Mt. Sinai wilderness medicine course at DWG by Alec Feuerbach

There were four victims at the top of Rattlesnake Mountain in Delaware Water Gap. One lay pulseless: dragged into the shade by the uninjured. One cried out in pain—gripping his leg—while another wandered the scene hysterical. The last was off to the left. He gripped a large branch that stuck straight up from his abdomen. I was on the radio with 911 as I stopped by each victim. For the first, CPR had been started by one team member sent ahead when we received news of the lightning strike and the potential casualties. Two of us were speaking with the man gripping his leg and, after a quick assessment, started gathering supplies to make a traction splint with a hiking pole. For the third victim, I asked a team member to take her to the shade and figure out what was going on: she was hovering around the victim with the abdominal trauma making it difficult for the team working on placing a tourniquet with a couple of pieces of cloth that had been torn from an old t-shirt and a pen.

“Disclaimer: for anyone listening this is just a training exercise,” I heard over the radio.

I was surprised by the adrenaline I felt. Despite knowing this was a scenario set up for the last day of the wilderness medicine elective, I was immersed in the supposed mass casualty for all but a few moments. Once when I chuckled watching as the “injured victim” impaled by the branch tired of holding the wood perpendicular and had his “partner” hold it for him; another as I arrived at the last patient and reflected on how much we had all learned in just one week on the trail.

The first scenario we had completed was a few days before. Two of the course leaders had “fallen from a tree” as they tried to set up a tarp to cover camp. We meandered over, wondering what to do and hoping (at least I was) that someone else would take the lead. It took us a while to figure out what we should do as we each shouted out random questions about their current symptoms. Now, as I walked around, I marveled at how equipped the rest of the team had become—each member quickly assessing what should be done, gathering the appropriate supplies, and (without causing too much unnecessary discomfort to our fellow classmates) treating the “patients”.

When the scenario ended, we gathered in the shade to break down what we did well and what could have been done better. Each patient talked about the quality of their care and each team member elaborated on their thought process and decisions for treatment. Some areas of improvement were noted (a tourniquet should have been placed earlier, a patient’s cervical spine had not been assessed before they were moved), but most had felt the team had accurately assessed their injuries and adequately treated (or pretended to treat) their ailments. One “patient” even pointed out how he had appreciated that the two team members treating him had taken the time to bring his partner aside before pronouncing him dead (a reminder that even in—or especially in—a trauma setting, a second spent on compassion can go a long a way).

This scenario was one of several throughout the weeklong trip: each a unique experience impossible to mimic in the restricted walls of a classroom or hospital, each with important lessons that will transcend the wilderness setting to the hospital (lessons such as prioritizing treatment in a multiple casualty event, treating someone quickly with lack of supplies, or personnel, you might like, and, as already mentioned, treating patients as people even in the most harrowing and stressful of settings), and each an opportunity to make mistakes when the consequences were low.

 After the disclaimer came through the radio, the “911” operator came back on: “the helicopter is not going to be able to make it, another storm is coming in.” I asked how long we had. It was not enough time to get everyone to shelter, but I pressed the team to make litters. Minutes later, the storm “came back” and those of us gathering felled branches for transportation were injured or killed as well. Despite all we had learned, I had forgotten the first lesson from the wilderness course: ensure the scene is safe. Of course, far better to make the mistakes here, sitting in a shaded spot on the side of the Appalachian trail, than in real time, when a mistake can mean a lost life.