Wild Side of Medicine
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iSn’t alWayS liKe the claSSroom BY TOD SCHIMeLPFeNIG, NOLS WILDeRNeSS MeDICINe INSTITUTe CURRICULUM DIReCTOR
classrooM MedIcIne Is Wonderful. It works. Our splints make the patient comfortable, dislocations reduce easily, and litter carry practice is over in a matter of hours. But, as a NOLS semester learned when a seemingly innocent fall in the Southwest caused a painful patella dislocation, the real world is not so simple. This particular patella, which easily slips into place in the classroom, refused to budge. It was eventually reduced with sedation and a physician’s skill. The steep terrain made crafting the splint and moving the patient to a flat camping spot an epic unto itself, requiring careful communication and coordination, blending leadership and teamwork with wilderness medicine. the Steep teRRAIN MADe CRAFtING the SplINt AND MoVING the pAtIeNt to A FlAt CAMpING Spot AN epIC uNto ItSelF. The arrival of the litter and accompanying litter bearers the next morning made an extremely difficult task only difficult. Gaining the first ridge took hours of sweat and toil, a rope to belay the litter, and coordination between the litter bearers and those lugging the course equipment. This remained the theme over the next two days. Those of us watching this event unfold from the comfort of our offices looking at the topographic map and Google Earth remembered the vegeta-
tion and shattered rock underfoot and knew a litter carry was not going to be a picnic. While classroom speeches speak of reserving the use of helicopters for life and limb wilderness rescues, it’s an altogether different matter to determine, for real, that neither life, limb, patient, nor rescuer safety is in jeopardy and to make a decision to carry a patient. The reward is hard work and pride in your high standards for wilderness. Much of wilderness medicine seems mundane yet is so very necessary. The tasks of patient cleanliness and comfort, hydration, nutrition, and the improvised bathroom are classroom words that become real effort in the field, especially over days and days. The splint must be checked, and in this case opened, to dry and clean the skin that became sweaty in the hot environment. The focus must remain on the patient; nonetheless, the caregivers cannot forget to keep themselves healthy and effective. Two full days of manhandling the litter uphill, slipping on loose scree and whacking the bush delivered the patient to the waiting NOLS vehicle. The evacuation team wore the weary and satisfied smiles of knowing they did the tough job without complaint and did it well. This patient’s companions demonstrated their excellent expedition behavior and leadership when it mattered— not in the blush of excitement or the comfort of the classroom, but in the days of sustained effort.
The students put their lessons to work in challenging terrain. Nick Cross.
WilderneSS medicine Quiz SKill SerieS WMI has a growing collection of skills videos to refresh your memory on such practices as splints. Watch our pelvic wrap video to review the stabilization used in this recent drama in real life by scanning this QR code or visiting www.nols.tv and searching “Pelvic Wrap video.”
Prevention PrinciPleS For communicable diSeaSe include a. Immediately picking up dropped food. b. Storing food between 45°F (7°C) and 140°F (60°C). c. Heating water until small bubbles appear. d. Washing hands. Answer on page 26.
Spring 2013
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