Introduction
Trauma care in cave rescue is a unique situation in wilderness medicine with extremely long prehospital time. Environmental and logistical factors limit therapeutic options and transport and also can influence survival and outcome.
Objective
To describe trauma care during the longest cave rescue reported to date.
Methods
Case report of a 53-year-old male patient with a severe head injury at a depth of about 1000 m from the cave entrance in Bavaria, Germany.
Results
Search and rescue (SAR) operation required 12 days until evacuation. SAR activation was delayed because of the location of the accident, and it required several days to recruit experienced cave rescuers and medical teams. More than 700 rescuers were involved, including 7 physicians from 5 different countries. Basic first aid was performed by companions in the acute phase and prevented the patient, who sustained a severe traumatic brain injury, from developing severe hypoxia. Thereafter, professional medical care was limited to continuous monitoring and basic therapeutic measures by medical personnel because of the extremely confined space in the cave and long evacuation time. At 6-month follow-up, the patient had recovered completely and resumed his job.
Conclusion
First aid education and training and international collaboration of cave rescue teams play an important role in cave accidents. However, trauma care often relies on expert knowledge and is not yet evidence-based practice.