Underwater Cave Exploration Dilemma

"In the end, I thought they wouldn't find me because Guillem couldn't get out."
"He didn't know the caves well and I was scared he would end up without air."
"We are used to being alone, but to stay in a pocket without being able to leave and nobody finding you is a diver's worst nightmare."
"[The water was] brackish, but quite sweet."
Xisco Gracia, speleologist, Spain

"I think they made the right decisions and that's why [Gracia] is still with us."
"They could have tried to stretch out the remaining oxygen [between them], but surely that would have been suicide and they would have both died."
Enrique Ballesteros, civil police underwater task force

Divers spent days looking for the man (Photo: rtve.es)

People can get lost or trapped in the most desolate, isolated places on Earth, brought there by their immense sense of curiosity, of scientific enquiry, or simply the adventure inherent in reaching those inhospitable places where nature never really intended people to inveigle themselves, and where to survive the elements and the geology represents a feat of impossible endurance. There are vast, empty deserts and impossible heights of the world's tallest mountains, underground caves that beckon spelunkers, as well as great white frozen wastes of permafrost-covered land -- and there also are underwater caves.

It was underwater caverns with their labyrinthine tunnels that the power of water on rock has etched out over the vast space of time and erosion, that motivated Professor Xisco Gracia, an experienced speleologist and his friend and diving partner Guillem Mascaro, to indulge their curiosity. These underwater caves were discovered in the 1800s, with their three kilometers of tunnels, not all of which, given their remoteness and difficulty in approaching, have been explored. An irresistible lure for a specializing scientist.

And while it is perfectly true that such resolute, enquiring minds are prepared to take great risks to fulfill their search for answers to the great mysteries of life and the natural world, none among them deliberately gamble with risks that might turn out to be inimical to the continuation of their lives. Yet this is just what happened to the pair, 40 metres underground, researching the undersea topography of the Cova de sa Piqueta in Manacor, Spain, when they were jolted by the realization that their guide wire had snapped.

A swift response to attempt to fix the guide wire took so much time that their oxygen store had been almost depleted. Insufficient oxygen to allow both men to return to the surface became their existential dilemma. Leading them to make a choice. And that decision was made by 55-year-old Dr. Gracia who urged his partner to return to the surface with the use of the remaining oxygen and he would himself await his eventual return with a rescue team. Dr. Gracia assured his friend that he would survive by remaining in a cavity in the cave that had an air pocket.

Little did they both realize at the time the decision was made that the one left behind would be stranded for fully 60 hours, unable to move from the place where some oxygen was available to  keep him alive. Without food to sustain him, Dr. Gracia drank from a thin spread of murky water. But the air that he was breathing was heavily laced with carbon dioxide, which weakened him, affected his brain, resulting in hallucinations and the loss of much of his executive function. After awhile Dr. Gracia was convinced that his diving partner hadn't reached the surface.

He had been unable to sleep since the poor air quality and extreme humidity bore heavily on him. All he could do was remain, uncomfortable and wet, in the pocket of the cave. When hypothermia threatened, Dr. Garcia clambered over nearby jagged rocks to a site close to the thin water pool which provided him with potable water. And in that place no light, only darkness prevailed. He had flashlights, using them when he had to source the water. And he resigned himself to the inevitable, that he would never be found, and there his life would end, just where he was.



Yet, his friend had not been lost, he had reached the surface and alerted authorities who prepared to mount a rescue operation by the civil police. However, rescue divers, despite being armed with precise instructions provided by Mr. Mascaro where they would find Dr. Gracia, were held back by conditions that turned the water opaque, making vision extremely difficult; if they were unable to see where they were swimming they placed themselves in a situation where they would themselves become lost inside the labyrinth of tunnels.

A few days later they managed to reach the cave and thought they knew where Dr. Gracia was.

They drilled into the cave wall hoping to deliver oxygen and food to Dr. Gracia, before discovering they hadn't found him after all. But from the cavity where Dr. Garcia was located, he felt he could hear faint sounds and that raised his expectations and his hope for rescue. The sounds stopped echoing through the cave walls when the divers realized they were not in the right place for a rescue, leaving Dr. Garcia deflated and resigned, that if a search had been underway, it had also been called off and he was now, once again, and finally, on his own.

Visibility improved, however, and the 60 people and more that comprised the rescue team waited another 15 hours, then set out again. Two divers finally discovered where Dr. Gracia was -- locating him 900 metres from the entrance of the cave.To return to the surface Dr. Gracia had no option but to swim for an hour and a half, through his exhaustion, but the canister oxygen the rescuers had brought along had the effect of "charging the batteries", enabling him to forge ahead.

The video that the civil police took shows the rescue team pulling Dr. Gracia from the depths of the cave he was trapped in, back to the surface. At that point, the rescued man was able to walk independently on his own two feet around midnight, when the surface had been reached. A short hospital stay ensued, during which Dr. Gracia's condition was diagnosed as fit and well recovered from his ordeal.

Xisco Gracia was rescued (Photo: Twitter/@112IllesBalears)

Tactical Combat Casualty Care

"It was undeniable that we were saving lives with the use of tourniquets."
"If you keep the blood in [the injured person's body], then the patient survived. It was a complete change in thinking [use of tourniquets]."
"The first priority [for military medics as with paramedics] was making sure that no one else got hurt [making swift interventions critical]."
Lt. Col. Colleen Forestier, physician, director of health services operations, Canadian Armed Forces

"We are always prepared. We know that these environments [dangerous or distracting landscapes detracting the paramedic from fully focusing on the patient] exist."
"Is there more stress [for the responding paramedic, trained to assess situations through 'stress inoculation training']? I don't think it's any worse, except for the volume."
Greg Forsyth, superintendent of special operations, Ottawa Paramedic Service

This discovery of a simple enough technique long in use as an effective method whereby a deep wound could be stopped by use of a tourniquet from spilling enough life-blood to sap existence, from a critical wound, turned around the spurning of tourniquets to a recognition of their indispensable status as a life-saver under battlefield conditions. Trauma treatment that recognized the utility of tourniquets among other procedures came out of observations during combat in the Vietnam War.

Those observations led to the creation of a new protocol named TCCC, Tactical Combat Casualty Care, introduced for U.S. Special Operations Forces. The protocol was designed by physicians who reviewed battlefield casualties and avoidable deaths in the recognition that utilitarian measures that would never be considered in a hospital setting had their function in a battlefield setting. A deeply penetrating review of medical response on the battlefield brought about a new blueprint for a battlefield-casualty protocol, to save lives.

That protocol has now been adopted in urban areas where paramedics are called upon to respond to medical emergencies. Toronto introduced the first such tactical paramedic unit in Canada, in 1996, followed by Ottawa, in 2003. At the present time, similar units work out of every major city in Canada. Since Ottawa's first responders are called upon for response to federal government and embassies in medical emergencies where a myriad of risks could arise, work with the military, with police and the RCMP exist as additional options.

Canada's elite military special forces -- dispatched to respond internationally when high-risk situations arise requiring an expertly trained force deployed in extraordinary venues -- adopted TCCC in 1999. Since then the protocol has been adopted for more conventional, non-military responses in the recognition that just as battlefield wounds in the extremities were recognized as the leading cause of bleeding to death, that realization extended to the outcome of peacetime critical accidents or violent attacks.

On the battlefield, as on an urban highway or  through a criminal act, the use of tourniquets stopping morbid hemorrhaging was vital to maintaining life, and as such was prioritized as first-response treatment. Tourniquets now make their presence on all ambulances, as well as being carried by tactical paramedics. Gauze impregnated with blood coagulation agents and intraosseous IV (injecting drugs or fluid into the bone marrow) represent additional new rapid response aids.

These especially highly-tuned tactical paramedics must be prepared to face extraordinary situations, bringing their training and personal protective equipment into play. Where high levels of threat exist, as represented by their presence at an active crime scene or where unstable situations prevail, the tactical paramedics are skilled in appropriate response, including following the command of police partners and knowing how to proceed with direct and indirect threats complicating situations.

Tactical paramedics wear a 25-pound ballistic vest. They carry with them over 50 pounds of additional equipment, including collapsible stretchers, infuser for IV fluids, surgical tool kits, bleeding/hypothermia kits, hemorrhage and respiration kits, dressings, first aid kits and various other complex medical-response baggage to ensure they are fully capable of responding to a variety of emergency situations.

They must be extremely physically fit, aside from being well-trained and capable of responding under extremely stressful situations. This is obviously no career for the faint of heart. These professional first-responders learn to instantly form an action plan and use their expert qualifications as medics to treat for critical injuries and prepare patients for transport to hospital. Lives hang in the balance.