The Times West Virginian

West Virginia

January 26, 2014

Interest in wilderness medicine picks up in West Virginia

LEWISBURG — They heard the crash on the water from inside the cabin. Dr. Michael Antolini, then a 4th-year medical student, was vacationing with his dad and a couple of friends on an Indian Reservation in the Canadian wilderness when a loud noise brought him outside to investigate.

“The boat impacted hard enough to break rock,” Antolini explains, describing the scene when a member of his group struck a rock at a high rate of speed with his boat.

Ejected from the backside into the front of the boat, pinned beneath the bow, the traveler was in grave danger as the vessel began to take on water. Antolini realized within a split-second that it was his turn to put what he’d learned into practice — not in a well-equipped emergency room, but from wreckage sinking in a bay.

“I did what I’d been trained to do.” After reaching the friend from inside another boat, Antolini evaluated him by following the ABCs — airway, breathing and circulation. “Up until an experience like that, you have a sort of cavalier attitude about what you’ve learned. When you’re faced with something that intense, you have to rise to the occasion.”

Noticing multiple fractures requiring immediate attention, he assessed for signs of neurological damage. Resources were few — a sling from a basic first aid kit, athletic tape, a piece of wood from the boat and a wakeboarding handle he could fashion into a splint. “It took us an hour to get to an ambulance — that was my invitation into wilderness medicine.”

Wilderness medicine is emergency care made even more critical by a remote, non-medical setting and scant resources. A Boy Scout in elementary school and a preparer by personality, Antolini views his interest in care under extreme conditions as only enhancing his abilities in an everyday setting — particularly practicing in southern West Virginia.

As the region becomes more of an outdoor hub of skiers, kayakers, campers and Scouts, having a solid base of knowledge in how to best stabilize and get a patient to better conditions can get creative — and scary. Following a newly instituted one-month wilderness medicine rotation that allowed him and others to work with medical teams at the National Boy Scout Jamboree this past July, he developed a deeper appreciation for medicine as it applies to harsh environments, learning how to treat hypothermia, how to backboard patients for transport, and how to perform a swift-water rescue, among other survival scenarios. He is now seeking Advanced Wilderness Life Support certification to help with his permanent appointment to the Summit Bechtel Reserve medical team.

“It’s a nice thing to know you’re doing as much as possible for your patient when minimal resources are available. (Wilderness medicine) really facilitates thinking on your feet. Even if I don’t use it regularly (as a family practice physician), it enhances your ability to think critically and think fast.”

The study of wilderness medicine is growing in popularity. In West Virginia, Marshall University Medical School offers a Wilderness Medicine track beneath the umbrella of its Family Practice program.

Across the country, physicians and other medical practitioners read medical journals and articles dedicated to “how would you respond?” case studies. There are a number of fellowships available to students interested in wilderness medicine along with continuing medical education conferences dedicated solely to the craft. Unrelated to America’s obsession with zombie apocalypses and doomsday preparations, the field has rational appeal across disciplines, striking many emergency-minded and primary-care practitioners as good medicine to know, especially in the backcountry.

West Virginia School of Osteopathic Medicine began a Wilderness Medicine Club two years ago that has grown to a roster of 180 members.

Club organizers hosted an event earlier this month to illustrate coordinated efforts across disciplines and under less than ideal circumstances.

Member and student James Mason, also a Navy Commander and helicopter pilot, planned the forum to retell the February 2010 Navy MH-60S crash near Snowshoe Mountain, 70 miles north of WVSOM, and how those involved rallied to rescue the passengers.

The 17 personnel aboard, sailors, soldiers and Marines, survived more than 18 hours in the elements . below-freezing temperatures, at a 3,000-foot elevation, with 4 to 5 feet of snow, drifts exceeding 8 feet in height and 30-plus knot winds. Guest speakers who were part of the successful rescue efforts described the dedication of medics, firefighters, National Guard, rescue crews and a rural West Virginia hospital health care team. Thanks to the victims’ training for survival and to the responsiveness of rescuers, all aboard survived.

Club president and second-year medical student Kurt Schmidt explains such educational sessions and practical hands-on learning are part of the continuing agenda of the club. “The focus is learning to provide medical care in an austere environment. It doesn’t have to be at the top of a mountain — it’s any low-resource environment. It could be by a highway or on a commercial flight or on a medical mission trip. There are innumerable scenarios where your resources could be limited.”

Wilderness medicine is more than knowing how to treat a snakebite — it is the ultimate in intelligent improvisation, where common sense and medical knowledge join forces to conquer the most challenging of settings and circumstances.

“A hospital is a controlled environment,” Schmidt explains. “Wilderness medicine is how you care for a patient in an uncontrolled environment — how you follow the intent of an algorithm or protocol when you don’t have a 12-lead EKG in your backpack.”

Thanks to technology, which is also rapidly changing the practice of wilderness medicine, you can have an EKG if you have cell service.

“Especially with iPhones and iPads — there’s so much more to it than a stick and a bandanna. There’s an app for that,” he states.

It’s also about being aware of your environment and who you’re with. “When my dad and I go hunting, I change what I’m going to carry. My supplies are going to be different than what I would carry if I were going out with someone different, like my wife,” explains Schmidt, a hunter and kayaker who adds that most club members are outdoor enthusiasts.

“It’s even about knowing what bacteria are prominent in Appalachia. It’s a little bit of everything.”

So for the adventurous, outdoorsy types with “what might happen if . ?” in the back of their minds, be careful, be prepared, but know there are like-minded medical professionals with a thirst for adventure. They’re growing in number and geared to imagine just what you might get yourself into — and how to get you out of it, safe and sound.

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