Every rescue veteran has a story about the complexities of rescuing an obese person. But here’s one that probably tops them all-certainly in terms of time (9 hours) and the situation’s effect on others (22 people also trapped).

Although this rescue featured the extra complication of confined space-a natural cave passage-the incident is a scenario that many rescuers potentially face.

The incident leading to the challenging rescue occurred just after noon on New Year’s Day near the South African town of Oudtshoorn, where visitors can take guided tours through the Cango Caves.

Among the group of 23 tourists being guided through the caves was an obese female. Guides had suggested to the 37-year-old woman that she was too big for the “adventure tour,” which included some tight passages, but her husband insisted that she be allowed on the trip.

The need for sensitivity was on the forefront of the staff’s mind because three days earlier, staff advised another overweight woman that she would be unable to navigate the crawl chambers on the adventure tour. That woman had become incensed and complained to management of weight discrimination. Perhaps because of the earlier incident, the guides relented and allowed this woman to go on the tour. It would turn out to be a big mistake, with unpleasant consequences for not just the woman, but for 22 other people as well.

At about 1230 hrs, the group was about 1?10 of a mile into the caves in a passageway known as the “Tunnel of Love,” which is less than 2 feet wide. As the woman moved through this passageway, she slipped and fell into a half-sitting position, with her legs folded under her and her abdomen stuck under a rock. She could not get into a position to stand up. In addition to the woman’s predicament, she was blocking the exit of 22 other people, including a child, a diabetic and six hearing-impaired American tourists.

The guides and visitors attempted to loosen the woman, but constrained in part by the confined space, they couldn’t move her from the passage. She was quite stuck.

After prolonged but vain extrication attempts, cave staff called 911. The response included Oudtshoorn Emergency Medical Services and Ambu 911 ambulance service. As the incident wore on, staff also called in a rescue helicopter carrying a rescue coordinator and a 20-member rescue team.

Responders gave the woman oxygen; the diabetic was supplied with insulin; and the trapped people were given blankets, water, sandwiches and chocolates (as well as buckets to use when nature called). Concerned with permanent damage to the cave formations, management asked the rescue team to cut and drill rock only if the woman’s vital signs deteriorated.

Ultimately, it was not necessary to employ power equipment. Two petite female members of the rescue team, equipped with a large supply of petroleum jelly, managed to reach the woman. They thoroughly lubricated her and, with the assistance of a simple hauling system, were able to free her at 2115 hrs.

The group left the caves at about 2300 hrs. The woman was taken to a private hospital in Oudtshoorn for observation. After exhibiting only minor injures, she was released.

The rescue costs totaled 15,000 Rand (just under $3,000 USD).

Despite the ordeal, there was one happy outcome for cave personnel. The cave had been suffering financially due to low visitation. But after the rescue, bookings increased significantly, partly due to tourists wanting to be taken to the Tunnel of Love and shown where the woman became stuck.

SOURCES: South African media reports.

LESSONS LEARNED/LESSONS REINFORCED:

Although this rescue had a happy outcome and some humorous aspects, entrapment can be very time-consuming and extremely difficult and frustrating for rescuers. Further, this type of entrapment can escalate rapidly into a life-threatening situation, due to compression, hypothermia and circulation and breathing problems.

Entrapments involving crevices, particularly in caves, are the most difficult, due to access problems, but they can also occur on the surface.

One favored approach is to first thread webbing or straps under the patient to lift them from the confined space. But this is easier said than done, since the crevice may be too narrow underneath the victim for the rescuer’s hands.

Remember: Entrapped patients must be closely monitored at all times during the ordeal, and particularly when they are first freed, because of the danger posed by crush syndrome.