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    Expert Q & A: What Are the Risks Facing Thai Soccer Team?

    Thailand drawn on gray map.

    By Kathleen Doheny
    WebMD Health News

    Over the weekend, more Thai soccer team players who had been trapped with their coach in a murky, dark cave were rescued. Now, the world awaits the final mission to bring the remaining boys and their coach to daylight. The ordeal began more than 2 weeks ago, when the boys were on a post-soccer outing and got trapped in the Tham Luange Caves after water levels rose.

    Ever since, the players and their coach have coped with flooded and cramped conditions as dive teams strategize how to save them. No small feat, as escaping requires the boys to navigate murky, dark waters wearing diving equipment.

    WebMD asked Paul Auerbach, MD, Redlich Family professor of emergency medicine at Stanford University, a founder of the Wilderness Medicine Society and author of a respected textbook on wilderness medicine, to talk about the logistics of the rescue, the challenges the team, the coach and the rescuers likely faced, how they likely are coping and what they can expect going forward.

    WebMD: Why is the rescue taking so long?

    Auerbach: The rescue is taking an appropriate amount of time. This is a complex, dynamic process. They had to balance the physical and emotional conditions of the boys with the fact they needed to be trained to be swimmers and divers against weather conditions that would cause them to proceed sooner or later. They had to pick the optimal time with the least amount of risk knowing they had to do something because of the impending weather.

    My hat’s off to everyone involved in this. They have assembled an amazing team of people who have performed in an exemplary fashion. Dive rescues and cave diving are two of the most potentially hazardous and dangerous activities under water.

    Auerbach:  In the cave, the challenges are isolation, darkness and adequate physical and emotional reserve to undertake what is a highly dangerous rescue. The training of the students and the coach are essential.

    Paul Auerbach, MD

    Paul Auerbach, MD

    WebMD: Can you elaborate on the psychological challenges? What might be going through the minds of the team?

    Auerbach: It’s reasonable to expect they are somewhat apprehensive, up to the point of being frightened. However it’s to their advantage that they are young. Teenagers tend to be optimistic by nature. The adults in some cases are more worried and pessimistic than these young boys who are friends and athletes.

    WebMD: Does team camaraderie work to their benefit?

    Auerbach: Yes. From everything I know, they are highly supportive of each other. They are choosing to look at the positive side of things. To be supportive of one another physically and emotionally is big help. The rescuers want them to be as optimistic and as brave as possible.

    WebMD: What about other coping mechanisms? What might help?

    Auerbach: I’m sure the rescuers are dealing with them both as individuals and a group to try to provide encouragement and to explain what is going to happen and how important it is to stick to the plan. They are explaining what things might be problematic during the rescue, what to expect. Being educated about it helps. Knowing there is a plan for getting them out and knowing that other boys have followed the plan and gotten out successfully is an important message. This all reduces the possibility of panic.

    WebMD: What are the potential health risks now for those rescued?

    Auerbach: The immediate are malnutrition and dehydration, if any. Body chemistry may be abnormal, muscle mass may be diminished, but these are reversible problems. If they had any injuries, those would have to be addressed. Any infections, such as skin infections (would need care).

    There has been a lot of talk about cave disease, which is called histoplasmosis. The boys will be watched for this. It’s a fungal disease (with the fungus found in the environment, especially in soil with bat and bird droppings). It has an incubation period that ranges from about 3-17 days. In people with normal immune systems, histoplasmosis is a brief disease, with fever and cough. Most people probably don’t know they ever had it.

    It’s generally a problem for people with seriously comprised immune systems. (If treatment is needed, antifungal medication is prescribed, according to the CDC.)

    WebMD: What are the potential psychological risks?

    Auerbach: The boys may experience emotional effects — hypervigilance, insomnia, perhaps flashbacks. They may have posttraumatic stress disorder (PTSD) and they should be evaluated for that.

    Of course the rescued boys will have accomplished an amazing feat and should be both proud and perhaps in the long run emotionally stronger.

    WebMD: What about the rescuers?

    Auerbach: Rescuers in these kinds of difficult situations become intensely engaged, with little sleep and lots of adrenaline. Once it is all over they will be tired. They need to be tended to as well to make sure they recover. Their extraordinary bravery and dedication are remarkable. With anybody who puts themselves out there to help other people, there is an energy cost associated with that, both physical and emotional.

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