Adventure – Page 2 – In The Study

February 12, 2010

WMS Day 12 – Knoxville

Almost a day of rest with no scenarios – but a day of constant activity. We left camp at 8 am and drove to the University of Tennessee (UT) Medical Center in Knoxville (UTMCK). We spent the morning in the Graduate School of Medicine Family Medicine conference room treated to donuts, orange juice and coffee. We had three short lectures regarding group travel and emergency medicine finishing off with a visit to UT Lifestar helicopter.

After seeing Lifestar we went to RiverSports Inc. for a treat of a free 2-hour climb in their climbing gym. It was great climbing for “real” for the first time. I was really amazed watching some of the climbers. Many of the holds were really difficult.

Finally about half of us went over to my parents house for some good home cooking and to watch the Opening Ceremony of the Winter Olympics. Another good day and looking forward to our days off.

February 11, 2010

WMS Elective Day 11 – Scenarios

Tired. I think that word describes everyone tonight. We were on four scenarios today of increasing difficulty. I now understand why were are at UT tomorrow and have Saturday and Sunday off. I’m sorta wondering about next week given we have three days off.

Our day started at 8am after breakfast with a small incline scenario of some individuals injured in a hunting accident. These first extractions were difficult and required some thought but were nothing when compared to the later ones.

What was more interesting then the actual extractions was seeing the dynamics change in the groups as we learned to work together. It was a bit rough at the beginning as we learned to lead and follow. A lesson, which we will continue to learn all of next week.

TK has a quote taken from the Air Force which says, “The more we sweat in peace, the less blood we spill in war. It is a quote he often reminds us of was we are performing these scenarios. Reminding us of the importance of doing things right now so as to do it right in the future.

As to the scenarios, the second was a climbing accident. I forgot my camera and couldn’t take any pictures but Jason was a great victim. It was hard at time keeping from laughing. After finishing this scenario we ate lunch and then had two more scenarios in the afternoon with camp staff and an EMS volunteer as victims.

The first afternoon scenario was a tree accident on a steep embankment requiring ropes to assist in transport. The second was much more difficult requiring an ~1.5 mile extraction with half of it through a streambed. This victim “fell” off a 20-foot cliff after having a stove accident and being burned. Once we were able to move him to the opposite shore we were able to stabilize him, package and carry him to the next point. A waterfall. Yep, we had to take the basket down a 10-foot waterfall. I’ll post some pictures once I can get copies but it was really neat to see everything work out. Everyone really worked hard to ensure the safety of the team and the patient. Only one person was injured after slipping on the way up but none were injured on the extraction.

Once we were done, we ate dinner, cleaned everything up and had 1 presentation and 3 student presentations. I think this was the best day so far. Learned a bunch and will sleep great tonight.

Till tomorrow.

February 10, 2010

WMS Elective Day 10 – Lectures and Scenarios

Quick plug for the official WMS Elective Blog for anyone interested in reading an official version of our daily activities. Only thing I have on it is the pictures. 🙂 Mainly because I’m here and collecting all the photos for the elective DVD and not being able to send many due to limited internet connectivity.

For the first time since the elective started, my brain isn’t really ready to write anything. I have this interesting collage of thoughts floating in my mind but refusing to come to any semblance of order.

I will, however, make a shout out to my cousin in Philly, already has 27″ of snow and expecting 12-22″ more. That is crazy. I’m glad we only got the little bit (about 1 inch) this morning. It made our afternoon scenarios much more interesting. Oh, I forgot to mention we were able to do two scenarios this afternoon. It was quite the learning experience. Many problem-solving skills in use to perform the packaging and extrication.

The day started out with the completion of the frostbite lecture, moving on to Poison Ivy, then to Hypothermia, Sunburns, Blisters and Avalanches. Busy morning and lots of learning. From what I was told there is a great new products out for the treatment of Poison Ivy call Zanfel. It is used to reduce the symptoms and duration through a topical application, which helps reduce the immune response. I must make note I’ve not tried it nor endorse it but would be interested in hearing from anyone who has tried it.

We also talked about sunscreens (cannot use the word sun-block anymore) and how often the SPF can be misleading due to only working for UVB but not UVA. From what we were told sunscreens with Zinc Oxide or Titanium Dioxide are the best sunscreens out. To get the best sunscreen look for something without preservatives and chemicals (like perfumes) because those are often what causes hypersensitivity to the lotions (allergies). There is some cool stuff to do about surviving an Avalanche but mainly what we learned is to really understand it we need to take another class taught in the snow.

Both exercises were great learning experiences. The first one was somewhat simple given it was our first scenario. We had to package the patient and were done. The second scenario, however, was much more challenging because the scenario had three victims of a tree falling on them.

Each “victim” they were placed around a downed tree and had “fake” wound accordingly. We had to extricate them and prepare them for transport, which took about 30 minutes for each. We were split up into three teams so it went quickly but since we didn’t bring the litter baskets one team was split up to retrieve them and help transport two of the patients back (our teams were not big enough to transport three back). So, one patient ended up helping carry the others back. How funny.

Well, probably should get up to Sunset lodge. That is where all the guys are staying and everyone hangs out in the evenings. We are going to have more scenarios in the morning so probably need to get ready for them. Hope you enjoy the pics. It is taking to long to label them all so I’m just gonna upload them for now and let you imagine the captions.

In the afternoon we had two scenarios, one a snowboarding accident and another a chainsaw accident. The student’s “wounds” were quite realistic (sorry for the lack of pictures) and made it easy to treat the scenario as a real situation. The first scenario was ended once we packaged the patients for transport and the second required us to transport the patients up and back down the mountain to the main lodge for completion.
Both exercises were great learning experiences. The first one was somewhat simple given it was our first scenario. We had to package the patient and were done. The second scenario, however, was much more challenging because the scenario had three victims of a tree falling on them.

February 9, 2010

WMS Elective Day 7 & 8 – Rest, High Altitude and SAR

Sunday, or the seventh day, was a day of rest, church, relaxation and superbowl. It was good seeing all my friends back in Knoxville and attending ORBC again after a month out in Memphis. Everyone except me went to Buffalo Wild Wings for the Superbowl and it sounds like they thoroughly enjoyed it. Lots of wings, a good game and new friends.

Yesterday was a day of several lectures. We started the day was learning about high altitude illness and progressed into Search and Rescue (SAR). There were a few really interesting bits of information I pickup throughout the morning. I learned that at a high altitude blood could become much to thick. Ugh, that would stink having a stroke because the blood thickens to transport more oxygen.

After the first lecture talked about high altitude illness the rest of the morning and all afternoon were devoted to SAR. As part of these lectures we instituted two of the three classical search techniques (Efficient and Thorough) practicing them outdoors.

As to the stats of those saved by these techniques, in 2008 there were ~300 saved and a total of ~6000 saved overall since the inception. As to airplane crashes, 100% of the victims alive after EMS arrived survived the extraction and transport to the hospital (includes transport out of the woods). It is an amazing stat given only 21% survived the first 24 hours.

After another great lunch, we practiced the Efficient search method where everyone lines up and scans the ground for signs. We started out in a field looking for cards the instructor left. Then we progressed to 50% less cards in the woods. In both cases it was not only a matter of not only finding the cards but remembering where we found them so as to recreate the track of the individual and to determine direction of travel. Each card was laid out in the order of being found from the first person and according to the number of steps taken by that individual. This method recreates the track and helps determine the direction of travel by deducing the order of discarding the items.

Once we learned the efficient method by scanning we progressed to tracking. It is simple. A simple but methodical method but still very much an art. It was fun having the chance to practice this but different in knowing we will be doing it in the very near future. It also made it much more real life.

After dinner we had a lecture by Dave Halstead from the University of Tennessee about head injuries. From all his experiences and consults with the NFL, multiple college football teams and high profile athletes Mr. Halstead appears It was a very interesting lecture and was very worthwhile. According to his research it takes ~6 weeks to recover from a concussion or a MTBI (mild traumatic brain injury).

February 8, 2010

WMS Elective Day 6

We left this morning from camp at 8 am for the Blount County Sheriff’s Department to learn about different types of weapons, entrance and exit injuries and tracks. Those instructing us in the various firearms took aim as the pig heads with 4 or 5 different firearms. After demonstrating the effects on the pig heads we progressed to the human simulate to see the actual tracts through something with the consistency of flesh. Yeah, it is sorta morbid but necessary in wilderness medicine.

After the demonstrations, we were given the opportunity to try our hands at the firearms. Yep, it was really great to have the opportunity to fire the different rifles and handguns. The instructors were so generous with their time and resources. It was a cold and dreary day and there were little thanks to go around for their generosity except our smiles and handshakes.

After returning to the lodge for lunch, we had an emergency medicine doc give us lectures throughout the afternoon on various topics including “Leave No Trace,” “Flight Medicine” and “Fire.” Soon the lectures were over and we were done for the week, done to enjoy a day of rest and then the Superbowl. Yeah, it was a good day and week all around…

After the demonstrations, we were given the opportunity to try our hands at the firearms. Yep, it was really great to have the opportunity to fire the different rifles and handguns. After everyone had a chance to fire the weapons, we learned how to extract ourselves or someone else from a vehicle. There were really cools stories as to breaking into vehicles and extractions. We also saw a really useful device everyone should have in their car. It is called ResQMe. I’m gonna be getting one for my car, never know when it could come in handy and it came with very high recommendations from the Assistant Chief of the Blount County Sheriff’s Department.

The instructors were so generous with their time and resources. It was a cold and dreary day and there were little thanks to go around for their generosity except our smiles and handshakes.

After the demonstrations, we were given the opportunity to try our hands at the firearms. Yep, it was really great to have the opportunity to fire the different rifles and handguns. After everyone had a chance to fire the weapons, we learned how to extract ourselves or someone else from a vehicle. There were really cools stories as to breaking into vehicles and extractions. We also saw a really useful device everyone should have in their car. It is called ResQMe. I’m gonna be getting one for my car, never know when it could come in handy and it came with very high recommendations from the Assistant Chief of the Blount County Sheriff’s Department.

The instructors were so generous with their time and resources. It was a cold and dreary day. Snow was falling off and on. The wind was bitting and the ground was soggy. The job of the instructors almost seem thankless except for our smiles, excitement and hearty handshakes when we were done. Here is a special thank you to those who were willing to give their Sat. morning to us and let us experience something few are able.

Again thanks to Gabe and John for the pictures.

February 8, 2010

WMS Elective Day 5

Well, we are back from our day off and are starting up with Search and Rescue. We have Jeff Wadley presenting today and are going to “skim the surface” of this topic. Also just found out that our first night scenario is next Monday. Gotta start hitting the trails and make sure we know the area to keep the night a bit shorter.

As to Days 5 & 6, they were days full of multiple and varied experiences as are becoming common here at the WMS Elective. Each and every experience has broadened my perspective on Wilderness Medicine. Not all have been as glamorous and exciting as my posted highlights, but all have served to increase my appreciation for the wilderness.

Thursday was a first for the WMS Elective in terms of education. We spent the morning at the Heritage Museum here in Townsend, TN. In the morning we had the privilege to hear about the discovery of equipment from an old iron mill. It was in a river and was only discovered after an earthen dam failed and all the silt was washed away. A former park ranger was hiking up the river when he noticed a “square rock” after noting, “God doesn’t make stones that way.” Dwight McCarter was the presenter with a classic East Tennessee story telling style. As for the story, it wasn’t the point of our visit but the cultural aspect and how it relates to wilderness medicine.

After the presentation a tour of the museum was in order. It turns out that the federal government decided to expand the road outside the museum. While one of the bulldozer operators was working to prepare the roadbed, he noticed some bones. The bones turned out to be from an old Cherokee settlement. The University of Tennessee excavated the area and the Heritage museum was created as an agreement with the Cherokee to allow the road construction.

About ½ of the museum presented the history of the Cherokee in the area. I learned several interested bits of information about the Cherokee, their social structure and a little about the medicine. The other half of the museum presented the history of Cades Cove through buildings, equipment and vehicles moved to the area. One of the more unique stories we told was the story of a moonshine operation lasting for > 80 years without detection. It lasted through prohibition all the way to the donation of the 500-gallon still to the museum.

As part of the presentation, some of us stayed behind to try throwing an Atlatl (pronounced at•lat•tel). It was a very surprising and neat experience to try throwing it. Easier then I expected but still challenging as evidenced by the videos and pictures.

The remainder of our day (after dinner) consisted of a series of infectious disease lectures by Dr. Mark Rasnake from UT Medical Center.

The remainder of our day (after dinner) consisted of a series of infectious disease lectures by Dr. Mark Rasnake from UT Medical Center.

February 5, 2010

WMS Elective Day 4

What about day 4? I’m glad you would ask. Today started of student presentations. Each of us is required to give a presentation on a certain topic related to wilderness medicine. Today we had about 10 individuals give their presentations. All were quite refreshing without power points. I’m trying to figure out how to give mine without any slides.

I have one illustration I’d really like to show for my topic. It is a poster showing the spectrum of light – from infrared to ultraviolet and everything between. It really gives a good idea of how the bandwidth is partitioned and where our electronics are functioning. The other problem I have is I don’t have my visual aids (i.e. Radio and license.)

After the morning round of presentations, we were given about 2 hours off to explore the camp and prepare ourselves for the coming scenarios. All our instruction is done whatever the weather, just like any rescue. No, it isn’t fun in the rain, ice, snow or water but it must be done. A person’s life is at stake and a rescue doesn’t wait on good weather.

After taking my GPS, marking several trail heads and tracking the trails I hiked, we had lunch. Once I download the trails I might upload them into my computer. However, I can say is we hiked from about ~1100 ft to ~1700 ft on our max ascent, covered 3.13 miles and circled ~0.25 acres. It had great vistas and also had cell reception on the ridge-tops. Once back, we ate lunch, had a long PowerPoint lecture and then had a great afternoon.

The afternoon consisted of a ropes course with a challenge and a giant swing. The challenge was crossing a suspended ~24 ft wire ~30 ft in the air. A parallel wire was suspended above crossing wire with ropes dangling from it at increasing intervals (each was further apart). The objective was simple, ascend the tree, cross the wire and descend the opposing tree to the “v-swing.” Once at the v-swing we were sent swinging.

After all this we ate a filling supper of Spaghetti and completed the night with 5 more student presentations. All in all a great day I’m sure to be followed by many others.

Hat-tip to John, Gabriel and David for the pictures.

February 3, 2010

WMS Elective Day 3

More pre-hospital medicine & pseudo simulations

Tuesday brought another day of learning and many really interesting stories. Of all our instructors almost are all volunteers and this day our teachers were from Roan State Community College, an assistant chief of the Knoxville Fire Department and a Park Ranger Smokey Mountain National Park. Each was great and really taught us many useful tools for survival and rescue.

Our day started out with learning intubation techniques and airway management in both urban and wilderness pre-hospital settings. I guess now would be a good time to ensure everyone knows what “pre-hospital” means. I wondered the first time I heard it and the answer is the most obvious answer – it is pre-hospital care. Yep, so obvious it almost hit me in the face.

But back to day 3. The morning consisted of learning multiple techniques in securing the airway be it using a bag-mask, endotracheal tube, esophageal tube, double lumen tube, LMA or a needle decompression. We discussed various situations in airway management and practiced the techniques. The esophageal tubes were a really ingenious idea for pre-hospital intubation. Also the S.A.L.T. was a great idea for providing a bite block and guidance of the intubation tube right through the vocal cords. How cool is that. In fact, it would have been great for a patient I remember in the trauma bay.

The afternoon consisted of learning to secure the c-spine and spine for mobilization to the hospital (i.e. packaging up the patient for the hospital.) We learned several different methods of stabilization for extraction. We practiced the techniques on each other. The photos you see of me demonstrated how to remove someone not lying on the ground. It was developed by NASCAR for the extraction of drivers but works great for other uses.

An alternative reverse bean-bag used to stablize the c-spine

After this, we had a short simulation to cement a little of what we learned through four of us acting as victims and the rest as the first responders. We managed the scenes and brought back all the patients. We only made a few errors covered up by the proximity to the base camp. All in all though, no patients were dropped (but one was close), all were successfully immobilized and transported.

We ended the day with a talk by National Park Ranger Hester. His stories of the wildlife, people and hikes were all inspiring. Many hilarious stories of practical jokes Park Rangers play on each other and “green” campers or illegal campers (ones without a permit). Sufficed to say, make sure you have a permit. 🙂 Ranger Hester is a great speaker and I look forward to him returning in the next couple of weeks.

I finished the night with a hike to “David’s Bald” trail head and the Blue Berry trail head before heading to bed after doing some reading.

February 2, 2010

WMS Elective Day 1 & 2

Well, all finished with day 2 and it has been an interesting and fruitful experience so far. Entering this elective I wasn’t quite sure what to expect. I know several of the faculty from UT who teach for it but details were sketchy. All I really know was what one of the faculty told me, “You’ll really enjoy it.” When people would ask me what to expect all I could say, “Take a look at the website to see.”

So, for the first two days of the month, we have had two days full of lectures and practical survival skills. A pleasant surprise, however, has been the camp. Camp Wesley Woods has been a wonderful hosting facility and the staff has been excellent. The introduction games and leadership games they have used are very thought provoking and great for learning names. Normally, I have a horrible time learning names but now I feel much more confident after all these exercises.

One specific leadership game they had us perform used a hula-hoop®. Everyone stood in a circle and placed both index fingers pointing toward the center of the circle with the hula-hoop® resting on the index fingers. The task was simple. Lower the hoop to the ground. Yes, a simple task but hard to execute. It is a weird feeling to be standing with six other individuals wondering why the hoop is going up and not down. We eventually got the hoop on the ground and advanced to two hoops, one on the right index fingers and one on the left above it. These hoops couldn’t touch and both had to be lowered. After the experience with the one we did a much better job with keeping these on a downward course.

Otherwise yesterday we learned about incline rescue and evacuation using ropes and how to setup a system. Today we did navigation ending with a two-mile trek around the camp to specific points and the leadership exercises. The rest of the week is going to be a full week with the days starting at 7:30am and lasting till about 7-7:30pm all the way through Saturday. We won’t really have much other then didactics this week but the real fun will be starting next week when we start the “scenarios.” What are the “scenarios?” Well, maybe an example of what happened yesterday is better then me trying to explain.

So, after all the introductions and just before dinner, one of the pre-hospital instructors asked if anyone brought some through away cloths. I as ever readily mentioned I had some and was instructed to go change into it. We were going to learn the proper technique of removing the cloths in a wilderness emergency. Yes, the “scenarios” I am mentioning have us (the students) as the victims and the rescuers. In this case, I was just a “dummy” and my cloths were sacrificed but in the real scenarios we will be given make-up and instructions as to the type of injuries. We will be placed out in the woods and our team will have to come rescue us. It is all live simulation and will require the exact same response. There is no other way to simulate it and learn.

What does that mean, well if a student is an “unconscious” victim and during the primary survey our team forgets to cover us up in the cold or rain, we get really cold and wet. It is to help teach us what it is like as a patient and learn invaluable lessons in patient care. Some of the simulations we will be running will be a night. Some will have victims in the cold water. Who knows all they have dreamed up for us? All I know, it will be an invaluable experience in my medical studies.

Well, that’s all for now. Better get some reading done and ready for tomorrow.

January 29, 2010

I-40 Storm

Why is it when I don’t want it to snow, it does and when I would love for it to snow, it doesn’t. Oh well :). Today was an interesting day and nothing like I thought it would be at the beginning of the month. I ended up leaving Memphis at 7 am and driving to Knoxville arriving at 2:30pm. Not bad time considering I saw two wrecks on the way. Yep, it was an interesting drive filled with ice, sleet and snow.

What I had planned was to wait for my exam at 10:00 am and then leave. What a wonderful surprise when I found out school was canceled. I was able to stay just ahead of the storm and get to Knoxville for the Wilderness Medical Elective starting this weekend. I’ve been getting gear and am really excited it is finally starting. My adventure for the month started a bit early with my drive back. Below are photos I took from my trip back. Yes, that is between 1/4 and 1/2 inch of ice coating the front of my car.

Enjoy the photos and keep reading for my month in the Smoky Mountains.