Pushing the Limits of Treatment in Rural America

“We were immersed in smoke, the fire alarms were blaring, the adrenaline was pumping, people were screaming for help. We walked through dark classrooms, looking for victims.” First-year student Jordan Wilkes described the scene he encountered while at an elementary school in Baggs, Wyoming. Despite knowing that this scenario was not real, it didn’t stop students from feeling tense, panicked, and more than a little emotional. With the rise of school shootings in our country, this scene is becoming terrifyingly common. With victims being portrayed by both adults and children with realistic wounds, the situation felt very real to the students: “The school shooting scene was close to home and it made me truly imagine that this could be a very real situation for any of us. The acting and moulage made the experiences that much more real, as well. I couldn’t believe I saw blood squirting out of limbs, but it could very well be what we see during a mass casualty incident.”

The shooting scenario was one of three scenes created for students during the weekend in Baggs. This annual training exercise is offered to students in the Rural and Wilderness Medicine Track to introduce them to the concept of physician-as-first-responder. While many physicians will never experience being a first responder on a scene, that is not the case for rural physicians. Oftentimes, they are one of the first (and maybe the only) medical personnel at the scene of an accident or disaster. The students worked closely with EMTs from Little Snake River EMS, firefighters, and law enforcement, similar to a real-life rural emergency.

During the shooting scenario, students unexpectedly grappled with an ethical issue: prioritizing and treating the shooter. “As we moved patients out of the school,” described SD Wilkes, “the wounded and handcuffed shooter was lying next to the treatment area. Most of us passed by [him] as we transported patients. It took us a while to want to help the shooter because we felt more of an obligation to help [the] victims…even though some of their wounds were not as serious. By the end of the scenario, though, we realized that the shooter was still a patient that needed our attention.” Multiple students reflected later on having to come to terms with “treating the bad guy.”

During another scenario, students were informed that an explosion had taken place at an oil and gas facility. Upon arriving in an ambulance, they found victims with burns, carbon monoxide poisoning, broken arms, disorientation, and more. Students learned to triage and prioritize patients, determine the mode of transport (ambulance or helicopter), and to work on a medical team, all while factoring in environmental hazards, working in tight or potentially dangerous spaces, dealing with distractions, and more. “I learned how difficult it is [to] arrive on a scene and take a minute to check if the environment is safe,” said Rebecca Grenvik, OMS I, who was chosen as the incident commander for the first scenario. “I wanted to run and find a patient to care for but had to stay back and strategize how to communicate with each team of responders. It was great to have that leadership opportunity to really test my skills.”

While not participating in a scenario, many of the first responders also took time to teach the students important skills. “I was taught how to start an IV and intubate a patient, which I didn’t expect to learn for years!” said SD Grenvik. “[They] were beyond amazing…always excited and eager for us to learn everything we could. I wish I had more time to listen to their experience and soak in more knowledge from them. I have a newfound respect for [first responders] after spending time with them and seeing firsthand how much they do for the patients and how much incredible knowledge they have. I would not trade this experience for anything…it was hands-down the best experience I had during my first year of medical school!”