Medicine University of Arizona
U of A

The call of the great outdoors is irresistible to many, and in Southern Arizona you can count on nearly 300 sunny days per year. But venturing into the wilderness and exploring can mean entering into an extreme environment, where an injury can leave you stranded on a mountaintop or in the desert, hurt on a remote bike path, or severely dehydrated. 

During the spring semester, the University of Arizona's new Wilderness Medicine and Advanced Wilderness Life Support class, offered by theDepartment of Emergency Medicine, provided certification and training for graduating medical students, medical residents and faculty, teaching them to apply their medical expertise in the great outdoors. The new medical student elective course is intended to instill a lifelong appreciation for wilderness medicine, both as a practical tool for future forays into the wild and as a legitimate academic pursuit.  

Two weeks of lectures and in-class training were led by Dr. Christopher G. Williams, clinical assistant professor of wilderness medicine in the Department of Emergency Medicine. Williams started the course to teach medical students how to plan, organize, triage, diagnose and treat patients and how to improvise and provide the best medical treatment possible outside of a traditional clinical setting.

The true test of students' skills came through simulated emergency medical situations in the field at Madera Canyon in the Coronado National Forest, 25 miles southeast of Tucson.

On a cold, blustery Saturday, UA medical students encountered mock medical scenarios along the trail in Madera Canyon, where they had to take on, assign or assume various roles to make sure patients' immediate medical needs were met and also ensure the patient's rescue and recovery, while also keeping themselves safe. Students were evaluated on their ability to secure the scene, obtain patient history and perform an interview, develop a likely diagnosis, initiate appropriate treatment – including assessing medication needs and/or fabricating splints, all while ensuring patient comfort.

"It is important to get the students out in the field. You can only do so much during the lecture and it's not real enough until you are out in the gusty wind and cold focusing on patient safety, working on fractures and figuring out how to pack people out and evacuate. Then it becomes real," said Dr. Vivienne Ng, assistant professor of simulation in the Department of Emergency Medicine.

Ng and colleagues from the Department of Emergency Medicine led the students through various simulation exercises that included assessing and treating volunteer patients with heat-induced injuries or cold-induced injuries; managing arterial bleeding, diabetes or low blood sugar; and treating mountain biking and climbing injuries, including fractures. Students also did a bit of injury sleuthing involving a nearby snake, allergies and seizures.

One of the more complicated simulation exercises involved a wounded mountain biker with arterial bleeding. The students split into teams and focused on a variety of needs, such as stopping the bleeding, sending out a team to call for an airlift, clearing an evacuation path, building an improvised stretcher using whatever materials were on hand and hoisting the patient to safety.

"Wilderness medicine means you have to be adaptive," said Corey Steinbrecher, a member of the Southern Arizona Rescue Association, which helped stage the simulated emergency medical situations. The association is a nonprofit, all-volunteer search and rescue organization that has served Southern Arizona and Pima County since 1958.

"Part of wilderness rescue is that the scene is hectic and isolated and you don’t have everything you need, so you have to improvise and provide the best care you can under any circumstances," said Steinbrecher, who has been accepted to the UA College of Medicine – Tucson and begins classes this summer.

An additional benefit of the class was the opportunity to earn Advanced Wilderness Life Support certification.

"I have a new perspective for being out in the wilderness. I learned so much from this class and am now much better prepared," said Kelley Stanko, a 2014 UA College of Medicine – Tucson graduate who opted to earn certification in Advanced Wilderness Life Support and who will begin her residency training in emergency medicine at the University of Toledo in Ohio. "Nothing can compare to being out in the wilderness. They did a fantastic job preparing us for what we need to know and what to continue to learn and prepare for in the future being out in the wild."

Williams added: "There are few fields I've found that incorporate the degree of creativity, practicality and fundamental understanding of physiology quite like wilderness medicine. The improvisation and skills we're trying to foster won't occur in a vacuum; they have to be practiced, and a degree of muscle memory and cognitive, experienced-based skills must be developed. I teach my students that only after they understand concepts like physiology, hospital systems, emergency medical system logistics, biology, outdoor survival, psychology and leadership will they be in a position to use that knowledge abstractly and adaptively."  

To certify and train more wilderness-certified physicians, the class will be offered again next spring.

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