In Full Swing

What's the best way to really understand hypothermia after spending five weeks in Costa Rica?

a) endless Powerpoints
b) watch Frozen again
c) take off most of your clothes and stand in freezing mud while talking about what your body is going through?

Guess which one we chose for our Semester students?

Back in Montana!

Students are all back in the US, gearing up for their time in Montana while cleaning off some of the sand from Rafiki.

We haven't been able to post for a bit, so here are photos from the last few weeks, starting with the clinic.

FREE HEALTH CLINIC
During three days, students, our medic/ EMT instructors and three MDs ran three separate health clinics.  The first was in an indigenous community, the second in near the classroom itself, and the third in the areas surrounding both while visiting families at home.  These clinics are our chance to give back to the communities that are so gracious to us every year.  They also allow our students a unique opportunity to assess real people (as opposed to their fellow students in scenarios) and to work with health care professionals as they assess and treat their patients.  These were long days.  At night, we gathered back at the classroom to discuss patients are review their care.  Adding to the educational experience, students will now head to MT and complete clinical time in a US emergency room and on an ambulance.

Students and staff receive and triage patients

Some of the equipment we take to the clinics 

Night-time review of patients and the next day's plan

SWIFTWATER RESCUE
After a month in Mastatal that culminated in three intense days of health clinics, everyone headed to the Rafiki Lodge on the Sevegre River.  On the Sevegre, students worked for three days and earned their Swiftwater Rescue Technician certifications, which is the certification typically required by raft guide services.

ESTERILLOS

Before the clinic, we also headed to the beach to practice rescues in a new environment.

Monday, February 16th

It's getting both more difficult and at the same time easier to challenge the Semester students.  They know more, which allows them to respond more appropriately to emergencies, but this new knowledge allows the instructors to give the students more diverse and complicated scenarios.  For example, today students responded in small groups to a person with a severe arterial bleed, another with a rupturing ectopic pregnancy, a third with severe dehydration and a fourth with full thickness burns to the hands.   In addition, as a group they extricated a patient who was entrapped under a vehicle (see photo for the class post-scenarios).  

On the didactic end, they covered management of envenomations as well as management of anaphylaxis.

Wednesday, February 11

Scenario complexity and duration are ramping up significantly.  Every day, students are out in the field, using their skills, following the mantra, "you will respond like you train".  The instructors monitoring these scenarios have years of professional experience taking care of patients in these exact situations, ensuring accuracy and applicability.

Monday and Tuesday

The program has hit full medical stride, with lectures and practical scenarios about head, neck and abdominal trauma.  Students are learning to immobilize spines with traditional backboards as well as with materials found in a typical backcountry setting such as tarps, backpacks and poles.  They will take these skills and put them to the test in extended scenarios that require integration with other core course topics, such as shelter construction.

Additional Skills

Rescuers with high-level medical certifications who cannot read a map, set up a shelter or start a fire are often more of a liability than an asset to a wilderness team.  Aerie developed the Semester in Wilderness Medicine in part to address the gap between medical certifications and outdoor skills by providing the context and skills for everything that happens before and after a backcountry injury or illness.

Knots are a good example.  Throughout the Semester, students learn and use knots common to rescue, shelter and splint construction, including bowlines, various figure of eights, taut-lines, trucker's and clove hitches.  Then they get out into the field, using these knots repeatedly in various scenarios, getting to know how they work, where they may fail, and when they are best used.

By the end of the program in mid-April, students will know these knots well enough to trust someone else's lives with their appropriate use.

Saturday, February 7

Here are a few pictures from this week's activities.  Everyone remains healthy.  Today is a light day: lecture/ review of communication/ documentation from 10 until 12, and then the rest of the day free to catch up on reading, explore the local area, and relax. Students are also completing their second written exam, this one a take-home.

 Tomorrow we have a review session and preparation for the next week, which is going to be very busy.

Two more great days.  Everyone remains healthy and motivated.

Students were down at the Rio Negro (about a half an hour walk through a beautiful forest) most of the day yesterday, learning to move patients out of difficult situations (a slippery-bottomed river) and care for them in less than ideal environments (a hot, sandy/ rocky shoreline).  Wilderness medicine differs from hospital-based medicine primarily because it assumes that resources will be limited, environmental conditions will be challenging, and distance from definitive care will be significant.  

Today students reviewed human anatomy and physiology and were taught to administer supplemental oxygen, how to suction patients' airways, and how to construct improvised litters with materials on-hand.  Tomorrow we cover CPR and head injuries, and then we are off for a well-deserved weekend.

Tonight, Aerie instructor Roman Sanchez arrives from Colorado.  Roman has been teaching for Aerie for years, is a ski patroller and works on an ambulance in Ward.  One of the goals of the Semester is exposing students to instructors who work professionally in the rescue, medical and outdoor leadership fields.  During their stay in Costa Rica, they will interact with seven different Aerie staff, including three MDs and four EMTs/ paramedics who work as ski patrollers, river guides, and ambulance/ flight medics.

Day Three

Power was out most of Tuesday, which precluded our daily posting until now, at midnight.

For the students, a lack of power in the course is almost inconsequential.  They are out, running scenarios with people bleeding, in pain. or otherwise in need of their ever-increasing skill-set.

To that end, Tuesday was spent learning about the core of any good wilderness medicine course:  patient assessment.

Tomorrow we take those skills down to a local river for extended, more complicated scenarios.  In addition, students will begin integrating other skills learned, such as fire-building and knot-tying, into the mix of caring for patients in remote settings.

Assuming the power remains on, we'll do our best to post some more photos at the end of the day, hopefully with higher resolution!

Day Two

Everyone is healthy and working hard!

Today students were introduced to the US EMS system, to the legalities of providing medical care, and to methods used to assess scenes.  We also began learning various knots used in rescue and other outdoor activities.  Class started at 6:45 am and ended at 5:30 pm, so by the end of the day they were definitely tired.  At the time of our writing this (10:45 pm), they are all in the classroom catching up on reading and preparing for Wednesday's exam.  

Tomorrow we begin with patient assessment, which forms the foundation of the EMT curriculum, and from there we will begin giving them the first of hundreds of scenarios.  

The connection is slow, so we can't post photos tonight but will continue working on it and will have some up shortly.

First Day!

Everyone is here safely.  Students received their tour of the facility, hiked down to the local waterfall, and are now settling in to dinner.  As it is Superbowl Sunday, we will have dinner at the local store, or "soda", where they have the game playing.

Class starts in earnest tomorrow at 6:45 am, with an introduction to emergency care, learning how to take vital signs, and a review of risk management.  If the internet connection holds, we will post pictures then as well.

One Week to Go!

Some students have already arrived in Costa Rica, but most are making final preparations to start on this adventure.  Instructors Ryan Berube and Fernando Giaccaglia are finishing up a WFR at the Ranch now.  They'll be joined by David McEvoy in a few days, and then by Roman Sanchez in another week.  We are really looking forward to getting started!