“Pt. 1, A: MOI spine, TBI, A’: increasing ICP. tx: spine stable, monitor MS, evac.” my notes read. All this studying was preparation for the 4-day Wilderness First Responder course I was taking in Idyllwild. I had to complete a 32-page pre-course study packet so that I would be up to speed with the rest of the course participants. So not only did I have to get reacquainted with all the abbreviations used in emergency medicine, but I had to refresh my memory as to how to differentiate between a traumatic brain injury and increasing intracranial pressure, for example.
When the course started, we jumped right into some new information (joint dislocations!) which built upon the info in the study packet, so I was glad to have had a little advance prep. The class days were long… we went from 8 a.m. to 6 or 7 p.m. with an hour break for lunch. During lunch and the bathroom breaks between textbook units, I took every chance I could to study. Five minutes here, seven minutes there… I was living and breathing wilderness medicine for four days straight. Towards the end, I felt like my brain was going to explode. But all the studying and class hours paid off, though, because I left Idyllwild with a WMA WFR Certificate in hand!
I find emergency medicine fascinating, and with a wacky instructor and good classmates, this course was all the better. The instructor, JJ, is well over 6 feet tall and skinny as a lodgepole pine. He has long black hair that he keeps in a pony tail at the nape of his neck. His round eyeglasses have Croakies pushed up all the way to the hinge in the frame. Without the glasses, JJ kind of looks like Daniel Day-Lewis on the cover of “The Last of the Mohicans” DVD. JJ’s in his mid-40s, but the way he talks and his zany sense of humor makes him come across a lot younger. I remember from the last course I took with him that he hates water and motorcycles with a passion. Although he didn’t go off on a tangent explaining why he will never put a foot into the ocean, he did allow himself a rant on motorcycles. “Whoever says that loud exhaust pipes make drivers more aware of the motorcylclist…it’s so not true. Because they point backwards, you don’t even hear the pipes until they’re right up next to you or in front of you! They’re so obnoxious. It just rattles the freakin’ mountains!!” he exclaims, before switching back to his lecture on cardiogenic shock.
There were ten others in my class, from different places and all walks of life. There was an Outdoor Ed. high school teacher from Ojai, a surfboard shaper and rock climber from Whittier, an astronomer from Geneva, Switzerland, a 46-year-old father of two who “was just getting bored with life,” a NPS Resource Management Specialist from Lake Mead, and a 21-year-old college student from Arizona, to name a few. We got acquainted real fast, because not only were we in class together 9 hours a day, but we also had to take each other’s vital signs (“hm, your respiration rate is 22; that’s a little high…”) and do a focused history and physical exam on each other as part of our Patient Assessment Drills.
Oh those Patient Assessment Drills…haha. JJ comes up with a wild assortment of emergency scenarios. He’ll give us “rescuers” a briefing on one of them. Then we go out to find and treat the patient. JJ might start with something like: “OK, so your friend Binky was skiing some gnarly slopes in the backcountry when he flies off a ledge, misses his landing, and takes a tumbling fall into the trees. When you ski down to him, you notice that his helmet is cracked and his arm is twisted in an unnatural way. Ready? Go.” So we set off outside in search of “Binky,” armed with med kits and a radio. As the the course goes on, the drills get more complex and more realistic (with fake blood, vomit, and facial make-up).
On the last two drills, JJ uses a video camera to record our rescue efforts. The video camera is a “great cerebral evacuator” according to JJ, who uses it to add some pressure and stress like there would be on a real rescue. We’re all a little more nervous because of it, and when he points the camera at us and asks “So where are you in your assessment of the patient?” sometimes we stumble a little. Some goof-ups are funnier than others. At one point JJ questions Daniel about his decision to clear Adam of a spine injury. “Are you sure he is a reliable patient?” JJ asks, the camera zoomed in on Daniel’s face. Daniel gets flustered and answers: “I think his mental status is pretty good… I mean, do you hear all the smart-ass jokes he’s been making?? Look at his face. He looks pretty awake and reliable to me!” Adam is in the corner of the screen, trying to keep a straight face and look ill.
There were a lot of light moments in this WFR course, but I think there was some serious learning taking place. In our drill de-briefings, we’d go over what we did wrong and what we could improve on the next time. We had two quizzes and a big test, and plenty of on-the-spot questions thrown at us in class. My classmates and I were studying around the clock and mentally preparing ourselves for the next emergency scenario. I feel like I learned a lot and got more comfortable in my role as a first responder. I now have a professional-level CPR (adult, child, & infant) certification and the ability to:
**reduce simple dislocations,
**administer epinephrine injections for anaphylaxis and severe asthma,
**administer medical oxygen,
**use diagnostic tools (blood pressure cuff, stethoscope), and
**use an AED
After four days of fast-paced learning, emergency scenario drills, and a bit of fun, I think it’s time to celebrate! Cheers to my fellow “woofers,” may you never need to use some of the skills we’ve learned…
Until next time,
–A