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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.
Contact Phil McPeck at getpjm@aol.com.
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