After my summer courses ended in California, I took a few days to road-trip back to Dallas, stopping to adventure with my sister, Kristal, in Phoenix for a few days then to west Texas to visit my good friend Mitch and his family. Kristal and her friends introduced me to the world of 4-wheeling and shooting. Who knew that jacked up Land Rovers could do such crazy climbing over nearly vertical boulder terrain in the dessert?? Well.. now I know..
After just over a week back in Dallas, I'm prepping for a move this Friday, up to UNT in Denton for my graduate coursework in Clinical Mental Health. I'm excited about my new roommate (she's awesome!) and the opportunity to apply some of my novice interior design skills to the new place! It will be fun to live amidst the college and young professional population again.
Already I'm finding myself challenged and intrigued by the material we are covering in class. On day 1, my professor said, 'we are reflective helpers.. we must first process the information we are learning and only after we have reconciled it with the way we live can we apply it in a client setting' (paraphrased). Needless to say, I've been doing a load of processing already and it's only been a week of coursework. Suddenly I'm asking a whole slew of questions of myself that I don't remember asking before - why exactly do you feel that way, what led up to that type of thinking, how does this dictate your actions?.. this is, what we are in one of my courses referring to as, the language 'Shrinkish'.
I'm taking a 12 hour graduate course load, which, currently looks like about 36 hours of studying and 12 hours of classwork each week. I feel a little slow on the uptake given that I've been out of academia for almost 4 years now, but I'm encouraged by the energy and enthusiasm of our professors. This will certainly be a cool semester!!
Sunday, September 5, 2010
Graduation: Way to Play W-EMT Crew!
After 4-weeks of intensive coursework and testing, our class took the National Registry EMT exam. For many, the certification would not directly impact their career or next steps in life, but for all, the education gained would be readily put to use given the need and opportunity. I'm so proud of all of my peers, a group of strangers that met less than a month prior, who shared sleeping, bathroom, training and classroom quarters all nestled within the same economically sized building, shared nights on the ridgetop watching meteor showers, breakfast lunch and dinner at the same tables, adventurous days in Yosemite conquering mountains and domes for that matter, afternoons practicing patient assessments on one another and evenings studying new course material in small ad hoc groups. For a month we did life together, got to know one another, encouraged, challenged and studied one another - I could not have picked a finer group of peers and instructors to grow with. Congrats Midpines 08/10 WEMT crew!!
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..
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
removedthen 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..
Sunday, August 8, 2010
Reality Check #2: Trauma Center Emergency Room
Friday, August 6th marked the mid-point of my EMT course. That night one of my roommates, Charis, and I drove out to a major California trauma center for the 11pm - 7am emergency room shift. We were blown away by what we witnessed..
Over an 8-hour period we saw 4 patients with various gunshot wounds, 1 patient with blunt trauma to the head with a possibility of a subdural arachnoid hemorrhage (bleeding between the brain and its protective layer that stores cerebral spinal fluid), a multiple stab victim and various other traumas. We stood in the trauma pods and watched medical professionals assessing and treating conditions we've only read about. Seeing real people going through this type of triage and trauma process was quite an education.
As we drove back after virtually no sleep for 2 days, I reflected on the fragility of life. I will not be able to see the ER the same again.
This week holds more coursework, tests, scenarios and studying. I'm thankful for continued opportunities to see the grace of God in the midst of my coursework and medical rotations. Asking for strength and retention this week.
Over an 8-hour period we saw 4 patients with various gunshot wounds, 1 patient with blunt trauma to the head with a possibility of a subdural arachnoid hemorrhage (bleeding between the brain and its protective layer that stores cerebral spinal fluid), a multiple stab victim and various other traumas. We stood in the trauma pods and watched medical professionals assessing and treating conditions we've only read about. Seeing real people going through this type of triage and trauma process was quite an education.
As we drove back after virtually no sleep for 2 days, I reflected on the fragility of life. I will not be able to see the ER the same again.
This week holds more coursework, tests, scenarios and studying. I'm thankful for continued opportunities to see the grace of God in the midst of my coursework and medical rotations. Asking for strength and retention this week.
Reality Check #1: Mass Casualty
After a 1.5 weeks in class, I found myself feeling that the knowledge I was gaining was just the tip of the iceberg in medical response. The scenarios we faced seemed to bring only more questions about what the expect, what to consider and how to treat different wilderness and urban trauma situations. Yet, it was in the midst of these scenarios that I discovered, the knowledge I was gaining was providing a solid foundation for me to assess and respond to any trauma situation, regardless of what it was.
On Tuesday, August 3rd, our class was broken into a team of 'patients' and 3 teams of responders. I was privileged to be selected as the Incident Commander for my response team and facilitated the assessment, extraction and care for a family who had gone rafting and had an accident on the river. Our patients were a mother and her two 20-something year-old children. One patient, half submerged in the water, was deaf and had a mid-femur fracture (the strongest bone in our bodies / the thigh bone), another, which our 
team had to pull from the river, had an open pnemothorax (basically a chest wound that was leaking oxygen into her chest cavity, placing pressure on her lungs and a ticking time bomb for lung collapse) and a diabetic woman in insulin shock with a chunk of wood lodged in her humurus (upper arm). All patients were positive for possible spinal injury and the team backboarded and carried each one up the river bank and to the road approximately 100 yards from the incident.
On Tuesday, August 3rd, our class was broken into a team of 'patients' and 3 teams of responders. I was privileged to be selected as the Incident Commander for my response team and facilitated the assessment, extraction and care for a family who had gone rafting and had an accident on the river. Our patients were a mother and her two 20-something year-old children. One patient, half submerged in the water, was deaf and had a mid-femur fracture (the strongest bone in our bodies / the thigh bone), another, which our 
team had to pull from the river, had an open pnemothorax (basically a chest wound that was leaking oxygen into her chest cavity, placing pressure on her lungs and a ticking time bomb for lung collapse) and a diabetic woman in insulin shock with a chunk of wood lodged in her humurus (upper arm). All patients were positive for possible spinal injury and the team backboarded and carried each one up the river bank and to the road approximately 100 yards from the incident.
I thought, this could happen to anyone along a river that some of my peers and I run along a few times a week. This family is just like any other family on Yosemite, that didn't anticipate an accident but were violently thrown into a time sensitive, trauma situation. When I run that river, I don't see anything the same way I used to..Within a 45-minute period the team had successfully triaged and extracted the family. It was a reality check to see 'patients'
The Yosemite Bug and Wilderness - EMT Course Begins!
On Monday, July 26th at 7:45am, the Wilderness Medicine Institute of the National Outdoor Leadership School course for Wilderness EMT certification began. This day and time marked a really cool transition in my life.. from being able to recall only the very basics of CPR to really gaining knowledge in the area of trauma assessment and treatment in both an urban and wilderness environment!
The course runs Monday through Friday from 8am to 5pm every day with additional class time 7pm to 9pm on Tuesday and Thursday. Time is spread across classroom instruction, hands-on skills practices, mock trauma scenarios and debriefing. While we have only 44hrs. required class time each week, after class each day my 29 classmates and I are actively studying for the course. You can hardly go anywhere at the hostel we are staying at / taking the course at, without tripping over teams who have set up their own mock scenarios, small groups studying quizzing one another on chest trauma and assessment, partners setting up traction splints one another or individuals pouring over any one of the number of reading materials we have for class.
We have 30 participants and 3 instructors and the class dynamic is incredible. Ages range from 20 to 60 and experience is even more diverse. However, we all seem to have a really heart for the outdoors and adventure. It makes our weekends quite an exciting time!
The course runs Monday through Friday from 8am to 5pm every day with additional class time 7pm to 9pm on Tuesday and Thursday. Time is spread across classroom instruction, hands-on skills practices, mock trauma scenarios and debriefing. While we have only 44hrs. required class time each week, after class each day my 29 classmates and I are actively studying for the course. You can hardly go anywhere at the hostel we are staying at / taking the course at, without tripping over teams who have set up their own mock scenarios, small groups studying quizzing one another on chest trauma and assessment, partners setting up traction splints one another or individuals pouring over any one of the number of reading materials we have for class.
We have 30 participants and 3 instructors and the class dynamic is incredible. Ages range from 20 to 60 and experience is even more diverse. However, we all seem to have a really heart for the outdoors and adventure. It makes our weekends quite an exciting time!
The first weekend, one of my roommates, Annie, and I took a 26-mile hike in Yosemite which started out on the Ten Lakes trail in the middle of the park and led us to the Grand Tuolumne (pronounced 'two-all-o-mee') Canyon which borders the northern end of the park. It was spectacular and a welcome break from studying!
Around every turn we came across what seemed like an untouched, brilliant-colored lake, quietly waiting for wildlife and rouge hikers to ripple its glassy surface. Even in the forest and summiting mountain peaks we were able to consider the implications of our most recent class topics.
We met a park ranger that was the first responder to a trauma situation only a week earlier which involved the care of a woman that had tumbled approximately 100 feet from a mountain ridge. He has the same certification we are pursuing right now and was able to confidently say that he and his team provided the best medical care possible before search and rescue could pull her from the steep, rocky terrain.
I am so very thankful for the knowledge I am gaining and was encouraged by Ranger Cliff's story. We don't ever want someone to undergo trauma but if they do, I want to be prepared to respond in a way that gives them the best possible chance of survival.
Around every turn we came across what seemed like an untouched, brilliant-colored lake, quietly waiting for wildlife and rouge hikers to ripple its glassy surface. Even in the forest and summiting mountain peaks we were able to consider the implications of our most recent class topics.
We met a park ranger that was the first responder to a trauma situation only a week earlier which involved the care of a woman that had tumbled approximately 100 feet from a mountain ridge. He has the same certification we are pursuing right now and was able to confidently say that he and his team provided the best medical care possible before search and rescue could pull her from the steep, rocky terrain.I am so very thankful for the knowledge I am gaining and was encouraged by Ranger Cliff's story. We don't ever want someone to undergo trauma but if they do, I want to be prepared to respond in a way that gives them the best possible chance of survival.
Grand Canyon & Yosemite Intro
After Sedona, we headed up to the Grand Canyon for a day of adventure. It was gorgeous on the drive in.. huge full pines, some residual snow still melting off from a particularly cool Spring season, huge puffy white clouds and a bold blue sky. After about 15 minutes at the south rim of the canyon, the skies changed just as quickly as they do in Texas. Apparently there is a well-known season called 'monsoon' in AZ. I learned quickly what the term meant.. over a period of 5 to 10 minutes, the skies went cloudy, temperature dropped from 85 to 65 degrees, rain poured down, follow quickly by hail and brutal winds!
We took a wet stroll along the rim when the lightning subsided long enough for us to gain some confidence about the safety of the activity.. We checked out the museum and information center where we imagined ourselves actually hiking down into the canyon.. It seems so funny that my fear of 108 degree temperatures on the canyon floor was met with a 65 degree monsoon reality! While it wasn't quite what we expected for our day trip, adventure was still had!
After our canyon adventure, we headed to Flagstaff then out to Yosemite. Opting for the 13 hour route (with an approach from the southeast) meant that we could be driving between Death Valley and the Mohave Desert! It was quite a visual treat. Some parts of the desert were white sand, others rolling foothills of orange dirt and brushy stubble, still others shorter green trees and more mountainous views.
Our approach dropped us north of Mount Whitney (the tallest point in the lower 48 states - approx. 20,000') on the east side of Yosemite National Park just before dark. We were able to see more than 2 hours of the most spectacular mountain views on the drive in. Clearings in the pine groves revealed sneak peeks of serene, sleepy lakes which projected mirror images of the surrounding mountains.
On Thursday, July 22, we hiked Half Dome! We charged up a 4800' elevation gain over a 7-mile path up to the summit where we met 400' of vertical cables which led up apex of the granite boulder that is Half Dome. Several thousand weekend warriors take the Half Dome challenge each year, we were happy to be counted among the percentage that made the ascent. The views were well worth the trip up and we enjoyed reflecting upon them during the 7-mile return hike!
On Friday, July 23, we had a picnic lunch then swam in the Merced river at a spot just outside of Curry Village in Yosemite. Then we explored the Mariposa Grove, home of some of the largest trees in California. The sequoias we saw were more than 3,000 years old and were truly spectacular. One of my favorites, the Grizzy Giant sequoia, was 98' around the base, its limbs measured 6' to 8' in circumference and it was taller than a Boeing 747 jet!
After a wonderfully memorable southwest adventure road trip, I dropped Phil off in Fresno to fly back to Dallas then headed to church on Sunday in a town near the Hostel I would be staying at the for next month and started prepping for the beginning of my Wilderness First Responder and EMT course (W-EMT)..
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