Help at hand, a kilometer down

"The Austrian doctor and the Italians have reached the patient," read the short text message sent back above ground using a specially-installed communications system within the Bavarian cave complex late on Wednesday. The Bavarian mountain rescue agency said that the rescue team had made it to the site "more quickly than was hoped."

The doctor would first examine 53-year-old Johann Westhauser, offer whatever treatment was possible on site, and then advise on how efforts to extract the researcher should continue. Another rescue team, including an Italian physician, was making its descent towards Westhauser.

Any attempted extraction could take up to six days, rescue official Robert Nagel said on Wednesday.

Westhauser suffered severe head injuries in a rockslide early on Sunday morning. His bleeding head wound first prompted concerns that he might have to be extracted from the Riesending cave system lying down. Yet he has been able to stand for short periods since the injury and has remained lucid.

Equipment, treatment options limited

Frankfurt-based doctor and cave explorer Michael Petermeyer is helping the rescue team and said on Wednesday that Westhauser appeared to have overcome the worst of his injuries, before cautioning: "We really have very little prior experience with an intracranial injury left untreated."

The position, in cool temperatures and deep underground, also complicated what might normally be standard medical practice, Petermeyer said. He gave the example of therapeutic hypothermia, reducing a patient's body temperature in a bid to slow the metabolism, reducing the amount of oxygen cells need to survive.

"Doing this would be an absolutely critical hazard," Petermeyer said. "Down there, we have none of the resources needed to warm a patient back up." Hypothermia is already a major danger for spelunkers in cave complexes like Riesending, where temperatures rarely exceed 3 degrees Celsius (37.4 Fahrenheit).

The aptly named Riesending cave system - it translates as "massive thing" - is Germany's deepest and largest.

The first rescuers to arrive on the scene were cavers who were dispatched almost immediately, none of whom also boasted medical qualifications. The mountain rescue service in Bavaria said this team was now working on setting up the necessary infrastructure to better transport materials, other rescuers and hopefully Westhauser himself. The cave is only accessible via almost vertical shafts.

msh/slk (AFP, dpa)