Reality Check #3 - MVI Scenario Meet Real Life

I believe, beyond a shadow of a doubt, that the NOLS Wilderness Medicine Institute W-EMT course prepares students for real life emergencies. The scenario-based teaching continuously placed each of my classmates in a high energy, stressful situation that demanded performance. Through this learning approach, I was provided with the opportunity to rotate through virtually every role there is in an emergency situation - with the exception of bystander.. I gained experience as a 1-on-1 patient caretaker, an operations gear chief, incident commander, patient manager and actual patient. I was given the opportunity to see a trauma event unfold through the eyes of every vantage point on the ground and that experience has proven invaluable.

At the end of the 3rd week, we performed our final scenario - the Motor Vehicle Incident (MVI). At this point in the game, each of my peers and now friends in the class were fairly seasoned at seeing something quasi-disturbing then taking a breath and getting into the weeds of it. In addition, we had all become expert patients, so staying in role seemed no longer difficult for those who were 'experiencing the trauma'. This made the scenario that much more real for each of the rescuers.

In this scenario, 1/3
of the class was removed
then the remaining 2/3's were split into two small teams which would each be performing a different rescue. After a short period of prep time for the teams to identify leadership and roles, we were set loose on a scene which we had no prior information about. Trodding out of the classroom with backboards and oxygen tanks in tow, we walked out the door and directly into the middle of our scenario - two cars, a truck t-boned by an SUV and a pedestrian pinned between them. No one flinched - we just went to work.

In just over 30 minutes we had all 4 of the passengers and the 1 pedestrian extracted. All passengers were removed from the cars using spinal precautions and were back-boarded and transport ready. The patients were tagged based on level of critically and were whisked away accordingly. Faced with challenging and cumbersome interior car compartments and patient positioning, various levels of consciousness and types of injuries - we just did what we had be taught. The completion of the scenario was somewhat bitter-sweet. It was our final scenario, our last time to work with one another as a team of medical professionals in training.

And yet.. it wasn't more that 24-hours later that I found myself surreally thrown back into that scenario, except the patients weren't my friends 'playing a role' and the components of the incident weren't props strategically arranged for dramatic affect.

7:00am: I started the morning with an ambulance crew out of a small town about an hour from our hostel. My shift was 7am to 7pm and would fulfill the professional EMT ride-along component of my coursework. The paramedic showed me the ropes when I arrived - the rig and all the various equipment it held and the house where employees relaxed between calls, she also introduced me to the EMT on the rig. We visited for about 15-minutes, chatting about the possible slowness of the day (I had made sure to bring my textbook so that I could study for my upcoming finals, sure that the day would provide ample time for such a thing).

7:30am: We received our first call of the day.. and hit the ground running. Call after call we were responding to all different types of medical emergencies. I quickly realized that while there were variants that changed with each call - type of emergency, age and gender of the patient, location and duration of time spent with the patient - there were two constants.. (1) the patient and family member's need for affirmation and encouragement and (2) the fact that the medical providers were in the best position to provide it.

So, call after call, I found myself perfectly positioned to speak peace and calmness into situations, validating the family member's decision to call us, encouraging an elderly man to take deep breaths and focus, handing off tattered medical cards from the patient's wife to the paramedic, toting the bag that would monitor a drug addict's irregular and weak heartbeat, soaking down towels with water to wipe blood from the hands and legs of a woman paralyzed with weakness. This is the side of emergency medical response that we don't really hear about.. the side that brings a medical provider into the very intimate details and setting of some of the most traumatic moments of a person's life.

5:04 pm: After a long day of calls we stopped to refuel the rig then were headed back to the station. I overheard some chatter on the radio about an MVI in a town about 25 minutes away. 'We're too far..' the paramedic said, 'there is another rig closer that will respond'. I began thinking about what the dispatcher had said, the location announced was 7 miles from where my class was staying and was the largest town nearby. The closer ambulance rig reported back, they were on another call. The dispatcher came back and requested that we respond to the incident. The dispatcher also clarified the location of the incident while we were in route, it was less than 1/2 of a mile from the hostel my class was staying at. Head on collision, multiple patients, two trucks and a motorcycle.. In the blur that was the drive to the site, I remembered doing three things: praying that none of the patients were my classmates, putting on two layers of gloves, and going through the basic patient assessment process in my head.

I am convinced that the scenario approach works.. from the moment we arrived on scene, I began processing everything I saw as if it were another scenario. While we were not the first on scene, I started from the beginning, noting the environment, how many patients I could see, where they were located, what might have happened to each and what their status appeared to be. I have snapshots of various parts of the experience burned in my mind now - a motorcyclist's boot empty and upright in the middle of the road, crisp white sheets in comparison to the torn figures they partially covered, a patient's mom climbing into our ambulance for a few precious moments, the helicopter medic's focus as he spoke to a patient prior to transferring her into the medi-flight, a classmate's face when we returned to the site to pick up another patient, staring in the eyes of one of our patients helping her fight unconsciousness, holding a girl's hand, how very quite things seemed..

There were a number of firemen and police officers on site already and a throng of bystanders from the community - undoubtedly shocked by the incident. And then.. there I was, finding myself to be strangely calm and rational given the circumstances, seeing clearly, moving methodically, and doing exactly what I was trained to do - I was completely someone else in those moments..

I could say it 100 times and still struggle to believe it.. but I wasn't phased, I walked right into the situation and got to work, doing exactly what I had been taught and yet, learning all along the way..