'I could never be sure that I would be understood'

The entrance area of terraXcube – Eurac Research’s Center for Extreme Climate Simulation is getting crowded. Experts and 40 emergency physicians from all over the world, who have accepted Eurac Research’s invitation to spend two days training in the use of innovative technologies and procedures under difficult conditions in the mountains - in wind, cold and darkness - are packed around the exhibition tables. Giacomo Strapazzon, Head of the Institute for Alpine Emergency Medicine, concludes his welcome address to them with the sentence: “Let’s learn and be safe in adverse conditions.”

The extraordinary training follows a simulated rescue scenario in the Large Cube, the largest chamber of the extreme climate simulator. Inside, the participants encounter environmental conditions similar to those in the high mountains. The groups, formed in advance, consist the following rescues teams; three female emergency doctors, two male emergency doctors and two mountain rescuers who take care of technical matters. After a short briefing in which the instructions to “act as realistically as possible and be quick as you can, and take as long as you need,” the team is equipped for the high mountain emergency mission. Two of the test doctors who have traveled from afar are given protective clothing, the others have their own: the logos and lettering of the Austrian Mountain Rescue Service, the Bavarian Mountain Rescue Service and the American Mountain Rescue Association can be seen on the jackets and helmets. While the rescue team familiarizes itself with the equipment provided by Aiut Alpin Dolomites, climbing harnesses are put on and headlamps are attached, final preparations are also underway in the technical control room.

The interior of the Large Cube can be seen on several monitors. From here, Carsten Patzelt, Senior Technician of the terraXcube, controls the climate conditions in the chamber. Lights are still illuminating the set-up scene, in but soon the participants will find themselves in the dark. A huge boulder block mimics a mountain peak, around which the “wind” from two turbines is already whistling. “The instructors tell me when they need wind and how much,” explains Patzelt as he pushes a regulator upwards.

It slowly becomes clear that there are three injured people: casualty number 1 - played by a volunteer, is lying in a narrow space between the wall and the climbing cube. He appears to be conscious but seriously injured. His right leg is twisted into an unnatural position and an ice pick is stuck in his left shoulder. An emergency doctor kneels next to him and tries to talk to him. The injured man’s thin voice is barely audible in the howling wind.

Loud cries for help come from behind the rock. A mountain rescuer and a medic clip in with their carabiners and begin to ascend the boulder. Once on the other side, they abseil down into a narrow hole in the rock. Down here, somewhat protected from the icy wind, casualty 2, also a volunteer, sits leaning against the rock face, holding his obviously broken wrist and screaming in pain. Just above him hangs casualty 3 in a climbing harness. The lifelike dummy simulates someone who has fainted.

First, casualty 3 is slowly lowered down, the doctor checks his vital signs and begins resuscitation. He calls for reinforcements, but the wind is so loud that his colleagues can’t hear him. The emergency doctor will later say about casualty 2: “He was crying, so I knew he was okay.”

Back to casualty 1: His leg has now been stabilized and although he is wrapped in a rescue blanket, he is shaking all over. The two doctors, working with their bare hands don't seem to notice the freezing cold. In order to communicate, they have to shout against the wind. The darkness, which is only broken by the beams of their headlamps, makes communication even more difficult. One does not always seem to understand what the other is trying to say.

In the meantime, the emergency doctor behind the rock has managed to make contact with the team leader, and now there are two injured people, two doctors and a mountain rescuer in a very confined space in the hole in the rock. While casualty 2 is still moaning, the dummy is being tirelessly resuscitated. Here too, the conditions make communication between the doctors and the rest of the team on the other side of the cliff visibly more difficult. Finally, everything is ready to pull casualty 2 out of the narrow space and lower him back down on the other side. He is escorted to a sheltered place and the team leader stays with him from now on. After gaining an overview of the situation, she calls the emergency center and orders the rescue helicopter. Shouts can be heard through the wind from the darkness: “Where is the blanket? The casualty is shivering badly.”

After everyone has got rid of their climbing harnesses, helmets and functional clothing, the group meets with scientists from the Institute for Alpine Emergency Medicine for a debriefing. This debriefing in the warmth is just as important for the training as the simulation of the mountain accident itself. It is not only about evaluating whether and how the team has mastered the task, but also about sharing and discussing the knowledge and experience gained. In this way, the experience can be analyzed and used as preparation for future assignments. This helps to process things on a personal level and helps the team to improve.

It soon became clear that the extreme climatic situation complicated communication at all levels: between the doctors, with the mountain rescuers and the team leader, as well as with the rescue center at the hospital. Unsurprisingly, experienced teams had it a little easier, but overall, everyone agreed that the biggest difficulty was passing on all the relevant information quickly and safely to their team as well as to the outside world. “Every word I wanted to say, I had to scream it out, and I could never be sure if it was understood.”

Simon Rauch, emergency physician and researcher at Eurac Research, also confirms that operations in the mountains present rescue teams with completely different challenges to emergency medicine in the city. This is why it is so important to test how life-saving interventions can be carried out on seriously injured people, even in difficult terrain and under extreme conditions.

It became clear that being prepared for rescue operations in extreme situations requires more than just knowledge and practice with the latest technologies. Soft skills such as teamwork, communication skills, leadership and situational awareness also need to be trained so that communication works even under adverse conditions.