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The newspaper of The Johns Hopkins University April 4, 2005 | Vol. 34 No. 28
Docs in the Boondocks

Bill Kane leads students through a first-responder exercise on day three of Wilderness Medicine, a two-week course being held in the Catoctin Mountains.

Grizzly bears, cliffside falls and snakebites, all part of new SoM course

By Greg Rienzi
The Gazette

Johns Hopkins medical students don't grow on trees, but in the woods of Catoctin Mountain National Park last week, it looked like they were falling from them.

The students, in reality, were acting the roles of victims who had just plummeted from a scenic overlook. Fellow students, playing the part of first responders, knelt over the "motionless bodies" of their classmates and were instructed to perform such unwelcome measures as pulling a hair from the fictitious accident victim's wrist to gauge his or her response level.

"Do they respond to that?" asked Bill Kane, an EMT and education director with Solo Wilderness Medicine. "No?" he laughed, as the victims cried out in actual pain. "OK, then let's give them the sternum noogie."

Sternum noogies, which look like they sound, were followed by respiration checks, searches for pools of blood around the victim, pulse-taking and "chunk checks," in which students felt down the length of the body looking for anything out of the ordinary.

The afternoon's learning exercise was just one part of the School of Medicine's new Wilderness Medicine course, a two-week elective designed for those interested in preparing for real-life emergency situations out in the field and away from medical facilities.

Through classroom lectures and in-the-field clinical scenarios, the students are taught various wilderness survival skills, search and rescue procedures, exotic travel planning and a host of techniques to manage common illnesses and injuries in an austere or remote environment with limited resources, whether it's a desert or an airplane.

Andrew Krakowski, coordinator of the course and an assistant resident in the SoM's Department of Pediatrics, said that the elective provides an opportunity for students to get out of the classroom and into the field, where they can apply what they have learned.

"It's a chance for students to see that there are clinical applications, even with the somewhat limited amount of knowledge that they have as second- and third-year students," said Krakowski, who participated in a similar course when he was a third-year medical student at the University of Pennsylvania. "There are things they can do to help people who have perhaps hurt themselves in a rural setting, where the nearest hospital might be three hours away. Sometimes they don't know how much they know until they see how they can avail themselves in the wilderness."

Course coordinator Andrew Krakowski, second from right, with teaching assistants Zubin Vasavada, Andrew Shannon and Emmy Betz.

For the two-week period, Krakowski and 22 students have based themselves in the small camp at Catoctin Mountain Park, which is located approximately 90 minutes northwest of Baltimore. The students, who likened the experience to camping, live in dormitory-style lodging, where they cook and clean for themselves and immerse themselves in the wilderness experience, taking part in late-night fire circle chats or watching wilderness-related movies such as Deliverance, Alive and Touching the Void.

The lectures, which are given by 12 medical and public health faculty members and a half-dozen guest experts, take place in the camp's conference center. The practical sessions of the course are held in the extensive recreational and hiking areas of Catoctin Mountain Park and the Catoctin Wildlife Preserve and Zoo.

Students begin the course with an introduction to the content and a lecture on how to prepare for a trip in the wilderness, including bringing along proper gear such as a flashlight, compass, map, raincoat and iodine tables to purify water.

Next, students begin to learn how to handle themselves in specific situations, such as coming across someone who has fallen down a cliffside, been bitten by a poisonous snake or spider, been shot in a hunting accident or even been struck by lightning.

"We even talk about what to do when a bear actually starts running after you," he said. "Do you play dead, or turn around and scare the thing?"

Krakowski said it depends on the bear.

"Well, grizzly bears are carnivores, so they don't care if you are half dead or dead; they will devour you," he said. "Black bears you might try to run from, but they are fast and they are agile — they can climb trees. One of the things that is becoming more understood is that bears sometimes respond to your confidence. If you can turn around and scare it, the bear might walk away and count its losses."

But, he adds wryly, you're out of luck if it doesn't.

Students are also taught about environmental illnesses such as hypothermia, severe sunburns, frostbite and high-altitude disorders. In the realm of infectious diseases, the students learn about tick-borne illnesses, malaria and types of parasites and protozoa. On the legal side of the things, the course also offers lectures on laws and ethics in the wilderness, including such topics as standards of care, duty to act, patients' rights and good Samaritan laws.

"Sometimes people don't want to be helped, and you have to deal with that," Krakowski said.

On Wednesday, Bill Kane from Solo taught the students such techniques as the single-person log roll, beaming (picking a person up as he lies) and decrumpling, which involves stabilizing a person's body that has fallen and come to rest in an awkward and unsafe position.

Emmy Betz, a fourth-year student and teacher assistant for the course, said that one reason she enrolled is because she always wondered what she would do if she were far away from health care and needed to help someone.

The class, she said, has taught her about how to improvise medical equipment, the multiple uses of common drugs and the importance of such items as a waterproof jacket.

"You never really think about how you would assist someone if you were all by yourself," she said. "It will be interesting now to go back to class with a new take on medicine, like what you can do with a ballpoint pen."

What can you do with a ballpoint pen? As an extreme measure, you can insert it into the patient's adam's apple like a straw to help him breathe.

Adena Greenbaum, a second-year student, said that she has always been interested in wilderness medicine and was excited when she heard that Johns Hopkins was starting a course like this.

"It's great," she said. "It's about how you can think creatively and outside the box when you don't have all the fancy medical equipment around, just whatever you might have on your person or in your first aid case."


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