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Backcountry lessons could mean life or death

Re-printed courtesy of the:
Casper Star-Tribune

CASPER --- The thin beam of light from Tom Fink's headlamp moved from side to side, bouncing slightly as he skied among the dark shapes of spruce and fir trees in the quiet, winter night.

Then someone yelled, "Mark is down. Mark is down," and the light flashed around as Fink turned toward the voice.

Minutes later, he joined two others skiers at the side of a friend lying in the snow.

The injured skier, Mark Stierwalt, appeared to have sustained an open fracture to his right leg and was losing blood. The temperature was below freezing and falling. Dawn and an ambulance or helicopter were more than 10 hours away.

The rescue scenario, created by instructors from the Wilderness Medicine Institute (WMI) in Pitkin, Colo., was designed to mirror a real-life backcountry medical emergency as closely as possible.

The four skiers were among 16 students who participated in the WMI's Wilderness First Responder course in Yellowstone National Park earlier this month.

Fink and the other two skiers worked together and quickly splinted the leg, determined that Stierwalt had no other "injuries," and went about building a makeshift shelter to keep him warm until daybreak.

Shortly after Stierwalt was attended to, another member of the group, Julie Zelenakas, collapsed in the snow. Fink and the remaining member of the party, Asa Hultman, puzzled over Zelenakas' hypothetical condition and discovered she was diabetic. She was treated and quickly recovered.

Almost three hours later, Lance Taysom, an instructor with WMI, approached the group and informed them that the scenario was over, and that they had done a great job.

The fracture that Stierwalt sustained and Zelenakas' diabetic condition were not real, but all other aspects of the training were, Taysom explained.

The difference between life and death for a patient many miles from the nearest ranger station or hospital depends on long-term medical aid, Taysom added.

The course, held Jan. 2 to Jan. 11 at the Lamar Buffalo Ranch, was offered by the Yellowstone Institute, a non-profit, educational organization based in Mammoth. It was taught by Taysom and Jeff Holmes, also of WMI, whose combined experience includes more than 15 years of Emergency Medical Technician (EMT) and nursing work.

The class is a prerequisite for instructors at National Outdoor Leadership School (NOLS) and is taken by park rangers, backcountry guides and members of search and rescue squads.

The course began with an explanation of the difference between urban and wilderness first-aid and initial patient assessment followed by instruction in Cardio Pulmonary Resuscitation (CPR) and treatment of shock.

In the six days that followed, the students split their time between the classroom and practical, outdoor instruction and covered topics including spinal injuries, fractures and splinting, frostbite, altitude illness, cardiac and respiratory emergencies, bites and stings and gender-specific medical concerns.

It's a lot of information to take in and retain in such a short amount of time, and for Scott Karley, a participant in the course who is attending Montana State University in Bozeman, that was the hard part.

"The most challenging part of the course is keeping it all straight in your head --- the signs and symptoms of certain ailments --- and understanding how to take a thorough patient history and exam is definitely key," he said.

Taysom and Holmes said the success of the course stems from the continuous repetition of the basics, taught the first two days of class and the constant practical applications of classroom information in the form of realistic scenarios outdoors.

"I've been teaching EMTs for (more than) 10 years," Taysom said. "The (students) that come out of these classes are better."

As realistic as the scenarios might be, Taysom and Holmes said the enthusiasm and energy of the students also go a long way toward making the course work.

For instance, on Friday after an eight-hour day of instruction that included neurological, cardiac and respiratory emergencies, the students were given the option of participating in a large-scale, night rescue scenario.

All 16 students agreed to take part.

In below-freezing temperatures and darkness that cut visibility to almost nothing, three student volunteers were split from the group and led away by Holmes across a nearby creek, through thigh-deep snow and out of sight.

Meanwhile, Taysom explained the scenario to those remaining:

There had been an avalanche, which had buried a number of skiers. The rest of the students were asked by Taysom to organize a search-and-rescue party, and he designated one party leader.

The students took over from there. The leader designated sub-leaders to handle equipment, personnel and a base position. A small group, with only the minimum of first-aid equipment, was dispatched immediately to locate victims and provide initial care.

The second group divided up shovels, blankets, backboards, sleds and snowshoes and long-term care equipment and slogged across the creek and toward the mock-avalanche site.

In one hour, three victims were located, assessed, treated and transported to a base camp where two, with more severe injuries, awaited dawn and a helicopter rescue.

At that point, Taysom and Holmes looked at their watches, noted how efficiently and completely the students handled the rescue, and complimented them on their success.

"Their greatest strength is their energy," Taysom said later. "They don't slow down, and they take whatever we throw at them."

Holmes said this class was slightly younger than what he normally sees. They ranged in age from 20 to 48 and included Hultman, who is an ocean kayaking guide from Ostersund, Sweden.

Most of the students had some backcountry experience in skiing, hiking or climbing, and some will use the skills they learned in class on the job.

"Primarily, the reason I took (the course) is that I work for the Forest Service on a fire crew out of Greybull, (Wyo.)," explained Fink, who is from Worland, Wyo. and attending MSU. "We do get some basic first aid (training), but it's nice to have more skills to better take care of your buddies out there."

But some, like Ardell Wells, who moved from Chicago to attend MSU, are just beginning to discover and explore the Rocky Mountain region's wilderness.

For her, the course provided the confidence she needed to take extended trips into the backcountry, and she encouraged anyone ---regardless of their experience level --- to take the course.

"I put myself in the situation where if I was out with my friends that maybe don't really know what they're doing," she said, "I feel I would be completely comfortable taking them or even dealing with a situation. ...

"You can never be prepared enough to go to the backcountry and hike. Even if it's a day hike, you never know what is going to happen. So you can never go wrong by taking something like this," she said.

As long and difficult as the class may have been, it wasn't all work and no play.

The students used their lunch hour one day to construct a ski jump on a nearby hill, and Taysom, Karley and Hultman managed to get in some air time.

Another day, the students built a large snow shelter, and the next night, Deaby Gregoire and Lindsay McClintock, both from Alaska, slept in it.

"I just did it for the heck of it," McClintock said. "It wasn't cold at all. I had a pretty good night's sleep, but I slept on a couple of rocks."

In addition to the final written exam, which all the students passed, the final practical exam was a mock ice-climbing accident 13 miles from a road.

The patient had fallen, striking his head and fracturing his wrist. He also had an underlying asthma condition.

Although two test teams had to go through the practical a second time because of incorrect prioritization of care or overlooking a potential complication, Taysom said, "all the teams (passed) and did an excellent job of assessing for life-threatening injuries and functioning as a team."


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