You Might Not Want to Call the Ambulance Anymore

Thanks to the National Outdoor Leadership School’s Wilderness Medicine Institute, I am now a licensed EMT (and a WEMT). Just four weeks ago I knew nearly nothing about urban medicine, but now I could theoretically show up the next time you call 911. Here’s how I got there:

On December 31st, instead of celebrating the turning of the year with my friends and family in Chicago, I found myself alone on a plane to Casper, Wyoming. After landing I enjoyed a tasty plate of fries at the sole restaurant in the airport and began to wait for the Share-A-Ride shuttle that would be taking me to the NOLS campus three hours after my arrival. I watched a movie while I waited and I slowly started to notice other people with bags trickling in to the restaurant. While we probably knew that we were all headed to the same place, we kept to ourselves, counting down the minutes until our shuttle departed. Eventually, it was 4:30 and we formally met each other as we piled our bags into the bus. We were loaded up and ready to go before realizing that we were missing someone. After a little bit of checking, we found out that his flight was delayed and wouldn’t be arriving until 7:15. After a little bit more waiting and a freezing two and a half hour drive, we finally arrived at the NOLS Wyss Wilderness Medicine Campus, thirteen miles outside of Lander. I began unpacking and spent the final moments of 2017 in my bed as I drifted off to sleep around 11:30 PM.

At 8:00 the next morning I was sitting in our classroom, looking around at the 31 unfamiliar faces that surrounded me. We went through names, medical backgrounds, and hometowns, and then our instructor Marcio went over what the next four weeks would look like. Here’s what they did look like:

Class

The vast majority of our waking hours (180 hours to be exact) during the course were spent learning. We had class every day from 8:00 until 5:00 and then twice a week we had an additional night session from 6:00 until 10:00. Our class time was divided into three main areas: lectures, scenarios, and skills.

Lectures were taught by any of the three instructors, Marcio, Joy, and Kendra. These lectures were on a range of topics, usually broken into a larger theme such as cardiac issues, environmental emergencies, etc. For the most part we would discuss anatomy and physiology, causes, signs and symptoms, treatments, and evacuation protocols of these issues. Sometimes the instructors would relay this information via whiteboard and discussion, other times we would watch an Australian television show about paramedic trainees or have a simulation involving a male dummy giving birth to a teddy bear. While there was a diverse route of information presentation, we soaked up what we could and moved on.

Usually, the issues we talked about would come up in a scenario. The scenarios were simulated emergencies (usually in a wilderness environment) in which we had to demonstrate an understanding of the problem, the treatment, and the patient assessment system. 1/3 of the class would act as patients and the rest of us would pair up, put on our winter layers, grab our gear, and head outside to treat our patients. Our pretend emergencies varied greatly in severity and cause. We had patients with a minor injury from a snowball fight and unresponsive patients who were going into hypovolemic shock. While it was sometimes difficult to manage a fake patient perfectly, (for example when you move a patient’s “broken arm” and he forgets to say “ow”) we used these simulations as practice for real life scenarios and as a way to guarantee we were comprehending the information taught in class.

Aside from the written final exam, all EMT’s must pass a practical skills exam, consisting of six different stations where students must exhibit mastery of certain basic urban medicine skills. These include oxygen delivery, AED and CPR, traction splinting, normal splinting, the trauma patient, and the medical patient. The practical exam is graded by adding up points which can be collected by properly resolving every issue while staying with the patient assessment system. The test is stressful, nit picky, intense, and tiring, so in order to properly prepare, we spent a lot of time practicing these skills. Normally, an instructor would first demonstrate one of these skills to the class, for example back-boarding a patient. Then, we would all give it a practice go, and then a day or two later we’d come back to it, and continue to refine the skill until we gained muscle memory. We spent a fair amount of class time doing practice practical exams and we were watched closely by instructors and medical professionals from the community to ensure we would be able to pass on test day. It must have worked because we all did!

Reading and Quizzes

When we weren’t in class, we unfortunately weren’t off the hook. While the instructors did a great job of teaching the concepts, our course was extremely accelerated and there simply wasn’t enough time to cover every little thing we needed to know. That is where our lovely EMT textbook came in. With just over 1200 pages of page turning, edge of the seat drama, this book soon became everyone’s favorite, well, least-favorite. Most of my nights were spent hunched over the textbook, reading about random things that I would never need to know, but might be on my quiz. So I would read a chapter, take the practice quiz, and repeat.

The practice quizzes were a way for us to prepare for the 6 graded quizzes we took over the span of the course. In addition to passing the final written exam and the practical exam, students must maintain an 80% average on all quizzes taken during the course. These quizzes were 50 question multiple choice tests that frustrated many of my group members due to their ambiguous wording. They were a necessary evil, however, and we all made it through the quizzes.

Clinicals

While we did have weekends off during the course, we were also required to complete two clinical rotations of eight hours at the local emergency rooms. So, during the first two Sunday’s of the course, I woke up at 5:15 AM and made my way to the ER where I would stay until 3:00 PM. Since I am not a nurse, nor have I been to medical school, I wasn’t of much help. I had a good laugh when one of the patients in the emergency room told me about a surgery she had a few years back and asked my thoughts, when I had only been in the course for five days. That being said, we were able to assist the nurses by taking vital signs, asking SAMPLE history, cleaning wounds, and making up the rooms after each visit. Despite the fact that the emergency rooms in Central Wyoming are not the most action packed hospitals in the country, I really enjoyed my time during clinicals. It was interesting to see the various medical issues that came up and nice to test my knowledge as I learned more during the course. I also got to talk to the nurses and doctors, and see how they approached the problems in order to solve them. As an 18 year old who hadn’t ruled out going pre-med, it was a nice way to dip my toe in the water and get a glimpse of the medical world.

Free Time

Somehow, even with all the other aspects of the course requiring many hours and a lot of attention, I found a way to have a little bit of free time during the course. I was able to enjoy some of the benefits of our surroundings in the least densely populated state in America. The first weekend, a few other students and I made the trip up to Jackson Hole and had a fantastic day of skiing. I was happy to have gotten in a day this season and glad to have seen the Tetons, even if only for a few hours. I went on a bunch of runs around the campus and enjoyed the beauty of the area. It was a little more difficult running on the hilly, snowy, and ice covered roads than it is on the flat streets of Chicago, but the awesome sunset views were beyond compare. With the backdrop of the wind river range and a property tucked next to a striking red rock cliff face, our setting was a great one. I may never be able to live in a town with a population of 8,000 people, but there is no denying that there are many advantages of getting away from the hustle and bustle of the city for a month. Most importantly, however, the best moments of my free time were spent hanging out with the 28 other students in the course. Though we came from all across the country and ranged in age, medical background, and motivation for the course, we all came together as one family. We slowly got to know each other as we conversed during meals, breaks, and evenings. We picked each other up, lent a helping hand, and made sure that we passed together. It was a pretty great evening when all of us went into town on the last night of the course after passing our last exam. Getting to celebrate together made it hard to remember when my friends were just a bunch of unfamiliar faces in a classroom.

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