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Medical Students Take on Wilderness Medicine in Yosemite

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students in wilderness training
During the final scenario in the woods of Yosemite National Park, students gather around Nelson Diamond, MD, to assess, stabilize, and transport the patient with what limited supplies they have.
Photo: Greg Richardson, MD

By Jeffrey Chen, MS4

“I can’t breathe!” a man screams, struggling to keep his head above the running waters of the Merced River. “Somebody, I’m drowning!”

“Please! Somebody help us!” shouts a woman, from the far bank of the river.

Two bystander medical students dive into the water with life jackets, securing the man in distress and dragging him to shore. A group of medical students gathers around, each prepared to help save this man’s life.

Except Nelson Diamond, MD, the man in the river, is not in any real danger. We’re in Yosemite, and Diamond is wading in the frigid snow melt of the river, but he is also an experienced swimmer and third-year resident in the UCSF Fresno Emergency Medicine program. The woman is Michelle Storkan, MD, an attending physician in the residency, recent graduate of the wilderness medicine fellowship, and director of this course.

Out of the Classroom and Into the Wild

classroom with students and a resident
The fourth-year elective features many hands-on skills sessions on lifesaving procedures. Nelson Diamond, MD (right), a third year emergency medicine resident at UCSF Fresno, teaches medical students to perform cricothyrotomies on pig tracheas.
Photo: Jeffrey Chen

During the past two weeks, the two led classes for the UCSF Wilderness Medicine fourth-year elective with Greg Richardson, MD, a current wilderness medicine fellow. The first week featured lectures and small group discussions on topics ranging from hypothermia to snake bites to cave rescue. We practiced our skills in daily patient scenarios that featured diseases or injuries we were learning about in the classroom, culminating in a session on how to perform various lifesaving procedures and ways to stabilize and transport patients in the backcountry.

students learn wilderness training skills
Students work to “stabilize” Greg Richardson, MD, a wilderness medicine fellow at UCSF Fresno who is playing the victim of a bear attack. From left to right: Brandon Seminatore (UCSF), Fernando Rios (UC Davis), Anita Hargrave (UCSF), Claire Gibson (UCSF), Julia Janssen (UCSF), Samantha Rudolph (UCSF)
Photo: Jeffrey Chen

The following week, we traveled to Wawona Campground in Yosemite National Park. Towering pine trees and large granite cliffs provided an immersive environment for us to reinforce and build upon our wilderness medicine skills. One day featured a series of water rescue and resuscitation scenarios in the Merced River. During that day, a group of third-year medical students participating in the UCSF Longitudinal Integrated Fresno Education (LIFE) Program and the UC Davis Rural-PRIME Program joined us to get a preview of the elective.

While at Yosemite, we had the unique opportunity to meet with park rangers and paramedics and tour the Yosemite Medical Clinic. From these experts, we learned the bare minimum equipment necessary to save lives in the wilderness and the complex decisions that these providers face when responding to emergency calls. Importantly, we also learned and practiced the incident command system that many federal agencies employ in response to real-life disaster situations.

Managing a Mass Casualty in the Forest

Now we are facing the final scenario for the elective, and it’s a mass casualty incident. On the shore are five other “patients” who are acting out different injuries after an imaginary bus crash in the winding forest roads. Claire Gibson, MS4, has volunteered as incident commander, coordinating the triage, treatment, extraction, and transport of these patients.

Daniela Maristany, MS4, and I attend to Rawnie Ruegner, MD, also an attending emergency physician in the residency program. On a rocky slope near the bank of the river, she is clutching her left thigh and moaning in pain. Airway, Breathing, Circulation, we tell ourselves. After checking for scene safety, we resort to the ABC’s of trauma evaluation that our instructors had repeatedly emphasized.

As we realize that her left foot has lost its pulse, we diagnose her with a displaced femur fracture that is cutting off the blood supply to that leg. Without immediate stabilization, she could lose her leg or worse, she could bleed nearly all of her blood into her thigh. Together, we fashion a traction splint out of a hiking pole, rope, and camping mug to pull her bones back into place.

We then check on her 3-year-old son, Wally. Ruegner tells us that he recently vomited and is now complaining of belly pain. We find that his pulse is soaring, suggesting that his heart is trying to keep up with heavy internal bleeding. Without a CT scanner or any other luxuries of the hospital, we know he needs definitive medical and surgical care —fast.

Daniela runs to update Claire about the conditions of our patients. Meanwhile, another team of medical students is working on stabilizing Diamond, the man who was rescued from the river. He has sustained many serious injuries and requires helicopter transport to get to the nearest hospital. A team of students is working together to stabilize him. Yet more teams are working on the other patients, as our incident commander gracefully leads the scene.

Learning about how sick Wally is, Claire calls the EMS dispatcher (played by Storkan) to request more space on the helicopter. Everyone works together to build a makeshift stretcher out of rope and a sleeping bag.

“It was incredible to watch my classmates roll up their sleeves and put into action everything we learned during the course,” remarks Claire. “The experience of being the incident commander reminded me how important it is to keep communication organized and thorough but concise in emergent settings.”

For any small group of people, carrying Diamond and Ruegner down the rocky path to the parking lot “helipad” on this rope stretcher would be an arduous task. But as a team of 14 students that has learned to skillfully work with one another, we easily whisk our patients to safety.

“To see a group of individuals bring their unique skills and personalities and combine those into an effective group dynamic is really rewarding,” says Storkan. “We were hoping to foster team building as well as individual leadership skills.”

From the classrooms in Fresno to the wilderness of Yosemite, we truly bonded as a group of fourth-year medical students learning to lead together and work together for patient care. Though we are each ultimately headed in different directions and specialties, our unique wilderness experience has united us.

Yosemite group shot

After visiting the Yosemite Medical Clinic, students and leaders of the wilderness medicine course come together in front of Tunnel View.
Photo: Jeffrey Chen