After rescue from Thai cave, boys face a physical and psychological battle

The eightboys rescuedafter spending the last two weeks trapped with fourother teammates and their coachin a flooded cave in Thailand now face a new challenge after surviving recovery.

Medical experts warn that the ordeal for the soccer team may take a physical and psychological toll.

The teamhasbeen trapped since June 23 when heavy rain flooded theTham Luang Nang Non cave complex in Chiang Raiprovince.

Officials said Sunday the healthiest boys were taken out first. But malnutrition and dehydration will likely mean immediate physical problems once they are out, said Dr.Peter Lin, aCBCNews medical contributor.

"My concern is there has not been an image of the boys," Lin said Sunday."We had seen the ambulance going away. We were hoping for a smiley face.

"That's probably not the reality."

The rescue team had one ambulance ready for each person brought out of the cave on Sunday.

Adrenalin runs high during the rescue

"When the person is actually rescued, they actually collapse," Lin said. "They pass out and that's probably because their adrenalin is running very high and that's keeping them going. So, imagine the long swim, adrenalin high, squeezing their arteries, keeping the blood pressure up, heart is pounding, in the fight or flight mode, and to safety: It shuts off."

The team relied on drinking waterthat dripped from stalactite formationsto survive, and have since been consuming high-protein liquid foodafter being found by rescuerson July 2. But the team will be physically very weak.

More video of the 12 teens stuck in a cave in Thailand

6 years ago

Duration 0:50

In the video, you can see some of the boys saying their names and smiling while others receive some first aid

"When you starve yourself, your body takes away and uses all the current nutrients," he said. "They have gone through their fat stores and now they are breaking down muscleto make sugar for the body to function."

Once in the ambulance or helicopter en route to a hospital 50 kilometres away, Lin says they will begin receiving treatment immediately. That will likely include starting an intravenousdrip and taking blood samples, though extensive dehydration could make those tasks challenging.

"The first couple minutes out is the scariest part," Lin said.

The boys' eyes will have to be protected as they adjust to daylight after being in the dark for two weeks and their sleep patterns may also have been disrupted by lack of light.

Assessing impact of hunger, dark

Doctors will try to assess the boys' organs, which could be compromised after the extended time in the cave."Are the kidneys functioning OKor shut down? Is the liver working? Because they were breaking down all the protein, they may have started to break down some of those cells as well."

Authorities have not confirmed the identity of the rescued boys. Some of the parents told Reuters they had not been told who had been rescued and that they were not allowed to visit the hospital.

Narongsak Osottanakorn, head of the rescue mission,said on Monday that the rescued boys had not been identified out of respect for the families whose sons were still trapped, adding that the boys were being kept away from their parents due to fear of infection.

Medical teams previously said concerns included hypothermia and an airborne lung infection known as "cave disease,"which is caused by bat and bird droppings.

Lin saidit will be days before the hospitalized boys are considered "out of the woods."

One of the concerns, he said, is that in order to be able to digest food, they will need to be properly hydrated, and haveproper organ function.

"The pancreas has to make the enzymes to help you digest food. Remember, the enzymes are really made from protein, and the proteins are coming from the proteins that you eat," Lin said.

"They did not have a lot of protein for 10days, and in fact, they were breaking down their own muscles to survive. so, that's why the systems are not working well."

One advantage, though: "Because they are kids they will bounce back more quickly, I hope."

Beyond the physical recovery, Lin says the ordeal could have profound psychological effects, including post-traumatic stress disorder (PTSD).

"The brain makes the memory circuit a dangerous situation. Dark, cramped, cold: So, your brain says 'I better panic and get out of the situation.' Unfortunately, the brain will misinterpret some things. So, go into an elevator it's a closed environment: Panic. Dark, all of a sudden: Panic. Maybe nightmares as well."

Psychological scars lingered for Chilean miners

"That's what the Chilean miners went through and I have to expect it in the kids as well," Lin said. "When they checked back with the miners five years later, they had a lot of psychological problems."

In 2010, 33Chileanminers were trapped underground for more than two months when the mine they were working in collapsed.

Dr.JeanRomagnoli, who helped rescue 33trapped Chilean miners in 2010 says there is a key difference when comparing the two events: The miners he helped rescue were familiar with being in confined spaces the youths and their coach in Thailand do not have that advantage.