in the study

WMS Day 26 - going home

Fri, 26 Feb 2010 16:34:00 -0800

Tired and sad. Two words to describe how I feel right now. What a wonderful month of learning and adventure. So many amazing things and people. How cool it was to discover so many individual with similar interests. I'll be posting more tomorrow from the hike, but I'll post a few photos from the hikes right now.

WMS Elective Day 19 & 20

Sat, 20 Feb 2010 18:35:00 -0800

Day 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 -

Today 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.

After 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

Fri, 19 Feb 2010 09:58:00 -0800

All 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.

All 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

Thu, 18 Feb 2010 06:11:00 -0800

Day 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:

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.

Day 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.

Between 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

Tue, 16 Feb 2010 13:17:00 -0800

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

After 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.

As 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.

Our 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

Fri, 12 Feb 2010 21:17:00 -0800

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.

WMS Elective Day 11 - Scenarios

Thu, 11 Feb 2010 19:23:00 -0800

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.

WMS Elective Day 10 - Lectures and Scenarios

Wed, 10 Feb 2010 19:50:00 -0800

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.