Toccoa River, Georgia
                                                            By Roger K. Thomas

                                           Author's Preamble for posting on Bill Logan's Suwannee River website. 

I hope readers won't think they are seeing too much of Roger Thomas.  Bill generously encouraged me to send the three articles I described to him when he first called for writings.   I look forward to seeing the stories others have to share. 

The account below was written at the time and posted on the Georgia Canoeing Association's e-mail listserve.  It was deliberately written in two parts and mailed on separate days to encourage readers to think between Parts 1 and 2 about their medical preparedness if they had encountered such a chance event as we had.

For those unfamiliar with the Toccoa River, it can be seen on standard Georgia maps by finding Dahlonega, GA, way up in north central Georgia and following GA 60 NW towards east Tennessee.  It was my first and only trip, so far, on the Toccoa, so I am hazy on river details.  We put in at Deep Hole in the Cooper's Creek WMA and paddled several miles to take out at
Margo Booth's (see Part 2 below) place.  The Appalachian Trail was about mid-way on the section we paddled.  The AT suspension bridge crosses over the beginning of the largest rapid on this section, a class III in my book.

Wilderness Medical Emergency: Part 1

Yesterday, 16 May 1998, four paddlers on a trip that developed from postings on the Georgia Canoeing Association ListServe were drawn into a medical emergency that may be useful for others to ponder.  As we approached the Appalachian Trail suspension bride over the Toccoa River, we planned to stop for lunch.  On the left bank we saw a group of boys and men obviously on some kind of outing, so we headed for the right bank. Before we landed, we heard a voice (or voices) screaming in apparent terror, and quickly witnessed an outbreak of pandemonium as men and boys, some with sticks flailing, converged on the area from which the screams were coming.  My initial hypothesis was that a poisonous snake had been discovered and had possibly bitten someone.  We had not yet exited from the canoes when one of the men began beckoning us over to their side and yelling "medical emergency."

As we were crossing over to their side, we were informed that a dog had attacked a boy, and we could see some of their party accompanying him towards the clearing where they were setting up camp.  As we drew closer, it could be seen that his neck and shirt were bloody, especially the shirt in the left shoulder, side, and upper arm area.  It would become obvious after we arrived that there were also bites on his right arm and a deep gouge that was bleeding profusely in his right cheek.  The dog, a large
German shepherd, was running back and forth around the periphery of the clearing, as some members of the party continued to ward it off with sticks.  By tee shirts and other symbols, including one adult's tee shirt that read "Be Prepared...for anything that happens," it was becoming apparent that it was a Boy Scout outing.  There were four adults, three of ages 40 or more, and, perhaps, 10-12 boys.  The boy who was attacked was probably one of the youngest and smallest in the troop. 

Surprisingly, it was also made clear very soon that they were looking to us to take care of the medical aspect of this emergency, although none of us was a physician.   One of the adults was now holding a wet paper towel to the boy's face on the right side.  It was also apparent that the boy who was now sitting on a log was highly traumatized with some trembling
evident, and he was hyperventilating.  A larger boy was holding his hand, and one of the adults was also in physical contact with him and trying to console him.  It was approximately at this point that we reached the boy. It further unfolded that they had hiked three miles to be there, and very quickly, one of the adults was dispatched to retrieve a vehicle or, possibly, emergency assistance.

Because I did not take the lead which I will tell you now was taken admirably by Steve Cramer, I have pondered how I might have handled the situation if it had been up to me to take the lead.  I have also pondered whether my first aid kit was as carefully maintained as it should have been.  These and other matters I have pondered since, and thought it may be a useful for other list-subscribers to consider.  How prepared would you have been to address this fast-unfolding situation?  How adequate
would your first aid kit likely be?  I do not expect actual responses, since I have only sketched the situation as I witnessed it and can best remember it.  It is likely that my observations missed a great deal, and perhaps my paddling partners will provide their own accounts, or supplement mine, as it unfolds.  Tomorrow, I will give you my account of how it was handled.   

Wilderness Medical Emergency - Part 2

To review briefly, on 16 May 1998, four GCA paddlers were drawn into a medical emergency near the Appalachian Trail suspension bride over the Toccoa River.  Stopping for lunch, we saw a group on the left bank, so we headed for the right.  Before we exited a voice began screaming in terror, and we witnessed an outbreak of pandemonium as men and boys, some with sticks flailing, converged on the area from which the screams were coming. One of the men beckoned us over and yelling "medical emergency."  A large German shepherd had attacked a boy.  His neck and shirt were bloody on the left side, and there were bites on his right arm.  The right side of his face was bleeding profusely.  He was traumatized and hyperventilating.
Although it was a Boy Scout outing with at least four adults and although none of us was a physician, it became apparent that they were looking to us to handle the medical emergency.  We learned that they had hiked three miles to be there, and they had quickly sent an adult to retrieve a vehicle. 

Steve Cramer in our paddling group took charge.  He replaced a wet paper towel that a Scout leader was applying to the cheek wound with a sterile compress and stopped the bleeding.  The only other bleeding wound, behind the head, had stopped. Concurrently, with applying a bandage around the head designed to hold the cheek compress in place, Steve addressed the
trauma and hyperventilation by talking to the boy and by coaching him into slower and deeper breathing.  When Steve's hands were freed from bandaging and while continuing to talk to the boy, Steve made gentle up and down hand movements which he got the boy to follow visually and with slight nodding. This had a becalming effect. It should be noted that the hyperventilation persisted for many minutes. Also helpful, another older boy was holding the injured boy's hand and consoling him.  Margo Booth, in our group, had early on counseled with increasing fervor to get a blanket for the boy; for some inexplicable reason, undue hesitation in accomplishing this was being demonstrated.  Eventually, one of the leaders produced a Mylar blanket.  Meanwhile, Steve got the boy to lie down on a sleeping bag and elevated his feet on a log.  My contribution consisted of
little more than assisting Steve with access to gauze and tape and to paying some attention to the where-about of the dog.  My apology to Jim Kautz in our paddling group, but I was unaware of where he was or what he was doing.  There was both the need to keep the crowd around the boy to a minimum and to maintain protective vigilance, as the dog was running about the perimeter of the clearing with apparent attempts to enter it.  After several minutes it began to appear that the dog was calming down and that it had a collar.  Margo and others began planning to try to contain it and, perhaps, examine its tags.

Meanwhile and about 20 minutes after the attack, two fishermen began crossing the suspension bridge from the opposite bank, and it was learned that they had vehicles about 1/4 mile away.  The dog, which did not belong to the men, also came on the bridge, and it was soon evident that it was manageable.  It was arranged to carry the boy to a vehicle, and a Scout leader carried him piggy back.  Steve and I accompanied them, in part, because the man was unable to make some of the short steep ascents without assistance.  The boy was holding up well, and Steve kept talking to him along the way.  Another boy who said he was the injured boy's best friend accompanied us.  When we reached the truck, the man had the dog secured. 

The truck had a camper enclosure as well as an extended cab separate from the camper.  The dog was put in back, and the driver, the Scout leader, the injured boy, and the other boy filled the cab.  As far as we know, the plan was to take the injured boy to the Scout leader's vehicle, and the leader would then take the boy to the hospital in Dahlonega. That was the last we saw them, but we encountered the two fisherman about two hours later down river.  They said that they had turned the dog over to a U.S. Forest Service Ranger.  The dog's tag indicated that it had a rabies shot in 1997.  We also learned that the dog had followed the Scouts in, having joined them somewhere along the hike.  It was probably owned by someone in the area.  Other than the attack, the dog seemed gentle enough.  It may have reverted to instinct if the boy had shown fear and panic and had
run.  We do not know if the boy had provoked the dog.  A reasonable person, as all GCA members are, will probably have some concern for what may happen to the dog.

The experience enabled me to become aware of how rusty my first aid training had become.  I had an excellent Red Cross course in conjunction with Water Safety Instructor training ...40 years ago!  I cannot say whether I could have acted as efficiently and effectively as Steve did (Steve also confessed that he felt rusty and uncertain).  I have been the lead-action person in some outdoor first aid events, but none with all the complexities that were operating here.  I intend to be retrained soon, so actions will be better informed. I have also pondered my first aid kit which, fortunately, was still well stocked.  It was mainly what we used in the dog attack. However, I had not reviewed it in terms of expended supplies, since I had treated someone else's deep foot laceration on a GCA trip a year ago.

Post Script
Jim Kautz from our group was able to contact the boy's mother later that weekend.  Jim's account may be seen in the Georgia Canoeing Association Newsletter for July 1998.  It draws partly from mine above and mainly adds the following new information.  The mother expressed her gratitude for our assistance and reported that the boy, Kenny, was doing well.
Nevertheless, she said he had to have 67 external stitches, and she was unsure how many internal ones (probably inside the mouth as his cheek had been lacerated completely through).  She did say a plastic surgeon had been available for the stitching, so maybe his scars will be minimal.  She also said that the dog's owner had been located (he lived near where the Scout troop had hiked in) and that he was not willing to have the dog euthanized; apparently, the owner was within his legal right not to
destroy the dog. 

Post-Post Script
I retook the standard Red Cross First Aid course, including CPR, in February 2000, and I plan to be re-certified as required every two years.  My first aid kit has been completely refurbished. 

                                                                                               Roger Thomas  E-mail: rkthomas@arches.uga.edu
                                                                                                      URL: http://www.arches.uga.edu/~rkthomas/