The patient was unconscious. The medical team had found him after he had been missing for several days from his campsite. They were waiting for a helicopter to evacuate him when the unthinkable happened: The chopper crashed.
“What started out as a very simple plan ended up being markedly complex,” said Dr. Michael Caudell, Associate Professor of Emergency Medicine and the Medical Director for Wilderness Medicine and Survival Medicine in the GHSU Center of Operational Medicine.
Helping students, residents and practicing physicians deal with the variables in a simulated situation like this is the purpose of MedWar, an orienteering race begun by Caudell and former GHSU Professor of Emergency Medicine David Ledrick in 2001. The annual race combines adventure racing with wilderness medicine to test academic and practical knowledge.
Teams of four run, canoe and bicycle through a course at Fort Gordon, stopping at stations for medical exercises. Organizers hit them with anything related to wilderness medicine –fractures, cuts, infections, animal attacks, exposure to elements, food and water contamination, lightning strikes and even avalanches. Anything that can occur in the wilderness is fair game.
Rachel Nix, a second-year medical student who is helping to organize this year’s race, remembers a year when racers had to perform an emergency cricotomy using pig tracheas. A first-year medical student may have had no previous exposure to surgical techniques, so mistakes can abound.
“It’s exciting because whether you’re racing or volunteering, you’re going to learn a lot. The attendings are wonderful about teaching – it’s what they love to do. Even if you don’t necessarily know what to do when you approach a medical situation, you’ll be instructed in a respectful way. And it’s great to get outside, and in a learning situation that is hands-on, rather than in the classroom,” she said.
For example, racers evaluating a missing camper have a number of decisions to make. Upon “finding” him, they can construct a litter (an impromptu stretcher) or wait for the rescue chopper’s long spine board. They can carry him up the hill to the clearing, or wait until he can be winched. Each decision has immediate consequences that affect the fictional patient and the ability of team members to finish the grueling race.
“They’ve got to figure out what’s going on. If they do get through the scenario and do it properly, that’s great. But if not, we immediately give them feedback,” Caudell said.
There is more than one way to approach a situation, and the intractability of wilderness medicine often inspires innovation and improvisation that teaches something new to the volunteers and experienced medical professionals who oversee it.
“You think you know what the best options are, but then you see someone stabilize a c-spine in a way that I never would have thought of,” Caudell said.
Nix said that they try to make the medical scenarios as fun as possible – but it’s best when the participant playing the role of the injured person is a good actor. In fact, organizers sometimes give a Drama Queen Award for acting.
The muscled military members playing very confused victims of altitude sickness were good for a few laughs. And during one race, a participant portraying a trauma-induced psychological break was so annoying to the “rescuers” that some of the teams opted to tie him down. While amusing, Caudell said that the scenarios serve a medical purpose as well.
“They had to figure out how to take care of this person who is losing it,” Caudell said.
The lifelong lessons ingrained by practical experience are precisely what the creators intended. Three students used Caudell’s and Ledrick’s first orienteering experience at Wildwood Park in Columbia County as a research project on innovations in education and presented it to the Society of Academic Emergency Medicine. When Ledrick returned to his native Ohio, he began one there, while Caudell continued here.
The project continued to grow, so the pair formed a non-profit to oversee the direction and quality of the races. Presently, there are nine races nationwide and in Canada. The local planners run the races as they desire, but submit the medical scenarios to the directors for approval. Some races host as many as 50 teams.
“This stuff is really fun, but there’s a reason that I organize it but don’t race it. It’s challenging. Start training now,” Nix said.
Caudell and Ledrick just returned from competing in a MedWar in Park City, Utah, that was raced entirely on snowshoes. The directors knew who they were, but kept it quiet. Their team beat most of the younger teams that competed.
“You old guys were just flying through those medical scenarios. You didn’t miss anything,” one competitor commented in surprise.
“Yeah, we better not have,” Caudell said.
Registration is open for MedWar 2011 April 16 at Fort Gordon. Visit medwar.org.