Technical Rescue Interface: Cave Rescue

Technical Rescue Interface: Cave Rescue

Keith Conover


This chapter provides an overview of cave search and rescue for those who practice wilderness EMS (WEMS), supervise WEMS providers, or are interested in WEMS but not trained members of a cave rescue team.

Scope of Discussion

Eighty percent of the skills and knowledge of cave rescue and aboveground wilderness search and rescue overlap. However, that remaining 20% is critical, and this chapter will provide an overview of it. The primary differences fall into the following categories:

  • the cave environment and hazards

  • caving and cave rescue sociology and politics

  • navigation and communications

  • specific cave rescue techniques

Care Environment

Caves Are Dark

This may seem one of those “duh” statements, but a fair number of cave rescues simply consist in escorting out people whose light sources have failed. Cavers are taught to always carry three independent sources of light that will support hands-free caving. (Candles are nice for warmth, especially if inside a plastic leaf-bag heat tent, but purists decry counting them as a third source of light.)

Caves Are Cold

Caves are cold or warm, depending on the season. Although it seems that way, in reality, it’s aboveground that gets hot and cold, whereas caves are the same temperature year-round. Yes, there are a few exceptions, such as the ice caves at the top of Mount Rainier, and Warm River Cave in Virginia that’s famous for its hot spring. But the majority of caves have developed from thousands of years of water dripping or flowing through water-soluble rocks such as limestone, and the caves are at the temperature of the surrounding limestone, which is the average temperature of the area (Figure 29.1).

Caves Are Wet

There are exceptions—“dead” caves that no longer have water flowing through them—but again, in general, caves have water dripping or flowing through them.

The fact that caves are wet and cold means that there is always the danger of hypothermia. Even if it’s 95° and 95% humidity outside, it’s still wet and cold inside the cave. While this may seem another “duh” observation, it is not at all uncommon for spelunkers to go in the cave and then become hypothermic. The hypothermia causes clumsiness, and sometimes poor
judgment, causing a spelunker to suffer an injury. It is also possible, especially in wet caves, for spelunkers who are unprepared to be totally incapacitated or die from hypothermia. See Chapter 13 for more details on hypothermia and cold illnesses.

FIGURE 29.1. Mean Annual Temperature (°F), North America, 1981-2010. Almost without exception, cave temperatures are, yearround, the average temperature of the area. This map depicts the temperature you may expect in a cave in a particular geographic area of the United States. (Map produced by DonaldFerguson, Ph.D, based on data from: AdaptWest Project. 2015. Gridded current and projected climate data for North America at 1km resolution, interpolated using the ClimateNA v5.10 software (T. Wang et al., 2015). Available at

Caves Are Dirty and Muddy

Aboveground can be dirty and muddy, but the mud in caves is of an entirely different magnitude, and as Josef Stalin reportedly once said: “Quantity has a quality all its own.”3 Cavers tend to wear full body coveralls, either surplus flight suits or mechanics’ coveralls or specially made cave suits. Coveralls keep the mud from sneaking in around the waist of a jacket/pants combination. Coveralls, especially those specifically made for caving, also make it easier to twist your body into the various contortions required while traversing cave passage. Having mud all over your boots makes you more likely to slip and fall and break an ankle, and while this sometimes happens aboveground, in caves, muddy boots are the rule rather than the exception.

Caves Are Enclosed

That means that to efficiently traverse a cave, you must use different parts of your body and different techniques than either climbing or hiking. Counterforce techniques, where you have an arm or a leg on either side of a small passage, are much more common and using them effectively takes practice (Figure 29.2).

Caves May Be Vertical

Cavers tend to divide caves into horizontal caves which require neither ropes nor special vertical equipment, and vertical caves which require them. Unlike rock climbing, where the emphasis is on lead climbing where you are dependent on your hands and feet to move up the rock, and the rope is only there for a belay, cavers tend to go down rather than up. Therefore, they tend to rappel into a cave, and when coming out, simply ascend the rope. Therefore, for cavers, the emphasis is on what is called single rope technique (SRT): rappelling and ascending. Indeed, most of the innovations in single rope technique that have moved over
into mountain rescue were developed by cavers (see, eg, our Chapter 31, which does indeed refer to SRT during certain mountain rescue operations).

FIGURE 29.2. Tight Passage during Cave Rescue. Using counterforce techniques efficiently and smoothly in narrow canyon-like passages is an important physical skill for cavers to develop, to avoid exhaustion. Crawling through tight passages without wasted effort or injury also requires practice. For cave rescue, moving litter patients efficiently through canyons and tight passages is also an important physical skill. Courtesy of Bill Frantz, NSS 11706, used with permission.

Caves May Be Confusing

There is a reason the first text-based computer adventure game, also known as Colossal Cave, featured the phrase “You are in a maze of twisty little passages, all alike.” Standard instruction for beginners on cave trips is to look over their shoulders at every intersection, to see what the intersection looks like on the way back. Navigation in caves is much different than navigation aboveground. Topographic surface maps and cave maps are almost completely different in all respects (Figure 29.3). And, for many caves, no cave maps are available. And even for those caves where cave maps are available, cavers’ emphasis on secrecy keeps these maps restricted; cavers may even be reluctant to release such maps to cave rescue teams. The map reproduced in Figure 29.3 is of a commercial (guided-tour), gated cave.

Caves Are Remote

Even if the entrance to the cave is near the road, rather than halfway up the side of the mountain, once you enter the cave, it becomes remote. Even a short way into the cave can seem very remote, given that cell phones do not work in caves. Therefore, getting word back out to initiate a rescue effort can take a long time. For cave rescuers, this can be a big problem, since standard search and rescue radios do not work in the cave either. There are a few radio systems that can be used between the surface and deep in the cave, but for the most part these are experimental and are very large and bulky or only work with Morse code. These are not routinely used for cave rescue. Instead, cave rescue teams usually use military surplus field phones. Learning how to set up, use, maintain, and fix these field phones is an integral part of cave rescue training.

FIGURE 29.3. Map of Laurel Caverns Pennsylvania. Navigating in a cave is very different from navigating in an aboveground wilderness area: completely different navigation skills must be developed. Cave maps, when they are available, are very different from aboveground topographic maps. Laurel Caverns is a commercial cave with guided tours. Courtesy of Vic Schmidt and David Cale for Laurel Caverns, used with permission.

Caves May Have Bad Air

Unlike mines, there are very rarely any sort of explosive gases, but carbon dioxide buildup can be suffocating, and oxygen can be depleted. This is relatively rare, but the author was once in Ireland to teach at a cave rescue conference and was invited to go on a trip to the most famous cave in Ireland, Polnagollum. The translation of the name is “the cave of the doves.” It’s a river cave with lots of small sinkhole entrances. The plan was to go into one of these potholes, get up into an upper-level dusty crawlway to another part of the stream passage, then wade the stream passage back to the entrance. As I was crawling through that dusty passage, at the end of the group, I started breathing heavily. Is it my asthma acting up? No, I only get an asthma attack when I’m sick, and I’m not wheezing. Maybe I was just jet-lagged?
Perhaps. Breathing harder now. Oh, no, maybe I’m claustrophobic and I’ll never be able to go caving again! We got out into the main stream passage and I started breathing easier. I mentioned this to the Irish cavers. “Oh, didn’t we tell you? There’s no air circulation in that passage and the last person through doesn’t get much oxygen.” Hmph. There was a rescue at Keyhole Cave near Albany, NY in 1998.1 A caver was trapped by his leg in a narrow part of the keyhole passage. There were so many people in the cave, and they were there for so long, that the CO2 started building up. They had to start pumping fresh air into the cave.

Caves May Flood

As with the famous slot canyons of Zion National Park and surrounding areas, such as The Subway and Zion Narrows, the weather above can be sunny and dry, but a large thunderstorm in a remote region of the watershed can cause the area to flood, making some passages impassable, or even drowning a group of spelunkers. Most cave passages do not flood; clues to a passage that does flood include leaves, sticks, and other debris high up on passage walls, or mud lines along the walls indicating the top of the most recent flood.

Caves Are Delicate

Formations that have taken tens of thousands of years to develop, and are found only in one particular cave, can easily be destroyed by a careless rescuer. Cavers tend to be fanatic conservationists, buying deeply into the Leave No Trace4 movement. They even sometimes argue with the traditional motto of “take nothing but pictures, leave nothing but footprints, kill nothing but time” because they think that there are sections of caves where there should be no footprints. In recent years, the bat population throughout North America has been decimated by white nose syndrome, a deadly fungal infection. Bats like to hibernate in caves, and disturbing bats while they are hibernating makes them more susceptible to dying from white nose syndrome. Many caves are gated to keep out casual visitors and permit the landowner to screen those entering the cave; for caves known to be bat hibernation sites, the gates may be closed all throughout the bat hibernation season. Even outside of that hibernation season, cavers emphasize the need to decontaminate caving gear so as not to bring white nose syndrome into the cave.

Caves May Be Psychologically Stressful or Downright Scary

Most people joining a wilderness search and rescue team are those who are comfortable in the outdoors, and in general are people who really enjoy being in the great outdoors. For some of these people, going into the cave is just an extension of the great outdoors. But for some, even those without claustrophobia, a cave is not the kind of outdoors in which they are comfortable. And being comfortable in the environment is important to top performance. Some mountain rescue teams are also cave rescue teams, for example the Allegheny Mountain Rescue Group (AMRG). AMRG expects all of its members to meet not only Appalachian Search and Rescue Conference standards for Field Team Member and Field Team Leader certification, but also the more stringent Mountain Rescue Association (MRA) standards. However, meeting the cave rescue standards, and going into a cave, is quite optional. For any large cave search or rescue operation, there are plenty of jobs that need to be done aboveground, not just in the coordination sense, but also things such as rigging the evacuation route from the cave entrance to the road or helicopter landing zone. More discussion of management of psychological stressors in both rescuers and patients, and the use of psychological first aid, is included in Chapter 10 (Psychological First Aid) and Chapter 23 (Management of Behavioral and Psychiatric Emergencies).

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Oct 16, 2018 | Posted by in EMERGENCY MEDICINE | Comments Off on Technical Rescue Interface: Cave Rescue

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