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Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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A Winter Tragedy


The practice of wilderness medicine is unfortunately frequently necessitated by tragic events and circumstances. We are all enormously saddened to learn of the death of James Kim, whose recovery was announced today. Mr. Kim succumbed to the cold Pacific Northwest environment, after he became lost searching for help and a rescue of his family, which became lost, then snowbound and stranded in a harsh environment. His wife and daughters, who remained with their vehicle, survived.

In my view, Mr. and Mrs. Kim are heroes - he for attempting to seek rescue for his family, and she for keeping her young daughters alive.

To assist others, I will summarize the advice of Warren Bowman, M.D., a good friend and former National Medical Advisor to both the National Ski Patrol System and the National Association for Search and Rescue, and his co-author Peter Kummerfeldt of Outdoor Safe, adapted from their chapter on wilderness survival in the forthcoming 5th edition of the textbook Wilderness Medicine.

Travelers should always plan for the unusual and unexpected. Tools include familiarity with weather forecasts, strategizing worst-case scenarios, carrying emergency items, avoiding solo travel, and leaving notice of the projected route and expected time of return. With good planning, deteriorating weather or a forced unexpected night outdoors might then become more of an inconvenience than a life-threatening ordeal. While we usually consider a life-or-death situation due to the elements to be associated with a remote expedition or natural disaster, the fate of James Kim highlights that even a drive home in a seemingly normal situation can turn ugly in a hurry.

Winter storm preparedness is essential for anyone who drives a motor vehicle in snow country. One must always be aware of the possibility of spending an unplanned night out in a vehicle. Causes include bad weather, breakdown, having an accident, running out of fuel, becoming lost, and getting stuck. Winter driving is especially hazardous because of the dangers of driving on snow or ice, losing visibility and orientation, fewer people on the road from whom to receive assistance, and the threats of frostbite and hypothermia. Accepting the possibility of trouble, carrying a vehicle survival kit (see below), and giving some thought to survival strategies will help prevent a night out in your car from deteriorating into a life-threatening experience.

Most travelers dress to arrive at a destination and not to survive a night out; in other words, they dress "to arrive, not to survive." A vehicle survival kit (listed below) should include extra clothing, blankets or sleeping bags, food, water, signaling equipment, and communications equipment (cell phone, citizen's band radio, etc.). It is also always better to stay with the vehicle, which provides significant protection and which is more visible to rescuers than a person on foot. Most laypersons are not experienced trail-blazing in wilderness environments, and particularly when landmarks are obscured by rain or snow, and darkness and cold weather conspire to alter orientation and judgement.

In cold weather, and especially for long-distance travel, drivers should keep their vehicles in the best possible mechanical condition. Drivers should use winter-grade oil, the proper amount of radiator antifreeze, deicer fluid for the fuel tank, and antifreezing solution in the windshield-cleaning fluid. Windshield wiper blades that are becoming worn should be replaced and special snow-and-ice resistant blades used when available. A combination snow brush and ice scraper should be carried. A can of deicer is useful for frozen door locks and wiper blades. Snow tires, preferably studded (illegal in some states), are desirable, but even with special tires and/or 4-wheel drive, chains should be carried. All-wheel drive or four-wheel drive is optimal, and front-wheel drive superior to rear-wheel drive. The battery should be kept charged, the exhaust system free of leaks, and the gas tank full ("drive on the upper half of your tank.").

Despite best efforts, you may become stranded or lost. If that happens, tie a brightly colored piece of cloth (such as a length of surveyor's tape) to the antenna. At night, leave the inside dome light illuminated so that it may be seen by snowplow drivers and rescuers. Headlights use too much current, so use the dome light. If necessary for heat, the standard recommendation has been that the motor and heater can be run for 2 minutes each hour (after checking to see if that exhaust pipe is free of snow). However, a more recent recommendation is that since it takes more gasoline to start a cold engine than a warm one, one should initially turn the heat up all the way and run the car engine until the inside is comfortable. Then, shut off the engine and wait until it becomes uncomfortably cold inside the car (which could be 10 to 30 minutes depending on outside temperature). The engine, however, will still be "warm." Start the engine again and run the heater until the occupants feel warm. Keep repeating this process.

Keep the tailpipe free from snow pack. Carbon monoxide (CO) poisoning can be a threat, so do not go to sleep inside the car with the engine running; if the engine is running, keep a downwind window cracked 1 to 2 inches in case there is a CO leak into the interior of the vehicle. A reusable CO detector is a wise addition to the survival kit. One or two large candles ("fat Christmas candle" size) should be carried to provide heat and light if the gasoline supply runs out, since two lit candles can raise the interior temperature well above freezing. However, resources should be used sparingly because you are never sure how long you will be stranded. In the situation of the Kim family, they were alone for more than a week.

Foresight enough to include heavy clothing and blankets or sleeping bags in the cold-weather vehicle survival kit is better than relying excessively on external heat generation. Do not smoke tobacco products or drink alcohol. If you have to exit the vehicle in a snowstorm, put on additional windproof clothing and snow goggles, and tie a lifeline to yourself and the door handle before moving away from the vehicle.

You must decide whether to wait for rescue or attempt to walk out under your own power. If rescue is possible, it is almost always better to remain in a snug shelter and conserve your strength. If you decide to leave, you must effectively mark your trail, in order to aid rescuers and enable you to return to the site if necessary. Travel should never be attempted in severe or extremely cold weather, or in deep snow without snowshoes or skis. If no chance of rescue exists, prepare as best possible, wait for good weather, and then travel in the most logical direction.

The best way for a lost or stranded person to aid potential rescuers is to do everything possible to draw attention to his or her location. Most modern rescues utilize ground parties, helicopters, and fixed wing aircraft. Besides radios, cell phones, and other electronic equipment, signaling devices are either auditory or visual. Three of anything is a universal distress signal: three whistle blasts, three horn blasts, three fires. The most effective auditory device is a whistle. Blowing a whistle is less tiring than shouting, and the distinctive sound can be heard farther than a human voice. An effective visual ground-to-air signal device is a glass signal mirror with a sighting device, which can be seen up to 10 miles away but requires sunlight. Special rescue beacons are available and can be carried as emergency equipment. These include strobe lights, laser signal lights, special beacons with both signaling and GPS capability, and personal locator beacons (PLBs).

Smoke is easily seen by day and a fire or flashlight by night. On a cloudy day, black smoke is more visible than white; the reverse is true on a sunny day. White smoke stands out well against a green forest background but not against snow. Black smoke can be produced by burning parts of a vehicle, such as rubber or oil, and white smoke by adding green vegetation to a fire. The lost person who anticipates an air search should keep a fire going with large supplies of dry, burnable material (wood and brush) and have a large pile of cut green vegetation close-by. When an aircraft is heard, the dry materials are placed on the fire, allowed to flare, and then armloads of the green vegetation are piled on top. This produces lots of smoke and a hot thermal updraft to carry it aloft.

Vehicle Cold Weather Survival Kit:

1. Sleeping bag or two blankets for each occupant
2. Extra winter clothing, including gloves, boots and snow goggles, for each occupant
3. Emergency food
4. Metal cup
5. Waterproof matches
6. Long-burning candles, at least two
7. First-aid kit
8. Spare doses of personal medications
9. Swiss army knife or Leatherman-type multi-tool
10. Three 3-lb empty coffee cans with lids, for melting snow or sanitary purposes
11. Toilet paper
12. Cell phone and/or citizen's band radio, with chargers
13. Portable radio receiver, with spare batteries
14. Flashlight with extra batteries and bulb
15. Battery booster cables and/or car battery recharging unit (plugs into cigarette lighter)
16. Extra quart of automobile oil (place some in hubcap and burn for emergency smoke signal)
17. Tire chains
18. Jack and spare tire
19. Road flares
20. Snow shovel
21. Windshield scraper and brush
22. Tow strap or chain
23. Small sack of sand or cat litter
24. Two plastic gallon drinking water jugs, full
25. Tool kit
26. Gas line deicer
27. Flagging, such as surveyor's tape (tie to top of radio antenna for signal)
28. Duct tape
29. Notebook and pencil/marker
30. Long rope (e.g. clothesline) to act as safety rope if you leave car in blizzard
31. Carbon monoxide detector
32. Ax
33. Saw
34. Full tank of gas

In this holiday season, we are all especially sensitive about the fragility of the human condition, and the good fortune to be at peace in our homes. My heartfelt condolences go out to the family and friends of James Kim.

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photo by Paul Auerbach
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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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