Into the Wilds of Lowell: Wilderness First Responder Certification Course, January 2-9, 2015

[prudenceb]

Into the Wilds of Lowell: Wilderness First Responder Certification Course

January 2-9, 2015

Three NSPNers kicked off the New Year in educational style, returning to school at UMass Lowell to take an eight-day Wilderness First Responder certification course run by SOLO. While what follows is not a trip report in the usual sense, because many of us have done Wilderness First Aid (two day) training to make us better equipped to handle medical emergencies that might arise on any of our adventures, I thought there might be some interest in what it's like to take things up a notch or two.

I am confident that I speak for all three of us - Warren, Julie and me - in saying that the course was terrific, we learned a lot, and ended up feeling better qualified to do not only the things we'd already learned about in our WFA courses, but also other things - many involving working smoothly as a team - that were newer to us.

We started the day after New Years, gathering at 8:00 am at the sparkling recreation center at UMass Lowell. Our early start meant that I got to see lovely sunrise over Lowell as I arrived early to beat the morning traffic:

Surrounded by gleaming basketballs courts, pristine racquetball courts, and with access to a full array of fitness equipment that no one had any time to use - although we were welcome to - we met in the bright and comfortable Rec Center Conference Room, which would be our headquarters throughout the course.

There were fifteen of us in the class, the majority of whom were not yet born when I started my own medical career. That ended up being one of the most enjoyable aspects of the class! Among us were rock climbers, ice climbers, sailors, scuba divers, mountaineers, hikers and cyclists. NSPN supplied the only paddlers, although our terrific instructor, Nate Duclos, does kayak as well.

Over the next eight days, we moved back and forth between indoor lectures and practical exercises, to more challenging outdoor practicums where we put to use what we'd learned in more comfortable conditions. Exercises typically involved teams - from two to eight or even fifteen people for our grand finale - working together to assess and if possible to treat medical conditions.

But our first task, the first day, using only our gear - a hodgepodge of tarps, sleeping pads, sleeping bags, rope, line, extra clothing, gear bags, and backpacks - teams of three attempted to build a shelter that could hold one patient and one caregiver. Our wilderness was a large turf field outside the Rec Center, a treeless area across which the cold January wind blew with gusto on that first day.

Of course Warren had come prepared with a full tarp setup - tarp, poles, tie downs, stakes and a hammer to pound them into the frozen ground - and so his team had it easy, sitting back in no time with fully constructed shelter, while the rest of us struggled with flapping tarps and improvised stakes that couldn't penetrate the unforgiving ground. But we all learned something about improvisation and thinking outside the box, an approach that we would use throughout the rest of the course. I'm sorry I didn't take any pictures of our sorry attempts. Shelters that you see in natural disaster areas on TV looked better than what we made.

Later that day, two teams competed in a litter building exercise. The winning team's design was chosen (hint, backpacks and hiking poles are really good starting materials while kayak paddles and tarps...not so much) to transport our instructor, Nate,

from the classroom to the outdoors (NOT a short walk)

and then around part of the building to end up where we'd started. We carried the litter in constantly revolving teams of six and were pretty much done in when we finally dumped - er, gently lowered - Nate back to the floor in our classroom.

Over the next few days, we spent a good deal of time talking about and doing primary and secondary assessments of our ailing classmates, and also learned about traumatic injuries. Bones bones bones!

Sunday was a day of fashion shows of splints and slings for various body parts. Chris, Warren, Lisa, Dylan and Mu demonstrated what their partners had come up with for their upper arm fractures.

What was helpful was that while Nate instructed us in principles, he left us to do problem solving on our own (thus, the many different looks), and only afterward critiqued and made suggestions for doing things better the next time. As he put it, if our splints were as sorry looking on the last day as they were on the first, well, that wouldn't give him great confidence to pass us!

We moved from arm fractures to the dreaded femur fracture that afternoon. By then, we'd made enough messed up splints that we had started to get the hang of doing it right. Red and Chris worked on my leg:

and the results were quite tidy and stunning.

Exhausted by his efforts building a splint on someone else, Warren zoned out on the floor next to my nattily roped up foot:

From femurs we moved on to ankle sprains and constructing splints that would allow an injured individual to hike rather than be carried out. Another fashion show:

And then on to the day's grand finale: learning how to construct an in line traction device for a displaced femur fracture. Nate demonstrated on Jamie using a hiking pole, cravat and rope,

then our teams of three went back to constructing these devices on each other. My team used a paddle (difficult but doable) and a hiking pole (much better). Only those of us with brand new knees declined the opportunity to feel our leg being stretched out in the traction splint.

The next day, Monday, it was surprisingly still Christmas in Lowell.

More lectures and exercises. Including unexpected events when half the class suddenly passed out and those of us who were still alert had to organize ourselves quickly into a team to respond appropriately.

Tuesday introduced us to the abdomen in all of its quadrants and wonders, and more litter building practice to move our acute abdomen patient who couldn't walk. It was easier this time around because we'd learned from earlier attempts, and it was all smiles as Julie, Ben, Mu, Warren, Sam and Chris carried out what looked like a pretty light team member.

I'm not sure if the patient here had flown the coop or not,

But Maeve sure looked as though being packed up for take-out was the best thing ever.

The weather had mostly cooperated thus far. It had been cold and blowy, but manageable. And then it was Wednesday and we were all listening to the dire reports of life-threatening cold heading our way. It snowed a bit. And time now to concentrate on keeping patients warm and dry. Our teams of four were allowed to use any gear they wanted for a first attempt. Then Nate took away all of our good shelter stuff like tarps and space blankets, and we were left again to think outside the box. Foam sleeping pads will protect you from the rain and snow. Here's Julie working on me.

Two pads are better than one.

Then it was Thursday, the day the weather forecasters had been speaking of in dread tones for days. Thursday was COLD. Thursday was the day that schools shut down so the little ones wouldn't have to go outside. Thursday it was minus one degree with a wind chill in the minus teens or twenties when I arrived at UMass at 6:30 am. Thursday was the day of our major group rescue. Outside! The cold *@#$%$#* day when we would have to put together everything we'd learned to respond to an accident/disaster with multiple victims. Outside. In the cold.

We spent the morning allowing the temperature to rise minimally, while each class member gave a 10 minute lecture on an assigned topic ranging from snakes and scorpion bites to frostbite, dental emergencies and the dangers of eating stuff you find in the wild.

Then it was time for the major exercise. Nate, our "dispatcher," gave us a preliminary report of the accident, and then the 15 of us had to go to work creating an organizational structure that would (hopefully) allow us to respond as a team going eight miles into the wilderness to be the first responders on the scene.

We sorted ourselves into a first responder squad made up of a leader, deputy, gear chief, gear chief's deputy, three teams of two - leader and assistant - and five standbys who would be called on to assist as needed once we had a better sense of what we were facing and what we would need to do. We were given time to do this, and to organize our gear.

Red, Chris and Sam thought about cravats:

Warren and Maeve's team went over what they would need while Ryan contemplated cravats as well.

And then we were out into it. It was COLD in the wilds of Lowell! Nate carried this sign, to reassure any wildlife we encountered:

And then we were on the scene. The treating teams were directed one by one to the patients. Over the next hour or so - did I mention that it was COLD? - the teams assessed, made tentative diagnoses, and treated and managed what they could, all while ensuring that their patients were warm enough - and as comfortable as they could be given the conditions and their injuries. Among the three patients there were: a compound femur fracture, an upper arm fracture and a sprained ankle, an impalement injury involving a knife stuck in the upper arm and a rib injury. As soon as we knew there was a femur fracture, a new team of two was pulled from our standby pool to construct a litter. Another standby team member built the in line traction device. Here is the scene litter building to front right; femur fracture patient in middle; and blocked by red jacketed man, the arm and sprain patient team; and in the distance the impaled patient and his caregivers.

The litter team, Conor and Ryan in the middle of construction.

The femur patient being tended to by Mu.

Warren, Maeve and Jamie working on the fracture and sprain patient.

Our patients were all generous and hardy UMass Lowell outdoor club members who had agreed to be dressed in what must have been inadequate clothing given the conditions clothing that we were free to cut open as for the first time all week, all affected body parts had to be thoroughly examined and treated. I did not envy them lying there and not moving even on multiple sleeping pads and swathed in sleeping bags - while bits of clothing were cut off or moved aside while wounds were irrigated with water and in the case of the open fractures, covered with a moist dressing!

What took the longest was getting the most seriously injured patient squared away - traction splint, padding etc etc - and making a litter that the team could use to carry the patient "eight miles" back to the helicopter evacuation site. "Eight miles" was not a short walk, and required crossing a major river (with traffic stopped in both directions as we slowly crossed). They were still smiling at this point:

Not so much a few minutes later...

And finally back in the warmth of the classroom (hallelujah!), our femur fracture patient - thank you, UMass student! - being deconstructed from the traction splint.

We got helpful feedback on our group performance from Nate, and then sorted out our gear (everything was completely mixed up, and I do hope that in the end, everyone left with everything they'd arrived with and nothing they hadn't). That night for the first time we didn't stow our gear at the school, as the final day would only be a few lectures and a 50 question final exam.

The week had passed quickly. I think we all felt good about having been tested in very difficult real-life conditions - at least to the extent that any experience can be said to be real-life when it involves fake patients. But the ambient temperatures were real. The wind chill was real. Our freezing hands were real. Doing things in the cold successfully was a source of pride. It would be a very different experience to take a WFR course in the summer.

So then it was Friday. Nate loves altitude and gave us a good lecture on medical conditions experienced above 10,000 feet, and then there was the exam, which - as is true of every multiple choice exam ever constructed - was annoying. Everyone passed the course, and we posed for a group photo in front of one team member's 23^rd birthday cake.

Thank you, Nate, for being such a great and fun teacher. Thank you Dylan, Ryan, Sam, Red, Warren, Chris, Mu, Conor, Julie, Ken, Jamie, Maeve, Ben and Lisa for being such excellent classmates and teammates. Our group was lively, interested, engaged and cooperative. I will leave it to Warren in his Warren-ish way to more clearly lay out lessons learned from the experience if he so chooses but it was clear to me from all the group and teamwork that was at the heart of the course that if even one individual hadn't bought in, that person would have had the capacity to derail the whole group and the tasks that the team was facing. But everyone was respectful of the lines of communication and authority that were established, followed orders that were given and quietly and more or less confidently went about doing the work. It was a real pleasure to take the class. I would encourage anyone who has thought about learning more medical skills to do so in a WFR class, and UMass Lowell is a terrific venue for doing so.

And finally, as much as Warren would like to say it isn't all about the stickers and patches, hey, let's face it, it really is all about the stickers and patches and here's the cool stuff that we got when we finished!

pru

[...]

Pru,

As always, another excellent trip report. It never ceases to amaze me how you sort through all the details of a multi-day event and weave them so beautifully into a report.

As you can imagine, I would like to add a few thoughts for our gentle readers to consider.

I would imagine after reading this report, some NSPN paddlers may feel a journey into Wilderness First Responder (WFR) training is what they seek. Keep in mind, it is a significant investment in time and effort. We found it involved 8 long days with time spent performing preparation and follow-up in an effort to maximize the learning. The investment of time and effort was greater than any other kayaking related course or program I have engaged in to-date.

I thought it was an exceptional learning experience and very different from my previous three Wilderness First Aid programs. From my perspective, that is an important observation and requires an explanation. So here goes

1. For me, learning is most beneficial when I choose the activity and I am ready to embrace the knowledge. I wanted the WFR knowledge since I felt it would be useful when engaging in kayak trips in Alaska. On those trips the paddler is out for 10 plus days and more than several hours away from definitive care. You do not want to risk your health or end the trip prematurely. I found the WFR training to be far more extensive than the WFA training and just what I needed!

2. As Pru mentioned, the venue of the University of Massachusetts at Lowell was superb. Since we were nontraditional learners, we could add a unique series of experiences while also learning from the other students. I enjoyed the wide variety of buddies in our class and their many different backgrounds. I sensed we all brought unique creativity to problem solving which I had not seen to this extent. It also helped to have challenging weather conditions for all our outdoor scenarios. That added great purpose to our efforts.

3. In many ways, Wilderness First Responder training is all about planning, leadership and teamwork. While at the same time, you learn and practice a methodology for decision making which promotes a focused effort giving you confidence in your skills. You learn not only process, you also learn how to use gear and equipment is very creative ways to help your injured buddies.

4. Over the 8 days, we had many opportunities to reinforce the skills of planning, leadership and teamwork. The WFR training fits very well into my overall journey and was just the catalyst I needed to begin my next learning adventure

And yes, I love the wicked cool patch and sticker as well!

Warren

[JulieC]

Pru, and excellent report of our adventure. Thanks for sharing!

This was definitely a fantastic week full of great interactive learning, amazing people, and a lot of fun. Oh, and as Pru reported - It was COLD!!!!

I am thrilled that I took this adventure with Warren and Pru this week. As Warren stated, this really takes WFA up a level. While we have taken WFA a few times, many of the topics covered are the same, the depth that you get out of WFR is completely different. It also focuses more on thinking outside the box from both a leadership and team member aspect when it comes to dealing with situations that may arise. Overall, the experience from my perspective was well worth the time invested.

[Michael_Crouse]

Thanks for the great report!

My WFR expired years ago but someday I'll take it again. It's definitely an intense week and those simulations can really put you through a lot of stress. I recall meeting at the beach at 10:00pm in Bar Harbor in March for our night time scenario. I was lucky enough to get the patient who was instructed to vomit when the back boarding was 99% complete causing them to shift.... then attempt to back board them again... repeat 4 times then die.... ok onto the next patient. Our instructors definitely pushed us through our weaknesses. I felt so prepared and confident when it was all over it was great. I think our class started with 26 people and 18 of us were taking the final test.

Nice job on the casts/splints they are BUF (Big, Ugly, and Fluffy)

[gyork]

I would guess that this course is designed for mainland-based wilderness scenarios. Of course we have a different, wetter wilderness that we play in.

To attendees: It would seem appropriate to have at your disposal ALL of your cothing/gear that you would normally pack for a day (minimum) or camping (maximum) paddle-yes? Were you instructed to bring such to the workshop?

(I'm thinking of my repair/first-aid kits and assorted paraphenalia that could be employed in practice and real scenarios)

[prudenceb]

Gary, We were all encouraged and instructed to bring the gear that we would normally have with us on trips. Other than leaving tents and cooking gear at home (which everyone did), the paddlers in our group had paddles, paddle floats, pumps, Ikea bags (!) to use in scenarios. It was interesting to see what different folks brought. For example, climbers had backpacks and lots of rope, both of which were very useful. Without all that stuff, we wouldn't have been able to construct the BUF (see Michael's post) splints that we did. The instructor was aware of the different environments that different people in the class would most likely be in (although the "most kayaking accidents happen on land" truism put us squarely in the same environment as others in terms of possibilities of breaking bones etc, spraining body parts etc -- and the medical, rather than trauma, stuff can happen anywhere.) One woman was preparing for a two YEAR sailing trip around the world, in which she and her family would be far from definitive medical care for long stretches of time. As for medical kits, we did bring those (and found out how much better they could be than what we had), and we used stuff from them - like sam splints, gauze and DUCT TAPE.

Michael, sounds as though your course was a bit more intense than ours. We had no night scenario, although the bitter cold perhaps made up for that. No one dropped out and it seemed pretty clear that everyone would pass. But at the end we all had the feeling that we were a lot more prepared than we had been after multiple WFA classes - although there is clearly a use it or lose it aspect to these skills. You need to recertify every several years, but can do so with just a WFA class - unless your certification has run out.

Warren and I talked at the end about recertifying with the whole eight day class down the road... We'll see.

pru

[Michael_Crouse]

Our class was certainly intense, hey it's break time, feel free to practice giving these oranges shots of insulin (if I remember currently). The first scenario we did I was a drunk driver who immediately got the point of scene assessment across but getting my (fake) blood on everyone who rushed in, then I was back boarded and evacuated since I had killed the other person in the accident. It was definitely set up as a moral/triage issue. Most critical case gets the immediate care, or as the instructors asked "what's going to kill this person in 5 minutes?"

That said it was fun and it wasn't all doom and gloom and we learned a lot.

Sam splints are awesome, as is duct tape , bandanas, etc... It was interesting that a lot of the gear they used we don't carry. Who uses a closed cell foam pad in a kayak? Trekking poles? Yes we have rope (tow lines, deck lines) and a couple of pumps could make a short splint..... oh this is fun, who wants to volunteer to try a paddle float neck brace? ;-)

[prudenceb]

Michael, As for insulin, we were specifically told we would NEVER adminster it. Greater chance of killing someone whose blood glucose you don't know, or whose response to the drug you don't know, than just letting them by hyperglycemic for a time u til theynget definitive care - particularly if you've just given them a nice simple sugary snack in thought that mental status changes in diabetic pt might be hypoglycemia.

As for gear, some of us do carry trekking poles in kayak, ALL of us carry spare paddles ( and, hey, we could always just saw someone's spare Greenland paddle in half!), some carry yoga mats ( closed cell foam) for sitting on cold beaches, and a blow up pad makes an excellent splint. We found the hiking/ kayaking gear pretty interchangeable actually - and this was more so the better we understood what we were trying to accomplish. Yup, thinking outside the box. Hasn't there recently been a thread here on why both carrying a paddle float - well, of course, now we know....for a neck brace!

pru