On July first I began an eleven day journey at Landmark Learning in North Carolina. I enrolled in a NOLS WMI Wilderness First Responder Course to improve my knowledge and skill in helping others during emergencies in remote settings. I succeeded in officially becoming a part of the WFR Pack, but I received knowledge well beyond that of wilderness emergency medicine. The value of relationships is what came out of my NOLS course.
Midday Friday I arrived and Visha and Dave welcomed me. At first glance I thought Visha was in charge; but she was like me a participant. Visha took a few days off from through hiking the Applachan Trail to take this course and Dave is a lawyer who specializes in Human Rights. Things were starting off great until I met my new personal trainer.
I have been going to LA Fitness and working out with a personal trainer to build muscle endurance. So when I met the hill to the bunk house I figured it would be an enjoyable walk. I was wrong. This Florida boy had difficulty walking up that hill. It took me an average of seventeen minutes to walk up and only seven minutes to walk back down to the classroom.
Six a.m. came quick and everyone began to gather in the classroom. Image twenty-four people from 17 to >45, no college education to surgeon, blue collar to lawyer, missionary to hippy, and the list of differences continued. Nevertheless, no one defined themselves by their differences or their dislikes. It became quickly obvious that everyone had an innate love of the outdoors and a desire to help others.
The thing about wilderness medicine is the contact time with the patient and the ability to get definitive care is more than an hour away. Consequently, a WFRs focus towards the patient is different. We explored the layers of wound care, how to monitor changes in the patient’s condition, their needs, and to take into account what long-term care looks like in the wilderness.
There were only a few times that we were able to get away and visit some of the local towns. And when we did what happened was memorable. After the second day of class Chris W, Dan, Kylie, Nick, and I went into town to get a bite to eat and hopefully see some fireworks in the town square. We decided to eat at two different restaurants. Nick and Chris were shocked when they discovered that Dan, Kylie, and I left our phones back in camp. “How will we find you?” It is funny how people who have always lived with instant access can’t access the idea of patiently waiting for people to meet them at a designated time and place. Dinner was great and we discussed giving initial patient assessments, exams, and vital signs. Having a Doctor at the table was a great help.
After dinner Chris and Nick found us and we attempted to continue our drive to find some fireworks. We missed seeing them. What happened to us on the road was better than seeing a light show. A police officer stopped to talk to us. “Did you know that you have a drunken ukulele player in your truck bed jamming away?” “Yes, officer” “Good, he’s pretty good. And you guys drive safe tonight” “Thank you officer”. That is how the conversation went. We all looked at each other and laughed.
- Chris knows how to jam
Every day we would take each other’s blood pressure. And between our lectures we would run mock emergency situations with complete patient assessments, exams, and vital signs. Up to this point I had mimicked the signs of a broken rib, broken shin, possible spinal injury, and shock. After class Chris S., Kylie, and I hiked Devils Courthouse and Richard Balsam Mountain.
It was on that journey that I felt like I was being kicked in the chest “for real”. I live at sea level and on the 4th of July I hiked up to 6410 feet above sea level. Did I hurt because of the elevation, the lack of hiking experience, or the fact that Chris bounced up the trail like a gazelle while not wearing shoes? Hiking through those woods was well worth the pain in my lungs. My only regret was that we did not take along with us a blood pressure cuff. My BP was elevated.
Eating popcorn and dehydrated food we sat on that mountain as the sunset and watched the clouds flow over the mountains like waves as fireworks lit up the sky.  The only thing that would have made it better was if we had some hot tea to drink.
It had been two days since my hike to 6,410 feet and after spending thirteen hours of continuing instruction with only a pizza break during class. Dan, Kylie, and I chose to escape and hike Deep Creek in the Great Smoky Mountains. As we walked we practiced S.O.A.P.S., talked about different job opportunities. Then we discussed different writing styles and goals as we rested our feet in the mountain waters and gazed in to the waterfalls.
Around 8:30pm we headed back into town to get a bite and drink some local brew.  We walked to three places trying to find something to eat. The Brewery did not serve food, the Tavern next door had just turned off the stove, and the Pizza restaurant had thrown their last pizza for the night. The pizza shop suggested that we go to McDonalds or Arby’s to find something to eat in town.
I was driving that night, which is not always a good thing. I get lost frequently. The advantage of this is I sometimes find a gem.  We left town and headed back to Silva. We saw a sign for Silva and to exit 80a. That exit actually was a u-turn exit and we ended up returning back to Bryson City from where we left only 30 minutes ago.
Driving back into Bryson City Kylie saw a sign for Mexican. That wrong turn was the right turn for us. We sat down in Guayabitos Mexican Restaurant, we got our menus, and drinks, then we started talking about how lucky we were to find a place to eat. The waitress came by the table and we had forgotten to even look at our possible menu items. Kylie wanted a few more minutes to look over the menu. The waitress politely smiled and shook her head no. It was almost 10pm and the kitchen was about to close. It is funny how things turn out. We ordered her recommendations and then continued to drink margaritas. To quote Kylie it is “the best (and only) food in town!!! LOL”. And Dan “the only criteria for restaurants is ‘can i get food here?’ only if you order quick”.
I do not care for needles. Yet I do give blood. And apart of WFR is to understand how to assist others with their needs. We practiced with Eppi Pens and discussed how to help with giving a patient a shot. We practiced giving and receiving shots on each other. Emily gave me a shot of saline and my pupils constricted then quickly dilated the moment the needle made contact with my shoulder. I may look happy in the photo, but inside my heart was leaping.
On the last night of being students we all left Landmark to eat dinner at Nick and Nate’s.  We laughed at some people’s expressions when we had discussed groin problems during class. And relived our experiences of the previous days long-term night scenario and care of two fellow hikers. Afterwards we all went back to study in a way fitting our group’s needs.
Chris Owen and Kylie organized the evenings study session. We did team Trivia Night. This was a great way to review all of the new knowledge, and a way to decompress. I was very nervous before the game but afterwards after talking to some of my new friends I felt great.
Nine days quickly passed and when I woke up for the last time in the Nook I knew that if I did not do well on the exam I still learned a lot. I learned more about myself, and others. And the most important tool is a WFR’s brain, eyes, and hands, those three things that can save a life.
To no surprise of my friends I passed. After celebrations I then hung around saying bye to everyone. I chit chatted with Rob and Jason about their ACA whitewater Swiftwater rescue class. And then left saying bye to Chris W, and Nick. I took some nature pictures and then called Chris Owens.
Chris O. had invited me to stay the night at his place. He had left a good two hours before me. So when I called him with my estimated time of arrival. I had to chuckle when he said that he tried a new route home and got lost.
Listening to music and swimming in his pool we reflected about what cemented the WFR experience in us. For me it was the day of the mass casualty. We had run a group exercise that involved five injured people. What was acted out was an accident involving two ATVs, a brother and sister hiking down a trail, and a bystander trying to help. The signs and symptoms of the five people included: skull fracture, third degree burns on two hands, broken clavicle, dislocated shoulder, and broken femur.  I worked on the male hiker who had a possible broken femur. What made this uniquely special for me was the roll the “patient’s sister played”. The fellow participant played the role of a hysterical sister beautifully.
And that is the key to being a WFR. We not only treat the patient for possibly hours into days. But we also give reassurance and calm to the patient’s hiking partners. We all entered into this class knowing that we would be tested in Detection, Reporting, Response, On Scene Care, Care in Transit, and Transfer to Definitive Care. But it was the dual nature of life and death, sickness and health, and taking care of the patient and the relationship of the witness/family member/friend who is worried about the patient.
Relationships and its value in care is what came out of my NOLS course. We are all kindred spirits and members of the WFR pack –  Jeff
Liquid Rhythm Journal 