[sidebar]Emergency medicine residents and students participate in simulated wilderness rescue exercises at the Boy Scout National Jamboree. They gained experience with spinal immobilization and the management of orthopedic injuries and heat-related illness.[/sidebar]
In July 2013, a unique educational offering for medical residents and students was created in the New River Gorge in West Virginia. This four-week elective rotation in wilderness medicine was held in conjunction with the 2013 National Jamboree for the Boy Scouts of America (BSA) and was a first of its kind. There had never before been an organized rotation for residents and students held during a National Jamboree. In addition, this is the first wilderness medicine rotation ever offered by an osteopathic institution in the country. The concept for the rotation was inspired by my visit to the 2010 National BSA Jamboree at Fort A.P. Hill in Virginia. My son was a scout attending the Jamboree that year, and my husband and I were visitors at the event. In 2013, the Boy Scouts of America moved the Jamboree to a site near the New River Gorge in our home state of West Virginia. The 10,600-acre site was donated to the BSA by the Bechtel Corporation and is named the Summit Bechtel Reserve.
My husband and I have been involved with the leadership of our local scout troop for the past 13 years. Both of our sons have achieved the rank of Eagle Scout. We are both medical professionals. My husband is a firefighter/paramedic, and I am an emergency physician and serve as core faculty for the emergency medicine residency program at Ohio Valley Medical Center in Wheeling, W.V.
We had both committed to serving as volunteer medical staff for the 10 day event. In the midst of my excitement about this opportunity, I began to think that it would also be a great experience for EM residents to be challenged with providing medical care at this mass gathering in a wilderness environment.
Coming up with the concept for this medical rotation was the easy part. Turning this dream into reality was a completely different story. Arranging housing for the participants, finding a meeting space for lectures, and locating local resources and instructors for workshops and lectures was very challenging. I was able to reach out to the other Jamboree medical staff members, medical professionals from all medical specialties and from all over the country, and received a very good response. Many were eager to present wilderness medicine topics and were willing to arrive a few days early for their presentations or deliver them as morning lectures on site during the Jamboree. The schedule was arranged to allow most of the wilderness lecture topics and workshops to be completed during the first two weeks of the month.
The second two weeks would be spent on the Summit providing medical care to the Jamboree attendees and staff, followed by a half-day final scenario exercise utilizing many of the skills learned on the rotation. Raleigh General Hospital in Beckley, W.V. generously donated a conference room for our use for the didactic sessions and even provided free meals for the participants and lecturers during our time there.
The West Virginia School of Osteopathic Medicine arranged housing for the students and residents for the month without any charge to them. Other physicians and PAs in the area with a special interest in wilderness medicine gladly assisted with completing the lecture schedule.
AirEvac Lifeteam in Summersville, W.V. was instrumental in setting up many of the workshops in swift water rescue, basic rope rescue, spinal immobilization, landing zone set up, and the final scenario exercise. Working closely with Dr. Steven Eshenaur, Summit Medical Director, we were able to work out transportation issues for the participants on and off of the Summit, meals on the Summit, and their clinical assignments at the high adventure events there.
During the first two weeks of the rotation, we covered a wide variety of wilderness medicine topics. This included material such as animal bites, insect envenomation, altitude sickness, burns, diving emergencies, hypothermia, cold water immersion, heat emergencies, and many more.
Our schedule covered a fair amount of the core curriculum required for a Wilderness Medicine Fellowship by the Wilderness Medicine Society, and we were granted 24 credit hours toward fellowship by the WMS. We also had workshops in basic rope rescue, orienteering, spinal immobilization, splinting improvisation, landing zone set up, wilderness survival, and basic swift water rescue.
These experiences were new for many of the residents and students, but everyone enjoyed learning these new skills and putting them into practice on the Summit. Once the Jamboree commenced, the nine participants were divided into groups of three and had rotating assignments to areas of the camp that were considered to have the highest risk of injury, such as the mountain bike trails, BMX bike trails, and skateboard park. The Wilderness Medicine participants each spent one day working in the mobile hospital on site and two days with EMS response units. Thankfully, we had a very well-planned and safe Jamboree and had very few serious injuries.
Many of the activities on the Summit that were feared to be high risk, such as the zip-lines and the rock climbing and rappelling, had no injuries at all during the Jamboree. The students and residents gained a great deal of experience with spinal immobilization and management of orthopedic injuries and heat-related illness.
Once the Jamboree ended, the Wilderness Medicine participants did their final scenario exercise. This event tied together many of the skills that they had acquired. The scenario involved two female patients from an ATV accident who were over a 35-foot cliff and lying in a creek bed. The objective was for the participants to set up ropes; rappel down to the victims; assess; stabilize, and immobilize them; lash them into a Stokes basket; and use a rope hauling system to raise them to the top of the cliff. They were then to evacuate them to an open field, set up a landing zone, and bring in a medical helicopter to fly them from the scene. This was a challenging experience for the students and residents, as they had no prior rescue or EMS background, but they executed their rescue plan very well and did a good job with the management of the patients.
The participants had a great and unique experience in preparing for and providing medical care at this mass gathering of nearly 40,000 scouts and Jamboree staff in an environment with limited medical resources. I believe it is likely that some of the participants from this year and in the rotations to come will choose to return to serve at medical staff at the Jamboree, now that they have had this exposure. For me, it served as probably the largest project and greatest success of my career in EM. I am looking forward to organizing and offering this elective rotation on a yearly basis.
I am deeply indebted to my lecture and workshop faculty and to my partners at EMP of Ohio County for their support.