With the Westin's rock lobster waterfall crashing down behind us, Loren Greenway, Chief Executive Officer of the Wilderness Medical Society (WMS), keeps to the shade of the Firerock patio. He fixes me with a steady stare — a gaze perfected in all probability during his time as a Hospital Corspman for the US Navy. This is what it means to be under the manic eye of a medic, I think to myself. They see right through you to your bones.
Greenway, who can claim more experience than you can shake a defibrillator at — and whom I will respectfully, under pain of the bends, call an elder — is not only an avid fisher, diver, and search and rescue enthusiast, but a licenced Respiratory Care Practitioner and a Master's Fellow in Dive Medicine with a PhD in Business Administration. Greenway has been involved with the WMS for 10 years, holding down the fort as CEO since 2008. He and scores of other like-minded people were in Whistler this past weekend for the sixth World Congress on Wilderness Medicine.
Why does this matter? Well, with his medical interests, outdoor passions and rescue and relief background, Greenway epitomizes something of the spirit of the 501(c)3 "charity for the public good" that is the Wilderness Medical Society.
"The Wilderness Medical Society," says Greenway, "is a membership society that people with experience or interest in wilderness medicine can become a member of and participate in," reminding me that hey, I too could get in on the latex action. Anyone can sign up, be they physicians, EMTs, guides, or just layabouts who want to poke needles into soft and tender bits — the WMS is an open society, focused on research, publication, and practice, offering education and training on all levels.
"We don't treat them any different though," says Loren of the newbies, otherwise known as the medically unprofessionalized, many of whom put in the hard hours of education, training, and examination to become FAWNs — Fellows of the Academy of Wilderness Medicine. Point being that the WMS provides next-level involvement for physicians, patrollers, guides, firefighters, and other response and rescue personnel, as well as an entry-level starting point for those intrigued in the outdoor medical profession and/or seeking to tune up their survival and medical skills.
Check–out from the ER... you like it so far?
It is strange to think that our entire medical system is based upon high-speed ambulances carrying the unlucky to well-stocked hospitals. What the WMS grapples with are the hard issues of access and survival where 911 is not an option. The WMS is the wild outlier to a medical establishment entrenched in urban areas; it is the Do-it-Yourself remedy to a system that relies upon ready access to advanced technologies.
"Really and truly, when you're up on a mountain somewhere, and you don't have the ER behind you, it's a really different set of skills," says outgoing WMS President Tony Islas, who was peacefully drinking ice water with lemon until I showed up and started badgering him on the patio. He adds: "It is a different skill set that we are teaching."
Islas, who is a Family and Sports Medicine Physician, and teaches as an Associate Professor at the Paul L. Foster School of Medicine in El Paso, Texas, emphasizes that the mission of the WMS is to take any medical practitioner of any background — as well as the all-but uneducated members of the public — and give them the kind of training that will allow them to adapt to the demands of outdoor emergencies or situations where supplies and resources are scarce.
Besides learning to treat the patient in what the WMS calls "adverse environments," wilderness medicine encompasses basic survival and safety skills for the practitioner. And last but not least, as Islas emphasizes, the idea is to pass along such holistic skills to others — be it a ski patrol or Scout group. In this sense, it is the humanitarian mission of the WMS to diffuse medical practice beyond hospital walls.
"It doesn't really matter if you are an OBGYN or a family physician," says Islas, adding acronyms that most of us can only nod unknowingly at. "If you become adept at that certain skill set, there's a place for you in the Wilderness Medical Society."
Of course, much hinges on what is meant by that skill set, and the WMS defines it broadly across vast spectrums of outdoor activity — from desert to dive medicine, jungle to mountain medical, disaster triage and relief logistics to search and rescue. If you can imagine it somewhere on the planet, whether it's a destitute situation (such as a hurricane) or the outcome of a sudden act of violence (such as terrorism), the WMS has probably written a response manual for it. Indeed, looking up such topics in the conference program, I find both are more-or-less covered. Likewise, if it's the unfortunate consequence of some gnarly, quasi-lunatic sport, the WMS probably has some kind of training in it, if not a Fellow who has been there, done that.
Fellowship of the Spirited Wild
Given that Whistler has no hospital and would be utterly cut off should something take out our access roadways — a disaster scenario compounded if the weather socks in — it would seem that the benefits of the WMS to the valley's outdoor keeners is clear. The WMS conceives of medicine for the rest of the world, which is to say most of the world — a planet that, even in its overdeveloped state, is nonetheless still a challenging globe of all but inaccessible wonders. And what is called wilderness medicine in the West is more or less slang for standard practice in the rest of the underdeveloped world. This is medicine without sterilized hospitals, high-end anesthetic, prescriptions on demand, and technological basics including electricity — which is why the WMS handles not only backcountry and rescue scenarios, but disaster and relief medicine, working with NGOs and aid organizations worldwide. In terms of medical theory and practice, the backcountry and the so-called Third (and Fourth) world go hand-in-hand.
So if I say that there is a spirit to the WMS, it is clear why — this is not your usual bunch of pallid and pale doctors shoo-shooing you for taking part in "extreme sports" or giving you the evil eye for going on yet another "dangerous trip" to some part of the world where, hey, all kinds of other people live just fine all the time. These are physicians who are also dedicated climbers, who have been bitten by weird bugs, who have suffered dehydration at altitude, have had their heads and ears blown out with the bends, and collapsed in a heap, babbling about becoming an Incan flower god after taking too much ayahuasca. Well, maybe not the last one — though it is possible. These are fun people to be around.
"It's soul-regenerating to hear people talk not only about high-altitude problems, dehydration issues, heat issues, but hearing them give their presentations and telling you about the things that they do . . . it is very, very invigorating," says Islas, getting a tad misty-eyed. He goes on to explain the camaraderie experienced by WMS members when experiencing the challenges of fieldwork. But he also adds, significantly, that this experience of belonging and community "also has to do with the beauty you encounter when you are out there." In short, nature, and a love for it, is the common denominator of the WMS, the silent partner in the medic's go bag.
Getting wild with the wild beauty
Any medical practitioner seeking wild medicine must thus be a wild lover — as in a lover of the wilderness world. The WMS membership is stocked with climbers and divers, paddlers and alpinists, skiers and overall backcountry addicts. These physicians, paramedics, nurses and first responders mix getting off in the outdoors with everything from hyperbaric medicine (what to do if you get the bends) to Exercise Associated Hyponatremia (extreme sodium loss from endurance activities).
Then there's the seminar I missed, due to a wacky and dated schedule (trust the WMS with field triage, but not with the interwebz) — "Field Orthopaedics" by Sam Baker and Bob Quinn, otherwise known as how to saw through bone in the backcountry. I had this on my mind when wandering unexpectedly into a room full of half-undressed participants bearing unusual tattoos, reclining on tables while the rest of the room's participants poked and prodded them with ultrasound equipment.
This was interesting. The tattoos, I mean.
Tim Benge, from Goldsboro, NC, had a mean set of tats, combining medical crosses and snakes with a large, round circle on his back, fairly freshly inked, that sported a Ju-Jitsu logo. A man watching close by was dressed in a khaki uniform that said STORM on it — Specialized Tactics for Operational Rescue and Medicine, a unit from the Georgia Health Sciences University and the National Tactical Officers Association. I wanted to see his tattoos too, but I didn't ask. Benge, meanwhile, was having his eyeball scanned. The clinic, I discovered, was "Ultrasound in Disaster" with Teresa Wu, which consisted of a bunch of heavy-duty looking ultrasound machines the size of field laptops being used to scan participants for "intraperitoneal hemorrhage, pneumothorax detection, maternal-fetal applications and foreign bodies."
There were a lot of foreign bodies. At least to me.
Tim, meanwhile, looked like he had a Borg implant sprouting from his eye. It was pretty cool, I must say. However, apparently I had missed the truly awesome session — the one with the bone saw action. Mr. STORM said I had really missed "the good one" that time. "We practiced cutting through bones!" said a grinning participant beside him. When I asked about painkillers in such situations, they all laughed. Ha ha ha. Yah right.
The other tables were engaged in the same weird science of ultrasound, scanning insides for defects. Wu had the most interesting advice. "Use the liver as a window," she said, gesturing as to where to put the hand-held ultrasound scanner, "keep moving it until you're right in the meat of the liver."
This reminds me of a quote and appropriately indescribable 3D scene from Andy Warhol's Frankenstein with Udo Keir, but I really won't get into that. Not here, at least.
Point being, everyone had fun, and let me take lots of pictures. Everyone got their old injuries scanned, and enjoyed pointing out things that were apparently missing, such as John Herman's gallbladder (residents of San Antonio, Texas, watch out — it's on the loose).
Indeed, let us all pause for a moment and thank the starry heavens that the green-gown-and-scrub crowd is also into clipping 'biners and/or descending into the life aquatic — because the rest of us need these kind, overeducated, calm folks when the seriously bad suckage hits the fan. Bite your lip, it's only bone.
But let's get back to beauty.
"The WMS this year [organized] an educational event in Nepal — the Everest Basecamp," recounts Tony, who went along on the medical expedition that partnered with the Himalayan Rescue Association, raising proceeds from participation fees for the Everest ER, a base camp hospital for climbers founded by former WMS president Luanne Freer in 2003. Everest ER embodies the outreach aspects of the WMS by using proceeds from the seasonal test-based medical clinic to subsidize free and low-cost health care for the Sherpa people of the Khumbu region of Nepal.
"It truly was a life-changing experience," continues Islas, clearly enraptured by his time in the high Himalaya. "It was a beautiful experience. Life changing — not in a big way but in a little way. In the way the people treated you, in the way the mountains looked and the way that the yak bells sounded and the way that the Mani stones felt as you passed them, the way that the prayer wheels squeaked when you turned them... it's all those ways that affects you and changes your outlook on world issues."
Islas was one of the faculty members on the trip, teaching 17 hours worth of mountain medicine during lunch breaks on the trekking trail, covering everything from high-altitude conditions HAPE and HACE to traveller's diarrhea. To me, this combination of education, practice and the outdoors is an exquisite introduction to what it means to be active with an organization such as the WMS.
Then there's the next level — science.
Wild Science for the FAWNS
Contrary to what we hear from our current federal government, science can be a beautiful thing. While on the Everest Basecamp trip, Scott McIntosh, who is the Editor-in-Chief of the WMS' peer-reviewed publication Wilderness & Environmental Medicine, conducted studies in the minimum dosages of acetazolamide, known as Diamox, to preventatively treat Acute Mountain Sickness. He is scheduled to present his results at the next meeting in Park City, Utah.
Indeed, the latest issue of the WMS journal (23/2, 2012) discusses how the use of what's called pulse oximetry — monitoring the saturation of hemoglobin to see how much oxygen you've got in your blood — isn't as accurate at predicting altitude sickness as many had hoped. Other papers go on to consider genetic predispositions for such things, which is why the Sherpas have an easier time playing soccer at 4,500 metres than us lowlanders. Then there's a paper on getting injured from marathon paddling in a canoe. No kidding. And of particular interest to all of us here in the Valley, "The Epidemiology of Mountain Bike Park Injuries at the Whistler Bike Park, British Columbia (BC), Canada." Who knew that the savage lust for dirt and air would feature in scientific research?
This paper, carried out by a host of researchers (please buy them beers: Zachary Ashwell, Mary Pat McKay, Jeffrey R. Brubacher, Annie Gareau), digs into research from 2009, looking into how the downhill scene likes to destroy its limbs. Indeed, risk is somewhat high with downhill biking — the researchers conclude that "injuries with significant morbidity" can occur, which highlights "the need for continued research into appropriate safety equipment and risk avoidance measures." Of course, risk avoidance in any sport dedicated to embracing it is a moot point, but developing better equipment does all riders good. Details from the report: going over the handlebars is common; as is putting an arm out to the side; and if you're a 20-something male riding in August, do take care, 'cause you're a probable statistic.
The journal is an intriguing academic publication, insofar as its reach is much broader than one would think. Other factors relating to human health out in the wild are reported upon too, from the effects of environmental changes to the increasing commercialization of iconic peaks.
David Weber, a Mountaineering Ranger in Denali National Park, Alaska, and a Technical Rescue Adviser to the WMS' Diploma in Mountain Medicine program (DiMM), comments upon the convergence of factors that led to the nine fatalities during the 2011 Denali climbing season. The editorial reflects upon what are, I would argue, the effects of climate change — uncompromising seasonal shifts resulting in less snow but lower temperatures, turning snowfields to ice and adding technical challenges to usually easier routes — along with those of commercialization, though he avoids pointing out what many climbers deride in publications such as Alpinist: the increasing Disneyfication and industrial tourism of the backcountry. Weber does not draw judgments, but only makes observations: the inability to self-arrest in low-snow conditions (i.e., to stop oneself with an ice axe), and the fact that less-experienced parties remained roped in terrain where self-arrest would not be possible (thereby increasing the danger for the rope team) led to five deaths from climbing falls alone in 2011.
Because Everest is well known as an over-abused peak — today, it rarely sees challenging ascents by alpinists; almost all of its summits are made by commercial expeditions hauling clients up established lines along the standard route — I asked Islas what he thought of the Everest Basecamp experience, well known to be akin to finding oneself in one of the most beautiful places on Earth only to discover it has been turned into a garbage dump. Despite valiant efforts to clean it up, Everest itself is still strewn with garbage. And corpses.
"Those lines this year on Everest were phenomenally long," says Islas, referring to the practice of having all teams siege the standard Khumbu Icefall / Hillary Step route at the same time. "It does put people in harm's way when you do that," he explains. "I think there is an ethical issue there — we've got to say, look, at some point, we've got to draw the line, because having that many people on the mountain at one time trying to summit on the same day really causes issues."
Islas saw similar conditions as to Denali in 2011: "This was a strange year on Everest. It was very dry. The first part of the year up there wasn't a whole lot of snow, so there was a lot of rockfall and it was very dangerous."
Perhaps not so strange — the Himalaya are seeing massive melt from climate change. The title of a 2009 paper by Chinese scholars Jianchu Xu (et. al.) is clear enough. It reads: "The Melting Himalayas: Cascading Effects of Climate Change on Water, Biodiversity, and Livelihoods." The paper, published in the journal Conservation Biology (23/3), lays it out plain and simple in the abstract. I'm going to quote this here, as it matters — the WMS is very interested in the effects of the changing environment on human health. A future conference, WMS CEO Greenway tells me, will be dedicated to it; Greenway also makes the point that there is well-documented scientific research that the glaciers on Everest are receding, though he believes the reasons are "multi-factorial." Xu and his cohorts are a little more on point:
"Rapid reduction in the volume of Himalayan glaciers due to climate change is occurring. The cascading effects of rising temperatures and loss of ice and snow in the region are affecting, for example, water availability (amounts, seasonality), biodiversity (endemic species, predator–prey relations), ecosystem boundary shifts (tree-line movements, high-elevation ecosystem changes), and global feedbacks (monsoonal shifts, loss of soil carbon). Climate change will also have environmental and social impacts that will likely increase uncertainty in water supplies and agricultural production for human populations across Asia."
Indeed. Which means that such climate change is going to start — and already has started — having a serious impact upon those of us seeking to travel, especially in areas where massive natural processes are being rapidly altered. Here in the Coast Range, the evidence is easy to see — glaciers have retreated significantly since the first ascents, most notably in the Tantalus Range, where once walkable glaciers are now nearly impassable from the melt, the original routes now a maze of crevasses and technically challenging bergschrunds.
Carnage at the Conferences
The WMS throws several conferences yearly, with the latest having just rattled windows in Whistler (which probably explains the strange use of medical tubing as a unique fashion accessory at Garf's for the past week). The conferences have almost as many streams as the proposed Enbridge pipe crossing, with various subsections holding their own pre-conferences — Dive Medicine, the Diploma in Mountain Medicine, Disaster and Humanitarian Relief — alongside a swath of panels and speakers at the main conference, with such endearing titles as "Patient Packaging and Transport" (I always thought that Dracula had it right — ship out with a coffin) and "Surgical Airway in the Austere Environment: Myths & Realities" (myth or reality: you can eat pine needle soup through a hole in your neck — yes or no?).
Indeed, with the latest shindig, the WMS overran the Westin and the Hilton for a solid five days, with seminars ranging from the self-explanatory "Bioterrorism" to a rather more opaquely titled "Security & Bug Out Kit."
As a recently infected victim of communist carpenter ants, I was disappointed to discover that the Bug seminar is not the ultimate ant/mosquito defense I was hoping for, but rather "risk mitigation in the field with development of [a] security plan for Whistler environs, [with] preparation for unexpected departure." This, I discovered, was cool too. In short, if the zombie apocalypse hits and/or the Big One shatters the tectonic plates, sending rivers of molten lava through a fiery village that no Tourism Whistler campaign will ever be able to revive, this seminar is all about buggin' outta' here without wiggin' out. Think survival evacuation and long-term self-sustainability in a world without cold beer and wine, pizza delivery, or GoogleMaps. Or oil. Or electricity.
Speaking about oil... the WMS is turning to the environment for its 2013 conference in Alabama, a State that has seen its share of devastation from the Deepwater Horizon fiasco of 2010. The conference will talk about the environmental impacts on human health.
"That's going to be a watershed conference for us," Loren Greenway. We are now at the end of a marathon interview session on the patio, and he and I have both gulped down our beers — his buzzless, mine grapefruity. "Following the impacts of the British Petroleum explosion, we're going to talk a lot about the impacts of drilling and pollution on human health and environmental health," he says. "It's going to be really interesting. We're going to have the Surgeon General [of the U.S.] come in, we're going to do some actual sea lab experimentation and observation . . . it might prove to be one of the standing hallmarks of the Wilderness Medical Society."
Greenway expects it to be standing room only.
However, defining "impact on human health" is not easy. "We can't just focus on ecological issues, because it's just not our focus," he adds. "So somehow we have to tie that to human health. But in that, we're going to talk about all kinds of things."
To me, this sounds like a politically coded way of getting medical and environmental science, as well as medical practitioners involved in the disaster and relief scenarios that result from climate change, involved in the broader issues that are redefining our ability, as the human species, to survive on this planet. In a country as polarized as the U.S., even taking this step would be contentious (as it is now in Canada: all those who oppose the Northern Gateway pipeline are "radicals" funded by "foreign money," according to our honourable PM).
Greenway goes on to play both sides of the coin.
"To quantify that impact [on human health] is really difficult, I've come to appreciate. We all talk about the dangers of the oil spill in the Gulf of Mexico but we don't know at all that it's impacted anybody's human health. It's impacted some birds and a couple of fish maybe, but I don't know what it's done to the humans."
Try saying this to those whose economic health has been devastated due to the loss of the Gulf of Mexico fishery. Entire communities have been left impoverished. And to say the largest spill on record knocked out a couple of birds seems to underplay the extent of the damage. But I see Greenway's point — which is always the failing point of careful science. By the time that slow and steady science has established a definitive link between the persistence of minute oil particles in the water supply and, say, persistent cancer, it can be generations too late.
"This is really a new area for us," says Greenway. "I'm afraid there will be a lot of conservation interest, and not much medical interest, is what I'm afraid of. And we don't want to be PETA. That's not what we do. the problem is separating, at least for me, separating the whack jobs from people who are thoughtful about the impacts on human health. That's always been my cautious foray into environmentalism. There's a lot of heat and a lot of angst and not a lot of science."
I'd rather imagine a point down the road where the Hippocratic Oath is changed ever so slightly, to where the physician's duty to protect the life of the patient includes not just the one body, but the body of the environment that nurtured the patient into being.
Step Right Up to the Magical Medical Mystery Tour...
Out on the patio with Greenway, basking in the sweltering waves of a climate-changed summer, I have been lost in thought again, paused in the middle of a question, and thinking of the volcanic revenge we are all due should the Great One unearth the induction faults — and all I can think about is: if I had to, would I cut my arm off with a penknife?
Greenway is from Utah, as is famed outdoorsman Aron Ralston, who after being trapped by a dislodged boulder in a slot canyon for five days and seven hours, cut off his withered and useless limb with a dull multi-tool. The epic self-rescue was dramatized in the flick 127 Hours, which should all but put anyone off travelling solo in the backcountry. It's probably one of the few flicks I can think of that nearly everyone at this conference has seen (and I'm certainly not going to mention the likes of Cliffhanger).
Thinking about Ralston's ordeal has me wondering what level of first aid I should be carrying into the backcountry. My training, like so many fellow skiers and mountain bikers I know, has long since lapsed. Sure I can tie tight that bleeding stump, but I've gone hazy on the details of chest wounds and spinal fractures. New medical research has also updated standards in basic first aid over the past few years. In 2010, good ol' CardioPulmonary Resuscitation (CPR) even changed its breathing regime, requiring a new, arm-intensive 30:2 ratio of chest compressions to breath ventilations. The old memory moniker of ABC (Airway, Breathing, Chest Compressions) switched up to CAB. And there's a different ratio for children (15:2). In short, my skills are dwindling. Besides getting recertified and taking a Wilderness First Aid course, is the WMS for me? Indeed, shouldn't I, and others like me, get a bit more educated so that should the karma cards come up short, the steps to survival will be clear?
We do, after all, live in Whistler and play on its boundaries. Take a jaunt East or West and it be lonely back there. It is also vast inside the Valley. As I discovered three years ago, even a minor escapade along Cut Yer Bars can result in broken wrists and a careful walk out.
To this end, tuning up with challenging, hands-on wilderness medical education is one of the prime goals of the WMS.
Nurse, turn on the lights — it's DiMM!
In 2005, the WMS launched the Academy of Wilderness Medicine — a series of standards for certified education in wilderness medicine, organized as a modular system of adult education combining both classroom and practice, held to critical standards of academic excellence. In short: you better be good both in the field and in the books.
"Currently, at least in the United States, and I think everywhere, you don't have to have any specific training to hold yourself out as a wilderness medical practitioner," says Greenway, reflecting upon one of the main missions of the Society: wilderness medical education. "If you're a physician, it doesn't matter what your background is, you can say that you're a wilderness medical practitioner without having any experience or formal training in wilderness medicine. The same can be said for mountain medicine."
To this end, the WMS set out to create a diploma program to standardize mountain medicine.
"What [DiMM] will provide is a group of individuals who actually have a codified background and experience in mountain medicine," explains Greenway, "specifically in search and rescue mountain medicine, who have been tested, and who have demonstrated the skills necessary to really know what they're doing in the outdoors."
DiMM is geared specifically to medical practitioners; while doctors receive a diploma; mid-level medical personnel receive a certification, even though the course content and exams are the same. For those with Wilderness First Aid, or who are Wilderness EMTs, this would be a logical next step. Besides the didactic education required in the classroom, the DiMM features hands-on training in the backcountry, blending technical rescue, wilderness medicine and self-sufficiency, while moving through the disciplines of expedition medicine, search and rescue operations, mountain guiding, ski patrol, and mountain recreation. Candidates must also be competent in the backcountry as hikers and basic-level climbers, with snow travel and cold weather camping experience. The DiMM is an internationally recognized certification, satisfying the hard requirements thrown down by the world's guiding associations including UIAA, ICAR and ISMM.
To this end, the DiMM would be a worthy course for a Whistler University — while offering diplomas in tourism and hotel management might satisfy the Bates Motel crowd, expanding any planned higher-education to include in-depth training in wilderness medicine and emergency response would create a whole other level of academic training in the Valley — one that the Corridor (and beyond) needs, and one that Whistler could undertake exceptionally well given its current setting as a DIMMs course location for its outdoor environs.
Though the WMS offers the DiMM through the University of Utah and the University of Colorado, similar training is already available here in Canada through The Canadian Society of Mountain Medicine, which has a DiMM module upcoming from September 9th–15th.
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