Last Updated: Dec 15, 2021
Your subspecialty in wilderness medicine is one many
may not have heard of before. Can you tell us about
this specialty and what motivated you to pursue it?
Wilderness medicine is basically medicine in a remote or austere environment
with low resources. I was introduced to the specialty when I was a fourth-year
medical student at Vanderbilt. I took a wilderness medicine course for fun
through the Wilderness Medical Society. I showed up in simply a sweatshirt
and rain jacket. Turns out, I was grossly underprepared.
I had an absolute blast! I learned so much from not only the volunteer faculty
but also the group of students I was with. My backpacking group included
three Eagle Scouts and a flight surgeon!
During residency, I did a couple of unique rotations as part of my elective time,
exposing me to medicine in different environments. As a second-year resident,
I went to Alaska with the Indian Health Service and rotated there for a month in
a rural setting. During my third year of residency, I traveled to Guyana in South
America for a rotation at Georgetown Public Hospital. It was a very different
experience in an urban environment with a different availability of resources,
which required a very different skill set.
What interests me in wilderness medicine is that I love that almost minimalistic
approach to medicine and really having to be facile in these different skill sets
to treat in a variety of conditions in unfavorable circumstances.
After residency, I completed a year-long fellowship in wilderness medicine at
Massachusetts General Hospital in Boston. I spent three months in Nepal in
2015 working at high altitude clinics—one was at 12,000 feet and one was just
below 16,000 feet. The experience was interrupted by the 7.8 magnitude
earthquake that hit Nepal in 2015, so we spent the final month of our rotation
doing unpredicted disaster relief. I was involved in managing a field hospital
for perioperative orthopedic and surgical patients volunteering with a
non-governmental organization. It was a very enlightening experience.
In the field of wilderness medicine, there is an emphasis on improvisation,
critical thinking, resourcefulness, and tenacity. My very first patient at the high
altitude clinic, before the doors of the clinic even officially opened, was a man in
a nearby village who was suffering from high altitude pulmonary edema. It took
us about 40 minutes to trek down to him in the snow. When we got to him, his
oxygen level was 48 percent on room air (at the altitude we were at, normal is
about 89 percent). Even once we put him on supplemental oxygen, it only came
up to into the 60s. So, we had to think: How are we going to safely get him back
to our clinic so we can put him on continuous oxygen while waiting until we
can get a helicopter to evacuate him? Every time he’d lie back, he had trouble
breathing because his lungs were filled with fluid. He was very tired. He couldn’t
walk. It’s very hard to carry someone in that snow. We ended up using the bike
I had trekked down on to guide him back to our clinic. In wilderness medicine,
you have to think quickly, creatively, and efficiently.
Can you tell us a little about your experience educating
medical students? Why did you establish the Wilderness
and Environmental Medicine elective at Sidney Kimmel
Medical College (SKMC)? Can you tell us a little bit about
the elective’s focus and what students are learning?
All of my experiences have helped solidify my love for education, wilderness
medicine, and humanitarian medicine. In my academic career, I’ve focused
on becoming a clinician educator in the field of wilderness medicine.
The Breckenridge Wilderness and Environmental Medicine elective at SKMC
was started by myself and Dr. Josh Rudner, who was really the impetus to
making the elective happen. We had a more senior mentor, Dr. Liz Edelstein,
who serendipitously was one of the course directors when I took a wilderness
medicine course as a medical student. We all worked together to make this
happen, partnering with the Wilderness Medical Society and the Breckenridge
Outdoor Education Center.
It’s a four-week elective where a group of senior medical students get the unique
opportunity to have an immersive experience that provides a comprehensive
introduction to the field of wilderness and environmental medicine while gaining hands-on experience and exposure to skills required for expedition planning,
rescue, and wilderness survival. We have about 20 volunteer faculty who are
heavily invested in education, and creating a rich curriculum. We challenge
the grit of the students, sometimes waking them up at 5 a.m. to run medical
scenarios or running simulations under harsh weather conditions as well
as running mass causality scenarios.
Despite its rigor, it’s a wonderful experience for the students, many reporting
it is one of their most memorable experiences in medical school. The first
two weeks is spent in Breckenridge, Colorado, at an altitude of 10,000 feet.
The students get an immersive experience in alpine medicine. The first half is
focused on didactics on core principals and skills sessions including instruction
on thermal wraps, evacuation, improvisation for splints, etc. Then, we put them
into experiential learning situations through different simulations. Our night
scenario takes advantage of the surrounding alpine environment, where
students perform a search and rescue of several victims buried in the snow in
the mountains. Students are in the elements trudging through the snow in 20
degree weather trying to locate victims, provide treatment, and perform an
extended evacuation. During the second half of the elective, we head to the
deserts of Utah for an immersive experience in desert medicine. The contrast
between the two environments helps expose the students to
a diversity of conditions. This backcountry portion focuses primarily on
experiential learning with in-the-field scenarios.
Can you tell us a little about your experience with
Philadelphia’s Regional Rapid Response Healthcare
Collaboration during the COVID-19 pandemic? How do you help
assist with emergency preparedness and education efforts?
I was asked to become involved by a colleague, Dr. Effe Kean. She was working
with the Regional Response Health Collaboration Program to assess residential
care facilities with COVID-19 outbreaks. I’d go to the facility and do a site visit
and a needs assessment, and then coordinate efforts with our team to
support the PPE, training, testing, and staffing needs of the facility.
During one site visit, there were about 60 people living in a facility. At first,
only a handful of people tested positive for COVID-19. A couple of days later,
testing revealed that nearly everyone in the institution had now tested positive
for COVID-19. We worked with them to employ the National Guard who helped
administer medication, preform vital sign assessments, and help in any other
way they could including delivering meal trays to rooms to assist with
It was very rewarding to watch this facility come out of this tenuous situation
and hear their appreciation. Just being able to offer these vulnerable sites
help at a quick pace and see the change was very rewarding.