Ground Fall @ Drive-By

[clif]

i'd like to think most people are very glad to see you write with clarity and in good form.

i only hope that this experience is used to broadly advocate for spotting lead climbers at least.

[Liz_Weber]

after the deductibles and copays, the industry also has a 'usual, customary and reasonable' clause. yes, ALL THREE. if the expense does not comply with these proprietary confines, they will pay what they want and declare the rest up to you, and hit your credit rating.

it's a hassle.

anyway, about 2/3 of an ambulance ride from outer Beattyville to Lexington is NOT reasonable.

Regarding insurance, medical insurance does not cover the heli... you would need evacuation insurance for that. A small policy, usually less than $20-25/month, but definitely nice to have if you do a lot of backcountry alpine stuff. Or apparently, sport climbing in the Red too!

Just a clarification about medical insurance--at least as it applied in my case:

My experience has been that the "usual, customary, and reasonable" clause applies in those instances in which the insurance company has a contractual agreement with the particular provider to accept that as payment. In those cases the balance is written off by the provider, not declared to be up to the patient, and will not hit his credit rating. Large insurance companies do have a lot of clout in negotiating such contracts, but without such a contract in place they will pay the full amount. I've had several instances where the insurance company paid only a small fraction of the charges billed by a physicians group and a nation-wide laboratory with whom they had contracts. In all cases the balance was written off with no attempt to collect from me.

In my case my insurance company (employee group insurance) did cover the heli evacuation. And they paid in full.

In retrospect, I did not feel that the heli evacuation was medically necessary, but at the time I did not realize I had a choice. EMS who picked me up said I needed heli transport, because the bone from one of the breaks was just ready to pierce the skin, making it a compound fracture. I didn't know that I could have signed a "Patient Refuses Transport" form and found my own ground transportation.

I fully expected my insurance to refuse the heli fee as not being medically necessary, but when I called to check, they told me that judgment wasn't up to me. They paid in full. There was no negotiated lower payment, because they apparently didn't have a contract with that heli company. The only thing I paid were my standard deductible and co-insurance obligations.

That being said, all bets may be off under the terms of the Health Care Reform Law as its provisions go into place.

Bottom line: If you have concerns about what your insurance will pay, check with them before you buy an additional evacuation policy. As you are waiting for transport, it is rather difficult to say, "Hold everything while I call my insurance and see what they will cover."

[clif]

Mrs. Weber,

I will take heart with your understanding, but that is not the impression the insurance company and the collection agencies are struggling to portray.

[Josephine]

**I will henceforth always extol the virtues of stickclipping the second bolt and wearing a helmet while leading!!!!!**

Glad to hear you're ok - and that you'll be joining the ranks of the helmet-wearers 8)

[dustonian]

Glad to hear you're doing well... and no long-term consequences? Great news if so! We are all just a little shaken up around here with the Dark Side and Pebble Beach (more hiking than climbing) deaths and a few other accidents already this season on everyone's minds.

[pigsteak]

ND Clee....did you have a bunch of rope out trying to clip the second bolt? It has been ages since I was one breakfast burrito, so I don't know the bolt placement on it...your expereince could help us all learn something from it..

glad you walked away from the fall...

[clif]

ND Clee...your expereince could help us all learn something from it...

since you're new here, what he means is 'how far is this route from one of mine? and don't you know that this would not have happened if you had been climbing one of MY routes'

[Shamis]

Climbing is dangerous.

[the lurkist]

A word about head injuries. Loss of consciousness is the decision point between potentially catastrophic brain bleed, diffuse axonal injury, severe concussion, and just a bruised head. If there is LOC, without a CT of the head it is difficult to say with any degree of certainty that there is not a sub dural or epidural bleed. The great fear with a head injury with LOC with accompanying neurologic symptoms (seizure activity) is epidural bleed, sub dural bleed, or intraparenchymal bleed (within the brain tissue).
With epidural bleed, typically this injury presents with a "talk and die" history. So the patient hits his/her head, has LOC, wakes up, has a brief lucid period, then, unknown to the patient, they have torn an artery (usually the middle meningeal artery under the temporal bone just above and slightly behind the ear - the thinnest bone of the skull) and bleeding occurs on the outside of the dural covering of the brain. Of course the artery is a high pressure system, and pumps blood into this space, pushing the brain out of the way. Only one place for the brain to go- down through the foramen magnum. This is called herniation and it equals death.

My concern is second guessing head injury. If a bleed occurs, and it is causing shift of neural tissue due to increasing volume and displacement, your only hope is rapid neurosugical eval. Military medics are trained to drill vent holes in the temporal bone to de compress these things in the field, the concern and necessity is that high.

In this case, based on what was said here, I think helicopter evac was very much indicated.

The other big issue with any head injury with any amount of energy involved (fall, sudden deceleration) is cervical spine injury. Always assume there is c spine injury.
This person could very easily have had a benign head contusion, but have a c spine injury with cord injury. In this case time is not necessarily of the essence, but proper immobilization is. C spine control, spine immobilization, back boarding, and transport has to be done correctly to avoid tragedy.

[One-Fall]

ND CLee,

Very well thought out response. EVERYONE is glad that you are ok. Its good to see that you are going to keep climbing, AND that you are doing everything you can to remain safe. Could you hazard a guess as to how we can reach others so that they don't have to go thru the same experience to gain your new perspective.

Hope to see you out there,

lee