March 2010 promises to be the best UNM Wilderness class ever, with excursions to New Mexico deserts, snow covered mountains, and canyons. Check back to this site for frequent updates.
Joe Alcock MD
Tuesday, September 29, 2009
Friday, April 10, 2009
Highlights
Sunday, March 29, 2009
Hyper-Bueno Rotation
Hey team, as reality hit today about moving across the country and starting a real job soon, I just wanted to say that I had a blast surviving the wild with all of you. The "epicity" was off the hook and a great way to end four long years of medical school. I'm excited to see where the future takes each of you in your careers, life, etc. (guess that means I better join facebook and have my wife teach me how to use it). As I reflect on the month it's apparent that we are a fortunate group of folks:
1. Learned some awesome medicine in nature's amphitheater
2. Made 20 great new friends (doubled Pat and Dave's census...ha ha)
3. Got credit towards becoming a DOCTOR for hiking, biking, backpacking, climbing, snowshoeing, navigating, jumping in rivers, etc.
4. Had a lot of great laughs and made some amazing memories
5. Didn't die falling off a snowy cliff during the final exam OR meeting a backcountry rattler OR picking up a fire salamander (which I was really tempted to do, leave-no-trace!)
Good times....I'm gonna go catch some dinner with a squirrel pole. I'll try and attach my slideshow to the blog. If anyone finds my pant legs or wants to hang out in Portland, ME gimme a holler (505) 270-5314. Peace out, Mike
1. Learned some awesome medicine in nature's amphitheater
2. Made 20 great new friends (doubled Pat and Dave's census...ha ha)
3. Got credit towards becoming a DOCTOR for hiking, biking, backpacking, climbing, snowshoeing, navigating, jumping in rivers, etc.
4. Had a lot of great laughs and made some amazing memories
5. Didn't die falling off a snowy cliff during the final exam OR meeting a backcountry rattler OR picking up a fire salamander (which I was really tempted to do, leave-no-trace!)
Good times....I'm gonna go catch some dinner with a squirrel pole. I'll try and attach my slideshow to the blog. If anyone finds my pant legs or wants to hang out in Portland, ME gimme a holler (505) 270-5314. Peace out, Mike
Black & White Cookie Recipe
Hi all,
It was a great month and I hope to see many of you in the future. Since the black and whit cookies were my final project, I decided to share the recipe, just in case anyone wanted to make a few for themselves.
Lars
Black & White Cookies
Cookies
3C Flour
Scant ¾ Tsp salt
¼ tsp baking soda
1 1/3 C Sugar
2/3 C butter (slightly softened)
½ C white shortening
2 large eggs
2 ½ tsp vanilla
2 tsp white corn syrup
Scant ¾ tsp lemon extract
1/3 C sour cream
Fondant
¼ C light corn syrup
5 C powdered sugar
¾ tsp vanilla
2 oz unsweetened chocolate
Combine flour and baking soda in a separate bowl
Beat sugar, butter, shortening in another bowl
Add eggs, vanilla, corn syrup – mix well
Beat in ½ flour mixture
Add sour cream – mix until just blended
Add remainder of flour mixture
Let stand 5 minutes
Using a 1/4 C of dough at a time, make dough into balls and then pat them down with your hands on a cookies sheet
Bake at 350 degrees for 11-14 minutes (done when edge is light brown)
Let cool completely.
Fondant
Bring ½ C water and corn syrup to boil
Remove from heat and add powdered sugar, stir until blended and mixture is thick but can be spread
Chop chocolate and keep in separate bowl
To chocolate add 2/3 C fondant until chocolate melts, then another ½ C fondant
Ice cookies with fondant
It was a great month and I hope to see many of you in the future. Since the black and whit cookies were my final project, I decided to share the recipe, just in case anyone wanted to make a few for themselves.
Lars
Black & White Cookies
Cookies
3C Flour
Scant ¾ Tsp salt
¼ tsp baking soda
1 1/3 C Sugar
2/3 C butter (slightly softened)
½ C white shortening
2 large eggs
2 ½ tsp vanilla
2 tsp white corn syrup
Scant ¾ tsp lemon extract
1/3 C sour cream
Fondant
¼ C light corn syrup
5 C powdered sugar
¾ tsp vanilla
2 oz unsweetened chocolate
Combine flour and baking soda in a separate bowl
Beat sugar, butter, shortening in another bowl
Add eggs, vanilla, corn syrup – mix well
Beat in ½ flour mixture
Add sour cream – mix until just blended
Add remainder of flour mixture
Let stand 5 minutes
Using a 1/4 C of dough at a time, make dough into balls and then pat them down with your hands on a cookies sheet
Bake at 350 degrees for 11-14 minutes (done when edge is light brown)
Let cool completely.
Fondant
Bring ½ C water and corn syrup to boil
Remove from heat and add powdered sugar, stir until blended and mixture is thick but can be spread
Chop chocolate and keep in separate bowl
To chocolate add 2/3 C fondant until chocolate melts, then another ½ C fondant
Ice cookies with fondant
Reflection
Hey all,
I hope everyone had a day or two to rest up before your journey continues. A few days of reflection on the course has given me the opportunity to focus on what exactly I feel the main learning experiences of this course are. First off let me say that this class was one of, if not the best, class that I have seen thus far.
After 4 years of medical school you all know medicine relatively well. With a little refining of the patient assessment and gaining some emergency medicine and rescue experience you all were set to go. The essential element was not medicine…
The traits and skills that everyone brought to the course and built upon, or gained throughout the course, was impressive and hopefully life changing. The temporary transformation that this course brings on will carry over into other aspects of your life. The situations that everyone encountered, scenarios or genuine life, gave you all the opportunity to truly test your body and mind. To find out if you’ve really, “got it.” Whether you were happy with the results or not the journey is not over. You all will continue with your medical journey and be incredibly successful. I encourage you to seek out your next voyage in the hills and find that strength, clarity and confidence can be found there.
Thank you for making the month incredible and stay in touch.
-Jason
A good article for those interested…
http://www.gymjones.com/knowledge.php?id=5
Friday, March 27, 2009
So I was looking through some of the pictures from grand gulch tonight when I saw the one of the salamander that the long hike group found. I could have sworn that I remembered the black and yellow spots from somewhere.
This is a fire salamander. They are fairly common and can live up to 40 years. They can excrete a very toxic poison when threatened. From glands located behind the head and along the flanks the poison can cause Hyperventilation, HTN, and muscle spasms. Having said this, the poison rarely if ever (that i could find) effects humans.
Its been a fun month with you dudes.
Final Party and Creative Project Presentations...
Hey guys,
Map to my house posted below. Please feel free to bring friends/family or some random guy off the street... Kicks off at 6:30pm. There is limited parking around my house but plenty at the park across the street.
From Tramway and Paseo Del Note head North. Turn Right, east, onto Cedar Hill. Take the second left onto Cedar Hill Ct. 727-12. See you all there, call 505-249-0170 if you get lost.
Jason
View Larger Map
Map to my house posted below. Please feel free to bring friends/family or some random guy off the street... Kicks off at 6:30pm. There is limited parking around my house but plenty at the park across the street.
From Tramway and Paseo Del Note head North. Turn Right, east, onto Cedar Hill. Take the second left onto Cedar Hill Ct. 727-12. See you all there, call 505-249-0170 if you get lost.
Jason
View Larger Map
Thursday, March 26, 2009
Into the Gulch of Death, the 20 hours, and the 3 Incomparables
It is terribly unfair to characterize the Grand Gulch of Utah’s Cedar Mesa as the Gulch of Death. It was, after all, a source of life to uncounted generations of Anasazi people in presumably wetter times. It was also a treasure of other-worldliness for us who backpacked there during the wilderness medicine course, not only in its geological presentation but also in the art and architecture left for us by those who once called it home.
I call it the Gulch of Death because death, after all, is the final helplessness, and it was in the Grand Gulch that I came to a point at which I truly felt helpless. The hike began as hikes usually do, with buoyant walking, bearing a quite manageable load. It rapidly became obvious to me, however, that I was not up to the task of keeping the same pace as the others in my group. I was a slow hiker years ago even when younger and fitter, and now am fatter and indisputably middle-aged. I was told that a brisk pace was necessary to reach a particular distance goal that day.
Now it does no good to kick a lame horse, and it did no good to urge me to speed on. I certainly tried to increase speed, but this was at a cost of safety, as I then tended to stumble and once almost twisted my ankle. I had chosen what had been presented to me as the “short hike group” of our three divisions because I knew myself. I reasonably believed I could complete a long hike based upon my experience, but at my accustomed pace. I did not sit out the Grand Gulch trip because, earlier in our course, I had little difficulty in completing the orienteering hike during the survival weekend and the snowshoe hike up the mountain during the Taos weekend, where I had been advised that “it’s the journey, not the destination” and to hike at my own pace.
I pressed on as fast as I could. We made our first camp by nightfall. We arose Sunday morning and set off. All of us enjoyed the Green Mask painted in amazingly still-vibrant hue by a long-departed Anasazi artist high on a cliff face, as well as other paintings and ruins along the way.
After stopping for lunch I realized how tired I felt. When we resumed the hike, I found that I could barely place one foot in front of the other, plodding at a speed that could hardly be called walking. The group divided up my pack and its contents. Even without a burden to carry, I found it hard to walk. I was short of breath and could feel my pulse racing. I sometimes felt mild, diffuse pain in my left chest and left upper back as I walked. I did not feel overheated, but my companions wet my shirt down out of concern for me. We walked to a cool spot where I could lie on a tarp on a rock.
Like most people, I prefer to be self-reliant and contributory, and I did not like it that others had to carry my pack. No one complained, and everyone was gracious, but I still did not like it. Nevertheless, reality was obvious to me. I simply could not do what I wanted to do. I could not will my way through it. I could not will strength to my body nor will my racing pulse to slow like some legendary Yogi from the Indian subcontinent. I realized that, had I been alone, I would possibly not have made it out.
After a time, I walked to where others had made our camp and pitched a tent for me. I rested supine in the tent with a headache and nausea. Shortly after consuming some electrolyte solution kindly prepared for me, I projectile vomited. I subsequently received intramuscular Phenergan and oral Benadryl. I slept a few hours, which was less then expected, and the nausea was gone for good.
The next day, I slowly walked and climbed out of the Grand Gulch with a near-empty pack. Upon our return to the ranger station, I received a bolus of intravenous saline. We returned to Albuquerque.
Shortly after I returned to where I was staying, the incomparable Dr. Joe Alcock called me to discuss his concern that I had experienced a cardiac event. He picked me up and accompanied me to the UNM Emergency Department. I was there 20 hours. After I made it past the waiting room, EKGs, and initial labs, the incomparable Dr. Diane Rimple had arrived and was my attending through the night. The cardiologists saw me in the morning, I had a stress test and echocardiograms, and by Tuesday evening the incomparable Dr. Daryl Macias had come on as my attending and discharged me.
The upshot was that the cardiologists detected no obvious or severe heart disease. I attribute my misadventure to over-exertion and dehydration, although my own perception would have been that I was hydrating adequately.
I still feel tired but not at all like I did in the gulch.
A few things to think about:
1. Foreknowledge is hard to come by. When we hike with friends or family of known ability, both they and we know to some degree what we’re all getting into. In a situation like our Wilderness Medicine class, we don’t possess that knowledge and must acknowledge ahead of time that we will all have to adjust. In reality, because beating a lame horse more won’t make her win the Kentucky Derby, the group will usually have to adjust to the less-able members.
2. It might be helpful if, prior to departure, everyone in a group communicates about the plan. I never saw a map or participated in any detailed discussion about what we were going to do. I usually had no idea where I was. I was just tagging along.
3. There is a strong argument for a group staying together. At one point, I heard a whistle and called out in that direction. It turns out that four of us, all at the end of the caravan, were walking on three divergent paths. Also, I am perhaps the worst person on this side of the galaxy to choose the correct path at any given fork. I am probably the Tracker Tom Brown in the Bizarro World, if any of you have read old Superman comic books and get my drift.
4. It’s a great comfort when your colleagues show that they are really decent human beings when you are relatively helpless. It shows the true character that we all hope to find in a physician or EMS rescuer. The actions of the members of our little “short hike” group bode well for our collective future.
5. Pack lighter and drink more (water, that is, not Patron Tequila).
That’s it. I’m glad I’m alive to write this, and I am glad to have met you all. God grant you a happy future.
I call it the Gulch of Death because death, after all, is the final helplessness, and it was in the Grand Gulch that I came to a point at which I truly felt helpless. The hike began as hikes usually do, with buoyant walking, bearing a quite manageable load. It rapidly became obvious to me, however, that I was not up to the task of keeping the same pace as the others in my group. I was a slow hiker years ago even when younger and fitter, and now am fatter and indisputably middle-aged. I was told that a brisk pace was necessary to reach a particular distance goal that day.
Now it does no good to kick a lame horse, and it did no good to urge me to speed on. I certainly tried to increase speed, but this was at a cost of safety, as I then tended to stumble and once almost twisted my ankle. I had chosen what had been presented to me as the “short hike group” of our three divisions because I knew myself. I reasonably believed I could complete a long hike based upon my experience, but at my accustomed pace. I did not sit out the Grand Gulch trip because, earlier in our course, I had little difficulty in completing the orienteering hike during the survival weekend and the snowshoe hike up the mountain during the Taos weekend, where I had been advised that “it’s the journey, not the destination” and to hike at my own pace.
I pressed on as fast as I could. We made our first camp by nightfall. We arose Sunday morning and set off. All of us enjoyed the Green Mask painted in amazingly still-vibrant hue by a long-departed Anasazi artist high on a cliff face, as well as other paintings and ruins along the way.
After stopping for lunch I realized how tired I felt. When we resumed the hike, I found that I could barely place one foot in front of the other, plodding at a speed that could hardly be called walking. The group divided up my pack and its contents. Even without a burden to carry, I found it hard to walk. I was short of breath and could feel my pulse racing. I sometimes felt mild, diffuse pain in my left chest and left upper back as I walked. I did not feel overheated, but my companions wet my shirt down out of concern for me. We walked to a cool spot where I could lie on a tarp on a rock.
Like most people, I prefer to be self-reliant and contributory, and I did not like it that others had to carry my pack. No one complained, and everyone was gracious, but I still did not like it. Nevertheless, reality was obvious to me. I simply could not do what I wanted to do. I could not will my way through it. I could not will strength to my body nor will my racing pulse to slow like some legendary Yogi from the Indian subcontinent. I realized that, had I been alone, I would possibly not have made it out.
After a time, I walked to where others had made our camp and pitched a tent for me. I rested supine in the tent with a headache and nausea. Shortly after consuming some electrolyte solution kindly prepared for me, I projectile vomited. I subsequently received intramuscular Phenergan and oral Benadryl. I slept a few hours, which was less then expected, and the nausea was gone for good.
The next day, I slowly walked and climbed out of the Grand Gulch with a near-empty pack. Upon our return to the ranger station, I received a bolus of intravenous saline. We returned to Albuquerque.
Shortly after I returned to where I was staying, the incomparable Dr. Joe Alcock called me to discuss his concern that I had experienced a cardiac event. He picked me up and accompanied me to the UNM Emergency Department. I was there 20 hours. After I made it past the waiting room, EKGs, and initial labs, the incomparable Dr. Diane Rimple had arrived and was my attending through the night. The cardiologists saw me in the morning, I had a stress test and echocardiograms, and by Tuesday evening the incomparable Dr. Daryl Macias had come on as my attending and discharged me.
The upshot was that the cardiologists detected no obvious or severe heart disease. I attribute my misadventure to over-exertion and dehydration, although my own perception would have been that I was hydrating adequately.
I still feel tired but not at all like I did in the gulch.
A few things to think about:
1. Foreknowledge is hard to come by. When we hike with friends or family of known ability, both they and we know to some degree what we’re all getting into. In a situation like our Wilderness Medicine class, we don’t possess that knowledge and must acknowledge ahead of time that we will all have to adjust. In reality, because beating a lame horse more won’t make her win the Kentucky Derby, the group will usually have to adjust to the less-able members.
2. It might be helpful if, prior to departure, everyone in a group communicates about the plan. I never saw a map or participated in any detailed discussion about what we were going to do. I usually had no idea where I was. I was just tagging along.
3. There is a strong argument for a group staying together. At one point, I heard a whistle and called out in that direction. It turns out that four of us, all at the end of the caravan, were walking on three divergent paths. Also, I am perhaps the worst person on this side of the galaxy to choose the correct path at any given fork. I am probably the Tracker Tom Brown in the Bizarro World, if any of you have read old Superman comic books and get my drift.
4. It’s a great comfort when your colleagues show that they are really decent human beings when you are relatively helpless. It shows the true character that we all hope to find in a physician or EMS rescuer. The actions of the members of our little “short hike” group bode well for our collective future.
5. Pack lighter and drink more (water, that is, not Patron Tequila).
That’s it. I’m glad I’m alive to write this, and I am glad to have met you all. God grant you a happy future.
Party Time!
Hey Everybody,
I have taken on the duty of trying to coordinate the food/drinks for tomorrow night's final shin-dig, to take place at Jason's house. We all saw the grouchy-ness that ensues when deprived of dinner, so it would be great if everyone could pitch in in some way.
As it stands:
I am bringing the fixings for frito pies- my final project, couldn't let the out-of-towners leave without trying a NM staple.
Chang- is cooking up something bound to be delicious for her final project as well.
Chris- has agreed to have his momma fix us some enchiladas.
Anna- homemade ice cream
We are still going to need more main dishes, side dishes, desserts and drinks.
Think it over...We can talk about it tomorrow morning.
Jayme
I have taken on the duty of trying to coordinate the food/drinks for tomorrow night's final shin-dig, to take place at Jason's house. We all saw the grouchy-ness that ensues when deprived of dinner, so it would be great if everyone could pitch in in some way.
As it stands:
I am bringing the fixings for frito pies- my final project, couldn't let the out-of-towners leave without trying a NM staple.
Chang- is cooking up something bound to be delicious for her final project as well.
Chris- has agreed to have his momma fix us some enchiladas.
Anna- homemade ice cream
We are still going to need more main dishes, side dishes, desserts and drinks.
Think it over...We can talk about it tomorrow morning.
Jayme
Eco-Rescue Challenge Final Exam!
Get ready for the Primal Quest of Rescue! This coming Friday the 27th we will be meeting at the Sandia Peak Tramway at 8:30am to begin your final exam. Please do not be late, as the tram will leave at 9am with or without you and that would just be embarrassing….
Once on top of the Sandia Crest we will break into our 4 rescue strike teams, listed below, and your first scenario will be given. Medical equipment will be provided for you. Please being your RESCUE ORIENTED day pack and be prepared for a long day on the mountain. If for some reason the tram shuts down, most likely due to wind, we will be hiking 8 miles down the La Luz trail. Check the weather…. http://www.wunderground.com/cgi-bin/findweather/getForecast?query=87122&wuSelect=WEATHER It should be interesting. Below is a list of skills that will be assessed throughout the day. The Strike Team that is most proficient in the skill sets based off of the instructors recommendations will be awarded the "Golden Carabiner" at the party.
O and also, a camera guy from local fox show called New Mexico Wild will be accompanying us on the final exam…. As if you needed more pressure J
Movement over terrain
Land Navigation
Patient Packaging
Improvised Patient Transport
Improvised Splinting
ACLS
Hypothermia Treatment
Survival Skills
Teamwork
Communication
Group Leadership Dynamics
Stress Tolerance
If you own a harness and a helmet please bring it with you. For the rest of the class harnesses will be provided for you. Strike Teams listed below:
Strike Team 1 Strike Team 2
TL: Katie TL: Anna
Justin Hoops
Mike Pat
Chang Fernando
Jason
Strike Team 3 Strike Team 4
TL: Owen TL: Lars
Chris Tim
Jayme Desiree
Dave Evan
Rob
If any questions or concerns arise feel free to call. Map and directions below. See you all on Friday!
-Jason
505-249-0170
From Tramway Blvd. and Paseo Del Norte head North. You will come to a stop sign, Tramway Rd., head West. You will come to a gate house where at 8:30am there may or may not be a guard. If there is he will want one dollar for parking... tell him you are with Albuquerque Mountain Rescue going to a training and he will let you proceed. Note: Google Map takes you a different way... Click on view larger map for the directions
View Larger Map
Wednesday, March 25, 2009
Elena Gallegos Wilderness Journal Club
Tomorrow will be a fun filled time, which includes a journal club review by those below. While we have lived the dream this month with rich outdoor experiences, we are mindful that, while wilderness medicine is not always evidence based, we are trying to unearth nuggets of evidence in this field, so that at least, if faced with real life situations, we can be a bit more authoritative (or pretend to be)!
The List:
Dan Hoopes: Cycling Sportsmedicine article from JBJS
Evan Tobin and Mike Roehlk: Adventure Race injuries (under "Ortho and Sports" in Trauma-Sports Med folder
Rob Shoots and Tim Madden: Backcountry Ultrasound in Resuscitation folder
Lars Peterson, Justin Kan and Chris Loucks: Airline Emergencies and Fever after Travel (under "Casual Travelers" in Infectious Disease folder)
Chang Rim and Fernando Monreal: Worsening Breath Hold Dive Hypoxia (under "For Diving Pros" in Marine folder)
We will discuss many topics that will be pertinent to the final exam. The fun begins at 1pm, under the covered BBQ area of Elena Gallegos: go to the gate and turn left, following the road till you find a large covered open roof area. If lost, call Jason. BTW: you are free to barbeque!
Aquarium
We meet at the Albuquerque Biopark at 4:30pm.
Directions are here: Scroll down this link for mapquest map
We are going to do interactive marine envenomations, followed by brief lecture, followed by real live dive scenarios!
Dinner will be at the Japanese Kitchen at 8:30pm, restaurant is located at:
6521 Americas Pkwy, Albuquerque, NM 87110-5358
Click here for detailed directions
We will be at the sushi bar, NOT the main restaurant. They are actually in two separate adjacent buildings.
See you tonight!
Joe
Directions are here: Scroll down this link for mapquest map
We are going to do interactive marine envenomations, followed by brief lecture, followed by real live dive scenarios!
Dinner will be at the Japanese Kitchen at 8:30pm, restaurant is located at:
6521 Americas Pkwy, Albuquerque, NM 87110-5358
Click here for detailed directions
We will be at the sushi bar, NOT the main restaurant. They are actually in two separate adjacent buildings.
See you tonight!
Joe
Case #1
Sandia Downhill Bomber
19 year old extreme downhill mountain biker collides with a tree, has a brief loss of consciousness. First Aid team attends to him; He recovers consciousness, his helmet is removed and his spine is immobilized. He complains of lip numbness and facial pain. 1st responder notices a loose tooth in his mouth and tries to retrieve it. The biker’s entire palate moves freely as he taps the tooth. His palate seems to be detached from the rest of his face.
Diagnosis: Le Fort Injury.
An Austrian report suggests that facial injuries, including Le Fort Fractures are common among extreme mountain bikers.
Le Fort 1: Maxilla is separated from pterygoid plate and nasal septum.
Le Fort 2 Maxilla and nose moves but not eyes
Le Fort 3 Craniofacial disjunction. Facial Skeleton separates from skull.
During transport biker becomes unconscious again, develops a widely dilated and fixed R pupil.
Diagnosis: Epidural hematoma pushes temporal lobe over tentorium, trapping CN III, and putting pressure on the midbrain. Uncal herniation. Compression of CN III is responsible for pupil.
Discussion points:
Overall mountain bikers have 40% decreased incidence of head and face injury compared to roadies. Helmet use is more frequent. Absence of cars. Downhill bikers often wear full face (motorcycle style) helmets. Despite these, head and face injuries still can occur. More on this later…
Case 2
Roadie Helmetless
Road biker doing her afternoon commute home is struck by a station wagon that failed to stop at a stop sign. She is found 25 yards from her bike, unconscious and unhelmeted. There is clear fluid oozing from the left ear and nose. A large bruise is noted behind the ears and under the eyes. A large laceration over the forehead reveals an underlying step-off of the bone. She is pulseless.
Dx: Depressed skull fracture Basilar skull fracture. Traumatic arrest. Unlikely to recover.
Road vs. Mountain bike Injury Pattern.
MTB have 40% - 60% decreased incidence of head/face/dental injuries than roadies. Decreased traffic and increased helmet use.
Rivera (1997) Seattle study. Surveyed bicycle injuries prospectively between 1992 and 1994. Study involved 7 ED’s and 3390 injured bicyclists.
Only 4% of these were mountain bikers.
73% of MTBers were between 20 and 39 years of age.
86% were male
Helmet use: 80.3% MTB vs. 49.5% on road. (Perception of risk and Difficulty changing habits) Injury cases – 29% head injured pts helmeted vs 56% of non-head injury pts helmeted.
Head and face injuries: MTB decreased risk compared to those incurred by roadies.
Severe Injuries (dislocations,concussion,fractures): 4% of MTB injured patients vs 7% of road injured. Hospitalized: MTB 6% vs 9% of road injuries.
Safer with helmets, safer off road!
In other surveys: Head injuries complicate 22-47% of injured bicyclists. Usu MVC. Head injuries account for 60% of deaths.
JAMA study: Helmets provide 4-fold protective effect against head injury. 85% effective against head injury and 88% effective against brain injury.
Helmet type: doesn’t matter. Hard shell, thin shell (most), no shell are all equally effective. All must meet ANSI, Snell requirements. Fit is probably the most important consideration when buying a helmet.
Helmets reduce risk of nose and upper face injury by 65%.
CA helmet legislation has resulted in 18% reduction in head injury for<18 yrs.
Case 3
“Slickrock Handlebar”
40 year old 1st time mountain biker rents a bike in Moab Utah. 10 minutes into the ride at slickrock, he falls off a rock ledge and lands directly on the bar-end attached to his handlebars. He develops guarding of his abdominal muscles and complains of upper abdominal pain. He does not want to be moved.
Diagnosis: Liver injury vs. Splenic injury vs. bowel injury. In this case: sub-capsular liver hematoma. These have been associated with the use of bar-ends. Many can be managed non-operatively. Of intra-abdominal injuries secondary to handlebars: spleen > liver. Spleen injuries are generally managed non-operatively, as are sub-capsular liver injuries.
Handlebar injuries.
Israeli Study of children. Handlebar mark in only 15% of children admitted for handlebar injuries. 30% had ruptures of spleen or liver. 5 of these 25 were operated on. Small bowel injuries also can occur this way when bowel is trapped between the spine and the handle bar.
Case 4
Extremity in Extremis
26 yo F bicyclist falls over the handlebars on a rocky descent. Notices brief numbness and paresthesias of R hand and cannot move R arm. L hand is becoming progressively more swollen and painful. Her companions notice a squared off R shoulder and numbness over R deltoid.
Diagnosis: R shoulder anterior dislocation. Axillary nerve injury. Consider also ulnar nerve injury. Brachial plexus injury.
Hand Exam shows snuffbox tenderness.
Most common injury involves going over handlebars. Upper extremity injury is most frequent. Abrasions, followed by contusions and sprains, then fractures and dislocations.
Attempt splinting of hand if possible and Consider reduction of shoulder. Scapular manipulation/ traction.
For hand consider splinting with a Sam Splint. If shoulder is reduced use safety pins to splint the shoulder.
Get patient to a place where XR can be performed.
Case 5
Endurance Race Wipeout
22 yo M triathlete participates in 24 hour mountain bike ride. The weather is hot, he is rehydrating with evian water and the occasional powerbar. 10 hours into the race he is getting drowsy, and beginning to have transient visual hallucinations. Is it just because it is 11:00 pm? Begins to feel weak. Then falls onto the sandstone and has a brief seizure.
Diagnosis: Hyponatremia. Fluid replacement without sufficient salt to match sweat losses. This entity has killed marathoners and triathletes every year with the advent of extreme endurance sports. Prevention with salty foods is important. Fritos might be the most important thing in your pack. Hyponatremia is one of the most common diseases to afflict visitors to the Grand Canyon
Case 6
Cactus Encounter
First time mountain biker from Oklahoma visits New Mexico and barrels down a steep foothills path, he is unhelmeted but luckily doesn’t strike his head as he tumbles over his bike into a staghorn cactus and prickly pear. He also has a deep abrasion from a sharp rock he acquainted himself with a nanosecond before kissing the cactus.
You can usually grab the end of a big thorn with needle-nose pliers. Splinter forceps (tiny sharp tweezers) are ideal.
If there are multiple small thorns in a fairly small area, try removing them with glue. Spread a generous coating of patch glue over the entire area. Wait until it dries, then peel it off. It will usually pull the thorns (and your body hairs) out as it comes away from the skin. Of course duct tape will probably work for small thorns too. If thorns remain in the skin they may provoke an inflammatory response or cause infection and may end up causing a granuloma.
Case 7
Heatstroke
Scenario:
You're sweating like a pig in the Durango sunshine, trying to figure out the Colorado trail. Dang that CamelBak is heavy on the uphills! So you dump out some water. Getting kind of dizzy. Don't stop, because the significant other will be waiting. Odd -- you're getting goosebumps despite the heat, but at least you're not sweating so much any more. Which fork do you take here? Your eyes blur and its impossible to figure out this old map. Boy, this heat is making you dizzy. Better sit down for a minute. Whoops, kind of fell down there.
Description:
Heatstroke occurs when your heat-regulation system fails. Often sweating stops and there are signs of excess adrenaline such as goosebumps. The body temperature climbs and begins to interfere with thinking. Symptoms of heat exhaustion usually precede the confusion that marks the beginning of heatstroke. Finally, consciousness is lost and brain damage (and death) can occur rapidly.
When has a biker passed the line between heat exhaustion and heat stroke? To oversimplify: if the brain isn't working perfectly (confusion, dizziness even when lying down, etc) you've crossed the line from dangerous to deadly.
Immediate care:
Immediate cooling can be lifesaving. (Often, the victim can no longer sweat, so the temperature just keeps rising. You can't just "wait it out.") Get the person out of the sun immediately. Remove extra clothing. Spread arms and legs to increase evaporative surface. Have them lie down, while keeping as much skin open to the air as possible. Wet your biking shirt, then drag it loosely over exposed skin, moving from one area to another. Keep the cloth loose and very wet, letting it pass through the air to cool between wipes. If there's a cool but shallow stream nearby, consider moving the victim so their back and legs are in the water. If you're close to a camper where ice is available, put ice in the groin, armpit, and under the back. If the victim remains confused or becomes unconscious, send someone out for help.
Case 8. “Numb Perineum”.
You are on an all day ride on the boundary trail in Taos, at mile 20, your partner begin to complain of numbness of her ring and little finger.
Dx: ulner nerve compression (ulnar tunnel syndrome or cyclists palsy). Ulnar neuropathy is much more common than median nerve palsy in cyclists.
Tx: change gloves, change handle bar position. Of note road and mtn bikers get these symptoms in roughly the same proportions. Although road bikes offer more hand positions, rides are often longer.
At mile 22, you (male) note a numbness in a sensitive area. Bilateral pudendal nerve compression. {Impotence is no more common among competitive cyclists than among other athletes}.
Change saddle, Change into more padded shorts.
Sandia Downhill Bomber
19 year old extreme downhill mountain biker collides with a tree, has a brief loss of consciousness. First Aid team attends to him; He recovers consciousness, his helmet is removed and his spine is immobilized. He complains of lip numbness and facial pain. 1st responder notices a loose tooth in his mouth and tries to retrieve it. The biker’s entire palate moves freely as he taps the tooth. His palate seems to be detached from the rest of his face.
Diagnosis: Le Fort Injury.
An Austrian report suggests that facial injuries, including Le Fort Fractures are common among extreme mountain bikers.
Le Fort 1: Maxilla is separated from pterygoid plate and nasal septum.
Le Fort 2 Maxilla and nose moves but not eyes
Le Fort 3 Craniofacial disjunction. Facial Skeleton separates from skull.
During transport biker becomes unconscious again, develops a widely dilated and fixed R pupil.
Diagnosis: Epidural hematoma pushes temporal lobe over tentorium, trapping CN III, and putting pressure on the midbrain. Uncal herniation. Compression of CN III is responsible for pupil.
Discussion points:
Overall mountain bikers have 40% decreased incidence of head and face injury compared to roadies. Helmet use is more frequent. Absence of cars. Downhill bikers often wear full face (motorcycle style) helmets. Despite these, head and face injuries still can occur. More on this later…
Case 2
Roadie Helmetless
Road biker doing her afternoon commute home is struck by a station wagon that failed to stop at a stop sign. She is found 25 yards from her bike, unconscious and unhelmeted. There is clear fluid oozing from the left ear and nose. A large bruise is noted behind the ears and under the eyes. A large laceration over the forehead reveals an underlying step-off of the bone. She is pulseless.
Dx: Depressed skull fracture Basilar skull fracture. Traumatic arrest. Unlikely to recover.
Road vs. Mountain bike Injury Pattern.
MTB have 40% - 60% decreased incidence of head/face/dental injuries than roadies. Decreased traffic and increased helmet use.
Rivera (1997) Seattle study. Surveyed bicycle injuries prospectively between 1992 and 1994. Study involved 7 ED’s and 3390 injured bicyclists.
Only 4% of these were mountain bikers.
73% of MTBers were between 20 and 39 years of age.
86% were male
Helmet use: 80.3% MTB vs. 49.5% on road. (Perception of risk and Difficulty changing habits) Injury cases – 29% head injured pts helmeted vs 56% of non-head injury pts helmeted.
Head and face injuries: MTB decreased risk compared to those incurred by roadies.
Severe Injuries (dislocations,concussion,fractures): 4% of MTB injured patients vs 7% of road injured. Hospitalized: MTB 6% vs 9% of road injuries.
Safer with helmets, safer off road!
In other surveys: Head injuries complicate 22-47% of injured bicyclists. Usu MVC. Head injuries account for 60% of deaths.
JAMA study: Helmets provide 4-fold protective effect against head injury. 85% effective against head injury and 88% effective against brain injury.
Helmet type: doesn’t matter. Hard shell, thin shell (most), no shell are all equally effective. All must meet ANSI, Snell requirements. Fit is probably the most important consideration when buying a helmet.
Helmets reduce risk of nose and upper face injury by 65%.
CA helmet legislation has resulted in 18% reduction in head injury for<18 yrs.
Case 3
“Slickrock Handlebar”
40 year old 1st time mountain biker rents a bike in Moab Utah. 10 minutes into the ride at slickrock, he falls off a rock ledge and lands directly on the bar-end attached to his handlebars. He develops guarding of his abdominal muscles and complains of upper abdominal pain. He does not want to be moved.
Diagnosis: Liver injury vs. Splenic injury vs. bowel injury. In this case: sub-capsular liver hematoma. These have been associated with the use of bar-ends. Many can be managed non-operatively. Of intra-abdominal injuries secondary to handlebars: spleen > liver. Spleen injuries are generally managed non-operatively, as are sub-capsular liver injuries.
Handlebar injuries.
Israeli Study of children. Handlebar mark in only 15% of children admitted for handlebar injuries. 30% had ruptures of spleen or liver. 5 of these 25 were operated on. Small bowel injuries also can occur this way when bowel is trapped between the spine and the handle bar.
Case 4
Extremity in Extremis
26 yo F bicyclist falls over the handlebars on a rocky descent. Notices brief numbness and paresthesias of R hand and cannot move R arm. L hand is becoming progressively more swollen and painful. Her companions notice a squared off R shoulder and numbness over R deltoid.
Diagnosis: R shoulder anterior dislocation. Axillary nerve injury. Consider also ulnar nerve injury. Brachial plexus injury.
Hand Exam shows snuffbox tenderness.
Most common injury involves going over handlebars. Upper extremity injury is most frequent. Abrasions, followed by contusions and sprains, then fractures and dislocations.
Attempt splinting of hand if possible and Consider reduction of shoulder. Scapular manipulation/ traction.
For hand consider splinting with a Sam Splint. If shoulder is reduced use safety pins to splint the shoulder.
Get patient to a place where XR can be performed.
Case 5
Endurance Race Wipeout
22 yo M triathlete participates in 24 hour mountain bike ride. The weather is hot, he is rehydrating with evian water and the occasional powerbar. 10 hours into the race he is getting drowsy, and beginning to have transient visual hallucinations. Is it just because it is 11:00 pm? Begins to feel weak. Then falls onto the sandstone and has a brief seizure.
Diagnosis: Hyponatremia. Fluid replacement without sufficient salt to match sweat losses. This entity has killed marathoners and triathletes every year with the advent of extreme endurance sports. Prevention with salty foods is important. Fritos might be the most important thing in your pack. Hyponatremia is one of the most common diseases to afflict visitors to the Grand Canyon
Case 6
Cactus Encounter
First time mountain biker from Oklahoma visits New Mexico and barrels down a steep foothills path, he is unhelmeted but luckily doesn’t strike his head as he tumbles over his bike into a staghorn cactus and prickly pear. He also has a deep abrasion from a sharp rock he acquainted himself with a nanosecond before kissing the cactus.
You can usually grab the end of a big thorn with needle-nose pliers. Splinter forceps (tiny sharp tweezers) are ideal.
If there are multiple small thorns in a fairly small area, try removing them with glue. Spread a generous coating of patch glue over the entire area. Wait until it dries, then peel it off. It will usually pull the thorns (and your body hairs) out as it comes away from the skin. Of course duct tape will probably work for small thorns too. If thorns remain in the skin they may provoke an inflammatory response or cause infection and may end up causing a granuloma.
Case 7
Heatstroke
Scenario:
You're sweating like a pig in the Durango sunshine, trying to figure out the Colorado trail. Dang that CamelBak is heavy on the uphills! So you dump out some water. Getting kind of dizzy. Don't stop, because the significant other will be waiting. Odd -- you're getting goosebumps despite the heat, but at least you're not sweating so much any more. Which fork do you take here? Your eyes blur and its impossible to figure out this old map. Boy, this heat is making you dizzy. Better sit down for a minute. Whoops, kind of fell down there.
Description:
Heatstroke occurs when your heat-regulation system fails. Often sweating stops and there are signs of excess adrenaline such as goosebumps. The body temperature climbs and begins to interfere with thinking. Symptoms of heat exhaustion usually precede the confusion that marks the beginning of heatstroke. Finally, consciousness is lost and brain damage (and death) can occur rapidly.
When has a biker passed the line between heat exhaustion and heat stroke? To oversimplify: if the brain isn't working perfectly (confusion, dizziness even when lying down, etc) you've crossed the line from dangerous to deadly.
Immediate care:
Immediate cooling can be lifesaving. (Often, the victim can no longer sweat, so the temperature just keeps rising. You can't just "wait it out.") Get the person out of the sun immediately. Remove extra clothing. Spread arms and legs to increase evaporative surface. Have them lie down, while keeping as much skin open to the air as possible. Wet your biking shirt, then drag it loosely over exposed skin, moving from one area to another. Keep the cloth loose and very wet, letting it pass through the air to cool between wipes. If there's a cool but shallow stream nearby, consider moving the victim so their back and legs are in the water. If you're close to a camper where ice is available, put ice in the groin, armpit, and under the back. If the victim remains confused or becomes unconscious, send someone out for help.
Case 8. “Numb Perineum”.
You are on an all day ride on the boundary trail in Taos, at mile 20, your partner begin to complain of numbness of her ring and little finger.
Dx: ulner nerve compression (ulnar tunnel syndrome or cyclists palsy). Ulnar neuropathy is much more common than median nerve palsy in cyclists.
Tx: change gloves, change handle bar position. Of note road and mtn bikers get these symptoms in roughly the same proportions. Although road bikes offer more hand positions, rides are often longer.
At mile 22, you (male) note a numbness in a sensitive area. Bilateral pudendal nerve compression. {Impotence is no more common among competitive cyclists than among other athletes}.
Change saddle, Change into more padded shorts.
Tuesday, March 24, 2009
Mountain Biking
Folks, we are going to split up into two groups: You can ride with me in the bosque or you can ride with Diane Rimple in the foothills. The bosque ride is a fun, winding singletrack ride through cottonwood trees in flat terrain down by the river. You can go fast or slow on this one. You will see Canada geese and maybe sandhill cranes, possibly porcupines, while whizzing by on your bike. The foothills ride will be slightly longer, with moderate climbs and descents in rocky terrain. You will see the occasional coyote, the Albuquerque jogger, and feral housecats. We have taken classes to both places in previous years and you will get your money's worth no matter which location you decide. There is a didactic component to this, so be prepared to learn something about biking injuries!
Bosque with Joe: Go to the Alameda Trailhead at 9:00am. Directions: take I-25 north to Alameda, go left. Just before you cross the river, turn left into the parking lot. Contact me if you need help with your bike, etc. See below.
Foothills with Diane: Go to the parking lot at the top of Indian School at 9:00am. Take I-40 west to Tramway. Go left (north) on tramway. Indian School is the 4th stoplight. Go right until you reach the trailhead.
We will need to get a head count, so leave a message with me @ 280-5181 or Jason to let us know what you are up to!
We will ride until lunchtime and there will be scenarios along the way. Be certain to bring a well maintained bike. We don't need mechanical breakdowns on the trail.
At 4:30pm we will meet at the biopark aquarium parking lot for diving emergencies and marine envenomation demonstrations!
Good Luck!!!!
Bosque with Joe: Go to the Alameda Trailhead at 9:00am. Directions: take I-25 north to Alameda, go left. Just before you cross the river, turn left into the parking lot. Contact me if you need help with your bike, etc. See below.
Foothills with Diane: Go to the parking lot at the top of Indian School at 9:00am. Take I-40 west to Tramway. Go left (north) on tramway. Indian School is the 4th stoplight. Go right until you reach the trailhead.
We will need to get a head count, so leave a message with me @ 280-5181 or Jason to let us know what you are up to!
We will ride until lunchtime and there will be scenarios along the way. Be certain to bring a well maintained bike. We don't need mechanical breakdowns on the trail.
At 4:30pm we will meet at the biopark aquarium parking lot for diving emergencies and marine envenomation demonstrations!
Good Luck!!!!
Monday, March 23, 2009
NEXT UP... BIKING/AQUARIUM
Enjoy your well earned day off on tuesday! And congratulations to everybody for teamwork, successful navigation, and trail-side wound care, not to mention impressive hikes from everybody!
Bike rentals for those that need em:
Northeast Cyclery on Menaul. There should be a discount for UNM Wilderness Med Students.
Map and Phone number for Bike Shop
See you on Wednesday am at 9:00am at the Alameda Trailhead. Check back for directions and details tomorrow.
Joe
Bike rentals for those that need em:
Northeast Cyclery on Menaul. There should be a discount for UNM Wilderness Med Students.
Map and Phone number for Bike Shop
See you on Wednesday am at 9:00am at the Alameda Trailhead. Check back for directions and details tomorrow.
Joe
Monday, March 16, 2009
Grand Gulch!
Folks,
At 10:00 am 3/20/09 - Meet at UNM Continuing Ed.
Barring an armed rebellion (a distinct possibility), or natural disaster - we are planning on leaving for the Grand Gulch on Thursday noon.
The first night (friday) that we spend in the area will be at the Valley of the Gods. This will be car camping. Following this (saturday, sunday, maybe monday nights) we will be in the grand gulch canyon backpacking.
Our decision:
We are going to split into three groups, each leaving at different trailheads. The three trailheads are Kane Gulch ranger station, Bullet Canyon trail, and Collins Canyon trailheads. We will have the opportunity to do some incredible hikes!
Your decision:
You must decide which group you will hike with. We are looking at groups of about 7-8 students with 1 faculty each. At some point we can look over a map and decide the route each group will take.
Options:
This map gives a good overview of the area but without trails labeled.
The distances between trailheads are here.
One long hike option is this:
Kane to Collins is 38 miles:
http://www.usatf.org/routes/view.asp?rID=198462
But I think that option is tough to do with our schedule. So, most groups will cover 8-12 miles a day and end up at the same trailhead that they started at.
Some things that are not allowed in the canyon are: building fires, taking or damaging artifacts, damaging vegetation and defacing rocks. (We are allowed to have fires at Valley of the Gods).
Leave no trace!
My equipment list: (yours may vary)
pack
pack cover (garbage bag)
flashlight
blade
whistle
map
compass
(gps)
toiletries
foot care (moleskin)
tp - wet wipes
sunscreen
sunglasses
water filter
stove, firestarter
plastic spoon,fork,knife
fuel
water bottle
waterproof shell
waterproof pants or poncho (or umbrella)
waterproof shoes or good boots
teva sandals
tent, or bivy, or tarp
tent footprint (garbage bag or tarp)
sleeping pad
sleeping bag 20 deg minimum
long underwear/fleece pants
synthetic long-sleeve shirt
fleece sweatshirt
gloves
My food list:
snacks: nuts, trailmix, granola bars, jerky
breakfast: instant oatmeal, hot chocolate, coffee, tea, sugar
lunch: rice cakes with peanut butter and jelly
dinner: instant soup, top ramen, cup o' noodles, instant mashed potatoes
drinks: koolaid, tea, emergenC
dessert: girl scout cookies!
Remember: the lighter the better - for enjoyment of the hike, fewer blisters, and speed.
Bring the lightest warmest clothes, leave the canned peaches at home. I sometimes put just enough sunscreen, or toothpaste in a ziploc. Bring ricecakes instead of bread. Split the load - not everyone needs a water filter and a separate tent, stove and cookware. Do you really need to bring jeans and 4 changes of t-shirts and underwear? Well....maybe the rest of us will appreciate it but your feet will not!
JA
Sunday, March 15, 2009
Firearm Day-March 17, 2009
We are gonna make your day on Tuesday, March 17 for some firearm safety and shooting! We will meet at Starbucks on the corner of Central and Tramway Blvd, in the Four Hills Shopping Center where the theater is. Meeting time is 0830 in the morning. Take the Interstate 40 east, and exit Tramway, turning right. Starbucks is on the southwest corner of the intersection. From here, we will be driving out to the New Mexico Big Horn Gun Club in Edgewood. We will arrive about 9 am, and leave in time to get you to the afternoon activities at the EMS Academy.What to bring: safety glasses or goggles (clear or yellow amber ideal; sunglasses ok). We will provide earplugs, unless you wish to bring your own ear protection. If you have a firearm, you may bring it as well. Bring something to drink, and snacks if desired. Camo optional! Scenarios? Can't say at this time...ask Bob Quinn; I am just a facilitator. Questions? Call my cell number.
Hasta la vista, baby.
Dario
Helicopter Operations SF, NM
Tomorrow we will be meeting at the NM National Guard hanger in Santa Fe at 9am. Plan on leaving ABQ by 7:45 to make it to the hanger by 9. It looks like it will mostly be inside lectures and scenarios, but as always come prepared to be active.
Directions: Head out of ABQ on I-25 North. Get off on exit 599 (The Santa Fe relief route) and head West. You will come to Airport Rd./Paseo Real where you will make a Left. Then make your next Left onto Huey Rd. where there will be a security gate. Tell the guard that you are with UNM Wilderness Medicine and are traveling to the Guard Hanger. They will direct you to its location.
If you have any questions feel free to call: 505-249-0170
-Jason
Note: Click on "view larger map" below to see the correct arrow on HUEY RD, which is right of the arrow shown in the map below.
View Larger Map
Saturday, March 14, 2009
Thursday, March 12, 2009
Embudo Mountain Rescue Day!!!
SATURDAY MARCH 14th 8am
The Embido SAR day is coming up this weekend. I hope everyone is excited as it is going to be an action packed day. When we gather in the parking lot we will divide into strike teams and support teams. Whether you are in a strike team or a support team everyone will have the opportunity to provide patient care. As soon as the teams are in the parking lot at Embudo at 8am you will be given a scenario and a brief overview/introduction of the equipment and staff for the day. Teams will be provided with radios for day. Keep in mind that communication is key in a rescue situation, not only for relaying medical patient information to base, but also for dispatching adequate resources to the rescue site... And yes you will need a lot of resources during this scenario. Last Hint: Review how to manage Mass Casualty Incidents.
See you all there - Jason
ITEMS TO BRING:
Day Pack
Adequate Clothing
Water/Lunch
Harness/Helmet if you have it
You will be provided with your FASTPACKS and 2 ALS kits
Map Link Below. See you all on the 14th at 8am! We should be wrapping up around 3pm.
From Tramway and Indian School Head East on Indian School until it dead ends at the trail head parking lot।
Monday, March 9, 2009
Pictures from Hypothermia Lab
Some pictures from burying people alive in snow and heating them up again.
Wednesday, March 4, 2009
Paparazzi!
Hey everybody! I hope everyone received the invitation to view pictures at my picassa site. If not, please let me know since the album's privacy setting is high and you'll need an invitation to view it. I'm not that great a photographer but I compensate by taking a lot of shots so I'll continue to take a bunch throughout the course and keep posting them to the same album. Enjoy! :)
- Chang
- Chang
Tuesday, March 3, 2009
Give me that pen!
While the improvised IV bag needle was good, this might be a little bit better, though pricey:
http://www.airstat.org/
http://www.airstat.org/
Monday, March 2, 2009
Patient Assessment
SOAP NOTE.
S: Setting, Safety, Mechanism, Number
O: Organ Systems
A: "(S)AMPLE" history
P:Plan, Anticipated problems.
SAMPLE = Secondary Survey, Allergies, Medications, Pertinent History, Last Meal, Events.
Saturday, January 3, 2009
Prepare for the 10th Wilderness Medicine Course!
Welcome to all of you planning to participate in our tenth course at the University of New Mexico! The 2009 New Year is providing us here with lots of snow for great skiing in Northern New Mexico and Southern Colorado, and nice sunny days to even go for a great mountain bike ride. I have been practicing survival skills as well-last week drove from Taos to Silverton and got benighted in a snowdrift, but it was all good! We hope you are also preparing for a fantastic course in March!We have some new classes for you, always geared toward personal and group preparation. You see, true wilderness medicine is more preventative medicine...you really want to avoid doing ACLS in the field, for instance! With our wilderness and international emergency medicine fellowship looming next year, our excitement for the March course (which will be a part of the fellowship) is bigger than ever. In the meanwhile, if you are not on an exercise plan, start now! If you get the chance to be outdoors in the next couple of months, do it! And keep up to date on the events relevant to wilderness and austere medicine-the news and popular press is doing a good job of that (see our regular Mountain and Marine Medicine blogs for some of those press releases). On behalf of the faculty here, we can't wait to meet you. So, have a safe New Year, a prosperous New Year, and a well prepared New Year! If you're in the area, say "Hi" to us at the Ouray Ice Festival (Jan 10-14, 2009).
Dario
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