From vol. 114, Winter 2016-17

Words and photo By Mike Inniss, MD, DiMM (ICAR)

THE MORE TIME WE SPEND IN THE MOUNTAINS, the more likely we are to find ourselves assisting fellow mountain folk in times of distress. Whether we are responding as organized professionals or because we happen to be in a certain place at a certain time, hopefully we can safely act in an efficient, effective manner to make someone’s bad day a whole lot better. Unfortunately, to err is human nature. This article reviews the most common human factors that interfere with the safe operations of a rescue mission, at times with tragic results.

The mountain environment contains certain inherent elements of risk. At the end of the day we all want to go home to our loved ones in one piece—physically and mentally. A mantra of mountain rescue states that the priority of care is yourself first, your team next, and then your subject. Being mindful of the human factors that can interfere with an operation and potentially lead to an accident helps us to follow that sage advice. By identifying and minimizing the most common human factors that could contribute to a potential chain of negative events during a rescue operation, we can explore ways to lessen their potential impact.

Much of the work in this field comes from within the aviation industry, where the impact of human error can be immediate and drastic. Similarly in the field of medicine, medical error has now been established as a major cause of illness and death. Studies have shown that in Canada more people die from medical error than motor vehicle accidents each year. In the mountain environment, estimates are that upwards of 60 percent and perhaps as high as 80 percent of all accidents during mountain rescue are human error.

SITUATIONAL AWARENESS
At its roots we are all striving to maintain situational awareness and mitigate the human factors that can so easily sabotage it. The ability to maintain situational awareness is a critical and extremely valuable skill required on rescue teams. We have all likely experienced a momentary loss of situational awareness, often during stressful situations, and perhaps suffered consequences as a result. The cost to yourself and/or your team members can be too great in the mountain  environment to allow a lapse to happen. Only with the maintenance of situational awareness can we maintain the critical shared mental model with our teammates that will enhance and ensure successful outcomes.

HUMAN FACTORS IN MOUNTAIN RESCUE
Communication
We are all aware how a frustrating communication breakdown such as lost radio contact can impact a rescue. Miscommunication affects the flow and safety of a rescue mission. Timely, clear and concise communication is a learned skill. The art of closed loop communication (e.g. “heli eta 15 mins” followed by “copy that, heli in 15”) is a skill effective teams practice and promote to reduce communication errors.

The effectiveness of a calm approach to communication cannot be overstated. At times assertiveness may be essential. For example, saying something like "double check that knot; it doesn't look right to me for some reason" could save a life.

Fatigue
It is no surprise to anyone that fatigue as an isolated factor is a common culprit leading to human error during mountain rescue. Professions like pilots, truck drivers and medical residents in training now follow strict guidelines regarding work day length. Many of the world’s most notorious accidents, perhaps most famously Chernobyl, revealed operator fatigue as the major factor when
analyzed. Individual team members must be aware of their fatigue level and teams must have protocols in place to identify and prevent fatigue-related errors.

Stress
Stress has a negative effect on a person’s ability to think and act clearly. Both personal, chronic stress and acute stress in the moment will impact a rescuer’s performance. Fear is also a form of stress and can be severely distracting to the point of immobilization. Physiologically, stress results in the release of stress hormones, most notoriously the avalanche adrenalin, which actually diverts blood away from the brain to the muscles and cardiovascular system. It is challenging to think straight during a fight-or-flight response. The ability to slow things down at critical stressful moments is an invaluable skill. It’s a common tactical adage that “slow is steady, and steady is fast.”

Complacency
“That’s the way we've always done it” is a defining statement and red flag for complacency. Those in the avalanche industry are well aware of the dangers of complacency within a fixed group mindset and the trap of familiarization, both of which are common heuristic traps found when avalanche incidents are analyzed.

Teamwork
Lack of effective teamwork can be a troubling human factor in mountain rescue. Being a good team member takes work and doesn’t necessarily come naturally. Effective communication and the willingness to put the success of the team over personal gain are keys to effective teamwork. There is no role for the individual hero in mountain rescue response. Effective teams make rescue work look downright routine and matter of fact.

Knowledge and Skill
Individuals have to be willing to admit when they may not have the necessary knowledge, experience or skill set to be safe and effective on a rescue mission, no matter how much they may want to help. A rescue mission is no time to test one’s personal limits when an entire team is depending on surefooted, steadfast work. There should be zero tolerance for jumping in over one’s head as the consequences could be too great.

Self-awareness
A healthy dose of self-awareness goes a long way in mountain rescue. It can feel uncomfortable to depend on an overconfident team member who lacks self-awareness about their limits. Blindly pressing on, perhaps even in the face of deteriorating operational or personal factors, is a surprisingly common phenomenon in mountain rescue and reveals how easy it can be to lose situation and self-awareness.

MITIGATING HUMAN FACTORS
Mitigating the human factors that can negatively impact mountain rescue occurs is necessary on both personal and team levels, and should be a continual work in progress during training and throughout a rescue effort. On a personal level, it is necessary to maintain a healthy body and mind. A high level of physical fitness is desirable to reduce the physical stress of mountain rescue work. A clear, positive mindset allows for clarity of thought. And we are becoming more and more aware of the risk of lasting emotional effect of traumatic rescues and how it can interfere with performance.

Regular training and skill maintenance clearly helps team members work as effectively as possible. The development and use of clear operational guidelines and memory aids (e.g., colour-coded ropes, laminated knot cards) can be of great benefit. From a team perspective, communication workshops, rules regarding time on task, and operational debriefs immediately after tasks can all be fruitful exercises when trying to minimize or eliminate human factors that may negatively affect any mountain rescue scenario.

Within the challenging and dynamic mountain environment it will never be possible to completely eliminate individual human factors that could potentially contribute to human error. However, with awareness it is possible for individuals and teams alike to identify these factors, both prior to and during a rescue mission, and to intervene in a timely manner to thereby minimize the impact of those human factors, leading to better outcomes for all involved. After all, someone is already having a bad day and they are counting on you not to have one yourself.