My Mountains: RMI Wilderness First Responder Class June 10th-19th

After taking the Remote Medical International Wilderness First Aid course back in February, I found myself craving more education and information. The next logical step was to look for a Wilderness First Responder course, and who better to train with than the group I started with. I was lucky enough to be able to get time off from work and have a place to stay (thanks to my sister and brother in law), so I ended up in Seattle for 10 days training with RMI. Since the WFA class, I'd been studying on my own time with the Medicine for Mountaineering book and a few other selections, as well as my RMI booklet and notes. Right from the first day, I knew that I'd made a wise choice. The instructors for the WFR course were just as knowledgeable and with as diverse backgrounds as the WFA course.

The ringleader of the instructors was Kate Earle ("Another bad analogy!") who comes from an EMS background as well as being a world traveler and spending several years in the Peace Corps. Working with her was Phoebe Robinson ("No you cannot improvise that!"), who is an ER nurse and EMT with an extensive outdoor background . Rounding out the instructors for the first few days was Carrie Parker ("Oh my gosh dude! You just fell out of your rocketship! Are you ok?") who spent time as a paramedic in Las Vegas as well as being a mountaineering guide and rock climber. There is no way I could really sum up the experience, knowledge and backgrounds of the instructors, other than to say they are all amazing. From the very beginning they started training us using the same format I was already familiar with from my WFA class but now the information was being expanded on and much more in depth.

Day one consisted of defining wilderness medicine and going over the steps of primary patient care. The steps of the patient assessment were the same as the WFA class, but now they were being expanded upon. An example was in assessing vital signs, in which we learned the first day how to take a blood pressure reading. I've had it done to me hundreds of times over the years, I've seen it done hundreds of times. That day was the first time I actually did it myself, and even though it could be considered simple and routine by people in the healthcare field, to me that was a milestone! Now the process was starting to become more clear to me, these steps that were taught to me were now being expanded and explained further so as WFR's, we would be able to gain a clearer picture as to what was happening with our "patients".

Day two we started with a bit of review, just to see if we were retaining information, then on to CPR. If you haven't taken a CPR/AED class in the last 6-8 months, I highly recommend it. The protocols have change drastically, and if I hadn't taken a basic class in February, it would have all been new information to me. After CPR we transitioned to thoracic injuries, and followed the standard format: lecture, demonstration, scenario. That's what I find the most beneficial in learning emergency medicine. You can read a book on wilderness medicine, or even urban emergency medical, and unless you work hands on, you aren't going to understand fully how it all works together. If I was in the roll of the healthcare provider, I would always ask my "patients" how I was doing, was I thorough, did I miss anything, and what could I improve the next time. I've had experience with traumatic accidents over the years, and although I knew "some" first aid, I really didn't know near enough. In the "if I only knew then what I know now" scheme of things, I would have acted much differently.

We spent the next few days working through trauma scenarios, spinal injuries, and working in teams. After day three, Carrie had to leave to instruct at the RMI W-EMT class, so it was Kate and Phoebe for most of day four. It also happened to be one of the long days in the course, we were working in to the evening to all spend time on different techniques and to have some direct evaluation from instructors. After returning from a dinner break, the instructors brought with them Dee Allen, who was one of the instructors from my WFA class. It was a nice surprise to see her again, and when it was my turn to be evaluated, I ended up working with her. Up to this point, we had only been covering injuries and not illnesses, and my training partner had brought that up to Dee with a few questions. To make things interesting, when it was my turn to evaluate, she threw me for a loop by giving me a medical case instead of trauma. I had to shift my whole approach and assessment because of it, but with knowing what Dee had taught me in my previous class, I went down the medical side of the assessment triangle until it was getting too late to finish completely. She gave me valuable feedback, and told me I was doing good and was very thorough.

By Tuesday, I think everyone in the class was feeling a little overwhelmed, but I could see us all having that moment where everything started to click. Even with differing personalities, we started developing teamwork and leadership skills, but at the same time knowing when to be subordinate and let the leader do their job and lead. That was also when I received another surprise when Kate Peters from the WFA class came in to instruct. She also has a varied outdoor and urban background with powerful teaching skills. All throughout the progression of the lecture and scenarios, I was getting great feedback and encouragement from Kate Earle and Phoebe. Their lecture skills make you want to take in everything they have to say. The legal pad I brought along on day one may have had 3/4 of its pages blank when I showed up. Tuesday night on my way home, I had to stop and pick up another because of the extensive note taking I was doing through the lectures. After class concluded for the day, I spent a few minutes working with another student before finally heading out, with the promise of a much needed day off on Wednesday. 80 hours of training in a 10 day period is a touch on the intense side.

A smarter person may have actually taken a break and rested, but not me. I decided to head on out to Mt. Si and going hiking before getting another 5-6 hours of sleep and heading back to class Thursday. Day six we started discussing mass casualty incidents and triage, but also began working more into medical issues, illnesses and allergies. The high point of the day was when we reach medication administration. The lesson was how to administer an intramuscular injection of epinephrine on a patient suffering from anaphylaxis, which in a remote setting may possibly fall under our protocols. First and foremost, we had to learn and recite the 5 R's of medications: Right patient, right medication, right date, right dose, right time. Then we took turns injecting each other in the arm with sterile saline. Everyone stayed conscious, and no one screwed up..... it was a good day! Only real downside of the whole class for me started about the end of Thursday when I started catching a cold. The stress, lack of sleep, physical exertion, and sleeping on an air mattress in a house with pets was taking its toll.

Friday was the day of our mass casualty drill. We spent the earlier part of the day recapping mass casualties, and triage, but then spent the better part of the day on environmental issues such as hypothermia, frostbite, heat illness, dehydration/hyponatremia, drowing/submersion, and began to touch a bit more on psychological issues that someone way encounter. We broke for dinner around 5p.m. after a quick planning session to appoint our incident commander and begin designating roles for rescuers. We started filing back in around 7p.m., and were allowed back into the classroom while the instructors took the "victims" out into the park to set the scenario into motion. At this point, none of us know what we're in for. It could have been a bus going off a mountain road, a group of ill Boy Scouts, we had no clue.

After 8p.m., we were given a radio call of a floatplane crash in the park. Again, an event I know all too well, having lost a few friends over the years and having other friends survive crashes, it hit close to home. After finding the "crash site", we began assessing patients and doing what we were trained to do. I ended up with one of the worse off of the patients, someone who in real life probably would not have survived. I just had to do the best I could, try and keep him calm and comfortable, and wait for the IC to make the call. Around this time, Kate Earle walks by and tells me quietly that in 5 minutes I'm going to go into hypoglycemic shock and to see if the other students would see it happen, how the would react, and if they could diagnose correctly. You are taught that if one of your fellow rescuers goes down, that they become a priority. I have to say, my classmates did a fantastic job. They assumed I'd fallen, so it took a few minutes to get to my "medical history" to find that I was "diabetic", then they grabbed glucose from someones pack for me. I was back in the scenario. By this time someone else had taken over caring for my patient, so the IC grabbed me and had me start helping him decide who was going to be evacuated first, and shortly thereafter we were informed that the exercise was over.

It was an insane experience, but I think we did a phenomenal job. Given that some in the class had no medical experience or their training was years if not decades ago, we gelled as a "Team" and organized a great response to what would be a horrific incident. There was much hugging and hi-5ing going on as we all left for the night, everyone physically and mentally drained, heading home for much needed sleep and the promise of an extra hour of sleep the next morning. Saturday started with a recap of the previous night, some discussion of rescuer stress and critical stress incident meetings, terminology, dental emergencies, as well as envenomation. In the afternoon it was a review by playing a game of WFR Jeopardy, which I don't think my team won, but maybe placed second....I still never heard the final score.

Sunday was test day. I'd spent the night before reviewing my notes and preparing the best I could. At the beginning of testing day, we were asked if any of the group would want to volunteer to do the practical first to speed up the day, and for some strange reason I raised my hand. The practical was the part I was most worried about! I had this feeling "of impending doom" (have to use that in humor) that I was going to screw something up bad. Other than sweating profusely from wearing my hoodie with a face mask to keep my "patient" from getting sneezed on, I was told I passed and did an excellent job of assessing my patient. There was a few mistakes made in the order of exam steps, but I didn't miss anything and was thorough. Then it was back in to take the written test, and here I had a moment of panic. As I started reading the questions, I had, for the lack of a better term, a brain fart, and had to kick my brain back into gear. It went well, though, only missing 7 questions for a 93% score. That's a number I can be proud of. I made it through 10 days of intensive, hands on training, knowing the fact that now I have a greater responsibility to help those who are injured or sick, but have better skills and decision making criteria than I had before. Of course it doesn't stop here. Now that I'm back home, I've already had a talk with my local EMS about volunteering once we can show the state that the 80 hour class I attended will satisfy the states requirements. I want to eventually work my way into an EMT program, followed by more training with RMI to learn even more skills.

I will say this to anyone who spends any amount of time in the backcountry, the WFA and WFR classes are more than worth it. People get complacent when they think "Oh, I'll just call 911 and the paramedics will show up", when in reality it could be hours or days before help can arrive in some cases. Having the skills to keep yourself and others alive is worth the class time regardless of who you take a course through. I will push for and advocate that you do train with Remote Medical International, not just because I have and wrote positive statements, but because these people live this and experience these situations regularly. They bring a hands on, "I'm telling you this because I've been there before" way of teaching. They are climbers, mountaineers, guides, rafters, and expedition members. They've seen the things they teach firsthand, and they love what they do.