Episode 150- Critical Care for going Deep with Justin Grisham

If it happens, preparation and training is the key

Justin Grisham is an emergency medical physician, wilderness medical expert, and search and rescue volunteer who wants to get our flying community better prepared for dealing with emergencies in the field. In this fascinating and note-worthy episode we brush up on some of  Justin’s free-flight first aid curriculum: medical decision making, common paragliding injuries (what you can fix, what you can’t), the primary assessment, secondary assessment, heat and cold injuries, the use of narcotics and pain medications for victims, drowning and water risk, wound care, tourniquets and securing a scene. Justin has built awesome youtube courses for each of these subjects and offers courses for our community so we can be better prepared for when things go wrong, as they unfortunately often do. Please listen, share with your flying community and reach out to Justin if you want to have him help you design an incident plan for your club or to help your club members get hands-on wilderness medical practice.

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Show Notes:

Justin’s website: https://www.paraglidingfirstaid.com/

First Aid Kit list we discuss in the show and what Justin carries:

  • CAT Tourniquet (be sure to get from a reputable manufacturer like North American Rescue. There are a lot of counterift ones on the market.
  • Nasopharyngeal Airway (NPA)
  • Chest Seal
  • Emergency Blanket
  • Pressure Bandage
  • 800mg Ibuprofen
  • 1000mg Tylenol
  • Link: https://www.paraglidingfirstaid.com/first-aid-supplies

Recommended courses:
Justin’s own: https://www.paraglidingfirstaid.com/s/shop
Remote Medical Training
Wilderness Medicine of Utah

Clubs interested in either a course or help with designing an incident plan can contact Justin through the website. There’s a contact form on the bottom of the homepage.

Stuff we discuss in the show and associated courses Justin has made:


Pre-course Material (6hr) Topic Link
0.5hr Medical Decision Making https://youtu.be/U0GEH_9whuQ
0.5hr Common Paragliding Injuries https://youtu.be/K6Mr8Yb7yhg
0.5hr The Primary Assessment https://youtu.be/zcO7Z3vf7E0


0.5hr The Secondary Assessment https://youtu.be/sbuKwMceYv0
0.5hr Emergency Evacuation Planning https://youtu.be/zLCCVJedNSI
0.5hr Heat Injury https://youtu.be/1xy9Z4b67mM
0.5hr Cold Injury https://youtu.be/z5knXTb0x08
0.5hr Allergic Reaction https://youtu.be/Be91nEMw-B4



0.5hr Drowning https://youtu.be/IZy2tfdpM_k
0.5hr Wound Care https://youtu.be/Q1_51sqxlMU
0.5hr Altered Mental Status https://youtu.be/RZLfNzOTc9c


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Speaker 0 (0s): Welcome to another episode of the Cloudbase Mayhem. And I have to apologize yet again for getting these out a little bit late. I am not living at home. We had rented our house out back June 1st before the race. And it's proving very tricky to book library time and get these, you know, the sound quality, good enough and book people right now. So I'm having trouble with that, but we will get back on normally scheduled programming as soon as we can. I do have a fantastic show for you today, Justin Grisham and ER doc and emergency position and newer paraglider, but Barry, very stoked to reached out to me long time ago about, and he listened to the Matt Wilks podcast and we've done a couple of those and Matt now, and a good friend of mine in the UK will be heard those, but about just a medical assessment.

And he just wanted to kind of expand on his own training and what he's learned, what he's seen and share all that love and knowledge with all of you. So get into that here shortly, but it's, we just had a great chat and really excited to share this with you. Couple quick bits of housekeeping, I've got a whole new stack of really beautiful recaps, hats, and new, a new schwag in the store go to Cloudbase, Mayhem dot com and check out the store. And we're carrying the, this Roush Swiss critical gloves now, and a bunch of new Patagonian t-shirts and stuff.

So check those out. If you're in need of some, some gear for flying and the hat, the, the gloves I used and the race actually, they're the really pretty neat. And the other bit of housekeeping is the ECS red rocks. We are fully going forward with this hike and fly race. It's a three-day stage race. Three-day two nights stage race at the Munro flying that his now the biggest flight. And I think by far in north America, every fall and the flight, and is the 27th of September two, the 2nd of October, and the race is going to be that weekend Friday, Saturday, Sunday.

So September 30th, October 1st and second leave the we've got two divisions, the pro division and the adventure division and the pro division. There is a $5,000 prize for first place scoring super simple. You when the day and get one point and get second and second two points and on down. So whoever has the least amount of points at the end of the three days wins the, the grand prize. It's going to be a lot of fun. It's going to allow us to make things harder or easier at the end of each day to kind of moving forward because it 'cause, it's the stage race, and we'll all get to start together.

And probably won't all be ending together at the end of each day and certainly the pro division, cause it's going to be pretty tough, but the adventure division is, is open really to anybody. And you just gotta be comfortable hiking and taking care of yourself in a environment and getting off probably different launches. But, and the pro division is going to have a lot of top landing and be physically pretty tough and really tough courses. And it's all gonna be a blast. And it's all going to take part in during the flying, which is just awesome.

So I know it's tough getting to the states right now with the whole Delta variant taken off. And so I know a lot of people aren't allowed to travel and from here and we were hoping to get a bunch of international pilot's and a bunch from the XL apps and stuff and this. So we shall see, hopefully that'll get better and that can still happen. But if you are overseas and thank you can make it reach out to me, we'll make a spot for you. And if you're interested just to learn more or to sign up, go to X red rocks.com, there's a lot more information there and that's it, that's it for housekeeping.

Let's get into the show. We talk with Justin Grisham about medical decision-making common injuries and Free flight primary and secondary assesment, emergency evacuation, planning, heat injuries, cold injuries, how to deal with water and how to deal with patient and what you should be carrying in a wilderness environment. And I found all this just awesome. I always learned something new from these and the, some of the knowledge that we as a community really need to be dialed in with an understand and share, and because it does happen and the better prepared we are, the better the outcomes will be joining the show.

Justin, man, I think this has taken us like two years.

Speaker 1 (4m 44s): It's taken a long time and I'm excited to have this opportunity to chat with you. I wish we were doing it live out and it sounds like you were in Cheyenne right before I was, we could have done it, then that would have been great. But I thought a cool place for us to start is you, you reached out to me when you first reached out to me, you and listened to the Matt Wilks podcast and kind of inspired by that and started using your background to teach about, you know, medical wilderness, first response and, and medical things in the wilderness environment, which is what we're doing, paying lighting, paragliding all the time.

So, and we've been kind of, kind of trying to align for quite a while here. And we finally got the opportunity to do so. So why don't you tell everybody your background, why you kind of reached out to me and why it makes sense for us to do this? Yeah, thanks Kevin. It's I'm glad we're here. It's, it's pretty cool to be talking even if it's not in person. So yeah. I and listened to the podcast with Matt Wilks and that was a real big inspiration for me as well as just starting to fly and, and the part of the community.

And unfortunately, starting to see a lot of people get hurt. So my background I'm an emergency medicine physician. One of my fellowships is in wilderness medicine. And then before that I was an EMT and a medic, both for the national park service and then in salt lake county on their mountain rescue team, doing all there on the mountain, rescues, which as you know, there's, you know, there's a lot of people who fly in salt lake city, whether it's paragliders are speed fliers or the smell, the occasional hand glider.

And so, you know, working in there. And that was well before I was a pilot. We rescued a lot of folks and I don't think I really appreciated the sport or kinda what it took until I started flying. And then as a, as I started flying, I realized like, it's, it's pretty out there. I even compare it to, you know, the other sports I've done Alpine climbing and back country skiing. And, you know, even the big climbing expeditions to south American stuff, I don't think I've ever felt more alone than paragliding.

And so, you know, as a sort of thinking about it and thinking about like, well, what would I do if, if I got hurt in this situation and then, and then seeing some accidents on the hill are in the mountains. And I felt like there was a need to spread a little bit of love in the community and, and kinda spread some knowledge and maybe help some people get out of bad situations. And so that was, I guess, that's what I'm hoping to do. What kind of spread some stope and spread some knowledge. Yeah. And we're going to reference a lot of the courses that you've put together. These are all kind of half an hour courses on a bunch of topics that we're going to go through right now, but those of you listening and go to the show notes on this and this podcast, and there's a whole bunch of YouTube that Justin has created specifically for these.

So what do you think, should we just take it from the top and go, yeah, let's just go through the top to bottom. And these videos are, these are all from a course that I teach a few times a year. I teach like an in-person paragliding first aid course. And usually that's in somewhere in Colorado where I live. And even though the traveled for a few of them and I, I just want, I want to spread the love and spread the knowledge. There's a lot of good courses out there as far as medical courses. And, and usually they're cheaper than an SIV. So I encourage people to try to get some sort of knowledge, but these are, these are the good starting point and what we've talked about this quite a bit with our club.

And I think some other clubs are even doing, and I know they've done this in Jackson, but it almost seems like clubs around the world, not just here in the states is pertinent no matter where you fly, but should be kind of, and you know, it could almost sponsor this kind of thing or at least do the, the three-day version of Wolffer, you know, the kinds of the wrap and version and keep people tuned in what, what I have found in every emergency I've been involved in it. And unfortunately now, and been involved in a ton is it's, you know, you have the emergency, you do the debrief, a lot of things you've done right.

As a team, some things always have not been done, you know, what could be done better, which is what we do debrief. But, you know, it's one of these things where a lot of the same stuff keeps happening. Cause you, you had the incident, you S you do the debrief and then you kinda, you know, you waffle on, you know, making the first aid kit really is bombers. It should be, you don't put the back board and the retreat vehicle, you know, the little things that we can really shore up.

I think his club's and kind of have, you know, we've talked about it. We should have a lockbox at the main Elzhi where whoever's going on and treat could just go in there and get everyday, you know, there's the medical box. And we know that that it's, you know, we've got it with retrieved driver. Cause you know, it's kind of expensive to make up five of them. Anyway, this I'm sure you've talked about some of the stuff and your thing, but it seems like this is just something that sure would be nice if you know, everyone in the community could do it, but you know, like you said, it does take time.

It just takes money to get, certainly go through Wolffer and it's pretty intense tonight, the course. So, and it'd be nice to, ah, anyway, I like what you've broken this down and making it kind of piece by piece and tack more tackable and yeah, and then I think it's pretty analogous to fly in, right? I've learned and continue to learn the same lessons flying over and over, and sometimes feel like I don't always remember mistakes that I've made flying. And I think medicine is the same way. You know, it's, there's a reason that we do, you know, thousands and thousands and thousands of hours training when we go through medical school and residency and everything else.

And I don't think you need that and necessarily to take care of your friend who crashes, but you know, consistent practice and something that I've seen with a, the last class I taught, which was in Boulder, a bunch of the students and that class, they get together once a month, once every, once, every two months and just meet at the hill before they fly. And they just kind of talked about some stuff for a little bit. And, and that's something that keeps those skills pretty fresh in their mind. And, and I trust them a lot more if I'm the one who crashes to take care of. And so I think there's a lot of like little things that can go, but, and it, it takes, it does take a lot of work and this isn't fun stuff to think about.

You know, it's fun to think about flying and it's fun to plan whether it's not, it's not fun to think about what you do and an emergency. And, and that's probably one of the barriers to it. And I don't know how we can kind of get over that as a community. Yeah. I mean, unfortunately it's just so relevant and we, we have to go through this pain literally and metaphorically, but yeah, well, let's, let's go through this. And you know, the one thing I would say we need to add to this, you know, at the bottom and the last one, and a lot of people have been reaching out to me lately and not the distract is from what you're going to be telling us here, but is a little inReach briefer, you know, a half an hour show on best practices there.

Because again, it's like, you know, most people take it out of the box and learn how to turn it on. Maybe learn how to turn on tracking and that's about it, you know, and those little guys can be, or something similar, pretty much in every rescue I've been involved in, we haven't had cell and that suddenly becomes something that's really critical. Just, you know, just knowing where to find your position so you can give it out and give it over the radio and that kind of thing. It's, you know, it's, it gets real frustrating if you get slowed down.

Totally. And, and maybe I should. And I was thinking about putting something together, like a lessons learned from search and rescue and, and, and there's probably a lot of thoughts on this and the community, but don't, don't people shouldn't expect to be seen from the sky. You know, everyone loves helicopters. It's really hard to spot a paraglider in trees and I are on the ground. And depending on what color it is, you know, I fly a bright orange wing and sometimes even that's hard to find. I mean, it's, it is so hard to see people to, to find people whether you're walking around or from the sky.

I think there was some lessons learned probably with what the key research. Yeah. Yeah. It's a good opportunity to tie, but we've never really done a proper debrief of that. I was just hanging out with bill up and Chalan, and that's on the way. And that's on the docket. We really need to do it for, for a lot of people that just need a little bit more time, what was probably time to do it now. But there was, I think I mentioned this when I just mentioned the, the key, the incident months ago, the color and the wing was the big one there, he, and a blue and white wing, which was really not visible.

And the other was that we had, and I was one of them, dozens of people with really good glass within feet of where they ended up finding him in the first search. And I mean, I was looking right where he ended up being, and he didn't move between where he, you know, when he landed and, and a few weeks later when they actually found them, it's really hard to see somebody in that many trees and it's just phenomenal.

He was a big dude and the wing wasn't packed way. It was, you know, we don't really know what the wind configuration was. And those first days, what do you know where they found it? It was separated from him. So, you know, I did move quite a long way. So who knows what the, what, what it was like when we were in there, but still we were right on, we were standing on them and we didn't see him. And I think, I think in the us, aside from a few areas that are real close to the metropolitan centers that have really well-trained rescue teams and expecting self rescue is the way to go and kind of what should be everyone's expectations when they start to think about what am I going to do to plan for an emergency, how am I going to practice for this?

What are the kinds of my mental thought's going through this? And it probably should be, I'm going to get myself out of this. Or my friends are going to get me out of here. Yeah. Rely on your own crew. I think that that was the end of the things that one's come up and rescue editor been, and we're way more, or we're just more used to the wilderness environment than, and a lot of the search and rescue teams. And we're just, we're, we're we, we understand what's going on. We understand what the free flights all about. And, and we've got all the resources, we've got the enriches and we've got the first aid kit and we've got the radio's and, you know, we, we, we understand operating out there.

So we're much more, we're much more effective and fast for sure. Yeah. Radios are a huge, a huge thing. There's no other population of athletes that I've rescued who have radios, you know, and in the U S clamors don't carry the radios. I, and I didn't rescue and a sailor as I was never doing the maritime thing. And I'm sure they'll have radios, but 'em, you know, paragliders have radio's and communicating now with the search and rescue team is, is huge of, because, you know, we're used to being able to talk on the phone with folks that's not going to happen.

If you can come on the radio, there's even teams that can triangulate radio signal, and that's not that hard to do. And the national park service can do that pretty easily. So I like the sounds in some ways like your first topic medical decision-making, let's get into that. Yeah. And so, you know, making medical and making medical decisions is, is an amazingly complex kind of set of ideas, but I think it can be boiled down and it's really analogous to how we make decisions.

Flying paragliding is, is a really complex sport. There's a luckily for all of my patients, I'm a much better physician than I'm a paragliding pilot. I'm still learning a lot about flying a paraglider. And I think I learn more every day and the there's so many similarities here. And, and so much of it comes down to preparing yourself beforehand. I, we, premake a lot of decisions when we fly. All right. I think we've all probably pre-made decisions as far as when we're going to toss our reserve, right?

If X, Y, and Z happens or, you know, X happens and I'm this close to the ground, I'm just gonna throw my reserve. It's a pre-made decision to kind of make that decision faster. And medical decision-making is the same way you can pre make a lot of your decisions. We talk about an O O D a loop, right? And this is a military thing that a lot of fighter pilots kind of coined and started using and an ODA loop. If you think of, you know, kind of four letters in a circle, and it's observe first, you observe, and then you orient yourself to a situation you decide on a course of action.

You act according to that decision, and then you reabsorb what's going on. So this is kind of how humans not only make decisions, but make fairly complex decisions, and then look at how those decisions affected their environment and kind of affected what's going on. So say like, you know, the analogous to paraglide and it would be like, okay, Hey, you know, I'm on a, which line do I take? And, okay, so maybe I'm gonna, you know, what kind of head off to the right a little bit. So I'm observing everything around me. I'm looking for, you know, do I seeing other wings going up?

Do I see bird circling? You know, I'm orienting myself to the situation. What's my wing field. Like, what do I see on the ground? What is all the data from my instrument telling me, I decide on a course of action. I turn right. Or see, like, maybe there's a lift the line over here, you know? And, and I decided on that and act on it. And then I'm re orienting and re observing to my situation to see if I screwed up or not, and be like, oh, Nope, that was the wrong decision. Should a turn left medical stuff is the same way.

And you see a patient and maybe they're bleeding heavily on the ground. We know the number one cause of death and trauma is just bleeding. And it's really, really simple if you take, if I, if people take nothing else away from any of, kind of the talks or the lectures that I give, it's like, just stop bleeding. You know, that, that takes care of almost 90% of preventable death in trauma. You know, there's a lot of stuff we can't fix. I can't fix massive head injuries. I can't fix big, big injuries to the heart, but blood that's spilling out on the ground, you know, I can fix, you can fix a six year old can fix it, what the proper training, you know?

And so, you know, kind of pre making that decision. Right. I know that if I see, I observe a lot of blood spilling out of someone who just crashed right. Coming out of a big wound on their leg or a big wound on their arm, I've already oriented myself to that situation. I see the blood, I know what's going on. I've pre made that decision in my head. I'm putting a tourniquet on that limb to stop that bleeding. And that's the decision. And I made sitting in my house, you know, and the, on my couch drinking a beer there, and I've already made that decision right.

Listening to this podcast. Right. And then, and then you can just decide. Yeah. And that's going to make all of our decision-making faster. And now that requires some medical knowledge, but more important than that, I think it takes some imagination. I think, sitting at home what that beer, or maybe we're caught in traffic, or, you know, maybe you're sitting in the LZ cause the weather sucks and you didn't get to fly, but going through some scenarios in your head and preparing yourself for them and kind of playing the, what if game, you know, what, if this person crushes and it looks like, what am I gonna do?

Or, Hey, I'm gonna go and try to fly this big line with my friends. What happens if we crash? If someone goes down halfway through this, how, what are we going to deal with? That, that imagination can really set us up for success. Yeah. And like backing that weigh back. And, you know, there, there are certain people love flying with, because you know, the night before they've set up the telegram group and you know, they've, they've done the spreadsheet for resources, phone numbers, you know, who to contact and all that stuff's kind of done.

So you're not trying to do it when something happens and then trying to figure it out by radio, you know, or something else or crappy cell phone service. And you know, it just, it just removes a lot of the what ifs. Totally. I love that you brought up a cell phone number, something I've been trying to do. And haven't been great at it is before I go fly with my friends, if it's people I don't know, or I don't already have it written down, just like, Hey, scribble down your emergency contact phone number for me. Because I don't, I mean, you know, I don't know a lot of these guys outside our guys and gals outside of flying.

And if they crashed, I don't think I would know who to call if they were unconscious. And that's something as a community, I think we can do a lot better. And, and people don't like to think about that stuff. And I get that right. I mean, there's a time and a place for it. I think when you're walking away from the car is what to think about and not when you're on launch, putting your harness on. Sure. But it's something I definitely think we could do better as we, as we kind of work towards this paradigm of like, how do I make medical decisions? There's a few key points that help us make better decisions.

It, and again, this isn't just medical stuff. It's, it's, it relates to so many aspects of life, but within the medical realm, it's, it's going to help you either save your life or save your friend's life. And that's knowing what to look for. So when we're observing a scene, when we're looking at a patient, you have to know specifically what to look for. Otherwise, you're going to probably be pretty overwhelmed with kind of sensory information.

And most of it's going to be useless. So as you know, folks kind of go through a few of these lectures and look at stuff or take a course it's worse. What worthwhile thinking about, well, you know, what order am I going to look for things? Because some things kill people faster than others. So bloodstream talked about this blood spilling out and the environment is going to kill you the fastest. So that should be the first thing you look for in the first thing. And you kind of observe and orient yourself to it. And that's gonna be the, the only thing on my mind until I make sure that there's nothing else going on with that patient or really good thorough, you know, get your hands around underneath and make sure there's nothing being held in by pants or clothing or harness and make sure there's no blood.

And there was no blood. Totally. And, and to know, to look for that first and then to know, you know, second is to look for airway stuff and make sure that their airway is open, that they're able to move air through there, you know, through the mouth or through their nose, hopefully both, you know, and, and if something's wrong with that to fix it, but to have a paradigm to look for and to look for one thing at a time in a specific order and the, that specific order, it's, it's another primary assessment lecture. It's, it's the first you look for massive bleeding and then you look for airway compromise.

Then you look for breathing like respiratory stuff. Are they actually getting enough air and then circulation, right. Is their heart beating enough that there's actually, you know, are they in shock? You know, do they have a low blood pressure? So there's not enough blood and oxygen getting to important stuff like brain and heart. And then finally like a hyperthermia and, and a C spine assessment. And, and you're going to go through some of these. I know. Yeah, yeah. We'll touch on. I think I, you know, it's, it's hard to the, you know, these are 40, 50, 60 hour courses, but I think there's some, there's some key stuff people can walk away with.

You mentioned a tourniquet, what's the current, I just want to leave people with good, clear, are we still, are we still doing tourniquets? So we just do and pressure and you can, you, you put a bunch of rags and tie it with a tourniquet. So the rags are applying pressure. So you're not really what we just hit on that briefly. And then I'd love for you to hit on to airway or low blood pressure. What can we do there in a wilderness environment to help that for sure. So I'm a huge fan of tourniquets.

I am a military flight doc. So I work with our helicopter teams. You know, everyone in the military we've been using tourniquets for, for 20 years. The last, the last 20 years of conflict, a great success. If, if you're only going to carry one thing in a first aid kit, as a paraglider or a base number or a speed flier or anything that involves high velocity sports, I would carry a commercial made tourniquet. And that's a north American rescue. Like a cat tourniquet is probably the easiest one to get your hands on out there.

So tourniquets are key for stopping bleeding. Commercial tourniquets are far superior to everything else out there. I have seen some improvised tourniquets work, right? Like a belt around a lamb. We recently had a speed fire crash in Colorado. And that, that pilots partners put a belt around, around that pilot's legs. And, and it was a semi effective tourniquet. But what the, all the research studies show is that usually that doesn't work and you need a commercial tourniquet.

I think people are scared of tourniquets because there's a lot of medical superstition around them. But the end game is that you can put a tourniquet on and you can leave it on for two hours without any ill effects. I could put a tourniquet on my arm right now. Just use one. Yeah. So no question to ask. You should take it and you should have a tourniquet, know how to use it. If there's massive bleeding or any hint of massive bleeding, put the tourniquet on and you can always take it off later on. And so that's the takeaway.

I'm a big fan of pressure bandages to, and oftentimes will start with the term kit and then kinda put a bandage on that same wound and then slowly loosen the tourniquet. And oftentimes that pressure bandage will take care of it and you can then take the tourniquet off, but your first bet should be to just put the tourniquet on that tourniquet is your safety net in massive bleeding, and it takes care of the problem. So you can start to think about other things. Great. Right? So airway wise, mainly positioning.

So positioning is always the first bet with airway stuff. Patients usually, if they're conscious will position themselves in the best way for them to breathe. Right. And it's really important to recognize that because sometimes as well, meaning, you know, rescuers will be like, oh no, no, no. You have to lay down in your back and lay down on your back. And we'll position them. Humans don't breathe very well on their back, right? I mean, I snore at night. I think we've all heard people that store at night when they lay on their back that's cause you know, a lot of the soft tissue of our airway just occludes it normally.

And then you add in a head injury or, you know, maybe they've actually hit their face and have some bleeding or some broken bones in their face. Laying back flat on the back is really, really bad for breathing. So you should let the patient position themselves. No one is going to compromise their spine, their own spine by moving humans. If they have a broken back or a broken pelvis, they're not gonna, they're not gonna move and hurt themselves. And we even do that in professional EMS.

Now we know that the, the best and the safest way for someone who's been in a car accident to get out of that car, isn't for us to lift them out of that car. It's the it's to put a C collar around their neck and just have them get out of the car themselves because they're going to protect their own back better than anyone else. And, and it's the same way, you know, for S a paraglider who's crashed. So there are some more advanced airway techniques. The one that I'm a huge fan of that I teach to everyone I can get my hands on is called a nasal pharyngeal airway, which sounds really fancy.

It's a plastic tube you put in the patient's nose and the nasal pharyngeal airway. We use this a lot in the military. I can teach an eight year old to put this in. I'll put one in to the course and walk around with it for an hour. It doesn't bother you. It's just, it is literally just a plastic tube that you having a first aid kit and you put in the nostril and it'll hold the back of someone's airway open. And so if you have an unconscious patient, they're a lifesaver. I mean, and it is a half ounce piece of equipment that will do something that you really can't do on your own, because it's really hard to hold.

Someone's airway, open for a long period of time on your own, but you can drop an NPA and nasal pharyngeal airway, and it'll do it for you. And if you're in the show notes of kind of your first and totally, totally, you know, and I don't carry much, I see people carrying these huge first aid kids. And, you know, my first aid kit fits in like a, like a sandwich baggie, like the Ziploc sandwich bag. And I think he should only carry the stuff that you can't either make yourself or get out of the patient's pack and that kind of stuff.

Yeah. It was interesting when I did the Alaska thing, my, a good friend of mine that I do a lot of baggage for schema is the one on the ER docs here in town. And a, and so I had them come over and check it and he whittled it down to almost nothing. You know, really this is all I need Terry, as the only need beyond this you're toast man. And like, oh, it's so true. Or, you know, stuff you can't make up. Like, I, I can't make up medications on my own. So I carry meds because I'm like, I can't make a med. I can make a splint out of damn near anything, you know?

So I don't, I don't carry a Sam splint. I don't carry anything like that. I carry things I can't make on my own. And that was my next question. So you may have heard, you know, a few years back, my, my ex out supporter and very good friend, Ben broke his back on a terrible landing in, in Nevada. And this was one of these enrage, you know, the helicopter. It was kinda of a big process and all it really well, except in Nevada or the, the, the, the ambulance that came in and kind of stabilize them and everything before the helicopter came in, they're not allowed to carry narcotics.

And we, yeah, and it's, it's the Nevada state thing. And so he had a dislocated shoulder and, you know, and a broken back. And it was in a lot of pain, obviously, mostly from the shoulder, because the back was, you know, he, when I got to him and I, I got him four seconds after he crashed, I was on him right away. But this was one of these communications things to, of the guys that didn't know that he crashed, worked 14,000 feet and sending, and the first aid kit was in one of their trucks.

And we didn't know, we had a first aid kit. We did, we didn't know he had it. So this poor guy, my best bud laid there for two and a half hours before getting in a helicopter without any drugs. And the ambulance showed up and they couldn't give anything. And so this was just, I mean, that's the thing that's in my first aid kit always now is, you know, 400 whatever grant was and what it is for the ibuprofen and some Oxi and the heavier stuff just in case.

But, you know, I think this is another thing that I think people are really nervous to use. So maybe talk about when, and when not sure as far as pain control, you know, my, my go-to to start off with all of these things is 800 milligrams of ibuprofen and a thousand milligrams of Tylenol in the mix, too. Yeah. That sounds like that's the way to go these days truly is. And that's what we use in the emergency room all the time to start off with that, that is the equivalent pain control of 10 of Oxy.

And it doesn't get you high now. And our products certainly have their place. I don't routinely carry narcotics in my bag because there's, there's a lot of legal stuff around that on, you know, and, and that's like routine, like if I'm just going up to Boulder or look out to fly or something like that, and metropolitan kind of flying, and I'm not carrying narcotics, you know, there is a, there is a place for it in the back country, I think, but I'm always going to start off with a, the Tylenol Motrin combo and you can retake that about every four hours for 24 hours.

And it works pretty well. I walked about 20 miles out of the Utah back country with a dislocated shoulder with that cocktail. And it, it wasn't great, but it definitely like, it'll definitely get you out. So 800 milligrams Advil. That's exactly what I took when I crashed Mac at the end of the March. And it just made such a difference. It was so great. And then a thousand tunnel thousand and Tylenol. Yeah. And, and that's a really safe combination and contrary to popular belief. You know, you can, as someone who is on the ground and you could eat and drink, I mean, don't, don't go smorgasbord, but you can eat and drink and be perfectly safe.

You know, anyone who can eat and drink, you should, because these rescues are going to take a really long time. And that patient needs to stay hydrated and drinking is going to be much better than any Ivy. Anyone is going to get you anyway. So let's, let's totally clean this up. Is there ever a time where you wouldn't give the 800, 1000 cocktail, if someone is not conscious enough to like put the pills in their own mouth and take a drink of water themselves and swallow, I'm not giving them anything in their mouth.

Okay. So nothing. So head injury still it's okay. It's okay. Yep. Great. Okay. That's, I'm glad you cleared that up cause there's no, you can't give it if they've had this or that or this or that, man. I think it's pretty nice to get people out of their pain. And now I, you know, you're going to get a better patient assessment and you're gonna be able to figure out what's going on better. If the patient's pain is controlled and everyone's life is easier. If you're carrying that patient out, you're going to be more comfortable if they're more comfortable.

Right. Gotcha. So yeah. Other things we can do, you know, we kind of talked about some, some massive lead and stuff. Some airway stuff, circulation is, is hard, right. In, you know, professional EMS and this kind of stuff. We're moving to where we, you know, we even give blood products, you know, in the field, the last big paragliding crash in Colorado, that I was a part of, right. We had actually bags of blood there on scene at the helicopter crew brought in that's clearly. And you're not going to carry that with you. That's not, that's like a luxury, but you know, what you can do is recognize shock early on.

We've all heard things like so shock is just low blood pressure. And what we're really worried about is vital organs, the brain and the heart, not getting enough blood and therefore not getting enough oxygen that's being carried by the blood. There's a lot of different types of shock. The one really almost every paragliding incident and injury is going to be hypovolemic shock, which just means you've lost so much blood that your body is having a hard time keeping up.

Right? Yeah. The hard thing there is, there's really nothing we can do about that and outside other than get to the hospital as fast as possible, which really just means recognizing it as fast as possible. And so things like, you know, maybe a patient that was talking to you and clear sentences is now starting to get a little bit groggy. I would start to worry about a head injury, but also the fact that maybe, you know, their blood pressure's going down or someone who had nice pink nail beds, you know, initially now the nail beds are kind of gray or blue, you know, you know, their, their hands don't look nice and nice and pink, nice and fleshy they're hands and short and to feel kind of cold.

Those are all signs that someone's going downhill. What we can do in that situation is keep them as absolutely warm as possible. So something we know in trauma is that the older you get, the more you bleed, right? So in medicine, we talk about this as, as the, the terrible triad or the triad of trauma, which is an essence, like the more, the colder you get, the less your blood clots, the less you're blood clots, all right.

The more acidic you get kind of like, you know, your acid builds up in your body because you're losing blood and then you get colder because you're losing blood and it starts this terrible cycle. And so trauma patients of any sort, but especially high velocity trauma, like flying injuries, you should keep them as absolutely warm as possible things that I've had a really good luck with it. And you don't have to carry a sleeping bag with you. Right. Wings like wrapping someone up in their wing, keeps them pretty warm.

I've popped patients reserves, right? I'll, I'll pull their reserve out of their harness and wrap them in that if it's not already out. And that keeps them pretty warm, getting them off the ground. Yeah. With any use the PA use the patient's reserve, not your own, of course, anything you can do to get them off the ground, you know, you know, kinda laying their own harness out or taking the foam out of their harness. Or if you're on a Volbeat and you have a sleeping pad, getting them off the ground to kind of insulate them.

And then that combined with a, like a reflective space blanket with her super light, super cheap, and that'll really warm someone up quite a bit. And if you can do that super early on, really at the end of your primary assessment, when you're looking for all the things that are going to kill your patient right here, right now, you've checked and make sure that they're not bleeding out onto the ground, that, you know, they're breathing that they're moving air in and out of their lungs. You've plugged any big holes in their chest, that kind of stuff with S any sort of fabric, any sort of sticky, sticky fabric.

And that's what we'll talk about next kid warm and get those patients and absolutely warm as possible. And that's going to help save their life because they're going to bleed less. If they're warm. And then the other big one is, you know, look for big old holes in their chest. And you have to look with your eyes and you have to really feel carefully with your hands when paragliders hit. Especially if they land in a tree or there's sharp rocks or this kind of stuff, it's pretty easy to put a hole on your chest and to put a hole on your chest wall is something I recommend that people carry it's called the chest seal.

It's just a sticky piece of plastic. It's about a six inch diameter circle. It's the stickiest thing. It's almost like a, like a rat trap kind of sticky. And you peel the side off of it. And, you know, once you find a whole and some of the stress and you just slap this thing on and they're vented, so they have a one-way valve in. And so if someone has started to accumulate, you know, a, a drop long, a pneumothorax where they have air, that's compressing their lung down kinda air and the wrong space of their chest, not in there long, but in between their long and the chest wall, as they breathe, it will push that air out.

And this whole cause that air is caused by having just a big old hole on your chest. And that's something that you can do really early on to save someone's life. And so kind of going through that and that's, I mean, and that right there, that's my first aid kit. Like we've gone through all of it. I carry a tourniquet, I carry a nasal pharyngeal airway. Right. I carry a chest seal to plug holes in the chest. And I curious something to keep my patient warm. And it's something to keep him comfortable as far as the meds. That, that is the, that's the, yeah.

You know, and we're going to add anything onto that. I'll maybe add a little bit of tape. I'll probably have some duct tape around trucking pool anyway. And the compression bandage like, and Israeli bandage, but that's on the website in the show and we're gonna go get this stuff right now, Amazon, Jeff Bezos is gonna make a lot of money off this podcast right here. That's awesome. Affiliate links. That's okay. And, and that's really, it. That's the primary assessment is just checking to see what's going to kill your patient, your buddy, who just crashed in front of you right here right now and fixing it.

And you don't move on to the next thing. If you find something, you fix it, you know, your act and stare at half your wing, that's collapsed and not fix it. And don't do the same thing with medical stuff. Super interesting. You haven't mentioned any of the stuff. And I think you're going to mention next, and you know, the common paragliding, paragliding injuries, you know, we think of broken, back's broken ankles. We think have all the stuff that snaps, but none of that is the stuff that we lose people over. Is it it's, you know, it's the bleeding and just wholes and the blunt force trauma that you bleed out.

Well, he was one of the problems with, and challenge and preparing for a lot of these things is we're preparing for low frequency, high consequence events, things that don't happen very often, but if they do happen are absolutely disastrous and human brains don't deal very well with those kinds of situations, right? Things that we don't see all the time, we kind of pushed to the back of our mind.

And don't really think about, you know, the really, really horrible self this is when it pays to have a pretty active imagination and kind of be able to imagine this kind of stuff, as far as common paragliding injuries, you know, it's the most common stuff is what you said. It's rolled ankles, maybe a broken ankle, maybe a broken wrist, because someone puts their hand out as they tumble when they do a PLF, when are not supposed to a dislocated shoulder, most paraglide injuries. Aren't very serious.

All right. The stuff that I think people should focus on first is all right, what are, what are the ways that I can save someone's life? If I absolutely have to. And a lot of the injuries, like we said, massive head injuries, massive internal bleeding, and you can't do anything about, so focus on the things we can do things about, which is kind of what we just talked about and then focus on the other common stuff. And the other common stuff is all orthopedic injuries.

So it's broken bones, broken bones, as long as you're not bleeding to death because of them, you know, in the wild you're splint it. And the way that is the most comfortable for the patient, whatever's most comfortable for the patient splint it like that put as much padding around that thing as possible, put something stiff on the outside and tape the hell out of it. It's really not rocket science. You don't want to tape it too tight so that they're losing circulation, right? If they could move their fingers before you put the split on and they should be able to move their fingers after they've put the splint on or their toes.

And, and there's certainly a little bit more of a science to it than that, but that's, that's the end game is you're really putting something from like a trekking pole, even a stick on that, that broken bone, that injury, just so that patient doesn't have to use their muscles to stabilize it. As far as timeframe wise, if you're talking about simple orthopedic injuries, right? Like a broken arm, a broken leg, you know what? You really have quite a bit of time to get to the hospital and get that thing fixed as long as it's not cutting off and you sort of blood supply down-stream.

And so something that's useful to learn how to do is to like, actually know how to find the pulse somewhere and find the impulses can be hard for medical professionals, much less like non trained folks. And so a really easy way to do that is if you just take, you know, take, say your thumb, for example, and you guys, and, and people can follow along as it was just tick, like the end of the thumb and just squeeze the nail bed for a few seconds. And that whole nail bed is going to turn white as you squeeze it with your other hand. And then if you just let go of it, it should turn back to the pink within two to three seconds.

Right? So under the new, yeah, that's cause we're all healthy. We're sitting here nicely and hopefully, you know, if it didn't have that we'd have problems. And so that's a great indicator, how much blood supply that is getting into your hand. Like it should turn back to the pink within two to three seconds, if it takes longer than that, there's some issue going on. Now that issue could be a lack of blood supply because of kind of global shock, because there's just not enough blood in general, but if there's a broken bone above that, you know, say your arm's broken and you look at that from, and you squeeze it and it takes awhile to go from white back to the pink.

Well then I'm a little more worried about that broken bone, cutting off some blood supply. And if I ever have any question, luckily we have the other, and non-injured side of the patient that we can compare it to. So I'm going to squeeze the thumb on their non-injured side and see it. And if that turns right back to pink, well, then I know that I have a problem on the broken side. So anytime there you have some question about a patient, you know, and well, is this normal or is this normal? Cause humans are weird or, and we have all sorts of scurry stuff with us just compare left or right.

We're lucky in that. We're kind of given this, this great comparison to see what's, what's abnormal and what's normal within that person. So someone who does have blood supply, that's cutting, you know, a fracture that's starting to like maybe cut off some blood supply to that extremity. That's someone that needs to get to the hospital as soon as possible. And that's something that needs to be reset professionally and, and kind of yanked on and, and, and that kind of stuff. And that's hard to do outside. And it's hard to do without a lot of training outside.

Is there ever any, you know, for you guys doing this professionally, what happens when you've got a patient who's, you know, pretty with it and they're making sense and they're, you know, they're not panicking, they're not shocked. And you identify something along these lines, like, yeah, thought you were all for three hours, but I think we need to hit your ass. What if they resist? Are you in any kind of, you know, Hey man, I don't have insurance.

No, I'm fine. You know, can you just, w what should you do in that situation? Is it just always patient care? No matter what, no, it's a, I mean, it's a free country. I've had patients on the professional rescues that I've treated for a life-threatening anaphylaxis that then refuse to go to the hospital and we're like 10 miles in the back country. And it's, it's a free country. They're allowed to do whatever they want, as long as they're completely with it. The thing that I will remind everyone is that in the, in the United States, the mountain rescue association, which is kind of the overarching body of mountain rescue crews in the U S, which are predominantly volunteer, right?

And the mountain rescue association and the one who likes sets the standards and, and kind of as far as skills and all the stuff, they have a rule and a guideline, which is that mountain rescue should be free because people will wait to hit that SOS button. If they think they're going to get charged. And the coast guard found this out to the coast guard, figured out that the riskiest rescues that they were doing were sailors, who were afraid to call for help until things got really, really bad. And the mountain rescue association and the same thing. And so if, if you hit, you know, if you call in Ramone and you hit the SSOs and you know, one of these great volunteer rescue teams comes and gets you, they're not going to charge you now, if there's a helicopter involved and it's a private helicopter, they're probably going to charge you, right.

If they, if they take you to the hospital in salt lake, I can say that, you know, we flew LifeFlight, which is a company out there that flies a lot of rescue missions. They have a hoist ship, which is amazing in the United States, they write off about $10 million of rescues a year out of the kindness of their heart. If they don't take you to the hospital, usually they don't charge you by the way. And life flight membership for your family is 60 bucks a year. And that's a different company that the company is worth it to get those. I mean, everyone calls themselves and everyone calls himself LifeFlight.

Right. But it is worth it. All of these helicopter companies have a membership. If you're flying in their area, I mean, 60 bucks, like, you know, I just bought a new backpack, right. So to fit my kid into it, it costs a lot more than $60, very cheap insurance. And I love getting that renewable every year. And yeah, heck yeah. The most people after you walked for awhile outside, if there pretty heard the change, their mind on calling from the rescue of head and everyone should expect for it to take a really, really long time to get an injured person out of the back country.

So even well-trained professional mountain rescue teams with the nicest stuff, right in salt lake, we had a two-piece titanium litter with a wheel and all this fancy equipment. We would, it would take us between three and four hours to move a mile. Yeah. And that's with professional gear. I mean, if you're doing this on your own with like a litter, you've put together out of ski poles and, and all this other kind of stuff is brutal. It's brutal. You really are only moving to an evacuation area.

And, and that goes, and along those same lines, write if the patient can walk, let them walk. Like the best way to the hospital is the fastest way to the hospital. And then, and that helicopter we're a pedantic bunch, but that might not be a helicopter. And we talked about this and Chalan were like, you know, out in the flats I was, and I was in my friend's Subaru, you know, playing doctor and chasing the gaggles around. And if someone crash, I'm like, well, Dan, it might be a while the helicopter, I'm probably just going to put them in the back of the Subaru and start driving rather than sitting out in the flats, wait, and for waiting for someone to show up.

Sure. So the other thing I see a lot in paragliding are cold injuries, right? People get sweaty when they're walking up hill and then they don't really dry off because they're para waiting and then they go fly and they get cold. And it's important to notice because people make really, really bad decisions. When they get cold, they get crabby, they don't make good decisions. They rush things that were not as good as the athletes when we're cold.

So I think you're actually more likely to crash and more likely to kind of tumble in a Landy and that kind of stuff. And it's important to notice the real differentiation there as far as like hypothermia and cold injuries, is that if someone has any sort of altered mental status, because they're so cold. And what that really is, is like, you know, if they act drunk because they're cold, that's a pretty serious thing. That's someone who you probably need to be looking at, getting out of there. You need to be warming up very rapidly and you probably need to be calling for a rescue up until that point, which is usually that's the point like shivering has stopped well before that point, if someone's shivering.

Well, I don't think they should fly because they're just going to get colder sitting in the chair, right? If you're shivering, you can warm yourself back up outside. It's the point at which our bodies stop shivering that we have a really hard time warming ourselves back up. And to that same note, like calories are your friend, like hot drinks make us feel good, but you need sugar to warm yourself back up. And, you know, we see this a lot in, in Colorado. I moved to Colorado from the Northwest and you know, the Northwest, it never really gets that cold and Seattle and Colorado, God, there are some really, really cold flying days and it's, and it's really easy to launch, you know, and the foothills and it's, it's reasonably warm and, and you get up here and it's really, really cold and be able to recognize kind of the stages of hypothermia in yourself.

I it'd be really important. Yeah. I always worry when I go through and when the whole wing is shaking, 'cause, I'm shaking. So, and then it stops and I'm 2000 feet higher than I was when I was really shaking yesterday. And oh God, you know, and then you have, there's, there's a lot of things I think, too, that we need to be really careful of there. You know what? I've frozen my fingers badly enough, few times, not frostbite, but that they don't come back for months and that can't be good for my tissue, you know?

And, and that, and you know what? Hypoxia are getting hypoxic. We talked a lot about and other episodes and stuff too, but it's spring flying or even Smith's summer flying. And our desert environments when you're really tall, I have often thought, man, if I had a blowout right now, I barely know my name. I'm not too sure I could handle it. You know what? You just, you're so cold that you're, you know, you're way beyond what you should, you should be, you know, playing tennis.

You shouldn't be flying a parallel. Totally. Yeah. I, you know, I, I climb a lot. That's my other passion. And I can tell you that the stupidest decisions I've ever made in the mountains are being read the cold ice climbing, the worst anchors I've ever made. The only times I've ever screwed up time, myself and the it's, it's all been won. I'm really, really cold. Cool. And we, you know what I mean? You know, you've talked to him, Matt and he's been on here, you know, he's certainly the expert as far as the hypoxia and, and decision-making, we do a lot of the same stuff with our, our army pilots.

We actually put them in an altitude chamber and drop the pressure. We take them up to 28,000 feet and just to prove to them how big of idiots they are when you're up there. And, and it really is. Everyone is just a blithering idiot and, and everyone has a tell. And I think it's important to find your tell, like, I get really giddy. I'm a, I'm a pretty happy dude when I'm hypoxic and you know, I'm, I'm fun to be around. Some people aren't like that. Some people are assholes. Some people see things it's really important to kind of find your hotel.

And there's probably more hypoxic events than we know about paragliding. Yeah. Yeah. Yeah. I think a lot of people don't, I've talked to a lot experienced it a lot. I'm also, I'm the giddy person, but, but what I'd like that I have, and the first time I recognize that I had no idea what was talking to Nate scale. I've said this on the podcast before, but when I first moved here and, and we started to go and talk and just because you're in Idaho and I had never experienced that. And it was very late the day, big day from here, deep into Montana.

And I I'd sucked up all my oxygen. So I was out and I was really tall that he's 17. And Nate called me on the radio. I was about 20 K ahead of him. And he said, Hey, Nate, check in. Where are ya? And I thought, I S perfectly said, you know, that's awesome. And I'm here and it's great. And everything's, and he responded back. You sound like a fool. I didn't understand one thing you said. And I thought, oh, it must be because my visor is down and I'd learned. And if my advisor is down, you know, it gets kind of garbled.

Like the wind comes in there and screws up my transmit. And then I realized that in thinking this, I went and reached and put my advisor up and that was already up black. I should have known that was already up and what I thought. Okay. And I've put it up and send the same thing. And he said, yep. Nope. Not any better. You sound like a moron. Wow. Then I realized I had just been kind of flying around and just looking at stuff. I had no plan.

No, I didn't really know what I was doing paragliding, but with no knowledge. And I was, wow, holy cow. I think I better dial. It's just this wild, this wild dream that we're found ourselves. And this is awesome. Oh yeah. Wait a minute. And paragliding, this is awesome. Oh yeah. Wait a minute. And unfair. Yeah. Yeah. It's and you know, it's the result, like if you're hypoxic, you're going to get cold a lot faster, you know, and you know, and the ghost it for the same, I mean, if you crash on top of the, you know, the crash at 13, 14,000 feet and California or Colorado, one of these, like what are your patients going to have a lot harder time staying warm and facing this.

And I have a lot harder time clotting their blood and not bleeding altitude kind of makes everything worse. And so, and I think it's important too, to look at and makes head injuries worse. The header injury at altitude is going to be considerably worse at a head injury at sea level because of the lack of oxygen. So I'm going to be much more careful about evacuating and someone with even a minor head injury, if they're a PI and, and kind of get them out faster and get them down faster. And the solution is always just to go down, that is the solution to all altitude based illness.

But yeah, it's the, the question has come up before about, you know, well, if we have, you know, if, if, if you have extra oxygen there, should I put it on the patient while this isn't necessarily always true? You know, oxygen can hurt people in all the situations we're talking about within like paragliding and trauma or head injuries, Oxys, and it's just going to help them. So if you have extra owes, you know, if you have some owes and your harness or the patient's will have some, keep them on those oxygen and you can turn it up a little bit, it's just going to help him, you know?

And, and I don't know if this was just, and when I crashed and March, and that, like you said, the first thing I did was I took the drugs and that helped me immediately. Cause I just thought, okay, there's a lot of pain come in here. And so I took that immediately and then I, you know, I, I just taken off, so I had a completely full oxygen bottle. So I, I started, I just sat down like, okay, just chill out for a bit. And I felt like it really helped. And it was just nice. It was probably just nice to have something else to, and how high up were you, you're in the mountains or aren't you and your wasn't that tall.

I, and you're pretty well and you're pretty well and climatized and not a big deal. Yeah. There's, you know, the altitude is definitely one of the kind of special considerations with paragliding. There's really no other sport out there that you can climb so rapidly. And, and, you know, we're kind of limited by our, our own fitness and all these other sports or paragliding, and you can get shot to the moon and then, and then really see some rapid altitude effects that otherwise we only see and in power deviation.

So there's some other like, kind of cool special, I guess, considerations that I think everyone should know about paragliding. One of which when you're, when someone crashes, whether they came down under their reserve or they're under their wing, the most dangerous thing after they hit the ground is being attached to that wing. So there was not too long ago, a paraglider in the UK who crashed into a tree and it was alive.

And then when they did the helicopter evacuation, the downdraft from the helicopter caught her wing and she didn't, and she didn't survive. And so if you're, if you hit the ground and you're still conscious, you know, the first thing you should be doing is getting out of your wing. That is the single most dangerous thing there. People crash in and get drug all the time, especially with reserves, you know, the reserves, a fairly large piece of fabric that catches the wind pretty easily.

And so, you know, and if you're the first one on seeing the someone detaching them from their wing is vital to them not getting hurt. And that double goes for, if you're bringing a helicopter in, you know, the, the helicopter crews probably haven't dealt with paragliders before, you know, maybe, maybe some of them write like the Utah crews all have a lot of the Colorado crews have, but otherwise we're, we're a pretty small community. And so not only making sure that the patient it has been unattached and the wing, but everyone's wings are like put away, not just constituted in a ball and put under a tree.

I mean, everything needs to be put away before the helicopter comes in the window and have those helicopter blades can be up to 200 miles an hour. And those catching wings, the worst case scenario is it can catch a wing and take the helicopter down. And so, and that goes for helmets that goes for harnesses. Just everything needs to be put anything that could catch the window. And so we put away nicely. And when you roll up on scene, what these books and remember, you know, it's cheaper to hook knife risers and this hook knife in lines, and they've cut really easy to do.

You know, we all know the dangers of landing and water statistically in the only good data we have on paragliding and injuries comes out of a funny enough Turkey for the most part. And there's a little bit of data that comes out of France. We're trying to fix that with the United States. We're trying to revamp kind of the big accident reporting system that has to make it a little more academic and to pull. And so to make it anonymous and people can report stuff, sort of like the American Alpine club has accidents in north American mountain area and that they publish every year.

And I think publishing the same thing for paragliding would do nothing but help our community to see the accident's and to see, and the maybe not where they're occurring, but I know it's gonna be the same accidents over and over, but until those get published and until everyone's looking at them, I don't think we're going to start changing things a whole lot. Right. Yeah. So, but drowning, interestingly enough, like there's not that many drowning injuries in paragliding.

Wow. You know, and we all talk about it because I can certainly be catastrophic, but the, you know, the study and I was reading and, you know, it was like less than 10 over a 10 year period and Turkey. Wow. Yeah. And, and maybe that's because we're doing things right. And being really careful around water. I think people are really terrified of that. I mean, that was one of the first things I learned when I first learned. He just can't go on the water. Yeah. I remember the cat and I talk about that a lot. And the Rockies, cause we were flying, you're a lot of water between the water and us was often and just nothing but trees, you know, and you know, she'd go and the tree was on the water and yeah.

But I think it's really, it's, that's one of the there's many other things that should be, that should be drilled into our minds that aren't. But I think that's one of the things that is, I think people are just really wary of water. I know they had a battle on, up at nationals and Pam and the Canadian nationals, a few, and then there's the bad one on the Oregon coast and one of the cliff line sites. Yeah. Course. But yeah. I mean, I think if there's, you know, there's, there's any kind of current or action to the water, you're really in trouble.

Yeah. You know, I've only landed in the water once it was and, and SIV with Hensey and it was very intentional. Right. I threw my reserve intentionally to see what it was like. And I was amazed at how fast my wing filled with water, you know, after I hit the ground. Yeah. It's the wrong way up. You're you're in trouble. Yeah. Other stuff that I don't think a lot of people think about is if you, you know, so you're, you're making this decision between odor land and the water oil and the trees and you choose the trees, which is probably what I would choose is to land and trees over water.

If you're hanging there, especially if you're kind of semi-conscious or unconscious, or just hanging there for a long time. And there's a lot of pressure on our leg straps, that pressure will actually kill you. It's called harness syndrome. It's something that we deal with a lot. And climbers, we deal with a lot in industrial rescue. So the guys working on power lines and the guy's working on big a, you know, the windmills and this kind of stuff, what happens is if you're dead hanging in a harness, that's compressing the veins of your lower extremity.

There's not going to be enough pressure there to cut off blood supply into your legs, but there's enough pressure to cut off blood supply out of your legs. So if the blood can go into your legs, because those, the harness straps aren't enough to compress the arteries, kind of feeding our legs, but they will compress the veins that are draining blood from our legs. Then all of the blood, literally all of your blood will pool in your legs. And until there's not enough to keep your heart going.

Yeah, it's something that doesn't get talked about a lot. Now. It's pretty rare. I mean, you have to be unconscious hanging in your leg straps probably for a half hour. It can kick in as soon as 15 to 20 minutes, but probably for a half hour there. And so the thought it's easy to fix the thought being there is you just need to reposition that patient or yourself back into our normal kind of seated paragliding and position. So something where, you know, your legs are a little elevated. You put the pressure off of the straps. And so I'm not a big fan of people, you know, like running up the tree and thinking that they can perform this miraculous tree rescue and repel out of the tree with their friend.

I think that's fraught with danger tree rescues are really, really hard. It's it's high angle rescue in a, in a pretty dynamic environment and which you don't really know what branches are going to hold you, but you can easily reposition someone by just tilting their harness back. So their pressure is not on their leg, so they're not pooling blood and their legs. And I think that's really, really important. Something I would like to look into. I do a lot of hike and fly. That's really how I got into the sport and what I love about paragliding and, and fly with the alleyway harness and, and usually a front Mount reserve.

And I don't think that hanging from a front not reserved kind of mounted to our karabiners, I don't think you'd have the same problem with that harness syndrome of kind of hanging from your leg straps as you do from like a traditional reserve that's pulling from like shoulder bridles. Yeah. And I think you would either cause the, the front mounts really lay on your back. It's one of the real, and it's one of the things that people don't really understand when they throw a front Mount reserve. I mean, depending some of them wrap all the way through your shoulders, but the ones that just go to your carabiners will lay you out on your back.

And so one of the things you really have to be active to do, and I know this because that's how I landed when I crashed in March, it was under from out. But you have to grab your risers and pull yourself up so you can stop do a PLF. That's that's really important. So you, you know, you have to, it's, it's, it's an extra thing that's I learned from Dylan doing the, you know, the hacker go training out there and the spring. But yeah, that's, that's something, I mean, obviously if you have time, you know, if you're on your back, you've got some padding hopefully, but what is the greatest way to land?

You know, you'd be better to land on your feet and PLF. So if you, if you, you know, once you've thrown the front Mount, you'll find your, your with most of them that just go to the Caribbean or here, and kind of an awkward position, what can we rectify? But you got to be active to do it. Interesting. Well, that's good to know. And, and so maybe the pluses and minuses there, right. You're going to, if you are caught in a tree, you're going to hang in a better position, but you know, that's the sounds like a real, the recipe for a back injury or a pelvis injury. Yeah. And a lot of the really, you know, unfortunately if you've got the front reserve, you're probably, you know, it's probably a small reserve and those are problematic anyway, but you're also going to probably light kit and most light kit doesn't have any backpacks.

It's only got an under the button and it does. And that's the problem. Yeah. I agree with that. And the other thing, that's kind of a special situation that we should really know how to do. Paragliding is a, it's called a pelvic binder. So there's a lot of pelvis injuries and all high-velocity sports and the really bad pelvic injury that we worry about us. What an open book pelvis, literally your, your pelvis kind of opens up like a bucket becomes wider than it should be.

And when that happens, it tears apart veins on the inside and you can bleed a lot into your pelvis. And so the way we fix that is by making the pelvis smaller. And what we do is you literally just take any sort of strap. I've done it with like a, like the strap that goes, that we use to like pack up like our nose real nicely. If you're going to do like a real nice pack on your wing, you can take that. And it's, it's really just wrapped around about the level of the bottom of your zipper on your pants.

And you wrap it around both legs and you just make that thing as absolutely tight as possible. And that compresses down the pelvis. So you don't bleed as much into your pelvis and that will save someone's life. So every anyone who hit the ground hard, I don't care how the hit the ground. If they hit the ground hard, that when I walk up to them, they haven't stood up yet. Cause they're hurting. I just bind their pelvis. If they're not walking out of there by and their pelvis, you're not going to lose anything by it. And you might save their life because pelvic injuries are really hard to treat God.

They just, they bleed so much and it's internal bleeding. You can't otherwise do anything about. Wow. Interesting. Just, and I know we're up against the timeframe here for you kicked out of the library. I just want to go through the two things, you know, in your list. There's a couple of things we haven't talked about. So take a list, take a look at it and just see if you want to tap into any of them. And then my last question is I thought about this before we even started talking in your profession, you obviously see a of trauma and now you're a pilot, you know, it's, it's kind of like me with motorcycle writing.

And I used to be really into bikes growing up. And I had one in college, which I definitely shouldn't have had. And there were just so many injuries there that were bad, you know, so many head injuries and that kind of thing that I just thought, yeah, that's, this is in the good sport for me. Whereas, you know, paragliding, we see a lot of injuries. I would like, my question is, you know, with your background and you say now, you know, getting into flying and seeing all of this, is it making you more hesitant to fly, more excited to fly?

Does it just change your perspective on flying and maybe how should the rest of us, you know, non emergency trained people maybe think about it. So I'll let you stew on that and then look at, look at this list and see what else we should be talking about here and your final minute, as far as the list things. I think the only thing we haven't, we touched on it a little bit with emergency evacuation planning there. I have a bunch of like sheets in there that you can fill out kind of examples of sheets to like preplan for emergencies.

But I think that's the real key is to like, you don't want to be looking at what the closest hospital is after. There's an incident that's already started. If it's, you need to know. And each, I think each club and each hill should have these plans prewritten and, and an easily accessible place. We humans become really stupid and stressful situations. So anything you can do to take a cognitive burden off of yourself in these situations will only lead to better outcomes.

So, and if clubs want help with that, I am more than happy to help, you know, write up these plans and do this kind of stuff and kind of spread that love in the community. I think it's something every club should have for every common sight that the clubs are flying at. And awesome. So as far as, you know, my own thoughts flying, yeah, it has definitely made me a more cautious pilot. It's made me cautious as far as, you know, when I fly and, and kind of the risks that I'm willing to take.

I'm certainly not the guy tossing down and really big wing overs right above the LZ. And I S I know the consequences and I've seen a lot of the consequences, or I think it affects me the most is honestly watching other people fly. I, I tend to worry a lot about other, you know, my friends flying and watching folks who are even newer than I am get into it and make risky decisions. And I think we have an opportunity in this sport to really acknowledge the risks. I think Kriegel talked about this some on the podcast he did with the, or, you know, this it's a risky, it's a risky profession and to act otherwise is kind of just disingenuous, right.

And to accept those risks. And I think seeing all this, and honestly, I mean, I saw 10 years of paragliding accidents before I ever picked up away. And so I knew the risks going into and doing well and speed flight, and it looks fun and it is fun. And that's what it is and safe with the safer than base jumping. So sure. But, you know, I think we should all have a, an honest acknowledgment of the risks and what we can do to mitigate those risks.

And that's really what we're seeing. A lot of injuries has given to me is like, Hey, you know, these things are out there and, and there's a, there's a good chance it'll happen. And we all need to either come to terms with that, or start playing golf. Exactly. And I really appreciate your work. Those of you listening, please do go to the show notes. He's put together some awesome stuff here and thank you for your offer, what the clubs. I think you're going to get a lot of people

Speaker 0 (1h 15m 11s): Taking the time on that. And thanks for doing what you do. We need people like you. I, I tell my buddy Terry, that all the time has been dealing with COVID all year and those guys were wiped out. And, but yeah, thank you for doing what you do and thanks for educating us and being a part of this, not all community.

Speaker 2 (1h 15m 32s): Well, thanks, Kevin. Thanks for, thanks for spreading the love and spreading the stoke. And it was a good conversation. I hope we get to chat again some time

Speaker 0 (1h 15m 39s): 92. That'd be great. See you, bud. Cheers. If you find the Cloudbase Mayhem valuable, you can support it in a lot of different ways. You can give us a rating on iTunes or Stitcher, or however you get your podcasts that goes a long ways and help spread the word. You can blog about it on your own website, or share it on social media. You can talk about it on the way up to launch with your pilot friends. I know a lot of interesting conversations have happened that way. And of course you can support us financially. This show does take a lot of time, a lot of editing, a lot of storage and music and all kinds of behind the scenes costs.

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