Building a Wilderness Medical Response Team in Red River Gorge

Powell County's RedSTAR program works to save people from the pitfalls of nature—and themselves—along the increasingly crowded cliffs.

“Sorry for the delay! I was out on a routine call—cardiac arrest.”

David Fifer apologizes profusely as I hear him settle into his phone, the hum of 911 operators answering emergency dispatches droning in the background. I quickly ensure him that I am in no way inconvenienced (sitting safely indoors pecking away at my laptop) because he was—actually, literally—saving someone’s life in the wilderness.

Fifer is an EMT and board member of the Red River Gorge Special Treatment, Access, Rescue team that’s better known as RedSTAR: a volunteer wilderness special operations unit of Powell County Ambulance Service. Founded in 2015, RedSTAR ensures wilderness and rope rescue-trained EMTs, paramedics, nurses and physicians can reach distressed individuals when accidents occur in the Red River Gorge, making them actual lifesavers for overly confident rock-climbers and folks with preexisting conditions who didn’t anticipate the rugged conditions of their “fun” day hike.

People have such an extraordinary level of confidence in their own abilities when it comes to the outdoors, and I’ve never quite understood why. The need to have a sense of control over nature just straight up does-not-compute for me, because that’s just not possible. One man’s crag to scale is another man’s tumble to his death, and one person’s leap off of Jump Rock is another person’s drowning incident. Nature isn’t in the business of rationalizing.

We talk with David more below. Be careful out there, folks.

Sarah Baird: Outside of heart attacks, what does a “routine call” for RedSTAR look like?
David Fifer: The most routine calls are actually not critical emergencies. They’re people who are feeling kind of ill and, usually, don't know why. They call 911 because that is what society tells them to do. The popular conception of EMS—and definitely “wilderness” EMS—definitely involves a lot of critical emergencies, and we run a lot of those calls. But the most common one is really for general complaints like pain, nausea, vomiting and headaches.

In Eastern Kentucky, owing to certain health behaviors like smoking and industrial jobs, we happen to run a lot of “trouble breathing” calls where people are having respiratory distress.

SB: What it's like to work in Red River Gorge, and how is it different from other places you've worked?
DF: It's a very challenging environment. Caring for somebody's illnesses or injuries is just made a lot more complicated and difficult by being in an outdoor wilderness. We certainly run a lot of kinds of calls that you might associate with outdoor recreation, like injuries and falls. It’s cliff country, and there's a lot of rock climbing—people do fall off of cliffs.

But the interesting thing about [Red River Gorge] is that it's a very popular recreation area for lots of different demographics. That means people bring whatever medical issues they have with them when they take a “short hike” around the Gorge. You might not expect somebody to be having a cardiac emergency related to heart disease in the wilderness. Most people would not put those two things together. But we run those sorts of calls on trails and out in the woods pretty routinely.

SB: Do you think some people are too confident with their outdoor skill levels when they come to the Gorge? Because it’s so lush and beautiful, even inexperienced folks think, “Oh, I can handle this!”
DF: I think you're exactly right. When most people think of the Rockies or a very specific kind of outdoor sport like scuba diving or mountaineering, most people think, “OK, I can either do this or I can't. I can handle this or I can't.”

But the Red River Gorge has really been marketed as being family-friendly and very accessible. There are all different lengths of trails. And for the most part, these days, there's cell phone service in most places, and it's easy to get to most of the trailheads. So yeah, I do think it invites people who may not always perceive the realities of being outdoors.

SB: It seems like there has been an uptick in stories about major accidents in the Gorge and surrounding areas. What are the first steps you take when one of these calls comes in?
DF: The first step is to try to figure out where the call has actually occurred, which can be challenging. If you're standing in a particular spot in the Red River Gorge and you call 911 on a cell phone, it might hit a cell phone tower that’s in a different jurisdiction than where the emergency actually took place.

The next step is trying to get some idea about the nature of the injuries and whether or not the patient is even still alive. That's also very challenging. Many people call 911 and, despite the really exceptional efforts of our dispatchers, are just not able to communicate very clear information. Sometimes that's a factor of being in a slightly more remote area where—even though the cell phone coverage does tend to be pretty good—it's almost like Murphy's Law.

SB: Is there a certain personality type that’s drawn to work with RedSTAR? Adventurous people?
DF: The county search and rescue teams have a lot of locals join because it's a little bit easier to get involved. You don't have to be a healthcare provider. Anybody who has an interest in serving their community can join, and they will put you through all of the necessary training to do rope rescues and find missing people.

RedSTAR is a regulated healthcare operation, so technically, we are a unit of Powell County Ambulance Service. In order to be on our team, you have to be an EMT, paramedic, nurse or physician. Our healthcare providers are usually passionate about the outdoors for one reason or the other. A lot of our members are themselves avid rock climbers, kayakers, backpackers and mountaineers. That's the kind of people that we tend to attract to the RedSTAR team. We have about 25 people right now.

SB: How has your work with RedSTAR changed over the years in terms of just the sheer volume of visitors to the Gorge?
DF: Call volume has definitely increased, and I think that's a combination of a couple of factors. The first is just that the visibility and popularity of the Gorge is really increasing year after year.

I first started coming down [to RRG] in 2003 when I was going to Eastern Kentucky University, and there were certainly people here, but it felt a little bit more closely guarded. It was very well known to rock climbers but had a little bit more of a cloistered nature to it.

Now, there’s increased interest in the outdoors and better marketing. There are local tourism campaigns that did not exist 15 years ago, and usage really is increasing. I think that if you talk to Forest Service personnel, their statistics will probably bear that out.

The other thing, though, is the responses to [emergency] calls from a healthcare perspective were very ad hoc when I started. The reason we formed RedSTAR was that the search and rescue teams would go in and get the patients but were only doing first aid treatment. They do a good job of that, but first aid is inherently limited. The ambulance services would customarily stay at the trailhead and not go up to get the patient. For years and years here, that's just how it was. There were some exceptions to that rule—maybe you had an ambulance crew who was into hiking and jonesing to get their hands dirty—but, again, very sporadic. This led to a gap in care.

So, a few years ago, I really set about to try and close that gap and create a purpose-built wilderness medicine response team that was operating at the full scope of what we're able to do within the healthcare framework. I wanted to bake that into the search-and-rescue responses.

SB: You’re Powell County-based. What is your relationship like with the search and rescue teams in other counties that are home to parts of the Gorge?
DF: We make ourselves available to any surrounding county that needs our services, and that part is fairly routine within the emergency service community. That's the concept of mutual aid. Any of those counties could say, “Hey, we'd like you to deploy your RedSTAR team.” But some counties do not avail themselves with that option regularly. So, we primarily focus on Powell County, and that accounts for roughly half of the Red River Gorge, including very popular areas. We have an off-road park where we get a lot of ATV accidents and stuff like that, too. We have a lot of climbing areas. We definitely stay busy!

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We’ll be back tomorrow with a special Wednesday story, and are now updating our mask guideline document each Friday for the foreseeable future. If you’re interested in a blow-by-blow on that as it updates statewide, Kentucky Equal Justice Center has built a similar spreadsheet.