Wilderness medicine in South America and Africa: Dispatch from WMI Instructor, Mike Moxness
I am a registered nurse living in Anchorage, Alaska. I spent much of my career in the emergency room. I got my Wilderness Emergency Medical Technician (WEMT) from NOLS Wilderness Medicine Institute (WMI) back in 1999 in preparation for a tour of duty up with the mountaineering patrol on Denali in 2000. I started teaching for WMI in 2001, mostly WEMTs with a few Wilderness First Responder (WFR) courses up here in Alaska.
About 5 years ago, I started signing on to medical teams going to developing nations, and once I started, there was no looking back. I've worked in Guatemala, Nicaragua, Honduras, Uganda and Kenya on multiple occasions. I am typically a member of a small expatriate team sent in to support local medical staff during emergencies. My last two trips have been to Uganda at refugee camps along the border with Congo. In January, I'll be back in Honduras, teaching at a rural hospital.
My work has been with Medical Teams International, located in Portland, Oregon, and MEDICO, located in Austin, Texas. There are quite a few good outfits out there, but these two have been good fits for me. I've also been seconded to World Concern (on the Somalia border) and worked in multi-organizational teams with Médecins Sans Frontières (MSF) and Humedica.
The wilderness medicine model is extremely useful in these assignments where resources are few and problems are many. Wilderness medicine is a context of practice: improvised or inadequate gear, inconsistent or non-existent communication with outside support, challenging environments for patient and caregiver, and independent risk-benefit decision-making.
Sharing a Love for the Outdoors: Debi and Scott Flora
“The only sticker on my banjo case is a NOLS sticker,” Scott Flora proudly told me last week.
Scott and his wife, Debi, are the parents of two NOLS graduates, one of them an employee at NOLS’ headquarters in Lander, Wyo. The Floras were introduced to NOLS through a backpacking buddy and NOLS instructor when their son and daughter were still too young to really consider the program.
No strangers to the backcountry themselves, the couple met on a cross-country skiing trip Scott was leading through Colorado State University- Pueblo (formerly the University of Southern Colorado). As their family grew and the kids got old enough to walk (most of the time) they began taking family camping and backpacking trips into the Rockies and beyond.
Years later, their son, Bradley, was considering advancing his career in the ski industry. Debi and Scott remembered the Wilderness Medicine Institute, founded near their home in Colorado. It seemed like a good fit, so Bradley journeyed to Lander to become a wilderness EMT.
Scott and Debi witnessed a growth in their son’s confidence after his course, along with an increased awareness of the safety ramifications of adventure activities. This boost was in part to the clinical time the students spent in the ER of a nearby hospital.
“He was being treated as a professional, treated with a level of responsibility,” Debi explained, “I think that had a huge impact on how he saw himself.”
Bradley also benefited greatly from the scenarios that allowed him to work as a member of a team. Overall, his NOLS training was such a positive experience that when his sister, Larkin, was looking for a gap year program, Bradley suggested that she look into the semester courses.
Larkin’s Spring Semester in Baja brought on many challenges, including being one of two female students on the course. She worked on holding her own with men, and Scott believes that she came out of it able to relate to men in a new and different way.
Larkin and her coursemates faced other challenges, including multi-day windstorms, desert heat, lack of water, and long days of paddling. They also experienced the small joys of an unexpected citrus orchard, and a pod of dolphins playing near their boats, along with the cultural opportunities traveling in another country provided. For Larkin, these moments made the discomfort worth it.
This controlled adversity can be built into a course, such as an extra hard day of hiking, or it can come from external effects such as the weather. Debi and Scott feel that this adversity helped make Larkin’s transition to college the next fall smoother.
“Parents have concerns about their children going off to college, and having an intermediate step for kids is a good thing,” Scott stated, “When you think of a college student going through a course, and then they get to college and they realize that ‘Oh, this isn’t so bad!’ They are better prepared for adversity and challenges in life because they’ve experienced adversity and challenges at NOLS.”
The Floras believe that NOLS, and all extended wilderness travel, has a transformative affect on young people especially. For this reason they are strong proponents of wilderness education.
“NOLS graduates bring their personal growth back into the world,” Debi insisted. “How they interact in their job, with their family, their friends, their community is all effected by how they feel coming out of NOLS.”
Because of this, Debi and Scott have decided to donate annually to NOLS. They believe that outdoor education will contribute to making the world a better place and want to see the school continue well into the future.visit donate.nols.edu.
Drumroll, please ...
It has arrived. Thirty thousand copies of the shiny new course catalog have been unloaded and piled up at NOLS Headquarters, and another 30,000 will be shipped to potential students soon.
We thought we’d introduce you.
Like last year, the NOLS course catalog has a clean, square shape and inspiring personal accounts to make the NOLS experience relatable.
With this catalog, though, we have dedicated more pages to courses and NOLS locations, specifically for the upcoming season. In fact, it’s dedicated almost entirely to the winter and spring course offerings at NOLS because we are going to publish three seasonal catalogs a year from now on. This will allow us to tailor the information in each catalog to each season to give you more helpful information about our course offerings.
You can look forward to a summer course catalog in January and a fall course catalog in April. All three catalogs will be available iPad apps shortly after their publication.
If you haven’t already requested a catalog, do so here or keep an eye out for the app, to be released soon!
Permalink | Posted by Casey Dean on Aug 28, 2013 in the following categories: Alaska, Australia, India, Mexico, New Zealand, Northeast, Pacific Northwest, Patagonia, Professional Training, Rocky Mountain, Scandinavia, Southwest, Teton Valley, Wilderness Medicine Institute, Wyss Wilderness Medicine Campus
WRMC to Host the Acclaimed Author, Laurence Gonzales
Join us at the Wilderness Risk Management Conference (WRMC) as we celebrate our 20th anniversary. The conference seeks to provide practical solutions for challenging issues that face organizations that explore, work, and teach in wild places. This year the conference will be held at Jackson Lake Lodge in the Grand Teton National Park, from Sept. 30 to Oct. 2. The event is co-sponsored by NOLS, the Student Conservation Association, and Outward Bound—three organizations that understand the complexity of running a quality outdoor educational program and provide workshops that meet the needs of industry professionals.
The WRMC provides a professional setting for outdoor educators to share and learn from one another. Our quality workshops are led by some of the most seasoned veterans in the outdoor education community. They will teach you all about risk management skills, administrative practices, pertinent research, and up-to-date field techniques. All the while, through our open forum, you can voice your comments, concerns, and questions to help improve the quality of the conference. Among this year’s array of qualified presenters is award-winning author Laurence Gonzales.
Gonzales was born in St. Louis and grew up in Houston and San Antonio. Drawing from the experiences of his father, a World War II pilot who survived against all odds, Gonzales has pursued a career in understanding who survives, who does not, and why. He has authored several books including Deep Survival: Who Lives, Who Dies, and Why and its sequel Surviving Survival: The Art and Science of Resilience. Gonzales has won several awards, including two National Magazine Awards and the Distinguished Service Award from the Society of Professional Journalists.
During his keynote address, Gonzales will address intelligent mistakes: why smart people do stupid things, based on his work for his books Deep Survival and Everyday Survival. His talk will explore the natural functioning of the brain and how, even when we are performing basic tasks, it can lead us in to systematic errors.
Don’t miss out on this year's opportunity to witness the culmination of twenty years of collaboration between some of the most respected names in Wilderness Risk Management! Come and join the conversation!
NOLS to Play Major Roles at Cowboy Tough Adventure Race
Starting Thursday morning in southeastern Wyoming is the Cameco and City of Casper Cowboy Tough Expedition Race. As part of the Rev3 Adventure Race Series, this point-to-point race, starting in Cheyenne and ending in Casper is also a national qualifying race for the North American Adventure Racing Series (NAARS). Teams of two or four people will race through a series of outdoor disciplines including trekking, biking, river travel, rappelling as well as other challenging activities.
NOLS is a major sponsor of the event, providing support in multiple ways. As the racers depart from Cheyenne, NOLS Wilderness Medicine Institute will join the medical crew, bringing the experience of three of WMI’s own WEMTs. Jared Steinman, the NOLS social media coordinator, Travis Welch, WMI’s program and retail store manager, and Greg Flemming, a WMI instructor will all use their training to provide medical attention as needed for the racer. In addition to being there to treat race-related illnesses and injuries, NOLS Wilderness Medicine Institute will provide most of the medical gear.
A section of the adventure race will be orienteering. NOLS’ own Casey Pikla and Kelly Carlin will manage and oversee this portion as adventure racers go to and from each checkpoint. There are mandatory checkpoints as well as optional checkpoints for time bonuses. Once the race is over, Pikla and Carlin will continue to help by breaking down the orienteering section of the race.
On the other side of the race, NOLS’ own Katie Everson, admission office and Adam Swisher, instructor and curriculum and publications manager, will participate in Cowboy Tough. Everson, with a background in marathons and swimming and Adam, with a history of long -distance adventure races will be strong competitors as Team Wyo.
NOLS will also set up an information booth at the finish line in Casper, Wyo. The booth will host backcountry cooking demonstrations and knot tying lessons. Anyone in Casper for the race is encouraged to stop by the NOLS table for information and demonstrations.
“NOLS has been taking people into Wyoming’s backcountry for over 45 years. We’re excited to support an organization and race whose goal is to showcase and raise awareness to Wyoming’s recreational opportunities and wild places,” said Steinman.
While Yellowstone and Grand Teton National Parks garner most of the natural world attention of Wyoming, it’s important to remind visitors that the entire state is full of natural beauty from the sagebrush plains of the high mountain desert to the craggy peaks of Wind River Mountain Range and into each lush river valley surrounded and contrasted by the arid red rock canyon landscape.
Backpacks, Fake Blood and Femur Fractures: Wilderness First Responder Course
"Recently, over a span of 10 days (May 28 – June 6), 30 new Wilderness First Responders (WFR) entered the outdoor world. Adventure Outings hosted its yearly WFR course through the National Outdoor Leadership School’s Wilderness Medicine Institute (NOLS WMI) in Chico.
This 80-hour course takes students through many of the possible first aid situations and solutions that may arise in backcountry or wilderness situations. Throughout the 10-day course, participants spend lots of time learning through scenarios where they practice treating “patients” as if they were truly out in the wilderness; they also get to practice their acting skills as students play the “patients”. Along side the interactive experiential learning, students also spend classroom time taking in the knowledge and information needed to treat patients."
Community Relief Medic Course
This is an article in the Wilderness Medical Society magazine by Jon Lowrance, WMI Instructor, about the Community Relief Medic Course offered by NOLS Wilderness Medicine Institute affiliate, Landmark Learning, in Cullowhee, NC. The redesigned Community Relief Medic course is unique in that it focuses the medical training and scenarios to the context of responding to a disaster or assisting in relief medical clinics. The two-day course includes hands-on training in patient assessment, common medical problems and their management, and medical decision-making. The course is appropriate training for medical mission and disaster response teams, local fire, law enforcement and EMS groups, scouting groups and members of the public who wish to be prepared and possibly volunteer when disasters occur.
Community Relief Medic Student populations include:
• Current relief workers or people interested in relief work, including mission groups, rescue and construction crews.
• Public safety, law enforcement, and first responder personnel.
• People interested in disaster medicine or those living in areas of frequent natural disaster.
Rock Rescue and Wrapping Up
As they entered the last week of their semester, the WMR (Whammer) students had a chance to use their skills in a student-led cliff rescue scenario in Sinks Canyon outside of Lander, Wyoming. The exercise involved rappelling to two “victims” on a small ledge, assessing and treating their injuries, and evacuating one with a tandem rappel and the other with a litter lower. This is in preparation for students’ final “graduation” scenario on May 2nd, the last day of their course. This full-day scenario will incorporate skills learned on every section of the course.
The Wilderness Medicine and Rescue Semester is a new course offered for the first time in 2013. It began with a one-month Wilderness EMT course outside of Lander, Wyoming, followed by one month in the canyons of southern Utah, two weeks on the Yampa River, and two weeks of climbing around Lander. Students will walk away with Wilderness and Urban Emergency Medical Technician, CPR Instructor, Leave No Trace Master, Basic Swiftwater and Rock Rescue certifications. You can read more about the first WMR here and here.
Checking In with the WMR
After weeks of wilderness medicine training, students on the Wilderness Medicine and Rescue Semester (a.k.a. the Whammer!) were ready for another scenario, but they weren’t expecting it to be, well, real. Regardless, when one of their course mates had to be evacuated, students were calm and prepared to help. Unlike their other scenarios, this one ended with a real satellite phone call to the NOLS Evac line. Dave, the evacuated student, attributes the group’s reaction to weeks of commitment, enthusiasm and a willingness to learn. Happily, Dave will be able to rejoin the group within the next week for rock climbing in southern Utah.
WMR students have now completed a month long WEMT course and a month in the slot canyons of southern Utah. While in the canyons, students practiced the medical skills they learned on their WEMT and learned the technical and decision-making skills necessary for managing risk during slot canyon travel. By the end of this section, students were able to do a technical entry into a slot canyon, including rappels and pack lowers, on their own while instructors took on the role of silent observers. According to their instructor Anna Gast, they did “phenomenally well.” The canyon section also highlighted a curriculum strong in fundamental wilderness living and travel skills, leadership, teamwork and communication.
Students are now on the Green River in Utah on the swiftwater rescue and canoe section of their course. The section began with a three-day river rescue seminar on the Yampa River in Colorado led by instructor Nate Ostis. Much of the time was spent in the water learning rescue swimming, throw bag technique, river crossing and mechanical advantage rope systems. The group will practice these skills as they travel down the Green for 12 days while also continuing their wilderness medicine scenarios on a real wilderness expedition.
Next up, students are moving on to a CPR Instructors course and finally the rock rescue section. Stay tuned for more information as the first WMR wraps up on May 2nd!
Have You Seen This Man(nequin)?
Known as: Mr. Hurt
Responds to: Well, nothing really.
Work History: 150-lb. mannequin used for WEMT scenarios
Place of Residence: The WMI Gear Room
Hair Color: Golden Beige
Eye Color: Golden Beige
Skin Color: Golden Beige
Distinguishing Characteristics: Adaptable fashion sense, never loses a staring contest, often scripted as the unconscious patient in an emergency scenario, stoic demeanor.
Recently Noted for: His role as a special ops advertising agent for the March Moulage Madness challenge
If you walked into the NOLS Headquarters break room the past few days, you might have seen this dashing fellow as you grabbed your morning coffee or reheated weekend leftovers in the microwave. Despite his tendency to startle unsuspecting employees who haven’t quite made it to the coffee pot yet, the real purpose of his placement is to raise awareness for the recent “March Moulage Madness” challenge posed to the NOLS HQ community.
With the facilitation of every NOLS Wilderness Medicine Institute (WMI) course comes a turnover of supplies, including splints, cravats and stethoscopes. Additionally, every gear set comes with a set of stage makeup and a bag of moulage clothes - the shirts and pants used in course scenarios that involve simulated blood injuries. Rather than subjecting participants' own clothes to a smattering of “arterial bleeds” or trauma shear cuts, WMI provides gently worn clothing for these scenarios.
In April, May and June, WMI will support over 250 courses ranging widely in length and location. That’s a lot of moulage clothes! To meet this high demand, WMI gathered clothing donations from NOLS HQ staff from March 19-25. Over the next few days, pictures of these high-fashion options, as modeled by your favorite WMI in-town staff, will be posted to the NOLS Wilderness Medicine Institute Facebook page. Staff donors and Facebook page members who “Like” their favorite photos will be eligible to win WMI swag! Prizes and winners will be announced on April 1 (no joke!). The clothes donated for this event will then be shipped off to support the realistic scenarios that are so critical to WMI courses. These scenarios provide our students with the hands-on experience to become competent and confident graduates.
Vote for your favorite moulage look! Visit the WMI Facebook page and while you’re there, tell us about your favorite scenario on your WMI course!