Diary: A Pittsburgh Wilderness ER Doc in Wales

--Keith Conover, M.D., FACEP

November, 1999

WEMT field exercises, Wicklow Mountains, south of DublinSeveral years ago, I was invited to the U.K. to give a presentation on the Wilderness EMT program developed by the Wilderness EMS Institute (WEMSI), an organization I head. This was at the annual conference of the Mountain Rescue Council of England and Wales, in Cardiff, Wales. The presentation was well-received – enough so that I was invited back the next year: I was privileged to be one of two keynote speakers at the first joint Irish/U.K. mountain rescue conference, held in Dublin. The other keynote speaker was Mary Robinson, then the Irish President, and now the U.N. High Commissioner for Human Rights. Several other WEMSI staff people traveled to Dublin to give presentations at the conference. Also, the week prior to the conference, we took a week of working vacation to help the Irish Mountain Rescue Association run WEMSI Wilderness EMT and Wilderness Command Physician courses in the Wicklow Mountains just south of Dublin. This worked out quite well, because the night before the conference, the Dublin-Wicklow Mountain Rescue Team rescued a photographer with a broken leg from the mountains, and I was able to mention their use of WEMT skills during my keynote address. (No, I didn’t pay the photographer to go out and break his leg!)Irish Mountain Rescue WEMT Course, Irish Air Corps helicopter inserting student team into field

For each of the next three years, the Irish Mountain Rescue Association (IMRA) continued to run courses. Held in the Wicklow mountains south of Dublin, each years’ course had a fair number of attendees from other countries, including the U.K. Each year, several of us tok a week of our vacation time and flew "across the pond" to help IMRA with these Irish Wilderness EMT/Wilderness Command Physician classes.

This year, IMRA decided to take a rest. But Dr Jel Coward, a GP (family practitioner) in North Wales, who took WEMT and WCP courses in Ireland, decided to be the medical director for the first U.K.-based Wilderness EMT and Wilderness Command Physician courses. There are three of us coming from the U.S. to help Jel with the course. Jack Grandey is a STAT flight paramedic, long-time supervisory cave rescue instructor, and for many years the Operations Director for WEMSI. Jack’s wife Emily is a third-year internal medicine resident at Mercy.

Mercy and WEMSI offer a special rotation for R-2 and R-3 emergency medicine residents once a year – this rotation is designed to outfit residents to be the medical director for a wilderness search and rescue team. The centerpiece of this rotation is to participate in a weeklong Wilderness EMT and Wilderness Command Physician program.

Although the rotation is limited to emergency medicine residents {if you are NOT an emergency medicine resident please don't bother calling or emailing about resident or medical student training opportunities here in Pittsburgh -- other than the standard WEMT and WCP course, information available at http://www.wemsi.org, and the various other opportunities posted by the Wilderness Medical Society at http://www.wms.org, I know of no other training opportunities}, Emily has long experience with prehospital care, has completed a Base Station Course, is certified in cave rescue, and is a Mercy resident – as well as being married to WEMSI’s operations director. So we made an exception, and graciously allowed Emily to do the rotation the month of November. The fact that we would then have a resident for slave labor at the Welsh WEMT/WCP course made not the slightest difference at all in our decision.

Wednesday, November 3:

Work overnight in the ED at Mercy Main. Have a very good night for the first time in about a year. (Good night = get to go pee. Very good night = get to pee AND get to eat dinner.)

Thursday, November 4:

Sleep for about four hours.

Prepare handout and presentation, and give EMS Grand Rounds at Mercy Providence Hospital. The ACEP ED Information Systems Symposium is next month.

Recently found out that they want the handouts for my lectures BEFORE I’ll be getting back from Wales. Get every handout done except for one, and give them to my wife to be emailed and snailmailed.

Help take care of baby (our 4-month-old).

Sleep a few more hours.

Friday, November 5:

Get up at 7:30 AM. Pack. Get to airport, meet Jack and Emily — fly to Philadelphia, then on to London’s Gatwick airport. Get to sleep an hour or two, fitfully, on the plane.

Saturday, November 6.

Keith snoozing in Royal Orthopaedic Hospital libraryEmily snoozing iin Royal Orthopaedic Hospital libraryArrive at 5 AM local time. We are met by Simon Ross, a whitewater canoeing instructor from the outdoor school that’s helping sponsor the North Wales Wilderness EMT and Wilderness Command Physician courses. The Land Rover broke, so he’s got a small sedan – and with all of our search and rescue gear, medical kits, and the LCD projector, we’ve got a lot of gear. Manage to get some of the gear packed onto the roof rack and with only minor squeezing fit all four of us and all the rest of our gear in the car. Head out for a two-hour drive to Birmingham, where Jack and I are scheduled to give a lecture on wilderness EMS for the Faculty of Prehospital Care, Royal College of Surgeons. Jack and Emily pile into the back. I have to sit in the front and navigate. Simon hasn’t been to Birmingham before, and has no idea where the hospital is except for the address on the conference announcement and an email about the best route. Luckily there is a current UK motoring atlas in the glove compartment, and eventually I figure out more or less where we’re going – the Royal Orthopaedic Hospital in the southern suburbs, a small hospital dedicated to special orthopedic operations. I have to stay awake and navigate while Jack and Emily snore in the back. Hmph.

Find the hospital, first try – get there about 11 AM local. We drag all of our gear from Simon’s car into the research/teaching building at the hospital. Jack starts setting up the computer and LCD projector. I grab a ThermaRest pad and sack out in the corner of the library for an hour. Emily also grabs a few winks.

Unusually for Jack and me, the lecture goes off flawlessly. We alternate 15-minute segments, we keep on time, none of the computer equipment explodes (remind me sometime to tell you stories about our lectures in Dublin a couple of years ago and the amount of electronic gear we managed to destroy either right before or during presentations). Despite our anxieties about presenting topics like reducing dislocations and clearing the cervical spine in the field, the lecture is quite well received – many good questions afterwards.

Jel's houseJel's old farmhousePack all of our gear onto Jel Coward’s car – including wrapping the stuff on the roof rack in plastic, since Wales is mostly famous for choral singing and rain, especially the rain. Drive 2-1/2 hours to Jel’s house – it has a wonderful address (Crynllwyn, Bryncrug, Tywyn, Gwynedd, Wales) and the house is beautiful. It’s about 150 years old, but the old original farmhouse across the yard dates to the early 1500s. We grab a quick bite to eat and collapse, exhausted. Sleep almost 12 hours – best sleep I’ve had in three months! (cf. note above about having a new baby)

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