A Trip In The Dark...

Posted by Jeremy Windsor on Jan 24, 2020

In a recent edition of the "The Fellrunner" Dr Alan Stone wrote an extraordinary first hand account of an injury he suffered whilst out running with friends. Thanks to the author and the team at "The Fellrunner" we are able to reproduce it here. We've also taken the opportunity to ask Alan a few questions and his answers are included at the end of the post...

"I fell and broke my leg on a training run with my fell running club on bonfire night this year. A potentially serious event that could happen to anyone of us, that has fortunately ended well. I thought I ought to try put something on paper to see if there any lessons to be learnt from my experience.

My remote position is marked by the blue X

It was a standard Tuesday night run in the dark in winter up a mountain in South Wales. I was running with a group of my friends from Mynyddwyr de Cymru (MDC). The ground was wet following recent rain and there was a lot of standing water around in puddles. On the night there was no wind and no rain and air temperature was about 7 degrees. I had gone with the faster group as I felt I have been running well following a recent increase in training. I am preparing for the Cape Wrath Ultra in May 2020, 400km over 8 days. We had done all of the uphill and had just started the return along the top of the ridge heading back towards the downhill and the cars. We were in a muddy, rutted track with puddles in the ruts. I was mostly running on the ridges between the ruts to avoid the unseen dangers in the puddles and to prevent getting too wet and cold. My foot slipped suddenly on a greasy bit of mud and my foot shot sideways into one of the puddles. I felt it suddenly stop and I felt that sudden snapping sensation and sounds of tearing shooting up my leg as I plunged forward onto my outstretched arms. I juddered to a halt on my front in the track and rolled onto my back to look at the damage. What I saw was not a pretty sight. My foot was pointing 50 degrees out to the side in a very unnatural shape. I knew immediately from my years working in casualty, that this was a fracture-dislocation of the ankle and is one of the more serious ankle injuries. I could see the others now disappearing into the distance and didn’t want to be left alone so shouted for help. Fortunately, they heard me and made their way back to me to see what had happened.

The scene of the slip

It was suggested that they carry me off the mountain down to the cars over 4km away. My foot was flopping around every time it moved and I knew this wasn’t going to be an option. I was pretty certain this was going to require mountain rescue and/or ambulance at the least and possibly a helicopter to get me off the mountain. After some discussion Claire dialled 999 and called for help. The next job was telling them where we were. Easier said than done as there is a plethora of tracks in that part of the woods. I have an app on my phone called OS locate which gives you your coordinates and were able to give them those, as well as general directions from the Gethin Park Woods main entrance. While we were waiting for the cavalry to arrive there were several tasks that could and should be achieved. My memory is a bit hazy as to the exact sequence but the most important in my mind was getting my foot straight. My casualty training had taught me that you try to reduce this type fracture as quickly as possible before the nerve and blood supply to the foot is irreparably damaged. There is not much finesse to this as it largely consists of grabbing the foot and pulling in the same direction as the leg is pointing. I saw Martyn ahead of me and asked him to do it. A worried expression came over his face and he rightly looked hesitant. I realised that Claire was standing next to me and as a qualified doctor couldn’t think of anyone better to do it. She grabbed my foot firmly and I braced anticipating shed loads of pain. Much to my surprise the foot came straight relatively easily with lots of grating and twanging and vibration shooting up the bones in my leg – but no pain. I presume this was partly because I was on an adrenaline and endorphin fuelled high but also because the bruising and swelling you expect around a fracture had not yet occurred. The leg was straight within 3 minutes of the original injury. I asked Ake to hold my leg in position as it still felt unstable and wobbly on the end of my leg while I put on hat, gloves, leggings (on my good leg) and waterproof top. 

I was aware of the cold and was starting to shiver now I was no longer moving. I suspect this was largely a nervous reaction rather than just the cold. Martyn, Matt and Marcus then went down to the cars to get warmer clothing and also to be in a position to guide the rescuers up when they arrived. Claire and Martyn had also lent me spare tops to add to the layers keeping me from going hypothermic. I also moved away from the puddle and sat on my bum bag to try and conserve as much heat as possible. Matt and Martyn returned with more warm clothes and wrapped me up as much as possible. After what seemed an age Marcus reappeared with two ambulancemen in tow. Richie and Mark were superb and had gone above and beyond the call of duty. Marcus had managed to get the night warden of the park to open the forestry gates and driven the ambulance to about a kilometre away from where I was on the gravel forestry tracks. My foot was put in a gutter splint and I was lifted on to the scoop stretcher. Between Martyn, Claire, Marcus, Matt, Ake and the ambulancemen, Mark and Richie, they carried me off the mountain and down to the waiting ambulance. I never found out if mountain rescue had been called or whether they were waiting for ambulance crew assessment. We later found out that you have to ask the police to call out mountain rescue (as in the FRA guidance on being “first on the scene” which can be accessed here.

As you can imagine this took time, despite an immediate response from my friends, an immediate call to the ambulance, a fast recognition of my position and a quick allocation of the crew to me. The whole exercise of going up and down the mountain meant that it was 3 hours from the original injury to my arrival in casualty at Prince Charles hospital in Merthyr Tydfil. Realistically I don’t think we could have done it much quicker. 

The cavalry arrive!

So, what are the lessons to be learnt apart from not going out running in dark nights in winter up muddy hills? That isn’t going to happen so what can we learn? Firstly, some things went well, I almost always carry a bum bag with a first aid kit and full body cover on me nowadays. This was invaluable on the night in preventing me getting cold. In the event it had been raining and windy would probably have prevented me from getting hypothermia. The first aid kit was useless for this major injury and didn’t make the difference between getting off the mountain unaided and needing rescue. They are not designed for this purpose. I was going to need rescue anyway. Knowing your position was vital and the OS locate app is a useful tool for that. The “what three words” app would be a good alternative and possibly easier to use. Having a good group of people to run with was also really important. If there had just been two of us then the whole saga would have become more difficult. It would almost certainly have meant the casualty (me) being left alone while help was sought. If I had been alone then in that location, I would probably have still been okay as there was good mobile phone signal. If I had been alone in an area without signal, then I might well not be here now. By the time anyone had realised I was missing and sent out search parties and they had found me then I would probably have been dead from hypothermia. A sobering thought.

The x-ray picture taken in hospital showing the excellent position Claire had got the fracture into. If you look closely, in addition to the obvious fibula fracture you can see that the talus has shifted towards the letter L on the right and gaps have opened up between the talus and tibia on the inner side of the ankle and between the fibula and tibia above the talus. This is an unstable fracture as all the ligaments holding the ankle joint together have all snapped.

In summary...

Enjoy off-road running but don’t take unnecessary risks.

Running alone at night in remote country in winter can be serious if you are injured.

Ensure someone knows where you will be running and stick to that route.

Hone your navigation skills to know where you are at all times so that in the event of an accident you can tell people where the casualty is.

Don’t rely on the ambulance service to contact mountain rescue. This should be done through the police and will require a separate phone call if needed.

Carry full body cover and a first aid kit (for more minor injuries). A small Bivvy bag such as the SOL could prove invaluable if it is wet and cold. For group runs consider having a portable splint in the emergency equipment: devices such as a SAM splint are light and small, but could make the difference with getting off the mountain without calling for help.

Carry a charged mobile phone, but don't rely on it – and remember that batteries drain much faster in the cold. Have a location app on your phone – If running alone then live tracking from your phone could be a lifesaver. These are available through Strava pro or Buddy Beacon on Viewranger at a cost – though these apps can affect battery life.

Carry a whistle – they’re very light, and so much louder than trying to shout for help. If no one hears you, you’re on your own.

I was wearing iNov8’s but even these won’t prevent slips on greasy mud, never wear road-running trainers.

Know a bit of first aid and put yourself on a course!

Run with a great club such as MDC, where people look out for each other.

With immeasurable thanks to Martyn Driscoll, Matt Whipple, Claire Dallimore, Ake Fakerang and Marcus Pinker. I owe a huge debt that I can never repay. Will a beer do instead?"                                                                                                                             

Dr Alan Stone

Thanks Alan for granting us permission to reproduce your article. What has been the response like to your article? Has the process of publishing the article been helpful to your recovery and rehabilitation?

There has been quite a lot of interest with the web version of the article which has been read and shared thousands of times. I've not had any response to the written item yet (apart from you)!

Yes, I'm a positive person most of the time and aware of the risk of slipping into the sick role. I have found it helpful to write this and also to do a video log. It has also helped me engage with others and get me outside of my own head and stay positive and focussed on my recovery.

You speak very highly of your friends and members of the rescue services who helped you. It might at first sight seem a strange question to ask, but did this have an impact upon your recovery and rehabilitation?

Less so. I tend to be quite reflective and was genuinely interested in what went well and what didn't go so well and could be improved. I suppose planning for the future and my return to mountain running helped me keep focus and has prevented me tackling the possibility that I may not be able to do everything I used to be able to do.

Coming from a medical background what has it been like to be a patient? Has it changed the way you interact with your patients?

I am older anyway and I think I have become more empathetic as I have got older. I am not yet back in work and therefore can't comment on whether it will affect my future care of patients. It has been interesting being on the receiving end of care and comparing this with care I experienced as a junior doctor. I have been shocked by how freely opiates are sloshed around in hospitals these days. I think this should be addressed. As a GP I see increasing numbers of patients being discharged from hospital addicted to opiates. It was also interesting to witness the pressures on the NHS. I was 11 hours on a trolley in the corridor and then put in a bed for 24 hours in a store cupboard on a ward due to lack of beds!      

Alan is a GP and has recently retired from being a senior clinical lecturer at Cardiff University School of Medicine where he was involved in GP training.

Thanks to Paul Booth and the team at "The Fellrunner" for giving us permission to reprint Alan's article. 

Membership of the Fell Running Association (FRA) means that you receive 4 copies of the brilliant "The Fellrunner" each year - highly recommended!

Thanks to Mr Tim Halsey for taking a look at the x-ray!

For more details take a look at this!

2 thoughts on “A Trip In The Dark...

Tim Halsey commented 1 year, 8 months ago
Great article and thoughts: thanks for sharing. Just to re-iterate John's comment and the comment in the article that re-aligning broken limbs is the right thing to do as soon as possible. The patient will be more comfortable and it minimises long term damage from stretched nerves and blood vessels. I have manipulated a couple of fractures "on scene" and a lot in the operating theatre and have yet to come across anything being made worse by re-aligning on scene. Tim Halsey (Consultant Orthopaedic Surgeon)
John Ellerton commented 1 year, 8 months ago
Great piece; thanks Alan for sharing this. Early reduction so important and shouldn't be feared. I agree that opioids are thrown around even in the acute phase when other non-pharmacological measures can be just as good. Modern aids to identifying casualty location are extremely helpful. OS locate, 'what3words' or following a text link sent by the mountain rescue service can all work and direct the rescue services with a degree of accuracy unknown five years ago. Your query about '999' and which service is an old chestnut that has improved but is still not infallible. Joint Emergency Service real-time logs and awareness of the best resource have helped but we, in Patterdale, still occasionally get an ambulance being sent to Striding Edge with a delay in mountain rescue activation. Yes, '999' and Police is usually most appropriate away from a road. This is likely to remain as long as there are separate dispatch centres for the Emergency Services. Good luck with your recovery. Dr John Ellerton (Patterdale MRT and ICAR MedCom)

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