WMS Elective Day 19 & 20

Cave beforeDay 19 —

Everyone split-up today and went different directions enjoying the beautiful weather.  Some went bordering, others hung-out at camp and enjoyed the sunshine while others went for a hike on Rainbow Trail almost getting to Mt. LeConte.  The snow became knee deep and thus they had to turn around but they really enjoyed the beautiful views.

I on the other-hand went home to do laundry and rested for most of the day.

Day 20 – 

On the way inToday we went to The Lost Sea and did the wild cave tour.  It was great fun.  Our guide, Shane, was really enjoyable and really tailored the tour for our group.  It was funny to hear him really enjoy having a tour of adults rather then children.  The lake in the cave is huge.  In the 70’s they went diving with sonar and couldn’t identify any walls or floor.  Thus the floor is deeper then 3500 ft and the back wall is farther then 3500 ft.  That is a huge cavern.

Small holeAfter finishing we went to a place call Joe’s for the best burgers in Sweatwater, TN.  The burgers were really good.  They were really good.

Well that’s all for now, enjoy the pics.

WMS Day 18 – Finale

Where we had all our lecturesAll good things must come to an end and certainly the lectures went out with a bang.  We had 3 lectures spanning from 8am to 4:30 pm with 3 breaks (one for lunch).  It was a marathon session but very interesting.  The lectures were over Space Medicine, Toxicology (i.e. venomous and poisonous animals) and making a Wilderness Medical Kit.  It became one of our first beautifully sunny days and during our few breaks we made sure to enjoy it.  All the pictures of us today were on the front porch of Tipton Lodge where we had all our lectures and was the headquarters of all our scenarios.

Enjoying the sunAll in all it was an interesting day.  All we have left for the remainder of the elective is the 4-day hike.  Unfortunately, one mentor had to drop out.  Because of this one group had to disband and join the other groups.  Fortunately everyone found a hike they were interested in hiking so everything worked out.  Now to rest and relax until Monday.  Here’s hoping for more good weather.  

As to the weekend, tomorrow some of us are going to the Lost Sea http://www.thelostsea.com/ for a Wild Cave Tour.  It should be fun.

Here are some interesting facts from yesterday –

  • Politics in NASA really hinders science
  • Medicine in space requires a completely different thought process.  
  • CPR in space is worthless due to taking to long to initiate
  • The most dangerous venomous animal is the Bee
  • Most use the term poisonous and venomous interchangeably but that is incorrect.  A Bee or a Rattlesnake is venomous but not poisonous (i.e. they will make you sick if they inject the venom but will not make you sick if you eat them).  Poisonous animals are like the Puffer fish.
  • Superglue, duck-tape, trash bags and safety pins are essential in a wilderness medical kit

WMS Day 16 & 17 – Random facts and the final scenarios

Long dayDay 16 was a day full of lectures as will be day 18.  Day 17 was our final day of scenarios.  The posts are a day late and a bit short in content because as a camp we exceeded the daily bandwidth allotment and I didn’t take time yesterday to write.  Yep, no internet yesterday so I couldn’t post anything about Day 16 or 17.  It made me lazy :).

On day 16 we had lectures for a bunch of different topics.  We learned about Dive Medicine, a recent medical trip to Haiti, preparing to lead a wilderness expedition, making a medical kit and lots of random facts.  Some of the most intriguing were from the dive medicine lectures.  Did you know:

Lots of lectures

  • 1 clo – the amount of insulation created by a Summer business suit in England during the 50s and 60s.
  • You can increase your total lung capacity via Lung Packing.
  • Record for a man holding his breath is 17:19 on pure Oxygen.  On room air it is 11:35.
  • Record depth for free diving (diving while holding breath without breathing apparatus)  is 702 ft for men and 525 ft for women (http://en.wikipedia.org/wiki/Free-ping).
  • When adjusting to a new timezone allow 1 day for the first 3 time-zones and 1 additional day for every additional time-zone.
  • FAST – Fatigue Avoidance Scheduling Tool.  It was used to determine the hours limits of medical residents and show the equivalent blood alcohol level to the fatigue level.  So someone with only 2 hours of sleep one night and works 18 hours the next day would have an equivalent  blood alcohol level of ~1.8.  Yep, basically drunk.
  • The abbreviation SHAG, Social Hand Grenade, is someone who has trouble making all social interactions cease when they appear.  

Waterfall rescueDay 17 was all about our final two scenarios.  The first one was all about two very difficult extractions.  The victims situated beneath a 50 ft waterfall (i.e in it) and since it was below freezing there was lots of ice.  I was on the medic team and was stationed at base camp.  Everything I hear was how great the teams did in their extractions.  I didn’t see anything until the victims were brought back when we re-evaluated them and repackaged them for transport to the hospital (i.e. once we were done let our classmates free to get changed).

The second scenario was two male four-wheelers accident victims.  They were both on a really steep slope demonstrated by the photos (rotate your laptop until the people are upright to see the angle of the slope).  The packaging and transport went really fast and we were off the slope and ready for dinner in about 1.5 hours.

Plunger used to stop a nasal bleedBetween the two scenarios we had a wilderness improvisation demonstration.  Each of us was required to demonstrate two improvisations using supplies we would have while in the wilderness.  These ranged from making air splints from bedding pads to snow goggles made of aluminum foil.  It was a great experience and many great ideas were shown.

The day ended at the Heritage Planetarium learning navigation through the night sky.  It was an incredible experience and one I would like repeating.  

Well, today we have a day of lectures starting with space medicine.

Gonna be a good day.

WMS Day 15 – Good to be back

Please note all the injuries are simulated (i.e. no real blood).

All injuries are simulated - except being coldAfter a long weekend we are starting our final week of lectures and scenarios.  The month has flown by and it is starting to sink in that we are finishing up.  Only 3 more days after today and so far the course has been great and I’m sad to see it ending.  I’ve met a bunch of great individuals and have learned a tremendous amount about wilderness medicine.

Enough reminiscing though, yesterday was a great day of learning with several new lecturers and two more scenarios.  We learned about lighting strikes, burn injuries and planning for an expedition from the medical perspective.  We saw videos and pictures from Haiti from a Doc who had been there treating patients.  The pictures and stories were heartbreaking and sobering in terms of our training and what some of us are shooting for as a career.

Our first scenario - the hard oneAs to the scenarios, we had two in the afternoon and evening.  The first scenario of the afternoon started around 2:30 and didn’t end until after 5:30pm.  Of all the scenarios this was by far the most difficult.  We didn’t rise to the occasion and struggled with the difficult extractions and triage.

Adding to the difficulty of the extractions we learned a new rescue structure and roles.  The confusion about the new structure really increased the time to extraction and treatment.  We learned a lot from our trials and struggles.  In the end everyone was extracted successfully and no one got injured.  

Around the fire keeping warmOur dinner consisted of MREs around a campfire waiting on our next scenario.  The MREs from today are much better then the old ones.  They are still not the greatest but are nourishment.  After finishing our dinner, it was dark and we were notified there was a group of Boy Scouts missing but we were not given a point last seen.  After about half an hour we were provided a point last seen and preceded to start searching for them.  

I was on the transport team and since we had an unknown number of inpiduals we positioned ourselves in strategic positions to quickly transport them out.  It turned out that only two inpiduals need transport and 3 of the 5 could walk out.  We completed the entire scenario by about 9:30pm.  It was great and we set a new record for speed of extraction.

In total, we were outside for about 9 hours by the end of our second scenario and slept really well.  We finished up about 10:30 and were able to get in bed by 11:30.

WMS Day 12 – Knoxville

LecturesAlmost 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.

All of us with the crew

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.

WMS Elective Day 11 – Scenarios

Heading out to an accidentTired.  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.

Second one on a slopeWhat 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.

Learning to leadThe 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.

WMS Elective Day 10 – Lectures and Scenarios

Neither rain, nor sleet, not snow . . .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.  

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.  

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.

How to keep someone warm in the wildernessThe 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.  

ExtricationIn 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.  

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.

WMS Elective Day 9 – Lectures

From my years of practice I have discovered testosterone and alcohol are a failed combination. – TK

LecturesI think this quote is a great summary of our day.  It was a day of many lectures imparting lots of wisdom, some student lectures and a little hands on demonstrations.  Our day consisted of lectures about High Altitude illnesses, Cold injuries, Facial Trauma, a talk from a Chiropractor and ending with a lecture about orbital injuries.

We started with lectures about high altitude medicine and cold injuries but were unable to complete the cold injuries lecture.  It will be completing it later and I am looking forward to it.  After stopping, we had several student lectures learning about methods to start fires in the wilderness, wilderness improvisation and two wilderness survivor lectures (one of our classmates has been a Survivor contestant).  

Some take away points from the morning lectures –
   • Ambien and beer is a bad combination
   • Fire is hard to start
   • Too much coconut can act as a laxative
   • Poke a bear in the eyes
   • Cold, numb, loss of motor coordination, burning pain after rapid rewarming are signs of cold injury or a level of frostbite.

Replacing a fillingAfter lunch some Oral and Maxillary Facial Surgeons from UT Medical Center spoke to us about facial tram and allowed us to try our hand at making fillings and attaching replacement crowns using Intermediate Restorative Material (IRM).  It is available from your local pharmacy in a premixed form from what I understand and looks very useful for long expeditions.

We ended the day with a lecture about orbital injuries (eyeball injuries) and the treatment in the field.  It was a somewhat disgusting lecture given the trauma displayed in the pictures (one showed a nail sticking through the orbit).  It was a long day.  Tomorrow afternoon we have our “first” scenario so we’ll see what happens.

Thanks to Gabe and John for the pics again.

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.

Finding those cardsYesterday 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.

Recreate the trackAfter 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.

Trying to TrackOnce 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).