Med Ship Inbound

View of Half Dome from the Snow Creek Trail

Hello ProRangers and Park People! My fourth week in Yosemite was very eventful as preparations were made for the annual ALS refresher and I responded to emergency calls on the valley ambulance. I started the week assisting one of the park paramedics who is in charge of putting together the annual ALS refresher. The refresher is a week long series of lectures and scenarios for paramedics and parkmedics that reinforces existing knowledge while providing new information and techniques to ensure that medical providers in the park are up to date with current protocols and procedures. Although I am not currently an ALS provider, the refresher provided an opportunity to learn a lot of valuable information and network with experienced healthcare providers. Attending the refresher reinforced the importance of continuing education within the emergency medical field and furthered my interest in pursuing parkmedic certification. In addition to preparing for and attending portions of the ALS refresher this week, I responded to a EMS call that involved applying some skills and knowledge discussed during the refresher. The call exemplified the need for clear communication, incident command, and teamwork while working on a seriously injured patient. I look forward to attending the remaining portion of the ALS refresher this week and learning new information!

One of the most important presentations at the ALS refresher focused on first responder resiliency. As a first responder, it is common to care for those in need. However, caring for others can come at a cost. While responding to emergency calls, first repsonders can suffer physical and or emotional pain. Although the effects of responding to emergency calls and caring for others differs among emergency responders, it is important to care for yourself and colleagues. The presentation focused on dismantling stigmas that prevent first responders from acknowledging the effects of their work and encouraged self care. I am grateful to have been a part of this discussion where I learned how to manage stress and work through traumatic situations early in my career.

In addition to attending lectures presented by a variety of medical professionals, I also participated in a wide array of skills based scenarios. The first scenario focused on bleeding control through the use of a tourniquet and hemostatic gauze. I was able to refine my ability to utilize a tourniquet to control major bleeding while learning how to pack a wound (chicken breast) with hemostatic gauze. Even with these basic bleeding control skills, it is important to practice and stay sharp. Unbeknownst to me, I would apply a tourniquet to a patient only an hour after this scenario!

Self application of a tourniquet inferior to the knee

Hemostatic Gauze used in puncture wounds

Packing a simulated wound with hemostatic gauze

After the bleeding control scenario, I joined a group of ALS providers for a pediatric cardiac arrest scenario. The scenario was a great team building exercise in a high stress environment. Working as a team exemplified the need for clear communication during a medical call. Although I have practiced cardiac arrest skills for adult patients in the past, I learned a lot of new information specific to pediatric patients.

Pediatric Cardiac Arrest Scenario 

In addition to attending portions of the ALS refresher this week, I responded to my first trauma call in the park that involved applying some skills and knowledge discussed during the refresher. After falling from 15 feet, a climber sustained a significant injury that resulted in the use of a tourniquet and lower extremity stabilization. The patient was ultimately flown out of the park on a med ship for more definitive care. While there is always room for improvement, I was amazed by the clear communication, teamwork and establishment of incident command early on during the call. Together, these skills ensured that the patient had the highest level of care possible.

PHI Med Ship landed in Ahwahnee meadow to transport the patient

Although this has been a busy work week, I have spent some of my time off reading, hiking and relaxing. This past weekend, I went on a rigorous hike up to Snow Creek that included some serious elevation gain and over 100 switchbacks! I also started reading a new book, "Off the Wall: Death in Yosemite" that documents all the known fatal mishaps in Yosemite. While gruesome at times, this book offers readers an inside look into search and rescue events in the park and cautions against making similar mistakes in the future. I look forward to the remainder of the ALS refresher and the opportunity to go on some ride alongs in the coming weeks.

Until next time,

ProRanger Caruso

Firefall

Firefall

View of Horsetail falls in 2019 and 2020.

Hello ProRangers and Park People! My third week in Yosemite has come to a close. This past week was very busy as preparations were made for the annual "firefall" event. Occurring for a short two week period in February, "firefall" is the name given to a phenomena that occurs when water cascading down Horsetail falls is illuminated by the setting sun to resemble lava flowing down the granite cliff face. However, for this event to occur water needs to flow over Horsetail falls. Unfortunately, given the lack of precipitation this winter, there is little to no water coming over the falls. Nevertheless, preparations have been made to ensure that the thousands of visitors who come for the event can view "firefall" safely and without damaging any park resources. 

In response to erosion and resource degradation that occurred in 2019 when over 2,000 visitors huddled on riverbanks to catch a glimpse of the falls, the park has placed restrictions on where visitors can park and view the falls. From February 13th-27th, North side drive will see an alternate traffic pattern as the right lane will serve as a pedestrian walkway. Additionally, all pull outs along a three mile stretch of North side drive and portions of South side drive will be closed for parking. To implement these closures, a variety of signs are required to indicate parking zones, crosswalks, speed restrictions and pedestrian walkways. Fortunately, for the law enforcement personnel planning the event, there was an eager intern to help make all the signs. I spent a portion of the week designing, printing and organizing a variety of signs for the event. After all the signs were complete, they needed to be staged along North and South side drive for the start of the closure. 

Closures in effect daily from 12:00PM-7:00PM. 

Signs waiting to be staged for the closure

One of the "Pedestrian Crossing" signs I made for the event 

Sign used to indicate the proper lane of travel for vehicles and pedestrians. 

Hundreds of delineators placed over a three mile stretch of North side drive to ensure vehicles remain in the left lane. 

In addition to preparing for and assisting with the implementation of park closures for "firefall", I spent time on the valley ambulance this week. During one of my night shifts, there was a visitor who was injured after falling 10+ft and landing on a rocky outcrop lining a stream. The patient was evaluated by park paramedics and the decision was made to transport the patient to the hospital via med ship. To transport a patient out of the valley in a helicopter during the day requires a lot of planning, but transporting a patient at night requires even more planning and constant communication between those on the ground and in the air. I watched and listened closely as law enforcement personnel set up a landing zone and made contact with the incoming med ship. Once on the ground, flight medics from the med ship evaluated and packaged the patient for flight. I was able to assist with transporting the patient from the ambulance into the med ship. Although the situation was unfortunate, I garnered a lot of valuable information that will enable me to assist in future landings. 

Rescue three on scene at Ahwahnee meadow for the night landing. Lights on rescue three and the patrol vehicle are used to illuminate hazards for the incoming med ship. 

Med ship landing in Ahwahnee meadow. Notice all the traffic in the background, it was a very busy weekend in Yosemite!

Until next time,

ProRanger Caruso 

Reaching New Heights

Reaching New Heights

View of Half Dome from the Mirror Lake Trail

Hello ProRangers and Park People! My second week in Yosemite was full of new experiences climbing outdoors and snowshoeing for the first time. In addition to reaching new heights on the granite cliffs of Yosemite and snowshoeing through snowy Badger Pass, I organized and updated the basic life support (BLS) bags in the patrol vehicles and continued working on inputting data from the 2019 search and rescue (SAR) incidents. To finish off my week, I hiked the Mist Trail to Nevada Falls where I was rewarded with spectacular views of Half Dome and Yosemite Valley. While hiking is an enjoyable activity during my time off it also serves to familiarize and prepare me for future SAR's during the busy season, where multiple incidents can occur within a single day.

Outfitting BLS Bags

As first responders, Park Rangers wear a variety of hats. This includes the ability to respond to, assess, and provide emergency medical care for those in need. Responding to calls in which emergency medical care may be required necessitates having the right type of gear. For this reason, all of the patrol vehicles within the law enforcement fleet are outfitted with a BLS bag. To ensure the BLS bags are adequately stocked with the necessary equipment, I spent some of my time this week checking, stocking and updating each bag. This process was a great way for me to introduce myself to some of the law enforcement rangers in the Valley and provided insight into the process of increasing my medical ability as a Parkmedic. While most Rangers in the Valley are EMT's, there are a few rangers who have undergone further training to serve as Parkmedic's or paramedic's. The select group of rangers who have undergone this intense training are able to provide care at the advanced life support (ALS) level which is an invaluable skill set in a area where access to hospital care is over two hours away. 

Checking equipment, expiration dates on supplies in all items in the BLS bags.

To create uniform BLS bags for each patrol vehicle, I updated tags to indicate where each item was located . 

In addition to outfitting BLS bags for each of the patrol vehicles, I worked my first night shift on the Valley ambulance this week. Along with my ALS partner, I responded to one emergency call in the Valley and transported a patient out of Yosemite. As previously noted, the nearest hospital is almost two hours away. For this reason, we often rendezvous with neighboring EMS agencies who take patients the remainder of the way to the hospital. This first call was a great test of my knowledge and familiarity with roads in Yosemite and will help ensure I can respond to calls anywhere in the Valley come summer.

300 Feet and 3 Pitches Later

On Friday, I had the opportunity to go climbing outdoors for the first time. Although I have climbed in indoor climbing gyms for years, this experience was nothing like what I was accustomed to. Fortunately, my supervisor is an avid climber and very experienced. With his assistance and guidance, I was able to climb Munginella, a 300 foot 3 pitch route adjacent to Yosemite Falls. This experience was a great introduction to outdoor climbing and provided a great stepping stone for climbs in the future. I look forward to learning more about the art of outdoor climbing and applying what I learn to search and rescue training in the coming months.

View from the base of the Munginella route.

View from the second pitch of the Munginella route.

View from the top of Munginella route.

Snowshoeing in Badger Pass

Another first this week was learning how to snowshoe. I joined one of my roommates for a moonlit hike to the the top of Badger pass. The nighttime hike was led by a ranger who provided insight into the rich history of winter sports in Yosemite. From this talk, I learned how winter sports in Yosemite were specifically shaped to ensure visitors could experience the beauty of Yosemite while maintaining natural habitat for native wildlife. Instead of creating vast networks of down hill ski slopes like many other ski areas, the ski area in Yosemite focuses more on creating experiences for visitors through a network of cross country skiing. Through this approach, visitors are able to view the vast wilderness Yosemite has to offer while limiting development and protecting natural habitat. 

Snowshoeing during the nighttime Ranger hike.

The full moon provided plenty of light during the hike.

Looking forward to another eventful week here in Yosemite! Check back next week to see what I have been up to.

Until next time,

ProRanger Caruso