Medicine in the wild

On the first Saturday in September four med students spent the day hiking, canoeing, and mountain biking through 3,500-acre Wompatuck State Park near Boston, racing against seven other teams over a 15-mile course while responding to challenges in wilderness medicine.

Five major challenges in the Medical Wilderness Adventure Race (MedWAR) forced them to “treat” hypothermia, anaphylactic shock from a bee sting, and lacerations from a bear attack. “You run around all day,” said team member Will Hancock-Cerutti, a second-year student in the M.D./Ph.D. program. “It’s a 12-15 mile course with major and minor challenges that test your wilderness medicine skills and knowledge.”

The first MedWAR was organized in 2000 by emergency docs and students at the Medical College of Georgia. The goal was to teach the knowledge, skills, and techniques of wilderness medicine, while fostering teamwork among the competitors. MedWARs have since been held around the country.

The Boston MedWAR, the first in Massachusetts, included teams from throughout New England, and a mix of participants ranging from med students to undergrads to EMTs. They went by names including the Pawnee Goddesses, GI(ardia) JOEs, and The Expendables. The Yale team—the Worst Responders—included second-year M.D./Ph.D. students Dan Barson and Zach Kloos, and second-year Whitney Fu. With a winning time of about five and a half hours, the Worst Responders reached the finish line first, 16 minutes ahead of their nearest competitor. They completed four of the five major challenges—the simulated medical emergencies—and 35 of 50 minor challenges, which involved finding a hidden note taped to a tree or stake and answering a trivia question about wilderness medicine. For example, how do you triage several patients struck by lightning?

All four students, who have hiked, backpacked, and climbed in wilderness areas around the country, see a value in wilderness medicine that will serve them throughout their careers, regardless of the fields they might choose. Creativity, improvisation, and reliance on such basic skills as the physical exam and patient interview take on added importance when resources are limited.

“A lot of it is teaching creativity, being aware of your surroundings, and inventing things,” said Barson.

“It’s a low-tech approach to treating medical emergencies,” added Kloos, who’d like to teach med students how to improvise a stethoscope from a funnel and tubing from a hiker’s water hydration system.

Late in October, the four students were in a classroom in the Hope Building, where the Wilderness Medicine Interest group (now 15 strong) was holding its first meeting of the academic year. (The group had been inactive for some time when the four decided to give it a jump start.) Their guest speakers, and the group’s advisors, were Evie Marcolini, M.D., assistant professor of emergency medicine, and her husband, Paul Marcolini, a flight paramedic with extensive experience in wilderness medicine who runs a medical tent at 14,000 feet on Denali, in Alaska.

Wilderness medicine, said Paul Marcolini, is part of what he called “austere medicine,” defined by hostile environments, limited resources, and delays in getting patients to medical facilities. The umbrella of austere medicine includes combat medicine, disaster medicine, and medicine in developing countries. The medical providers’ task is not only to stabilize patients until they can be transported to medical facilities, but to ensure the safety of the rescue teams as well.

After the presentation, the students broke up into pairs to role-play medical emergencies, one playing the caregiver, the other the patient. The Marcolinis wandered from pair to pair guiding students through the critical decision-making process required to assess and treat the patient.

The students recently led a six-mile hike though Ragged Mountain in central Connecticut, getting students outside and teaching basic wilderness survival skills. Longer term, they’d like to add a wilderness medical component to the annual Medical Outdoor Orientation Trip, a voluntary activity for incoming first-year students. Wilderness medicine, said Kloos, is “a really fun way” for medical students to get training not usually available in their first and second years.

“There’s a lot of improvisation,” added Hancock-Cerutti. “You have to use what is around you, but you have this framework to keep you on the right track.”

For more information on the Wilderness Medicine Interest Group, visit http://yalewmig.wix.com/wilderness-med.