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Backcountry Medical Guides
By Scott Surface

John demonstrates CPR hand positioning on a manikin. Photo: Jeff Howard

It’s a Saturday morning in early June, I find myself on my knees, arms locked and fingers intertwined, as I thrust downward with concentrated intensity on the rib cage of a cold, gray torso. Sweat starts beading on my forehead as I count 22, 23, 24… to 30, then administer two rescue breaths.

“Faster guys!” exclaims John Taussig, founder and lead instructor of Backcountry Medical Guides (BMG), “you’ve only got ten seconds between each set of compressions before the organs start to fail due to lack of oxygen.”

After two minutes of simulating CPR on the manikins, Taussig cues us to stop and launches into a story about his first EMT call in response to a heart attack.

“I arrived on the scene to find an elderly man on the floor at a family gathering,” Taussig recalls, “After a quick assessment, the lead EMT on scene told me to start compressions as he prepared the breathing bag. The feeling under my hands as I administered those first few thrusts was so unexpected and disturbing that I completely froze up. With the family hovering behind my shoulders, and every ounce of hope hanging on our performance, I almost panicked.”

“Snap, crackle, pop,” John continues matter-of-factly, “you’re probably not going to be effective if you’re not crunching the chest during the first handful of compressions. Don’t be afraid to push hard and push fast.”

This anecdote was the first of many that Taussig shared with the Wilderness First Aid class in Big Sur weekend, effectively cementing the importance of mental preparation and proper technique. I found it striking that, throughout my six years as a lifeguard, no previous instructor had provided such a vivid example of a real emergency situation.

Stunning views and blue skies make for an ideal Backcountry Classroom. Photo: Jeff Howard

Winding along the rugged Vicente Flat Trail, Big Sur. Photo: Jeff Howard

Following the brief classroom introduction and CPR training, we hiked down to Sand Dollar Beach, where the early summer sun had just begun to bake the fine white sand and illuminate the cold, turquoise waves lolling about the Pacific. The next few hours were spent running through lectures on traumatic injury, interspersed with mock cardiac arrest and cold-water rescue emergencies, before we moved to a rock face bordering the beach, forcing us to take into consideration a range of new factors.

The minute differences in each unique scenario location clarified the importance of scene and patient assessment, topics which were heartily drilled into us until late afternoon. As the sun shifted toward the horizon, we secured our packs, filled our Hydrapaks, and set out on the five-mile hike to Vincente Flat. The trail to BMG’s backcountry classroom rises abruptly from Highway 1, immediately giving way to dusty switchbacks and spectacular views.

We fell into an easy rhythm in the evening heat and John broke into another story as he lazily swung a dirty machete through the encroaching weeds. Suddenly I heard a loud cry from the front of the group and saw a spurt of blood trigger from John’s arm. A surge of adrenaline rocked through me, and though it took only a few seconds before I realized that he had staged this incident, the emergency response gene had been triggered.

I ran to his side and clasped both hands above the ugly Halloween-store mock-wound to cut off circulation (not an entirely correct technique, but better than nothing) and shouted for a fellow student to grab the first aid kit. We then applied gauze, put pressure on the wound, and rapidly twisted a tourniquet into place.
By the time we arrived at Vincente Flat it was an hour past dark and a much-welcomed wind was flowing through the warm valley. We quickly kicked off our shoes, scrubbed down in the pristine creek and made camp for the night. Like any good outing in the backcountry, our dehydrated meals never tasted better. Hunkering down by the fire we shared stories and laughs until the Milky Way lulled us to sleep.

Taussig’s passion for the field of emergency medicine blossomed early, as he began teaching CPR and First Aid for the American Heart Association shortly after arriving at college in Bozeman, MT at the age of 19. For the past twelve years the charismatic and mild-mannered Santa Cruz resident has served as an EMT and paramedic from Monterey County and Big Sur, to Jackson Hole, Montana, and Washington. Naturally, his fascination with emergency medicine and love for the outdoors lead to a dedicated study of wilderness medicine.

When John founded Backcountry Medical Guides in 2010, his goal was twofold: he wanted to offer a range of courses for medical professionals as well as average backcountry enthusiasts, which would provide a summation of the most current information in the dynamic field of wilderness medicine, and he sought to assemble a staff whose first-hand experience would offer invaluable insight and perspective. Today BMG provides students with realistic wilderness scenarios as they participate in a range of activities—including backpacking, surfing and climbing.
Big Sur is ground zero for the majority of BMG classes, as it remains a land of true isolation, chock-full of breathtaking scenery and adventure. Along the 90 miles of coast line there is little, if any, cell service, providing minimal value in the rugged backcountry if an accident does occur. Even the majority of road side locations are an hour or so away from the help of first responders—the perfect location for total wilderness emersion.

John and his roster of talented paramedics, MD’s, RN’s and EMT’s pride themselves on their ability to create scenarios that are challenging and charged with the energy of a real emergency—sometimes to the point of nausea for those, like myself, who have an aversion to blood. After each mock accident John would give us the opportunity to review our performance and self-assess how we could be more effective the next time around, before offering his own insight into the response situation.

Technology and hands-on learning blend together seamlessly in John’s course. Photo: Jeff Howard

On the second day of the course we awoke early and jumped back into the fast-paced curriculum, this time under the shade of massive redwoods. John led off with a lecture on first aid, and as we bandaged and set faux injuries, I found my new favorite backcountry tool—the incredible SAM splint. This handy malleable split proved its merit on the sweaty hike out, as we were confronted with yet another series of disasters of varying severity.

Considering that participation in backpacking increased 30.4% from 1994 to 2004, and that interest in sports such as kayaking, climbing, rafting, snowboarding, mountain biking and surfing continues to rise, it is no surprise that, so too, are the numbers of people getting injured.

While Traditional First Aid focuses on common medical and trauma injuries, CPR, and the 911 system, a Wilderness First Aid course will provide training for a plethora of challenging variables including environmental considerations, extended care, infection, reductions, improvised equipment and search and rescue⎯essential tools for anyone who ventures into the backcountry. The critical judgment skills developed will not only empower individuals to recognize and prevent hazardous situations, but to respond effectively if faced with an emergency.

I came away from the weekend feeling tired and sore, yet empowered with the knowledge that I had improved my ability to think through complex situations, while enhancing my chances of survival if things were to go wrong. There is no definitive assurance of safety when heading into the backcountry, but that might be part of the allure. Enjoy testing your personal limits in the outdoors, just do it smartly. As the BMG mantra states, “Knowledge is Key”.
In addition to the Wilderness First Aid course, BMG also offers highly acclaimed courses for medical professionals, including Advanced Wilderness Life Support, Wilderness First Responder, Maritime Medicine and an EMS Environmental CE series. Visit www.backcountrymedicalguides.org for more information.
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Upcoming Wilderness First Aid courses in your area:

• NOLS: REI Outdoor School
www.nols.ed
Sacramento, CA
August 11-12

• Foster Calm
www.fostercalm.com
Mill Valley, CA
August 25-26

• Wilderness Medical Associates

www.wildmed.com
San Diego, CA
September 8-9

• NOLS: YMCA Camp Surf
www.nols.edu
Manhattan Beach, CA
September 8-9

• Backcountry Medical Guides
www.backcountrymedicalguides.org
Big Sur, CA
September 21-23

• Backcountry Medical Guides:
Wilderness First Responder
Big Sur, August 11-19
Lake Tahoe, August 25- September 2

Basic Backcountry Safety Tips

– Dress accordingly: Make sure your clothes are suited for the environment you are entering, proper footwear, wicking synthetic layers and waterproof outerwear is a must. Remember cotton kills!

– Check your equipment: A pack, tent, sleeping bag, or stove could leave you in a serious predicament if its integrity is compromised.

– Carry the necessities: A map, compass, water-proof matches, pocket knife, flashlight or headlamp, insect repellant, duct tape, sunscreen, a mirror and whistle, and extra food are a must for every outing, no matter the length.

– Pack a foolproof first aid kit: Make sure to include biohazard bag, latex gloves, micro (face) shield, thermometer, a range of sizes of gauze pads and band aids, opsite transparent dressing, steri-strips, gauze roll, tweezers, cravats, oval eye pads, safety pins, 12cc syringe, Bactracin, Benzoin, Betadine, scissors, ace bandage, athletic tape, moleskin, adhesive knit (Source: NOLS Wilderness Medicine)

– Hydrate consistently: During hotter months this means at least one gallon per person per day. Iodine tablets and water treatment systems are a must for longer outings.