There are plenty of places in the backcountry where things are more likely to go wrong than right. The backside of Hollyburn in high avalanche terrain is one of them. It’s also where backcountry skier got caught in an avalanche in January 2022, breaking his leg in the process. Though his friend pulled him out, hypothermia began to set in, just as the light was fading.
When things go badly wrong in the North Shore mountains, among the first people heading in are members of North Shore Rescue’s advanced medical provider resource team. Made up of 11 emergency room or ICU doctors, anesthesiologists and one nurse, the team combines advanced emergency medical skills with experience and training in backcountry mountaineering.
Medical personnel on the team also must live on the North Shore, so they can be ready to head out at a moment’s notice.
Of the 12 people currently on the team, seven doctors and one nurse work regular jobs at Lions Gate Hospital, while four doctors work out of Royal Columbian in New Westminster.
Dr. Alec Ritchie and registered nurse Kayla Brolly are team leaders of the medical resource team who are both also regular members of North Shore Rescue.
'We're all mountain people'
“The common denominator for all the AMPs is we’re all mountain people,” says Ritchie. “So we’re all comfortable on skis, or crampons or ropes and that sort of thing.”
Ritchie, an emergency department doctor who is also a clinical professor of emergency medicine at UBC, is also part of the Whistler ski patrol as an embedded physician.
Brolly, who grew up on the North Shore, also spent time as a ski patroller before becoming a rapid attack forest firefighter, where she rappelled out of helicopters into danger. When she started nursing school at UBC, Brolly decided to volunteer with North Shore Rescue as a way of continuing to use her skills. She hasn’t looked back since, and was out providing medical help at an NSR SAR station two days before giving birth to her daughter.
About 40 per cent of calls are medical
About 40 per cent of North Shore Rescue calls are medical calls. Of those, about 25 to 30 per cent are serious. It could be a serious bone fracture, chest pains, a heart attack, someone who is falling unconscious or showing signs of a collapsed lung or internal bleeding after a fall.
Sometimes there’s a mental health issue – someone’s drunk or high, paranoid or suicidal.
There is no “typical” call.
But just as an example, says Ritchie, consider the “boot top tib/fib fracture” – what happens if a skier falls over and snaps their leg at the top of their ski boot. “Sometimes the bone’s even sticking out of the skin.… Then put yourself in the backcountry of Seymour.”
The advanced medical provider program is unique in Canada. In Europe, such teams are much more common, said Ritchie – with one big difference. “In Europe you’re a paid professional. That is your job, to do helicopter mountain medicine. We just do it for free.”
Today, their capability rivals any search team in the world.
Bringing intensive care to the backcountry
“We have the medications and the equipment to essentially bring an intensive care unit to the mountains.”
Among the equipment they often carry: monitors, a defibrillator, a CPR machine that does chest compressions, oxygen, IV tubing, breathing tubes and even a handheld portable ultrasound.
Beyond the technical gear and medications, knowing as much as possible about what they’re walking into helps.
Once in the field, however, a lot of critical care comes down to a doctor or nurse’s own clinical skills. “When you’re there, you have to make whatever you have work,” says Ritchie.
Emergency medicine on the side of a mountain slope in the dark will never be the same as it is in hospital. “When the technical complexity of the mission increases, the medical care must decrease. Something has to give,” says Ritchie. “If they’re on the side of the mountain on ice and it’s -10 and we’re helicopter longlining, that’s a technical mission. I can’t be doing a lot of medicine. I must stabilize the patient and get out of Dodge.”
Medical decision-making is key
“There’s a lot of medical decision making on what do we need to do immediately and what can wait until we get to somewhere warmer, drier, better lit.”
Brolly points to a call in September as one where the medical team made all the difference. In that case, Brolly used a portable cardiogram to diagnose a heart attack at the top of Mount Strachan. Knowing cardiac emergencies should be handled at certain specialist hospitals, they flew the man straight into Vancouver Harbour for transfer to St. Paul's ER.
“That’s a case where this program is making a difference,” she said. “If it was 10 years ago and we didn’t have this technology and this level of care, it could have gone a different direction.”
Not every call is a success. “Not everybody lives,” said Ritchie. “That’s hard on us.”
Deaths that result from foolish decisions are especially difficult, he said, because “this didn’t need to happen.”
But those days are far outweighed by the satisfaction of making a difference in an environment they love.
“It’s very gratifying,” says Brolly. “Because you’re in these really bad spots with people where no one else is coming. It’s just you and your team.”
This story appeared as part of a special North Shore Rescue feature section in the Jan. 25, 2023, edition of the North Shore News. You can find out more in this article examining the major advancements North Shore Rescue made in 2022, as well as this story about a new book that gets to the heart of volunteer rescue teams.