying to cope with my present circumstance, which was scarier than the injury. It was when Alan stated I needed to go back to the launch that I understood returning was my only option. So what might be obvious to trip leaders may not be obvious to the rescuee.

(2) When it finally sunk in that I was going back to the launch and not completing the training, it also sunk in that I had to get back into my kayak. Not a pretty thought. My mind was selectively taking in and processing information. At different times, I was able to grasp what was happening but I could not grasp everything at once. As time progressed, I was able to take in more information but, it took time. If it appeared that I was not paying attention or being unresponsive, it was because I could not take in information. Leaders had to tell me what to do. As a trip leader, it is probably a good idea to repeat your statements to the rescuee to make sure he or she got the information.

(3) I don't know who picked me up and helped me get in the cockpit without bending my knees, but that was very helpful. it wasn't until I got to the boat that I realized I could not get into the boat--again, selective thought process. All through the rescue, leaders were asking me if I was okay, asking me questions, using humor, but also creating a climate of competency. At one point Rick C. came up to my kayak and asked the details of the plan from one of the leaders. The step-by-step rescue plan was logically stated and I knew what was expected. Letting me know the plan helped me remain calm.

(4) Probably the biggest gasp came from comprehending my vulnerability. I'm in my boat, can't bend my knee, can't use my foot pegs, can't steer the boat. Now, I am going to launch off a beach, paddle through surf to get to deep, cold water. What am I? Nuts??? No, I trusted the people who were towing me. I knew and have paddled with the leaders who were towing, but I can easily imagine if I did not know the leaders how more vulnerable I would feel.

(5) First step to this rescue is to get off the beach while sitting in my kayak. This meant I had to get through the surf without capsizing--remember, can't bend my knee, can't use my foot pegs, in pain, now I have to get through surf without capsizing-yeah, right. Again, luckily, I was with leaders who knew what they were doing. Bill used a long tow to get me through the surf, and there were leaders on both sides of my boat to make sure I did not capsize. Pronto, I was through the surf. Leaders on both sides of my boat literally had to get in the surf and push my boat through the surf as Bill was towing so I would not capsize. It was not easy for the leaders and for Bill to get me thorugh the surf, but it was fast and effective method for getting a rescuee off the beach.

(6) Okay, I'm in my boat and on the water. Getting back to the launch is disorienting and scary because of distance. I am feeling nausea and faint--my knee is starting to have a burning, sharp pain because the tow line tugs at the boat. John is towing, Scott is on one side and Deb is on the other side. At first, I don't paddle but then I realize by paddling it takes my mind of the pain, the nausea, and the strong, sudden urge to fall asleep. The paddling helped my breathing and to focus on something other than nausea and sleep. And, paddling cut down on the tugging from the tow. I suggest that if the rescuee can paddle, he or she should try.

(7) Deb and Scott asked me how I was doing without being alarming, they joked, and kept the banter light. I got into a nervous chatter mode but the talking helped me remain calm.

(8) When Scott took over the tow and John was paddling next to me, he check to see how I was doing physically--can I feel my toes? do I still have a pins and needles sensation in my leg or toes? I told John that he needed to keep talking to me about anything because I was ready to vomit and to sleep, and talking to me was a distraction. Chit/Chat works. As a rescuee, tell the rescuers what you need and how you are feeling so they can be prepared. The communication has to happen both ways.

I hope this information is helpful to trip leaders and to rescuees. Again, this is just my experience of a rescuee. However, some or all of this narrative may be applicable to future rescues. In summary, this rescue was well-executed because it was timely, efficient and leaders worked as a team. Les

[jeffcasey]

Les -

Thanks for taking the time to write this up in so much detail. This ought to be required reading for leaders. Your perspective - the thoughts and lapses of a knowledgeable person in pain - is very insightful.

Take care of that knee!

[Guest guest]

Les,

Where did this happen? Where were you towed to, and where did the injury take place?

Thanks, if you can give us this info it helps me to understand it more.

[Lbeale]

Hi Ken,

We launched from Marblehead Harbor and went out to the light around the bend of Marblehead Neck and landed on the beach by Castle Rock for lunch. We were practicing surf landings with Deb as the leader and I was the first to go in. The surf was not particularly high but as I was landing on the beach, the surf slammed my boat around somewhat. So, I quickly tried to get out of my boat. As I was jumping out of my cockpit that was when I did the knee damage. When I finally got out of the boat, I tried to stand up on the leg but couldn't because my leg would not go straight. I forced myself to stand up on it and made my leg go straight. Brian was on the water, closest to me and was watching me land. As soon as he saw I was in trouble, saw me hopping around, he quickly came in to shore and assisted me. It was that simple and that quick for me. I've gotten in and out of my kayak lots of times in surf conditions with conditions more challenging and never had any problems. Does this response help you in clarifying the events? Thanks for asking, Les

[Guest guest]

Thanks Les,

I guess the thing that would help me to better understand is to explain why you were towed back to the put-in in your condition. Could you not call a Marblehead cab, and get back to your car without the trouble of the tow? You were safe on land in a nice residential neighborhood with a very serious injury. Or did you feel ok when you decide to re-launch and head back to the put-in and start to feel poorly after you started to paddle back?

[Brian Nystrom]

Where we were located would not have been an easy exit to get help. We considered paddling around to a better landing and doing the driving thing, but Les made the call that she was OK to paddle back as long as she didn't have to exert herself, hence the tow. Since it was not an emergency situation and the conditions were benign, the thinking was that it was logistically much easier and probably faster to paddle back (~40 minutes) than any alternative solution.

To put things into perspective, after the accident, we all sat down for lunch on the beach and debriefed the morning's events, with Les participating actively in the discussion and showing minimal discomfort. It wasn't until we were ready to leave that the determination was made that she couldn't finish out the rest of the day's planned activities.

[Lbeale]

I actually did not feel too badly on the beach--I thought the leg would just get better if I waited it out a bit--Da nile just ain't a river--(Zora Neele Hurston)--

But there was something about getting back into the boat and on water that triggered the secondary response--and that secondary response was unpredictable --I did not know that it was going to have that response until I got on the water--So I learnt that how the rescuee is on land can be different than how he or she is in their boat and on the water--

At any point while I was being towed back, I could of said "stop, let's land here and let's call a cab or, someone go get my car"-- but my choice was to get to my car asap--I was given that option of bailing out before the launch by Scott a couple of times while being towed--an option given by the leaders to make a different decision if I wanted--So, I never felt coerced or that my input was not valued--

I just was not ready for my surprise secondary response on the water. In retrospect, a confounding factor was on the beach my leg was not confined so there was no added pressure and I could bend my knee to relive some of the pressure. Once in the boat, my leg was confined by the hull so that confinement may have caused additional pressure on my knee.

An additonal consideration was that the beach was well below the road's access point. I would of had to climb many steps and/or rocks to get to the road. So I was literally caught between a rock and a hard place (no pun intended). les

[Brian Nystrom]

I didn't realize what you went through on the way back. At the beach, you definitely did a convincing job of downplaying your injury (at least you had me fooled). Perhaps I simply wasn't being observant enough, but even when we were helping you into your boat, you seemed pretty much your normal self, in between occasional winces. I had no idea you were as "out of it" as you were. Lesson learned.

[Lbeale]

Yes, you are right Brian. Things shifted for me unexpectedly. On the beach, I could handle the situation but there was something about being in the boat and on the water again that changed things for me. Different environment, different response. That's all I'm trying to say. How the rescuee behaves on the beach may change once he or she gets back into the boat and onto the water. Being on land I felt I could handle the situation but on the water I felt more vulnerable to the conditions. But that could be just me. les

[djlewis]

Les's experience out of and in the boat suggests a possible tactic in such circumstances -- a choice between going back in their own boat, towed or not, or some other way.

Have the injured person just sit in the boat on the beach for a few minutes to see how they are going to feel when on the water. Of course, bouncing around on the water, especially in surf, is going to be even more stressful, but this is at least an approximation. Hmmm.. maybe you could wiggle the boat around on the beach very gently at first, and have the injured person do some air strokes, etc. to improve the "simulation".

It's 20/20, armchair hindsight for this event, of course, but maybe an idea for the future.

--David.

[scamlin]

Les:

I've been going over our choices since Saturday and can add the following:

We considered several evacuation options, including carrying her up some steep, narrow and winding cement stairs to a house (about 80-100 feet above the beach), paddle back to a beach east of the lighthouse (steep rocky beach with uncertain access to the parking lot), continue around the corner to one of the yatch clubs, and paddle back to the launch. Our focus was on minimizing movement of Leslie and secondarily minimizing time. All of the land options involved moving her up stairs, beaches and/or ramps. The launch at Riverhead Beach involved minimal distance and elevation from the kayak (In fact the distance from boat to car was about 15 feet). We estimated that by the time we figured out how to get Les up to the top of the cliff, called for a cab or waited for someone to paddle back to the launch and shuttle her car over, and got her back to the launch, we could have paddled back. We also were adverse to getting her in and out of vehicles too many times. The paddle back seemed the least movement and no more time than the other options.

That much said, we identified the lighthouse beach and/or yatch clubs as bail out points should something go wrong. We conferred with Les at each decision point and agreed to continue on. The paddle around the point was bumpy due to reflected swell but it was 6-8 minutes by the time we turned the corner to calmer water inside the harbor--an eternity when you're in pain I'm sure. We could see her behavior change once underway but as Les says, even though we talked with her throughout, it took some time before her nausa became clear.

I'm not sure I'd take the water option if we had it to do over again. Although there was little indication of how Les' condition would change once on the water, we should always consider whether the person condition can change. Obviously, we had a lot less options for dealing with things like vomiting, fainting or worse on the water than on land. However small the chance of significant deterioration of condition, I'm thinking the prudent thing would be to remain on land. I for one was thinking that while painful, the ligament damage was structural and stable. John appropriately checked several times for the indicators of more unstable injuries (mobility, circulation, nerve damage, etc.). I did not consider that pain itself or delayed shock might trigger an unstable condition. (I don't think Les was in classic shock in a physical sense: her description is more the mental shock of denial and reduced awareness).

Given that we decided to paddle back, in retrospect I wish we had tried to stablize Les' leg in the boat. We offered several times on the beach to bind or immobilize the leg, but Les did NOT interested want anyone touching her leg. But once in the boat, some padding or bracing would have been helpful. Perhaps a paddle float or dry bag under the knee would have given her some relief. I for one was unclear which position was least painful (apparently leg slightly bent), which highlights the importance of careful communication. Of course, fiddling with padding in the cockpit would involve moving her leg around more and eat up a lot of time.

As for the launch, the method devised was to get her in the boat on the beach. Four people then dragged boat to the water and waded in holding two on each side through the surf up to about chest deep, pretty much through the surf, and then shoved her completely out of the surf zone. It was as quick and non-eventful as Les describes. There was no tow line attached to the boat through the surf (remember: lines in the surf are dangerous). We wanted to keep her completely stable and not depend on her bracing or paddling at all. Bill Gwynn and I were on the water just outside the break zone, one on either side as Les came through. I don't remember Bill using a line at all: I think Les simply held onto Bill's grab lines at his bow for the 30 foot reverse tow out to where we rafted up. (Bill can correct me on this). From there it was a simple matter for John and Deb to come out, hook up the tow and we were off.

Les' description of her evolving mental state raise a fundamental dilemma of any accident or rescue situation: how to allow the person affected to retain control or at least choices over what happens to them while taking into consideration the possibility of unacknowledged reduction in capacity to make decisions or even give accurate information? There is no easy answer to that one except to always be mindful of it while not discounting or ignoring the person needing help.

To illustrate: On the phone tonight with Les, I told her that while both John and I repeatedly advised her at the take out to go an emergency room to get her knee checked, we acknowledged to each other that we would probably do the same thing she did (go home, rest, see how it felt and call the doctor if it didn't get better).

Les' willingness to share her story gives us some insight into what goes on for the person in this kind of situation and we're all wiser for it.

Thanks, Les.

Scott

[Rick crangle]

Scott and Brian did a fireman carry to allow Lesley to use nature’s facilities during the break. In this same fashion it would not be possible to carry her up the steps. Each of these large stone block steps, going up from the beach, had a width of no more than two feet, if that, and a rise of at least a foot, plus quite a distances up. Anything is doable, but choices must be made.

The way we got her off the beach was to use her boat as a liter and hand float her out past the dumping surf, all of one boat length, and she then laid on Bill’s deck to pull her back to raft up, all prearranged for her safe passage out. Since it was a single wave dumping surf there was no zone to speak of.

In talking to Lesley by phone, I encouraged her to write about her view of the event, because I thought that this kind of a perspective would be good for people to hear. It was interesting that her recollection of the launch was not accurate.

As to stabilizing her knee I don’t know whether that was discussed, but she sat in her boat for about ten minutes as we arranged to get under way and she seemed like she was comfortable in her position, but still in pain in general. I did ask her if she felt stable and if she could let her leg lay straight out in her boat, as I didn’t think putting any pressure on it would be good.

I don’t know how many people and how many times we suggested her going to the hospital. It was a honorable, and valiant, effort to take her back home and deal with all of the logistics. I think Scott, Deb, and John did a great job. Let us not speculate too much, it belittles the efforts taken.

[Brian Nystrom]

...for a few minutes. That didn't seem to be enough to predict her reaction on the water. As I recall, it was somewhat painful for her to slide into the boat, but once in, she seemed fine. Perhaps the acts of securing the spray skirt, putting on gloves, etc. preoccupied her to the point of not noticing the discomfort?

[Brian Nystrom]

...since you WERE more vulnerable. Despite the fact that help was close at hand, unpredictable things can happen on the water. Becoming nauseaous probably just heightened your emotional distress, which probably made the nausea worse; a classic downward spiral. I'm just glad that it all worked out well in the end.

[PattyP]

As a bystander watching this all unfold on the beach, I was very impressed by the efficient, thoughtful and calm handling of the whole situation. I've had the privilege of paddling and practicing with everyone involved and would have trusted each one. But I was still awed at the compassion, kindness and caring shown by everyone involved.

This was the ultimate test of NSPN's training - taking care of one of our own!

I wish Leslie a quick recovery and thank you for your insight from the rescuee's point of view.

Patty

[Lbeale]

You are right Rick, that's it--why did I think I was towed off the beach when clearly to everyone else I wasn't? I could swear I was towed out by Bill and those by the side of my kayak were there to navigate the boat through the waves, assisting the tow. Therefore, I must of been "losing it"--that is, my ability to process information or events on the beach before I even got on the water--it was getting into that boat that flipped the switch off--I remember you asking me while I was in my boat if I was okay and about the leg--and I said yes I was okay and I could keep my leg straight--but I must of been losing my capacity for judgement--and not know it--and as Brian stated, the spiral effect takes over.

Sooo, this is what I learnt by having this bi-polar experience of training as a rescuer in one moment then the next moment being a rescuee:

Rescuing someone is a dynamic process not a static process. There is a begiining, middle and end to a rescue.

At different points in a rescue, the rescuee may be going though various stages of physical and psychological stress or discomfort. During a rescue, physical AND psychological conditions can change for the rescuee, consciously and subconsciously.

Psychological changes that the rescuee experiences can impact the logistics of a rescue not just physical experiences.

When there is an injury, the person may experience a selective information process--that is, the ability to take in limited or selective information at a given time and given place. This selective information processing is sometimes referred to as Post-Traumatic Stress Disorder (PTSD)--A rescuee can experience PTSD and not know they have PTSD -- Does this make sense???

Communication between the rescuee and rescuer is vital to a successful rescue. In NSPN trip leadership training there is a strong emphasis on consistent and constant communication between rescuee and rescurer. This rescue was successful because of the paddling experience level, the rescue competencies including team work, and the communication skills of the trip leaders.

I was very fortunate on Saturday. Les

[Bill Gwynn]

Just to clarify the tow out with Les. We did a standard contact tow (no line), she leaned over onto my foredeck facing me as I paddled backwards keeping our boats close together. At one point during the tow out she sat up and held onto my deck lines, but her boat started to sepearate from mine making the tow more difficult, so Scott instructed her to go back to the previous position laying over my foredeck. We thought that the contact tow was the best option because it provided support for the victim rather than just hooking up a tow line and leaving her vulnerable to a capsize.

[bethany]

You were probably the most cooperative "victim" of the day! Hope your knee is healing up quickly, Les.

--b