By Addi
It’s 11:00 PM on a frigid January night. The rugged wilderness of Wyoming expands around us in every direction, miles separating us from the nearest hospital. Our patient, found lying face down with an open head wound, has just become unresponsive.
Luckily, this is not real life – it’s a wilderness medicine scenario as part of the Wilderness EMT course with the National Outdoor Leadership School. Nonetheless, the stakes feel real, and adrenaline clouds my judgment. There are a million things that could be wrong, and a million ways I can make it worse – what am I doing here? My mind claws for any memory of how to treat a head injury. Is the patient presenting with Cushing’s triad? Do they have Cheyne-Stokes breathing patterns? Is their intracranial pressure increasing?
I think back to class, recalling what the instructors emphasized repeatedly. I don’t need to magically diagnose herniation or an epidural hematoma or whatever else might be going on. I need to work with my team to follow the simple patient assessment system that we’ve practiced again and again. We communicate and delegate tasks, starting with a scene size-up. Is the scene safe? Do we have proper protective equipment? How should we call for help? We move on to the primary assessment. Is the patient’s airway open? Are they breathing adequately? Is circulation sufficient?
Using procedures that have proven effective time and time again, within minutes we immobilize the patient’s spine, gather a set of baseline vitals, and prepare a patient report. We work together to craft an evacuation plan, weighing factors like the terrain and the patient’s condition. Before we know it, we are carrying the patient on a backboard to definitive care.
In times of doubt, it doesn’t take some brilliant strike of genius to reveal the perfect solution. Often, a perfect solution doesn’t exist. What prevails instead is trust. Whether responding to mock mining explosions, bear attacks, or avalanches, I learned to react to whatever the course threw at me not with panic, but with trust. Trust in myself to follow my knowledge and instincts and trust that others would have my back in pursuit of a shared goal.
