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Twice in my life, once in Madrid and then again a few years later in Washington, I have watched a man in front of me on the subway station escalator seize and fall frothing and twitching to the bottom. My brother thinks it’s a weird curse, but to me it seems like a test. The first time, I panicked, burst into tears, and called my best friend, who was helpful emotionally but less so medically. I had just recently been trained as a Wilderness First Responder - essentially an amateur emergency medical technician tailored for backcountry situations - but the overwhelming shock of the moment ultimately got the best of me. Years later, when it happened again, I kept my head screwed on and helped to care for the man until professional help arrived.
In the outdoor industry, a Wilderness First Responder certification is a common requirement for backpacking, kayaking, and mountaineering guides that face extreme conditions far from hospitals and often even cell service. We have to get it renewed every three years, which is why last week I found myself on the concrete floor of the Miami University of Ohio’s rec center, chatting with an aging computer science professor and a soft-spoken mutton-chopped lumberjack, the three of us hunched over a single piece of badly wounded raw chicken gleaming in a Tupperware. We were spattered with a combination of water and fake blood and breathing through damp face masks. What better way to spend a Sunday?
As it turns out, the dreamlike chicken-irrigating scenario was part of our wound cleaning lab, which was mercifully held inside after a below-freezing morning in a frostbitten local park learning about, of all things, severe hypothermia. WFR classes are designed to replicate real scenarios as closely as possible, with assigned responders having to find and treat their classmates that are bleeding out, badly stung, tripping mushrooms, experiencing acute appendicitis, and regardless of diagnosis always wailing mournfully from the woods. This year, our instructor was a fire chief and paramedic from Kentucky who got his medical start while driving foreign aid trucks into conflict zones in Sub-Saharan Africa. Needless to say, he was intense. On the first day, he asked if we had any guns or knives in our pockets before he demonstrated how to roll an unconscious body across the floor; he later compared the sugar absorption process in diabetics’ gums to dip tobacco and was unafraid to brusquely correct us if we used any indirect or unclear language in the heat of the moment. When a classmate tentatively determined an issue of brain failure in a patient, he said that no, the problem here was just plain ol’ being dead. He went on to tell us that it was our collective problem, really; it’s just a question of timeline.
When I first got certified in the summer of 2018, it was in the company of all my favorite coworkers at the University of Maryland’s Adventure Program. While any good first responder class contains certain elements of the theater, ours was like a sketchy off-Broadway audition stage; it was a rowdy seven days of convincing shrieks and stifled laughter. This time around, it felt different. There were the small nods to new cultural norms, like our instructor giving us the option of sharing our pronouns upon introduction and making sure to use inclusive language. The rest, though, was more somber. We were a room of adult strangers facing the classic awkward social situation in which you have to feel up someone you just met from head to toe as they lie flat on their back on the ground, desperately avoiding eye contact with each other as you cautiously palpate their lower left abdomen. To make things worse, we have all just lived through almost two years of limited in-person interaction of any kind, much less physical touch. It made me feel for today’s full-time students, who, if they are anything like me, now feel both less equipped and less motivated to create meaningful connections with new people.
The course content, too, was darker. As a country, our normal range for vital signs increases every decade as our unhealthier bodies must work harder to move oxygenated blood around. We talked about America’s messed-up pharmaceutical industry, like the EpiPen scandal of 2017, when the rotten, price-gouging company successfully got its competitor taken off the market by secretly flooding the FDA tip line with false illnesses supposedly caused by the other brand. We compared normal lungs to COVID-19 lungs to high-altitude pulmonary edema lungs, the latter two stunning to examine. I noticed that our all-white, heavily male class, which seemed representative of the adventure industry as a whole, was learning from textbooks and case studies that rarely included patients of other races. Our instructor told us that as a paramedic in the urban Midwest, almost all his calls are for diabetic emergencies, elderly falls, car crashes, school shootings, and narcotics overdoses. He made sure that we knew how to tie a tourniquet, as it has become his go-to fix on children, at least until he can get them to safety, in active shooter situations.
The second day of class, we had to stay inside due to high winds and strange, dark, fast-moving rain clouds. Our instructor’s phone rang off the hook as his fire station dealt with the fallout from the midwestern tornadoes that killed over 75 people across eight counties in Kentucky alone. Tornadoes aren’t usually seen this time of year, but with warming weather patterns, any semblance of predictability has been abandoned. The lumberjack next to me, who wore honest-to-God black-and-red plaid all three days, told me that as a beginner homesteader and disaster prepper, he specifically chose to live in Southeast Ohio as he thinks it’ll be significantly less affected by climate change than the Rockies or the coasts will be. A few days later, it hit 74 degrees at my relatives’ house in Iowa City, a new all-time record, and then that night came more tornadoes.
After months of political debate about the pandemic, it was refreshing to be reminded of how much good medicine always has and always will change in light of new scientific research. Life-saving techniques and protocols are revised all the time, and we simply relearn, adapt, and move on. Our recertification was entirely about judgment, nuance, and personal responsibility. As a Wilderness First Responder, I can legally, although probably not morally, walk by someone laid out across the trail and go along with my day. However, once I begin to care for them, I am required to see it through until the end, however that may look. Lately, both in the classroom and out, I have been trying to both take things less personally and to fully accept the consequences of my decisions. I am proud to have done something by myself, for myself, as I attempt to cherish the world and try to make it a better, safer, fairer place.
There are many pressing problems that America - and, hell, the planet - is facing. Climate change, the opioid epidemic, gun violence, and the enduring pandemic are just a few of the issues that threaten to overwhelm. Like I learned the hard way from that first subway station incident, though, freezing up and crying only makes a bad scene worse. In class, we learned how to assess a situation, whether it’s a drowning, a fractured femur, or a case of heat stroke, break it down into workable, improvable steps, and then fix it piece by piece. At the end of the day, Douglas Adams’ eternal directive is, I think, the key to emergency medicine and possibly to life as well: DON’T PANIC. We’re staring down the barrel of plenty of tough and scary things right now, but I have to believe that if we stay calm, stick together, believe the science, and remedy it one well-tied bandage at a time, we will be okay.
Walking around campus like this after class got me some well-deserved stares.
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