Tonight I can say we are all very exhausted, so needless to say my post will be shorter than normal. Tuesday was once again a beautiful day. The morning started out with a fantastic talk about tactical medicine that gave us a general gist about what our practical portion will be like tomorrow. The injuries, while they are not new to many of us working in the hospitals, are thought of and treated slightly different in situations where you may be under fire or fearing for you and your patients life actively. Following this we had a very useful talk on legal issues in medicine and this lecture sparked all kinds of questions and discussion. This is a topic that we get very little in medical school, and it was great to have this exposure. The afternoon was a great practical experience of white water rescue activities. Unfortunately because of the recent heavy snowfall that is now melting, the river had about 6x the volume and speed as normal, so needless to say our actual white water canoe trip had to be cancelled for fear that a real world emergency would be sure to ensue. However, we were able to simulate the white water rescues using a throw bag and a boat drag using a Z-drag rope system that we could use to free a boat from being stuck on rocks in the middle of a river. At the end of the night, we had some additional presentations about caving and cave rescue medicine by our future guide. He also was kind enough to share his experience of working with the Tarahumara indians in Mexico and all about their culture. He has done some amazing medical mission trips there and it was amazing to hear him speak!!
Today was yet another exhausting (but really fun!) day!! In the morning we were split into two different groups and half started with caving while the other half started with climbing! The caving portion was absolutely amazing! We got muddy, dirty, very wet, sweaty and tired! But it was really cool all grouping up in one of the amphitheaters and having everyone turning off all their lights...total darkness is not something many people have experienced. Even cooler is when they passed out mints for everyone to chew on and watching the luminescence in peoples mouth from crunching on sugar...didn't even know that was a thing! Of course we were challenged with a medical scenario, but after last weeks going-on's, I feel like it barely phased us. Anyways, we changed and headed over the climbing gym and spent the next few hours climbing and bouldering away. We were given a very cool demonstration of a rock wall rescue and how to use a person's own rope to climb up and rescue them. The rest of the time we spent completely exhausting our grip strength and forearm muscles. We left the gym completely tired and having a difficulty time with anything requiring dexterity. The night was capped with an Indian dinner and hitting the hay getting ready for an early start tomorrow!! Good night everyone!!
Our extended weekend brought a ton of fun but also a ton of rest to some of us in much need of both. Sunday some of us continued our hiking expedition with a trip to one of the most (if not the most) photographed spots on the Appalachian trail…MacAffee’s point (I think that’s how it is spelled, already got it wrong once). It was a four mile hike up and out onto an overlook whose beauty is quite honestly beyond words. You could see for miles and the expanse of the blue ridges went as far as the eye could see. The only limit to our visit was the bitter cold that almost immediately completely numbed up our fingers as we were clicking away photos on our phones. Seriously…it was the kind of cold that caused bitter pain at the tips of your fingers, and soon we were all re-gloved, with one hand in our armpit to rewarm and the other balanced with Puppy Chow (Muddy Buddies – a.k.a. chocolatey , peanut buttery goodness) on the other. The weekend was capped off with a visit for many of us to Home Place with never ending fried chicken, roast beef and biscuits. Not to mention, we returned home and our awesome elective co-director Steph had brought us chili and potatoes for dinner to keep something warm in our bellies.
Monday brought an amazing surprise….we awoke to at least 5 inches of fresh powder on the ground. Needless to say, some of our speakers had a hard time traveling to meet with us, and our afternoon of mountain biking had to be at least put off. In other words..SNOW DAY!! We were able to relax in the morning and had a nice fireside lecture with Dr. Steph Lareau, and then she graciously set us loose to have some much deserved fun in the snow. It was an exhausting two hours of snowball throwing, people tackling, friend burying, kayak sledding, kangersnipe hunting, and face-washing good time!! At the end of the two hours we had a surprise scenario that left us to deal with a couple of our own ‘injured’ patients that we had to travel to in the back woods and decide on a management and extrication plan. Though at times for some it was hard to decide whether the situation was real or a scenario, we treated it like the real thing and took good care of our friends J. The snowy day ended with a very powerful video of the two doctors that were present on Everest during the avalanche describing their experience there. If there were ever two heroes, those doctors definitely made the cut.
The snowy Monday led to a bit warmer, rainy Tuesday. The day started bright and early with new scenarios for us to test our skills, but devoid of the equipment that we had become so comfortable with last week. Instead, we were given a new (and might I say not quite as bountiful) set of supplies to work with and improvise such things as a litter to carry our patients out with. It was phenomenal practice to deal with scenarios using supplies that we were to more likely have with us at the time of an emergency (sleeping pads, sleeping bags, ropes, limited medical supplies, etc.). There was a cold rain coming down, and somewhere in the back of our heads we heard Kirk and Fred laughing and cheering at us being out in the chilled rain. We had some fantastic lectures in the afternoon including tips on taking Kids out in the wilderness, toxicity of various plants and mushrooms, and field pain management. It was a great day that ended in yet another great hike to the bluffs. Well, that didn’t quite end it as a big group of us headed into town to catch a show at the theatre in Roanoke and possibly may have stopped for a close-to-midnight snack run at the local Krispy Kream. Sweet end to a sweet day!
Insane, amazing, exhilarating, exhausting, entertaining…there were a lot of words to describe the last 48 hours, and all of them could never do it justice. Yesterday morning started off with a fantastic talk on mass casualty medicine and organizing the scene into different stations and how to effectively triage patients. They ran us through many cases and we were able to have some great conversations on how we would manage the different patients in triage. After that we had a talk on how to set up a landing zone and the different aspects we need to keep in mind if we were to ever secure a scene for a helicopter to land. Lastly for the morning we went through a slew of different splints and how to apply a proper traction splint for a broken femur. We then broke into our groups and got to go practice bandaging up each other’s heads, arms, legs and abdomens, practicing for the coming times.
After that we headed outside, and began a long string of scenarios that would keep us on our toes the rest of the day and all through the next day. We each broke into our groups, packed up all our blankets, tarps, immobilization equipment and medic supplies onto the basket and assigned a team leader. One of our team was sent to be the ‘patient’, and they disappeared into the back room to get dressed up with fake blood, fake vomit, mock ups of fractures and eviscerations, and much more. The team lead would head to the check out where we would get the report of the incident and where we needed to go to find our victim. We would head out as a team, assess, manage and treat the patient as best we could, and got them off the mountain as quick as possible. Mind you, this patient was typically undressed in snowy, blowy and very cold weather, so keeping them warm was one of the top priorities….but I guarantee you that the shivering that most were demonstrating was very real. Today was an entire day of scenarios, and that basket gets heavier with each time we went out. Even as a team, the weight of the patient began to weigh on each of us, and of course the instructors never made the extraction easy for us. Every single scenario involved getting the patient off of the side of a very steep incline with downed trees, stumps, dead trees, loose leaves and rocks to avoid. But I have to really give it to them, after practicing on that terrain, most others will seem really easy. This long day coming to an end, but we all have the looming knowledge that tomorrow promises to be much longer, much harder, and much more exhausting. Needless to say…its bedtime…
Sunday morning started early again with a great talk by Dr. Gordie from Cornell on Heat Illness and followed by an almost completely interactive dental lab that taught us all the basics of dental emergencies that we may expect to come across not just in the wilderness but in every day life. If there is one thing in medical school that I can confidently say we learn very little it is dental medicine, and this four hours taught me more about this topic than I learned over the last four years! We went through how to replace an erupted or avulsed tooth, how to apply local anesthetic or a regional block to the teeth or soft tissues, how to replace a loose bridge and how to handle broken teeth (which happens to be one of the most common dental emergencies that I have seen in the ER as well). After this workshop we took the party outside to do some comical, competitive and quite fun team building activities. These ended in everything from sprinting across the field acting out superheroes and fast food chains, walking a giant wooden structure across the lawn with rope, hitting each other with foam noodles while blindfolded, etc. Needless to say, they were all quite fun and ended in a belly shaking round of laughter.
Monday was the start of our Wilderness First Responder course, and although it was a bit intimidating as the instructors (Kirk, Fred and TK) recounted the expectations of being undressed outside in the 20 degree weather, performing a rescue under a waterfall and being pushed to our limits during a search and rescue operation in the dark...I think we could all feel the electricity and excitement at the idea of being comfortable with all these things by the end of the week. To start the course we did multiple interactive stations including oropharyngeal airways, nasopharyngeal airways, combitubes, king tubes, infant intubation, endotracheal intubations from the ground and cricothyroidotomies on pig tracheas. We ended the day with various spinal immobilization methods such as the Hartford Vacuum bag (blue) and KED (green). Great skills for the coming scenarios no doubt, and obviously great photo ops!
Friday closed out our first week of the wilderness elective, and it ended on a great note. The CEO of the Wilderness Medical Society himself, Loren Greenway, came to speak to us about safety and diving including an incident they had at one of their conferences where a diver met a catastrophic end that could have potentially been avoided. We also gained some useful knowledge from our infamous leader Erin Meyer, when she gracefully made the oh-so-sexy topics of chronic medical conditions and elderly in the wilderness come alive :). Friday ended with a bang, and along with continuing to prepare for our coming trip by going through all our gear and routes, we were able to break out the guitar songs, sit back and enjoy a futbol (soccer for us US folk) game, and get a little, but not too, rowdy :)!
Saturday was our first free day, and the group split up into numerous activities to spend the day. There was a large chunk that took advantage of the offer by our leadership to join in a beginner's scuba class. They went into town for the classroom version and then down to the pool to practice their skills (which from what I heard included underwater frisbee and rocket throwing)! Another group tested our their canoeing skills on the river right next to camp, and while those sitting in the front of the canoes said that felt rather easy and they'd love to do it again...I heard from good sources that those in the back of the boat had their work cut out for them. The group I was with took off for a great hike that ended in cliff row where we set up a few crash pads and proceeded to climb (and occasionally crash) on and off the bluffs. It was great fun, and nothing came back broken or bleeding (too bad)...so I count it a success! A group outing at a local brewery for dinner later, and we all hit bed a little early to prepare for Sunday's antics.