Survivor:
Trauma
Rocky Mountain nurse teaches outdoor enthusiasts how to
manage medical crises in the backcountry
By Phil McPeck
December 9, 2002
If practicing wilderness medicine has taught John Bleicher, RN, anything, it is this: Never give up on a trauma patient.
Bleicher, 52, is trauma coordinator at St. Patrick Hospital and Health Sciences Center in Missoula, Mont., and co-founder of Aerie School for Backcountry Medicine, which teaches first-aid, first-responder and wilderness emergency medical technician skills to about 300 outdoor enthusiasts a year.
Course lengths range from a weekend to a month. Some are taught in a formal setting, but Bleicher’s true classroom is the deep reaches of the Rocky Mountains and anywhere hikers, climbers, campers, four-wheelers, hunters, skiers, snowboarders and snowmobilers make their way.
From Montana to Colorado, Washington state and Alaska, Bleicher teaches injury and illness prevention, patient assessment, improvised care, patient management and thought processes in emergency care to recreationalists, people seeking employment as group leaders, ski instructors and river raft guides, and paramedics wanting to add wilderness experience to their résumés.
“Snowmobiling is really on the rise with hypothermia and winter injuries,” Bleicher said. “I’d say we actually have twice as many hurt on snowmobiles as five years ago.”
But the No.1 cause of trauma cases in any season is auto accidents, he said. “We have people on Forest Service roads who are going hunting, driving to go skiing or who live way up in the mountains, and the next thing you know, their car is 200 feet down a ravine in a river.”
Bleicher, formerly the education coordinator for a rural ambulance service, said, “A lot of the people who take wilderness medicine classes have good, basic first-aid skills, but they haven’t taken care of people in life-and-death situations very often. Between being a paramedic and being an ER nurse, I’ve been in those situations a lot.”
As St. Patrick’s trauma coordinator, Bleicher’s role is less that of a clinician and more of a manager responsible for physician assistants, improving quality of care and case review. But in any role, he has never-say-die beliefs about the prevention of accidents and survivability when they do happen in remote areas.
In preaching prevention, he relies upon personal experience as an endurance runner in the summer and backcountry skier when the snow flies. “I went out once skiing. It was 28 degrees. By the time I came home, the wind chill was 40 below. We’re talking a two-hour ski,” Bleicher said.
“Always anticipate the worst. Have an extra layer of clothes, even if you’re going out for just a couple of hours. It doesn’t take that much space or weight. Be able to start a fire and have some sort of signaling device for rescue, be it whistle, mirror or gun.
“People always should carry enough water to get them through the day if they’re not going to be near reliable sources of drinking water, because being dehydrated is one of the main causes of becoming hypothermic and it’s a real complicator.”
In teaching survivability, where wilderness and winter compound medical crises, Bleicher calls upon his knowledge of anatomy and physiology from the nursing degree he received from Northern Montana College in Havre.
When a snowboarder falls and hits his head on a rock, an Aerie School-trained caregiver will be concerned not only with bleeding, but also internal injuries and hypothermia, Bleicher said. “Time to treatment and hypothermia work against healing.”
The experience of a woman last year reinforced Bleicher’s belief that you never give up on a patient, especially in trauma.
“Sometimes you get fooled,” he said
“We had a lady come in profoundly hypothermic. She had gone on a hike and we believe had gotten lost and fallen. It was amazing that she actually got here alive.
“We developed an algorithm for hospital treatment of hypothermia,” he said, but, “We don’t do these things a lot, so it’s always a challenge. We don’t see 10,000 patients a year. We only admit 300 trauma patients a year.”
Through external and invasive rewarming—peritoneal, chest tube
and bladder lavage—the woman survived. “She was actually discharged
from the hospital neurologically intact four days later. It was really
cool to be a part of that,” Bleicher said.