In this podcast, we take a glimpse into the world of wilderness medicine and learn about how it ties in with Emergency Medicine and EMS. To do this, we look at the practice of medicine in a place where harsh environment and unique geography lead to the ultimate inaccessibility: the Grand Canyon. I spent a few weeks there working with EMS response and Search and Rescue teams. For this podcast, I interviewed two of the physicians working with the Grand Canyon about the practice of medicine there.
About the experts:
The first of our experts, Dr. Thomas Myers, has worked as a physician in the Grand Canyon for over 20 years. He has seen, responded to, treated, and tried to understand the ontogeny of thousands of injuries and all too many traumatic fatalities occurring in the Canyon. In addition, he has an immense amount of practical knowledge base about the practice of medicine in the field. Dr. Myers made the first ever detailed statistical analysis of Grand Canyon accidents in his book Death in the Grand Canyon.
Our second expert for this talk is Dr. Drew Harrell. Dr. Harrell serves as the current Medical Director for Grand Canyon National Park and in addition to this role, assists in the training of the EMS responders there. He is part of the University of New Mexico Emergency Medicine faculty and the EMS medical direction consortium.
Summary of the Key Points:
From Dr. Myers:
1) The Grand Canyon is an incredible range of climatic zones that can be traversed on foot in a matter of hours, and this subsequently creates unique challenges for both visitors and the search and rescue teams.
2) It is up to you how much you want to practice medicine in the backcountry as a physician. Some physicians choose to bring a full medical kit and provide full services while others have no interest in doing so.
3) While a good history and physical are important in all areas of medicine, they become of paramount importance in the backcountry when other labs and imaging are not always available.
4) Don’t underestimate the importance of the ability to talk people down from a crisis in the backcountry.
5) Be comfortable managing the basics of care, and know when to step back for first responders who are trained to do so.
6) Spend time on the front lines so you know what responders are up against, particularly if you are going to be advising them as a medical director in the future.
From Dr. Harrell:
1) The deep canyon and harsh environment of the Grand Canyon make it a perfect people trap, and while the Grand Canyon doesn’t necessarily have a high call volume, managing calls can be an involved process because often it involves technical rescues.
2) The facilities from the Grand Canyon are far away and many times require a helicopter evacuation to shorten transit time to the hospital or difficult logistics.
3) Working with EMS allows for a population level impact, which is sometimes hard to achieve working in the ER. Working with EMS allows you to develop or improve a system for many responders to use.
Olivia Linney, MS4 at Oregon Health and Sciences University