A Trauma Doctor Analyzes the Thai Cave Rescue: ‘Nothing Short of Miraculous’

You probably already know the story.

In 2018, 12 juvenile members of the Wild Boar soccer team, along with their 25-year-old assistant coach, became stranded in the Tham Luang Nang Non cave system in Thailand. The group was exploring there after practice when an early-season rainstorm caused water levels to rise dramatically, forcing the team to retreat to a high cavern far from the cave entrance.

Turbid, fast-moving water, low visibility, and narrow, difficult-to-navigate passages hampered the subsequent rescue. Divers fully expected most, if not all, of the soccer team to die in the attempt.

A miraculous rescue

Despite those odds, the rescuers successfully extracted all 12 children and their coach. The story inspired a documentary by Jimmy Chin and a dramatic adaptation by Ron Howard, among other projects. With the recent release of these films, the event is back in the public consciousness, prompting some to ask the question, “What can we learn from this unprecedented success?”

Andrew Petrosoniak, an emergency physician and trauma team leader at St. Michael’s Hospital and Assistant Professor in the Department of Medicine at the University of Toronto, is such a person. In a viral Twitter thread, Petrosoniak breaks down the rescue and looks for takeaways that could aid first responders in future situations.

A few reminders

Before we get to Petrosoniak’s takeaways, it’s worth remembering just how difficult this rescue was.

It wasn’t even clear that the soccer team was alive until they’d been missing for more than a week. Divers plunged again and again into frigid, muddy water, exploring chamber after chamber with increasingly grim expectations. When British divers John Volathen and Rick Stanton found the group huddled on a narrow shelf above the rising floodwater, hungry but alive, it was a surprise to all involved.

But finding the Wild Boars and their coach was just the beginning of the problem. Reaching the chamber required more than three hours of travel (one way!) through some of the most hellacious, dangerous conditions a diver can face. So how to get the boys and their coach to safety in circumstances that gave world-class divers pause (and had already claimed the life of a Thai Navy Seal?)

Members of the Thai military at the rescue site.

Rescuers at the Tham Luang Nang Non cave network. Photo: Shutterstock

 

On the bleeding edge of the monsoon season proper, rescuers realized that the children, untrained as divers, would not be able to avoid panic if rescuers tried to assist them underwater back to dry land. Instead, they made the unprecedented decision to anesthetize the group and ferry them out one at a time over the course of several days.

The strategy carried immense risks: the anesthetic had to be re-administered periodically throughout the dive, and asphyxiation was a constant possibility. Rescuers could not monitor vital signs electronically after administering the anesthetic. Instead, they had to observe air bubbles to ensure the children were still breathing.

Moving an unconscious human body through the water is no easy task, even under the best of circumstances. Add in tight passages and near-zero visibility, and it becomes nearly unthinkable. And yet, the team achieved total success.

Five key takeaways

In his Twitter thread, Petrosoniak views the events through his unique perspective as a trauma expert. To summarize his conclusions:

  • The situation was nearly impossible.
  • Rescuers did not let that fact paralyze them into inaction.
  • After thinking outside the box, the only viable solution was still frighteningly dangerous and prone to failure.
  • Rescuers mitigated what risk they could and then proceeded with the rescue.
  • Success was a combination of skill, teamwork, physical stamina, correct application of mental tactics, and luck.

Petrosoniak begins by stating that rescuers acknowledged when they had to act — they did not let the circumstances paralyze them into inaction. Freezing up is the hidden third response behind “fight or flight,” and it’s quite common in complex or traumatic situations. It takes training and experience to overcome it, two things the rescuers luckily had in spades.

A crazy idea was the key to success

The doctor also notes that sometimes standard solutions are inadequate to solve extraordinary problems. The rescue team briefly considered far more typical options, such as attempting to keep Wild Boars alive until the water could recede, drilling a rescue tunnel, or training the children in basic diving techniques. For various reasons, rescuers rejected all of these proposals before landing on the only viable, if extreme, option.

“Crazy ideas sometimes are the key to success,” Petrosoniak concludes.

Managing personal mental state is a crucial tactic in extreme situations. One challenge the rescue divers faced was the knowledge that the children in their care could — and likely would — die at any moment during the swim to safety.

The solution? A technique called cognitive reframing.

“The rescuers considered each child as a package. It removed the emotion and helped reduce stress in an incredibly stressful situation,” Petrosoniak writes.

A narrow (but dry!) passage in Tham Luang Nang Non cave network in northern, Mae Sai, during the rescue. Photo: Shutterstock

 

Pre-mortem

Petrosoniak concludes his thread by remarking that the rescuers conducted a pre-mortem, allowing themselves to consider worst-case scenarios and then creating mitigation strategies for those scenarios. It’s a technique that’s been around for millennia (the Roman Stoic philosophers called it premeditatio malorum.)

Such a strategy can be counter-intuitive for high-performers that have trained themselves to visualize success, and yet Petrosoniak identifies it as a crucial element in the rescue mission’s positive outcome.

Finally, Petrosoniak acknowledges that despite world-class skills and correct decision-making at every point in the rescue, getting every child out alive required a certain amount of luck. It’s an important point to make, as it highlights the somewhat random nature of disasters and disaster management.

You can read the entire thread here. It’s an interesting perspective on the nature of rescue attempts and is applicable to adventurers of all stripes.

Andrew Marshall

Andrew Marshall is an award-winning painter, photographer, and freelance writer. Andrew's essays, illustrations, photographs, and poems can be found scattered across the web and in a variety of extremely low-paying literary journals. You can find more of his work at www.andrewmarshallimages.com, @andrewmarshallimages on Instagram and Facebook, and @pawn_andrew on Twitter (for as long as that lasts).