Every year, second-year students from the Rural and Wilderness Medicine Track (R&W) trek into Castlewood Canyon State Park to partake in their annual Orienteering course. With only a map and compass to guide them, students must use their navigation skills to search for “injured” hikers hidden among the mountain junipers and towering boulders. The course is designed to prepare students to practice medicine in rural and remote areas and to test their ability to communicate efficiently as a team and coordinate treatment in high-stress situations.
As the students embarked from their designated trailhead, six “patients” took their places at the scene of the simulated accident: a rock slide that had caught hikers and mountain bikers by surprise. “Caroline,” one of the patients suffering from a head injury and broken arm, had rolled down to the edge of steep cliff. She felt disoriented and her arm sported a large bruise accompanied by a sharp, throbbing pain. Was her family nearby? Where were the other hikers? Despite the pain, she started noticing small details, like a yellow jacket that periodically buzzed by, a spider that crawled towards her, and crows circling overhead. She thought maybe she could use her reflective water bottle to signal for help, or at the very least make some noise by banging it on the boulder behind her.
After what seemed like hours, Caroline heard the distant sound of voices. Somebody she could not see started calling out for help. Suddenly, the student doctors emerged from the woods directly across the riverbed from her. They quickly navigated around the boulders and fallen trees and, upon reaching Caroline, immediately started assessing her physical injuries. They asked her if she knew where she was, if she remembered what had happened, if she felt dizzy, if she knew her name? After stabilizing her arm with a splint, they carefully pulled her out of the canyon and guided her to a safe area. The student doctors reassured her they were doing everything they could to rescue everyone, and continued to assess her injuries.
One by one, the students evacuated all the “patients.” Other traumatic injuries included a man who had an open fracture that was bleeding significantly and required a tourniquet, a young woman who had fallen on rocks and had bruising and abrasions on the anterior and bilateral abdomen, and a middle-aged man experiencing chest pain. In a medical emergency, physicians must assess a victim’s external and internal injuries, and state of mind, as well as evaluating the safety of the surrounding environment. Patients are often confused, scared, and overwhelmed in emergency and disaster situations. A physician who is both clinically competent and compassionate will be able to quickly gain control of a situation such as the one simulated for the R&W students. Ultimately, the goal of the Orienteering course is to provide a comprehensive, simulated learning experience and enhance the navigation and emergency medicine skills of the future physicians.