"The Register" Blog

Official blog for "The Register" newsletter; containing articles and updates from the ATC about stewardship on the Appalachian Trail.

"The Register" Blog contains selected articles from The Register newsletter. You can view previous issues of The Register here.

Lessons Learned- Mitigating Medical Emergencies on the Trail

by Natrieifia Miller

Recently there was an unfortunate death of a volunteer work trip not affiliated with the Appalachian Trail. However, the important insights that came out of this experience for another volunteer trail crew working on public lands is valuable to all A.T. volunteers. Here are some of the “Lessons Learned,” noted by the trip leader on that day. 

“There were many, many lessons learned from this tragedy.  We never learned the actual cause of death, so it could have been a number of heart or circulatory problems.

A brief recap of real world problems with trail work or hikers:

Location, Location, Location

Make sure several people in the work party have the location and directions written down. Most of the individuals on site were unfamiliar with the location and how to give directions on the trail.  Phone reception was good, and 911 was fully functional.  But, I was immediately involved with CPR and was trying to give directions as someone else spoke to the 911 operator.  This does not work well! 

When leading a large group, write the location and directions down and make sure a couple of people can direct rescue workers if needed. 

Leave “bread crumbs”

We cut into the trail from a Forest Service road side trail, not directly from a trailhead (bush-whacked).  I sent two people out to help direct the rescue workers to the site and followed this up with two more people to help carry rescue equipment.  The first two people had no problem finding the parking and drove out to meet the rescue team.  The second pair missed the side trail to the parking area and the vehicles -- and had to retrace.  

When leading a large group, mark side routes with flagging tape in case of emergency. This will help both rescue workers and crew members in an emergency. 

Stay Tuned In

My suspicion is that individual who collapsed began to feel bad earlier in the day, and never said anything.  He walked to the site with no problems, worked for awhile and then took a long break.  He was working with two other people, and I came by a couple of times to check their work on water diversions. I should have spoken with him while he was at rest to make sure he was okay. Instead, I spent all of my time directing the work effort.  One of the folks he worked with said when he walked up for lunch and sat down, his speech sounded slurred.  He collapsed shortly thereafter.  Slurred speech could have been a big help in recognition of a problem had I spoken with him and recognized a symptom. Had someone noticed slurred speech one hour before the collapse, rescue workers could have been well on the way to the site.

The Value of Wilderness First Aid

Know best practices for wilderness medicine, far from emergency responders. Many other issues come up in this type of situation. With CPR, today they are teaching compression only, except for drowning, infants or young children, and unobserved collapse. The fine print also says long term cardiac arrest. Most trail issues are long term events, since help can be so far away. Another person and I started 2 man CPR -- compression and breathing.  If I were doing this again, I would have had them do compression only for the first 3-4 minutes while I gave directions and tasks to the others present.  Then I would have started breaths.

Editor's Note 2017: For a concise look at the differences between Wilderness First Aid and regular first aid check out our previous article. -Natrieifia Miller

Get Everyone Involved

Everyone present needs to feel like they did everything they could to help, even though the chances of survival are minuscule in this type of event.  I would like to have had more people giving compressions at some point.  And I think you can demonstrate and show people what to do as you take breaks yourself. ” 



BioPicBlogger: Natrieifia Miller
Title: Trail Program Assistant & CLC Lead Coordinator with the Appalachian Trail Conservancy
Based out of Asheville, NC
Affiliation: Biology Student, University of North Carolina Asheville, in Asheville NC








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  1. Carol steiner | Apr 06, 2017
    Your article had important points. We have many people hiking and maintaining that are in the prime age for heart attacks and strokes. Knowledge of what to do, where we are,and how to get there are really important. GI3J5

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