Remote Location "Medical Clinic"

[Hooch.NREMT]

Hey All... its been a few years since I have been on here. Im getting ready for the summer coming up, and I wanted to get some input from you guys on here on what you would consider.

Little background on me, I have been an EMT for nearly 10 years, certified in 3 states as well as NREMT. I have worked Urban and Rural 911 Services. I am also a Search & Rescue Team member/tracker. I have been backpacking since I was a kid. I am a Camp Medical Director in the summer for a camp in the North East.

The camp i work for is holding its first long term camping expedition this summer. We have 20 youth who have signed up, with 4 other staff. We will be going out for 60 days, setting up base camp for 10-15 days in each location. We will be using a few horses to carry the base camp supplies and gear. In addition to reviewing and becoming familiar with the medical files of 24 individuals, I have to plan for and set up the base camp "clinic", Besides the basic supplies and equipment, I will be using a separate tent to house the "clinic" storing the medical supplies and 2 cots for sick bay. I have a general sense of what I will be taking and will be creating a check list in the next few weeks.

I would like input from any others who have done expeditions on what you would take. Im sure ill see a few things that i didnt think of. Alot of the stuff I plan on taking are multi function. Feel free to tell me your thoughts. type of tents, type of supplies or equipment. I will be using one of the horses to carry the medical supplies and such, I will be carrying my personal stuff in my own backpack.

[Just Plain Ruff]

First question, how remote?

Second question - how remote and how will you contact EMS for Evac?

[island emt]

How far are you traveling?

How old are the Kids?

Do you have a release from the parents for medical treatment if needed.?

Do you plan to have a way for a sick camper to be evaced out to a hospital along the route if needed from any point along your travels?

Are you hiking the Appalachian trail by chance?

I'm thinking your adult to youth ratio is a little lean.

[Hooch.NREMT]

The youth are ages 15-18, a rather older age group. We will be in the Adirondack Park, primarily in the Stillwater Reservoir Region. The trip leader is actually still recruiting some staff. I will be carrying a radio for rescue contact if needed, some of the higher points in the region offer signal on cellphone. There are a few options for evac in the area, ranging from walking the casualty out at the least, to airlifting them out. In all honesty, in remote medicine, trying to have a contingency plan for everything just isnt worth it. Ill have the daily minor issues covered as well as a general worse case scenario. But for the most part, there is a good pool of resources to utilize if the need arises. The fastest evacuation time in general is going to be about 6 hours, being that the Air Medivac in the region currently do not have hoist ability unless the USCG on Lake Ontario does an inland mission, and large enough LZ's for a Medivac will usually be some distance from the casualty.

[triemal04]

Knowing how you will get any sick/injured person out of the area and on the road towards a hospital is your first priority; once that's taken care of you can start deciding what is/isn't really neccasary.

I don't know anything about there area, but when you say the fastest evac time would be 6 hours, have you taken into account what the available local resources would be, including what the nearest hospital is like? (depending on that and what was wrong you might be going further) Are there local search and rescue teams? How quickly can they mobilize? What are their capabilities? Could you potentially get the coasties to come? What would it take for that to happen? Do you have a litter that can be dragged by a horse? Do you have a saddle/soft saddle for the horses? Do you have a litter or other object that could be carried by the rest of the campers? (self-rescue would be best, and given that you have those nice 4-legged friend available, your best option)

As far as any equipment goes, unless one of the campers has a specific illness that needs to be catered to, nothing fancy.

[Just Plain Ruff]

The other thing you have to think about is how many of your people will it take to get the injured/sick person to the rescuers. If you have let's say 6 staffers for 20 campers and it takes 4 staffers to evac the injured one out, how many do you have left to watch the existing campers.

Do you continue to move on in your hiking or shelter in place until the adults return from the evac?

Just a thought.

[scubanurse]

Do you have a medical director for this trip? Someone who can authorize PRN OTC meds? Sat phone to contact a doctor if needed? Years ago I was a W-EMT through NOLS and it was a great course I highly recommend taking. Keep everything you take light. You don't want to be lugging a heavy bag around with pointless stuff. SAM splints are your friend, plenty of triangle bandages, a few big gauze dressings for compression bandages, and OTC meds. Athletic tape isn't a bad idea if you know how to tape ankles since commonly on trips like this, people will twist an ankle or two.

[DwayneEMTP]

I'm not trying to bust your chops, as this sounds like an amazing trip, but how do you plan to manage worst case scenario without IV fluids and/or significant pain management at the EMT-B level with a minimum evac time of 6 hrs?

[ClutzyEMT]

I agree, it sounds like an amazing trip but I tend to be a little concerned with your comment stating that a 'contingency plan' is not worth it...

How well is this trip planned? Sounds like you will be moving every 15 days or so. Do you know where you are moving to or is it just a random "pick up and move camp"? Is it possible to pre plan the move and also map out a camp next to an area where it would be possible to land the bird in the event "the unthinkable" happens and you don't have 6 hours to wait?

Trying not to be a 'downer' or judge you but even in the best of circumstances, things can go wrong in a heartbeat. If it were me as "Camp Medical Director" I would want a lot of input into where we are headed and how we are going to evac a patient immediately in the event of a life threatening emergency happening.

I am speaking from a bit of experience of having been the only EMT on a "wilderness trip" many, many years ago into a dense forest area in Minnesota. Things were moving along great until the sixth day around dark thirty when one of the horses was either spooked or bitten by a bee (we never figured out what happened) and ran over one of the campers while it was bucking and trying to toss off its load of camping gear. This was a horse that had been packed on and ridden for ten years and was as solid as the ground just to give you a clue as to how well we thought our best thought out plans were.....while trampling the camper, the horse stomped on her head just above her ear. The shoe of the horse, or perhaps a rock lodged in the shoe, sliced her scalp from the top of her ear to the bottom of her chin as the horses weight came down on her head.The weight of the horse also crushed her eye socket, cheekbone, and jaw. CAT scans later showed bits of bone lodged in her brain. She never did wake up and eventually her family made the decision to discontinue life support and donate her organs.....

At the time we didn't carry cell phones or radio's and getting her out of the area we were in, in the dark, without a travois, (we fashioned one out of a cut up tent and rope) no c-collar (rolled up towels and two of us taking turns 'riding' on the tent with her holding c-spine as best we could) and no BVM to assist respiration (mouth to mouth all the way), it took over four hours to get her to an area where a rig could pick her up and transport her.

If I had it all to do over again, you can bet we would have had Contingency plans in the event of an emergency or life threatening event. You can bet I would have had some more emergency gear along, and you can bet to this day I wouldn't wonder if we had gotten her out sooner and gotten her to a more definitive point of care if the outcome wouldn't have been entirely different.....

So when I caution you about not having contingency plans and stating that they are 'not worth it', I also caution you that in essence, you are saying that the life of one of those entrusted into your care for those 60 days, is not worth it......and you just might be sleeping with a ghost for the next 30 years of your life as well...........

Edited March 17, 2013 by ClutzyEMT