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May/June 2009 - Deep-Woods Doctoring |
Deep-woods Doctoring
What to do when the ER's too far
By Lisa Bramen
Medical students simulate a wilderness
evacuation at Camp Dudley, in Westport.
Photograph courtesy of Todd Miner
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Not since the Donner Party has an expedition faced as many calamities as this pack of eight hikers scaling Ampersand Mountain, near Saranac Lake, in a pitiless October downpour. In their first five days in the Adirondacks members of the group have so far endured venomous snakebite, hypothermia, bear attack, limb dislocation, near-drowning and anaphylactic shock. Oh, and lightning strike.
Now, during a lunch break in a cave near the summit, Flavio Gaudio, one of the group's leaders, has begun staggering and vomiting explosively.
Ignoring for a moment that they are at an elevation of only about 3,000 feet, Gaudio's fellow hikers—not coincidentally, all fourth-year medical students—quickly recognize the signs of acute mountain sickness. This emergency, like all the others that have befallen the students since they arrived in the backwoods, is a staged scenario to help them practice wilderness medicine skills in a realistic setting. Within 10 minutes, they have diagnosed Gaudio, "treated" him using what might be available on a high-altitude trek and begun to evacuate him to a lower altitude.
The Weill Cornell Medical College at NewYork-Presbyterian Hospital, in Manhattan, has been offering a wilderness medicine elective each spring and fall since 2007. The spring session brings students from medical schools around the country to the Arizona desert, while the fall course is held in more proximate wilds, the Adirondack Park. After a week in the classroom, the students in the New York session set out for Camp Dudley, a YMCA summer camp in Westport, for a few days of practical instruction before embarking on a three-day canoe camping trip on the Saranacs.
The course was designed by Jay Lemery, an emergency-room physician at NewYork-Presbyterian who grew up near the Blue Line, in Glens Falls. He and Gaudio, also an ER doc, teamed up with Todd Miner, the head of the outdoor education program at Weill Cornell's parent school, Cornell University, in Ithaca.
The students practice wilderness skills such as building fires and using a compass, as well as participate in the medical emergency scenarios. They take turns acting as victims, or patients; the rest of the class doesn't know when catastrophe will strike or what form it will take. This element of surprise, Miner says, makes the situations feel more realistic. And since they know they're being evaluated on their response, the aspiring doctors take these exercises seriously.
Occasionally the emergency is real. Once an attendee came down with altitude sickness on Mount Humphreys, the highest peak in Arizona. "It was a good real-world scenario," Miner says. The student recovered, of course.
Although few of the students plan to sign on with Mount Everest expeditions, Lemery says the skills taught have applications for all kinds of doctors.
For instance, some physicians take part in medical missions to developing nations, he says, where resources are limited. "You show up at a clinic in Africa, and you have a pair of scissors and a bottle of alcohol."
The class teaches these future doctors not to rely too heavily on technology; ultimately, medicine is about a relationship with the patient, Lemery says.
"On the last day, we got kind of deep—what is our role as physicians in terms of the environment?" he says. "To be a steward of the environment is to be a steward of human health."
Most of the students come from urban or suburban areas and have spent little time in the wilderness. A stint in the woods can have a profound effect.
"The peacefulness of being in the mountains for a week didn't strike me until we were driving back to New York City, and we stopped for lunch in Saratoga Springs," says Jessica Hu, who took the class last fall. "We were in a typical suburban strip mall surrounded by large signs, chain stores, cars in every direction, traffic lights and the hum of the I-87 in the background. I wanted to turn my car around and go right back to the Adirondacks."
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