Johns Hopkins medical students don't grow on trees,
but in the woods of Catoctin Mountain National Park last
week, it looked like they were falling from them.
The students, in reality, were acting the roles of
victims who had just plummeted from a scenic overlook.
Fellow students, playing the part of first responders,
knelt over the "motionless bodies" of their classmates and
were instructed to perform such unwelcome measures as
pulling a hair from the fictitious accident victim's wrist
to gauge his or her response level.
"Do they respond to that?" asked Bill Kane, an EMT and
education director with Solo Wilderness Medicine. "No?" he
laughed, as the victims cried out in actual pain. "OK, then
let's give them the sternum noogie."
Sternum noogies, which look like they sound, were
followed by respiration checks, searches for pools of blood
around the victim, pulse-taking and "chunk checks," in
which students felt down the length of the body looking for
anything out of the ordinary.
The afternoon's learning exercise was just one part of
the School of Medicine's new Wilderness Medicine course, a
two-week elective designed for those interested in
preparing for real-life emergency situations out in the
field and away from medical facilities.
Through classroom lectures and in-the-field clinical
scenarios, the students are taught various wilderness
survival skills, search and rescue procedures, exotic
travel planning and a host of techniques to manage common
illnesses and injuries in an austere or remote environment
with limited resources, whether it's a desert or an
Andrew Krakowski, coordinator of the course and an
assistant resident in the SoM's Department of Pediatrics,
said that the elective provides an opportunity for students
to get out of the classroom and into the field, where they
can apply what they have learned.
"It's a chance for students to see that there are
clinical applications, even with the somewhat limited
amount of knowledge that they have as second- and
third-year students," said Krakowski, who participated in a
similar course when he was a third-year medical student at
the University of Pennsylvania. "There are things they can
do to help people who have perhaps hurt themselves in a
rural setting, where the nearest hospital might be three
hours away. Sometimes they don't know how much they know
until they see how they can avail themselves in the
Course coordinator Andrew
Krakowski, second from right, with teaching assistants
Zubin Vasavada, Andrew Shannon and Emmy Betz.
PHOTO BY HIPS / WILL KIRK
For the two-week period, Krakowski and 22 students
have based themselves in the small camp at Catoctin
Mountain Park, which is located approximately 90 minutes
northwest of Baltimore. The students, who likened the
experience to camping, live in dormitory-style lodging,
where they cook and clean for themselves and immerse
themselves in the wilderness experience, taking part in
late-night fire circle chats or watching wilderness-related
movies such as Deliverance, Alive and Touching the Void.
The lectures, which are given by 12 medical and public
health faculty members and a half-dozen guest experts, take
place in the camp's conference center. The practical
sessions of the course are held in the extensive
recreational and hiking areas of Catoctin Mountain Park and
the Catoctin Wildlife Preserve and Zoo.
Students begin the course with an introduction to the
content and a lecture on how to prepare for a trip in the
wilderness, including bringing along proper gear such as a
flashlight, compass, map, raincoat and iodine tables to
Next, students begin to learn how to handle themselves
in specific situations, such as coming across someone who
has fallen down a cliffside, been bitten by a poisonous
snake or spider, been shot in a hunting accident or even
been struck by lightning.
"We even talk about what to do when a bear actually
starts running after you," he said. "Do you play dead, or
turn around and scare the thing?"
Krakowski said it depends on the bear.
"Well, grizzly bears are carnivores, so they don't
care if you are half dead or dead; they will devour you,"
he said. "Black bears you might try to run from, but they
are fast and they are agile — they can climb trees.
One of the things that is becoming more understood is that
bears sometimes respond to your confidence. If you can turn
around and scare it, the bear might walk away and count its
But, he adds wryly, you're out of luck if it doesn't.
Students are also taught about environmental illnesses
such as hypothermia, severe sunburns, frostbite and
high-altitude disorders. In the realm of infectious
diseases, the students learn about tick-borne illnesses,
malaria and types of parasites and protozoa.
On the legal side of the things, the course also offers
lectures on laws and ethics in the wilderness, including
such topics as standards of care, duty to act, patients'
rights and good Samaritan laws.
"Sometimes people don't want to be helped, and you
have to deal with that," Krakowski said.
On Wednesday, Bill Kane from Solo taught the students
such techniques as the single-person log roll, beaming
(picking a person up as he lies) and decrumpling, which
involves stabilizing a person's body that has fallen and
come to rest in an awkward and unsafe position.
Emmy Betz, a fourth-year student and teacher assistant
for the course, said that one reason she enrolled is
because she always wondered what she would do if she were
far away from health care and needed to help someone.
The class, she said, has taught her about how to
improvise medical equipment, the multiple uses of common
drugs and the importance of such items as a waterproof
"You never really think about how you would assist
someone if you were all by yourself," she said. "It will be
interesting now to go back to class with a new take on
medicine, like what you can do with a ballpoint pen."
What can you do with a ballpoint pen? As an extreme
measure, you can insert it into the patient's adam's apple
like a straw to help him breathe.
Adena Greenbaum, a second-year student, said that she
has always been interested in wilderness medicine and was
excited when she heard that Johns Hopkins was starting a
course like this.
"It's great," she said. "It's about how you can think
creatively and outside the box when you don't have all the
fancy medical equipment around, just whatever you might
have on your person or in your first aid case."